Dermatologists raise concerns over safety, care fragmentation and conflict of interest in pharmacy pilot expansion

Pharma News: The New South Wales (NSW) Government has announced the expansion of a pharmacy prescribing trial, promising easier access to prescription medicines for individuals with specific skin conditions.

The pharmacy trial, devised to ease the strain on general practitioners and primary care practices, enables pharmacists to prescribe and dispense certain medications subsequent to a consultation. Set to progress in late March 2024, pending ethical approvals, the trial’s ambit will encompass treatments for impetigo, shingles, dermatitis and plaque psoriasis

Impetigo, although considered a relatively minor condition, disproportionately affects First Nations and Pasifika children, with recurring infections potentially leading to heightened risks of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD). Meanwhile, shingles, affecting one in three individuals during their lifetime, will now see pharmacists empowered to provide primary medicines for uncomplicated herpes zoster cases in patients above 18 years old.

Director of Policy, Advocacy, and Engagement for the Australasian College of Dermatologists, Caroline Zoers, voiced concerns about expanding the scope of pharmacy practice.

“Our advocacy on inappropriate scope of practice expansions continues. These expansions include the Queensland Pharmacy Scope of Practice Pilot and recently announced plans for similar pilots in NSW and VIC. The College has written to state premiers to express our opposition to these models on the basis of clinical safety, continuity of care, conflicts of interest when there is a lack of separation in prescribing and dispensing, and costs to patients,” she said.

The state announcement follows the commencement of the trial’s first phase earlier this year, which piloted the prescribing of treatments for urinary tract infections (UTIs) across 100 participating pharmacies. In September, it expanded to more than 900 pharmacies and extended the trial to the prescribing of the resupply of the oral contraceptive pill.

Minister for Health Ryan Park expressed enthusiasm for the trial’s progression, noting its positive impact on over 6,000 women.

Minister Park said “Everyone knows it is sometimes difficult to get in to see our very busy GPs. And people know where to find a pharmacy and this trial offers patients who can’t see their GP another treatment pathway. Through this trial, we are making it easier and more convenient for people to access the medications they need but working hard to ensure their care is not fragmented.

“By bolstering the capacity of pharmacies, we can take pressure off other parts of our primary care system, so that those who need them can access them. Where we can do things better, we should, and these are the kind of innovative initiatives that I am keen for our health system to embrace.”

The Pharmacy Guild NSW Branch President David Heffernan lauded the move, highlighting the positive impact on patient access and cost savings. He referred to the success of the ongoing urinary tract infection treatment trial and anticipated even more significant benefits for patients when NSW adopts a full-scope trial akin to Queensland’s model.

“Patients could be walking into their pharmacy as early as 1 July 2025 and receive treatment for a wide range of everyday health conditions like wound care, asthma, hay fever, and shingles,” Mr Heffernan explained, painting a promising picture of future healthcare accessibility for NSW residents.

However, concerns persist from the Royal Australian College of General Practitioners (RACGP) and Australian Medical Association (AMA) regarding fragmentation of care within an already complex healthcare system.

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