AMA ‘sat like a moo cow’ while GP surgeries corporatised: Guild


black and white cow staring at camera

An AMA state councillor has attacked what it calls the “open secret” of complex pharmacy ownership structures, as well as discount chains and alternative therapies

Writing on the AMA WA’s blog, state branch councillor Dr Michael Page has claimed that the Pharmacy Guild’s stance on pharmacist ownership – that it ensures maintenance of professional standards – is undermined by less-than-transparent ownership structures.

“Where the Guild has harmed the broader pharmacy profession, including its traditional independent pharmacy owner members, is in its silence and inaction on the rise of pharmacists who, through complex, opaque management agreements and equity structures allegedly hold controlling interests in tens or even hundreds of pharmacies,” Dr Page writes. 

“This has been an open secret in the pharmacy industry for decades, but is rarely identified in official reports.”

He wrote that the recent review into the pharmacy sector in the state had “brought it to light”.

“The question becomes: does pharmacist-ownership guarantee the delivery of a high-quality service when a Western Australian pharmacy is (strongly rumoured to be) controlled by a likely non-practising pharmacist in another State who controls dozens of other pharmacies?

 “Further, if the pharmacy’s puppet master is purposely hidden, how can any kind of meaningful clinical governance be implemented to ensure the safe and accountable delivery of clinical services?”

Dr Page writes that the “de facto corporatisation” of pharmacy had facilitated “another phenomenon that the Guild has failed to meaningfully resist,” namely the rise in discount pharmacies.

“These often unprofessional-appearing, low-service environments further undermine the Guild’s arguments against deregulation of pharmacy ownership.

 “In addition, it is patently self-evident that unproven and alternative therapies have found a firm foothold in community pharmacies as a rule, rather than an exception.”

Singling out Chemist Warehouse, Dr Page said that while the discount giant’s interests were “not entirely aligned” with those of the Guild, it has achieved such influence in the pharmacy sector that it has begun to lobby the Government to relax the location rules.

“Such changes would represent an existential threat to many of the Guild’s members, who would face stiff competition from Chemist Warehouse outlets opening in their immediate vicinities, and would diminish the Guild’s standing,” writes Dr Page.

 “These trends in the pharmacy industry have been a slap in the face to many hard-working, professional employed pharmacists who increasingly face poor working conditions and uncertain futures, as well as those independent pharmacy owners attempting to deliver high-quality pharmaceutical services.”

These trends undermine the credibility of pharmacy when it comes to the delivery of expanded clinical services, Dr Page claims.

“The Pharmacy Guild may ultimately have cause to regret its inaction on the degradation of professionalism in community pharmacy.”

A spokesperson for the Pharmacy Guild told the AJP that the organisation believes the pharmacy ownership laws in all States and Territories should be rigorously enforced because they are in the best interests of consumers. 

“Far from being complacent about pharmacy ownership laws, the Guild urges all jurisdictions to ensure those laws are enforced,” the spokesperson said.

“The pity for the AMA is that it sat like a moo cow watching the passing traffic as medical practices all over Australia have been corporatised – reducing levels of service, and condemning many GPs to be mere cogs in the corporate wheel.”

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18 Comments

  1. pagophilus
    22/08/2019

    Thank you Dr Page for speaking so plainly and clearly. As for the Guild’s call for ownership laws to be rigorously enforced, it’s just lip service. How about doing something? And getting some better lawyers, as the recent case against Ramsay showed how complex this issue is to deal with.

    And who let the cat out of the bag without so much as a peep when the clause prohibiting a pharmacist having a pecuniary interest in more than 5 pharmacies disappeared from the Act? Who advised the government in formulating the new Act?

    • Anthony Tassone
      22/08/2019

      Pagophilus

      Dr. Page seems to infer that the Guild is somehow complicit or responsible for alleged breaches of state and territory pharmacy ownership legislation.

      Far from ‘silence and inaction’ the Guild has been advocating in state and territories across Australia for regulators to uphold the legislative intent of pharmacy ownership laws for pharmacist only ownership of pharmacies.

