Page 11 - Federal Budget Submission 2016-17

Current challenges
The major documented obstacles to effective GP-pharmacist collaboration in Australia include geographical isolation, poor communication, lack of time and lack of remuneration.67,68
PSA is aware that there are currently approximately 26 pharmacists working
on average 18 hours per week within GP practices in Australia. The majority of these practitioners rely on remuneration from conducting Home Medicines Reviews (HMRs) to compensate for providing other unpaid services.69 However, restrictive criteria of the HMR and Residential Medication Management Review (RMMR) programs create limited scope of services and thereby potentially diminish beneficial outcomes. The absence of remuneration for practice pharmacist-delivered services has been identified as the biggest barrier to the advancement to this area of practice in Australia.70,71 This is despite the fact that over 200 pharmacists have registered their interest in working in this space already.
Proposed solution
As outlined above, there are opportunities in general practice for a pharmacist to work with other members of the health care team to improve medication use and reduce error in consumers with chronic disease. However, this is only possible in very limited circumstances due to existing arrangements and funding restrictions. Currently a GP can call on the specialist skills of a nurse, physiotherapist or psychologist to help them meet the needs of consumers with chronic disease under programs nationally funded through the Medicare Benefits Schedule (MBS),72,73 yet a pharmacist can’t easily be included in the practice team to review and advise on the consumer’s medicines regimen.
Given the central role of medicines in the care and treatment of consumers with chronic disease, this doesn’t make sense. Lots of consumers with chronic diseases are missing out, and an opportunity to improve their health is being lost.
Examples of ways in which pharmacists can assist within a general practice (non-exhaustive) 59,60:
Implementation of a Pharmacist in General Practice Incentive Program (PGPIP)
PSA have developed a possible remuneration model which is outlined below, and supported by independent analysis commissioned by the Australia Medical Association (AMA).74 The model
is based on the Practice Nurse Incentive Program (PNIP) which provides payments to general practices to support an expanded and enhanced role for nurses working in general practice.75 It is suggested that the Australian Government funds a similar program for pharmacists.
A Pharmacist in General Practice Incentive Program (PGPIP) would support the cost of employing a pharmacist for the majority of general practices.
The PGPIP would pay $25,000 per year per 1000 Standardised Whole Patient Equivalent (SWPE)a with a pharmacist working a minimum of 12 hours
40 minutes per week. Incentives would be capped at five per practice meaning that practices would be eligible to receive up to $125,000 per year to support their pharmacist workforce. A loading of up to 50% should apply for rural practices.
In line with the requirements for the PNIP, a practice must meet certain requirements to be eligible to receive the PGPIP (see box).
a. The SWPE value of a practice is the sum of the fractions of care provided to practice patients, weighted for the age and gender of each patient. The average full-time GP has a SWPE value of around 1000 SWPEs annually. www.medicareaustralia.gov.au/provider/incentives/pip/payment-formula/#N101B6
Federal Budget Submission 2016-17 I ©Pharmaceutical Society of Australia Ltd. 11
Staff-directed services, e.g.
• Sharing current drug information with physicians and practice staff
– Education sessions
– New evidence & therapeutic uses – New guidelines (summarized)
– Teaching students & registrars
– Patient education seminars
• Responding to medicine queries
– PBS queries
– Sourcing medications
– Specific medication concerns from GPs e.g. switching anticoagulants, antidepressants, opioid equivalence
– Questions about medication formulations
• Increasing practice efficiency and freeing up
GP time
– Providing seamless care with community pharmacists
– Prompt medication reviews and advice Patient-directed services, e.g.
• Providing in-practice referral based medicine reviews
• Private consultations for medication-based concerns for patients
• Documentation and patient follow up on adverse drug events
• Counselling on smoking cessation, lifestyle issues and medicine-based activities
• Assisting patients navigate the health system and medication changes between health settings
Practice based quality assurance activities, e.g.
• Documenting and follow up adverse drug events
• Optimising medication regimens
• Drug utilisation reviews (DURs)/Drug use evaluations (DUEs)
• Monitoring and advising on prescribing behaviours