Doubling down


RACGP and CHF have called on the Federal government to rethink its 60-day dispense decision, but the Guild tells doctors to stop ‘meddling in pharmacy matters’

The Royal Australian College of General Practitioners (RACGP) and the Consumers Health Forum (CHF) have joined forces to call on the Federal Government to rethink its decision to put a hold on plans that would enable patients to collect two months of scripts in a single visit to a pharmacy.

The proposal, suggested by the Pharmaceutical Benefits Advisory Committee (PBAC) several months ago, was scrapped just before the 2019-20 Budget was announced after the Pharmacy Guild voiced strong concerns about the measure.

These concerns surrounded the potential impact of the measure on the viability of the community pharmacy network as well as impacts to patient medication adherence.

Meanwhile the PBAC had suggested increasing the maximum dispensed quantities on selected PBS items from one month’s supply to two months’ supply per dispensing would “allow clinicians to exercise greater choice and provide patients both financial and convenience benefits”.

In a recent statement RACGP President Dr Harry Nespolon has argued the government’s decision not to allow 60-day dispenses for 143 medications was in the best interest of pharmacy owners, not patients.

“We are extremely concerned the government has backed down on a decision that was in the best interest of Australian patients, after intense lobbying by the Guild,” Dr Nespolon said.

“The Guild has lobbied for this change not because they believe it will improve patient safety and convenience, but because they know pharmacy profits may be impacted if 60-day dispensing was implemented.

“The public needs to be aware that when it comes down to pharmacy profits or patient benefits, the patient comes second to the Guild,” he said.

“We don’t want to see a positive initiative for Australian patients dismissed because it doesn’t suit the financial interests of one particular lobby group.”

In response to Dr Nespolon’s comments, a Pharmacy Guild spokesperson told AJP: “The Guild always acts in the best interests of patients, and supports more affordable medicines for all.

“However, the proposal to double quantities for some PBS medicines has been raised without consultation and without regard for the possible unintended consequences for patients in terms of quality use of medicines and for pharmacies in terms of patient care and contact, and pharmacy viability.”

The Guild pointed to a separate media statement released this week in which Dr Nespolon said: “As a GP for over 30 years, the last thing I ever want to do is turn away a patient because they cannot afford it, but if something doesn’t change soon that is going to become a reality.”

“It is a bit rich for the RACGP to talk about putting profits ahead of patients when they’ve launched a campaign threatening to abandon complex patients because they don’t pay enough,” said the Guild spokesperson.

“It might be time for the RACGP to focus on general practice and the impact of corporatised medicine rather than meddling in pharmacy matters.”

CEO of the CHF Leanne Wells said enabling patients to collect two months of scripts in a single visit to a pharmacy would be safe, practical and convenient for patients.

“This policy reversal takes little heed of PBS and the expert, multidisciplinary advice of the PBAC and is counter to undertakings from both sides of politics that PBAC advice will be acted on,” Ms Wells said.

“Pharmacy owners derive considerable business as dispensers of PBS medicines. Pharmacists also have widespread community respect.

“We urge them to display respect for the community and accept the two-month script proposal and recognise the importance of patient convenience and cost savings for patients. The Guild’s action dismisses patient interests and risks eroding optimal access to health care.

“There are built in Quality Use of Medicine safeguards to discourage inappropriate use or waste. Whether patients get a two-month script is subject to the prescribing doctor being satisfied that their medication is warranted,” Ms Wells said.

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47 Comments

  1. Thomas Lake
    12/04/2019

    Next will be AMA and RACGP wondering why we push clinical services. Or the PSA wondering why we push CAM’s. At the end of the day, half the Dr’s turnover – they will go bust too. Half the PSA’s salary, they will find it difficult to pay rent too. It is not financially feasible. The PBS, gov, patients, Pharmacists, Pharmacies – we are a team – we need to make sure we can all exist otherwise essential services will die. My Pharia 6 will go (or operate only every 2nd month when scripts are due) and this will detriment all.

