Pharmacy trial no cure for workforce shortage

 

Queensland’s health workforce shortages can only be fixed by removing the barriers to doctors working in rural and regional areas, not by forcing pharmacists to diagnose and treat conditions they are not trained to deal with, AMA Queensland will tell a state parliamentary inquiry today.

The Queensland Government has proposed a trial allowing pharmacists in North Queensland to prescribe a wide range of medications for serious conditions and chronic disease without medical supervision.  

The federal and state AMAs have written to federal authorities with their concerns about the plan, and AMA Queensland has withdrawn from the steering committee advising on the trial.

AMA Queensland will also raise concerns at today’s hearing of the Queensland parliament’s wide-ranging inquiry into the public health system.

“When we wrote our submission to the parliamentary inquiry two months ago, full details about the proposed pharmacy scope of practice trial were not known,” AMA Queensland President Professor Chris Perry said.

“As more information about its scope has become clear, AMA members have overwhelmingly told us that they oppose this pilot and do not want it to go ahead in any way, shape or form.

“It’s fundamentally flawed and will deliver second rate health care to people in North Queensland.”

AMA Queensland Committee of General Practice Chair Dr Maria Boulton, who will appear before today’s hearing, said the proposed pilot risked patient health.

“Health care is a team effort, and pharmacists are a vital part of that team. We rely on them every day to ensure patients get the correct medication and advice on how to use their medicines,” Dr Boulton said.

“However, they do not have the medical training to diagnose serious health conditions, which are often masked by symptoms of minor, temporary ailments.

“GPs on average have 12 years of training under their belts before they start diagnosing and treating these conditions.

“This is risking patients’ health. Resource primary care appropriately and more patients will be healthier, have fewer hospital visits and enjoy continuity of care. All Queenslanders deserve first class accessible evidence based medical care.”

Professor Perry and Federal AMA President Dr Omar Khorshid have written to Therapeutic Goods Administration (TGA) head Professor John Skerritt, asking for advice on the trial’s potential impact on the nation’s health system.

“We believe that Australia’s system of regulating medications will be completely undermined if states can unilaterally decide that certain medicines no longer require a prescription,” Professor Perry said.

“For example, the trial will allow pharmacists to prescribe the oral contraceptive pill - a move expressly outlawed by the TGA late last year given the health risks for patients.

“We are seriously concerned that this trial will lead to significant misdiagnosis of potentially serious conditions plus undermine attempts to manage antimicrobial resistance.

 “We initially agreed to take part in the steering committee as we felt it was important to be a voice at the table to try to change the direction of this pilot, or at least mitigate its worst aspects. But we cannot in good faith remain on the steering committee for a proposal that we fundamentally reject.”

The North Queensland Pharmacy Scope of Practice Trial would allow pharmacists to diagnose 23 serious conditions, including asthma, type 2 diabetes, heart failure and middle ear infections, and prescribe medications without consulting a GP for a formal examination and diagnosis.

The National Council of Primary Care Doctors (NCPCD) has written to the Queensland and Federal Health Ministers recommending that the pilot be ceased immediately.

AMA Queensland is particularly concerned that the trial is proposed for 37 Local Government Areas in North Queensland which have significant Indigenous populations and serious doctor shortages.

“We know there are major medical workforce shortages in North Queensland, and some communities face long waits and long drives to see GPs,” Dr Boulton said.

“The answer is not in pressuring pharmacists to make diagnoses they are not trained to do – the answer is properly addressing the underlying factors.

“AMA Queensland has always acknowledged and appreciated the role that pharmacists play when working in collaboration with GPs, but this trial does not support the close working relationship that currently exists.

“We would much prefer to see long-term strategies put in place, such as programs that support allied health practitioners, including pharmacists, be streamlined into medical training programs.

“Many doctors start their training in pharmacy, physiotherapy or another allied health practice. We need better pathways to encourage and support more allied health practitioners to undertake the additional years of training required to become GPs.”