Could GP pharmacists worsen rural shortage?


remote rural regional Australian animals sign

Is the PhARIA system still fit for purpose? How could pharmacies host other health professionals? What could pharmacy learn from the Defence Force? Anthony Tassone takes a look at solutions to the rural workforce crisis

The Government’s announcement of a Workforce Incentive Program in the Federal Budget as part of the $83 million Stronger Rural Health Strategy, whilst being immediately welcomed by the PSA and the AMA as a result of ‘direct advocacy’ by these groups, raises more questions than it answers.

Under the program, it seems there will be incentives for general practice to employ other health professionals, including non-dispensing pharmacists, in clinics and practices.

Collaboration between all health professionals is to be welcomed, and there is no doubt that the Budget move recognises the medicines expertise and clinical value of pharmacists.

Such funding could provide benefits for patients and the rural health workforce, but we need to be aware of the realities of the dynamics of the rural and remote health workforce before we close the books on the problem.

The real question is whether this announcement addresses the short and medium-term priorities and urgent needs of rural workforce challenges and may potentially have longer term unintended consequences.

Community pharmacies in rural and remote regions of Australia struggle desperately to attract pharmacists to their pharmacies. The lifestyle and other benefits of country life just don’t seem to cut it, with the result that many pharmacies are under pressure to continue to provide the range of services they and their community would like to because they simply have difficulty finding the pharmacists to provide them.

This is reflected in data from what is now the Department of Jobs and Small Business in its Labour Market Survey published last year.

In it the department noted shortages of pharmacists in regional areas of Victoria, Tasmania, Queensland, South Australia and the Northern Territory.

Using Queensland as an example, the department noted: “Shortages of both hospital and retail pharmacists are evident in regional Queensland for the third consecutive year, with 43% of regional employers surveyed unable to attract any suitable applicants for their vacancies. In contrast, 89% of metropolitan vacancies were filled.”

While it did not note the percentages for other States, anecdotal evidence suggests it is similar, if not worse.

There has been feedback from some pharmacy owners in regional areas that on cyclical inspections, pharmacy authorities have raised questions in some instances about the pharmacists’ workloads and their need to consider hiring additional pharmacists. These proprietors have been attempting to hire additional staff, in some cases many months or even beyond a year without success. 

This situation can only be compounded by offering inducement for pharmacists to work in GP clinics. Concerns raised by rural based pharmacy proprietors are that the offer of a 9-5 job with weekends off in a rural GP clinic with a perceived more attractive work environment may be more enticing to some pharmacists with the result that the community pharmacy—and importantly the health of the patients it serves—suffers. 

We do not want to see taxpayer money potentially picking winners and losers.

The Guild is keen to hear further feedback from members and regionally based pharmacists as to their views on this recent Budget announcement and I strongly recommend members contact their local State or Territory branch.

Clearly there needs to be a strong Government focus on the community pharmacy workforce in rural and regional areas. Community pharmacy must not be bypassed in rural workforce investment in favour of a novel and new—and not yet comprehensively proven—bauble that is placement in a GP clinic. 

I am not suggesting that GP clinic placements are to be absolutely avoided, but there is a need to get our priorities right so that we can best meet the needs of our patients. Proponents and advocates for this model have been quoted numerous times recently that the majority of a pharmacist’s time would be spent educating the medical staff rather than patient facing roles. 

The question must be asked: is this the immediate priority with public funds to address rural workforce challenges?

Patients’ needs clearly would be better served in the immediate term by having these pharmacists available in a community pharmacy and enabling expansion of the services provided.

As such rural health workforce funding should include the enablement and provision of new services including telehealth services to increase access for patients with medical practitioners. This is a simple example of community pharmacy hosting other health professionals for the delivery of patient care. Currently, very few types of telehealth consultations gain MBS funding and rebates to reduce out of pocket costs for patients and consumers and so are not reaching their full potential to improve the health of rural and regional patients.

Incentives to attract and retain rural workforce need to be developed, and perhaps a model that could be built upon what already exists.

Our military personnel are offered reductions in HECS/HELP loan discounts on their higher education should they serve a minimum amount of time in the defence force. Should something similar be considered for the rural workforce to encourage more early career professionals to practise in regional areas? Quite possibly so, and we need to start thinking outside of the square for solutions to this problem that is not going away and seems to be getting worse.

Demonstrably, if community pharmacy is not supported as part of a broader rural workforce strategy, what we will continue to see is an uneven playing field that fails to attract and maintain a quality workforce for the community pharmacies that provide such a vital service in the communities they serve.

In looking at how to solve the problems of the pharmacy workforce in these areas, we must revisit the PhARIA (Pharmacy Access/Remoteness Index of Australia) classification system which has been left behind by developments in these areas. 

For instance, is the PhARIA system still fit for purpose when pharmacies may be classified as PhARIA 1 simply because of their proximity of other pharmacies, but a general practice nearby is classified as a rural clinic? Clearly this is an anomaly which is holding back rational and pragmatic development and implementation of practical solutions.

