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Bring pharmacists into general practice

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As it gears up for negotiations with the Federal Government on the 6th Community Pharmacy Agreement, the Pharmacy Guild of Australia is trying to expand the role of pharmacists in primary care to further the financial interests of pharmacy owners.

The Guild is proposing that the Government fund pharmacies to provide cholesterol and blood pressure checks, vaccinations, and to devise non-prescription treatments for minor ailments.  It is apparently planning a multimillion dollar advertising campaign to promote its case.

AMA President Associate Professor Brian Owler has branded the Guild’s plan as dangerous and irresponsible because it will fragment patient care and undermine the doctor-patient relationship. I wholeheartedly agree.

General practice is the home for high quality patient care and advice, and if pharmacists want to use their skill set to assist GPs in the care of patients, then they should do so as part of a GP-led multidisciplinary health care team.

The AMA is working in collaboration with the Pharmaceutical Society of Australia (PSA) on a proposal to integrate non-dispensing pharmacists into general practice.

Both organisations think that such an arrangement would improve use of medicines, reduce adverse drug events and better coordinate care. It could also save the health system money by helping patients improve the management of their medication and make better use of medicines – potentially reducing the 190,000 hospital admissions caused each year by adverse drug events.

I agree with the thrust of recent comments made by the PSA’s National President Grant Kardachi that we need to have a mature and evidence–informed discussion about how the expertise of pharmacists can be better used for the benefit of patients, and of the health system in general.

However, while the PSA says that pharmacists don’t want to take over the role of doctors, the Guild certainly seems to want funding for providing services that are traditionally part of the ongoing preventive care undertaken by GPs. 

I’m not sure why any government would fund programs that fragment patient care. Why fund pharmacists to provide ad-hoc cholesterol and blood pressure checks outside of general practice?

Supporting the integration of care and health services through the patient’s family doctor is a far wiser way to spend scarce health dollars. Only the family doctor is trained to treat the whole person, interpreting results in the context of a person’s full medical history and treatment regime.

The key to quality preventive care is the comprehensive training and diagnostic skills of GPs, coupled with the GP-led integration of medical and health services, the ongoing monitoring of patient risk factors, access to a patient’s medical history and clinical record, and the trusted relationship patients have with their family doctor.

With more pharmacists than pharmacy jobs, and increasing numbers of pharmacists wanting more from their work, there is a real opportunity to make the best use of their skills within general practice.

This is worth further discussion, but it should be based on the best interests of patients and not the bottom line of pharmacy owners.