‘Once again, the pharmacy sector is picking up the slack.’


Temporary arrangements now allow GPs to send digital copies of scripts directly to a patient’s pharmacy of choice, but does this impose an onerous workload and financial burden on community pharmacies?

The Federal Department of Health has recently announced new interim arrangements whereby patients can get a digital copy of a prescription from their GP directly sent to their pharmacy of choice via email, fax or text message and the medication delivered to their door.

S8 and S4D medicines are excluded from this arrangement.

Welcomed by the RACGP, the announcement followed closely after the government acted on calls to expand GP telehealth to all patients.

“This is a vital part of the puzzle to enable GPs to continue providing the same quality care to their patients via telehealth as they do face-to-face,” said RACGP president Dr Harry Nespolon.

“It means patients with a variety of health conditions can get a prescription from their GP sent to their pharmacy of choice and the medicine can be delivered.”

However while there is a legislative instrument at a Federal level that allows for e-prescribing – where the paper prescription is no longer required – this has not yet been rolled out at state and territory level.

Additionally the Department of Health is still working with software providers to upgrade clinical software so that it supports electronic prescribing, with the system anticipated to be up and running by May 2020.

Therefore paper scripts still need to be provided after the GP has sent in a digital copy, such as a photo or PDF of the prescription, by email, fax or text message.

This special arrangement has led to a dramatic increase in workload for pharmacies, highlights PSA national president, Associate Professor Chris Freeman.

“I’ve heard reports that anywhere between 60—80% of a pharmacy’s script load is coming by fax or email from the GP practice. That poses problems about securing the physical script at a later date,” he told AJP.

There are further issues with how the pharmacy is able to collect or have those scripts delivered.

While the Federal Government advises prescribers to send the pharmacy the paper script as soon as possible, where possible, “GPs are expecting the pharmacies to manage coming to pick up the scripts or supply funds themselves to have the scripts posted,” said A/Prof Freeman.

In some cases there has been a “complete lack of clarity” on where the script should be sent, with some patients being given the digital copy of the script.

Under the special arrangement, prescribers are only allowed to send the copy or digital image of the legal prescription to the pharmacist of the patient’s choice, a spokesperson for the Department of Health confirmed to AJP.

The interim changes are also having a trickle-down effect on the pharmacy’s cash flow, particularly if medications have to be dispensed as script owing.

“This is increasing the cost of doing business for pharmacies. There is a significantly larger amount of work for them to do in the process than before, with little financial support being given to pharmacies even with the recent announcements,” A/Prof Freeman said.

“Community pharmacies should be receiving additional remuneration to make sure they’re able to adapt to the changes in the sector.”

He called on the government to implement e-prescribing as soon as possible, and in the meantime encouraged pharmacies to communicate with local medical centres about how they want the prescription process managed.

In early meetings the PSA reportedly flagged that there would be a flow-down effect in initiating the telehealth model of care, and there would have to be real thought provided on how pharmacies would manage.

“Unfortunately this hasn’t been thought out. Even though this had to be implemented urgently, all intended and unintended consequences need to be seen through,” said A/Prof Freeman.

“Once again we see the pharmacy sector picking up the slack.”

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16 Comments

  1. Bente Hart
    08/04/2020

    Would be great to see this published in main stream media. I was talking to a non-pharmacy retailer about the changes we had to deal with. She was not aware of the consequences for us with all these changes. The message needs to get to the masses.

    • PeterC
      08/04/2020

      Exactly. Long after the panic buying has subsided the increased operating costs will persist.

  2. Paul Sapardanis
    08/04/2020

    I was told if I could call a patient ( not a regular of mine ) about when I could deliver an antibiotic. I said the patient needs to organize that with me but they would need to call me after all they wan th me to provide a service. When the patient called I offered to deliver for a fee, they came in store within half an hour. Why do we do this to ourselves?

    • Russell Smith
      10/04/2020

      Exactly, for most of 50 years the same sort of lazy bastards have been trying this on me too. IF someone has a car they cannot afford to run, a taxi they dont want to pay for, or the TV program they cannot afford to miss for a while, THEY don’t value THEIR health.

  3. Russell Smith
    08/04/2020

    Just another case of doctors kicking the can down the road – I/we do NOT have a responsibility to go get Rxs from them – THEY have a legal obligation to deliver to us, no ifs or buts. They get paid, we do not. Or they still have the option to give an Rx to their patients. And though many dont have the balls to actually see patients, THEY expect US to do so. There’s not enough $ in an Rx to be bothered with allocating even half an hour’s worth of staff time per day to this bs, let alone dealing with those who think that immed after a teleconference with a dr they can show up and get that which we dont yet know about – since some drs dont know how to (or cannot be bothered with finding out how to) send a fax or an email. Time to kick the can back – and charge for our services otherwise un-remunerated to date

    • Dr E Ackermann
      09/04/2020

      Wouldn’t it be good if a GP could send a script to a central supplier to deliver medications straight to the patients door.

      • Jarrod McMaugh
        09/04/2020

        everything except “central” already exists.

        The reason a centralised service doesn’t exist is because it would remove choice for health care recipients.

      • Russell Smith
        10/04/2020

        So, where might that “central supplier” be?
        IF, say “Sydney”, where exactly, and just in case some poor sod gets sick in outback NSW where might that “central suppiler” be located then? IF Sydney, how might the delivery timescale – and the economics actually work?
        Might there be, say, a 3pm order deadline for a despatch to a regional redistribution location, for dely to a local town at about 10am the following day, then down some “highway”, and another 20k on a dirt road to a patient on a staion in the middle of nowhere? So what if its after the 3pm cutoff, weekends, public holidays. How exactly would that work out in real life? OH – and who pays for this?

