On the 5th of March a report by the Australian National Audit Office was tabled in Federal Parliament with 257 pages of analysis into the administration by the Department of Health of the Fifth Community Pharmacy Agreement (5CPA).
I am not someone who reads these reports every day, but even to my untrained eye there were many things that stood out more clearly than the Q1 tower at Surfer’s Paradise.
As an Accredited Pharmacist I was particularly interested in the parts of the report that related to the funding of the Home Medicines Review (HMR) program. Coming to the conclusion that there was a clear intention of undermining the program from the outset by those negotiating the 5CPA I would argue is about as logical inference to make as that the monorail is likely to get you to the Mercure Hotel and Oasis Shopping Centre from Jupiter’s Casino.
The first piece of evidence is found in Chapter 4 of the report where the setting of the program budget is discussed. The total budget for the HMR program over five years was 52.1 million dollars with a sudden approximately thirty percent decrease in the annual program budget to begin from the 1st July 2012. This critical piece of information was obfuscated from all relevant stakeholders. Annual HMR program budgets for the five years of the agreement were as follows: 2010-2011 $12.79m; 2011-2012 $12.79m; 2012-2013 $8.6m; 2013-2014 $8.6m; 2014-2015 $8.6m.
The ANAO reports notes that the reason why the budget for HMRs was to be decreased from Mid-2012 was unknown to them, but was possibly due to assumptions made during the 5CPA budgeting process, that uptake of in-store Medschecks would be a preferred method engaging patients in Medication Management Reviews as a parallel increase in the uptake of Medschecks had been budgeted into the 5CPA at the outset to occur at the corresponding point in time.
Instead of this pattern of expenditure occurring, the rate of HMRs and Medschecks both increased at an accelerating rate. As the actual 2012-2013 financial year began (the first with an $8.6m budget) there were quickly calls by the Pharmacy Guild to clamp down on “Rogue Service Providers” and then ultimately call for a moratorium on the HMR program in early 2013. These actions from the Guild came out of the blue and would have corresponded with worried phone calls from the then Department of Health and Ageing who could see that the HMR program was trending towards increased expenditure and not towards the reduced budget the Guild had negotiated in the 5CPA.
The Guild had always known that this would happen because it had negotiated the HMR program budget deliberately to fail at this point in time. They had lined up various source of information for their propaganda campaign (all anecdotal) to argue to the department that HMR Pharmacists must be reined in, and that MMR services were better performed through their Budget friendly Medschecks services in community pharmacies. ANAO says the Department was made aware of anecdotal reports of systematic co-ordinating of Medscheck and HMR services and a large number of HMRs being conducted outside of the home and also by non-accredited pharmacists. To date no evidence has been provided to support these allegations to my knowledge despite several providers being allegedly pursued by DOHA for inappropriate conduct in performing Medscheck services.
The ANAO report exposes the 5CPA professional programs funding arrangements as an overly complex web of contracts, many of which may have been legally ambiguous and may have placed the Guild at “significant reputational risk” as the Guild were required to adhere to legislation relating to the handling of public monies. To avoid this reputational risk the new Coalition Government organised all of the professional program expenditure into a single contract which simplified the Guild’s legal responsibilities greatly and provided funding for electronic claiming to be implemented.
Clearly if the current Government was worried about the Guild’s reputation there were deficiencies in the ways the Guild handled the initial contracts. It would be concerning to Guild members that their lawyers had allegedly allowed them to sign into such leaky contracts in the first place. I guess we have to cut the Guild some slack here, a Community Pharmacy Agreement had never been audited before and all the good lawyers for negotiating Government contracts were tied up helping Twiggy Forest dud the Gillard Government in negotiating the mining tax at the time.
Encouragingly the ANAO report cites all the key Australian evidence for HMR services concluding that there was significant evidential support for both patient outcomes and the cost-effectiveness of these services. The ANAO writers were unable to identify any evidence for the benefit of Medscheck services although it says the Guild had said that they were backed by strong evidence.
ANAO were particularly kind on the Guild regarding this point. A cursory examination of the Ontario Government website about its program of the same name implemented in 2007 shows the Guild program to be a monumental cut and paste job that wouldn’t get past any self-respecting Eighth Grade English teacher. The Ontarian Medscheck program allegedly was not based on evidence, but was a political concession to Pharmacy owners in Ontario, Canada to compensate for decreased remuneration from medication. I have heard from insiders that the Medscheck program was identified via a Google search which does not surprise me.
The fact is there is no evidence for the effectiveness or cost-effectiveness of Medscheck services. only HMRs and RMMRs have robust peer-reviewed evidence of reduced costs, hospitalisations and improved patient outcomes and high levels of patient satisfaction. They represent exceptional value for money.
From the ANAO report it is clear that the Pharmacy Guild is no friend of Australian Accredited Pharmacists. George Tambassis indicated at an interview at APP on the Gold Coast last week that there were changes being proposed to the business rules surrounding HMRs behind closed doors and without input from stakeholders during the current 6CPA negotiations. Accredited Pharmacists cannot afford a repeat of the negotiations that occurred behind closed doors when the last agreement was negotiated. The Guild has broken faith with Accredited Pharmacists and the ANAO audit provides unequivocal objective evidence of this.
I would call Professional Pharmacists Australia and the Society of Hospital Pharmacists Australia to support calls by Medical and Consumer Groups for a delay in the negotiation of the Sixth Community Pharmacy Agreement until 2016 to get the best deal for all consumers and stakeholders.