Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

I rise to speak on the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill 2011. The Commonwealth allocates considerable taxpayer funds for community pharmacy to provide timely access to medicines. The most recent pharmacy agreement will provide $15.4 billion over a five-year period to fulfil this important role in our health system. There are 5,000 community pharmacies across the country dispensing around one-quarter of a billion scripts a year. The coalition in government provided policy certainty and stability for community pharmacy. We support in principle the fifth agreement but will continue to consider carefully all legislative changes presented to this parliament.

The bill before us enacts the Continued Dispensing Initiative and the Medication Chart Initiative as included in the Fifth Community Pharmacy Agreement between the Commonwealth and the Pharmacy Guild. It also makes amendments to conditions for authority-required medications. The continued dispensing provision will allow pharmacists to supply pharmaceuticals without a prescription, however the eligible pharmaceutical items and the conditions of supply are not specified in this bill. Proposed section 89A subsection 3 states that the minister will determine the details by legislative instrument.

The then Health Minister, Hon. Nicola Roxon, said in her second reading speech that the measure will apply to oral hormonal contraceptives and lipid modifying agents. These two groups were chosen apparently because they are well tolerated and have a good safety profile. This is also reflected in the government's consultation paper issued in 2011. Importantly, the consultation paper does provide some more specific parameters and context for this particular initiative. It states:

The Continued Dispensing initiative will apply where a patient has run out, or is about to run out, of their essential continuous therapy medicine/s and does not have a valid prescription available.

The patient must be able to demonstrate they have been prescribed the medicine for at least a six month period and have been taking the medicine immediately prior to the request for continued dispensing.

The supply of increased maximum quantities based on an 'Authority Approval' will not be permitted.

… supply under this initiative cannot be utilised on consecutive occasions.

There will be no switching of medicines within the same class.

The department's briefing notes further clarify that patients must not have received the medicine by continued dispensing within the last 12 months. The department also states that the pharmacist must provide within 24 hours written communication to the most recent prescriber advising of the supply of the medicine to the consumer. It is important that the medical practitioner remains the principal care provider and is kept fully informed of patient treatment, especially when pharmaceuticals have been supplied under section 89A subsection 1 without a prescription.

The Australian health workforce, particularly the medical profession, continues to face shortages and maldistribution. Any change in scope of practice for a particular health profession must reflect the skills of those practitioners and not be a rash attempt to provide a second-best option for Australians otherwise unable to access treatment.

On the available information, the targeting of this provision to two common, well-tolerated medications, in combination with clear conditions and protocols, assists in addressing any issues regarding patient safety. However, the coalition's concern is that this detail was not contained within the legislation. It is a common practice of this government to defer considerable detail to delegated legislation, with the risk being the final instrument does not reflect an earlier intent. In this instance, we could not be sure that the legislative instruments would reflect the conditions stipulated in Minister Roxon's second reading speech—and Minister Roxon was notorious for this practice.

Whilst it would be preferable to have a copy of the draft legislative instrument, I do welcome the information that the current minister's office has provided on the proposed legislative instruments in response to the coalition's concerns. Nevertheless, there remains some unease that eligible pharmaceuticals and conditions may be changed into the future. However, such changes would have to be by legislative instrument and therefore subject to parliamentary scrutiny and disallowance.

The coalition will carefully consider any future changes in close consultation with all stakeholders, including the medical profession. The proposed continued dispensing initiative is intended to complement existing emergency supply provisions. The existing and proposed provisions assist patients to continue their treatment when presenting to pharmacies without a valid script.

The outcome of a Pharmacy Guild survey is contained in the government's consultation paper. Conducted in January 2009 and involving 2,000 guild member pharmacies, it found: firstly, approximately 67 per cent of pharmacies are presented more than five times a week with a situation where supply of a medicine is requested to be dispensed in the absence of a prescription in order to ensure continuity of therapy; secondly, that 43 per cent of respondents indicated the main reason given for such a request was difficulty with obtaining an immediate appointment with the prescriber; and, finally, approximately 64 per cent of the respondents considered that five or more patients attending their pharmacy per week may not be compliant because of difficulties with current emergency supply arrangements.

