‘We’re on a fantastic trajectory in terms of scope’

So the UTI services now become permanent practice and this decision to make the UTI service usual business is a policy decision that's been made by New South Wales Health and the research team is currently in the process of finalizing a comprehensive report on the clinical and economic outcomes of the service delivered. With regards to the oral contraceptive trial, as I mentioned, we've now recorded over 2000 consultations and that services also transitioned

to usual practice. The number of consultations was really influenced by the scope of the authority regarding both age and other eligibility criteria, which was set during the trial. Plus it was also a resupply arrangement, meaning that the individual had to have seen the GP within a certain period and have taken that specific oral contraceptive pill before. With regards to the dermatology trial,

we are now focused on pharmacists managing select conditions. So for example, we have exacerbations of atopic dermatitis, mild plaque, psoriasis, impetigo and herpes zoster or shingles. And so we've seen now 825 consented pharmacies that are participating in the trial alone with, as I mentioned, over a thousand consultations recorded so far. And this trial is really aiming to evaluate the safety and effectiveness of pharmacists-led management of these conditions overall.

So we're doing quite a lot of qualitative research on some of the unique challenges and outcomes in rural and regional settings among some other qualitative work with key stakeholders, for example, pharmacy and general practitioners as well as consumers, particularly those that have accessed the services to gather the insights and perspectives. So I think this is really important to highlight a lot of the work and the

outputs that will come as a result of the research that we're doing. And again, importantly for recommendations which we made as part of the overall reporting to New South Wales Health in terms of the scope of work that's happening in other states and updates globally.

So we've seen now that urinary tract infection services and management is now approved across all states and territories, and we've seen the scope of practice expansion in many states, and that's really following the model of the Queensland pharmacy scope of practice pilot. As an example, we've also seen the Queensland Community Pharmacy hormonal contraceptive pilot, which commenced mid-year this year.

And this pilot is really looking to enable pharmacists to autonomously prescribe hormonal contraceptive services for women and girls aged 16 years and older. And some of the contraceptives that can be accessed as part of the pilot not only include oral medications but also some injected medications. For example, the depo injection as well as some contraceptive devices such as the

vaginal ring. In terms of global updates, there are some general trends and globally the expansion of pharmacy practice really has been a key focus area. So some of the major developments really include vaccination services, and we've also seen a rise of services such as the management of UTIs and oral contraceptive services in other countries. And there is also a growing emphasis on chronic disease management.

And I'll just go through a couple of examples. So for example, in the United Kingdom they've seen the establishment of the Pharmacy FIRST initiative. Now this has been in practice for some time, but in 2024 they've announced a national service in England, which has been rolled out. And this is really a structured protocol based service where pharmacists can provide treatment for specific minor elements following defined guidelines.

So this program has really aimed to alleviate the GP workload and improve patient access care to treatment and alleviate some of the pressures on the NHS system. So they've seen conditions being treated such as earache, sore throat, sinusitis, insect bites, impetigo shingles, as well as urinary tract infection. So it'd be interesting to see that results that come out there is a concurrent evaluation occurring for this service.

With regards to autonomous prescribing in the UK it's slightly different and it's just important to establish the differences between the autonomous prescribing as well as the pharmacy first initiative. So autonomous prescribing is really referring to the ability of a qualified independent prescriber to prescribe medications without needing doctor's approval or a predetermined framework.

So pharmacists must complete a postgraduate independent prescribing qualification and they're generally registered with the general pharmaceutical council as independent prescribers. Now these pharmacists are operating as independent prescribers, generally work in hospitals, general practice or primary care networks, which is different to the pharmacy first initiative,

which is generally in community pharmacy. And of course they can prescribe for a wide range of conditions and they often involve managing longer term conditions. So for example, hypertension, diabetes, or acute issues in various other health settings. Just moving to Canada, we've also seen obviously some prescribing for minor ailments across various jurisdictions. So for example, in Ontario they can prescribe for 13 minor ailments in British Columbia.

Similarly as of June 1st, 2023, also prescribing for a number of ailments, contraception among other things. And in Nova Scotia as well, they were really the first in the country to obtain prescribing authority for minor and that's been undertaken since 2013. Some other examples of countries that maybe are not as commonly mentioned.

