MBS Item 900 - unique in the schedule, hailed the opportunity for General Practitioners to work directly with the pharmacists their patients see regularly and get paid for it.
The item also offers pharmacists the opportunity to expand their practice into the community and be reimbursed for cognitive services of home visiting referred patients and reporting medication related management problems to the GP with the patient's permission.
This medication management innovation has been established for more than three years. How is it all going?

As always with a re-engineering of practice both GPs and pharmacists have encountered challenges in implementation.
Off to a slow start the numbers of reviews conducted has steadily increased until now there are over 46,000 reviews that have been paid for by the Commonwealth.
Considering that a review conservatively will take 2-3 hours of GP, pharmacist and patient time there is much effort in the community actively engaged and related to a Quality Use of Medicines initiative.
Without an active evaluation, the results of this are difficult to ascertain except from an anecdotal evaluation.
Research done prior to the initiation of the model showed benefits enough to convince authorities of the necessity of implementing the model and using expertise in the community to address a problem born out of the more sophisticated drug therapies available to prescribers and their patients and the ability of patients to understand and manage complicated regimens along with the plethora of other OTC and complimentary medicines readily available and consumed.
Individual pharmacists and general practitioners will be aware of the benefits to their individual patients and several GPs have commented to me that they have 'learned a lot 'from their own involvement. Others have been honest enough to comment that the review did not add much to the knowledge they already had of the patient and yet others have been very wary when pharmacists have suggested medical management as opposed to medication management.
Refinement of the process and reporting to prescribers should occur as more reviews are conducted. Good results will encourage more GPs to refer patients for HMR and happy patients will talk to others.
A small study of GPs in two large metro areas indicated that GPs found the time taken to organise a referral made the MBS item not attractive and it generated a lot of paperwork - the scourge of GP-land, where there is already a mountain to address after each session.
The Item 900 also was introduced when several other Extended Primary Care items on the MBS were developed.
Pressure on GPs to implement these along with Item 900 proved too much for many, especially sole practitioners already worked to the bone!
There are solutions offered such as computer templates to address the referral writing and practice nurse education to take the burden of identification and paperwork off the GP.
In many places these initiatives have driven the process and patients have benefited as more HMRs are generated.
It has not all been plain sailing for pharmacists either.
The process of accreditation has proved very onerous for many - both in the time required after a busy day dispensing and the costs.
Many do not see a financial case with the volume of requests they are receiving at present.
Others have engaged others to do the reviews as a service to their customers and goodwill to see the initiative advance.
There is no doubt as to the benefit that the community will receive from an increasing implementation. Several hospital projects with outreach pharmacy services to discharge patients have integrated the HMR referral as a request to the GP on behalf of the patient.
On discharge, patients are rated according to a risk tool developed for the project.
Depending on this, initiatives such as a hospital pharmacist home visit or a letter to the patient's GP suggesting that an HMR would be worthwhile, are actively working to avert the many preventable hospital re-admissions that occur today.
There are other good initiatives in the pipeline to let it be known to the public of this service and many in Divisions of General Practice working with both pharmacists and GPs to ensure the tools, resources and knowledge is available when required.
Over all the results are magnificent - pharmacists are working with GPs as professional colleagues for the benefit of patients.
Many ancillary health workers are supportive and encouraging of the initiative and hospital staff are recognising a service available that will help patients cross the chasm between hospital and community that many fall into.
This is one of the most exciting steps forward health professions have taken together- if we all embrace the opportunities then the next three years progress could be astounding!