The inequity of pharmacy distribution

THE INEQUITY OF THE DISTRIBUTION OF PHARMACY BUSINESSES IN AUSTRALIA

Quote from Letter to Editor of the Australian Financial Review (14 November 2013) from Greg Turnbull of The Pharmacy Guild of Australia:

The provision of quality dispensing of PBS medicines at around 5300 pharmacies evenly distributed across Australia is an essential health service for Australian consumers, appropriately subsidised by government since 1948.

Source: http://www.afr.com/p/opinion/fact_is_the_best_cure_for_howes_A0ttA6GrLqkaGxR0gDmb0H

This was posted in a rebuttal of the article by Paul Howes in the Financial Review on 13^th November 2013

See it at http://www.afr.com/p/opinion/no_room_left_for_pharmacy_guild_RHF7RyCxkhd0I65945sCkL

So what? – Just another bun fight between the Pharmacy Guild and a critic of the current Australian retail pharmacy industry. “Nothing new about that” one could say.

Yes BUT there are aspects of the quote that need comment when looking at the provision of pharmacy services to ALL Australians.

There is one group that is left out of the assumption that the pharmacies in Australia are evenly distributed throughout the Nation.

There are 53,000 Aboriginal people living in remote communities in the Northern Territory who would not know what a “pharmacist” is let alone what a pharmacy business looked like.

The reference to quality dispensing of PBS medicines is a joke with no pharmacist in sight at the point of dispensing and supply to the patient – unlike every other Australian who, thanks to the PBS money, has a pharmacist available at the point of supply everywhere a PBS medicines is supplied.

And as for this being an essential health service for Australian consumers well “yes” maybe but NOT if you are an Aboriginal person living in one of the 100 remote communities in the Northern Territory.

It is time the Pharmacy Guild took its head out of the sand and started to look around for ways its beloved “service” can be improved for these Australians with the worst health status in the land and who would not know why their prescribed medicines will work let alone why they should take them.

Adherence is a problem and none more so than amongst remote living Aboriginal Australians.

One more thing – the statement that the PBS has been appropriately subsidized by government since 1948 is wrong for remote living Aboriginal people – it was not until the year 2000 that this occurred for these people through the special arrangements made possible using Section 100 of the National Health Act.

Any pharmacist interested in investing in a pharmacy business and any one of the 20 remote “growth towns” in the NT should contact the writer at rollom@iinet.net.au or on 08 8991 8457 or 0411 049 872.

A Prospectus is to be produced to assist future investors with their decisions.

Chief Minister supports pharmacies in the bush

TRANSCRIPT

ABC RADIO ALICE SPRINGS

Thursday 6^th September 2012

Listen to sound file

CALLER:

An interview today with Rollo Manning encouraged the Government to provide pharmacies in remote communities …. what is your notion on that to get pharmacies in communities ….so there is the provision of quality use of medicines….

COMPERE:

This is a story that has been around today …. about establishing pharmacies in remote communities that could lead to some employment by taking services out bush…is that something you would consider encouraging?

TERRY MILLS MLA, Chief Minister of the NT
Yes certainly – I have been at Ampilatwatja today …and had a very sobering briefing on the health issues …I heard this report from Rollo Manning and it does make a lot of sense. I will be talking to my new Health Minister to pursue this. Our core philosophy is to make sure wherever possible we put the decision making closer to the people that are affected by that decision. It does fit with my philosophy of allowing local people to be involved in solutions to their own problems in this case administering health and medicines to local people.

Pharmacies should be built in communities says consultant - Northern Territory Country Hour - ABC Rural Australian Broadcasting Corporation)

Go to ABC Rural website for story and sound file

Pharmacy businesses in remote Aboriginal communities are a “natural” and must be supported to provide income to the local economy, real jobs, and career prospects for local people, a Consultant in pharmacy services to Aboriginal health facilities is telling the new CLP  Government in the Northern Territory.

