Some pharmacies may stop dispensing medicine under a radical overhaul undertaken by DHBs, writes Thomas Coughlan.
Community pharmacies have won a stay of execution over a plan to “unbundle” their twin roles of providing clinical advice and dispensing medicines, but have probably not won the war.
DHBs are still keen to progress work on the funding of community pharmacies with the aim of having some pharmacies that no longer dispense medicines, and even of having medication delivered directly to patients. But opposition to the plans from some pharmacists means the implementation of the policy may be years away.
Back-pedalling on unbundling
The way pharmacies dispense medicines is outlined in the Pharmacy Action Plan, an overarching plan for how pharmaceutical services are delivered, implemented in contracts that pharmacies sign with DHBs.
The national contract that community pharmacists enter into with DHBs outlines the services they will perform in return for DHB funding, projected to be $460 million next year.
The current national contract expired in July last year but negotiations to renew it stalled. The contract was extended by a year at first and then a further three months as pharmacies and DHBs struggled to reach agreement. That extension will expire in October and a new agreement will need to be reached before then.
A sticking point has been the “unbundling” of what are known as schedule 1 and schedule 2 services.
Schedule 1 is the dispensing of pharmaceuticals and schedule 2 covers professional advice given to patients by pharmacists.
The draft versions of the contract would have seen these two services broken up, with the result that some pharmacies would only be contracted to give clinical advice. The DHBs are also open to medicines in future being dispensed by courier direct to peoples’ homes.
After consulting with pharmacies, DHBs have back-pedalled on the decision to unbundle schedule 1 and 2 services.
Community pharmacies received an email late Friday afternoon advising them that the new contract would not unbundle schedule 1 and 2, but that work to eventually separate the services was ongoing.
One of the people leading the charge, Canterbury DHB executive director Carolyn Gullery, told Newsroom that the DHB would be developing a work plan as to how the schedules may be separated in future.
But she said pharmacies would never be completely rid of their mandate to dispense drugs.
“It will never be a completely pure model,” Gullery said.
“There’s always going to be those pharmaceuticals you need urgently, if you want your amoxycillin because you’ve got a chest infection, well you want it now.”
She said that there would always be cross-over and that pharmacies would not be forced to stop dispensing if they did not want to.
“All the pharmacies that want to… we weren’t trying to get everyone to do this,” Gullery said.
“It’s about saying here’s an opportunity for those who want to do it,” she said.
“If you’re not supplying product, who’s going to visit your pharmacy…?”
Gullery said separation might be advantageous for small remote pharmacies who could do away with the time-consuming packaging and dispensing of pharmaceuticals and focus instead on giving advice.
But some pharmacists contacted by Newsroom said anonymously they were concerned they may not have a say in whether or not they continued to provide schedule 1 and 2 services, given DHBs have the ultimate say over what gets funded.
Des Bailey of Selwyn Village Pharmacy in Christchurch was concerned.
“The medicine is associated with the advice, we don’t want to separate the two,” Bailey said.
“There are big risks involved,” he said.
He said it might have a big impact on community pharmacies’ businesses.
“If you’re not supplying product, who’s going to visit your pharmacy, you’re not going to come in for advice, are you?” he said.
Gullery said that unbundling schedule 1 and 2 would not happen within the first year of the new contract, meaning change could be as far away as 2020.