The You Deserve More campaign from the Australian Medical Association has an alarming message: allowing pharmacists to prescribe a wider range of medicines is a threat to patient safety and undermines the health system.
Queensland now allows pharmacists to prescribe medicines for uncomplicated urinary tract infections after a successful pilot. Other states including New South Wales and Victoria are developing their own pilots so pharmacists can administer medicines such as health and travel vaccinations and prescribe drugs for UTIs, skin ailments, ear infections and birth control.
Patients are “part of an experiment” if they take part, the You Deserve More campaign warns. “Patients deserve access to the full range of treatments and holistic doctor-led care, rather than being treated as a customer at a counter,” AMA president Steve Robson says. “They deserve the care of someone who has the qualifications to properly diagnose them, who can take the time to ensure they get the best health outcomes.”
The Pharmacy Guild disagrees. “Currently it may be quicker for a woman in metropolitan Melbourne to fly to Queensland to be treated for a non-complex urinary tract infection at a pharmacy than it is to book an appointment to see a local GP,” the guild’s Victorian branch president Anthony Tassone says.
“Pharmacists are highly skilled and qualified medicines experts, who already assess, diagnose and treat common conditions every day.”
Dr Elizabeth Deveny, the chief executive of the Consumers Health Forum, says patients are sick of what she describes as “a turf war between the pharmacist and the doctors groups”.
“What I’m not hearing from either of these groups is that they’re engaging with everyday Australians to find out what they actually want and alleviate any concerns,” Deveny says.
“If doctors think these prescribing schemes are so dangerous, why isn’t the AMA coming up with a list of five questions consumers should ask their pharmacists to be safe?
“They’re still just arguing that this prescribing shouldn’t happen. But it is happening, and I would like to see the doctors and pharmacists groups to stop the turf war, work together and listen to consumers.”
The CHF has consulted consumers and Deveny says people broadly support pharmacists being able to prescribe for more ailments than they do currently. It is increasingly difficult to find a bulk-billing doctor, appointment availability can lead to delays and people with uncomplicated ailments want the convenience of going straight to their pharmacist.
“However, pretty much every consumer we talked to has a ‘but’,” Deveny says. “Some of them have concerns about how much the pharmacist may charge, some of them have concerns about conflicts of interest if a pharmacist prescribing a drug is also getting money or incentives for selling that drug, some worry about continuity of care. So consumers want checks and balances in place.”
But the message from the AMA that prescribing schemes are dangerous and harmful is not washing with consumers, she says.
“Consumers are not frightened by pharmacy prescribing, but they do have questions,” Deveny says. “And every time we ask them what they want and need, they say they want cheaper, faster access to primary care. Instead, what they’re getting is commercial interests and turf wars getting in the way.”
The productivity commission report on efficiency in health identified that using pharmacists to their full scope is an efficient and effective way to improve access to healthcare, particularly in regional and rural areas. The Strengthening Medicare taskforce also recognised this need.
The Victorian pharmacy prescribing pilot, based on Queensland’s program, will see pharmacists able treat some mild skin conditions and uncomplicated UTIs in women, administer public health vaccinations and reissue oral contraceptive prescriptions. No start date has been given. The Victorian department of health is also working closely with New South Wales Health, which is preparing to run a clinical trial allowing pharmacists to dispense medicine for UTIs.
But while states and territories work together to prepare to roll out their prescribing programs, the AMA has doubled down.
“These services are not backed by evidence and bypass the national checks and balances intended to protect you,” the You Deserve More campaign website, launched in April, states.
Yet evidence suggests pharmacy prescribing schemes, when run with checks and balances in place and evaluated properly, benefit consumers. The “Urinary Tract Infection Pharmacy Pilot” that ran in Queensland from June 2020 and which was made permanent statewide in October 2022 received no formal reports or complaints regarding specific cases from doctors, pharmacists or patients.
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More than 10,000 women accessed treatment during the pilot and no concerns have been raised with Queensland Health since it was made permanent, a Queensland Health spokesperson said.
Pharmacists in the UK, Canada and New Zealand also provide a wider range of care, including prescriptions. In the UK, pharmacists with additional training have been independently prescribing since 2006.
A UK report found the scheme was safe, clinically appropriate and was generally viewed positively by patients. Similarly, two Canadian studies of pharmacist prescribing for UTIs and patients at risk of heart problems found pharmacist prescribing led to better clinical outcomes.
A NSW Health spokesperson said a University of Newcastle-led group including GPs, infectious disease clinicians, pharmacists, rural clinicians and Aboriginal and Torres Strait Islander people will ensure the clinical trial there is safe.
“The principles guiding the UTI clinical trial already include a number of important safeguards, including the selection of the patient population,” the spokesperson said. “The trial will involve women aged 18 to 65 years of age who are displaying symptoms consistent with uncomplicated UTI and who do not have significant risk factors identified through the consultation process.”
The federal health minister, Mark Butler, said the government was monitoring the various pilot prescribing programs.
“I have said for some time that all of Australia’s healthcare professionals should be working to the top of their scope of practice using the full extent of their skills, training and experience,” he said.
“At a time of skyrocketing demand for quality healthcare and real constraints on the health workforce, it doesn’t make sense not to have everyone working to the full range of their skills.”
He said while giving pharmacists more legal rights around prescribing is a decision at the state level, “health ministers as a group want to try to have national consistency as far as possible around healthcare professionals scope of practice”.
In the meantime, more than 1,200 consumers worried about healthcare affordability and access and who have signed a CHF petition calling for stronger consumer input towards Medicare reforms are making their views clear.
One signatory to the petition wrote: “Our healthcare system should work for us, not industry bodies.”