Wednesday, 21 June 2023

Bills

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

Second reading

Debate resumed.

Tim READ (Brunswick) (14:55): I will just recap briefly to bring people up to date on the story so far, which is that the Greens support the concept of this bill, because with GPs booked out forever and a day and people wanting to get their urgent needs met, a pilot of this sort seems a very appropriate approach, particularly since it is being done in a number of other countries and states. However, we do have some concerns about this that are shared by stakeholders, in particular – and I have mentioned already – the non-disclosure agreement signed by the various experts on the clinical reference group and the advisory group; the risk of a lack of communication of what is prescribed to the patient’s GP or to My Health Record; and, of particular concern to me, the risk of overprescribing of antibiotics and greater emergence of antibiotic resistance. Having said that, it is not as if the medical profession has an unblemished record in this department, with Australia in the top 10 per cent of antibiotic prescribers around the world. However, our greatest concern is what seem to be the inadequate plans for evaluation of the pilot, which is why we have drafted the amendments that I have outlined, to be further discussed in the other place.

I will now resume where I left off, with a couple of other concerns. The first one is whether the patient customers who attend the pharmacies for some of these schedule 4 medications will also get the right advice that should go along with the medicine. For example, if someone is showing up at the pharmacy for, say, travel vaccinations, will they be appropriately advised about antimalarial medication? It is not a vaccine, it is a pill. For example, if you are planning a trip to India or Africa, you need to take antimalarial medication for much of those areas, but that would require a medical consultation. So it is fine to get your hep A and your typhoid vaccine done – and it is quite appropriate to get it done at the pharmacy – but you need the other advice.

Similarly, quite a lot of younger women in particular who are getting the oral contraceptive pill really would be better served by going onto long-acting reversible contraception. I am talking about implants like Implanon or the new small hormone-eluting IUDs like Mirena. They have much lower rates of unplanned pregnancy, and they are underused in Australia, with rates of around 11 per cent in Australia compared to 46 per cent in the UK. Long-acting reversible contraceptives would save those women money and prevent unwanted pregnancy. So will women picking up the pill get all the right advice that they need and in the right environment, not just standing at the counter? Some will need cervical HPV screening or other STI tests. The oral contraceptive pill is just one example of the importance of advice. How to prevent recurrent urinary tract infections (UTIs) is another important area that needs to be discussed.

None of these are reasons to abandon this well-intentioned pilot, but they are reasons to do a bit better than just a quick survey of a percentage of users. What it really needs is a comparison, as I described previously when I was talking about evaluation. The advice, the care and the consequences for the users of this system need to be compared with the experiences of those having usual care. That does not need to be obtained with a simultaneously recruited control group, but it does need to be compared with the experiences of other people.

Finally, I want to just raise, briefly, the risk of misdiagnosis. What if that urinary discomfort is actually a sexually transmitted infection or perhaps a more serious kidney infection requiring urgent intravenous antibiotic? What if that eczema, which is about to be treated with a low-potency corticosteroid, is actually a superficial spreading basal cell carcinoma? I have made that mistake before. The important point here is, again, it is not as if doctors are 100 per cent perfect, and it is possible that the protocols could be devised such that the misdiagnosis and complication rate is no higher in the pharmacy pilot than in normal care, but unless we evaluate it properly with some kind of comparison population, we will not know.

This sort of risk that I have just outlined is actually the easiest to communicate and probably the easiest to overstate, so I do not want to hysterically claim that this is a terribly dangerous undertaking. I think that the clinical reference group will devise clear protocols to minimise these risks, but it would be nice to see some evidence of these protocols before the upper house has to vote on the legislation. Doctors make mistakes and we should expect pharmacists will too, but we should carefully measure the rate in the evaluation. We should measure the rate of hospitalisations in participants and the comparator group or reference population. So we do not need to overplay the safety risks, but we do need to take them seriously. We do not know if the limits and protocols for this scheme will ensure that it is as safe as or safer than general practice. A brief online questionnaire completed by customers and patients while they are waiting to see a pharmacist could answer a few key diagnostic questions, and by doing so that would simultaneously reduce the risk of misdiagnosis, it would create a record to send to their GP and it would provide data for evaluation.

If the Department of Health is worried about the complexity of developing such a process, they should look at their very own website, and I will spell it out: ispysti.org. That was developed by the Melbourne Sexual Health Centre, which is part of Alfred Health, and it calculates a likely diagnosis from genital symptoms that are entered by a patient. In this case the patients show the printed output to their doctor. The Melbourne Sexual Health Centre has developed a number of online resources to assist patients to get the appropriate patient treatment.

There are further uncertainties about this pilot, but none of them are deal-breakers. For example, once a pharmacist is trained, will they get continuing education? How will pharmacists be indemnified for harm to patients resulting from misdiagnosis or failure to provide appropriate advice? How much money will Medicare save from this, and should a grateful Commonwealth actually be giving some money to Victoria for this? But this pilot will take pressure off GP waiting lists, and if it means women get their contraceptive pill or their UTI treated faster, then it is worthwhile, provided we properly measure those impacts and compare them against something. A properly designed and resourced independently conducted comparative study will do that, and I commend that approach to the government.

Paul MERCURIO (Hastings) (15:03): I am happy to rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. The purpose of this bill is to amend the Drugs, Poisons and Controlled Substances Act 1981 to introduce new regulation powers to enable pharmacists to supply, dispense, administer, use or sell schedule 4 poisons without a prescription in certain circumstances.

