National President’s Message: COVID-19 Update

1 April 2020

 

The past week has been tough for everyone. Tough for Australians who have lost their jobs. Tough for families who need to keep distance from their loved ones. Tough for pharmacists and their teams working extended hours with little rest to support the health needs of Australians. And I know that number of you already feel like you’re at breaking point.

 

I am so proud at how pharmacists everywhere are adapting, innovating and providing inspiration to their colleagues while caring for their community.

 

These are just some of the extraordinary measures pharmacists are undertaking to ensure they continue to provide a safe environment for them, their staff and the best healthcare for their communities.

 

As another week of unprecedented challenges looms, in today’s message I have detailed just some of the changes and issues that have arisen this past week.

 

Job Keeper announcement

 

The Prime Minister and Treasurer yesterday announced a once in a lifetime $130bn package to support the income of Australian employees during COVID-19.  At first glance, the majority of pharmacists and pharmacy staff would not be eligible for this payment as the businesses must have revenue projected to decline >30% year-on-year to be eligible.

 

The initial surge in demand for community pharmacy will mean it’s unlikely you might see a >30% decline in revenue. PSA is very conscious that this might change as the pandemic develops and there may be dips in revenue, particularly in discretionary front-of-pharmacy spending.

 

This will occur at a time when costs of providing essential pharmacist services to the community are significantly higher due to PPE, cleaning requirements and the need to adopt to alternative medicine delivery models.

 

PSA is engaging the Treasury and the ATO to see if there are some specific concessions which can be made for pharmacy. In all the daily conversations I have had with bureaucrats and elected officials, it’s clear the Government is very aware of the immense challenges pharmacists face and try to work towards access to measures which provide stability for pharmacists, their employers and most importantly the community during the COVID-19 pandemic.

 

Expanded Continued Dispensing during COVID-19: ensuring continuity of access to essential medicines.

 

The Health Minister this morning announced an expansion to Continued Dispensing – Emergency measures which will see Australians able to access any PBS/RPBS medicine (excluding S100 medicines) in an emergency without a prescription.

 

This is an extension of the funding arrangements announced earlier this year in response to the bushfire crisis. It is a measure that I have been in constant communication with the Government about over the past couple of months and I welcome this announcement.

 

In the past week, Western Australia, NSW, Victoria, South Australian, Tasmania and ACT governments have all moved to ensure continuity of access to medicines through expanded emergency supply provisions (for PBS and non-PBS medicines). I understand all other jurisdictions are also rapidly undertaking regulatory work needed to enable access to this initiative.

 

These measures provide sensible and pragmatic options to continue essential medicines if prescribers are unexpectedly unavailable or consumers are unexpectedly isolated at home.

 

It is vitally important the profession is judicious in their use of these provisions. Professional guidelines, state regulatory instruments and Continued Dispensing Program Rules govern the scope and limitations of this service. Patients can only access this initiative when it is impractical for them to access a prescription from their regular doctor – and they can only access each PBS/RPBS medicine once in a 12-month period via this initiative.

 

An Addendum to the Continued Dispensing Guidelines will shortly be published on PSA’s website, along with FAQs and other supporting resources.

 

Therapeutic Substitution

 

The Australian Government also announced today it will implement changes to allow pharmacists to substitute dose strengths or forms of medicines without prior approval from the prescribing doctor, if a medicine is unavailable at the time of dispensing.

 

The changes, which I have been working on with the Government and Department of Health over recent months, will allow a pharmacist to dispense different strengths of a product (such as two 20mg tablets in place of a 40mg tablet), or a different dose form of the same medicine (such as a capsule instead of a tablet).

 

Specific details have not yet been released, but the Commonwealth has advised the changes will be implemented through the Scheduling Policy Framework and Poisons Standard, with implementation by States and Territories and the Government through the TGA.

 

I strongly supports this announcement and will continue to work with the Government on this commitment and potential expansion of these substitution measures. I will provide guidance to members in my weekly messages to you on this common sense initiative as more information becomes available.

 

Infection control: Protecting yourself, your colleagues and your community

 

I’ve heard from many of you regarding your concerns on how to protect you and your colleagues from transmission of COVID-19 in your workplace.  This has seen many pharmacists work to develop changes to their work environments, including innovative adjustments to workflow, such as one way customer flow, limiting patient numbers in your pharmacy or closing premises for brief periods for cleaning and breaks.

 

Hand hygiene and social distancing remain the most significant protection against COVID-19, and as far as possible pharmacists should be working with their colleagues and patients to maintain these protections at all times.

 

As the influenza season approaches, concerns regarding how vaccinations can be safely administered by pharmacists during a phase of COVID-19 community transmission has increased.

 

At this stage, PSA’s advice remains that vaccination proceeds, but that pharmacists perform appropriate close contact measures such as measuring a surgical mask at least, along with using gloves and hand sanitiser. This includes not vaccinating anyone with fever or cold and flu like symptoms.