Rollo Manning, a pharmacist, and the architect of the Tiwi Health Board pharmacy business in 2001, has been trying for ten years to repeat the effort in other towns but says he has received no support from the Government.

“To read the publicity blurb behind the ‘Growth Town’ future program of the Henderson Government it appeared that here was the answer. At last something would be done to create real jobs in communities through local entrepreneur opportunities” he said. “But alas nothing happened except an army of bureaucrats hide behind the glossy websites and colourful brochures”.

The NT has one pharmacy to every 7.900 persons compared to the National figure of one pharmacy to every 4,200 people. The reason for this according to Rollo Manning is that the 53,000 persons living in remote   communities are not serviced by a “local” pharmacy.

“There is the is business out there due to the people having a health status recognised as four time worse than non Indigenous Australians. A population of 1000 remote living Aboriginals need the same amount of medicines under the Pharmaceutical Benefits Scheme as 4,000   people in mainstream.” according to Rollo Manning.

“Towns like Maningrida, Wadeye, Galiwin’ku and Jabiru should be able to support their own pharmacy business and I can assure anyone that there are the pharmacists ready and   willing to be a part of such a movement.” he added.

The inclusion of a pharmacist to the primary health effort is likely to be welcomed by all practitioners and a “point of sale” for all things towards “good health” would be the location of the pharmacy business.

“A whole of Government approach is needed and this  includes the Department of Health”, he added.

NT election outcome signals new era

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A new approach is likely to economic development in remote Aboriginal communities as a result of the resounding victory of the Country Liberal Party (CLP) election held last weekend.
It now looks as though the CLP have won 16 seats in the 25 seat Parliament with one seat held by the Independent Gerry Wood and the balance by the outgoing Labor Party with eights seats – down from the previous 12 seats.

Picture courtesy NT News

The significant element to the result was the success “in the bush” – all those seats outside of Darwin and Alice Springs – now held by CLP members of Parliament and which were previously Labor held seats.
The gains have seen the following significance Aboriginal people being elected to the Parliament:
Alison Anderson – Seat of Namatjiraa - previous Labour Minister under leader and Chief Minister Paul Henderson who defected to the cross benches in 2009 and then joined the CLP. Ms Anderson has been outspoken in her views on the Federal Intervention, that 12 maxi Shires replaced some 80 Community Government Councils and the new Stronger Futures legislation for the next ten years from Canberra.

Francis Xavier Maralampuwi – Seat of Arafura – a local Traditional Aboriginal man from Nguiu, Bathurst Island where he has lived all his life with distinction as a leader in the Community Government Council, Land Council and more recently the Shires. Maralampuwi has a good record in sport as a footballer and in charity work helping people with alcohol and drug problems for the past 30 years. He has won the Seat of Arafura by a 58 seat margin – a seat formerly held for 11 years by popular ALP member Marion Scrymgour who also had a strong local following. It was the people of Nguiu that have put Maralampuwi into Parliament with an 80% support from that polling booth.
Bess Price – Seat of Stuart- has ousted former Henderson Government Minister Karl Hampton. Ms Price has developed her own strong personal profile as a person who will say it as it is and not resort to politically correct verbage when describing how she sees the major issues confronting Aboriginal people in the “bush”. Her views are well known in the National sphere through appearances in shows such as ABC Q & A and SBS Insight. Her margin was a mere 187 votes in an electorate that is larger that most countries in Europe and spans from the centre around Alice Springs through the Tanami Desert to places like Timber Creek on the main highway to WA.
Larissa Lee – Seat of Arnhem – has won from popular Government Minister for Indigenous Affairs Malandari McCarthy – a former ABC journalist in Darwin and well known traditional Aboriginal person from Borroloola. The seat had been uncontested in 2008 and the selection of Larissa as the candidate was a stroke of brilliance by the CLP given her powerful family background being the daughter of the late Jawoyn Aboriginal Elder Robert Lee. An Aboriginal Health Worker from Barunga, Larissa won the seat with a 10.6% margin.

