If it ain’t broken…

The King Review discussion paper poses no fewer than 140 questions about virtually every aspect of Australia’s community pharmacy model, says George Tambassis.

But it omitted one key question: should we take a system that is working well for consumers and taxpayers and dismantle it for the sake of an economic theory?

It won’t surprise people to know that the Pharmacy Guild’s answer to this question – let’s call it question 141 – is a resounding ‘no’.

Certainly, we oppose deregulation of the pharmacy sector for a range of evidence-based reasons – based not only on the best interests of our members who are the owners of community pharmacies and their hard-working staff, but also the best interests of Australian health care consumers.

But while we oppose untested, ideologically-driven deregulation which will only put a tried and tested system at risk, we do not oppose reform. We believe in building on the strengths of the current model of community pharmacy which is so well-regarded by Australian health care consumers. As Australia’s most accessible health care professionals, community pharmacists are well placed to broaden their services and add even more value to the health system.

That’s why we have been pleased to assist the King Review in its round of industry and stakeholder consultation since it began its work in 2015. We urge our member pharmacists to tell the Review panel their stories about the health services, support and advice they provide for patients, often seven days a week.

The broadening of pharmacist services is happening in comparable countries all around the world; and it must happen here.  It is part of the momentum that now sees pharmacists legally authorised to administer flu vaccinations in every Australian State and Territory – a real step forward for patients.

The King Review discussion paper poses many thought-provoking and complex questions – such as: how many pharmacies do we need; how should they be paid for dispensing PBS medicines; is the link between professional advice and the sale of medicines appropriate; do we need Location Rules; what is the most efficient way to distribute medicines across our vast continent?  And most importantly: what do consumers expect from their community pharmacy in relation to the safe and high quality dispensing of their medicines – and are pharmacies generally meeting these expectations?

To its credit the Panel’s discussion paper does not revert to the usual arguments in relation to pharmacy regulation. On Location Rules, it helpfully sets out why the rules were introduced by the Government in 1991. An inquiry in 1988 had found that there was a marked inconsistency in the location of pharmacies supplying PBS medicines. In urban areas, they were clustered; patients in regional and rural areas were not so well served.

Any objective assessment of the impact of Location Rules since 1991 would find that they have worked a treat to fulfil the Government’s aim – an efficient geographical distribution of pharmacies that provides a high level of access and choice for consumers – including in rural and regional areas – while avoiding costly and unnecessary duplication.

A recent national geo-spatial analysis conducted for the Guild  by MacroPlan Dimasis found that pharmacies today are more accessible and provide more choice than supermarkets, banks and medical centres, including for the elderly (less mobile) and low socio-economic communities.

Time and again, consumer surveys find that the customer satisfaction ratings of pharmacies exceed 90 per cent.  Pharmacists are always in the top tier of most trusted professions.

As part of its submission to the Harper Competition Policy Review, the Guild commissioned the Institute for Choice at the University of Adelaide to undertake a qualitative survey of consumer preferences for community pharmacy relative to alternative models of service delivery.

This analysis confirmed that 89 per cent of consumers trust their local pharmacists very highly or completely.  Two-thirds of respondents supported the principle that professionals like pharmacists should own the businesses they work in.  There was a stark contrast between pharmacies and supermarkets in terms of trust, quality of service and managing patients’ health information.

The ownership rules – which are the terrain of State and Territory Governments, and therefore not part of this review – ensure that pharmacies maintain a strong health focus, putting patients before shareholder profits.

The Guild will be making a considered and constructive response to the many questions in the discussion paper. No doubt our individual members, other stakeholders and consumers will also be providing robust feedback.  

Constructive reform will always be welcome and necessary. But unless and until a better alternative has been specified, properly tested and proven to be demonstrably superior, it would be irresponsible to jettison a pharmacy model which has clearly demonstrated its merit.

To paraphrase question 141: Why would you dismantle a good system that achieves its objectives, just to blindly follow an economic theory?

George Tambassis is national president of the Pharmacy Guild of Australia

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  1. pagophilus

    “If it aint broken…” isn’t an argument in this case. The system IS broken. It’s hanging together, but it is broken. It needs fixing, and people without vested interests need to be involved in finding solutions.

