Profits, not patients, win under deregulation: Kardachi

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Profit would be put ahead of patients and professional services if large-scale corporate ownership of community pharmacies was permitted as recommended by the Harper Review, says PSA national president Grant Kardachi – and opportunities for pharmacists could be curtailed.

“The danger of allowing large-scale corporate ownership of pharmacies is that profit rather than health outcomes could become the focus of their operations,” Kardachi told the AJP.

“Large corporates would face competing dynamics of shareholder responsibility to maximise profits against the responsibility of patient care.”

The Harper Review’s recommendation that the community pharmacy ownership and location rules be gradually relaxed were slammed by the PSA and the Guild, but welcomed by some other stakeholders, including Professional Pharmacists Australia, which represents employee pharmacists.

Kardachi says that rather than holding back employee and specialist pharmacists, the current system helps to maintain a viable community pharmacy network that provides employment for a large part of the profession.

“Deregulation would be a backwards step and may reduce opportunities for pharmacists given the perceived corporate culture of minimisation of pharmacist-delivered professional services to maximise profits,” he says.

“PSA is advocating for a greater range of professional services to give pharmacists greater opportunities to use their clinical skills, a move which will result in greater professional and personal satisfaction.”

Kardachi told the AJP that the growth of opportunities for non-dispensing pharmacists, for example, could be limited under corporate pharmacy models as they have an increased business impact on pharmacies – and corporate owners may not understand the benefits, commercial and otherwise, they bring to pharmacies.

“I cannot see corporate owners being interested in adding pharmacist-delivered professional services over dispensing, given the added costs of extra staff and facilities involved in pharmacist-delivered professional services,” he says.

Non-dispensing pharmacists figure strongly in the PSA’s Health Destination Project.

“Again we have to recognise that the big corporates focus on profits above all else and we have seen this in the supermarket chains and their approach to petrol and their treatment of suppliers, particularly farmers.

“We must also recognise that some services currently provided by community pharmacies such as free home delivery and affordable dose administration aids may fall victim under a corporate structure.

“I am concerned about the profit motive overriding health care and it is just not acceptable to move in this direction.”

Peter Anderson, one of the panel members of the Harper Review, recently told the AJP that good pharmacies which provide valued services may be in a position to compete well with pharmacies owned by supermarkets and other corporate interests, but Kardachi says that remaining profitable in an increased competitive environment is only one part of the equation.

“Given the tenor of the Harper Review, I suspect the committee member’s approach would be ‘good’ equals ‘profitable’, with little or no regard to health outcomes,” he says.

“It is not a matter of relaxing or not having to worry about big corporates competing against small pharmacies; it is about the health of consumers.

“All pharmacists in Australia are required to abide by the Pharmacy Board of Australia-mandated PSA Code of Ethics.

“One of the principles of the code is that the ‘pharmacist recognises the health and wellbeing of the consumer as their first priority’. This could be at odds with the profit motivations of the big corporates.”

Kardachi says the Review’s recommendations weren’t entirely surprising in the current deregulatory environment.

“Pharmacy is one of the very few regulated environments in Australia now but there are good reasons for this, to ensure the health and wellbeing of consumers and timely access to medicines,” he says.

“These regulations are still relevant because location and ownership rules were put in place to better serve the public’s health needs,” he told the AJP.

“Ownership by individual pharmacists is limited so that pharmacists who own pharmacies can oversee the running of their business to ensure proper access by consumers and quality of healthcare.

“Location rules are designed so that there is an appropriate distribution of pharmacies across the nation.  One principle of the National Medicines Policy is timely access to medicines and the location rules enable this.

“A danger of deregulation is that pharmacies could become aggregated in certain areas while country and remote areas may not have a pharmacy at all.”

He says he hopes deregulation won’t happen, but the profession must start recognising it as a possibility in the distant future.

“PSA acknowledges this but if and when these changes occur; they must be made in full consultation with PSA and the profession, and not be driven by the corporates.

“The professional bodies such as PSA understand the profession and the health needs of the community and so we must drive and control any change in the future.”

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