Wednesday, 21 June 2023

Bills

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

Second reading

Debate resumed.

Emma VULIN (Pakenham) (17:56): I rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. This bill creates a legal mechanism for a pharmacist to be authorised to supply certain prescription medicines without a prescription to enable the community pharmacist statewide pilot to occur. Access to timely medical care is so critical for the people in my electorate. Busy working families need to be able to get assistance locally and affordably when they need it most. I welcome this bill, which will enable the 12-month pilot to commence.

In my electorate the average person is a 32-year-old mum who busily runs around Pakenham. She likely works full time or part time. She is a carer with three school-age children. She has a partner at home or potentially is on her own or co-parenting. Let us call her Louise. Louise wakes up one morning feeling a little bit off. She has a slight sniffle. She does a COVID test, and it is negative. At her quick run to the toilet before she loads the kids in the car for school, before her onward journey to work, she notices a burning sensation when she urinates. But she has a big day ahead and a 30-minute drive to work, and Louise is the only one in the office that day.

By lunch she is feeling dizzy. She checks her general practitioner’s appointment booking website, and they are fully booked until after 5 pm. She cannot leave early as the business would need to close for the day. She must also take her kids to sport after she finishes work at 4; her son is training for the regional basketball team. Louise is pretty sure from her past experiences that she has a UTI, a urinary tract infection. She rings another GP and finds they do not bulk-bill after 5, and besides that, they are not taking any new patients. She rings another clinic, and they are charging full fees for walk-in patients after 5 but they have one appointment left at 7:45 pm. This is the time she will be tucking her primary-schooler into bed. The weekly budget is tight, her car insurance bill is in and it has just gone up and she does not have the cash for the appointment anyway. What are her options? She knows by tomorrow she will be feeling unwell and potentially a lot worse than she does right now. She needs a quick resolution.

In Queensland she could walk into a community pharmacy, and after consultation with a trained pharmacist she would have the antibiotics she needs to get well again. This is not an option for Louise in Victoria currently. In short, this legislation paves the way for another option: for Louise to call past her community pharmacy on the way home to seek some assistance.

The bill will make a minor amendment to the Drugs, Poisons and Controlled Substances Act 1981, creating a power to make regulations that will authorise pharmacists to supply specified schedule 4 medications without a prescription. Please note this is just the first step in creating the framework for pharmacists to supply medication.

Under the pilot, participating community pharmacists will be authorised to supply relevant specified medicines directly to consumers without a prescription or direction from another prescribing health practitioner but according to established protocols for the identified health condition groups. This approach is known as structured prescribing under the national Health Professionals Prescribing Pathway framework.

We are not the first state to take this approach. It is consistent with New South Wales’s clinical trial, which is currently underway, and the Queensland urinary tract infection pilot. So how did the pilot go in Queensland? Well, one in two Australian women experience a UTI in their lifetime. Pharmacists in the pilot of course have completed a minimum length of training as well as ongoing mandatory professional development and have undertaken specialist training in order to deliver the UTI service. The UTI health service in Queensland is open to non-pregnant women aged 18 to 65 who are deemed to have uncomplicated urinary tract infection. Treatment options may include a supply of antibiotics if appropriate. However, through the screening process if the person is deemed to have a complicated urinary tract infection or potentially suffer from a different condition, the treatment options may include a referral to a GP for further investigation. The success of the pharmacy pilot has resulted in the service becoming a permanent feature of community pharmacies in Queensland. This pilot, according to the Pharmacy Guild of Australia, had more than 9000 women participate, with a recorded 87 per cent resolution of symptoms and over 92 per cent highly satisfied with the service. This bill paves the way for Victoria to emulate this experience for women in my electorate.

While I have only given the example of the treatment of UTIs, the aim of the Andrews Labor government through this bill is to also have trained pharmacists able to continue a prescription for resupply of a low-risk oral contraceptive pill for women, again under structured prescribing protocol. Also, the intention is that prescription medication for minor skin conditions and travel vaccines will also be available and provided by a trained community pharmacist without a script.

Affordability is an issue. Importantly, there will be no financial barriers for Victorians to access services under this pilot. Consumers receiving an improved service from a pharmacist will pay no more than if they had visited a bulk-billing GP.

There were concerns expressed by the Australian Medical Association Victoria branch when the pilot was promised last November. The peak medical association raised concerns about incorrect treatment and the risk of compounding a person’s illness, transparency around profits and incentives for the pharmacy business and the inherent medical risk of prescribing. We note these concerns, but again, I reiterate that this bill is just the first step. Government will be informed by stakeholder participation in the project governance for the pilot, but to get this underway this bill is required.

Pharmacists have a wealth of experience. They are highly trained healthcare professionals, and we have heard a lot about that in the chamber today. They can recognise when there is a simple solution and when things need to be escalated to a doctor. This gives the authority to pharmacists to assist our community. There is time for the pilot protocols to be established. We also have the advantage of learning from the Queensland trial, for example, to make sound improvements. The conclusion after the Queensland UTI trial was that community pharmacists involved were found to follow the treatment protocol and referred appropriately to GPs when UTI symptoms had not resolved. When the Queensland study was evaluated, the findings suggested that there was an opportunity to decrease the workload of GPs managing minor ailments such as UTIs in Australia, confirming that about a third of patients who sought care from a GP practice reported having to wait more than two days for an appointment – and we know that is the case.