      The Guild is not the regulator to be able to enforce any compliance measures or penalties for breaches of the legislation – and it is unclear whether Dr. Page fully understands that point.

      This has seen active advocacy with the Queensland parliamentary inquiry into community pharmacy, the litigation in the NSW Supreme Court (the latest decision still being considered by the Guild), activities involving collaboration with the Western Australian Pharmacy Board in helping ensure compliance in their state and in Victoria advocacy to see reform of the pharmacy business license application and renewal process along with an audit program introduced by the Victorian Pharmacy Authority to ensure compliance;

      https://ajp.com.au/news/ownership-applications-investigation/

      In terms of pecuniary interest being removed from the Act, I’m not sure whether you are referring to Victoria where there was the introduction of the Pharmacy Regulation Act 2010 (superseding the Pharmacy Practice Act 2004) and there was mention of only proprietary interest, not pecuniary interest.

      I am not personally fully aware of the circumstances for the change in the legislation leading up to 2010 as it preceded my time in my current role but would add that NSW is one of the few jurisdictions that has a mention of pecuniary interest in their pharmacy ownership legislation. Further, some jurisdictions go further to provide examples of what is an allowable proprietary interest (or not) in their legislation with Western Australia and South Australia having more detail in definitions than some other jurisdictions.

      It is not only the law itself that is important but is the process and administration of the Act by the relevant regulator in that jurisdiction.

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

      • pagophilus
        22/08/2019

        Thank you for your reply. Yes, the Guild has been advocating, but for how long and how actively? Does the Guild push for an inquiry into complex pharmacy ownership structures and how they fit in with the relevant Acts?
        And yes, I was referring to the Victorian Pharmacy Practice Act 2004 (and Pharmacy Regulation Act 2010). It was the 2004 Act which removed the clause I believe. When I started (1998) it was the Pharmacists Act, and it was that one that contained the pecuniary interest clause, and it was limited to 3 pharmacies, later increased to 5. What surprised me at the time was the complete lack of discussion (to my knowledge) in the pharmacy media at the time the new Act came out. It was as if this new act was just sprung on us and suddenly pecuniary interest disappears. Of course, most pharmacists wouldn’t have noticed as most just practice day to day and probably haven’t read the Act for years, but I’m sure the entrepreneurial types took notice. Can the explosion of discount pharmacies in Melbourne be linked chronologically with this change? I wonder what vested interests were behind that change and who was involved in the review of the Act and who (i.e. which pharmacy representatives) advised the government at the time to consider removing the pecuniary interest clause (as I’m sure a review of the Act in preparation for replacing it with a new one involves discussions behind the scenes with relevant stakeholders).

        • Anthony Tassone
          22/08/2019

          Pagophilus

          You are actually correct, the Pharmacy Practice Act 2004 (which superseded Pharmacist’s Act 1974) does not make mention of pecuniary interest in the sections relevant to pharmacy ownership.

          This was prior to my time as an elected official of the Pharmacy Guild so cannot comment on the level of consultation at the time.

          In addition to a change in the number of pharmacies a pharmacist could have a proprietary interest in (from three to five) the Pharmacy Practice Act 2004 effectively capped the number of pharmacies a Friendly Society could own in Victoria (allowing some further acquisitions but up to a maximum within a sunset period).

          In terms of how actively the Guild has been advocating regarding pharmacy ownership, I have held my current position since the end of October 2013 and it has been a continual matter with vast correspondence between our branch office and the Victorian Pharmacy Authority as well as politically with the relevant Health Minister of the day. It has been a priority that has been an active point of representation throughout that time.

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

          • pagophilus
            22/08/2019

            Thank you for your detailed reply. I hope the discussion continues and pressure keeps being applied to ensure the spirit of the law is complied with.

