Making change work to benefit our profession

Joe Demarte, PSA national president

Healthcare reform is well and truly underway in Australia and will continue over the coming years, says Joe Demarte 

In the face of this, our profession needs to ensure that it embraces change and is not left lagging behind and refusing to evolve. Saying ‘stop we are not ready’ or ‘it doesn’t suit’ is not an option.

The pharmacist in GP practice model is a case in point. It represents a new practice model for our profession and is already underway both here and overseas.

It is not a matter of stopping it happening. It has the proven potential to provide better patient outcomes, professionally rewarding work and greater professional collaboration. Why would anyone consider stopping it?

Rather, it is a matter of ensuring that whatever model is finally adopted in Australia the profession gets the model it wants after having debated and resolved any issues to best effect, and the public gets the model that gives it the best health outcomes.

It is natural to be wary of, or perhaps even fearful of the unknown and change is always full of unknowns. I know that many are genuinely concerned that this model will have a variety of deleterious consequences for community pharmacy.

However, this model is currently being practised in New Zealand, Canada, the US and the UK and it has not led to the collapse of community pharmacy in these countries.

Best evidence to hand suggests that rather than diminish the value of community pharmacy in patient care, in fact community pharmacy’s role has been enhanced.

Yes there may be some crossover and duplication of services but this is offset by new referrals generated by the GP pharmacist, further collaboration between the pharmacy and the medical centre and a deeper involvement in clinical practice.

We already have crossover of services with hospital pharmacy and this has not resulted in community pharmacy losing its ability to provide professional input for patients.

Indeed hospital pharmacists and community pharmacists collaborate quite well to get a better outcome for the patient and this can only be a good thing.

PSA expects that based on international and local experience, some of the benefits that we would expect to see include:

  • Increased uptake of 6CPA-funded services in local community pharmacies e.g. MedsChecks, DAAs and HMRs, as the practice pharmacist raises awareness of, and creates referral pathways for these services.
  • Increased medication adherence and new medications dispensed through community pharmacies for prevention and management of chronic disease. This is enabled through the practice pharmacist identifying at-risk patients.
  • Increased referral and communication between local GP surgeries and pharmacies – for services not provided by practice pharmacists (e.g. for minor ailments etc).

Of course there are other sticking points. The payment model appears to be one of these. Many potential models of payment could be considered but the payment model has not yet been determined and suggestions otherwise are wrong.

PSA’s preferred payment model would involve pharmacists being paid directly from the MBS for services provided as are all other healthcare professionals – except our profession. This is an obvious advantage that we do not currently enjoy.

As I have said in previous articles, PSA must necessarily take the broader view and support proposals that are in the interests of the overall profession. The pharmacist in GP practices model carefully planned and managed to balance the views and concerns of the whole profession would be another rewarding area of practice that would benefit the broader profession and importantly, patients – and as I have also stated previously on many occasions, our future as a profession is inexorably linked with the patient outcomes we are able to generate.

PSA welcomes debate in order to get the best overall result possible. This project is too important to be allowed to develop into another divisive them and us situation like the HMR debacle of pharmacy owner versus accredited pharmacist.

This was damaging to all of us.

Finally, PSA has no intention to divest community pharmacy of its professional input. To the contrary, PSA is totally committed to a stronger commercially viable community pharmacy model based on healthcare. Our Health Destination Model and the financial commitment we have made to it should bear testament to this.

At present many in the profession are forming their views based on emotion rather than evidence, working on fears and opinions rather than facts. It would be better to have more knowledge and to fill in any gaps in evidence.

A trial should be funded to establish this and to test any impacts.

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