‘Both sides should take a cold bath.’

Rural pharmacists want collaboration not turf wars, says Rural Pharmacy Network of Australia

Rural Pharmacy Network of Australia (RPNA) has called for an end to the ‘turf war’, appealing to both medical and pharmacy organisations to take more care in how they characterise the problems and challenges of rural healthcare.

The group has also highlighted the financial struggles and additional workload that rural pharmacists have taken on in recent years, adding that GPs may not be aware of these pressures.

“Doctor groups, including the Rural Doctors Association of Australia and Australian College of Rural and Remote Medicine, last week joined forces to react strongly against the push by the Pharmacy Guild of Australia for pharmacists to be practising at their full scope, including independent prescribing rights,” says RPNA.

“Instead of engaging in the sort of press releases and twenty paces nonsense we’ve seen in the last few days with the Guild splashing about easily misunderstood terms like ‘pharmacist prescribing rights’ and the GPs making ridiculous claims that pharmacists want to practice medicine … both sides should take a cold bath, a few deep breaths and try to understand what rural pharmacists are actually saying.”

United General Practice Australia (UGPA) said that it reached unanimous agreement at its meeting in Canberra last week to combine resources, including members spread across Australia, to convince governments to resist any attempts by the Pharmacy Guild to “undermine and weaken quality primary health care in Australia”.

Dr Adam Coltzau, President of the Rural Doctors Association of Australia (RDAA), claimed that the Guild is spreading misinformation about poor access to doctors in rural and remote areas.

“The Guild’s dishonest claims that supposed reduced access to doctors in rural and remote areas could be addressed by increasing the scope of pharmacy practice are factually incorrect,” Dr Coltzau said.

There is a huge amount of common ground between rural pharmacists and doctors, as well as a shared determination to improve primary healthcare outcomes in rural communities, says RPNA Chair Fredrik Hellqvist.

“RPNA wants to go on record for the benefit of rural doctors to say that rural pharmacists have zero desire to work against or replace their medical colleagues. Absolutely zero. The opposite is true,” says Mr Hellqvist.

“GPs have the most valuable healthcare skillset in rural communities. Along with everyone else, rural pharmacists know and embrace that and want to see GPs’ abilities utilised in the best possible way.

“We already collaborate extremely closely with our GP colleagues, who are often also our personal friends, and a large proportion of the work we do is designed to support and boost rural medical practices.

“In fact, it’s not too much to say that rural pharmacists are rural GPs’ greatest supporters,” says Mr Hellqvist.

“There is no competition going on between rural pharmacies and GPs – it is spurious to suggest it – and no-one in any small rural community is working harder to keep rural GPs viable than the local pharmacy.”

RPNA says that GP groups may not fully realise that the scope and mix of rural pharmacists’ work has completely transformed as rural medical practice has become less popular with graduates and the rural hospitals have been downgraded.

“The average pharmacist in a small rural town now finds themselves spending dozens of hours every week dealing with complex medication safety problems; supporting – often quite intensively – inexperienced prescribers, many of whom were not trained in Australia and have no familiarity with the PBS; dealing with increasing numbers and complexity of patients walking in and asking for care, all of whom must be triaged and many referred to appropriate medical care – the local GP or hospital as appropriate.”

The group says that rural pharmacists are also being required to act as unpaid patient educators in areas like diabetes, asthma and COPD, post-myocardial infarction, stroke, post-surgery and even as de-facto mental health and alcohol and other drugs caseworkers, and have often undertaken substantial training at their own expense without receiving formal recognition of the work itself.

“Pharmacists are also involved in monitoring people’s chronic medical conditions, improving adherence with drug and non-drug treatments and coordinating patient care with local GPs, community nursing, mental health services, Aboriginal Community Controlled Health Services and hospitals,” it says.

Meanwhile virtually none of the new workload that rural pharmacists are being forced to take on is currently remunerated.

“It’s important to understand that this is not the ‘normal’ unpaid work of the healthcare system,” said Mr. Hellqvist.

“It is the result of a large-scale, radical transformation in the work that rural pharmacists are required to do, and the abject failure of the pharmacy remuneration system to address that transformation. This has now become a threat to rural pharmacy viability.”

RPNA says its members are seeking more adequate remuneration, which recognises the work they do.

“We would like to see more recognition of pharmacy roles such as triage and referral, chronic disease management, improving adherence and even treating less serious conditions,” said Mr Hellqvist.

The group also calls for effective workforce support.

“Again, this is a question of being treated equally to other groups,” says Mr Hellqvist. “It is simply a fact that pharmacy has been completely overlooked in rural clinical workforce planning at both the Commonwealth and State levels and that is just not fair or acceptable.”

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