      • pagophilus
        22/08/2019

        I’m wondering though, even without the pecuniary interest clauses, how do the owners of discount chains meet the requirements to own not more than 5 pharmacies in Victoria for example? Is this a law that exists on the books but nobody can be bothered to investigate and enforce (possibly because it would be politically unhelpful – the perception it would increase prices of medications)? When a new pharmacy opens or an existing one changes hands, shouldn’t the ownership be checked at that stage, including whether it meets all the conditions of the Act?

        • Anthony Tassone
          22/08/2019

          Pagophilus

          That is a question for the relevant regulator, in Victoria’s case the Victorian Pharmacy Authority.

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

      • Andrew
        22/08/2019

        >>>>The Guild is not the regulator to be able to enforce any compliance measures or penalties for breaches of the legislation.

        Conveniently so, but didn’t stop PGA lawyers running an utterly absurd case against Ramsay did it? The one that was summarily dismissed? TF Guild aren’t regulators if that’s the quality of their counsel.

        • Anthony Tassone
          22/08/2019

          Andrew

          Not sure what you mean by ‘conveniently so’ – it is what it is. The Guild is a registered organisation under the Fair Work Act and a members association that represents the interests of its members.

          The Guild does not make apologies for any advocacy or litigation where the objective is to support the legislative intent of pharmacist only ownership of pharmacies.

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

        • Paul Sapardanis
          23/08/2019

          At least the guild tried to test the Ramsay model. What have the regulators done? Lets be angry but lets be angry at the right authority

  2. Wilson Tan
    22/08/2019

    Ultimately complicity and accountability rests with the Authorities and the Boards.

  3. Wilson Tan
    22/08/2019

    Ultimately complicity and accountability rests with the Authorities and the Boards.

  4. Nicholas Logan
    22/08/2019

    It seems to be a lazy/ignorant cop out for AMA to routinely blame the Pharmacy Guild for everything these days.

  5. Wilson Tan
    22/08/2019

    Ultimately complicity and accountability rests with the Authorities and the Boards.

  6. Still a Pharmacist
    22/08/2019

    Question: Why a pharmacist buys a pharmacy where he or she does not practice as a pharmacist?

    Answer: To make profit.

    Question: Then why only pharmacists can own a Pharmacy in a free market economy like Australia?

    Answer: Because only pharmacist owners can ensure ordinary Australians are getting proper pharmacy services.

    Question: Isn’t it the responsibility of the working pharmacists? If not, why do they get sued for the service they provide?

    Answer: You are asking too many questions.

    Question: Now I understand that everybody in Australia is equal, but in pharmacy sector, some are more equal than others.

    • Wilson Tan
      23/08/2019

      The proprietor pharmacist is ultimately culpable for breaches of the pharmacy legislations and standards even if he or she is on holidays.
      Employed pharmacists often gets away with slipping professional standards. I fronted the board when my locum pharmacist did not write into DD register, left the S8 drug out of the safe. She got away scot free, not even aware of the troubles she caused me. She was also fully paid for her work promptly too. As the proprietor, I was fully made accountable even when I was overseas at the time of the incident. (So go figure who’s more equal!)

      For all pharmacists, if there is a dispensing error or patient harm, then AHPRA will investigate the health professional.

      • Still a Pharmacist
        23/08/2019

        I am surprised to see that the pharmacist got away free. In an incident I know, the employee pharmacist, who was increasing the sales of the business unlawfully, suspended for a specific time period and the owner was just sent for a course. And this is very common.

        The employee pharmacist told me that the owner asked him to do that but flatly denied in front of the board. The board said that that was the responsibility of the employee pharmacist who did the job and not the owner’s. So we can understand who is more equal in this case.

        • Willy the chemist
          24/08/2019

          The pharmacist who illegally dispensed a medicine or altered a DD entry or made an error that resulted in injury or patient complaint would most likely by investigated.

          However if supposed standards were not adhered to in the work environment, eg. If the employed pharmacist replied, “oh I don’t know the password to eMims” or his name is not displayed as on duty, or if the DD register is not entered then the employer is in trouble.

          So the time you commit an illegal or injury or error in dispensing, the pharmacist will be accountable (and depending on the error, certainly the proprietor pharmacist will be as well).

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