On the way home from work last week I called one of my best friends who I do not often get the chance to speak to these days. Our lives are both very hectic. We asked the usual – ‘How are you? How’s work? How are the kids?’ – but then she said that just a day earlier she had been racing to get to an after-hours GP. She said she had called 10 different doctors clinics trying to get an appointment to get a prescription for antibiotics, as she knew she was experiencing symptoms of a UTI.

She is a single mother of three, a woman who works crazy long hours to support her family, and she told me that eventually she found a GP who would stay after the clinic closed to see her. But $65 later, then there was a drive to find a pharmacy that was still open, trying to coordinate making dinner and school lunches and sport commitment drop-offs for her kids and a quick load of washing, then ensuring all of the kids were in bed by a reasonable hour so she could leave for work at 5 am. We spoke about how difficult it was, and I explained about this upcoming bill. She said, ‘Oh, that would have been so much easier and less expensive.’ This is the exact reason we need this pilot here in Victoria, not just for the Louises but also for our loved ones who are struggling to keep up both with time commitments and making ends meet financially. So logically, being able to visit a community pharmacist on the day an issue arises is a good thing.

Women’s health in particular is a priority for this government. That is why I am excited that my constituents will be able to utilise the women’s health clinic which will be based at Casey Hospital. This clinic was a commitment of the recent Andrews government 2023–24 budget. One of 20 new women’s health clinics around the state, the service will overcome some of the barriers to treatment that women face, such as cost, confidentiality, geographic locale of services, and cultural and communication differences. This clinic will change the way women’s health issues are treated, providing care and support for conditions like endometriosis, pelvic pain, polycystic ovary syndrome, perimenopause and menopause. Just like this bill, this will assist women and all Victorians to access more timely health care. This bill is about boosting local health care, which is so vital to my electorate. I commend this bill to the house.

Martin CAMERON (Morwell) (18:05): I rise also to talk on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. The aim of it here is to amend 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 due to start in October 2023 – so not too far away – to provide access to treatment for participating pharmacists for the following selected health conditions: (1) the treatment of minor skin infections, (2) the treatment of uncomplicated urinary tract infections (UTIs) and (3) the 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 pressures on GPs and hospital EDs, improving access to primary care for the specified conditions. The government made an election commitment last year to implementing a pilot to expand the role of community pharmacists. Access to GPs, particularly bulk-billing GPs, is very hard for many Victorians to get into, especially in our regional areas and growth corridors. This leads to more pressure on the GPs and our hospital emergency departments, and more patients are actually delaying getting treatment because of this. The Victorian pilot uses the model of a structured prescribing arrangement. Pharmacists are authorised by legislation to supply a limited range of prescription medicines without script – examples, as we said before, are specific vaccines, antibiotics or oral contraceptives. This is a similar approach to the Queensland pilot and now the New South Wales trial that have already been carried out or are in the throes of being carried out.

Shortages at the moment with the health crisis here in Victoria are paramount. Especially in country Victoria, trying to get in to see your local GP can sometimes be a nightmare. If you ring up and try to get a booking, if you can get it within the week that you ring up or the following week, you are doing very, very well indeed to be able to do that. In some of our country towns we do not even have our local GPs or pharmacists in the area, so for those having to travel to the bigger regional cities in Victoria, it just takes a lot of time and effort for them to get there, and as I said before, they are putting off getting their health checked because of these issues. That flows on. If they cannot get into a GP, they go to our hospitals and enter the ED process. If they have not got a major hospital around in country Victoria and they are travelling to try and get into the GPs, as we know, when you are sick or you do have an issue, you want it done then and there on the spot, you are not willing to wait or you do not want to wait for weeks and weeks on end. Some regional towns, as I said, do not have chemists or GPs outside of the major regional centre. Some may just have a chemist, and at the moment we can always go in there for our vaccines for flu and some COVID injections. To be able to further push that out, to be able to go and get your vaccines for overseas travel, like for a couple of the members heading off shortly to Kokoda, makes it a lot easier rather than booking into your local GP to get that done.

The member for Lowan brought up during her talk on this some stuff going on with the federal government at the moment – the Albanese federal government’s 60-day dispensing policy and what hassles that may actually cause to pharmacies around the place. It was interesting to listen to her say that around Australia it could cause up to 20,000 job losses in the pharmacy industry, to pharmacy workers, and over 600 pharmacies may close.

A program that is prevalent down in Latrobe Valley and in a couple of our pharmacies is the methadone program that runs in country Victoria, delivered by the country pharmacies. If that is put in jeopardy, what do these people do that are doing the right thing, trying to get off heroin, and are on the methadone program? Just as a sidelight to what we are talking about here, if they are unable to access these facilities in our local pharmacies throughout country Victoria, where do these people go and where do they turn if that is not available for them?

Nineteen million dollars has been allocated, according to the election commitment costings. 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, so it covers a wide area. It is an opt-in system for our pharmacists, so it is not mandatory that they do it; they can opt in if they want to participate. Pharmacists will be paid $20, roughly, per consultation by the government, and patients only pay for medicines dispensed, so that is the payment structure there.

