Dispensing back in the spotlight


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RACGP head calls for six-month dispensing, cuts to dispensing fees in discussion about scope of practice

Doctor and pharmacist group heads have debated pharmacist scope of practice, dispensing and complementary medicines in a segment on ABC radio.

Radio national program Life Matters interviewed RACGP president Dr Harry Nespolon and PSA national president Dr Chris Freeman about scope of practice, with doctors saying pharmacists have been encroaching on what they see as medical turf.

The Queensland pharmacy trial was brought up, along with discussions on antibiotic prescribing for urinary tract infections (UTI) and pharmacist prescribing of the morning-after pill.

Dr Nespolon argued that properly assessing a patient for a UTI would not be suitable to be performed ‘in one minute across a counter’ in a pharmacy.

“The first thing to understand is that the pharmacy environment has evolved over the last 5-10 years,” responded Dr Freeman.

“Many pharmacies now have a consultation room to provide a private consultation. There would be a process of consultation. If there were any red flags for that patient, they would be immediately referred onto their GP.

“Where it would be considered to be a lower risk UTI symptom, then the pharmacist would go through a protocol process to actually consider supplying that antibiotic.”

The conversation soon turned to the topic of dispensing, with Dr Nespolon bringing up the two-monthly dispensing proposal.

“The head of the Pharmacy Guild had, I think it would be fair to describe it as, a meltdown, he suggested that the pharmacies would all go broke because they wouldn’t be able to get the walkthrough traffic to go and buy other things in the pharmacy,” Dr Nespolon told the ABC.

“They’re making a profit out of effectively getting people who are being in a sense forced to go to their pharmacies to get their pharmaceutical benefit.”

When asked whether he would like to see a cut in the dispensing fee if pharmacies continued to sell non-evidence-based products, Dr Nespolon said: “Absolutely. As a taxpayer we should be trying to minimise our costs or having our healthcare dollars spent in the most effective way possible.

“Something as simple as increasing the amount of medication that a patient can pick up at a single time – we would argue six months – but two months is a good start, we can’t even get past that line. The Minister of Health had slammed it before the ink had even set on the laser printered paper.”

A spokesperson for the Pharmacy Guild told AJP: “Dr Nespolon’s views on pharmacy are well-known, but not well-founded.

“If he was really interested in ‘our healthcare dollars spent in the most effective way possible’ he would address the sharp and disturbing rise in Medicare fraud by doctors, as reported in The Australian newspaper last week.

“He is noisy on pharmacy, but silent on Medicare rorts,” said the spokesperson.

“Patients value and trust the advice and assistance they receive from their local pharmacist and pharmacy staff.”

Health Minister Greg Hunt confirmed at PSA19 over the weekend that PBAC recommendations to increase the prescription lengths of certain medicines from one to two months were still under consideration.

“We’re consulting on that at the moment. It’s a carefully considered consultation because there are arguments for and against it. And even within the health sector there are very very different views,” he said.

Dr Freeman said that it is “very hard to make a blanket statement” on the drastic suggestion such as cutting dispensing fees for pharmacies that stock complementary and alternative medicines.

“The PSA has come out earlier this year and suggested that all pharmacies should stop stocking homeopathic products. Many of them have written back to us saying that they’re moving in that direction.

“But we also have a range of complementary and alternative medicines such as supplements and vitamins, and it’s not to say that the evidence shows that they don’t work, just that there is no evidence,” he said.

“We do have an obligation to allow people to make choices in their own health treatment. If someone is coming into a pharmacy as opposed to a supermarket or a health food shop, they have access to that pharmacist to ask questions and for that pharmacist to provide advice.”

Listen to the full Life Matters interview here

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