In November 2022, government committed to establishing a pilot to increase access to timely treatment for common health conditions, and these health conditions are uncomplicated urinary tract infections, the resupply of some oral contraceptives, some mild skin conditions such as shingles – although I would not call shingles mild – and the additional travel and public health vaccines such as flu shots and COVID shots and other vaccines required for overseas travel protection. This pilot is consistent with the pilot which is being run in Queensland and another trial being established in New South Wales and is aligned with Commonwealth initiatives to increase timely access to safe primary care and common medications.

So what does this actually mean? Well, it means that people can go to their pharmacist and get their ongoing normal prescription filled for the pill or get some antibiotics for uncomplicated urinary tract infections and get their flu and COVID vaccines without a prescription, and it is the same with mild skin conditions – and all without going to a doctor, which I think makes a lot of sense.

I do not really understand the tension between the doctors and the pharmacists. I would have thought that it is in all of our best interests for everyone to work together for the health and wellbeing of all our community, not to work against each other. It reminds me of 50 years ago when my father was a chiropractor – and my uncle – practising in Australia. In those days doctors really considered chiropractors to be witchdoctors – seriously – and the same with physiotherapists and osteos. It has taken 40 years for doctors and chiropractors to come together, so I hope there is hope for doctors and pharmacists to come together.

This bill will help with the cost of living. People who are struggling at the moment to put fuel in their car or food on the table can save the cost of jumping in that car and going to see their doctor and also save the cost of an additional fee to see their doctor. Then they can get a script and save the cost of the petrol driving home again. Instead they can just go straight to the chemist and get their script filled. Of course if you live in my electorate, with timetables for a bus every 2 hours and a train every 2 hours, trying to catch a public service to go to the doctor’s and then get your script filled and catch a public transport service home is a pretty arduous task, especially if you have young kids and especially if you are sick or in pain with a urinary tract infection or shingles or whatever.

Doctors will argue the policy undermines the holistic care they offer to their patients when they visit. Especially in the case of the pill, a woman would still need to visit a doctor in order to obtain their first prescription but then would be able to get repeat scripts of the drug over the counter from pharmacists. The member for Brunswick spoke a lot about risk, and I think he made a lot of sense, but we have got to remember that this is a trial. Part of the 12-month trial is to look at all of the circumstances and, through that period, mitigate those risks and work towards – especially after a year – putting it together so that it actually works in the way that it is intended, and I fully expect that will happen with this trial. He also spoke about the risks of pharmacists overprescribing and whether they are going to notice shingles or whether it might be cancer. Well, I can just say from my experience with my pharmacist that I watched him the other day talk to a client. He listened very carefully to what they were asking, and at the end of the day he recommended that they go back to their doctor, because he knew that was the best advice. I have got to say I certainly trust my pharmacist. Pharmacists are highly trained, intelligent and caring people. Certainly during COVID they stepped up massively to look after their communities, and where it was very difficult to go to your doctor because of COVID, you could still go and see your pharmacist. They were open and ready to give you the best care that they could. They have trained for a minimum of five years and additionally – I look at the lived experience of my pharmacist and the other pharmacists I have been to – they have years and years of lived experience and certainly know how to look after their community. They also undertook new training so that they could administer a variety of different vaccine shots, thus alleviating a lot of pressure on doctors and doctors surgeries, so they, in turn, could look after more people.

The member for Box Hill spoke about the difficulties of getting his travel vaccines. I know when I was dancing with Sydney Dance Company and we would go overseas, it would take me half a day to find a specialist who could give me the vaccines I needed before I could get back to work. I think going straight to your pharmacist for these sort of vaccines, again, makes a lot of sense.

I have to say during COVID – and after COVID if there is such a thing – and certainly since COVID, I have seen my pharmacist more times than my doctor. Now, do not get me wrong; I love my doctor, and she is an integral part of my ongoing health and wellbeing, but so is my pharmacist. This is why I believe this bill and this trial are important to me and to our community. Every time I go to my pharmacist, whether to buy vitamins, get a script filled or show them the gruesome results of my latest and greatest slip-up with one of my cooking knives, from the treatment I get and the care, concern and considered advice I receive I can see without a doubt that this is feedback from someone with lived and living experience of being at the coalface throughout COVID. They did what was asked, and I am more than comfortable with this bill and giving them more responsibility. Of course we are only talking about four health conditions being part of this trial, so the need to still go to your doctor is pertinent and relevant.

This trial in my view will not and does not adversely affect the doctor–patient relationship of care. In fact I think it assists that relationship by freeing up doctors so they have more time to see patients on other health issues that may be more critical. I have to say that one of the most common complaints about going to the doctor is the fact that wait times are incredibly long; I know with my doctor I need to book at least two months in advance. Quite frankly a woman with a urinary tract infection cannot wait that long to see their doctor and get treatment, and quite often a woman does not – and in fact I do not – want to go to a doctor they have never seen before. To be able to go to your pharmacist, who you most likely have already built up a relationship with, and get a fairly common antibiotic that will fix an uncomplicated urinary tract infection makes enormous sense. Community pharmacists are accessible and trusted health professionals in our community who already manage a range of health conditions and refer customers to doctors when required. The same can be said about treating common and mild skin conditions and vaccines and those things. So obviously I support this bill.

There is something else I would like to ask everyone to consider, and that is a little bit different, and that is around the pill. It is usually considered that the pill is prescribed only for birth control, but the fact is that is only one function of the pill for women. The pill is also often prescribed to help with issues of pain, anxiety and depression caused by hormonal conditions. Hormonal birth control can help alleviate the depression symptoms associated with conditions such as premenstrual syndrome and premenstrual dysphoric disorder. For many women birth control helps to manage and even improve their mood and overall mental health. Some studies have found that the pill can reduce the symptoms of depression in some women. I have three daughters. I have lived experience of this.