I am the father of a 20-year-old daughter. As she was growing up we used to see her, as I suppose every parent would, unluckily get urinary tract infections and try to explain to us how sore she was and how much pain she was in, and it always seemed to happen that it was in the middle of the night or on a weekend when the GPs were not open. To be able to go to a pharmacy to get access straightaway to medication, if this is taken on board, instead of having to wait that Friday, Saturday and Sunday before getting into a GP, if you were lucky enough, on the Monday, would be a great asset to a lot of our young ladies and, in my case, to my daughter – to be able to access that part of it. Also, with the skin conditions and oral contraception, it is just an easier way. As I said before, trying to get to a GP is really, really hard at the moment, so it is going to take that pressure off our GPs and the health system. So that is it.

I would like to thank our pharmacies in and around the Latrobe Valley. We are one of the lucky places around the valley that does have a 24-hour chemist, Chemist Warehouse in Traralgon, which services a large part of the surrounding community, and it does make a difference. If you drive down the main street at 10 o’clock at night, you can see cars constantly parked out the front and people going in to access medication. For this to be a part of the pharmacists’ policy so that they can actually help people out with these three prescribed medications that we have got here – it only makes sense that it does continue on and work. We have pharmacies in Traralgon and also in Moe and Morwell and out at Churchill, and we have got a pharmacy at Glengarry. Glengarry does not have a medical service as such, so it is a standalone pharmacy out there. It is just good for the people of Glengarry to be able to access all of this through their Glengarry pharmacy.

The member for Lowan did put up a reasoned amendment, and it was to change it from a pilot program to a clinical trial. We have seen with Queensland and New South Wales and the programs that they have done that actually running it as a clinical trial would be more beneficial. We know it is working in other states, and I am sure that, instead of having it as a pilot program, to sit down and have it, as in the reasoned amendment, as a clinical trial would be beneficial for all people accessing it. So I thank the member for Lowan for her lead role in this, and as I said, we are supporting this and hopefully the reasoned amendment gets up.

Matt FREGON (Ashwood) (18:15): I also rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. I thank the Minister for Health, who is in the chamber, for her work and her team’s work on this bill. I think it is a very important bill, which I hope to see pass in this house and the other. As the member for Glen Waverley said at the start of his contribution, quite rightly, I will probably refer to my father during this contribution, because I was lucky enough not only to grow up with that particular father but also in a pharmacy. I missed the member for Wendouree’s contribution – I was, unfortunately, in a meeting – but I have no doubt that she would have told a few family stories. A community pharmacy is really a place for the whole community. The community pharmacists, and I go back to the 1970s and the 1980s and so on –

Mathew Hilakari: Surely not.

Matt FREGON: Surely so. Thank you, member for Point Cook – that will go far.

It was a place back in those days where you were probably the only place open on a Sunday morning. You were probably one of the few places open at 7 pm at night that would keep opening your door every 5 minutes when someone came in saying ‘I just need …’ And so Dad would walk down and he would unlock it and he would let them in, and he would come back and then he would go on back to the till, and then we would see him about 8:30 at night. But because of that we grew up in the pharmacy; we were always there. I consider that a great privilege, because not only did I get to spend a lot of time with my working father when a lot of people that I went to school with did not have that luxury, but I also got to see – and I will just put this to all pharmacists – the care and the compassion for their clients.

This bill enables those pharmacists to do more than what they have historically done in our state, but it is something which I have no doubt they will do with the utmost of care and professionalism in order to effectively prescribe the types of medications we are talking about. If you go through some of these medications and you factor in some of the issues we have had on bulk-billing over the last decade or so in this country, bulk-billing GPs are harder to find. We know that; I am not attacking anyone on that – they are. The pharmacist historically, if I go back to the 1970s, was considered the poor man’s doctor most of the time anyway. I distinctly remember a period of time when – I was not there at the time; I got told about this – the local butcher had done a pretty good job with the bandsaw on his finger and came in holding it, a tough bloke, saying, ‘John, can you sort this out for me?’ There was a reason Dad was a pharmacist – he did not like the sight of blood – and he quickly said, ‘No, mate. You’ve got to go to the hospital.’ But that was the sense from the local community: ‘I’ll go down to Fregon’s, and he’ll look after me.’

People still do that with their community pharmacist. If we go through the examples: the ability for a woman who finds herself without the contraceptive pill for that evening and thinks, ‘Well, that’s not a good thing. GPs are shut, no way I’ll get in. Ah, but I can actually go down to the pharmacy, and let’s hope they’re still open and they can sort me out.’ That is a real change for women in those circumstances. Obviously I do not take the contraceptive pill myself, but I am sure it happens, and I have seen it happen. It will benefit people who get urinary tract infections. We can all get them, but especially with seniors it happens a lot more often. Correct me if I am wrong, member for South-West Coast, with your nursing background, but it happens more to women as they get older. Those women will know exactly what is going on because they are having them more often than not. I will not name people, but for members of the extended family I know that is a regular occurrence. So to be able to skip the GP and go to a pharmacist to get that sorted will be a real benefit to their daily lives.