'Owing prescription' protocols already allow a pharmacist to supply a PBS medicine after contacting the patient's doctor by telephone. The doctor is required to provide the pharmacy with a prescription within seven days. The pharmacist will be able to continue to supply under the owing prescription protocols pharmaceuticals not covered by section 89A. It is argued that for well-tolerated medicines with a good safety profile and high volume supply, the continued dispensing provision will reduce the administrative burden associated with owing prescription procedures.

In addition, pharmacists can supply under emergency provisions without a script. Under state and territory regulations, this allows a three-day emergency supply of an essential medication. The medication is dispensed as a private item and the patient has to pay the full cost as opposed to just the PBS co-payment. It is argued that 'breaking' full packs to provide just three days' supply can lead to wastage for pharmacists and risks incorrect dosage. Also, it leaves patients out of pocket as they are not eligible for subsidies under the PBS and it only provides for a very limited supply. Despite these difficulties, it will also continue to be available in addition to the proposed continued dispensing regime. I also note that Minister Roxon gave an undertaking for a review after two years. The PBS statistics that are published annually should also contain information on the continued dispensing provisions. This is not reflected in the legislation. It is something the coalition would like to ensure does occur, and I will be addressing this further during consideration in detail. The coalition's proposal is consistent with the government's stated intent and should be facilitated by recording requirements contained in guidelines for pharmacists.

Guidelines for the continued dispensing of eligible prescription medicines by pharmacists have been developed by the Pharmaceutical Society of Australia. The purpose of the guidelines is to assist pharmacists to meet their professional responsibilities, exercise professional judgment in individual circumstances and manage risks associated with the continued dispensing of eligible prescribed medicines. The guidelines require an appropriate recording mechanism. They stipulate that information recorded by pharmacists should include: the date of the request for medicine supply without a valid prescription; consumer details such as name and address; the medicine requested, including strength, form and directions for use; the reason for the request; most recent prescriber and practice details; dispensing history; consumer history and clinical notes obtained during consultation; and details of any communication with other health professionals or providers and the prescriber. Therefore, according to the guidelines, sufficient data should be recorded and available to facilitate the publication of detailed statistics and an appropriate review of the measure's implementation and use.

More broadly, it is important in the context of this bill to understand the process by which medicines are subsidised and made available through the PBS. Minister Roxon said that continued dispensing would help prevent the interruption of treatment for patients prescribed eligible medicines and ensure they do not bear the financial burden of the full cost of those medicines. This was a reasonable position for the then minister to advocate. Unfortunately, though, Labor's actions, particularly over the last 12 months, have seriously jeopardised timely access to subsidised medicines for Australian patients. In fact, Labor's actions fell well short of their rhetoric.

There has been longstanding bipartisan support for an independent process of assessing which medicines should be subsidised by government. The Pharmaceutical Benefits Advisory Committee rigorously assesses medicines according to set criteria. A recommendation is then provided to the health minister. Until recently, the minister could list medicines costing less than $10 million in a given year. Cabinet considered medicines over $10 million. Almost without exception, previous governments listed medicines according to the advice of the PBAC. In February 2011, the government indefinitely deferred the listing of seven new medicines and a vaccine recommended by the PBAC due to the Commonwealth's 'fiscal circumstances'. This occurred just months after Minister Roxon signed a memorandum of understanding with Medicines Australia to provide policy stability in return for $1.9 billion in savings to the PBS. Minister Roxon promised that the MoU would provide:

… policy predictability to the industry for the next four years, cut red tape and speed up the addition of new medicines to the PBS.

But the ink was not even dry on the paper—in fact, it was only a matter of months—when Labor dishonoured this signed agreement, sent the sector into policy chaos and denied patient access to important medicines.