The other thing the pill is prescribed for is to help manage symptoms of endometriosis. It is thought the pill could slow down or inhibit the growth of endometriosis, which I have to say is an absolutely insidious, incredibly painful and debilitating disease. That said, with the growing awareness of endometriosis, the community and many health professionals still lack a genuine understanding of this life-destroying disease, which affects one in nine women – around 11.4 per cent of the female population. It costs a woman with endo on average $30,000 a year and costs the economy $9.7 million per year. My daughter Emily has this disease, has suffered immeasurably because of it and suffers still to this day. No doctor could work out what was wrong with Emily, and they would often diagnose her with something that did not make sense. Many doctors did not know or believe endometriosis was a thing, and sadly the diagnostic time for endo was around 10 to 12 years, but it has now dropped.

This government is doing stuff: we have put $283 million towards women’s health, $65 million of that towards treatment for debilitating endometriosis. If a woman is suffering from a hormonal or mental health issue or endo pain from an attack and her script has run out, she should not have to wait to see a doctor. She should be able to go to a pharmacist. I commend this bill to the house.

Tim BULL (Gippsland East) (15:13): I rise to make a contribution on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. Following on from the member for Hastings, I certainly acknowledge all the good things that he had to say about the local pharmacists in his community, and I can say the same about the pharmacists down my way. We have got a good group of people with the community’s best interests at heart. Good luck with your daughter Emily too, member for Hastings. I hope she is going well now.

We acknowledge this is an interesting bill that we have here, because normally when you have a reasoned amendment to a bill what follows on from that is that the bill position is opposed. What we have done is we have moved a reasoned amendment here to have this treated as a clinical trial rather than supporting a pilot, but the concept of this bill is something that we support and is something that we think is a good move and a good idea. We just simply believe that it adds more rigour to have it as a clinical trial.

I acknowledge the member for Brunswick’s contribution – he has just left the chamber – as a former GP. Whilst I do not agree with some of the Green philosophies all that often, he is certainly a person who, with his work history, should be acknowledged and should be listened to in his commentary on legislation like this. It was interesting to hear his views in support of a trial over a pilot. We support this bill and the intent to increase access to primary care at a time, as other speakers on both sides of the chamber have said, when we have difficulty accessing GPs, and also when hospital emergency departments are often stretched well beyond their capacity and capability. Having said that, we also acknowledge the matters raised by the AMA, the Royal Australian College of General Practitioners, the pharmacy guild and the Pharmaceutical Society of Australia, who have expressed some concerns with this. I think all members in this chamber would agree that patient safety should always be paramount and we should always have appropriate safeguards in place, including the training and including oversights and evaluations of any trials or pilots that we have. Again, I refer to the member for Brunswick’s comments around the fact that if we are going to have, I guess, an official pilot program, a two-year pilot program, we will get a much higher level of feedback on what perhaps needs to be improved as part of this structure, and also on the commentary that he made, the potential oversubscribing of some items needs to be very carefully monitored.

I note that this is going on in other states – other jurisdictions of Australia – but quite clearly a trial gives a far greater oversight level than a pilot. We acknowledge that there are matters of balance here in determining the best long-term outcome and what that will be. Pharmacists are indeed, as members on both sides of the chamber have said, highly trusted members of our community, and I do note that other health professionals apart from doctors, apart from GPs, already have the authority to diagnose, treat and prescribe in certain circumstances that suits their field of expertise. Some of those, for example, are podiatrists, optometrists and nurse practitioners. I also acknowledge that this is a significant step – to allow pharmacists to be legally authorised to supply, dispense and administer certain prescription medicines – but this will allow limited access to treatment for a participating pharmacist for very select conditions, those being minor skin infections, treatment of uncomplicated urinary tract infections (UTIs), and for the reissue of oral contraceptives for women. I will not go into the level of detail that the member for Narracan went into in his contribution, but there is no doubt that this will also expand the scope of pharmacist immunisers to administer travel and other public health vaccines. I just had a very recent situation because I am heading overseas next week to tackle the Kokoda Trail – I know the Minister for Police, at the table, has done that – but getting vaccinations in time at relatively short notice was quite problematic. I managed to get it done, but this is the legislation that will assist with those sorts of issues.

This pharmacy pilot is designed to help ease pressure on GPs and hospital EDs by improving access to primary health care. I also note that the government made a commitment to do this in the lead-up to the last election, so it is incumbent on the government to put this step in place, and I think, confined to those three particular areas as a first step, this is a good, measured first step. I represent an area of rural and regional Victoria that has a very significant lower socio-economic component to it, and access to GPs is often very, very difficult, particularly if you are living in a remote area – and particularly bulk-billing GPs, I might add. Not only will this avoid some of the wait times for what are deemed to be, without being disrespectful, relatively easily handled medical matters, it will also help in alleviating the pressure on emergency departments. In a country town after hours, if you get crook, you really have no option but to rock up to your emergency department at your hospital for what might end up being a relatively minor issue, but you are not to know that at the time.

I acknowledge that there are similar pilot schemes in Queensland and New South Wales. Queensland conducted a two-year pilot in June 2020, where pharmacists supplied antibiotics for UTIs for women, and they have now made this a permanent measure. New South Wales started a clinical trial this year, which is what we would indeed like to do, allowing participating pharmacists to provide treatment for uncomplicated UTIs, and this will expand to allow the resupply of oral contraceptives for eligible women. So it is quite similar to what is being proposed here.

