April 2002 issue Pharmacy Today magazine

MISSING OUT ON SUBSIDY

Jon Hoyle

At least two Otago pharmacies are servicing large tracts of isolated country but neither qualify for a rural subsidy.

Alaistair Forbes is sole pharmacist and owner of Roxburgh's only pharmacy. He also operates a depot pharmacy, 60 kilometres away in Lawrence after the local pharmacy closed two years ago.

His patch covers an area the size of metropolitan Auckland, serving more than 3600 residents and a host of seasonal horticultural workers.

The pharmacy is 160 kms from Dunedin and 40 kms from the nearest bank or pharmacy.

He is oncall, and available 24 hours a day.

To attract locums, he pays top rates as well as travel and accommodation.

Alaistair Forbes fails to qualify for the rural subsidy as the Lawrence depot and Roxburgh operations are considered one business. Together they dispense more than the cut off point of 20,000 subsidised prescriptions.

While both outlets may be seen by the Ministry of Health as one unit, overheads are duplicated, courier and personal travel costs are high, and large stockholdings must be carried to cover any eventuality.

While Alaistair Forbes says he was under no illusions about the economic realities of an isolated pharmacy when he started out, he believes future reductions in dispensing margins could endanger the business and patients.

He argues the prescription level set by the Ministry of Health is "arbitrary" and if Roxburgh and Lawrence were separate, they would attract two rural subsidies.

Chosen few

The Ministry of Health paid out $183,700 in "rural bonuses" to 14 pharmacies in the 2000/2001 financial year.

Locations range from Great Barrier Island to southern Southland.

The subsidy varies from case to case, depending on degree of isolation with the main factor being the number of subsidised prescriptions dispensed. The exception to the 20,000 dispensing cut-off is if the pharmacy provides regular "outreach" services to remote areas, according to ministry deputy director Gordon Davies.

Ranfurly pharmacist Denis Todd lost his rural subsidy after his pharmacy broke through the 20,000 prescriptions barrier two years ago.

The closest pharmacy and bank is an hour's drive away. He says there are no "stable" courier or passenger services readily available.

His pharmacy serves around 2000 people.

"I would maintain that if you're a rural pharmacist doing 20,000 prescriptions a year, then you are vital to that community," he says.

Carrying large stockholdings and attracting locums have their own economic and personal costs, Denis Todd says.

In the last 33 years as the local pharmacist, he has averaged two weeks' holiday a year.

Both Denis Todd and Alaistair Forbes say "professional isolation" is another concern, limiting support from other pharmacists and making continuing education difficult.

The cornerstone of the Primary Healthcare Strategy is equitable access to primary healthcare services.

The current rural bonus system is operated under the Pharmacy Services Contract, which is soon to move to District Health Board (DHB) management.

Both pharmacists have approached Otago DHB to state their case and gauge what support they can expect.

Neither the DHB 's chief executive or manager for community services returned Pharmacy Today's calls.

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