Pharmacy shortcut risks patient care

Transcript: AMA Queensland President, Dr Maria Boulton, ABC Brisbane, Breakfast with Loretta Ryan and Joel Spreadborough, Thursday 25 April 2024

Subjects: Pharmacy prescribing; AMA Queensland priorities

LORETTA RYAN: If you have struggled to get an appointment at the GP for something like a cold, stomach bug or even to get the pill or discuss weight management, there's a new pharmacy pilot that you might be interested in.

JOEL SPREADBOROUGH: It's begun in North Queensland and the plans are to expand this right across the state over the next 12 months. But Queensland's peak body for doctors has concerns that pharmacists might not be prepared. Dr Maria Boulton is President of the Queensland branch of the Australian Medical Association. Good morning to you, Maria.

DR MARIA BOULTON: Good morning, Joel. Good morning, Loretta.

JOEL SPREADBOROUGH: Can you expand on these concerns? Is it a short lead-in for the pharmacists? Is that what's driving this?

DR MARIA BOULTON: We are concerned about exactly that - what is driving this? And it seems that it was a political election promise that is driving this move towards this dangerous pilot rather than any clinical evidence. This pilot will see pharmacists treat and diagnose 17 conditions that are quite complex, and they could be anything from an ear infection through to chronic obstructive pulmonary disease.

Pharmacists are brilliant. My grandpa and my uncle were both pharmacists, and I spent a lot of time in a pharmacy when I was a child, and certainly they are amazing at what they do and where would we be without them? They're a very integral part of the treating team that treats patients.

The issue is that they are not GPs. They are very different professions. As a GP, I spent 12 years training, and I train many GP Registrars. And when it comes to one of the conditions that they're trying to treat, which is ear infections, unless you have the adequate training, you just don't know what you're treating. And that means that that patient may get a misdiagnosis or they may get the wrong treatment, or they may end up paying for something that they don't need. And this is our problem with this pilot.

The other issue we had is that it was announced that it started yesterday and we did request for Queensland Health and the Government to let all doctors know when this pilot was starting and what to do in case patients or doctors perceived adverse events and this information didn't go out. We found out by the media instead.

LORETTA RYAN: So you're concerned that people will go to the pharmacist and then have a reaction to something that they've been given?

DR MARIA BOULTON: Yes, they might have, and not only that. We know that there were adverse events with the UTI pilot, which is where pharmacists can prescribe antibiotics for women who present with UTI symptoms. The issue there is that a woman may present with a UTI symptom, but that doesn't mean that it's actually a urinary tract infection. It could be a pregnancy. It could be a sexually transmitted infection. It could be a pre-cancerous lesion, which is what we saw through that pilot.

The concern is that when somebody presents with a sore ear to a pharmacist, unless you know what you're looking for, unless you've had all that medical training, how are you going to be able to treat that patient safely? When you speak to doctors who were pharmacists in a previous life, the thing that they will tell you is that they didn't know what they didn't know. Above all, we're concerned that there will be harm done to patients.

JOEL SPREADBOROUGH: Dr Maria Boulton, President of the Queensland branch of the AMA, so what's the call here? Because we spoke about how difficult it is to get in to see a GP at the moment. Is it a case of more time? Is that what you want, more time to get this training and make sure it's done correctly?

DR MARIA BOULTON: The call is for the Government to support us doing what we do the best. I'm a GP, we keep people healthy and out of hospital. When you look at our health outcomes compared to the rest of the world, we're in the top three. Why not fund what we know works, what we know has evidence backing it? So why not fund people accessing their GP more? Why not fund Medicare rebates better so that people have better access to their GPs? Why not fund after-hours access to GPs? And why not fund more medical students going into general practice?

One of my colleagues works with a pharmacist in his clinic. The pharmacist wants to study medicine. Why not fund that pharmacist to become a doctor? We know that there are healthcare worker pressures in all areas, so that’s medicine, pharmacy, allied health, nursing. We need to ensure that all those professions are being funded, but we need to ensure that you’re funding the right access for patients for the right things. If patients need general practice care, then fund for patients to see a GP. Don’t fund a shortcut that may cause harm to that patient.

Everybody deserves the best care. Everybody deserves access to their pharmacist when they need medication dispensed, everybody deserves access to their GP when they have a medical issue, everybody deserves access to an emergency department in an emergency. Fund that instead.

LORETTA RYAN: Maria Boulton, no doubt big concerns over this pilot. You are the President of the Queensland branch of the Australian Medical Association. But you are leaving the presidency very soon. How long before you hand that over?

DR MARIA BOULTON: Yeah, sadly, my term is up. We're allowed two years, and my time will be up in four weeks. It's been quite a busy time because I was also the Chair of our Committee of General Practice through COVID. I can tell you, AMA Queensland works so hard to ensure that not only our members’ needs are represented, but also the community. We're a very small but very agile team. We also rely on a lot of support from our members who are very involved and really care about the healthcare in their communities, and I'm forever grateful for all the work that they do. It's been an absolute privilege to represent them and our community these past two years.

LORETTA RYAN: And how do you feel as you leave the post of President? Obviously, we're talking about the concerns you have over this pilot project, but the state of the situation at the moment in health?

DR MARIA BOULTON: There's a lot of issues at the moment with health. For the first time, though, we're seeing the State Government step up and actually fund some initiatives that will help people access general practice which is badly needed.

But our priorities going forward with AMA Queensland - the No.1 priority currently is workforce. We know that there are workforce pressures in all areas, like I said, but particularly in regional and rural Queensland. We are the most decentralised state and it's really important that our healthcare workers in all areas are supported. But it's also important that we're also training enough and providing them with those brilliant educational opportunities.

I'd also like to see the Federal Government step up and really address the fact that the Medicare rebates people receive to see their GP and access other healthcare, they just haven’t kept up. And they forget that investing in general practice is an investment. It's much cheaper than having someone end up in an emergency department, for example, and we need those rebates to really go up to ensure that everybody continues to have access to their GP.

We also need to ensure that there are enough doctors going into general practice and we're advocating for the State Government to ensure that they match incentives that have been provided in other states to incentivise doctors to train as GPs.

General practice is a wonderful profession, it’s such a privilege to look after families through many years. Often we're the first port of call for people, not only with physical diseases but also mental health issues.

LORETTA RYAN: So true. Dr Maria Boulton, thank you so much for that and for all you do. And good luck over the next four weeks.