Patients at risk from pharmacy trial

 

Transcript: AMA Queensland Committee of General Practice Chair Dr Maria Boulton, Doorstop, Friday 11 February 2022

Subjects: Pharmacist prescribing trial

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QUESTION:   Maria, what evidence did you give to the committee today?

MARIA BOULTON:    Today we spoke about the effects of COVID on primary care.

QUESTION:   And did you speak specifically about the new trial to allow pharmacists to prescribe for certain conditions?

MARIA BOULTON:    The scope of today's parliamentary inquiry was about primary care, NDIS and aged care in Queensland. So I guess the scope of it was a little bit broader than the pharmacy trial.

QUESTION:   How productive was today's evidence?

MARIA BOULTON:    I think it's extremely productive whenever you speak with decision makers, especially because it's just a good opportunity to share with them what's happening on the ground, and also discuss what our patients’ needs are.

QUESTION:   What are you seeing on the ground?

MARIA BOULTON:    On the ground with the COVID pandemic, what we're seeing is an increased number of patients presenting to general practice with many different issues, especially mental health issues. But also, a lot of people are stressed about COVID. Also, we have a lot of catch-up screenings to do. GPs are also caring for the bulk of COVID-positive patients in Queensland now, and we're also doing more than half of the COVID vaccine. So it's been a few very busy months for us in general practice.

QUESTION:   Would the proposed trial take off some of that pressure on GPs?

MARIA BOULTON:    No, absolutely not. GPs, above all, believe that patient safety comes first. And what we see sometimes, when people are not treated as they should be treated, is that they end up coming to us anyway, so you're just doubling up. And above all, I mean, if you have a child like I do, would you prefer that child to see someone who has medical training, on average, 12 years under their belt, or someone who's done online training of 120 hours, when you have a kid with say, for example, a sore ear?

I train GPs and I know for a fact that it takes a long time until they are confident in managing an otoscope looking at a kid's ear, and it takes a long time for them to be able to tell between the different diagnoses of ear pain, and then also consider the whole child when it comes to ear pain. Is that child having any speech and language difficulties, for example? So it's quite complex. If any allied health professionals want to come and do our job, fantastic, but please make sure that you do your medical degree first.

I have many colleagues who were pharmacists or physiotherapists in a previous life, then they did medical training. And what they tell us is that they did not know what they did not know. And that takes years and years and years of study, training and also supervision.

QUESTION:   So what representations will you be making to the Queensland Government?

MARIA BOULTON:    So this morning, we spoke about what our patients are facing with COVID. We also spoke about the need to support our patients with the costs of living for example, we also spoke about how difficult it is for patients to access some mental health services such as psychologists and psychiatrists. And we also spoke about the need to ensure that general practice is supported so that patients enjoy continuity of care.

Australia has the third best primary care system in the world. We want to keep it up there, if not going to number one, and we're not going to achieve that if we start making compromises in patient care, fragmenting their care. Above all, I think patients are better served by having GPs that they can access in all areas of Queensland.

QUESTION:   So now that the AMA has removed its representative from the steering committee on this trial for pharmacies, are you concerned that it might reduce your ability to provide input that could improve patient outcomes at all?

MARIA BOULTON:    We fundamentally have issues with the trial itself. And that's why AMA removed itself from the steering committee. We are opposed to patient safety being challenged. And, you know, I think with this trial, it's really interesting, I think every trial needs to be transparent and it would be great if we could be kept abreast of what's happening. But above all, we removed ourselves because we have deep concerns about patient safety. We also have concerns about the ability of someone to prescribe a medication, but also sell that medication. I think there needs to be some removal from that.

QUESTION:   You mentioned a concern around pharmacists by being able to diagnose and then sell a medication? Can you speak a little more to that?

MARIA BOULTON:    There needs to be a removal. If you prescribe something, there needs to be a removal as to who makes the profit out of what you're selling. GPs are not allowed to sell medications for a good reason. Ethically, we're not allowed to do it. And I believe there needs to be that separation, and the same should apply for pharmacists. But not only that, I don't think pharmacists have the necessary training to diagnose, treat, or even prevent disease.

You know, they're fantastic. As a team member, they're fantastic at what they do, which is provide education for patients with medication, and also there's compounding pharmacists that make special medications for patients. And they're great at what they do. Community pharmacists, we work with them day in, day out, especially in aged care facilities. But in the end, I think the prescribing, the diagnosing and the treatment should be left to the GP.

QUESTION:    So what's your reaction to the Chief Health Officer’s news yesterday that over half of Queenslanders could be infected with COVID by the end of the month?

MARIA BOULTON:    The Chief Health Officer has been saying this for some time, and it's not surprising. Omicron is extremely infectious. It spreads very quickly. And we know that there are a lot of people who perhaps have tested positive who don't know that they have COVID and the only difference between you not knowing and getting severely ill is the vaccination.

QUESTION:   And what's your reaction to ATAGI’s updated advice about the definition of a fully vaccinated person now?

MARIA BOULTON:    We welcome that advice. COVID has been an evolving situation and I can hear how people are frustrated. First, we got told we needed one vaccine, then two, now we need a booster dose. And it makes sense. As GPs, we provide many vaccines. So for example, if you're going travelling, you get a hep B vaccination course, that's a course of three vaccines. It's just what you need to get maximum effect. And we’ve just got to do what we’ve got to do.

QUESTION:   One more question, the Chief Health Officer said he wouldn't be increasing restrictions in the wake of growing cases in children. Do you believe this is the right approach?

MARIA BOULTON:    We need to wait and see what the numbers keep doing in children. It's important, though, that we look at things like ventilation in schools, I think that is essential. We know that ventilation makes a difference. So there's other things that we could be doing to make sure that our children are safe.

QUESTION:   Can I just ask more about the North Queensland pharmacy trial? Maria, tell us how many regions is this going to affect and what part of Queensland is going to be impacted?

MARIA BOULTON:    Well, they're trying to roll it across 37 Local Government regions and I guess our advocacy is for patient safety. Patients in all of Queensland, what they deserve is the best medical care that they can get. They deserve to be able to see a doctor who has the necessary training to treat their medical illness.

QUESTION:   So what kind of conditions will it be treating?

MARIA BOULTON:   The pharmacy trial proposes to have pharmacists treating conditions such as asthma, diabetes, middle ear infections. And, as we know, asthma unmanaged can be deadly, and it is not an easy thing to learn how to listen to someone's chest. It takes years of practice to be able to know whether what you're listening is a wheeze or crackle, pneumonia, asthma, heart failure, and it's not something that you can learn on an online 120-hour tutorial.

QUESTION:   What has the AMA Queensland done in in relation to the TGA? What steps have you taken there?

MARIA BOULTON:     AMA Queensland is particularly concerned about this trial bringing up the possibility of pharmacists prescribing the oral contraceptive pill. This is something that that the TGA has said is not safe. And we have asked the TGA to look at the entirety of the trial to assess it for patient safety because we have deep concerns about it.