Wednesday, 21 June 2023

Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023

Second reading

Debate resumed on motion of Mary-Anne Thomas:

That this bill be now read a second time.

Emma KEALY (Lowan) (10:55): I rise today to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. This bill intends to amend the Drugs, Poisons and Controlled Substances Act 1981 to allow pharmacists to be legally authorised to supply, dispense and administer certain prescription medicines without a prescription as part of a 12-month community pharmacists pilot due to start in October 2023 and to provide access to treatment from a participating pharmacist for selected health conditions, which include treatment of minor skin infections, treatment of uncomplicated urinary tract infections and reissue of oral contraceptives for women. It will also expand the scope of pharmacist immunisers to administer travel and other public health vaccines.

The pharmacy pilot is designed to help ease pressure on GPs and hospital emergency departments by improving access to primary care for the specified conditions. Of course we know that any action that is taken by any level of government to take pressure off our health crisis that we are seeing in Victoria is something that should be evaluated and looked at. In my electorate of Lowan we are facing significant shortages of doctors. It is always a challenge to recruit pharmacists to our fabulous local pharmacies and also nursing staff, allied health professionals and particularly those who work in the mental health sector.

At times we have certainly seen changes at both a state and a federal level in regard to incentives offered to attract people to work in rural and regional Victoria, but we are also looking at some of the levers that are in place which provide that level of additional interest and ease for people who have trained overseas to come and work in rural and regional Victoria and to choose that as their home – for example, for a doctor to receive their fellowship in a shorter period of time. This is something that is very, very important for seeing the rural and regional sector thrive and to ensure that we are competitive with recruiting pharmacists or other medical professionals against some of the bigger centres like Ballarat, Bendigo and Geelong or in particular Melbourne, which is where generally most people who were trained overseas gravitate to.

This legislation will of course provide that opportunity for pharmacists to supply certain drugs in accordance with these selected health conditions. I would like at this point in time, in the early part of my contribution, to make mention of the former Minister for Mental Health and former Shadow Minister for Health Ms Mary Wooldridge from the other place. Mary was a fierce advocate for opening up accessibility of pharmaceutical goods that would otherwise be deemed relatively safe to dispense by a pharmacist and for really looking at supporting the good work and the intensive knowledge that pharmacists do have and really elevating them as an opportunity to not just utilise their skills and experience in a way that they were able to take pressure off the state’s health system but also look at areas where patients were able to get a more prompt response to receive the medications that they knew they needed and had the experience of taking, where they simply wanted to shortcut that system of having to go to a general practitioner. Rather than doing that, they wanted to be able to go straight to a pharmacist.

A policy that we took to the election back in 2018 was particularly focused around oral contraceptives for women. I am sure that any woman who has been prescribed an oral contraceptive has at one point in time been in a position where they have been caught short. And really for women who have a prescription for an oral contraceptive, when they have gone travelling somewhere, when they are moving between different places – or it could just be that they simply cannot get in to see a general practitioner by the time their current script is finalised – it would enable them to continue the management of their own bodies and their own contraception in a way that is extraordinarily low risk. I strongly support that. It was one of the policies – we had a lot of policies at that election –that I certainly did promote quite strongly, and I think it is a good thing that we will give women in Victoria that opportunity to have continuity around supply of oral contraceptives in particular.

One of the reasons that the Liberals and Nationals were so strong at looking at these opportunities for pharmacists to step into the void where there are massive gaps in the health services that are able to be provided is that we simply have these massive work shortages across the regions. It may not be ideal, and I know certainly the AMA are strong advocates against this. They believe that most work should always come through a GP first, and I understand their reasoning behind that, but we are simply at a point, particularly in rural and regional Victoria, where we do not have the workforce to enable that. So in my personal view, to look at other ways that we can utilise a very skilled and experienced workforce that is in our local communities which would ensure that Victorians can access the medication they need in a shorter time frame so that there is less risk of, particularly perhaps, a urinary tract infection that may become a renal infection or progress to a stage that that individual would then perhaps have to go into a hospital to take up more resources in the health system, is a good measure in terms of supporting people to keep as well as possible and providing a much quicker health response to provide that care when people need it, where they need it, and that is where we need to see much, much greater flexibility within the health system.

I might stray for a moment because of course the other fabulous group of people we have got in our local communities who are very skilled and experienced and have a lot of knowledge but in many instances are under-utilised in rural and regional areas in particular across the state is our paramedics. Our paramedics do an absolutely fabulous job, and I think that the member for Melton may have actually been in his previous role with Ambulance Victoria at Edenhope hospital when I was CEO there and we signed off the first memorandum of understanding between a health service and Ambulance Victoria so that should we come to a position –

Cindy McLeish interjected.

Emma KEALY: Well, it was bipartisan support, member for Eildon, in our past lives. We were able to utilise the services and see paramedics and value them for the skills they had. And if we were short-staffed at the Edenhope hospital when doctors perhaps were not available or did not have the skills available, we would be able to call in paramedics to actually practise their amazing skills within the hospital grounds as a backup to ensure that we had additional support for the patients and for the residents in the hospital. I think that that was a really good opportunity – looking at the necessary flexibility that we required, particularly in rural areas. But as the workforce shortages grow in Ambulance Victoria, with nursing staff, with GPs, with pharmacists and with allied health professionals, for all of those specific skills we really need to look at what levers we can have to use all the skills that everybody has – all of the expertise – and work in a flexible system with the intention that we always put the patients’ needs first.

I would like to go through some of the aspects of the legislation, and there are varying positions from different groups – feedback that the Liberals and Nationals have received from key stakeholders in the community – around the way that this legislation has been drafted. In regard to, I guess, the position that we have received, it is really around particularly the AMA being concerned around an additional responsibility given to pharmacists. As I have gone through, I understand that position, and it is not an ideal position. However, with the workforce shortages we have at the moment I believe we need to have greater flexibility and an ability to, in low-risk instances, utilise the other skilled health practitioners we have in the local community.

We also have feedback from the Royal Australian College of General Practitioners. The RACGP also oppose the changes that enable pharmacists to supply, dispense, administer, use or sell schedule 4 poisons or classes of schedule 4 poisons without a prescription or other instructional authorisation from a registered medical practitioner or other formally recognised prescriber. There is a number of reasons behind that that they have put forward, and they have obviously gone through this in great detail. Whether it is the AMA, the RACGP, the Pharmaceutical Society of Australia or the Pharmacy Guild, they have all considered the implications of this legislation in a way that is quite fulsome and with their hearts in the right place in terms of ensuring that this is a safe system for all Victorians to be able to access and that this program would work in a way that is most effective, most efficient and at lowest risk to the patients that are involved.

I would like to go into further detail now around the other professional group that are involved in the legislation before us today and share the feedback from pharmacists and their position around this. The Pharmaceutical Society of Australia noted that the word ‘prescribed’ is not used and would prefer a prescribing model whereby participating pharmacists have prescribing rights consistent with regulation that provides for prescribing by dentists, nurse practitioners, authorised midwives, authorised podiatrists and authorised optometrists.

I think this is a fair and reasonable point, and it has been a theme of my contribution today, which is looking at how we can best utilise the skills and experience of every single health practitioner in our local community. We have just gone through all the different professions that have prescribing rights. Pharmacists, through their studies, have an unbelievable knowledge when it comes to drug interactions and the relevance of using a certain drug in certain conditions, and of course have got experience also in even just talking with people. They have a lot more time when they are in a pharmacy to talk through what issues people are presenting with. They understand that people want to get a resolution quickly, and they will often – in my experience – go back, talk to the GP and question whether a dosage has been accurately prescribed or not. They really have an enormous amount of knowledge, which in many ways is under-utilised. Given that we do give limited scope of practice to dentists, nurse practitioners, authorised midwives, authorised podiatrists and authorised optometrists, I think it is fair and reasonable what the Pharmaceutical Society of Australia are asking for, which is that they would also like to have the opportunity to have limited prescribing rights for certain conditions. This would make for a more efficient health system and a lower-cost health system but, most importantly, would provide the care for Victorians that they need when they need it and where they need it.

Another point that stakeholders raised was that it is not consistent to create a separate pathway for the supply of schedule 4 medicines when existing regulations that apply to those other professions could be used to allow prescribing by pharmacists, including safeguards of the requirements for training, record keeping and penalties for non-compliance. We know that pharmacists have significant obligations already when it comes to record keeping and also around prescribing. A number of years ago the government brought into place SafeScript. SafeScript is a computer program which monitors the prescribing patterns of GPs to individuals to ensure that drugs of dependence, when they are being prescribed, are not at too high a quantity, and also that people are not doctor shopping or utilising these drugs in a way that would indicate that an addiction is at play. While we have had this system in play there have been an enormous number of red flags raised – hundreds of thousands of red flags raised – for overprescribing, generally of benzodiazepines, for individuals in Victoria. There has been no support from the government to ensure that pharmacists have somewhere to refer these people. There has been no education and support for GPs to understand what to do around that aspect of people who do red-flag. For me it is something that has really been a key omission in the implementation of SafeScript. I think there is an enormous amount of work to be done and there is a huge opportunity to reduce the number of Victorians who are dying due to overdose of prescription medication, simply by better support around the SafeScript computer program.

This is something the alcohol and drug sector are calling for and certainly something pharmacists flagged when the program was initially rolled out. They have provided continued calls in the community that they want to see more done around that back end of what happens when there actually is a red flag, because with a system that only red-flags when there is nothing to actually provide additional support – a pathway into rehabilitation, a pathway into different pain management modules or supports – until those things are in place it is not achieving the goals, and we will continue to see, sadly, the number of people who are overdosing on prescription medications continue to rise in Victoria.

