SHPA says 6CPA lacks detail, patient focus

Budget 2015: $50 note in blue piggybank

The SHPA says it is concerned about the lack of detail and patient focus in the SIxth Community Pharmacy Agreement, including lack of clarity as to whether HMRs will remain capped.

SHPA says it believes the 6CPA should be patient-focused and facilitate patients’ access to services that improve medication use and patient care, including reducing admission to hospital.

These services must be targeted at those most in need, it says.

The 6CPA has a strong focus on programs and services delivered through the four walls of a community pharmacy; SHPA believes the Agreement should provide broader scope for pharmacists to practise and deliver professional services independently, such as the HMR and RMMR services provided by independent accredited pharmacists.

SHPA believes pharmacists should be able to deliver services in settings most appropriate and accessible for patients, including in GP practices, a view held by its medical colleagues and many pharmacists.

“Community Pharmacy Agreements should always put the patients first,” says SHPA President Professor Michael Dooley.

“It is imperative for healthcare professionals such as pharmacists to be able to practise as part of a multidisciplinary healthcare team in settings where they can have the greatest impact on patient-focused outcomes.

“This includes not only within a community pharmacy, but also in GP practices and in residential care settings, for example.

“Cognitive programs through the 6CPA must enable pharmacists to practise in these settings and provide high quality and effective services focusing on patient outcomes.”

It is unclear whether any of the $600 million contingency reserve will be allocated to the HMR and RMMR program, with indicative funding in Years two to five not shown.

SHPA says this creates an uncertain environment for accredited pharmacists and for patients who require comprehensive medication reviews to avoid medication misadventure and hospitalisation.

SHPA says it would also like more clarity on hospital-initiated home medication reviews, as well as whether the cap on the number of HMRs an accredited pharmacist can deliver will remain.

The organisation says it believes the current arbitrary caps on HMRs introduced in March 2014 are unacceptable as they put vulnerable patients at risk by reducing their access to services that improve medication use.

However, it welcomed the fact that $50 million has been allocated to trial new and expanded programs through the Pharmacy Trial Program, to improve clinical outcomes and/or to extend the role of pharmacists in the delivery of primary healthcare services.

Yet it is concerned that the 6CPA states that these will be delivered through community pharmacy and consequently, innovative pharmacist programs within GP practices may not be considered.

The Agreement states that a range of stakeholders and bodies will be extensively consulted and SHPA says it looks forward to contributing to these consultations to ensure that any expanded programs are patient-focused.

It says it is also strongly encouraged that professional programs and services will undergo an independent review that may include PBAC or MSAC to ensure they are evidence-based, demonstrate cost-effectiveness for the taxpayer, and are appropriately targeted at patients.

A key component of the 6CPA is the change in the funding of chemotherapy preparation with fees paid directly to compounders under new arrangements yet to be determined.

The compound fee is $40 for non-TGA-licensed providers (such as hospital pharmacies) and $60 for TGA-licensed providers – this has the potential to substantially impact on the provision of these services in public and private hospitals, says SHPA.

SHPA is also concerned that funding for the additional clinical pharmacy services required to ensure safe and effective delivery of chemotherapy treatment to patients has not been detailed.

From 1 January 2014, the PBS Efficient Funding for Chemotherapy Schedule was amended to allow for reimbursement of up to $152.66 per chemotherapy infusion to ensure the ongoing viability of pharmacies who deliver chemotherapy services.

This funding ends on 30 June 2015; it is not clear how the fees listed in the 6CPA for compounding chemotherapy relates to the EFC Schedule, or if the EFC Schedule will be extended.

If there is an overall reduction in the fees paid to those compounding chemotherapy, this could threaten the viability and sustainability of these providers, says SHPA and many of the access issues that threatened the appropriate care for cancer patients in 2013 will be revisited.

SHPA says it continues to state to the Commonwealth that the priority for Community Pharmacy Agreements should be sufficient funding and bureaucratic support to be made available for:

  • all consumers who require medication management services commensurate to their clinical need;
  • consumers to have timely access to a comprehensive review of their medicines – and the choice of whether it is conducted in the home or not;
  • targeting patients recently discharged from hospital at risk of medication misadventure; and
  • maintenance of current professional fee payment to ensure long-term viability of the HMR program that has only recently developed a ‘critical mass’ of providers.

It says it looks forward to more detail becoming available regarding the 6CPA and opportunities to further support and explore models of care where pharmacists can practise as part of a multidisciplinary healthcare team in settings where they can have the greatest impact on patient-focused outcomes.

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