The government's decision to subject all PBAC recommendations to cabinet and refuse to list medicines based on the government's fiscal situation set a very dangerous precedent. For the first time, it subjected the listing of medicines to a political decision. After a Senate inquiry and considerable public pressure, the government eventually agreed in September last year to list medicines deferred in February. However, the government's announcement did not provide any greater certainty for the PBS listing process. The Gillard government announced on 30 September last year there would be further 'deferrals into the future' for new medicines being subsidised on the PBS. The government only committed to not deferring 'drugs that cost under $10 million a year for the coming year'. At this stage, we do not know which patients are going to be denied access in the future to their medicines and on what grounds. While we are considering an initiative today that is supposed to improve continuity of access to medicines, the government's broader pharmaceutical policy is causing uncertainty that may lead companies to reconsider the costly process of listing new medicines in Australia.

The pharmaceutical sector is also important for the health and wellbeing of our economy. Medicines Australia recently highlighted that the pharmaceutical sector in Australia had exports to the value of $3.7 billion in 2011. This is compared to $2.5 billion for the car industry and $2 billion in the wine industry. The Australian medicines industry is reported to have grown 1,200 per cent since 1990 and employs over 14,000 people. Constant changes to the listing process risk patient access to medicines and jeopardise a very important sector in our economy. The coalition renew our call for the Gillard government to rule out further deferrals and to subsidise new medicines according to the independent advice of the PBAC.

The second initiative in this bill will allow for the supply and claiming of pharmaceuticals based on a standardised medical chart in residential aged-care facilities. This measure has broad support, with the claim it will reduce the administrative burden in aged-care facilities and improve patient safety. The Australian Commission on Safety and Quality in Health Care has commenced development of a standardised chart, and further consultation is due to occur during 2012. According to the commission, the National Residential Medication Chart Project will develop standardised information fields and layouts. It will enable pharmaceutical supply and PBS claiming directly from the chart. It follows the development and implementation of the National Inpatient Medication Chart by health ministers in 2004 for use in public hospitals. This is also a standardised medical chart designed to improve patient safety and specifically intended for hospital use.

It is common for residential aged-care facilities to use the inpatient chart at present, but the commission has identified a number of potential problems. Aged-care facilities have differing medication management needs to hospitals, including but not restricted to the following: they have long-stay residents with chronic conditions and comorbidities rather than short-stay, unstable, acute-care patients; they have general practitioner rather than frequent specialist prescribing; medicine administration is not always conducted by registered nurses; PBS medicines require duplicate documentation unlike in public hospitals; and many ongoing and regular prescription medicines are delivered in prepackaged dose administration aids, which are prepared off-site rather than dispensed by a co-located pharmacy.

Whilst a separate standardised medication chart for aged care may still be a way off, it is appropriate that pharmaceuticals can be supplied and claimed for from the chart. Removing the need for a separate prescription is a simple and sensible way to reduce red tape for providers, staff, pharmacists and medical practitioners.

The third schedule of the bill addresses the minister's power in relation to conditions that must be satisfied for prescribing in certain circumstances. As outlined in the explanatory memorandum, this includes specifying different conditions, including maximum quantity and repeats for medicines with different uses. The schedule clarifies that determinations made under section 85A are a legislative instrument.

In conclusion, the coalition do not oppose this bill but we intend to ensure the government's assurances are honoured. Unfortunately, we know this government does not have a good recent history on keeping to its word. The Coalition will propose amendments to ensure that a review is conducted of continued dispensing and is publicly available after two years. We will also act to ensure annual statistics are published on pharmaceutical items supplied under this initiative. I do appreciate that the continued dispensing provision may be contentious. However, on the available information the current proposal in a number of ways is more limited than existing provisions and the coalition's amendments will allow genuine scrutiny of the implementation and operation of the measure.

The proposed conditions are appropriately restrictive and will be subject to further parliamentary scrutiny as disallowable instruments. An important condition is that there will be timely feedback to the prescribing medical practitioner within 24 hours to help maintain continuity of care for the patient. Whilst we do not oppose the initiatives in this bill, we will hold the government to its word through our amendments and we will examine in detail future legislative instruments.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

I speak in support of the National Health and Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill 2011. I had the privilege of being a delegate to the national conference of the ALP in December 2011 and there I heard one of the best speeches at that national conference by a minister in relation to the national platform. In an earlier address in November 2011, the then Minister for Health and Ageing, the Hon. Nicola Roxon, made this point:

As Australians there are many things about our society that define us.

