Why health is like a three-legged milking stool


three-legged wooden stools

The Rural Pharmacy Network Australia is calling on the National Rural Health Commissioner to recognise the pivotal role that community pharmacies play in rural communities

In its response to the Discussion Paper for Consultation: Rural allied health quality, access and distribution: options for Commonwealth Government policy reform and investment, it also calls on the Commissioner to take steps to ensure that they are empowered to deliver the best possible pharmacy care to rural patients. 

RPNA says that the paper does not do justice to the complexity of rural pharmacy practice and its crucial underpinning role in rural health infrastructure. 

“While pharmacy must be included in rural primary healthcare planning, and faces similar workforce challenges to other medical professions, it is distinct from Allied Health and warrants separate treatment and consideration,” it says.

“Community pharmacists are important investors in rural communities large and small across Australia and—sometimes—the only healthcare professional with ‘skin in the game’ in their local community. 

“Collectively, rural pharmacists spend millions of dollars of their own money in establishing and growing primary healthcare infrastructure, skills and resources throughout rural Australia, including through the employment and training of pharmacy students, interns, support staff and paraprofessionals.”

Pharmacies are particularly important in rural communities with less than 4000 population, the response says, where typically a single pharmacy, one or perhaps two GP practices and a small hospital, usually of less than 20 beds and staffed by the local GPs in a VMO capacity, are the entire health offer.

RPNA likens healthcare in small rural towns to a three-legged milking stool.

“In these communities, the GPs, the hospital and the local pharmacy form the crucial or ‘determining’ health services which form the foundation of health service infrastructure and make possible all other health services such as aged care, community health, mental health, drug and alcohol, baby and children’s health, birthing and motherhood, visiting medical specialists and indeed the other Allied Health professions,” it says.

“When one leg fails the system collapses.”

In order to harness the rural Community Pharmacy contribution to rural healthcare, several immediate and critical issues must be resolved, says the Network.

It says the most important of these are:

  • include Community Pharmacy in all health service planning;
  • address workforce shortages;
  • redirect remuneration towards patient-centred, team-based care, rather than instances of care;
  • better utilise the skills of community pharmacists by expanding scope of practice and incentivising the delivery of services that improve patient outcomes; and
  • support integration of Community Pharmacy with rural GP surgeries and hospitals as well as other local healthcare providers such as Aged Care, Aboriginal Health Centres and so on.

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