  2. Thomas Lake
    12/04/2019

    RACGP and AMA please upskill ALL your GP’s in mental health – the new patient segment coming your way (pharmacists) will make you a killing…

  3. Thomas Lake
    12/04/2019

    If two month’s goes ahead my pharmacy is gone. Simple as that. Half the scripts, half the turnover, half the traffic. Unless of course remuneration matches the loss or we are allowed to charge a commensurate amount to cover the loss. I have millions invested in providing the public with the PBS. I think I deserve a little bit back in order to maintain this delivery please. Pharmacy has been smashed over the recent 5-10 years and screwed to the bottom of the bucket. There is nothing left to scrape.

    • Red Pill
      13/04/2019

      My friend, even if most of us go under, there are always the big boys with deep pockets that can absorb the costs and turn a profit. The Red and Yellow Pharma bros are eager to see small operators finally throwing in the towel. They’ll get your shop and approval number at 50% discount and convert it into a discount fries and coke model.

      • Thomas Lake
        13/04/2019

        There isn’t the volume for a coke and fries model, otherwise they would have already turned it into one. We won’t go down, just cut costs and services like them. Same shoestring cost model, just bare-bones services and go to that well known – checkout-chick + Rx model with no roamer’s on the floor.

  4. Ai Nguyen
    12/04/2019

    RACGP thinks that only doctors care for patients. Yeah. GPs please don’t charge extra on top of bulk bill to patients. Specialists please don’t charge hundreds dollars per visits. You also think about profits to stay open. A medical centre near my work place has been opened and closed for the last 5 years by 3 subsequent doctors because they did not have enough profits. Stop meddling in other professions. Thank you RACGP who only think for patients first.

  5. Thomas Lake
    12/04/2019

    The RACGP and AMA are clearly quiet of hearing and squint of seeing – thus I must post to infinity… You do not know what you are lobbying for. You clearly want the end to community pharmacy. You want to bury us, burn us and desecrate us. Any drastic change in the fragile financial ecosystem of a pharmacy will destroy it. Overnight. Convenience of patients? Doctors? The pharmacy won’t even exist – now show me the convenience.
    Immediately I’m gearing up by cutting staff and service. I’m cutting operating hours and ceasing my after hours service. I’m cutting counselling by the exact amount you cut my remuneration, and I’m not making that third or fourth phonecall to chase up the Dr about an erroneous script. The patient wins in convenience but their health will only potentially be at detriment.
    I will cease medschek, vaccinations, clinical interventions, HMR’s and limit Webster’s and maximise generic conversion. I will cease public health screening, bp, glucose monitoring, smoking, weight, and public education and stick to dispensing and FOS. You called for it – you’ll get it. And did I say counselling… Yep, just google the CMI !

  6. Ai Nguyen
    12/04/2019

    Pharmacies have been given free advices for many conditions without selling any products or medications. Doctors don’t. Don’t think that only doctors care for patients and pharmacists only think about profits.

  7. Elsa Chiang
    12/04/2019

    I have been seeing a lot of scripts that were endorsed with regulation 24, even though the patients were not going away. Is this a way that GPs are forcing us to dispense multiple repeats?

    • Thomas Lake
      13/04/2019

      A Reg 24 is like a suggestion. Cross it out and its gone.

  8. Andrew
    12/04/2019

    Got to say, not happy with comms from the Guild “spokesman” lately – they’re often impolite, accusatory, and usually resort to “whataboutery” rather than trying to calm a situation or concisely explain the point.

    My personal dealing with the spokesman have been about the same too. He’s part of the problem.

    • Thomas Lake
      12/04/2019

      Guild are off the rails. They’ve lost it. They were into financial advice, insurance, legal services, accounting, you name it, they lost their way and their key focus due to historical leadership ego. But, we need them. They might turn around, or they might submit to the PSA. I’m starting not to care anymore, what will be, will be. Just keep paying your subs and try not to think about the future.

