Chair of GP advocacy group GenPro Angus Chambers.
Photo: Supplied
Doctors are warning of fishhooks in the latest government proposal to improve access to healthcare.
Under the scheme, community pharmacists would be able to directly provide a range of commonly funded medications such as for pain and fever, or children’s conditions like scabies and headlice.
Health Minister Simeon Brown said the proposal meant treatment could be provided at a lower cost, rather than paying full over-the-counter prices, or waiting for a GP appointment.
Chair of GP advocacy group GenPro Angus Chambers said the proposal sounded good in theory, but in practice ran the risk of misdiagnosis.
He said the scheme relied on a diagnosis being clear-cut – and that was not always the case.
“For us, diagnosis is key. So you might say conjunctivitis is a diagnosis, but that can actually be a result of an ear infection and if you aren’t able to look in an ear and diagnose that, you may just give eye drops which actually won’t treat the underlying condition.”
He said pharmacists prescribing rehydration therapy could run into similar issues.
“You must ask yourself, ‘What’s the cause of the dehydration? Is it a viral infection? Is it gastroenteritis? Is it meningitis? Is it diabetic ketoacidosis?’. All of these things can cause you to get dehydrated.
“So, I think there’s an element of oversimplication in their policy.”
Chambers said pharamacists were sensible and risk-averse but unlike GPs did not have years of training in diagnosing health problems.
He said GP wait-times were a problem and the proposal could provide some people with more timely access to healthcare.
However, he said the solution was a stop-gap at best and the money would be better spent addressing GP workforce shortages.
“And then we would actually have the access issues solved by people who are trained in diagnosis.”
Health New Zealand had budgeted $5 million for the changes nationwide, which would be up and running from June, following public consulation – which is currently open.
Chambers said GenPro would likely make a submission.
“In the end, we do want people to have access to healthcare.”
However, General Practice New Zealand chairperson Dr Bryan Betty told Morning Report he felt positive about the idea.
“I think there’s positives to this, our pharmacy workforce is an integral part of the primary care landscape,” he said.
“I think access to care and treatment is incredibly important and the use of pharmacies in this way is something as a system we absolutely need to be thinking about.”
But he said it was vital the system was well-integrated with GPs and that patients were referred to doctors when necessary.
“For things like pain and fever, the issue in children is not actually the pain and fever, it’s the underlying cause, so that ability for a pharmacy to refer into a general practice when they’re not confident or it’s outside of their scope is incredibly important and that’s what has to happen,” he said.
“It’s not just treating the fever, it’s not just rehydration, it’s what causing the fever and dehydration that’s absolutely critical, and that does often need a GP assessment, so that integration, that ability to have that second opinion is absolutely critical.
“It’s something that needs to be worked on, and I hope with the Pharmac proposal that they are thinking about that very hard.”
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