Docs cutting noses off to spite their face: Tassone


woman holding her nose

The AMA is calling for a move away from community pharmacy as the vehicle for dispensing medicines in rural and regional areas

Along with incorporating pharmacy services into general practice under medical practitioner ownership, this is one of several concepts that will be pushed by a new lobby group formed by the Australian Medical Association.

The AMA’s newly formed General Practice Pharmacy Working Group is aimed at driving policy, strategy, and advocacy on pharmacy and dispensing, and plans to provide the Government with AMA general practice input to the Seventh Community Pharmacy Agreement, the AMA said in a statement on Tuesday.

The working group plans to consult with the AMA Council of General Practice to develop an advocacy blueprint on new dispensing models.

It was created following an Urgency Motion passed at the August meeting of the AMA Federal Council.

According to AMA national president Dr Tony Bartone, the two priority issues for the group’s consideration will be the pharmacy ownership rules, and the pharmacy location rules.

“The AMA has long called for the Commonwealth pharmacy regulations to be amended to enable pharmacies and medical practices to be co-located,” Dr Bartone said.

“The AMA supports high-quality primary health care services that are convenient to patients, enhance patient access, and improve collaboration between health care professionals.

“Co-location of medical and pharmacy services would clearly facilitate this.

“The AMA also wants to see State and Territory pharmacy regulations changed to allow broader ownership of pharmacy businesses. The AMA wants to see an end to pharmacies only being owned by pharmacists.

“Incorporating pharmacy services into general practice, under the ownership of a medical practitioner, would improve patient care by allowing GPs to lead a team of co-located health professionals in providing multidisciplinary health care to patients at the local community level.”

Dr Bartone noted that many general practices already offer co-located services such as pathology collection or podiatry. He said that adding pharmacy would benefit patients, pharmacists and GPs.

“Under such an arrangement, each health professional would be able to work collaboratively to their full potential and scope of practice in a well-supported, multidisciplinary, team-based environment,” he said.

“Patient medication management, compliance, and literacy would be improved, delivering better health outcomes for patients and reducing the number of adverse medication events.

“This is evidence-based world’s best practice.”

Dr Bartone also questioned the validity of community pharmacy as the location for dispensing services, particularly in the bush.

“With shortages of pharmacists in rural and remote areas, consideration also needs to be given to moving away from community pharmacy as the vehicle for dispensing medicines.

“Rural doctor groups have clearly identified that there are very few rural towns that have a pharmacy and no doctor.

“They also report that, in smaller rural towns, pharmacies are rarely open after hours, or for any significant time over a weekend.”

The Pharmacy Guild’s recent submission to the National Rural Health Commissioner stated that there are currently “57 towns in PhARIA 4-6 with one pharmacy and no medical centre”.

Dr Bartone said the formation of the Working Group is well-timed to coincide with the development of the Seventh Community Pharmacy Agreement.

“With negotiations for the Seventh Pharmacy Agreement now underway, there is an enormous opportunity for the AMA to inform the Government how it could increase competition in the pharmacy space, provide pharmacists with improved opportunities for working to their scope of practice within general practice, and safely deliver patients more convenient access to prescribed medicines,” Dr Bartone said.

“It is important that all key stakeholders have input to the next Pharmacy Agreement,” Dr Bartone said.

Dr Bartone also told 3AW’s Ross Stevenson that medical practitioner ownership of pharmacies would not mean increased dispensing of medicines to enrich doctors, a suggestion Mr Stevenson said was being made by pharmacist stakeholders.

“Nothing could be further from the truth,” he told Mr Stevenson.

“And, in fact, if you look at what they’re saying could be a risk is what’s happening at the moment now, if—even using their own plan of what they want to achieve is—they’re seeking to increase the amount of primary care services in their retail space. So, really, you know, it doesn’t fly.”

The announcement of the formation of the working group followed the announcement that United General Practice Australia reached unanimous agreement to combine resources to convince governments to resist any attempts by the Pharmacy Guild to “undermine and weaken quality primary health care in Australia”.

UGPA comprises representatives from the AMA, Rural Doctors Association of Australia, Australian College of Rural and Remote Medicine, General Practice Supervisors Australia, and the General Practice Registrars Australia.

RACGP national president Dr Harry Nespolon has also taken aim at the ownership rules in Fairfax media this week, rejecting the Guild’s stance on pharmacist-only ownership and the suggestion that pharmacy-owning doctors might overprescribe.

“Most doctors are more interested in getting people off drugs than on them,” Dr Nespolon said.

 

Renewed call ‘extraordinary’

Spokespeople for the Pharmacy Guild and the PSA expressed disappointment at the AMA’s stance.

“The renewed call by doctors’ groups to open up pharmacy ownership to non-pharmacists are extraordinary given the medical profession’s own negative experiences with corporatisation following deregulation of general practice,” said Victorian branch president Anthony Tassone.

“Are the AMA and RACGP now saying that corporatisation of primary healthcare is a good thing? 

“In response to worthy discussion about best utilisation of our health workforce and pharmacists practising to the top of their scope for patient benefit, they seem obsessed with pharmacy regulation urging government to relax laws and allow the same corporate forces that have had such a detrimental impact on medical care,” said Mr Tassone.

“Having given up so much influence over the terms and conditions of general practice for their own members while they watched deregulation happen in their sector, they want to see the same poor outcomes inflicted on pharmacy. 

“If ever there was a time where you could say ‘two wrongs don’t make a right’ it’s here.

“Talk about Hippocrates meets hypocrisy,” he said, echoing his comments made last year for the AJP on the doctors’ resistance to pharmacist-only ownership.

Mr Tassone said that in supporting calls for pharmacy ownership deregulation, the RACGP is “all at sea” with the views of their own leadership, with Dr Bruce Willett, Queensland chair of the RACGP telling the Queensland parliamentary inquiry into pharmacy ownership last year that “It (pharmacist ownership of pharmacies) will probably lead to better outcomes if pharmacists continue to control their pharmacies”. 

This was due to concerns of non-clinician ownership of general practice had led to the roll-out of models with a “profit driven ethos,” Mr Tassone noted.

“It’s actually sad that peak medical bodies would resort to cutting their nose off to spite their face around opposition to pharmacists practising to their full scope and go against what the public’s preferences are with the majority of consumers rather having health professionals owning their own practices,” he told the AJP.

“It’s not pharmacy or pharmacist’s fault that there was deregulation of general practice. Pharmacists aren’t ‘writing their own script’ for scope of practice, that is up to our regulatory Board, the Pharmacy Board of Australia.

“Are these calls by the AMA and RACGP motivated by patient need or by greed?

“Calls for unravelling pharmacist only ownership seemed to be driven by envy, greed and wrath more than anything else – and we all know they form part of the seven deadly sins.”

Mr Tassone said that unfortunately, there is enough acute and chronic disease in the community to keep all of Australia’s health professionals busy for quite some time. 

“The sooner we can start talking about working effectively as a team to ensure tax payer dollars get the best return and quality in patient care for Australians the better.”

PSA National President Dr Chris Freeman also commented on the formation of the working group.

“It’s quite unfortunate that the AMA views that owning a community pharmacy is the only way to increase collaboration between pharmacists and general practitioners,” he said.

“We invite the AMA and others groups such as the RACGP, ACRRM and the RDAA to sit down with PSA as a co-signatory to the 7th community pharmacy agreement to identify and work-up the models of care that integrate community pharmacy and general practice to improve access to care and that improve the quality and safe use of medicines.”

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