She talked about four pillars of our society that Australians expect to be universal and available for all: health care, education, retirement benefits and social security. The shadow minister would be well advised to read that speech because it should form the basis of the coalition's policy at the next election. We should note that the shadow minister was very critical of the national health reforms, particularly in the areas of pharmaceuticals. Health and Hospital reform has been mentioned many times, and even today in his wide-ranging speech he was very critical of what we are doing.

Health care is of particular importance to the Australian community. Health expenditure increased to 9.4 per cent of Australia's GDP in 2009, according to the Australian Institute of Health and Welfare report Health expenditure Australia 2009-10. It highlighted the fact that this federal Labor government has contributed a record $52.9 billion to Australia's healthcare sector in 2009-10, representing an increase of $13 billion or over 32 per cent compared with the previous coalition government's contribution.

We have a record as a reforming government, and the legislation before the House today is in that particular vein—a reforming piece of legislation. In her second reading speech on 23 November 2011 about this bill, the then Minister for Health and Ageing said:

These initiatives represent another important step in improving services for Australian health consumers, and will bring pharmacists even closer to the centre of the Gillard Labor government's health reform agenda.

She talked about four pillars in her speech, as I said. She also talked about the healthcare pillar in her second reading speech on 23 November 2011. She said:

A pillar of these reforms is the $15.4 billion, five-year Fifth Community Pharmacy Agreement, particularly the clear role within it for pharmacists to improve professional practice and patient care.

We heard the shadow minister talk about this and he was quite critical of our position. But I am interested in what third parties have to say about the healthcare reforms of this federal Labor government, which have poured so much money into health care to make sure we have more doctors, nurses and less bureaucracy, less waste and shorter waiting times. That has been our agenda and that is why we have come to an agreement with the states through the COAG process.

On 24 November 2011, the Pharmacy Guild of Australia issued a press release supporting the legislation without amendment—and I note the shadow minister wants to make amendments to this legislation. The Pharmacy Guild urged parliament to pass this legislation as is and said:

The move towards continued dispensing medicines by pharmacists in defined circumstances will deliver better health outcomes for Australian consumers and should be supported by Federal Parliament.

... ... ...

The Pharmacy Guild of Australia fully supports the measure because it is in the best interests of health consumers.

Do not listen to the shadow minister, listen to the independent party, the Pharmacy Guild. And listen to the Australian Institute of Health and Welfare when it comes to what this government has invested in health funding for hospitals, which were sorely neglected when the now Leader of the Opposition ripped a billion dollars out of the healthcare sector when he was the minister. The Pharmacy Guild make this point in the press release:

Continued dispensing will provide an additional mechanism for patients to gain access to certain Pharmaceutical Benefits Scheme (PBS) medicines where a valid prescription is unavailable. This could apply, for example, in cases where a prescription has been lost and a doctor consultation is not readily available. Professional protocols will apply, so that quality and patient safety will not be compromised.

As the guild mentions, the measure applies to two particular items: oral hormonal contraceptives and lipid modifying agents used in the treatment of high cholesterol. The Pharmacy Guild—lest it be said that they want to take over the role of doctors—make this point in the press release:

Pharmacists value their close working relationships with general practitioners and specialists, and the Guild is confident that this limited measure will ensure optimal outcomes for patients without jeopardising relationships between pharmacists and doctors.

There will be a review in two years time. The shadow minister is accurate when he says that. In point of fact, there has been some criticism by the AMA in relation to this, as I understand it, but the truth is that this is an important measure.

Consumers will certainly benefit from these initiatives. They will benefit from the medication charts initiative. Doctors will have more time to spend on clinical care. There will be improved patient safety through a reduced risk of transcription errors, and there are a number of other benefits as well. We think this is important legislation. Particularly there are two initiatives funded through the Fifth Community Pharmacy Agreement, an agreement that the government came to with the pharmacists in this country. The two initiatives in this legislation are the 'supply and PBS claiming from a medication chart in residential aged-care facilities' and 'continued dispensing of PBS medicines in defined circumstances'. The initiatives boil down to one important principle: ensuring good health outcomes for all Australians. This bill is good for our country and it is good for the communities that I represent in Blair and South-east Queensland.

