‘Held hostage’: Grattan Institute calls for pharmacy overhaul

The influential Grattan Institute says essential services are being ‘held hostage’ by the Pharmacy Guild of Australia and is urging officials to carry out far-reaching policy reforms.
 
The highly critical new report from the independent thinktank is recommending sweeping change, including removing pharmacy location and ownership rules, allowing pharmacies in supermarkets, and injecting $80 million of Federal funding into helping pharmacists work within general practice.
 
Its policy document, ‘Future pharmacy: A better deal for patients and taxpayers’, also contains several pointed criticisms of the Guild, with authors saying it is willing to ‘weaponise’ trust to resist policies that would benefit patients.   
 
Examples include the changes to allow 60-day prescriptions, as well as previous moves to change location rules.
 
‘Pharmacy policy is too important to be controlled by a powerful lobby group,’ its authors wrote. 
 
‘But the Pharmacy Guild of Australia, which represents most pharmacy owners, is calling the shots.
 
‘The Guild negotiates funding and policy directly with the Federal Government.
 
‘Unlike almost any other country, Australia’s negotiations include no one else, and are based on almost no public evidence.’
 
The Grattan Institute called for an end to the Community Pharmacy Agreements negotiated with the Government – or, failing that, for pharmacists and patients to be part of negotiations.
 
It also advocated for an end to ‘backroom deals’, and more transparency with pharmacy dispensing fees, the removal of ‘arbitrary’ caps on MedsCheck, and for pharmacies to be allowed to discount medications.
 
While the report backs funding pharmacist prescribing for urinary tract infections, it recommends ‘rigorous national trials’ before expanding policies to allow prescribing for minor ailments, smoking cessation, and collaborative chronic disease management.
 
It comes as policymakers consider Pharmacy Board of Australia proposals to allow pharmacists to prescribe Schedule 8 medications and develop a national standard for pharmacist prescribing.
 
The Guild has signalled it will push back strongly on Grattan Institute proposals it says could ‘Americanise’ the healthcare system, but RACGP President Dr Michael Wright welcomes the thinktank’s findings.
 
‘This report highlights a number of issues within the pharmacy sector requiring greater transparency, and also ensuring future reform is delivered safely,’ he said. 
 
‘This is not about limiting access to care – it is about ensuring access to safe, evidence-based and connected care.
 
‘Australians deserve a healthcare system that delivers the best quality care for patients and the best possible value for taxpayers.
 
‘We can’t have lobbyist-led healthcare in Australia.’
 
The new report follows the release of a Sax Institute study, commissioned by the RACGP, which also raised concerns about the quality of evidence available for expanded pharmacy prescribing initiatives.
 
In addition, the Grattan Institute called for the Government to provide an $80 million boost for non-dispensing pharmacists to be embedded in general practices and Aboriginal Community Controlled Health Services.
 
It supports a joint call made by the RACGP and the Pharmaceutical Society of Australia last year, with the thinktank saying successful trials should encourage wider uptake.
 
‘The risk of low-value care is reduced by locating pharmacists within a clinic, rather than a shopfront,’ the authors write.
 
‘Typically, a patient would be referred to the pharmacist or explicitly make an appointment.
 
‘And integrated pharmacists do not have the conflicts of interest that come with a retail setting.’
 
Dr Wright strongly agrees.
 
‘The best patient outcomes occur when healthcare professionals work together as part of a coordinated team,’ he said.  
 
‘Integrating pharmacists within general practice supports medication safety, improves communication and helps patients receive more coordinated care.’
 
In response to the report, Simon Blacker, the Guild’s National Vice President, said the existing funding structure ‘recognises the full value pharmacies deliver to patients and the health system’.
 
He pointed towards the ‘broad range of services’ offered by pharmacies to the community.
 
‘Medicines are not ordinary retail products, and community pharmacies should continue to operate as healthcare providers first and foremost,’ he told newsGP.
 
‘Healthcare decisions must remain focused on patient needs and appropriate clinical governance – not shareholder returns.’
 
Mr Blacker also said the Guild has been ‘a leading advocate’ for cutting medication prices, including the reduction of the Pharmaceutical Benefits Schedule copayment to $25, which was introduced at the start of this year.
 
For Dr Wright, patient safety has to be the ‘overriding priority’ in any policy reforms.
 
‘Expanding healthcare services should be driven by evidence, appropriate governance and clear benefits for patients,’ he said.
 
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