Pharmacists need to quit retail and partner with GPs

Pharmacies expanding into store-based primary-care roles do so to shore up profits, but the moves show limited clinical value, argues Dr Evan Ackermann

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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.