GP pharmacist claims don’t pass the pub test

Moves towards integrating pharmacists into GP surgeries duplicate roles and may drain community pharmacies of talent, writes Catherine Bronger

Suggestions made in a recent report that integrating non-dispensing pharmacists into GP clinics may in some way be a panacea for our health system are misguided and misinformed.

The report, Snakes and Ladders: The Journey to Primary Care Integration, makes a solid attempt to – among other things – find ways to lift professional collaboration between healthcare professionals in the interests of patient outcomes.

This is a principle that I believe the vast majority of healthcare professionals support wholeheartedly on the proviso that populist expediency doesn’t override pragmatism when we look at the realities of healthcare delivery.

Quite bluntly, some of the conclusions and statements when referencing pharmacists and their role in this report don’t pass the pub test.

In fact, they go against the very principle that they’re purporting to support: recognising the importance of professional collaboration and team-based care within care settings and across all areas of care.

The report states: “The inclusion of pharmacists within general practice brings benefits for patients in terms of better medicines management, and to the system through better use of medicines and reduced adverse events. To speed up the desirable inclusion of pharmacists within practices, the Australian Government should dedicate a component of the professional services program under future Community Pharmacy Agreements to support models of care that integrate general practice and pharmacy services, and fund general practices (through increased funding of the Workforce Incentive Program or through PHNs) as an incentive to employ non-dispensing pharmacists.”

This statement is quite breathtaking in that it somehow manages to completely ignore the existence of the 5,700 community pharmacies across Australia, as well as those many pharmacists already working collaboratively with their health professional colleagues.

While strongly advocating the use of non-dispensing pharmacists in GP practices, the report also demonstrably fails to acknowledge the broad range of health services that are already being provided by community pharmacies.

Quite clearly such acknowledgment may have diluted the narrative of this report.

The report makes the leap to suggest that having a non-dispensing pharmacist co-located in a GP practice will bring better medicines management, better use of medicine and reduced adverse events to patients in rural settings. 

What it doesn’t articulate is that the services it so strongly argues for to be delivered in a GP practice are already universally available and delivered to patients in their community pharmacies right across Australia. And yes, that includes rural, regional and remote locations where dedicated community pharmacists are the stalwarts in health care delivery.

Not to mention some areas where the community pharmacist is the only health care professional available, with no GP, let alone a GP clinic, in sight.

Clearly, what the report is suggesting represents a mandated duplication of services. It is not innovation, but rather replication.

While advocates of pharmacists in GP clinics argue strongly in their favour, I am unaware of any cost effectiveness review or thorough evaluation of such a role in relation to any health outcomes achieved through embedding a pharmacist in a GP clinic. Until we have such evidence we are delving into the realms of fantasy as to the purported benefits of such a model.

What we have to take into account is that this debate is actually counter-productive.

At a time when rural Australia, including community pharmacy, is facing workforce shortages the concept of promoting roles for health professionals that duplicate existing roles, seek to create silos and fragment care can only be detrimental to patient care and to the overall health system.

Trying to attract pharmacists to clinics while community pharmacies are battling to fill positions is a regressive step and one which we must avoid.

The use of the Workforce Incentive Program as mentioned in the report will serve to exacerbate the already serious workforce shortages seen in community pharmacy small businesses in regional, rural and remote areas.

It is crucial that any workforce incentives are specifically aimed at encouraging pharmacists to practise in regional, rural and remote community pharmacies. The incentives also must support community pharmacies in their ongoing commitment to retain and enhance the professional roles of their existing pharmacist workforce. 

Rather than following the Snakes and Ladders path, I believe we must use these incentives to facilitate a “community pharmacy outreach model” which would result in true collaboration between GP practices and surrounding pharmacies focusing on genuine integration and collaboration across the primary healthcare sector, right across Australia.

Such a model would appeal to pharmacists attracted to the GP practice concept. It would give them the opportunity to work with other health professionals in a variety of settings while also providing greater opportunity to better utilise their skills and knowledge.

This is the way forward for patient care.  The Snakes and Ladders approach in regard to pharmacists in GP clinics, when broken down, seems to me to be little more than a poorly disguised proposal for additional funding for GPs, with little or no positive outcomes.

The report only exposes its interest in pushing a certain political agenda and ignoring the very needs of the people it is supposed to be representing – health consumers and patients.   

Those health consumers and patients deserve better. 

Catherine Bronger is a community pharmacy owner, national councillor for the Pharmacy Guild of Australia (NSW) and a member of the UTS industry advisory Board.

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