In North Queensland another trial is set to begin in 2023, with plans to include treatment by pharmacists for a wider range of conditions, including shingles and nausea. So as we can see, this is a step that the vast majority of jurisdictions around the country are indeed taking. It will be an opt-in system for pharmacists to participate, so there will not be any pressure there. It will be a matter of pharmacies taking up that opportunity if they deem themselves fit and appropriate to be able to handle what will be an additional workload.

While on pharmacies, I want to make a quick comment on the government’s supercare pharmacy program, which I think is actually a reasonably good initiative. That supercare pharmacy program aims to increase accessibility of healthcare services for Victorians, particularly in rural areas where after-hours care options are limited. I have just described that in my electorate that is a very, very significant issue. The basis of this program is this government is offering subsidies for pharmacies to open extended hours and in most cases 24/7. I have a pharmacy in Maffra that is very, very keen to participate in this. I have written to the minister on this particular issue on behalf of the pharmacy in Maffra. They would love to be involved, but the nearest pharmacy that is being engaged in this program is in Traralgon. While that is great news for the member for Morwell, it is a long drive from Orbost, Lakes Entrance and Bairnsdale to get to the 24-hour pharmacy in Traralgon. So I would urge the minister to revisit the parameters of this program and allow pharmacies like the one at Maffra to participate where they are putting up their hand and they are keen to get involved. They can see what the benefit will be to their community, and they simply want to offer that service.

On this trial – and winding up – let us see how this trial goes. Let us see what it does to wait times to see a GP. Let us see what it does in relation to alleviating the burden on emergency departments at our hospitals. The best way to measure that is through a clinical trial. A specific clinical trial, as the member for Brunswick pointed out, will get much more detailed data and feedback on how this program is working and how it can be structured to work better in the future. Only then, after the detailed analysis that a clinical trial provides, can we fully assess the outcomes. We can fully assess whether this sort of program needs to be expanded and what fields it may be expanded to or indeed if it needs to be altered in any way, shape or form.

I will wind up by saying that whilst we have moved a reasoned amendment it is not the standard practice where we are opposing the bill, it is just that we think an alteration could be made. But we agree with the ethos and the background of this legislation, and I think it will provide vastly improved services in a lot of country areas.

Jackson TAYLOR (Bayswater) (15:23): Just briefly, with the indulgence of the house, I want to make a very brief comment in relation to my dad’s partner, who is in hospital at the moment. She has got a really, really tough battle ahead. I only say this because I know that she will get a kick out of this. She has been a great supporter of mine. She is a lovely, lovely person. She has been a fantastic supporter of my father. She has got a very, very tough road ahead. We all love her. I love her, and I look forward to seeing her in the next couple of days. For the record I will say my dad’s partner is Marie Avacone, a lovely, lovely woman.

It is a great pleasure to rise today to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. Of course a great deal of work has gone into this bill. I thank the Minister for Health for her work and the team, the department, who no doubt have done a lot of work, clearly, from looking across the detail of the bill, as I know members of this place would have done. It is quite clear a lot of stakeholder work, consultation, has gone into this. We know that this bill is also about acquitting an election commitment of the Andrews Labor government. We met first in December last year, and already we have had an opportunity to acquit a significant amount of election commitments in this place via legislation that Victorians voted for, and this is indeed the acquittal of a very, very important election commitment that we made to the Victorian people. It is also great to hear in this place of the bipartisanship, the support from all sides of politics that is critically important when we are talking about these very important matters.

It would be remiss of me not to mention that I am very proud to be part of this Labor government, a government that is wholly and solely focused on making sure we provide the support to our healthcare system that it needs via this important legislation, which I hope has a speedy passage through this place and the other place. We know we have got a proud record when it comes to supporting our healthcare workers and healthcare infrastructure, and we have provided billions and billions of dollars of investment, because that is what spending in health care is: it is an investment in this state and an investment in our healthcare workers to support them to do the work they do – our pharmacists and people right through the sector – and of course it is an investment in Victorian people.

I just want to briefly acknowledge some of the previous speakers. The member for Brunswick has, I will say, an incredible medical background – I do not think I could outdo him on any of those matters. It is always wonderful to hear some of his insights and his thoughtful and considered debate, which is usually the case in this place and certainly was on this occasion. The member for Hastings made a fantastic contribution. He has been up twice on his feet on bills this sitting week, doing a fantastic job for the people of Hastings. It was interesting to hear some of the different angles. We talk about ease of access, the important role this legislation will play in terms of accessing services, and some of the detail that the member for Hastings talked about in terms of public transport and accessibility, from that perspective, is perhaps not something that people immediately consider but is clearly an issue that the member for Hastings is very passionate about and something that this legislation will no doubt go a long way to supporting in his community. I am sure we have all got very similar issues in our own communities about public transport and access to critical services. So well done to the member for Hastings. And of course the member for Gippsland East – again I am referring back to the good-spirited support of this legislation and the debate in this place. It is sort of dovetailing with some of the comments of the Premier. It is quite clear that the member for Gippsland East has a strong love for his community. He is a fierce advocate, and I did appreciate his considered comments on this bill today as well.

Of course this is but one piece of the work of this government when it comes to reforming our healthcare system, making sure that Victorians can get the care they need when they need it. It has been great to hear from, again, all sides in terms of some of the other investments this government has made and some of the issues that are important to their local communities. In my local community this bill itself, if passed, will work in tandem with a range of other investments we are making. For example, the member for Ringwood will know all too well that one of 20 women’s health clinics that we are rolling out over the next four years will be at Maroondah Hospital. That is a very critical investment, and we know the work we are doing to rebuild the Maroondah Hospital from the ground up – a significant investment, and the budget that we have just recently passed, obviously through here and the other place, acquits the planning to get that work started, and that is now underway. Women’s health clinics and the major rebuild of Maroondah Hospital are both critical investments for our local community to make sure they get the care they need when they need it.

