CHF – New Friend of Pharmacy?

The Consumers Health Forum (CHF), not always known for a friendly approach with pharmacy, seems to be moderating its view in recent media releases.
Currently, it is calling for the role of a pharmacist in primary health care to be debated.
In a recent media release it states:
“The Consumers Health Forum says the AMA‟s concerns about the Pharmacy Guild proposal for the Federal Government to fund pharmacies to provide cholesterol and blood pressure checks, vaccinations, and non-prescription treatments for minor ailments raise some important questions about the optimum delivery of primary care in Australia and negotiations around the 6th community pharmacy agreement.

It is well recognised that pharmacists play an essential role as frontline health professionals who provide timely expert advice on medicines and aspects of healthcare. In a recent submission to a Victorian Parliamentary Committee Inquiry, CHF has been broadly supportive of an expansion in the scope of practice of this skilled workforce.”

i2P does believe that an open discussion regarding the formal integration of pharmacists into primary health care is essential to rationalising an agreed approach, also a supportive approach by the various health disciplines.
In many respects pharmacy has been its own worst enemy by not debating this issue many years ago.
Pharmacists of yesteryear used to provide the majority of primary health care services to their local communities. That is, before the advent of the PBS and MBS systems.
However, it was done “under the radar” to avoid AMA reprisals. Now everybody, (not only pharmacists), are getting sick and tired of the AMA’s negative stance.
Prior to their introduction, patients traditionally went to consult with their pharmacist first, where ninety percent of common ailments were treated with high levels of patient satisfaction.
The initial PBS and MBS saw a massive shift of primary health care patients directly to doctors.
And why not?
It was free!
Once installed, the PBS and the MBS became commoditised over time to the extent that as designated products, they were both reaching the end of their life cycle by 2014.
Despite the doctor advantage in pricing their product, pharmacists still retained a large percentage of market share of the primary health care market.
As the PBS and MBS became distorted through the pressure of drug companies seeking higher prices and more listings, pharmacy was made to bear major components of market adjustment through the PBS, with the recent “price transparency” process causing a flood of bankruptcies on a scale never before seen in pharmacy, with accompanying employment opportunities being diminished as well.
Pharmacy’s major strength has been its highly trained (but under-utilised) pool of pharmacists, the majority working from strategically located pharmacies giving ease of access to the majority of Australia’s consumers, with the exception of some very remote communities.
The remote communities have been serviced usually by a government-funded outreaches in the form of multidisciplinary team of health practitioners, not always involving pharmacists, and certainly not capital intensive pharmacies.
The CHF media release goes on to say:

“CHF believes that consumers benefit from, and appreciate, the ease of access, and the personalised services such as medication management and vaccinations, that they can get from pharmacists in the community without waiting for a GP appointment. It is essential, however, that such services be provided in a safe, confidential environment, with necessary follow up or referral where required.” said CHF CEO Adam Stankevicius.
“Strong international evidence also supports the delivery of less complex services by pharmacists and research by the Grattan Institute estimates that with additional training, pharmacists could take on five per cent of the workload of GPs in less accessible rural and remote areas.”

I2P supports these statements and would support any open inquiry as long as it was a genuinely transparent one, because we have the secondary and disruptive issues of the AMA accusing pharmacy of usurping its turf and running negative media campaigns to loosen public confidence in pharmacists that has been embedded within communities for a very long time.
There has also been a disruptive campaign by the PGA insinuating itself in some questionable processes involving government whereby it has become accepted (by government) that the PGA speaks for all pharmacists.
This has erupted recently with the PGA trying to anchor a range of clinical services exclusive to pharmacies e.g. Medschecks; while at the same time financially squeezing independent consultant pharmacists providing a superior product in the form of and HMR or an RMMR.

The lessons here are that government, Consumer Health Forum and the Pharmacy Guild of Australia need to recognise that pharmacies will never deliver a meaningful or appropriate health service without an alliance with independent clinical service pharmacists, who have been politically thwarted from being able to form their own support structure and develop real and appropriate policies to support their discipline.

The PBS is the main reason pharmacies need additional revenue streams, because it has reached the end of its life cycle.
Professional services need to be provided by independent practitioners because they need to deliver to a depth not necessarily supported by a pharmacy, because its infrastructure requires, understandably, a profit level to sustain itself.
Independent practitioners can use or discount their currency (hours of research or patient input) to a level that they would wish to.
Being independent (but in alliance) the aspirations of both types of pharmacist can be achieved.
The current level of activity can only be described as a conflict of interest by the PGA as well as a turf war, as pharmacies try to replace a quality HMR service with an inferior Medscheck service.
Consultant pharmacists need to mobilise themselves to support an enquiry that the CHF is calling for, and now would be the time to prepare for it, gathering all evidence in support of the debate.
CHF is clear on its support stating:

“CHF supports the view that appropriately trained allied health professionals including pharmacists and nurse practitioners should be able to provide basic primary and preventative care and vital health services like vaccinations in an appropriate environment, particularly where it makes such services more accessible especially to the elderly and young families and communities in rural and remote areas.”
“CHF agrees with AMA that the transparent Medical Services Advisory Committee (MSAC) process is the appropriate place for the consideration of government funding for such services, not the secretive Community Pharmacy Agreement negotiations.Further discussion and analysis of this proposal is clearly required, particularly about whether any changes would lead to additional out of pocket costs for consumers.

“More broadly, the professions, government and consumers need a transparent nationwide discussion on the best way to deliver primary care services to all in Australia, in a consumer-centred manner which is safe, effective, accessible and timely. This includes whatever plans the government has for the sixth community pharmacy agreement.

“The future of healthcare is increasingly moving towards a consumer-centred and driven service delivery, and CHF sees responsive pharmacists in the community as an integral component of delivering that type of care” Adam Stankevicius said,”

In fact the Consumers Health Forum is calling for a much broader and a more fundamental reshaping of Australia’s health system around six key consumer-focussed principles.

In its submission to the Senate Select Committee on Health, CHF CEO Adam Stankevicius called on policy makers to re-orient the health system towards a “consumer-centred governance, planning, management and delivery.”

“It would mean considering issues such as service design, co-payments, accessibility, quality, safety and value from a consumer perspective, rather than a government, provider or professional point of view,” he said.

The CHF has been one of the most outspoken opponents of the proposed $7 GP co-payment and increase in PBS co-payments and safety net thresholds.

According to Mr Stankevicius, “CHF has, and will continue to be, a willing participant in debates on health care financing. CHF strongly believes that the rising consumer burden of healthcare in Australia needs to be addressed through robust, evidence based and consumer-centred research.”

The following are the six principles that make up the CHF request for all health professions.
i2P would support these principles as being appropriate for any component of pharmaceutical care, and they could be incorporated within any values or cultural statement for a pharmacy or pharmacy service business model.

  • Accessible and affordable care;
  • Co-ordinated and comprehensive care;
  • Appropriate care;
  • Whole of person care;
  • Informed decision making; and
  • Trust and respect.

Interpretation of each point should be taken to the widest level possible e.g. accessible and affordable care might only happen when one form of health care practitioner competes with another.
Ensuring everyone starts from a level playing field would also ensure a lower consumer price. Provided the service envisaged is based on quality at a lower price, then overtones of “turf wars” would be silenced.
Co-ordinated and comprehensive care might only be possible with high-investment infrastructure such as a pharmacy or a doctor’s surgery. This would introduce new levels of competition.
Appropriate care may need a partnership with a nurse.
Whole of person care may need a paradigm shift for some health practitioners.
Informed decision-making should be a feature for all health practitioners while trust and respect ought to be a given for all health practitioners

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