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Integration, not duplication, the way ahead for better care

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At a time when the AMA has been working with the Pharmaceutical Society of Australia (PSA) on developing a model for integrating pharmacists into general practice, it was disappointing recently to read of them making a bid to independently provide GP-type services.

The proposal, currently up for discussion, is expected to be included in the PSA’s submission regarding the 6th Pharmacy Agreement.

It seems illogical to me that proposing to pay pharmacists a consultation fee, paid at the same rate as GPs, would do anything more than significantly increase the Government’s expenditure on primary health care services. It is, after all, not that long since the Home Medicine Program provided for under the current 5th Pharmacy Agreement had to be amended to rein in a three-fold blow-out in costs.

What it will do is fragment patient care, undermine quality, threaten patient safety, create inefficiencies and service duplications, and add to the cost of health care in this country. The AMA will not support any scheme or proposal that threatens the quality and continuity of patient care.

The AMA is not opposed to the greater involvement of pharmacists in providing health care services to patients, but it must be as part of a GP-led team.

There are significant limits on the extent to which tasks can be taken out of the hands of medical practitioners or away from their supervision. These limitations include the inability of lesser-trained groups to appreciate the complexity of medical decision-making and treatment options.

The GP is the only clinician who operates in the nine levels of care: prevention, pre-symptomatic detection of disease, early diagnosis, diagnosis of established disease, management of disease, management of disease complications, rehabilitation, terminal care and counselling.

The AMA Council of General Practice in November will be considering a draft incentive model for integrating pharmacists into general practice. The model will enable general practices to engage a pharmacist to provide services such as:

·        medication management reviews;

·        advising patients on medication and medication management;

·        patient education sessions;

·        updating GPs on new drugs; and

·        quality assurance and prescribing support.

The model up for consideration would provide practices with the flexibility to best utilise pharmacists skills as part of a GP-led multidisciplinary team. The benefits would include improved use of medicines, fewer adverse drug events and improved coordination of patient care.

Rather than pouring more funding into the 6th Pharmacy Agreement in a way that will lead to the fragmentation of health care, the Government would be better off investing in general practice by supporting integrated, collaborative and coordinated care.