GP Practice Pharmacists – What is the Future?

Many of Australia’s accredited pharmacists have become frustrated with the “silo” they have been forced to occupy.
The frustration was triggered when financing of HMR’s was manipulated so as to create “caps” on the numbers of reports that could be produced, and that a lower-level PGA inspired “Medscheck” was thrust on the scene that competed with the original budget for HMR’s.
However, the original source of this frustration had its genesis through the PGA setting up an administrative structure to manage the future of HMR development, but with the hidden agenda to ensure as many HMR dollars were attached to community pharmacy.

Certainly it is always argued that the PGA only works for the interests of its members, so why did the government allow the PGA to negotiate for accredited pharmacists.
That is purely and simply conflict of interest.

Surely some form of “lip service” may have been achieved by instead, negotiating with the Australian Association of Consultant Pharmacy (AACP), but this entity contains no voting rights for its members.

It’s akin to Bill Shorten negotiating with a labour hire company and being paid simultaneously with a dollar value benefit.

So it seems that our pharmacy politicians have been keen students and have learnt well from our current crop of career politicians.
The development of accredited pharmacists has been relatively slow because of the diversionary tactics of the PGA, so we see a very good product in the form of an HMR visit and report, but no role expansion for the talented group of accredited pharmacists.
And more importantly, no practice “home” because the PGA has excluded the idea of either directly employing and providing a first rate clinical service offering, or leasing space to a contractor under a shared risk alliance contract that allows for income sharing (but not ownership) for such a service.
With the commoditisation of the PBS, the folly of past PGA policies are now exposed, because a large component of core business now has inadequate profitability.

Because of the politics, accredited pharmacists (now moving to an expanded clinical service pharmacist role) have begun to look for areas other than community pharmacies, to work out of.
Suggested have been GP surgeries, allied health clinics, private hospitals, nursing homes or any other professional space.
For a number of reasons, i2P has always advocated for practice from multiple professional spaces, but has always seen the “spiritual home” as being the community pharmacy.

Now we have an offer on the table by the GP’s , to work collaboratively within a GP practice setting.
After years of negative comment by the AMA, the offer has been received cautiously by pharmacists.
Fortunately, there have been some positive experiences already from pioneer pharmacists already embracing collaborative practice with GP’s, and they are promoting the benefits.

The UK experience is somewhat similar to Australia except that pharmacist aspirations have been given more government support than in Australia.
Clincal services by pharmacists in the UK are more developed and accepted, so are seen to be ahead.
Recently, NHS England announced a grantof £15 million to fund 300 pharmacists in GP practices. This action has also prompted a cautiously positive reaction from the clinical pharmacist sector.

The funding will be allocated to installing one senior pharmacist and five clinical pharmacists in pilot sites across England and is regarded as a positive step.
However ther is general agreement that any effects on community pharmacy should be taken to account.
This is a more generous feeling than that existing in Australia for the moment, but there is always room for improvement as conflict of interest disappears.

Some commentators on the UK pharmacist initiative state that it could reduce GPs’ workload and provide patients with more integrated care, but it was “vital that the remit” of these practice pharmacists was to “strengthen the link” between community pharmacy and GP’s.
The Australian peak body coalition of GP’s has also put forward a plan to have practice pharmacists incorporated within the practice setting.

A Deloitte Access Economics analysis shows for every $1 invested in the program it generates $1.56 in savings to the health system further down the track.

The expected hospital savings were put at $1.266 billion — due to reduced number of admissions following adverse drug reactions.

A further $180.6 million in medicine subsidy savings would come from a reduced number of prescriptions from better prescribing and medication compliance.

Patients would save $50 million from reduced co-payments for medical consultations and medicines, the report claims.

So there is economic benefit from a government and community health perspective, and as such is a valid opportunity for a clinical service pharmacist to develop unique systems for health.
The US does have a similar system in place, but difficulties in pharmacists receiving proper clinical service payments have been experienced, except where the pharmacist had independent provider status.
There is a lesson here for Australian clinical service pharmacists.
Also, valid community pharmacy projects should not be affected in their funding of their developments (unlike the reverse that involved HMR funding).

The general feeling surrounding the UK initiative is that it will be very successful provided it links all areas of both professions around the patient (genuine patient centring).
Other UK comments have included:

“Anything that increases access to the expert advice of a pharmacist is a good thing, but we must also ensure there is clarity over roles and responsibilities so we don’t end up with local disputes over who does what.
“It’s a good move in that the NHS is recognising that pharmacists can make an immediate impact on costs.
“We know it shouldn’t be a problem for pharmacists to deliver savings many times in excess of their salaries.” Use sector for ‘better savings’”

With no real advocating and management body for clinical service pharmacists to oversee their new venture into GP settings, there is a certain level of vulnerability in moving forward.
The risk is will both the doctors and the PGA be destabilising factors?

One would hope this disruption would cease in the best interests of all involved.

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