Queensland pharmacy pilot officially takes off

After an extended period on the runway, the North Queensland scope of practice pharmacist prescribing pilot has finally begun.

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Ten pharmacists in Queensland can now diagnose and prescribe for 17 different conditions under the state’s contentious scope of practice pilot, which has kicked off today.

According to Queensland Health Minister Shannon Fentiman, there are currently only six pharmacies which have received final approval to begin offering services.

As at time of writing – midday Wednesday – there are only four active pharmacies listed on the pilot’s website.

Two are in Cairns, one is in Mackay and the other is in the central Queensland town of Goondiwindi.

The news that the pilot had in fact begun came as a surprise to some, including the Queensland AMA.

“While we are disappointed the Government is pushing ahead with this experiment with Queenslanders’ health, we were assured communication materials would be sent to GPs, emergency department doctors and key health organisations before the pilot commenced,” AMA Queensland President Dr Maria Boulton said.

“This has not occurred.

“Queensland Health must notify all doctors, regardless of specialty or location, about the full details of the pilot and how they can report associated patient harms.”

The remaining 290 pharmacists from the first tranche of trainees will go live across north Queensland over the coming days and weeks.

In theory, pharmacists in the southern section of the state won’t come online until the end of the year; the announcement that the pilot was to be expanded beyond north Queensland didn’t come until September 2023 and training takes 12 months.

It’s unclear how a pharmacy in Goondiwindi, all the way down at the NSW border, would have been able to go live this early on.

The 17 conditions pharmacists can treat under the pilot range from acute conditions like ear infections, shingles and minor wounds to chronic conditions like obesity management and support for smoking cessation.

Hormonal contraceptives are included in the list of treatable conditions under the pilot that Ms Fentiman’s office distributed this morning, despite the recent revelation that hormonal contraceptives will be evaluated separately and will technically constitute a separate trial.

The contraceptives component will commence statewide in July.

Six conditions were dropped from the original 2022 list, including asthma, COPD, hypertension and type 2 diabetes.

Pharmacists will still be managing these conditions under the pilot but will only be able to do so as part of a chronic disease management program.

Participating pharmacists will be required to communicate with each patient’s GP via a “secure messaging platform”.

“The Pilot’s chief goal is to supplement – not replace – existing primary healthcare services and give patients in Queensland more choices to access the healthcare they need,” Pharmacy Guild Queensland president Chris Owen said.

Mr Owen anticipated that the pilot would alleviate the pressure being felt in hospital emergency departments “as patients get greater and more timely access to the healthcare services they are seeking”.

RACGP Queensland chair Dr Cathryn Hester begged to differ.

“I think what we’re seeing is a desperate grasp from the Pharmacy Guild to maintain relevance, even though their profession is under significant strain and facing significant challenges,” she told The Medical Republic.

“They’re suffering from extreme workforce shortages in regional and rural areas – actually much worse than general practices – and they’re also suffering from a loss of workforce due to suboptimal working conditions.”

Dr Hester said there was robust evidence from overseas that fragmentation of the primary healthcare system results in high costs and poor outcomes.

“What we would like to see the state government doing is actually making genuine and renewed efforts at supporting general practice in the community, because we know that is the most cost effective, safest and best way to improve healthcare provision,” she said.

Ms Fentiman, meanwhile, called pharmacists “highly trained and regulated healthcare professionals”.

“Receiving treatment and medication for common health conditions without having to make an appointment with a GP will be a gamechanger for so many people,” she said.

“In a decentralised state like Queensland, it’s so important that we continue to improve access to healthcare for Queenslanders, especially in rural and remote areas.”

Michael Healy, the state member for Cairns, welcomed the official start to the pilot with a shot at the opposition.

“All the LNP do is cut our health heroes and trash the incredible work they do across this state,” he said.

“Only the Miles Labor government can be trusted to innovate our health system to ensure it’s accessible for Queenslanders, no matter where they live.”

Queenslanders will head to the polls in October.

Doctors and patients can write in complaints via the Queensland Health website.

The final list of conditions to be treated autonomously by pharmacists participating in the pilot is as follows:

1. Gastro-oesophageal reflux and gastro-oesophageal reflux disease
2. Acute nausea and vomiting
3. Allergic and nonallergic rhinitis
4. Impetigo
5. Herpes zoster (shingles)
6. Mild to moderate atopic dermatitis
7. Acute exacerbations of mild plaque psoriasis
8. Mild to moderate acne
9. Acute wound management
10. Acute diffuse otitis externa
11. Acute otitis media
12. Acute mild musculoskeletal pain and inflammation
13. Smoking cessation
14. Hormonal contraception (separate pilot)
15. Oral health screening and fluoride application
16. Travel health
17. Management of overweight and obesity

The conditions for protocol/structured prescribing as part of a chronic disease management plan are:

1. Cardiovascular Disease Risk Reduction Program for type 2 diabetes, hypertension and dyslipidaemia
2. Improved Asthma (and exercise-induced bronchoconstriction) Symptom Program
3. Chronic Obstructive Pulmonary Disease (COPD) Monitoring Program