The NSW Government is allowing pharmacists to prescribe a range of medications – without a prior appointment with a GP.
The landmark reform, announced 14 November 2022, will expand the number of vaccinations pharmacists can administer, trial pharmacists prescribing medication for urinary tract infections (UTIs) and develop a pilot for trained pharmacists to prescribe medications for a range of other conditions.
NSW Premier Dominic Perrottet said the proposed reforms aim to relieve pressure on emergency departments and wait times to see a GP by giving the community more access to primary care services.
“By giving the community greater access to medications and vaccines through their local pharmacist, we are taking pressure off our hardworking GPs by giving them more time for patients with other medical issues,” Mr Perrottet said.
“The Federal Government should be providing more support for GPs and a greater amount of free bulk-billing services, but we can’t sit around and wait for them to catch-up and meet the growing demand.”
NSW pharmacists were already able to dispense six vaccines, including COVID and influenza, but can now legally administer more public health and travel vaccinations, including Japanese Encephalitis, Hepatitis A and Hepatitis B, Poliomyelitis, Typhoid and Zoster.
The reform includes funding for a 12-month UTI trial, and the state-wide pilot will assess whether appropriately trained pharmacists can prescribe medications for certain disorders, such as skin ailments, ear infections, and hormonal contraception.
NSW Health Minister Brad Hazzard said the trials were in step with pharmacist reforms being implemented in QLD and would be open to pharmacists in NSW who undertook appropriate additional training.
“While some in the primary care sector have firm views on the role of pharmacists, their positive contribution to the management of the COVID pandemic has demonstrated that they are able to deliver more for their communities,” Mr Hazzard said.
“NSW Health will work with the pharmacy sector, and its regulators, to inform training to ensure we maintain high safety standards, while also providing the community with more convenience.”
In a press conference held later that day, Federal Minister for Health and Aged Care, Mr Mark Butler, said that the NSW government had not informed him of the decision prior to the announcement.
“So, I am going off media reports, as you are. But I have said time and time again, that in this time of soaring demand for health care and the real challenges of workforce supply, it is important that all of Australia’s healthcare professionals work as close to their scope of practice as possible,” Minister Butler said.
“I have been talking about this issue with representatives of health, nursing, and other groups at the Strengthening Medicare Taskforce, [and] I obviously talk very regularly with the pharmacist associations including the Guild and the Pharmacists Society. We are stepping through these issues carefully.
“Australians deserve the best possible care they can get, from the investment the community makes in training hundreds of thousands of doctors, nurses, pharmacists, and other healthcare professionals.”
AMA President Professor Stephen Robson said he was concerned that this ‘poor decision’ by State governments would undermine important safeguards for patients, suggesting that a “dangerous” prescribing experiment had already been approved for North QLD.
“This is a model that promotes pharmacy profits at the cost of patient safety,” he said.
“Pharmacists are experts in medications and medication management and the AMA wants to work with pharmacists to develop models where we can contribute more to the delivery of health care in this country in a safe and collaborative way.
“Unfortunately, we are seeing models being pushed that do the opposite. They fragment care and lead to negative health outcomes, as we have seen in QLD.”
Earlier this year, AMA Queensland conducted a survey of more than 1300 doctors across the state about the outcomes from what was at the time a trial of pharmacy UTI prescribing.
The survey revealed at least 240 patients treated by pharmacists suffered complications from misdiagnosis – most common sexually-transmitted infections (STIs), but also cancerous conditions and pregnancies – and patients were also sold antibiotics that were not only inappropriate but dangerous.
Professor Robson said one in five GPs and one in eight of doctors who responded to the AMAQ survey, including emergency doctors and oncologists, reported seeing at least one complication.
“At least six pregnant women were sold antibiotics that are unsafe in the first trimester. One of them had a potentially life-threatening ectopic pregnancy,” he said.
“And at least nine patients ended up in hospital with sepsis or kidney and bladder infections due to ineffective or delayed treatment.”
The AMA said that policy makers must preserve the separation of prescribing and dispensing to protect medical safety and is calling on “all state and territory governments considering adopting QLD’s irresponsible trials to reflect on the real harm this has caused the community.”