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Pharmacists told to stop pushing bad medicine

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The AMA has accused the Pharmacy Guild of reviving the idea of chemist health checks as a ploy to strengthen its bargaining position ahead of crucial talks with the Federal Government.

As negotiations over the next five-year Community Pharmacy Agreement loom, the Guild has unveiled plans for a multi-million dollar advertising campaign spruiking the contribution of pharmacists and arguing that their range of services be expanded to include health checks, vaccinations and non-prescription treatments for minor ailments.

But AMA President Associate Professor Brian Owler condemned the Guild, accusing it of cynically using primary health care “as a bargaining chip in its efforts to secure the best possible deal for pharmacy owners – not patients – under the new Community Pharmacy Agreement”.

The Guild has proposed that the Government should fund pharmacists to conduct cholesterol and blood pressure checks, administer vaccinations, and devise non-prescription treatments for minor ailments. It has previously suggested a fee of $50 for such services.

In an interview with The Australian Financial Review, Guild Chief Executive George Tambassis said: “[It’s a good thing] if we’re allowed to step up to do these extra services – we believe five years of education should able or allow us to do more things in our pharmacy that are remunerated by the Government and/or remunerated by the patient”.

But A/Professor Owler said it was unacceptable for the Guild to propose that its members be able to offer services that, for strong clinical reasons, should be the preserve of general practitioners.

“This is a dangerous and irresponsible model of primary care,” the AMA President said. “It fragments patient care, and undermines the important doctor-patient relationship.”

He said it was likely the Guild would press the Government to include remuneration for pharmacist primary care services in forthcoming negotiations for the next Community Pharmacy Agreement.

The current agreement, worth $13.7 billion over five years, expires this year, and the stakes are high for both the Government and the Guild heading into negotiations for the next five-year deal.

The Government is pushing hard to contain spending across the board, while pharmacists have had their profit margins squeezed by the previous government’s price disclosure reforms which saw the amount paid by taxpayers for medicines brought in line with the discounted prices manufacturers charge pharmacies.

Nationals Senator John Williams earlier this month spoke up for pharmacists, urging his Government colleagues to embrace a broader role for pharmacies, and to be fair in their negotiations with the Guild.

“Pharmacies need to broaden their horizons to survive,” Senator Williams said. “I encourage my colleagues in Government to see that we do the right thing by our pharmacies in this new agreement.”

But A/Professor Owler called on the Government to reject the Guild’s plan.

“The Government would be foolish to consider handing over precious health funding to the Guild for an untested and unnecessary primary care experiment when huge cuts are being made to the mainstream health system,” the AMA President said. “It would be completely unacceptable for the Government to seriously negotiate the Guild’s proposal.”

He suggested, instead, that the Government could consider alternatives for the distribution of medicine, such as providing prescription services at supermarkets.

“We actually have the potential for other providers, such as Woolworths and Coles,” A/Professor Owler said. “The case should be looked at in terms of what the best thing is for the patient. If the best thing is…being able to access medicines at a cheaper rate…then that’s something I think needs to be considered.”

But Health Minister Peter Dutton ruled out the prospect, telling the ABC’s Lateline program the Government had no plans to change rules governing pharmacy location and ownership.

“Nobody’s convinced us of the need for Coles and Woolies to run a pharmacy, and we want to make sure the pharmacy location rules and the pharmacy ownership rules don’t change,” Mr Dutton said.

He warned the Guild’s scheme could end up costing the Government more, because patients diagnosed with a clinical condition in pharmacy health checks would have to be referred to doctor in any case.

A/Professor Owler said an assessment by the Medical Services Advisory Committee (MSAC) would confirm that GPs remain the most efficient and effective providers of primary health care and chronic disease management.

His call for an MSAC assessment was backed by the Consumers Health Forum, which said the AMA had raised “some important questions” about the best way to deliver primary health services.

Forum Chief Executive Officer Adam Stankevicius said MSAC’s transparency made it the “appropriate place” to consider the Guild’s plan, rather than secretive Community Pharmacy Agreement negotiations.

A/Professor Owler said pharmacists had a well-regarded role as a first port of call for everyday ailments, including providing over-the-counter medicines.

“But, as the saying goes, when pain persists, people [should] see their doctor,” he said. “GPs and pharmacists work together at the local level in providing appropriate care for people. There is no need for pharmacies to take over the role of the local family doctor.”

Unsurprisingly, the Guild rejected the AMA’s criticisms, and accused it of being primarily concerned with protecting doctor interests.

“There is an overwhelming case for more and better use to be made of the infrastructure and expertise in Australia’s 5400 pharmacies,” a Guild spokesman told Pharmacy News. “No amount of tunnel-visioned turf protection by the AMA should prevent Australian health care consumers benefitting from a safe and sensible expansion of pharmacist services.”

Adrian Rollins