6CPA: why GPs are upset

Primary Health Networks: doctor holds up stethoscope

The allocation of $1.26bn over five years in the 6CPA for professional services announced in the recent letter of intent has been welcomed by pharmacy as win for consumers but the Australian Medical Australian has slammed the initiative.

The letter, agreeing on the broad parameters of the 6CPA, includes provision for the doubling of funds for pharmacist-delivered evidence-based professional services, though the full details are yet to be revealed.

The AMA hit back at the announcements saying the government has got its priorities wrong, given that there will be a Medicare Rebate freeze until 2018. It claims the government is “election-focused”, “wrong” and “illogical”.

Dr Brian Morton, AMA councillor and former NSW president, told the AJP that the move, which could see pharmacy extend its scope of practice into primary care, is simply wrong.

“Pharmacists are not medically trained,” says Dr Morton. “Primary care involves whole person care; who is the best trained and has the most skills? The GP.

“The corollary is, if pharmacy has so much time to extend its scope of practice and move into areas outside their usual practice, what is happening to their skills?

“Why do they need to do this? Should we be looking at fundamental change to community pharmacy?

“Should we be saying, ‘Do we need so many pharmacies and pharmacists then’? Should the location rules be changed and should pharmacy, therefore, be deregulated?”

Dr Morton also criticises what he describes as an inherent conflict of interest if pharmacy is to offer primary care services.

“If pharmacy is offering these services such as cholesterol, and blood pressure monitoring and also selling patients products in a retail environment, we see a conflict of interest,” he says.

“On the other hand, we ethically resisted dispensing rights because there would be a conflict of interest.”

He also says any suggestion on the Guild’s part that the GPs’ objections are about pharmacy encroaching on GP’s turf is deeply hypocritical.

“The Guild—with the government’s blessing—seems to be above the ACCC regulations,” he says.

“But the Guild is the number one turf protector, so any claims this is about turf is pure hypocrisy and it should hang its head in shame.

“In the 6CPA there have been no changes to the location rules—no changes to this protectionism.”

Dr Morton calls for a more collaborative approach as he says pharmacy’s move into primary services and will result in the fragmentation of patient care.

“GPs have the whole history and deliver holistic care and that dimension is lacking in pharmacy. Health professionals should be working together to bridge gaps in patient care. This latest announcement results in silos which is bad for the patient.

“We need team work not patient care in an ad hoc fashion.”

He says having a non-dispensing pharmacist in the general practices a good approach because it leads to quality improvement and it is in the realm of a pharmacist’s scope of practice, and therefore, appropriate.

“Why not have a pharmacist come into a GP practice once a month and sit down with the GP and patient and do a case conference? That’s what we should be doing; not this silo approach.”

But the AMA and PSA project which was developed to have a non-dispensing pharmacist working in GP practice has not been included in the funding in the 6CPA.

Dr Morton also says he doesn’t have an issue with pharmacy dealing with minor ailments such as cuts and scratches “as long as pharmacist doesn’t sell the patient the most expensive dressing”.

But, he says, if there are issues with the continuation of care the patient should be referred to the GP.

by Janet Doyle

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