In terms of easing pressure, this legislation also works very well hand in hand with our government’s work, now partnering with the federal government, with those priority primary care centres. My community is very grateful that we have got one right underneath my office essentially. Just down the escalator we have got the primary priority care centre, and that operates 16 hours a day, I believe. That is basically playing a huge role in making sure people do not always have to go to the emergency department for some of those mild cuts and sprains and burns –

Belinda Wilson interjected.

Jackson TAYLOR: and broken bones et cetera – yes, absolutely, member for Narre Warren North. So that has been a fantastic way to divert people from the emergency department. It has been great for people who may not be able to afford the care of going to a GP. Bulk-billing I will come to in a tick, but it has been a godsend, and now hundreds of people have used that service.

We have also got the Angliss Hospital. Early works have started on the expansion to the Angliss Hospital. It is a really, really critical upgrade that will see more beds, more elective surgery suites and more services, which means people can get the care they need without having to travel for it as well, with the Angliss supporting quite a peri-urban community.

We have got more healthcare workers coming online on top of the thousands we have delivered. We know there is always more to do in that space. We have just delivered the new aged care facility – $82 million, 120 beds. It is aged care as it should be, with really, really bespoke facilities and individual en suites in all the rooms – a really incredible investment. The list goes on. All of this is again a part of our government’s commitment in terms of working in tandem with legislation that we have passed through this place, like the bill we have got before us today.

Members have spoken a bit about some of the issues with bulk-billing, and without getting too critical, we know that unfortunately in some of the preceding years other governments of different political persuasions at a federal level have probably not done as much, it is fair to say, on Medicare. I appreciate and acknowledge the work the federal Labor government has done. I think there is an acknowledgement that there is more to do, but this legislation, in terms of accessing health care and accessing some of those services that this legislation will allow through our community pharmacists, will go a long way to making sure that people do not look to perhaps not accessing those services because of the potential cost being prohibitive.

It comes down to saving families money. It comes down to being able to access the services and this legislation is a critically important part of that. As we know, this bill will support the community pharmacist statewide pilot by amending the Drugs, Poisons and Controlled Substances Act 1981 to establish a new regulation-making power under part 11 of the act to expressly provide for the Governor in Council to make regulations that allow for pharmacists to dispense, use, administer, supply and sell schedule 4 poisons without a prescription, written instructions or verbal authorisation from a medical practitioner or other prescriber. We know – and it is being debated at length – all of the benefits, all of the reasons why this is a good piece of legislation, but I will also use my last minute just to say a great thankyou to all the pharmacists out there. I am actually situated right next door to a pharmacy; it is like the healthcare hub near my office apparently. We have got the priority primary care centre, we have got a pharmacy – it is all happening.

Darren Cheeseman interjected.

Jackson TAYLOR: The member for South Barwon points out ‘And Jackson Taylor’. I am not sure everyone is entirely always pleased about that, but it is what it is. You can’t win ’em all.

Darren Cheeseman interjected.

Jackson TAYLOR: I know, I know. Yes. Despite the interjections, I will move forward with my thanks to the chemist next to me, Keith, who is a fantastic bloke. He has helped me with a number of vaccines; I have just walked across – made a booking of course through all the usual processes. But to Keith and to all the people like Keith, all the pharmacists out there that do a wonderful job of supporting our community, I am very happy to say I speak for all of us – I hope that is okay – in saying that we all support our pharmacists. They do a great job, and this legislation will support them in doing that work and supporting their communities and working in tandem across the healthcare system. I commend the bill to the house.

Annabelle CLEELAND (Euroa) (15:33): I rise today to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. This legislation authorises the dispensing of a limited range of treatments by pharmacists, from minor skin conditions to uncomplicated urinary tract infections (UTIs). It allows the reissuing of oral contraceptives for women and the administration of travel vaccines. We do see the merits of this bill, which is why we do not oppose it, and I would like to take the opportunity to express my heartfelt thanks to pharmacists throughout my electorate who have a close relationship with locals and act as powerful preventative care and alleviate pressures on our health system.

This bill promises to ease the pressure on our hospitals and GP clinics, which have been crumbling under the strain of Labor’s mismanagement of Victoria’s health system. It proposes alleviating the cost-of-living issues imposed by our mismanaged health sector by fostering facilities that bulk-bill. Above all, it offers a swift and effective treatment route for urgent issues that in the past have been deferred for a time while awaiting a GP’s attention.

Despite these benefits, I would like to raise some of the reservations that must be considered. Our primary demand is enforcing a rigorous two-year clinical study period crucial for addressing several key concerns. The study period should serve as a stringent regulatory mechanism, ensuring pharmacists uphold high healthcare standards despite broadening their roles. It should also act as a litmus test for the adequacy and funding of pharmacist training, considering the weight of their new responsibilities. This proposed study period should safeguard the continuity of care through efficient information sharing between pharmacists and family GPs.

