The first publicly released King Review submissions include GP concerns over pharmacies as a “shonky operation” and frustrations over HMR restrictions and ownership
The first five submissions that have been published are non-confidential responses to the Review discussion paper, which was released on 27 July.
Two further responses have been submitted to the Review but withheld from the public.
Here we synthesise the striking arguments made in these first submissions.
Veteran delivers scathing rebuke of pharmacy ownership
Retired WA pharmacist Ron Dymock, who has 60 years’ experience buying, operating and selling pharmacies under his belt, argues strenuously against commercial ownership.
“The ideal is for ownership to be restricted to ONE (or two at most) pharmacy for ONE pharmacist owner.
“Until recently the West Australian situation worked very well with only WA registered qualified pharmacists ownership of two pharmacies,” says Dymock.
“Unfortunately, since this situation was abandoned and looser limits instituted in the ideal of Australia-wide harmonisation, several pharmacists have succumbed to GREED and OVERT rampant capitalism and are not really “dinkum” practising pharmacists at all.
“Schemes of arrangement appear to exist whereby pharmacists pretend to own a pharmacy but in fact financial benefit and control of a chain of pharmacies is in the control of one or two pharmacists. The existing looser regulations are not adhered to and those getting around the ownership rules are not punished,” he says.
It’s difficult for young pharmacists to buy or start a pharmacy, and this is caused by pharmacists amassing five or more pharmacies and ‘chains’ of multiples, Dymock argues.
He adds several other concerns, including:
- “Extremely disastrous” high rents in shopping centres for pharmacies;
- Lowered remuneration by the government;
- Pharmacist wages are too low;
- There is an oversupply of graduates; and
- “Warehouse-type” establishments cast a bad image.
A GP states his concerns over expanded pharmacy role
“It is with concern that I note the increasing push for an expansion of the clinical role for community pharmacists,” Dr FM Janse van Rensburg from the ACT begins in his submissions.
Dr Rensburg says while GPs are “increasingly restricted” in involvement with pharmaceuticals to avoid perceived bias, pharmacies have no such rules.
He goes on to list his concerns with the way pharmacies are run, including:
- Pharmacies near well-equipped GP clinics offering their own clinical services such as weight loss programs in “off [sic] course all the products required for sale”;
- Poorly shielded, semi-private areas that serve as the “confidential area where questions and possibly an examination of some sort could be performed”;
- Billboard advertisements within the pharmacy; and
- Pharmacies advertising the services of a naturopath within the pharmacy.
“We certainly would not want to mix up the allopathic drugs behind the counter with the homeopathic drugs, magnets and other miracle cures this side of the counter,” he says.
“And please take care not to trip over the equipment that is being used for flu injections, melanoma diagnosis or assessing for sleep apnoea – all done by people with a few hours’ worth of training.
“The hypocrisy of this situation is mind boggling – a medial professional with nine or ten years formal training is considered so untrustworthy that there are even rules as to what food he or [she] is served by a pharmaceutical company and under no circumstances should he be allowed to dispense medication.
“On the other hand the shonky operation I describe above repeats itself in shopping centre after shopping centre and the authorities reward this type of behaviour by considering an increase in the clinical role of pharmacists.
“Surely the powers that be cannot be this naïve?” concludes Dr Rensburg.
HMR restrictions leaving pharmacists frustrated
In her submission to the review, SA clinical pharmacist Juliet Richards expresses her frustration with the HMR restrictions and lack of remuneration for clinical services.
“As my role is a non-dispensing pharmacist, and I have no affiliation to a retail pharmacy, there is no conflict of interest and I can focus my efforts on clinical services to promote the quality use of medicines, getting the best outcomes for my patients,” says Richards.
“Unfortunately I am currently restricted as to the number of HMRs I can do and there is little to no remuneration for the other services I am able to provide, such as ongoing reviews, monitoring and check ups, education sessions, chronic disease management and other pharmaceutical or health advice.
“This makes it difficult and frustrating for myself and other like-minded pharmacists as we are left out of pocket when we provide these quality and valuable services,” she says.
Richards recommends that pharmacists be paid a wage similar to the pharmacist in a general practice model, although not within the confines of a practice.
“Alternatively the cap on HMRs should be altered to 40 so the non-dispensing clinical pharmacist is able to make an adequate living,” she offers.
Victorian pharmacist Greg Luke agrees that the HMR scheme is currently not working.
He says in his 40 years as a pharmacist he has provided in excess of 4000 HMRs, but is not happy that the Pharmacy Guild of Australia is associated with the HMR scheme.
“The Guild has a vested interest in the scheme failing (they don’t want to lose business for their members and there exists a PROFESSIONAL JEALOUSY to the point that the Guild wants to control all funds for HMRs, hoping that members will take up diabetes checks and med checks,” writes Luke.
However a Guild spokesperson counters that the organisation took up administration of HMR payments at the request of the Department of Health.
“At the request of the Department of Health, the Guild has administered payments for the Home Medicines Review and some other 6CPA professional programs since 2013,” the spokesperson told AJP.
“These are administered centrally, not by individual Guild pharmacies. The online system developed by the Guild for such payments has introduced significant improvements and responsiveness in the payments system,” they said.
The Review’s discussion paper will be open for submissions until 23 September 2016. See the website for more information.