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

I rise to continue my remarks in this debate. In my arguments for support of the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill 2011, what I had previously covered was accessibility to the continuation of medical treatment. The second tranche of the bill allows for the supply and claiming of pharmaceuticals based on the standardised medical chart in residential aged-care facilities. I support this initiative because it reduces the administrative burden on medical practitioners and improves patient safety. Often within certain locations across Western Australia, and certainly across Australia, GPs are not readily available for those who are in aged-care facilities. This bill enables continuity of medication. It also enables nursing staff to ensure continuity of treatment. I think access to pharmacies is an important development given the way in which points of access to health care have become necessary. Pharmacies are certainly a first point of reference for many people and there is a high degree of trust. If you look at some of the surveys about whom people in society trust, pharmacies and pharmacists certainly sit high in that consideration.

In Hasluck, the bill's proposed changes will enhance care arrangements for constituents within aged-care facilities. For example, there is Amaroo Village in Gosnells, where over 150 people will benefit directly from this initiative. This centre is located in the community of Gosnells. I know from my visits to this particular centre and from talking with David Fenwick, the CEO, that this would be a very welcome initiative. Equally, taking Morrison Lodge in Midland, again there is a number of people who will benefit from this change. They take comfort in knowing that the continuity of medications will be something they do not have to worry about. That reduces anxiety. In Parry Hostel in Lesmurdie there are 40 residents who will benefit. In the Jeremiah Donovan House in Forrestfield, where there are over 50 residents, all of them will take a high degree of comfort from knowing they have that continuity of care.

The coalition's proposed amendments will bring the bill into line with the minister's statements and the government's commitments, and they are consistent with the government's stated intent. The coalition is not opposed to the bill but does intend to ensure the Commonwealth assurances are honoured.

The amendments proposed firstly require the publication of annual statistics on pharmaceuticals supplied without a prescription as allowed under proposed section 89A(1). They secondly require a review of proposed section 89A two years from commencement and that it be tabled in the parliament within six months of the required review date. I think both of these amendments are commendable as they allow those of us who have a role within our electorates to advocate to have a sense of the level of dispensation processes occurring within the community. It also may highlight the particular needs around primary healthcare services provided at certain points. Certainly within my electorate I would be interested to look at the trends in the review based on the data. That will show trending that will be important in the way in which we consider whether there should be future amendments to the legislation. I think it is beholden on us within this House to ensure that access to primary health care and to the pharmaceutical benefits that are there for all Australians both are consistent and alleviate anxiety that occurs.

I have a constituent who is anxious that, when his prescription comes towards the end of its time, his carer is sometimes not available to take him to the pharmacy or, more importantly, to his local GP. The other issue he raised is that sometimes he forgets when the prescription is due and when he rings his GP he cannot get in because of the waiting list and so he forgoes his medication. This measure ensures that he will be able to go to his pharmacy with his carer and access medication based on the regime of treatment that has become standard for him and the new arrangements will enable the pharmacist to ensure continuity of dispensation and treatment occurs.

I acknowledge the government's reform in this area and I commend the bill to the House. I endorse the intent of the bill and the consequences that it will have for constituents within Hasluck and for all Australians who require continuity of medicines and medical treatment.

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

I also rise to support the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill 2011. I think that the Australian public, almost to a person, supports our Pharmaceutical Benefits Scheme, the PBS, and the subsidisation of certain medicines for those who really need them but may not be able to afford them. The Pharmaceutical Benefits Scheme is one of the cornerstones of our modern, world-class health system—a system that now has a bright future due to the reforms of this Labor government.

We saw last year an unprecedented alignment of the states and the Commonwealth with the National Health Reform Agreement, with some $20 billion in additional Commonwealth funding committed over this decade to cut elective surgery waiting times and fund growth in the health and hospital budgets across our nation. One of the central elements to modern healthcare delivery in this country is the maximisation of the healthcare outcomes the public receive for the tax dollars that fund the health system. With all players coming to the table and reaching an agreement, as we saw under the leadership of the Prime Minister last year, we are minimising waste and maximising the health benefits that come from the amount of taxation revenue that is channelled into the health system that Australians love and rely on so much.

Health is clearly an area of public policy where the public sees best management, minimal waste and best outcomes for the Australian public. Wringing out every healthcare service and outcome possible for the money that is put into the system is an ongoing theme of this government through negotiations with the states in the running of hospitals and negotiations with the Pharmacy Guild of Australia in the development of successive community pharmacy agreements for the delivery of the PBS.

The Community Pharmacy Agreement is central to the operation of the PBS. It is a fundamental part of the operation of the PBS and the dispensing of medicines across Australia at a reasonable cost to the public as a whole. Negotiations between parties to the Community Pharmacy Agreement always strive to achieve the best outcomes for those with health issues at the most affordable cost to the Australian taxpayer. It is very pleasing and reassuring to see that the agreement is not just a deal reached between a funding body and those who implement a part of it. It is not just between the government or the Department of Health and Ageing and the Pharmacy Guild of Australia. This Fifth Community Pharmacy Agreement was also open, in a sense, to the public through the Consumers Health Forum. The department conducted a broad public consultation process in early 2011 about the initiatives, aided by Medicare Australia and the Pharmacy Guild of Australia. This is nothing new. There was excellent consultation carried out in the development of the Community Pharmacy Agreement as a whole. The Pharmacy Guild of Australia has an account of the initial scepticism of the Consumers Health Forum toward the fifth agreement turning to uncompromised praise. According to the Pharmacy Guild of Australia website, in May 2010 the Consumers Health Forum wrote:

CHF welcomes the final version of the Fifth CPA. For the first time in the history of Community Pharmacy Agreements, the views of consumers were specifically sought, and some of their concerns appear to have been taken into account in the final version of the Agreement. The Patient Service Charter is particularly welcome.