All of these factors point to the need to develop a dedicated workforce development plan for pharmacy which assesses and responds to the supply and demand dynamics of the health workforce across Australia. 

Currently and historically the medical and nursing profession have had their own dedicated workforce plans. Why hasn’t pharmacy? Why are we lumped in with the broader ‘allied health professional’ development plans despite community pharmacy being the most visited and accessible healthcare destination in Australia? 

Without this, it is difficult to properly plan and target public funds appropriately.

Medical practices are not the only premises that can host allied health professionals for delivery of care and governments need to take their blinkers off and recognise that pharmacies can—and must—provide an option in some instances.

Location rules have been highly effective in disbursing PBS-approved pharmacy sites, but there are still inherent challenges in obtaining the workforce to work within and from them.

The Guild is committed to working with all levels of government to find sustainable solutions that ensure a properly resourced and targeted rural workforce that serves the needs of patients and the community.

If we don’t get this right, and soon, we are doing a disservice to the rural and regional communities whose health and wellness depends on these pharmacists.

Anthony Tassone is President of the Victorian Branch of the Pharmacy Guild of Australia and a National Councillor of the Guild.

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12 Comments

  1. GlassCeiling
    15/05/2018

    Want to attract pharmacists to rural locations ??

    I am afraid the Guild cannot ignore their role in creating and maintaining the rural pharmacist shortage and at the same time expect to hinder role innovation outside the Guild managed community pharmacy network . The Guild have had decades to recommend and lobby for changes / funding to solve the current and impending rural shortage. Profit over people has led us here and the Guild will never be the people to fix the problem.

    Want to know why pharmacists won’t go rural ?? The Guild support the woeful and insulting award rates of pay that anchor all community pharmacy wages . $45 an hour to work rural / remote ?? Not worth the country change.

    If investor pharmacists didn’t own the single pharmacy location rule rural stores you would find dedicated owner / operators would move to the country. Visiting the country twice a year to check on an investment whilst enticing employee pharmacists with an oh so generous above award $100000 wage ( approx $45 / hr) to build your assett does not inspire rural service from the masses.

    Pay people properly and give them the opportunity to own the business . Then they will ‘ go rural ‘.

    In the meantime get out of the way of professional progress Anthony. Support a 30% rise in the award wage as a minimum as well as location rule relaxation/ removal and/ or reduce pecuniary interest numbers and maybe rural community pharmacy will be enticing.

    Pharmacy is lumped in with ‘ allied health ‘ because the retail focus of community pharmacy precludes us from having a serious plan. Perhaps we can arrange Telehealth consults between the homeopathy and Darrell Lea stands?

  2. Greg Kyle
    16/05/2018

    Let’s have a brief history lesson here:
    – 20 (odd) years ago, the guild were supporting the need for more pharmacy schools and graduates because there was a “shortage” of pharmacists in their future modelling. In other words, guild members were stuck on the demand side of the locum market and were “forced” to pay higher wages. The guild solution was to increase graduates to flood the market and thereby reduce the wages their members were paying in an employee market.
    – 10 (odd) years ago, the guild changed tack when they were trying to woo NAPSA and pharmacy students and their rhetoric changed to blame “evil universities” who were greedy for money and pumping out pharmacy graduates with no regard to whether they would get jobs. (Pharmacists telling school students this line led to reducing enrollments in pharmacy)
    – Now we have the same guild changing its rhetoric again saying there aren’t enough graduates and there are workforce shortages (albeit they are only talking about rural areas).

    They claim that pharmacists in rural areas will be attracted to GP Practice over community pharmacy. My question is what do guild members (ie. owners) offer to keep pharmacists in the retail sector? Graduates today want more clinical roles.. They do not want to be stuck in prescription dispensing factories with sales targets to meet, maximum time allocations to interact with patients, etc. If it is a choice between this existence and a career in direct patient care interacting in a professional environment, why wouldn’t they go into GP practice?

    The guild can’t just blame the government, they need to take a long hard look at what their members are offering and make it attractive to pharmacists to want to practice there. Welcome to the competitive marketplace where you (guild members) need to compete with other employer offerings. Unlike the competition provided by the HMR market, the guild cannot kill off the competition from the GP practice pharmacist model as easily since that funding comes from places OUTSIDE the guild-government agreement!

  3. Debbie Rigby
    16/05/2018

    Government funding on health services is directed towards high value services and consumer needs. The role of non-dispensing pharmacists in general practice is supported by a growing body of evidence and experience, both in Australia and overseas. The role has repeated been described as complementary to community pharmacy and collaborative with GPs. The role does not replace or usurp the role of community pharmacists. It fills the gap… And it does encompass non-patient facing roles ie GP education, quality improvement and clinical audit – leading to better clinical governance and patient care. And experience has shown it promotes the services of community pharmacies. This is all what is termed “high value” care. The return on investment for the Govt is significant.

