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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4 Comments

  1. Dr Evan Ackermann
    13/10/2016

    The King inquiry has called for submissions to the financing of Community Pharmacy; to re-imagine the
    delivery of PBS services to the community. In the battle of intellect and ideas for pharmacy future, the Guild seems to have again turned up unarmed. Mr Tassone’s response to the RACGP proposal merely underlines the poverty of thought which characterises the approach to delivery of PBS medication to Australians. The
    time is ripe for innovation, and Community Pharmacists should take the opportunity to affect a major change in direction for their profession.

    I am sure many community pharmacists like Mr Tassone have read the Harper competition review and the
    ANAO review of the 5th Pharmacy Agreement to know that Government is not convinced that it is getting value from Community Pharmacy. Mr Tassone only needs to read the numerous submissions to the King Inquiry to know that community pharmacists are unhappy, consumers are unhappy, and note the almost
    universal call for fundamental change.

    I am sure community pharmacists are concerned that their role as pharmacists seems to be transforming to part community nurse, part complementary medicine therapist, and part retailer. I imagine many pharmacists would have squirmed in disbelief when some of their representative bodies tried to justify sales of complementary medicines in their King enquiry submissions.

    The call for change is understandable.

    Mr Tassone objections to the RACGP proposal seem vague. He quotes multiple statistics concerning the current PBS expenditure, PBS history and my comments on an AMA/PSA proposal for a GP based pharmacist. In some areas Mr Tassone is factually correct, but his arguments are universally irrelevant to the RACGP proposal being put forward.

    The gist of the RACGP submission to the King enquiry was an alternative to the current model of
    community pharmacy delivering PBS medications. Under the RACGP model, dispensing and other fees associated with community pharmacy would be “cashed out” to support a general practice-based pharmacist to take responsibility for medication governance within the practice population.

    Payment for pharmacists would be based on QUM outside the retail environment. This would include existing individual advice and education, but also population medication safety audits, problem identification and response to address medication issues. Broader services such as antimicrobial stewardship or managing drugs of dependency would also be included under this arrangement. This can now facilitate appropriate remuneration and career structure for pharmacists. Wouldn’t that be a refreshing change Mr Tassone?

    In reality medication delivery can be distilled down to IT and transport systems taking most long term medications straight to the patient’s door. A central supplier would take on the role of drug storage and supply of drugs. This is already occurring in Australia with internet based pharmacies, indeed individual dispensing of medication packs for nursing homes now happens 100’s of kilometres away. Does Mr Tassone suggest that the technology and practice do not already exist?

    I am sure that multiple entities would like to fill a central supplier role, including existing Pharmaceutical companies and may include state based hospitals or private hospitals.

    Acute medications would be dispensed at the general practice – once again more convenient for patients –
    and the practice pharmacist ultimately responsible for medication governance within the practice.

    Similar innovations occurred in Medicine with Radiology and pathology services; its where and how the
    specialty input associated with the service that changed. Mr Tassone’s response to innovation remind me of arguments and advice given to Henry Ford to “..disband his idea of a car, and train more of those reliable old horses”. It simply doesn’t wash. At some point we all have a responsibility to make health services more patient-focused, of higher quality, and have health care delivered in a more effective and efficient way.

    Clearly a fundamental change for PBS delivery would not happen overnight, and it would not happen without
    pharmacy leadership. A once in a generation opportunity is before you – its starts with conversations about how pharmacy is funded now and in the future. You can continue to hold the hand of the guild, big business etc; or you can make a decision for the good of your profession, and step toward a major change in how the health sector views community pharmacy and the roles you perform.

    Consider the RACGP proposal wisely for you and future pharmacists. Your call.

    • Owner
      14/10/2016

      Stay out of my trough!

    • amanda cronin
      14/10/2016

      How on earth will your scheme actually save any money? people still have to actually dispense the stuff and make sure it is safe- same number of people will need to do it either at a GP or a pharmacy.
      all it would do would be line GP’s pockets.

      It also negates all the free health advice and treatment of minor ailments we do every day, the webster packing, the deliveries, the reassurance. Do you think it is feasable for every surgery to have their own pharmacist?
      Pharmacies service several pharmacies and get drugs to people with personal advice every day. Saying it should be shipped to their door sound like one hell of an inefficient model. it not like we just hand out drugs either. we actuially keep and eye on our patients making sure they are well and referring them back to the GP if we feel it is needed. And the is the social aspect of visiting the pharmacy is great for elderly people who live alone. Webster pack! i bet your would love to provide them for free.

      OTC ailments? you really want to deal with all the minor complaints? Is that really better for tax payers? And we deal with many many minor conditions from fungal nails warts etc every day. it would be unviable to have many non PBS pharmacies so your essentially saying peoples access to minor medications has to be curtailed. Can’t see that being profitable for the government.

      Your submission shows your lack of understanding for what pharmacists actually do. Is it really helpful to attack your collegues?

      I do see a roll for starter packs of antiobiotics and pain relief to be kept on hand and used as needed – much like accident and emmergency do and this type of prescriber dispensing is realistic and sensible.

  2. Simon O'Halloran
    14/10/2016

    I am curious to take a closer look at the RACGP submission, sounds wonderful. However, much like unicorns and rainbows and the AMA submission, completely out of touch with reality and consumer needs. Internet based pharmacies, centralised dispensing, Australia post and couriers could surely do a better job than the existing network of pharmacies….in imagination land.

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