s Part one -HMR Evolution | I2P: Information to Pharmacists - Archive
Publication Date 01/02/2013         Volume. 5 No. 1   
Information to Pharmacists


From the desk of the editor

Well 2013 has certainly begun and I must admit it has been hard to get out of “holiday mode” and back into “pharmacy mode”.
This year is looking quite challenging as many issues left in abeyance in 2012 are bubbling over , so I don’t anticipate a restful year.
One important issue we will cover for some time yet is the quality of drug  evidence in the Australian setting, and to kick off the debate the feature article  “Sense About Science”describes what is happening in the UK to help tidy up science in that country.
Comparisons have been made with the Australian experience and it seems that we have a long way to go before it can be regarded as “tidy”,

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News Flash

Newsflash Updates for February 2013

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

Sense About Science – or Up To Your Ankles in Waste Water

Neil Johnston

My recent holiday reading included catching up on subjects that have slipped off my radar, mainly because the issues themselves have adopted a lower profile.
Then an article in the 6Minutes e-publication caught my eye.
It concerned a UK initiative by a group called Sense About Science”, that has started a campaign to have all clinical trials registered and have the results published, while simultaneously urging the patients to boycott trials if the researchers cannot guarantee the findings will be made public.
They have published a petition (found at www.alltrials.net) and are encouraging people to sign it.
The petition has the support and backing of the BMJ, the James Lind Alliance and Ben Goldacre (author of Bad Pharma) and is designed to put pressure on researchers, pharmaceutical companies and institutions who are in a position to bury research data that may reflect on reputations and drug company profits.

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Face of Priceline - Australian of the Year 2013

Peter Sayers

Few would not recognise Ita Buttrose, an iconic Australian well-deserved of the Australian of the Year Award for 2013. The award was presented in Canberra on Australia Day (January 26 2013), by PM Julia Gillard.
And there must be a lot of backslapping going on in the Priceline camp for their recent signing of her to front for their 200 member pharmacy franchise.
Ita’s profile was already stellar, but with the added impetus of the Australian of the Year Award, the Priceline brand will now increase in value considerably.

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Determining needs and wants…

Joseph Conway

In pharmacy media commentary, I often come across the idea that we need to give people advice on what they need as opposed to what they want. This is understandable given that we have specialist knowledge on medication therapy and live our lives discussing health issues with patients and dispensing their medication. We get to know very intimate details about people and many pharmacists working in community pharmacy get to follow people as they grow older and are a tiny (but important) part of their lives sharing their health issues over ongoing chats at the dispensary counter if they choose to shop at our store.

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Is the ‘weekend’ an anachronism whose usefulness and relevance has passed?

Neil Retallick

When I taught Sunday School, which seems to be about a hundred years ago but was only about forty, we learned from the Bible that on the seventh day, God rested.
After all, he had been busy for six days.
I do not wish to belittle anybody’s religious beliefs in these comments but use them to focus attention on just how much our society has changed.
At the same time I was teaching Sunday School, the shops all closed at mid-day on Saturday and at 5.30pm during the week.
A trip into town to shop on the weekend meant getting up bright and early on Saturday morning and being at the bus stop by 8.30am at the latest.

Comments: 1

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Fitting Your Pharmacy for the Future - Funding & Depreciating for Best Tax Effect

Chris Foster

Editor's Note:
I2P will be developing a series on pharmacy designs - ideas and concepts in respect of clinical services spaces.
In designing such spaces it was realised very early in the exercise, that to be properly integrated in an Australian pharmacy setting it could not be just an “add-on” but a whole of pharmacy redesign.
Similarly with the introduction of automated dispensing machines (original packs and dose administration aids) it is important to design workflows properly to capture efficiencies, and this also entails a “whole of pharmacy” redesign.
2013 may be the year of decision in terms of the type of pharmacy design to house your market offering. To survive you need to be different and there is not a lot to differentiate one pharmacy from the other, even if you belong to a marketing group.

