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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