So in Ireland recently they've launched the free contraceptive scheme and that was launched in 2022 providing free contraceptive services to women from 17 to 25 years. And that's since been expanded this year to women age 35. And under some of these services include not only oral contraceptive, sorry, but also some of the long-acting reversible contraceptives as well as emergent contraceptive under these three schemes.

So these trials really that have been developed and also designed to evaluate services like ary tract infection prescribing or oral contraception as well as the dermatology as a previously mentioned, are really prioritizing high quality data, which really has helped to inform safe, effective and evidence-based policy decisions.

So I think while Australia's approach highlights really a strong commitment to evidence-based improvements, I think true leadership also involves ongoing evaluation and adaptability. And I think this is imperative as we're moving to further expansion in scope and as it becomes business as usual, what is going to be evaluated on an ongoing basis if anything.

And I think the philosophy and rigor, particularly behind the New South Wales trial based approach really reflects a dedication to ensuring that any expansion of pharmacy practices underpinned by a robust evidence-based. So I think just in summary, Australia must not only build on its evidence-based, but also ensure a timely implementation of proven practices while staying aligned with global developments in healthcare innovation.

So firstly is around economic sustainability and the financial model that's underpinning these services is really critical. So questions really about the funding remain central. So will services be funded through Medicare benefit schedule NBS or the medicines provided part of the PBS scheme or will there be subsidies to ensure equity for vulnerable populations or will services rely on out-of-pocket costs as we've seen in other states and territories?

And so the answer to these questions will really influence uptake in accessibility of the services in the community pharmacy network, particularly in diverse socioeconomic context. And I think this is really important that we need to talk about this more with regards to infrastructure. I guess as the industry adapts, many pharmacies have started to invest it in consultation rooms if they didn't already previously have one and other infrastructure to accommodate the delivery

of these new services. However, of course these changes come with associated costs and the question really remains whether the entire profession will adopt these models or if they will primarily appeal to those already committed to advancing clinical roles.

There's been quite a lot of discussion around education and upskilling and of course providing these expanded services requires significant investment in education, accreditation and training not only by the individual pharmacists by the business, but of course also the deliveries of education, for example, the universities and other institutions.

So pharmacists will need to advance, undertake advance qualifications to meet legislative requirements also with state and territory harmonization essential for seamless implementation.

I guess just to touch on lastly, the change management piece, and I think this is a huge point, particularly given that this is such a huge practice shift for pharmacy and pharmacists for introducing and scaling these services does require effective change management and implementation processes, not just within the profession but also across the broader healthcare landscape.

So this includes obviously collaboration with other health providers, patient education and consumer awareness, and as well as addressing potential resistances there.

And we've demonstrated the value of the support and the structured support for pharmacies involved. So just to give you a background, we have four what we call practice change facilitators, and these facilitators or individuals have really been integral in assisting pharmacies with the implementation of these new services. So physically visiting pharmacies, providing follow up phone calls, emails and advice to pharmacists and ongoing support

throughout the duration of the trials. And so what we've seen so far is that 98.8% of pharmacies have been contacted through the course of the trials, which is upwards of 1300 pharmacies across the state. And at the same time, close to 80% have actually received an in situ visit or face-to-face visit. So as a result of the support, we've actually seen now 88.3% of pharmacy statewide delivering at least one occasion of service, which I think is a fantastic effort.

And so as part of this work that we're doing in implementation, we've now seen or we're now being tracking so significant amount of data, particularly around the barriers and facilitators in practice and monitoring of those and providing some pharmacists and pharmacies, particularly when they've identified a barrier to practice or service delivery, that we are able to offer some strategies to overcome those and ensure that it's

sustainable in the long term. So if for example, we've identified an average of 2.2 barriers and 5.2 facilitators per pharmacy as part of the UTI trial. And of course we're looking at ways that we can address those barriers in practice and support our pharmacies on an ongoing basis with regards to future opportunities, I think conditions that you've mentioned and definitely on the horizon.

