Crisafulli Government’s pharmacy misjudgement puts patients at risk: RACGP

The Royal Australian College of GPs (RACGP) has warned the Queensland Government against prioritising retail politics and pharmacy owners over patient health and safety.   

This follows the announcement that the state’s pharmacy scope of practice pilot would be expanded and made permanent by Queensland’s Minister for Health and Ambulance Services, the Hon Tim Nicholls MP, in a keynote speech at a key Pharmacy Guild of Australia trade conference. 

The RACGP has consistently said pharmacists are GPs’ key colleagues for advice on medicine safety and efficacy, and should be recognised for this expertise. They are not, however, trained to diagnose medical conditions, raising the risk of misdiagnosis, inappropriate treatment, delays to healthcare, and a less efficient and well-connected health system. 

RACGP Rural Chair and Townsville-based GP, Associate Professor Michael Clements, said the move will not increase access to healthcare, and called on the Government to improve access to medical care and prioritise patient safely. 

“As a North Queensland GP, I’ve been at the heart of the pharmacy prescribing trial, and the myth of its value as a a solution to rural health access,” he said. 

“This is not a criticism of pharmacists, who are our colleagues – as GPs, we can’t overstate the value pharmacists, both those based in general practices and our local pharmacies, provide for us and our patients. The problem is one of a powerful industry lobby seeking to expand pharmacy owners’ revenue streams, and offering what seems like a straightforward solution. That this was announced at the largest pharmacy trade exhibition in the southern hemisphere  speaks for itself. 

“Boosting access to care for ‘everyday’, ‘easy’ medical issues sounds straightforward – until you consider the low evidence base for it and the risks of adverse outcomes. A quick inspection by a pharmacist without medical training and consulting simple health guidance might lead to appropriate treatment where odds are in their favour. That’s the basis of this pharmacy prescribing approach – picking the most likely of a limited range of problems and solutions. But the Crisafulli Government should not be gambling with people’s health. 

“GPs and other doctors are trained to diagnose conditions, and we spend at least a decade training to do so. You can’t learn diagnosis in an online course – it’s a process of elimination, and this is the opposite approach. By expanding pharmacy prescribing, the Queensland Government is making more misdiagnosis statistically inevitable. 

“Diagnosing a patient is difficult – patients present with symptoms, which can be any number of conditions. As just one example, the symptoms of a UTI are similar to symptoms for pregnancy, STIs, cancer, and undiagnosed diabetes.  Too many patients will be waiting for a mistargeted medicine to solve their issue instead of seeing a doctor, without knowing that medicine is at best doing nothing useful. The Queensland Government should be investing in better access to medical care, instead. That’s what Queenslanders actually need. There is no substitute for the comprehensive, accessible, high-quality care you get from a GP who knows you and your history.”  

Associate Professor Clements also raised concerns about the poor evidence base for the expansion. 

“The scale and types of service provided by pharmacists in the pilot has been small, giving a limited basis for claims of safety at best,” he said.  

“The data simply has not been provided to claim this approach is effective, let alone safe. If anything, it also speaks to the limited value this approach will provide for Queenslanders who need access to medical care. 

“Exceptionally few pharmacy consults led to a referral to a GP. Less than half of services by a pharmacist resulted in notification of a patient’s GP, meaning when they tried to address an issue a pharmacist didn’t solve, only the patient can tell their GP what was observed and what treatment was provided.  

“Despite guardrails in the pilot, it’s resulting in a less well-connected and effective healthcare. This is the Crisafulli Government listening to an industry lobby’s suggestion of an easy solution, not the evidence. The pharmacy lobby wants more people though its owner members’ doors.  

“Increased access to suitable treatment might happen in some cases, but that’s a side effect. ‘First, do no harm’ is the fundamental principle of medical ethics, and it’s a lesson that should be applied here.” 

~ENDS 

RACGP spokespeople are available for interviews: 03 8699 0992 / media@racgp.org.au.