The above four persons have brought about the change in Government and the strength of the effort means that a 100% commitment has been made for doing things better for the “bush”.
One of the key elements of any improvement program will be more jobs and developing real economies in places (towns) that have up until now relied on no competition, welfare handouts and a static work environment with unemployment being the main occupation.

And this is where pharmacy comes in on two fronts.
The first is bringing into the community money that is currently going to the main centres of Alice Springs and Darwin by way of surpluses made on trading with Medicare for the supply of Pharmaceutical Benefits Scheme medicines. This could all be going to these towns with the strategic placement of local pharmacy businesses in the Growth Towns. There are many young pharmacists keen to establish there own businesses and what better or more challenging place to do it than a remote Aboriginal community classified as a “Growth Town” and with the support of a Government committed to creating economies.
The second contribution pharmacy (or pharmacists) can make is the provision of a “point of sale” for all things that will lead to a healthy lifestyle – food, activities, exercise programs, books, DVDs, motivational programs and the many many things that are taken for granted in “mainstream” culture way but denied of these people by a governance that has seen no reason for competition or no more that one store.

A comparison between an Aboriginal Growth Town and a mainstream country town shows that there are 15 retail outlets in the mainstream town compared with five in Aboriginal land and yet a disposable income far higher with the Aboriginals than in mainstream. This is because they pay very little rent for fewer houses and are not likely to own a car. If the cost of these is taken out of a family budget it is not hard to find and extra $500 a fortnight and yet have nothing useful to spend it on. In one store there is 35% of purchases spent on tobacco products and this has increased over the past 20 years by 2%. Quite unlike the downward spiral in mainstream where tobacco products have gone down from around 60 % of the population smoking to 15% in the same period (20 years). Problem – no point of sale for health promotion – just messages through print and media.

The CLP Government comes into office with the following policy commitments:
o The creation of a commercial environment so that businesses can earn decent profits and grow.
o The creation of a strong and growing economy by allowing and encouraging private industry to thrive.
o Expanding the Small Business Advisory Service across the whole Territory will help more Indigenous people in remote communities get into real jobs and off welfare.
o Shires and Regional councils will be assisted to pursue new business opportunities to expand their service and revenue base.
o Regional Councils will give a greater say to local people on where money is spent and how services are delivered in their region.
o The Country Liberals are committed to delivering a stronger local voice, better services and a safer, more prosperous future for our regions.
No better climate could have been created for emerging pharmacy businesses but it is now for the industry to get behind and back such a progression. The present profile in the NT shows that for a population of 220,000 there are 28 pharmacies – one per 7.900 persons compared with a National figure of one per 4,200.
The difference is in the persons in remote communities NOT being served by a pharmacy meaning that the profits from their communities is going to the big stakeholders in Alice Springs and Darwin.
Now is the time to jump and a consortium started that will seize the opportunity and allow many young pharmacists to make a contribution which although not being the most rewarding financially will certainly be rewarding in health outcomes through professional satisfaction.
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Comments welcome to Rollo Manning, PO Box 98 Parap NT or rollom@iinet.net.au or 0411 049 872

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Who is an “Aboriginal”? The need to distinguish between “remote” and “urban”

The averaging of indicators of disadvantage does nothing to help understand the plight of remote living Aboriginal people in Australia.

There are some 140,000 persons living “in remote” out of a total population of 520,000 claiming Aboriginal heritage – that is 26%.

The majority of Australia’s “Aboriginal people” live in urban areas of the cities and towns with access to education, health services, employment opportunities and the lifestyle of mainstream Australians. They have been born and raised in those developed environments and so have access to facilities to improve their life. The majority have succeeded.

