Peak doctor bodies are concerned about a New South Wales government proposal to allow pharmacists to prescribe a limited range of medications.
Despite these concerns, a spokesperson for the NSW health minister, Brad Hazzard, told Guardian Australia: “The government is not going to scrap a pilot before it even begins.” Hazzard has said the program will proceed in a cautious and careful way.
So what is being proposed, why are GPs against the proposal, and what do we know about similar schemes elsewhere?
What will it involve?
From 14 November, pharmacists in NSW can administer a wider range of public health and travel vaccinations including Japanese encephalitis, hepatitis A and hepatitis B, poliomyelitis, typhoid and zoster.
A 12-month trial will also be introduced that will see pharmacists prescribing medication for urinary tract infections [UTIs].
Finally, a state-wide pilot will allow pharmacists with additional training to prescribe medications for some skin ailments and ear infections. They will also be able to prescribe hormonal contraception.
Who will benefit most?
Women get UTIs up to 30 times more often than men do, and most are uncomplicated and easy to treat with antibiotics. They can be extremely painful, have a sudden onset, and delaying treatment if it is difficult to get a GP appointment can lead to complications. It is also frustrating for women to have to go to the GP and then the pharmacist when suffering from a common and uncomfortable medical condition.
Similarly, for those who use oral contraceptives for birth control, waiting for a GP appointment if a script runs out can lead to missed days taking the pill. And paying for both a GP appointment and the medication can be costly.
The NSW premier, Dominic Perrottet, has said reforms also aim to help GPs by freeing them up to see other patients with more complex medical issues, and that access to quick care from a pharmacist will mean people don’t delay help, get worse and end up in emergency departments.
Why are some doctors opposed to the plan?
Dr Michael Bonning, the president of the NSW branch of the Australian Medical Association, says allowing pharmacists to treat urinary tract infections, gastroenteritis, nausea and vomiting, and shingles, psoriasis and acne, and prescribing oral contraceptives is “not acceptable” because pharmacists won’t have the patient’s entire medical history in order to be certain these medicines are appropriate.
“Similarly, repeat scripts are an opportunity for planned care with a patient and as such should be organised so that the GP and the patient can review their condition and assess any changes that are necessary,” he says.
Meanwhile, in a statement the Royal Australian College of General Practitioners [RACGP] said it wanted the state government to “abandon” the plan. The RACGP president Adj Prof Karen Price said: “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.”
Do such schemes exist anywhere else?
The Urinary Tract Infection Pharmacy Pilot began in Queensland in June 2020, and a Queensland Health spokesperson says since then more than 10,000 women have accessed the service, receiving immediate advice, treatment and/or onward referral.
An evaluation of the service found that 87% of women who took part in the follow-up survey reported that their symptoms had resolved, and overall consumer satisfaction with the service was very high.
“This was significantly due to the professionalism of community pharmacies and pharmacists, who play an important role in providing consumer access to a range of effective health care services,” the spokesperson says.
Due to the success of the pilot, a decision was made to introduce it permanently in Queensland from October 2022.
To date, neither the department nor the trial coordinators have received formal reports or complaints regarding specific cases. All pharmacies participating in the UTI pilot have completed additional training and, under the pilot’s clinical protocol, patients are referred on to a medical practitioner if symptoms do not resolve within 48 hours.
New Zealand, the UK and Canada also have pharmacist-prescribing programs. New Zealand pharmacist prescribers can prescribe hundreds of medicines, but require much more comprehensive training to do so, and the latest available data from 2021 shows there are just 37 pharmacist prescribers there.
What about antimicrobial resistance?
An infectious diseases physician and professor of medicine with the Australian National University, Peter Collignon, says the antibiotics prescribed for common, uncomplicated UTIs carry a low risk of bacteria becoming resistant to them.
He says whether pharmacist-prescribing schemes are a good idea is “not black and white” because it depends on all of the protocols put in place to ensure appropriate training and prescribing occurs. He says he would like to see more details about how NSW plans to implement its scheme.
“I think there is also a potential conflict of interest issue, because it is accepted that it is not a good idea for the people prescribing drugs to also be the ones dispensing them and potentially profiting from them.”
What has the federal government said?
The health minister, Mark Butler, says while NSW did not consult the federal health department about the scheme, pharmacists have shown throughout the pandemic in particular the valuable role they have in health care.
“There are a range of other pilots going on around Australia to expand the scope of practice of pharmacists and other healthcare professionals, for that matter … nurse practitioners and registered nurses as well,” he says. “These are all good things. I encourage states to continue to do that work. I’m talking with healthcare groups about that on the national level, as well, because Australians deserve the best possible care they can get.”
