The Pharmacy Guild’s national call to pharmacists to misinform, why the RACGP needs its part-time members to pay more, Pilot’s money rollercoaster and how to spend your new $50,000 grant.
A lot happened this week, some of it approaching bizarre.
Within hours of the federal health minister announcing that 60-day dispensing for 320 common drugs will be in the budget, an emotional and enraged Pharmacy Guild had drafted a script for phone calls and a letter they wanted every pharmacist to send to their local member immediately.
Guild letter asks nation’s pharmacists to misinform MPs
The contents of the letter and script reveal an organisation that is increasingly becoming irrational to the point of practising Trump/NRA-like misinformation campaign stunts, something which, in Australia, feels like it’s a bridge too far, maybe even for “North Queenslanders”.
The full letter is here. Note the call to action as follows (our emphasis):
(Once talking to member)
- I want to know what is going on with 60-day dispensing.
- Do you know the dangers this poses to patients in XXXX?
- 60-day dispensing will make the medicine shortage worse.
- Just today I had to tell one of my patients we were all out of <EXAMPLE>.
- Giving two boxes out instead of one will make this worse.
- 60-day dispensing will lead to hoarding, and increase the risk of overdoses, including among children and seniors.
- Can you ask the prime minister what I’m supposed to say to my patients when I have run out of their medicine, or when their child overdoses?
- This is a cut to healthcare. My patients and your constituents will be worse off.
There’s a very obvious problem with this script and instruction.
What if “just today” didn’t happen “today” or at all?
Does a pharmacist make it up, or use an example from a couple of weeks back, and lay claim to it happening “just today”?
If they did, as this letter suggests they should do immediately, wouldn’t that be knowingly and grossly misleading our entire installed MP base, scaled nationally?
Nowhere in the letter does it warn a pharmacist that they should make sure that they had a real example from today if they were going to ring their local member and say this.
The whole tactic is essentially a nationally scaled misinformation campaign which is asking every pharmacist in the country to potentially compromise some basic standards of ethics.
So much for “brand pharmacist” which is one we know has traditionally had a very high trust factor with the community.
It’s reckless on the part of the guild to so openly risk trashing that brand and very unfair on an army of well-meaning and hard-working pharmacists across the country, most of whom aren’t owners of big pharmacy chains and probably have very little interest in such misinformation.
It’s that community trust which has provided the guild with so much political power over the years.
It might go to this once very powerful big pharmacy owner lobby group starting to lose the plot.
Certainly, in this clip of guild president Trent Twomey, from this week, the strain appears to be showing.
Mr Twomey, who seems to excuse his reference to key personnel in the federal government, including the federal health minister, as “not giving a shit” by saying he is a “North Queenslander”, spends much of the clip pointing to examples of pharmacists going broke and attempting to conflate that with the new script initiative, suggesting that the policy will lead to widespread shortages of important medicines for patients.
The problem a lot of people are likely to have with these lines of argument is that there is plenty of evidence to suggest there aren’t going to be widespread shortages. Even Elizabeth Deveny, who heads the Consumer Health Forum, came out and quashed the claim, probably thinking she did not want unnecessary patient panic.
If some pharmacists are going broke, it’s clearly not because of this policy, because it doesn’t start until September this year and it is going to be phased in via three tranches of about 100 drugs per tranche over the following 18 months.
That’s if anyone accepts that Twomey’s cited examples of pharmacies suffering to the point of failure are actually real, after the guild’s letter clearly indicated that it is an organisation prepared to ask its members to potentially make stories up in order to panic local members and patients.
One interesting other PR problem for the guild is that for the first time in a long time the federal government is happy to point out in national press conferences that the organisation is lobbying on behalf of vested commercial interests not patients.
To Twomey’s comment that he didn’t want to “see a Hunger Games stand-off in any community in Australia where some patients get double the medicine they need, while others get nothing”, Health Minister Mark Butler swiftly responded.
“I advise people to take advice around medicine supply and shortages from our medicines authorities rather than the pharmacy lobby group,” he said.
