JULY,Edition # 29, 2001

EDITOR'S NOTE:
In our last edition, we introduced Allan Jelleff, a medical centre pharmacist without an approval number.
We, like Allan, are unable to agree with the logic of the Pharmacy Guild in the restriction of approval numbers to pharmacies located in medical centres.
In all circumstances similar to Allan's, particularly where there is an identified public need for access to Pharmaceutical Benefits, the Guild attitude is unconscionable.
More so, when the objective of the entire pharmacy profession is being directed towards closer professional interaction with the medical profession, and other allied health professionals, all being represented in the medical centre in which Allan practices.
Allan is deeply concerned about this problem and would be interested in talking privately with other pharmacists who may have been refused approval numbers, no matter where the location.
Any communication directed to Allan would be in the strictest confidence, and any pharmacist wishing to contact him can do so by e-mailing the editor at neilj@computachem.com.au , and we will give you Allan's contact details.
For those who did not view the first part of Allan's article, or would like to review it a second time, please click on this link.

We pick up the story, which is a commentary on an article we originally ran back in December, in edition #18 , and which initially involved an interview with Kos Sclavos, from the Queensland Pharmacy Guild. He was endeavouring to justify the Guild position in respect of medical centres.
The remarks under each "comment" heading are Allan Jelleff's.

[Computachem]
* Would doctors be bothered with dispensing medication in volume to conform to all legal requirements, or simply employ a pharmacist?

[KOs Sclavos]
Corporate doctor groups will look at anything that makes them money.
That is why they give their employee doctors patient targets to reach each day. That is why the large groups charge for medical detailers and pharmaceutical companies to visit their centres. (up to $50 for 15min visit)
That is why they make pharmacists subsidise their rent. (One of the big three doctor groups charges over $1000m2).
That is why they aggressively sell vaccines including flu vaccines. (They sell the flu vaccines to general patients even though they were supplied free of charge to give to pensioners under a national scheme)
That is why they vertically integrate with pathology and radiology services.
That is why they will amalgamate practices and are not concerned by loss of services in a whole area.
All the above cases are factual all have occurred on numerous occasions.

Comment
Shopping centre developers will do anything to make them money, and charge whatever they can squeeze out of the pharmacist, including rents at over $1000m2.
There is nothing to stop pharmacists walking away from these sharks except that the location restrictions force them to congregate in shopping centres.
The guild has promoted exemptions for these locations, so what is his point?
If pharmacists could relocate PBS numbers to these sites, they could insist as a part of their lease that no doctor dispensing occurs, reinstating the pharmacist as the dispenser of medications as well as working closely with health professionals in a professional environment.

[Computachem]
* Would a better tactic be to allow this to occur, and meet the challenge by, say, creating a "rider" on the approval number and having it offered to local pharmacists collectively first?

[KOs Sclavos]
Name your model and I will tell you the loophole.

I work in an unapproved pharmacy in a large Medical Centre that is privately owned, i.e. not corporate. The rent is nowhere remotely near $1000m2 and the owner is a highly respected and ethical doctor who sees the pharmacy as a necessary service.
The medical centre sees nearly 2000 patients per week so there is a real need for the supply of PBS subsidised medications to the acutely ill, the elderly, frail and those who rely on public transport.
It is adjacent to the district public hospital which has 56,000 attendances per year, 28,000 of which are emergency patients.
This hospital does not dispense any outpatient medications, so the patients leave with a script to fill, even from the emergency department.
Virtually all health professions are represented at the site, including physiotherapy, pathology, speech therapy, diabetes educator, dietitian, clinical psychologists and podiatry.
Specialists include ENT, general physicians, surgeons, dermatologists, urologists and cardiologists.
The one conspicuous exemption is a PBS approved pharmacy.
The nearest PBS approved pharmacy is located adjacent to another large medical centre nearly a kilometre from the hospital, across a major arterial road.
Large numbers of acutely ill, infirm, and elderly patients have to use taxis and public transport to obtain their prescriptions on their way home when it could be and should be available to them on-site.
This is an unnecessary and costly burden on this group.
Using the criteria in point two above, can the Guild tell me the loophole that makes relocating a PBS number into the existing pharmacy unacceptable, or such a huge problem that the entire brains trust of the Pharmacy Guild cannot overcome it?
To the readers, do you consider it appropriate to allow the relocation of a PBS approval number into the above site?

[Computachem]
* How long can the Guild oppose Medical Centre pharmacies, especially as the CoAG Working Group examining the NCP Pharmacy Regulation Review, has endorsed the Review recommendation and is supporting this to be possible from 1 July, 2001?

[KOs Sclavos]
The Guild/ Govt Agreement is between two parties. The agreement chose not to treat medical centre pharmacies any different than other pharmacies. The criteria rules were agreed to by both parties.

Comment
The agreement does treat pharmacies differently, so sorry, but this comment is misleading. There is an exemption to the 2km rule that allows PBS approval numbers to be relocated into the retail environment of a shopping centre.
The requirements for this were not too onerous for the Guild to develop.
Why won't the Guild allow PBS approval numbers to be relocated into the professional environment of a health centre?
The Wilkinson Report was clear in it's attack on the restrictions to relocations, and it's concerns for the withholding of competition of pharmacists, and it not being in the public's best interest.
The Government spent our money on this report, and received a range of arguments, including the Guild's.
The location and relocation rules are highly restrictive on our profession and pit pharmacist against pharmacist to bid for an artificially limited number of sites available.
They stop pharmacists relocating where they can be more commercially viable. They often force pharmacists to be tenants where freer rules (if any) would wrest the bargaining advantage that developers, including shopping centre developers, know they have, back to the pharmacist.
No other profession allows itself to be restricted to specific locations so that developers can force up rents in the knowledge that the pharmacist has no choice.
The absolute shame is the professions' own body instigated this, and rigidly defends and promotes it.
Ends
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