The number of patients presenting to Queensland emergency departments with UTIs has increased, not dropped, since pharmacists were allowed to diagnose and sell antibiotics for urinary tract infections.
New figures show the number of urinary tract infection (UTI) cases presenting at emergency departments has blown out since pharmacists have been allowed to autonomously diagnose and prescribe UTI treatments in Queensland.
Health Minister Shannon Fentiman released figures about ED presentations across Queensland’s 16 Hospital and Health Services (HHSs) showing 36,911 ED presentations between 2022 and April 2023 were due to UTIs.
This is up from 24,620 in 2020, the year pharmacists were first allowed to diagnose and sell antibiotics to patients without undertaking a basic urine test or seeking any medical oversight.
“Urinary tract infections are serious and hard to diagnose, particularly in men and aged care residents, who make up the majority of UTI presentations at EDs,” AMA Queensland President Dr Maria Boulton said.
“The Minister’s own figures show the UTI pharmacy prescribing pilot has not reduced the number of presentations to EDs. In fact, UTI presentations have increased since the flawed pilot began.
“This is not a criticism of our hardworking pharmacist colleagues, who we work with every day to get the best outcomes for our patients. It is a criticism of short-term, short-sighted political band-aids that will not resolve our health workforce shortages.
“We continue to call on all levels of government and all sides of politics to work together to recruit, train and retain our own healthcare workforce, and to scrap dangerous experiments with patient health.”
AMA Queensland gave Health Minister Shannon Fentiman the benefit of the doubt for her first few months in her new position. But her decision to radically expand the North Queensland pharmacy prescribing pilot with no consultation with medical groups, only political donors, smacks of a desperate pre-election gamble.
The three main medical bodies representing Queensland doctors and patients are concerned at the state government’s decision to radically expand its North Queensland pharmacy prescribing pilot.
The government will now allow pharmacists across the state to diagnose a range of serious conditions and prescribe and sell medications with no medical oversight.
This decision leaves patients at risk and will not resolve longstanding workforce issues in regional Queensland.
The Royal Australian College of General Practice, the Australian Medical Association, and AMA Queensland were not consulted about the expansion, despite taking part in good faith discussions about the NQ pilot.
AMA Queensland withdrew from a proposed one-hour working group meeting about the NQ pilot in August due to concerns about extreme confidentiality restrictions imposed by Queensland Health.
However, none of the medical groups were given notice of Monday’s announcement, while supportive comments from pharmacy lobby groups were included in the minister’s media release. The pharmacy lobby donated more than $130,000 to both sides of politics in Queensland in just four months last year.
QUOTES ATTRIBUTABLE TO AMA PRESIDENT PROFESSOR STEVE ROBSON:
“It seems several state/territory governments are intent on pursuing policies that will fragment care and lead to poorer health outcomes and greater costs to the health system in the long term.
“Real innovation in healthcare delivery should put patients at the centre with GPs and pharmacists working in collaboration to deliver the best possible care for patients.”
QUOTES ATTRIBUTABLE TO RACGP PRESIDENT DR NICOLE HIGGINS:
“As a GP in far north Queensland, I am concerned for the safety of my patients and our vulnerable regional communities.
“There is also a central conflict of interest in this pilot, as it removes the important separation between prescribing and dispensing, which is a basic safety mechanism in our health system. Instead, it sees pharmacists put in a deeply conflicted position where they will assess a patient’s condition and gain financial benefit from selling them a medication.
“The state government has decided to ignore nationally agreed processes established to ensure safe and appropriate prescribing, as well as decisions made by the Therapeutic Goods Administration (TGA).”
QUOTES ATTRIBUTABLE TO AMA QUEENSLAND PRESIDENT DR MARIA BOULTON:
“This is a reckless act by Queensland Health Minister Shannon Fentiman that ignores the science and puts the interests of political donors ahead of patients in a pre-election scramble.
“The process has been secretive, not based in evidence, rushed and dangerous since the start.
“It is a political decision flowing from an election commitment to the Pharmaceutical Society of Australia and was never about patients or their safety.
“The NQ pilot is based on the urinary tract infection (UTI) prescribing pilot that started in Queensland in 2020. That pilot was not conducted as a clinical trial and Queensland Health constantly resisted our requests for information about its outcomes. It also refused to provide any mechanisms for doctors or patients to report concerns.
“Out of frustration, we surveyed Queensland doctors about the UTI trial and found hundreds of cases of women who needed further treatment, most for missed diagnoses of sexually transmitted infections, but one ectopic pregnancy and one pre-cancerous mass.
“When Queensland Health finally released its evaluation of the UTI pilot, it found even more cases of women who needed further treatment, but claimed the trial was a success, despite being unable to follow up two-thirds of women who took part.
“The Office of the Health Ombudsman (OHO) in Queensland is still considering an open complaint about the conduct and outcomes of the UTI pilot, which makes it even more inappropriate that the Health Minister would go ahead with this unwarranted and unacceptable expansion while this investigation is still open.
