s Chemist Warehouse and the PGA prepare for Open Warfare | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Chemist Warehouse and the PGA prepare for Open Warfare

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

The battle for retail pharmacy control has just taken a very sharp turn.
Chemist Warehouse has thrown down the gauntlet and taken on the Pharmacy Guild of Australia (PGA) in respect of the new set of location rules negotiated by the PGA and the federal government - a set of rules that will severely hamper Chemist Warehouse expansion into the future.
At i2P we have never been in favour of location rules existing in the first place because of the artificiality created in the market place.
Nor have we been in favour of pharmacy company structure with only pharmacist shareholding - a system that keeps out specific skills from a board of directors that pharmacies badly need.

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The Pharmacy Guild of Australia had a perfectly good blueprint made available to them after Warwick Wilkinson conducted a landmark review into pharmacy practice and ownership back in the year 2000.
It was virtually ignored by the PGA and while their decisions have been politically enforced to reflect their view of the world, it has created friction with government (because of the potential retaliation through petitions and vote influencing) and disappointment with individual pharmacists,who simply want to concentrate on delivery of core business i.e. clinical pharmacy.

One of the underlying problems with the Chemist Warehouse business model is that because of very low product margins, it relies on ever-expanding cash flow volumes to pay its way.
Recent downturns in retail coupled with PBS reforms has meant that cash flow volumes have become hesitant and generate insufficient gross profit dollars,
Chemist Warehouse knows that it will be facing an inevitable cash flow crisis that endangers their whole business structure.
Therefore Chemist Warehouse must break the location rule nexus or risk going "belly-up".
Many of their clones are already suffering from a deficit of management skills and are going down the pathway of receivership, scheme management etc. as they become unable to get off the treadmill.
Next April with PBS reforms in place, there will be an acceleration of this trend.
Their argument to government is that the rules restrict the time-frame to establish new pharmacies.
Yet every area they are proposing to take their 48 proposed Chemist Warehouse pharmacies already has an overload of existing pharmacies!

It is not right that the PGA should use its political clout to discriminate between its pharmacy members - but it has always been the case (Chemist Warehouse is a PGA member).
Nothing new there!
It is also not right for Chemist Warehouse to set up an unsustainable model of pharmacy that is predatory in intent. It has already damaged one wholesaler through the use of market power (the extraction of very extended trading terms) and it damages many sound community pharmacies because of the unfair use of local market power.

The timing of the Chemist Warehouse/PGA battle is also significant, coming on top of the loss of credibility sustained by the PGA in relation to perceived unprofessional promotion of Blackmore's products. The PGA have become politically weaker because of this incident.
The PGA enemies blew that incident out of proportion and destroyed what might have been a good channel for pharmacist practitioners if the elements were appropriately implemented in an ethical and professional manner. It is significant that the AMA led the hypocritical charge in relation to secret payments and software "flags" when they had been using a flag system in their own software for years (now ceased).
And they are still battling to keep secret the payments made to doctors by manufacturers, for promoting their drugs in a certain fashion.
Integrity in all the above activities, has completely disappeared.
So the "battle of the Titans" is about to start and with all the mudslinging that will occur, some will stick to all pharmacists.

I personally resent having to put up with all this nonsense based on greed as the primary motivation.

The federal government will simply follow a pathway that is favourable to their position and one where the PGA can have little influence on electoral issues and a weaker negotiating role in the PBS.

The longer the PGA can spin out the fight with Chemist Warehouse the more is the chance that Chemist Warehouse will have to drastically alter its business model to one that is sustainable.
Their strategy of being the last pharmacy group standing in the discount war is unsustainable and market share won by these current predatory methods, by definition, is also unsustainable.
We all suspect that retail prices would have to be increased once Chemist Warehouse reached a majority market share of the entire pharmacy market.
Impacting on top of all this are the prospects for employment for newly graduating students with even recent graduates maybe having to fight to retain their existing employment.
The last two generations of senior pharmacists should hang their collective heads in shame for not leaving a profession in good shape and in good hands.

At the foot of the following press release put out by Chemist Warehouse I note one of their proposed pharmacy developments was mooted for Colac in Victoria. This was the site of a previous skirmish by the PGA and the entire population of Colac, which was forced to put up with a sub-standard pharmacy service, because location rules created a local monopoly.
This was covered in detail by i2P after representations to our publication by community leaders.
While there is no doubt that Colac could sustain another pharmacy entrant, I am wondering how this may have been proposed by Chemist Warehouse, as Nicola Roxon had virtually frozen any new approval number applications.
Also, the Colac residents made it quite clear they did not wish to deal with franchised pharmacy groups preferring to support a new start-up with two young pharmacists.

So 2012 looks like a lively New Year coming up.

Among New Year resolutions proposed by i2P include:

* A return to the Wilkinson Report recommendations and a restructure of the entire pharmacy market under sustainable conditions.

