Dr Omar Khorshid transcript

 

Transcript:   AMA President, Dr Omar Khorshid, Press Conference, AMA Queensland, Thursday, 21 July 2022

Subjects: North Queensland pharmacy prescribing experiment, COVID cases   

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DR OMAR KHORSHID:   All right. My name's Omar Khorshid. I'm the President of the Australian Medical Association, and I've come up to Queensland this week to talk to doctors and to talk to communities in North Queensland about the Queensland government's outrageous pharmacy prescribing pilot.

This is a pilot program in name only, but a significant change to the delivery of primary care in North Queensland that would allow pharmacists with just three weeks of online training to undertake diagnosis, management, prescription and dispensing of drugs for 23 different conditions, complex medical conditions that are very high in prevalence in the North Queensland community. This is outrageous because it puts patient safety at risk, all in the name of protecting the business interests of the few wealthy people who are lucky enough to own community pharmacies in North Queensland.

The problem with a trial like this is it'll start in North Queensland, but soon enough it'll be throughout the Queensland community. And in fact, Queenslanders, instead of having access to high-quality, team-based primary care led by a doctor who's been trained for a decade or more in exactly that type of care, their care will be fragmented. They'll be encouraged to just pop in and see their pharmacist in a retail pharmacy environment, and somehow expect to get anywhere near the level of care that you would normally expect from primary care here in Queensland.

It means we will see misdiagnoses. We will see inappropriate drug treatments. We will see an increasing cost in both primary care through general practice and at the hospital emergency department when patients present with further problems.

Yesterday, I was up in Cairns and I was talking to North Queensland doctors, and I was lucky enough to visit Yarrabah where I went to the Gurriny Yealamucka Health Service in Yarrabah, which is an extraordinary example of how primary care should look in one of the most needy communities in Queensland.

That was a team of seven doctors, nurses, nurse practitioners, a pharmacist, public health workers, Queensland health employees as well, all working together to deliver primary healthcare for that very needy community. It's a health service that's been designed by the community for the community, and it delivers care in the way that the community wants.

That is the model for care in North Queensland. Not a model that says a young pharmacist who's done only [inaudible] hours of online training being expected to step into the shoes of a team like that and deliver care anywhere near like what a team like that can deliver.

Because healthcare is complex. It's not as simple as a label and then a specific drug that goes with that label. Healthcare involves understanding a patient's past medical history, understanding their family, their social and cultural background, their work. All of these factors need to be properly understood for doctors to be able to deliver appropriate primary healthcare.

The other thing that we heard from the doctors in Yarrabah was that they had not seen the Health Minister, they had not seen the Premier, and the community in Yarrabah has had absolutely no say in the design of this trial. And the fact that one of the potential sites for this trial is, in fact, Yarrabah, is, in fact, that practice where there is a small community pharmacy within the Gurriny Yealamucka Health Service. And the idea that a community pharmacist through, literally, a hole in the wall could deliver anywhere near the primary healthcare that we would expect from that whole 100-person team that is that health service - it's absolutely astounding that politicians think that this is reasonable and it's only because they've not been to those communities.

I call today on the Premier of Queensland and the Health Minister to make the trip up to North Queensland, to talk to the doctors and other health professionals in North Queensland, and to go out to the communities, to consult with the communities about what kind of healthcare they expect to receive, rather than this imposition of a trial based on a community pharmacy model that’s just not right for North Queensland.

One of the other things we heard up in Cairns was that they have a huge shortage of pharmacists. They just don't have the pharmacy workforce to be able to step in and, in some way, replace or support the primary care that is, we know, difficult to access sometimes in North Queensland.

Professional groups that we have spoken to, all of the medical professional groups that we've spoken to about this trial are implacably opposed to it. Many of them have written to the Queensland government and we've received most recently communication from the College of obstetricians and gynecologists. That was around the Queensland UTI trial. They are very concerned about the impact on women's health, of women being encouraged not to seek diagnosis and treatment from a doctor, but to turn up at a retail pharmacy and seek antibiotics for their UTI symptoms when the diagnosis could be very different and their health could well be harmed.

We've already seen in the Queensland UTI trial that's been conducted that women's health has been harmed, and yet the Queensland government has doubled down and has actually now made that so-called pilot permanent. So the women's health has now taken a backward step in Queensland compared with the rest of the country where women are encouraged to see a doctor and access that team-based care that we know works best in primary care.

