Pharmacy has a long way to go before it can be seen as playing a role in arresting the continuing downward spiral in Aboriginal health. In the area of kidney disease in the Northern Territory there is an increasing rate of admission of Aboriginal people to end stage renal failure through dialysis. This is the direct result of the health systems failure to manage these people in the early stages of kidney disease associated with diabetes and cardiovascular disease. Part of the reason is cost and not enough money in the Australian Health Care Agreement for the Territory Government health department to allocate sufficient resources to preventative measure that will arrest the slide to end stage failure. The cry is that there is not the money to employ pharmacists.It is worth looking for a moment at exactly what is being said here. It is as if the sole responsibility for Aboriginal health rests with a Territory Government health department. This should not be the case for with respect to pharmacy the subject is fairly and squarely on the Pharmaceutical Benefits Scheme. The pharmacy lobby has been careful to ensure that the business of the PBS goes through its retail pharmacy outlets. There have been no supplies through the NT Hospital System since this was moved to the private sector after the introduction of the s100 arrangements.
So why should the same health department that was left out of this loop be put to blame for not providing pharmacists to go out and promote adherence for diabetic and cardiovascular sufferers in the remote areas now being supplied their PBS through a retail pharmacy. Every other Australian citizen has access to a pharmacist paid for by the PBS to give advice and put in place programs that will assist with information and dose administration aids for their chronic disease.
Not the remote living Aboriginal. He/she has to suffer a PBS where the remuneration is $4.30 short of the mainstream fee paid to Approved Pharmacies and then see that same pharmacy get an extra payment based on sales volume rather than quality achieved.
The announcement by the Pharmacy Guild that there will be a reward to retail pharmacies based on the volume of stock it sends out to remote health clinics under the s100 arrangements is hard to believe.
See at http://www.guild.org.au/content.asp?id=1562
Fourth Agreement money being used to supplement the income of already satisfied pharmacy contractors with no apparent accountability back for improved quality use of medicine!
“Payments for pharmacists with existing supply arrangements to AHS have been increased based on volume of PBS medicines supplied to the AHS per year,”
Really and truly what sort of a message is this sending to the policy makers at Government level? The more you send out the more you will get paid. This is calling on all to let the medicines go out of date so the pharmacy can replace them and make more money. The media release accompanying the announcement does say… “…These increases will be accompanied by improved accountability arrangements.” One would hope so but the Information Kit relating to this still carries the dateline of 2001!
Surely the remuneration structure should in some way be geared towards improved quality in the way medicine is used rather than using Fourth Agreement money to reward for higher sales achievement. The question must be asked where the Pharmaceutical Society Australia is in all of this or does the body representing the professional aspects of pharmacy practice not get a look in when it comes to PBS remuneration.
The fact that there is $27 million in the Fourth Agreement budget for Aboriginal health projects should not be a reason for approaching the priorities of need from the wrong end of the spectrum. The Aboriginal client should come first or is it just another case of pharmacist’s wealth before Aboriginal health?
This area of medical need (Aboriginal health) that is requiring so much is being treated as a second class audience when it comes to pharmacy services dominated by the vested interests of the retail industry leaders. The Aboriginal community controlled health sector through its peak body (NACCHO) sees the Pharmacy Guild as the experts in a complicated and hard to understand sector of primary health care (pharmacy). No doubt the longer interest groups like NACCHO can be kept in a state of confusion the better for retail pharmacy. There is little apparent balance in thinking provided by the pharmacists in the field working on quality programs who expect to be represented by their professional organisation - PSA.
A recent visit to a remote community in the NT by this author revealed a situation where the visiting pharmacist spent the time checking for out of date product and assisting with the ordering while medication reviews, education and information programs for clients and clinicians had to take a back seat. And at the same health service dosette boxes were still being used because the clinic budget could not afford the cost of Websterpaks. It is a pity some Fourth Agreement money could not be used specifically for this. It would certainly be more towards the quality use of medicine goals.
But it is not just in remote Aboriginal health that the health system is being let down by “pharmacy” - it is also in urban areas. In urban Aboriginal health services the cry has been to “…give us Section 100”. Why? Because they have been told it gets the PBS product for nothing. As for what happens then? - it has never been near enough to ask but obviously it would need a pharmacist on the premises to dispense the prescriptions that are written in accordance with State/Territory law. No support from the retail pharmacy lobby is probably the reason why this has never got off the ground and yet all that is needed is a Ministerial regulation saying that the same claiming procedure can be used by an AHS as is used for the remote PBS business – and by an approved pharmacy operating from within the precinct of the AHS. As pharmacies have to be owned by pharmacists (everywhere except the NT) the pharmacy could also be a Guild Member.
