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The NSW Government move to broaden the scope of practice of pharmacists has angered GPs.
A NSW Government plan to broaden the abilities of pharmacists to treat a range of conditions from ear infections to joint pain has been labelled as “reckless”.
The plan, according to the state government is designed to alleviate pressure on GPs, but it has angered them instead.
The state’s Health Minister Ryan Park announced that pharmacists’ scope of practice will be extended to include:
- acute otitis media (middle ear infection);
- acute otitis externa (outer ear infection);
- acute minor wound management;
- acute nausea and vomiting;
- gastro-oesophageal reflux and gastro-oesophageal reflux disease (GORD);
- mild to moderate acne; and
- mild, acute musculoskeletal pain.
He said barriers to seeing a GP and long waiting lists led to the Minister making the call.
“We know that it is becoming more difficult to access a GP than ever before, with people often waiting days or even weeks before they can find an appointment,” Minister Park said.
“People should be able to access treatment as and when they need it, and the expansion of this important initiative will improve access to care,” he explained.
“By empowering pharmacists to undertake consultations on more conditions, we can relieve the pressure on GPs and end the wait times,” Minister Park said.
Doctors are anything but relieved by the move
The Royal Australian College of General Practitioners (RACGP) is angry about the announcement and says it is reckless, poses health risks and puts politics before patient safety.
“This is politically driven policy, and it has potentially devastating consequences for people across New South Wales due to the risks of incorrect treatment and serious illnesses being missed,” RACGP NSW Chair Dr Rebekah Hoffman said.
“If you get a diagnosis wrong, the consequences can be devastating. There are significant risks of serious and even life-threatening illnesses being missed with the conditions the NSW Government wants to allow pharmacists to treat”, Dr Hoffman said.
“The NSW Government is kidding itself if it thinks this move will do anything to reduce pressure on the state’s overflowing hospitals. If anything, it will have the opposite effect,” Dr Hoffman said.
Overseas experiment problematic
“We know from the UK that letting non-medically trained health professionals do the work of GPs results in much higher rates of incorrect treatment, delayed diagnosis and serious illnesses being missed,” Dr Hoffman said.
“It costs governments and patients much more because people often need to go back to the doctor and can end up in hospital when they don’t get the right treatment,” she said.
Proposed training will be “inadequate”
NSW Health said it is consulting with universities on the development of suitable training as well as the Pharmaceutical Society of Australia on request supports for pharmacists including:
- condition-specific training; and
- upskilling in clinical assessment, diagnosis, management and clinical documentation.
The RACGP said this training oversimplifies the expertise of general practitioners.
“What Health Minister Ryan Park clearly doesn’t understand is patients come in with symptoms, not a diagnosis. Diagnosis is complex and requires years of training — GPs train for over 10 years. You can’t squeeze this training into a short course for pharmacists and expect good health outcomes,” Dr Hoffman said.
“For example, nausea can be a symptom of stroke or neurological disorder. Ear infections are also hard to diagnose and the consequences of misdiagnosis in children can be very severe, it can result in abscess or a ruptured eardrum. And someone presenting with reflux and chest pain might not just have reflux, it can mean cardiac problems or heart attack,” she said.
Journey towards an unfair system
“NSW is on a trajectory towards a two-tier health care system in which those who can afford GP care can see it, while everyone else will have to settle for ‘cheaper’ services at a retail pharmacy,” Dr Hoffman said.
“There is no substitute for the quality care you get from a GP who knows you and your history. I invite the NSW Premier and Health Minister Park to meet with GPs and learn about what we do for our patients across the state every day, and what high quality primary care actually involves,” she said.
The increased scope of practice is the expansion of trials that began with pharmacists being able to resupply the oral contraceptive pill. The second phase saw pharmacists provide more than 18 000 consultations for uncomplicated urinary tract infections. The third and final phase will see pharmacists able to manage common minor skin conditions and is underway.
The RACGP also cautioned that current trials have not reached completion and the decision to make the announcement at a Pharmacy Guild conference in Sydney early in September was a political one.
