The PBS system for medication delivery is costly and inconsistent with the needs of the community
The PBS system for medication delivery has been mostly unchanged over 50 years; it is costly and inconsistent with the needs of the community or pharmacists.
So the recent King Review into the pharmacy sector offers a once in a generation opportunity to totally re-imagine community pharmacy, and redesign the delivery of PBS medication and pharmacy services to patients.
The submission of Professional Pharmacists Australia, the professional association and union for non-owner community pharmacists, highlighted the tension between the profit motives of owners and the ethics of pharmacists.
While pharmacy remuneration should be around the quality use of medicines (QUM), currently too many owners were simply profit-focused, to the detriment of the taxpayer and the pharmacists doing the work, they said.
The time is ripe. The RACGP submission proposes an alternative to the current model of community pharmacy delivering PBS medications, one that focuses on payment for pharmacists for QUM outside the retail environment.
Under the RACGP model, dispensing and other fees associated with community pharmacy would be “cashed out” to support a general practice-based pharmacist to take responsibility for medication governance within the practice.
A central supplier would take on the role of drug storage and supply of drugs for non-urgent illness medication, rather than pharmacies as is now the case, and medication delivery would utilise IT and transport systems taking the drugs straight to the patient’s door.
Acute medications would be dispensed at the general practice – once again more convenient for patients – and the practice pharmacist ultimately responsible for medication governance within the practice.
This would include individual advice and education, but also population medication safety audits, problem identification and response to address medication issues. Broader services such as antimicrobial stewardship or managing drugs of dependency would be improved under this arrangement, offering a refreshing career structure for pharmacists based on professional issues and quality use of medication rather than sales.
Payments for pharmacy services would be facilitated by an improved Practice Payments scheme such as that proposed by the RACGP as part of the sustainable funding/medical home model.
We all have a responsibility to make health services more patient-focused, of higher quality, and be delivered in a more effective and efficient way, whether its via the MBS Review or the King Review.
The RACGP pharmacy proposal provides a medication delivery system for the future. One where pharmacists are recognised for their professional role, not their sales abilities.
Medication governance gives a far broader community pharmacy role and responsibilities, and one that we believe treasury and government would support.
The King Review should look at this seriously. We are all designing a health system for the future and this proposal has too many advantages to ignore.
Dr Evan Ackermann is chair of the RACGP Expert Committee on Quality Care