Don’t forget the bush


remote rural regional Australian animals sign

Rural pharmacy, and rural health in general, are being ignored in the current federal election campaign, says Fredrik Hellqvist

Community pharmacies are critical frontline healthcare professionals which daily help to address the problems of access to health services experienced by some 7 million Australians living in regional, rural and remote areas.

The services these community pharmacies provide are pivotal to the ongoing health and wellbeing of the people living in these communities.

But as a rural pharmacist, what I am very keenly aware of is the lack of focus on this sector during the current election campaign where the needs of this sector appear either lost or relegated to the back burner. This ‘out of sight, out of mind’ approach is simply not good enough, and patients in regional, rural and remote areas will suffer in the long term.

Community pharmacies in these areas face challenges and hurdles which are often unique; not the least of which being the continuing battle to attract staff to these areas.

Such workforce shortages and workforce distribution inequities come on top of the problems we pharmacists in these areas face in accessing appropriately funded training and services. These issues compound the challenges I and other similarly placed community pharmacy colleagues have in providing services to a population with high rates of chronic disease, lower health literacy and socioeconomic status – all of which require more time to be spent with patients to ensure quality health outcomes.

But to continue to be able to meet the needs of our patients and to help them to achieve equity of access to culturally safe primary healthcare services in rural, regional and remote Australia this sector needs urgent attention in a number of critical areas.

There are myriad issues that need to be addressed to improve services and access for regional, rural and remote patients but in the space available I have listed only a few below. However, I impress on those from all sides of politics the need to examine the issues below and act on them.

Keeping the sector healthy

Greater access to medicines and professional pharmacist services for residents in regional, rural and remote areas can only be achieved through the provision of funding to enable community pharmacies in these areas to employ a second pharmacist who can provide primary healthcare services and medicine management activities. In some regions we see flexibility being built into this role so that this additional pharmacist may be shared amongst other pharmacies in surrounding communities.

The sector also needs a community pharmacist specific workforce incentive which will go a long way in helping to attract experienced pharmacists to work in regional, rural and remote regions. Such an incentive could include relocation assistance, travel allowance and a rural loading based on remoteness.

The sector also needs to see focussed and urgent action to better support access to essential medicines in emergencies through expanded State and Territory emergency supply and Commonwealth continued dispensing arrangements. We have seen a spate of natural emergencies in recent times and the access to emergency medicines has become a matter of priority for residents affected by these floods and bushfires.

Is the connection there?

Telehealth offers great opportunities to provide better services to people in isolated or very remote areas and to grow this capacity I see a need for capital grants to implement this telehealth technology infrastructure in rural pharmacies.  

Expanding telehealth also provides scope to better support inter-professional collaboration and community to access doctors, specialists, and pre and post tertiary hospital assessment and education.

To further grow this area of great potential, telehealth services must be included as Medicare items which will help improve equitable access and reduce financial barriers for patients who live in towns where there is no GP available (or after hours GP services are not available).

Workforce incentives

A number of incentives would also help to address the workforce issues and one of these is a HECS/HELP reimbursement scheme for pharmacy graduates who undertake their intern placement and remain working in rural and remote locations in the immediate post-intern year.

Another strategy is to provide funding to universities for a 25 per cent quota of Commonwealth Supported Places (CSP) for pharmacy students from rural and regional Australia.

Yet another initiative that I urge be considered is equitable access to funding opportunities for student placements as part of the University Departments of Rural Health (UDRH), with support to the community pharmacies that factors in the time cost to single pharmacist community pharmacies providing student placements in remote areas.

Application fees act as a disincentive for employers seeking to sponsor overseas pharmacists on temporary skill shortage (TSS) visas if the domestic market cannot meet the recruitment need.  Waiver of these application fees would be a very positive step and would likely have a negligible overall budget impact.

Cultural education and mentoring

The need for cultural education and mentoring is particularly important for community pharmacies in regional, rural and remote areas.

To facilitate such mentoring I urge that seed funding be provided to develop a community pharmacy specific, cultural education and locally based cultural mentoring program. This program would be directed to enhancing access and the quality use of medicines for Aboriginal and Torres Strait Islander people in Australia.

In addition, an enhanced community pharmacy medicines enablement program needs to be developed for all patients of remote Aboriginal Health Services across Australia, funded directly to community pharmacy through an expanded Section 100 RAAHS Support Allowance program.

*’Fredrik Hellqvist is a member of the Community Pharmacies for Rural and Indigenous Australia (CPRIA) and one of the founders of the Rural Pharmacy Network Australia

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