Putting a dollar value on GP pharmacists


an pharmacist holding up a piggy bank employee pharmacist wages money earning funding salary salaries wage

How much income can GP pharmacists generate? Researchers make a financial case for the practice pathway in Australia

A pilot study led by pharmacy researchers at the University of Canberra has investigated the value versus cost of employing a pharmacist in general practice, finding positive value in some scenarios.

Pharmacists in Australia can generate revenue for general practices through medication reviews and other activities, said Associate Professor of Pharmacy Sam Kosari and his research team.

They collected and reviewed data from two part-time pharmacists in general practice over 19 weeks (May to October 2016).

Weekly totals were calculated and recorded for time worked by each pharmacist; number and time for Asthma Cycle of Care, HMR and Health Assessment claims; time saved for GPs; and face-to-face patient consultation with the pharmacist.

Meanwhile income generated by pharmacists was estimated by the sum of: value of MBS and Practice Incentives Program (PIP) claims resulting from pharmacists’ involvement; time saved for GPs due to pharmacist activities; and potential direct payment from patients to visit pharmacists.

Activities undertaken by the pharmacists that freed up time for GPs to conduct more patient consultations included: medication review; post-hospitalisation medication reconciliation; drug choice; patient education; review and act on blood test results from pathology; updating medication list in medical record; liaising with community pharmacy and aged care facilities; contacting patients about medication recall; and smoking cessation.

Over 19 weeks, Pharmacist A and B recorded 243.5 and 135.8 h of work over 19 weeks with corresponding salaries (AU$60 per hour, including on-costs) of AU$14,608 and $8,150, respectively.

During the same time period, the two pharmacists supported 47 and 23 Asthma Cycle of Care activities, generating income to the general practice of AU$4700 and AU$2,300, respectively. The pharmacists spent 36.4 and 24.1 hours on activities usually conducted by GPs, allowing additional time for GP-patient consultations.

The potential additional GP-patient consultations resulting from the activities of Pharmacist A and B could generate AU$8720 and AU$5616 in private clinics, AU$4038 and AU$2668 through MBS item 23 for standard 20-min level B consultations in bulk-billed clinics, or AU$5162 and AU$3442 through MBS item 36 for 30-min level C consultations in bulk-billed clinics.

The researchers calculated that AU$0.61 – AU$1.20 of income could be generated by the pharmacist for each AU$1 spent on wages.

Based on these results, “the value-cost ratio of employing pharmacists for a general practice business may be positive in some scenarios,” they said.

A greater return on investment per AU$1 of pharmacist salary was associated with the more experienced pharmacist with additional clinical qualifications, private practice and patients’ paying for consultations.

“Our pharmacists generated income from three services which are associated with financial reimbursement from the government. This finding builds on the research by Freeman et al., who demonstrated that one practice pharmacist in Queensland, Australia (working 0.6 full-time equivalent) could potentially generate AU$17,374 over 12 months by facilitating completion of government-funded HMRs,” the researchers highlighted.

Future work should focus on developing a robust business model that includes health care system savings resulting from practice pharmacist interventions, they added.

“Practice pharmacists have conducted other clinical activities (for example clinical audits, smoking cessation, post-hospital discharge medication review) that contributed to improving patients’ health and risk reduction; estimating the economic value of all these activities was out of the scope of this study.”

The GP pharmacist workforce is growing in Australia but is still relatively small.

PSA national president Chris Freeman told AJP in March this year that the PSA estimates the number of GP pharmacists to be excess of 100, up from nearly 50 in 2017. Most of these work part-time.

“We expect that this model will continue to grow year on year becoming a mainstream pathway for pharmacist practice,” Associate Professor Freeman said at the time.

