So there is a budget crisis. There’s also a new federal Health Minister. And, here it comes, community pharmacies are negotiating over a billion-dollar deal with the Government: The Community Pharmacy Agreement sets out the Government funding pharmacists receive for dispensing PBS medicines.
If it’s up to the Pharmacy Guild, pharmacists will be:
- Filling repeat prescriptions to ‘free up doctors time’
- Treating ‘easy’ minor ailments
- Giving more vaccinations (e.g. a flu-shot for $25 with no Medicare rebate)
- Doing ‘easy’ health checks, screening and preventive health services
- Giving mental health support.
Sounds great doesn’t it? At first glance this improves access to health services and saves tax payers bucket loads of health dollars. This can’t go wrong!
Maybe not. Here are 5 reasons why role and task substitution by pharmacists will fail:
#1: Avoiding the doctor is probably not going to help
A repeat prescription or a vaccination is a valuable opportunity for a family doctor to screen for, and treat health issues before they escalate. This is one of the strengths of general practice. If people don’t come in because they get their cholesterol or blood pressure scripts from the pharmacist every 6 months, this system will fail.
It will worsen health outcomes at drive up costs. Is that really what we want?
#2: We are treating people (not ailments)
People are more than the sum of their ailments. Over the years there have been many attempts to replace the doctor with algorithms, machines and computers, and they have all failed.
The human body and mind are complicated. Take the nurse-practitioner clinics trial in the ACT. They created duplication and resulted in more emergency department presentations. The clinics were also more expensive than a GP service.
If you think a professional is expensive, wait until you hire an amateur.
#3: Don’t put the cart before the horse
If it’s improved access or multi-disciplinary care we’re after, then strengthen general practice. Unfortunately the opposite is happening: Practice nurse support has been cancelled, and I won’t mention the Medicare rebate cuts and freeze.
One GP said about role substitution by pharmacists:
“If this was a good way to practice a profession, we could all just buy a book on law and represent ourselves in court, organise our own house sales and never need a tradie either. But we all know that there is more to a ‘job’ than it appears.
#4: Disruption is not innovation
A common mistake is to assume that disruption is the same as innovation. Disruptive services – like those suggested by community pharmacists – may be simple or convenient, but the quality will be poorer.
A recent study showed that only 3 out of 32 fish oil supplements contain what the label says; I believe pharmacies should focus on evidence-based medication advice and quality control of over-the-counter drugs.
#5: Conflicts of interest
A question we should ask is: Can the person who is selling the drugs give independent health advice?
Pharmacies face reduced profits because the Government has set lower prices for generic medications under the price disclosure arrangements.
Although it is understandable pharmacies are looking for other income streams, it is unlikely that the proposal by the Pharmacist Guild is a win-win solution.
Playing doctor may be good for the pharmacist and possibly for the health budget in the short-term, but not for the health of Australians. It will hinder GPs in the effective delivery of care and will eventually increase costs.
There is value in team work, but only if we work together.