Government expands pharmacists’ scope of practice despite GP backlash

Pharma News: New proposed reforms aim to relieve pressure on emergency departments and wait times to see a GP, by giving the community more access to primary care services, according to the NSW Government.

The landmark reform will expand the number of vaccinations pharmacists can administer, trial pharmacists prescribing medication for urinary tract infections and also develop a pilot for trained pharmacists to prescribe antibiotics, the contraceptive pill and repeat scripts for conditions such as high blood pressure, with patients paying a private fee to the local pharmacist who will prescribe and dispense drugs on the spot.

NSW Premier, Dominic Perrottet, said “By giving the community greater access to  medications and vaccines through their local pharmacist, we are taking pressure off our hardworking GPs by giving them more time for patients with other medical issues. We are stepping up to provide yet another innovative policy to improve the lives of people by offering more support for primary care. The Federal Government should be providing more support for GPs and a greater amount of free bulk-billing services but we can’t sit around and wait for them to catch-up and meet the growing demand.”

Health Minister Brad Hazzard said the trials were in step with pharmacist reforms being implemented in Queensland, despite the Australian Medical Association (AMA) and Royal Australian College of General Practitioners (RACGP) urging the Government to dump plans allowing pharmacists to become ‘de-facto GPs’.

Earlier this year, the RACGP and other medical bodies resigned from the North Queensland Pharmacy Scope of Practice Pilot steering committee amidst serious concerns regarding patient safety. The slightly watered down pilot in Queensland will allow pharmacists to prescribe medications for many common conditions without any GP supervision or consultation.  

Now, the RACGP has warned the NSW Government in the strongest possible terms to abandon its plan to dramatically expand the scope of pharmacists role state-wide.

RACGP President, Adj. Professor Karen Price ,said “Stop this madness before it’s too late, this is a recipe for disaster plain and simple. Healthcare is about more than just writing prescriptions and sending people out the door on their way. This alarming NSW scheme promises to be little more than a dangerous script writing service that puts patient safety in jeopardy.

“I strongly urge the state’s leaders to resist the lure of the powerful Pharmacy Guild lobby group and look at what has happened in Queensland and overseas when greater power is handed to pharmacists. For example, incidents have emerged from Queensland’s Urinary Tract Infection Pharmacy Pilot, which should make policy-makers second guess expanding pharmacy scope of practice.

“GPs have reported many concerning incidents including a patient in their 50s prescribed antibiotics for a presumed UTI who turned out to have a 15-centimetre pelvic mass. There was also another patient in their 60s with a recurrent UTI being prescribed the antibiotic trimethoprim despite know resistance to the drug. Keep in mind too these are just some of the cases we know about. Meanwhile, in the United Kingdom the British pharmacists’ own defence union warned of incidents of unsafe practice that have emerged with the rise of independent pharmacist prescribers.”

However, Mr Hazzard said “While some in the primary care sector have firm views on the role of pharmacists, their positive contribution to the management of the COVID-19 pandemic has demonstrated that they are able to deliver more for their communities. NSW Health will work with the pharmacy sector, and its regulators, to inform training to ensure we maintain high safety standards, while also providing the community with more convenience.”

Mark Butler MP, Minister for Health and Aged Care, commented “The NSW Government hasn’t chosen to reach out and have a discussion with us about this. So I’m going off media reports. But I have said time and time again, that at the time of soaring demand for health care and the real challenges of workforce supply, it’s important that all of Australia’s healthcare professionals work as close to their scope of practice as possible. We’re stepping through those issues carefully on the Strengthening Medicare Taskforce, which is working towards the end of the year make recommendations about our investment of $250 million every year on Strengthening Medicare.”

Minister for Women Regional Health and Mental Health, Bronnie Taylor, said these reforms will be transformational for healthcare in the regions, particularly for women. 

“Pharmacies are part of the fabric of our regional communities and empowering our trusted pharmacists to work their full scope of practice will be a gamechanger for so many,” Mrs Taylor said. 

“The NSW Government has heard loud and clear that the process of getting a script for things like a urinary tract infection or birth control must be made easier. This reform delivers on that as well as eases the burden on our GPs.”

Adj. Professor Price added “What particularly concerns me is that if this plan goes ahead patient care will be fragmented, resulting in reduced patient safety and reduced health outcomes. This isn’t a solution for patients, this is a solution for the pharmacy lobby. Continuity of care with a GP is so important, particularly for those patients with multiple, chronic conditions that need careful follow-up and management. Under this NSW scheme GPs will be flying dark because we will have no idea what the pharmacist is prescribing and vice versa. I cannot stress enough how dangerous that is, especially for those patients on multiple medications for serious health concerns.

“Additionally, recent workforce data also shows there are significant shortages of pharmacists, so handing more responsibility to them doesn’t make sense.”

RACGP NSW Chair, Associate Professor Charlotte Hespe, said the pilot was terrible news for patients across NSW.

She stated “This expansion of pharmacy responsibilities will put people at risk and must be stopped. Consider how this scheme will hit the hip pocket of patients too. Patients, including those who are up against it financially during a time of rising cost of living, will be slugged a private fee for consultations and keep in mind that there will be no reimbursements under the Pharmaceutical Benefit Scheme.

“Under this plan, as with Queensland, I doubt there will be sufficient training and supervision for the pharmacists. In Queensland, pharmacists will be able diagnose and treat patients from a variety of backgrounds, some with serious health concerns, after completing a 120-hour prescribing course. Even if NSW pharmacists are given more onerous training responsibilities, this does not come anywhere close to being equivalent to the training GPs do. A GP like myself has usually well over 10-years of extensive training and that not only includes the rigours of completing a medical degree but also the vocational training that follows, including in hospitals and GP clinics.”

NSW Health will work with pharmacists to support the expansion of the vaccination program with education modules and materials for both themselves and their customers.

NSW pharmacists are currently able to administer six vaccines, including COVID-19 and influenza vaccines. 

An expression of interest process for participation in the urinary tract infection trial will commence on 14 November 2022.  

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