I rise today to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. This legislation authorises the dispensing of a limited range of treatments by pharmacists, from minor skin conditions to uncomplicated urinary tract infections (UTIs). It allows the reissuing of oral contraceptives for women and the administration of travel vaccines. We do see the merits of this bill, which is why we do not oppose it, and I would like to take the opportunity to express my heartfelt thanks to pharmacists throughout my electorate who have a close relationship with locals and act as powerful preventative care and alleviate pressures on our health system.
This bill promises to ease the pressure on our hospitals and GP clinics, which have been crumbling under the strain of Labor’s mismanagement of Victoria’s health system. It proposes alleviating the cost-of-living issues imposed by our mismanaged health sector by fostering facilities that bulk-bill. Above all, it offers a swift and effective treatment route for urgent issues that in the past have been deferred for a time while awaiting a GP’s attention.
Despite these benefits, I would like to raise some of the reservations that must be considered. Our primary demand is enforcing a rigorous two-year clinical study period crucial for addressing several key concerns. The study period should serve as a stringent regulatory mechanism, ensuring pharmacists uphold high healthcare standards despite broadening their roles. It should also act as a litmus test for the adequacy and funding of pharmacist training, considering the weight of their new responsibilities. This proposed study period should safeguard the continuity of care through efficient information sharing between pharmacists and family GPs.
As we delve deeper into the implications of the bill, we see that this legislation, while absolutely a positive step, is barely touching the surface of our health system’s problems. The category 1 surgery waitlist, which covers critical cases, has surged by over 45 per cent in three months. This is coupled with a distressing 147 per cent increase at Bendigo Hospital. The overdue wait times for category 2 and 3 surgeries have also seen an alarming rise. The health professional shortage in regional Victoria contributes to the deteriorating conditions. This shortage extends across dentistry, mental health, Indigenous health and medical radiation. Without adequate staffing and adequate government support for country hospitals and healthcare providers, regional Victorians are bearing the brunt of this healthcare crisis.
With all of this in mind, the introduction of the bill is a step towards broadening healthcare access. We agree with the ethos and background to this bill and the benefits to our regional communities, but it hardly addresses the root of the problem. It is not merely about diversifying healthcare delivery channels but fundamentally about improving the standards, responsiveness and reach of our health service. We must remember that quality health care is a fundamental right and not a luxury. The bill stands as a reminder that we need comprehensive measures to address the systemic issues that plague our health services. It is time the government addressed the disparities in health care between regional and metropolitan areas, reinforced emergency services, reduced surgery waitlists and reinstated funding for preventative healthcare programs. Without these actions, the bill risks becoming just another bandaid on a wound that needs thorough care and attention.
In terms of the delivery of this program, the government made an election commitment last year to implement a pilot to expand the role of community pharmacists. $19 million has been allocated, and it is expected to deliver around 232,000 repeat oral contraceptives, 130,000 treatments for UTIs, 66,000 treatments for minor skin conditions and 41,000 travel vaccinations. These figures assume that approximately 50 per cent of people will seek treatment for the eligible conditions from a pharmacist rather than a GP during the 12 months. This pilot is modelled on similar schemes found across the country, particularly in Queensland and New South Wales. In Queensland a two-year pilot program was conducted starting in June 2020, where pharmacists supplied antibiotics for uncomplicated UTIs for women. This program has now made this permanent. In New South Wales a 12-month clinical trial started on 15 May 2023, allowing for participating pharmacists to provide treatment for uncomplicated UTIs. This trial will expand to allow the resupply of oral contraceptives for eligible women. In north Queensland another trial is set to begin later in 2023, with plans to include treatment by pharmacists for a wider range of conditions, including shingles, acute nausea and rhinitis.
The Victorian pilot will follow the same approach as the Queensland pilot and the New South Wales trial as well, using the model of a structured prescribing arrangement. This is a different standard to autonomous prescribing, like in north Queensland, which allows for prescribing a wider range of medicines for more conditions, expanding pharmacists’ scope of practice. This requires more training and accreditation, similar to prescribing rights for other health professionals, such as nurse practitioners, optometrists, podiatrists and more. This bill proposes an opt-in system for pharmacists to participate, and pharmacists will be paid $20 per consultation by the government.
I have spoken with Avenel pharmacist Belinda, who is in my electorate, to hear how this bill would impact her in our local community, which she services. Avenel Pharmacy has been in operation for over 12 years now, providing an essential service to a community that had previously gone without. Starting from humble beginnings, this pharmacy, thanks to the fantastic work of Belinda and her team, has gone from strength to strength over the years. It offers a wide range of critical services, including blood pressure and glucose measuring and reliable advice about medications, and it even has a coffee shop that has become a vibrant part and heart of the Avenel community. Belinda tells me that in theory this bill should be helpful to both her and our local community. She says:
While I haven’t had much advice from the guild on this matter, easier access to medications in rural and regional areas is always something that should be considered.
People are often not able to make it to doctors in time and need faster access due to pressing medical conditions.
In regional areas, our doctors are often busy, full or inaccessible – especially on weekends when our pharmacies will be open.
Of course, I am not sure about how the training will be facilitated.
We would require intense training to ensure that pharmacists are well prepared, and can effectively and safely deliver this program.
A major concern that Belinda raised is something that will likely be shared by many smaller pharmacies, something very common in regional areas:
This needs to be worthwhile to pharmacists in order to take them away from the dispensary.
Many pharmacies across my electorate will only have one pharmacist, meaning extra consultations will take away from other important services they already provide. Incentivising this and allowing further employment within these pharmacies was put forward as a positive step.
Other national and statewide stakeholders have been contacted for their thoughts, including the Australian Medical Association. The AMA raised concerns about potential misdiagnosis and inappropriate treatment, saying that pharmacists do not have the knowledge, training and experience of GPs, which may lead to worse outcomes. On the other hand, the Pharmaceutical Society of Australia has different concerns. They note the word ‘prescribe’ is not used and have said they would prefer a prescribing model whereby participating pharmacists have prescribing rights. This would be consistent with existing regulations that provide for prescribing by dentists, nurse practitioners, authorised midwives, podiatrists and optometrists.
Considering the bill’s objective to alleviate some of the pressure on our healthcare system, we must critically examine the landscape of public health. At its core this is a noble pursuit, with government decisions supposed to serve, primarily informed by the welfare and needs of the people we serve. These pronounced deficiencies in our health system, which this bill does aim to address, to a degree come from more than just a near-decade’s worth of policy mishaps, funding cuts and unintended oversight of a stressed bureaucracy. This government has a callous indifference to the residents of our state, an apathy that has resulted in a health system in disarray and the health of our community being impacted.