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 https://www2.health.vic.gov.au/primary-and-community-health/primary-care/pharmacy

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