Bigger role for pharmacists worries doctors

Annabel Young. Photo / Paul Estcourt

Pharmacists' calls for more healthcare responsibility could have dangerous consequences if patients stopped seeing their GP, the head of the Medical Association has warned.

Peter Foley's comments follow the Pharmacy Guild's push for more funding, as part of a review of its district health board contracts, to act as a first point of contact in administering some health care.

Health Minister Tony Ryall said this week the Government was in talks with pharmacists about them playing a bigger role in tending to the sick.

Pharmacy Guild chief executive Annabel Young said pharmacists wanted to be given the right to help patients in managing chronic conditions such as diabetes, heart disease and asthma through health counselling and guidance on prescribed medicine use. They also wanted to be able to carry out medicine-use reviews, which involve monitoring patients' use of prescribed medication to ensure better results and cut the costs of unused medication.

Other services included nicotine replacement programmes and providing the emergency contraceptive pill.

But Dr Foley yesterday said pharmacists could enter into dangerous territory by being given the power to do so. "Doctors, with their scientific background, are the only people that are trained to diagnose health conditions and to manage the risks involved in doing so."

Pharmacists were also not qualified in the management of chronic illnesses such as heart conditions and diabetes, Dr Foley said.

"To suggest that they would reduce the need for hospital admissions is dreaming ... they need to be very careful, and the minister needs to be careful, and I'd be advising him so."

He said pharmacists were under-used but any expansion of their role needed to be limited to the management of effective and efficient use of medicines.

"There's a big difference in dealing with coughs and colds and dealing with the complications of a full influenza infection. There's a big difference between indigestion and a gastric ulcer. There's a big difference between a haemorrhoid and cancer of the bowel. The list could go on with many conditions that appear simple but have a complex background."

The Pharmacy Guild has said people go to their pharmacists for health information more than any other health professional but Dr Foley wanted to "lay that one to rest" as it probably included cases where people were asking for minor things such as Panadol for a headache.

This didn't compare to the number of doctor consultations - about 100,000 a day - and the complexity of those consultations.

But Annabel Young said the proposal was not about taking patients off doctors but catering for people who could not get an appointment with a GP or could not afford one.

"The risks are quite low because the alternative is a person who will probably not end up seeing anybody. It's better to see a pharmacist than no one and that's usually the alternative ... the effect of them being unserviced makes it more likely they're going to turn up in an emergency room."

She said if pharmacists could not deal with the problem, they would often phone a GP to refer a patient.

Every 10 to 15 people who had a medicine use review worth about $200, stopped one hospital admission worth about $5000. Pharmacists DHB funding contract comes up for renegotiation in March.

The Independent Practitioners Association chief executive, Fiona Thompson, said GPs had already started relying on pharmacists more and the industry supported them having more power.

"Over the last period general practice is forming closer relationships with pharmacy even to the point where some pharmacies are co-located with general practices and that's certainly consistent with the concept of integrated family health services. There is definitely a role for clinical partnerships with pharmacy.

"I think it's consistent with the direction we are moving in health care teams and team environments. If people have the appropriated level of training and it's co-ordinated it can only be a good thing."