The Queensland government is under fire over a plan to allow pharmacists to diagnose and treat chronic health conditions, including in remote Aboriginal communities.
Yarrabah is one of 37 local government areas chosen to take part in the trial, which would allow pharmacists to diagnose and treat illnesses like type 2 diabetes, hypertension and childhood ear infections at the chemist.
"We have quite a high number of people with chronic diseases here and a great many of those people have more than one chronic disease," local Yued Noongar GP Jason King said.
It will be a user-pays model with extra charges for pathology and medication.
Dr King said he had been blindsided by the plan to include his community in the pilot and only found out when he asked his local pharmacist if they were participating.
"The fact that this is already [set to happen] ... and yet the health organisation on the ground are totally unaware of this is just — it's shameful," he said.
"It's unprofessional, it's unsafe and it's ignorant to the complexities that we have to overcome on a daily basis."
He believes the trial could put the health of some of the most vulnerable people in the country at risk.
"It's hubris on a scale that is unfathomable," he said.
"You can't close the gap with stop-gap measures."
Steering committee members withdraw
The pilot is the brainchild of the Pharmacy Guild of Australia, a powerful lobby group that represents chemist business owners across the country.
The details have not been publicly released, but documents seen by the ABC reveal the pilot would charge customers up to $55 for consultations and allow pharmacists to diagnose 23 different conditions.
Participating pharmacists would be required to do 120 hours of additional training over 12 to 16 months with an existing prescribing practitioner. The pilot is due to commence in June.
But the wheels appear to be falling off the pilot's steering committee.
The Royal Australian College of GPs (RACGP), the Queensland branch of the Australian Medical Association (AMA) and the College of Rural and Remote Medicine all withdrew their support this month.
The RACGP argues the pilot sits "in direct opposition to current clinical arrangements across Australia" and "compromises high-quality care".
Now, the Queensland Aboriginal and Islander Health Council (QAIHC) has announced it will not support the trial.
"QAIHC's representative attended several steering committee meetings but has decided to step back from the North Queensland pharmacy pilot program," the state's peak body for Aboriginal-controlled health organisations said in a statement.
"We advocate strongly for consistent, quality healthcare services that meets the needs for all Aboriginal and Torres Strait Islander Queenslanders and believe that open and transparent discussions with our members needs to be a priority."
National Aboriginal Community Controlled Health Organisation deputy chief executive Dawn Casey said the proposal made “no mention” of the need for “culturally safe, comprehensive primary health care” for Aboriginal and Torres Strait Islander people.
“There has been insufficient consultation with the community-controlled sector on the proposed trial,” she said.
“Furthermore, the proposed trial will fragment care and result in missed opportunities for comprehensive team-based primary care.
“An example is the proposal to diagnose and treat acute otitis media, a condition that needs extensive and comprehensive follow-up of hearing health to help address hearing loss in Aboriginal and Torres Strait Islander kids.”
More than 175 North Queensland doctors have also banded together to call for the pilot to be scrapped.
"It's not just outrage, but it's concern — it's genuine concern about what it means for patient safety," the group's spokeswoman Dr Aileen Traves said.
"It's not just general practitioners who are concerned about this -- that group involves dermatologists who are concerned about the skin prescribing in this, it involves gynaecologists who are concerned about the oral contraceptive pill."
The Cairns-based GP said the proposal undermined the public health system and amounted to privatisation by stealth.
"We're also concerned about the process of how this came about, how this was signed off as an election promise that didn't involve the medical community of North Queensland where the trial is set to be rolled out," Dr Traves said.
Integrity concerns and counter claims
Some of the concerns raised include questions about the integrity of the trial and the management of potential perceived conflicts of interest among those pushing for its rollout.
The state government has defended the pilot's merits and denied allegations it is being rolled out to appease the Pharmacy Guild, a key political donor.
"It is not accurate to say that the election commitment that we made to look at full scope with pharmacies has anything to do with donations," Health Minister Yvette D'Ath told reporters on Monday.
"It can, if you get this right, help the community get better access to healthcare, and with such a decentralised state, I think that's a sensible thing to consider."
Ms D'Ath was unavailable for a further interview with the ABC, but the department issued a statement saying the pilot would be subject to “strict governance and reporting requirements”.
"The aim of the North Queensland Pharmacy Scope of Practice Pilot is to improve access to high-quality, integrated, and cost-effective primary health care services for communities in North Queensland by increasing the scope of practice of pharmacists,” it said.
“The services provided by pharmacists in the pilot will complement existing primary care services currently available in North Queensland."
Grattan Institute health economist Professor Stephen Duckett said the political influence of the Pharmacy Guild was well-known.
"They are a very, very powerful lobby group, for both commonwealth and state levels, possibly because they're well networked into both sides of parliament, politics locally — and they're big donors,” he said.
"I think the government is acting in the best of intentions ... But they've listened too much to the pharmacy guild, rather than listening to what might be the interests of patients and rural communities."
“How much should it be about helping rural communities get good community service?" he said.
The Pharmacy Guild also declined an interview with the ABC but said in a statement it was “clear that doctors don’t want to collaborate, they want to control”.
"If doctors wanted to work collaboratively, they would have remained on the pilot steering reference group and collaborated," the guild said.
“The AMA and RACGP have a history of pulling out of pilots instead of working together.”
Dr King said there was a risk the pilot would do more harm than good.
"I think that it shows a complete lack of understanding of the complexities of primary health care in Aboriginal communities," he said.
"A project like this actually undoes that [work] and suggests that they'll be able to solve the problems of regional Australia by making people pay for it out of their own pocket -- and that's greatly concerning to me."