 

Limits on medicines

 

The introduction of these limits have been particularly difficult for pharmacists, particularly in the face of consumer aggression and abuse at imposing restrictions on the volumes of medicines they can access.

 

While some lines are starting to return towards normal stock levels with wholesalers, it is vital these limits continue to be enforced.  This will ensure our medicine supply chain will withstand the pressures thrown at it during the COVID-19 pandemic.

 

Where multiple months’ supply of medicines are requested, particularly by people who are self-isolating, pharmacists should encourage other options such as medicine delivery services.

 

Evidence requirements for supply of salbutamol as a Pharmacist Only Medicine

 

An amendment to the SUSMP last week provided legal backing to the announcement pharmacists require evidence of medical diagnosis of a respiratory condition or dispensing history for salbutamol MDI to legally supply salbutamol MDI as a Pharmacist Only Medicine (Schedule 3).

 

Members have reported this measure has been generally well received by those with long-standing conditions such as COPD, bronchiectasis and chronic asthma in providing confidence in being able to access vital medicines. I have also received reports about aggression and confusion from some people seeking salbutamol who were unaware of this change.

 

Anecdotally, members have reported to me that this evidence change has identified a large number of consumers who appear to be self-managing respiratory symptoms with salbutamol at a frequency suggestive of the need for medical review for an undiagnosed condition.

 

It is important these people receive an appropriate diagnosis and therapy in the early stages of the COVID-19 pandemic as we know COVID-19 infection outcomes for people with respiratory conditions are more severe than those for the general population.

 

FAQs and resources on this issue are available on the PSA COVID-19 website.

 

Immunisation Webinar – Covid-19: Your Immunisation Questions Answered.

 

I would like to thank so many of you for attending our COVID-19 webinar last Wednesday. We had more than 500 pharmacists attend the webinar and I would like to thank Associate Professor Charlotte Hespe who stood in for Professor Robert Booy.

 

You had some insightful questions that demonstrated the pressures that pharmacists have been under. And in response to your many questions about vaccination during COVID-19 with the upcoming influenza season, I will be running another webinar tomorrow night from 7.30pm to 8.30pm AEDT with Associate Professor Hespe on the topic of immunisations and how to vaccinate your patients safely.

 

I encourage you to register here and ask any questions you may have on immunisation and any other COVID-19 questions you are uncertain about.

 

Medicine reviews via telehealth

 

On Sunday, the Health Minister made strong announcements to support telehealth services, such as GP and psychology consultations, during the COVID-19 pandemic, declaring “As of tomorrow, we will have universal telehealth available in Australia and that “Everything which can be done by telehealth will be done by telehealth”.

 

I will continue to work with the Department of Health and the Minister for Health to ensure that medicine management programs are available to be delivered where appropriate by telehealth arrangements.

 

Now, more than ever, it is critical to minimise adverse drug outcomes in the community and aged care settings, to free hospital beds for the national response to COVID-19 and I will continue to work on this measure and keep you informed of progress.

 

Personal Protective Equipment (PPE)

 

I have been hearing from many members about the use of PPE. This includes everything from whether pharmacists and pharmacy staff should be routinely wearing PPE to how pharmacies can access PPE. These are important questions in a rapidly evolving environment and I’m keen to address these concerns as quickly as possible.

 

PSA is in the process of developing FAQs to complement existing primary care guidelines for pharmacist and pharmacy staff which will be published on the PSA COVID-19 microsite.

 

In the meantime, the Department of Health has issued interim guidance for the use of PPE, intended for practitioners in primary health care settings. Read the interim advice here.

 

To obtain PPE for your pharmacy from the National Medicines Stockpile, contact your local Primary Health Network. The contact details for all 31 PHNs can be accessed here.

 

PSA

 

Your PSA teams around the country are now predominantly in work-from-home arrangements; liaising with government agencies, supporting you on the phone, and developing resources which helps the profession to play its role in the pandemic response.

 

I am pleased this transition has been a smooth one and members continue to be able to access all member services.

 

Keep up to date

 

Our dedicated COVID-19 website is continually updated with the latest information that you need to be supported while you care for the community during the COVID-19 crisis.

 

Please contact our team or myself for support, feedback or inquiries you may have at membership@psa.org.au.

 

This is another pivotal week in Australia’s pandemic response.  One of the most important ways you can contribute to Australia’s response this week is to echo public health messages on social distancing to your patients: #StayatHome – if you are not buying essential supplies, working, exercising locally or seeking essential health care you must stay at home.

 

PSA anticipates further announcements which affect pharmacist care through this week. Your PSA will keep you up-to-date on these announcements as they happen.

 

Sincerely,

Associate Professor Chris Freeman
National President
Pharmaceutical Society of Australia