The RACGP also said there was no collaborative discussion prior to the announcement being made at the conference.
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GPs might as well dispense our own medication then. Surely the pharmacists are on board with this
Laughable that non doctors will be attempting to assess ears for OM/OE etc. It takes years of practice in supervised clinical roles to fully master the otoscope and know what you are assessing. It’s insulting that our registrars are scrutinised and undergo rigorous exams for pharmacists be waved through with a short course
I hope they are ready for indemnity premiums which rightly should be sky high due to the lack of training
I was a Pharmacist prior to commencing my Medical degree. At Sydney University we were trained in “forward Pharmacy” – that is , coming out from behind the counter and talking to patients bout their medications etc. I thought we were really competent at this process. It wasn’t until I was in my medical training that I realised how dangerous I could have been in mis-diagnosing conditions. The art of differential diagnostics, the skill of proper examination and the utilisation of specific treatments are all aspects of medical training that Pharmacists do not possess. This is a way for GPs to be sidelined out of the process.
Scope creep is dangerous. I worked in Australia, and then moved to the UK. I was shocked and appalled by the level of care available to UK residents. The NHS has failed so badly it is no longer a safe system. The UK government has devalued the NHS by introducing roles such as advanced nurse practitioners, physician assistants and have allowed paramedics and pharmacists to prescribe certain meds. Obviously there are some benefits, especially in the short term. But it comes at immense risk, and causes rot throughout the health system due to a general decline in standards of care across the board. I’m sure the NHS didn’t see the rot in its system early on. It’s now been about 10 years since the start of these policies, and it has only been to the detriment of the UK population.
Governments will always say that scope creep happens safely. The NHS continues to claim that ANPs are not replacing doctors, but they are. They are now performing the job of junior doctors, without the medical training that doctors undergo. Medical treatment is now often based on protocol, rather than clinical acumen. Australia – beware.
The solution to pharmacists providing medical care is logical. If they want to diagnose and provide medical care they need to be liable for their errors. When the errors occur the pharmacist should be sued.
No insurer is likely to want to provide medical indemnity. I’d suggest that the lack of training, adequate notes, inability to adequately examine the patient, inability to order appropriate tests and provide follow-up limit the pharmacist to the most basic conditions.
Even with basic conditions eg a UTI the possibility of alternate diagnosis and complications preclude management by a pharmacist.
We as a profession should fund some of the resultant negligence claims.
This another bandade which will fail. I certainly reserve appointments for urgent case and have done so for 30 years. And despite this will have extras squeezed in where this is no room which will mean my day will stretch out to 8pm. The issue here is recruitment to general practive down from 50% of graduates to 16% of gaduates which is a direct consequences of the deliberate erosion of the medicare rebate over many years.The government has got what they paid for and are now desparate to find any half solution to calm the chaos they created. This fragmentation of care ultimately will make care more costly.
What a great way to fragment care and ensure suboptimal outcomes in the future. What happens when Jane Blo presents with nausea and dies at home with an acute MI. What happens when a child gets recurrent ear infections, goes to a different pharmacy every time and overtime they lose their hearing? What happens when an STI is misdiagnosed as a UTI, given some anti’s and the person goes on to spread it? What’s to stop pharmacists from prescribing meds unnecessarily to meet KPIs or make money?
The only times something is a ‘simple’ presentation is hindsight.
I agree with the 3rd comment : Pharmacists are generally very risk averse and trained to work within clear guidelines.
These are simple problems that need early access to relieve symptoms and managed with the right guidelines.
Us GPs need to be more flexible and available to meet the needs of distressed patients.
Tele-health consulting should allow that but OOPE will discourage more as Cost of Living worries more of our patients.
The more I see of this world and the difficulties many people face, and the many ways people are struggling and are at their very breaking point with stress, the more we need to open up access to resources.
