I Am Looking Forward To Seeing How These Changes Work Out Over Time.

This appeared last week:

New pharmacist prescribing powers see thousands of women bypass their GP

June 1, 2024 — 1.30pm

New prescribing powers for NSW pharmacists allowing them to treat women who present with uncomplicated urinary tract infections (UTIs) have come into effect today.

Bypassing the need for a GP appointment, women aged 18 to 65 can pay for a private consultation with a pharmacist trained specifically to deal with UTIs, to be prescribed antibiotics.

In a 12-month clinical trial led by the University of Newcastle, 1000 participating pharmacies provided 17,000 consultations.

The trial results have yet to be released, raising concerns among GPs that the prescribing powers have been implemented prematurely, risking misdiagnosis and ineffective use of antibiotics.

Hailing the trial as successful, Pharmacy Guild New South Wales branch president David Heffernan said he was aware of only one adverse event. A patient’s UTI was so advanced she needed intravenous treatment after oral antibiotics proved ineffective.

“I’m very proud of the trial – it was robust, and we worked with GPs in a professional and collaborative way,” he said.

“It’s a very positive thing – there’s one disease state out of thousands that we’ve had red tape removed to treat. It’s about opening up options for patients.”

During the trail, Heffernan said, on average one woman presented to a participating pharmacy each week, meaning many still chose their GP for treatment.

However, Royal Australian College of General Practitioners NSW and ACT chair Dr Rebekah Hoffman said she was concerned about the powers being made permanent before the release of the trial results.

“The trial [is being] used as a rationalisation after the fact rather than a genuine evaluation … We still have genuine concerns about the lack of supporting evidence for patient safety given the potential for adverse events, as well as cost-effectiveness, and appropriate communication back to the GP,” she said.

Hoffman said she was also concerned about antibiotics being prescribed inappropriately, or pharmacists misdiagnosing UTIs instead of more serious health problems.

In a similar trial in Queensland, two patients were misdiagnosed with UTIs. One had chlamydia and another had a 15-centimetre pelvic mass.

“Pharmacists aren’t [adequately] trained to diagnose a UTI and this doesn’t change that, it just puts the cure before a diagnosis,” Hoffman said.

A spokesperson for NSW Health said the trial was under evaluation.

“[The evaluation includes] a review of service satisfaction levels, how often antibiotics were supplied, how often women were referred to other services and what, if any, medical and pharmacy services the trial participants required after the consultation,” the spokesperson said.

NSW Health Minister Ryan Park said similar trials and models has been implemented in Queensland and Victoria.

“Empowering pharmacists to expand their scope of practice is critical to relieving pressure on our GPs, and improving timely access to care,” he said.

The number of GPs in Australia has been declining since 2018. There were about 9550 GPs in the 2022-23 financial year, down from 10,062 the year before.

Blooms The Chemist health programs pharmacist Alex Elia said pharmacists’ response to the policy was overwhelmingly positive, as it was from patients who said they had struggled to book a GP appointment.

“As pharmacists, we are healthcare providers and provide medication, counselling, information … but sometimes in those conversations you fall short of being able to help customers,” she said.

The government had paid pharmacists $20 a consultation during the trial, but pharmacies can now set their fee, to be covered by the patient.

A separate trial allowing pharmacists to treat impetigo (school sores) and shingles is under way.

Here is the link:

https://www.smh.com.au/national/nsw/new-pharmacist-prescribing-powers-see-thousands-of-women-bypass-their-gp-20240530-p5jhyf.html

If ever there was a case of wait and see how it works this has to be it. I only hope our systems are good enough to detect if there is a real excess of patient problems as the approach is rolled out.

I think that this change should not result in major harm but I hope it is not seen as a way to go further in expanding the pharmacist scope of practice beyond what is sensible.

We wait and watch!

David.