See the full research article in Research in Social and Administrative Pharmacy here

Previous Prolonged daily aspirin use bumps up bleeding risk
Next That’s the way the cookie crumbles

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

15 Comments

  1. Tim Perry
    19/08/2020

    Interesting research but it should not to be seen as encouraging practices to engage pharmacists to generate income. Hopefully ongoing research will focus more on the major motivation for incorporating experienced consultant pharmacists into general practice, which is better health outcomes for their patients. While it is nice to know that this research indicates GP Pharmacists are probably not a cost burden for the practices in which they work, what we hope to show over time is patients needing to visit emergency departments less often, require hospital stays less often and be assisted and supported to minimise the impact of chronic disease. The role of GP Pharmacists is a lot more nuanced than medication reviews. Yes, we to want to optimise medications for the patient, but we also work closely with patients, along with the rest of the patient’s healthcare team which includes community pharmacy, to help them achieve their treatment goals. This will save money for our health system and improve quality of life for patients – that is the real goal and a very worthwhile investment.

    • Debbie Rigby
      19/08/2020

      I agree Tim, value to patients and the healthcare system is the goal. But reality is general practice and community pharmacy are small businesses (and in some cases very large businesses), so this is valuable research to remove one barrier to having more pharmacists in general practice doing non-dispensing roles to optimise patient care and medication management.

      I just read a BMJ article on interventions to reduce healthcare use and improve quality of life among patients with asthma. The systematic review and network meta-analysis showed that support involving regular reviews totalling at least two hours was effective at establishing self-management skills and significantly better than usual care at reducing healthcare use in people with asthma. And that unsupported, or minimally supported, self-management programs are not effective. Pharmacists in general practice can spend that amount of time, GP usually can’t. Community pharmacists don’t. This investment in time with patients is offset by a reduction in unscheduled healthcare use.

      1 in 9 Australians have asthma and 90% don’t use their inhalers correctly – imagine the benefits if they were all optimally controlled….

      Multidisciplinary care should be the norm.

      • JimT
        19/08/2020

        …but someone has to pay someone…that is the question !!

        • Dr Evan Ackermann
          19/08/2020

          Look at the current $ in pharmacy and see where its going.For instance – the $1.2Billion in 7th CPA for all med reviews etc. (where does it go now)
          Could that have been used more strategically to seed some of these positions.

        • Debbie Rigby
          19/08/2020

          That’s the point. Having pharmacists funded to work in general practice can be funded by existing models within MBS funding, let alone different models of care which Evan points out. And patients are willing to pay if they value the care and support by the pharmacist.

          So much more needs to be done to care for people with multiple chronic diseases and in aged care. Better medication management is just one part of that care. And pharmacists should be part of collaborative care models.

    • Dr Evan Ackermann
      19/08/2020

      Well said Tim.

      The role of a GP pharmacist is not to generate income with existing item numbers. In the end it is to develop a new system of care, where medication delivery, monitoring and safety is enhanced; where public benefit is clearly delivered.
      The current PBS delivery system via community pharmacy is failing. All the meds checks, medication reviews etc have no evidence of benefit – so why continue them. A new system needs to be developed; not an added one to the current PBS delivery – the government is unlikely to pay for this.

      The critical thinking that needs to occur – can a system of care be developed in GP, which usurps the professional roles of the current pharmacy model (ie but not storage and distribution of drugs), that improves care, improves pay and conditions for front line pharmacists, and can be developed using existing funds.

      I suggest it can. First pharmacy has to ditch this level of thinking and research which has held it back.

      • JimT
        19/08/2020

        by definition, pharmacy remuneration is only always going to be a cost recovery exercise. Yes the system doesn’t work and needs fixing at all levels.

  2. JimT
    19/08/2020

    and while pharmacists are battling to be cost “neutral” we will never evolve our earning potential.

