After hours services in community pharmacy

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How can community pharmacy help take pressure off after-hours services? asks Shane Jackson

The recently released draft consultation report by The MBS Review Taskforce’s after-hours working group is an opportunity for the community pharmacy network to highlight the community pharmacy sectors role in after-hours care, in an effort to reduce emergency department presentations and to reduce the explosion in claims for “urgent” after-hours MBS claims by medical practitioners.

The MBS Review Taskforce’s after-hours working group recently released a report outlining suggested changes to the MBS after hours rebates system for medical practitioners.

You would expect that after-hours Medicare GP-type services should have some impact on emergency department presentations, but on the contrary, data is showing after-hours home medical services are a burden on the health budget and don’t ease the strain on emergency departments as indicated in this recent study.

According to a report from the Australian Institute of Health and Welfare, emergency department presentations in all states increased between 2011/12 and 2015/16 by 2.7%. The report highlights that in the five years to June 2016, the number of urgent after-hours MBS services has increased by 150%, from 734,000 to 1,869,000 per financial year.

The MBS Review Taskforce’s after-hours working group report also criticises the deputising industry for the high rate of dubious urgent claims: “Many urgent after-hours services claimed as urgent are not truly urgent, as intended when the items were created, and the distinction between ‘urgent’ and ‘non-urgent’ appears to be not well understood by many medical practitioners.”

Whilst, community pharmacy is listed in the report as a pathway for seeking care in the after-hours period, community pharmacy is not systematically supported to deliver specific after-hours care program, and is not part of a strategic after-hours framework which builds on the capacity and expertise in this setting.

It is well known to the community pharmacy sector, that treating minor illness type presentations in the after-hours period is a common activity within the community pharmacy setting. Yet this role is often under-recognised, and with the recent report by the MBS Review Taskforce’s after-hours working group, the time is right to formally include community pharmacy as part of the supported after-Hours care programs either supported by the Commonwealth directly, through Primary Health Networks or State Departments of Health.

The Victorian State Government has already taken the first steps with some of these programs with their Supercare pharmacies initiative

Many Australians consult after hours GPs for minor, self-limiting conditions that could be appropriately managed in a pharmacy, freeing up general practitioners and emergency departments to manage the more serious and urgent cases.

Population groups that may benefit from the implementation of a structured program include individuals who present frequently to GP/A&E departments and after-hours services, individuals who frequently seek urgent care (particularly for minor, less complex or self-limiting conditions), individuals that need to see GPs but choose not to (based on geographical, economic, social or other reasons) and individuals that have difficulties accessing primary health care providers.

Pharmacists can triage individuals effectively and are ideally placed to ensure responsible self-medication. The delivery of self-care and minor ailment management is a key professional activity.

I am not suggesting that community pharmacists can take over after-hours care programs, but what we need to recognise is there is a proportion of consumer healthcare presentations that can adequately be dealt with by a community pharmacist in a community pharmacy. This premise is well supported in reports such as this from the Grattan institute

The pharmacy profession should work with consumer bodies, and medical profession organisations to understand what consumers expect from community pharmacy in the after-hours setting, what care is appropriate to deliver and how referral to up-stream providers can occur in this setting so that we can all achieve valuable care delivery from after-hours programs. Greater collaboration between GPs, pharmacists and consumers is essential to deliver consistency in patient management to benefit GPs, pharmacists and ultimately patients.

Community pharmacies could be supported in delivering after-hours care by organsiations such as the Primary Health Networks to deliver programs that are supported by accreditation, protocols, and robust referral pathways linking into established general practice that are targeted based on the needs assessments of the communities in which the community pharmacies are located.

Shane Jackson BPharm PhD MPS AACPA Adv.Pract.Pharm is a proprietor of two rural community pharmacies in Tasmania and a National Director of the PSA


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  1. Karalyn Huxhagen

    I spend a lot of time in ED and short stay units. I see many many cases of category 4-5 patients who could be dealt with in community pharmacy. for example elderly patients with constipation being referred by the deputising GP to the hospital for treatment of their constipation. I sit on a Health Pathways committee and have raised this issue so many times that I am the broken record at the meeting. When we had Primary healthcare committees under Medicare Locals it was a major part of my work. When we had District Health Councils it was a major part of my work.
    Resources were developed and are available. BUT when I raise it with the intake nurses at the hospital they tell me that they are abused by patients if they give out flyer for the after hours pharmacies and the deputising services.
    SO I then raised that we needed a patient education program of a national format to help patients understand what services community pharmacy , after hours GP clinics and deputising services can provide. Amazingly after a lot more pushing I was shown video clips that are available and had been developed by one PHN. I asked why this is not a national program and was told that this PHN is precious with their material.
    PHNS were developed to not be precious. They were developed so that we did not waste resources by each area developing their own material. Licencing issues and bickering over IP should be sorted at a national level and these programs deserve to be used nationally as they are excellent materials and we need to stop the inappropriate use of ED and short stay units.
    we need the walls of ED and short stay units to be adorned with primary health messages of where to go with your cold symptoms,constipation, headache of short duration, ant bite. We need the PHNs that have developed the video clips and booklets to be recognised and enabled to make their resources national resources funded on a national roll out.
    Why develop PHNs and make them into silos all over again?
    To be told that these resources have been available for over 18 months at a board level and never initiated or engaged made me so angry. Once again we have projects that never reach implementation stage on a national level. Hopefully the PHN that I live in will gain the ability to provide these materials to consumers. I work across thee PHNs so I will keep advocating for national roll out.
    PS The person that made PHN boundaries not align with Health and hospital service boundaries needs their toe nails removed and any other form of painful torture that I can deliver. It is impossible when you work as a contractor to work with the current system of boundaries. It drives those of us in primary health care insane.

  2. Jarrod McMaugh

    I think there needs to be a very large investment in public awareness for this to work effectively…. And if we look to the UK we can see how this can be implemented.

    I’ve just recently reduced my opening hours because it’s just not viable to stay open past a certain point of night…. And that’s with a late-night bulk-billing medical centre on the next floor above my pharmacy.

    Awareness is not the only area that will require investment… Pharmacists need to be given access to a MBS items as a demonstration that the government values the expertise and accessibility of pharmacists. That way when we see patients who don’t require a referral to an after hours GP or hospital, we can still be remunerated for our time and clinical role in taking the burden off the hospital system.

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