Again, I am not writing the regulations on this, and nobody would want me to. But if you consider skin irritations – I know my daughter had skin irritations when she was very, very young – you would get a GP and he would prescribe cortisone or something similar. When you ran out of that and you saw the rash was coming back, if you could not get to the GP, you would have to go to the pharmacist to get the Aquaphor, or whatever it is called, but you could only get the 0.02 one or the 0.05 or whatever it was. You could only get the little one, because they could sell it to over the counter. They had the one that you really needed in the back, but obviously you could not get it because you did not have a script. That is another change. Parents with young kids and people who live with eczema and other diseases their whole life and flare up constantly will know exactly what they need and the pharmacist will know and the doctors will know. This is not necessarily a problem. Obviously we have to be careful, with regulation and checks and balances, and again, I have no doubt that our pharmacists will do a very good job on this.

I commend the minister on the work and note also that we took this to the people in the previous election and they obviously said yes. I appreciate the member for Lowan’s reasoned amendment and that the opposition would prefer this to be somewhat different. However, from my point of view, I would ask the house to pass it as is, because delaying this goes against what we promised the people we would do. That is my personal opinion; we will all get our chance to vote.

I guess while we are talking about pharmacists, a number of members have gone to the issue in regard to the federal government’s changes on 60-day prescribing. I have no doubt that this will have an effect on the revenue of our community pharmacies when it comes in. The standard when my old man was running one – and he does not speak for himself anymore, so I will do my best to say what I reckon he would say. I will keep out the ‘Your bloody Labor Party’ bit, but anyway. I am cognisant that a significant proportion of the bread-and-butter revenue for a community pharmacy comes from prescriptions. That has always been their bread-and-butter revenue. Of that revenue – even from my time being in the chemist – the people who were using a lot of those prescriptions were coming in again and again and again. They are the ones that are filling up the little pillboxes. It was mentioned before, quite rightly, that there are limits on what gets charged, but I have no doubt that there will be a revenue change for our pharmacists, who are also business people. But I am also cognisant that the Australian Medical Association and other medicos are saying that this 60-day prescription is a good idea. I encourage the guild and the federal government to sit down, and maybe they want to talk about funding going forward and come to some form of way forward on which we can all get together.

In the time I have left – and someone else mentioned the methadone program – I would also like to note that I think when my old man did the methadone program back in the 1990s he was getting paid then around about the same amount of money they are getting paid now. One of our problems with the methadone program in this country – and I appreciate that it is mostly a federal matter; I am not trying to have a go at the feds, whichever side and when – is we have not increased the rates for our pharmacists on methadone for over 20-odd years really. What that means is that any pharmacist who wants to provide the methadone program to their clients, pretty well does so out of the goodness of their heart. They are effectively donating their time, if you like, to the fact that this program does work for some people. It is very good for the people it does work for. It does not work for everyone. Again, I would encourage the guild and our federal colleagues to get together and have a think about that as well, because it is an important program, and our pharmacists do good work. I could probably rabbit on about this for the next 2 hours, but nobody wants that.

Juliana Addison: I do.

Matt FREGON: Apart from the member for Wendouree, who I appreciate. This is an important bill. It adds to the body of work that this government has done with increasing our reliance on pharmacists, with vaccinations and with other work. They have done very well, and they will continue to do so. I recommend the bill to the house.

Bronwyn HALFPENNY (Thomastown) (18:25): I also rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. First of all, I would like to give a bit of a shout-out to some of the pharmacists and also the GPs in the Thomastown electorate. During the pandemic I was introduced to a number of pharmacists and general practitioners. In fact they actually donated their own time to help me to produce videos in various languages, because many of the doctors and pharmacists in the Thomastown electorate speak more than one language. They wanted to do that so that they could provide proper, informed, educative information to the local residents. They did this in their own time, and they made an enormous contribution. You could really see that both the GPs and the pharmacists were very caring of their patients and of course were also very concerned generally about the wellbeing and health of all people.

The way I think the opposition has presented this bill, it is almost like the Andrews Labor government is going to be doing some sort of radical move here in looking at giving powers to pharmacists to provide certain medications that previously would have been through a doctor and a prescription. We are in times where we need to make change. The health system really has been given a battering since COVID. There are a whole lot of issues, and we need to ensure that we protect people and ensure that they have proper access to whatever services they need to keep themselves in good health.

This is not a radical plan anyway, because of course other states are already involved in programs, pilots and trials, whether it is Queensland or New South Wales. So we have also been able to have the benefit of seeing those start up and looking at what is good in there as well as now providing this legislation, which is all about piloting a program that allows in certain circumstances for pharmacists to provide certain types of medications. They are fairly restrictive in what sorts of medications can be provided to people. They are things such as continuing supply of certain oral contraceptive pills, certain medications for urinary tract infections and mild skin complaints – issues like that, which perhaps do not need the same sort of complicated diagnosis like blood tests or whatever.