As we delve deeper into the implications of the bill, we see that this legislation, while absolutely a positive step, is barely touching the surface of our health system’s problems. The category 1 surgery waitlist, which covers critical cases, has surged by over 45 per cent in three months. This is coupled with a distressing 147 per cent increase at Bendigo Hospital. The overdue wait times for category 2 and 3 surgeries have also seen an alarming rise. The health professional shortage in regional Victoria contributes to the deteriorating conditions. This shortage extends across dentistry, mental health, Indigenous health and medical radiation. Without adequate staffing and adequate government support for country hospitals and healthcare providers, regional Victorians are bearing the brunt of this healthcare crisis.

With all of this in mind, the introduction of the bill is a step towards broadening healthcare access. We agree with the ethos and background to this bill and the benefits to our regional communities, but it hardly addresses the root of the problem. It is not merely about diversifying healthcare delivery channels but fundamentally about improving the standards, responsiveness and reach of our health service. We must remember that quality health care is a fundamental right and not a luxury. The bill stands as a reminder that we need comprehensive measures to address the systemic issues that plague our health services. It is time the government addressed the disparities in health care between regional and metropolitan areas, reinforced emergency services, reduced surgery waitlists and reinstated funding for preventative healthcare programs. Without these actions, the bill risks becoming just another bandaid on a wound that needs thorough care and attention.

In terms of the delivery of this program, the government made an election commitment last year to implement a pilot to expand the role of community pharmacists. $19 million has been allocated, and it is expected to deliver around 232,000 repeat oral contraceptives, 130,000 treatments for UTIs, 66,000 treatments for minor skin conditions and 41,000 travel vaccinations. These figures assume that approximately 50 per cent of people will seek treatment for the eligible conditions from a pharmacist rather than a GP during the 12 months. This pilot is modelled on similar schemes found across the country, particularly in Queensland and New South Wales. In Queensland a two-year pilot program was conducted starting in June 2020, where pharmacists supplied antibiotics for uncomplicated UTIs for women. This program has now made this permanent. In New South Wales a 12-month clinical trial started on 15 May 2023, allowing for participating pharmacists to provide treatment for uncomplicated UTIs. This trial will expand to allow the resupply of oral contraceptives for eligible women. In north Queensland another trial is set to begin later in 2023, with plans to include treatment by pharmacists for a wider range of conditions, including shingles, acute nausea and rhinitis.

The Victorian pilot will follow the same approach as the Queensland pilot and the New South Wales trial as well, using the model of a structured prescribing arrangement. This is a different standard to autonomous prescribing, like in north Queensland, which allows for prescribing a wider range of medicines for more conditions, expanding pharmacists’ scope of practice. This requires more training and accreditation, similar to prescribing rights for other health professionals, such as nurse practitioners, optometrists, podiatrists and more. This bill proposes an opt-in system for pharmacists to participate, and pharmacists will be paid $20 per consultation by the government.

I have spoken with Avenel pharmacist Belinda, who is in my electorate, to hear how this bill would impact her in our local community, which she services. Avenel Pharmacy has been in operation for over 12 years now, providing an essential service to a community that had previously gone without. Starting from humble beginnings, this pharmacy, thanks to the fantastic work of Belinda and her team, has gone from strength to strength over the years. It offers a wide range of critical services, including blood pressure and glucose measuring and reliable advice about medications, and it even has a coffee shop that has become a vibrant part and heart of the Avenel community. Belinda tells me that in theory this bill should be helpful to both her and our local community. She says:

While I haven’t had much advice from the guild on this matter, easier access to medications in rural and regional areas is always something that should be considered.

People are often not able to make it to doctors in time and need faster access due to pressing medical conditions.

In regional areas, our doctors are often busy, full or inaccessible – especially on weekends when our pharmacies will be open.

Of course, I am not sure about how the training will be facilitated.

We would require intense training to ensure that pharmacists are well prepared, and can effectively and safely deliver this program.

A major concern that Belinda raised is something that will likely be shared by many smaller pharmacies, something very common in regional areas:

This needs to be worthwhile to pharmacists in order to take them away from the dispensary.

Many pharmacies across my electorate will only have one pharmacist, meaning extra consultations will take away from other important services they already provide. Incentivising this and allowing further employment within these pharmacies was put forward as a positive step.

Other national and statewide stakeholders have been contacted for their thoughts, including the Australian Medical Association. The AMA raised concerns about potential misdiagnosis and inappropriate treatment, saying that pharmacists do not have the knowledge, training and experience of GPs, which may lead to worse outcomes. On the other hand, the Pharmaceutical Society of Australia has different concerns. They note the word ‘prescribe’ is not used and have said they would prefer a prescribing model whereby participating pharmacists have prescribing rights. This would be consistent with existing regulations that provide for prescribing by dentists, nurse practitioners, authorised midwives, podiatrists and optometrists.

Considering the bill’s objective to alleviate some of the pressure on our healthcare system, we must critically examine the landscape of public health. At its core this is a noble pursuit, with government decisions supposed to serve, primarily informed by the welfare and needs of the people we serve. These pronounced deficiencies in our health system, which this bill does aim to address, to a degree come from more than just a near-decade’s worth of policy mishaps, funding cuts and unintended oversight of a stressed bureaucracy. This government has a callous indifference to the residents of our state, an apathy that has resulted in a health system in disarray and the health of our community being impacted.

Juliana ADDISON (Wendouree) (15:42): I am very pleased to rise to contribute to the debate today in support of the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. I wish to thank the Minister for Health, her minister’s office and the Department of Health public servants who worked so hard to bring this bill to the house. I welcome the proposed changes and believe that they will have a positive impact and provide positive outcomes for health consumers across Victoria, particularly in regional and rural Victoria. Once again the opposition have shown their true colours – that they are only interested in being a barrier to progress and better care for our communities – and it is a real shame. I welcome that the Greens are supporting this, understanding the benefits that it will provide to so many health consumers.