This feedback was to the process up to the point of the signing of the agreement in the early part of 2010.

As I have said, community input was also sought in the development of the programs which make up this bill. They were developed, at least in part, subsequent to the signing of the agreement and were commented on by the public in their development toward this legislation and a better functioning system and superior health outcomes.

It is in pursuit of superior outcomes—the best health outcomes for those who rely on prescription pharmaceuticals—that the government has introduced the bill before us. This bill will improve the continued supply of medicines to those who need them, improve the treatment people receive by use of the medicines in certain situations where gaining access to a GP to request a new prescription puts the continuance of supply and treatment at risk. The changes are about better access to medicines, better ongoing treatment for conditions and, consequently, better patient health outcomes. The beneficiaries of these changes are those in our communities with chronic conditions requiring ongoing treatment and residents of nursing homes.

The situations in which these changes will apply are not broad. There are basically two situations, and the changes are delivered by two programs. The Continued Dispensing of PBS Medicines in Defined Circumstances program will assist those with ongoing, chronic conditions and an ongoing need for prescription medicines who have already had a prescription, where the issuing of yet another prescription cannot be arranged but would have been a formality. Only people being issued with oral hormonal contraceptives for systemic use and lipid-modifying agents used in the treatment of high cholesterol will be covered by the program. Additional pharmaceuticals will be considered for inclusion within the program in two years time.

The second situation and the second program are to do with the needs of residents of nursing homes. The Supply and PBS Claiming from a Medication Chart in Residential Aged Care Facilities program will have the ongoing administration of medicines managed through the resident's, or patient's, medical chart, more akin to the administration of prescribed medicines within a hospital setting. The course of treatment is set by the doctor and implemented by other staff. The treatment is ongoing until staff are told otherwise.

Again, the changes are about enabling better access to medicines when they are needed, better adherence to the required administration of those medicines and a superior benefit from the treatment that patients require. These implementation dates were agreed to by the government and the Pharmacy Guild of Australia as a part of the fifth agreement negotiations and have been publicly announced. Both initiatives are scheduled to commence on 1 July 2012. I commend the bill to the House.

Bob Baldwin (Paterson, Liberal Party, Shadow Minister for Tourism) Share this | Link to this | Hansard source

I rise today to address the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill 2011. This bill has the potential to help a vast array of patients right across my electorate of Paterson. However, it is critical that patient care is the utmost consideration. Any additional powers given to pharmacists must be carefully capped, reviewed and assessed.

This bill has two important functions. Firstly, it will allow pharmacists to supply medicines without prescription under certain circumstances. Those require the patient to have been prescribed the medicine for at least six months. The patient must also be taking the medicine immediately prior to requesting a continued supply from their pharmacist. Secondly, the bill will allow residents of an aged-care facility to access their medication, based on a standardised medical chart. They will also be able to claim their rebate directly, for those medicines on the Pharmaceutical Benefits Scheme. This move is supported by the Australian Medical Association, as it is hoped to cut red tape for doctors and other health professionals.

For my electorate of Paterson, the latter is particularly significant, as we have the fourth-highest median age in the country. Australian Bureau of Statistics data shows that the median age for Paterson residents in June 2009 was 42.6, compared with a national average of 36.8. That figure continues to grow higher in our region, which is attractive to retirees thanks to its proximity to Sydney, beaches, recreational facilities and more. It is actually the perfect sea-change, tree-change environment for people to retire to. The rising median age also means that many of the doctors in Paterson are retiring themselves, and services cannot always be duplicated straightaway.

Many rural and regional areas across Australia are also dealing with doctor shortages. As the ABC detailed on 21 November 2011:

GP Access says more doctors are choosing to work fewer hours which is adding to the critical doctor shortage in the Hunter.

A senate inquiry has been set up to look at the factors affecting the supply of health services and medical professionals in rural areas.

GP Access Practice Workforce officer Jenni Scott says historically, doctors used to work around the clock to tend to patients.

But she says that is now a thing of the past.

"The work life balance that's permeating all workforce scenarios is the same in general practice," she said.

"Doctors going into the practice want to go to work, do their work but also go home and be with their families or do other things that are part and parcel of life these days."

The role of new 'Medicare Locals' organisations like the Hunter's GP Access will come under scrutiny as part of the senate inquiry.

Ms Scott says the doctor to patient ratio in some areas is very concerning.

"The preferred GP population ratio usually quoted as approximately 1:1100 or 1:1200," she said

"But the relevant ratio for some of our smaller communities is usually 1:2000.

It goes without saying that mechanisms like this, which can reduce the pressure on waiting times and costs to constituents and the government alike for simple consultations like those for repeat scripts, could have a positive impact.

In my electorate office I receive quite a number of complaints from people who go to the doctor simply for a repeat script to be issued but are charged $50 to $60 for something that takes but moments. There are some doctors who simply run it through a bulk-billing, but the majority of doctors in my area charge the full fee of $50 to $60 just for issuing a repeat script.

