5 reasons why task substitution by pharmacists needs more thought

So there is a budget crisis. There’s also a new federal Health Minister. And, here it comes, community pharmacies are negotiating over a billion-dollar deal with the Government: The Community Pharmacy Agreement sets out the Government funding pharmacists receive for dispensing PBS medicines.

If it’s up to the Pharmacy Guild, pharmacists will be:

  • Filling repeat prescriptions to ‘free up doctors time’
  • Treating ‘easy’ minor ailments
  • Giving more vaccinations (e.g. a flu-shot for $25 with no Medicare rebate)
  • Doing ‘easy’ health checks, screening and preventive health services
  • Giving mental health support.

At first glance this improves access to health services and saves tax payers bucket loads of health dollars. Here are 5 reasons why role and task substitution by pharmacists needs more thought:

#1: Avoiding the doctor is probably not going to help

A repeat prescription or a vaccination is a valuable opportunity for a family doctor to screen for, and treat health issues before they escalate. This is one of the strengths of general practice. If people don’t come in because they get their cholesterol or blood pressure scripts from the pharmacist every 6 months, this system will come at a cost.

#2: We are treating people (not ailments)

People are more than the sum of their ailments. Over the years there have been many attempts to replace the doctor with algorithms, machines and computers, and they have all failed.

The human body and mind are complicated. As they say, if you think a professional is expensive, wait until you hire an amateur.

#3: Don’t put the cart before the horse

If it’s improved access or multi-disciplinary care we’re after, then strengthen general practice. Unfortunately the opposite is happening: Practice nurse support has been cancelled, and I won’t mention the Medicare rebate cuts and freeze.

#4: Disruption is not innovation

A common mistake is to assume that disruption is the same as innovation. Disruptive services – like those suggested by community pharmacists – may be simple or convenient, but the quality will be poorer.

A recent study showed that only 3 out of 32 fish oil supplements contain what the label says; I believe pharmacies should focus on evidence-based medication advice and quality control of over-the-counter drugs.

#5: Conflicts of interest

A question we should ask is: Can the person who is selling the drugs give independent health advice? Pharmacies face reduced profits because the Government has set lower prices for generic medications under the price disclosure arrangements.

Although it is understandable pharmacies are looking for other income streams, it is unlikely that the proposal by the Pharmacist Guild is a win-win solution. There is value in team work, but only if we work genuinly together.

14 thoughts on “5 reasons why task substitution by pharmacists needs more thought

  • You make a good point (#3) that “there is more to a ‘job’ than it appears”. Psychologists felt the same way when it was suggested that diagnosed mental health conditions could be treated by a GP using “focused psychological strategies” (FPS) instead of referring on to a mental health care professional. The two-day training course qualifying a GP to deliver FPS raised some eyebrows in the mental health sector, for similar reasons described in the above article. I agree with the main point being made here that we should leave complex and sensitive work to those professionals who are properly trained for the job.

    Liked by 2 people

  • Nice summary of the main issues.
    A problem that is the bane of my working life is the lack of communication from pharmacists (except for soliciting Home Medicine Reviews). Patients will often be given an alternative drug or told something is not available, without any attempt to contact the prescribing doctor.
    However, I have developed a good relationship with the pharmacist at two of the local pharmacies, and this makes all the difference. One was setting up new business, and actually wanted to review all the webster pack arrangements and get to know the patients; the other pharmacist stores my vaccines for me and will chase down information and hard to get medicines, leave memessages, faxes if any issues. These pharmacists don’t want to do the vax themselves, but are interested in perhaps having a doctor run “clinics”at their place in flu season. At least the communication channels are there, and I think good patient care is possible with these arrangements.
    And then there is the other pharmacy that has high turn over of pharmacists, where they don’t know the names of local doctors, can never find scripts, send patients away without the correct med, never call the doctor if a problem with the script….those ones will be first in line to do the vax, health checks, depression checks, weight loss promos etc themselves. They also have a large range of gift items in the front half of their store. Hmmmm…


  • I practise in New Zealand where pharmacists are allowed to treat “easy” diagnoses like urinary tract infection. Last week I consulted with a young lady who had had two diagnoses of UTI and two courses of Trimethoprim . When I examined her she had a significant UTI, thrush and the possibility of a chlamydia infection, results awaited. Nothing is “easy” in medicine!