“This is not the fault of pharmacists.
“As a GP, I work closely with my local pharmacist every day to manage my patients’ care. This is an important safety check for patients. Under current arrangements, neither of us make any extra money from prescribing a medication. Doctors and pharmacists are important stewards against antimicrobial resistance from over-dispensing of antibiotics and these pilots threaten that safety.”
The Queensland Government’s decision to push ahead with its dangerous plan to allow retail pharmacists in North Queensland to diagnose and prescribe for a range of serious conditions shows a blatant disregard for patient safety.
“People need access to doctors, not short-term, short-sighted experiments that place them at risk,” AMA Queensland President Dr Maria Boulton said.
“This experiment will not reduce the pressure on our hospitals, ambulance ramping or bed access block. Patients who need hospital beds are patients who are unwell enough to need hospital care. I have visited many Queensland hospitals and witnessed these issues first hand.
“What the government is proposing goes against the independent, unbiased, evidence-based advice from the federal Therapeutic Goods Administration (TGA) about who can prescribe and access medication, and research into patient safety.
“GPs train for 12 to 15 years to be able to diagnose these conditions, yet the Health Minister thinks pharmacists can deliver the same level of care after 120 hours of learning in practice.
“The pilot proposes that pharmacists will perform a lung exam, spirometry, otoscopy without the appropriate training. This goes against a holistic approach to patient care.
“For example, nausea may seem straightforward, but it can be a symptom of diabetes, gastroenteritis, brain cancer, appendicitis, sepsis, meningitis and more. Treating just the symptom and not the underlying cause places the patient at risk and leads to more expensive hospital stays.
“This pilot is an approach to medicine that has no input or support from doctors or pharmacists on the ground - doctors and pharmacists who work together collaboratively every day to ensure the best and safest health outcomes for patients.
“The Minister says this was an election commitment to pharmacy bodies. But bad election promises should be dumped. Promises to political donors should not trump patient safety, particularly when pharmacists are in short supply in these regions.
“This is not the answer to overcrowded emergency departments and over-capacity hospitals around Queensland. We need more staff, with proper qualifications, and better resourcing.”
This dangerous experiment is based on the failed urinary tract infection (UTI) prescribing pilot that the government’s own evaluation showed led to hundreds of women needing further care. AMA Queensland’s survey of doctors found missed cancer cases, serious sexually transmitted infection misdiagnoses, antibiotic resistance and an ectopic pregnancy among patients needing further care.
AMA Queensland Vice President Dr Nick Yim, a pharmacist who retrained as a GP, said pharmacists were already overworked and underpaid.
“This not the answer to workforce shortages,” Dr Yim said.
“An Australian Journal of Pharmacy survey found ‘increasing professional services workload eg vaccination’ is the third highest ranked reason for pharmacists to consider leaving the profession.
“It is simply not true to claim that similar schemes operate in New Zealand, Canada and the United Kingdom. In New Zealand, pharmacist prescribers train in a specific clinical area – paediatrics for example – and then they work within a hospital ward, not in a retail pharmacy.
“Getting a diagnosis and prescription from a chemist while doing the weekly grocery shopping may seem more convenient than seeing a GP, but it’s like fast food – it’s not good for you in the long-term.”
Cairns GP and AMA Queensland Councillor Dr Lee Jones said North Queenslanders – particularly Aboriginal and Torres Strait Islander communities – were tired of being treated as expendable.
“If we are going to be experimented on, we want it to be a proper clinical trial, so doctors and patients know how to report adverse effects from this ‘pilot’,” Dr Jones said.
“Our communities need to know when this is going to begin, which pharmacists are taking part, what training they have had, and exactly how this experiment’s effects on patient safety and health are going to be measured.
“The UTI trial was promoted as filling healthcare shortages in regional areas and after hours, but the government’s own evaluation shows that the majority of services were provided in cities and major regional towns during normal business hours – not in country towns at night or on weekends.”