There are also a number of local aged-care facilities right across Paterson that could stand to benefit, from Largs Lodge in the west to Regis the Gardens in the east, Barclay Gardens in the north and Raymond Terrace Gardens Nursing Centre in the south of the electorate. Having to obtain a prescription for long-term medication can be costly and timely, and there are certain circumstances where this will alleviate the burden on aged-care providers. For example, there is currently a situation in Bulahdelah, in my electorate, where the local GP, Dr Habashi, has had to take sick leave. He has been off sick for a number of months and there is no indication of when he will return, yet there is no permanent replacement doctor. The two closest major centres are Newcastle and Taree, which are 96 kilometres and 75 kilometres away respectively. Doctors in Forster-Tuncurry and Tea Gardens have been working hard to assist, taking what patients they can on top of their own extreme workloads. However, this is not an adequate solution to the problem. As the resident GP, Dr Habashi was also responsible for patient care at the Bulahdelah Nursing Home and the Bulahdelah Hospital. With this legislation in place, many of the nursing home residents would be able to continue to access their medications without having to place further burden on the temporary doctors.

The benefits seem quite straightforward. However, with any initiative like this, it is important that ideals of ease and convenience do not overshadow what is the most important thing, that being the patients' safety and wellbeing. That is why the coalition will move amendments to ensure that this new program is adequately reviewed and monitored.

The government has already limited the scope of this legislation in the first instance in a bid to ensure safety as the program is rolled out. Those medicines that can be dispensed without a prescription will be limited to oral hormonal contraceptives, known as the pill, and lipid modifying agents, which are drugs to lower cholesterol. Past experience of these two medicines shows they are usually well tolerated and have a good safety profile. Provided the scheme is rolled out successfully, the hope is that other chronic therapy medicines will be added to the list. From personal experience with things like asthma preventatives, I know that Ventolin is available over the counter, but some of the stronger preventatives, which are regular script items, should also be included in this list, provided an asthma management plan is in place.

The coalition's amendments would ensure that review mechanisms are included in the legislation. We believe it is vitally important that the program is assessed after two years, with statistics and results made public. The government has given guarantees that it will do so; however, it should be put directly into the legislation. The health of patients is far too important to simply take the government at its word. After all, this is the same Prime Minister who said, 'There will be no carbon tax under a government I lead.' Prime Minister Julia Gillard also said she would be more likely to play full forward for the Bulldogs than challenge Kevin Rudd for the Labor leadership. So we have real concerns in trusting this Prime Minister with the health of our nation, placing her word.

It is worth noting that some emergency options for pharmacists already exist. Under the current legislation, pharmacists can dispense a medication on the Pharmaceutical Benefits Scheme without a written prescription if they speak to the patient's doctor on the phone. They then need to get a written prescription from that doctor within a week. Proponents of the bill argue that the existing legislation puts pharmacists at financial risk, because a PBS claim cannot be made if that written prescription is not received within seven days. Of course, by that stage, they have already dispensed the medication.

Further, state regulations allow pharmacists to supply three days worth of medicine where it is just not possible for a patient to get a script. However, if getting medicine this way, the patient has to pay the full cost rather than the PBS co-payment, and the pharmacist has to break a full pack to provide it. The patient is also back in the doctor's surgery within a couple of days to get a full script. This bill would, therefore, largely prevent these problems from occurring. It could also represent significant cost savings for individuals by ensuring they do not have to pay for a doctor consultation every time they need a script repeated. This would also provide cost benefit to the government, because the Medicare rebate for that visitation would not be required.

With the cost of everyday living skyrocketing and the carbon tax set to boost everyday household costs from July this year, any cost savings for the individual will be most welcome. This past year, under the Gillard Labor government, there has been no net job growth for the first time in two decades. That is clear evidence of a struggling economy and tough times for workers and their families.

Health is certainly not an issue that people can easily put aside. People cannot do without their medications if they do not have enough money that week. Just one missed blood pressure dosage could result in a heart attack, while one missed pill could cause unwanted pregnancy.

The National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill has some great potential in the Paterson electorate. In regional areas such as ours, distance, limited travel options, doctor waiting times and cost-of-living pressures mean that access to health facilities is not always easy. Our government should be working hard to cut red tape, and for this I commend it. However, patient care has to always be at the top of one's mind. The government should always be accountable for the decisions it makes with regard to our health system, and it is vital that we review new initiatives like these to ensure that the outcomes they are designed to meet are indeed being fulfilled.

With the coalition's amendments, this bill has great potential for my constituents in Paterson, and therefore I look forward to supporting the amendments to the bill. Hopefully, they will be carried, and the bill will be carried as a whole.

Kirsten Livermore (Capricornia, Australian Labor Party) Share this | Link to this | Hansard source

I rise to add my support to the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill 2011, which puts in place initiatives from the Fifth Community Pharmacy Agreement. This is the first chance I have had to speak on a health related bill this year, so I would like to take the opportunity briefly to offer my congratulations to Nicola Roxon, the former Minister for Health and Ageing, on her promotion to Attorney-General. I would also like to congratulate her on her achievements during her time as health minister. At the national level she oversaw record levels of investment into our health infrastructure and our health workforce. In Central Queensland during her time as health minister, we saw the massive expansion of Rockhampton Base Hospital, including the building work going on right now that will give us a cancer centre capable of providing a much broader range of treatment for cancer patients. Very importantly, it will see the addition of radiation therapy and a more-than-doubling of the chemotherapy chairs that are available for treating people. That is extremely important for people in my electorate, who know that they will no longer have to travel to Brisbane for those sorts of treatments and be away from their family and a familiar environment at such a distressing time.

