As George Tambassis said at the Pharmacy Guild Parliamentary Dinner, “it’s been a big year”. AJP takes a look back at 2018 in the world of pharmacy…
As is common after the silly season, January was all about pain: but this year was different, with the codeine upschedule looming and trouble – which largely didn’t happen – predicted.
Health Minister Greg Hunt announced a $20 million trial program to help people suffering chronic pain, to be run through community pharmacies – but the Chronic Pain MedsChecks would soon be delayed due to the need to meet Commonwealth Grants Rules and Guidelines, and would not commence until November. Doctors were unimpressed by the announcement, calling it a “slap in the face“.
As the last OTC codeine products flew off the shelves, causing out of stocks in many areas, consumers began to get angry. Media reports leading up to the ban might have caused stockpiling behaviour, myDNA suggested. And the TGA opened a consultation on options for a regulatory response to the potential misuse of S8 opioids.
We finally said goodbye to OTC low-dose codeine, as the upschedule to S4 took place… though not without a few bumps in the road. Consumers complained about lack of access to the new Prescription Only version, while pain stakeholder groups accused pharmacists of hiking up the price of the medicines (taking a pot shot at Pain MedsChecks while they were at it).
Guild Tasmanian branch president John Dowling said that “our members have had to put up with some of the flak” over the price change.
“Again, pharmacists get stuck in the middle over things that aren’t under our control, and we’re being blamed for it all,” he said. And Guild NSW president David Heffernan took to the airwaves to refute the claims and plead with the public not to take their anger out on pharmacists.
A Channel Nine story about methadone patients driving caused outrage among health professionals, with one saying that there is little direct evidence that pharmacotherapy treatment such as methadone has direct adverse effects on driving behaviour, and others slamming the stigmatising treatment of the story.
A report tabled in Victorian Parliament highlighted that misuse of pharmaceuticals is now the leading cause of drug-induced deaths in Australia, with benzos and opioids the most misused.
Codeine, unsurprisingly, remained in the headlines. A RMIT ABC Fact Check examined Minister Hunt’s claim that making codeine prescription-only would save 100 lives a year and found that there wasn’t good evidence to support it; but the TGA responded by reaffirming the claim. Meanwhile Tasmania moved to establish real time monitoring of drugs of concern.
Libertarian Senator David Leyonhjelm presented the findings of the inquiry into red tape, saying that “the pharmacy industry has far too great an influence on its own regulation” and complaining that reports into the sector tended to “disappear”.
The GP-pharmacist turf war concentrated mainly on vaccinations this month, as then AMA president Dr Michael Gannon highlighted its problems with vaccinations being offered before mid-late April, and telling many people to avoid pharmacy altogether for their flu jabs. Earlier, he’d complained that pharmacists were advertising the service at a time which might not be “clinically appropriate“, while the RACGP’s Bastian Seidel said that “urging patients to receive their flu vaccination too early in the year may put them at serious risk”.
Meanwhile Guild figures showed that half of Australian adults didn’t plan to be vaccinated against flu this year… though as it turned out, during flu season demand would surge mightily. As Shane Jackson pointed out, the key issue was vaccinating more people, not focusing on the timing.
Pharmacy also came under fire… again… for offering sick notes. Mainstream media commentary attacked Chemist Warehouse in particular for offering $20 absence from work certificates. The PSA pointed out that such notes are within pharmacy’s scope of practice.
There was controversy over how much pharmacists’ roles had changed as the Guild lodged a submission to the Fair Work Commission in response to a work value claim made by APESMA (now PPA) in which the Guild said there was no “‘significant net addition’ to the work of pharmacists. The SHPA’s Kristin Michaels responded by saying that “there is no question new pharmacy roles are emerging and core pharmacy roles are expanding in scope” and this needed to be recognised.
There would also be controversy throughout the year regarding pharmacists in GP clinics. In April, the PSA rolled out the Pharmacists in General Practice program, a new model of care that would see non-dispensing pharmacists in four GP surgeries. The AMA was also advocating the model this month.
The turf war bubbled away, with the RACGP’s Evan Ackermann claiming that pharmacy was just a “street shop where sales techniques are disguised and marketed as ‘health services’.” Anthony Tassone said it was “like Groundhog Day”.