Big ouch.
That’s very unlike the good old days of ministers cowering under the political sway the guild used to have.
College letter: hold on, we can explain about fees and finances
The RACGP must be getting a lot of unexpected pushback on its move just over a week ago to increase the fees of most of its part-time members by a whopping 60% (who happen to be mainly women) as this week they sent a letter to all members announcing that management will front up to a please explain webinar on membership fees and the colleges financial position next week.
The letter points to an FAQ page everyone can visit now, but those FAQs explain virtually nothing about why the college thinks it’s okay to target their part-time members, most of whom happen to be female, for huge fee increases.
The FAQs are concentrating mainly on explaining to members why the college is in no financial trouble, albeit it feels under enough pressure that it has to risk doubling the fees of a lot of their female membership.
There’s a lot going on here and it’s not immediately easy to discern why the college on the one hand is freaking out members by pointing out that on an “operational basis”, it will lose up to $10m in the 2022/23 financial year, and on the other outline all the reasons everything will be okay.
Before you attempt to work out what they are trying to do in their very comprehensive FAQs, I think I can save you a lot of trouble.
Financially the college is in great shape, it has been for some time now, and despite some likely short-term ups and downs around fixing software platforms, dealing with covid and absorbing the GP Synergy business (the NSW GP training group), it’s a solid outfit with tons of assets and cash in reserve to change course in time, even if things were going wrong (which largely they aren’t).
For those GPs who aren’t used to understanding things like balance sheets, profits and losses and the ins and outs of accounting terms like “operational profit” versus “consolidated performance”, there is a lot of opportunity in the FAQs to become confused and worried enough to buy the line that the college pushes that the best thing they could do to help the situation is stay a member of the college.
It’s not explicit anywhere in the FAQs but it feels like the “just keep on being a member” line might somehow get extended to “just accept how we’ve restructured how fees are paid” as well.
The upshot of the new fee structure is that fees are going up by about 20% overall (which is quite a bit more than CPI even taking into account they went up under CPI once recently), and that probably a significant proportion of part-time members (heavily female skewed) are going to have to going to have to pay most of that via a 60% increase to their fees.
I’m all for lots of upfront transparency, and extensive FAQs are one way of achieving this in an organisation, but in this case, the college FAQs might easily have the opposite effect of explaining what is actually going on.
One thing that the FAQs do say upfront is that the college will make an “operational loss” of $10 million this financial year, which based on its turnover, is not good. So the signal is definitely, we all need to be careful here.
But the financial reality of the college could be explained a lot more simply by saying to everyone that reporting of “operational losses”, while useful for management and accountants in planning and keeping a good eye on current and future cashflow, can be hugely misleading.
The consolidated result of the college, which is the real result, is going to be that the college is going to break even this year, make profit, or at worse make a small loss.
The reported operational loss last year was $1.65 million but the consolidated position was a profit of over $3 million.
In fairness the college does get to all this eventually in the FAQs.
But by that point a lot of confusion and anxiety will have set in.
It’s a balancing act for sure.
You want to be wholly transparent. But “operational loss and profit” are an internal accounting construction designed for management to understand internal dynamics and to help with understanding net cashflow forecasts.
It’s important – particularly in respect of understanding the cash position of an entity (cash is king in the end) – but the college knows that both its asset position and cash position are fantastic relative to most organisations, even relative to some very well-run corporations (they should actually get kudos for this).
The underlying position of the college is solid and has been for a long time.
The very mention of the dire situation the college did find itself in in 2000 (when it actually nearly did go broke) is likely to create anxiety, no matter how much you say “it’s not happening again don’t worry”.
Of course members will worry. So why risk the confusion?
It might be in an attempt to be wholly transparent.
But some confusion might be convenient too.
