Top GP says less pharmacist presence would improve compliance

robot pharmacy pharmacist

PSA goes to bat for Guild stance on pharmacy regulation as RACGP president argues longer scripts and machine dispensing would ‘improve compliance’

Location rules and pharmacy ownership regulations are good for the industry and consumers, PSA national president Dr Chris Freeman argued on Radio National over the weekend.

Pharmacy regulation was the topic of discussion in the Sunday Extra segment hosted by Hugh Riminton, with RACGP president Dr Harry Nespolon reiterating his call for an end to pharmacist-only ownership.

“Our view is that anyone should be able to own a pharmacy,” he told the program.

“We want it to be deregulated, I’d like to put a pharmacy in my large practice. Having a pharmacy within a general practice for example is convenient and also enables that interaction between the doctor and the pharmacist a lot easier than if they’re down the road.”

Professor Graeme Samuel of Monash University – and former head of the ACCC – also repeated his previously stated assertion that the current rules are anticompetitive.

“I’m not an advocate for discount pharmacies or Chemist Warehouse or anything like that,” said Professor Samuel.

However he added that location rules “are ludicrous rules, they’re asinine, they’re archaic … they were designed to protect the incumbent pharmacists from competition.”

Dr Freeman came to their defence, arguing that “the current location rules are stopping a concentration of pharmacies in one particular area and leaving other areas without the pharmacy.

“We know that up to 90% of the Australian public live within a 2.5 km radius of a community pharmacy,” he said.

“And so they are one of the best served in the health system.”

He added that two recent reviews in Queensland and Western Australia have indicated that “it continues to be in the interest of the public for a pharmacist to own a community pharmacy”.

“If we were to open up pharmacy ownership rules, what we would see is large corporates come into the industry and we’ll end up with a similar duopoly as we have, say, with the supermarkets. That will give consumers less choice in my view,” said Dr Freeman.

While the Guild had declined the invitation to be on the show, they told AJP that Mr Samuel’s view was ‘incorrect’.

“What would pharmacy look like if the location rules were abolished as Graeme Samuel wishes? Probably a bit like pharmacy in the 1980s—too many pharmacies, and not where they were needed.”

‘The reality is the world’s changed.’

During the Radio National interview, Dr Nespolon again brought up the topic of increased script length, and suggested that medicines could be dispensed by machines to make it more convenient for patients.

“The reality is the world’s changed, and patients want to be able to order their medications late at night online and get it delivered by post or any other means,” he said.

“They want to be able to choose how they get their medication. If you’re for example on thyroid medications the rest of your life, do you really need to interact with anyone other than your GP when you’re going to get your script done, just to make sure you’re on the right dose?

“The problem with this argument about people being physically close to a pharmacy, I think is getting a little bit worn,” said Dr Nespolon.

“There’s a whole lot of new ways of delivering medication, for example, there are machines where you can literally go and put a script into and get your medication out.

“Now that’s never going to happen under the current rules as they exist today. There’s a whole lot of innovation out there that doesn’t require a physical [pharmacist] presence which is convenient for patients and most importantly for patients means they get their medication when they need it and as often as they need it,” he said.

“You can have subscription services, for example, so that the medication is sent out every month or every two months or however often we’re allowed to do it. These are all things that would actually improve patients’ compliance and improve their medication management.”

However Dr Freeman said, if anything, pharmacists should be more involved.

He pointed to the PSA’s Medicines Safety report, which showed that around 650,000 people each year go to hospital because of their medicines.

“There is a need for the pharmacist, who has expertise in medicines, to be managing and helping consumers with their medicines on a day-to-day basis,” he said.

codeine medicines
There is a need for more, not less, pharmacist involvement to improve medicines safety, says Dr Chris Freeman.

“Dr Nespolon is not an expert on factors that influence medication compliance,” Dr Freeman told AJP following the interview.

“A Cochrane review published in 2014 concluded that interventions involving pharmacists in medicines management, such as medicines reviews and consultation between a pharmacist and patient to resolve difficulties, make a care plan and provide follow up were shown to improve adherence,” he said.

Even Professor Samuel said dispensing should be in the hands of pharmacists, although he repudiated the existence of location and ownership rules.

“There’s one fundamental rule that I think must be in place.  And that is that that is chemist-only medicines shall only be issued by a registered pharmacist … the same rule that says that the only person that can wield a scalpel is a registered surgeon,” he said.

“In terms of delivery of medicines and prescriptions, that is the dispensing of prescriptions, then the safety benchmark ought to be that the person doing it should be a registered pharmacist.”

However he added, “once you’ve got that safety rule in place, the rest then can only be there to serve anti-competitive purposes and they ought to be removed.”

The Guild told AJP that Dr Nespolon’s comments were ‘disappointing’.

“It is extraordinary and disappointing that a GP organisation would advocate for less direct contact between patients and pharmacists as health professionals,” said a spokesperson for the Guild.

“In relation to the Radio National interview, Dr Freeman held his ground admirably on behalf of pharmacy, in the face of hostile incoming.”

Listen to the full segment here

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1 Comment

  1. Michael Ortiz

    The AMA is attacking Pharmacies again to divert attention away from why Pharmacies are being excluded from NIP vaccinations. There is an underlying vulnerability for GPs because Pharmacists deliver vaccination at a lower cost per dose than GPs, when GP consultation costs are included.

    Government has a minimum pricing t policy for medicines which has not been applied to vaccinations. Were this policy to be applied to vaccinations then it could affect GP incomes.

    The argument about increased quantities of PBS medications has a number of issues. The PBS has an unwritten policy that the Australian population should receive one month supply of chronic use medications for one copayment. There have always been some exceptions like the oral contraceptive with four months supply as this ensures that a patient has contact with a health professional once a month with chronic use medication.

    Government can make some savings by doubling quantities by avoiding dispensing fees but there will be increased wastage where patients need to switch drugs. In addition patients will interact less frequently with a health professional. Currently the PBS scripts are for six months supply, so will Government reduce the number of repeats to two (6 months supply) or will the script duration be extended to 12 months (5 repeats).

    I doubt the AMA leadership has considered these implications on patient care.

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