The improvement this would create is huge with a pharmacist on site, product sourced from wholesalers and the PBS used to claim the cost. The AHS would need to meet the cost of the pharmacist and this could be included in the business model where a retail pharmacy worked in collaboration with the AHS to provide the business expertise, management and professional oversight.
Sounds easy and should be - apart from the barriers that will be put forward to protect the status quo in retail pharmacy land.
Maybe the new Federal Government Department for Finance and Deregulation will have something to say about competition policy now that Labor is back in power and it will be able to pick up the pieces that were left on the “cutting room floor” after the National Competition Policy reviews around the turn of the millennium. It was after all Labor under Hawke and Keating that started off that whole process of deregulation. Watch out pharmacy – you are still on that cutting room floor after the deals done behind the scenes with the NCP review of pharmacy regulation.
Ends
“Payments for pharmacists with existing supply arrangements to AHS have been increased based on volume of PBS medicines supplied to the AHS per year,”Really and truly what sort of a message is this sending to the policy makers at Government level? The more you send out the more you will get paid. This is calling on all to let the medicines go out of date so the pharmacy can replace them and make more money. The media release accompanying the announcement does say… “…These increases will be accompanied by improved accountability arrangements.” One would hope so but the Information Kit relating to this still carries the dateline of 2001!
Surely the remuneration structure should in some way be geared towards improved quality in the way medicine is used rather than using Fourth Agreement money to reward for higher sales achievement. The question must be asked where the Pharmaceutical Society Australia is in all of this or does the body representing the professional aspects of pharmacy practice not get a look in when it comes to PBS remuneration.
The fact that there is $27 million in the Fourth Agreement budget for Aboriginal health projects should not be a reason for approaching the priorities of need from the wrong end of the spectrum. The Aboriginal client should come first or is it just another case of pharmacist’s wealth before Aboriginal health?
This area of medical need (Aboriginal health) that is requiring so much is being treated as a second class audience when it comes to pharmacy services dominated by the vested interests of the retail industry leaders. The Aboriginal community controlled health sector through its peak body (NACCHO) sees the Pharmacy Guild as the experts in a complicated and hard to understand sector of primary health care (pharmacy). No doubt the longer interest groups like NACCHO can be kept in a state of confusion the better for retail pharmacy. There is little apparent balance in thinking provided by the pharmacists in the field working on quality programs who expect to be represented by their professional organisation - PSA.A recent visit to a remote community in the NT by this author revealed a situation where the visiting pharmacist spent the time checking for out of date product and assisting with the ordering while medication reviews, education and information programs for clients and clinicians had to take a back seat. And at the same health service dosette boxes were still being used because the clinic budget could not afford the cost of Websterpaks. It is a pity some Fourth Agreement money could not be used specifically for this. It would certainly be more towards the quality use of medicine goals.
But it is not just in remote Aboriginal health that the health system is being let down by “pharmacy” - it is also in urban areas. In urban Aboriginal health services the cry has been to “…give us Section 100”. Why? Because they have been told it gets the PBS product for nothing. As for what happens then? - it has never been near enough to ask but obviously it would need a pharmacist on the premises to dispense the prescriptions that are written in accordance with State/Territory law. No support from the retail pharmacy lobby is probably the reason why this has never got off the ground and yet all that is needed is a Ministerial regulation saying that the same claiming procedure can be used by an AHS as is used for the remote PBS business – and by an approved pharmacy operating from within the precinct of the AHS. As pharmacies have to be owned by pharmacists (everywhere except the NT) the pharmacy could also be a Guild Member.
The improvement this would create is huge with a pharmacist on site, product sourced from wholesalers and the PBS used to claim the cost. The AHS would need to meet the cost of the pharmacist and this could be included in the business model where a retail pharmacy worked in collaboration with the AHS to provide the business expertise, management and professional oversight.
Sounds easy and should be - apart from the barriers that will be put forward to protect the status quo in retail pharmacy land.
Maybe the new Federal Government Department for Finance and Deregulation will have something to say about competition policy now that Labor is back in power and it will be able to pick up the pieces that were left on the “cutting room floor” after the National Competition Policy reviews around the turn of the millennium. It was after all Labor under Hawke and Keating that started off that whole process of deregulation. Watch out pharmacy – you are still on that cutting room floor after the deals done behind the scenes with the NCP review of pharmacy regulation.
Ends
