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Pharmacists: shopkeepers or health professionals?

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Pharmacists could face restrictions on the amount of shelf space they devote to selling vitamins, shampoo, toothpaste and other retail products as their dual role as health care professionals and shopkeepers comes under scrutiny in a Federal Government review.

The Government’s Review of Pharmacy Remuneration and Regulation is looking into whether there should be limits imposed on the retail activities of community pharmacies amid accusations that pharmacists are misleading consumers and undermining their own professional integrity by selling vitamins, herbal remedies and other complementary medicines that have no proven health benefit.

While dispensing prescriptions is the principle source of pharmacy earnings, generating 61.5 per cent of income in 2015-16, sales of cold and flu remedies, cough syrup and other non-prescription medicines contributed 16 per cent of revenue, purchases of vitamins, herbal remedies and other complementary medicines provided 15.5 per cent of earnings and sales of cosmetics and beauty products generated 7 per cent of income.

The review panel, led by Professor Stephen King, has been told that community pharmacists face a conflict of interest between their role as a health care professional and a shopkeeper, particularly when stocking their shelves with products for which there is no evidence of efficacy.

As community pharmacists push for an expanded role as health service providers, they are coming under scrutiny over their business practices, particularly regarding the sale of complementary medicines.

The issue is probed in a discussion paper released as part of the review, which has been set up to examine the role of pharmacists and community pharmacy in delivering health services, now and in the future.

The review panel said it had heard of numerous examples where community pharmacists had gone “above and beyond in providing additional services that are in the patient’s best interest, even though they may not be compensated for these valuable services”.

But, it added, there were those who objected to the current direction in which community pharmacy was headed, and were concerned that issues around their dual roles as a retailer and health service provider were yet to be resolved.

“It was put to the Panel that community pharmacists face conflicts of interest between their role as retailers and as health care professionals,” the discussion paper said. “This tension between treating consumers as customers or patients was attributed to the contrast in the remuneration from dispensing and the revenue generated from the sale of over-the-counter medicines and complementary products.”

The Panel said it had heard concerns that financial pressures might cause pharmacists to compromise on the professional advice they provide, such as recommending medicines or products that were not necessary.

“It was also claimed that many complementary products do not have evidence-based health benefits and, as such, the sale of these products in a pharmacy setting may misinform consumers of their effectiveness and undermine the professional integrity of community pharmacists.”

The review has been set up under the terms of the current Community Pharmacy Agreement, and the panel is seeking comment on possible reforms in the sector, including changes to the pharmacy business model.

The discussion paper cited Guild Digest data showing that community pharmacies have an average annual turnover of $2.8 million, and a net profit of $107,000 (excluding proprietor salaries).

Among the proposals up for consideration is that Government funding, which is worth $13.2 billion under the life of the current five-year agreement, should be made conditional on the amount of revenue pharmacists generate from other sales.

“Should Government funding take into account the business model of the pharmacy when determining remuneration, recognising that some businesses receive significant revenue from retail activities?” is one of the question raised in the discussion paper.

“Should there be limitations on some of the retail products that community pharmacies are allowed to sell? For instance, is it confusing for patients if non-evidence-based therapies are sold alongside prescription medicines?”

It noted that some hospital pharmacies have designed their service area to resemble a clinic, getting rid of a counter and “providing a private environment without distraction, which maximises the professionalism of patient-pharmacist interaction”.

The review is being undertaken in the context of a sustained push by pharmacists for an expanded role as health providers.

Health Minister Sussan Ley said pharmacists were already taking on a greater role, including providing routine vaccinations and blood pressure checks, and the industry is pushing to be allowed to undertake broader screening and patient health checks.

The AMA has raised concerns about the risk to patients from pharmacists providing services beyond their realm of expertise, and is expected to make a submission to the review.

The Pharmacy Guild said the discussion paper raised many “thought-provoking questions” about the pharmacy sector and was preparing a formal response.

The review panel will conduct a series of public forums over the next five weeks, and those interested have until 23 September to provide a written submission.

Details of the review, including the discussion paper and the consultation process, are at: http://www.health.gov.au/internet/main/publishing.nsf/Content/review-pharmacy-remuneration-regulation

Adrian Rollins

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