Community pharmacy in Victoria (14.10.2014)

Written on the 15 October 2014

 

On 14 October, 2014 the Legal and Social Issues Legislation Committee tabled its report on the Inquiry into Community Pharmacy in Victoria. For an electronic copy and a video featuring Committee Chair, Georgie Crozier discussing the Report, please click here.

 

 

Ms CROZIER (Southern Metropolitan) presented report, including appendices, together with transcripts of evidence.

Laid on table.

Ordered that report be printed.

 

Ms CROZIER (Southern Metropolitan) -- I move:

That the Council take note of the report.

It gives me great pleasure to table and speak to the report by the Legal and Social Issues Legislation Committee on the inquiry into community pharmacy in Victoria. I would at the outset like to thank all those who made submissions to the inquiry and all those witnesses who came before the inquiry to give evidence. Their input and expertise in the various areas greatly assisted the committee with collating the report and providing recommendations.The committee has made 17 recommendations that support improved health care for the Victorian community. Like all jurisdictions, Victoria with its diverse population faces challenges within the health system to meet the demands of an ageing and growing population. This inquiry gave the committee the opportunity to review the role of the community pharmacy, otherwise known as the chemist, across Victoria.

Community pharmacies are an integral component of our health system and exist in almost all suburbs, towns and shopping strips throughout Victoria.

As mentioned, we know our population is ageing. As people are living longer the prevalence and incidence of chronic diseases such as diabetes, heart disease, mental illness, cancer and arthritis are also increasing. Many of these conditions require complex medication regimes together with lifestyle advice and education, and constant monitoring.

Pharmacists are a highly educated and professional group of individuals. The committee heard that one area of their expertise is dispensing of medications. Yet evidence to the committee suggested that medication-related hospital admissions are estimated to comprise 2 to 3 per cent of all Australian hospital admissions. These readmissions are extremely costly to our health system, with an estimate of around $320 million per year to Victoria. In many instances these readmissions can be completely unavoidable and are particularly relevant to elderly patients.

Medication reviews by pharmacists are a service that should be further expanded within Victoria. A submission from Eastern Melbourne Medicare Local backs up this view. Page 24 of the report states:

 

    . . . GPs have a positive attitude towards medication reviews, believing that pharmacists' greater knowledge of pharmacology, dosage forms, adverse drug effects and drug interactions are an asset in helping to improve patient safety.

 

Our emergency departments across the state provide excellent and high quality care to thousands of Victorians who require immediate emergency attention. At times, however, our emergency departments are also required to provide treatment and advice for ailments that are not acute or do not require immediate attention and could better be addressed in another primary health care setting such as at a GP's surgery or even at a pharmacy.

In addition the committee heard evidence suggesting that pharmacists following proper and appropriate training can play a greater role in a number of other preventative health areas such as providing a cost-effective influenza immunisation service for adults. This is already being done in a number of international jurisdictions, and an adult-only influenza immunisation trial is soon to be complete in Queensland.

Likewise evidence to the committee suggested pharmacists could play a greater role working with GPs by providing a triage service for minor ailments before referring on to the appropriate health professional; or, if no prescription were required, treating and offering advice for future management -- for example, in the event of minor abrasions and injuries.

The inquiry also looked at the area of pharmacotherapy. In Victoria around 37 per cent of pharmacies in Victoria offer pharmacotherapy services for opioid dependency. As more areas across Victoria are being affected by opioid drug abuse, the need for pharmacotherapy services needs also to be expanded.

Finally, the committee heard evidence suggesting that pharmacists receive funding from a variety of sources. However, despite them providing a service to patients, they do not have a Medicare number and cannot seek reimbursement through private health insurance.

The committee believes that in future pharmacy agreement negotiations with the commonwealth government this area could be reviewed.

As this is the final report to be tabled by a Legislative Council standing committee in the 57th Parliament, I conclude by thanking the staff for assisting the committee, including Mr Richard Willis, Mr Keir Delaney and Ms Sarah Hyslop, and my colleagues, some of whom have been with the committee from the outset. I particularly thank Mr Shaun Leane, who has substituted for Mr Matt Viney as deputy chair. We are very pleased to see Mr Viney back in the house today. I also thank Mr David O'Brien, Mrs Amanda Millar, Mr Andrew Elsbury, Mr Nazih Elasmar, Ms Colleen Hartland, Ms Jenny Mikakos and Ms Marg Lewis for their valuable contributions.

 

Mr LEANE (Eastern Metropolitan) -- I congratulate everyone who was involved in preparing this committee report.

At the start of my involvement the cynic in me said this reference might have been given just to keep a committee busy so that we would not have to do general business on Wednesday nights, but I have to say that with the end result the cynic in me was proved wrong. There are some very good recommendations for a future government to embrace about how pharmacies can assist in taking the load off the health system. I also thank the committee chair and all the other committee members for giving me time to catch up on their work and the opportunity to fill the shoes of a great man, Mr Matt Viney.Mr D. R. J. O'BRIEN (Western Victoria) -- I too would like to follow on from the remarks made by the chair and the deputy chair of the Legal and Social Issues Legislation Committee. I thank the pharmacists and other submitters who provided an excellent source of evidence to the committee, from which we can again provide a bipartisan report.

I thank the other members of the committee, particularly Mr Viney, and I join all members of the house in wishing him all the best and a fulfilling day today. I would also like to thank the committee secretariat: Keir Delaney and Sarah Hyslop -- and Richard Willis before he went on to other duties.

