Editorial

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Welcome to the first homepage edition of i2P for 2012.
In many ways it has been a slow start to the New Year because of having to deal with the “leftovers” from 2011.
One of those items for i2P was that a third-party provider to the site did not advise of a code change to the security section in our subscribe panel, creating a range of frustrated subscribers not able to get on board.
We apologise to all those potential subscribers who were unable to register with us in the second half of 2011, but if you try once more you should have no problem.

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Volume 2012 Number 1

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Pharmacies to write prescriptions? Yet another conflict?

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Neil Retallick articles by this author...

Neil Retallick is a former General Manager, Merchandising, for National Pharmacies, the successful community pharmacy model owned by the Friendly Societies. Neil holds a Graduate Diploma of Marketing from Monash University, is a CPM and a graduate of the AICD.He began his career with Myer Stores Ltd and worked for FMCG companies including TIA (Sheridan) and Pacific Dunlop. Prior to these roles Neil worked for Cadbury Schweppes Drinks Division - Grocery, and Trimex Pty Ltd in Victoria in State management roles. He is currently Chief Executive Officer at the  Combined Dispensaries in Sydney and is a Member of the Advisory Board at Ehrenberg-Bass Institute for Marketing Science

The divide between who writes prescriptions in Australia and who dispenses them has traditionally been seen as an important construct in minimising any conflict of interest.
Will the evolution of nurse practitioners working in pharmacies mean that this protection mechanism for the average Australian (and their taxes) is dissolved?

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Most people working in community pharmacy have been observing the development of in-drugstore health clinics in the USA with some interest over the last several years. An argument supporting these has been that they improve accessibility to healthcare for many Americans. They are more convenient and less expensive than a visit to an American GP (General Practitioner). An argument put forward to counter concerns from GPs is that there is more demand for GP consultations than there is capacity in the US system. By diverting ‘minor’ health concerns to the nurse practitioners who consult in these clinics, the excess demand is alleviated and the GPs can focus on the more serious health concerns of the average American. These are the same arguments being put about in the public discussions around the introduction of healthcare clinics into community pharmacies in Australia. 

There is much anecdotal feedback that supports the view that there are insufficient GPs in many local Australian communities to allow ready access to their services as and when required. In a sample of one, I returned from an overseas trip earlier this year with some form of dreaded lurgy. On ringing for an appointment with my GP I was informed the soonest I could be seen was in two weeks. I took the appointment offered and had almost cured myself by the time I saw my doctor. Now I accept that I wanted a first thing in the morning or last thing at night timeslot, but the notion of leaving the office for two hours in the middle of the day to be able to see my doctor for 15 minutes doesn’t thrill me. And I do love my GP. He’s been taking good care of me for ten years. I don’t want to see anybody else.

The new business model for GPs that has evolved in recent years – the “we’re a clinic and we share patients” approach – hasn’t struck a chord with lots of Australians either. There is no doubt that there is a tension between the fact that a person can fall ill at any time 24/7 and that a GP needs to have a life too, but maybe this supports the argument for a different kind of healthcare service. 

Pharmacies have recently entered the bailiwick of GPs in being able to provide Sick Leave Certificates to their customers. The introduction of this new service was accompanied by the argument that this would allow GPs to focus on the more important needs of their patients. Healthcare clinics in pharmacies can be argued as an extension of this reality.

The conflict of interest argument is important in all this. There are many in the health profession who have argued strongly over the years that the separation of writing and dispensing prescriptions is an important safeguard against the temptation that would exist should any entity ever have the opportunity to do both. Think ancillary medical services here. Whilst considerations of the impact on the hip pocket of doctors and pharmacists should not influence the outcome of deliberations about how the Government might structure the delivery of healthcare in Australia, the reality is that this initiative is likely to add to community pharmacists’ income and reduce that of GPs as unmet need is met. Community pharmacy revenue will rise if an increase in prescriptions written is an outcome and assuming the clinics either pay rent or are operated by the pharmacist.

The Government’s view of this development will be swayed by its analysis of the fiscal impact of the introduction of health clinics in pharmacies. Will the cost to the Government of people visiting pharmacy-based clinics be lower than the cost of those same people visiting their GP? If so, will this saving be offset by an increase in the cost of the PBS as more prescriptions are written? 

A further consideration here is the impact this initiative will have on the relationship between community pharmacists and the doctors in their local areas. It could be deduced that where the local GPs are up to pussy’s bow with patients (there are many stories of GPs not taking on any new patients) there ought to be no issue. However, where a GP is operating at less than capacity then there may be some angst created when the local pharmacy sets up in competition (effectively). 

The community pharmacy landscape in Australia is deeply etched with conflicts of interest between many of the various entities that populate it already – community pharmacists/wholesalers/ manufacturers/the Government. The introduction of these clinics into pharmacies will add General Practitioners to the list of conflicted parties.

The challenge for us all is to ensure that any new initiative improves the quality of healthcare available to the average Australian over the medium and long terms. Any short term financial gains need to be considered against this outcome. We need to hasten slowly.

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