Mr JENKINS (5:08 PM) —I am pleased to rise in support of the National Health Amendment Bill (No. 1) 2000. The basis of the bill, of course, is that in May of this year there was an agreement between the government and the Pharmacy Guild of Australia on the third community pharmacy agreement, to start on 1 July 2000. This bill is designed to make some minor changes to the act as a consequence of that agreement. As discussed in the debate, this third agreement follows on from the first two agreements, the first being in 1991 and the current one, which was put in place in 1995. The honourable member for Bruce made mention that the first agreement was achieved—and I think he made quite an understatement when he said that it was not an easy agreement to complete. I can remember those years and the angst that surrounded the discussions, but I would hope that what we saw in the development of the first two agreements has led to the degree of trust now being shared between those who negotiate on behalf of the government and those who negotiate on behalf of the guild. I know some of the people in the guild quite well and I know that the absence of great public angst on this occasion does not mean that these were not very hard fought negotiations where people put their points, and along the way there would have been a degree of trading over them. I think the important thing, something I look back on with some satisfaction, is that the first agreement was reached at a time when the Hawke government was under considerable attack, which caused us some considerable pain, but the type of agreement we put in place has been slowly but surely built on. Many of the outcomes that we had hoped for at the time of that agreement have been achieved and developed. I think that is very important.

The third community pharmacy agreement has five key features: it provides agreement for the remuneration of the dispensing duties of pharmacies; as was mentioned by other speakers, it seeks to increase the access to pharmacy services in rural and remote Australia via a $76 million package of incentives during the life of the agreement; it involves a $140 million enhanced medication management service for the elderly; it introduces a pharmacy development program—some $188 million over five years; and, lastly, it relaxes the degree of regulation applying to new pharmacies by reducing the zone from a two kilometre distance down to 1.5 kilometres, as the crow flies. Another aspect of the agreement is the one-off $11 million bonus, the basis of which, regrettably, at this point in time, is not quite as clear as perhaps it could be.

Now that the pharmacy agreement is signed off and will come into force in July, the issue does not end there. There are still a number of issues that the pharmacy industry should be considering. This agreement, of course, is between the government and the guild. In this case, the guild represents the owners of pharmacies. As has been outlined, concerns have been raised by associations such as the Association of Professional Engineers, Scientists and Managers, Australia, which represents employee pharmacists. It believes the guild needs to ensure that the benefits of this agreement with the government flow equitably to employee pharmacists as well. The association has expressed some concern that there is little in this agreement to encourage young pharmacists to stay in the industry, given that the cost of a licence can now add some $900,000 to the price of a pharmacy.

I think these are important issues, which I hope the guild will consider for the future of the pharmacy profession. These are the types of things that, while not directly included in the agreement, should form some part of the negotiations. The agreement also introduces a Pharmacy Development Program, with financial incentives to make quality improvements in pharmacy services. As with my previous comments about the one-off payment, there is some concern about the lack of detail. We would like to see perhaps more detail about the specific measures that can be undertaken to improve quality in which outcomes qualify for the incentive payments.

I have stated before in this place that I believe pharmacists are part of a team approach to health care and that the future of pharmacy lies in developing this role. Indeed, when I chaired the Standing Committee on Community Affairs and we did an inquiry and in the report, entitled Prescribed Health, we said that this meant that, where necessary, doctors, pharmacists, nurses and allied health professionals should work together with consumers and their carers to improve health outcomes. That was in relation to the way in which health services operate in Australia. I noted with distinct interest the minister's expectation in the second reading speech, where he said:

Of course that is integral and lies at the base of the Pharmaceutical Benefits Scheme that Australia enjoys.

I have always pondered the fact that one of the difficulties is—and it is recognised by the guild—that the way in which pharmacy services are delivered to the community very much relies on community pharmacists. I have no problem with that, but the economics of community pharmacies relies also on their retail aspects. I have quoted from time to time the evidence that our inquiry received back in 1992, where people unashamedly indicated that without what I describe as the `front of shop activities' of pharmacies, they may not be able to put in place their professional duties. I think that continues to be of some concern, and that is probably why concern is developing about what is put in place for pharmacists who are lucky enough to be owners of community pharmacies against those who work for them as employees. I am not going to offer any sort of definitive answers to those ponderings, but I really think that it is getting to the time where we have to revisit the nature of what we have put in place.

While the recommendation that involved the association of pharmacies with medical centres getting under the zoning rules has been rejected, at some stage we have to think imaginatively about ways in which community pharmacies can better relate with general practitioners and other allied health professionals working in the community. It is clear that if we look at the way in which a pharmacist working in an institution works with other allied health professionals, there are great advantages. But through the PBS, because we are trying to get out of it by not recognising the full value of the professional service given by the pharmacist by tying their remuneration to the mark-up of drugs as well as a payment for professional services, we are not getting as great a value as we could. This is not something that we would be able to change overnight, because the system of community pharmacists based on retail outlets is well entrenched.

The other comment that I want to make is that the guild realise that they do not live in a world that is frozen. There is not some expectation that they have to do things differently and that they have to improve. Like other members, I have had community pharmacies that have got their accreditation under the guild's Quality Care Pharmacy Program. I am pleased to see that, because it means that these pharmacists recognise that they have to come up with a product other than just the goods they are selling. They have to come up with a product that is about the way in which their information is delivered, so that consumers feel confident when they enter the pharmacy that they are not treated as somebody who is just there to buy something off a shelf; they are treated in the way they would expect to be treated by a health professional.

It is pleasing to see that this third agreement has been completed in the successful way it has. I hope it continues to have the outcomes that we have come to expect of the earlier agreements. But those with an interest in matters to do with pharmacy really do have to see that this is not just the end of a struggle or a long march. This is a developing and continuing activity, and the guild now faces the challenge, post the signing off of the third agreement, to decide what the future holds. There is no doubt that challenges will continue under the guise of competition policy, because it is now down to three sectors: pharmacies, the taxi industry and newsagents. Everybody else has been dragged, screaming, into deregulation, and some of the questions asked during question time indicate the troubles that the dairy industry is having. That type of pressure will continue.

I have always been comfortable in supporting community pharmacy, because I believe that the strength that the community pharmacies have is that they are health professionals. They are on about providing a health service, and therefore the blanket use of national competition principles should not apply. But to do that, we have to divorce the front of shop, retail aspect from the back of shop professional aspect.

Finally, whilst I was happy to sign off on the joint retail committee's recommendation that the supermarket chains should be kept out of ownership of pharmacies, I suspect that those supermarket chains are still hovering around and testing the wind to see if they might get a toe in the door. I think if anybody goes into the newly built supermarkets they will see some very strange little corners and portions of supermarkets where they have congregated all of their health products and they have started to put in counters and things like that. I would be very suspicious about why they were going to that trouble. At the end of the day, one of the strengths the community pharmacies have will be the way in which they project themselves. I think they have to continue to make the improvements that they have been making. They are best served not only by looking at things in the interests of pharmacists as owners but also by looking at pharmacists as health professionals and employees. They should be embracing any support that they can get through involving consumers in negotiations. In that way, they can continue to provide a good service that continues to improve. I have no problem with supporting this piece of legislation that is before the House.