GP pharmacists yet to gain foothold

A new paper has called for standardisation of aspects of pharmacy practice in GP surgeries, as the model struggles to gain a foothold in Australia

An Issues Brief, Integration of general practice pharmacists into primary healthcare settings for chronic disease managementwas written by final year James Cook University medical student Caitlin Shaw as part of a Jeff Cheverton Memorial Scholarship undertaken at the Deeble Institute.

The brief makes a number of recommendations, including that a standard term for a general practice-based pharmacist is needed “urgently” and should be agreed upon by relevant stakeholders.

It says that a recognised position description framework and scope of practice for GPPs should be developed and that integrated GPP models should be underpinned by supportive policy frameworks and appropriate funding.

Quality of care indicators should be consistently measured, it says, and governments should support further integrated GPP trials and data collection; ultimately, they should support the integrated GPP model of care.

Integration of GPPs within primary health care services is a model of care which could help address these gaps, yet GPPs currently have a very limited role in primary health care in Australia,” the brief notes.

“Integration of GPPs should be more widely adopted across primary health care services.

“This model of care must be supported by national policy frameworks and appropriate funding structures, as well as a defined scope of practice for GPPs.

“Current data is insufficient to adequately understand the potential role of GPPs in improving medical management of chronic disease and health outcomes in the unique Australian health care context.

“Governments should support further data collection and research efforts trialling this model of care in Australian primary health care settings. Developing appropriate delivery and funding models of GPP integration in Aboriginal and Torres Strait Islander and rural and remote health services is also required to support the potential benefit of this service to underserved communities.”

Australian Healthcare and Hospitals Chief Executive Alison Verhoeven said that general practice pharmacists are “a proven asset in managing chronic diseases in the community while keeping costs and hospital admissions down”.

“They have proven to be effective and well-accepted by patients and GPs in countries such as the UK, the USA, and New Zealand,” she said.

However “the concept has yet to gain a solid foothold here in Australia”.

“There are no health system policy or funding arrangements to support the integrated GPP model of care in Australia— although several Primary Health Networks around Australia have either conducted or are conducting pilot programs, with encouraging results,” Ms Verhoeven said.

“Hurdles so far include confusion about the role of GPPs, with doctors as well as patients perceiving pharmacists as solely dispensers of medication while being unaware of their other clinical skills. 

“There is also the issue of pharmacist prescribing—permitted in the US, the UK, Canada and New Zealand, but not here in Australia, where it has met fierce resistance from doctor organisations in particular.

“There are several ways forward suggested in the Issues Brief, including team care training for pharmacists, research programs, and GP-based data collections to track effectiveness.”

PSA national president Associate Professor Chris Freeman told the AJP that PSA has long advocated for pharmacists to be embedded in general practice as an important member of the primary care team, most recently in its Pharmacists in 2023 report.

The report suggested that 2023, pharmacists should be embedded within healthcare teams to improve decision making for the safe and effective use of medicines.

“It is critical to acknowledge that this model is not at the exclusion of community pharmacy, as it also offers community pharmacists an opportunity to work across both settings, bridging the general practice and community pharmacy divide,” A/Prof Freeman said.

“General practice pharmacists collaborate with GPs and other health professionals in order to improve medicine safety and manage patients with chronic illness.

“Health outcomes for patents are improved by GPPs undertaking consultations with patients on the safe and quality use of medicines providing medication advice, conducting clinical audits and providing education to GPs and other practice staff.

“We believe there needs to be more support for pharmacists through lifting the funding cap on the workforce incentive program which was expanded this year to include pharmacists for the first time earlier in the year.”

However Anthony Tassone, Victorian branch president of the Pharmacy Guild, told the AJP that the Guild’s long-held stance is that the preferred model for an integrated pharmacist in general practice is an outreach from the local community pharmacy.

“Our members based in rural and regional areas have expressed valid and strong concerns that an already challenging workforce situation could be worsened if public tax payer funds are used to attract pharmacists to general practice instead of community pharmacy,” he said.

“Community pharmacy has been absolutely vital on the frontline of primary care during the COVID-19 pandemic, and collaborated well with local GP’s who may be practising telehealth during this period. 

“In saying that, if doctors have chosen to undertake telehealth during a global pandemic – would integrated pharmacists also be doing similar?

“Our members have asked ‘why can general practice obtain a tax payer incentive to employ a pharmacist but community pharmacies cannot obtain an incentive to employ other health professionals?’

“You would be hard pressed to find a town with a medical centre but not a pharmacy. If anything it would be the opposite, making these questions very reasonable and worth the government answering.”

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1 Comment

  1. Kevin Hayward

    In response to the concerns raised by Mr Tassone, when I first started as a GP practice pharmacist my pharmacy provided an outreach pharmacist to support a practice near to our pharmacy, but not so near as it could be construed as constituting a financial gain for either party or to the detriment of another local community pharmacy. The funding came from the medical practice budget, through a scheme not dissimilar to a PIP payment in Au, and not out of community pharmacy funding. Latterly we worked as independent practice support pharmacists, employed by the equivalent of an Australian PHN rather than a pharmacy, but again paid for from the medical practice budget. Both models worked well, both met the criteria of providing cost effective rational evidence based prescribing support. The key for me was that in both cases the practice pharmacist had the ring fenced time to undertake the work in the medical practice, distinct and distant from other obligations and commitments, was supported with strong clinical governance and continually up-skilled to undertake the role of practice pharmacist.

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