There is a lot of pressure on our pharmacists at this point in time. As we know, there are a lot of changes coming through from the federal government, which particularly the Pharmacy Guild have flagged will have a massive impact on the people who work within their businesses. They have had an independent report done, the Pharmacy Guild, which indicates as many as 20,000 jobs will be lost, 665 pharmacies will close and Australia’s most vulnerable patients will suffer under the Albanese government’s 60-day dispensing policy. This is a significant report, and again I would like to really drill down into the impact on pharmacists, because we simply cannot afford it, particularly in rural areas where there might only be one pharmacy in a community. There may only be one pharmacy within a 100-kilometre radius. We need to ensure that we have got those continuing supports, particularly around the incentives for doctors to provide certain drugs. We need to make sure that pharmacies who are in rural areas are provided additional incentives, because they simply do not have the volume of patients coming through the doors to support an income, and of course that means that we end up losing a vital service for the people who live in that area.

We also need to ensure that we have sufficient incentives for doctors to prescribe opioid replacements such as methadone and also that we are providing sufficient supports for pharmacists to dispense methadone. There has been a massive shortage of both doctors prescribing and also pharmacies who are dispensing methadone, and that is because it is a really challenging area and challenging group of people to engage with. It is not necessarily the individuals themselves, but there is a concern that having people in your waiting room who are under the influence of drugs or having people at your pharmacy or winding up out the front of the pharmacy in the morning has an impact on perception by the wider community. They are concerned that there is a greater risk there will be a negative impact on their business. They see that as a large risk. As a result we are seeing more and more Victorian doctors and Victorian pharmacists pulling out of the methadone program.

I understand that as a result of the Albanese government’s proposed changes to the PBS there will be a huge number of pharmacists who pull out of dispensing methadone, and I understand the community of Morwell will be left without a pharmacy. This is information that has been passed on to me; I have not spoken to those pharmacies directly. Certainly we have a community where currently there are three other pharmacies, I believe, who are dispensing methadone; there is already a shortage of methadone prescribers and dispensers in that community. To see a massive loss of this kind of service, which provides an essential pathway to reduce harm for people who are facing a heroin addiction and trying to battle that heroin addiction, to take that support away inadvertently would have catastrophic implications not just for the individuals who can no longer receive their methadone and participate in the methadone program but also for the wider community and the families that support those individuals. There is of course a much higher risk that they will go back to using heroin because they will be able to access it more easily than methadone or they will relocate to another area, such as Melbourne, and then people will lose contact with their family members. It can be very, very worrying for people, and we see horrific outcomes as a result of that far too many times. I believe there are a lot of issues that have been raised by the Pharmacy Guild around the Albanese government’s proposed changes to the PBS, and while I understand this is really about cutting a budget spend, I think that the government need to understand the really important role that our pharmacies play in our community, which we can see reflected in the legislation before us today: we are actually finally seeing pharmacists as valued stakeholders and part of our health service delivery sector.

I would like now to go to an element which is of key concern to the Liberals and Nationals, and that is the framing of the commitment around there being a pilot as opposed to a clinical trial. There is a key difference in this, and that is something that is keenly understood and known within the medical sector. A pilot is something you usually see for a different program, where it is not really evaluating the outcomes of it, it is just testing whether it works or not and getting some feedback around the procedural systems of that new service, whereas a clinical trial involves a clinical overlay to evaluate the clinical outcomes of participating in it. There are key measures for the individuals involved before the clinical trial, and they are measured throughout and measured at the end of it. There is also a requirement for an ethics overview and an ethics approval to be undertaken as part of a clinical trial.

There have been two different protocols established across the nation. Queensland had a two-year pilot which started in June 2020, where pharmacists supplied antibiotics for uncomplicated urinary tract infections for women. They have now made this permanent. We also have New South Wales, which started a 12-month clinical trial on 15 May 2023 for participating pharmacists to provide treatment for uncomplicated UTIs, and they are going to expand that to allow the resupply of oral contraceptives for eligible women in the near future. In north Queensland they have set up another clinical trial to begin later in 2023 with plans to include treatment by pharmacists for a wider range of conditions, including shingles, acute nausea and rhinitis – and as a sufferer of chronic rhinitis, that sounds like a fabulous idea to me. But you will note that over time, while it started off as a pilot process in Queensland, it has now moved on to a clinical trial, being the best and most effective way to evaluate whether these drugs should be able to be supplied, whether it is by prescription or otherwise, by a pharmacist.

The Victorian pilot will use the model of a structured prescribing arrangement where pharmacists are authorised by legislation to supply a limited range of prescription medicines without a prescription, including specific vaccines, antibiotics and oral contraceptives, which is the same approach as the Queensland pilot and the New South Wales clinical trial, of course without that clinical trial overlay that New South Wales, importantly, has. This is a different standard to autonomous prescribing, which allows the prescribing of a wider range of medications for many more conditions and expanding the pharmacist’s scope of practice. This requires more training and more accreditation, similar to prescribing rights for other health professionals such as nurse practitioners, optometrists, podiatrists and others. It is important to note that the Queensland clinical trial actually has included autonomous prescribing, so rather than the Victorian model of just having the right to provide a medicine without a script, what Queensland are doing as part of the clinical trial is actually providing those prescribing rights to pharmacists in their own right. It is a much more progressed position than the legislation we are debating in the Parliament today, and the Victorian Labor government’s position is around this.

At this point in time we have seen $19 million allocated to the program. 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 vaccines. This is based on the assumption that around 50 per cent of people will seek treatment for their eligible conditions from a pharmacist rather than a GP during the 12-month period. This will vary in different areas of course depending on the ability to access a general practitioner. In so many areas of my electorate you simply cannot get in to see a GP – not in the same week and sometimes not in the same month. For my GP there is a six-week wait to see them, if not longer. It is extraordinarily difficult to get in to see a GP, and when you have got these conditions and you have got a pill prescription which is looking to run out within that period – when you know you have got a UTI, you have got all the symptoms of a UTI, you have had UTIs before – it is simply too long to wait and has a massive impact.

As we know, the government have a policy and have opened up a couple of GP clinics in Melbourne and in the larger centres, but it has really missed the mark when it has come to closing the gap and filling those gaps where there are critical GP shortages. In Casterton and Coleraine, for example, we have had critical shortages of general practitioners over the last couple of years. We had the closure of a significant and respected GP clinic in Coleraine. Dr Brian Coulson did an enormous amount of work not just supporting the community and the hospitals in that Coleraine and Casterton region but also supervising and training a lot of postgraduate year 1 and 2 students in particular to provide that support and help them understand what the pathway is to be a general practitioner in rural and regional Victoria. I certainly do thank and acknowledge Dr Brian Coulson for his longstanding work of decades for that region.

On approaching the Minister for Health there really has not been any support when it comes to looking at ways we can incentivise and bring doctors into those areas. It has been disappointing that the only initiatives we have seen around that are to set up more GP clinics in Melbourne in areas where there is already a great supply of general practitioners. I would urge the government to reconsider their positioning on that and actually to target the GP clinics that they are opening in the state to really focus them on areas where there are no GPs or a critical shortage of general practitioners, because that is where we need to get the base level for making sure everybody in Victoria, no matter they live, has access to the health care that they need and deserve in their local area.

There was also a change by the federal government, where they changed the rule allocation for general practitioners and where they would be located, in that they would spend less time in more remote areas and therefore shorten their period of time before they would get their fellowship of general practice. That has now been expanded. I think Edenhope, for example, a town of a thousand people, 400-odd kilometres from Melbourne, is in exactly the same remoteness area as Frankston. Now, it is a big difference for an area where you have not got connections to public transport, where you are a very, very long way from Melbourne and where you might have the only doctor working in that entire area to compete with somewhere like Frankston, where you are basically an outer suburb of Melbourne these days and have all the luxuries that you get in larger capital cities.

Today I will be putting forward a reasoned amendment. I move:

That all the words after ‘that’ be omitted and replaced with the words ‘this bill be withdrawn and redrafted to take into account feedback on the value of a two-year trial period’.

I ask that to be circulated, please. The reason we are doing this is for matters that I raised earlier in my contribution. It is to ensure that we are taking into account the valued feedback of our key stakeholders, who have expertise in pharmacy or in general practice, and ensure that this would be a clinical trial as opposed to a pilot and be something that is taken into consideration by the government. Should this reasoned amendment not pass on Thursday, then I would urge the government to consider reframing those elements of this legislation before it goes to the upper house, to ensure that we can see this program rolled out in the time frame that we would expect. It will not be debated until the first week after the winter break. It would not be until August, but there is an opportunity to provide that refinement. If it should not occur before this legislation does go to the upper house, then I urge all members of the Legislative Council to consider this small amendment, which would make a significant difference in ensuring that this is viewed as a clinical trial, that we are evaluating the patient outcomes and the changes, ensuring that it is safe and that we are considering also going to the model that Queensland are looking at at the moment, which is around prescribing rights for pharmacists, rather than simply dispensing certain medications, and setting up a proper framework that would help to support and elevate pharmacists to utilise the skills and expertise that they have in their communities. In many instances the relationships they have with those patients and their families and the conversations that they are able to have are much more flexible. They have longer time frames and I think are much more personable in many instances in a pharmacy and really support the great work that they do in our local communities.

I would like to finally, as I am wrapping up, just again thank all of the pharmacists in my local electorate and our general practitioners and all of the health workers in our system, who do a fabulous job of providing the care and support that our local people need when they need it. I urge the government to take those further considerations into account, ensure there is flexibility in the system so rural and regional people do not miss out and of course amend this pilot to a clinical trial.

Kat THEOPHANOUS (Northcote) (11:25): I rise to speak in support of the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023, a bill that gives effect to our commitment to delivering a community pharmacy statewide pilot and a bill that will make health care more accessible and affordable for Victorians when they need it most and close to home. Back on 23 November, when this commitment was announced, I was on my second week of pre-poll, standing out at Northcote Central shopping centre talking to hundreds of local residents coming in to vote, doing their shopping or grabbing a coffee with their friends. Let me tell you, this announcement struck a chord with my community.