    • Russell Smith

      To what are you referring re “the system IS broken” ?
      The rational supply of medication to the majority of the populace at a reasonable price with reasonable promptness – and with professional care, is NOT broken.
      You may well question the short sighted motives of the feds who continually chip away at remuneration with little care for the consequences. You may well question the apparent rorting of ownership rules. You may well question the concentration of market power that a number of groups have acquired. You may well question the gross over production of graduates. You may well question the imposition of pathetic pay rates for pharmacists and staff. You may well question the Guild’s motives. Better, you and we should question why “we” as a profession are subject to an apparent and never ending circus of enquiries at vast cost to all parties.
      My answer to the very last is that not only are there planty of ppl out there who havent yet run out of ppl to annoy, and that if a pack of accountants, academics or assorted do-gooders can get paid to do us over again, they will.

      There are lots of ppl out there who are jealous of us – and they are intent on breaking whatever they can

  2. United we stand

    AJP please run a poll on whether Pharmacists want things to stay the same or want to see a complete overhaul. It’d be interesting to see the results. I have a feelig majority couldn’t care less about keeping things the same.

  3. Kevin Hayward

    Regarding question 141 – Forgive my if I have misinterpreted Mr Tambasis, but from a corporate governance and management perspective ( for my sins I teach this stuff) it would seem a poor risk management choice to suggest that any system would not benefit from re evaluation and change management. In the industrial revolution the Luddite movement bears testimony to a failure to adapt and survive.

  4. Travis

    King won’t be happy until pharmacy is all warehouse / supermarket based, with medicines and pharmacists costing nothing. But at that point, why would anyone with good school grades, be stupid enough to sign up to do pharmacy? If at best you will be replying ‘Sir, yes sir.’ for minimum wages, if you can get even that, why not study something that pays more than the poverty line? eg just about anything. King should be CALLED OUT for his real intention – to de-professionalise pharmacy, and have medicines legally dispensed by an unqualified or semi-qualified pharmacy assistant, or dispensed and handed out by a machine – and too bad if the patient needs advice from a real pharmacist, or can’t make it to a warehouse distribution centre. Se Mr King can keep his 141 questions – I have one for Mr King – what is your HIDDEN AGENDA?

  5. Paige

    Widespread mistreatment of staff.. The system definitely is broken. Deregulation needs to happen ASAP to improve working conditions of employee pharmacists and assistants.

    • Ray

      You are deluding yourself. When I was in Britain, I worked in pharmacies inside supermarkets, and the same were also owned by supermarket chains. The store manager considered himself above all the pharmacists, despite usually having left school at 15 years with no further education. They always saw the pharmacists as being a problem, because the pharmacists had weird, ‘anti-team’ ideas of ethics and professionalism ie the pharmacist might actually REFUSE A SALE if the pharmacist felt the medicine wanted by the customer was inappropriate. The store manager never missed a chance to vent the chip on both shoulders at those troublesome pharmacists. The same applied almost as much to the attitude to the pharmacy assistants. So expect the status of pharmacy employees to be distinctly lower, if supermarkets ever take over.

  6. Harriet Wright

    I am sad to read the comments below. As a proprietor of a small independent rural pharmacy I feel strongly that certainly in my town, the system works really well. I feel the frustration of many that supermarket-type models are taking over and I do feel that the Guild isn’t working hard to contain that take-over and thus, having to deal with a public who see pharmacy as nothing more than a supermarket. But that’s a whole ‘nother debate.
    I am really sad to see employees who feel mistreated. I care about my employees (maybe because I only have 5?) and work hard to ensure that they are happy, trained and well-paid. Also, it might be possible that the movement of pharmacy into deregulated retail industry may actually increase your dissatisfaction, not solve it?
    Anyway, I don’t always agree with the Guild, but this time I really do feel that the current pharmacy model works. It is up to us, the proprietors, to promote and expand the model we have without turning it into a mainstream retail environment. When we do that, we can’t blame the patients or the government for questioning it.

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