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THERE is something quite distasteful about the report from the Queensland parliamentary inquiry into pharmacy ownership and pharmacy scope of practice. Like a fungus on an orange, the sickly-sweet aroma of the report infers a deeper, more putrid process spreading across public health policy.
Despite numerous submissions supporting the deregulation of pharmacy ownership, including from Health Consumers Queensland (p 57-58), the committee elected to maintain ownership restrictions in line with the views of the Pharmacy Guild and the Pharmaceutical Society of Australia. This outcome requires examination and honest public debate; public health policy deserves to be supported by independent advice and direction and not influenced by commercial entities.
We all know that pharmacy is big business and the Pharmacy Guild represents this aspect of community pharmacy. Protected boundaries, protected ownership and support for care that is not evidence-based have not only resulted in increased costs, but stifled innovation and safety development in the community sector. In the government-commissioned Harper review of Australia’s competition laws and policy, recommendations were specific that the community pharmacy ownership and location rules should be removed in the long term interests of consumers. The recent Productivity Commission review regards the community pharmacy model “resistant to repeated calls for reform” and operating “at a significant cost to the nation”. It called for a fundamental policy shift from government and an abandonment of the current community pharmacy model.
So, how could the Queensland inquiry find the opposite view, that is, to continue protectionist practices rather than supporting innovation and consumer rights?
We are all familiar with the necessity to declare potential conflicts and biases when we present arguments to the public. We are all familiar with the adverse public health outcomes when government has a cosy relationship with industry – tobacco companies, the alcohol industry, the food industry, just to name a few. How is it that politicians in political inquiries do not reveal their conflicts with pharmacy?
The political donations of the Pharmacy Guild to the major political parties are well known, and it is a legitimate question to ask what influence these donations buy. Data on the Electoral Commission Queensland donor location map reveal that the Pharmacy Guild of Australia (Queensland Branch) has donated almost $43 000 to Queensland political parties this cycle; $11 000 of that happening on 23 August 2018 to the Australian Labor Party just after the commencement of public hearings for the Parliamentary inquiry.
It would be understandably difficult for people to have faith in politicians to form an independent analysis and view of pharmacy vaccination services, when the Chair (Aaron Harper MP) and Deputy Chair (Mark McArdle MP) of the Parliamentary inquiry have previously arranged with the Pharmacy Guild to appear in their publications to support those very services.
According to the Pharmacy Business Ownership Act 2001, (section 8) ownership restrictions are deemed necessary in order to:
(a) promote the professional, safe and competent provision of pharmacy services; and
(b) maintain public confidence in the pharmacy profession.
Any superficial examination of pharmacy in Queensland or Australia would find that current pharmacy models are failing to deal with drug safety issues with preventable adverse drug events. Pharmacy services that are not evidence-based are flourishing and are arguably exploitive of patients with low health literacy. Complementary therapies are now sold or routinely added to prescriptions by pharmacy-based software – a practice described by one pharmacist as “unscientific, anti-scientific, pseudoscientific and outright fraud”. Community shopper surveys indicate that the line between a pharmacist and a salesperson is often blurred – Choice’s 2017 pharmacy advice shadow shop found that almost one in three pharmacists recommended products that have “no evidence to demonstrate they work”.
If pharmacy ownership rules have any influence on professional safe and competent services, it clearly isn’t working at present.
The Queensland Parliamentary inquiry heard senior independent views from Professor Stephen Duckett, Director of the Health Program at the Grattan Institute, and from Dr Stephen King, a member of the Productivity Commission.
Dr King reported that rural patients were already paying too much for their medicines, the current ownership rules were ineffective, and that they fostered gaming of the pharmacy rules and lack of innovation.
Professor Duckett posited that many recent Australian reviews all recommended relaxation of pharmacy ownership rules because of the benefits of more efficient ownership.
Instead, the Committee’s decision on pharmacy ownership rules was informed by the testimony of the Pharmacy Guild and pharmacy owners. In making its decisions regarding pharmacy ownership, the committee found that “no reason for deregulation has been demonstrated”:
“After examining the evidence provided through submissions, in particular from pharmacy owners and the Pharmacy Guild of Australia during the public hearings, the committee assessed, on balance, that the objectives of the Act are best achieved by maintaining the restrictions on who may own a pharmacy business.” (p 63)
It seems to me that big business has prevailed at the expense of the health priorities. This is quite irresponsible at a public policy level, and an indictment on the integrity of the parliamentary inquiry process. Hopefully, the Queensland Government will not support the review findings.
Similar events are being played out at a federal level where the protection of pharmacy location rules has been described as a “protection racket”. Pharmacy Guild donations to both sides of politics has arguably cemented pharmacy location rules and protected business interests ahead of public policy.
At the recent conference of the Royal Australian College of General Practitioners, Greens Leader Richard Di Natale raised the inappropriateness of the influence of big business on health policy, and singled out the Pharmacy Guild and the need for more transparency in the way multibillion dollar pharmacy agreements are negotiated. Mr Di Natale also described the Pharmacy Guild as “the most powerful lobby group in Canberra,” but noted that they are powerful because politicians give them that power, by conceding it to them.
In short, we have a politically influential business group, being the sole negotiator with government for the multibillion-dollar Community Pharmacy agreements. This financially supports the community pharmacy model to provide PBS medications which the Productivity Commission notes is at significant cost to the nation. These agreements also fund pharmacy-based professional programs for which high level evidence states there is little or no public health benefit (here, here, here, here, here, here, here, here, and here).
The cost to taxpayers is significant. It is a valid question to ask, whether the relationship between the two major political parties and the Pharmacy Guild, supported by political donations, is compromising the public health benefit of appropriate pharmacy policy, and leading to unnecessary health expenditure.
