Woolworths and Pharmacies.

Jul 8, 2014

The response of the Australian Pharmacy Guild (APG) to Woolworth’s proposal for free health checks was entirely predictable. It was about protecting the territory of pharmacists.

But the APG did have a point. Are the leviathan department stores who sell large amounts of alcohol and tobacco really serious about our health? I don’t think so?

But if the challenge of Woolworths would help curb the anti-social behaviour of the APG that would be a real public service.

Pharmacists are the most over-qualified and under-utilised of health professionals. In the national interest and in their professional interest, pharmacists must participate in the transformation of our health sector. The 5,000 or so pharmacies on high street are a highly accessible and high profile resource, more so than GPs’ surgeries. Pharmacy attracts HSC students with high academic scores. Standing at the boundary of self-care pharmacists provide a range of services to customers – advice on medications, advice to see the GP, aches and pains, colds and flu, burns, rashes and abrasions. I cannot see why pharmacists for example shouldn’t almost immediately undertake blood tests, as well as flu injections and managing repeat prescriptions.  Their more active involvement in preventive health programs and primary care in general is essential.

But the APG sees pharmacists primarily as shop keepers rather than health professionals

Professor Sansom, described as Australia’s ‘pre-eminent pharmacist’, a former Chair of the PBAC, and the Australian Pharmacy Examining Council, put it bluntly a few years ago. ‘The profession would miss out on inclusion in future healthcare models unless it changed its current structure.’  He added ‘the current structure which is heavily structured on drug distribution…All of those things together and independently restrict the innovation and development in pharmacy practice which will promote this profession as a legitimate partner in new primary healthcare delivery models rather than being seen simply as a distributor.’

Andrew Gilbert, Professor and Director of the Quality Use of Medicines and Pharmacy Research Centre at the University of South Australia, also described the problem very graphically a few years ago…

I know from the many telephone calls I get from disgruntled young pharmacists who are expected to dispense over 300 prescription items a day. They say that they are instructed that their primary duty is to supply the product, correctly labelled to the right person and that this type of professional performance measure limits any attempt to work with patients, to use Consumer Medicines Information Sheets as part of the patient consultation process and to provide a primary healthcare service. … These [supply] requirements leave no time for patient-centred healthcare, primary healthcare services, patient education and training, professional development through mentoring by experienced pharmacists and discussions with other health professionals regarding the care of complex patients. Professional services … [are] viewed as optional extras by many community pharmacists; services that may be provided if they are not too busy with the core business – supply. … Why is one of the most valuable professional services a pharmacist can offer, a pharmaceutical care focussed review in collaboration with the patient and their doctor only offered as an add on service in some pharmacies that chose to participate.’

In addition to resisting the enhanced professional role of pharmacists the APG is in the front line in resisting competition. For example pharmacies must generally, in urban areas, be 1.5 km from each other? One consequence of this restriction of competition agreed to by the PGA and  Australian governments is that the number of community pharmacies has remained substantially unchanged at 5,000 since 1993.(At 30 June 2012  there were 5298 community pharmacies)  There are Pharmacy Location Rules which effectively put a cap on pharmacy numbers, This capping of pharmacy numbers is despite  population increase of almost 30 % since 19993 and an increase in PBS services, including Repatriation Pharmaceutical Services of over 80% since 1993.  In 1993, the average number of PBS prescriptions per pharmacy was 21,200. Last year it was close to 40,000.

The consumer organization, Choice, in 2005 commissioned a study by the Allen Consulting Group on these location rules. Choice commented that ‘the location rules provide little consumer benefit and only advantage existing pharmacy operators’. (Choice, August 2009, p65)

Last week the Productivity Commission said ‘There has been a failure to act on recommendations of a national independent review of pharmacies to relax ownership and other competitive restrictions”

Our pharmacy sector needs a major shakeup. It needs to encourage pharmacists and particularly young pharmacist to be in the front line of primary care including employing nurse practitoners. In short they need to be less like shopkeepers and more the professionals they were trained to be. Further we need more competition but not from types like Woolworths

I outlined the above case to the 2009 Pharmacy Australia Congress. It was well received well by many pharmacists but not by all. It was particularly welcomed by younger pharmacists who felt their professional skills were not being effectively used. Subsequently I accepted an invitation to speak to the Australian College of Pharmacy Dinner in Brisbane. It was described as a “must not miss event”. But the invitation was withdrawn. It was the first time in my public life that this had occurred. Perhaps I did not have the pulling power I thought! But the real reason for the withdrawal I am certain was that the APG leaned on the Brisbane College. This is typically the way the APG works–don’t engage in public debate but like all vested interests covertly lobby ministers, members of parliament and senior officials. That lobbying would now be going on with the present five year Pharmacy Agreement to expire in June next year. The present agreement is worth over $10b or $2m each year for the 5000 or so community pharmacies in Australia

The APG like other powerful vested interests in the health field, the AMA, Medicines Australia and the Private Health Insurance Industry stand in the way of necessary reform. The public pays in higher prices and higher taxes.

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