By contrast, the remote living Aboriginal people who make up the 140,000 that live in communities may have never seen a train or tram, caught a bus or attended a movie cinema for entertainment. Their view of the world is entirely different from their cousins in the towns and cities. To them the world is little or no education, over crowded houses, one store with a limited range of fresh food and people who come and go delivering health services. It is a “world view” that the average Australian cannot imagine.

Nearly all of the remote living Aboriginals are full blooded Aboriginal people with no mixed blood and thus with the full gene compliment of the original race of people. Western culture has added its genes to the pool that make up the remainder of the Aboriginal population thus making comparisons difficult on the basis of genotypes.

So why is it that when analysing the “gap” - disadvantage, life expectancy or disease incidence the all Aboriginal statistic is given?

Surely the Australian Bureau of Statistics knows by now who is who – it is after all since 1967 that Aboriginal Australians have been included in Census data. So long as statistics are averaged across all Aboriginal persons a skewed picture will be obtained and the contrast between the two population cohorts not appreciated by the policy makers.

A good example of this was the PBS QuMAX/s100 Forum recently held in Melbourne with pharmacists from all over Australia gathered to learn about and discuss quality use of medicine programs to Aboriginal (and Torres Strait Islander) people in Australia. Thus pharmacists dealing with these two world views were thrust together and expected to understand each others target audiences as if they were the same. It has to be recognised by the policy makers and program planners that this is not the case and it is only when it is taken into account that realistic programs can be put in place.

The statistic is given that in 2006 deaths and hospitalisations caused by cardiovascular disease for indigenous Australians were double the rates of non-indigenous Australians[1]; or that Aboriginal and Torres Strait Islander people are much more likely to develop complications (e.g. pneumonia and ear damage) from respiratory tract infections[2].

Such sweeping statements do nothing to help understand the degree of Aboriginality that makes up the cohort from which such conclusions have been drawn. It must be possible to draw a distinction between the remote living Aboriginal people and urban living persons. The Pharmaceutical Benefits Scheme for one thing is done differently and the medicine use for remote Aboriginal people is through special arrangements using Section 100 of the National Health Act to supply medicines directly to the Aboriginal Health Services. This would allow an analysis to be done on the supplies that are paid for by Medicare to the supplying Approved Pharmacies in either hospitals or the community. But alas, after three years of trying the Centre for Chronic Disease at the University of Queensland has been denied access to the Medicare data.

At the above mentioned Forum in Melbourne it was stated that the three most prescribed medicines for “Aboriginal people” were Metformin, Atorvastin and Salbutamol. This was from CTG prescriptions and should have been possible to correlate with the usage through the s100 arrangements - but no – there is no such data available even though the scheme has been operating for 12 years.

This writer knows that from the data of one Aboriginal Health Service[3] in a remote location the usage shows the top three supplied medicines are Ramipril, Atorvastin and Amoxycillin. Such a figure should be available from supplies to all AHSs.

The final piece of information that demonstrates the point of this article is life expectancy.

When averaged out across the total population of Aboriginal Australians the 17 year gap is identified. This means the Aboriginal person has a life expectancy of 62 years for males and 67 for females.

However if the age at death is looked at for Aboriginal people in the Northern Territory[4] the median age at death for males is 51 years (15 years less than non Indigenous) and females is 55 years (20 years less than non Indigenous). A stark contrast to the “average” over the total population. When remote locations are taken into account the difference is even greater.

In the words of Professor Wendy Hoy, Director of the Centre for Chronic Disease in Brisbane:

“The quickest way to “narrow the gap” is to reduce disease burden and deaths in remote areas, where rates are much higher than in Indigenous people living closer to population centres”.