There was also funding in the last budget to build an accommodation facility at the Mater hospital, just down the road from Rockhampton Base Hospital. That accommodation is a long-cherished project in our community and has had terrific support across the community. It was great to see the government add funding to make it a reality. The accommodation facility will give support to people from the broader Central Queensland region who find themselves or their family members needing medical care in Rockhampton, many miles from their home.

In Mackay, in the north of my electorate, we are very close to finding out who has been successful in the bid to build the GP superclinic, which will add to services in that very fast-growing city. It was great to see, just before the end of last year, that one of the GP clinics in my electorate in the town of Sarina was given funding under the Primary Care Infrastructure Grants program to expand its services and keep its fantastic work going for the people of Sarina.

I am very grateful for the working relationship I had with Nicola in her time as health minister. My constituents can see how well she listened to the representations I made and how well she understood the dynamics of our region, particularly the growth we are experiencing and the need for new and better health infrastructure together with more medical and allied health professionals to meet the needs of our growing population.

I also want to congratulate the new Minister for Health, Tanya Plibersek, on her well-deserved elevation to cabinet and to welcome Tanya to the portfolio. Despite the long list of things already delivered by this government, I can assure the new minister that there is still plenty to do in health in Central Queensland, especially in the area of primary health care and the workforce required to deliver that care. Two of our divisions of general practice have merged to become the Capricornia Division of General Practice, covering the urban areas of Rockhampton and Gladstone, and the mining and farming hinterland that make up our region. In recognition of its experience and excellent relationships throughout Queensland, the division has now been handed the responsibility of forming the Medicare Local for our region.

Medicare Locals will provide the focus and leadership needed to make sure we get the absolute most out of our primary healthcare sector by placing it at the heart of local planning and decision-making about health care, and by linking the various parts of the sector to better meet the needs of patients. This is an exciting time as we look at how best to coordinate our existing health resources and come up with innovative local solutions to fill gaps in services, and help practices deal with the specific challenges of life at the heart of the mining boom. I know that the new health minister brings great insight into her region as a result of her time as the Minister for Housing and more recently as the Minister for Human Services. I look forward to working with her as Labor's reforms and investments in health continue to deliver real improvements for people in central Queensland.

I turn now to this bill, because I do want to speak on the bill and its particulars. I want to do that because it is emblematic of Labor's commitment to reform in the health system and our continual search, in partnership with other players in the sector, for ways to deliver more affordable, more efficient and more timely care for people. That is especially the case when it comes to primary health care. We see a properly coordinated primary healthcare sector as the key to ensuring that health care is patient-centred and affordable, both for individual patients and for the national budget. That means supporting professionals across the primary healthcare sector to operate out of up-to-date infrastructure to facilitate an integrated, holistic approach to patient care. It also means creating opportunities through the education system for more people to gain qualifications and clinical training as GPs, practice nurses and allied health professionals.

This bill is a great example of how we have worked closely with an important element of the healthcare system, in this case pharmacists, to see how we can better understand how they interact with other health professionals and how to better utilise their professional skills within a team of professionals providing care to patients and, ultimately, to come up with measures that save money and, importantly, deliver a better service to patients.

This bill puts in place two initiatives and a number of technical amendments arising out of the Fifth Community Pharmacy Agreement. The agreement was signed by the Australian government and the Pharmacy Guild on behalf of its members in May 2010 and commenced on 1 July of that year. The agreement has a life of five years and governs the remuneration and other important aspects of the relationship between the government and around 5,000 community pharmacies across Australia. In all, the agreement provides $15.4 billion over that period in recognition of a whole range of services provided by community pharmacies to consumers and the value that they add to the health system as a whole.

The agreement, like those before it, provides the basis upon which the government remunerates pharmacists for their role in dispensing medicines under the Pharmaceutical Benefits Scheme, recognising the valuable part pharmacists play in delivering advice and health services to the community. It also underpins the community service obligation under which payments are made to eligible pharmaceutical wholesalers to assist in making it commercially viable for them to supply the full range of PBS medicines in a timely way across Australia. Provision is made in each successive agreement for a range of different programs that cover a variety of professional services when they are delivered by community pharmacies—for example, medication management services.

I am pleased to see that the Fifth Community Pharmacy Agreement continues funding for the rural pharmacy workforce program. This focuses on strengthening and supporting the rural pharmacy workforce so that access to quality pharmacy services is increased for people living in rural and remote parts of Australia. It is hard to overstate the importance to a small country town of its local pharmacist. Together with nurses, they are usually the health professional with the strongest ties to the community and are therefore a trusted source of advice for local people. Their long-term knowledge of individual patients makes them a vital part of any course of treatment prescribed by other health professionals. Investment by the government in assisting rural pharmacies is an investment in the health and wellbeing of rural people. I note the Pharmacy Guild proudly reporting the track record of community pharmacy in rural areas as the only health professional service to have expanded its services over the past decade. The figures depicted in the graph on the Pharmacy Guild fact sheet only show the period up to 2008, but I have no doubt that the kinds of workforce incentive measures and allowances paid under the fourth and fifth pharmacy agreements have continued to encourage pharmacists to look for opportunities in rural and remote areas like some parts of my electorate. The fifth community pharmacy agreement builds on those continuing measures and introduces some initiatives, including the two that are the subject of this bill.

