Rural generalist Dr David Leaf resigned from NSW Health’s expert advisory group on pharmacist prescribing “in disgust,” last month, stating that his and other doctors’ concerns were repeatedly ignored.

The NSW government is expanding pharmacists’ scope even further, announcing a new trial to allow ‘eligible pharmacists’ to treat ear infections, provide wound care and help manage chronic conditions including hypertension and COPD.

Speaking on ABC radio, Dr Leaf said he and colleagues had raised concerns both in writing and in meetings, before he ultimately quit after 12 months on the committee.

“It was clear that they simply weren’t interested in the experts gathered there from various specialty colleges,” Dr Leaf told the ABC Drive host.

“When our evidence-based opinions were put forward, they were dismissed. They were not recorded. It felt like the assembled experts in this meeting were there to be ticked off as ‘attended’.”

“In the meetings, the pharmacists completely overrepresented the type of training that they have,” as well as over-representing their ability to consider all the differential diagnoses and provide follow-up, Dr Leaf said. He also questioned the conclusions drawn in the University of Newcastle’s evaluation of the NSW trial for pharmacist-led prescribing of uncomplicated UTIs.

Another GP who has remained on the advisory group despite similar frustrations told the Medical Republic he stayed on to keep up to date with the changes and potential impact on patients – and so he wouldn’t find out through media releases.

Should GPs help train pharmacists?

This has raised questions about how involved GPs should get – and how much influence they can have from within.

A Healthed poll found that more than 60% of almost 800 GPs who responded so far felt doctors should not help train pharmacists – and four out of 10 felt strongly about it.

Many GPs said they and their colleagues are already too overstretched and time poor with heavy workloads. Some worried about potential medicolegal risk, while others did not want to help train pharmacists because they felt the risks outweighed potential benefits.

“Heading in the wrong direction. I’d rather spend that time and effort training doctors,” one GP commented.

“That would make us complicit in the increased risk of healthcare in the community and the demise of general practice,” another said.

“GPs should only train pharmacists who have enrolled in medical school,” one GP quipped.

But 39% of survey respondents agreed GPs should get involved, with several saying it could improve safety.

“It seems inevitable, so GPs should be involved as we have the experience,” one GP commented.

“It’s an opportunity to guide the direction pharmacist prescribing will take,” another said.

“Pharmacy prescribing is likely to increase, and whilst I do not entirely agree with it, we should all work to make sure safe dispensing is done,” another GP commented.

“Not for me perhaps, but if they need training, who better than a GP,” another said.

A few said it would depend on the remuneration.

Does the Guild’s lobbying power know no limits?

The Pharmacy Guild has donated $2.5 million to political parties in the last five years, the Grattan Institute uncovered, and RACGP NSW & ACT chair Dr Rebekah Hoffman is among those saying the Guild’s political influence is concerning.

“The NSW Government is expanding pharmacy prescribing into more complex care when the evidence for the existing model remains weak. Health policy should follow the evidence, not the money,” Dr Hoffman said.

For his part, NSW Premier Chris Minns has been unabashed in his coziness with the Pharmacy Guild.

“I really love this relationship between myself, my government, and the Guild,” Mr Minns said during a speech at the Guild’s conference earlier this month as he announced the trial to expand pharmacists prescribing power.