The challenges of bush pharmacy

A couple of weeks ago I had the Pharmacy Guild of Australia President George Tambassis and the Guild’s Communication Manager Greg Turnbull travel with me in remote Western Australia. Here is George’s view of the trip originally published in the Guild newsletter “Forefront”.

ForefrontIf I had to choose three words to summarise my recent tour of pharmacy services in remote Aboriginal communities in Western Australia, they would be: educational, confronting, and inspiring.

The idea for the four-day tour arose when I bumped into my old university friend Andrew ‘Robbo’ Roberts, at the FIP international pharmacy conference in Thailand in September last year.

Robbo has been a remote pharmacist attached to the Ngaanyatjarra Health Service for the past ten years. The health service, with headquarters in Alice Springs, covers an area the size of Victoria, including 10 clinics equipped with drug rooms. All of the communities are actually in Western Australia, in the remote lands to the west of Alice Springs.

The catchment area includes about 2500 people – 90 per cent Aboriginal. Robbo’s job as a salaried pharmacist is to maintain the medicine stocks across the ten clinics, provide professional pharmacy services directly to patients at the clinics and in homes, and to provide medication continuity across the vast area.

For one thing, this means more driving than I imagined could be inserted into anybody’s workflow! On day one of my tour, Robbo picked me up at Alice Springs Airport, we stopped for a meeting with the CEO of the Health Service, James Lamerton, then drove 924 kilometres to Robbo’s home in the community at Jameson.

One of the key achievements I observed was Robbo’s organisation of the remote clinic medicine facilities – through an ‘imprest’ system he has devised. The purpose of this is to ensure that the medicine stocks at all of the clinics are the same, and fully replenished as needed. The stock comes through bulk supply under Section 100 of the National Health Act – medicines packed and supplied by community pharmacies in Alice Springs and Kalgoorlie.

Near Windborne Rocks

One area of concern for Robbo is the inability of pharmacists to claim Medical Benefits Schedule funds for services within his scope of practice and where no community pharmacy is available, while a nurse delivering the same service can make a claim. This is a vexed and longstanding issue, but I feel it is one that should be addressed in recognition of the primary health care role that can and should be played by pharmacists in remote parts of Australia.

What I saw on this brief visit was quite confronting in terms of living standards and cultural differences. It was a first-hand glimpse of why our society has found it so hard to bridge the gap in morbidity, mortality and education. The Third World conditions in which some people are living in these areas is quite disturbing. Health literacy is very poor and is reflected in adherence rates. I wish to sincerely thank the Ngaanyatjarra health Service for the work it is doing, and for allowing me to visit some of its clinics. I also pay my respects to Robbo for his commitment.

I was pleased to learn that some of the medicine shelving in the clinics was provided with the assistance of the Guild under the Fourth Community Pharmacy Agreement. I believe there is more we can do to assist, and as we work on the shape of the next Pharmacy Agreement we will look for opportunities to assist Aboriginal health, through rural and remote community pharmacies, and through services such as the one that employs Robbo.

A Future of Pharmacy – explanatory comments

Yesterday’s post attempted to show what would happen with pharmacy in urban Australia if the norms of remote Australia were implemented.

Allow me to make a few comments that may clarify some of the points I made yesterday.

• Some pharmacies do an outstanding effort with their S100 support funds. Some communities still do not access these funds. Some services I have heard of from health services around Australia are pretty poor.

• From personal experience I am aware of conflicting advice within boards in a number of areas. The Australian Pharmacy Council to their credit have a process looking at way legislation can impede pharmacists in rural and remote areas from providing care.

• At least one state health department has also been looking at how pharmacy/pharmacists can work better in rural areas.

• The current business rules contained within the November 2008 S100 Pharmacy support kit state:

“It should be noted that any Outstation/s that do not meet this definition, will not be included in the calculation of the Allowance.”

With more health services going to a hub and spoke model to give support to health staff, with nurses and GPs providing regular clinics and on call visits, with visiting physicians being funded under MSOAP to visit these small communities the Guild feel we don’t have a place in the care of these patients.

Unfortunately this seems to have resulted from a query I put to DoHA who then spoke to the Guild. When this appeared in the draft document I mealed DoHA an received this response.

“Whilst there is technically a requirement for a full-time Health Worker to be employed at each Outstation, it is the Department’s view is that if a valid State/Territory Poison Licence for each of these is in place, and there is a ‘fully functioning clinic and medicines’ room in which ‘S4 medicines’ are stored, this would be adequate as a minimum requirement.”

• If you care about indigenous health please remove all sharp objects from your reach before you read the submissions from our pharmacy bodies to the National Health and Hospital Reform Commission

• Despite hearing some months ago that Qld PSA would be employing someone to deal with rural and remote issues for PSA the job has yet to be advertised. The board at PSA national also needs a member whose role it is to bring the issues before the board.

The professional Programs and Services Advisory Committee (PPSAC) had alternative proposals to look at funding of pharmacists for remote health services rather than the S100 support service. . I can understand the Pharmacy Guild not liking it but what was the Pharmaceutical Society of Australia’s (PSA) position? There was no consultation that I am aware of.

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