40
Q
O
Dec
2018
Q&A
Opinions
Why the practice pharmacist model
needs a complete rethink
There’s too much at
stake for community
pharmacy, especially
in rural Australia.
Katie Stott
Small Pharmacy
Group steering
committee member
L
ITTLE to no consideration is
being given to the potential
impact of embedded
pharmacists on community
pharmacy in general, let alone in
rural areas.
Furthermore, there is no
evidence that a pharmacist located
in a GP surgery can deliver superior
health outcomes for patients than
a pharmacist working out of a
community pharmacy. This is
because the two models have not
been compared.
A pharmacist in a community
setting can (and does) perform
all the activities that have been
listed as services that might
be provided by an embedded
pharmacist, including medicine
reviews, medication management/
optimisation, post-discharge
reconciliation and deprescribing.
A pharmacist does not need to be
embedded in a medical practice to
provide these services.
The Small Pharmacies Group
(SPG), which represents owner-
operators of small pharmacies
across Australia, is particularly
concerned about how the
embedded pharmacist model will
affect the dynamics of clinical
service delivery in one-pharmacy
towns and rural areas, where there
are existing strong relationships
between community pharmacists
and local health professionals.
In such settings, community
pharmacies are playing an
important role — including
working closely with the GPs,
servicing patients living in aged
care (not just a supply role, but also
the delivery of clinical services)
and collaborating with Aboriginal
Health Services. In many cases,
pharmacies have been trying to
achieve even greater collaboration
— including semi-embedded
models of care — but have been
stymied by lack of financial
support for the staffing required.
GP practices in small
communities are often not large
enough to sustain a permanently
embedded pharmacist. In many
cases, there is no permanent GP,
and locum doctors service the
community. The community
pharmacy is often the only
healthcare setting where patients
see the same health professional
each time they visit.
For these patients and
communities, who have first-hand
experience of fragmentation of
care, it is far more important to
have a comprehensive pharmacy
service embedded in their
community. A local pharmacist
with local knowledge is far better
at holding together the local
healthcare team than having a
part-time visiting pharmacist —
or worse, a series of pharmacists
embedded in the GP practice for a
few days every month or so.
The potential for this model
to worsen the rural workforce
shortage in community pharmacy
has already been raised, but the
problem goes beyond this.
Both the PSA and the
government suggest that community
pharmacies can be contracted to
provide these services.
However, if community
pharmacy is placed in a position
where it must tender for these
services to GP surgeries, we are
likely to see a similar pattern as
happened with aged care — a race to
the bottom to provide the cheapest
service. How is this good for
community pharmacy or patients?
For small pharmacies operating
in remote areas, there is concern
that incentives will be used by
GP surgeries to attract fly-in
fly-out pharmacists who lack an
understanding of community
dynamics and needs, and are not
able to provide the same continuity
of care as the local community
pharmacy.
If an embedded pharmacist
takes over the role and duties of
the community pharmacist, there
is also real potential for this model
to affect the viability of community
pharmacy and lead to a deskilling
of community pharmacists. While
there might be enough medication
management problems to keep
all of us occupied, it does not
necessarily follow that there will be
enough money to fund this.
It just does not make sense
for a community to gain a
non-dispensing pharmacist if
it puts the local community
pharmacy at risk.
A better solution would be a
funding model that allows a local
community pharmacy to provide a
service to the local GP practice.
We are arguably in a better
position than a GP surgery to know
how best to utilise the skills of a
pharmacist as we have the existing
infrastructure and knowledge to
deliver what is needed.