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Ransomware - The New Kid on the Block

Steve Jenkin

Editor's Note:
Late in 2012, a medical practice on the Gold Coast of Queensland came under cyber attack in a unique way.
Instead of patient data being stolen, it was kidnapped in place, by encrypting all practice data so that it could not be read.
A key was then offered at a price so that the data could be opened.
Thus was born "Ransomware", and a a new threat had emerged.
i2P asked Steve Jenkin, our resident IT expert to give some insights to this new threat and what precautions we might all need, to eliminate this new approach to hacking.
If you need an incentive, just imagine if your PBS claim data was locked up for a week and your ability to generate a claim was locked up for six weeks, plus all attendant costs in restoring your data.
Would you survive in your business?
This reference article by Steve is important enough to use as a checklist for your IT provider or for your IT consultant to utilise in the next complete review of your entire system.
Steve's comments follow:

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Workplace Pressure in Pharmacy

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

The psychological definition of stress is a feeling of strain and pressure.  Small amounts of stress may be desired, beneficial, and even healthy.  Positive stress helps improve performance.  It also plays a factor in motivation, adaptation, and reaction to the environment.  Excessive amounts of stress may lead to many problems in the body that could be harmful.  Symptoms may include a sense of being overwhelmed, feelings of anxiety, overall irritability, insecurity, nervousness, social withdrawal, loss of appetite, depression, panic attacks, exhaustion, high or low blood pressure, skin eruptions or rashes, insomnia, lack of sexual desire (sexual dysfunction), migraine and gastrointestinal difficulties (constipation or diarrhoea).  It may also cause more serious conditions such as heart problems.

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Arm Yourself For The Battle For The Mind

Barry Urquhart

Social media, and the internet in general, are largely “blind” media.
They can be frustrating, time-wasting and inefficient.
Entries and enquires about wide-ranging but pertinent topics, products and services elicit countless responses, most of which are irrelevant and unappealing. Information overload abounds.Use of SEO's (Search Engine Optimisers) simply cluster companies, brand and service names, among large, often spuriously ranked groupings.Being on the shopping list has very little quantifiable and lasting value. Nor does the standing of being “first amongst equals”.
Establishing and sustaining unique, differentiated presences in the marketplace is difficult.
In the brave and new world of digital, mobile, on-line, multi or omni-channel reality, the importance, nature and value of effective branding is deepened and broadened.

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Positive thinking has no negatives

Harvey Mackay

One of life's great annoyances is the tendency of folks who ask you to perform an impossible task, list the issues they foresee and the problems that have plagued previous attempts -- and then admonish you to "think positive."
Wow! Does that mean you are so good that you can achieve what no one else has? Or are you being set up to fail?   
Because I am an eternal optimist, I prefer to believe the first premise. Positive thinking is more than just a tagline. It changes the way we behave. And I firmly believe that when I am positive, it not only makes me better, but it also makes those around me better. I think that good attitudes are contagious. I want to start an epidemic!

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Feasting on Fat

Loretta Marron OAM BSc

With the Christmas and New Year opportunities to over-indulge, it was easy for girths to increase a little.
If so, it might be very difficult to lose those extra kilos.
Many advertised products and services allegedly help us lose fat without diet and exercise.
Most will fail; some might even be dangerous.

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Hanukkah, Oxygen Masks and Christmas

Mark Neuenschwander

I've been thinking about Hanukkah, oxygen masks, and the Christmas presents I am duty bound to muster for my kids and grandkids. Thank God dad asked for pajamas.
Today I’m flying from Las Vegas to Seattle. About the only thing I liked about Sin City was the fountain show at Bellagio, the Elvis Christmas songs that popped up here and there, and a pretty good keynote address by Bill Clinton. Just thinking of shopping makes me wonder if the cabin isn’t losing its pressure.

