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- Issue 81: April 2009
- Issue 80: March 2009
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Let me own my HMRs

Stephen Carbonara
From an Independent Professional Pharmacist Perspective

Issue 80: March 2009
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For those who may be unaware, the Pharmacists’ Division of APESMA has recently advocated for HMR payments to be made directly to individual pharmacists.
As an independent contractor and employee, allow me now to go on record as saying: “This is the right thing to do.”
Unfortunately the Pharmacy Guild along with a certain number of proprietors are not in agreement with this position! Surprise surprise!

I am bemused that opposition to APESMAs position can be argued so blatantly!
Let’s all remember that proprietors are in a unique position in the Australian healthcare spectrum.
No one else does it. They are protected.
They are probably the last people in Australia that have their industry protected by legislation. Why then must they own service provision as well?

In this era of increasing risk of deregulation, where community pharmacy is a notable exception, why is the emerging field of service provision similarly restricted?
Does it need to be?
Do proprietors need to be gate-keepers of HMR service provision?
Does owning a shop make them more qualified or better at reviewing?
Do they have a better patient understanding?

This may sound funny to some, but aren’t proprietors busy enough running their shops than to provide a dedicated HMR service?
Or otherwise, could proprietors provide an as dedicated HMR service than an independent accredited pharmacist whose sole work-base is HMR provision?

I believe that proprietors’ “thing” is selling medicines.
That’s why they bought a shop.
That’s what they do.
As an independent accredited pharmacist, I believe that my “thing” is performing medication reviews.

Do I argue against proprietors’ ability to sell medicines?
Do I believe that I (as an independent) should be able to start selling medicines?

Then why do proprietors still argue that I shouldn’t be allowed to receive direct referrals and payments for the HMRs I perform?
Is this not fair?
I do the HMR. I pick up the referral.
I make the phone calls.
I drive my car to patients’ homes.
I conduct the interviews.
I write the reports on my computer.
I send the reports to the doctors.
I fill out the claim form.
I receive feedback.
I follow up with another review when needed!
Surely this cannot be argued against?
I’ve done all the work, why can’t I get all the re-imbursement?

Surely proprietors are not so greedy that they want to monopolise everything to do with medicines?
Surely they’re not so complacent that they’re exploiting their protected-industry status to grab another income stream?
Surely they’re not so arrogant that they believe that by virtue of shop-ownership, they are more qualified or better-placed than other registered pharmacists?
Surely they’re not so insecure that their customers could conceivably agree to see another accredited pharmacist because their GP (whom they undoubtedly trust) believes that it is more beneficial?

Then why can’t they just accept that WE ARE ALL REGISTERED PHARMACISTS who are equally capable and should be afforded equal opportunity to perform HMRs.
Bugger the position of: “but it’s more appropriate that customers receive an HMR from their own pharmacy”.
“More appropriate” doesn’t enter into the equation.
“More appropriate” is not relevant when many, many consumers are not receiving HMRs because of proprietor monopolisation!
It is however more appropriate to have the GP decide who performs the HMR.
This may be a proprietor, or this may be an independent.
Either way, the referral is still going to an individual registered pharmacist!
This is the way every other referral works.
Why does it need to be different here?

We as a profession must recognise that we need to collectively perform MORE HMRs; and that restricting HMRs to only be performed through shops is an inappropriate and out-dated method of service delivery.

I don’t want to own a shop that sells medicines.
So at least let me own my HMRs!

Stephen Carbonara.

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