Over recent years it has become harder and harder to get to get in to see a GP. You can sometimes wait weeks for an appointment, and if you do not have a regular doctor, finding a clinic that can take on new patients can be incredibly challenging. And when you are unwell, finding a GP or waiting a week or more to see them can make a difficult situation even more stressful. On top of that, even if you can get in to see a GP, there are less and less clinics providing bulk-billing. This situation is the direct result of almost a decade of neglect of primary care by the former federal Liberal–National government, but thankfully we now have a partner in Canberra who is committed to fixing Medicare and supporting our GP workforce, and we are working alongside them to deliver tangible reforms to the health system for Victorians. That is why we are stepping in to take action, just as we have with GP respiratory clinics and our urgent care centres, to help Victorians access the affordable care they need.

The community pharmacy statewide pilot is a practical step to ease pressure on families and make health care more accessible in our communities, and this bill is the first step in establishing the legal and regulatory framework to make this pilot a reality. What does it mean for Victorians? Well, the Andrews Labor government is investing $20 million to deliver a 12-month pilot expanding the role of community pharmacists from October this year. I do note the proposed amendments by those opposite, and I will just say that I think that a 12-month trial is appropriate, given that we do want to evaluate this pilot and not delay the implementation of the pilot on a more permanent footing if it is evaluated to be effective.

What will it enable community pharmacists to do? Well, treat mild skin conditions, provide antibiotics for uncomplicated urinary tract infections, reissue oral contraceptives and administer more travel and public health vaccinations, including hepatitis A, hepatitis B, typhoid and polio from the age of five. This will help ensure that Victorians, particularly women, can access care for some of the most common conditions impacting our community. UTIs are the third most common human infection after respiratory and gastrointestinal infections. Women are more likely to be impacted, with 12 to 15 per cent of women experiencing these infections annually. Nearly one in three women will require treatment before the age of 24, and this increases to around one in two women by the age of 32, so half of all women. If left untreated, UTIs can become extremely painful. The infection can travel up to the kidneys and become a kidney infection, which is very dangerous. If you have ever experienced a kidney infection, you will know how excruciating that is. I was in my early 20s when I was hospitalised for a kidney infection; let me tell you, it was a rough, rough time.

Women will also have better access to contraceptives, with the inclusion of the pill under this pilot. Oral contraceptives are the most common method of birth control in Australia, with 30 per cent of women who require birth control relying on this form of contraception. Safe, affordable and timely access to contraception is a priority for this government as a fundamental part of health care. We know that when you run out of your script, waiting to access a GP appointment just for a refill is not just inconvenient, it is critical. The pill takes about seven days to actually kick in and take effect, so disruption to your regular pill schedule is not a straightforward matter and can mean scrambling around to find other forms of contraception in that intervening time where you cannot find the pills to continue.

Last year we did publish the Victorian Women’s Sexual and Reproductive Health Plan 2022–30 to provide a framework to ensure Victorian women, girls and gender-diverse people have access to the sexual and reproductive health services they need. We know there are still significant gaps in this, particularly across regional and rural Victoria, so alongside our work to improve access to things like long-acting contraceptives and medical abortions, this pilot is a critical piece of the puzzle in ensuring women and girls do have access to the sexual and reproductive health care they need. For anyone who needs some advice around that, we have a wonderful service called 1800 My Options, which provides independent and confidential advice on contraception, pregnancy options and sexual and reproductive health services that you can find in your area. So I will just put that on record.

Finally, the inclusion of skin conditions, primarily mild ones, will ensure care for very common conditions that affect all parts of our community. For example, one in three people will develop shingles during their lifetime.

By expanding the role of community pharmacists to provide care for these conditions, we will deliver a significant benefit for Victorians. That includes improving access to primary care in a trusted and welcoming setting. It will also help save Victorians money, as the government will subsidise the cost of medications for pharmacists and consumers, so there is no more cost than if the service had been accessed through a bulk-billing GP. The pilot will also help ease pressure on our GPs and hospital system by ensuring access to affordable care in the community and freeing up GP appointments that otherwise would have been used. This is particularly important for regional and rural areas, where there are fewer GPs available. All community pharmacists will be eligible to participate in the pilot, and participation for both pharmacists and patients will be on an opt-in basis. When it comes to our health and the healthcare system, patient safety is paramount. That is exactly why the pilot model will be designed to protect patient safety and maintain professional practice. Community pharmacists are trusted health professionals who already help Victorians manage a range of health conditions. This was never more apparent than during the pandemic, when many Victorians turned to their local pharmacists for advice, support and clinical services.

My mother was a pharmacist, and actually I myself worked in community pharmacy for a great many years when I was at university. What I learned during that time was that pharmacists have an immense amount of respect within our community. They are trusted sources of advice. They have built up relationships with their communities. They are there for our community in a very accessible way when they need them. These are highly skilled and qualified medicines experts, and the depth of their knowledge is quite extraordinary. I will attest to that, because whenever I have any condition or my girls have any condition, the first place I will go to is asking my mum, who is a pharmacist, and she will always have the best advice for me, as she did for all of her patients who came into her community pharmacy.

Pharmacists prescribing is already an established practice in a number of countries including New Zealand, Canada and the United Kingdom. There are pilots already underway in New South Wales and Queensland. This is not a new thing, but it is certainly something that is going to make a big difference to the availability of these treatments for so many Victorians. Our pilot will be guided by a clinical reference group made up of expert clinicians. The reference group will play a critical role in determining the exact conditions, medication and eligibility for accessing services under the pilot. The bill also enables structured prescribing, which is where prescribing is tied to conditions like the completion of special training or following specific clinical protocols. This means that before pharmacists participate in our pilot, they will need to meet certain conditions and complete mandatory training.

The model will be informed by an advisory group representing stakeholders, including pharmacists, GPs and consumers. A safety and escalation framework will also be developed to support the pilot, and the pilot will be evaluated to assess how well it is working. So any future considerations of the pilot will also be informed by work undertaken at a federal level on Medicare and the PBS. The pilot will be safe, it will be effective and it will protect patient safety. It is something that we need to do to create a more accessible healthcare system for Victorians, and I absolutely commend this bill and this pilot to the house.

Tim McCURDY (Ovens Valley) (11:35): I rise to make some comments on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023 and follow on from the enthusiastic contribution from the member for Lowan, who made a wonderful contribution and also flagged our intention to look at undertaking a two-year clinical trial, in an amendment, rather than the pilot program.

This bill amends the Drugs, Poisons and Controlled Substances Act 1981 to allow pharmacists to be legally authorised to supply, dispense and administer certain medications without a prescription as part of a 12-month community pilot, which is due to start in October 2023. As you have heard from our lead speaker the member for Lowan, we do believe a two-year trial, instead of a pilot, would be more fitting, and I do hope the government take that into account. Just to clarify, this legislation if passed is not for all prescriptions, it is for specific prescriptions: for the treatment of minor infections, for the treatment of uncomplicated urinary tract infections, or UTIs, and for the reissue of oral contraceptives for women. It is important that we keep the list to a minimum, because sadly we have seen some very greedy pharmacists over time. We certainly had one case in our local community, the Tozers, and I am glad that the community is purged of them as pharmacists in our community, because we take pharmacists as being very honest. When I met with Jane a couple of years ago, we were talking about businesses. I was in the dairy industry and she was obviously a pharmacist, and we were talking about revenue streams. I was saying that as dairy farmers we are price takers and we are vulnerable to the Australian dollar and the international commodity prices. Then she said I should be in their industry, the pharmacy industry, because they get compensated by the government for every prescription, or most prescriptions, and then they charge Cobram’s most vulnerable as much as they can, which covers the wage base. I thought that was quite disgraceful, and I was shocked to hear that arrogant attitude. That I why I say, in terms of how far we go with this bill, we have got to be careful that we do not open this up too wide. It is about certain prescriptions. I am not suggesting for a moment that all pharmacists have that attitude – quite the contrary. But we must always be mindful that some are greedy, and the Pharmacy Guild of Australia needs to work harder to keep people like this out of the industry.

This bill will also expand the scope of pharmacist immunisers to administer travel and other public health vaccines. The pilot is designed to help ease pressure on GPs and hospitals. I think that is a good thing, because I know our communities in the Ovens Valley – Wangaratta, Yarrawonga, Cobram – are all battling to find GPs. In fact I had somebody call me only maybe six months ago who had moved from Melbourne to Wangaratta and could not get in to see a GP. They just needed a script for their two young sons, and they could not even get in to see a GP. They actually had to go back to Melbourne to see their old GP before they could get that script. That is the pressure that is on GPs, and I suggest that is all over regional Victoria and probably metropolitan Melbourne as well. So this bill will help take the pressure off GPs as well.

We know that other jurisdictions are doing trials and pilots. Queensland, for example, conducted a two-year pilot, and that started in June 2020, where pharmacists were supplied antibiotics for uncomplicated UTIs for women, and this has now been made permanent. This pilot obviously worked well in Queensland, and I see no reason why it could not work well here in Victoria as well. New South Wales started a 12-month clinical trial in May 2023 for similar uncomplicated UTIs and a plan to allow resupply of oral contraceptives for women. North Queensland is set to begin another trial later this year for a broader range of conditions – for example, shingles, nausea and a few others.

In this day and age, as I say, bulk-billing is becoming more and more difficult, and with the cost-of-living pressures that people are under these days I think there is a lot of logic in this bill to make sure that people can get these resupplied or reissued prescriptions through a pharmacist rather than having to get a doctor that they cannot get in to see – and obviously the cost that is associated with that.