Of course we also know that pharmacists do many years of study. They are very knowledgeable in medication, and I do not think there is anybody that has not been to a pharmacy to ask for information about the medication or some sort of cream or whatever it is that they may need to treat a certain condition that they have. In a number of those circumstances I know, particularly with my children, as I think somebody else was saying, it was always the late-night chemist that you would often go to if there was something wrong, and often either the pharmacist would say, ‘No, you ought to be taking your child to the Royal Children’s Hospital,’ or they would give some sort of advice and tell you to go to the doctor the next day. Pretty well they were right in what they were saying, and that is what I found. That was not just one pharmacist. That was many pharmacists across the many years of my children and all those little ailments and things that they get. As new parents you worry and want to have some sort of action taken straightaway.

So this legislation really is not new. It is already happening in other states. Really, when you look at the reasoned amendment that is being proposed by the opposition, I mean, that is just further delay. We cannot delay these things anymore. We need to do things. It is all about action, and you cannot sit on the fence. The reasoned amendment is really, as I understand it, a way of trying to please everyone or trying not to upset anybody – so whether it is the GPs or whether it is the pharmacists, trying to keep everybody onside. But sometimes you need to show leadership and you need to do not what is good for one interest group or another but actually what is good for the Victorian people. This pilot and the changes to the legislation, the amendment we are talking about today, really is about doing the right thing for the Victorian people while ensuring that there are proper safeguards but also acknowledging the skills and expertise of pharmacists. Sometimes other disciplines or fields may think that no-one is as good as them, but in this case pharmacists are very knowledgeable and very well trained. There are of course going to be a number of safeguards around the implementation of this pilot. Even for some vaccines that you might require for travel, with these things why should you need to go to the doctor and hold up their time when there will be another 10 people trying to get in to see that same doctor or if in fact you are unable to afford to go to the doctor because of the big gaps in Medicare? The federal government has started a number of initiatives around that, but these are things that are going to take time. We really need to make sure that we do do things differently but also protect the public, and this is what this legislative amendment does.

The bill talks about, as I said, the pilot study, which will go for 12 months to see what the learnings are from that and how things are working. There will be the ability for people to contribute and raise issues during the pilot, and there will be the clinical reference group that is going to look at it further once this legislation passes, if it does pass, both this chamber and the upper house. It will look at having proper protocols and arrangements around, for example, what level of urinary tract infection a pharmacist can dispense medication for and what sorts of schedule 4 drugs and the protocols and ways of doing that. Of course the clinical reference group will be made up of a lot of very experienced people with a lot of expertise. If you go through some of the organisations that are going to be part of that, they certainly have the knowledge and expertise to make sure that things will be done in a proper way that will protect all of us and ensure that the system has all the safeguards that are needed.

I am looking at the list of the clinical reference groups. We have got the Austin Hospital; practising community pharmacists; the Alfred; Monash University; Safer Care Victoria of course, which oversees a lot of how hospitals operate and what is going on; the Department of Health; the Pharmaceutical Society of Australia; Therapeutic Guidelines Limited; and the Royal Australian College of General Practitioners. I think with a clinical reference group like that we are in good hands. They will ensure that this program will be done in the best way, the most efficient way, in a way that protects all of us and ensures that we get the proper care that we need but in a way that is, often, more convenient for us and takes the strain off the health system.

I look at, for example, the northern suburbs and the electorate of Thomastown, where we have the busiest emergency department, at the Northern Hospital, in the state. Really a lot of the conditions that people are there for require them to be prescribed some sort of medication rather than there being urgent and emergency situations. I know from a lot of the locals that the pharmacists they go to are very trusted. They feel comfortable to talk to their pharmacist. In fact they probably see their pharmacist more than once a week, in many cases, particularly among the older members of the Thomastown electorate. So this really is a system that is going to support our health system as well as give the best possible care to Victorians.

Anthony CIANFLONE (Pascoe Vale) (18:35): I rise to speak in support of the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. In doing so I would like to begin by acknowledging the work of the Minister for Health, her office and the department in preparing this bill, and I would also like to acknowledge the contributions of all the previous members in this debate, including particularly the member for Northcote’s contribution, which I found quite compelling. However, I would also like to begin by stating that I am very proud to be part of the Labor Party, which has always fought to uphold the promise of universal access to health care. Regardless of one’s postcode, bank balance or circumstance, Labor has always been a strident defender of the community’s right to access public health care and medicines. Whether it was the creation of Medibank under the Whitlam government, the creation of Medicare under the Hawke government or the establishment of the NDIS under the Rudd–Gillard governments or whether it was laying the foundations for the pharmaceutical benefits scheme in 1944 under the Curtin wartime government, which I will touch on shortly, the fact is Labor’s DNA is ingrained in the roots and origins of what is today’s universal public health system in Australia.

While Medicare tends to receive a lot of the public attention when it comes to the public health policy debate, and rightly so, I would like to draw the house’s attention to the origins of the pharmaceutical benefits scheme, especially given that we are debating a bill that focuses on the role and the future of Victorian pharmacies in our local communities. In this respect I draw the house’s attention to an article published in the Medical Journal of Australia of August 2014 by Martyn S Goddard, which eloquently outlines the origins and the politics around the creation and evolution of the PBS. The article outlines how nearly 80 years ago now the Curtin Labor wartime government first introduced legislation for a PBS in response to the need for the provision and supply of a wave of new antibiotic drugs, including penicillin, to the whole population, not just the minority who could afford them at the time. To quote Martyn Goddard from the journal article:

On 11 February 1943 … Chifley introduced the government’s financial statement … The main item was a national welfare scheme … which was to be a central element of the postwar reconstruction program … It was the most ambitious welfare program to be introduced by any Australian government.

