The doubling of funds for professional services in the 6CPA represents recognition that community pharmacists are now primary healthcare providers, claims Charlie Benrimoj, professor of pharmacy practice and head of University of Technology Sydney’s graduate school of health.
“We have been working towards this for at least 20 years and I never thought I would see it in my lifetime. This agreement is moving us from retailers to a professional fee position which has a dramatic change in the way pharmacy owners are going to think about their business. It will move people into thinking about professional services much more,” Prof Benrimoj told the AJP.
“That’s a massive change in thinking and the real issue is how owners are going to react to that in terms of the way they do business and change their practice.”
He says the funding boost for professional services also shows clear recognition by the government that pharmacists are primary healthcare providers including investing money—$50m—into trials and positioning community pharmacists as providers of primary care.
“This is fantastic from the point of view of the profession and pharmacists should be delighted,” he says.
He stresses that pharmacists should understand that this measure is also delinking dispensing fee from the price of the product.
“In the old way on dispensing a medicine you received a dispensing fee, the cost of the product reimbursed and a mark-up of 10–15%; the mark-up is gone now. In its place is a handling fee that is pretty adequate. The important thing here is that whether the product is $1 or $1m it doesn’t really matter, because now remuneration is not based on the price of the product, and not affected by price disclosures,” says Prof Benrimoj.
A helping hand
The future of pharmacy is in services and it’s pretty clear those retailers who are focused on products and their mark-ups are now going to need to rethink their business, he adds.
“I and my core group of research collaborators have been undertaking research in this area since 1981 because the evidence showed that this is where the future of the profession should lie. So, we have concentrated all our research in the area of pharmaceutical services from community pharmacy.
“Now there is a whole body of research that is available for the profession to use. The big issue is not about the evidence, but how these services will be implemented in the daily practice of a pharmacist in community pharmacy,” says Prof Benrimoj.
In the latest UTS Pharmacy Barometer report published late last year there was wide spread uncertainty from pharmacists whether 6CPA funding should be reallocated from dispensing fees to services. Approximately 30% strongly support, or supported it, 34% were not sure, and 35% did not support reallocation. It appeared that a large proportion of pharmacists wanted additional funds for services, rather than money cut from dispensing.
However, there was discrepancy in the views depending on between owners and managers. Pharmacy owners seemed particularly divided on the issue, although they leaned towards maintaining the current system. But pharmacy managers/pharmacists-in-charge and employed pharmacists tended to support the reallocation of funds, and those who supported the reallocation did so with greater conviction—with 15% and 12% respectively strongly supporting it, versus 6% of owners. However, employee pharmacists showed greater uncertainty with 38% and 49% saying they were unsure (See Figure below).
However, for employee pharmacists, Prof Benrimoj says this new allocation of funds enables them to become service providers or professional services managers.
Prof Benrimoj claims his research and international studies support the two big areas within professional services—primary care and chronic medication management—and this is where pharmacists should focus their attention on.
“I believe we should choose the whole area of primary health and the area of managing chronic medications. The challenge now is how do we manage those areas, and implement and integrate them into the healthcare system? Really, this is the time now to start using the knowledge we have been teaching them at university,” he says.
“The challenge now is not about finding the value of pharmacy any more as there is enough evidence. [It’s about] how do we translate this evidence into practice? The issue is now is how we implement that we are service providers which leads to sustainability?” he says.
Clearly, Prof Benrimoj says a section of the profession is ready to make this transition, according to his research, but whether the whole of the profession is ready is another matter.
“What I think will happen now is that a whole lot of pharmacists and owners will see this as a business opportunity and will be looking to their staff for capacity to deliver. And this capacity will come from a range of sources: PSA, Guild, private providers, and universities.
“What we will see now is a plethora of training. But training on its own is not enough; it’s all about how you implement that training within the practice. Through the past eight years of research we have developed evidence-based models for implementation that the profession can use,” says Prof Benrimoj.
In theory, pharmacists when asked in the last UTS Pharmacy Barometer Report if they would support agreement funds being for professional pharmacy services, there was strong support with almost 60% agreeing to it.
However, the devil is in the detail as to how the pharmacy trial money will be spent, and how it will be audited to ensure it is actually goes towards the implementation of services, Prof Benrimoj stresses.