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[1] NPS at http://www.nps.org.au/news_and_media/media_releases/repository/Experiencing_the_outback_side_of_pharmacy

[2] NPS at http://www.nps.org.au/bemedicinewise/common_colds/antibiotics_dont_kill_viruses

[3] Personal communication to author

[4] ABS - Deaths of Aboriginal and Torres Strait Islander Australians. 2010

May 2012 be the year that SOCIAL INCLUSION is the commitment to inspiring a reinvigorated relief for Aboriginal disadvantage

Minister for Social Inclusion, Mark Butler MP needs to be reminded that remote living Aboriginals are in need of        recognition before being excluded even more—write and tell him c/o Parliament House, Canberra, ACT, 2600

Extract from The Australian, Monday 26th December 2011

I never stop wondering what I could do to help bring about social inclusion. There are so many examples of where it has gone wrong over the few years I have been involved, such as the following...

Deleece was let down by a system that thrives on mediocrity.
Centrelink, Job Services Australia and the entire “job ready” effort is organised by an army of bureaucrats gobbling up endless amounts of money and losing sight of what they are really there for – the people, and yes... there are people at the end of the line that need help.
SOCIAL INCLUSION should mean the provision of the tools for everyone, regardless of location, to education and training to join in their share of the Nation’s wealth.

 Zoe and Lucinda are from a remote community with a population of 1200 people 500 Kms north east of Darwin. There are few employment opportunities apart from services and little attention is given to starting entrepreneurial businesses. Without this to observe, the growing child has little opportunity to view scope, dreams or vision for the future. Their future is in our hands.

SOCIAL INCLUSION should give all children the chance to dream and aspire to future successes - at present they complete their schooling and have no idea what they want to do with the rest of their life. Hundreds of young Aboriginal children who finish their schooling are lost every year to another generation of welfare recipients simply because they know of nothing better to do.

Bob Beadman asked...
"WHAT HAPPENED TO THE DREAMS?"
(Do Indigenous youth have a dream– Menzies Research Centre 2004)

“I am looking at human detritus right here in Darwin, and wonder what dreams they might have once had for themselves?

What dreams they might have had for their children? What dreams their children might have had for themselves?

I wonder if people have abandoned those dreams, what caused them to give up, what is it about the world that surrounds us all that makes them think that their dreams are  unachievable.”

We must strive to assist the young ones to develop those dreams they once had but now seem forgotten.

SOCIAL INCLUSION should not be hard to grasp - it does what it says - includes people in a social context as well as economic and environmental settings in communities. Where social capital is the glue that holds a community together - social inclusion is the philosophy under which all else happens.

SOCIAL INCLUSION must be the focus of a renewed reconciliation for all young Aboriginal children and youth no matter where they are from BUT particularly those from remote commuinities where an understanding of the dominant culture's world view is somewhat lacking. The youth of Australia must be made to know they are wanted and loved and be inspired to enjoy the Nation's opportunities just like their urban counterparts attending the plush private schools in the capital cities.

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INTEREST HIGH WITH STUDENTS IN ABORIGINAL HEALTH

The future supply of pharmacists to work in Aboriginal health is healthy if the outcome of a National Australian Pharmacy Students’ Association survey is anything to go by.

While 83% of respondents felt it is important to be taught about Aboriginal and Torres Strait Islander health issues as part of their pharmacy course curriculum, only 60% have access to such education. Furthermore, only half of those respondents feel they are taught enough about this topic.

Students believed that the present level of awareness was good with 60% saying they had exposure to Aboriginal health learning during their course.

Only 9% of respondents had Aboriginal health as an integral part of the core curriculum while 50% had the information delivered in just one or two lectures.

A minority of respondents (25%) felt they were trained to competently practice in a culturally acceptable manner while 35% felt they could not.

The favoured method of learning about cultural awareness in Aboriginal health was a half day or one day training course (45%) while practical experience was mentioned as the best way of learning the subject.

The recommendations of the survey outcomes should see an increase in the component of Aboriginal health training in pharmacy curriculum with an emphasis on cultural awareness.

With a workforce planning study being commenced on the supply and demand for pharmacists in rural and remote areas it is to be hoped that staff establishments for primary health care in communities will include the position of a pharmacist.