I'm here today also to announce that the AMA will be conducting a survey of all doctors around the country, because we know this is a national issue. The things that happen in Queensland are rolled out very often around the rest of the country. And we are implacably opposed to any suggestion that primary care can be delivered with only 30 hours of online training, when doctors are expected, encouraged, and required to not just do the 10 to 12 years of basic and ongoing training, but they have to keep their training up-to-date with over 50 hours a year for every single doctor in the country, over 50 hours a year of ongoing training. That's what makes healthcare safe. And the idea that you can dumb that down and that'll still deliver reasonable healthcare for Australians is simply ridiculous. So we're going to survey all doctors in the country and we'll be taking the results of that survey to our national government and to further our advocacy with the Queensland government.

The last thing I want to say is that this trial has come about in secret. There appears to have been some sort of deal done between the government and wealthy lobby groups who pay a lot of money to political parties here in Queensland and around the country. And it's a really sad indictment, I guess, at the state of our politics, that it is money that determines policy here in Queensland, rather than the health needs of the community. I think any government that makes decisions like that against the advice of every learned body of every professional organisation, a government like that should be ashamed of itself, should be called to account. And that's what I'm doing here today.

QUESTION:   Are you suggesting this strikes to the heart of the integrity crisis for the Queensland government?

DR OMAR KHORSHID:   This, we believe, is another example of the integrity crisis in this Queensland government and, in fact, around the country, where wealthy lobby groups are able to employ lobbyists who get in the doors of our parliamentarians and they have a huge impact on the political decision-making process against sometimes the advice of the relevant departments and against the advice of those on the ground, like the doctors, nurses, and other healthcare workers who know how the health system works and who know what needs to be done to fix it.

QUESTION:   Can you go into a little bit more detail on what sounds like a, the [inaudible] deal here?

DR OMAR KHORSHID:   So we understand from the government that they've made a commitment, an election commitment, which is a commitment to the pharmacy community, that they would allow pharmacists to work at that the top of their scope of practice. But the top of their scope of practice means working as a pharmacist in a pharmacy or in a hospital, or even in a general practice location. It does not mean becoming a general practitioner in scope. It means staying within being a pharmacist. Of course, we know that's just code. It's a code word for a deal that's obviously been made. We don't know what goes on behind closed doors, but we can see the outcome of it. And we see the amounts of money that will change hands, which are quite honestly eye watering.

The other thing about this pilot is it's completely secret.

Early on there was an attempt by the doctors’ groups to be involved and to actually be on the steering committee, but they were sworn to silence. And it was only because the proposal for the pilot was leaked that any of us know what's actually going on here in Queensland. Now those doctors’ groups, as soon as they saw what was proposed, they all pulled out of the steering committee for the trial because it's outrageous. But now the problem with that is it's even more secret. We've got no idea where this is up to. What the Queensland government's current intentions are other than what they've stated publicly, which is that this is going ahead, regardless of the very deep concerns from the medical community.

QUESTION:   The time where a lot of people can't actually even get into a GP – is there not an argument that the good of being able to see a pharmacist and get some drugs could outweigh bad, which is misdiagnosis. But also what could happen is that people can't actually get in to see a GP at all. They can't actually get the medical medicine that they need.

DR OMAR KHORSHID:   The responsibility of government is to provide healthcare to the community. That means investing in primary care, investing in general practice, investing in the multidisciplinary teams that we know work and that are in need of reform. So we do call on the Queensland government to do more, to improve access to general practitioners and to other primary healthcare practitioners in the community. That means developing these teams ...

QUESTION: [talks over] largely effective responsibilities into the allied health system, widely recognised collapse, I guess, or degradation in the ability. And the availability of that service is not the Queensland government maybe just trying to fill a gap that has been created?

DR OMAR KHORSHID:   This pharmacy trial does not fill any gap in primary care. There are less pharmacists in North Queensland than there are GPs. GPs actually are very well distributed in the community compared with other types of health practitioners. So it just falls flat on its face when you look at the actual facts. This is a deal done to support the incomes of pharmacy owners, rather than a deal to improve the health of Queenslanders. That's what we're pointing out today.

We want to improve access to primary care for Queenslanders. That means the state government working with the Commonwealth, who is the primary funder of primary care, but actually working together. Because if the Queensland government wants to do something, they have money. They can invest in primary care, they can assist general practitioners to do more. And there are multiple models around, even in Queensland, the one I saw up in Yarrabah yesterday of where federal money for Medicare is being blended with other sources of funding to deliver really good team-based community primary care. And it doesn't mean that a doctor always has to see a patient. They have nurse practitioners. They've got community healthcare nurses. They've got Aboriginal healthcare workers. They've got Aboriginal practitioners all doing their bit to actually deliver the healthcare to one of the most needy communities in Queensland.

QUESTION:   Can we just ask you a question about what are you hearing from the front lines here in hospitals, in Queensland at the moment with the COVID surge and the record number of hospitalisations that we've seen in the recent days?

