Pharmacist fears patient safety at risk

Patient safety could be at risk under a new pharmacy contract, because pharmacists are being forced to focus on revenue-gathering, Mosgiel pharmacist Jenny Kerr-Mackenzie says.

The pharmacy sector is undergoing upheaval this month as the controversial new Pharmacy Services Agreement is implemented.

The contract seeks to remove a $5.30 dispensing fee that used to form the basis of pharmacy revenue, and replace it with a $1 handling fee.

Transition fees negotiated with pharmacists have been introduced to avoid sudden revenue drops and pharmacies being forced to close.

Opportunities for pharmacists to increase revenue include registering long-term-care patients.

"Now we are being paid peanuts to be accurate in our dispensing in which one mistake can not only cost a person's life, but our job," Mrs Kerr-Mackenzie said.

Mrs Kerr-Mackenzie, who has owned and operated Taieri Amcal Pharmacy for 16 years, would "just about guarantee" an increase in dispensing errors.

Pharmacists were being encouraged to speed up dispensing to focus on revenue-gathering areas to make their business viable.

Pharmacists were undertaking the patient-management measures the new financial model encouraged.

However, now they would be forced to prove what they were doing to get paid, while coping with the loss of the dispensing fee.

The changes were designed wholly to save money, she said.

Pharmacists were "easy scapegoats" to address rising prescribing, which had nothing to do with them.

"We expect the new contract will force reduction in staff numbers at most pharmacies and closures of many other pharmacies, at a great detriment to the people of New Zealand."

Southern District Health Board Crown monitor Stuart McLauchlan, also the chairman of Pharmac, was reported in Saturday's Otago Daily Times citing an 8% annual rise in prescriptions as the reason for the change.

Mrs Kerr-Mackenzie said Mr McLauchlan's comment, during a Southern DHB meeting, proved what most pharmacists suspected, that the changes were cost-based and not based on what was best for the patient.

"Pharmacy has to fund the pharmaceutical blow-out, due to their inability to stem prescription growth over which pharmacy has no control."

She said the ageing population meant prescribing increases were partly inevitable.

"Mosgiel has an ever-growing population of the older generation, which obviously generates a much larger demand on all health services, including pharmacy.

"To obtain a relatively basic return for managing this population involves a time-consuming process of registering patients as `long-term conditions' (LTC).

There had been no pilot scheme, and a rushed consultation period for the new model, she said.

South Dunedin pharmacist David Lai, who owns McNaughton's Pharmacy, believed mistakes were not likely to increase, because it was so important to get dispensing right.

"I believe it's burnt into the psyche of every pharmacist [to be extremely careful."

This included triple or quadruple checks making sure medicines were correctly dispensed.

While the new model had "noble intentions" around patient-management tools, there was stress and uncertainty about the ramifications, he said.

Pharmacy was being called on to share the financial burden of the increase in prescribing.

The increase was driven by several factors, partly the rise of preventive medicine prescribing, like vitamin D for bone health.

Another factor was new prescribers added to those mandated for subsidy prescribing; midwives, dentists, opticians, and even pharmacists themselves, were joining doctors.

Mr McLauchlan said it was hoped the measures would stem rising pharmaceutical volumes from 8%, to 1%-2% per year.

The new system was not a funding cut, but constituted a "redistribution" away from programmes like "close control" which incentivised repeat prescriptions.

Pharmacy Guild president Karen Crisp did not believe the new contract would increase dispensing mistakes. No other pharmacist had raised that point during the recent controversy, she said.

-eileen.goodwin@odt.co.nz

 

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