Is pharmacy prescribing really madness? Up to 42% of GPs think it’s not, if…

Yasmin Clarke

writer

Yasmin Clarke

Data analyst; Journalist

Yasmin Clarke

 

Despite many concerns, 16% of GPs support a trial and 26% are undecided.

A surprising number of GPs would be open to pharmacist prescribing trials under specific circumstances, exclusive Healthed data reveals.

The survey results paint a more nuanced picture of GPs’ views than recent media reports might suggest, following news of a 12-month pharmacist prescribing trial in New South Wales, which mirrors a trial in Queensland.

The NSW trial would allow some pharmacists with additional training to administer travel vaccines and prescribe medications, including antibiotics for UTIs, treatments for skin conditions and infections, and oral contraceptives.

Former RACGP president Karen Price described the NSW trial as “madness” and “a recipe for disaster” when it was announced in November, and leading GPs voiced strong opposition in the media, highlighting the lack of consultation, risk to patients and potential conflict of interest.

In Healthed’s survey of about 350 GPs, almost three quarters said that in general, they opposed expanding pharmacists’ authority to prescribe. But many were open minded toward a trial. In fact, 16% supported a trial of pharmacists prescribing some medications, while 26% were ‘unsure.’

However, there were significant caveats. GPs were more comfortable with pharmacists prescribing some medications than others.

GPs seemed to be most comfortable with pharmacists prescribing medications for intermittent symptoms such as vomiting, nausea and allergies, or for stable, chronic conditions such as dermatitis.

Half of GPs (50%) were in favour of pharmacists prescribing allergy medication. More than a third (39%) were supportive of pharmacists prescribing nausea and vomiting medication, and 32% thought pharmacists should be able to prescribe gastro medication.

The medications that GPs were most concerned about pharmacists prescribing were hormonal contraceptives, with 76% of GPs opposed, followed by medication for psoriasis, shingles, UTIs and acne.


Professor Andrew McLachlan, the dean of pharmacy at the University of Sydney, said pharmacists cannot replace GPs, but are trained to triage clinical symptoms and to deal with sensitive health matters, and are bound by the same code of ethics as other health professionals.

“Pharmacists are skilled at providing short term management options for acute minor and common health conditions and also knowing when to refer patients to their GP and sometimes for urgent referral to the hospital emergency department,” he said.

“The UTI trial in NSW provides patients with timely access to treatment for a common health condition provided by an appropriately trained health professional according to an evidenced based protocol,” he said.

“This builds on the experience in Queensland where trained pharmacists used an evidence-based protocol to safely provide management options for 6,500 women (18 to 65 years) with clinical symptoms of uncomplicated UTI,” Professor McLachlan said.

The dissenters

Most GPs (58%) were against trialling pharmacy prescribing, and their reasons fit into four main themes:

• Lack of clinical skills and experience
Three quarters of GPs felt that pharmacists lacked knowledge of how to diagnose a patient. The other main concerns in this category were: lack of training (62% of GPs), risk of harm to patients/safety/inappropriate prescribing (60% of GPs), risk of increased bacterial resistance to antibiotics due to higher antibiotic use in population (51% of GPs), lack of training navigating ethically tricky situations (50% of GPs), lack of suitable counselling for patients (44% of GPs), lack of side effect management (34% of GPs).
• Lack of appropriate infrastructure
Most GPs (75%) said that pharmacists lacked appropriate medical records, while 60% were concerned about a lack of privacy and 49% of GPs were worried about rushed prescribing and lack of time.
• Loss of continuity of care
Most GPs (73%) were concerned about fragmentation of care or loss of continuity of care.
• Conflicts of interest
More than half of GPs (54%) were concerned about pharmacists’ financial conflict of interest when prescribing a drug that they would profit from selling to the customer.

Only 21% of GPs said they were concerned about loss of GP clinic income because of pharmacy prescribing, suggesting that their concerns with the policy relate more to patient safety than self-interest.

Newly appointed RACGP president Nicole Higgins echoed the concerns of many GPs regarding financial conflict of interest, as well as the potential impact on antimicrobial resistance and increased workload.

“Do you want Inner Health Plus with the antibiotics we’re prescribing?” Dr Higgins quipped.

“It seems a bit of an oxymoron that we’re allowing more people to prescribe antibiotics when it should be less,” Dr Higgins told Healthed. “It’s a retail pharmacy, they sell goods to keep their profit margins up. If you’re selling an antibiotic, the pharmacist will often be under pressure by the owners to upsell.”

“My concern is that it will actually increase work for GPs, as we follow up any complications or try to understand where patients are getting their medications. Are they still on them? Have they had any complications that are related?”

Other GPs surveyed by Healthed expressed similar concerns. When we asked GPs what impact pharmacy prescribing would have on their practice, 32% said it would increase their caseload.

We asked GPs why they think the government is launching the pharmacy trial in NSW and what problems state governments are trying to solve.
The overall perception was that the trial was probably a knee-jerk response by politicians to a lack of capacity in general practice without giving proper consideration to patient safety.

“This is a non-functional arrangement by the government without thinking of the safety of multiple levels of management.”

“Reckless and short-sighted solution to a broken healthcare system that is under-resourced and politically embarrassing (as it should be – it’s a national disgrace).”

“[The government is] trying to compensate for falling GP numbers.”

“Politicians have no understanding of antimicrobial stewardship. [They] are looking for publicity … without subjecting the idea to rigorous consideration of all costs and benefits prior to announcement.”

“Not enough GPs due to a smaller number of graduates wanting to do general practice. General practice has not been recognised and remunerated properly. Allowing pharmacist prescribing rights will not solve the problem.”

“I think they are responding to big delays in patient appointment times but also may have one eye on reducing Medicare costs.”

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Yasmin Clarke

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Yasmin Clarke

Data analyst; Journalist

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