Battle over pharmacy pits quality against access

According to National Medicines Policy review submissions, GPs want to join forces but pharmacists want to go it alone and expand their scope.

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Should pharmacy join forces with general practice to improve the quality of healthcare, or expand its scope of practice to broaden access?  

These are the two very different positions being staked out as part of the review into the National Medicines Policy.  

This is the first review of the policy in its 22-year history, and as such has a special focus on preparing for the future healthcare landscape of the country.  

The deadline to give feedback on the draft NMP was extended today from next Wednesday to midnight on 2 March.

Given that Medicines Australia claim the renewed NMP “will be significant for all Australians”, The Medical Republic figured it was high time to see what the major healthcare groups envisioned for the future.  

Across submissions from four of the big players in primary health – the AMA, RACGP, Pharmacy Guild and Pharmaceutical Society of Australia – it became clear that there are two distinct visions for where pharmacists are best placed to promote quality use of medicines.  

On one side, the AMA and RACGP call for more funding to allow pharmacists to be embedded in general practice clinics.  

“As a key component of a multidisciplinary team, practice-based pharmacists allow general practices to increase their capacity to offer medication management and education services to patients,” the RACGP submission said.

Instead of brick-and-mortar chemists, the RACGP proposes that non-urgent medicines could be stored in a central location and be directly delivered to a patient’s door.  

In this scenario, the job of the pharmacist is working within the GP clinic to manage medication safety and educate patients.  

The college also detailed concerns with the rise of standalone pharmacy-initiated consultation services, which it said jeopardised continuity of care and increased the risk to patient safety. 

Meanwhile, the AMA went so far as to count current pharmacy ownership and location rules as one of the main issues affecting patients’ access to medicines.  

Under these Commonwealth Pharmacy Agreement rules, pharmacies can only be owned by a pharmacist and must be located within 500m of a supermarket but at least 1.5km from the next-closest pharmacy.  

The AMA said the location and ownership rules did not meet NMP objectives as they limited access to medicines and inhibited access to pharmacists.  

It also argued for more funding allowing pharmacists to be part of a multidisciplinary primary care team, in much the same format as the RACGP laid out.   

“Economic modelling by Deloitte Access Economics demonstrated that for every $1 invested in the program, $1.56 in savings is delivered to the health system,” it said. 

In line with the RACGP’s stance, the AMA also argued for a continued distinction between prescribing and dispensing.  

“Expanding prescribing scope of practice is commonly proposed by non-medical health professionals as a method to increase medicines access,” the AMA said.  

“However, it is important that these proposals are very carefully … [as] increased access to medicines on the basis of convenience may compromise quality use of medicines.” 

The Pharmacy Guild and PSA take a predictably different approach to the issue.  

“It is disappointing to see healthcare practice models involving pharmacists being successfully implemented in other like countries, but proposals to design and implement similar services in Australia meeting resistance or disinterest,” the PSA wrote.   

“Collaborative prescribing is one such area.”  

The pharmacists’ professional association also floated the idea of pharmacy as part of a collaborative primary healthcare team arrangement, but with a more individualistic spin.  

“Pharmacists, within their scope of medicine and medication management expertise, should be included as eligible providers and remunerated as part of a team delivering collaborative care services under the Medical Benefits Schedule,” it said.  

The guild, which represents pharmacy owners only, zeroed in on Australia’s shift toward preventative health to argue for more services to be offered in pharmacies.  

“We note that the use of pharmacogenomic testing and technology should not be confined to MBS-funded service settings, but instead it should be utilised throughout the patient journey including in community pharmacies,” it wrote.  

While not directly mentioning pharmacist prescribing, the guild’s submission advocates for increases in the pharmacist scope of practice, to include services such as pharmacogenomic testing, pharmacist-initiated medicine checks and expanded continued dispensing. 

It makes no mention of pharmacists in the context of a primary health care team, as envisioned by the AMA and RACGP.  

The NMP received a total of 121 public submissions, and no date has been set for a final report.