In vaccination news, the Queensland Guild was granted Preferred Supplier status with the State Government for members to provide flu vaccinations to employees at several State Government Departments; and pharmacists were reminded of the strict controls around their advertising. And all state and territory Health Ministers committed to achieving a national solution on real time prescription monitoring.
Australia’s first pill testing trial went ahead at the Canberra stage of the Groovin the Moo music festival… and uncovered several deadly substances. It was hailed as a success by harm minimisation stakeholders.
The Commonwealth Games began, with a team of pharmacists staffing the specialist sports pharmacy at the Commonwealth Games village; and pharmacist runner Madeline Hills and her teammates Celia Sullohern and Eloise Wellings winning some hearts by being good sports towards a competitor.
Two former OTC codeine products went into shortage… the first of several. Some codeine products would come out of shortage in July… but only some. The EpiPen shortage rolled on, too, as a plan to ship in Emerade to help did not pan out.
And we ran our most-clicked story of the year, announcing the theme of this year’s World Pharmacists Day in September: “Pharmacists are your medicines experts”.
Thanks to the Commonwealth Games, the APP conference was moved to May this year, so we had to wait a little longer to hear that Southcity Pharmacy Wagga Wagga was this year’s Pharmacy of the Year. The Professional Innovation award went to the Gerald Burns Pharmacy while Friendlies Pharmacy Busselton took home the Business Management award,
The sector let out its collective breath as Greg Hunt outlined the Turnbull Government’s response to the King Review, by “noting” most recommendations and rejecting the proposal of generic medicines tendering. However, it accepted a few proposals, including that it investigate alternative payment arrangements for supplying high-cost PBS medicines. And pharmacies aren’t going to be replaced by vending machines any time soon, he said.
At APP we also heard George Tambassis back the National Pharmaceutical Services Association in calling for PBS listing of medicines to be conditional on supply through CSO wholesalers; there was uneasiness about Amazon’s plans for the future, with one presenter saying it could “damage sectors and destroy jobs;” and Shane Jackson foresaw pharmacist prescribing by 2020.
This was prescient given an inquiry into the pharmacy sector announced in Queensland, would be charged this month with examining this as well as ownership laws and the establishment of a Pharmacy Council. Following the announcement, the RACGP said claims pharmacists could help free up GP time were “ludicrous” and that pharmacist prescribing would put patients at risk.
The Government handed down its Budget, in which the headline event for pharmacy was major change in the way Government would pay for high-cost PBS medicines: a gradual reduction to most rebates previously paid to the Government by manufacturers.
In April and May, the number of flu vaccinations administered in pharmacy nearly doubled, according to MedAdvisor… good reason to include pharmacy in the National Immunisation Program, said the Guild. Even outgoing AMA president Dr Michael Gannon very grudgingly admitted that pharmacist flu vaccinations were “better than nothing“. Uptake of flu vaccination was so high that some states began to ration doses by May.
In sad news, a coroner recommended laxatives be upscheduled to Pharmacist Only, after an Adelaide woman died following abuse of the medications. Laxatives require pharmacist advice, the coroner noted. Another inquest – a joint proceeding looking into the deaths of four people who had doctor shopped to obtain drugs of concern – highlighted the urgent need for real-time monitoring.
PSA announced the launch of tailored workforce training, and that the Chemist Warehouse Group would be the first national pharmacy group to implement it – an announcement which attracted a certain amount of criticism amongst AJP readers.
The Federal Government moved to protect pharmacy gambling revenue. One of our most popular articles this year looked at Chemist Warehouse’s marketing strategy, after the brand was featured on Gruen… and described as “more media empire than chemist“.
And the Victorian Pharmacy Authority reported some good news: following the codeine upschedule, there had been little of the expected patient backlash about its availability… only about its price.
The Government wrote to the top 20% of opioid-prescribing doctors in a bid to crack down on opioid over-prescribing… and warned them that 70% of all fatal opioid overdose deaths were due to prescription opioids. In codeine news, pharmacists, manufacturers and wholesalers were cleared by the ACCC after being accused of raising the prices of low-dose codeine following the upschedule.
Medici’s Frank Sirianni warned that talented pharmacists are leaving the profession due to poor pay; also in June, pharmacists and supporters criticised the new award minimum rates announced this month, saying employee pharmacists deserve more money. And NPSA Chairman Mark Hooper kept the discussion about the supply chain going, warning that some current supply arrangements are undermining the CSO’s structure.
