The future of pharmacy is in the primary care sector
Much of modern health care can be delivered more effectively when it is provided and coordinated in the community, at or near the patient’s home. This is what true patient-centred care is about.
We are in an age where consumers demand a responsive healthcare system, are vocal about the characteristics of the system they don’t want eroded and have expectations about the directions future healthcare should take.
One of their greatest calls is for care to be better coordinated, connected up and delivered by a cohesive team of clinicians. This team needs to comprise, at a minimum a GP, a nurse and a pharmacist with appropriate care and support from others as needed.
Modern technology and medicines make this possible, improving care of chronically ill people, reducing need for hospital care.
A challenge is to provide the right incentives for health practitioners, like doctors, nurses and pharmacists to coordinate and integrate their care and services in the best interests of the patient…and for patients to know how to access that care.
Making this patient-centred primary care happen depends to a large extent on government policy. We have seen forays designed to stimulate primary care advances including through Primary Health Networks and the Government’s own Health Care Homes Programme.
Already some commentators say these are languishing for lack of support and resources. For CHF, we believe PHNs continue to show much promise as health system improvers and Health Care Homes has the needle moving in the right direction.
Last week’s Federal Budget took us further along the incremental path to primary health care reform notably with an announcement for a Workforce Incentive Program that will enable general practices in all rural and remote locations to engage allied health providers, including non-dispensing pharmacists. This will be a benefit to real world care.
What needs to happen now is for the same, if not greater, level of reform of professional pharmacy services.
As longtime pharmacy leader, Professor Lloyd Sansom, said on his retirement from a career in which he played a national role in pharmacy and pharmaceutical policy and oversight, the future of pharmacy is in the primary care sector and the pharmacy profession needs to shift from its dispensing mentality to one of community care.
Professor Sansom is not alone in his views. The Smith 2013 ‘Now or Never’ review in the UK drew much the same conclusion saying that the traditional role of community pharmacy will be challenged and that disruptors such as automated technology to undertake dispensing and the use of online and e-prescribing will bear down on pharmacies and drive change.
The Pharmacy Guild’s own 2025 plan contemplates nine growth pathways for community pharmacy. This shift to community health hubs, online and in-home care futures are right up there.
Apart from the Budget, the latest episode in this process has been the fate of recommendations suggested by a Government-appointed review panel to open up pharmacies to greater competition and more dynamic primary care.
The Government’s response to the report by the Review of Pharmacy Remuneration and Regulation – known as the King Review – has been equivocal to major changes and to largely stick with the status quo. This has sparked much commentary with GP groups, lead researchers and CHF largely suggesting that it was a lost opportunity.
There is significant discussion still to be had about the future of pharmacy and its place in the primary health care system if consumer interests are to be served. A status quo approach to the professional services component of the Community Pharmacy Agreement is not the way to achieve this.
The inquiry, when established two and a half years ago also held out of prospect of the involvement of other stakeholders besides pharmacy owners in negotiating the Community Pharmacy Agreement which at a cost of $18.9 billion over five years finances the dispensing and other operations of pharmacies.
The review called for measures ranging from deregulating restrictions on new pharmacies, encouraging practice by pharmacists outside their traditional retail outlets and enabling consumer and professional pharmacists to be represented on negotiations for the pharmacy agreement.
The calls for consumer views on choice and access have largely been ignored. The Government response to broadening the participants in the Community Pharmacy Agreement did not commit to including other parties.
The review proposed payment arrangements that effectively would enable pharmacists to provide services through primary health outlets other than the pharmacy shopfronts. The Government only “noted” this proposal saying it could potentially “duplicate” existing Medicare-funded services.
But this is a missed opportunity to put community pharmacy into the primary health care team. If we are to achieve an integrated approach with people accessing care where it is appropriate and convenient for them then services need to be funded in a similar way.
The Government’s refusal to review in a systematic way the location rules which prevent competition among pharmacies is ignoring potential for improvement. The arrangement has been challenged by the review and by leading economic authorities.
A recommendation for the pharmacies, whose dispensing income relies largely on public money, to be required to offer a range of minimum services and to have accounting arrangements that enable appropriate evaluation, have been not been taken up by the Government.
And it was disappointing that the Government did not support the recommendations regulating the display of often unproven complementary “medicines”. This is an area where consumers are not given sufficient high-quality information and so often make ill-informed and costly choices when they could be spending funding on evidence based treatments and interventions.
The Government’s response locks in the current model of community pharmacy and refuses to even trial ideas designed to improve access such as machine dispensing: a reality in other countries.
A disturbing aspect of the Government’s reluctance to support evolutionary reforms to pharmacy is that such changes cannot be dismissed on cost grounds as they need not involve significantly increased government expenditure and should improve efficiencies and improvements for the community.
Where does that leave us? Sometimes reform is a slow burn. But as Professor Sansom has said “the future of pharmacy and its role in the health system has to evolve and its integration and acceptance of the medical model of health is what will give it the pathway to make a difference for the generations of pharmacists to come and for the community as a whole”.