Misinformation spreading about GP pharmacists: Demarte


Misinformation is being spread about pharmacists working in general practice, says PSA national president Joe Demarte.

Demarte was commenting on the launch of a new document by PSA addressing concerns about integrating pharmacists into GP practices with evidence-based facts.

The Fact Check document – which is supported by local and international evidence, PSA says – outlines the wide-ranging benefits of integrating pharmacists in a GP environment as part of an interprofessional team.

“Pharmacists working in General Practice is one of several innovative strategies PSA is pursuing to support pharmacists to practice to their full scope, ensuring their skills can be optimised in consumer-focused, cost-effective, collaborative models of care,” Demarte says.

He says PSA has led the GP-pharmacist model in Australia following many years of advocacy and positive stakeholder relationships culminating in a collaborative model of care that has widespread support across Australia’s healthcare community.

The latest University of Technology Sydney (UTS) Pharmacy Barometer released this week also showed pharmacists working in a medical practice were supported by 49% of pharmacy owners/owner managers, 63% of pharmacy managers/pharmacists-in-charge and 80% of employed pharmacists.

“Despite this strong support, misinformation is being spread about pharmacists working in General Practices and their impact on the wider profession and health system and PSA would like to address these misconceptions,” Demarte says.

“Let’s be very clear that PSA strongly supports Australia’s community pharmacy network, as evidenced by our numerous policy positions, submissions and advocacy activities as well as our investment in the Health Destination program, an initiative designed to improve the viability and sustainability of pharmacies.

“We also support the role of pharmacists working in general practices and see the two roles as complementary, not in opposition to one another.  

“A flexible GP-pharmacist model will enhance integration of pharmacists and community pharmacies within the primary healthcare setting to ensure alignment and better coordination of services.  This model is all about optimising the contribution of pharmacists and pharmacies, for the benefit of consumers.

“As a profession, if we put up barriers to innovation, we may miss opportunities for pharmacists to play a role in the broader health reform being progressed by Government – opportunities that are critical to pharmacists being utilised to their full potential.”

Demarte urged the Federal Government to move ahead with its desire for a trial of integrating pharmacists in GP clinics.

“Let’s evaluate the outcomes through a trial so we can test the impacts,” he says. “Based on international and local experience, we believe a trial of GP pharmacists will demonstrate a positive impact on community pharmacies and local communities. 

“I would encourage anyone who has concerns or doubts to read PSA’s Fact Check.”

Previous Prescribing key focus of new Govt antimicrobial plan
Next Inappropriate antibiotic use up to 50%

NOTICE: It can sometimes take awhile for comment submissions to go through, please be patient.

17 Comments

  1. David Haworth
    11/11/2016

    Could the AJP report just exactly what the misinformation is saying? I am curious.

  2. Debbie Rigby
    11/11/2016

    David, recently there was a statement from the Small Pharmacies Group which suggested that the practice pharmacist model will place general practice and community pharmacy in direct competition. The group stated “We are concerned that this model has the potential to destabilise and marginalize community pharmacy and reduce us to performing merely a supply function.”

    Recent stories in AJP from the trials in ACT and Wentwest PHN have highlighted the practice pharmacist role actually increases awareness by GPs of services delivered by local pharmacies, and strengthens communication and liaison between GPs and community pharmacists. The role does not duplication services, rather complements them.

    I think the PSA fact sheet sets those myths straight, so we can move on as a profession to support innovative roles that benefit consumers.

    • Toby
      17/11/2016

      How naïve. In the UK, the dispensing in surgeries is done by un-qualifieds – the doctors don’t even have to check the dispensing. But the doctors get all the money for it, and make sure they don’t bother dispensing anything difficult or unprofitable, which they leave to the sucker pharmacies. There’s your answer, Debbie. I’ve worked in the UK, next to dispensing surgeries. I’ve seen it. It can happen here. Stop fooling yourself. But then again, since you don’t yourself have a PBS licence and the associated risk, maybe you (and the PSA) just don’t care.

      • Jarrod McMaugh
        17/11/2016

        G’day Toby

        I’m an owner, and I’m also one of the Victorian VPs of PSA’s VIC branch committee.

        There are many members of PSA and representatives on PSA branch committees and the national board who “have a PBS licence” as you put it.

        To suggest that PBS doesn’t care about “associated risk” is unfounded given the position statement that has been released on this topic.

        If you have concerns, have you raised it directly with your branch committee, the national board, or the national executive?

