North Queensland Pharmacy Pilot

Pharmacy trial

 

Members may have heard Minister Fentiman’s announcement of the start of the state-wide pharmacy prescribing pilot in Cairns today.

While much fanfare has accompanied the commencement, what is missing is the promised education package ahead of the start of this ill-conceived and risky pilot.

AMA Queensland were assured communication materials would be sent to GPs, emergency department doctors and key health organisations before the pilot commenced.

This has not occurred.

Queensland Health must notify all doctors, regardless of specialty or location, about the full details of the pilot and how they can report associated patient harms.

Patients must be informed they are taking part in a trial and be given clear information as to how to report any adverse effects and how to seek help.

We have repeatedly expressed our alarm at the Government’s doggedness in establishing and then expanding this experiment as part of a secret election commitment made four years ago.

Doctors tell us their local pharmacy colleagues do not seem willing to risk treating patients under the pilot, given the inherent patient safety issues and the fact pharmacists are also run off their feet with existing workloads.

This appears likely given only 10 of Queensland’s 7,000 pharmacists across the state are taking part.

Instead of grasping for short-sighted, band-aid solutions to our health workforce crisis the Government must invest in more medical student placements, training pathways and GP training.

The government should be supporting pharmacists who want to become GPs to study medicine.

AMA Queensland has offered to conduct a joint PhD research project with Queensland Health to analyse doctors’ scope of practice to identify which tasks can be safely performed by other health professionals to free up doctors to spend maximal time working at the top of their scope.

We will continue to call out the dangers of this pilot and encourage all AMA Queensland members to report patient harms through the Department’s feedback mechanism and their local State MPs.

Our patients deserve better and must be protected from this and similarly reckless initiatives.

Following AMA Queensland advocacy, Queensland Health has released more information about its pharmacy prescribing pilot that starts this month.

Queensland Health has updated its website to include details of how much the patient consultations and medications will cost.

A brief consultation with a pharmacist of less than 10 minutes will cost patients $18.85, a standard consultation of between 10 and 20 minutes will cost $35.45 and a long consultation of more than 20 minutes will cost $68.10.

Medications prescribed as part of the pilot will be charged as a private prescription. They are not subsidised by the Pharmaceutical Benefits Scheme (PBS) and do not count towards the PBS Safety Net.

Patients are also responsible for covering the costs of any items used during the consultation or as part of ongoing care, for example bandages and other retail items, and for any necessary tests or diagnostic services.

The consultations are not covered by Medicare.

The pilot will be evaluated by Deloitte in partnership with Griffith University.

Read more on the Queensland Health website.

A pilot is about to start in North Queensland, allowing pharmacists to diagnose and sell medications for a range of serious conditions without a doctor's prescription. AMA Queensland has called on Queensland Health to create an information campaign for patients and doctors.

AMA Queensland has called on the Queensland Government for a community information campaign about its pharmacy prescribing trial, which is due to start in the first quarter of this year.

Under the pilot, pharmacists will be able to diagnose a range of serious medical conditions and prescribe and sell medication with no medical oversight.

“We are already into March but there has been no official advice to medical associations and no information to share with doctors and the community about what is happening,” AMA Queensland President Dr Maria Boulton said.

“We do not know how many pharmacists or which pharmacies are taking part, how many have completed their extra training, how much it will cost patients or how people can report adverse events.

“We have asked the Chief Medical Officer and Deputy Director-General for Health for an education campaign for all doctors and the community, including clear reporting mechanisms.

“This was one of the major failings of the urinary tract infection (UTI) prescribing pilot that this expanded scheme is based on – Queensland Health did not tell doctors or patients it was happening, and there was no reporting mechanism for adverse outcomes.

“Convenience should not over-ride safety or quality.

“We are seeing far too many Band-Aid solutions to our very real problem of workforce shortages affecting all healthcare professions, including these pilots.

“AMA Queensland is actively working with Queensland Health to develop collaborative care models that allow doctors, nurses, pharmacists and other allied health professionals to work as teams to safely care for patients.

“In the meantime, Queensland Health must ensure the community is informed about prescribing pilots.”

AMA Queensland gave Health Minister Shannon Fentiman the benefit of the doubt for her first few months in her new position. But her decision to radically expand the North Queensland pharmacy prescribing pilot with no consultation with medical groups, only political donors, smacks of a desperate pre-election gamble.

The three main medical bodies representing Queensland doctors and patients are concerned at the state government’s decision to radically expand its North Queensland pharmacy prescribing pilot.

The government will now allow pharmacists across the state to diagnose a range of serious conditions and prescribe and sell medications with no medical oversight.

This decision leaves patients at risk and will not resolve longstanding workforce issues in regional Queensland.

