Report calls for end of community pharmacy model

wrecking ball

A Productivity Commission report, tabled in Parliament this week, has recommended community pharmacists be replaced by automated dispensing and a sub-class of “supervisors”

The Shifting the Dial report, sent to government on 3 August, then tabled in Parliament and publicly released on 24 October, has advised the Federal Government to move away from community pharmacy as the vehicle for dispensing medicines.

Instead the Productivity Commission recommends a model it says is “inevitable”, involving automatic dispensing supervised by people with a qualification involving “substantially less training” than is currently required for pharmacists.

“A new model of pharmacy would adopt now-available technology – for example, e-scripts and machine dispensing of drugs – and recognise retailing as incompatible with a genuine clinical function for pharmacists,” the report states.

“Machine dispensing (now a well-proven technology), will, absent government and pharmacist moves to prevent it, overtake retail dispensing simply due to its inherent commercial efficiency benefits.”

The Commission, an advisory body and agency of the Federal Government located within the Treasury Portfolio, says under this new system the role of pharmacists would be defined as part of a collaborative clinical model.

“In clinical settings, pharmacists should play a new remunerated collaborative role with other primary health professionals where there is evidence of the cost-effectiveness of this approach,” says the report.

As there would be less need for pharmacists, it suggests various university departments of pharmacy be contacted and informed about the “reduced need for future supply of pharmacists”.

“This new model would not, under any realistic assumptions require anywhere near the current 20,000 pharmacists who provide clinical services, and so would require a transition to a much smaller employment base.”

It suggests that these changes be phased in after the lapse of the Sixth Pharmacy Agreement, after technologies have been trialled in remote and rural areas.

“Shifting the dial to dumb”

The Pharmacy Guild of Australia has completely rejected the recommendations of the Productivity Commission, which is says are “ill-informed” and would lead to “the dumbing down of a revered health profession”.

“In an astounding piece of short-sightedness, the Commission actually recommends a reduction in the qualifications and training required to become a pharmacist, creating a sub-class of under-qualified people to ‘supervise’ automated dispensing.

“This displays an appalling misunderstanding of the complexities and responsibilities required in the safe dispensing of prescription medicines.”

The community pharmacy model in Australia services healthcare consumers “remarkably well”, says the Pharmacy Guild.

“This irrational recommendation to deprive Australians of this direct personal care from highly trained medicine specialists should be roundly rejected by governments and by the community.

“The complete lack of meaningful consultation with relevant stakeholders – let alone the Australian consumers who make 350 million visits a year to local pharmacies – before making such radical and unworkable recommendations is breathtaking.”

Reflecting UK’s changing pharmacy landscape

The Commission’s proposed approach mirrors elements of the automated hub-and-spoke dispensing model being pushed in the UK.

Pharmacy stakeholders have warned of the community pharmacy’s demise in the region, with funding cuts compounded by a move towards a “click and collect model” and online digitisation of the sector.

Last year, the UK’s Pharmacy Minister said he expects to see between 1,000 and 3,000 pharmacies – up to nearly a quarter of pharmacies in England – close based on the new model.

Read the Productivity Commission’s report here

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  1. James Lawson

    Automated dispensing sounds great to patients, until you get the message “ERROR: Drug interaction detected. Prescriber authorization required to continue.”

    I’m curious to know who is legally at fault when unclear medication instructions, drug interactions, duplication of therapy or many other sources of harm occur with an automated dispensing model.

    • Red Pill

      Oh it will happen. Just not yet. Many AI researchers believe machine learning and neural networks will approach human level by 2025 and will surpass a single human brain by 2030.

      These AI/Robotics lobby groups are merely testing the water in Canberra, starting the discussions and setting the political mood for the eventual roll out.

      • Red Pill

        Having said that, now more than ever, all pharmacy bodies must unite, working day and night to move pharmacists away from a simple supply chain model, and instead towards a more clinical role. HMRs should be valued far more than they are today, vaccinations, chronic drug management, blood monitoring and weightloss programs should be given far more weight than they are today. Downscheduling of statins and diabetic medications should be encouraged.

        Time is running out and if we dont change our scope of practice soon we will be the first to be automated long before doctors, nurses, physios, etc.

        • M M

          Well said. The current model involves one value chain; dispensing and you ad-hoc all other services, and selling relevant OTC products if needed.

          Changing this current model into two separate value chains (Dispensing and Services) will improve innovation, productivity and customer health outcomes.

          The required shift/change is expected to be picked up with in ten years.

          Pharmacy staff structure will need to be changed to more professional structure. You’ll have dispensary team lead by a dispensary manager and a dispensing pharmacist and clinical services team lead by a senior pharmacist.

          Investing in clinical services will need pharmacists to have the authority to practice… we will need to collaborate with doctors hence the need of holistic collaboration ERP system.

          I don’t see the report as bad as many see it. It’s time for a real change. It’s either we take our profession and patients health seriously ourselves or we might be forced to change.

          • Jarrod McMaugh

            Mina the model you describe exists in practice now.

            The “productivity report” isn’t a pathway to achieving it

  2. Jarrod McMaugh

    So, I think its clar that this is an ambit claim style of report. It’s clearly ridiculous to expect a complete transformation of the most accessed part of any industry within three year. As Red Pill notes below, this is about setting the mood for the future.

    That being said, if the government isn’t capable of automating the Safety Net, how do they expect to automate something as complex as the clinical role of a dispensing pharmacist?

  3. stuart walker

    I think the worrying thing is that the report was commissioned in the first place.
    I think as JM and RP outlined, the timescale is impossible logistically, if it was feasible, I have no doubt that it would be implemented, I assume that the robotic supervisor (human…before eventually replaced by a robot) is there to oil the joints, because I would have thought as medication became more complex, the need for highly trained pharmacist skills would be needed even more so as to oversee mechanical dispensing, not a sub-class of supervisors.
    One area of the report that should be heeded was the warning to Universities that already feeds too many pharmacist graduates into the system, soon to be renamed Sub-Class Dispensing Robot Supervisors.
    However as RP said, it WILL happen but also reach into AI provision of extended services, so there is only a perception of a safe space for Pharmacists to retreat into (maybe this safe space will be inundated with a multitude of homeless Doctors who have also been replaced by AI scanning pods that diagnose and administer treatment,….threatening the “jobs” of the AI Pharmacists!!) This philosophical argument though is VERY important as you can extrapolate the scenario to every “occupation” a human is employed in, and if AI is employed to do all the work/thinking etc how can the current economic paradigm exist with no workers to pay for anything, just corporate entities (who have more rights than a human being even now! ….to think they will pass on the benefits of AI for humanity is naive, they don’t perceive the rights of humans to a basic quality of life important now, never mind when we are part of a 9 billion out of work, resource depleting blight on the planet or maybe the AI will benevolently provide us with welfare cheques) operating the world, a Utopian future where robots do all the work and we fill our days playing chess and composing symphonies is a dream, futurists and trans humanists are already signalling and advocating the end of humans as a species….why not start with the pharmacists……. Now where’s that oil can!?

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