GPs are growing concerned that pharmacy trials could push long-acting reversible contraceptives to the wayside.
Queensland’s pharmacist-led contraceptive prescribing pilot is either a move to boost female empowerment or a “cheap and nasty” substitute for quality care, but that depends on who you’re asking.
Hormonal contraception had been a planned feature of the wider, 17-condition pharmacy prescribing pilot since its inception.
Earlier this month, state health minister Shannon Fentiman announced that contraception would be cleaved off and run as a separate trial beginning in July.
Queensland Health told The Medical Republic that allowing pharmacists to prescribe hormonal contraceptives without GP oversight would “provide women and girls with the opportunity to exercise self-determination over their reproductive health decisions”.
“The Queensland Community Pharmacy Scope of Practice Pilot will involve a phased statewide rollout over 2024 and 2025,” a spokesman said.
“Rolling out the hormonal contraception service as a separate pilot means women and girls across the state will be able to access hormonal contraception through participating pharmacies sooner.”
Queensland’s next state election is scheduled for October of this year.
RACGP Queensland chair Dr Cathryn Hester said she had questions about clinical governance for the contraceptive pilot.
“There seems to be a priority to get oral contraceptive prescribing rolled out much quicker than the rest of the pharmacy prescribing pilot,” she told TMR.
“I have concerns over that, because that might mean that oral contraceptive prescribing is not going to be subject, necessarily, to the same level of clinical governance or oversight that we could have in terms of reporting adverse events.”
The department has also said that having a short, standalone contraceptives training program would encourage more pharmacists – perhaps those who might balk at the idea of prescribing for 17 different conditions – to take part in a prescribing pilot.
Pharmacists who are already participating in the scope of practice pilot do not need to do additional training.
Dr Hester also challenged the government’s assertion that pharmacist-led prescribing was a way to empower women.
“I absolutely agree that women should have access to reproductive healthcare, and that we shouldn’t be putting any artificial barriers in place to that,” said Dr Hester.
“But what I don’t want to see is the substitution of quality women’s healthcare for cheap and nasty second-rate care.
“That’s not what I want as a woman, but also as a GP.”
Instead, she said, women deserved whole-person care – something that only GPs were properly placed to deliver in the community setting.
“I would be more comfortable in working with a pharmacist if I actually had the mechanisms to work with them [directly],” she said.
“But at the moment, they are fragmented from general practice.”
AMA Queensland president Dr Maria Boulton echoed Dr Hester’s words.
“But rather than funding improvements for our existing workforce, [the Queensland government] has chosen to increase the workload of pharmacists and the risk of fragmented care,” she told TMR.
“We want to ensure every girl and woman in Queensland can access safe and suitable contraception, but quick fix, band-aid solutions are not the answer.”
Participating pharmacists will be allowed to write scripts for low- and standard-dose oestrogen formulations of the combined oral contraceptive pill, the progestogen-only contraceptive pill, the combined hormonal vaginal ring and the progestin-only injectable depot.
Dr Boulton said she was concerned that the pilot risked sidelining long-acting reversible contraceptives.
“Oral contraception is often not the best option, and patients need to have detailed and considered conversations with their doctor who has trained to assess the most suitable contraception method for each patient,” she said.
The hormonal contraception service will be evaluated as a separate trial to the 17-condition pilot, which will be independently analysed by Deloitte in partnership with Griffith University.
Related
The smaller pilot evaluation will use the same approach as that planned for the wider trial, but Queensland Health did not confirm whether its evaluation would also be independently handled by Deloitte.
The broader pilot itself was slated to kick off in North Queensland this month, but so far there hasn’t been an official launch.
TMR was told an announcement regarding the pilot’s start date would come toward the end of March.
With just one business day left until April, time is running out.
