King Review national webcast: remuneration, location rules & HMRs

Participants posed some tough questions about pharmacy pay and restrictions, but what did the panel have to say?

Chair of the Review of Pharmacy Remuneration and Regulation, Professor Stephen King, began the live national consultation webcast on Wednesday night by reiterating the aims of the review.

“The key driver for this review is the consumer experience: are people getting the right medications at the right time?

“We need to make sure people have access to medicines across Australia, and not leave parts of the country behind,” he said.

“The aim isn’t to make sure pharmacies that are operating today will be operating tomorrow. Unfortunately we can’t prop up community services that are not best serving the community.”

Prof King then went on to describe the pharmacist role and remuneration.

“Pharmacists receive fair remuneration in a very different way to other allied health professionals. To put it simply, they sell stuff. It’s hard to think of another health profession that receives its primary remuneration through selling stuff… medicines and other retail products.

He mentioned there is a lack of accountability “from the taxpayers perspective,” adding that “it is taxpayer dollars that are remunerating medicines through community pharmacy.”

What you said

Some webcast participants were not happy with Prof King’s view of the pharmacist role.

“I do NOT just ‘sell stuff’,” wrote Fiona. “I counsell [sic], I advise I am there long after medical centres have closed ….. So condescending.”

“How are pharmacists expected to continue to deliver medicine advice and other important services to patients with price disclosure continuing to eat away at our margins?” asked Miranda.

Philip Smith asked the panel, “How do we get remunerated for saving a Dr visit when the child only has a viral rash?”

Would an MBS payment be a more appropriate way to remunerate pharmacists for delivering medicine advice and clinical interventions,” asked Sam.

Panel member and pharmacist Bill Scott pointed out that there is a need to make sure people are taking their medicines correctly, using the example of pharmacists teaching the correct asthma puffer technique.

“A payment for a clinical service would be a great idea, and through the MBS is possible,” said Scott.

Prof King agreed, saying, “We need to think about how to remunerate pharmacists for the additional services they provide.”

Home Medicines Reviews

Clinical consultant pharmacist Debbie Rigby brought up the issue of HMRs with the panel.

“You stated this is a consumer-focussed review. Consumer surveys and research have supported the value to the consumer of HMRs. And yet funding for HMRs is limited in the 6CPA, in fact reduced compared to previous Community Pharmacy Agreements. Have you had positive feedback from consumers on HMRs? Can the Review recommend continued or expanded funding for programs that are evidence-based, cost-effective and valued by consumers.”

Scott reassured participants that “the HMR is a very useful product” and the panel was aware of concerns.

“It’s the gold standard. There are issues about the limits on it at present. As we’ve travelled around the country, we’ve had people requesting that they need to do more HMRs for people in their cohort,” he said.

Prof King confirmed HMRs were being discussed as part of the review.

“As a clinical intervention, they’re fantastic. There is debate out there in the community pharmacy sector as to why there were a lot more of these reviews than what the government expected to be, and the money started running out for them. So these reviews were capped.

“But this means that in many areas these have fallen by the wayside, a consulting pharmacist can’t really build up a business on that. We’re asking for submissions so we can find out, how we can make a sustainable HMR system,” he said.

Rigby called on the panel to make HMRs a priority.

“I think current program such as HMRs, RMMRs are valuable services that start to address the 230,000 medication-related hospital admissions every year, half of which can be avoided. And yet these programs have been restricted, when in fact they should be expanded, albeit with a more targeted approach for patients at high risk. Can the Review make recommendations to the Minister to expand these programs?” she wrote.

Location rules

Many webinar participants brought up the current location rules.

“Location rules promote high rent – an approval cannot be granted or relocated unless strict rules are adhered to regarding leases and location,” said Mike.

“Removal of location rules will reduce rents across the board and lower cost of business can be passed onto consumers in the form of medicine prices. Pharmacy may survive under accelerated WAPD if cost of business is reduced.”

“Location Rules are being used to commit monopoly behaviour,” said Madonna.

“It is fair to say, the Guild do not speak for the majority of Pharmacist. The government does not act on behalf of other industries to support monopoly. Why do you think a rule from 1952 should be given to protect one industry only? Please get the ACCC to assist in this process of Location Rules,” she wrote.

Guest said “location rules are a deliberate form of protectionism”.

“The Guild negotiates the Community Pharmacy Agreement with the Government, and a requirement for the pharmacy to be QCPP accredited to be remunerated for supply. The Guild has a vested interest in pharmacies maintaining their QCPP accreditation to continue to be remunerated under CPA for successive, and successful, renegotiation. The QCPP is The Guild’s so this conflict of interest (actual or perceived) needs to be managed. Perhaps when an approval number for a small pharmacy is purchased, and then relocated (‘bunny-hopped’) and metamorphasised into a Discount Warehouse, the pharmacy should have to undergo a bridging QCPP re-accreditation.”

Jo Watson, review panel member and Consumers Health Forum Deputy Chair, responded to the comments by asking “what do location rules actually afford the consumer?”

“At the moment, taking into account the geographical spread, what do they do? What is the reason for them today, and what are the consequences of abandoning them altogether?”

Scott responded that “the aggregation of pharmacies in the better suburbs has actually decreased and the metropolitan area, the spread of pharmacies is a lot better than before. The number of rural pharmacies has increased and rural areas are being better serviced than they have ever been. That doesn’t mean there aren’t issues, such as the problems in shopping centres, but that doesn’t mean they can’t be fixed. We’re interested in looking into those but it doesn’t mean there haven’t been benefits.”

Prof King disagreed with Scott.

“What is the objective? There is not objective to the location rules. The government brought them in to save money. We only have the same amount of pharmacies today that we had in the 1990s.”

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