SHPA calls for prescribing pilot, role in CPA negotiations

In its 2017-18 pre-Budget submission, the hospital pharmacy group also threw its support behind pharmacists in general practice, removal of HMR caps, after-hours funding and more

The membership organisation has issued a strong set of recommendations to the Federal Government ahead of the May Budget announcement.

Its first recommendation is a call to be included, along with other stakeholders, in the negotiation of remuneration for pharmacy services.

“In Australia pharmacy services have traditionally been divided into largely separate spheres of pharmacy activity: those within a community retail pharmacy; and those in institutional setting[s] such as hospitals,” the SHPA says.

“However the remuneration of medicines and associated pharmacy services as delivered to outpatients and in clinics by hospital pharmacists is traditionally negotiated exclusively with The Pharmacy Guild of Australia, a membership organisation reflecting the interests of pharmacists who own community pharmacies. This is despite the fact that 20% of PBS expenditure is managed by pharmacists in public or private hospitals.

“SHPA awaits the recommendations of the Pharmacy Remuneration Review in mid-2017 and welcomes greater involvement with the development of the remuneration framework for pharmacy.”

This recommendation is in opposition to the Guild’s argument that, “as the recognised representative of the majority of community pharmacy owners who fund and manage the infrastructure to deliver the PBS to patients”, it should continue to have responsibility for negotiating future CPAs.

The SHPA also petitions the government to remove the “arbitrary cap” on HMRs in regional and rural areas for patients over 70 years old.

“HMRs have potential to play a valuable role in improving health outcomes for a population that has higher health needs and poorer health outcomes than their metropolitan counterparts, however access to HMRs remains a significant barrier,” it says in the submission.

In addition, the SHPA also recommends the following:

• Funding for pharmacists with relevant experience and accreditation to work in primary health care settings such as general practice through the Medicare Benefits Schedule.

“In GP settings, experienced pharmacists can provide a range of cognitive services that support treatment for chronic disease; review medications; monitor medicine-related side effects; and provide additional patient counselling for people taking new medicines or with special needs,” argues the SHPA.

“The transformation of the pharmacy workforce is essential to meet Australia’s future healthcare challenges: an ageing and increasingly diversity population with increasingly complex medicine regimens within a cost-controlled health system,” it tells AJP.

“Hospitals are the most fertile environment in which to develop early career pharmacists to meet these challenges, and there is great opportunity in transferring the resulting core expertise and experience … from acute to primary care settings.”

• Funding of a pilot program to test the effectiveness of enabling pharmacists to prescribe in hospital settings as part of a collaborative practice model.

“Substantial evidence has demonstrated that non-medical prescribing by pharmacists and nurses for acute and chronic disease management can be an asset for patient care,” the SHPA states.

• Funding for a pilot of a hospital-directed New Medicines Support Service.

Such a service “would identify people diagnosed with flagged conditions beginning a new medicine as they are discharged from hospital for either a face-to-face or telehealth consultation.”

• NSW and ACT to adopt the PBS Public Hospital Pharmaceutical Reforms remuneration model to support supply of 30 days of necessary discharge and outpatient medicines.

• Review funding for the Closing The Gap Pharmaceutical Benefits Scheme Measure.

• Provide incentives for pharmacist services in Principal Referral Hospitals to be offered after hours and on weekends in order to improve patient care.

“Internationally, providing extended weekend and after-hours pharmacy services to patients in major hospitals has increasingly been recognised as routine practice to improve the quality and safety of patient care,” says the submission.

The SHPA tells AJP that the Budget recommendations reflect the existing expertise and future aspirations of its membership.

“Our recommendations take into account current and future trials of pharmacist deployment, ensuring every patient, regardless of where and how they are cared for, is seen by a pharmacist who is fit for purpose, who can identify, mitigate, manage and ideally prevent, as part of an interdisciplinary approach to medicines management and pharmaceutical care,” it says.

See the full submission here.

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  1. SPG

    “In GP settings, experienced pharmacists can provide a range of cognitive services that support treatment for chronic disease; review medications; monitor medicine-related side effects; and provide additional patient counselling for people taking new medicines or with special needs.”

    Community pharmacists are already performing these services yet we are not being adequately remunerated for doing so. Would it not be a more efficient use of government money to invest this funding into the community pharmacy network that is perfectly placed to deliver these services to patients? We already have the patient relationships, and with additional funding, we could devote more resources and infrastructure to enhancing our current services.

    • Andrew

      There’s pretty clear evidence that these services (in a community pharmacy setting) don’t contribute to better health outcomes, though.

      • SPG

        Hi Andrew, it is good to see acknowledgement that community pharmacists do perform these services. In this regard it is worth pointing out that the PSA continues to advocate that the role of a practice pharmacist will not duplicate the role of a community pharmacist (see Furthermore, the SHPA submission also recognizes that unnecessary duplication of pharmacy services should be avoided.

        With the success of the Northern Queensland Primary Health Network (NQPHN) and the My Health Record ‘opt-out’ trial it seems that the community pharmacist will be ideally placed in their ability to access, utilize and positively contribute to the patient’s health journey in the near future. As stated by Dr. Shane Jackson regarding My Health Record “and for the pharmacist, they will be able to access information that they would not have had, in an efficient, effective and valuable way, resulting in better care for the patient. A good example is when a patient has been discharged from hospital, the pharmacist can access their discharge summary, which will help them provide ongoing care and support after the patient is discharged.” (

        We were not aware of any studies which demonstrate that clinical services delivered in a community setting do not contribute to better health outcomes. Can you let us know what studies you are thinking of as we would be interested in looking at them?

        SPG continue to advocate, as we have elsewhere, that the studies usually cited by proponents of the practice pharmacist model do not advocate that the co-location of a pharmacist within a GP practice is essential. Rather, the studies put forward in relation to this proposal show that it is increased communication between healthcare professionals regarding patients that seem to produce better healthcare outcomes and not where it takes place.

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