s A visionary approach needed in the 5th Community Pharmacy Agreement | I2P: Information to Pharmacists - Archive
Publication Date 29/04/2010         Volume. 2 No. 4   
Information to Pharmacists

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Feature Contribution

Introducing Jeanette Sell - The Colac Community Leader who took on a Pharmacy Monopoly

Peter Sayers

In the April edition of i2P, a story involving the ministerial removal of pharmacy location rules was published.
It involved a disparate group of Colac residents coming together to fight the location rules and to establish a third independent pharmacy.
The story was important for a number of important reasons:
(i) The Colac residents did not want a "chain-type" pharmacy.
(ii) They wanted true competition between local pharmacies to avoid a perceived monopoly.
(iii) They wanted good old-fashioned pharmacy personalised service in an appropriate time frame.

As pharmacists we often bemoan the spectre of "Colesworth" providing pharmacy services and the potential for them to strip personalised service out of the independent pharmacy environment.
Yet the existing Colac pharmacies (having the same owner) did exactly that.
The question I pose is if this is the direction of pharmacy (as formulated by the PGA supply side pharmacy and warehouse-type pharmacies) the Colac community have clearly demonstrated that those models are not the preferred version.
i2P asked Jeanette Sell to tell her story in her own words.

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My two bob’s worth on COAG’s Health Funding ‘Reform’ (sic)

Pat Gallagher

Health Reform? Is that what we have been given by COAG: I don’t think so at all. It is wrong from the get go. In that 60% will come from here; 30% will be taken away from there; 40% will be paid by them and we will layer some more highly experienced and very necessary bureaucrats on the top to make sure no one ever knows what is actually going on.
Same old, same old, just tarted up differently so the punters think something is happening.
Health Reform it aren’t. Pretending to reform hospital funding it is.
Not a word about technology, e-health, savings, over-staffing of suits in place of white coats and blue blouses, blame shifting, waste, incompetence and all the other ills that riddle the hospital operational (non-clinical related) networks.

And there are enough ills for a zillion hypochondriacs to wallow in. Just this past week I had occasion to sample it first hand with a relative that needed emergency attention. The ambulance picked her up at 6:55 pm, after just a ten minute wait. We arrived at the hospital about the same time as the ambulance at 7:15 pm.
So far so good.

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A once in every five years opportunity that must be taken.

Neil Retallick

On July 1 2006, the Federal Government reduced the pharmacy wholesaling margin from 10% to 7%. This action was an outcome of the Government’s negotiations with the Pharmacy Guild as these two parties hammered out the 5 year deal that was the Fourth Community Pharmacy Agreement (4CPA).
To put this change into today’s context, Sigma’s wholesaling business turned over around $2.4 billion in the last twelve months.
If 70% of this turnover is generated by dispensary medicines, and if 65% of these are PBS items, then the 4CPA pulled about $33 million in revenues off Sigma’s top line in today’s dollars.

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The Light and Dark side of some Pharmacies

Loretta Marron OAM BSc

Living in outback Queensland, especially during the long periods of drought, the elderly grazier has struggled from day-to-day to keep his cattle property going.
He had only been 12 years old when his father died, but with the Second World War still raging, and with no men available, the local police officer had issued him with a drivers licence and told him to go home to help his mother run the property.
That had been the end of his schooling and to this day, he can still barely read and write.

Comments: 1

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Pharmacist Support Service now Extended to Tasmania

Staff Writer

Tasmanian pharmacists now have access to the Pharmacists’ Support Service (PSS), developed by the Victorian PSA.
It can be contacted by phone on the toll free number: 1300 244 910.

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Expensive drugs cost Australia billions

Staff Writer

Consumers and the Australian Government are paying up to 10 times more for generic cholesterol-lowering drugs compared to the United Kingdom, according to research carried out by health economists at the University of Sydney.