        We always welcome input from our members, and if you aren’t a member at the moment, joining will certainly give you a voice with which to express your concerns

  3. SPG
    11/11/2016

    David this is a good question. Here is the link to the letter that the Small Pharmacies Group submitted to the PSA.

    http://www.smallpharmaciesgroup.org/uploads/8/9/7/9/89797727/pharmacists_in_gp_practice_psa.pdf

    It is worth noting that many of the ‘myths’ addressed in the PSA document are not points that we have raised in our letter and must come from other sources. As evidenced by the comments in other recent articles on this topic in both AJP and Pharmacy News we are not alone in our concerns about this model. In fact the UTS Barometer from 2016 indicates that less than half of pharmacist owners/owner managers support this idea (and that support has actually fallen since last year). Furthermore, of those who supported the idea, opinion was split on the best system between local community pharmacy working on a sessional basis versus a pharmacist being employed by a GP surgery.

    Our group is in the process of formulating an official response to this fact sheet. However, there are a few points that we can make now. We are not convinced that the roles of a practice pharmacist and community pharmacist will not overlap. The fact sheet points to the PSA prebudget submission 2016-17 for a list of the functions that a practice pharmacist might perform. As already mentioned in our letter, we are particularly concerned about the services listed in the patient directed services list (p.11) that seem very similar if not virtual replications of the services that a community pharmacist can already (or could, if funded) provide. PSA’s list on page 11 includes:
     Providing in-practice referral based medicine reviews
     Private consultations for medication based concerns
     Documentation and patient follow-up on adverse drug events
     Counseling on smoking cessation, lifestyle issues and medicine based activities
     Assisting patients navigating the health system and medication changes between health settings
    Even some of the other listed services in PSA’s prebudget submission (i.e. staff directed services and practice based quality assurance activities) are services which the local community pharmacy already regularly assists with. These include:
     Responding to medicine queries
     PBS queries
     Sourcing medications
     Specific medication concerns from GPs e.g. switching anticoagulants, antidepressants, opioid equivalence
     Questions about medication formulations.

    We can also say that we do not think this is the end of discussion on the matter. The PSA fact sheet does not provide much material that is new or different from what they have presented elsewhere and which we have already given consideration to in formulating our position. While we support the idea of funding for pharmacists to take on an expanded clinical role we will continue to question aspects of the PSA’s proposal and advocate for a model that is more incorporative of community pharmacy.

    • Debbie Rigby
      12/11/2016

      Small Business Pharmacies post above says “UTS Barometer from 2016 indicates that less than half of pharmacist owner/owner managers support the idea”

      But 49% of owners DO support the Practice pharmacist model and 80% pharmacist employees. That’s pretty good affirmation.

      • John Cook
        15/11/2016

        To be fair Debbie, I think you and others are too close to this project to see that concerns raised are legitimate. Of course practice Pharmacists will have an impact on the role of Community Pharmacists.

        Personally if this proposal succeeds I will ultimately have to choose between a role as a Community Pharmacist with less opportunity for meaningful clinical input or a job in a Medical Centre where I will miss meaningful interactions with patients which I greatly enjoy. Success of this proposal will also limit my income.

        I am supportive of a role for Pharmacists within Medical Centres but I believe it is necessary to have an independent scaleable funding model with freedom of setting rather than be paid by the owners of General Practices. Such a funding model is already used in the US MTM service model and would be equally suitable in Australia.

        • Debbie Rigby
          16/11/2016

          People will always have different views depending on their perspective and experiences. So I think it is best to stick to facts and evidence. The evidence both here in Australia and overseas (mainly UK) supports the role of practice pharmacists in improving patient care and medication management.

          Experiences to date also shows improved communication and cooperation between community pharmacists and GPs.

          The role of a practice pharmacist is complementary to and supportive of community pharmacists. It is also about direct patient care so “meaningful patient interactions” are very much part of the job description.

          Funding models are being tested now through a number of pilots and trials. The Deloitte/AMA PGPIP is only one proposal. Existing practice pharmacists are remunerated through a variety of negotiated models.

          Let the model evolve and be evaluated.

  4. Timothy Perry
    11/11/2016

    I work full time as a Practice Pharmacist in western Sydney. The WentWest trial aims to help health professionals working more closely together to provide the best health outcomes for patients. It has been a very rewarding experience working closely with the patient, their doctor, the practice nurse and their community pharmacist. I have experienced nothing but support from community pharmacists. I have had several patients though, who do not see their community pharmacist as part of their health care team, which is sad. It does suggest that some pharmacies have already chosen to place themselves in the “mere supply function”, and some patients choose to go to pharmacies on the basis of convenience and price, rather than quality of service provided.

    A practice pharmacist will see a patient maybe 3 or 4 times in a year. The community pharmacist sees that same patient 12-13 times a year. There is no destabilising. Community pharmacies need to establish and maintain a good level of communication with their local doctors as well as their customers. That communication is only augmented by the involvement of a Practice Pharmacist, building an even strong bond between the community pharmacist and their customer.