In particular, this bill addresses the needs of patients in regional and rural Australia, particularly those from disadvantaged backgrounds and those living in residential aged-care facilities. About 170,000 Australians live in residential aged-care facilities. We spend a lot of money on residential aged-care facilities. They take up about two-thirds of the aged-care funding in this country. We need to make sure that those facilities are safe and secure, well funded and well resourced, so that people can live good-quality lives with clear choices and dignity and respect in their older years.

I applaud the Department of Health and Ageing for its broad community consultation in relation to the two initiatives in this bill, because these initiatives focus on patients and they target areas of genuine need in the community. The continued dispensing of PBS medicines in defined circumstances would allow pharmacists to provide an urgent supply of a limited number of medicines, as I described earlier, for long-term therapy where a valid prescription is unavailable despite the best efforts of both patient and pharmacist. As I say, it is limited to oral contraceptives and some cholesterol reduction medications. This initiative promotes compliance with ongoing treatment of chronic conditions as well. The other initiative would introduce supply and claiming of PBS medicines from a medication chart in residential aged-care facilities. These initiatives are sensible, they are beneficial to patients and they strengthen the community pharmacies program. Community pharmacies are critical components of health care in our nation.

Reform does cost, but reform can be undertaken in a practical way that helps people. I have always had a keen interest in aged care. I was a lawyer for many aged-care facilities in Queensland and, for about 14 years before I was elected, I served on the board of an organisation that ran aged-care facilities throughout Queensland. Indeed, my family has, for three generations, been involved in aged care in the Ipswich area.

We need to make significant changes to not just manage but reform aged care, and I am looking forward to our response to the Productivity Commission report. In my electorate, the West Moreton-Oxley Medicare Local has identified out-of-hours care for older Australians—who will benefit so much by the legislation here, particularly those living in aged-care facilities—as a major area of concern. I want to draw to the attention of the House the work of this Medicare local and particularly its CEO, Vicki Poxon, who has overseen the implementation of programs which will help people in residential aged-care facilities.

It is a very challenging time in aged care across the country. Today I met with representatives from the HSU and United Voice to talk about the challenges for low-paid workers in the aged-care sector—carers, nurses and ENs. We want to make sure locally that the residential aged-care sector and these homes and facilities are dealt with—funding them appropriately and properly and making sure patient care is done. I think the legislation here will help do that, improving the health and welfare of our community and improving health outcomes for the people in my electorate.

We have seen a lot of changes in my electorate in health care from this reforming government—everything from GP superclinics to funding for the Ipswich General Hospital, to telehealth, to e-health. Our area is one of the sites that has been allocated for that, and work is being undertaken at the moment in that regard. We have seen two new Medicare locals. We have seen also a tremendous amount of resources being put into primary care, with doctors' surgeries getting all of this.

Sadly, those opposite have whinged, moaned, carped, griped and opposed initiative after initiative. It does not surprise me today to hear the moaning, whining and whinging of the shadow minister as they reluctantly support this bill with some amendments. But yet again they cannot bring themselves to acknowledge the great initiatives of this government. This legislation stands fully inside the matrix, the fabric, the framework, of this particular government, which is very committed to making sure of good health outcomes across the country and in the communities that I represent in Blair.

Ken Wyatt (Hasluck, Liberal Party) Share this | Link to this | Hansard source

I rise to support the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill 2011 and I welcome the proposed changes to the act. Let me assure the member for Blair that it is not a matter of carping or complaining. Rather, it gives us the opportunity to review and reconsider those elements that are extremely strong within this proposed amendment and the changes that will be implemented, and it gives us the opportunity to make adjustments so that we better service the community. Allowing the supply of pharmaceuticals without a prescription by a pharmacist is, under certain conditions, a constructive initiative and extends point of access for primary health care for those who have a need of those services. Every one of us has pockets in the electorate in which the levels of disadvantage or age or income are factors in the way in which people access or do not access medical services, in particular GPs.