It is only by participating that pharmacists will be able to show how they can contribute beyond the “pick and lick” image that is currently held on their role.

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Comment to Rollo Manning at rollom@iinet.net.au or call on 0411 049 872

  

Senate inquiry agreed to in Parliament— PBS to remote living Aboriginals to be examined

 

On 24th March 2011 the Senate agreed to a motion from Senator Rachel Siewert (Greens, WA) that the supply of Pharmaceutical Benefits Scheme medicines to remote area Aboriginal Health Services be referred to the Senate Community Affairs Reference Committee. The special  arrangements under Section 100 of the National Health Act have provided a bulk supply scheme with no value added component from a pharmacist.

Three reviews of the scheme in 2004 (Kelaher) 2006 (Urbis) and 2010 (Nova Policy) have failed to produce any significant improvement in the quality use of medicines by Aboriginal clients of health services. 

A matter of equity

The matter to be reviewed by the Senate Committee is a matter of justice, fairness and   equity particularly relevant at a time when Closing the Gap is so much in the headlines and remote living Aboriginal people are dying at such a young age.

After three reviews of the Section 100 supply arrangements little change has occurred. The Senate Inquiry should be able to identify what needs to be   improved and which agency should be responsible for making it happen. The involvement of pharmacists in this process should be a leading principle.

Inequities for remote Aboriginal Health Services (AHS) and the Pharmaceutical Benefits Scheme (PBS) include:

• Over the ten years the scheme has been in place there has been no money made available to the Aboriginal Health Services to develop their own pharmaceutical care program.
• Recording of outgoing supplies (dispensing) by any electronic process incorporating scanning is absent and hand written labels are the norm.
• While the PBS pays a dispensing fee ($6.42) to pharmacies in all situations under Section 85 (mainstream) there is no fee paid for the dispensing  carried out at Aboriginal Health Services.
• The PBS saves $3.68 every time a PBS medicine is dispensed to a remote living Aboriginal person. A handling fee of $2.74 is paid to the supplying Approved Pharmacy for the bulk supply but no dispensing fee is paid to the AHS.
• Mainstream Australians have access to a pharmacist (by law) in every pharmacy in Australia when a PBS prescription is dispensed. No such facility is available to an Aboriginal patient of an AHS or to a  
  person trained by a pharmacist to inform them of the nature of the medicine prescribed.
• No data is analysed to assist in decision making towards improved medicine utilisation across States and regional boundaries. 

Go to the following link for details on the Inquiry and the making of a submission:
http://www.aph.gov.au/Senate/committee/clac_ctte/pbs_medicines/index.htm

Closing date for Submissions is 30th June 2011.

The Terms of Reference seek comment on a  range of issues. The full text of the Motion agreed to by the   Senate follows:

The effectiveness of the special arrangements established in 1999 under section 100 of the National Health Act 1953, for the supply of Pharmaceutical Benefits Scheme (PBS) medicines to remote area Aboriginal Health Services, with particular reference to:

(a) whether these arrangements adequately address barriers experienced by Aboriginal and Torres Strait Islander people living in remote areas of Australia in accessing essential medicines through the PBS;

(b) the clinical outcomes achieved from the measure, in particular to improvements in patient understanding of, and adherence to, prescribed treatment as a  result of the improved access to PBS medicines;

(c) the degree to which the ‘quality use of medicines’ has been achieved including the amount of contact with a pharmacist available to these  patients compared to urban Australians;

(d) the degree to which state/territory legislation has been complied with in respect to the   recording, labelling and monitoring of PBS medicines;

(e) the distribution of funding made available to the program across the Approved Pharmacy network    compared to the Aboriginal Health   Services obtaining the PBS medicines and dispensing them on to its patients;

(f) the extent to which Aboriginal Health Workers in remote communities have sufficient  educational opportunities to take on the  prescribing and dispensing responsibilities given to them by the PBS bulk supply arrangements;

(g) the degree to which recommendations from previous reviews have been implemented and any consultation which has occurred with the community controlled Aboriginal health sector about any changes to the program;

(h) access to PBS generally in remote communities; and

(i) any other related matters.