    • bill smith
      11/11/2016

      ask the chain stores what their view of actually spending worthwhile time with “customers” is. Cheers

    • Debbie Rigby
      12/11/2016

      Tim’s comments are based on experience and therefore should be listened to. The pilot has also been evaluated and on the basis of positive impact, funding has been continued.

      What evidence are the statements by Small Business Pharmacies based on? Experience? Research?

  5. Toby
    12/11/2016

    Anyone who believes that doctors won’t use surgery pharmacists to get PBS licences for doctors, is simply naïve. Also naïve, if they think that doctors keeping dispensing profits for themselves, won’t have a bad effect on margins, and jobs in, real pharmacies.

    • Debbie Rigby
      15/11/2016

      Seriously? Why would GPs want to dispense? Do you hear your local GPs saying they want to dispense their own prescriptions?

      • Jarrod McMaugh
        15/11/2016

        Some do but I don’t take them seriously – it is generally a reactionary comment whenever pharmacy announces an initiative that will increase pharmacy/Gp collaboration… usually by regular commentators who aren’t interested in collaboration.

        You’re comments on this article are all correct Debbie – I for one am looking forward to having more pharmacists employed in GP practice due to the ability of these pharmacists to facilitate collaboration and reduce silo-ing of care.

  6. SPG
    13/11/2016

    It seems clarification of the UTS barometer may be required. The UTS surveyed 362 pharmacists. With respect to the question of “Support for pharmacists in GP surgeries”, 181 owner pharmacists responded – 49% of owners said they supported it and 51% percent said no/not sure. Of those who said ‘yes’ that they did support it (i.e. 89 owners) only 15% supported pharmacists in GP practice only; the majority supported either a combined model or the idea of a sessional community pharmacist liaising with GP practice.

    We need to remember that there are over 5000 community pharmacies in Australia and only 15% of 89 owners supported pharmacists in GP practice only. That is around 13 owner pharmacists. It is also worth noting that there were even fewer respondents in the other categories (only 126 pharmacist managers and 55 employee pharmacists).

    Our interpretation is that this does not show overwhelming support for the PSA’s model.

    If you would like to view these results for yourself please follow this link: https://www.uts.edu.au/sites/default/files/2016%20UTS%20Pharmacy%20Barometer%20web.pdf

    • Drugby
      14/11/2016

      I agree that the UTS survey results require clarification. I have looked at the results published in the report. This is how I would interpret the figures:

      1. Only 30% of pharmacist owner/owner managers did not support the role of the pharmacist in general practice (ie 54 out of 181). I think it is inappropriate to combine owners who did not support
      the idea with those who were not sure. ‘Not sure’ does not mean they do not support the idea.

      If you then look at the support from non-owner pharmacists 63% of pharmacist managers/PIC (79/126), and employed pharmacists 80% (44/55), there is substantial support for the model. Overall, the majority ie 59% (214/362) support the role.

      2. I think it is important to acknowledge that the pharmacy profession is made up of more than just pharmacy owners and across all responses only 22% disagreed with this model with the majority 59% agreeing. An appropriate extrapolation would suggest that at least 3000 pharmacies (out of the 5500) would support this model.

      3. Given the uncertainty across all responses about the preferred arrangement for pharmacists in GP surgeries, a more appropriate conclusion is to support the idea that we should be undertaking a trial to better understand the best arrangement for pharmacists in GP surgeries to move forward with.

      So I think there is support for pharmacists in GP surgeries across the entire profession, particularly from non-owner pharmacists who represent the majority of registered pharmacists. Participants in the survey worked in community pharmacy the majority of the time. If other pharmacists (eg accredited pharmacists, practice pharmacists, hospital pharmacists) had been included, I suspect the support for pharmacists in GP surgeries would be even greater.

      This conclusion is backed up by comments from Charlie Benrimoj in the report: “Clearly the concept of community pharmacists working in medical practices is strongly supported…”

  7. Tim
    18/11/2016

    I’m an HMR pharmacist and sat down with a doctor this week (at his request) to discuss six HMR’s I had done for him.. (with great patient benefit and Government cost savings!). The Doctor can claim payment for case conferences .. I can’t .. could some of the GP/Pharmacist money be directed to HMR case conferencing?? should we get the HMR house in order first?
    I’m also interested in thoughts re the training/qualifications/accreditation of GP pharmacists IF they are to be funded by the Government, and at the $70-$80 per hour that is apparently being paid … How would HMR fit into this matrix?

Leave a reply