Communities need doctors

Transcript: AMA Queensland President, Dr Maria Boulton, ABC NewsRadio, Afternoons with Glenn Bartholomew, Thursday 21 July 2022

Subject: North Queensland pharmacy prescribing experiment

GLENN BARTHOLOMEW:   The Australian Medical Association says it's concerned about a trial in North Queensland that allows pharmacists to diagnose, treat and prescribe medications for 23 serious conditions. The North Queensland Pharmacy Scope of Practice pilot started last month and allows pharmacists in the region to treat asthma, diabetes and lung disease. The Pharmacy Guild of Australia says support for the program has been building for years, but there's also been criticisms of the pilot, including about a lack of consultation with First Nations communities in North Queensland. Dr Maria Boulton is the AMA Queensland President and joins us now. Doctor, thanks for your time.

DR MARIA BOULTON:   Good afternoon, Glenn.

GLENN BARTHOLOMEW:   What are your main concerns about this program?

DR MARIA BOULTON:   Our main concerns, and it's concerns of AMA Queensland, but also all the medical peak bodies representing doctors in Queensland, that this trial is truly just an experiment. And basically what they want to do with this trial is they want pharmacists to be able to prescribe and treat 23 different conditions. And as you said, they are serious conditions. They include asthma, diabetes, psoriasis, ear infections, just to name a few. And they want pharmacists to be able to do this after 120 hours of an online teaching tutorial, versus a GP who spends on average 10 to 12 years training to do just that.

GLENN BARTHOLOMEW:   Does the program though, make it easier for those patients to get help if they say, can't get to a doctor easily?

DR MARIA BOULTON:   Well, it's really interesting. One of the places where they're rolling out this trial is an Indigenous community, just south of Cairns, where there's actually seven full time equivalent GPs. And they work in a very multidisciplinary clinic with pharmacists already there, with nurses, aged care workers, care workers, et cetera. And they want to roll this program out in this community into a pharmacy next door, which operates out of a little pigeonhole basically. And I guess with the reasons used for this trial, when you look at the maldistribution of healthcare workers, GPs are actually the least maldistributed healthcare workers in Queensland.

The reality is that what people need is they need a doctor. They need doctors in every community, because what happens if you have a car accident and you need medical care? A pharmacist isn't going to be able to provide that. What happens if you have a woman who goes into labour? A pharmacist isn't going to be able to deliver a baby. What we need is we need doctors.

GLENN BARTHOLOMEW:   But are they talking about an either-or situation or a supplement? We've been hearing a lot of stories from doctors and GPs who say they're under enormous pressure due to the pandemic and the flu and the like. Wouldn't a program like this help those who are overworked?

DR MARIA BOULTON:   No, not at all, because what'll happen is that people will present to us anyway, like they have with the UTI pilot that they piloted recently, and they present to us much later. So it actually causes more work for everyone. Also, with the UTI pilot study, what happened was that people that received antibiotics for a UTI, which didn't end up being a UTI, ended up in emergency departments. So in the end it creates more work and it also puts patient safety at risk. And that's the main concern about this.

GLENN BARTHOLOMEW:   Didn't the Queensland government think that urinary tract, that UTI pilot was a success?

DR MARIA BOULTON:   Yeah, well, that's what they think. But when you read the report provided by QUT it actually lacks scientific rigour, governance, and a lot of the patients were lost to follow up. And it's just not good enough. And they themselves reported adverse outcomes with the patients. They reported that a few patients ended up in emergency. They didn't actually care to see why the patients ended up in emergency, and the lack of follow-up was just astonishing.

GLENN BARTHOLOMEW:   The Pharmacy Guild says pharmacists are being underutilised, and that this is a way to get better health benefits for the community.

DR MARIA BOULTON:   Well, pharmacists are fantastic. They do a really great job when it comes to dispensing, when it comes to checking interactions, et cetera, and we really, really value their contribution. I mean, healthcare is a team sport, but a pharmacist is a pharmacist. A doctor is a doctor. A nurse is a nurse. A physiotherapist is a physiotherapist. I think when you speak to doctors who were pharmacists in previous lives, what they tell you is that they didn't know what they didn't know, and it wasn't until they did medicine that they realised the knowledge that they lacked about diagnosing, examination, et cetera.

GLENN BARTHOLOMEW:   For the moment, a team sport, but they should know their place. I mean, I guess, you know as well as I do doctor, that no matter when pharmacists suggest that they should take a bigger responsibility in any kind of health mechanisms in the last few years, whether it pertained to the pandemic or not, the AMA was the first to resist that call. Is this something of a turf war that is going on here? Will you ever accept pharmacists having a greater role in some of these measures?

DR MARIA BOULTON:   Well, pharmacists are actually welcomed in many general practices. They're also part of the hospital system as well. And I know that we have doctors who are part of AMA Queensland, who have pharmacists embedded within their practice. And that's a true collaborative approach. I mean, we're all about patient-centred team care, and what this North Queensland community pharmacy trial proposes is far beyond that. It's not actually collaboration. It's pharmacists taking it upon themselves to independently prescribe to patients.

GLENN BARTHOLOMEW:   Dr Maria Boulton, the AMA Queensland President, joining us there.