If the very clear message to members was that the college’s consolidated position was good, cash and assets on hand were great overall, and future cashflows were assured given already started restructuring plans, then maybe members would be a little more reluctant to buy the line that given our financial situation as explained so clearly in our FAQs [not], maybe you should stop questioning things, accept fee increases of 20% (including 60% for part-timers), and our quite drastic short-term restructuring, including cutting 15% of our non-training workforce, and let us get on with our grand plans.
I’m definitely being a bit pernickety here. When you stand back from all this it looks like the college is planning long term for some significant future changes to the way it rolls, and maybe in a good way.
If you accept that its transition to managing training most of the GPs in the country was spectacularly well-executed then you might imagine that it has other good things in mind for members and the organisation as a whole.
But that doesn’t mean members shouldn’t be questioning stuff like how this new fee structure works, or why after years of being ignored and not engaged, they can’t take their bat and ball and play their cricket at ACRRM for a few years to protest, if they wish.
Instituting more reasonable fee increases, with a more reasonable basis for levying fees, a less drastic program of redundancies and losing even a sizable chunk of some of the longer-term unhappy members for a few years, is not going to send the college broke any time soon.
But don’t look at me. Ask the college management next week by attending to one of the three webinars they are putting on 3 May, 4 May, and 8 May (good on them for that).
If you eject 33% of your crew is the plane still good to fly?
Interesting news this week on once darling telehealth start up Eucalyptus (it has the Pilot and Juniper brands) in the Australian Financial Review this week, which reported that having run into funding issues due to the global tech meltdown, management had to fire a third of its workforce globally.
Apparently, the main problem for the Australia–based group has been in the UK and Germany, where it also has its Juniper and Pilot brands pushing the idea of fast and effective online-driven weight loss.
But as TMR reported a couple of weeks back, the stars aren’t exactly aligning for the group locally.
The TGA is examining how it can legally prevent some of the loose governance around online patient prescribing; just about every major consumer media group in the country is running stories featuring dissatisfied customers; the decision by our biggest indemnity insurer not to insure doctors practising asynchronous prescribing (which features in their model); and the medical media exposing that a prospective weight-loss treatment patient isn’t ever actually sighted, as a simple check of their need; nor is the actual identity of a patient or the accuracy of their online answers to questionnaires ever properly checked.
Literally, an anorexic could get a prescription for Saxenda.
As well as cutting a third of their workforce, apparently the group had to reach deep and cut 60% of their overall burn rate of $2 million per month.
A new question for patient advocates and health system authorities in Australia should be, who and what did they cut and given how drastic those cuts appear to have been, how exactly might such cuts effect the ability of what seems to be an already compromised patient enrolment process and the overall safety of its patients?
Not sure how you spend your new $50k grant? Neither is the government
Finally, just over a week ago, we got confirmation that the promised Medicare Taskforce practice grants of between $25,000 and $50,000 per practice, depending on practice size, would be part of the upcoming budget.
But it remains wholly unclear how you should be spending your grant and less clear how any of the grants would lead to any proper mid- to long-term benefits for the sector.
Increasingly, the grants are looking like short-term cash drops, which may or may not be a bad thing.
In the case of the digital health upgrade component of the ways you can spend your grant, it looks like it might retard the development of much needed interoperable digital health infrastructure in the country, which would be bad for GPs in the end, not good.
To recap, so far the government is saying you can apply for a grant in three areas:
- enhance digital health capability – to fast-track the benefits of a more connected health care system in readiness to meet future standards;
- upgrade infection prevention and control arrangements – to ensure infectious respiratory disease (eg covid, influenza) patients can be safely seen face to face; and/or,
- maintain and/or achieve accreditationagainst RACGP under the General Practice Accreditation Scheme
Beyond there being no detail so far to explain what will get over the line in each of these categories – application forms were sent out on 21 April – each of these categories has some very big questions hanging over them in terms of relevance, tax issues and alignment with greater health system needs.
Upgrading infection prevention and control is obviously a continuing and important component of running an effective practice these days, but if you don’t have this in place as a practice already following covid, you probably are not in business.
Is the return on investment there for the overall health system for practices to be taking another $50,000 to upgrade this part of what they do?
