Joint media release - AMA, AMA Queensland and RACGP condemn pharmacy prescribing expansion

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.”

Background:

• In 2020, the Queensland government began the Urinary Tract Infection Pharmacy Pilot – Queensland (UTIPP-Q), which allowed pharmacists to undertake a brief online training course and then prescribe and diagnose UTIs in women.
• There was no mechanism for the 6,751 women who took part in the trial to report adverse outcomes, other than directly to the pharmacist.
• AMA Queensland surveyed more than 1,300 doctors across the state in 2022 and found 240 cases where doctors had to treat patients who experienced complications as a result of participating in the pilot.
• The most common misdiagnosis was having a sexually transmitted infection rather than UTI.
• At least six pregnant patients were misdiagnosed with UTI and sold antibiotics that are unsafe in the first 12 weeks of pregnancy, including one patient with a potentially life-threatening ectopic pregnancy.
• The UTIPP-Q evaluation, carried out by QUT, found clinical protocols were not followed, including GPs not being notified of patients being prescribed antibiotics for UTIs.
• Six patients were prescribed repeat antibiotics by a pharmacist within 14 days of their first pharmacy prescription, in a clear breach of the GuildCare Workflow protocol.
• The QUT evaluation also found that one in two participating pharmacists said they would have found it difficult to not sell antibiotics after charging patients the $20 consultation fee.
• The planned North Queensland Scope of Practice Pilot, allowing pharmacists to diagnose and sell medications for 23 serious conditions for the 630,000 people living to the north and west of Mackay, became public in early 2022.
• All medical groups withdrew their participation when the scale of the proposal became apparent.

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