Those measures both have long and complicated names, but they are in fact very practical and common-sense improvements to current practices and, as such, have the support of pharmacists and others involved in patient care. The first of those is the Supply and PBS Claiming from a Medication Chart in Residential Aged Care Facilities program. Currently a doctor attending to a resident in an aged-care facility is required to complete the details of the medication he or she is prescribing on the resident's medication chart and then they have to fill out a separate prescription form to allow the medication to be supplied by a pharmacist. It is pretty obvious that that system can be improved and should be improved.

The changes in this bill will allow the resident's medication chart to serve as the authority to the pharmacist to supply the medication. As a result of this change, a new medication chart will be developed—a nationally consistent chart to be used in all residential aged-care facilities. The chart will be designed to encourage those prescribing to review the chart in its entirety every time medication is ordered and there will be standard fields included so that the chart in an electronic form can interface fully with other elements within an e-health environment. It sounds so simple, but the benefits are real and very significant. Eliminating the need for the prescriber, either a doctor or a nurse practitioner, to copy the information from the patient's medication chart to a separate prescription form greatly reduces the risk that it will be copied incorrectly and result in inadvertent harm to the patient.

Similarly, this allows for the medication chart to become the one and only complete and up-to-date record of everything to do with the resident's medication, from prescription to supply by the pharmacist to administration of the medication by the resident's carers. Everyone involved in the care of the patient is working from the same source of information. It also—and this is very important at a time when demand for GPs to provide services to aged-care facilities is growing ever greater— takes away a disincentive for those GPs. GPs attending to residents of nursing homes want to spend their valuable time on clinical care, not unnecessary paperwork. This streamlined process can help in its way to encourage GPs to maintain their partnerships with aged-care facilities in their area.

The second initiative is in the same vein, this time seeking to better utilise a pharmacist's professional judgment to remove an unnecessary and inefficient restriction on their ability to dispense common medications taken on a long-term basis. It is referred to in the legislation as the 'Continued Dispensing of PBS Medicines in Defined Circumstances'. Ordinarily, a pharmacist must not supply a pharmaceutical benefit unless a prescription conforming to the relevant regulations is presented by the customer. There have always been exemptions written into the legislation to deal with the dispensing of medications without a prescription.

One such exemption allows for a prescriber to communicate with the pharmacist by phone or by other means, in which case the pharmacist is permitted to dispense as normal. Even then, a prescription must still be forwarded to the pharmacist within a prescribed period of time to authorise retrospectively the supply of that medication. Where a prescriber cannot be contacted, provision is made in legislation for medication to be dispensed according to emergency procedures. In that case, only a small amount of medication can be supplied—perhaps three days worth—and the patient is not entitled to receive any PBS subsidy. They have to pay the full price of the medicine.

This bill allows for the relaxation of those procedures and gives pharmacists more power to dispense in certain circumstances and for patients to receive the normal PBS subsidy applying to the medication. The new rules apply to chronic therapy medicines—that is, medicines taken on a continuing, long-term basis. To start with, they will extend to oral contraceptives and some lipid-modifying agents. Pharmacists will be permitted to supply these medications to patients even when a prescription is not presented. They can supply the standard PBS amount and patients will only pay the subsidised price, not the full price imposed under existing emergency provisions.

Time will be saved, because the need to chase up owing prescriptions is eliminated and less medication will be wasted, because pharmacists can dispense standard packs rather than breaking into packs to dispense the emergency three-day supply previously required by legislation. Patients benefit because their medication regime is not interrupted simply because they lost a script or were unable to access a prescribing doctor before running out of their regular medication. Those patients still retain the benefit of subsidised medicine. Patient safety is not compromised because professional protocols still apply to the pharmacist dispensing under this system—things like the need to communicate with the usual prescriber that the supply of medication has occurred.

After two years the new system will be reviewed to ensure that it operated in the way it was intended and to see whether additional medicines can be added to the initial list. This is a thoroughly common-sense improvement on the current situation and one that continues our reform theme of utilising every bit of professional expertise within the primary health system so it meets patients' needs in a way that is efficient while still meeting the high standards of care.

This government has a proud record of reform and investment in health and it is delivering real results for people in my electorate and right across Australia. I commend this bill as another step forward in delivering better health care for those who need it and in a way that upholds the sustainability of our health budget.

Ewen Jones (Herbert, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives Bill) 2011. This bill makes two significant changes to the pharmaceutical industry that expands the responsibility of pharmacists. The first of these is to introduce the Continued Dispensing of Medicines in Defined Circumstances initiative. This will allow pharmacists to supply prescription medicine without a script under certain specific conditions. These conditions are that the patient has been prescribed the medicine for at least six months, that they have been taking the medicine right up to the point of requesting the new prescription and that they do not use this continued dispensing provision for consecutive refills. These are important caveats to ensure that safety and medical monitoring continues under this new framework. This set-up will also be used for low-risk drugs, being initially used only for oral contraceptives and cholesterol-lowering drugs. I spoke to a few pharmacists in Townsville about this measure to get feedback from those who will actually be affected by it. Christine Richardson, who runs Poole's Pharmacy at Fairfield Waters, outlined to me her support of this change, stating that it will help pharmacists meet the duty-of-care obligations under which they already act by allowing them to supply these drugs to patients who need them but are not able to see their doctor for a new script. She pointed out that it is important that we continue to bring pharmacists into the healthcare process. They see patients every time a script is renewed—which is more often than a doctor does—and have the opportunity to discuss with them how the treatment is going and to monitor their progress. For example, Christine will often measure patients' cholesterol when they come in to renew their script to make sure there are no problems. As Christine said, given the frequent face-to-face interactions of pharmacists, it is a waste to not allow them to play a greater role where it is appropriate and in areas in which they have been trained.