  9. Rosemary Peacey
    12/04/2019

    This is the second such discussion I have contributed to recently. My experience of dispensing multiple packs in the UK many years ago was that it led to incredible waste and medication confusion in elderly patients living at home. Does this mean that we should be able to enforce the use of DAAs in these patients and be paid adequately for the service?
    Many of these patients already benefit from the Safety Net so if they only get one ‘sticker’ per two month dispensing aren’t they worse off?
    It seems that the AMA is intent on replacing community pharmacists with pharmacists in G.P. practices or probably to have GPs dispense. Under this model patients lose access to widespread public health advice, minor ailment advice and evidence-based CAM advice.
    After reading ‘a day in the life of a G.P. practice pharmacist’ recently who saw maybe three (yes,3) patients per day, I wonder how ‘efficient’ this model would be in replacing community pharmacy where pharmacists speak to many, many more patients per day, give out practical health advice and refer patients to the most appropriate healthcare professional when needed. Each has a role to play but one should be complementing the other not replacing it. Where is the funding to support seeing so few patients per day? How is the long term job security for pharmacists under this model?
    Many patients who seek health advice want instant access to a pharmacist rather than waiting hours to see a G.P. We should support this access as much as possible so that patients get timely information and are directed to the right professional at the appropriate time. Eroding community Pharmacy can only lead to increased patient inconvenience and poorer health outcomes.

    • Thomas Lake
      12/04/2019

      GP Pharmacists will never take-off. They will never pay the going rate and will only pressure down our wages. They are only interested in leveraging off us for their benefit. Do you think they really want to give us a well paid job in their business? They want cheap, submissive labour. I’m sorry, but that’s the corporate GP model for pharmacy. PSA is trying to dress mutton as lamb with this one.

      • TALL POPPY
        12/04/2019

        I agree. You will indeed be government-subsidised slaves for GP surgeries.
        Why else do you think the GP’s want this (hint: $$$$).

      • Michael Post
        13/04/2019

        GP pharmacists are a great idea. I agree we cannot have general practice funding to employ pharmacists . Practice support pharmacists must have independent funding and general practice leeching of pharmacist income in the form of high rent / occupancy must be prohibited lest it be jobs for the boys or the desperate.

  10. Rosemary Peacey
    12/04/2019

    As an addendum, I am tired of the Pharmacy Guild spokesperson making poorly considered comments that do not best represent the majority of pharmacists. It would be helpful if they gave a well rounded view of the impact all these ‘cuts’ will have on community Pharmacy. In what is possibly the worst wages growth for decades, rising unemployment and underemployment we are seeing a steady move away from Pharmacy as a career, especially in Community Pharmacy. Last week I met a young pharmacist in the year after internship who is already considering a career change due to poor wages and conditions and lack of forseeable opportunity. CPA agreements are linked to wages so why doesn’t the Guild push for increased awards so that payments to owners can increase accordingly. Looking at the broader picture can only be in everyone’s best interests.

    • Tim Hewitt
      12/04/2019

      Rosemary.. you’ve made a bold assumption here.. that ‘CPA agreements are linked to wages’… for better or worse, that is simply not the case.. there is no ‘mechanism’ within the CPA so called ‘negotiations’ that make any reference or connection with wages.. or inflation etc (other than the linking o fee increases to an erroneous index.. NOT CPI, or wages)…

    • Thomas Lake
      12/04/2019

      That’s true. The pay of a pharmacist is embarrassing. And here’s the fun bit: it’s not going to. Ever.
      Community Pharmacy is a retail model (sure clinical mix, but fundamentally retail systematically). Retail does not and can not pay the “widget-turners” aka the floor staff much. As PBS remuneration shrinks, margins shrink, volume is lost to other channels and general costs of business increase, wages can just not increase. It’s a simple equation.