When you talk to people it is apparent that they certainly trust their pharmacists. They are seen as a crucial point to which you can go and seek sound advice on a medical condition which, while without the opportunity that you would have with a medical practitioner, is nevertheless still valued. This is particularly relevant to families and individuals who struggle with the increasing cost of living and limited access to a doctor. I want to remind members that this change is desired by and highly beneficial to Australians living in regional, rural and remote areas of this country, and is certainly beneficial to the residents of my electorate in Hasluck. Sometimes we overlook and take for granted that there are avenues of access that are not always consistent across any region. The geographic diversity of this country is challenging for the way that we keep that continual supply of medicines, particularly prescribed medicines, to those with chronic conditions.

The enablement of the supply of pharmaceuticals by a pharmacist is welcomed and ensures compliance with regimes of prescribed treatment. There are some medications that if you stop them suddenly they have a detrimental effect. I am pleased that the government has put forward this amendment because it enables the continuity of compliance and the continuity of prevention of the onset of an illness beyond the point of damage which is consistent with a regime of treatment that holds the condition at bay and gives an individual quality of life. It also means that the constituents within my seat will now have better access to important medications that they require to improve or maintain their health service as opposed to breaking the cycle of continuity of their medication.

Eligible pharmaceuticals and the conditions for supply will be determined by the legislative instrument and allow for the supply of and PBS claiming of pharmaceuticals in residential aged-care facilities based on a standardised medical chart rather than requiring a doctor to write a separate prescription. This is particularly important given the shortage of general practitioners and doctors in rural and regional Australia and in some capital cities where the ratio of patients to practitioners is unacceptably high. This is particularly relevant to those residents in the Gosnells area of the seat of Hasluck. The result is there are patients who require medication for a chronic, ongoing health condition running out of prescribed medications and having to wait to see their local medical practitioner. In some areas of my electorate it can be several days before you can get to see your local doctor, and in this instance the 'jeopardisation' of the continuity of prescribed medication becomes problematic.

The bill enacts initiatives agreed between the Pharmacy Guild and the government in 2010 under the Fifth Community Pharmacy Agreement, which includes the continued dispensing initiative—which I again commend the government for—the medical chart initiative and the technical amendments regarding prescriptions for the supply of pharmaceutical benefits. The strength of the benefits is beneficial ultimately for some of the chronic therapy medicines and allows continual dispensing. Even though the intent of the bill is evident and the coalition is concerned that the specificity of detail is not in the legislation but conveyed through ministerial statements or upon advice from the department, having worked as a senior bureaucrat I know that the detail is often left to the regulatory framework that can follow this or, alternatively, to the guidelines that are established under which the administering pharmacist would provide medications. Nevertheless, it would have been good to know the details of the process that will enable the distribution of those pharmaceuticals and certainly to know what some of the restrictions may be, if there are any at all.

The Australian Medical Association is strongly opposed to continued dispensing. It has said that:

… the Bill in its current form would permit a significant change in the professional role of pharmacists that the AMA believes is not in the best interests of patients or the professional relationship between doctors and pharmacists.

I concur with their sentiment. Nevertheless, the intent is that we enable multiple points of access to the ongoing supply of prescription medications required for the medical treatment of any individual. Again, I go back to the point that the trust that exists for pharmacists is extremely high. For me, it is a good practical way of ensuring that the relationship with both the pharmacist and the medical practitioner is critical to the ongoing treatment and case management plans for patients.

Currently, there are mechanisms in place for continued dispensing to occur—the owing prescription protocols where a pharmacist can supply a PBS medicine after contacting the patient's doctor by phone and the script is provided within seven days. The issues for pharmacists include the administrative difficulty for pharmacists and the financial risks as PBS claims cannot be made if the script is not provided. Whilst it is a good stopgap measure, these new amendments now alleviate that and allow people to better access the ongoing care that they need without having to worry that the seven-day requirement will not be met because they have been unable to get in to see their local doctor. I know that within my own seat are people who have to wait up to 14 days to see their local GP. If they go, they go and get their script but are charged for a full consultation. Emergency supply provision under state and territory regulations allows a three-day emergency supply of essential medication, where it is not possible for the patient—

Debate interrupted.