Patient safety is first concern

Transcript: AMA Queensland Committee of General Practice Chair, Dr Maria Boulton, 4BC, Weekend with Spencer Howson, Saturday 12 February 2022

Subject:  Pharmacy prescribing trial

SPENCER HOWSON:    Now, you may have heard about this trial, pharmacists want to diagnose and treat 23 conditions, including asthma, type 2 diabetes, heart failure and middle ear infections. The scheme would mean patients could access pharmaceuticals without consulting a GP, and doctors are not especially happy about that. You're going to hear from both sides of the issue. Both the Queensland Pharmacy Guild and the Australian Medical Association are going to explain where they stand. And we'll start with the President of the Queensland branch of the Pharmacy Guild of Australia, Chris Owen. Chris, welcome back to 4BC Weekends.

[Interview with Chris Owen]

SPENCER HOWSON:    Dr Maria Boulton is chair of the Australian Medical Association Queensland’s Committee of General Practice. Maria Boulton, welcome once again. Is this just a case of doctors wanting to protect your turf, or are there good reasons why pharmacists should not be diagnosing conditions and prescribing drugs?

MARIA BOULTON:   I guess it's really interesting how the Pharmacy Guild has made this a turf war instead of actually addressing our concerns about patient safety. And it’s not just us, AMA Queensland, pulling out of this pilot study, but it's also the rest of the GP peak bodies. We have grave concerns over patient safety.

SPENCER HOWSON:    Is there more that pharmacists could do? If you can look at it objectively, are there some things that pharmacists are not allowed to do at the moment that they should be or could potentially that would be safe, and that would take the pressure off other parts of the system.

MARIA BOULTON:   So my grandfather and my uncle were both pharmacists – they’ve passed on. We have a very good working relationship with pharmacists. What would like to see is to have pharmacists within general practice to help us with people who perhaps are on multiple medications and, you know, give them education from a practice level.

But I think if a pharmacist wants to prescribe, diagnose, especially treat chronic illnesses, I think that the best pathway for them is to do a medical degree. And I hear from friends who have done that - they were pharmacists, and then they decided to study medicine - and the thing that they say is that they didn't know what they didn't know. And it's really interesting. General practice, a few decades ago, it was recognised that general practice is extremely complex. And that's why the general practice training program was started. And so nowadays, even if you're a doctor who went through medical uni and has years of hospital experience under their belt, you still have to do specialty training in general practice, which involves years of training with supervision and difficult exams before you can actually do what the pharmacists want to do in this trial.

SPENCER HOWSON:    Similar things were said when pharmacists first wanted to be able to offer the flu injection. Have we seen the sort of adverse outcomes as a result of them administering the flu injection that this sort of suggests might happen if they're if they going forward and expanding what they're able to do, because I suspect that that it's ended up being fine. And the same with pharmacists offering the COVID job, we're not seeing people wandering out of pharmacies and getting collapsing on the footpath and being ignored.

MARIA BOULTON:   And I guess it's the same issue with the UTI trial as well. And what concerns us when things change is that there's not a lot of follow-up on what happened afterwards, like, what was that patient’s experience? Did that patient end up seeing their GP because they did have a complication? And I have seen people who have received vaccines elsewhere, at a pharmacy, who have come in to us after they've had side effects, where the pharmacist has asked them to go and see their GP to treat those side effects.

I've also seen patients who have gone to a pharmacy who are over the age of 65 being given the flu vaccine that should be given to people under 65, not the one that should be given to over 65s. So, you know, we're talking about a much different, much bigger kettle of fish.

Let's talk about high blood pressure, for example. High blood pressure’s not just high blood pressure. There are so many other things that are related to that. So when a patient comes in to have their blood pressure checked, I can't tell you how many melanomas I've picked up when I've put a blood pressure cuff on someone's arm, which a pharmacist wouldn't be able to do because they don't have the training in skin cancer. And it's not just about treating their blood pressure. It's about managing their lifestyle. It's about making sure that they don't have heart failure, making sure that their kidneys are working properly. It's a lot more complex than this study actually details.

SPENCER HOWSON:    The core problem is a doctor shortage. Just really briefly, can that be solved? Because Chris Owen says we can't solve that.

MARIA BOULTON:   What it needs is it needs collaboration with the GP peak bodies, the GPs that work in those areas, and it needs funding.

The mining industry, let's talk about that. They've got a FIFO workforce, they get people out to remote and rural communities. And there's a lot more than can be done.

And we need doctors there and you know why? Because, God forbid, you're driving in one of those areas and you have a car accident. You need a doctor to come in to come and treat you or put a chest drain in if you need one.

SPENCER HOWSON:    Dr Maria Boulton from the AMA. Thank you for being on 4BC once again.