While Australian legislation prevents Amazon from owning pharmacies in Australia, eyes still turned to the US as the online giant snapped up PillPack, which has pharmacy licences in all 50 states of the US. At this stage, it’s still just wait-and-see as to what they do with it.
An era ended at NPS MedicineWise, as former hospital pharmacist Dr Lynn Weekes stepped down as CEO after 20 good years.
And AJP ran 2018’s second-most-clicked story this month, in which a disgruntled customer dumped poo at a Chemist Warehouse. Sorry about that, to the staff in question.
PSA held its flagship conference, PSA18, where president Shane Jackson discussed the 7CPA, saying it “needs to be a facilitator for professional development, scope of practice and to recognise the scale and complexity of what we do”. He also launched the organisation’s revised 10-year plan, Pharmacists in 2023, and said urgent change was needed for better recognition and better pay across the profession. Talking of pay, this month Victoria’s final report on its inquiry into penalty rates found the reduction in penalty rates was already having a significant impact on workers.
Also at PSA18, the PSA named its top pharmacists for 2018: John Jackson was chosen as the 2018 Pharmacist of the Year, while Dr Jacinta Johnson was awarded the 2018 Early Career Pharmacist of the Year and Ross Brown AM was given a PSA Lifetime Achievement Award. Deanna Mill and Angelica Lagoda were jointly named Intern of the Year.
The SHPA held a Medicines Leadership Forum to look at ways to reduce opioid harm, particularly by tailoring quantities of opioids provided in hospitals as appropriate to patients’ individual needs.
Australians experienced “long delays and technical faults” as many decided to opt out of My Health Record on the first day they were able to do so, while the Health Minister talked to doctors about concerns about the system. The turf war took an interesting turn as immediate past RACGP president Dr Edwin Kruys called for greater collaboration between doctors and pharmacists.
In response to an increase in meningococcal rates, Tasmania moved to let pharmacists vaccinate children aged 10 and over against the A, C, W and Y strains.
EBOS Group won the tender to act as the exclusive third party distributor to the My Chemist Group; Later in the year it would be revealed that Sigma experienced more than a 50% drop in profit following the loss of the contract.
And a report on primary care by the Grattan Institute claimed that pharmacy was stuck in a “horse-and-buggy age of the independent pharmacies…” an interesting end to the month given August was all about change.
August saw change on the horizon, with another PM knifed and Scott Morrison taking the place of Malcolm Turnbull in the top job. Greg Hunt was welcomed back as Health Minister, but more change was foreshadowed this month, which saw stakeholders present their cases to the Committee scrutinising the pharmacy sector in Queensland… which would later recommend pharmacists be able to engage in low-risk prescribing.
The GP pharmacist model came under fire from the Small Pharmacies Group, which said that it’s a threat to community pharmacy.
Victoria announced expanded pharmacist vaccinations, with the age for such vaccinations dropping to 16. Doctors, unsurprisingly, were unimpressed, but the PSA also released figures which showed almost two-thirds of Australians believe pharmacists should be able to administer a wider range of vaccinations.
It was a busy month for Ramsay Health: the Queensland Inquiry continued, with Ramsay chief Peter Giannopoulos telling the panel that corporate pharmacies could potentially provide better services in rural and regional areas. But the Small Pharmacies Group slammed Mr Giannopoulos’ comments, saying that it is “highly unlikely that such a company would provide services where they are not financially viable”. Meanwhile the Guild initiated legal proceedings against Ramsay, seeking clarity over its ownership arrangements. Ramsay said it would not be “backing off” in the face of Guild legal action.
Pharmacists around Australia celebrated World Pharmacists Day in their own way; they also met in Sydney for Pharmacy Connect, where George Tambassis took aim at the rollout of Health Care Homes, saying that “there’s absolutely been no take-up by the GPs in signing up patients, it’s been an absolute mess“.
Catherine King said that a Shorten Labor Government would invite more stakeholders to the 7CPA negotiating table. Anthony Tassone talked about how rural workforce shortages are impacting the pharmacy sector. And new “hard-line” legislation on medicines shortage reporting was passed, though the wholesalers said that it’s not enough, with “loopholes in the supply chain” continuing to put patients at risk.
