Half of GPs have seen adverse outcomes arising from pharmacist prescribing in the past 12 months, according to a Healthed survey with over 1800 respondents.

The poll results come on the back of the federal government’s announcement that beginning in January, it will fund a 12-month trial in which concession card holders aged 18 to 55 will be able to get pharmacist-prescribed oral contraceptive pills and antibiotics for uncomplicated urinary tract infections at the concession rate of $7.70.

Health minister Mark Butler framed the trial as a win for women, ensuring that “access is affordable and equitable for women.”

Yet GPs say patients are already being negatively impacted in state and territory pharmacy prescribing trials.

Dr Mukesh Haikerwal, former president of the AMA, said the government is sacrificing quality of care and women’s health under the pretext of convenience.

“There will be repercussions in the end, from failed contraception or not detecting other things that are dealt with around the time of those consultations, like sexually transmitted diseases, like violence, and like other medical conditions that people have which makes it inappropriate for them to be on the pill,” he said.

Dr Terri Foran, a sexual health physician who helped develop the safety guidelines and parameters for the New South Wales pharmacist prescribing trial said in that trial, comprehensive protocols and checklists were developed to improve access without compromising safety, but trials in other states and territories haven’t always had the same level of rigour.

For example, the NSW trial only allowed pharmacists to continue a script for an OCP that had been prescribed by a medical practitioner at least two years prior, but not initiate a new script.

In NSW, OCPs with slightly higher risk of VTE were not included in the trial, while other states did not make that distinction.

In the government’s newly announced trial, pharmacists will be able to initiate and resupply OCPs and antibiotics in-line with respective state and territory requirements. Details of the trial are still being nutted out, but Dr Foran has concerns.

“What is not being acknowledged is that there is some risk to the women involved, and that very much depends on what sort of parameters are put around it, and what sort of safeguards are put in place, and also on the degree of communication with the usual medical practitioner,” she said.

“What’s happening, I suspect, is that in an attempt to make things as easy as possible, there may be some safety issues that are either being minimised or neglected.”

Nine out of 10 GPs in Healthed’s survey stated they had ‘unsatisfactory experiences’ when it came to pharmacists prescribing oral contraceptive pills — including patients not being given comprehensive advice on other available contraceptive options, getting incorrect advice on what to do if they missed a pill, and not getting adequate education about risks.

A number of GPs had patients who had migraine with aura who were prescribed combined oral contraceptive pills by a pharmacist.

Several noted that patients weren’t asked about other relevant health concerns, blood pressure monitoring did not always occur, and that there wasn’t appropriate follow-up when side effects occurred.

Dr Haikerwal said women’s health is not restricted to hormones and ‘certain quote-unquote women’s problems,’ and that “hiving off certain elements of care, and not joining up the care,” risks neglecting other health issues and fragmenting care.

Dr Foran said some of these risks could be mitigated with good checklists, boundaries and education.

“For example, unless you ask specifically about migraine with aura, and unless you know specifically what that is, people are going to slip through the system,” Dr Foran said.

“So you need a really, really, really well-designed checklist that’s done in consultation with really good medical advice.”

“Making sure that the woman has the right pill for her and that she hasn’t got any substantial risks that might make another method of contraception a better option is a really important first step. And we need some way of communicating with the patient’s own usual medical provider if they exist.”

Seven out of 10 GPs also said they’d encountered unsatisfactory experiences with pharmacists prescribing for urinary tract infections.

GPs recounted examples of misdiagnosis, including missed bladder cancer, leukaemia and other malignancies, renal calculus, thrush, herpes, chlamydia and other unspecified STIs.

Many GPs were concerned that prescribing without urine testing was leading to antibiotic overuse and resistance. Several had patients whose symptoms went unresolved after being given the incorrect antibiotic – leading to negative outcomes such as progression to pyelonephritis, prolonged antibiotics and discomfort, and even requiring hospitalisation.

“No follow up and the antibiotic did not treat patient. She got worse and had to be admitted for IV antibiotics,” another GP recalled.

There were also patients who had been prescribed multiple antibiotics when vaginal oestrogen would have been more appropriate, and several instances where the wrong antibiotic had been prescribed.

Some doctors described patients inappropriately prescribed trimethoprim without taking an adequate medical history or asking about pregnancy.

“No pathology was collected, which delayed the correct antibiotic being prescribed according to the sensitivities. The patient suffered several days of enormous discomfort and they were sold various adjunct treatments that were useless and unnecessary,” one GP recounted.

Many doctors raised concerns about the potential conflicts of interest. “You’re going to see very much commercial decisions made on what’s prescribed and what’s not prescribed,” Dr Haikerwal said.

“Patients complained that they were guided to the most expensive OCP unnecessarily and felt like they were being upsold to get more money out of them,” one GP said.

As for the upcoming trial, Dr Foran says “the discussion should be medically based, not philosophically or politically based,” with all stakeholders coming together to develop “a rational, national protocol to make it easier for our female patients, and doesn’t compromise their safety in any way shape or form… and I’m not convinced this is the way it’s being done.”

A spokesperson for the Department of Health, Disability and Ageing said: “The terms and scope of the trial are being developed and will be finalised in consultation with pharmacy groups, clinical experts and states and territories.”

“The trial is intended to test whether access to affordable and timely treatment for uncomplicated UTIs and certain hormonal contraception can be improved and done safely and effectively through a time-limited, independently evaluated pharmacy model,” they added.