Earlier this week Retail Pharmacy reported on the Pharmacy Guild of Australia Queensland Branch’s backing of a Queensland Government report calling for an expansion of primary healthcare services offered by community pharmacists.
The report, ‘Unleashing the potential: an open and equitable health system’, which presents expert advice to the Queensland Government on harnessing the lessons and opportunities arising from the Covid pandemic was welcomed by Pharmacy Guild of Australia, Queensland Branch President, Chris Owen, who said that “one of the lessons out of the pandemic was that communities wanted to seamlessly engage with multiple primary healthcare providers to receive the best care possible”.
“Community pharmacies are a critical part of primary healthcare with consumers visiting [a community pharmacy], on average, 18 times a year,” Mr Owen said, adding that by “expanding services such as pharmacist-administered vaccinations and prescribing” (p.127, Final Report), this would help to “alleviate the pressure on Queensland’s emergency departments”.
Commenting on Queensland regional and remote communities, Mr Owen added that one of the issues here is that “many regional and remote areas do not have access to a hospital or a GP but do have access to a community pharmacy … so it makes sense to ensure that pharmacists are enabled to do all that we can to provide vital frontline health services to Queenslanders throughout the state”.
“For long-term health system reform, the community pharmacy network needs to be empowered to reduce unnecessary hospitalisations and ensure that all Queenslanders have access to world-class healthcare,” Mr Owen said.
“We welcome the report and are committed to partnering with the Queensland Government to make it a reality.”
‘North Queensland Pharmacy Scope of Practice Trial’ opposition
Earlier in February 2022, the Queensland Government proposed a trial in North Queensland to allow pharmacists to autonomously diagnose 23 medical conditions, including asthma, T2DM and heart failure, and prescribe and dispense up to 150 different S4 medications.
The Royal Australian College of General Practitioners (RACGP) and the Australian Medical Association (AMA), along with the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Aboriginal Community Controlled Health Organisations (ACCHOs) in Queensland, have strongly opposed this proposed pilot project.
This opposition is reportedly on the concern that it sets to ‘indiscriminately increase the scope of practice for community pharmacists without due consideration for safety, effectiveness or manifest community need’, according to a statement released by NACCHO and the RACGP on 24 February.
“The trial is proposed for a region in Australia with a very large Aboriginal and Torres Strait Islander population, but the proposal makes no mention of the increased health needs of Aboriginal and Torres Strait Islander people and the need for culturally-safe, comprehensive primary healthcare,” Dr Dawn Casey, NACCHO Deputy CEO said.
Dr Casey expressed concern that “there has been insufficient consultation with the community-controlled sector on the proposed trial” and that the trial “will fragment care and result in missed opportunities for comprehensive team-based primary care”.
“Pharmacists are a valued part of the primary care team and NACCHO supports their role integrated within our ACCHOs where they provide for high-quality, team-based care,” Dr Casey said.
RACGP President Dr Karen Price added that the “lack of consultation was concerning and indicative of a poorly thought-through pilot”.
“Not only has proper consultation not occurred but there has also obviously not been adequate thought given to how this pilot will impact the health of Aboriginal and Torres Strait Islander patients,” Dr Price said.
“North Queensland has a higher proportion of Aboriginal and Torres Strait Islander people, and the stark reality is that many of these patients have complex health needs that require careful monitoring and follow-up from a GP.
“This pilot will compromise their long-term health because we will see a fragmentation of care.”
Dr Jason King, Gurriny Yealamucka Health Services Aboriginal Corporation Senior Medical Officer, said that while “pharmacists play an important role in primary healthcare” this “proposed scope of practice expansion is a bridge that will see low quality, disconnected healthcare that places the lives of our communities at risk with no indication of cultural safety or holistic approaches”.
Debra Malthouse, Apunipima Cape York Health Council CEO, said, “We are concerned about the negative impact this pilot will have on the quality of health care for the large Aboriginal and Torres Strait population in the North Queensland region.
“Many First Nations peoples have significant chronic disease burdens and co-morbidities that require ongoing care delivered through a comprehensive primary healthcare model.
“We expect that this pilot will focus on the patient’s condition, with little or no consideration of the multiple factors that impact on the health and wellbeing of First Nations peoples.
“Aboriginal and Torres Strait Islander peoples have higher levels of mortality and morbidity than other Australians and the implementation of this pilot will only serve to widen the gap.”
‘A disaster waiting to happen’
In a statement released today (25 February) by the RACGP, RACGP spokesperson and Brisbane-based GP Dr Krystyna de Lange, also a former pharmacist, said that the pilot is a disaster waiting to happen.
“This pilot will allow pharmacists to diagnose, treat and prescribe for very serious health conditions outside of a healthcare team and completely unsupervised,” she said.
“We aren’t just talking about relatively minor medical ailments; this pilot will allow pharmacists to manage patients with type 2 diabetes and serious heart conditions.
“The most alarming aspect is that pharmacists will not have had the proper medical training to manage these health problems,” she added.
Questioning whether this proposed expansion of the scope of practice in community pharmacy will allow for “collaborative, team-based care”, Dr de Lange says that there are concerns that continuity of care will be fragmented because “the GP won’t be aware of what the pharmacist is doing and vice versa”.
“Some patients, who would normally consult with their GP, will instead see a pharmacist and that will lead to a fragmentation of care,” she said.
“The GP won’t be aware of what the pharmacist is doing and vice versa, so we will struggle to achieve that continuity of care, which is so vital – especially for people with complex health needs including multiple chronic conditions.
“The left hand won’t know what the right hand is up to, and I strongly believe that this will lead to adverse health outcomes.”
Dr de Lange continued: “This pilot is happening in North Queensland where there is a high proportion of First Nations people.
“As a GP with a special interest in Aboriginal and Torres Strait Islander health who works at an Indigenous Health Service, I find this particularly troubling.
“It’s a reality that many of these patients do have complex health needs that require careful monitoring and follow-up.
“This pilot is the worst possible outcome for them because instead of promoting collaboration and teamwork, their care will be fragmented and compromised.
“Some communities in North Queensland, and in many corners of Australia, have a shortage of GPs. That is a problem the Royal Australian College of GPs is all too aware of, and we are working with national and state and territory governments to ensure a better distribution of specialist GPs across the country.
“However, role and task substitution won’t address workforce shortages and maldistribution problems and this pilot will have detrimental health outcomes.”
For more information and a copy of the full report, visit: health.qld.gov.au/__data/assets/pdf_file/0029/1143479/Unleashing-the-Potential-an-open-and-equitable-health-system.pdf
Have your say: what do you think of this proposed trial?