The details in this bill are based on the broad estimates of the election commitments of $19 million by the government. That should deliver 230,000 repeat oral contraceptive scripts, 130,000 treatments for UTIs, 66,000 treatments for skin conditions and 41,000 travel vaccinations. That is based on the fact that 50 per cent of the people will go and see their pharmacist to get the script rather than going to their doctor. As I say, those numbers are fairly broad; it is a guesstimate. Because of the cost-of-living pressures that Victorians are under I think that figure, the 50 per cent, may climb a little higher. So we will see how that goes. I certainly know that pensioners and others in my community are really suffering through those cost-of-living pressures at the moment.

The way the system works is that the pharmacist would be paid $20 to do that, and the patients would only pay for the medicines that were dispensed. In Queensland it was quite similar. The pharmacist was paid $19.95 – again, no cost to the patient – and New South Wales pharmacists were paid $20 by the government. So it is very similar to what has been put in this bill. As expected, the AMA opposes the bill. That does not surprise me. But as I say, I think on the whole there are some very good steps forward here that we can look at. I want to reiterate that the member for Lowan has looked to do an amendment for a two-year clinical trial instead of a pilot, and I do hope that the government considers that in full. I will leave my comments there.

Steve McGHIE (Melton) (11:43): Today I rise to contribute to the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. Of course with this amendment to the current legislation the government are proposing to establish a 12-month pilot of pharmacists dispensing repeat scripts for oral contraception, medication for uncomplicated urinary tract infections, travel medication and minor skin conditions.

I stand here again before you telling you about yet another election commitment by the Andrews Labor government, and we are delivering on just another one of our election commitments. Obviously mild skin conditions take many, many shapes, but on average scripts cost around $25. That $25 can add up when you add the cost of seeing a GP. I know recently I went to the GP and it cost me $150 for a consultation, which is quite expensive, but fortunately I can afford it. I get $70 back from Medicare, but not everyone could afford to see a GP and pay $150 on the day and only receive $70 back from Medicare. So the increased cost is an issue for a number of the members of our communities.

The next bit of the contribution that I will make is about women and their reproductive cycles and of course how they manage them. It is difficult to imagine, I know, but I had a bit of help with this part. Using the figures Treasury have provided, of the total number of women between 16 and 55, 30 per cent would choose to take the pill, and of that 30 per cent, 50 per cent would rather see a pharmacist for repeat scripts. I think that is an important matter in regard to access and availability for women in regard to obtaining the pill.

Of course we have all seen the demands on our health system, our health professionals and in particular our GPs. I know that it can be exhausting to get an appointment with a GP in some places, and I know in Melton it has been very difficult for a number of my constituents to get in to see a GP. Even then, as we know with the Medicare situation, many GPs are no longer bulk-billing, which is causing additional pressures on our public health system. The simple act of getting another prescription can take up unnecessary time not only for the patient but also for the consulting GP. This bill and this pilot will ease some of the burdens on those primary health carers.

In going to the GP, women have expressed that going cap in hand asking for a repeat script for the pill feels invasive, unnecessary and intimidating, and it can be exclusionary. In fact they often put it off because it is too expensive in some cases, and as I say, if you add the cost of it to the cost of the consultation, it can be quite expensive, in particular with the cohort of my constituents. Treasury used the estimate of $15 per PBS script, and that is clearly on an average. That is not so prescriptive, but it is on an average of $15.

I do have a staff member in my office who when she was at university would spend around about $80 a month on purchasing the pill. After many years of trying to find a good hormonal balance of the chemicals, the only one that did not come along with business-stopping side effects had a hefty price tag. So again, it depends on the individual’s circumstances and physical circumstances also. Of course with the erosion of bulk-billing, as I have already referred to, the cost per year could be upwards of $1200 for a 12-month supply. With a small Medicare rebate, it really makes it quite expensive for this medication.

There was a time not so far back in distant history when the pill was only prescribed to married women, and thank God we have progressed from those dark days. A UK Labor MP Edwin Brooks in 1967, over 50 years ago, through a private members bill enabled local health authority funded family health clinics to give contraceptive advice to unmarried women on both medical and social grounds. Edwin Brooks actually moved to Australia and now lives in Australia, and his daughter Victoria was the Labor candidate for the seat of Riverina in 2004.

I would like to share with the house some information that comes from the authority of the long-running peer-reviewed medical journal the Lancet. It twice recommended the non-prescription availability of the contraceptive pill, once because of its protective effect against cancer and another time because it would help women realise how safe it is. Pharmacists around the world have indeed proven they can manage these supplies without a doctor. Oral contraceptives still require a prescription in most developed countries, but in 2017 New Zealand announced that selected combined oral contraceptives and progestogen-only pills were to become available from specially trained pharmacists. So it is since 2017 that New Zealand has had this medication available to women in New Zealand.

Throughout the pandemic and since, we have heard stories from Victorians about the guilt that they have felt in taking up a valuable spot in the doctor’s waiting room and also, in some cases, waiting outside in their car to be called into the doctor’s waiting room. They feel guilty because they know that there are sicker people that have been trying to get in to see the doctor, but these people have been waiting outside in the car or waiting in the doctor’s waiting room only to go in there to receive a prescription to be able to go to the pharmacist and pick up some of this medication. Obviously that has caused many concerns.

Since 1974 the UK’s National Health Service has made the contraceptive pill free and confidential. In fact the house may be surprised to learn that the pill has been free in many, many countries, including Russia, since the 1990s. While our pilot does not go that far, it does show us how antiquated it is that we make young women wait to see a GP to get access to a life-prolonging, cancer risk reducing drug, one of the safest and most studied drugs in all of the medical world. In the States we have seen the rapid decline of human rights because of the erosion of women’s rights recently. I would like to thank EMILY’s List Australia, who have made incredible progress in this area. I know there are many women in this chamber and the other place who are EMILY’s List members.

I did want to make reference to comments made by the member for Lowan in her contribution. She referred to an MOU for the Edenhope hospital and Ambulance Victoria for using paramedics at the hospital where they were required to assist with patients. This did happen some years ago. It probably does not happen as much today and that is probably because of the demand on paramedic workloads nowadays, but of course that arrangement was done in all good faith by all the parties involved and taking into account the primary issue of the patients’ health and welfare. I think that is really important – that that is what this is about – rather than clogging up the health system and putting exceptional demands on GPs. Pharmacists can assist with, obviously, the dispensing of the medication that has been referred to in this bill.

In regard to the amendment that the member for Lowan moved, I do not see the need for that amendment, because of the fact that I think the 12-month pilot program is sufficient. I do not think that we need to extend it out to two years. There is enough research from around the country and around the world in regard to access to this medication and allowing pharmacists to do it.

Finally, my personal opinion is that we need to look at the scopes of practice of all health professions rather than ring fencing them as we have for so many decades. If we do not do that, the demand on our health system will just increase and delays will worsen, and access for patients to get better patient care and health care I think is important. That is only my personal view that we need to look further. I commend the bill to the house.

Roma BRITNELL (South-West Coast) (11:53): I rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. This is a bill that has the purpose of amending the Drugs, Poisons and Controlled Substances Act 1981 to allow pharmacists to be legally authorised to supply, dispense and administer certain prescription medications without a prescription as part of a 12-month community pharmacist pilot. It will start in October 2023. The reason behind it is to provide treatment to people with certain skin conditions or uncomplicated urinary tract infections – I will refer to them as UTIs from here on – and also to reissue oral contraceptives to women. It will also allow pharmacists to extend the scope of the immunisations they are able to administer for travel and other public health vaccines.

I completely understand why this bill is here. It was designed to take pressure off the health system, which particularly in rural regions like mine are under enormous strain. The doctors are no doubt overwhelmed, and in my office I consistently have people calling saying they cannot get a doctor. If you have moved into the town of Warrnambool or Portland, you actually cannot get a doctor. It is not about even being able to get an appointment, you actually cannot get a doctor. So people are bed blocking. In my own case of my mum in hospital needing to go into aged care, I could not get her in because her doctor had gone on maternity leave and I could not get another doctor. So she was sitting in an acute facility, and I literally had to ring every clinic and beg for a doctor for my 91-year-old mother. So that is how desperate it is. It really is extraordinary. So I get the whole pretext of this, but I am very concerned about the bill.

I obviously understand quite well UTIs from a nursing perspective; they are one of the most common things you treat. But the reason I have reservations about this and why I support the actions of my colleague in putting the reasoned amendment forward to make the bill be withdrawn and redrafted to take into account the feedback and the value of a two-year trial period and I am so concerned is that there is so little detail. There is no plan as to how it is going to be rolled out yet.

Today it is 21 June. We are going on a five-week break from the Parliament, so this bill will go up to the upper house in August. Yet it is supposed to start in October. I have spoken to a lot of pharmacists whom I have a deep regard for and respect of. I know their pharmacological knowledge is extraordinary, and they are the first people I always go to to talk with about a drug or an interaction or effect for something that I need to discuss. They are unbelievable. So I know they have the capability, but there is just no detail around how this will be rolled out. There is no information about the training that will be received.

There is no information on what incentive there will be, if any. When I spoke at the bill briefing, I asked, ‘Will they be incentivised?’ No, the word was ‘We will be encouraging people to partake in this.’ So I could not even get clarification on that. I also said at the bill briefing, ‘Can you help me understand the driver? Has there been an analysis of what conditions people are going to the doctor with a lot that could be put on this program so that we take the pressure off where the pressure is being created with things that could be treated without prescription?’ That is another issue, treatment being prescribed by the pharmacist – or supplied, as is currently the case with this bill. But I could not even get an answer to that. They told us at the bill briefing the committee, the reference group, the expert panel, had only been set up that week, which was last week or the week before – I think it was last week.

I have spoken to many pharmacists in my electorate. I contacted them and said, ‘Can you give me your feedback?’ No wonder the pharmacists are coming back and saying, ‘Look, we can do this, but we need some clarity and we need to have strong processes so we can be equipped to do it well and we do not have risks for the patient.’ They certainly have the capability, but they need some certainty. There is none there, and I do not see how that can possibly happen in the short time frame. There are trials that are taking place in other states, but we have not even got the time to look at the learnings from those trials.

