January 2002 issue Pharmacy Today magazine

WHY DEREGULATE?

Opening up pharmacy ownership is more likely to improve the health of corporate bank balances than that of New Zealanders, according to some pharmacy sectors.

Both the Pharmacy Guild and Pharmaceutical Society say the government's plans to deregulate pharmacy are flawed and suggest a "hidden agenda" is behind the move.

Treasury was brought into the debate last year and private sector interests have lobbied government on the issue.

National and The Greens oppose the ownership proposals as they stand, citing the risks of corporations focusing on profits rather than services and safety problems, as outweighing potential benefits. Labour's coalition ally Alliance is yet to take a stance.

The Australian government decided to retain pharmacist ownership last year.

Right to know

Society president Bernie McKone wants the government to divulge what is really motivating the change.

"We are expected to embrace the Primary Healthcare Strategy so I think we have the right to know whether this (ownership) is driven by Treasury, corporate philosophy or pharmacy itself."

The changes, according to Minister of Health Annette King, are in preparation for the Health Practitioners Competency Assurance Bill.

Annette King sees pharmacy as a key part of primary health services and believes those "progressive" pharmacists with a desire for clinical work will lead the profession into the Primary Health Strategy. Among the benefits being promoted by government are providing New Zealanders with better access to health services, and freeing pharmacists from "shopkeeping".

The government claims improved access will come from pharmacies being owned by supermarkets and PHOs - the latter being the vehicle which will deliver the government's Primary Healthcare Strategy.

This will also ease access for lower socioeconomic groups, Maori, and Pacific Islanders, Annette King told Pharmacy Today.

The ministry's deputy director-general of sector policy, Dr Gillian Durham, says a significant proportion of New Zealanders visit a pharmacy while grocery shopping or after visiting their doctor.

This is not news to pharmacy with proprietors historically seeking to place their businesses in close proximity to doctors and supermarkets, says Pharmaceutical Society chief executive Dr Joan Baas.

How supermarkets will slot into the Primary Healthcare Strategy is unclear, but Gillian Durham says in most provinces of Canada where licensing is in place, supermarkets have been slow to acquire pharmacies.

PHO as pharmacy owner

The ministry is working on draft guidelines on Public Health Organisations (PHO) ownership. So far the options are non-profit companies, trusts and incorporated societies. The ministry is also looking at ways PHOs can own pharmacies.

"If it (a PHO) wants to provide comprehensive services, that legal entity needs to be able to own a pharmacy," says Gillian Durham.

Some pharmacists suggest this throws up the question of whether prescribers will sit on boards governing PHOs and controlling their subsidiary pharmacies. Under the proposed ownership changes prescribers are prohibited from owning pharmacies.

Safety and service

The society remains unconvinced the changes will improve access or the quality or safety of pharmacy. President Bernie McKone says, "it's unfair (for the government) to assign these benefits when the concept is largely untested theory."

His main concerns revolve around erosion of services and pharmacy security.
He sees potential conflicts of interest where an employee pharmacist may have to block a non-pharmacist employer from access to the dispensary and pharmaceutical stock. In such cases pharmacists are likely to be torn between their legal and ethical requirements and the person who pays them. He also envisages cheap or free services provided by pharmacists will disappear if the focus moves to maximising profits.

"The new regime will drive these sorts of pharmacists away and New Zealanders may well miss them."

In a letter to the Health Minister, pharmacist Murray Binning gives the example of dispensing and delivering 210 cans of Ensure to an elderly patient for the payment of $4.95, which he adds, the ministry fought hard to reduce for much of last year.

Annette King says she is confident Medsafe will efficiently vet owners and effectively oversee pharmacy security. She also believes pharmacy services will not be negatively affected by non-pharmacist ownership.

Ownership, she says, is not a measure of a health professional's competency.
"Why would they (non-pharmacist owners) be any different from anyone (currently) providing the service - as long as they have a pharmacist in charge of services."

Gillian Durham says the ownership picture will become clearer once the legislation develops and a three-year primary health funding package is announced early this year.

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