AS someone who has worked both as a pharmacist and a GP, I can say without a doubt the Queensland Government’s plan to allow pharmacists to dispense medicines without a prescription is fraught with danger.
In April, the Queensland Health Minister Steven Miles announced a statewide trial allowing pharmacists to provide the contraceptive pill and antibiotics for urinary tract infections without a current prescription. The trial was recommended by a Parliamentary Committee into expanding the scope of services of pharmacists.
As a GP who has worked on both sides of the pharmacy counter, it is something I am very concerned about.
Before I became a GP, I completed a 4-year Bachelor of Pharmacy and worked as a community pharmacist. I then completed a Bachelor of Medicine and Surgery (4 years), residency (2 years) and Fellowship training (3 years).
So, when a patient presents to me with symptoms of a urinary tract infection, and to an outsider our discussions may seem relatively short and “easy”, it is those 13 years of training and experience I call on when diagnosing the problem and finding a solution.
My training and experience allow me to consider that there may be an alternative diagnosis and to ensure there is appropriate management of the condition, followed by adequate health screening and safety netting.
A pharmacist, who is not trained as a GP, may feel they can perform this same consultation easily due to the simplicity of the condition, but they don’t have the knowledge, training or background to ensure it is not something more serious which, if left untreated, could become a major health issue.
In my view, allowing pharmacists to prescribe puts convenience ahead of patient safety.
There are too many unseen risks and potentially higher costs.
Instead of allowing pharmacists to take on the role of doctors, the government should focus on injecting more funding into general practice to combat the rise of out-of-pocket expenses and increase funding for pharmacists to collaborate with GPs within their practices.
I am not dismissing the hard work that pharmacists do – I’ve been there. During my employment as a pharmacist, we trained heavily in pharmacology and became the experts of quality use of medicines. Pharmacists are the final barrier to ascertain drug interactions, dosing and counselling to ensure the doctor has prescribed the right drug, at the right dose for the correct patient.
But the differences between the prescriber and dispenser are what ensure safety for the patient.
Allowing pharmacists to prescribe could also potentially lead to conflicts of interest within their business.
During my time as a pharmacist, I had training in the workplace for “companion selling”, that is, trying to boost sales of other products while selling prescribed antibiotics.
So, for example, if I was dispensing antibiotics for a urinary tract infection, I would recommend customers also try probiotics or cranberry or an immune booster. I may have even promoted the odd fragrance or two during the festive season!
Pharmacy, like all areas of health, is underfunded because of the price-cutting of prescription medications from government and from within the pharmacy profession.
Pharmacists are not charging for their clinical expertise. For example, one commonly prescribed antibiotic PBS (Pharmaceutical Benefits Scheme) fee is $13.08; however, many pharmacies will charge $5.50 in the hope that customers will buy other items.
While this discounting saves money for the general public, it has affected the bottom line of pharmacy owners.
The way to improve the business of pharmacists is not to increase their scope of practice without also requiring they undergo the appropriate training. Health is not about convenience; it cannot be operated like a fast food chain. It is about the delivery of safe and quality health care. Increasing the scope of practice of pharmacists is a gamble that we can’t afford.
Queenslanders deserve safe, quality and accessible health care, but altering the scope of practice of pharmacists is not the way to deliver it. We need an appropriately funded health system, not shortcuts and further fragmentation of care.
Dr Nick Yim is a GP in Hervey Bay on Queensland’s Central Coast.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.