Colleges and AMA exit pharma-prescribing pilot

All three groups have pulled out of the steering group, three weeks after the Queensland Health proposal was leaked.

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The RACGP, AMA and ACRRM have pulled representatives from the steering committee of the north Queensland pharmacy scope of practice trial, leaving no more doctors on the committee. 

AMA’s Queensland branch said it could not “in good faith remain on the steering committee for a proposal that we fundamentally reject”.

Documents leaked to the media reveal that, in its current form, the pilot would see community pharmacists in the top half of the state able to independently diagnose 23 medical conditions, including type 2 diabetes, ear infections and COPD.

The pharmacist would then be able to prescribe and dispense medicines to that same patient.

To be eligible, pharmacists would have to complete a 120-hour training course, the contents of which are unclear. 

The proposal has drawn fire from all sides – even some pharmacists appear to agree that the scope of the pilot is too wide. 

“Without capacity to order pathology, radiology, conduct fully trained examinations, how can you hope to safely and accurately diagnose what a GP does in a day?” a salaried pharmacist commented on an Australian Journal of Pharmacy article on the subject. 

“With the phone ringing, scripts waiting … continuity of supply for uncomplicated conditions is one thing, finding and managing heart failure competently quite another.”

A pharmacist practising in north Queensland said she felt “blindsided” by the Pharmacy Guild, which had not been responding to her requests for further information about the pilot. 

“My GP colleagues all have a copy of the leaked report and I am fielding questions and barbs about a report that [has not been] seen by pharmacy,” she commented. 

The pilot itself originally had a 19-member-strong steering group, of which three were doctors; this has now dropped to zero after the colleges and AMA’s withdrawals. [Correction: the steering group includes Emeritus Professor Ian Wronski AO of the Tropical Australian Academic Health Centre.]

“While it’s important to have a seat at the table in order to influence change, we cannot provide representation on an advisory group for this pilot which compromises patient care – this is why we are withdrawing,” RACGP Queensland Chair Dr Bruce Willett said today.

Exactly a week ago, he told The Medical Republic: “It’s important to have a seat at the table in order to influence change in the interests of our members and general practice, and most importantly our patients,” Dr Willett said on 4 February. 

“We need to monitor this ‘trial’ to better understand it and express our deep concerns regarding patient safety and health outcomes. The Pharmacy Guild can’t be left unscrutinised.”

AMA Queensland Council of General Practice Chair Dr Maria Boulton said that “above all” the organisation had withdrawn because of concerns about patient safety. 

Ostensibly, Queensland Health is pursuing the pilot to help address the state’s rural GP shortage and make primary care more accessible for regional and remote residents. 

But far from relieving the workload of busy GPs, Dr Boulton told a press conference today, having pharmacists diagnose and manage conditions was likely to add to it. 

“GPs, above all, believe that patient safety comes first, and what we see sometimes [is that] when people are not treated as they should be treated, they end up coming to us anyway,” Dr Boulton said. 

“So basically, you’re just doubling up.”

Presidents of both the Queensland AMA and the national AMA have written to TGA head Professor John Skerritt voicing concerns over medication safety. 

Last year, the regulatory body expressly banned pharmacists from being able to prescribe the oral contraceptive pill – but under the Queensland pilot, pharmacists would be able to prescribe it both for contraception and for off-label use to control acne. 

“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,” Dr Boulton said. 

ACRRM took a slightly more conciliatory tone announcing its withdrawal.

“Withdrawal from further participation of this trial does not mean that ACRRM does not support pharmacists having a greater role in primary health care,” college president Dr Sarah Chalmers said. 

“We would love to work with all members of the primary health care team and have a long history of doing so in the rural and remote primary health care sector out of necessity.”

The rural college invited pharmacist groups to work with it directly in order to strengthen partnerships in primary care. 

“Pharmacists in rural and remote communities are our most utilised referring service – each prescription we write sends our patients to see a pharmacist, and we are aware of the immense impact that pharmacists have on our shared patients,” Dr Chalmers said. 

Both colleges and the AMA were co-signatories on a letter from the National Council of Primary Care Doctors which called for an immediate end to the pilot. 

“This pilot is not aimed at increasing rural access to primary care services, just a desire to increase profit for pharmacies based in cities and large regional centres,” Council Chair and RACGP President Dr Karen Price said.