'Ambitious' plan could see 80 per cent of pharmacists able to diagnose health conditions
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As a prescribing pharmacist, Sam Turner is able to treat certain conditions and illnesses without his patients needing to visit a GP.
In Queensland, the treatment of some conditions — including uncomplicated urinary tract infections, ear infections, acne, psoriasis, and school sores — can be managed by trained pharmacists after a pilot program was made permanent earlier this year.
On Wednesday, the Pharmacy Guild of Australia announced its ambition to have 80 per cent of community pharmacists across the country able to offer additional services, including examining, diagnosing and treating health conditions by 2035.
Mr Turner, who runs a community pharmacy in Brisbane, undertook a postgraduate pharmacy prescribing course through James Cook University.
"The training has not only improved my skills as a clinician but has also reshaped the way I approach most clinical conversations in the pharmacy," he said.
"With those acute conditions — whether it's shingles, school sores, or even mild to moderate eczema or psoriasis — a lot of patients come in and they need treatment straight away.
"We're able to at least provide them with an immediate diagnosis and treatment, and then referral if required."
With the correct training, pharmacists are also able to prescribe hormonal contraception.
Professor Trent Twomey, the Pharmacy Guild of Australia national president, would like to see more "harmonisation" across the country.
"The Toward 2035 strategic plan involves turning Australia's 6,000 community pharmacies into primary healthcare hubs... saving the Australian healthcare system $5.1 billion annually," Professor Twomey said.
He said internal modelling done by the guild suggested the changes would significantly ease pressures across health systems.
In a statement, the guild said modelling showed its plan would free up 52,000 hours at emergency departments and save 6.5 million GP consultations.
Professor Twomey says 75 per cent of Australians live within two-and-a-half kilometres of a pharmacy.
"It makes sense that pharmacists step up, take on more clinical responsibilities to ease pressure on public hospitals and GP clinics across the country," he said.
"These are common-sense reforms where safe, affordable healthcare can be provided more easily and more effectively through more access points.
"It doesn't replace other healthcare providers, it just provides citizens with greater choice."
Dr Michael Clements, the rural chair of the Royal Australian College of General Practitioners, is less than impressed.
He said prescribing pharmacists in North Queensland — where it was first trialled — hadn't alleviated pressures on rural and regional general practitioners.
"The promise or the hope was that [if] overrun GPs couldn't possibly squeeze in anybody, [a patient] that needed to urgently be seen could go next door to the pharmacy," Dr Clements said.
"The only places this was offered has been in bigger city centres and in urban centres. In the pharmacies near me, it was only offered during [on weekdays] when a particular pharmacist might be rostered on."
He said urgent care clinics and government incentives to get more doctors into general practice training meant the GP shortage was improving.
"The main thing that's really impacting us as GPs is tidying up the messes when [patients] have seen a pharmacist and there's been a mistake," Dr Clements said.
He said has seen multiple instances where a patient who had sought treatment at a pharmacy had been misdiagnosed, including one who was treated for a urinary tract infection but had a sexually transmitted infection.
Dr Clements said in another case a patient was treated with steroid cream but had shingles.
"When you teach people a small number of diseases and you give them a toolkit that only treats a small number of things, patients are at risk," he said.
"[There's potential for] confirmation bias where the pharmacist chooses the wrong treatment because they haven't seen anything else before. They haven't had an apprenticeship, and they haven't had supervision.
"When all you've got is a hammer in your tool kit, everything starts looking like a nail."
Not a replacement for GPs
Dr Clements said pharmacists' access to patients' medical history was limited. For instance, they can't test urine and blood, so they may misdiagnose a condition or miss something that is underlying.
"It doesn't matter if Australians want to ask their GP, ask their pharmacist or ask their nurse, as long as the treatment they are being provided is in accordance with the same Australian therapeutic guidelines and the practitioner is treating them to the same level of care," he said.
"Unfortunately, there is enough sickness to go around. If we are able to achieve all our ambitions in this plan... it frees up our precious GPs to deal with those more complicated cases."
Queensland Health Minister Tim Nicholls says the government has put $1.5 million into training subsidies to allow an additional 230 pharmacists to complete further training.
"We need our clinicians across the health system working to a fuller scope in order to deliver easier access to health services," Mr Nicholls said.
He said the government had fulfilled its election commitment by making the treatment of a range of acute conditions from the pilot program a permanent service of prescribing pharmacists.
But the guild's Professor Twomey said the objectives of the plan weren't to replace GPs, but help free up doctors for more complicated cases.
