I would like to acknowledge some special guests:
- Minister for Health and Aged Care Mark Butler MP
- Shadow Minister for Health and Aged Care, Senator, the Honorable Anne Ruston
- Leader of the Nationals, the Honorable David Littleproud MP
- Former Presidents of the Guild here tonight – George, Kos and Colin
- Guild life members and members
- Our community pharmacy exhibitors, and
- All the way from North Queensland, Australia’s first prescribing pharmacist Demi Pressley.
It’s my privilege to be here this evening, addressing you all, at the Guild’s Annual Parliamentary Dinner.
It’s an opportunity to reflect on where we are, and where we want to go.
You might not know this about me, but I was a Scout.
And I often think about the challenge set by Sir Robert Baden Powell to “try and leave this world a little better than you found it.”
It guides my work in community pharmacy and guides me as National President of the Guild.
And the question for us this evening is, how can we leave things a little better?
What reforms will lead to better, more sustainable healthcare?
The system is falling short of expectations – whether that’s in the capital cities, our First Nations communities or those in rural, regional and remote Australia.
The Government predicts a GP shortage of 5,000 in 10 years.
And the latest official figures—released only yesterday—showed another increase in the number of people delaying treatment or going without a prescription.
This challenge must be the catalyst for a rethink.
A rethink of how we work together to achieve real change for our patients.
I know the Minister and his department get this.
The investment in primary healthcare, through the 8th Community Pharmacy Agreement, has been much needed.
Tonight, it’s not my intention to lament where we are but to make the case for where we could be.
Learning from the past to avoid the same mis-steps in the future.
I see great opportunity to do better, to leave the system a little better than how we found it.
Slow revolution
The Covid-19 Inquiry made clear the crucial role that community pharmacists and other primary care providers played in managing the pandemic.
It also made recommendations to deliver consistency across States and Territories and expand the scope of practice of healthcare professionals.
Take vaccinations as an example. In 2021, 1-in-6 influenza vaccinations were given at a community pharmacy. Today it’s 1-in-4.
Policy, regulations and proactive decisions led the way for a fundamental shift in how patients interact with—and view—community pharmacy.
It was simply transformational.
Not all changes have been as visible, or as quick.
In the 40 years since Medicare was introduced, or the 80 years since the PBS was conceived, there have been many, many, small, and a few large changes in policy, regulation and law.
Each building on the previous.
Each had an impact on the direction of healthcare in Australia.
Each made sense in isolation.
But the cumulative effect was the creation of a system that has become confusing for patients and confusing for providers.
A system with a structure of payments that can create odd incentives and is, dare I say, vulnerable to turf-wars.
A system that has crept away from being patient directed.
Origins
The Pharmacy Guild of Australia is nearly 100 years old.
While times have changed our members have consistently played a valuable role in supporting health outcomes.
Pharmacists compounded complex medicines, managed long-term conditions and treated everyday health conditions long before the advent of the PBS or MBS.
Dispensing medicines was only ever conceived to be a small, yet vital part of our work.
So how did we get here? ...Come with me on a short journey:
The original Pharmaceutical Benefits Scheme was conceived at a different time.
The government was planning for a post-war Australia and the department was tasked to create a better, fairer society.
A hugely admirable ambition.
Breakthroughs in medicine had begun – including the mass production of antibiotics which meant pneumonia, meningitis and dysentery could be treated.
But the poorest could not access treatment.
In 1944 the architects of the PBS envisioned a world where any Australian could get a medicine without charge, with a prescription from a doctor.
But the AMA’s predecessor, the British Medical Association, together with some state governments, opposed this vision.
It could not succeed without them.
Because of this, by 1948, rather than a ‘comprehensive and universal’ scheme, the PBS became a ‘safety net’ limited to 139 drugs.
These ‘emergency’ medicines were available for free - with a prescription.
Medicines considered ‘essential’ but not lifesaving remained unaffordable.
The system didn’t provide financial relief for those trying to prevent or manage chronic disease.
Simply put, the first PBS fell short.
Fast forward, and the 1960s saw an expansion in the number of medicines available on the PBS.
And the introduction, for the first time, of a co-payment.
More medicines were available and affordable—subsidised—as long as you had a prescription.
It reinforced the idea that access to some medicines was dependent on a prescription from a doctor.
The co-payment was 5 shillings – the equivalent of $8.50.
Prescription volumes went from 25 million in 1960 to 100 million by 1975.
