There’s simply no evidence that costly pharmacy payments provide any public health benefit. It's time to end the experiment
Billions of dollars have been spent over the past 10 years on community pharmacy programs that show no evidence of benefit, according to a government review.
With negotiations for the 7th Community Pharmacy Agreement starting last month, there’s an opportunity not just to redirect funding where it will be effective, but to reframe a pharmacy model that is broken, says the former chair of the RACGP’s Expert Committee on Quality and Safety – if anyone has the guts to stand up to the Pharmacy Guild of Australia.
Queensland GP Dr Evan Ackermann, writing in MJA Insight, says the results of the review confirm what many have long known or suspected, and that the government “can no longer maintain extravagant payments to pharmacy while ignoring high patient co-payments and significant medication issues in Australia”.
The Medical Services Advisory Committee reviewed the programs for the Department of Health in accordance with a commitment in the 6th agreement, negotiated by then health minister Sussan Ley, that they would be subject to an independent cost-effectiveness assessment.
The programs, worth $1.26 billion over the life of the pharmacy agreement, are the Home Medication Review, MedsCheck and Diabetes MedsCheck, Clinical Interventions, Residential Medication Management Review, Quality Use of Medicines, Staged Supply Service and Dose Administration Aids.
Not one of them was assessed as showing evidence of clinical or economic benefit.
Speaking to The Medical Republic, Dr Ackermann said the whole premise of the MBS Review Taskforce was to weed out medical and surgical activities that lacked evidence of benefit, so the same must apply to pharmacy.
He expressed sympathy for pharmacists, as the job of medication dispensing had declined in status and remuneration thanks to automation and decreasing costs. However, the programs created to compensate were not working.
“For 15, 20 years now they’ve been saying pharmacists are underutilised, they’re highly trained and they need to find themselves something better to do,” Dr Ackermann said. “So they’ve tried all these medication reviews and so on in the hope that this was common sense and the evidence would come that this was worthwhile.
“Well, the evidence has said it’s not, there’s no benefit. They’d get these intermediate outcomes – improved prescribing or consumer satisfaction – but there’s just no evidence that it helped any health measure whatsoever.
“We’ve got to try something new: clinically we’ve got to address the problems [around medication safety] that are in the Australian health system and fiscally you can’t use taxpayer money for things that don’t work.”
Rather than occupying GP territory by vaccinating and prescribing, pharmacists should work in primary health settings as the professionals in charge of medications.
“Get these pharmacists out of community pharmacy where they’re basically sales people, put them into a professional environment like a general practice, and give them oversight and governance of the whole medication system within that practice.
“Their [pharmacists] prime role in the health system is medication safety, not duplicating [GP] services.”
Prescribing in a retail setting was an especially inappropriate ambition, given the conflict of interest and existing medication safety issues. The Pharmaceutical Society of Australia’s “Medicine Safety: Take Care” report from January says at least 250,000 people are admitted to hospital each year as a result of medication-related problems, costing $1.4 billion a year.
Dr Ackermann said the 7th pharmacy agreement would have more transparent negotiations and more signatories; but under legislation in place since the first agreement 30 years ago the Pharmacy Guild still had the right to be sole negotiator with the government.
He said the guild – an employers’ organisation that does not claim to represent every pharmacist – had successfully pushed the business of pharmacy at the expense of its professional reputation. Business owners were doing well, while frontline pharmacists were getting paid less for more work.
The average yearly income for a community pharmacist, according to several online estimates, is just over $80,000.
The 2017 Productivity Commission five-year review recommended that the government “move away from community pharmacy as the vehicle for dispensing medicines … In clinical settings, pharmacists should play a new remunerated collaborative role with other primary health professionals”.
This new model would “recognise retailing as incompatible with a genuine clinical function for pharmacists”.
“What the Productivity Commission and the colleges have been saying is that the model of retail pharmacy has reached its limit,” Dr Ackermann said.
“There are better and cheaper ways to deliver medications to patients, more professionally and at a lower cost.”