Question agreed to.

Any person or organisation requiring further background to the Inquiry or assistance with the writing of a submission can contact Rollo Manning at rollom@iinet.net.au or 0411 049 872.

Take medicines - seriously, and help Close the Gap

The life expectancy gap for Indigenous Australians could be significantly closed if the same level of pharmaceutical care was applied to those living in remote communities as it is for the rest of the Australian population. The management of chronic diseases requires urgent attention in the provision of prescription medicines - in both monitoring adherence and follow up adjustment of dosing.

Patients attending Aboriginal health services in remote communities are being dispensed medicines with little recording, probably no label and scant advice on what to expect of it.  This is the outcome of ten years of bulk supply of Pharmaceutical Benefits Scheme (PBS) medicines from an Approved Pharmacy with no involvement of a pharmacist in the dispensing process. The scheme is costing the Australian taxpayer $40 million a year yet even the Department of Health and Ageing admit there is wastage and an analysis of the Medicare records of payment would not be an accurate evaluation of what is being supplied to patients.

Whilst it will take years for medicine taking to impact on the life expectancy gap between Indigenous and non-Indigenous Australians this discreet group of patients with only one supply route should be an ideal target for some primary practice research.

But no!

Researchers admit that the missing element in data with respect to chronic disease management is knowing whether the patient is taking their medicine. Whilst this might apply to the bulk of Australians with chronic diseases, the clinical signs should be there to illustrate the benefits of medicine taking. Otherwise why is the taxpayer paying $8.4 billion a year on the PBS?

With no record of supply and the labelling an unknown quantity – the quality of pharmaceutical care is suspect.

Approved Pharmacies (agents for the supply of PBS medicines) are under no obligation to provide support in the supply on to the patient. That is the job of the Aboriginal health service and done by doctors, nurses and Aboriginal Health Workers with no payment from the PBS to meet the cost of dispensing.

In mainstream PBS supply the Approved Pharmacy is paid $6.42 every time a prescription is dispensed. It is recorded on an IT system that has been paid for and upgraded by the PBS. In remote “drug rooms” there is no such luxury – not even a typewriter for labelling.

Of the $40 million dollar cost to the PBS in this financial year, $10 million will go to the Approved Pharmacy through a combination of a $2.74 handling fee per item and a 15% mark up on the cost of goods. The PBS actually saves $3.68 every time a packet of pills is given to a remote living Aboriginal person. Extended across a year this amounts to $5.52 million and that would employ a lot of pharmacists at Aboriginal health services to add some quality to the supply and give the patients an understanding of what western medicine is all about.

All Australians, when given a prescription by a doctor, take it to a pharmacy for dispensing. They can then ask the pharmacist (always present by law) whatever question they want about that medicine. The salary of that pharmacist is largely contributed to by the PBS through the dispensing fee. For the remote living Aboriginal there is no such practice. There are no pharmacists employed by Aboriginal health services in the NT and only three in the whole of Australia.

This is a shameful situation and one that shows a high degree of discrimination and unacceptable level of unequal opportunity. The National Indigenous Health Equality Council is not interested in this matter claiming that it does not fall within its terms of reference. The Pharmacy Guild is interested in its members being viable entities while NACCHO (the Aboriginal health peak body) is overwhelmed by the Pharmacy Guild into thinking that “this is as good as it gets”.

The diseases killing Aboriginal people at a young age were not there 40 years ago and have been brought on by lifestyle choices. This makes it even more important that information is provided to help the patient understand what the medicine is going to do and how it will work to help them live longer.

Such is the need for a greater emphasis on the quality use of medicine for Aboriginal people in remote communities if Close the Gap is to be taken seriously.

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