Page 8 - Submission to the 2015-16 Federal Budget

Practice pharmacists have noted that being able
to access the patient’s medical file for a complete patient history enables meaningful, informed clinical interventions and enhances pharmacist–GP communication and collaboration.60,61 Full access by the pharmacist to the patient’s medical records is a necessity in order to provide optimal patient care.62
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.63,64
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 rely on remuneration from conducting Home Medicines Reviews (HMRs) to compensate for providing other unpaid services.65 However,
restrictive criteria of the HMR and Residential Medication Management Review (RMMR) programs create limited scope of services.
The absence of remuneration for practice pharmacist‐delivered services has been identified as the biggest hindrance to the advancement to this area of practice in Australia.66,67
As outlined above, there are opportunities in general practice for a non‐dispensing pharmacist to work with other members of the health care team to improve medication use and reduce error for 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, for example, 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),68,69 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. Many consumers with chronic diseases are missing out, and an opportunity to improve their health is being lost.
Proposed solution
PSA and the Australian Medical Association
(AMA) have developed a possible model which is outlined below. 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.70 It is suggested that the Australian Government funds a similar program for pharmacists. A Pharmacist Incentive Payment (PhIP) would support the cost of employing a pharmacist for the majority of general practices.
The PhIP would pay $25,000 per year per SWPE* 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 PhIP (see Box 3).
* The Standardised Whole Patient Equivalent (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. http://www.medicareaustralia.gov.au/provider/ incentives/pip/payment-formula/#N101B6
Box 2. Examples of ways in which pharmacists can assist within a general practice (non-exhaustive) 55,56:
Staff-directed services
• Sharing current drug information with doctors 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
• 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
• Documenting and follow up adverse drug events
• Optimising medication regimens
• Drug utilisation reviews (DURs)/Drug use evaluations (DUEs)
• Monitoring and advising on prescribing practices
8 Integratingpharmacistsintoprimarycareteams I©PharmaceuticalSocietyofAustraliaLtd.