George Fotinos from Terry White Chemists in Stockland was similarly supportive of this measure. He stressed the opportunity it presents for the patient, with people no longer having to go without medication because they ran out and could not get to their doctor in time. As he said, as long as it is done in a controlled environment this increased flexibility is a positive step.

Finally, Chris Boyle from Payless Chemists at Willows Shoppingtown pointed out that pharmacists have a detailed understanding of medication and are more than capable of expanding their role. As he said, pharmacists in other countries, like the UK, are doing a considerable amount of prescribing, so this is a logical expansion of the pharmacist's role in Australia.

The second initiative outlined in this bill allows for medicine to be supplied to those living in aged-care facilities based on a standardised medical chart. This is an important step in reducing the administrative burden on aged-care facilities so that patients have easier and faster access to the medicine they need. To meet this new provision, the Australian Commission on Safety and Quality in Health Care has begun its development of a standardised chart, with continued consultation due throughout this year. The Australian Medical Association has come out in support of this measure as a means of reducing bureaucracy for doctors. Any measure that reduces the amount of time medical practitioners have to devote to jumping through unnecessary bureaucratic hoops, without reducing patient care, has to be considered a good thing.

The pharmacists to whom I have spoken also threw their support behind this measure, emphasising the removing of red tape and the doubling up where a doctor writes a medication order on a patient's chart but still has to issue a prescription. Those in aged care are usually in a fragile state of health. It can only be a good thing that this measure will allow these people easier access to their medication when they need it. When I talked with George about this particular measure he too gave his support, saying that more was needed to ensure greater uniformity among aged-care facilities in the way they approach standardised medical charts. Some doctors and facilities are able to use an electronic system that instantly transmits any updates to medication back to the pharmacist, while others are still reliant on the more old-fashioned methods.

Chris Boyle described this as a long-overdue move. Pharmacists have been doing important work with the elderly in aged-care homes for a long time now. Chris told me about home medicine reviews, in which he and other pharmacists go into the home and do a full review of medication that a patient is taking and has on hand. He said it is common to find that patients are still taking leftover medication from old prescriptions, or that patients have changed brands of a medication and are accidentally taking a dose from each packet of the same medication, therefore doubling their intake. These visits can fix these high-risk problems but also allow a better understanding of a patient's habits and health needs, and how they are living. A pharmacist's visit to the home is able to be more thorough than a patient's visit to a surgery. Allowing pharmacists to work off a standardised chart is a logical next step in taking advantage of a pharmacist's more personal interactions with a patient, which a doctor's position simply does not allow.

I have close to 20 pharmacies in my electorate, so any bill that affects their operation is important to me. The consistent message I picked up from speaking to Christine, George and Chris, along with other pharmacists, is that their prime focus is always on the patient and how any change affects them. The message I am getting is that safely increasing flexibility is a positive thing for patients and that pharmacists want to see that happen. It is good to see the government taking these steps with this bill, given its poor record in this area. Until last year the health minister was unable to list medicines on the PBS that were over $10 million. It required the entire cabinet to approve that. Not only did this lengthen the process of making these medicines available to those who needed them but it was completely out of step with almost all previous governments, who were able to make listings based on the advice of the independent Pharmaceutical Benefits Advisory Committee, or the PBAC.

The government last year dealt a further blow to the supply of much-needed medicine when it deferred the list of seven new medicines and a vaccine that had been recommended by the PBAC because of 'fiscal concerns'. It took seven months for them to do the right thing and backflip on this initial decision, which had been made a matter of months after then Minister for Health and Ageing, the Hon. Nicola Roxon, signed a memorandum of understanding with Medicines Australia to provide policy predictability and speed up the listing of new drugs to the PBS. So on one hand they are removing red tape and on the other hand they are backing it up.

Given this chequered history, the coalition is putting forward amendments to require a review of continued dispensing, which is to be made publicly available, and to have information on pharmaceutical products that are supplied by these initiatives published annually. As health minister, Minister Roxon outlined that these two measures would take place. But this has not been followed through in this bill and it is crucial that the measures are included.

We do support these measures as they will make it easier for patients to safely access medication, but it is important that the government remain accountable and that the information be made available so that we can monitor these changes and make sure patients are getting easier access to their required medication without the compromise of safety. These amendments that the coalition have proposed are needed to make this possible. So I am recommending the bill. It is a good start, but we can do so much more here. I thank the House.

