“The time for criticism is over”

Calls for collaboration and support following GP criticism over secret shopper results

A recent study published in the International Journal of Clinical Pharmacy utilised mystery shoppers to assess whether they would be appropriately referred by a pharmacist or pharmacy staff member to a medical practitioner based on the presenting symptoms (all of the mystery shopper scenarios required referral).

A significant difference was found between visits where a pharmacist was involved and where a non-pharmacist staff member handled the interaction alone.

Interaction with a pharmacist, either directly or after first speaking to a non-pharmacist staff member, resulted in referral in 80% of interactions.

However, mystery shoppers who only dealt with a non-pharmacy staff member (i.e. a pharmacy assistant) were referred to a medical professional in less than a quarter (24%) of the occasions.

The finding led the authors, from the University of Sydney, to call for improved training of non-pharmacy staff.

However an Australian Doctor article covering the study did not clearly differentiate between the level of referral when a pharmacist was involved in the mystery shopper interaction, or when the customer only spoke with non-pharmacy staff.

Australian Doctor readers were quick to respond, with one saying the results were “the very reason that pharmacists should never be ordering pathology and treating diseases, as they are not trained to make clinical decisions on asthma and diarrhoea etc., and cannot therefore recognise “red flags”, nor be expected to do so.”

“This is whats happens when Govt promotes pseudo doctors to save money. In the end its costing more, leave aside the disability patients develops. Its the pharmacy guild who have bought their way in at peoples health cost. i have never seen such a bureaucracy anywhere where non-doctors are made doctors at the cost of peoples health,” said another.

The PSA has responded to comments and the article with a call for collaboration between GPs and pharmacists, saying that “the time for criticism is over”.

“What we need to be doing is working together to support evidence-based practices that improve the quality of care consumers receive,” says PSA National President Dr Shane Jackson.

He acknowledged that the report documented some behaviours that fall short of the standards expected of the pharmacy profession, and said that there is a need for support to enable pharmacists to have the majority of these consultations, and better training for pharmacy staff as a whole.

“While the majority do this well, PSA is working hard to support the profession through a range of resources to improve these practices, and has urged the government to allocate funding to develop quality indicators for pharmacist practice,” says Dr Jackson.

“We should also note, however, that this kind of challenge is not limited to pharmacists. Just this week we had reports of inappropriate antibiotic prescribing by GPs – at up to nine times the recommended rates – contributing to the problem of antimicrobial resistance and even deaths.

“The response from the GP groups was to encourage better education and protocols. Pharmacists are supportive of this and expect the same in response from our GP colleagues where the need for improvement is identified.”

Dr Jackson says there could be many positive outcomes for Australia by optimising the role of pharmacists, especially within collaborative healthcare frameworks.

“Internationally, we see GPs and pharmacists working together to build shared protocols and improved communication pathways, with evidence this improves outcomes for consumers, particularly those with chronic disease,” he says.

“With all the reform happening in primary care at the moment, let’s not miss the opportunity to realise these benefits in Australia.

“At PSA, our door continues to be open to RACGP and other GP groups to develop collaborative protocols that avoid the type of problems highlighted today, and deliver cost-effective health outcomes to consumers.”

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  1. Toby

    When is the Guild going to do the ‘mystery patient’ to expose doctor shortcomings? Pharmacists have to go through the meat grinder regarding this; why not doctors? Or are doctors perfect?

    • Glenda Abbott

      I had a young male patient get up the courage to consult a GP regarding his depression last week (with a family history of male suicide) and the GP response was to tell him he needed to “harden up”. No referral to counselling and no prescribing. I completely agree with the above comment. If pharmacy is constantly under “investigation” and criticism why are Doctor’s aways assumed to be perfect??

      • Philip Smith

        Please in future assist the patient with a complaint to the appropriate authorities.

