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All stakeholders need a say in pharmacy agreement

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5th Dec 2011
Dr Steve Hambleton   all articles by this author

LAST month, Greens health spokesman Dr Richard di Natale called for an inquiry into the Community Pharmacy Agreement.

Around the same time, a coalition of concerned organisations, including the Pharmaceutical Society of Australia, the Consumers Health Forum, the Society of Hospital Pharmacists of Australia, the Association of Professional Engineers, Scientists and Managers Australia and the National Australian Pharmacy Students’ Association (NAPSA), wrote to the health minister calling for broader meaningful consultation on the agreement.

The Pharmacy Guild’s ‘monopoly’ in negotiating the agreement with the government has come under fire because of concerns about some of the guild’s commercial deals, most notably with Blackmores and Pfizer. These deals have been a call to action from what were once ‘quiet voices’ in the pharmacy sector.

Australia’s biggest discount pharmacy chain has joined the conversation, urging changes to some of the protectionist provisions of the agreement. And the government is clearly aware of the disquiet.

Speaking at the National Press Club, Health Minister Nicola Roxon said: “I think there’s a lot of constructive discussion to be had about how things could be shaped differently in future agreements…”

The current five-year Community Pharmacy Agreement still has some time to run, but the AMA, like all these other groups, would like to see input from a more diverse range of stakeholders in the next agreement.

The Community Pharmacy Agreement is about more than the relationship between the government, the pharmacists and the community. It has impact across the whole health system.

We would like the government to open up discussions on the next agreement early to allow all stakeholders to have a say.

For a start, health reform should extend to lifting the pharmacy ownership and location rules so the health system can truly provide ‘joined up’ care in the primary care setting. 

The National Health and Hospitals Reform Commission also hinted at this in its recommendations to the government.

One service that should be expanded is a co-located pharmacy either within or next to a general practice. Co-located practices and pharmacies would lead to better communication between doctors and pharmacists. However, the existing criteria for pharmacy location are a hindrance to setting up co-located health services. 

Overly restrictive rules that impose location restrictions are difficult to justify in terms of public benefit, particularly when the government is actively promoting integrated care and treatment.

The same applies to pharmacy ownership rules. The current rules make it difficult for younger pharmacists to establish their own businesses. They also prevent doctors from owning pharmacies. It is curious that pharmacists can own medical practices, but not the other way around.

General practice pharmacies would allow GPs to lead a team of co-located health professionals, including pharmacists, in providing collaborative health care to local patients. 

They would ensure that primary healthcare was integrated, not fragmented or duplicated.There should always be a clear separation between prescribing and dispensing. The pharmacists would still retain the professional and legal responsibility for dispensing, independent of the GP.

Similarly we have urged changes in the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill. The bill allows pharmacists to dispense prescription medication under a process known as ‘continued dispensing’. 

Our professions work together to improve the medication management of patients and their clinical outcomes. But, continued dispensing represents a breakdown in this collaborative team-based approach to patient care. 

Good teams work best when the service is integrated and professional skills are complemented, not substituted. Such arrangements will ultimately be in the best interests of patients.

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