DR OMAR KHORSHID:   Queensland, like the rest of the country, is really struggling when it comes to the impact of COVID on hospitals. And there's that dual impact. There's initially the number of cases in hospital, which is now at a record here in Queensland, but it's also the number of healthcare workers that are being taken off the front lines because they themselves have COVID or they're looking after somebody with COVID. It is important that we, as a community, now act to slow the spread of the virus by doing the right thing when it comes to vaccinations, when it comes to mask wearing, and when it comes to reporting any symptoms of cold or flu, to going and getting a RAT test or a PCR and staying home if you're sick. If we all do the right thing, we can actually protect hospitals. But at the moment, it's a very worrying situation. And we're getting to the point where if a Queenslander develops any illness or has a car accident, there's no guarantee that you'll be able to access the hospital bed that you need in order to look after your health.

QUESTION:   Do you think there should be, given stress in the system, any mask mandates or any other further public health measure introduced by the government?

DR OMAR KHORSHID:   So we are very clear at the AMA that we need to trust the advice of the experts. And in this case, those people with the data are the Chief Health Officers of each state and territory. They need to make the call as to where the masks are required in indoor venues. And if they want people to wear mask in indoor venues, in order to slow the spread of this virus, they must actually consider a mandate because that's the only way we're going to actually change our behaviours in the community.

Simply saying ‘masks are a good idea, we recommend them’ does not change behaviour. And I think we can see the evidence of that if you go to the local supermarket, or if you go to the local pub. What we need to do is take this virus seriously, recognise that this winter is a major challenge for our health system. And if we, as a community, do the right thing, and if governments step up and make the mandates that they need to make at the time that they're necessary, then we've got the best chance of navigating this without a health system that collapses around us.

QUESTION:   In terms of the collapse to the health system, the Deputy Premier said yesterday that the numbers, while high, they're well within the surge capacity of the hospitals. At this stage, the hospitals would be able to cope. Is that what you're hearing from the frontline that there is no risk of collapse at the moment, or what are you hearing?

DR OMAR KHORSHID:   Well, it depends how you define collapse. What we're seeing is a health system that is bursting at the seams, with ambulances parked outside hospitals, with emergency departments that are chaotic and very difficult, and patient experiences as they work their way through the hospital that are disrupted. That means more mistakes get made. People's care is delayed. And we know there is a cost to that. A cost in lives, a cost in worst outcomes, which can mean a lifetime of disability, as opposed to potentially a cure.

So these are very serious situations here in Queensland and elsewhere around the country. And to say that, okay, we've got enough ICU beds - well, yes we do. We do not have a concern with ICU beds. But we are very worried that the system is not working to deliver the best care that it can. And we need to take that seriously.

Now, some of these are long term issues. They need to improve the investment in hospitals, right across the country, including here in Queensland. That is both a state and Commonwealth responsibility. But right now, the only thing we can do is try and limit the impact of these current winter issues, the flu, and this surging outbreak of COVID-19. We don't know where we're at in terms of this outbreak. If it peaks in the next week or so then I think hospitals will be okay. But the concern is that the extraordinary numbers we're seeing are just going to keep going up, that we'll keep seeing increased numbers of people in hospital, and there's a lag as well. The hospitalisations lag behind the case numbers in the community by four or five days. So we are certainly expecting things to get worse before they get better. And it's just a matter of how much worse is acceptable. How many deaths, how many permanent disabilities are acceptable to the Queensland government before they actually do what needs to be done to protect our hospital sector?

QUESTION:   When you say what needs to be done, you're talking about mandates are you?

DR OMAR KHORSHID:   I'm talking about mandates if that is what is necessary. I just don't have the data around where we're up to in this outbreak and what they're projecting in terms of hospitalisations. But what we're seeing on the ground is highly concerning. There are many expert epidemiologists who've been recommending masks now for weeks. And I think we are seeing some of the Chief Health Officers around the country getting more and more nervous about where this outbreak is at and what it's going to do to our hospital system. Those are signs to me that mandates are likely to be necessary. And the call that the AMA is making is that the premiers step up and actually deliver those mandates if that's what's necessary.

QUESTION:   Sorry, just one more. I know it's raining. We're hearing rural GPs are calling for mass vaccination hubs to come back. Do you think that's a good idea? Do we need that? Is our booster rate so bad?

DR OMAR KHORSHID:   What we need is for the community to get vaccinated. That means third doses for those who haven't had them, and fourth doses for those who are eligible, because we know they're highly effective at reducing that rate of hospitalisation. Now, access to vaccinations has been much better since the communities have largely been vaccinated. I don't have the data around Queensland as to whether it's too hard at the moment to get in to a GP to get a vaccine. But given the number of places you can go, including community pharmacies, et cetera, the real issue is convincing the community to get out there and get their vaccines. And that's where we should be focusing at the moment.