And I think achieving success in these areas not only requires significant implementation, support and education, but also the right framework. So clear protocols and guidelines which are tailored to these services, the supportive legislation, so ensuring alignment with regulatory requirements and scope of practice across the country. And as I mentioned, focused education. So really giving pharmacists the necessary clinical and communication skills.

And we've seen as an example, pharmacist in Queensland completing a body of work to undertake the scope of practice pilot up in Queensland, which is I suspect now achieved accreditation by our national bodies that we'll start to see something similar being rolled out in other states and territories as well. And the requirements for education to continue with the expanded scope in each of those areas.

And of course providing that level of face-to-face support is really helpful to understanding how maybe they could change their workflow by particularly with the dispensary. And it's really quite a practice shift. So understanding the barriers across the board is really important for our team. But of course, understanding strategies that might work for one pharmacy might also work for another pharmacy but may not work for the next pharmacy down the road.

So we're really have to tailoring those strategies to overcome some of those barriers, but tailor it to the specific pharmacy and model of pharmacy and business. So I think this will be really critical as we start to add more and more services on and making sure that pharmacists really have the right space, but also are really supported in the process to make sure, as I mentioned, that this is really sustainable in the long term.

So just coming back to the work that we're doing New South Wales, I think robust data demonstrating cost effectiveness and measurable health outcomes is essential. And this data will really be pivotal in convincing payers, whether that will be government bodies or private insurers or in fact patients of the value that these services bring to healthcare, and of course the value of our pharmacy network. Also, another consideration is thinking about the owner investment and return on

investment. So I've mentioned just previously, pharmacy owners obviously play a critical role in the implementation and sustainability of these services. So some of the costs that we need to consider include training costs and infrastructure costs as I've just mentioned.

And then of course when we're thinking about financial sustainability, creating funding models that ensure long-term viability is really vital to the success of this in the longer term services that really rely heavily on trial or initial funding, which is what we're seeing in New South Wales, often face challenges once these funding ends and we move out of the trial phase and therefore obviously see developing sustainable payment structures such as

either government reimbursement, insurance coverage, or patient co-payments will be essential as we move into future scope work. I think by proactively addressing some of these considerations, we can really build a solid foundation for delivering professional services that are both clinically impactful but also financially sustainable for a business.

And so balancing those immediate costs with the longer term benefits is some of the conversations that I think need to be had and are being had by our professional organizations as well as at the state and federal level. So it'd be really interesting to see how this all moves into the future.

So the New South Wales government has announced plans to allow pharmacists to manage seven additional acute conditions to those that are already under the trial, that being UTI, oral contraception and the four skin conditions I've mentioned. So those conditions include acute otitis media. Acute otitis is external, minor wound management, acute nausea and vomiting, gastroesophageal reflux disease, mild to moderate acne and mild acute musculoskeletal pain.

In addition, there's also been some discussions on chronic disease and chronic conditions at a trial being undertaken in regional and rural New South Wales. So there's a few question marks around this particular one, but there are ongoing discussions about initiating trial for pharmacists to manage certain chronic conditions in regional and rural areas of New South Wales.

I do know there's conversations obviously with our peak pharmacy organizations as well as universities, particularly around education and collaboration with the health departments to consider the needs of education for the safe and effective management of these particular additional conditions and what that will look like moving into the future.

change in healthcare. However, I think it's essential that obviously this change remains evidence driven and sustainable to ensure it translates into meaningful health outcomes for our patients. So I would say just in summary, these awards are not only just a reflection of my efforts, but of course my entire team and of course those working in this area. And I'm fortunate really to work alongside an exceptional group.

We have 18 partner organizations, 18 chief investigated a whole lot of project staff, PhD candidates, postdoc researchers, and a whole number of collaborators. So it is a team effort and of course we are looking to provide that evidence to improve patient patient care and outcomes. So thank you again for acknowledging this work. It does mean a great deal to me.

Of course these scope changes, but at the same time, providing the foundational elements for the pharmacy network to really thrive, be it education, be it implementation, be it the evidence base. And so that's really where I'd like to see funding and evidence and of course, emphasis on not only from our department of health, but also by our professional bodies, which everyone is moving forward and they're on the right path.