      Also, pharmacist demographics are skewed to submissive pay receivers rather than demanding wage setters. We are majority female, young, and a few other things. As we all know. Equal pay is a big issue. In a women dominated industry, the worker is undervalued and as such the pay divide is contributed to. There is a HUGE turnover of pharmacists – the workforce is getting younger.
      It used to be white, male dominated. Now there’s an oversupply of desperate young-careerers willing to take what’s given rather than demand what they want.
      There’s corporate players like C/W.H who work on low cost models and ruthlessly (as we have seen in recent wage cases) flatten the employee via unscroupulous methods and set maximum pay limits that they just won’t pay above. I don’t blame them. It just is.
      Corporate players will in the future further screw pharmacists as soon as deregulation occurs, say good by to a wage conversation and hello union bargaining and strikes.
      Look, it may all seem doom and gloom. But Pharmacy is just this. We have chosen this path and just have to make the best of it.
      As they say, business is business and it’s tough out there.

    • Thomas Lake
      12/04/2019

      That’s true. The pay of a pharmacist is embarrassing. And here’s the fun bit: it’s not going to increase much. Ever.
      Community Pharmacy is a retail model (sure clinical mix, but fundamentally retail systematically). Retail does not and can not pay the “widget-turners” aka the floor staff much. As PBS remuneration shrinks, margins shrink, volume is lost to other channels and general costs of business increase, wages can just not increase. It’s a simple equation.

    • TALL POPPY
      12/04/2019

      I’ve spoken to THREE young pharmacists plus one in her 30’s in the last fortnight that are absolutely fed up with the state of the industry, the low wages and the impossiblility of proper ownership. These are smart, well-rounded inviduals that have much potential. Incidently, they’ve all been offered ‘puppet’ ownership in some backwater of Australia at various times in their careers and all have wisely turned them down thank goodness!
      All of them are actively looking to change careers. This is not good.

    • TALL POPPY
      12/04/2019

      $51/hr+ should be the minimum award for your everyday pharmacist *IF* the award kept pace with CPI. Anything less means pharmacists are earning almost 50% LESS today than they were in early 2000. The Guild have opposed any meaningful increases.
      Pharmacist roles and responsibilities (AND workload) have increased significantly over the years. This fact is being conveniently swept under the carpet. They should be paid what they are worth.
      PS: if you want to really make money as a retail pharmacist – try exporting to China – the returns are REALLY fantastic!

      • Still a Pharmacist
        13/04/2019

        Even if they managed to get $20.00 per script, your $51.00/hr will remain as a dream.

        I am working for $35.00/hr for last 10 years. One employer tried to reduce that when good profit from generics of Lipitor, Zyprexa, Valtrex were still there.

        Employee pharmacists are just a cost component for the owners. I think Woolworths/ Coles might be a better employer if they get pharmacy ownership.

        • TALL POPPY
          13/04/2019

          Pharmacists will forever be wearing a namebadge & get paid by the hour.
          Like good little retail employees. That’s what Pharmacists are seen as now more and more. The only way to get change is to STRIKE. Like CWH employees. It’s the only way to get a much higher rate for starters.
          Campaign to get the ownership rules changed if want a chance at ownership – be a business owner – really the best way to get true wealth & success.

  11. Jim Tsaoucis
    12/04/2019

    has anyone done the numbers on the decrease in dispensing this will cause and the associated loss of pharmacists, dispensary technicians and other dispensary staff jobs that will be reduced in hours or actual positions lost.
    It’s NOT just about proprietors!!

    • Thomas Lake
      12/04/2019

      Exactly why the PSA MUST get involved! How about a position statement from the PSA about this! – those fence sitters, please-all’s, up-set no-one, give me a seat at the table so I can waffle on in PhD talk and achieve insignificance… Our tough and vocal advocate’s, the PSA – so tough, so mighty, should be attacking the AMA/RACGP and standing alongside the GUILD in supporting pharmacist remuneration.
      In the end, I employ pharmacists and staff, and if I have less cash – then wages go down! Simple! Please PSA, stop being pansy’s and take them on. I pay your wages too!

