Pharmacists working in general practice: an opportunity to improve medication safety


doctor pharmacist collaboration consultation pharmacists in general practice GP

Pharmacists should be grabbing opportunities to positively impact on the health of patients with both hands, write Dr Shane Jackson and Dr Chris Freeman

Dr Shane Jackson, National President of PSA

Dr Chris Freeman, National Vice-President of PSA

I am pleased to write this opinion piece, along with Dr Chris Freeman, who has been a tireless advocate of pharmacists working within general practice. This week, after a long period of advocacy from the PSA, and other medical groups including the Australian Medical Association, the announcement in the 2018-19 Federal Budget of a new Workforce Incentive Program that aims to strengthen multidisciplinary primary care through supporting general practices to engage allied health professionals including non-dispensing pharmacists was welcomed by PSA.

We applaud the efforts of the Government in starting to address the fragmentation and siloing of Australian health care with initiatives such as the My Health Record System and policy shifts towards collaborative multidisciplinary care. The announcement of the Workforce Incentive Program will further facilitate clinically meaningful interaction between general practitioners and pharmacists including aiding transitions in care for consumers between general practice medical centres and the community pharmacy, residential aged care, and hospital pharmacy settings. The immersion of pharmacists into general practice medical centres as a key member of the medical team and as a conduit between settings is an approach supported by evidence, health consumers and the wider medical and pharmacy community.

There has been significant commentary about this announcement. We should view this positively, as key recognition of the skills, expertise and training of pharmacists and the contribution they can make to team based care. This recognition should not be at the expense of the recognition of the vital role of community pharmacy. The roles should be complementary, remembering that as health professionals we are all in the game of improving healthcare and health outcomes.

For PSA, this program is about increasing the ability of the pharmacist to be a central player wherever medicines are being considered. With at least 230,000 people being admitted to hospital each year because of medication misadventure and costing our healthcare system $1.2billion annually there is enough medication related misadventure for every pharmacist to have a major role in improving quality use of medicines. It is sobering to acknowledge that approximately two-thirds of the harms associated with medicine use are considered preventable and should provide both hope that this harm can be attenuated and inspiration for the Government to invest in this area of healthcare. It remains clear that innovation founded in evidence should guide investment to further translate the principles of the National Medicines Policy into practice.

In the last five years, two systematic reviews and one meta-analysis of the evidence have been published on the benefits achieved from integrating pharmacists into the general practice team. The results from this research demonstrate significant improvements for those consumers with chronic diseases such as diabetes, osteoporosis and cardiovascular disease. Further, individual studies have shown improvements in other outcomes including identification and reduction of medicine-related problems, process measures such as appropriateness of prescribing, and reduction in total number of medicines. There is also potential for other priorities such as assessment of the management of chronic disease according to best practice guidelines and the education and training of prescribers on new and emerging medications.

Internationally, there has been significant investment by governments to support the development and integration of pharmacists into the general practice setting. NHS England through the General Practice Forward View reforms to the sector have committed to invest over €140 million ($AU245 million) to support the employment of up to 2000 pharmacists within England by 2020. This funding is being utilised to support pharmacist recruitment and employment costs, provide education and training for pharmacists transitioning into this role, and for organisational development programmes to support the general practice setting to integrate the pharmacist into the team. Many other countries, including New Zealand, Canada, USA, and other parts of the UK also have pharmacists providing services in general practice settings.

To provide some details about the Workforce Incentive Program announcement, overall, there has been no significant increase in the budget allocation for this program. However, the inclusion of non-dispensing pharmacists to the list of eligible health professionals allows the general practice to decide what health professionals would be best suited to support activities within the practice. This approach gives flexibility to the general practice to allocate the practice incentive in a way which supports the practice team to deliver activities, based on patient needs, without an overall increase in the budget allocation.

Whilst we might have hoped for an increase in the capped budget allocation for this program, now that pharmacists are included, we nevertheless see this as a positive initial step in engaging pharmacists within the general practice team. Under this program, the overall capped budget allocation remains the same that was in place under the Practice Nurse Incentive Program of up to $125,000 per general practice per annum. We certainly would like to see either a protected allocation for pharmacists in general practice in the future or a rise in the overall funding limit for the Workforce Incentive Program. There will be a rural loading allocated to general practices in acknowledgement of the higher costs of sourcing health professionals in rural Australia.

It is understandable that at a time of exceptional pressure on the viability of the community pharmacy sector, that the development of roles for pharmacists outside of the community pharmacy setting are perceived as potential threats. Soon to be published research reveals that investing in pharmacist integration into general practice may improve the uptake of professional services conducted in the community pharmacy setting as well as improving the rapport and collaboration between general practices and pharmacies. The data reports at least 42 pharmacists currently working within the Australian general practice setting with nearly two-thirds of those pharmacists actively referring consumers to their community pharmacy of choice for professional pharmacist services. This has occurred organically without any framework guiding the pharmacist in general practice collaboration with the community pharmacy, a figure that will increase with a targeted framework being developed by PSA.

