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Community pharmacy reforms in Australia

Gone is the era of the white-jacketed pharmacist in the distance, busy on the computer only venturing out of the dispensary at the behest of a patient. Your article on pharmacist awareness, albeit lack of it, of the implications of the healthcare reforms on their role is a reflection on what can only be described as a failure of implementation of any real reforms at the community pharmacy level. Much has been made about the pain of the Australian Pharmaceutical Benefits Scheme (PBS) reforms, and the reduction in profit margins for community pharmacies, without sufficient attention being paid to the accompanying changes these reforms have brought with them. Changes that pharmacists in the community have to embrace or risk becoming the metaphorical dinosaur of the healthcare field. While the PBS reforms involved statutory price reductions for a large proportion of generic medications, that affected the trading terms available to pharmacies, it can only be assumed that a large part of the estimated reduction in PBS outlays for 2008–2009 due to statutory price reductions of AUD274 million came at the expense of community pharmacy profits; what goes largely unmentioned by pharmacists was the AUD102.4 million that was paid to them in premiumfree dispensing incentives, AUD76.9 million in PBS online incentives and AUD89.4 million in increases in pharmacy mark-ups and dispensing fees as part of a structural adjustment package over the same period to help them adjust to the new arrangements. So pretty much every dollar saved by the government was indirectly reinvested into the pharmacy profession to prepare them for the new role they are expected to play in the ‘First National Primary Health Care strategy’. But this is where the reinvestment ended. Clinical governance is the framework through which health organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. And in a time of major healthcare reforms, when this sort of leadership and guidance was needed most by the pharmacy profession, it has not been forthcoming. As outlined in the article, the pharmacy profession was basically forgotten in the reform documents produced by the government and the Pharmacy Guild of Australia (who represent the interests of pharmacy owners), which does not necessarily equate to an invested interest in quality care as they failed to show any sort of leadership in preparing the profession for the changes with the bulk of their energies focused on stock and pricing issues. And this misdirected focus has then been passed on to individual pharmacy owners and pharmacy groups and chains who in the years since the commencement of the reforms have done little to focus on quality improvement. Instead there has been an emphasis on technical efficiencies aimed at churning out more scripts per pharmacist, reducing wage percentages, more efficient stock control and the offering of more nonhealthcare services. That was not the aim of these reforms and certainly not in line with continuous quality improvement. Introduction of a robotic dispensing system to allow a pharmacist more time to consult with patients would be an improvement, but automation in community pharmacy of late has been accompanied by increased demands for output and less emphasis on quality. So where does this leave the profession in Australia? Since the commencement of the Fifth Community Pharmacy Agreement (5CPA), many pharmacy practice initiatives have been launched that allow pharmacists to claim for quality activities which has sadly been promoted as a way of recouping losses from PBS reforms. But is that what it is meant to be? Is it just about the dollars? Some of the initiatives include disease-state management of consumers with chronic conditions, screening and assessment of at-risk individuals, MedsCheck and health promotion. Other programmes were the supply of dose-administration aids, staged supply, clinical interventions and working with others, which involved collaborating with other health professionals and also community support services that amongst other things involved the implementation of E-health. Essentially pharmacists have mostly continued with their normal practice apart from documenting sufficient evidence of these various activities to claim the incentive payments from government. And the Pharmacy Guild of Australia has mostly focused on providing ways of claiming these payments without any real emphasis on changing practice at the pharmacy level. Patient or consumer-centred bs_bs_banner