      • M M
        12/04/2019

        Neither PSA nor the Guild have a strategy. I am enjoying to watch how they both struggle. It is obvious.

    • M M
      12/04/2019

      Don’t worry about pharmacists. There is a high market demand for them. The pharmaceutical manufacturing industry needs them more now than ever. They are needed to lead the digital transformation of the health sector as SME “Subject Matter Experts”

      • Thomas Lake
        13/04/2019

        That’s why we did pharmacy. So we can be I.T. experts…..?

        • M M
          13/04/2019

          You definitely don’t know what I am talking about.

        • M M
          13/04/2019

          Now, you are a cash and wrap expert. Good luck with that!
          Clearly, you don’t understand what I am talking about.

          • TALL POPPY
            14/04/2019

            You’ll forever be wearing a namebadge & get paid by the hour – this is what pharmacists are – retail workers. More so these days than ever! Good luck.

  12. M M
    12/04/2019

    I agree with RACGP and CHF recommendations. All pharmacies that can’t compete should close down. Taxpayers shouldn’t fund those who don’t know how to run a business. All PBS cuts and savings should be reinvested in PBS itself; subsidise new medicines to treat more of our patients. (Increase access to more medicines).

    The CPA has destroyed our pharmaceutical manufacturing industry. PHARMA companies should lobby against the Guild. They (PHARMA companies) should co-sign 7CPA with Guild.

    CPAs should be no more than 3 years. A five year agreement is a waste of time and country resources.

    All funded services in CPAs should be removed immediately, because they add ZERO value to our patients. They only fund inefficient pharmacies.

    • Thomas Lake
      13/04/2019

      Totally. Remove privately funded pharmacies and make them medicare pharmacies owned by the gov. Complete savings model. Gov set’s prices and controls the whole supply chain. Remove all clinical services. And, remove pharmacists and replace with dispensing technician’s.
      You know it makes sense.

      The only issue MM is that the GOV fight between Fed and State and are desperate for funding. They need a public-private partnership to deliver. Small pharmacies are needed to support small communities. Remote pharmacies are required to support remote communities. Local health, state health and Fed’s don’t want a bar of it. They have trouble enough being wroughted by VMO’s exorbitant fee’s.

      • M M
        13/04/2019

        We don’t need a CPA for that.

        • Thomas Lake
          13/04/2019

          That’s right, let anarchy rule and leave organisation aside. Nice idea. You’re a genius.
          I love this publication. We are clearly all mis-informed, half-witted and make off the cuff remarks that have no purpose. EXCEPT to increase the publisher’s click rating’s and advertising pull. Nice work to all of us advertising fodder!

          • M M
            13/04/2019

            There is no role for CPAs. It is fine if you don’t get it. Many don’t. It was presented many times to the government. The guild still doubts the future of CPAs.

      • M M
        13/04/2019

        Clinical services have added zero benefits to patients. It is the reason why the government started to assess the outcomes from services like MedsChecks.

        Yes, the government sets the prices and should set better pricing models. We MUST remove all price floors and price ceilings as well. Better pricing models will help our pharmaceutical R&D and manufacturing grow.

        Why do you think that small pharmacies in remote communities will vanish? Simply, they won’t. Why do you think it is only big pharmacies who will grow?

  13. Thomas Lake
    13/04/2019

    Please remember this when we post:
    1. No one really reads your blogs.
    2. We really don’t know what we are talking about.
    3. We achieve nothing by blogging.
    4. No one really cares what we think.
    5. We are click bait and provide great advertising ratings for the publisher that just love are to-and-fro.
    6. This includes Ackermann.
    Peace-out….

  14. Sietel Singh Gill
    15/06/2020

    Hey Sheshtyn, have you reached out to the RACGP and CHF to ask how they would’ve solved Covid medication supply-chain shortages had their 60-day dispensing lobbying succeeded?

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