Given the dearth of detail on what you can actually spend the money on, this might end up one area where practices can take the money quickly and not actually have to spend it all on equipment and infrastructure.
In one PHN webinar advising on how to apply for this part of the grant, it was suggested that the following reasons could be given for use of the money:
- professional assessment of existing infection prevention and control arrangements;
- infection prevention and control infrastructure;
- infection prevention and control equipment; and,
- improving infection prevention and control procedures including upskilling of staff.
Half of that is not hard dollars a practice will need to outlay so there’s room for boondoggling by the looks of it.
Perhaps the most controversial immediate area of possible application of spend is on “maintaining or achieving accreditation”.
The first significant issue with a practice spending money on this is that at the moment there is a lot of confusion over whether the current standards for accreditation through the RACGP exposes a practice to a long-term and potentially disastrous state office payroll tax audit.
The AMA came out this week and said it might.
Past this not insignificant issue, how much sense is there in the federal government giving a practice another $50,000 to “maintain” accreditation?
Any practice that wants to stay in business and has accreditation surely isn’t going to let it slide and therefore will have maintenance of said accreditation as a part of their ongoing budget items.
That would make getting another $50,000 to maintain accreditation pretty much surplus money to most practices that have accreditation. Or, a free $50,000 grant for any practice smart enough to apply with a well-argued application.
In one respect, this isn’t such a bad thing. The Federal government is essentially coming up with an easy way to shove money over the fence into some struggling practices, and many will need and welcome it.
But it’s not exactly strategic and it’s not really going to help GPs long term in any way.
Finally, we have the “enhancing digital health capability” application.
That might have been a very significant and useful step for both primary care and the entire health system.
But not as so far proposed.
In fact, with the little detail provided so far, it’s feasible that this measure might reinforce some very bad dynamics currently in play in digital health infrastructure in the country, particularly in regards to how interoperable the primary care community is with the rest of the health system.
Here again is what one PHN is saying a practice can ask money for under this term:
- general Practice IT systems;
- internet connectivity improvements;
- upskilling in digital capability;
- professional assessment of existing digital/cyber security capability and arrangements.
Ninety per cent of general practice IT systems are antiquated 1980s-style technology which is isolating the GP community from the rest of the healthcare system and in some instances trapping GPs in a world where they can’t access their own patient data without paying more, can’t talk seamlessly to their own patients and can’t share important data or receive it from other key providers in the system.
We have a market failure in GP IT systems (not the fault of the IT vendors) and it can’t be solved by giving GPs $50,000 unless you specifically instruct that the money must be used on buying technology which overcomes all of the problems they currently face with these old systems.
Unfortunately, that can’t be done easily for any practice, because the current old technology is integrated with a mass of other old systems outside general practice so unless those other systems are required to change in line, it will be risky for a GP practice to move.
It’s a very big problem which can’t be all explained in this article, but essentially, all of the above uses of money bar improving your internet connectivity, will likely reinforce old bad system incumbency, unless the government specifically requires the money be used to upgrade to modern web based sharing technologies, which so far they aren’t, and at the same time requires the rest of the health network to do the same.
Notably, the government isn’t entirely walking away from this problem.
The wording of this grant clause actually says “fast-track the benefits of a more connected health care system in readiness to meet future standards” (our emphasis) which suggests that there will be standards one day that GP practices need to meet in how they buy and build any new technology.
The problem is, these grants are being applied for now, and those standards don’t exist yet.
The standards are likely to be coming but most pundits think that won’t be for quite a while, maybe not until we are into a second term of the current Labor government (if they make it to a second term).
Which means, the technology side of grants is likely going to be spent on old systems which are reinforcing the technical isolation of GPs from the rest of the system and the ability of GPs to access and share their own data to much better effect.
Overall, no one is going to begrudge GPs another $25,000-$50,000, no matter how they get it.
But this grants program is looser than most geese you’ll come across.
GPs deserve some better thinking on how this money should and could be spent.
