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Thursday, 16 February 2012
Page: 1609


Ms LIVERMORE (Capricornia) (11:37): 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.