‘Do I really need to see a doctor for this?’

NSW Guild president highlights out-of-pocket cost of medicines and criticises the “5-minute medicine” of corporate general practice in his latest column

Cost of living is a key issue for community pharmacy patients who are mostly comprised of the elderly and mothers with young children, and should be taken seriously by the government with an election on the horizon, says David Heffernan, President NSW Branch of the Pharmacy Guild of Australia.

“The former are either self-funded retirees or pensioners, and the latter either confronted with a mortgage and/or the prospect of saving for one while upholding the responsibilities of a parent,” he says in his latest bulletin.

“Ever since and including Peter Costello’s assault on the low hanging fruit of the Safety Net (including a near doubling of the pensioner co-payment and a year by year increase by two scripts, up to 60 scripts per year), the amount patients have had to contribute to PBS medicines has well exceeded CPI,” says Mr Heffernan.

“Patients are now contributing more to PBS medicines than ever before. Therefore, pensioners today, who took for granted that their taxes would contribute to supporting their future, are anxious about not only how they can pay for their medicines, but the cost of a doctor or hospital visit, energy bill, rent, fuel, mortgage, transport and groceries.”

He says all these pressures lend to increasing anxiety on the cost of living, and tells AJP this can be resolved by making changes to out-of-pocket costs, including by implementing the Pharmacy Guild’s recommendation in its pre-budget submission to remove the optional $1 discount and reduce PBS/RPBS co-payments by $1 for all patients.

“The fact is the PBS is the only sustainable area of the Medicare spend …

“The PBS was designed for access and affordability, however growing financial pressures simply removes the very remit of the PBS – access and affordability.

“The PBS can not continue to be the low hanging fruit for budget savings.”

In his column, Mr Heffernan also takes aim at “five-minute medicine”, arguing that pharmacists should be able to practise in the full minor ailment space to help ease the strain on general practice and emergency rooms.

“I have the tools to help this person but the law will not allow me to use them’,” he says is an increasingly common protest from pharmacists who work on Sundays and Public Holidays.

“There are a litany of minor ailments that could be addressed immediately by a community pharmacist – if the law permitted. The ability to treat UTIs, impetigo, migraine, to name a few, has the opportunity to save tax payers billions, along with continuing supply of medicines and pharmacist prescribing.

David Heffernan calls for legislation to allow pharmacists to take on the full minor ailments space.
David Heffernan calls for legislation to allow pharmacists to take on the full minor ailments space.

“Gone are the days where a GP would turn up on your doorstep in their dressing gown and doctor’s bag. The contemporary GP surgery likes to open normal business hours and prefers to have their books filled.

“Walk-ins are becoming rarer. You will find in the corporate GP practices, business models that appear to encourage five-minute medicine – turnstile operations which encourage patients to come in for short visits and often.

“More and more, healthier patients with low morbidity conditions fill GP time slots. Healthier and wealthier patients are financially more attractive to business models that put profits before patients (a GP practising five-minute medicine can earn over $400 an hour in a bulk billing practice).

“The unfortunate side effect is when GP books are filled with ‘easier’ clients, the poorer and more in need of health care are marginalised, forced into the public system of emergency wards.”

Mr Heffernan highlights the recent Productivity Commission report which revealed there were three million avoidable hospital admissions last year by patients who should have seen a GP instead.

“Could they see a pharmacist instead? It is a simple fact: if the pharmacist is not permitted to help you and the surgery is closed, there is no choice but the emergency department,” he says.

“Further, in 2018 the Australian Institute of Health and Welfare (AIHW) reported that up to 7% of Australians either delayed or avoided purchasing medicines, and more than a million people have put off seeing a GP because they could not afford it – out-of-pocket expenses for doctors’ visits continue to rise. There is a significant market failure in our health system when those who access medical services are only those who can afford it.

“Unsurprisingly, the AMA calls for more funding to fix the problem. They claim the Medicare rebate is not sufficient and is a reason why surgeries can charge $120 for a consult (in addition to a Medicare payment).”

However Mr Heffernan says more funding for GPs would be “a disaster for an already struggling MBS budget”.

“Increased funding to GPs will only incentivise five-minute medicine and blow out an already out of control GP and hospital spend.

“A solution is there for our legislators where community pharmacy stands ready to ease the strain on a burgeoning health spend and free up appointment times for GPs and emergency rooms,” he says.

“Allowing pharmacists to practice in the full minor ailment space is a simple legislative change with the potential for huge savings.”

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