The GP who trained pharmacists to prescribe

6 minute read

The North Queensland GP who helped train the first tranche of prescribing pharmacists says they’re 'smart, conscientious, hardworking and committed professionals'. But will they save GP time?

With around 35 years of medicine under her belt – including 20 as a rural GP and four as the director of an RTO – one might expect Associate Professor Peta-Ann Teague to be against the North Queensland pharmacist prescribing trial.

In fact, she’s one of its relatively few supporters in the medical field.

“The intention behind the trial is one that I really do support,” she told The Medical Republic.

“I think that pharmacists are genuinely very well-respected by their customers … and they understand the health needs of their community.

“For me, it’s a logical extension to look at what health practitioners are in any specific community and what they can offer, particularly in primary care.”

Professor Teague, who previously headed up the GP training organisation attached to James Cook University in Townsville, assisted in planning and delivering the training program for pharmacists wanting to take part in Queensland’s expansive scope of practice trial.

The pilot covers 17 different conditions, ranging from otitis media to smoking cessation.

It was initially intended to only cover the northern half of Queensland but has since been expanded statewide.

The first tranche of trainees were 300 North Queensland pharmacists.

Training was delivered in two parts – a three-month unit run by the Queensland University of Technology in Brisbane and a six-month course at JCU in Townsville.

Part two, which is what Professor Teague worked on, covered clinical assessment, diagnosis and management of the conditions included in the trial.

“As part of thinking about how I might draw up the program to support the teaching on this, I went one evening, quite late at night and sat in on a really, really busy retail pharmacy,” she said.

“I saw what people were bringing to the pharmacist and how little time the pharmacists had to make decisions on what people were asking about.

“What this course has shown me is that the pharmacists who’ve done the course so far don’t want to be doctors. They want to be pharmacists who can offer their patients more care.”

There is one aspect of the way the pilot has been marketed that doesn’t sit right with Professor Teague: the notion that pharmacist prescribing will free up GP time.

Freeing up GP appointments for urgent cases has been a key part of messaging surrounding pharmacy pilots across the country, and one that’s been repeated time and time again by different stakeholders.

“I think that as the pilot starts, there will be patients that the pharmacist sees who perhaps haven’t seen a GP or can’t get into the GP,” Professor Teague said.

“And the pharmacist will … [identify people] with undiagnosed diabetes or who have potentially got chronic obstructive pulmonary disease, and those conditions are going to be co-managed with the GP.”

Rather than saving GP time, the Townsville doctor said it seemed more likely that pharmacists would identify cases in the community that will be escalated to GPs.

In her opinion, once the trial is up and running, successful cases will be the patients who come down with shingles symptoms late on a Friday night and access antivirals through the pharmacy, or the child who comes home from daycare with a sore ear on an afternoon.

“The pharmacist can help with [those conditions] and assess and manage them appropriately, [but] would you say that they’ve saved GP time?” Professor Teague said.

“I don’t know how you count that in terms of [judging whether it has] freed up a GP’s time, but what I would say is that it’s put the patients in the centre of care.”

She’s confident that the 300 trainees she oversaw are in the trial for the right reasons.

“I would say that it’s not for everyone and not every community pharmacist is going to want to do this,” Professor Teague said.

“And that’s absolutely fine. But for the ones that do want to do it, what I have seen is a group of smart, conscientious, hardworking and committed professionals who want to do the best for their patients.”

JCU head of pharmacy Associate Professor John Smithson, who coordinated and delivered the clinical training component of the program, said that prescribing was not necessarily a new concept for the participating pharmacists.

“They treat a range of common self-limiting conditions with medications on a daily basis, so they’re not entirely unfamiliar with the act of prescribing,” he told TMR.

“The difference here is that the conditions are no longer self-limiting.”

The real power of the pilot, Professor Smithson said, is a collaborative approach to primary care delivery.

“When we have communities where patients are under-serviced … it makes sense to expand the scope of particular groups in order to meet the community’s needs,” he said.

“I think that there’s a risk if that is done in a way that fragments care, but that’s not the model that we’ve been teaching and emulating.

“Our pharmacists will be going out there working independently, but encouraged to work as part of a broader, multidisciplinary team.”

Professor Smithson and Professor Teague worked specifically on the training end of the pilot and did not have a say in the format or scope of the pilot itself; that part is Queensland Health’s job.

The only thing they can directly influence is what the pharmacists learn.

“We’ve engaged with a range of clinicians and medical educators who have helped us refine the modules and review the clinical protocols that we’re using,” said Professor Smithson.

“I think that there is a cautious optimism from our general practitioner counterparts.

“I know that there’s a lot of negativity out there, and I think that is because there’s been a lack of clarity around the pilot.”

Pharmacy Guild Queensland branch president Chris Owen told TMR that the negativity coming from the “GP’s lobby group” was not representative of GP attitudes.

“GPs were involved in the training for the pilot and the vast majority of GPs I work with are in favour of better patient outcomes that will come from all health professionals working to a fuller scope of practice,” he said.

Mr Owen said that every community pharmacist he had spoken to about the pilot had been enthusiastic and keen to get started on improving patient care.

The trial was meant to kick off in March, but the starting gun has failed to go off thus far.

TMR understands the delay is due to a review of the feedback and reporting mechanisms.

Queensland Health told TMR to look out for a press release toward the end of the month, but there are two business days left until April and nothing has appeared.

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