A recent study published by the Medical Journal of Australia (MJA) found Australia could have saved approximately $900 million on statin treatments (drugs used to lower cholesterol) over the past four years and could save up to an additional $3.2 billion over the next 10 years.

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Doors open on Australia's first zero-emission home

Staff Writer

Pharmacy designers in Australia have yet to come up with a zero emission pharmacy building, but they will have a model t draw from in the form of an AusZEH private home, designed and built by CSIRO.
Designed to fit the Australian climate – and the lifestyle of a typical middle-income family – Australia's first Zero Emission House (AusZEH) has been officially opened  in Melbourne.
Working with industry partners Delfin-Lend Lease and the Henley Property Group, and supported by the AusZEH consortium, CSIRO designed and built the demonstration house 30 kilometres north of Melbourne’s CBD, in the community of Laurimar in Doreen, Victoria.
The eight-star energy-efficiency rated AusZEH showcases off-the-shelf building and renewable energy-generation technologies, and new future-ready energy management systems.
Nearly 13 per cent of Australia’s greenhouse gas emissions are due to home energy use.

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Pain Management and Analgesic Sales

Neil Johnston

With the changes occurring restricting the sale of analgesic products within pharmacies, there has not been a great deal of discussion as to how best to handle these changes.
It has been said that the new processes impact severely on the pharmacist’s workflow.

The analgesic market is a very large one within pharmacy and the ability to lose a major income stream is very real.
The following is a press release from the PSA and we have asked Mark Coleman to comment on the various issues:

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A visionary approach needed in the 5th Community Pharmacy Agreement

Rollo Manning

articles by this author...

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

The talk of Green Paper/White Paper and Road Map to the Future mean nothing unless enshrined in the 5th Agreement as matters that must be addressed during the course of the next five years. Some resolutions of the many issues that face the profession of pharmacy are a must if it (the profession) is to move ahead as a meaningful contributor to primary health care. Pharmacy must be seen by all key stakeholders as a professional that knows it can contribute and legitimately wants to find the best way this can be done.

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The starting point has to be the establishment, within the 5CPA, of a PBS Advisory Council that represents all key stakeholders with a real role of informing a Sixth Agreement. There are some revolutionary issues that need resolution and these can only happen if there is “teeth” in the body charged with the responsibility of coming forward with recommendations that will bring about change that is to the long term good of consumers of the PBS. Without this the outcomes of the PSA consultative process and the Guild’s “road map” will be merely further reports that sit on the shelves gathering dust as the future rolls by and the community keeps wondering when pharmacy is going to move into the next generation of health care reforms.

Look what happened to the expensive and thorough Community Pharmacy: Strategic Change Management by Professor Dexter Dunphy et al – the master of change management in Australia.

A PBS Advisory Council would pick up from the previously good work of the body called the Australian Pharmaceutical Advisory Council, abandoned in the last five years and replaced by a National Medicines Advisory Executive and a Committee to advise the Executive. This mechanism has yet to make a mark after 15 months of operation and the conduct of a National Forum in June 2009.

A formally recognized PBS Advisory Council through the 5th Agreement with terms of reference seeking definite outcomes will ensure that change happens and that the recommendations made are in a climate of true co-operation between all key stakeholders. The role of the Pharmacy Guild needs to be reigned in so it is seen as the organisation that has the power under the National Health Act to negotiate fees with the Commonwealth on the supply of Pharmaceutical Benefits. There will be many occasions where the Guild has to be excluded from discussions and decisions on the basis of a conflict of interest. There is no doubt that improving health outcomes through a National health and welfare system is in conflict with making money to ensure the economic viability of a retail pharmacy infrastructure that is clearly inefficient. The range of services needing to be delivered to maximise the spend in PBS dollars is not conducive to enabling retail outlets to be positioned in high rental accommodation in glitzy shopping centres competing with supermarkets for the consumer dollar.

What would a PBS Advisory Council be asked to review?