The Royal Australian College of General Practice, the Australian Medical Association, and AMA Queensland were not consulted about the expansion, despite taking part in good faith discussions about the NQ pilot.

AMA Queensland withdrew from a proposed one-hour working group meeting about the NQ pilot in August due to concerns about extreme confidentiality restrictions imposed by Queensland Health.

However, none of the medical groups were given notice of Monday’s announcement, while supportive comments from pharmacy lobby groups were included in the minister’s media release. The pharmacy lobby donated more than $130,000 to both sides of politics in Queensland in just four months last year.

QUOTES ATTRIBUTABLE TO AMA PRESIDENT PROFESSOR STEVE ROBSON:

“It seems several state/territory  governments  are intent on pursuing policies that will fragment care and lead to poorer health outcomes and greater costs to the health system in the long term.

“Real innovation in healthcare delivery should put patients at the centre with GPs and pharmacists working in collaboration to deliver the best possible care for patients.”

QUOTES ATTRIBUTABLE TO RACGP PRESIDENT DR NICOLE HIGGINS:

“As a GP in far north Queensland, I am concerned for the safety of my patients and our vulnerable regional communities.

“There is also a central conflict of interest in this pilot, as it removes the important separation between prescribing and dispensing, which is a basic safety mechanism in our health system. Instead, it sees pharmacists put in a deeply conflicted position where they will assess a patient’s condition and gain financial benefit from selling them a medication.

“The state government has decided to ignore nationally agreed processes established to ensure safe and appropriate prescribing, as well as decisions made by the Therapeutic Goods Administration (TGA).”

QUOTES ATTRIBUTABLE TO AMA QUEENSLAND PRESIDENT DR MARIA BOULTON:

“This is a reckless act by Queensland Health Minister Shannon Fentiman that ignores the science and puts the interests of political donors ahead of patients in a pre-election scramble.

“The process has been secretive, not based in evidence, rushed and dangerous since the start.

“It is a political decision flowing from an election commitment to the Pharmaceutical Society of Australia and was never about patients or their safety.

“The NQ pilot is based on the urinary tract infection (UTI) prescribing pilot that started in Queensland in 2020. That pilot was not conducted as a clinical trial and Queensland Health constantly resisted our requests for information about its outcomes. It also refused to provide any mechanisms for doctors or patients to report concerns.

“Out of frustration, we surveyed Queensland doctors about the UTI trial and found hundreds of cases of women who needed further treatment, most for missed diagnoses of sexually transmitted infections, but one ectopic pregnancy and one pre-cancerous mass.

“When Queensland Health finally released its evaluation of the UTI pilot, it found even more cases of women who needed further treatment, but claimed the trial was a success, despite being unable to follow up two-thirds of women who took part.

“The Office of the Health Ombudsman (OHO) in Queensland is still considering an open complaint about the conduct and outcomes of the UTI pilot, which makes it even more inappropriate that the Health Minister would go ahead with this unwarranted and unacceptable expansion while this investigation is still open.

“This is not the fault of pharmacists.

“As a GP, I work closely with my local pharmacist every day to manage my patients’ care. This is an important safety check for patients. Under current arrangements, neither of us make any extra money from prescribing a medication. Doctors and pharmacists are important stewards against antimicrobial resistance from over-dispensing of antibiotics and these pilots threaten that safety.”

The number of patients presenting to Queensland emergency departments with UTIs has increased, not dropped, since pharmacists were allowed to diagnose and sell antibiotics for urinary tract infections.

New figures show the number of urinary tract infection (UTI) cases presenting at emergency departments has blown out since pharmacists have been allowed to autonomously diagnose and prescribe UTI treatments in Queensland.

Health Minister Shannon Fentiman released figures about ED presentations across Queensland’s 16 Hospital and Health Services (HHSs) showing 36,911 ED presentations between 2022 and April 2023 were due to UTIs.

This is up from 24,620 in 2020, the year pharmacists were first allowed to diagnose and sell antibiotics to patients without undertaking a basic urine test or seeking any medical oversight.

“Urinary tract infections are serious and hard to diagnose, particularly in men and aged care residents, who make up the majority of UTI presentations at EDs,” AMA Queensland President Dr Maria Boulton said.

“The Minister’s own figures show the UTI pharmacy prescribing pilot has not reduced the number of presentations to EDs. In fact, UTI presentations have increased since the flawed pilot began.

“This is not a criticism of our hardworking pharmacist colleagues, who we work with every day to get the best outcomes for our patients. It is a criticism of short-term, short-sighted political band-aids that will not resolve our health workforce shortages.

“We continue to call on all levels of government and all sides of politics to work together to recruit, train and retain our own healthcare workforce, and to scrap dangerous experiments with patient health.”