In following the contribution made by the chair, Ms Crozier, it is important to recognise that the committee made important bipartisan recommendations relating to an expansion of community pharmacy roles. The committee also emphasised that GPs should remain the centre of primary care in Victoria. Some of the recommendations in the report seek to expand the role in a very careful manner, particularly recommendation 1, by which the committee recommends that a step towards a trial in pharmacy-administered vaccinations be supported in Victoria. However, the committee considers that any expansion of the community pharmacy role should be undertaken carefully and incrementally. With those comments, I commend the committee on its work, and I commend the report to the house.

 

Ms HARTLAND (Western Metropolitan) -- I want to add a few words on this report. My voice is going so I will not go on for long. One of the aspects of the report on which I think we did some very good work was the issue of methadone dispensing. We came away from the committee with a much better understanding about how that works, the issues for pharmacists and the need for more pharmacists to be methadone dispensers. There is also the fact that it is some 30 years since they have had an increase in the amount of money they receive to dispense methadone.

The other interesting subject we touched on came as a result of submissions from various women's health groups about the issue, especially for rural women, of not being able to access emergency contraception when a pharmacist has a religious or philosophical objection to dispensing those medicines. That makes it very difficult for women in the country. There is also the issue of chemists who refuse to dispense contraception.

We touched on some very interesting subjects and the committee report outlines those things very well. I also thank the chair of the committee, the other members involved and all the committee staff.

 

Mrs MILLAR (Northern Victoria) -- I am pleased to make a brief statement on the Legal and Social Issues Legislation Committee inquiry into community pharmacy in Victoria. Can I firstly say what an outstanding process this inquiry has been. It gave us an opportunity to recognise and consider broadening the role of one of the most respected groups of professionals in our state -- namely, pharmacists. The 29 submissions received were of the highest calibre, and I thank those who submitted and gave evidence to the inquiry. Victoria's 6985 registered pharmacists play a vital role in health services in Victoria with the provision of trusted health advice and services. This is reflected in their consistent standing as one of the most trusted professions in the state -- a fact which was reflected in the evidence given to the committee.

I especially highlight the importance of the role played by pharmacists in regional communities. This was an aspect which I certainly emphasised in the inquiry and it was noted as significant in the final report. Many regional communities face barriers in accessing GPs and other health practitioners, and in this context the presence of a local or community pharmacist is critical.

Often they are the first source of advice sought by members of that community.

The 17 recommendations in the report offer the opportunity for a number of improvements to be made in primary and preventative health. In particular the opportunity to trial a limited vaccination program for adults and the consideration of expanding evidence-based chronic disease screening programs are very significant. The recommendations also consider important improvements to the significant issue of medication mismanagement.

I thank the other committee members most especially the chair, Georgie Crozier -- also Nazih Elasmar, Andrew Elsbury, Colleen Hartland, Shaun Leane, Margaret Lewis, David O'Brien and Matt Viney. I especially thank the very dedicated parliamentary committee staff members Keir Delaney and Sarah Hyslop who did a most superb job on the report which has been produced by the committee.

 

Ms LEWIS (Northern Victoria) -- I would like to add my thanks to the people on the committee especially our chair, who did an excellent job, and my fellow committee members. Some of the very important points we worked on in this area have been covered by Ms Hartland. Of particular interest to me were the issues for rural and regional people and the access they have to pharmacies, and the issue for women of access to emergency contraception. I thank our support people, Keir and Sarah.

 

Mr ELSBURY (Western Metropolitan) -- I join with my colleagues in speaking to the Legal and Social Issues Legislation Committee report on its inquiry into community pharmacy. Even though the first meeting was a bit rocky we were able to band together, have a look at what was going on in the sector and bring about a great report, which highlights some of the advantages that can be achieved by utilising pharmacies a lot better than we do currently. I commend my fellow committee members.

I also thank the staff, Sarah Hyslop, Keir Delaney and Richard Willis, for the work they put into the report, because without them collecting all the data, collating all of the submissions and, in some instances, explaining to some of the slower of us, like me, what certain terms meant, we would not have achieved the great result we have.

It is clear from the committee's report that there is scope for expanding the role of community pharmacies in the delivery of health services. This is especially the case for remote and regional settings where access to doctors may be limited. A cautious approach is being sought, but the value of allowing community pharmacies to assist in the management of health needs cannot be ignored. Pharmacists are highly trained and have a vast knowledge base of the medicines and treatments available. Pharmacists regularly work with doctors to assist patients to manage their medication, and as part of a managed treatment program this can benefit patients in their health care.

This has been a great opportunity to learn a bit more about the sector and to provide the Parliament with a greater knowledge base on what we can do with community pharmacies now and into the future.Mr ELASMAR (Northern Metropolitan) -- I rise to speak on the Legal and Social Issues Legislation Committee inquiry into community pharmacy in Victoria. I thank the chair, Ms Crozier, and other members of the committee as well as the committee's executive officer and staff for their professional commitment to and enthusiasm for the conduct of the inquiry.

The committee believes that community pharmacists already operate at the front line of primary and preventive health care and are a highly regarded and trusted group of healthcare professionals.

The committee believes that an expanded role for community pharmacists could be beneficial to the primary and preventive health of Victorians and be particularly useful in rural and regional areas where access to GPs can be more challenging for Victorians.

Key recommendations in the report include the establishment of a trial involving pharmacists providing influenza immunisations. The accessibility of pharmacies can contribute to a greater take-up of immunisations thus making a valuable contribution to preventative health care.

In conclusion, while the report is supportive of some expansion of community pharmacy, the committee emphasises that GPs must remain at the centre of primary care. Furthermore, any expansion must be evidence based and undertaken only with the necessary training, protocols and physical infrastructure in place.

 

Motion agreed to.

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