So it makes complete sense, as the member for Lowan put forward, that this be redrafted to take into account proper feedback and that an evaluation be done so that actual clinical trials can take place to see where the risks are and this can be evaluated, patient outcomes can be looked at and proper paperwork can be sorted. There is no reason to do this wrong. Patient health is something we should not be putting at risk, and I just think there is way too much risk here.

I do see that the government have tried to address in Warrnambool the problem we have with doctor availability. They have set up a new priority primary care centre, but what the doctors in the town are telling me is that that is just shifting the deckchairs, because there are not any doctors. If they are paying doctors to go from clinics into that, they are the same doctors in the same area. There are not new doctors that are coming in and doing this, from what they tell me. It is just shifting the deckchairs. It is not really addressing the problem, and that is what this bill is to me as well. It was a promise that sounded good prior to the election, and they have done nothing – typical of this government, being lazy and not doing the work and actually putting together what needs to happen because bringing the legislation in before the details have been worked out is one thing and one thing only: it is lazy. It is lazy because you do the work first and then you put forward the idea, not the other way around.

Members interjecting.

The DEPUTY SPEAKER: Order! The member for Eureka!

Roma BRITNELL: It is very cart before the horse, but we see a lot of that. We see it with lots of other bills which I can bring to the Parliament’s attention, but I will not take up the last 3 minutes I have available by talking about all the things they do to look good but which actually do not deliver outcomes as a result. These conditions, like the urinary tract infections, are things that could be treated by pharmacists, but pharmacists should be respected and given the structure so that they can prescribe, and that is what is happening in the Queensland trial. I do not understand why, if they really are genuinely wanting to take the pressure off doctors, they are not looking at it to the extent that they are in the Queensland trial.

The other thing I did want to talk about is what the pharmacists told me – that at the moment, with the Labor federal government bringing in the dispensing –

Juliana Addison: Irrelevant.

Roma BRITNELL: It is actually not irrelevant, thank you. It is very relevant, because the pharmacists told me why it is relevant, and I will try and explain that.

The DEPUTY SPEAKER: Through the Chair.

Roma BRITNELL: If I come into the chemist and I need to get one drug a month, I am going to be lucky enough to have to only come in every two months. That is great for me, but the chemist will only get paid from me once rather than twice, so they actually will have a reduction in income. And those that need it most, the most vulnerable who are on four or five – anti-hypertensive, anti-diabetic medication et cetera – they have already reached the threshold, the pharmacists told me, so they already get the assistance. So the income that will be lost will be from the more wealthy people who are only on one or two drugs. They will get the convenience of not having to go in every month, but the cost goes back to the pharmacists who miss out on the income. They will have less profit to be able to employ more pharmacists, so there will be less people to be able to look at the UTIs and to look at the person who has come into the pharmacy and needs to have a proper consultation, needs to have a consulting room and needs the attention to get the process right, which the pharmacists very capably will do – but how can they do that if they are on a reduced amount of people because of what the federal government are doing with their dispensing laws?

They have not consulted the pharmacists. They have forgotten to talk to the people that will actually deliver this to take the pressure off the government. That is why, whilst I understand this is a good idea, there is no detail that gives anyone confidence, particularly those people who have the capability, the pharmacists, to look after our community, as they do extremely well, and I might say who were the only people in the health profession that every single day opened their shops and faced the community and all the risk when we were quite worried at the time. They opened their pharmacies every day and said, ‘We will serve our community.’ I feel like this is the thanks they get from the Andrews Labor government. They are not even consulted, they are given more work, they do not understand what the training looks like or what the parameters are that will help protect them from risk and they are not even told whether they are going to be incentivised in a financial way. We can talk about $20, but in the bill briefing that certainly was not confirmed, and I specifically asked that.

I want to see the pressure taken off our health system. I want more doctors in the regions. I want to see a way of incentivising that, like we do with our wonderful Dr Brendan Condon and Dr Barry Morphett, who are running training out at Deakin University. There are good things we can do; this is probably not one of them.

Luba GRIGOROVITCH (Kororoit) (12:03): The Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023 is what I rise to speak about. However, before I do, I would like to refer to the amendment put forward by the member for Lowan. The proposed amendment is completely irrelevant, and I say that with some authority having actually taken the time to read through the papers and the bill itself. This proposed bill does not dictate the detail or operation of the community pharmacist statewide pilot. We should also note that the key stakeholders referred to by the member for Lowan were intimately involved in the design and delivery of this pilot through its advisory group. It seems that this is the opposition trying to keep both sides happy while sidelining women. That is something that my party does not do, and I am very proud of that with the Andrews government.

I will now go on to actually speak about the bill, one that I think is very important and one that I believe will make a difference to women’s lives. It will make it easier for Victorians to access the most basic pharmaceutical drugs and receive health care when they need it. It will help –

A member: Eyes up. You cannot read while speaking.

Luba GRIGOROVITCH: Do you like picking on women, do you? It is normally your line. Oh, we have got some silence, thank you. Where was I?

The DEPUTY SPEAKER: Through the Chair.

Luba GRIGOROVITCH: It will help free up our GPs to provide care to patients who need it more by authorising pharmacists –

Emma Kealy: On a point of order, Deputy Speaker, I note that the member appears to be reading a speech. I ask her to table her papers so that it is made available to the entire house.

The DEPUTY SPEAKER: Is the member reading a speech or referring to notes?

Luba GRIGOROVITCH: Deputy Speaker, I am referring to my notes.

The DEPUTY SPEAKER: There is no point of order.

Luba GRIGOROVITCH: Thank you very much. As I was saying – the pharmaceutical drugs and receive health care when they need it most. This will help free up our GPs, which is something that is very crucial, as we all know. Our GPs will then be able to provide care to patients who need it by authorising pharmacists to directly prescribe these drugs to people without the need of a GP’s prescription. I am pleased that this will especially benefit women who can fall pregnant by allowing them easier access to select oral contraceptives. It is a simple thing, but to the Andrews government and to me it makes sense. The framework in which the scheme will operate will be completely safe and well regulated.

Emma Kealy: On a point of order, Deputy Speaker, again, I note that the member appears to be reading a speech consistently. I ask her to make that available to the house.

Ben Carroll: On the point of order, Deputy Speaker, the member for Lowan full well knows that whenever someone – it could be the Premier, it could be a minister – is referring to notes, often we hold up a document to look at it and then put it back down. I have been watching the member for Kororoit. She has been holding a document up and then putting it back down. Clearly she is referring to notes.

The DEPUTY SPEAKER: The member has already explained she is referring to notes. There is no point of order.

Luba GRIGOROVITCH: Thank you, Deputy Speaker. I will continue referring to my notes. The framework in which the scheme will operate will be completely safe and well regulated within the community. The background to this bill is the community pharmacist statewide pilot – a $20 million 12-month pilot being delivered by the Andrews government starting from October. The community pharmacist statewide pilot will expand the role of the community pharmacist to deliver more accessible and affordable primary health care to people who need it. Community pharmacists are accessible and trusted health professionals who of course already manage a range of health conditions and refer customers to a doctor where required. The pilot will enable community pharmacists to treat mild skin conditions and uncomplicated urinary tract infections, reissue supply of oral contraceptives and administer more travel and public health vaccines. It goes without saying how this will help enormously to ease pressure on our healthcare system, including general practices of our hospitals.

By creating new regulation-making powers in this act, the bill is the first step in establishing the legal and regulatory framework for community pharmacists to supply medications within the scope of the pilot. Through regulations enabled by this bill pharmacists will be authorised to operate under a structured –

Emma Kealy: On a point of order, Deputy Speaker, I have been watching the member very carefully and, word for word, she is reading a set speech. This is a time to debate legislation. I realise when people are new it takes some time to familiarise themselves with the processes of the house, but it has always been the tradition and custom of this chamber that if you are reading a document, you make that document available to the house. I understand she is completely reading it. I have been watching her; I have been hearing what she is saying. She is not deviating from a written speech. I ask you to direct the member to make that document available to the house.

The DEPUTY SPEAKER: Thank you. The member has explained that she is referring to her notes. Is the member referring to her notes or is the member reading?

Luba GRIGOROVITCH: I am, Deputy Speaker.

The DEPUTY SPEAKER: Subsequent points of order are not necessary unless the member has some other point of order she wishes to raise in regard to this. I have ruled on the point of order. Members may refer to their notes, you are correct, if they are –

A member interjected.

The DEPUTY SPEAKER: The member has explained. There is no point of order.

Luba GRIGOROVITCH: Thank you, Deputy Speaker. As I was saying, participating community pharmacists will be able to supply certain medications according to established protocols for the identified health condition groups, including – as I said just earlier – the continued supply of selected oral contraceptive pills for women, treatment for some mild conditions and antibiotics for uncomplicated urinary tract infections. Participating pharmacists will also be able to administer additional travel and other public health vaccines and immunisations to people from five years of age in the community pharmacy setting, including for hepatitis A, hepatitis B, typhoid and polio.

I can emphatically say that this scheme will be a godsend for the constituents of Kororoit. Kororoit and Melbourne’s west more generally continue to have the most limited GP resources in metropolitan Victoria. In local government areas, like Melton especially, our GPs and health clinics are stretched beyond the limit. To take a snapshot, there are just 0.5 GPs for every 1000 people in the Melton LGA. Meanwhile Sunshine Hospital’s emergency department has had a 34.5 per cent increase in patients presenting with GP-like cases since 2018. Add this to the snapshot that GPs in Kororoit are mainly non-bulk-billing and the picture becomes not just worse but even more unexplainable. This is to say that the collapse of bulk-billing and the GP-workforce-to-hospital ratio in Kororoit has made emergency departments the only place where many people with non-life-threatening or non-serious health issues can present to be treated at all, while people who need more urgent treatment are being squeezed further down the queue. Almost three years since the COVID-19 emergency began, the end result is a health system in Kororoit and the west which is perpetually stretched to near breaking point, and with Kororoit’s population only set to grow in years ahead it is something which we need to address.