I am pleased to follow on from a number of contributions, particularly that of the member for Northcote. It was an outstanding contribution. Like me she is the daughter of a pharmacist, so we know firsthand the important roles that pharmacists play in our society and probably spent far too much of our childhoods at the pharmacy rather than at home. So I am a big fan of pharmacists, and that is why I am very, very keen to talk today. I really hope that Backroom Baz tuned in for Narracan’s contribution today – truly quotable and worthy of mention in Sunday’s edition. If you missed out on Narracan’s contribution, as Molly Meldrum would say, ‘Do yourself a favour’ and have a read of that. It was magnificent.

Last year our government committed to setting up a pilot program to trial the provision of more accessible and timely treatments for common health conditions by pharmacists. I welcome the changes proposed in the bill, because this bill recognises the importance of integrated health care and respects the professionalism of pharmacists as important healthcare providers in our community. Today we are considering the legislative amendments that will allow the design and implementation of this program in a manner which is safe, thorough and beneficial for all Victorians. At the heart of this amendment is the community pharmacists statewide pilot. What that will deliver is really significant, because it is accessible and affordable care as well as high-quality care. Under the pilot community pharmacists will be able to treat uncomplicated urinary tract infections – UTIs – and mild skin conditions and to reissue oral contraceptives.

I am particularly pleased about the improvements this will provide to Victorian women, especially those living in the regions and in rural areas, as the proposed changes will mean increased access to timely care for the discomfort of painful UTIs and increased access to the contraception pill. Additionally, further training will be available to pharmacists within the pilot program to provide a wide array of vaccinations, including select travel immunisations. I know this will be welcomed by travellers and holiday-makers as a convenient alternative to accessing a doctor’s appointment, which can take some time to get and are becoming increasingly expensive. The budget that was just handed down last month, the 2023–24 Victorian budget, has allocated almost $20 million towards this pilot, which will make it more straightforward and more cost effective to get health care closer to home. We know that the closer you are to healthcare provision, the better outcomes you are going to get. As someone living in the regions, that is really, really important to me.

It will not only improve access to primary health care in our communities to benefit everyday Victorians – and as I have said, women in particular – but it will also ease the pressure on our hospitals and our GP clinics, especially in western Victoria, where I come from. A particular emphasis will be placed on ensuring rural and regional community pharmacies opt in to the pilot. The pilot’s overall design will benefit from expert guidance on safety and efficiency from the clinical reference group of experienced clinicians, pharmacists, safety experts and educators as well as strategic operational advice from the pilot advisory group.

We are also looking to learn from other Australian jurisdictions trialling similar schemes, including what they have done in New South Wales. What they have done there is implement a year-long clinical trial with pharmacists dispensing medications for uncomplicated UTIs as well as resupplying oral contraceptives – so, very similar to what we are going to achieve through this pilot program. Following a successful pilot in Queensland, pharmacists are now permanently permitted to supply treatment for uncomplicated UTIs. Both programs, like the proposed Victorian pilot, revolve around structured prescribing, where pharmacists may dispense treatments for identified conditions following established protocols. Both of those models, however – in New South Wales and Queensland – involve greater costs to the consumer, whereas our model in Victoria, the Victorian pilot, provides funding towards the consultation as well as subsidies for applicable medications so that the medication cost to pharmacies and patients will be the same as under the Pharmaceutical Benefits Scheme, the PBS. We are focused on making treatments more accessible without making them any less affordable, so patients will not pay more than they would have if they had visited a bulk-billing GP, and that is great news for health consumers.

But we know – from my experience and the experience of my family and friends – that getting a bulk-billed GP appointment in a timely manner is getting harder and harder, if not impossible for some Victorians, once again particularly in rural and regional Victoria. A comprehensive evaluation following the 12-month pilot will include a cost-benefit analysis as well as assessing improvements to primary healthcare accessibility and benefits to broaden our health system. In doing so, we are ensuring that we get it right and that the service is meeting the expectations of community members and is workable for pharmacists and pharmacy workers, which is so important.

We know the role of a pharmacist is important, and as I said earlier, I particularly know, because pharmacists are experts in medicine who have completed a minimum five years of study to become a registered pharmacist in Australia. To be a qualified pharmacist you need to have a comprehensive understanding of how the human body works and ensure that the introduction of medicines does not have a detrimental impact on the overall health and wellbeing of a patient. The role of a pharmacist is not only to dispense medicines but, more importantly, to play a vital role in providing advice to the community and improving the health outcomes of communities. This has been the case for centuries. Within the healthcare system pharmacists are the medicine experts, and that is why this bill is so important, because at its heart this bill is about dispensing medicine and making sure that people have access to medicines. So why not let the experts do it?

Pharmacists and pharmacies play an important role, particularly in regional centres. I should know, as I said, because my dad ran a pharmacy in Ballarat that was open 9 until 9 every day of the year. Dad spent more waking hours at the pharmacy than he did at home. He often had to leave us on Christmas Day to go and work a shift at the pharmacy, because he never closed the doors on our community. Dad’s pharmacy provided an essential healthcare service to the Ballarat community. Before supermarkets and petrol stations stayed open late, Dad’s pharmacy was the only place in Ballarat where you could get a Panadol, a Lucozade, cough mixture, Dettol, baby formula, bandaids and bandages after hours. Pharmacists are highly respected health professionals who play a vital role in the provision of health care in the community, and this pilot will enable them to do more.