    • Marina Santiago

      Great point! I completely agree. They rescheduled codeine products but haven’t checked the amount of abused drug prescriptions coming out of GPs. I wonder if anybody have checked where the benzo in the black market comes from?

    • Jo

      I can’t tell you how many people I personally know who should have been referred but have not.

      Multiple GP diagnosed depression & bipolar cases, with ongoing meds including anti-depressants and mood stabilisers for 8-10+ years, but have not once been referred to a psychologist or psychiatrist. Or one that had a mental health plan almost 10 years ago but nothing since, not even a medication review.

      3 visits (each at full $90 fee of course) for plantar fasciitis, with only a prescription for anti-inflammatories written and an offer of an injection (for which he will refer to a nurse at the local pathology centre, but only after a visit for the referral and prescription). No referral to a podiatrist or physio or even mention to visit a pharmacy for a pair of footbeds.

      Duromine prescriptions from at least 3 doctors, none of which gave any more lifestyle assistance than telling this young lady to walk more. No referrals, no dietary guidance, very few questions (even after telling them she had used it before).

      Tell me how this is improving patient outcomes and saving both the consumer and the government money?

      • Philip Smith

        I think we need a place to put collective stories, or ask patients to put collective stories when a pharmacist helps above and beyond doctors who claim money from both patient and government, while we consult for free.
        This week alone, misdiagnosed migraines, patient had Hemicrania continua, responsive to indomethacin, gum absess needed tooth extraction, statins prescribed for triglycerides, no explanation on stoma flushing for child (mix it up at home), antibiotic ear drops given just in case… The list goes on.

  2. Debbie Rigby

    Great mature response by Shane Jackson, PSA President. It is time to stop the GP-pharmacist turf wars via social media.

    • Willy the chemist

      Agree. It’s so refreshing that Dr Shane Jackson take the mature approach. Now all pharmacists need to stop our quibbling and snapping, between our accredited colleagues and community pharmacists, and between “evil rich” proprietors and employed community pharmacists.

      First many proprietors are earning less than what many pharmacists are, certainly those earning at the higher quartile.
      Secondly, all community pharmacists are undervalued with a median income that is too low.
      Thirdly, our accredited colleagues need a proper income stream and career pathway. Even with the current HMR payments, assuming no caps, how does one make a decent income and support a family. And it is not good enough that the Accredited Pharmacist is only the supplementary income earner in the family.

      Even the business rules are wrong and sucks. Why must a HMR be required to be externally initiated only (really, couldn’t we be trusted to know when it is necessary?) and it takes an hour to do patient interview, time to drive to and fro patient’s residence, time to write a Proper report and make your professional input…all these for a pittance $200. We are living below poverty and when you see how much allowance and travel educational tours these local councillors get a year, one wonders!
      Our Accredited Colleagues need a body that truly represent them, not just speak. Develop and formulate a plan to take to government to get new income stream.
      And I challenge the current organisation PSA and ACCP to come up with a new sustainable funding model, not just take snipes at our other colleagues and not only saying that the solution is to take more monies out of community pharmacy.

  3. Kevin Hayward

    Functioning collaboratively as a pharmacist within the current primary care team paradigm in Australia is challenging.

    I have been fortunate, I based myself at a GP practice one day a week, when I do my home visits for medication reviews, I am working as a Pharmacist Facilitator in primary health education with another practice, and about to commence a 4 month research pilot into Pharmacists in GP practice looking at discharge from secondary care.

    It has taken me three years to transition from the traditional Australian community Pharmacy model to get anywhere near to where I was in the UK 15 years ago as a practice support Pharmacist in primary care.

    I still have to rely on my other business interests to financially support my indulgence in practice Pharmacy, and, no doubt will have retired long before practice based clinical primary care Pharmacy becomes a financially sustainable work option in Australia.

    When I look at the RPS recent case study presentation of the work being undertaken in 600 GP practices in the UK, it makes me feel that Australian Pharmacists are undervalued, underutilised and the further development of the profession is at best slow.

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