However, the conservative opposition at the time had a problem:

They were against the notion of universal welfare … because they believed it contradicted the central tenet of 19th century liberalism – the supremacy of the individual. But the welfare measures, introduced into a community traumatised by 15 years of economic depression and war, were overwhelmingly popular with the electorate. The October 1943 Morgan Gallup poll showed 76% supported universal health care.

…

So in February 1944, the Pharmaceutical Benefits Bill was introduced …

to the federal Parliament as part of a broader package that allowed that:

Any Australian resident would be entitled, on presenting a doctor’s prescription to a pharmacist, to be given the medicine at no charge: the pharmacist would be reimbursed by the government. There would be a … list, of approved medications to ensure quality and effectiveness; this would be drawn up by an expert committee.

It was a fair and reasonable proposition being introduced by a fair and responsible national party of government at the time.

However, from the get-go the proposed scheme was immediately and successfully opposed and undermined by the then conservative opposition and their conservative allies at the time, including through two High Court challenges, two referendums, a constitutional amendment which sought to limit the PBS’s reach and application and even then limiting the PBS to only a small number of expensive and life-saving drugs. From the moment that the then new health minister in the Menzies government was sworn in on 9 January 1950, they did not waste a moment. Because of these historic actions and resistance by the then conservatives it was actually not until 1960, well over a decade after the scheme was originally conceived by the Curtin Labor government, that Australians eventually had access to and benefited from the comprehensive PBS originally envisaged by the Curtin Labor government. As described by Mr Goddard, as scientists and manufacturers continued the race to develop new drugs, the Menzies government’s limited PBS list became increasingly inadequate, and:

The realities of scientific progress and the basic sense of social fairness, shared in different ways by both sides of politics –

eventually combined, with the Liberals finally realising Labor’s longer and larger PBS scheme –

… but it would be left to later Labor governments … to complete the task of providing health care …

including via Medicare. Does any of this sound familiar, whether it was in the 1940s or 50s, when the Liberals delayed action to introduce a fully fledged PBS scheme; whether it was a decade of ignoring the science and delaying action on climate change from 2013 to 2021 under the Abbott–Turnbull–Morrison governments; whether it was more recently when it was the Liberals joining forces with the Greens in Canberra to delay a vote on the Albanese Labor government’s Housing Australia Future Fund Bill until October; or even in this very chamber today where the Liberal–Nationals have moved an amendment to this bill by stating in their amendment that ‘this bill be withdrawn and redrafted’? The record clearly shows that while Labor has always sought to govern with vision and conviction to make a real difference to the lives of working people, others have simply been happy to just ride on the sheep’s back while blocking, delaying and obstructing. Whether in the 1940s or even today, on this very day in 2023, you just cannot trust the Liberals in government to do the right thing.

If we are talking about the future of our health system, including opportunities around the future role of pharmacies in the health system, it is fundamental to look at this history and which side of politics has stood on the side of affordability and access to health care for our community, and that has always been Labor. The election of the federal Albanese Labor government has now seen the Commonwealth urgently get to work, finally, on fixing a primary healthcare and Medicare system that has been experiencing unprecedented levels of distress and demand. After almost a decade of federal Liberal government’s cuts and neglect – including the devastating collapse in bulk-billing on their watch, leaving behind a legacy of burden and demand on GPs – we now have more people than ever before turning to state emergency departments, hospitals and state-based services.

In response, and in stark contrast to the contempt the federal Liberals have shown for primary health care and Medicare, since 2014 the Andrews Labor government have been doing more than ever before to help Victorians get access to the health care they need when they need it. Along with building more hospitals and recruiting more nurses, other key initiatives the Andrews Labor government has been implementing to provide Victorians with accessible, responsive and agile health services include the establishment of priority care centres – a landmark state initiative that provides GP-led care to people who need urgent care, treating people with lower level conditions such as fractures, burns and mild infections. The centres treated 50,000 patients just in September gone, seeing patients who otherwise would have created more pressure on our emergency departments. Victoria’s virtual emergency departments, our virtual EDs, are also playing a key role. First established as a pilot in October 2020, the virtual EDs have treated over 85,000 people as of December 2022, allowing patients to be virtually assessed and referred on by emergency doctors and nurses, again freeing up our physical emergency departments. Labor’s 24/7 supercare pharmacies provide after-hours healthcare service and advice and treatment for a range of minor injuries and illnesses. My family and I have made use of the one in Coburg, in Louisa Street.

In this context, I welcome the measures contained in this authorising pharmacists bill of 2023, which will see us expand the role of community pharmacists as part of a new 12-month trial. The 2023 Victorian budget invests $20 million to establish this pilot, with this bill to amend the Drugs, Poisons and Controlled Substances Act 1981 to allow more pharmacists to provide treatment and advice for common conditions and basic healthcare needs. The bill will create a new mechanism for pharmacists to be legally authorised to supply certain prescription medicines without a prescription and to enable community pharmacists to access the statewide pilot and participate. It will improve access to primary health care, particularly for women, and it will help ease pressure on GPs and hospitals, including the Northern, the Austin, the Royal Melbourne, the Royal Women’s and the Royal Children’s hospitals across Melbourne’s north, which many people in my electorate access and rely on.

