AMA’s response to TWCM promotion ‘hysterical,’ says Guild


The AMA’s national president has slammed a Terry White Chemmart/Bupa promotion as a “sneaky” way to introduce US-style health to Australia – a stance which has disappointed the Pharmacy Guild

On Thursday, Dr Tony Bartone said the Health Benefit Package being promoted by TerryWhite Chemmart pharmacies – in partnership with Bupa, one of Australia’s largest health insurers – is an attack on general practice which devalues quality primary health care in Australia.

“The so-called health package is asking pharmacy customers to pay an annual subscription to receive health checks (BMI, blood pressure, blood glucose, and total cholesterol), flu vaccinations, pharmacist health consultations, and REWARDS points,” the AMA said in a statement on Thursday.

Dr Bartone called this a “crass commercialisation of primary health care” and a “sneaky move to introduce US-style managed care to the Australian health system by stealth”.

“The AMA and other responsible medical groups used the recent election campaign to increase government and community focus on the importance of investing in high quality general practice,” Dr Bartone said.

“Properly funded and resourced primary health care, led by general practitioners who are skilled and experienced in holistic health care, is the future of health care in this country.

“The best and safest place for people to access quality primary health care and advice is the local community general practice from highly trained and experienced GPs,” he said.

“General practice provides confidentiality, privacy, and the value of the doctor-patient relationship throughout all stages of life.

“It is not appropriate to conduct sensitive, sometimes life-saving, health checks in busy retail environments, many of which promote dangerous, unproven alternative medicines and therapies.”

Dr Bartone said that general practice is the foundation of quality primary health care in Australia, and any threats to undermine it or replace it with inferior models of care must be rejected.

“It is outrageous that a large health insurer like Bupa would endeavour to undermine general practice, especially after a thorough Government review of private health insurance to ensure that policyholders received high quality and value for money for their significant investment in insurance,” he said. 

“This partnership will fragment quality primary health care and put further question marks over the value of private health insurance – just as radical new reforms are being implemented.”

The latter comments are a direct repetition of comments Dr Bartone made in March, when the strategic partnership between Bupa and TerryWhite Chemmart was announced.

Dr Bartone said that the AMA plans to ask the Health Minister to investigate the role of Bupa in this partnership.

“There has been no attempt at meaningful consultation by Bupa – a major player in the private health insurance and aged care sectors – with the AMA and the medical profession about this potentially dangerous initiative,” Dr Bartone said.

“Bupa is sailing into uncharted waters with this arrangement. It should be focused on its activities in private health, aged care, and its recent foray into Defence health services, rather than pursue a partnership that seeks to sabotage general practice and put patient care at risk.”

Dr Bartone said that pharmacists and GPs work well at the local community level in long-established partnerships that are built on mutual trust and respect for each other’s specialised scopes of practice.

“The health system and patients benefit most when all health professionals are fully engaged in their professional roles,” Dr Bartone said.

“Pharmacies marketing unnecessary and expensive pathology tests and other ‘health screening’ services to their customers – and charging an annual subscription – is a push to increase profits at the expense of evidence-based, cost-effective health care.

“These activities are not within the scope of practice of a pharmacist.

“Pharmacies in the community play an important role in providing medicines information to the public, and ensuring that all Australians have access to medicines in a timely and safe manner.

“But doctors are the only health professionals trained to fully assess a person, initiate further investigations, make a diagnosis, and understand and recommend the full range of clinically appropriate treatments for a given condition.

“Health checks, screening activities, and diagnostic tests should only be conducted if they are clinically indicated, backed by evidence, and cost effective. Unnecessary ‘health checks’ are costly for patients and can cause needless concern.

“There is no doubt that hiving off certain aspects of health care, such as screening and pathology ordering, only duplicates effort and fragments care.

“The Bupa-TerryWhite partnership is a misguided marketing exercise that is an insult to GPs, a threat to the health of patients, a blight on the health system, and the Government should outlaw it immediately,” Dr Bartone said.

A spokesperson for the Pharmacy Guild expressed disappointment in the comments.

“While we are not privy to all the details of the collaboration between Bupa and TerryWhite Chemmart, there is clear consumer demand for the skills and resources of modern community pharmacies to provide more health services and advice, within the scope of practice of trained pharmacists,” the spokesperson said.

“The hysterical response from the AMA President – while predictable – is disappointing and insulting to the skilled and highly-trained pharmacists in Australia’s most accessible health care infrastructure – community pharmacies.

“If the AMA had its way, no pharmacist in Australia would be administering influenza vaccines – a clearly beneficial public health development which has brought Australia into line with comparable countries.

“Fortunately, most general practitioners know and respect the work of their local pharmacies, and will ignore the shrill calls from the out-of-touch AMA.”

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4 Comments

  1. Michael Ortiz
    28/06/2019

    Why is the AMA so threatened by Community Pharmacy providing primary care services?

    Why does the AMA consider the BUPA collaboration is a “sneaky” way to introduce US-style health to Australia.”? This statement is ill informed and this collaboration is consistent with BUPA’s collaboration with other health professionals like Dentists and with Hospitals to benefit its members. Perhaps the AMA should look at some of the large out-of-pocket fees charged by its own members when discussing profits and a US-style health system.