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Antioxidants Prevent Cancer and Some May Even Cure It

Staff Writer

Orthomolecular Medicine News Service, January 24, 2013

Antioxidants Prevent Cancer and Some May Even Cure It

Commentary by Steve Hickey, PhD

(OMNS Jan 24, 2013) It is widely accepted that antioxidants in the diet and supplements are one of the most effective ways of preventing cancer. Nevertheless, Dr. James Watson has recently suggested that antioxidants cause cancer and interfere with its treatment. James Watson is among the most renowned of living scientists. His work, together with that of others (Rosalind Franklin, Raymond Gosling, Frances Crick, and Maurice Wilkins) led to the discovery of the DNA double helix in 1953. Although his recent statement on antioxidants is misleading, the mainstream media has picked it up, which may cause some confusion.

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HMR Moratorium – Killing Jobs in Pharmacy

Joseph Conway

It’s no secret that the Pharmacy Guild has called for a moratorium on HMRs until the alleged abuse of a tiny minority of Independent Pharmacists potentially rorting the system is investigated and the system is changed to reduce the possibility of such rorting.
They say that this is necessary as the budget for HMR’s has been overrun and any potential rorting could put the viability of future pharmacy-centric programs at risk too.
The Guild want payments stopped so that the business rules behind HMR’s are “tightened” to stop this apparent rorting.
If there is actually rorting going on, then I think that it’s in all pharmacists’ interest to “fix” this issue.
I for one have nothing against tightening the rules to stop pharmacists “Warehousing” HMRs?
This is great.

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Part one -HMR Evolution

Neil Johnston

With the furore created when the PGA went to print stating that the funds available for HMR’s were almost exhausted, it created an instant “blame game” and conjecture as to what really lay behind the belated PGA announcement.
I came to a conclusion early that it was a result of PGA mismanagement as the immediate problem, but also coupled with an underlying systemic flaw that was the major problem.
Between them they impact and threaten the long term development and survival of the consultant pharmacist program.
It has prompted me to create an analysis of some aspects of the program to evaluate what has gone wrong.

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Part two - Fixing the HMR Flaws

Neil Johnston

The PGA has succeeded in upsetting a broad spectrum of pharmacists that includes all accredited pharmacists, some employer pharmacists (with designs on creating a business model with professional services at the core), and employee pharmacists who see job opportunities being squandered.
It is obvious that the “engine room” for consultant pharmacists (The Australian Association of Consultant Pharmacy) needs urgent reform and a new focus, or be replaced completely.
And the PGA should stop its interference.

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Part three - a Better Umbrealla Organisation

Neil Johnston

Because a workable umbrella model for management consultants already exists, it is suggested that this model be adapted for consultant pharmacist use.
The existing umbrella model established for consultant pharmacists would need to be altered dramatically and be opened up to other organisations e.g Consumer Health Forum, APESMA)
Or an entirely new organisation could be developed from scratch.
This is, in fact happening and is unrelated to any of my activities.
However, I am suggesting that the umbrella model of organisation provided by the Institute of Management Consultants (Australia) provides an excellent reference to adapt to a consultant pharmacist version.

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Thought Bubbles From a Book Group Refugee

Gerald Quigley

Editor's Note:
One night recently, I received the following email from Gerald:
"My wife has a book-group here. I’m locked in my study and inspired to write!"
That's good news for an editor/publisher - getting copy in on time well in advance!
Then followed (the same night), three separate and disparate thoughts that were not directly concerned with a pharmaceutical issue.
But they all had application for pharmacy improvement, with a bit of applied creativity.
As these "thought bubbles" wafted in over the Internet I began to wonder how I might splice them together with some editorial ingenuity.
The following is the result.

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What Really Causes Kidney Stones (And Why Vitamin C Does Not)

Staff Writer

Orthomolecular Medicine News Service, February 11, 2013

What Really Causes Kidney Stones
(And Why Vitamin C Does Not)

(OMNS Feb 11, 2013) A recent widely-publicized study claimed that vitamin C supplements increased the risk of developing kidney stones by nearly a factor of two.[1] The study stated that the stones were most likely formed from calcium oxalate, which can be formed in the presence of vitamin C (ascorbate), but it did not analyze the kidney stones of participants. Instead, it relied on a different study of kidney stones where ascorbate was not tested. This type of poorly organized study does not help the medical profession or the public, but instead causes confusion.