You might be a single parent who (or your child) needs some basic anti-nausea medication because you or your child has their usual migraine, or you need a basic antibiotic for a painful ear that’s killing you or your child, you have have other kids screaming at home. You need to get some sleep in order to get the kids up and then get to work. You might have no support and have a special needs child. You don’t have 6 or 8 or 10 hours to wait in an Emergency Department.
So to all those pompous Marie Antoinette-wannabes, your solution of “let them see a GP” not only makes people needlessly suffer, but it shows the need for more socioeconomic diversity in the health profession.
I’m a specialist. And we need to make access to healthcare far more available in all parts of the system.
I mean, I think it was only a matter of time before this came about. It can be seen politically as increasing availability and access to GPs for more serious visits, but cynically it might be to save Joe Public a $65 gap fee every time they see a GP. So the majority of the public will probably be in favour of it.
Will pharmacists be paid the same medicare rebate as doctors? Will they be obliged to take out medical indemnity insurance? Will they be entitled to call themselves “Doctor”, like our dental colleagues? Who decides the definition of “mild” or “acute” conditions? Where are the boundaries? Will pharmacists have to keep medical records of the patients they advise and treat? Will they be bound by the Hippocratic Oath – Primum non nocere?
What a minefield! This is the most moronic government policy ever invented. A band – aid solution if ever there was one!
There are also shortages of Police officers and Armed Service Personnel. Will these roles be outsourced too to the untrained?
Pharmacists are generally very risk averse and trained to work within clear guidelines. The whole profession is geared towards ensuring safety of patient’s use of medications, and the consequences of making a mistake. Research has shown pharmacist prescribers are more risk averse and more likely to prescribe within guidelines than other healthcare professionals. Pharmacists are well placed to increase their scope of practice with the right training and system support
GPs have failed to evolve to meet current patient model needs. It’s unreasonable to complain that the roles are being outsourced, if they aren’t being done appropriately/ sufficiently. Risks are noted, but the bigger risk is patients not being treated at all, so choose your ‘bad’ people – something is better than nothing in the absence of evolution to meet the market need
Absolutely agree- no substitute for a GP consultation initially. Pharmacists can review if needed and continue the treatment started by the doctor
This situation has come about partly through increasingly difficult access to GPs–it is not uncommon for patients to have to wait days or even weeks for an appointment. At one time it was common for GPs to keep a few appointments free each day for urgent cases, but this policy seems to have gone the way of tape and video cassettes. Naturally , in these circumstances patients are going to seek advice from pharmacists, and providing pharmacists stay within their expertise there is no real issue. One other option is to increase the numbers of nurse practitioners to provide basic diagnosis and care, and basic prescribing. My own contact with nurses practitioners, both as a doctor and a patient has been nothing but positive. As GPs become increasingly unavailable for same day consultation and treatment, these changes in medical practice are inevitable.
The GPs have not developed their service model so they are filling that void. They haven’t used nurses and other staff in substitute roles for simple presentations. Half of the GPs don’t do BP, often don’t examine the patient. They need to future proof their important roles. Pharmacists are well equipped to do these tasks.
What is the point of diagnosing otitis media if there are drug shortages in Amoxycillin or providing the OCP if there
are shortages in Brevinor? Perhaps we can get Vets with their dispensing skills to take over and source these medications and take over the role of pharmacists? At least once would get a pat on the head and a treat after picking up one’s script instead of an incorrect diagnosis.
This proposal is reckless and unsafe. Pharmacists do not have the training, experience or expertise to correctly diagnose and treat any of the medical conditions listed [or any others]
It take years, specific training and experience for doctors to reach the desired level of knowledge, experience and judgement.
In each and every case a Provisional Diagnosis [PD] * and Differential Diagnoses [DDs] *needs to be established before the actual diagnosis can be made and treated.
I have no doubt if proceded with that many patients will suffer harm with some dying as a result of inadequate assessment, incorrect diagnosis and incorrect treatment
*Can be more than one
Note: My opinion is based on specialty training [Emergency Physician] and 40+ years of clinical experience
About time we started dispensing our prescriptions.
Horses for courses, stay in your lane.