        • Dr E Ackermann
          10/04/2020

          Good question.
          A central supplier may be (for example) NSW Health – they have widespread facilities (rural an urban), being large they would have corporate buying power to ensure low prices and stock availability. They may couple with Austpost for delivery.
          Ramsay health (and others) may do some urban areas as well – so there would be competition.
          Who pays – you would be amazed at how community pharmacy costs could be re-allocated.

          (I know you will disagree with this model – but it is possible)

          • brian mutsonziwa
            14/04/2020

            So you are claiming the public system is capable of a more cost efficient service delivery model that the private sector?Gee, they probably should have told that to Telstra, and I guess they should probably tell that to all those independent GP practices too.And if there happens to be a query relating to the medication, who gets to sort that out?The “regular” pharmacist who has been bypassed throughout the whole process?GPs always talk about the risks of fragmented patient care,but if part of the process is being done through a centralized mob in Sydney for example and then the regular pharmacist is supposed to be the one who reconciles the hospital discharges, centralized dispensing, regular pharmacist dispensing and all the OTC stuff that patients take, then I don’t really know whether that’s in the patients best interests

          • Dr E Ackermann
            14/04/2020

            Brian – I was asked who a central supplier may be. I provided both public and private examples (CWH may be another). Whether it would be more cost efficient is arguable.

            Your point about querying a medication is a good one. Essentially it is the broader argument of where does the “professional role” of the pharmacist fit into such a model.
            We have been saying a community pharmacy role is better within a General Practice as medication governance, responsible for multiple medication safety issues rather than in community focusing on individual dispensed units.

      • Anthony Tassone
        16/04/2020

        Evan

        Community pharmacies have done an exemplary job in the face of a crisis for their communities – being at the forefront of medicine stewardship and advocacy against hoarding and triggering of shortages.

        I could expend a level of energy and time to debunk and debate your suggestion Evan – but instead I will just say that right now you’re the only person that I’m aware of contemplating such though bubbles that deprive patients of choice, have little or no redundancy and fraught with risk for patient accessibility in our geographically diverse nation.

        Government at a state and federal level, departments of health across Australia, local GP’s practicing telehealth and most importantly the public are very grateful and recognize the value of community pharmacy as a reliable and trusted primary health destination.

        By all means Evan, pontificate away with your unoriginal pot stirring of our profession.

        We’re busy just getting on with helping our patients and addressing their needs during this very difficult and uncertain time.

        Anthony Tassone
        President, Pharmacy Guild of Australia (Victoria Branch)

        • Dr E Ackermann
          17/04/2020

          AT – I have not criticised community pharmacy or pharmacists during this time. All sectors are responding well in these difficult times. I have not “pot-stirred” the pharmacy profession.

          What this pandemic has exposed are the inadequacies in the
          health system. Eg Telehealth should have been imbedded in General Practice ages ago – only now has Government seen its value. Similarly the pharmacy sector, and the current models of medication delivery, are being exposed as being inadequate, Have a look at these AJP pages recently.

          Raising different models of pharmacy care to address these issues is a professionally responsible discussion to undertake.

          • Jarrod McMaugh
            17/04/2020

            “Raising different models of pharmacy care to address these issues is a professionally responsible discussion to undertake.”

            The tone of your responses, the beligerence you employ, the use of rhetorial questions to avoid taking a position, even the audience you choose, suggests that this is not your intent, whether the quoted line above is true or not

            There is a word to describe people who think that acting like this is constructive and helpful, but the automated moderation software will block this response if the actual word is used…. many people already associate this word with your reputation.

            Btw the automated moderation software is something you might want to enquire about with the editors of AJP since your posts activate it so often – despite your belief that your responses are singled out and censored, it’s a simple matter of avoiding the anti-spam filters if you’d like your posts published without delay.

            Lastly, while I’m wasting my time responding to you – something I tend to avoid as much as possible in recent years due to the toxicity associates with engaging with you – it would be worth your while to contemplate the impact your ‘style’ of ‘debate’ has – specifically on the audience you have chosen to interact with. You do have an impact, but it is one you shouldn’t wish to have, since that impact is on the mental health. More than a few times your name has been raised by people I have provided mentoring support to. This is not the impact you should be striving for

          • Dr E Ackermann
            17/04/2020

            Jarrod – I invite you to read the discussion again. It was started by RS several days ago lamenting the issues surrounding the current system with telehealth, expectations, responsibilities, and receipt of prescriptions.

            I replied by suggesting that a different system for medication supply may be better. This generated further responses from RS, BM and even yourself Jarrod; asking quite legitimate questions about how this would work. I replied to those questions. The discussion was always respectful and appropriate.
            Isn’t that the goal of professional discussion and these pages?

            What is censored here is a good point. For example to AJP readership, my post to RS starting with “Good question” was originally blocked – until I repeated the post. Surely the intent of moderation is not restricting pharmacists from reading alternate views.

            The derogatory remarks against me are par for the course, but your claim that my comments are somehow responsible for poor mental health of some people (?pharmacists) is taking things too far.

          • Jarrod McMaugh
            17/04/2020

            There is no censorship Evan – there is automatic moderation that will hold a post & prevent it from being published until reviewed by a moderator. There are specific words that trigger this.

            The ‘good question’ post wasnt blocked, although the “Brian – I was asked who a central supplier may be” post was

            With regards to your last point – “responsible” is not the word I used, but if you feel it suits, run with it.

            As i said, it has an impact. I provide mentoring & support to a number of pharmacists in my roles – your name is raised often when discussing feelings of denigration & negative perception of their work and impact in health. You’re entitled to express your opinions as you like, but you should be aware that they have real world effects on people

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