Russell Matheson (Macarthur, Liberal Party) Share this | Link to this | Hansard source

The National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill 2011 amends the National Health Act 1953 by introducing a number of initiatives agreed between the Pharmacy Guild of Australia and the government in 2010 under the Fifth Community Pharmacy Agreement. These include the Continued Dispensing of Pharmaceutical Benefits Scheme in Defined Circumstance, which seeks to allow the supply of pharmaceuticals by approved pharmacists without prescription under certain conditions and the Supply and PBS Claiming from a Medication Chart in Residential Aged Care Facilities initiative, which allows for the supply and claiming of pharmaceuticals listed on the Pharmaceutical Benefits Scheme, the PBS, in residential aged-care facilities. The bill provides for the use of a standardised medical chart for supply and for PBS claims, rather than requiring a doctor to write a separate prescription. Finally, the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill makes technical amendments through schedule 3 to allow the minister to make determinations in relation to the maximum quantity of, or repeats for, a particular medicine.

The continued dispensing initiative, as outlined in schedule 1 of this bill, allows for the supply of pharmaceuticals by pharmacists without a prescription under certain conditions. There are currently some provisions available to allow pharmacists to provide consumers with prescription medication without a script; however, these provisions are cumbersome and expensive for both the pharmacist and the consumer. The first is what is called the 'owing prescription' protocol, under which a pharmacist can supply a PBS medicine after contacting the patient's doctor by phone. This protocol places the pharmacist at financial risk as it relies on the doctor to provide the pharmacy with the prescription within seven days in order for the PBS claim to be made.

A second option allowing pharmacists to provide prescription medication without a script is the existence, under state and territory regulations, of emergency supply provisions. These provisions enable a consumer to purchase a three-day emergency supply of an essential medication in circumstances where it is not reasonably practical for that patient to acquire a script. The medicine is not subsidised through the PBS, so the consumer must pay full price. This practice can also result in the pharmacist having to break a full pack to provide three days supply. A number of local pharmacists have complained to me that these provisions can result in a wastage of prescription medication while leaving consumers out of pocket and with only a very limited supply of medication.

The continued dispensing initiative will help to relieve some of these issues for medications covered by the initiative. This is very true in regional areas of Macarthur, where patient to GP ratios are above 4,000 patients to one GP. A better solution to this problem would be for the government to deliver more doctors for the Macarthur region. However, this initiative does at least provide patients with a longer window of opportunity to see their doctor if their script runs out. I can report that local pharmacists in Macarthur are enthusiastic about the benefits of the continued dispensing initiative.

Unfortunately, there is no real certainty in this bill about which medications will be covered by the initiative. The department's consultation paper and the second reading speech of the previous Minister for Health and Ageing identified two groups of medication which will be covered by this initiative. These are oral hormonal contraceptives—the pill—and cholesterol-lowering drugs. The department's consultation paper claims that these two groups were selected because they are well tolerated and have a good safety profile. However, due to the astounding lack of detail in the bill, the eligible pharmaceuticals items and the conditions of supply are not specified and will be determined by ministerial determination.

In addition, this bill should have, at the very least, set out the specific circumstances under which continued dispensing can occur. The department's consultation paper advises that the ministerial determination will refer to the Guidelines for the continued dispensing of eligible prescribed medicines by pharmacists. These guidelines were developed by the Pharmaceutical Society of Australia in consultation with stakeholders and set out the professional standards which must be adhered to under this initiative.

The sheer lack of detail in this bill means that ministerial determinations will set out all the circumstances for dispensing under this bill. The minister will also determine the protocols for consumer safety and for the integrity of this initiative, as well as list the items or pharmaceutical benefits which are eligible to be supplied by pharmacists under the continued dispensing arrangements. I would prefer to actually see the draft legislative instruments. The minister's office has promised that this information will be tabled in due course. This is another case of the government providing little to no detail and asking the coalition, hat in hand, to just trust them. At the very least, future changes to eligible pharmaceuticals and conditions should be done by legislative instrument, allowing parliamentary scrutiny and disallowance.

I will now speak about the second initiative in the bill, the medication chart initiative, which will allow for the supply and claiming of pharmaceuticals based on a standardised medical chart in residential aged-care facilities. The Macarthur electorate is fast becoming a destination for aged-care and retirement living. Local residents and their families, as well as their doctors, are very excited about this initiative as proposed in the Fifth Community Pharmacy Agreement.

This measure will help to reduce the administrative burden in aged-care facilities and improve patient safety. I hope that this initiative will provide a better outcome for all stakeholders, especially doctors and patients. The Australian Medical Association also supports chart based prescribing in residential aged care as it will 'significantly reduce red tape for medical practitioners'.

The Fifth Community Pharmacy Agreement will provide $15.4 billion over a five-year period for community pharmacy. Community pharmacy has transformed Australia's pharmaceutical industry over many years, providing affordable pharmaceuticals to communities all over Australia, especially those in remote and regional Australia. The coalition provided solid and stable policy for community pharmacy while in government and we continue that support today.

The Pharmacy Guild negotiated with the government in good faith, making a number of large concessions, to arrive at the Fifth Community Pharmacy Agreement. While I support the Fifth Community Pharmacy Agreement and the initiatives that have come from the agreement, this bill—schedule 1 in particular—shows the Australian people what a woeful lack of attention to detail this government pays to its legislation. For example, this bill has absolutely no details whatsoever about what an approved pharmacist would be, it contains no details about what would be in place to protect consumer safety and prevent the misuse of this initiative and there are no details about what medications will be available under these initiatives. I hope that we do not see a repeat of the incompetence and deception displayed by the previous Minister for Health and Ageing when she signed a memorandum of understanding with Medicines Australia to provide policy stability in return for $1.9 billion of savings in the PBS.