The first task is to formulate a mechanism whereby all Approved Pharmacies are required to renew their approval to dispense PBS medicines and if selected have to enter into a binding contract to provide an agreed range of services to consumers. It could be that there is a need for two or three levels of service delivery ranging from the Internet Pharmacy, through discount fast service dispensaries in shopping centres to the high level professional service establishments combined with primary health care facilities. It has to be recognized that consumers do not always want the high level service and if they do not – and receive only a “pick and lick” treatment in dispensing the providing pharmacy is remunerated accordingly. The present system whereby ALL pharmacies are paid $6.42 for dispensing a PBS item has to stop with the available dollars rewarding those who provide a high level service and the “no contact” dispensary gets a lesser payment.

An Approved Pharmacy will be granted an approval to service the population of a geographic area based on the likely volume of PBS prescriptions generated within that area. The PBS Advisory Council would be charged with the responsibility of developing over the next five years the criteria for enabling a “fresh approach” to delivering a health and welfare program of Government to the Australian community.

The second task of the PBS Advisory Council would be to develop a Service Charter for the levels of Approved Pharmacies that is made known to consumers allowing them to have a real expectation of what they can expect from an Approved Pharmacy. An audit process would need to be installed so the public know that there is surveillance of the Government agencies which deliver the program. This is accepted practice on all other Government sponsored welfare programs with operators (Approved Pharmacies in this case) required to submit to audits either at regular intervals or at random to ensure they are meeting the Service Charter of consumer expectations.

Coupled with the Service Charter is the need for a complaints mechanism and this is an area where the Pharmacy Guild would certainly be excluded on the basis of conflict of interest. As much as the effort and cost that has gone into the QCCP program of the Guild it is a self administered, self evaluated program that rarely issues a statement of performance in the consumers interests. If anything consumer organisations are frowned up whenever they do their own auditing of pharmacy performance. The PBS Advisory Council would be charged with coming up with a complaints mechanism that would be an external review process of the performance of Approved Pharmacies against the objectives of the PBS.

The day should come to an end where the holding of an Approval Number to dispense PBS medicines is seen as a right to anyone that owns a pharmacy business rather than as a privilege to be part of a Government welfare program. The mere fact that Approval Numbers can be traded in the market place the same as a taxi number plate is enough indication of the commercial gain seen in such an asset. It should be viewed as a commitment to provide a range of professional services that can be taken away if ever the owner is found to be negligent in their provision of services.

By having the establishment of the PBS Advisory Council with terms of reference incorporating the above principles all business owners would be on notice. It could be that compensation is needed for those that miss out on an Approval Number within certain criteria (such as age of business) but this an expense that has to be borne if reforms are to happen. To dispense PBS medicines an agency – PBS “dispensing agent” – does not have to be on the top floor of a regional shopping centre as close as possible to a major supermarket or department store. A small unit near to the delivery of other primary health care services (or a part of them) might be a far more acceptable location to achieve the objectives of the PBS.

If Australians are to benefit from the $10 billion spend on PBS medicines (includes own payments) then it must embrace the need for an infrastructure that is designed to maximise that spend towards positive health outcomes.

The Nation cannot continue (and the Government should not allow) the reliance on a retail business competing in the market place which treats PBS dispensing as an “ordinary item of commerce” that can be discount promoted and supplied with all the haste of a fast food outlet.

The PBS is a key component of the National Health Network and must be brought back to what it was originally meant to be in the National Health Act of 1953. Regrettably it has been viewed for the past 30 years more as a small business support program rather than a key component of a healthier Nation framework.

This may be why the profession of pharmacy is viewed in such a low priority manner when it comes to discussions on improving the health of the Nation.


Quote of the month

To understand the heart and mind of a person, look not at what he

has already achieved, but at what he aspires to do.

Kahlil Gibran

(1883-1931, Lebanese poet, novelist)


Send your subject suggestions to Pharma-Goss for comment.

Edited by Rollo Manning at rollom@iinet.net.au

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