Wielding the sledgehammer

With community pharmacy showing its worth in the bushfire disaster and being asked to step up during the ongoing coronavirus pandemic, why is the government willing to risk the network, asks John Bronger 

As a community pharmacist of many years’ standing, I look at recent developments relating to the profession with dismay. Dismay for the profession, and dismay for the patients we serve.

Because what has become clear to me is that, in my opinion, there seems to be a concerted effort by the Federal Government, under the current Minister for Health, to dismantle what is regarded as a world-class model of community pharmacy.

And all of this at a time when community pharmacy has served its patients better and more broadly than at any time in its history, with drought, bushfires and other extreme weather events stretching pharmacy resources.

Proving our worth

Community pharmacies are the most accessible of all health professionals and for many patients are the first port of call in any health emergency or situation. They are also visited more often than other health professionals, which puts community pharmacists and their staff in a unique position to build relationships with patients and to observe their progress.

This has taken on a special significance with the drought, where many community pharmacies have been able to help identify patients suffering mental health issues arising from the effects of the prolonged dry. This has seen them talk to patients, be in a position to listen to and counsel them, and also to refer them for treatment when necessary.

What happens to these people if the dismantling of community pharmacy goes ahead? Not forgetting that in a number of rural and regional areas – those same areas most affected by drought – the pharmacist is the only health professional in the town or area.

The bushfire also highlighted just how critical the current model is to the wellbeing of patients. And also just how effective it is and how pharmacists are among the first to go the extra mile to help patients.

Some examples highlight this point:

  • Having been forced to evacuate their premises, staff at one NSW South Coast pharmacy shuttled between the pharmacy and the evacuation centre to get the medicines needed until they ran out of petrol – only to secure the loan of another vehicle and resume their work.
  • One pharmacist ran supplies out to a yacht on a jet ski and the yacht then sailed around the bushfires to a bay where evacuees were gathered.
  • Other pharmacy staff packed dose administration aids by phone torch light.
  • Pharmacy staff helped to organise the logistics when a Blackhawk helicopter was used to ferry urgent pharmacy supplies into towns for patients who had lost their medicines or left them behind in the haste to evacuate.
  • One pharmacist who lost his home, opened the next day without power because he knew his patients needed their medicines. He worked on an honour system because without power he had no way of collecting money or processing transfers. He even handed out free packets of Glucojel to lift the spirits of those affected.

And now we have COVID-19, which is again testing community pharmacies as they become the first place the public go to in search of advice – as well as masks and hand sanitisers. Pharmacies have risen to the occasion, providing advice and helping to reassure the public. They also are pivotal to any government emergency plan to deal with COVID-19 and stand ready to help in any way they can.

Wrecking the system

Yet against this backdrop we have this apparent determined effort to dismantle the model – at the same time as the model is recognised as being integral to the health and wellbeing of all Australians. And at a time it is indeed, being called on by the Government to help in emergencies. Does the left hand not know what the right hand is doing?

Let’s look at a couple of instances of the sledgehammers the Government is using or proposing to use to break down community pharmacy.

The first is 60-day dispensing, a policy which, under close examination, must fall into the category of ‘Poor Governance 101’. To begin with it was announced without any consultation and, on closer examination, without much thought as to its efficacy or consequences if implemented, with the big losers being the patients which the Government claims will be the big winners. Go figure!

What we do know is that, if implemented, some pharmacies will have to shut up shop, services will be cut and access limited. Services to the aged such as Dose Administration Aids and services to aged care facilities will be hit, and hit hard. The consequence of any reduction in the provision of DAAs because of government bloody-mindedness would be horrific. And it is the vulnerable who would suffer most. As for other services to aged care facilities; again it is the vulnerable and needy who would feel the pinch of poor policy. The minister and those advocating for this policy may not have family, relatives and friends in these facilities – but many voters do.

And this is without taking into account the fact that professional interaction between a patient and their health professional – the pharmacist – will be halved. At present some 250,000 Australians end up in hospital every year as a result of medication errors, inappropriate use, misadventure or drug interactions. And another 400,000 turn up to emergency departments. It is no stretch to say that if our ability to talk to and counsel patients is halved, these numbers will increase.

The other sledgehammer being wielded is the optional $1 discount which has recently been described as failed policy and flawed politics because all it does is disadvantage many patients and destroy one of the pillars of our health system, and that is that there should be universal access – regardless of who we are or where we live – to medicines under the PBS.

Only about 28 per cent of prescriptions are being discounted, which has created a situation where a consumer in a metropolitan area may well pay less than someone in rural or regional Australia for the same subsidised medicine. It also undermines the small business principles of community pharmacies, with large chains such as Chemist Warehouse able to absorb the discount while small operations, often with just an owner/pharmacist, are unable to match it.

The injustice and inequity of this policy has been highlighted by the Government’s own Pharmacy Remuneration and Regulation Review whose final report stated: “The $1 discount has not led to equitable outcomes for consumers …The Australian Government should abolish the $1 discount on the PBS patient co-payment.”

Yet despite all this evidence, the Minister pushes ahead against the stream like some King Canute fighting the tide. The motives behind this determination to ‘fix’ what isn’t broken are opaque at best and indecipherable at worst, with all public utterances mere obfuscations. This approach is fraught with dangers as history shows the voting public doesn’t take well to being treated with disdain.

It’s time the Government stopped its bullying approach to the profession of community pharmacy – a profession made up mainly of women – and started working with us to ensure our world-best system remains in place and grows and develops to meet the evolving needs of our population.

John Bronger is a former national president of the Pharmacy Guild of Australia and former NSW PSA branch president.

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