Type 2 diabetes

Doctor groups slam plan for pharmacists to manage and prescribe for people with diabetes

Medical groups have expressed alarm at a scheme to extend the scope of practice of retail pharmacists to allow them to manage chronic diseases including diabetes.

The Royal Australian College of General Practitioners (RACGP) has warned that a pilot “Scope of Practice” trial planned to start in North Queensland in June poses a serious risk to patient safety.

The trial would see community pharmacists allowed to screen patients for a wide variety of chronic illnesses and independently prescribe S4 medications. In the case of type 2 diabetes, it is proposed that pharmacists could potentially assess patients’ blood glucose levels and supply hypoglycaemic medications.  The proposals being discussed between the Queensland government and stakeholders are intended to help ease service gaps in areas with medical workforce shortages.

The Scope of Practice trial would also allow pharmacists to conduct assessments and supply S4 medications for numerous other conditions including obesity, hypertension, respiratory diseases such as COPD, and also to supply oral contraceptives.

Community pharmacists have previously conducted a trial of screening for type 2 diabetes that identified 136 undiagnosed cases of diabetes patients out of 14,000 customers screened with the AUSDRISK tool and HbA1C testing.

The proposals have been slammed by the AMA, which say the move will lead to significant misdiagnosis of potentially serious conditions while fragmenting care and undermining efforts to control antibiotic prescribing.

The AMA said it is seeking urgent clarification from the Therapeutic Goods Administration over proposals that pharmacist would be allowed to independently prescribe S4 medications, a move that appears to be illegal under the Therapeutic Goods Act.

“It’s second-rate medicine for people in north Queensland. It’s just dangerous,” said AMA Queensland president Dr Chris Perry.

The RACGP has also called for the trial to be stopped, with RACGP Queensland Chair Dr Bruce Willett saying pharmacists were completely unqualified to diagnose and treat patients.

“It’s playing with fire and putting patients at serious risk,” he said.

“A specialist GP undertakes a minimum of 10-years training, including medical school as well as vocational training to diagnose and recommend treatment to patients unsupervised. But this trial would see pharmacists diagnosing, treating and prescribing to patients for complex medical conditions unsupervised, after just a three-week course.

The Queensland government says the scheme is designed to address gaps in healthcare services in regional areas where no doctors are available.

But the Rural Doctors Association of Australia described the scheme as cheap band-aid solution and warned that pharmacist prescribing would only worsen rural medical workforce shortages by making rural regions unattractive for doctors.

“This pilot is not aimed at increasing rural access to primary care services, just a desire to increase profit for pharmacies based in cities and large regional centres,” they said in a joint statement issued with the RACGP.

“There are also serious conflicts of interests involved, with pharmacists encouraged to not only diagnose conditions, but also sell patients medications based on this diagnosis.”

The scheme is being promoted by the Pharmacy Guild, whose president Trent Twomey is a pharmacist in north Queensland and a former LNP campaign director.

The RACGP said the Pharmacy Guild was undermining the fundamental principle of separation of prescribing and dispensing.

“This no longer seems important when the profits of retail pharmacy are at stake,” said RACGP President Dr Karen Price.

“The RACGP has deep concerns about moves by the retail pharmacy sector to push through policy changes that put financial gains ahead of patient care and safety. We will fight this every step of the way.”

Both the AMA and RACGP have withdrawn from the trial’s advisory committee in protest.

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