20 June 2018

Pharmacists need to quit retail and partner with GPs

KnowCents Pharmacy

A prominent GP quality expert says Australian pharmacists will only realise their clinical potential by abandoning the retail setting and partnering with general practice.

In an opinion piece in the current issue of the Journal of Pharmacy Practice and Research, Dr Evan Ackermann argues the pharmacy sector should curb its enthusiasm for expanding into store-based primary-care roles.

He says these moves have been undertaken to shore up profits but show limited clinical value.

“Progressing pharmacy professional services under the retail model primarily serves the financial objectives of retail industries,” he writes.

“A major revision is justified; services development without systems change will only continue to subjugate community pharmacists to retail whims.”

The chair of the RACGP’s quality standards committee says the core responsibilities of medication delivery and safety need to be “reinvented” to address the medication problems of the health system.

Dr Ackermann says programs for medication reviews and management interventions by community pharmacists have failed or have had minimal impact.

“At best, there are minor improvements in surrogate markers (e.g., HbA1c, blood pressure, lipids) and minor medication error detection,” he writes.

“There are no consistent effects on quality of life, hospital admission, deaths or medical costs.”

The concept of pharmacists working as part of a primary-care team – now the subject of a number of government-funded trials around Australia – “has merit, but can’t be justified on current evidence”, he says.

A much-quoted AMA report lauding the benefits of in-practice pharmacists relied on projected savings from a fall in hospital admissions from adverse drug events, he added.

“This is a brave assumption given there is no evidence quoted where community pharmacy interventions can actually prevent hospital admissions.”

Instead, Dr Ackermann argues for a bolder reform – transferring the PBS delivery role to pharmacists in general practice – which he says would be fiscally justified and uphold safety.

For pharmacists, this could open up significant clinical opportunities, enabling medication governance of an entire general practice population, he says.

It would allow personalised quality interventions and promote national priorities such as antimicrobial stewardship and management of addictive drugs, vulnerable populations, and OTC drug misuse.

“Dispensing and other fees normally associated with community pharmacy would be ‘cashed out’ to support a general practice-based pharmacist position, to develop appropriate wage structures and career pathways.

Dr Ackermann says the health sector should heed the Productivity Commission’s view that the existing community pharmacy model is resistant to reform and costly.

“Testing alternative models under a professional umbrella is a logical progression,” he says.

“Although there are multiple claims by the Pharmacy Guild that the current system functions properly, there have been no formal trials of alternative models to test this assertion.”

To facilitate change, the guild, the powerful body representing pharmacy owners, should be relegated to “only a minor seat” at future Community Pharmacy Agreement negotiations, with protected funds to support a transition to a new system, Dr Ackermann says.

The journal, published by the Society of Hospital Pharmacists of Australia, pairs Dr Ackermann’s paper with an opposing viewpoint from pharmacy consultant Deborah Rigby.

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4 Comments on "Pharmacists need to quit retail and partner with GPs"

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Dr Raymond Yeow
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Dr Raymond Yeow
3 months 20 hours ago

Dear Editor,
may we have the “…opposing viewpoint from pharmacy consultant Deborah Rigby…” please ?

John Wilkins
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John Wilkins
3 months 1 day ago

Yes… let’s turn pharmacists into real health professionals rather than sellers of jelly beans, toiletries and masses of therapeutically dubious if not outright sham “health products”.

Manya Angley
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Manya Angley
3 months 1 day ago
Some interesting points and visionary in some respects. It is clear that some sort of reform of community pharmacy is needed. Of note, Deborah Rigby’s perspective is not entirely ‘opposing’ per se. In fact, many of Ms Rigby’s and Dr Ackermann’s views are congruent, especially regarding the potential value of general practice pharmacists. Before such a radical reform, there would need to be rigorous trials that provide evidence that Dr Ackermann’s proposed reform is feasible, cost-effective and acceptable to consumers. A 2015 Consumers Health Forum qualitative study revealed consumers value and want more input from pharmacists in all settings along… Read more »
Richard
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Richard
3 months 1 day ago

could not agree more Evan, however while we should not give up the fight, the pharmacy guild has shown to be extremely powerful while only representing a minority of pharmacists.

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