GPs attacking pharmacy this month included then AMA president Dr Michael Gannon, this time over the Guild’s announcement the long-awaited Chronic Pain MedsCheck trial was to go ahead.
And a key focus this month was aged care, with the Morrison Government announcing a Royal Commission into the sector ahead of a Four Corners report which highlighted significant problems, including over-reliance on antipsychotics; a number of stakeholders said that greater use of pharmacists in facilities could help.
The Fred IT Group – which developed Victoria’s SafeScript system, which went live in one PHN in October – was awarded the contract to develop the national real time monitoring system. But some health stakeholders began to doubt the system, with pain organisations saying real time monitoring without better access to pain programs was “putting the cart before the horse,” while substance abuse experts worried people in pain could turn to heroin instead of prescription opioids. Anthony Tassone stepped in to defend real time monitoring in both instances, pointing out that it will save lives, and the Guild is also advocating for better access to treatment and support. Pain stakeholders also had a go at the Guild’s Chronic Pain MedsCheck trial.
The Guild lost its management role in 6CPA programs, which went to Australian Healthcare Associates. The Guild’s legal proceedings against Ramsay Health began in NSW’s Supreme Court; the proceedings seek clarity over ownership of Ramsay-branded pharmacies.
We met 2018’s top pharmacy assistant, Alice Vanderpol from Moama Village Pharmacy in NSW.
The Committee undertaking the Queensland inquiry released its findings: that pharmacists should practise to the full extent of their scope, including low-risk prescribing, and that there was “no reason” for ownership deregulation.
Doctors attacking pharmacy in October included the RACGP’s Charlotte Hespe, over the expansion of pharmacist vaccination in NSW, also announced this month; Evan Ackermann, over the Guild’s ties to politicians; and Dilip Dhupelia, who said pharmacists were “not qualified” to take on low-risk prescribing. Dr Chris Zappala said pharmacists were “usurpers” with a “perverse profit incentive”. Greens leader Dr Richard Di Natale got in on the act, talking about “backroom deals” done by the Guild over the Community Pharmacy Agreements.
EBOS announced that it would acquire all shares in the Terry White Group that it didn’t currently own.
And in great news for public health, the WHO officially announced that rubella has been eliminated from Australia… a triumph for vaccination.
After a concerted campaign from Labor, the My Health Record opt-out period was extended again, until 31 January 2019.
The battle to improve pharmacist wages rages on, with PPA saying pharmacists need to lobby their employers to negotiate Enterprise Bargaining Agreements (EBA) that protect their work rights. The union also said that wage theft was running rampant across the sector.
Chronic Pain MedsChecks finally arrived. An AIHW report showed that opioid deaths have nearly doubled in 10 years, with pharmaceuticals the main culprit (though formerly-OTC codeine was absent from the data). And SHPA gained a new president in Peter Fowler.
The Guild’s Parliamentary Dinner saw Scott Morrison hint at an extension of the 6CPA; Opposition Leader Bill Shorten say that if Labor is elected, it will start the 7CPA negotiations early; and Greens leader Richard Di Natale call for “transparency” in the funding of pharmacy programs.
And AHPRA announced it planned a review of its policies and procedures regarding safeguarding the confidentiality of notifiers, after a terrible attack on a pharmacist by a GP who she had reported.
As we headed towards Christmas, the news kept coming, especially in the area of industrial relations: the Fair Work Commission rejected raising the pharmacist award based on overall workload, but accepted other grounds such as HMRs and vaccinations for increased remuneration. Professional Pharmacists Australia accused Epic Pharmacy of ignoring its efforts during enterprise bargaining. And Chemist Warehouse was targeted by the National Union of Workers, which says that the culture at two of the discount giant’s distribution centres featured “bullying and sexual harassment”.
Diabetes education pioneer Kirrily Chambers was named Innovative Pharmacist of the Year 2018; and the PSA farewelled Dr Shane Jackson as national president, though he’ll stay on as vice-president, while welcoming Dr Chris Freeman to the role;
AJP is now entering its shut-down period over the Christmas and New Year break… we’ll be back on January 8. Until then, from all of us at AJP, have a happy and safe festive season, and we look forward to bringing you all the news pharmacy brings in 2019.