It is time the influence of the Pharmacy Guild is fully exposed and consequences properly debated. Public health policy deserves to be supported by independent advice and not directed by business interests.
Dr Evan Ackermann is a GP on the Gold Coast. He has a long-term interest in safety and quality issues, and is immediate past Chair of RACGP Expert Committee Quality Care.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or MJA InSight unless that is so stated.
It can be viewed another way: [General Practice] models are failing to deal with drug safety issues with preventable adverse drug events. [GP} services that are not evidence-based are flourishing and are arguably exploitive of patients with low health literacy. Complementary therapies are now [prescribed by GPs} or routinely [recommended in addition to prescriptions] by [GPs]
Terms in parentheses are mine, substituted for the allegations leveled against pharmacists. They are no more or less supportable than the original content. If what is happening with GPs was to be so effective as to be unchallengable, one could possibly abide the unilateral criticism, but clearly GPs are no more effective than pharmacists in preventing iatrogenic harm, and as prescribers are far more likely to be the perpetrators where the origin lies. “When peering into the operations of pharmacy through a self-determined window, medical organisations such as the RACGP or AMA would be well-served to use the semi-reflective surface as an opportunity for some self-examination.”
It seems that the current retail model for pharmacy is unsustainable. Pharmacists are not feeling valued for their professional skills, and the physical process of dispensing is no longer such a skilled process, as virtually every medication is pre-packaged and the information for dispensing is computerised. In contrast, hospital pharmacists are employed for their knowledge and skills, not to sell products. It might be time to move pharmacists into community health rather than retail settings and use their skills for medication reviews and reconciliation, advice on choices and interactions, and instruction for patients.
Having said that, I don`t agree with Mr Cameron that pharmacists are substituting for GP services – their skills are complementary.
Pharmacists are extremely poorly paid.
They give out free advice all day long.
Relax ownership laws and let Chemist Wharehouse and supermarkets take over .
No more free advice, more GP visits.
Huge burden on the health system because the people who were getting free advice from pharmcists will now go to the GP.
GPs will be flooded and get paid for EVERY consult.
And have you forgotten about the AMA?
The Pharmacy Guild has been weak and spineless and watched as the profitability of pharmacies and subsequent wages have dropped year after year to the point where pharmacists are leaving the industry in droves because they can’t survive.
Rubbish article.
The majority of pharmacists are not pharmacy owners but still have to support the sale of CAMs, meet financially based KPIs and make up quotas set by their employer just to stay in a job, not to mention no chance of ever getting a pay rise. If it is true that Guild members do have money to give to political parties ( and I’m sure it is) they should be prepared for a backlash from their employee pharmacists the minute the doctor down the road wants to employ them for their clinical skills and at the same time offer them better and more professional working conditions.
Jarrod,
Ownership of only 1 pharmacy per pharmacist would minimise the risk of pseudoscience in pharmacy. It comes down to greed that we are in this situation. If pharmacist were paid via the nhs rather than the pbs for services provided it would make people trust the profession more.
The fact that we make money based on turnover rather than profession services frustrates me as a pharmacist. The fact that GPs are unwilling to share the workload with pharmacists regarding to dispensing OCPs and vaccinations yet will allow nurses to administer/prescribe seems counter productive and against public health benefits.
Just my thoughts
If Pharmacists were remunerated and paid well by the government, we wouldn’t have to sell the adjunct hock that we do. We are one of the lowest paying healthcare professionals. None of our services that we want to implement are subsidised and we get paid penuts to dispense scripts, which turns us into keyboard bashing monkeys because it’s the only way to profit and unfortunately it detracts from what we do. We don’t get paid For our time or our knowledge and unfortunately need to conform to selling … its what I want to do, believe me, I hate it. I feel so degraded by the profession. But without appropriate support and confidence instilled in us by higher authorities how are we expected to perform.
Jarrod McMaugh, a pharmacy owner in Coburg, PSA Victoria vice president. Interesting point of view!
Evan certainly has a strong opinion, but note the tactics he uses to attempt to make give his opinion more weight
I was making a list of each fallacious argument used, and I had 7 by the end of the third paragraph.
This is a theme with his articles… especially the use of Emotive Language, and Appeal to Anonymous Authority.
Readers should especially note that there are a lot of half-made claims that rely on an agreement from the reader to give them weight…. “We all know” etc. None of these types of comments are backed with evidence, but are held to be true by virtue to group think.
I remember a federal election a few cycles ago when deregulation of the pharmacy industry was mooted. I have it on very good authority, that mock election posters were drawn up saying “Don’t vote for this party, they are threatening your local independent pharmacist”. The threat was to distribute to every pharmacy in marginal seats.
Can a pharmacist explain to me how a pharmacist is allowed to own a medical clinic and employ doctors but not visa versa?
Sorry, NOS should read NPS
It was most interesting to note that no consumer Advocate was on this group. Consumers should be involved in the decision making at all levels of public health. As a Health Consumer Advocate myself, I find walking into a pharmacy with 50%of the shelves teeming with complementary products both confronting and disturbing. I live in a retirement village and am constantly amazed at the amount of these products being used by some of the residents. They tell me that the nice girl in the pharmacy said they would help their diabetes, osteoarthritis,rheumatoid Arthritis, etc.etc. They’ll gladly use all of them, but most still say they won’t take generic medicine. It’s a shame that the Quality Use of Medicines NOS funding was withdrawn from COTA . I was a volunteer peer educator during that campaign and it was most successful. Perhaps too successful as we encouraged participants to tell their gp about any complementary medicines they were taking in case they interfered with their legit. Medications,