For all its flaws, Australia’s health system is consistently rated among the best in the world for a reason.
Just as GPs in Australia are raising concerns about community pharmacist-led prescribing, their counterparts in Canada are doing the exact same, delegates at the RACGP’s annual conference heard on Sunday.
The final conference session saw a panel discussion between RACGP president Dr Michael Wright, his counterparts from the Hong Kong College of Family Physicians (HKPFC) and the College of Family Physicians of Canada (CFPC) and immediate past WONCA president Associate Professor Karen Flegg.
Newly-minted CFPC president Dr Sarah Cook said it had been interesting to see the common challenges faced by both Australia and Canada.
“There’s definitely been an expansion in scope of other health professionals in Canada into the primary care world, particularly with nurse practitioners and with pharmacists,” she said.
“It varies from province to province and territory to territory, but nurse practitioners now can provide primary care independently.
“There are nurse practitioner-led clinics that have no physician involvement whatsoever. There aren’t very many of them, but that is something that is definitely being discussed … because we are really trying to promote the idea of collaboration, not substitution.
“There is such need in our country for primary care services that we shouldn’t be wasting our energy arguing about who is doing what; but rather working together in multidisciplinary teams with everyone working to the top of their scope.”
Unlike Australia, Canada’s health systems are largely decentralised and state-run.
While all jurisdictions must follow the Canada Health Act 1984, which prohibits out-of-pocket billing for medically necessary services, each province and territory can define what services constitute as “medically necessary”.
It opens the door for more variation in health services from place to place.
“Pharmacists are also now providing primary care, [and it is] particularly of concern for us in some provinces where this is being delivered in retail pharmacies,” Dr Cook said.
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“There are several concerns, but one of them is pharmacists are working in an environment where prescribing is creating financial benefit for their employer, so there’s obviously a conflict of interest there.
“Seeing the rates of over-prescribing is certainly of concern, and … the care that [patients are] being provided there is not continuous with the primary care environment where they’re receiving most of their healthcare.”
Hong Kong GP college president Dr David Chao said that, although scope creep was not yet an issue, the island’s healthcare system was in the midst of a shift toward prioritising continuity of care using a voluntary registration system.
“In this new blueprint, the government has set an objective to pair uninsured patients to GPs in the community,” Dr Chao said.
“What they’re trying to do is hopefully create a development that everyone should have a family doctor or a GP, which is what we all want to do.
“We all want to have our own patients … it is still early days, but the response seems to be encouraging.”
Much like MyMedicare, Hong Kong’s Chronic Disease Co-Care pilot scheme involves patients enrolling with a specific doctor to unlock subsidised screening and treatment.
Australian GP and immediate past president of the World Organization of Family Doctors (WONCA) Dr Karen Flegg said it was no coincidence that health systems were moving in similar directions.
“It’s wonderful that we’ve got two of our colleagues from overseas on stage talking about their systems, because I think our governments talk to each other,” she said.
“So it’s high time that we actually started talking to each other about the various initiatives.”
The RACGP’s annual conference, GP25, was held at the Brisbane Convention and Exhibition Centre between 14 and 16 November.