The pilot will provide community access for treatment for three select health conditions and groups, including the continued supply of the oral contraceptive pill for women without a prescription, treatments of some mild skin conditions and antibiotics for uncomplicated urinary tract infections, UTIs, for women. Easy access to treatment for these conditions will assist many in our community, but will particularly assist women. UTIs are the third most common human infection, with around 12 to 15 per cent of women being affected annually. Nearly one in three women require treatment for UTIs before they are 24 years of age, which increases to around one in two women by the age of 32.

When it comes to immunisations, pharmacists participating in the pilot will be authorised to administer select travel vaccines following the completion of additional training and support and resources being provided. Treatment and designated medications will be provided through clear and established protocols for identified health condition groups. This approach, known as structured prescribing under the national Health Professionals Prescribing Pathway framework, is consistent with the New South Wales clinical trial and the Queensland UTI pilot. This approach enables the government and primary healthcare sector to assess the safety and effectiveness of, and for the Victorian community to build trust in, our alternative primary care pathway via pharmacies. The pilot is consistent with other reforms being progressed nationally across other Australian jurisdictions, as I touched on, in New South Wales and Queensland. There is so much more to say on this bill, but essentially it is a bill that I commend to the house, and it forms part of Labor’s tradition to support the health sector.

Will FOWLES (Ringwood) (18:45): I rise in not quite the graveyard slot – just one before – to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023, and I will endeavour to do so at a slightly more leisurely pace than my friend from Pascoe Vale. This is an important bill, and it is just important in framing this discussion to understand that we are talking here about a pilot. It is only a pilot; the sky is not going to fall in. It is an opportunity to try a different mode of delivery for a very common set of medications particularly accessed by women, a very common set of medications that can safely be distributed by pharmacists and that will of course have the effect of taking pressure off our primary healthcare GP clinics in particular.

So, what is the pilot? Well, this government is investing $20 million to deliver a year-long pilot expanding pharmacies to deliver primary health care that is more accessible and obviously cheaper as well. It very clearly fulfils an election commitment that we made in 2022, and I think if those opposite are proposing to say that there was no mandate for this in their reasoned amendment – which kind of kicks it into the weeds but kind of accepts the premise of what we are proposing – then they are in fact just wrong. The government was re-elected comprehensively, and on that basis those opposite ought not stand in the way of commitments, particularly pretty straightforward commitments like this one.

Indeed, the reasoned amendment asks that the bill be withdrawn and redrafted to take into account feedback on the value of a two-year trial period. Now, apart from the fact that the language is opaque and managerial, I am not entirely sure what the intention is of that reasoned amendment, because redrafting it to take into account feedback on the value of a two-year trial period – well, the value of a two-year trial period is not necessarily derived from the trial period itself. We make that decision as legislators. So it would effectively be legislating for the view of legislators, which strikes me as being something of a cognitive dissonance going on there. But nonetheless if the intention is to say that the bill ought ultimately take into account feedback on the trial period – not on the value of the trial period but actually on the trial period – well, we can revisit this in 12 months or two years time. That is actually the advantage of having a legislature that meets on 50-odd sitting days a year – if you have got something to legislate, you can get in and just crack on and do it. It is easier, of course, if you are the government, but you know.

The pilot, and as I say, the reasoned amendment, whilst it does not internally make a huge amount of sense, do refer to the trial, and we need to fully understand what that is in supporting this bill for passage. The pilot, the trial, will enable community pharmacists to treat mild skin conditions and uncomplicated urinary tract infections and reissue a supply of oral contraceptives as well as administer more travel and public health vaccines. I want to take you through each of those four categories, but a couple particularly in more detail.

Mild skin conditions are typically a relatively uncomplicated part of medical practice. They do not offer up serious risk to the patient if they are either misdiagnosed or perhaps suboptimally treated. We are talking about mild skin conditions here, so I do not think there is any particular risk attached to that. In terms of what constitutes an uncomplicated urinary tract infection, UTIs are pretty common. There are certainly plenty of instances of the prevalence of UTIs in my household. They are pretty common. They have without exception resolved – and I accept it is empirical evidence, not quantitative – with a short course of antibiotics. That is far from uncommon.

They are things that affect, again, particularly women, and the treatment for them is largely uncontroversial, and for that reason I think that is a very important inclusion in this pilot. It is taking pressure off those regular visits to the GP to just whip in and say, ‘Hey, I’ve got a UTI.’ You would not even necessarily bother with the pathology. It is a quick Q and A about the symptoms, here is your script and off you go. Well, this condenses that journey down to one stop rather than two, and it also takes pressure off our GPs, who we know are dealing with significant backlogs in demand at the moment.