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For health's sake, time to take on food giants

Staff Writer

Food Industry marketing practices are increasingly being brought under the spotlight as are various other worrying problems regarding additives to manufactured food products, also how food is grown using genetically modified seed and the range of toxic herbicides and pesticides.
These latter substances now pollute the entire food chain and not enough is being done to protect our food chain.
Many illnesses can be traced back to ingestion of unnatural substances over a long period of time.
It's time to grow your own.

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Consultant Pharmacists Should Lead The Way - But They Have No Leaders.

Mark Coleman

Isn’t it time that consultant pharmacists took control of their own direction and carved out a future?
Or is the current system of a single-product (HMR) service controlled by the PGA and the PSA, sufficient to provide an interesting and creative future?
How can the aspirations of consultant pharmacists be serviced by an organisation controlled by two major pharmacy-political bodies, when one of them (PGA) is directly working against consultant pharmacist interests.

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APESMA Campaigns for Pharmacist Lunch Hour Entitlements

Staff Writer

Australian pharmacists have been warned to carefully check exactly how much compensation they are getting for routinely working through lunch after an APESMA survey found 28 per cent of Australian pharmacists reported that they receive no financial compensation at all for the lack of a lunch break.
CEO of APESMA Chris Walton said working through every lunchtime was an unacceptable practice that could cause dangerous levels of fatigue.
APESMA has advised pharmacists who have signed any agreement to remove their lunch breaks to immediately ask their employer to itemise any compensation they are being paid in lieu of all award entitlements such as their lunch breaks.

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CHC Emphasises the Importance of Research

Staff Researcher

In light of a recent paper published in the Royal Society's Open Biology journal, proposing a theory that antioxidants can be detrimental in the late stages of cancer treatment, the Complementary Healthcare Council (CHC) of Australia emphasises the importance of clinical trials and studies into the prevention and treatment of cancer. Executive director of the CHC, Dr Wendy Morrow, highlighted this theory as being interesting and warranting more research.

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Advancing our understanding and treatment of motor impairment

Staff Researcher

NeuRA has secured significant funding to expand research into motor impairment, a problem that arises from many diseases and aging, and a growing public health challenge.
Everything the human body does requires movement, but our muscles—and our brain and nerves that control them—are often the first tissues attacked by a long list of disorders that includes stroke, spinal cord and brain injury, multiple sclerosis, Parkinson’s disease, musculoskeletal injury and cerebral palsy.Prof Simon Gandevia is an expert in the brain’s control of human movement at NeuRA (Neuroscience Research Australia) and will spearhead the nearly $7 million multidisciplinary program of study, funded by the National Health and Medical Research Council of Australia.

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Peter Waterman

Media releases issued from the office of Tania Pliberseck and the PSA arrived this morning.
What follows is the PSA take on recent events surrounding HMR managent.

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Pharmedia - The Vaccine Poll Hijacked by Pharmacists?

Neil Johnston

Editor's Note:
Professional services development was stymied when the AMA reneged on an agreement to support pharmacist vaccination clinics.
It has caused anger and unprofessional behavior has evolved on both sides.
It also appears that while the professional bodies of the AMA and the PGA attempt to disrupt each other, patients at large will become the eventual losers.
The PGA is central to other clinical service disruptions, even those within pharmacy involving contractor pharmacists.
This is damaging to an orderly development of clinical services in a pharmacy setting and demonstrates that current leaders of the PGA and the AMA are not fit to claim the title of "leader".
We asked Mark Coleman to provide commentary on an article recently published in Australian Doctor.

Comments: 2

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Part one -HMR Evolution

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.

