Editorial

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Welcome to the May 2012 homepage edition of i2P-Information to Pharmacists. Rollo Manning has been having some time out having staples removed from the site of his open heart surgery.He is now at home recuperating in Darwin, having arrived home last Friday, beating a cold and hasty retreat from Canberra.We all wish him a speedy recovery and hopefully, he will be fit enough to contribute by next month.
This month, Pharmedia discusses the toll that is taken when someone complains about you to an authority without good cause. Well, the good news is that you can now take action to protect yourself if such a complaint is made, and that may even include action for defamation. Read about a recent case involving two doctors, with Mark Coleman drawing on personal experience to illustrate.

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Pharmacy Businesses in Aboriginal Health Services

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Rollo Manning articles by this author...

Rollo Manning has experienced pharmacy practice from all sectors of the industry – retail, administrative, policy and remote Aboriginal practice. He spent 10 years with Glaxo Australia and was the first Director of Public Relations at the Pharmacy Guild National Secretariat in Canberra. He has also held the position of Pharmacy Policy Officer for Territory Health Services in Darwin. Rollo is currently a Consultant working in his own practice with remote Aboriginal communities, in Northern Australia.

By Rollo Manning Pharmacy and PR Consultant to Aboriginal health organisations and communities.

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The Barnes opinion in The Australian and CIS Policy Magazine follows an article in the Financial Review by Freehills Health Consultant Brendan Earle who said “maintaining professional standards is about governance, not who owns the pharmacy,”. Also an article in the Journal of Law and Medicine by Laetitia Hattingh, from the School of Pharmacy at Griffith University, said it was timely that current laws be reviewed given proposed Federal Government changes, and the “need for flexibility to ensure access of vital medicines to the community”. The suggestion by the Australian Greens of an inquiry by a Senate Committee into the 5^th Community Pharmacy Agreement may be the place to air the various views.

Terry Barnes is well qualified to comment and an authoritative source for a learned opinion on the subject. The fact that the Pharmacy Guild are quick to counter arguments put forward by authors such as Barnes is to be expected – that is its job – to maintain the present ownership laws to advantage the owners of pharmacy businesses – the Pharmacy Guild members.

The way around this is for the Guild to include in its constitution a membership class that allows alternative owners to be members of the Guild. However doing this could downgrade the importance to it (the Guild) of its current membership base which after all is the body that directs the organisation. The fact that the Guild is ruled by persons who are current pharmacy owners – no matter how far removed they are from the action at the coalface – it is impossible to change the direction with so much influence by the vested interests of today. The future has to look after itself and this is reflected in the short sighted approach by the Guild towards pharmacy ownership.

So the Pharmacy Guild believes the community pharmacy model has served Australians well and that they show this by going into pharmacies every day.

Amazing!

When there is no alternative of course they do as there is no where else to buy medicines (scheduled) or have prescription dispensed. It is evident that with no competition there is no option.

The Terry Barnes authored report[1] of the NCP inquiry into pharmacy regulation said on page 76:

A collateral cost of maintaining both the new and relocated pharmacy criteria is that they frustrate positive developments in pharmacy service planning and provision. They (the location rules) do not help to keep the shape of the community pharmacy industry abreast of current and likely future trends in consumer need and demand for pharmacy services, including:

• The ongoing popularity with consumers of “one-stop” shop medical centres containing a range of health care professionals under one roof;

• The development and expansion of care and multi-campus aged care nursing home and hostel facilities, which lend themselves to either on-site dispensaries or the contracting in of specialist pharmacy services not always provided readily by orthodox community pharmacies104; and

• Specialist health care facilities such as Aboriginal Medical Services, which could also sustain their own dispensary facilities.

It is often said that the health system is geared to a middle class audience of people who are well educated, employed and able to negotiate the various processes that confront the consumer. It could also be said that the pharmaceutical care required to maximise the use of PBS medicines is okay unless you are an Aboriginal person with poor education, unemployed and not able to negotiate the mainstream health system.

Yes if you are an Aboriginal you may NOT want to avail yourself of the glitz and glamour associated with a mainstream pharmacy and would prefer to go to the pharmacy at the health centre from where you had your medical consult.

Well bad luck! The Guild says “no” and is so fanatical about keeping the supermarkets out of pharmacy ownership that it steadfastly opposes any attempts for an alternative model of ownership.

As Terry Barnes says in his opinion piece last week:
"Provided that the owner is responsible for the safe and competent provision of dispensing and related professional services in their pharmacies, that's all that should matter to regulators." wrote Mr Barnes.

The classic piece of Guild rhetoric in the debate over the past week is this quote from the Guild:

"Pharmacies are not immune from competition – walk into any major shopping centre or down any main street and the evidence of competition is clear. The Location Rules simply ensure that where there is a genuine need for a new pharmacy, it can be established – a good piece of public policy aimed at ensuring that pharmacies are not clustered in populous areas, while other parts of the community go without equitable access to the PBS."

This is a curious argument and looks at the ownership from a purely population based assumption – a concept that went out on 18^th October 2011 with the new location rules. The rules now look more at other factors but still in the retail environment. The time was 12 years ago when the location should have been considering its role in primary health care.

Pharmacy as a profession has been stetted in time while the rest of the health care system has moved on and it has a lot to catch up or it will become obsolete with new technology able to dispense without the need for registered pharmacists.

The place to start is in Aboriginal health where the greatest contribution can be made to “Closing the Gap” is by making a pharmacist available to explain to people why the taking of medicines is important in the management of chronic diseases. This is after all a facility available to every other Australian when they get a prescription dispensed and it is paid for by the PBS through the dispensing fee of $6.42 per prescription – repeat or original. No such offering is made to Aboriginal people unless they go to a “white man’s” pharmacy.

Recommendation 9 of the final report of the National Competition Policy review said:
“The parties to the Australian Community Pharmacy Agreement consider, in the interests of greater competition in community pharmacy, a remuneration system for PBS services that restricts the overall number of pharmacies by rewarding more efficient pharmacy businesses and practices, and providing incentives for less efficient pharmacy businesses to merge or close;”

The amount of money provided by the taxpayer as a direct payment through the PBS or through the purse of general beneficiaries is adequate for an efficient service. However spread across 5,000 outlets it becomes diluted to the point of being almost ineffectual. The latest Practice Incentive Payments are an indication of this.

With a lesser number of outlets and with more strategically placed locations an efficient pharmaceutical care service could be built for all Australians.

The big question is “how does one overcome the power of the Pharmacy Guild when seeking a better deal for consumers?”

Comments welcome to Rollo Manning, PO Box 98 Parap NT or rollom@iinet.net.au or 0411 049 872

[1] Download at http://www.health.gov.au/internet/main/publishing.nsf/Content/ED90D96B6729FF84CA256FBA0016F956/$File/finalparta.pdf

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