    They argue that “Pharmacies marketing unnecessary … ‘health screening’ services to their customers …is a push to increase profits at the expense of evidence-based, cost-effective health care.”

    One only needs to look at the literature to see that Pharmacists can and do make a positive contribution to primary care and public health through evidence-based, cost-effective health care services like immunization. Primarily because Pharmacists are more accessible than GPs and many Pharmacists do not charge for advice or services and when they do charge, their fees are modest compared with GPs.

    These patient-centered services provided by pharmacists are not unique to Australia and the AMA seem to be getting more desperate in defending their turf. What patients need is collaboration and not confrontation from health professionals. Consumers will vote with their feet. If the new pharmacy services target an unmet need neglected by GPs then it may be successful. However if consumers fail to see value in the service, then it will not be successful.

    What the AMA fail to realise is that promotion of primary care services will raise awareness in the public arena. GPs could also take advantage of this raised awareness and offer similar services to their patients. We shouldn’t lose sight of the need for these services and the value of identifying at risk patients with undiagnosed diabetes, hypertension and hypercholesteraemia.

  2. Andrew
    28/06/2019

    Considered and respectful commentary from the Guild spokesman. “Shrill”, “hysterical”, “out of touch” – yeah that’s going to help the situation.

    Unlike the Guild spokesman I am a pharmacist, and I agree with the AMA that many of the services being promoted in Pharmacy 2.0 aren’t supported by the evidence, and without a functional and accessible eMR are likely to fragment care and promote wastage and overservicing.

    We should stick to pharmaceutical care. That’s what we do.

    • Michael Ortiz
      28/06/2019

      You don’t need to be a pharmacist or a medical practitioner to know that the AMA is blowing this out of proportion. This simple program is nothing like the US Healthcare system past or present.

      There is nothing new or earth shattering in what is being offered by TWC/BUPA.
      Please take the time to view their website below :
      https://www.terrywhitechemmart.com.au/bupa/

      The Subscription Benefits are all well within the current Pharmacists’ scope of practice:

      1 Health Check (BMI, blood pressure, blood glucose and cholesterol)+
      2 pharmacist health consultations+
      1 flu vaccination+ Commencing 2020 flu vaccination season.
      50% off Dose Administration Aids (DAAs)
      Free delivery of DAAs limited to 1 per month and up to 5km

      Health Checks are provided by Participating Pharmacies and take approximately 20 minutes.

      Health Checks involve the following: blood pressure check; blood glucose; total cholesterol check; body mass index calculation and waist measurement; advice on the results and/or referral to a doctor (if applicable); and advice on lifestyle changes.

      Health Consultations are provided by Participating Pharmacies and is a guided discussion and advice around health concerns. Health Consultation involve the following: discussion about specific health concern; a series of questions; and advice specific to health and/or referral to a doctor (if applicable).

      To suggest that there is no evidence to support these type of programs is misleading. Two Australian examples:

      An Australian study conducted in 56 randomly selected community pharmacies, 28 intervention pharmacies delivered a diabetes service to participants with T2D. The services included: self monitoring of blood glucose, education, adherence support, and checks for diabetes complications . The other 28 control pharmacies delivered no intervention. A total of 289 subjects completed the program and the mean reduction in HbA1c in the intervention group was −0.97% compared with −0.27% in the control group. Krass et al (2007)

      A 2018 yet to be published study of a weight loss program for overweight and obese diabetics (BMI > 25) found that Diabetic participants averaged a 2.5% weight loss (2.3 Kg) after 90 days as well as a -1.02 reduction in HbA1c (%).

      There many more studies of successful Pharmacy based primary care programs in Europe and North America (Hughes et al).

      Krass I,,et al The Pharmacy Diabetes Care Program: assessment of a community pharmacy diabetes service model in Australia. Diabetic medicine 2007 https://doi.org/10.1111/j.1464-5491.2007.02143.x
      Hughes JD, et al. The role of the pharmacist in the management of type 2 diabetes: current insights and future directions. Integrated Pharmacy Research and Practice 2017:6; Pages 15—27

      • Andrew
        28/06/2019

        Medication is better at lowering Hb1Ac and has the long term (>6m) data to support it, supervised by a practitioner who has better visibility of the longitudinal metrics that inform subsequent decision making.
        My concern is that the siloed pharmacist without this information may make recommendations that undermine or confuse the care-plan that the GPshould have in place, and lead to further deterioration of clinical partnerships with pharmacists. We’ve seen it on the small scale with HMRs.
        I don’t doubt that some pharmacy services may have merit, just not these ones IMO. The evidence isn’t robust enough, long-term outcomes aren’t available, and the paid subscription model excludes the section of the community who most need a service like this.
        If I as a practitioner could readily access a patient’s full Hx, labs, etc I could absolutely see a benefit from pharmacist interventions like this, but the silo of pharmacy doesn’t allow for it and as such I think recommendations based on a patient interview, their recollection, might just make GP consults less efficacious, dealing with not fully informed external noise, not focussing on what’s happening in front of them. I don’t think that’s a great outcome for anyone, but again, just my opinion.

        Edit – WRT the Guild spokesmans language and tone, it’s not really helpful is it? Anthony Tassone does it very very well, as do the PSA crew. Maybe the Guild could take a lesson from them.

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