With the furore created when the PGA went to print stating that the funds available for HMR’s were almost exhausted, it created an instant “blame game” and conjecture as to what really lay behind the belated PGA announcement.
I came to a conclusion early that it was a result of PGA mismanagement as the immediate problem, but also coupled with an underlying systemic flaw that was the major problem.
Between them they impact and threaten the long term development and survival of the consultant pharmacist program.
It has prompted me to create an analysis of some aspects of the program to evaluate what has gone wrong.

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Where to start?
At the beginning, of course, circa 1977, when future pharmacy design (by the PGA) was envisaging three forms of pharmacy development – the supermarket variety, the clinical variety and the existing corner store version.

Because of my background as an accredited management consultant to CMC (international level), I was very early able to see the vision of pharmacists performing in consultant roles.
Few pharmacists have experienced this form of training let alone work as a true consultant in the cold and hard environment of business at large.
This was around 1978, and as was my habit, I began to flesh out a business plan to document and test the concept of a consultant pharmacist (as distinct from being a pharmacy consultant).
When it came to the point of service design, I came to the conclusion that apart from medication reviews, nutritional consultancies would have public benefit, even though the science surrounding some of the nutritional supplements was a bit sparse.
An Integrated Medicine concept also seemed to have patient interest and support as the service outline was detailed to a small range of patients.

Statements by the government of the day also supported the notion that pharmacists ought to be gatekeepers for nutritional supplements, by virtue of their training, and were deemed the best health care professionals to deliver information and assistance to patients and other consumers.
It was also thought that nutritional supplements would be a good fit into a preventive medicine segment of Primary Health Care.

And the PGA seemed to be on the same page because they later created the College Of Advanced Clinical Nutrition that attracted initially over 500+ pharmacists to enrol and qualify with an Advanced Diplomas of Clinical Nutrition.

I had joined in full support and on graduation night I met for the first time the president of the Queensland Pharmacy Guild…Kos Sclavos.
I talked to him after the presentation ceremony and expounded on my views for clinical nutrition as a wing for consultant pharmacists (not yet evolved at that date) – in fact that a diploma in clinical nutrition ought to qualify a pharmacist for full membership in any consultant organisation.
Up to this point in time, the creation of consultant pharmacists had received little attention or debate. But it was just starting to be considered as a unique opportunity for pharmacists.
Kos advised that discussion had just started within the PGA on the design of consultant pharmacy, so I went on to expound on the possibility of consultant pharmacists forming up in their own business and contracting independently with a community pharmacy to formalise a place of practice.
I further commented that with the future of pharmacies heading towards supermarket style pharmacies, losses in PGA membership could be augmented by offering membership to consultant practices, because it was thought that pharmacy membership would deplete as amalgamations and takeovers occurred with community pharmacies.
It seemed to me a “win-win” situation, and Kos said he would discuss the matter internally and get back to me.

Well that never happened – at least as far as the getting back to me was concerned – but I am absolutely certain that the matter was discussed internally.

There was a lot of enthusiasm and goodwill surrounding the PGA College of Clinical Nutrition and there was general agreement that the college initiative was a great success judged by all participants.

Then a series of events that seemed to be orchestrated by the PGA occurred:

(i) The College of Clinical Nutrition was closed, ostensibly because the head of the college was poached by the AMA, for their own version of a nutritional college for doctors.
But no attempt was made to recruit a new head for the pharmacy college.
All infrastructure was in place, course material had been developed, it was popular and successful.
No explanation was ever given for this waste of a valuable resource.

(ii) The clinical pharmacy model was seemingly dropped by PGA with no further mention made of this fact or an explanation given. This has been commented upon in pharmacy media from time to time and it still remains a mystery.

(iii) The Australian Association of Consultant Pharmacy was formed – not with competent pharmacists as member shareholders, but only the PGA and PSA as shareholders.
The philosophy is further hinted at in that the organisation name refers to "pharmacy" - not "pharmacists".
This meant a tight lid was kept on consultant pharmacist development and direction.
I am in no doubt as to the reasons, but it has led to the current mismanagement of HMR’s.
There is no real input by consultant pharmacists because they are excluded from policy and funding decisions.