* An abandonment of location rules and an emphasis on creating a business projection as the only reason for applying for an approval number. Banks require such information before lending, so why not for pharmacy approval numbers?

* A development of pharmacy companies that will contain the skill mix on the board necessary to compete against major retailers. As long as the majority of directors and shareholders are registered pharmacists we do not foresee any major problems developing if non-pharmacist lawyers, accountants, consultants or other skilled people are able to invest in a pharmacy.

* The creation and development of pharmacist practice companies without pecuniary interest in the pharmacies to which they sell their services to. There is no reason why these companies cannot appoint the PGA to manage their industrial and political issues, with the PGA benefiting from an expanding member base and clinical input to balance the commercial majority.
i2P pointed out years ago that these types of practice companies could become a rich source of PGA members as pharmacies became fewer (because of size and fragmentation into major groups less dependent on PGA service provision).

* A separate payment stream to develop for pharmacist practitioners outside of PBS.

* The appointment of the Pharmaceutical Society of Australia (PSA) as the manager for all government grants involving Pharmacist Clinical Practice development (as distinct from pharmacy development).

There is no doubt that a major war is necessary to clear the impediments that stultify the creative development of the pharmacy profession.
The major participants look like being the PGA, Chemist Warehouse, the AMA and the federal government. If PSA is astute enough, it can pick up some gems in the fallout as "spoils of war".

What follows is an outline of the Chemist Warehouse press release. Coupled with the release they are polling their own customers on their website as to their view.

Petition launched to fight Guild’s secret pharmacy location deal
Australia’s largest chemist retail chain is stepping up its fight against a clandestine deal between the Pharmacy Guild and the Federal Government that will restrict Australians’ access to discounted medicines.
Chemist Warehouse group commercial manager Damian Gance said his company was calling on consumers to record their anger against changes which will restrict where pharmacies can be located. Chemist Warehouse has a launched a petition across its national network of over 200 stores calling on Members of Parliament to condemn the changes.
Changes to the Location Rules, which govern where pharmacies can be located, were agreed to in a series of meetings between the Pharmacy Guild and the Commonwealth Health Department earlier this year. Significant stakeholders, including Chemist Warehouse, were not invited to take part in these negotiations. Changes to the rules will threaten the establishment of forty-eight planned Chemist Warehouse stores mainly in communities which are growing and in rural areas.
“We are launching a petition calling on our representatives in Canberra to stand up against the power of one of Australia’s most influential lobby groups. These changes will not only threaten our business but will also restrict the access of Australians to discounted medicines,” Mr Gance said.
“Under the new rules, pharmacy owners will have to wait for a medical centre and a supermarket to be opened before they can establish a new pharmacy. As people living in growth areas know too well community infrastructure takes time and comes many years after the population of an area has been established.”
“Consumers have voted with their feet. 1,000,000 customers come through our doors each week, we dispense 500,000 scripts. These changes have forced us to shelve plans for new stores in areas of community need, including in growth corridors and in the bush. 20 per cent of our stores would not have opened under these new rules.”
“We are calling on our customers to stand up for their right to affordable medicine and record their vote against deals struck contrary to their interests. Copies of our petition will be available in existing Chemist Warehouse stores and online at www.chemistwarehouse.com.au along with more information about the planned changes and what they will mean for consumers.”
“Chemist Warehouse calls upon the Coalition and the Greens to vote against these changes in Parliament,” Mr Gance concluded.

Proposed Chemist Warehouse store locations affected by the new Pharmacy Location Rules

1- VIC Bacchus Marsh   2- VIC Ararat  3 - VIC Hamilton  4 VIC Colac  5 - VIC Maryborough
6 - VIC Mt Gambier  7 - VIC Swan Hill 8 VIC Stawell 9 - VIC  Portland

10 - NSW  Wagga Wagga  11 - NSW Armidale  12 - NSW  Batemans Bay 13 - NSW  Ballina
14 - NSW  Casino  15 - NSW  Katoomba  16 - NSW  Broken Hill  17 - NSW  Cessnock
18 - NSWCoffs Harbour  19 - NSW  Cooma  20 - NSW  Dubbo  21 - NSW Goulburn
22 - NSW Kiama  23 - NSW Port Stephens 24 - NSW Port Macquarie 25 - NSW Taree
26 - NSW Tweed Heads 27 - NSW Belmont
28 - NSW Morisset

29 - QLD Bribie Island 30 - QLD Dalby 31 - QLD Sarina 32 - QLD Strathpine 33 - QLD Warwick
34 - QLD  Yeppoon 

35 - SA  Gawler  36 - SA Port Pirie  37 - SA Port Augusta  38 - SA  Port Lincoln
39 - SA Renmark  40 - SA Victor Harbor 41 - SA Whyalla

42 - TAS Burnie  43 - TAS Devonport

44 - WA Geraldton  45 - WA Port Hedland  46 - WA Albany 47 - WA Augusta 48 - WA Kalgoorlie

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