  3. Kevin Hayward
    19/08/2020

    I have worked for many years as a GP practice support pharmacist in Au and UK. The UK model makes goal achievement in pharmaceutical care easier, because you are also guided in your work with a high level of top down strategic management. In Australia it seems to be operational management, bottom up driven by perceived need and demand. Over a long time working collaboratively with Australian GPs, nurses and professions allied to medicine in my practices I believe we have achieved a quality approach to the cost effective, rational, evidence based use of medicines, and associated education and management strategies. I also believe the new changes to HMR have meant that it is easier now develop a more useful patient relationship, I can now more fully support the primary care team to implement improved pharmaceutical care opportunities I have identified. The current system is not great in terms of defining and realising strategic therapeutic aims and objectives, but it does provide the GP practices with a financial opportunity, and gives me the a challenging and diverse professional working environment.

    • Karalyn Huxhagen
      24/08/2020

      Exactly Kevin. Debbie speaks of asthma and COPD which is vital patient care but how much worth can be generated by a pharmacist in mental health care pathways and other pathways. The complexity of management of patients with chronic disease such as pain and mental health drains the GPs time and effort enormously. The multi factoral team effort in chronic disease and mental health must give better outcomes for patients as well as supporting the GP to be proactive and engaged in their patient interaction. a GP practice pharmacist who sees these patients before the GP can sort, dissimilate and capture so much information that give the GP a much clearer picture of what has happened before and what is the proposed pathway and outcome.

      • Karalyn Huxhagen
        24/08/2020

        I will give you a case example- I have just spent the morning collating notes for a mental health patient who in four months saw two GPs, three psychiatrists and psychologists and self medicated with cocaine and ectasy. She bought Duromine off the street. I have mapped who prescribed what and why and tried to map the outomes, adverse reactions and reason for non compliance. This patient’s primary GP has had a bad accident and is gone from practice. So the new prescriber is dumped with a hx that would fill Medicare office in Canberra! I doubt there is a GP who could put the time into mapping this patient. If we do not map her she will be prescribed medication that she has taken before and be non compliant e.g. Seroquel makes her gain weight so she sells it and buys ectasy. A pharmacist can pull and push and put this map together relatively easily if given access then inform the prescriber with recommendations that have background and reasonable reasoning. As Chris Freeman and Kristen proved in their research we have a diversity of skills that can save the GP time and give them quality support that improves the patient outcomes

        • Dr Evan Ackermann
          24/08/2020

          Sounds very much like a patient with a substance use disorder characterized by illicit and prescription drug abuse.

      • Dr Evan Ackermann
        24/08/2020

        1. Firstly the argument of “saving GP time”, “replacing the GP” arguments get nowhere. I find, and I am sure many GPs do to, that “the complexity of management of patients with chronic disease such as pain and mental health drains..” is simply par for the course. Each GP has to go through things comprehensively with every patient with a chronic disease.
        2. In any system of care, all participants (and that would include GP pharmacists), should be allocated responsibilities that have most impact for the patient. These responsibilities should be because of their unique skills, not to replace others. Eg Debbie is quite correct – in respiratory care there are so many medication delivery devices that proper education/ technique analysis has shown to be beneficial. Focusing a pharmacist in this area will have good chance of impact particularly if patients are selected.
        3. “Mental Health” is a large area. Unless you have thought through a system of care to delineate roles and responsibilities – then a “generic strategy” of medication history will probably have little impact.
        Focus on known impacts (specific problem solving) and systems of care.

  4. TALL POPPY
    19/08/2020

    As long as pharmacists are not slaves to GPs AND adequate ($100k approx per pharmacist as in the UK) funding is provided for having a pharmacist AND they are allowed to write Rxs for minor ailments (only in the surgery) then consider my mind changed. Years ago I was against the idea. As an alternate pathway for pharmacists, this could be quite successful

    • Dr Evan Ackermann
      19/08/2020

      Great! I agree with setting parameters.
      1. Same as any GP in any practice – you are free / obliged to practice to your own professional ethics. In fact I would expect it if medication safety is paramount.

      2. Appropriate professional income – lets just be general – north of $50 per hour or $100K a year – OK agreed.

      What else?

Leave a reply