Surgeons, physicians and GPs have made an urgent joint appeal to Premier Chris Minns to freeze plans to give pharmacists new prescribing powers to treat complex conditions.
In a letter, five peak medical organisations say they hold serious safety concerns about the expansion of autonomous pharmacist prescribing into ear infections, wound care, hypertension and chronic obstructive pulmonary disease.
The group, demanding a meeting with the premier, said treating these conditions required patient history, expert diagnosis and the continuity of care that medical practitioners provide.
“Expanding pharmacist prescribing into this territory is a materially different proposition and carries significant risks for patient outcomes,” they said.
The warning comes after a prescribing pharmacist in Britain was suspended following a patient’s death and revelations that the federal government has bypassed Medicare’s strict subsidy system to fund pharmacist prescribing for urinary tract infections (UTI) and oral contraceptives.
The Pharmacy Guild of Australia dismissed the medical group’s concerns, accusing them of putting “professional self-interest ahead of patients’ needs” and pointing to GP waiting times.
Australian Medical Association NSW president Fred Betros, a general surgeon who also holds a degree in pharmacy, said it takes years to learn to diagnose and prescribe safely.
“This is substitution of healthcare,” he said. “With no disrespect to pharmacists, it’s of poorer quality and it gives a facade of clinical assessment that’s not backed up by clinical expertise.”
However, Betros said he did support collaborative care models, in which pharmacists can prescribe for some conditions under the supervision of doctors.
“Premier Minns is going for the really easy option here,” he said. “He wants to keep people out of emergency departments. But this is bad medicine.”
Last month British pharmacist William Terry Obeng was suspended for six months for unsafe prescribing, with one case resulting in a fatal overdose. At his hearing, it emerged he had failed to “adequately consider the possibility of medication dependence and misuse, refer patients back to their GP for appropriate assessment and put adequate safety-netting in place”.
However, with most of Obeng’s prolific prescribing done online, his case is unlikely to be replicated in Australia, where pharmacist consultations are undertaken in person.
The federal government on October 26 announced a 12-month trial that would cover the cost of pharmacist consultations and subsidise medicines for UTIs and oral contraceptives.
But rather than operate through Medicare’s subsidy system, which would require rigorous assessment by an independent expert committee, the funding comes from the government’s $792.9 million women’s health package.
The consortium behind the letter to Minns comprises the AMA, the Australian Salaried Medical Officers Federation, the Royal Australian College of GPs, the Royal Australasian College of Physicians, and the Royal Australasian College of Surgeons.
The organisations expressed frustration that Minns announced the expansion of pharmacist prescribing powers in September with “no indication that our concerns regarding patient safety had been meaningfully considered or addressed”.
The Pharmacy Guild of Australia said independent studies showed no significant safety concerns with pharmacist prescribing following best practice guidelines.
“Prescribing pharmacists undertake additional university study and training, including differential diagnosis, medical history taking and clinical assessment,” a spokesperson said. “Patients are seen privately, their medical history is taken, and details of the consultation and treatment are shared with their GP – where they have one.
“Medical lobby groups are determined to ignore the fact that one in four people is waiting an unacceptable time for a GP appointment. Pharmacist prescribing doesn’t replace GPs. It gives patients another safe, timely option and frees GPs up for complex and chronic cases where their expertise matters most.”
Health Minister Ryan Park said upskilling pharmacists would “make it easier for people to access safe, timely healthcare” and reduce pressure on GPs.
“Pharmacists are capable of having clinical discussions with patients, as well as dispensing medicines, and by increasing the number who can use the expanded scope of practice, we’re ensuring more communities around NSW can access this care,” he said.
NSW Health recognised the importance of pharmacists communicating and collaborating with a patient’s regular GP to “ensure safe and appropriate prescribing, as well as to ensure continuity of care”.
Last month medical indemnity insurer Avant called for a pause on expanding the powers of prescribing pharmacists, off the back of a report that revealed one in five patients suffer a serious injury in prescribing-related incidents by medical practitioners.
NSW pharmacists who undergo extra training can already prescribe for conditions such as uncomplicated UTIs, some skin disorders and contraception. About 40,000 people in NSW have been treated for uncomplicated UTIs by prescribing pharmacists since reforms were introduced by the Minns government three years ago, while more than 2000 have obtained a resupply of the oral contraceptive pill.
By the end of the year, 250 pharmacists across the state are expected to have qualified to prescribe for nausea and vomiting, reflux, rhinitis, musculoskeletal pain and acne, and initiating the oral contraceptive pill.
Start the day with a summary of the day’s most important and interesting stories, analysis and insights. Sign up for our Morning Edition newsletter.
Clair Weaver is a senior writer at The Sydney Morning Herald.From our partners
Disclaimer : This story is auto aggregated by a computer programme and has not been created or edited by DOWNTHENEWS. Publisher: www.smh.com.au
