Rural pharmacists miffed by funding cuts

‘Taking money away from communities in the bush is totally the wrong message,’ say pharmacy owners

AJP recently reported on criticism of the new Regional Pharmacy Maintenance Allowance (RPMA), with some pharmacies claiming they are worse off under changes that kicked in from 1 January 2021.

The RPMA program received a funding boost of an additional $5 million per year and also transitioned from the Pharmacy Accessibility Remoteness Index (PhARIA) to the Modified Monash Model (MMM) for rural classification.

However pharmacist Peter Crothers, who owns and manages a pharmacy in Bourke, NSW, told AJP that “there are quite a lot of winners and losers” from the program redesign, with some pharmacies missing out on thousands of dollars while others are newly eligible to gain funding for the first time.

“The losers are more likely to be in the remote classifications – not necessarily the most remote MMM classification, but certainly the two most remote PhARIA classifications,” said Mr Crothers, who belongs to the Rural Pharmacy Network Australia.

The local pharmacy in the small town of Merriwa, NSW, is one such business that has been markedly impacted by the changes.

Proprietor Robert Smith said Merriwa Pharmacy has been shifted from PhARIA category 5 (Remote) to MM 5 (Rural).

“That’s resulted in a decrease in the funding to our pharmacy by several thousand dollars,” said Mr Smith, who received the news in an email on Christmas Eve.

“If you lose those sorts of dollars off your bottom line and there’s no way to make it up, then it reduces your ability to employ locums and the like.

“We’ve been paid at that rate for the last 10 years at least. If anything, the operation has become more complex and the way that the community pharmacy is relied on now, with the doctors retreating into telehealth – and often having no doctor at all – often times in rural communities the pharmacy is the only point of contact that people have,” he told AJP.

“In terms of generally owner-operator businesses, you have to look at your least profitable times, which may then equate to reduced opening hours. For instance, Saturday mornings may be under threat in some instances.

“There should’ve been no disadvantage for anyone already in PhARIA 5,6 or 7 because we’re talking about the most remote and most vulnerable of the communities. For the most part, in lower turnover, single pharmacy towns, if you take the pharmacy out of a town like that or reduce opening hours then the whole idea of equal access to medications has evaporated,” he said.

Joanne Loftus, proprietor of Northampton Pharmacy in WA, said her pharmacy also went from PhARIA 5 to MM 5.

“I have been one of those pharmacies that have been detrimentally affected by the changes. What that equates to is a loss of about $7500,” she told AJP.

“It’s extra stressful because we also recently lost our full-time GP, so the impact of that is a burden that I have to carry as well.

“We already have lost two pharmacies in our Mid West region, one in Mt Magnet and one in Mullewa closed six months ago, they closed because they were unviable by the owners and that was before the MMM matrix came in.”

Ms Loftus’ pharmacy is 55km north of Geraldton, a major regional centre in WA.

Meanwhile all 10 pharmacies in Geraldton were reassigned from PhARIA Category 1 (Highly Accessible) to MM 3 (Inner Regional) and will now receive the base allowance of $3000 under the new matrix. Prior to this, they were not entitled to any additional financial support under the RPMA.

“For me and another pharmacy in the Mid West to lose money when we’re a much more vulnerable community, it doesn’t make sense,” she said.

The changes mean Ms Loftus has been forced to change her opening hours to stay viable.

“In terms of being able to employ another staff member, that’s unachievable,” she told AJP.

The funding influences my ability to hire a pharmacist and there is also a lack of locum pharmacists in my region which is an entwined issue.

“What that means is, the services I offer to my community are going to be reduced. As a single pharmacist, I can’t do blood pressure checks, flu vaccination, wound care on the elderly, sit there and counsel people, because who is going to look after front of shop and medication needs?”

Meanwhile the government has backed the changes, maintaining that its overall effects are positive.

“More than 400 additional pharmacies are now eligible for the RPMA with very remote pharmacies receiving significant additional funding to support the supply of medicines and healthcare in their community,” a spokesperson for the Minister for Health and Aged Care told AJP.

“The changes we proposed and agreed with the Pharmacy Guild of Australia will ensure that more rural and regional pharmacies are eligible for this important program.”

A spokesperson for the Pharmacy Guild said the new system has led to an increase of around 50 per cent in the number of pharmacies being supported.

“No system is perfect, but the Guild believes the additional funding and the transition to the MMM system will provide a fairer and more equitable outcome for pharmacies and patients in remote, rural and regional Australia,” said the spokesperson.

“Where a pharmacy believes it has been disadvantaged through an unintended consequence or an anomaly of the system, that pharmacy can submit an exceptional circumstances request for consideration by the Department of Health.”

However AJP understands that, behind the scenes, outgoing Guild president George Tambassis has taken up pharmacists’ concerns with the Guild’s Pharmacy Viability Committee, and a senior Guild staffer is now seeking the necessary data from the Department of Health to do a detailed assessment of the impact.

“My understanding is that someone at the Guild is now dealing with it, they’ve put a good person on the case too. And I think that’s good because, I think this has been difficult for a lot of people to process and deal with, and it is quite complex,” Mr Crothers told AJP.

More needs to be done to understand the issues that communities face in the bush, said Mr Smith.

“I’m just not confident that the people at the table – the bureaucrats in Canberra or even the Guild negotiators – I don’t think they understand the extent of problems people are facing in the bush,” he said.

“For anyone to be taking money away from these communities in the bush is totally the wrong message.”

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