Pharmacy teetering on the edge

New challenges are facing rural and regional pharmacists, writes Karalyn Huxhagen… due to changes to funding

The recent change from Pharia modelling to the Modified Monash Modelling has sent waves of despair through Pharia 5 and 6 community pharmacies.

Pharmacies located in extremely remote areas of Australia (Pharia 5 and 6) are suddenly worse off under the Modified Monash model while pharmacies located in areas where access to services are relatively good (MMM3) are receiving a payment from the Rural Pharmacy Maintenance Allowance (RPMA) scheme.

There are many owners and employee pharmacists asking: how did this occur? Were the negotiators asleep at the wheel when this part of the 7CPA was bartered or was this a trade off for another gain? Did the negotiators have faulty research to inform them of the impact of changing to the Modified Monash Model?

The ripple effect of the loss of these RPMA payments to remote pharmacies are many and varied:

  • Reduction in opening hours and pharmacy staff levels.
  • Reduction in services and good supplied e.g. not able to be the buffer for programs such as Hepatitis C programs.
  • Reduction in holidays and time off as reduced ability to afford locum costs.
  • Increased anxiety, stress, and poorer work-lifestyle balance due to lack of income.
  • Poorer mental health and coping ability of pharmacist owners in these locations.
  • Locum pharmacists and technicians will have reduced employment opportunities.

Why did this loss occur? How can it be rectified? Who should negotiate a fairer outcome?

These are all questions being asked by owners and Rural Pharmacy Network Australia (RPNA).

Currently the two peak bodies representing Australian Pharmacy – Pharmacy Guild of Australia and Pharmaceutical Society of Australia have made only simple statements. No absolute reasons for the significant impact and how these will be managed to offset the effect of viability of pharmacies that have been adversely affected have been forthcoming.

This week we saw the federal government stating regional Australians will not be disadvantaged in the rollout of COVID vaccinations. Community pharmacy will be expected to stand up and contribute to the roll out in these areas as we enter Phase 2.

How does a tired/overworked/under remunerated business owner add another role to their day when they have just lost $7500 or more off their bottom line and so cut back on staff and/or opening hours to compensate?

The Australian Government appears to consider pharmacy as a large spongy organism that will keep absorbing and taking on more and more roles with very little nourishment to keep the sponge alive. I see us as a huge rubber band that is teetering on the edge of its elasticity capacity.

In most of the communities classified as Pharia 5 and 6 there is already a reduction in so many services that a viable community requires:

  • Banking
  • Post offices
  • Grocery lines
  • Doctors and allied health support services
  • Community services e.g. community nursing, health and community care, meals on wheels
  • Essential services such as firefighters, ambulance, and police
  • Spiritual support

The pharmacy is at the centre of these small communities and often becomes the hub absorbing services such as Australia Post, Banking, Dry Cleaning, telehealth hub to name a few. The pharmacy is the drop off point for parcels ranging from sheep dip to Land Rover parts! Some pharmacies even use boats and aircraft to reach remote locations e.g. Thursday Island, Weipa in Queensland.

These pharmacies do sell more than a regular pharmacy located in inner Sydney because at times there is just the pharmacy, butcher, and a local grocer. You are the source of everything!

I have worked in these towns where you are part of the ‘health team’. You are expected to close the pharmacy and provide services to the local hospital with a medication round or fly out to service an outlying bush hospitals medicine chest so the local nurse or Aboriginal Health worker can supply medications via the Flying Doctor ‘Primary Care Clinical Manual’ when a situation arises in their community.

Catholic Social Services Australia commissioned research to look at an expanded list of variables to determine disadvantage of Australians. They expanded their research parameters to look at health, education, social and economic domains.

They looked at the ‘persistence’ of disadvantage. For example, if the community has been exposed to years of drought, several years of bushfire or other forces of nature.

Their findings showed that Australia has a significant mass of disadvantaged communities and this is affecting areas such as education of our children, health of our communities and our ability to economically stimulate growth in the community.

If we remove funding models from the pharmacies in these communities, the resilience of the community will be affected. The Australian government has a responsibility to keep all Australians supported to be able to access quality in education, health, and community services. These communities do not want a drive through community health service that passes through every twelve months. Your health does not deteriorate to the schedule of the cardiac bus’s next visit!

As community pharmacy absorbs another initiative supported by very little financial or valuable support material, we ask all levels of pharmacy organisations to consider how do we lead the way to improve the regional and rural and remote communities access to a fairer advantage. This advantage must be across education, health, social and economic domains as a community will not survive without all of these domains.

The rubber band that holds the community pharmacy together as an economically viable entity in regional and rural Australia is at breaking point. The 7CPA has not brought us the promises that we rely upon to keep our communities supported.

Karalyn Huxhagen is a community, consultant and locum  pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management. Karalyn currently has many roles within the Health and Hospital Services and Primary Health Network sector in Queensland.

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