PSA looks forward to working with the Government, medical colleagues, and other pharmacy bodies, on the training, credentialing and standards of practice for pharmacists working in these practices; and ensuring these complement and align with the range of professional programs provided through community pharmacy. We see the pharmacist working within general practice as facilitating uptake and delivery of pharmacy programs.

We see the pharmacist working in general practice as the glue that is going to bring relationships between community pharmacy and general practice even closer. There is no reason that community pharmacists through joint employment arrangements can’t be the individuals who provide these activities within general practice. It is likely to strengthen workforce capacity especially in rural Australia.

After the Federal Budget announcement of the Workforce Incentive Program, PSA has written to the Medicare Benefits Schedule (MBS) Review Taskforce again calling for inclusion of pharmacists as eligible allied health professionals to access MBS items as part of Team Care Arrangements within Chronic Disease Management (CDM) items.

Pharmacists are currently the only AHPRA registered allied health professional who are not eligible to provide allied health services through the CDM services. Given the central role of medicines in the care and treatment of patients with chronic medical conditions and complex care needs, this exclusion doesn’t make sense with the potential for sub-optimal health outcomes as a result. Inclusion of pharmacists (irrespective of setting) as eligible allied health professionals would enable greater flexibility for the GP to decide which allied health skill set would best help the patient with their chronic disease management.

As a profession we should be grabbing opportunities such as these to positively impact on the health of patients with both hands, making sure that we make the most out of them. PSA is committed to ensuring pharmacists are central to quality use of medicines in Australia.

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3 Comments

  1. Tim Hewitt
    18/05/2018

    Accredited pharmacists currently invest a huge amount of their own time and money to become and remain AACP accredited to conduct Home Medicines Reviews (and RMMR), arguably the ‘gold standard’ in patient centered mediation management. Where does HMR fit into this GP/ Pharmacist model? The article infers that specialised training will be required for a GP pharmacist, and that the training should be Government funded. How would such training differ from HMR training?.. and is it fair that HMR pharmacists have to fund their own training, but it seems that GP pharmacist training will be funded by the Government? Will GP pharmacists require specialist accreditation as HMR pharmacists do, and if not, why not?
    It has been suggested that HMR will work along with, or alongside GP Pharmacy, but I just don’t see GP’s referring patients for HMR, when they have ‘their own’ in-house pharmacists sitting down the corridor, carrying out a similar role. I don’t see the Government happily funding an HMR for a patient AND at GP Pharmacist consult, neither do I see a GP pharmacist referring patients for HMR.
    Remember, GP pharmacy was born out of HMR’s being conducted within general practices.. and all the political ramifications that flowed from that and which HMR pharmacists are still dealing with.
    PSA,.. Don’t abandon HMR pharmacists and please always include some info as to how HMR fits the GP?Rx model when you write these articles which spruik the wonder of the GP pharmacist model.. if only there was such fervour for HMR!!

  2. Jenny Gowan
    18/05/2018

    Excellent points Tim! I have worked in a GP practice for over 10 years as an HMR pharmacist. Reviews were mainly done in the home but where appropriate at the clinic until the rules changed. As it is a Community Health Centre in a low socio-economic areas with a high multicultural clientele,and a high percentage of drug & alcohol conditions the clinic visit was very useful as a first visit. Interpreters are also readily available . I receive weekly referrals from the clinic with the appointments already made by the practice staff for my day at the Centre.

    I have still maintained my presence in the clinic after the home visits and write the reports there and am available for multiple questions from Drs and other staff. Funding for this has come from the HMR work however this role has expanded to work with Chronic Disease groups, provide education to GPs, dentists, physios, mental health staff, podiatrists and sit on a number of Safety and Quality committees all of which has been funded by the Centre. Every 6 weeks a falls management group is run for 5-10 clients by the physios and I have a one hour session discussing medication issues , and encouraging HMRs. This week we have now started chronic pain management groups initiated by myself and the physios – 2 visits a week for 8 weeks for a gold coin donation!! Again the pharmacist funded by the state funded Centre. I am excited by the new funding which will allow expansion of this very vital role in general practice

    I would like to see the GP /Pharmacist model building on the HMR model rather than attempting to work alongside a pharmacist who was not accredited to do home medicines reviews. The Practice nurses have a similar model where they see patients and also do home visits.

    Let’s make it work but build on the very experienced accredited HMR /RMMR pharmacists not abandon them! These pharmacists have been trail blazers and are passionate about their work! It is more than a job!

  3. Kevin Hayward
    20/05/2018

    With an active interest in adult education, and having been on the receiving end of a Practice Support Pharmacist training program myself, I am keen to see what will be proposed for the training and assessment element.

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