Face the facts, doctor: Part two

Anthony Tassone, Guild Victorian Branch President

Pharmacy Guild of Australia’s Victorian branch president, Anthony Tassone, responds to comments by Dr Evan Ackermann

This is the second part of a two-part rebuttal published on the AJP. Read part one here.

Thanks largely to the ‘Pharmacy Location Rules’, community pharmacies are the most accessible major service across Australia, with superior accessibility than supermarkets, banks, and all types of medical centres.

Before the Location Rules being created under the 1st Community Pharmacy Agreement in 1990, many pharmacies were clustered in mostly urban areas with some areas having few or no pharmacies.

In 2014 and 2016, the Guild commissioned a detailed mapping of the distribution of community pharmacy (detailed in the Guild’s Review submission) which provided clear evidence of the high level of consumer access under the Location Rules:

  • The average resident is located less than 1km from the nearest pharmacy, while 97% of consumers are no further than 2.5km kilometres from a pharmacy. Outside of capital cities, residents are 6.4km on average from the nearest pharmacy, with 65% having a pharmacy within 2.5km.
  • Some 55% of consumers shop at a pharmacy that is open seven days.
  • Most Australians are in reasonably close to competing pharmacies, with 94% of metropolitan consumers being within 2.5km of at least two pharmacies and 76% of non-metropolitan consumers no more than 5km from at least two pharmacies.

In an article by Adam Creighton in The Australian, titled “Strong Medicine for GPs” (13/12/2014), Monash Academic Bob Birrell notes most GPs have ‘congregated in metropolitan areas undermining the marginal efficiency of public spending.’

Despite these increased practitioner numbers per head of population, accessibility of medical centres is not comparable to that of pharmacies. Yet, Dr Ackermann argues there would be benefit in ‘cashing out’ dispensing services to support a ‘general practice-based pharmacist to take responsibility for medication governance within the practice’. 

Interestingly, in an Australian Journal Pharmacy article titled ‘There’s professional ideals of pharmacy that have almost been abandoned’ (11/4/2016), Dr Ackermann was attributed with the below statements in relation to a proposal by the AMA and Pharmaceutical Society of Australia for a government-funded practice payment for non-dispensing pharmacists in general practice:

“The AMA did a submission to the Government about pharmacy in general practice and proposed a payment for this; they said it would be cost beneficial and had a DeLoitte study saying that but there’s not one bit of evidence to support that they can reduce medicines adverse events.”

Dr Ackermann told the AJP that these claims would need to be formally quantified.

“From a professional point of view I think the argument should be settled with a formal study, and that should be part of the pharmacy trial program under the Sixth Community Pharmacy Agreement. We need a formal trial to say, ‘okay, this trial is set up to see if a pharmacy review can reduce hospital readmissions as claimed’.

“And if it goes against the grain of international evidence and finds that it does, great. But if it doesn’t, we have information on which to base our health decisions.”

Despite the ‘lack of quantification’ of the proposal, Dr. Ackermann believes “dispensing and other fees associated with community pharmacy would be ‘cashed out’ to support a general practice-based pharmacist” would be a great idea at the expense of completely dismantling a community pharmacy model that meets National Medicine Policy objectives and consumers trust and are satisfied with.

One must wonder whether Dr Ackermann’s apparent change of heart on this proposal despite a lack of any new evidence or information could be as a result of general practice ‘cashing in’ on community pharmacy services being ‘cashed out’.

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