I want to make very special mention of the member for Melton for his tireless advocacy for a new hospital to be built in Melton, with his background in health care, knowing this was a need for our community. I proudly stand side by side with the member for Melton, as I know that this is a hospital that we not only need but deserve as a community. This is why the statewide pilot is so important not only to my constituents in Kororoit but also Victoria as a whole. This will help free up our GPs by allowing community pharmacists to prescribe some of the most common medicines and treatments daily. There is no financial barrier for Victorians to access many services under the pilot. Consumers receiving an approved service from a community pharmacist will pay no more than what they would if they had visited a bulk-billing GP. This represents a huge saving for most working families. This will make it easier and cheaper for Victorians to get the health care that they need. Women will particularly benefit, with improved and timely access to low-risk primary health care, including oral contraception. I hope that the barriers to accessing contraception that this scheme pulls down for women will stay down and will be replicated more widely.

The safety and regulatory standards for this scheme will be rigorous and will put the people who use it first, at all times. To ensure safety and efficacy, the design of the pilot, including training requirements and guidelines, will be informed by guidance from the pilot’s clinical reference group of expert clinicians, which will include educators from accredited pharmacy programs and clinical experts in the included health conditions and travel medicines. It looks like I am running out of time; however, I do want to say that I think this bill is absolutely fantastic. It is going to do a lot for my constituency in Kororoit, and it is one that will help all Victorians. I commend the bill to the floor.

Jess WILSON (Kew) (12:13): I rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023, which of course amends the act to allow pharmacists to legally administer, to supply, to dispense a range of over-the-counter medications that will be available to Victorians – and particularly women in this circumstance, when we look at the contraceptive pill. The legislation looks at implementing a pilot and particularly looks at expanding the role of community pharmacies across Victoria. We know the dedicated work that community pharmacies do in all of our electorates. I think we all can say that we have very positive relationships – and particularly can I say that over the period of COVID we saw a situation where community pharmacists actually did much of the dispensing, the prescribing, of certain medications to free up the health system and free up the GP network and were able to do what this legislation looks to implement today. Under this amendment community pharmacists would be able to treat minor skin infections, uncomplicated UTIs – urinary tract infections – and very importantly, as many of us have spoken about today, reissue the oral contraceptive for women. This will mean that we are expanding health care and allied health for Victorians and taking pressure off our stressed health system here in Victoria.

I know that the member for Lowan and previous members on this side who represent regional Victoria have particularly spoken about the fact that in regional Victoria it is very, very difficult to get a GP appointment. It is very difficult to get one quickly when you need it, and this legislation will allow Victorians to use their local pharmacies, work with the local pharmacies, to dispense medication for common issues. It will take that pressure off not only bulk-billing GPs but also hospital emergency departments, which are stressed beyond capacity as a flow-on consequence of the pressure on GPs.

We have looked today at the benefits of this legislation, and the member for Lowan has put forward a reasoned amendment that takes into account the opportunity to put some more clinical rigour into this pilot. We are not saying in any way today that we do not support the objectives of this legislation; in fact expanding access to the oral contraceptive for women was a policy we took to the 2018 election, one that we are very supportive of and one that we have wanted to see in place for some time. But this is putting some clinical rigour into the pilot, as we have seen has occurred in Queensland and New South Wales, where initial pilots have expanded and evolved into clinical trials, and making sure that we are looking at the impact, looking at what the outcomes are and what some of the risks are that are associated with this new approach. Putting that sort of stronger standard, that greater structure, around this initial pilot will ensure that we put patients’ health first. Then we will also make sure that this is working for our community pharmacists.

As I said earlier, we have seen this approach taken throughout COVID. As the Pharmaceutical Society of Australia pointed out at the time, it was a huge opportunity to test the capacity of our community pharmacists. When that was removed following the crisis point of the pandemic, there was recognition that our pharmacists stepped up; they stepped up in terms of providing vaccinations, but they also stepped up in dispensing medications.

We have seen similar pilots take off in Queensland. They have conducted a two-year pilot and are now looking at making it permanent, particularly around the issuing of medication for UTIs. New South Wales have initiated a clinical trial, and they are looking at UTIs and to also resupply the oral contraceptive for eligible women. Further, in North Queensland they are looking at how this can be expanded even further into prescribing medication in what would be called ‘autonomous prescribing’, with wider ranges of medications for conditions such as nausea, and looking at expanding that in a similar way, I suppose, to other health professionals, whether that is nurse practitioners, optometrists or podiatrists. This is something that the pharmaceutical society has pointed out in the drafting of this legislation is in line with how other health practitioners are able to prescribe medications, that these regulations are consistent with that, particularly around, as I said, dentists, medical practitioners, authorised midwives, optometrists and podiatrists and their ability to prescribe medication. So it is looking at how the regulation can align with that so we are not creating a separate structure for community pharmacists.

This is an opt-in system for pharmacists, and we understand from the legislation that pharmacists will be provided $20 per consultation and that patients will only pay for the medicines dispensed. Looking at the costings, $19 million has been allocated, and it is expected that probably 50 per cent of Victorians will seek treatment under these new changes; they will go to their pharmacist rather than a GP during the 12-month trial. Looking at that, it is expected to deliver over 230,000 oral contraceptive repeats, 130,000 treatments for UTIs, 66,000 treatments for minor skin conditions and 41,000 travel vaccinations, taking immense pressure off our GP system for these everyday needs for Victorians.

We have heard from stakeholders, the AMA and others, that they do have some concerns around the changes to this legislation. I think what we are proposing on this side, putting in place that clinical trial, goes to helping resolve some of those initial concerns in looking at how we can evaluate the impact and the benefits and the risks of this approach. As I said earlier, the New South Wales and the Queensland pilots and trials have evolved into clinical trials to put that greater structure and clinical rigour around the initial design of this to make sure that both patients and pharmacists are taking it out.

Community pharmacists are under immense pressure at the moment, largely as a result of the Albanese government’s proposal to change the dispensing model from a 30-day dispensing model to a 60-day dispensing model. We have heard from an independent report this week commissioned by the Pharmacy Guild of Australia that this is putting at risk 20,000 jobs within the community pharmacy industry and increasing the chance of over 600 pharmacies across Australia closing. Those would be the pharmacies that are in regional Victoria, putting Australia and Victoria’s most vulnerable at risk. We need to be conscious when we are putting in place this legislation that it does not impose an additional burden on community pharmacists and their ability to dispense medications, particularly in rural areas, at a time when they are under immense pressure when it comes to these new 60-day dispensing rules and are staring down the barrel of global supply shortages and not being able to meet the prescriptions that they are already trying to service under the 30-day model while shifting to that 60-day model.

So it is going to be paramount that there is support for community pharmacists and that they are able to deliver this model. The opt-in design of the trial will hopefully provide them with that support. If I turn to a local pharmacy in Kew and Freda the local pharmacist, she is so passionate about serving her local community and throughout COVID she made sure that she was able to deliver medications to those in need, the vulnerable in the community that were not able to leave home, and she has continued that approach in a way that does not charge her patients for that. This model, for her, will give her greater opportunity to demonstrate her skills and her ability to serve the local community when it comes to dispensing oral contraceptives or when it comes to making sure that UTIs can be treated quickly. I think everyone would agree that not being able to get into a GP when it comes to a UTI – often many will appreciate, when it comes to the oral contraceptives, not being prepared for the next script and going to the local pharmacist will just ease the pressure not only in our health system but on Victorians that need to access this medication quickly. So I support absolutely the objective of this legislation. It is an important change and one that we want to see implemented, but putting greater clinical rigour around this trial will be paramount for patient safety.

Paul HAMER (Box Hill) (12:23): I too rise to contribute to the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023, which is, as has been stated previously, seeking to amend the legislation in relation to the supply, dispensing, administration, use and sale of certain drugs which are currently prescription-only. I do want to start by acknowledging that this does introduce a commitment that the Andrews government made at the election to introduce this 12-month trial, and it was part of a broad suite of health-related commitments to improve our health care and improve access to health care for all Victorians, and in particular in our local area that also includes the priority primary care centre – there is one which is established in Whitehorse – and of course the $1 billion commitment to completely upgrade and rebuild the current Maroondah Hospital.

In terms of this particular bill, I also want to highlight the role of community pharmacies and the magnificent work that they do and the patient care that they provide. As has been said by a number of speakers, that was no better evidenced than during the pandemic when they did remain open, often probably longer hours than they were previously, and did change their work patterns to ensure that all their customers were provided for. I know that in my own situation there were a number of times when my local pharmacy would make sure that they would home-deliver the prescription medication that I required. I remember the first time that I caught COVID. Having a suppressed immune system I did require or was recommended to take the drug treatment that was recommended at the time. It was only available through the hospital pharmacies then, but they were able to communicate with the local community pharmacy and deliver it to us. It was a bit of an exercise, almost like a safety drop, getting it into the house and then trying to move it from the house into my isolation room – it was quite the logistical exercise, but I do thank our local pharmacy for going out of their way and making sure that I could get that medication as soon as possible. That is what they do for many people in our community.

This particular legislation does look to particularly change the dispensing model, if you will, in three main areas: in relation to access to oral contraception or the pill, mild skin conditions and uncomplicated urinary tract infections as well as the administration of vaccines. I might talk about some of those in more detail a little later, but I also want to just reflect on yet another one of my health conditions, and that is asthma, and how the access to asthma medication that can be over the counter is so life-changing for those with asthma. I was doing some research; I thought it had happened more recently, but the purchase of salbutamol, which is the medical name for what many people would know as the ventolin inhaler, actually became over the counter across Australia about 40 years ago. Like I said, I thought it was much more recent than that. But there were a number of times that I might have been stuck. Asthma attacks occur often without warning, and they often seem to occur in the evening. You are not always going to have the opportunity to go to the GP or have their availability. Even if you do have the money to go to a GP that is not bulk-billing, just making sure that you have the availability of the GP at the time that you need them and are able to go into the pharmacy and access that medication is really critical.

