GPs say politics and money behind NSW pharmacy prescribing push

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The controversial move was announced a week after a new report showed pharmacy profits had soared on the back of increased service delivery.

New South Wales Premier Dominic Perrottet said the proposed reforms were aimed at easing pressure on emergency services. (Image: AAP)


GPs have accused the NSW government of shifting the cost of healthcare directly onto patients, after announcing plans that will allow pharmacists to independently diagnose and prescribe medication for several conditions, including urinary tract infections, skin conditions and ear infections.


Details of the programs remain unclear, but it is likely that participating pharmacists will be able to prescribe antibiotics for suspected UTIs from early next year, while the expanded scope of practice trial will only begin. in 2024.


Unlike Medicare-subsidized consultations that take place in general practice, patients will likely have to pay between $30 and $50 per consultation, while drugs dispensed will not be subsidized by the Pharmaceutical Benefits Scheme.


At a news conference promoting the new trials, Prime Minister Dominic Perrottet said the proposed reforms are intended to ease pressure on emergency departments and general practice waiting lists, but medical groups of general practitioners are not convinced.


Associate Professor Charlotte Hespe, Chair of the RACGP NSW & ACT, spoke out strongly against the move, describing it as a ‘band-aid’ solution that will lead to a ‘festering wound’.


‘I think it’s a very political maneuver to try and secure victories for the current NSW government with an election looming in March because they can see access to GPs has been a key problem for marginal seats in rural and remote parts of the state, she said.


“To me, it’s very disrespectful.


‘They’re launching a program that’s supposed to fix GP access issues without any input from GPs or the AMA, on the back of Pharmacy Guild promises they can deliver those services in a safe way, which, of my view, is a false premise.’


When asked to comment on Monday, Federal Health and Aged Care Minister Mark Butler also said he had not been consulted ahead of the weekend announcement.


“The New South Wales government has not chosen to contact us and have a discussion with us about this, so I am going from media reports,” he said.


“All we’ve seen is a media announcement from the Prime Minister, I’m not sure you can call that a plan. They didn’t choose to tell us about it.


“I have spoken about this issue with representatives from health, nursing and other groups on the Strengthening Medicare Task Force. I obviously speak very regularly with pharmacists’ associations, including the Guild and the Pharmacists’ Society.


“We are looking at these issues carefully. But my starting point is that all Australian healthcare professionals…should work as close to the peak of their scope of practice as possible.


While most of the schemes have yet to be finalised, Health Minister Brad Hazzard said they would likely follow similar – equally criticized – Queensland schemes which have already taken place or are due to start next year .


Doctors say these pilot programs, the development and evaluation of which have long been shrouded in secrecy, have raised several red flags, including, but not limited to:

Given that patients will more than likely have to pay for each consultation and prescription, Associate Professor Hespe is skeptical of any pharmacy prescribing system’s ability to alleviate pressure on emergency departments, as much of this traffic is fueled by patients seeking free health care.

She also questioned statements made in support of the scheme by Minister Hazzard that patients have to wait ‘maybe six weeks’ to be seen for a UTI in a GP practice.

“I’m sorry, that’s a total lie,” she said.

“I don’t think there are any patients who aren’t seen for a urinary tract infection in six weeks, and there are plenty of ways even rural and remote people can access medical care in that time frame. of time.

“I am well aware that there are difficulties in accessing general medicine, and I am not going to deny it at all. But let us use correct data and not exaggerated figures.

Meanwhile, RACGP Vice President Dr. Bruce Willett believes the latest Guild Summary – produced by the Pharmacy Guild of Australia – shows that pharmacy owners have a strong financial incentive to continue their efforts to expand their practice.

While the Guild does not make the document freely available to its members, AJP reports that Community Pharmacy recorded a net profit of $1.39 billion in 2020-21 (compared to $998 million in 2019-20), despite a reduction in total prescription volume.

At the same time, there was also a decrease in the share of prescription sales as a proportion of total sales, from 63% in 2019-2020 to 59% in 2020-2021.

However, this shortfall was more than offset by growth in average revenue from other revenue, which increased from $71,000 in 2019-20 to $100,000 in 2020-21.

“This highlights the need for pharmacies to diversify into services beyond dispensing prescriptions to sustain business growth,” the report said.

‘Many successful community pharmacies [are] respond to the changing commercial landscape by shifting to a greater service orientation, for example by incorporating consultation rooms dedicated to the provision of professional health programs and services.

The protected nature of Guild Summary makes it unclear whether or not these numbers represent record profits – a point the Guild declined to clarify before publication – but earlier reports show average pharmacy sales have increased by $800,000 since 2014-15.

Over the same period, average net profits more than doubled, from $107,000 in 2014-2015 to $236,827, while the percentage of revenue generated from prescription sales increased from 66% to 59 %.

Dr Willett said newsGP the results suggest that the pharmacy’s ongoing efforts to provide better services are more related to profits than to good patient care.

“We are seeing an increase in investment in pharmacies at the expense of general practice – not just at the federal level, but at the state level,” he said.

“From Queensland’s perspective, we see millions potentially invested in a pharmacy prescription program which will ultimately mean patients will pay up to $55 for a consultation and receive unsubsidized prescriptions to boost pharmacy profits.

“It would be interesting to know what percentage of these profits are generated by the sale of non-evidence-based drugs.

“It’s a shame that these [potentially] record profits are not translating into fair payouts for practicing pharmacists.

Although expressions of interest for NSW’s UTI pharmaceutical prescription program have already been opened, NSW Health did not respond to requests for details of either pilot, or respond to questions related to requirements. training, clinical monitoring or trial design prior to publication.

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