Concerns about clinical pharmacy funding


The Small Pharmacies Group has raised concerns that the GP pharmacist model presents a threat to community pharmacy, in a letter to the PSA

The Small Pharmacies Group (SPG) has raised new questions about the model involving pharmacists in general practice, in a letter sent to the PSA this month.

SPG has three founding members – Terry Burnett, Fredrik Hellqvist and Katie Stott – who represent a growing network of small pharmacies in Australia.

“It has never been explained to us why there is a need to insert a second pharmacist into a patient’s health journey whereas such duplication is generally discouraged when it comes to GPs, specialists etc.,” says SPG in the letter.

“Furthermore, the question lingers about how a practice pharmacist resolves the problem of our daily need to consult directly with the patient’s prescribing GP.

New questions have also arisen regarding this model, says the group.

AJP has recently reported on the results of Chris Freeman’s 2017 survey of 43 Australian pharmacists working in general practice.[i] According to this AJP article, the survey found that there were ‘a significant number of referrals of patients to their community pharmacy for services such as MedsChecks, DAAs and HMRs.’

“We have not yet seen the research to be able to assess it fully, but it would seem to us that these results must be treated with caution given that we are not currently operating in the context of a funded model for practice pharmacists.

“It is interesting to compare Freeman’s results with an independent review of the UK clinical pharmacist in GP practice pilot program in the UK (which is a government funded program).[ii] In this review, researchers surveyed 78 GP sites where 373 pharmacists were employed as part of the NHS England scheme.

“This study found that ‘most CPs [Clinical Pharmacists] undertook patient facing work, focusing on complex medication reviews…For 70% they classified this as a major part of their role’.[iii]

“If practice pharmacists were to be funded by the government here would there still be the same flow-on benefits to community pharmacy in terms of increased medicine reviews that were seen in Freeman’s survey?

“PSA is strongly advocating for government funding for practice pharmacists. It is not clear exactly what funding model the PSA envisages but it would appear that an MBS-style model is one option that is being pursued.

“We are concerned that the pharmacist in GP model together with a potential MBS access can prove to be quite detrimental to the existing community pharmacy network in Australia if funding is diverted from CPA to MBS by the government to fund this,” says the SPG.

“It is quite probable that GP surgeries would like to capture as much of the MBS funding available before the patient leaves the surgery, including any funding through their ‘in-house’ pharmacist, blocking community pharmacists and pharmacies from access.”

“PSA seems to envisage that direct to patient activities would only occupy a small amount of a practice pharmacist’s time. However, patient-related activities are the activities most likely to attract new government funding and it is therefore hard to escape the conclusion that surgeries will push practice pharmacists towards funded services to make the position viable.”

SPG shares concerns that in the UK there have been “deliberate and systematic cuts to community pharmacy funding” with a lack of increasing funds and/or types of professional services for community pharmacy.

“At the same time, considerable amounts of funding have been invested in the GP pharmacist model. There is a limited timeframe on the government funding for practice pharmacists in the UK and that funding will eventually wind up. While there seems to be support from GPs in terms of the clinical aspect of the role, there has been acknowledgement that it is not particularly cost effective.[iv]

“If pharmacists are not kept on in this role, once government funding is reduced/ceased, the question arises as to where these pharmacists will find employment given that the UK community pharmacy sector has contracted.

“What guarantees does the PSA have that this is not part of the agenda of the Australian government? 

“Lastly, we feel compelled to raise concerns about the Workforce Incentive Program that was announced in the last budget. Members of SPG were not aware that PSA was pursuing this measure and are concerned by the apparent lack of consultation. Both PSA and the government have suggested that community pharmacies can be contracted to provide these services.

“However, if community pharmacy is placed in a position where it must tender for these services to GP surgeries we are likely to see a similar pattern as to what has happened with aged care – a race to the bottom to provide the cheapest service. How is this good for community pharmacy or for patients?

“In conclusion we would like to reiterate the need for greater transparency and more careful and collaborative strategic planning between the PSA and the Guild when it comes to mapping out the future of clinical pharmacy services – in terms of what services should be funded, who should be delivering them, where they should be delivered and how they should be funded.”

The PSA says it acknowledges the concerns raised by the SPG.

“It is understandable that at a time of exceptional pressure on the viability of the community pharmacy sector, the development of roles for pharmacists outside of the community pharmacy setting are perceived as potential threats,” the PSA tells AJP.

“A key pillar of the PSA Strategic Intent is to positively influence policies on pharmacist roles, recognition and remuneration.

“Our focus is to ensure that by 2023, remuneration and recognition for pharmacists is appropriate to their role and value,” says the PSA.

“This is why we are currently consulting on our discussion paper Pharmacists in 2023, where we are seeking input in the enablers and system changes that are required to ensure appropriate funding for pharmacist services and for pharmacists working in general practice.”

In regards to SPG’s reference to the Workforce Incentive Program, the PSA points out that the program “sits outside the Community Pharmacy Agreement and will receive no extra budget allocation”.

“It is simply an expansion of the type of health professionals who can participate in the program to include pharmacists,” says the PSA.

“PSA believes pharmacists should be meaningfully integrated in all settings in which a medication is being considered, which includes not only general practice medical centres but also aged care facilities.”

See the full letter from the Small Pharmacies Group here.

References:

[i] https://ajp.com.au/news/we-have-waited-far-too-long-for-this-to-occur/

[ii] Clinical Pharmacists in General Practice: Pilot Scheme Independent Evaluation Report: Full Report June 2018

[iii] Clinical Pharmacists in General Practice: Pilot Scheme Independent Evaluation Report, p.18

[iv] Clinical Pharmacists in General Practice: Pilot Scheme Independent Evaluation Report, p.20

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