This recent agreement includes speeding up the addition of new medicines to the PBS. It took this government until September last year to list medicines that were deferred from February. It also announced last year that there would be further deferrals in future for new medicines subsidised through the PBS. The lack of detail in this bill does not bode well. All I can say is that this government has a shameful record of failing to keep its promises.

I cannot see how this government can see it as being appropriate to deny patients access to their medication, especially the elderly and those suffering from long-term illnesses, at the same time as it sees fit to spend hundreds of millions of dollars on dodgy advertising about the carbon tax—including handing out funding to indoctrinate toddlers and schoolchildren. I will not oppose this bill. However, I believe this government needs to start paying more attention to detail and that it should include more operational aspects in this legislation if it wants to deliver any certainty to the pharmaceutical industry.

Tanya Plibersek (Sydney, Australian Labor Party, Minister for Health) Share this | Link to this | Hansard source

I thank the members for their contributions to the debate on the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill 2011. The bill establishes the framework that will allow the implementation of the Supply and PBS Claiming from a Medication Chart in Residential Aged Care Facilities and Continued Dispensing of Pharmaceutical Benefits Scheme in Defined Circumstance initiatives. These initiatives are provided for as part of the Fifth Community Pharmacy Agreement and will assist the government in meeting the objectives of the agreement in delivering patient focused professional services through community pharmacy.

The medication chart initiative will address administrative issues faced by prescribers, community pharmacists and aged facilities staff alike in managing a resident's medication. Currently, a prescriber must write a medication order on a PBS prescription and duplicate that information on a medication chart. The initiative will remove the need for a separate PBS prescription and ensure medication charts within residential aged care facilities can be used as a prescription.

The removal of this administrative step will result in a number of benefits. Firstly, it will provide more time for practitioners to spend on clinical care rather than filling in paperwork. Further, a standardised national medication chart will be designed to include all elements that are currently required to be captured on a PBS prescription, allowing practitioners to review the chart in its entirety, making it easier for them to complete quality use of medicine reviews whenever a change to medication is made.

Residents of aged-care facilities can expect improvements to their safety through the introduction of prescribing, supplying and claiming from a single source. Transcription errors will be significantly reduced as there will no longer be a need to duplicate the medication chart entry. Improvements in the quality use of medicines will also be seen through the pharmacy being provided with timely notice of updates and changes to a resident's medication regime, ensuring that the prescriber's most recent intentions for the resident's clinical care are promptly implemented.

Through this bill the Continued Dispensing of Pharmaceutical Benefits Scheme in Defined Circumstance initiative will introduce a new mechanism for Australians to access certain PBS medicines in situations where the patient does not have a valid prescription available. The initiative will introduce supply and claiming mechanisms that allow the provision of a pharmaceutical benefit to a patient in accordance with specific conditions where a patient is unable to present a valid prescription. The decision of the community pharmacist to provide a continued dispensing supply will be governed by a professional protocol and made on the basis of evidence of the previous prescription. The use of a professional protocol by the community pharmacist will mean that the quality in patient safety will not be compromised and that the role of the prescriber continues to be paramount. The protocols will also equip the pharmacist with tools to ensure that a person is on a stable medication regimen before a decision is made to provide ongoing medication.

For consumers who are taking medication for the treatment of certain chronic conditions, continued dispensing means that their treatment may not be interrupted should they not be able to synchronise their medical appointments with their medication requirements. Patients will also benefit from not paying the full cost of the medication, as occurs with current emergency supply mechanisms. In the first instance, a continued dispensing supply will be limited to two therapeutic categories: oral hormonal contraceptives for systemic use in the prevention of pregnancy and lipid-modifying agents—that is, statins—specifically the HMG CoA reductase inhibitors for the treatment of high cholesterol.

It is important to note that a pharmacist can supply medicines by continued dispensing only under the following circumstances: firstly, there is an immediate and ongoing need to supply the medicine to facilitate continuity of therapy and the patient cannot get to a prescriber in time to get a valid prescription; secondly, the medicine has been previously prescribed for the person and there has been a prior clinical review by the prescriber that supports the continuation of the medicine; and, thirdly, the medicine is safe and appropriate for that consumer.

The pharmacist must also provide written communication to the most recent prescriber advising of the supply of the medicine to the consumer within 24 hours. These initiatives will complement already existing emergency or urgent supply mechanisms that are available to the community where a person has lost or run out of their medication and does not have a valid prescription available. Importantly, though, this initiative will ensure patients can get the medicines through the PBS, reducing their out-of-pocket expenses in the circumstances.

The Gillard government is committed to the evaluation of new initiatives, which is why it has always been proposed to review this program two years after implementation and to publish the annual data on scripts dispensed under this initiative as part of its annual PBS reporting processes. The amendments that are likely to be moved today are supported by the government; they fit in with the legislation as it was originally conceived. The technical changes proposed in the bill for prescribing certain quantities of pharmaceutical benefits are intended to enhance current policy providing efficiencies and certainty for prescribers and patients. The amendments will continue the government's commitment to its 2010 policy for expanding the criteria for streamlining authority required medicines and will complement the medication chart amendments contained in this bill by accommodating specific conditions in the residential aged care sector.

Question agreed to.

Bill read a second time.