Reshaping primary care


building blocks

Location rules, ownership rules and funding model changes should be considered in the post-pandemic landscape, expert says 

Sweeping changes should be considered to the way primary care operates and is funded, a health economics expert says.  

In an article published this week, Stephen Duckett, head of the Grattan Institute health program, says the “response to COVID-19 transformed primary care” with new ways of working that were embraced by patients.

Mr Duckett, a long-term advocate for pharmacy regulatory reform, called for the post-pandemic health system to learn from the COVID-19 changes and “create a new normal”.

Among the changes he recommends as part of this ‘new normal’ are sweeping alterations to the community pharmacy landscape, in particular, moves to further integrate the pharmacy sector into the broader primary care structure.

“Pharmacy location and ownership rules should be changed to facilitate incorporating pharmacies into these one-stop shops [for co-located services],” he said.

“Grants (or loans) to encourage co-location or consolidation should be part of a post-pandemic economic stimulus package”.

Changes to consumer behaviour and supply difficulties had emphasised the need for a restructure of the system, he said.

“With the drop in face-to-face consultations, and an apparent drop in preventive visits, many general
practices and pharmacies are struggling to survive financially. They are also still finding it difficult to get reliable information, and many are desperate for supplies of personal protective equipment, testing kits and influenza vaccines.”

“The current challenges have highlighted the importance of regional planning, coordination
and communication. Primary Health Networks have played a central role in delivering the Commonwealth’s pandemic measures at the local level, but until now their importance has not been recognised,” he said.

“In future they will need to be strengthened, more closely integrated with state public health and acute services and freed from some of the bureaucratic shackles that applied to them before the pandemic.”

Australia had commenced the “first, hesitant steps” towards new primary medical care funding arrangements, with an enrolment fee for people aged 70 years announced in the 2019 Budget, Mr Duckett said. 

Examples from similar countries, like the Alberta, Canada, primary care networks, offer a solution where networks of practices (medical and other) would be eligible for additional funding to employ pharmacists,
physiotherapists, nurses and other health professionals. 

Mr Duckett also highlighted the growth of telehealth in the wake of the pandemic, and the introduction of new medication services on 31 March, “including the electronic delivery of prescriptions from the practice to the pharmacy and expanded home delivery of medications,” as important pandemic-derived developments that needed to be continued and built upon.

The article was published online first in the Australian Journal of Public Health

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3 Comments

  1. Michael Ortiz
    30/05/2020

    This is a great laugh

    Stephen Duckett’s “Cookie Exchange” with Edmonton media …
    https://www.youtube.com/watch?v=5DxeCK5Ne_Q

  2. Anthony Tassone
    31/05/2020

    Whilst it’s true that there has been changes in the way patients were engaged and their care delivered (mainly with telehealth) during the COVID-19 pandemic, the one thing that has not changed is community pharmacy continuing to keep their doors open and being there for their patients.

    These opinions from Professor Duckett are hardly new, and are well tried in his hobby horse of ideological views of community pharmacy.

    Whilst other parts of the health system either closed their doors or largely restricted access – community pharmacy turned up and was there.

    Given this experience, according to Professor Duckett it is somehow a catalyst for the need for change?

    Rather than use COVID as a justification for complete reform of the Australian community pharmacy model – if anything it largely validated what we all know to be a great system and showed all levels of government the value of it as well.

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

  3. Michael Khoo
    03/06/2020

    Reform and review are essential to the evolution of any system in response to a changing environment. It is folly however to begin with the conclusion, then build up the evidence to support it. Reform driven by dogma is revolution, not evolution.

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