Pharmacy trial puts profits ahead of patients

The Queensland Government’s decision to push ahead with its dangerous plan to allow retail pharmacists in North Queensland to diagnose and prescribe for a range of serious conditions shows a blatant disregard for patient safety.

“People need access to doctors, not short-term, short-sighted experiments that place them at risk,” AMA Queensland President Dr Maria Boulton said.

“This experiment will not reduce the pressure on our hospitals, ambulance ramping or bed access block. Patients who need hospital beds are patients who are unwell enough to need hospital care. I have visited many Queensland hospitals and witnessed these issues first hand.

“What the government is proposing goes against the independent, unbiased, evidence-based advice from the federal Therapeutic Goods Administration (TGA) about who can prescribe and access medication, and research into patient safety.

“GPs train for 12 to 15 years to be able to diagnose these conditions, yet the Health Minister thinks pharmacists can deliver the same level of care after 120 hours of learning in practice.

“The pilot proposes that pharmacists will perform a lung exam, spirometry, otoscopy without the appropriate training. This goes against a holistic approach to patient care.

“For example, nausea may seem straightforward, but it can be a symptom of diabetes, gastroenteritis, brain cancer, appendicitis, sepsis, meningitis and more. Treating just the symptom and not the underlying cause places the patient at risk and leads to more expensive hospital stays.

“This pilot is an approach to medicine that has no input or support from doctors or pharmacists on the ground - doctors and pharmacists who work together collaboratively every day to ensure the best and safest health outcomes for patients.

“The Minister says this was an election commitment to pharmacy bodies. But bad election promises should be dumped. Promises to political donors should not trump patient safety, particularly when pharmacists are in short supply in these regions.

“This is not the answer to overcrowded emergency departments and over-capacity hospitals around Queensland. We need more staff, with proper qualifications, and better resourcing.”

This dangerous experiment is based on the failed urinary tract infection (UTI) prescribing pilot that the government’s own evaluation showed led to hundreds of women needing further care. AMA Queensland’s survey of doctors found missed cancer cases, serious sexually transmitted infection misdiagnoses, antibiotic resistance and an ectopic pregnancy among patients needing further care.

AMA Queensland Vice President Dr Nick Yim, a pharmacist who retrained as a GP, said pharmacists were already overworked and underpaid.

“This not the answer to workforce shortages,” Dr Yim said.

“An Australian Journal of Pharmacy survey found ‘increasing professional services workload eg vaccination’ is the third highest ranked reason for pharmacists to consider leaving the profession.

“It is simply not true to claim that similar schemes operate in New Zealand, Canada and the United Kingdom. In New Zealand, pharmacist prescribers train in a specific clinical area – paediatrics for example – and then they work within a hospital ward, not in a retail pharmacy.

“Getting a diagnosis and prescription from a chemist while doing the weekly grocery shopping may seem more convenient than seeing a GP, but it’s like fast food – it’s not good for you in the long-term.”

Cairns GP and AMA Queensland Councillor Dr Lee Jones said North Queenslanders – particularly Aboriginal and Torres Strait Islander communities – were tired of being treated as expendable.

“If we are going to be experimented on, we want it to be a proper clinical trial, so doctors and patients know how to report adverse effects from this ‘pilot’,” Dr Jones said.

“Our communities need to know when this is going to begin, which pharmacists are taking part, what training they have had, and exactly how this experiment’s effects on patient safety and health are going to be measured.

“The UTI trial was promoted as filling healthcare shortages in regional areas and after hours, but the government’s own evaluation shows that the majority of services were provided in cities and major regional towns during normal business hours – not in country towns at night or on weekends.”

Read the AMA Queensland Survey Report

 

Media releases

Media coverage

 

Background

In February 2022, it was revealed the Queensland Government and the Pharmacy Guild were planning a trial in North Queensland allowing pharmacists to autonomously diagnose and prescribe medications.

Read more

 

Correspondence

AMA Queensland remains steadfastly opposed to the implementation of the Urinary Tract Infection Pharmacy Pilot – Queensland (UTIPP-Q) and proposed North Queensland Scope of Practice Pilot (NQ Pilot). Both programs pose a grave threat to the health and safety of all Queenslanders. 

AMA Queensland has written to the Director-General of Queensland Health and the Minister for Health and Ambulance Services outlining specific concerns with the NQ Pilot, including its adoption of many of the same failings as the UTIPP-Q. We have asked Queensland Health to justify and answer key questions about the dangerous program.

We have been asking questions of the Queensland Government and QUT on the providence and governance of the UTI Pilot and the NQ Pharmacy Pilot. Read our extensive correspondence seeking clarity and transparency for the public, patients and the medical profession.