Title GPs ‘horrified’ at latest pharmacy proposal Degree of recognition National Media name/outlet News GP Media type Web Country Australia Date 20/01/21 Description Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care, also has reservations about directing emergency department presentations to pharmacy. He told newsGP consultations are more complex than at ‘first glance’, and pointed out the extensive pathway GPs follow in order to properly prepare them to be clinicians.
‘It might seem that pattern recognition for frequently occurring minor ailments means that these presentations can be managed through protocols that include safety netting and a low threshold for advising medical review, but I believe the consultation process is much more complicated,’ he said.
‘For example, the minor ailment might be a ticket of entry to open opportunities for a patient to discuss underlying mental health issue. Or what appears to be a simple tension headache might be caused by any one of a number of rare conditions that are only likely to be contemplated by a healthcare provider with a great depth and breadth of medical training.
‘Medical school is an intensive 5–6 year process that builds foundational scientific knowledge, then integrates that into a deep understanding of pathophysiology and clinical management. This is then backed up by two full years of closely supervised clinical placements.
‘All of this is underpinned by assessment of skills and knowledge, and even then, graduates from medical school are only halfway through their training to become independent doctors capable of integrating and filtering complex information from medical records, knowledge of risk factors, patient history, examination and investigations.
‘Contrastingly, training for pharmacists is also comprehensive but with a major focus on the effective use of medications only.’
The GPs also warned of potential patient privacy issues, fragmentation of care, and record keeping problems as arguments against the PSA’s proposal.
‘Where patients see multiple providers, each with their own take on diagnosis and management, there is confusion and lost opportunities for the patient to learn more about the condition they are presenting with; how to self-care, when to seek help, how to avoid wasteful over-the-counter products and how to prevent spread of infections,’ Professor Morgan said.
‘GPs have records that cover past history and events, biopsychosocial context of their patients, physical measurements combined with blood test and imaging results, sometimes family history. All of these clues sit there for the astute GP to draw on when the patient presentation rings subtle alarm bells.
‘But in this scenario, the patterns of illness that build over time in the GP record are lost, leading to delays in diagnosis of underlying chronic disease and instigation of effective preventive strategies.
‘No protocol driven or final year medical student for that matter can be expected to integrate this information and filter the important components, and do so in the timeframe of a typical 15-minute consultation.
‘For this reason it is difficult to imagine a suitable pharmacy training program, short of medical school, plus junior doctor years, plus GP vocational training pathways.’...
However, Professor Morgan said economists can take a narrow focus when considering the apparent cost of a minor ailment appointment, which can lead to false assumptions.
‘The full costs of minor ailment services need to include opportunity lost for management and monitoring that goes on alongside minor ailment consultations in general practice,’ he said.
‘Often the comparator for minor ailment services is emergency department attendance, which is necessarily an expensive service set up to manage severe acute presentations and emergencies.
‘But rather than scratching around trying to see which bits of healthcare can be carved off to be done in community pharmacy, it would be better to look at how the health system as a whole could better use the expertise and experience of pharmacists.
‘There might be opportunities to invest more in models of care in which a non-dispensing pharmacist is part of the general practice clinic team, with roles in medication governance and patient education.’
Producer/Author Matt Woodley Persons Mark Morgan