    Pharmacists, young and not so young have welcomed this initiative announced in the budget, to commence July 2019. Job satisfaction and career advancement are critical to any worker. Different pharmacists will have different aspirations and what makes them professional proud of being a pharmacist. Different…not better or worse.

    I just read the Guild’s Forefront newsletter which talked about “changing customer and stakeholder needs and preferences” and the need for community pharmacy sector to be proactive to these changes. Being proactive should not mean limiting options. Looking to their preferred future, the Guild should reflect on their influence in creating the present. Please don’t hold back the profession, by trying to hold on to the past.

    There is no doubt there are concerns about community pharmacists wages, and yet the Guild argues the value of community pharmacists has not changed in recent times. New graduates have the skills and knowledge to meet the changing needs of an ageing people and increasing burden of chronic disease. Most older graduates are very committed to maintaining and growing their knowledge and skills through higher education and professional development. Community pharmacy can utilise those skills and knowledge, but so can other workplaces.

    If the same funding was directed to community pharmacies would this make a difference to pharmacists wanting to work in rural pharmacies? There already is funding – the Intern Incentive Allowance for Rural Pharmacies – Extension Program (IIARP-EP) supports the rural pharmacy workforce by enabling community pharmacies in rural areas to retain a newly registered pharmacist beyond the initial intern period.

    Non-dispensing pharmacists (practice pharmacists) will add value to patient care. They will add value to GP surgeries and GPs. And they will potentially add value to community pharmacy if a collaborative,
    non-competitive approach is shown. Non-dispensing pharmacists could also work part-time in a community pharmacy, thus positively impacting on the rural workforce shortage for pharmacists.

  4. Paige
    16/05/2018

    However, in the Guild’s view, the evidence presented by APESMA does not demonstrate the ‘significant net addition’ required in a work value proceedings nor has APESMA made the case for the inclusion of a new Accredited Pharmacist award classification

    • M M
      21/05/2018

      The guild submission sees Value as $$$ we as healthcare professionals define value as “Better health outcomes for our patients”

      The PGA approach is not patient centric but business centric. They are on a different track.

  5. Bryan Soh
    16/05/2018

    From my experience working in rural areas, there exists not just a shortage of pharmacists but almost all other health professionals as well. In several towns I have been to, rural doctors are under incredible pressure. Having pharmacists attached to GP clinics will ease their burden, and will only ever lead to better health outcomes for rural communities. Also, one can argue this is an evolutionary/or revolutionary change in a pharmacists role, which can work towards satisfying the revolutionary change criteria for a work value increase. Rather than greeting such wonderful progress with open arms, it is framed as working against the interests of pharmacy (owners). Again, the guild disappoints with its unsurprisingly blatant self-interests.

  6. Kevin Hayward
    16/05/2018

    Hopefully I can allay some of Mr Tassone’s fears.
    As a regional pharmacy owner in far flung rural area of the UK, I am only to well aware how difficult it was to get pharmacist cover.
    After having sold my community pharmacy business, and done a stint in education and research, it was the attraction of being a practice pharmacist coupled with community pharmacy practice that brought me back to working into the regional community pharmacy workforce.
    I would argue that practice pharmacist positions will attract talented and keen pharmacists to the regional and rural areas, offering them exciting new professional challenges,
    Far from diluting the rural workforce this paradigm of diverse portfolio working will enhance and strengthen the rural workforce.
    Many of my colleagues at the time, I am quite certain would not have been in the regional and rural community pharmacy workforce, if it were not for this exciting new professional paradigm.

  7. Anthony Tassone
    16/05/2018

    Thank you all for the comments on this forum (and thank you to all the direct messages I have received from rural based pharmacy proprietors over the past 24 hours).

    I think some comments on this forum, in their eagerness to criticise the Guild, may have missed the point of my piece and is to discuss prioritisation of public funds in addressing issues of rural health workforce.

    It was not to criticise the role of pharmacists in general practice or varied career pathways.

    It is simply to have a broad conversation of the rural health workforce challenges before us that are real, have been there for some time and are not showing evidence of improving. Particularly given the quantum of public tax payer funds being dedicated to this policy on grounds of improving the rural health workforce.

    Anthony Tassone
    President, Pharmacy Guild of Australia (Victoria Branch)

    • M M
      16/05/2018

      It’s not the position of the Guild to discuss prioritisation of public funds in addressing issues of rural workforce. The fund is not part of CPA.

      Pharmacists leave the profession at their mid 30s . We don’t have many pharmacy graduates like 10 or 8 years ago. And the guild won’t be able to deal with it this time..

      I am glad that pharmacists are well informed than ever before. They started to know how the industry works, what Guild and PSA are and how they work together.

      This article is epic from the marketing point of view. You have positioned PGA perfectly AT.

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