All bets are off, says review boss


Prof Stephen King

All bets are off for remuneration and regulation, review boss tells pharmacists

Community pharmacy has to ask confronting questions about how it operates, what it sells, what it is willing to do and how it positions itself to consumers, the federal governments pharmacy review chief says.

Appearing before a packed audience at APP2016, Professor Stephen King, chair of the Review of Pharmacy Remuneration and Regulation panel promised a fair but comprehensive process to examine how the sector operates and is paid.

At an occasionally tense session he gave no definitive answers but said the panel was still gathering information and feedback on the industry.

While reiterating that the panel members had no preconceived ideas and were talking to a wide rang of pharmacists and other stakeholders, Professor King indicated that all aspects of pharmacy regulation and remuneration were potentially liable to change.

In particular, Professor King questioned what he saw as a non-transparent and confusing remuneration structure which was prone to cross-subsidisation, leaving government and public unsure “who is actually paying for what?”

“The current system is not sustainable, we hear often,” he said. “Is your model of being paid for you professional advice by selling other things really the right one for an allied health profession?”

Professor King said the current system turned patients into consumers and potentially confused the health care role of the profession.

Professor King said untying advice provision from dispensing was under consideration by the panel.

He also discussed location rules, saying early evidence they had gathered indicated they seemed to be working well and had reasonably rationalised the ratio of pharmacies to population.

The panel is due to release a discussion paper in April, before undertaking a national consultation process from June.

An interim report is due to be released in the second half of 2016, with a final report to be delivered to the government in March 2017.

More on this story tomorrow

Previous Jessica Cahill is Guild Intern of the Year
Next Three key drivers of change

NOTICE: It can sometimes take awhile for comment submissions to go through, please be patient.

5 Comments

  1. Bruce ANNABEL
    19/03/2016

    Professor King’s comments at APP today should not come as a surprise to pharmacy owners or pharmacists. I have been writing, speaking and consulting on foundation pharmacy change for almost 18 years particularly during the past 10 since the specter of price disclosure regime raised its nasty presence. And I have had a firm belief that pharmacy had to change fundamentally during the period that generous generic discounts provided the funding platform. Prof King’s pointed comments flag that pharmacy now has little choice but to embrace change with the patient (not consumers who chemists sell stuff to) and their health at the heart of the transformation objective. That has been a consistent theme at APP (at last I’m pleased to say) and many many years have been wasted and now pharmacy and pharmacists have 4 years, 3 months and 11.5 days to begin and complete the transformation. Time is of the essence and the time honoured phrase of ‘Oh yeah but……’ as the precursor to a reason pharmacists come up with not to do something must be done away with post haste!. PSA Health Destination Pharmacy programme will fast track the process with you and make it easy.

  2. Drugby
    19/03/2016

    Prof Stephen posed many questions and is clearly considering all options, some of which are transformational. He acknowledged pharmacists are medicine experts but questioned the need for funding for training for additional roles. The risk is that we reinvent ourselves as community nurses. Prof King also posed the question should there be a bigger role for consultant pharmacists eg in GP clinics. Vaccinations, HMRs and in pharmacy Med reviews were mentioned, but he questioned the need for services beyond the normal expertise of pharmacists.
    Prof King concluded by encouraging all pharmacists and other interested persons/organisations to submit a response to the discussion paper in late April 2016. It doesn’t have to be a full formal response, individuals can submit even a paragraph. Sounds like alternate models will be considered.

    • Jarrod McMaugh
      20/03/2016

      Prof King readily admitted that he is not an expert in pharmacy, but in economics. The fact that he has been openly critical of pharmacy in the past does make me think that he has an agenda, but he says he’ll keep an open mind, so lets see.

      With regard to “services beyond the normal expertise of pharmacists” – who decides on what that is? Surely pharmacists do….. This is the reason individual pharmacists (as well as organisations) need to make submissions to the discussion paper.

  3. JimT
    19/03/2016

    It doesn’t matter which way you spin it there are 2 major issues. 1. Pharmacy businesses will have to change what it does for the patient. 2. Patients will have to learn to accept how this change is to be paid for. If Govt. is part of this payment model, totally or in part then that’s another discussion…..

  4. Anthony Tassone
    21/03/2016

    The reactions to Professor King’s presentation at APP were mixed; some found it provocative, others concerning and others interesting with enthusiasm to express a view to improve the remuneration methodology for community pharmacy.

    It was encouraging to hear acknowledgement that previous ‘work on location rules’ by Prof King’s colleagues was perhaps ‘naive’ and ‘less than complete’ without acknowledging its intent and desired outcomes. There was also acknowledgement of the removal of any location rule type safeguards in other jurisdictions like the UK have led to the very thing that location rules aims to prevent – clustering of pharmacies and deprivation of equitable access across the country.

    The general vibe amongst delegates at the APP conference was one of pragmatism and a realization that Pharmacy Transformation was not only necessary it needed to start immediately if it hadn’t already. There is genuine enthusiasm for community pharmacies to embark on this journey to best utilize the infrastructure that they have invested in and provided to the community and healthcare system.

    Bruce Annabel has pointed out one such program available – which I believe he may have a direct involvement in, and it would be remiss of me to not point out the recently announced ‘Health Advice Plus’ program by the Guild at APP.

    The Guild’s Health Advice Plus Program provides a suite of resources and operational processes, tailored to your business to ensure that services delivered by your pharmacy are commercially and operationally viable, and provide quality health outcomes for your patients.

    The Health Advice Plus Program is a cost-efficient, hands-on support package that provides common sense incremental change management principles to transition your pharmacy to a professional service model by people who work in and understand pharmacy.

    https://www.guild.org.au/services-programs/health-advice-plus

    Whichever program or process a proprietor and pharmacy team embarks upon for this journey (and many have commenced it already through their own initiative and innovation) – it is essential that all of our services are patient-centric and relevant to our local demographic.

    Whilst Professor King raised questions over some of the areas that pharmacists were wanting to venture into in role expansion likening it to becoming akin to a ‘community nurse’ – it will be important through the submission process that stakeholders all inform and demonstrate what community pharmacy is doing now but possibly not recognized for it, and is more than capable of moving into.

    One such area that Professor King raised questions of appropriateness of the community pharmacist’s role was in wound care and management. This was received by some groans and consternation by the delegates. Wound care and the management of common ailments are well within the scope of practice of pharmacists – and this must be informed through the submission process.

    Remembering from the outset, that Professor King in his presentation admitted that he did not have a strong background to pharmacy prior to commencing the review and is learning more and more as the process continues.

    Professor King expressed concern over ‘cross-subsidization’ of services in that it ‘lacks transparency and is unsustainable’ from a remuneration perspective. Whilst on face value this has merit and that any suite of services provided should have a cost benefit analysis conducted in their own right – community pharmacy have previously not had the opportunity for a number of important services delivered to be appropriately remunerated in their own right.

    Community pharmacy would welcome the appropriate remuneration of services delivered through the community pharmacy network that have a patient benefit and cost benefit to the healthcare system.

    Anthony Tassone
    President, Pharmacy Guild of Australia (Victoria Branch)

Leave a reply