  • The points made in this article are weak, and is clearly a response made due to fear of change. I practice pharmacy in Canada, where a lot of these changes have already occurred, and the problems you mention do not, or rarely occur. I will point out though, that there are lots of good pharmacists out there who will treat the patient and not the ailment and who believe in their ethical responsibility to them, not their fiscal responsibility to the pharmacy, and a few bad ones (we’re not all idiots, as the article suggests)just as there are good doctors who do thorough check-ups and bad ones who shovel patients through their doors.
    To clear up a couple points made, we do refill prescriptions where appropriate: as in a patient is unable to see their physician in time before they run out of meds, and it’s something theyve been on for months or years, and they report no ill-effects from use of the med, and we check their labwork (if applicable to the renewal), and we only give a limited supply in order for this patient to see a physician. We have no desire to become “low cost doctors”, just trying to be pharmacists bridging gaps in patient care.
    Most pharmacists probably do try to control the quality of their OTC sections already, while a few don’t care, and some yet have no choice because that’s a company decision. that is no reason we can’t take on more responsibility in patient care.
    We give vaccinations: Maybe as a physician, you do not realize the number of people who try to get flu shots or hep A/B via their doctor or health agency and cannot get in because hours are limited or they are booking 3 months in advance for appointments. I do. We again, provide a bridge for patients to get timely vaccinations before their vacation or before flu season is over. We have to get additional training to do this, and renew our first aid skills every 3 years and do refreshment in vaccination self-learning each year. We are not as ill-equipt as the article suggests. As I said before too, good pharmacists do evaluate the patient properly before giving a vaccination.
    Also, the point of any meds-checks by pharmacists is to make sure something in their medication list or history is not conflicting or being missed by their physician. Then, IF we identify potential problems, we most commonly recommend that the patient can go back to their doctor for a more thorough investigation. And, the physician is required to be notified of this encounter and the pharmacist recommendations. How does this replace your job? It’s meant to compliment and enhance the medical care and safety the patient is receiving. This does not mean you are doing a bad job or that pharmacists get excited by scruitinizing a physician’s decisions, just that we are all human and medications are getting more and more complicated and maybe you don’t see medications in the same light that a pharmacist could. As a pharmacist, I enjoy when another healthcare worker or co-worker has reviewed my work and this helps prevent errors in the pharmacy setting. I don’t understand why doctors do not see the value in this.

    Liked by 2 people

  • Hello, I agree as a pharmacist I should not be “playing doctor”. However I am tired of the argument #5 conflict of interest. In Canada most doctors are fee for service, is there a conflict there? The furthest thing from my mind is profit or “selling product”. I often discourage people from buying supplements and OTC’s recomended by friends, family and T.V. physicians (Dr. Oz).
    Patients quickly figure out which doctors at walk in clinics freely give out prescriptions for narcotics and antibiotics. Conflict?
    There is often poor communication between physicians and pharmacists. As a new pharmacist several years ago I had a parent present to the pharmacy whom did not have enough of their child’s medication to last until they saw the physician again. I glady volunteered to call the physician to ask for an extension. This phyician told me he couldn’t get anything done because all the G#@ Da@# pharmacists wouldn’t leave him alone and to give the kid enough medication for 5 years so I didn’t have to bother him again.


  • In Canada, family practice is under siege. It is being eroded and undermined by legitimate allied health professionals and a flourishing “alternative health” industry. Government enables this. Those who support the process are well organized, eloquent, and skilled in persuasive technique, while those who should be promoting and supporting family practice have essentially thrown up their hands, waved the white flag, and capitulated. Doctors don’t seem to have time or the requisite marketing skills to write charming (though self-serving) columns for the newspaper, nor have they taken to paying for large paid newspaper ads to self-promote. Perhaps we are all just to busy doing medicine. Or maybe, like good Canadians, we are just to polite. In any event, family practice in Canada is doomed, and I suspect we won’t realize what a good thing we had until it is gone. Pity.


    • Doctors must learn to unite, fight back and lobby – but also, and even more important, collaborate, build relationships, communicate and network. These are the new skills of the next generation of family doctors.


  • There is no harm in learning to unite, whether it’s the medical profession or a union of labourers…. There is no gain in attacking another fellow healthcare worker, whether that’s a psychologist, pharmacist, nurses….. Put the patient at the centre guys, not ourselves! Focus on our own strengths, not on the weakness of (some of the) others.

    Liked by 1 person

  • I am still wondering how you got through medical school without noticing evolution of professions. Until reading this article, I viewed doctors as diplomatic and tolerant. Your article betrays a writer who is chocking on pride, filled with envy and starved of innovation. Kindly take my advice and let another glance through your articles before posting them lest you terminate your career prematurely.


  • A person whose suggestion for any problem is a drug: pharmacist. I think you made very interesting points! I think a pharmacist’s job should rest solely in the production of medicine, and a doctor’s job should revolve around the patient’s health. Now, that’s not to say that all doctors are good either. Do you have experience in pharmacy?


  • Instead of settling from an advice of a pharmacist why not just have a check up from a doctor whose been referred by one of your trusted peers just so you could feel at ease with the consultation. It is given that pharmacist has a wide range vocabulary for the set of medicines to be distributed but the right treatment could not be given unless a proper consultation has been made.


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