Oral contraceptives are long-run prescriptions, and in many cases it can be years and decades on the same oral contraceptive. Of course women are encouraged to follow the health advice and make sure they do get their prescriptions reviewed, but in terms of that month-to-month or every second month activity, I see no good reason for the GP appointments to be clogged up by women seeking their 48th or 112th repeat of an oral contraceptive. It is an important medicine, it is a very safe medicine and it is a very widely utilised medicine. And again, I think most women would report to this chamber and elsewhere that the consultations they have around oral contraceptive scripts are typically very, very short because it is such a safe medicine and it is so widely utilised.

Finally, on the issue of travel and public health vaccines, we were introduced to lots of new ways of doing things over the course of the pandemic, but one of those things was having intramuscular vaccines delivered by pharmacy staff or nurses within a pharmacy setting. That to me is an entirely reasonable and sensible thing to do. I have certainly received one or two. I think they were two of my doses of the Pfizer or the Moderna vaccine – mind the chemtrails. The two doses I received of Moderna in a pharmacy setting were absolutely fine. The other two were in clinical settings. I just see no issue with pharmacists being involved in that piece of primary health care and that piece of frontline medicine. It is an entirely sensible component of this trial – a trial, as I remind the chamber, that was announced prior to the election, and this government was of course elected emphatically in November 2022.

The bill enables a trial by amending the Drugs, Poisons and Controlled Substances Act 1981 to create this mechanism. The mechanism then is in the statute, and the regulations ultimately will be crafted to give pharmacists the ability to supply these certain prescription-only medicines without a prescription, at which point they will become pharmacy-delivered medicines. That is a category many consumers are already familiar with in terms of some of the stronger kinds of off-the-shelf painkillers and other categories of drugs that are only available in the pharmacy. I think the member for Box Hill might have spoken a bit about ventolin, which is of course one of those drugs that has been available for a long time as an over-the-counter medicine. It is not over the counter at a supermarket, it is over the counter in a pharmacy. That is that mid level of care and that mid level of consideration when it comes to drugs. You can buy paracetamol at a service station, but there are some drugs that you can only buy from a pharmacist or you can only obtain by way of prescription.

This pilot will commence from October of this year. The bill sets up the structure and the ability to do that, and it also enables pharmacists to undertake structured prescribing, which is where prescribing authorisation is tied to particular conditions, such as completion of specified training and compliance with established clinical protocols. That is a sensible set of safeguards. It will be something that will be reviewed at the end of the trial in any event, and it ensures that patient safety will be always considered as part of this. But the balance we are trying to strike here is between efficiency, accessibility and patient safety when accessing these particular classes of drugs.

There is a trial currently underway in New South Wales. There is a UTI pilot trial in Queensland. This is not particularly novel. It is of course novel in Victoria, and that is why we have a bill to facilitate it happening. It is a very sensible bill. It is a bill that balances patient safety and patient rights with economic efficiency, accessibility of primary health care and making sure that in particular women can get the drugs they need when they need them, and I commend it to the house.

Katie HALL (Footscray) (18:55): I am very pleased to be bringing home the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023 in what the member for Ringwood kindly noted was the graveyard shift. I am really pleased to have the opportunity to contribute to this bill, although often the member for Ringwood likes to cut short his contributions to give me longer, generously, in the graveyard shift. As someone – as the member for Northcote spoke about – who campaigned on this issue during the election, I know that this is a very popular move in my electorate of Footscray, where I very proudly represent one of the youngest electorates. Also speaking to women in particular about these reforms there was a great deal of relief, because women know their bodies and they understand their healthcare needs, and when you have a urinary tract infection, you know about it, and the last thing you want to be doing is waiting to get an appointment at a GP.

Of course our pharmacists are highly skilled medical professionals. We should in any smart health system be looking at how we can optimise all of our health professionals’ skill sets, from nurse practitioners to midwives, maternal and child health care, pharmacists and GPs. We have an extraordinary health system, and our pharmacists are a very important part of that. In my electorate of Footscray we have a great local pharmacy on Somerville Road in Yarraville where you can get scripts at all hours of the night but you can also see a nurse who works in the pharmacy, and that was an investment from the Andrews Labor government, and I know as a parent of two young children that has absolutely been a benefit to me.

I know for particularly women in my community these reforms will make a huge difference. They will save money. They will save time. Really we sort of generalise, but we talk about issues of five-minute medicine. So if you have been on the oral contraceptive pill for decades, why should you have to go back to a GP when you know what works for you and for your body? The opportunity to go to a pharmacist, get advice if you need it and of course go to a GP if you think that you need it – certainly in my community I know that this will be well received. I have two children who have eczema. It drives me mad to have to go to a GP to get a script that I know that they need to treat a basic skin condition. Certainly for travel medicine this is absolutely an area where our pharmacists can help do some of that heavy lifting of those frequent but less complex items of primary health care.

Certainly I know that the Andrews Labor government in my area has also been doing heavy lifting after 10 years of federal government neglect in the primary health system. In Footscray we have opened a primary health clinic, which has been so well received by the community, with parents commenting to me that it has meant that they have not gone to the Footscray Hospital emergency department, they have gone to a primary health clinic to get the help that they have needed. So there is a lot going on, particularly in women’s health.

The DEPUTY SPEAKER: Order! I am required under sessional orders to interrupt business now. The member may continue their speech when the matter is next before the house.

Business interrupted under sessional orders.