A proper consultant association (such as the Institute of Management consultants http://www.imc.org.au/html/s01_home/home.asp  ) runs their organisation to support consultants at all level of development.
Their training insists that consultants, when accepting assignments, accurately identify what is called the “control executive” – the person with whom you have to receive your assignment from and who eventually pays you.
In a pharmacy context, this should be the patient.
Imagine my horror when the first model involved GP’s referring to pharmacies and then on to generally tied consultants to that pharmacy.
The competing interests grafted between the patient and the consultant should have made any valid professional consulting association shudder with horror.
I guess it’s only the government funding that has held it together and the one successful product that has emerged – HMR’s-while being a good one, is set to be strangled because the PGA has not had processes in place to halt any abuses or manage the entire program efficiently
Simple management procedures introduced with ongoing reviews is the norm for any organisation. Regular feedback ensures that trends noting people who are rorting the system can be quickly brought back into line.
For the PGA to call for a moratorium on all HMR production is not only disruptive to consultants, but is ridiculous in the extreme.
Their real motive needs to be questioned.
What if a moratorium was called on dispensing for just a single month?
How many patients would be damaged by that process?
How many pharmacies would virtually disappear when separated from their cash flows?

A professional services stream is the only bright spot for newly graduated pharmacists and HMR’s are probably one of the few valid services provided by pharmacists that genuinely supports patients and provides care.
For the PGA to be involved in any form of HMR management is a conflict of interest when it is known that that other “quickie” forms of medication reviews are being proposed and at the moment look as though they may be be funded from HMR funds.
The weak and belated explanations being released by Kos Sclavos on behalf of the PGA are simply a monument to bad management.

On the 12th March 2012 Kos Sclavos reported in Pharmacy News media that 5CPA spending was on track.
Have a look at :

"Spending on the Fifth Community Pharmacy Agreement (5CPA) is at record levels, Kos Sclavos, Pharmacy Guild of Australia national president, revealed at APP 2012 last week.
Speaking at the State of the Industry symposium, Mr Sclavos said spending on 5CPA programs was on track after the first year of the agreement.

“I’m very proud that in the first year of the agreement, 99.3 per cent of spending has occurred,” he said.
“That is the first time in the history of any CPA that that level of output and productivity has occurred.”

Mr Sclavos said community pharmacists should not underestimate the importance of the achievement.

“In the last agreement we underspent by $100 million,” he said.

“It’s use it or lose it, and in the last agreement we lost it.”

Surely that must include HMR Funds and isn’t he telling us all that everything is o.k?
And he talks about productivity then but now puts excess expenditure down to “rorting” by a small segment of the HMR community.
They have had productivity gains as well surely?
They have definitely used it – but they still may lose it, along with all the other casualties.

It would seem that simple rules built around the quality of an HMR need to be introduced as a first step.
Rules such as scoring an HMR as to whether the interviewer and the report compiled were done by the same person; whether the review was conducted in a patient’s home or other location.
If a pharmacy receives an HMR referral and elects to send out a non-accredited pharmacist to do the interview, (the most important step in an HMR), quality will suffer if that HMR then passes to a reviewer to analyse the interview and compare it to referral information.
It’s simply inefficient and a lower quality performance, and should be scored downwards for reimbursement.

A simple tick box identifying the above criteria plus a claimant’s signature should suffice to determine basic quality and price-and that should slow down any rorting of the scheme.

The current HMR alarm (it's not a crisis) is a break in the fabric of the political and managerial structure surrounding the governing organisations.
It is a flawed model and illustrations as to why are demonstrated in parts two and three of my analysis.
Tanya Pliberseck has now ridden to the rescue and assured consultant pharmacists that all will be well and a new consultant pharmacist management group has sprung up to fill the apparent breach, promoted by academics at the University of Tasmania.
I hope it stays and competes actively with the PGA/PSA existing version

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