I know that is an important part of my life, and I think that the medications that have been identified in this pilot program are going to have an equally important benefit to those who require the medication. As has been pointed out by other speakers, particularly for women’s health in relation to the pill and uncomplicated urinary tract infections, which I understand have a much higher prevalence among women, just being able to have access to those medications over the counter without having to rely on going through to the GP, with the difficulty that that might entail, is a really positive step forward. A lot of these lessons will be learned through the trial, and I will talk about the trial in a minute.

I also want to just touch on the vaccinations component. Going back a few years, when I got the flu vaccine or when I travelled overseas and got travel vaccines, it was always at the GP. You would always try and find a time that you could book in with the GP, and to be honest, sometimes I felt a little bit silly going to the GP and thought that that was really a pretty minor reason to take up a GP appointment. It is fantastic that we now have access to vaccinations like the flu shot, which I got a few weeks ago from my local pharmacy, and of course the COVID shot. They gave me a two-for-one offer – I was able to get COVID in one arm and the flu shot in the other arm, so I was all souped up. Just the availability that pharmacists and skilled health professionals provide I think is going to be really important.

I want to review what the pilot program will entail. It is, as has been said, going to be commencing in October this year, and the pilot is consistent with the trials that have already been established and are progressing in Queensland and in New South Wales. It aligns also with the Commonwealth initiatives to increase timely access to safe primary care and common medications. As has been mentioned, other jurisdictions like New Zealand and the United Kingdom have, with similar drugs, had success with these programs for a number of years.

I do want to just reflect for a few moments on, I guess I would say, the questioning that the member for Kew had about the clinical reference group. The clinical reference group is a group of expert clinicians that will look at this program, and the design of the pilot will be informed by their expertise and their guidance to ensure safety and efficacy of the program. I think to suggest anything other than that would really be a disservice to those who will give their time to be on this clinical reference group. The design will also be informed by an advisory group which will be represented by key stakeholders, including pharmacists, doctors and the community. I commend the bill to the house.

Wayne FARNHAM (Narracan) (12:33): I am pleased to rise today to talk about the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. I do support the member for Lowan’s comments, and I am glad the member for Lowan was in here to educate me on the rules of the house, because I can see the minister watching me with eagle eyes regarding my notes and my speech ability. Trust me, they are notes.

Juliana Addison: No pressure.

Wayne FARNHAM: And the member for Wendouree will be right on to me as well. Trust me, they are notes. We do support this bill. We are supportive of the bill, and we in –

Juliana Addison: Really?

Wayne FARNHAM: Really. We in regional Victoria know more than anyone how hard it is to get health professionals in our area. The problem – and I am sure the member for Gippsland East will back me up – for regional Victoria is we are always in competition with Melbourne metro to get more GPs and more doctors into those regional areas. When you live in an area like mine, in Narracan, we have extreme growth. We are the fifth fastest growing LGA in Victoria, so it does put so much pressure on the doctors. It is always a problem when you have got a condition and you need to get to your GP and there is a three-week wait for an appointment. So I do see the advantages in what the government is putting forward on this.

It is important to note that our pharmacists work extremely hard. They are, in my opinion, a frontline health service, and they do help a lot in our community. I know myself that you walk in there, you are feeling a bit crook or you have something wrong and you explain that to the pharmacist and he says, ‘Here, you can take this’ or ‘Here’s an alternative to what you’re taking’ and that is important – that really is important. We in regional Victoria have suffered with the health system. The health system at the moment is broken, especially in regional Victoria, so I see this as a good alternative.

As far as our reasoned amendment to this goes, which is for a two-year trial, I do not think that is a bad thing either. Going into a two-year trial would give you time to evaluate what is going on and reconsider options into the future, to come back maybe and amend the act at a later date. I do not see that as a major issue. I think it is a good way to go.

For pharmacists too, I can see this helping them now with the new federal government rules and the changes that they have proposed – ‘this’ being that pharmacists get that $20 per consultation. I can see that now actually helping the pharmacists. If pharmacies do fail in Victoria – I think around Australia with the new rules it is about 600 pharmacies they are talking about – that is going to put more pressure on health care. There is no doubt about that. So I see this as a way that pharmacists now will be able to supplement their income in one way or another, which I do not think is a bad thing.

Now, I could tell you about my own experiences going into pharmacies, and even one of my electorate officers tried to get an appointment with a doctor the other day. He was pretty crook, but it was a three-week wait. I actually said, ‘Just go to the pharmacy and see what they say.’ Thankfully he listened to me and got some appropriate medication to fix him up. I do see the advantage of it, especially with urinary tract infections. In no way am I going to pretend to know how a UTI feels – I do not feel I am qualified enough to know that – but I do have five sisters. I can imagine they are not great. I know when my sisters had UTIs they were quite irritable. That is the best way I can describe that. It will be good for women to be able to walk in and address that issue. I think that is a good thing.

The treatment for minor skin conditions will be a fantastic thing too; I have probably got a few of those myself. Obviously with oral contraception for women, you do not have to go to the doctor. If you know what you have been prescribed, you can go to the pharmacist and they can give you whatever the specific contraception is.

Juliana Addison interjected.

Wayne FARNHAM: So I do not think this is a bad – sorry, the member for Wendouree has got my attention over there.

It is good that the government has allocated $19 million for this. I am going to change tack very quickly. I have dug myself a hole. According to the election commitment costings, it is expected to deliver around 232,000 repeat oral contraceptives, 130,000 treatments for UTIs – that is a lot of irritability – 66,000 treatments for minor skin conditions and 41,000 travel vaccinations. The travel vaccinations are a good thing. We all want to go on holiday, and if we are not quite sure where we are going, then we can go down to the pharmacy and get vaccinated there.

I actually do think it is important that we have the opt-in system. I think it is important for those pharmacists to have that choice, whether they want to do this or not, so I think that is a good part of the bill that has been put forward. These are notes, so bear with me. I had to throw my speech to the side.

A member interjected.

Wayne FARNHAM: I do not think I am going to need the full 10 minutes, to be honest. Look, the bill is not a bad bill. We like what is in it, the base of it. We do want to have the amendment to a two-year clinical trial instead of a pilot program. I think the government should consider that. I am done, because I am going to get myself out of this hole I dug earlier.

John MULLAHY (Glen Waverley) (12:39): I rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. This bill will make a minor amendment to the Drugs, Poisons and Controlled Substances Act 1981. Can I thank the Minister for Health for bringing this important legislation to the house. I would also like to acknowledge the member for Narracan’s contribution previously and his complete backing of the bill, except for his wanting the one change. It was good to hear that he thought there was some sensible legislation before this body, and so eloquently done as well. I would also like to acknowledge the member for Northcote and the experience she had of working in her family’s community pharmacy. It was great to hear the experience that her mother had of providing highly skilled and trusted advice to the community. No doubt, Deputy Speaker, if you were to provide a contribution on this bill, I am sure that you would be mentioning John Fregon, your father, who provided a pharmacy to the people of Ferntree Gully for many years. I am looking forward to that contribution, if you make it.

The health and wellbeing of every Victorian is of utmost importance, and it is this government that has always invested in and strengthened our healthcare system. Since coming to office in 2014, we have invested $54 billion in our healthcare system as well as the workers we need to run it. The recent budget provided a further $4.9 billion to build and upgrade hospitals, boost healthcare services and give our healthcare workers the support they deserve and need.

That is why in November of 2022 the Andrews Labor government committed to backing our pharmacists and boosting our healthcare system, and I am proud that we are honouring that election commitment by investing $20 million to deliver this 12-month pilot. This bill provides a mechanism which allows for pharmacists to supply certain prescription-only medicines and is necessary for the delivery of the community pharmacy statewide pilot. By establishing such regulatory powers in the act, we are taking the first steps towards establishing a framework for pharmacists to supply medicines within the scope of this pilot. Through the implementation of these changes, pharmacists will be able to undertake structured prescribing on defined health conditions and medicines. This is similar to the approach in Queensland, which is currently running a pilot program for urinary tract infections (UTIs). There is also another trial being undertaken in New South Wales.

I would also like to acknowledge the consultation that has occurred in the process of drafting this bill. Key stakeholders have had meetings with the Minister for Health since the announcement of the pilot, and the department has liaised with the Pharmacy Board of Australia and the Australian Pharmacy Council on the intended approach for this pilot. Furthermore, the design of the pilot will be informed by an advisory group consisting of key stakeholders, including doctors, pharmacists, the community and consumers. This process is important to the success of this program. The pilot will make it easier and cheaper for Victorians to get the health care they need when they need it. Through this pilot the community will be able to access quicker treatments for mild skin conditions as well as oral contraception. Participating pharmacist immunisers will also be able to administer additional travel and other public health vaccines. Just a couple of weeks ago I popped into the pharmacy that is next door to my electorate office and was able to get the flu vaccine there. It was easy to book in straightaway, and they were very helpful. I was able to get the COVID vaccine there as well. Our community pharmacies are very important to us.

It also builds on our record of delivering for women’s health. UTIs are something that affects nearly one in three women before the age of 24, and this reform will mean that Victorians can access the care that they need quickly. Compared with men, women have higher rates of mental, sexual and reproductive ill health, and that is why we have committed to invest in sexual and reproductive health hubs, maternity services, the Victorian women’s health program, family and reproductive rights education programs and statewide women’s health services, amongst numerous measures to ensure equality of access to health services. We are giving women’s health the focus and attention that it deserves by meeting our obligations and commitments to the people of Victoria. Women’s health has always been and always will be a priority of our government.