- AMA Queensland media release - 29/09 - Reporting patient harms from UTI pilot
- AMA Queensland media release - 09/05 - Patients suffered during UTI trial
- AMA Queensland media release - 27/04 - PSR weighs in on NQ pharmacy trial
- AMA Federal media release - 03/03 - North Queensland pharmacy prescribing trial loses key support
- AMA Queensland media release - 22/02 - AMA Queensland calls for UTI trial evaluation results to be released
- AMA Queensland media release - 11/02 - Pharmacy trial no cure for workforce shortage
- AMA and AMA Queensland media release - 28/01 - Pilot will deliver second-rate health
- AMA 11/11 - Medicine safety depends on doctors and pharmacists working together
- 4BC News Talk - 12/02 - Debate between pharmacists and doctors
- The Courier-Mail - 11/02 - Doctors claim govt’s pharmacist diagnosis plan is illegal (Paywalled)
- 10 News First Queensland - 11/02 - Queensland Pharmacists may have the power to treat more illnesses however, there are fears patients could be misdiagnosed
- 9 News Queensland - 11/02 - GPs debate over a plan to allow pharmacists to diagnose certain illnesses
- 7 News Brisbane - 11/02 - The AMA is ramping up its plan to allow pharmacists to diagnose and treat serious conditions
- ABC Online - 11/02 - Queensland trial to allow pharmacists to diagnose and prescribe medication alarms doctors
- 7 News Queensland - 11/02 - Nth Qld pharmacy trial has doctors worried
- ABC Australia Wide - 11/02 - Doctors alarmed by trial to allow pharmacists to diagnose and prescribe medication
- Cairns Post - 11/02 - North Queensland Pharmacy Scope of Practice Pilot trial raises concerns (Paywalled)
- Australia Doctor - 11/02 - GP groups quit 'unsafe' Queensland pharmacy pilot
- RACGP - 11/02 - RACGP resigns from pharmacy trial steering committee
- Brisbane Times - 11/02 - Queensland pharmacies hoping for fresh front
- 4BC News Talk - 11/02 - GPs and pharmacists debate over North Qld trial
- 6PR News Talk - 11/02 - Pharmacists to prescribe medication
- Daily Mail Australia - 11/02 - Plan to allow pharmacists to diagnose and treat serious conditions in remote indigenous communities
- The Medical Republic 05/10 - NSW weighs pharmacist UTI prescribing
- The Medical Republic 05/10 - Pharmacy prescribing training standards on way
- ABC News 12/10 - Queensland government pursues watered-down pharmacy pilot, but doctors say patients still at risk
- News GP 13/10 - Controversial pharmacy prescribing pilot finalised
- The Medical Republic 13/10 - Pharmacy prescribing pilot to start next year
- AusDoc 14/10 - Watchdog to hear accusations of patient harm linked to pharmacy UTI prescribing (Paywalled)
In February 2022, it was revealed the Queensland Government and the Pharmacy Guild were planning a trial in North Queensland allowing pharmacists to autonomously diagnose and prescribe medications.
AMA Queensland remains steadfastly opposed to the implementation of the Urinary Tract Infection Pharmacy Pilot – Queensland (UTIPP-Q) and proposed North Queensland Scope of Practice Pilot (NQ Pilot). Both programs pose a grave threat to the health and safety of all Queenslanders.
AMA Queensland has written to the Director-General of Queensland Health and the Minister for Health and Ambulance Services outlining specific concerns with the NQ Pilot, including its adoption of many of the same failings as the UTIPP-Q. We have asked Queensland Health to justify and answer key questions about the dangerous program.
We have been asking questions of the Queensland Government and QUT on the providence and governance of the UTI Pilot and the NQ Pharmacy Pilot. Read our extensive correspondence seeking clarity and transparency for the public, patients and the medical profession.
- 21/11/2022 - AMA Queensland correspondence to Director-General
- 21/9/2022 - AMA Queensland letter to Health Ombudsman
- 12/9/2022 - AMA Queensland to Director General re UTIPP-Q
- 26/5/2022 - Incoming QUT to AMA Queensland re UTI pilot evaluation
- 9/5/2022 - Letter to Minister for Health re NQ Pilot Survey
- 9/5/2022 - Letter to Premier re NQ Pilot Survey
- 5/5/2022 - AMA Queensland reply to UQ UHREC
- 8/4/2022 - QUT UHREC response
- 7/4/2022 - Letter from AMA Queensland to QUT UHREC re UTI pilot
- 12/12/2022 - DG Queensland Health letter to AMA Queensland re letters of 3and 21 November 2022 re NQ Pilot
- 16/12/2022 - AMA Queensland letter to DG Queensland Health re letter 12 December
- 3/2/2023 - Queensland Health response to AMA Queensland re letter 16 December
- 30/6/2023 - AMA Queensland to Health Minister and DG Health re urgent cessation of UTI program
- 18/7/2023 - Chief Medical Officer to AMA Queensland re invitation to NQ Pilot quality and safety framework workshop
- 31/7/2023 - AMA Queensland to Chief Medical Officer re invitation to NQ Pilot quality and safety framework workshop
- 3/8/2023 - Chief Medical Officer to AMA Queensland re NQ Pilot accountability and transparency concerns
- 10/8/2023 - AMA Queensland to Chief Medical Officer re NQ Pilot quality and safety framework workshop
- 10/8/2023 - AMA Queensland to Health Minister re concerns about estimates and media statements
- 06/10/2023 - AMA Queensland to Chief Health Officer re: reporting mechanisms for state-wide community pharmacy pilot
- 11/10/2023 - Letter from Chief Medical Officer re: reporting mechanisms for state-wide community pharmacy pilot