Patients at risk from NSW pharmacy move

AMA Queensland President Dr Maria Boulton said moves by state governments to downgrade the role of GPs and other medical specialists in treating conditions such as urinary tract infections (UTIs) are dangerous and in breach of federal laws.

“This has been trialled in Queensland with disastrous results for patients,” Dr Boulton said.

“Patients will be at risk if this goes ahead. This is about governments caving in to big political donors and ignoring patient safety.

“Despite what some big pharmacy owners say, this does not happen anywhere else in the world and it should not happen here in Australia.

“It is currently illegal under federal law for pharmacists to dispense these antibiotics and oral contraceptives without a prescription from a doctor for good reasons.

“GPs train for 12-15 years to have the expertise to diagnose these conditions. A few hours of weekly online training does not give pharmacists the training or experience needed.

“This is flouting federal law and is a short-sighted attempt to fix a problem that has much deeper foundations.”

Dr Boulton, a GP in Brisbane who has treated patients who needed further treatment after being prescribed antibiotics by pharmacists under Queensland’s UTI prescribing pilot, said the NSW move was a disaster for patient safety.

“In our trial, we saw women with ectopic pregnancies, with cancer, and with sexually transmitted infections who were misdiagnosed with UTIs and sent away with antibiotics under this pilot,” Dr Boulton said.

“We surveyed doctors and found at least 240 cases of women needing further treatment. There was no way for doctors or patients to report adverse outcomes, because it was not a clinical trial.

“The Queensland government’s own evaluation of the UTI trial found 270 cases of women needing more treatment, and 97 per cent of women who took part were prescribed antibiotics, whether they needed them or not.

“Regardless, the Queensland Government decided the UTI trial was a success and has made it permanent, and is now expanding it to 17 conditions, but only for people living in North Queensland, who already face challenges with access to medical services.

“Many of these communities don’t have a pharmacist, let alone a GP, and these schemes will do nothing to support medical professionals to move to these areas.

“Short-sighted schemes like this that devalue the work of GPs will only exacerbate workforce shortages in regional Australia.

“We need all levels of government to make general practice viable. We need the federal government to address Medicare rebates for patients that go nowhere to addressing the cost of providing care, and we need state governments to review tax systems that are making general practice increasingly unviable.

“We are hearing about GPs who can’t afford to keep their practices open because state governments are applying new rules about payroll tax.

“GPs are not contractors or employees in the vast majority of cases. But now we are seeing practices being hit with six-figure backdated tax bills.

“Practices will close and this will lead to more pressure on our hospitals.”

Background

• The Queensland Government’s Urinary Tract Infection (UTI) prescribing pilot started in 2020, with the Queensland University of Technology commissioned to manage and evaluate the pilot.
• During the pilot, pharmacists were allowed to diagnose and prescribe antibiotics for women with ‘uncomplicated’ UTIs without any medical oversight or basic urine tests.
• An AMA Queensland survey of doctors in March 2022 identified at least 240 cases of women who needed further treatment, including one ectopic pregnancy, a missed cancer diagnosis and antibiotic resistance.
• The QUT evaluation did not contact 65 per cent of women who took part in the UTI pilot, meaning their safety or adverse events are not known.
• Of those who were followed up by QUT, at least 270 needed further treatment, either because they were misdiagnosed, suffered complications, or did not respond to treatment, possibly due to antibiotic resistance.
• QUT found 97 per cent of women who took part were sold antibiotics, whether they needed them or not.
• One in two pharmacists said they would have found it difficult to charge the $19.95 consultation fee without also supplying antibiotics.
• Claims that the UTI trial prevented almost 1,000 ED presentations are extrapolated from 12 participants agreeing that ‘one’ of the alternative options they would have considered was ‘Hospital/Emergency Department’.
• QUT is investigating whether failings identified in its evaluation report constitute a breach of its code for responsible conduct of research.

International experience:

New Zealand

• Pharmacists must have a postgraduate clinical diploma or equivalent and have several years of clinical experience in a specialised area before applying for the 12-month postgraduate course.
• The course involves a 250-hour practical along with an academic component.
• Qualified pharmacy prescribers work within their specific clinical area of practice in a hospital ward.

United Kingdom

• Minimum standard learning time of 26 days’ worth of structured learning and a 90-hour practical.
• Most work in general practices.

Canada

• Limited emergency prescribing and prescription extension powers in 10 of 13 provinces.
• One province (Alberta) allows pharmacists to apply for additional prescribing authorisation. All information must be relayed back to the patient’s doctor. If it is a new condition, the pharmacist must refer the patient to a doctor for formal diagnosis and treatment.