The pilot also alleviates financial stress for Victorian families, which is very important right now. It ensures that there are no financial barriers for Victorians to access the multitude of services offered under this pilot. No Victorian will pay more for an approved service than if they had visited a bulk-billing GP. The government will subsidise the cost of eligible medicines from community pharmacies so that the costs will be the same as under the pharmaceutical benefits scheme. In order to ensure patient safety and quality care, strong clinical governance will be in place.

Participating community pharmacists will be required to undergo additional training and will need to follow specific guidelines for medicine prescriptions. They will also be provided with further guidance and protocols as to which patients must be referred to a doctor and which patients can receive treatment immediately. These requirements will be guided by the pilot’s clinical reference group, consisting of educators and experts, and through such oversight pharmacists can provide competent clinical care and will be familiar with the latest evidence and recommendations. By expanding the role of community pharmacies, pressure is eased on our GPs and hospitals and our primary health care workers.

Primary health care services, including priority primary care centres, play an integral role in the community. I am proud that the Victorian government is investing $29 million to help operate priority primary care centres and GP respiratory clinics for urgent but non-emergency patient care and for preventative and community health programs. I can personally attest to the efficiency and excellence of the priority primary care centres. Some time ago I was playing futsal with the crew of the Monash Labor club, and it so happened to be that one of the players got a painful injury, where his finger was completely sideways –

Juliana Addison: Not a UTI?

John MULLAHY: No UTI, no. We are talking about a bent finger.

The DEPUTY SPEAKER: Through the Chair.

John MULLAHY: It was completely twisted sideways, and thankfully he was able to go down to the Glen Waverley Primary Priority Care Centre on Blackburn Road on a Sunday at 7 pm, and he got the treatment that he required. He was bandaged up and he was able to return home in less than an hour. If he had gone to the emergency department, it would have taken longer and been a much more complicated process. This example clearly elucidates the effectiveness of priority primary care centres for patients and as a measure for easing pressure on our emergency departments. That is why community pharmacies will be the next step in easing some pressure off our GPs and hospitals.

As part of the $154 million boost for primary care in Victoria there is $43 million allocated to expand primary health services through public providers in women’s prisons, increasing access to medical officers and integrated care. The Andrews Labor government is delivering on its promise to support community pharmacies and to strengthen our healthcare system. In Victoria there are some 1453 community pharmacies and 8324 pharmacists with general registration. Importantly, they are trusted and accessible health professionals who provide excellent service to all Victorians.

In a time when it is harder to see a GP and harder to get the treatment required on time, it is the next logical step to expand the role of respected and experienced community pharmacists. These changes positively impact Victorians and the people of Glen Waverley that I represent. Every Victorian has the right to acquire the medicines they need when they need them for a fair price. The health and safety of Victorians is the number one priority of the Andrews Labor government. This bill and the community pharmacists statewide pilot demonstrates the priority of the Andrews Labor government, because at the heart of every policy is a focus on the wellbeing of every Victorian, no matter their background. We have a responsibility to look after those in need and especially those who are at their most vulnerable. Through this bill and the pilot we continue to build on our progress to improve accessible and quality primary care for all.

We are delivering on yet another election commitment and doing what matters by investing in our healthcare system, our healthcare workers and the wellbeing of Victorians. Supporting women’s health, improving access to primary health services, saving families money, strengthening our primary care system and backing regional health care – these are the benefits of this incredibly important reform. This is what we promised and this is what we are delivering. I commend the bill to the house.

Tim READ (Brunswick) (12:49): It has been quite an interesting debate today – something of an organ recital really, as we have gone around the room and heard the litany of complaints. I was having flashbacks. The Greens support the concept of the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. We will not oppose the bill in the Legislative Assembly, because the government is proposing this bill for good reasons. When GPs are booked out, why should people wait so long for something that a pharmacist can provide, especially if it is urgent, whether is itchy eczema, needing a repeat of a contraceptive pill, treating a urinary tract infection or a hepatitis A vaccine? I also want to say that I am grateful to the government and the Department of Health for the briefing about the bill.

Nevertheless, the Greens do share the concerns of some stakeholders about risks and uncertainties, and I will just list those briefly: first of all, the non-disclosure agreements signed by experts and members of the various panels; what seem to be inadequate plans for evaluation of this pilot; from the information we have been given, the apparent lack of planning for communication with relevant GPs and hospitals; the risk of overprescribing and particularly the risk of antibiotic resistance; the risk of inadequate advice going to patients, particularly regarding, say, the need for antimalarials and the need in some cases for long-acting reversible contraceptives; and the risk of misdiagnosis and potential serious consequences.

I will just start by briefly mentioning the non-disclosure agreements. Several stakeholders who are members of either the advisory or the clinical reference group have told us that they have had to sign non-disclosure agreements, which in my opinion limits their ability to participate in public debate about a matter of public health. I think it is quite appropriate that the government has created a clinical reference group and an advisory group to sort out the protocols and the limitations around this program, but why should we swear experts to secrecy over this? If they want to speak publicly, let them. If the government does not agree, say so. We are talking about public health information, not military secrets, and silencing public figures with expertise does not reassure the rest of us.

The thing I want to talk about mostly, though, is evaluation. Given the risks that are inherent in dispensing medication, it is important that we find out if the benefits of this scheme outweigh the harms. I think they will, but we will not know unless we design a comparative trial. Similar schemes are being evaluated as part of a clinical trial in New South Wales. South Australia has decided to go down the route of a parliamentary inquiry. I can understand the government not wanting a time-consuming randomised control trial. That is where people who want to use the service are randomly assigned and either get to use the service or have to go to the doctor. It would be awkward and difficult to recruit enough participants over time. But there are many study designs that use existing populations as a comparison group. Why not look at rates of prescribing and rates of complications in people attending medical services or people attending non-participating pharmacies? People that do not have access to the new service because their pharmacy is not participating could form part of the comparison group. And you can find these populations in datasets: you can talk about people who went to the doctor or the pharmacy last year or 10 years ago in Victoria or in Sweden. So you can build a control group out of a reference population that already exists.

It is not as good as a randomised control trial, but getting some sort of comparison data is far better than just a single-arm response rate, a single-arm questionnaire – ‘Were you satisfied with the service? Did you collect the medication you expected to, yes or no? Thanks for your time’ – and then a few percentages presented as a pie chart. That sort of evaluation does not tell you much compared to an evaluation that says, ‘People using this service got more or less antibiotic or took more or less antimalarial when they went overseas to a malarious area than people who used the normal care situation.’ Comparison is critical in the sort of trial that needs to be done to tell us whether the benefits outweigh the harms. As I said, I think the benefits will outweigh the harms, but we need a proper comparison.

The selling point of this pilot that the government proposes should surely be time to treatment, because time to treatment will be shortened. If you have got a urinary tract infection, do you have to put up with symptoms for a week or a day? It should be very easy to measure time from onset of symptoms to treatment in a simple questionnaire administered to people who use the service and measured from either existing datasets or people not using the service, because time to treatment is what this is all about. So let us measure it.

Between now and the upper house voting on this legislation it might not be possible to develop and release protocols to reassure everyone concerned about the various risks that I have talked about, but at the very least a properly designed study that will measure those potential harms and benefits will provide the information by the time the pilot is over. And if the study is done well, it will silence the critics and also point to anything that needs to be fixed. I note that the opposition has circulated a reasoned amendment urging that this be done in the context of a clinical trial. The Greens have also drafted amendments for the Legislative Council. The wording is a little different but they point to the same thing. These amendments have not yet been circulated but will be shortly. These amendments require supply of medication to be undertaken in a clinical trial that is approved by a human research ethics committee and includes a control group. The final form of this can be negotiated by the MPs in the other place, but our particular amendments are drafted in the name of Sarah Mansfield, so I will not be circulating them today.

The DEPUTY SPEAKER: Order! Can I just remind the member not to pre-empt debate in the other place.

Tim READ: Thank you, Deputy Speaker – a very timely warning. Let me move on then and say that hoping that the government does pick up advice from all quarters concerning a clinical trial, it will need data. A convenient way to record data without inconveniencing patients, clients or customers when they go to a pharmacy would be to have them answer a few questions online while they are waiting. The pharmacist can just text them a link to a survey website, which could be put together very quickly. I should remind the government that they have actually done this before; they have actually developed survey websites like this that go to people’s symptoms, and I can talk more about that later. It certainly should be possible to get this done in the three months prior to the planned launch date in October. If it is not, maybe do not let this sink or swim depending on its launch date in October. In other words, why not put the launch date back a bit, design it properly, do it right and start it a few months later if necessary?

I want to turn to another risk that has been raised by many, and that is that many Victorians can identify a general practice and some cannot, but there needs to be a record for their general practice if they have got one of what medication they have received. It is not very helpful if the medication dispensing record sits only in the pharmacy where it is dispensed. The practice they identify as their own should be notified about what S4 medication, antibiotic or vaccine they receive, or it should be uploaded to My Health Record. Communication of this information to a health record of one sort or another, either a GP or My Health Record, ought to be a prerequisite for participation. Again, completing an online questionnaire would create such a record which could be sent to the appropriate destination.

There is also a risk of overprescribing and of antibiotic resistance. Not everyone with urinary discomfort has a urinary tract infection. Australia is in the top 10 per cent for consumption of antibiotics per person globally. Australia’s doctors are not the most restrained prescribers of antibiotics. Will the pharmacists who are selling it be any better at wise restraint, or what is known as antibiotic stewardship? We will not know unless we measure it. So will those with milder or atypical symptoms be just given antibiotic, or will they get a plan of action and a pathway to follow if their symptoms worsen? The rates of antibiotic use should be compared for those attending a pharmacist and those in the comparison group or population. I also note the time and stand ready to be interrupted.

Sitting suspended 1:00 pm until 2:01 pm.

Business interrupted under sessional orders.

The SPEAKER: I acknowledge a former member for Carrum Donna Hope in the gallery today.