The bill before us today proposes amendments to the Drugs, Poisons and Controlled Substances Act 1981 that will allow for the establishment of the community pharmacist statewide pilot. I am running out of time. I have so much to talk about, but I just really want to say that this legislation provides grounds for regulating the supply, dispensing, administering, use and sale of schedule 4 poisons under specific circumstances without a prescription by a pharmacist, but there are a whole lot of different checks and balances.

In concluding I would really like to thank the pharmacists and the pharmacy staff who work in my electorate, including at UFS, Eureka pharmacy, Crawford’s, Priceline, the pharmacists at Grampians Health and those at Amcal at Wendouree and Chemist Warehouse. Thank you for the work that you do in making my community healthier and the support you provide those living with disease, pain and injury. The work pharmacists do changes people’s lives for the better, and the care they provide improves the quality of life and wellbeing of all consumers. I welcome the introduction of this bill, and I commend this bill to the house.

Jade BENHAM (Mildura) (15:52): I am more than happy to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. I am glad that this does recognise the work of pharmacists as healthcare professionals, especially in regional and rural areas like ours, Mildura, and the 37,500 square kilometres of it where there are community pharmacists who are the backbone of primary health care in our communities. It is a lot easier to go and see your pharmacist a lot of the time for primary health care advice and direction than it is to get a doctors appointment, so it is great to see that pharmacists are being acknowledged for their skill level, which is fantastic.

I have been working with some amazing pharmacists that we have in Mildura and in the wider community and talking about exactly that – that they want to be acknowledged as the healthcare professionals that they are, obviously – but they do have some concerns around some of the wording in this amendment bill. So I am going to talk a little bit about that, particularly around the community pharmacists and the concerns that are held with pharmacists that practise in other locations – for example, GP pharmacists. GP pharmacy is perhaps not something that is as common as community pharmacy, but it is so critical, and it is becoming much more important, especially in rural and regional settings, to be able to close that gap and lift some of the workload with a more collaborative healthcare delivery model in both the GP clinics but also in residential aged care facilities.

I have seen recently, locally, where a GP pharmacist, who is incredibly valued in our community – and I will talk about her very shortly – working with the GP she works with, goes into residential aged care facilities with the GP to streamline that work. It gets rid of the administration, the reporting and the working in circles over the course of a week. Everything can be done onsite there – the vaccinations – because the trouble that she has had, being a GP pharmacist and not a community pharmacist, is that she cannot actually prescribe something like the flu vaccination because she is not in a community pharmacy where she can sell, administer and supply it. So it has become a little bit of an issue for her, but the collaborative model in delivery here is amazing.

The pharmacist that I am referring to is Brooke Shelly. She is the GP pharmacist at Ontario Family Practice in Mildura, and she, along with the rest of our pharmacists, the ones that are on the ground practising their profession, are the ones that we need to listen to. I am not an expert in all things, so when I do need advice and counsel on areas that I am not an expert in I turn to those who are experts. Brooke is an expert, and she is the one that I turn to for, particularly, advice on this bill. She has raised some concerns with me, and I am going to quote her now. Brooke said, ‘Prescribing is prescribing. The pharmacy profession have spent years preparing the profession to prescribe safely through the prescribing competency framework and putting it into our professional practice standards. By not calling it what it is and using the words “supply without prescription” creates the need for a whole new set of unnecessary guidelines that will not ensure we are held to the same standards as all other prescribers. Why are we reinventing the wheel here?’ Which absolutely makes sense – when you break it down and talk about these issues, it absolutely makes sense. Brooke working in this GP clinic as a GP pharmacist works very, very closely with those GPs, and as far as I am concerned Brooke along with Dr Trav, who is a rural generalist that works in the same clinic, are the face and future of health care in Mildura and they are the ones that we should be listening to.

She also said that perhaps the government needs to be more agile when presented with innovative models of care, like the collaborative model that I was talking about earlier. Just because there are not huge numbers of GP pharmacists should not mean that they should have to wait for years to have legislation changed because it was not done correctly the first time and they were not listened to the first time. It is great that they are being recognised for their skill set for independent vaccination, as an example, across location settings. I mentioned it before: for a GP pharmacist like Brooke, she cannot prescribe a flu vaccination or a COVID vaccination in a GP clinic without the direct direction of a GP, whereas you can walk into a community pharmacist and get the jab without seeing a doctor at all. These things are what Brooke and other pharmacists that I have talked to about this are most concerned about – just little words such as ‘location’, the dancing around the word ‘prescribing’ and saying ‘supply without a prescription’. Prescribing is prescribing, so shouldn’t the wording maybe be something around ‘pharmacist prescribing of S4 poisons at the discretion of the secretary’, because that is what it is – it is pharmacist prescribing. There are a whole list of things that can be prescribed by a pharmacist already: pharmacist-only medicines, it already exists. So it does seem like it is a little bit of reinventing the wheel.

Listening to those that have been through all of that university and have worked in different areas and worked in different settings like aged care, like community pharmacies, now will this also have an impact? If the federal government is talking about the 60-day prescribing, that runs a very real risk of actually closing down small pharmacies. The implications of that could be horrific. Is this going to have an impact on them? We need to be protecting our pharmacies and our pharmacists because if that implication happens and we do start – and we will start – to see the closure of these small businesses because it is just unviable to supply medicines, then we run a real risk of putting the very health of small communities in very real danger. People like Brooke, like GP pharmacists, like our community pharmacists are the ones that should be listened to, and slightly changing – (Time expired)

The SPEAKER (16:00): Order! The time has come for me to interrupt business for the grievance debate. The member will have the call when their matter is next before the Chair.

Business interrupted under sessional orders.