A majority of Australia’s GPs believe some low risk tasks could be taken off their plate by pharmacists to ease their workloads. In the main, however, medical practitioners are sceptical of pharmacists’ abilities to assist with more complex diagnosing and prescribing tasks.
And while GPs assess themselves as less confident in making ethically difficult recommendations or providing potentially addictive prescriptions, their confidence in pharmacists doing the same tasks is considerably lower still.
The GP and Pharmacy Landscape
Most Australian GPs (74%) have a close working relationship with a local pharmacist. The number of GPs with these working relationships declines, however, depending on how much of their practice is bulk-billed.
For Australian medical practices that are 100% bulk-billed, only 61% of GPs claim to have a close working relationship with a local pharmacist. Practices that bulk-bill between 70-100% of the time see the figure rise to 68%, while the mid tier category of bulk-billing (30-70%) has a figure of 82% and the low tier category (0-30%) records a figure of 83%. In short, the more GPs bulk-bill, the less they interact with pharmacists.
A Preponderance of Prescriptions
It might come as a surprise to the average Australian, but a majority of a general practitioners’ consultations involve seeing patients who simply need a prescription filled, rather than diagnosing treatment for an ailment.
EKAS’s December survey revealed that for all the patients GPs treat, 60.1% require a prescription for either Schedule 4 (prescription-only medicine) or Schedule 8 (controlled drug) medications.
Just over a third (36.9%) of GP consults are spent providing advice on a medical problem or ailment for patients, while around 3% specifically require a medical certificate.
GP Confidence in Providing Treatment
The confidence of GPs in fulfilling certain tasks diminishes as the level of expertise required and identified potential risks – such as developing an addiction – escalate.
Treating the common cold (99%), giving general medical advice and recommending and prescribing treatments for low-risk ailments like asthma and heartburn (97%), saw GPs overwhelmingly comfortable.
Moving into terrain where some ethical judgement is required, the survey revealed 80% of GPs were willing to dispense medical certificates and 78% were willing to recommend vaccinations to patients.
A narrow majority of GPs (59%) were willing to recommend and prescribe Schedule 4 medications (which are addictive and liable to cause dependence), while 56% were willing to give general medical advice and prescribe treatments for more complex chronic ailments like diabetes.
Less than half of Aussie GPs are willing to prescribe vaccinations to patients, suggesting that a narrow majority of doctors believe that patients should make up their own minds about getting vaccinated, irrespective of risks.
In matters of Schedule 8 drugs (which include amphetamines, barbiturates and codeine), there was a high degree of caution around these addictive substances. Just 14% of surveyed GPs were willing to recommend and prescribe Schedule 8 medications.
Generic GPs Duties & Pharmacy Assistance
Aussie GPs overwhelmingly feel that some tasks – such as treating the common cold and ailments like hayfever – are a drain on their resources, with 87% saying time spent treating these ailments would be better spent on more technical issues.
However, much like their own concerns about the ability to treat and prescribe, GPs are sceptical about pharmacists’ ability to take the load off them for anything other than the most straightforward tasks.
There were 92% of GPs who felt pharmacists were qualified to treat the common cold, while a further 87% thought that they were able to treat low risk conditions like asthma and heartburn.
Interestingly, 82% of GPs said they were happy with pharmacists providing medical certificates to patients (2% higher than the number of GPs who were happy to issue them). Clearly it’s an occasional, but irksome, task for GPs that they would be willing to outsource.
There were 71% of GPs who said that pharmacists were qualified to recommend vaccinations, 43% who felt they could prescribe vaccinations, 36% who felt they could prescribe Schedule 4 medications, but just 5% who felt they could prescribe Schedule 8 medications.
The sceptical majority
While the consensus of the survey from GPs was that they could be relieved of some tasks by pharmacists, the general mood when assessing pharmacists’ abilities was one of pessimism.
The chief concerns of GPs centre around a lack of clinical training and knowledge on the part of pharmacists, overlooking symptoms of more serious conditions and the opportunity to practice preventive medicine with patients.
Much of this boiled down to context and, in particular, the more in-depth, private relationship formed between GPs and the patients they treat. One GP commented in the survey: “The idea of outsourcing sounds simple, but general practice is complex. A consultation is an opportunity to assess screening needs, mental health and wellbeing and develop rapport. There are no simple consultations in general practice. This does not seem to be understood by many pharmacists.”
Another cited the nature of pharmaceutical business as a red flag: “Not only are pharmacists not trained in diagnosis and treatment, they make (probably most of) their profits from up-selling complementary therapies, so they have a huge conflict of interest.”
But there are advocates of pharmacists playing a larger role. One GP cited an overseas example of progress that is helping to ease the workloads of GPs: “This integration is happening in England currently and it’s working. I wonder why we aren’t we doing it here to lessen the GP burden?”
The problem for GPs treating minor ailments such as colds, hayfever and heartburn is that the patient is the arbiter of their own healthcare treatment and ultimately decides whether they visit a doctor or not.
The solution appears to lie in public education – encouraging prospective patients to consult with a pharmacist first if they feel they have a mild ailment. Raising awareness in this space, combined with extra training for pharmacists could be just the tonic for Australia’s overworked doctors.
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