Pharmacy needs clarity on rural, ATSI initiatives: Hannah Mann

Hannah Mann in her pharmacy's dispensary

Funding in the 6CPA for new and expanded pharmacy services focusing on rural and remote health, and Aboriginal and Torres Strait Islander health, are positive but pharmacies servicing these communities need to know some details, says Hannah Mann, of the 2015 QCPP Pharmacy of the Year.

Mann is the co-owner of Kimberley Pharmacy Services in Broome, WA, which dispenses mainly under Section 100 and provides services to a variety of communities in areas well outside Broome.

“While things are not going to be super fun for pharmacy moving forward, at least we’re in a position, now, with this [Administration, Handling and Infrastructure] fee instead of the markup to have a stable future,” Mann told the AJP.

“We know what we’re going to get paid for the next five years, regardless of the cost of the drug, which gives people a lot more stability.

“But we dispense most of our medicines under Section 100, the Aboriginal Health Service. We don’t function under a normal PBS arrangement: we get a handling fee.

“So with this new fee structure with the markup – does that actually apply to my scripts? For me, it would be disappointing if the new fee applied to mainstream pharmacy as a whole, but it didn’t apply to Section 100 dispensing.

“If not, what is there to close that gap for Section 100 pharmacies, if that fee structure doesn’t apply to us?”

The Section 100 fee is $2.88; the Administration, Handling and Infrastructure fee announced in the Sixth Community Pharmacy Agreement is three-tiered, starting at $3.49.

Mann says she welcomes the increased funding for pharmacy services under the 6CPA, but would like to know more about the focus on rural and remote health, and on Aboriginal and Torres Strait Islander health.

“It’s good to see a stronger focus on professional services, and the role of the pharmacist in primary care – that’s where we need to go as an industry,” she told the AJP.

“While for community pharmacy the dispensary is the backbone of the business, that growth, now, of our business needs to come from professional services, the things we’ve always been able to do, but haven’t jumped up and down about and said, ‘we can do that’.

“So overall I’m happy with the 6CPA, but with a hesitation around the lack of detail in the rural and remote and ATSI initiatives. There’s not really much detail there, and so I’m looking for more clarity around what that actually means.

“We’re saying we’re to focus on Aboriginal and Torres Strait Islander health – what’s that going to mean in real terms, for my patients? Does it mean increased access to services? Being able to access MedsChecks in their own community?”

Continuation of DAA program funding and rural support programs are welcome, she says.

“Regarding clinical interventions and HMRs – I think it’ll be interesting to see what happens with them, whether some of the business rules are altered to allow more flexible delivery of services, and delivery on need, as opposed to having them capped,” Mann says.

“Similarly, MedsChecks: for a lot of these programs it’s not just about how much money there is for it, it’s also a question of, well, what are the business rules around that, how are these programs going to be implemented, how are they going to be policed, monitored, assessed?”

She also says she hopes that significantly more funding is allocated to QUMAX and the S100 Support Allowance.

“Section 100 is capped at such a low level. We end up having to fund a lot of Section 100 support services ourselves, because the funding is capped so low, and at a level per site.

“For a lot of remote clinics, the cost of travel to those remote communities is astronomical and involves chartered flights – but that has to come out of your allowance. We get $1,000 a year if we fly somewhere, and for a charter flight that doesn’t cover one way!

“It’s also allocated on the number of PBS items a community uses, which doesn’t reflect the burden of chronic disease across a smaller community.”

She says that if a pharmacist works with the community to improve the quality use of medicines and reduce medicines wastage, this additional work results in reduced funding for that community.

“This is why smaller communities get less money. It doesn’t mean the patients are less sick or that the pharmacist doesn’t work as hard, it’s all on PBS volume and if you work to reduce wastage you end up with less support allowance.

“So I’m really hoping we see that cap increased, and the support allowance funded on what the community wants and needs.
The point of Section 100 is what the patients, clinic and community want from their pharmacist.”

She also says it’s good to see the Rural Pharmacy Workforce programs and the Rural Pharmacy Maintenance Allowance continue under the 6CPA.

“The allowance is really significant for small-town pharmacies,” she says. “If you’ve got a pharmacy in a small town you have a limited catchment and there’s only so many people in that town, so you can’t grow your PBS script program by trying to attract new customers.

“Rent can be phenomenal, wages have to be higher, the cost of doing business is higher and to run a pharmacy in a remote area even without a capped income is significantly higher. And if some of those single-town pharmacies become unviable, what happens to those patients and consumers if their nearest pharmacy is suddenly hundreds of kilometres away?

“So this is important, as is the Rural Pharmacy Workforce Program. Attracting people to work rural and remote rely on this allowance, and funded placements – really, the only way to grow the rural workforce is to get young pharmacists to come out here and see what we actually do.

“So this Agreement could have been a lot worse. I like the Agreement, but I’m hoping for more clarity, which I’m guessing will come in time – but it’s June already, so I hope it comes soon.”

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