By Baz Ruddick
In Queensland, the treatment of some conditions — including uncomplicated urinary tract infections, ear infections, acne, psoriasis, and school sores — can be managed by trained pharmacists after a pilot program was made permanent earlier this year.
On Wednesday, the Pharmacy Guild of Australia announced its ambition to have 80 per cent of community pharmacists across the country able to offer additional services, including examining, diagnosing and treating health conditions by 2035.
Mr Turner, who runs a community pharmacy in Brisbane, undertook a postgraduate pharmacy prescribing course through James Cook University.
"The training has not only improved my skills as a clinician but has also reshaped the way I approach most clinical conversations in the pharmacy," he said.
Under the 10-year plan, community pharmacists would be able to treat more conditions. (ABC News: Keane Bourke)
"With those acute conditions — whether it's shingles, school sores, or even mild to moderate eczema or psoriasis — a lot of patients come in and they need treatment straight away.
"We're able to at least provide them with an immediate diagnosis and treatment, and then referral if required."
With the correct training, pharmacists are also able to prescribe hormonal contraception.
Push for a national approach
The level of service a pharmacy can offer varies depending on the state and territory.Professor Trent Twomey, the Pharmacy Guild of Australia national president, would like to see more "harmonisation" across the country.
Sam Turner is supportive of the plan to expand the scope of pharmacists. (Supplied: Sam Turner)
"The Toward 2035 strategic plan involves turning Australia's 6,000 community pharmacies into primary healthcare hubs... saving the Australian healthcare system $5.1 billion annually," Professor Twomey said.
He said internal modelling done by the guild suggested the changes would significantly ease pressures across health systems.
In a statement, the guild said modelling showed its plan would free up 52,000 hours at emergency departments and save 6.5 million GP consultations.
"It makes sense that pharmacists step up, take on more clinical responsibilities to ease pressure on public hospitals and GP clinics across the country," he said.
"These are common-sense reforms where safe, affordable healthcare can be provided more easily and more effectively through more access points.
"It doesn't replace other healthcare providers, it just provides citizens with greater choice."
Guild president Trent Twomey says the plan would save 6.5 million GP consultations.
Rural practitioners weigh in
Not all practitioners agree this approach will have the desired effect.Dr Michael Clements, the rural chair of the Royal Australian College of General Practitioners, is less than impressed.
He said prescribing pharmacists in North Queensland — where it was first trialled — hadn't alleviated pressures on rural and regional general practitioners.
"The only places this was offered has been in bigger city centres and in urban centres. In the pharmacies near me, it was only offered during [on weekdays] when a particular pharmacist might be rostered on."
He said urgent care clinics and government incentives to get more doctors into general practice training meant the GP shortage was improving.
The high-street pharmacy is within a short drive for most Australians. (ABC News: Keane Bourke)
"The main thing that's really impacting us as GPs is tidying up the messes when [patients] have seen a pharmacist and there's been a mistake," Dr Clements said.
He said has seen multiple instances where a patient who had sought treatment at a pharmacy had been misdiagnosed, including one who was treated for a urinary tract infection but had a sexually transmitted infection.
Dr Clements said in another case a patient was treated with steroid cream but had shingles.
"[There's potential for] confirmation bias where the pharmacist chooses the wrong treatment because they haven't seen anything else before. They haven't had an apprenticeship, and they haven't had supervision.
"When all you've got is a hammer in your tool kit, everything starts looking like a nail."
Not a replacement for GPs
Dr Michael Clements has seen some patients misdiagnosed at pharmacies. (Supplied: Royal Australian College of General Practitioners)
Dr Clements said pharmacists' access to patients' medical history was limited. For instance, they can't test urine and blood, so they may misdiagnose a condition or miss something that is underlying.
"It doesn't matter if Australians want to ask their GP, ask their pharmacist or ask their nurse, as long as the treatment they are being provided is in accordance with the same Australian therapeutic guidelines and the practitioner is treating them to the same level of care," he said.
"Unfortunately, there is enough sickness to go around. If we are able to achieve all our ambitions in this plan... it frees up our precious GPs to deal with those more complicated cases."
"We need our clinicians across the health system working to a fuller scope in order to deliver easier access to health services," Mr Nicholls said.
He said the government had fulfilled its election commitment by making the treatment of a range of acute conditions from the pilot program a permanent service of prescribing pharmacists.
But the guild's Professor Twomey said the objectives of the plan weren't to replace GPs, but help free up doctors for more complicated cases.
By Baz Ruddick
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