Commonwealth expenditure rose from $55 to $250 million in the same period.
Then, in 1984 came the big bang, Medicare was born.
Just 40 years ago.
Before Medicare, 3 in 5 families had no health insurance because they simply couldn’t afford it.
Back then the prescription co-payment was $5, the equivalent of $19 today.
As new treatments became available for common everyday health conditions they were listed as prescription-only medicines.
This meant the system unintentionally directed patients, with everyday, non-complex, heath conditions, away from their community pharmacist.
Before, a patient with swimmers’ ear, needing pain medication or suffering from a mild skin condition, could see their community pharmacist.
Now they had to visit a GP.
Get a prescription.
Then head to the pharmacy to receive their prescription.
It moved the majority of everyday health conditions from community pharmacy to general practice.
An outcome that was never intended, never envisaged and never budgeted for.
It sidelined community pharmacists who were unable to use their knowledge and skills to assist their patients.
The purpose of today’s full scope initiatives, focused on everyday health conditions, is to rebalance our system to meet patient expectations - and not fall short.
Pharmacists are still—to this day—trained and qualified to provide these treatments. We always have been.
We also recognise that patient expectations have changed.
So pharmacists—including me—are heading back to university to build on and expand our skills.
In fact, we want the base registrable degree to change, so we meet patient expectations.
The Guild’s vision is for future pharmacy graduates to start their careers having already completed the highest level of qualification.
Reform
We know that health is now more complex.
40 years ago, there were about 2300 items on the Medicare benefits schedule.
Now there are about 6000.
There were 600 medicines on the PBS.
Today there are over 2900 different medicines and 5900 different products.
The healthcare system is supporting people to live longer and better lives.
There are more, and better, treatments for life-limiting diseases.
More lifesaving drugs and more cutting-edge breakthroughs.
I am proud of the role community pharmacy plays in delivering better and fairer access to primary healthcare.
But it is also a system that can do a little better.
The way we deliver healthcare has not kept pace with the astonishing scale and speed of innovation in healthcare.
Archaic structures see patients struggling to afford and access care.
I know how hard providers are working to manage an increasingly complex patient population.
The current structures often see too many preventable patient presentations in the highest cost setting; our hospitals.
Where consultations, without an admission, cost the taxpayer on average $900 each visit.
This is simply not sustainable.
Right now, highly skilled healthcare professionals—like pharmacists and nurses—are trapped in an outdated model of doctor-directed or doctor-only care.
This was never envisioned or intended by the original architects of the system.
What’s needed
So I ask, where to from here?
We want and need more GPs.
We want doctors to be properly remunerated.
And before anyone gets carried away, pharmacists are not asking for access to the MBS.
We need to make it easier for healthcare professionals to share patient information via the My Health Record.
We need to make access less confusing and more consistent across states and territories.
And in a cost-of-living crisis we need to ensure healthcare is affordable, especially the price of medicines.
We all know empowering community pharmacists to work to their full scope of practice is critical to deliver the change patients want and support.
Community pharmacists have the skills and knowledge to support patient health, in pharmacies that are in more locations than any other primary healthcare provider, and open at more convenient times.
We want patients to return to - Think Pharmacy First.
Just like women in every state can now think pharmacy first for the treatment of uncomplicated UTIs.
Every uncomplicated UTI treated by a community pharmacist frees up a GP to provide more complex care and reduce waiting times.
Reducing the pressure on GPs and acute health settings.
That’s good news for patients and good news for providers.
But right now, Queensland is the only place a parent can get treatment in a community pharmacy for school sores and earaches. We know this has to change.
We're working hard to address scope of practice with each State and Territory Government - with numerous commitments already made.
Pharmacists want to expand the range of treatments offered to patients, and patients want more options for world class healthcare.
More qualified and highly trained community pharmacists, delivering more treatments to patients safely, efficiently and effectively.
A system working for everyone and treating patients at the most appropriate cost setting.
Dare I say, it’s a system a little better than before.
There are challenges, but change is overdue.
Too many successive designers have created patch after patch, when a reboot is needed.
The coming election is an opportunity to deliver these changes – to make it less complicated, to reduce the cost, to increase accessibility and improve health outcomes.
We can all work to make our system a little better.
As the new National Council of The Guild takes office, I am humbled members chose me to continue to serve as their National President.
I will continue to serve you, as we continue to serve our members together.
Thank you.
