I'll be voting with my patients' best interests at heart at the next state election.
The NSW Premier stood on the Pharmacy Guild’s conference stage for the third year running and handed a lobby group chronic disease.
Hypertension. COPD. Ear infections. Wound care.
No protocol. No definition. No detail. He announced it anyway and called it reform. Announce first, work out what it means later. That is how health policy is made in NSW now.
So let me fill in the blanks.
Managing high blood pressure means titration, and titration means pathology. Renal function after an ACE inhibitor. Urine ACR. Lipids. Absolute cardiovascular risk, not one cuff reading at a counter.
And COPD does not exist as a diagnosis without spirometry, which no pharmacy shop can order or interpret.
There is no evidence base for any of it. Not for ear infections, not for wound care, not for hypertension, not for COPD.
We have been here before. The TGA examined whether a pharmacist consultation was sufficient to manage the risks of the contraceptive pill and found it was not, concluding those risks require a medical practitioner.
NSW routed around the national safety regulator by calling it a trial. That is the template, now applied to chronic disease.
Now the economics, because this is where it becomes indefensible.
NSW pays pharmacies directly — $60 for a pharmacist to start a patient on the contraceptive pill. The state can fund a faux primary care consultation outside Medicare whenever it feels like it. It simply chooses who.
If $60 is what timely contraceptive care is worth, why not pay a GP that? In a practice, where the same consultation gets you an examination, a blood pressure, a cervical screening conversation, and someone who will still be there in a year.
Automation is hollowing out the task pharmacies were built around. The consult room is how you get patients back through the door. No medical degree required. The NSW premier has decided that part is optional.
Related
So back to that $60. The Medicare rebate for a standard GP consultation is $45.05. The pharmacy fee has no rebate. No safety net. No bulk billing. And no audit.
Every Medicare item I bill can be reviewed. A pharmacy consultation fee cannot. Two professions, two sets of rules, and only one of them is writing cheques to government.
Meanwhile the crisis being used to justify it does not exist. A record 1772 doctors started RACGP training this year. The national GP bulk billing rate hit 84.1% in the June quarter, up from 75.6%. In my practice, and in practices across Sydney, the books are open.
This is a government that has stopped weighing evidence, because evidence is no longer part of the process. It announces from its largest donor’s stage, and it will legislate to match.
I’ll be voting with my patients’ best interests at heart at the next election.
Dr James Kelly is a GP at Double Bay Doctors in Sydney, and deputy chair of the RACGP’s NSW/ACT Faculty Council.
This article was originally published on Dr Kelly’s LinkedIn feed. Read the original article here.
