8 key facts about the non-dispensing Pharmacist Workforce Incentive Program 2019
From 1 July 2019, the new Workforce Incentive Program (WIP) is set to expand the available financial resources to help support the direct employment of allied health professionals, including non-dispensing pharmacists. In this article, we look at 8 key facts you need to know about the new WIP and how it could impact the way GPs work with pharmacists.
1.Replacing legacy GP rural and practice nurse incentive programs
According to the Department of Health, the new WIP is set to streamline existing GP, nursing and allied health incentive programs, replacing the General Practice Rural Incentive Program and the Practice Nurse Incentive Program.
2. Eligibility
Around 5,000 practices and more than 7,000 medical practitioners will be eligible for incentive payments under the new WIP. According to the Department of Health, the funding is set to strengthen team-based and multidisciplinary primary care and support practices to employ allied health professionals, including non-dispensing pharmacists, in all locations.
3. Who will benefit
The Workforce Incentive Program is set to particularly benefit regional, rural and remote communities, improving access to quality medical, nurse and allied health services.
4. Who instigated the changes
In April 2019 the Australian Medical Association (AMA) issued a pre-budget submission with a call for investment in primary care. As part of the submission, the AMA also requested additional support for better access to GP-led team-based care for patients by lifting the caps on subsidies available through the new WIP.
The AMA‘s proposal to establish a funding program to integrate non-dispensing pharmacists within general practices, states it will mean pharmacists could assist GPs with medication management to deliver a number of key health outcomes including:
- Better coordination of patient care
- Improved prescribing
- Improved medication use
- Reduced medication-related problems
- Fewer adverse drug effects (ADEs)
- Fewer hospital admissions (from reduced ADEs); and
- Improved health outcomes for patients, including a better quality of life.
5. GPs and pharmacists working together to enable better health outcomes
According to Dr Ines Rio, chair of the AMA, Victoria, evidence from overseas shows that having a non-dispensing pharmacist in general practice leads to:
- Greater interdisciplinary practice
- Improved management of chronic disease
- Better use of medication; and
- Reduced costs to both individuals and government.
In fact, a recent survey by the PSA found high levels of productive communication between practice and community pharmacists, while a study in the ACT reported that both GPs and pharmacists viewed the arrangement positively.
“Non-dispensing pharmacists in general practice is an evidence-based model with significant potential benefits for individual patients, GPs, pharmacists and the healthcare system as a whole,” he says. “It is supported by the AMA and the PSA and underpins truly coordinated and comprehensive multi-disciplinary care.”
6. Helping reduce polypharmacy and drug-related problems
Dr Rio notes how general practices are increasingly rising to the challenge of providing a comprehensive suite of services focused first and foremost on the patient. For patients with complex and chronic health problems, he highlights many other health professionals with more specific skill sets are frequently valuable in working alongside GPs in addressing a patient’s mental, physical and social needs.
“Non-dispensing practice pharmacists provide a wealth of potential benefits to both patient and doctor,” he says. “Their deep expertise in pharmacotherapy positions them to help drive reductions in polypharmacy and drug-related problems (a cause of a significant number of hospital admissions), improve patient compliance through simpler dosing, enhance patient understanding of self-medication techniques, and save time for the GP.”
7. Active medication reconciliation and the role of the pharmacists in general practice
Central to the role of the pharmacist in practice is active medication reconciliation, Dr Rio explains. This involves making a thorough audit of all current medications a patient may be taking and comparing the list to prescribers’ orders.
“The value of this becomes apparent when you consider that up to two-thirds of medication histories contain at least one error and a third of those are potentially harmful,” he adds. “The majority of these errors occur during transition to and from hospital. Additionally, patients who are missing medications on discharge are more than twice as likely to be readmitted.”
8. Proposed role for pharmacists in general practice
The AMA’s proposal to establish a funding program to integrate non-dispensing pharmacists within general practices, states the role of the general practice pharmacist would not include dispensing or prescribing medication or issuing repeat prescriptions.
The AMA proposes that non-dispensing pharmacists in general practice will focus on medication management, in particular:
- Medication management reviews conducted in the practice, an Aboriginal Health Service, the home or a Residential Aged Care Facility (RACF)
- Patient medication advice to facilitate increased medication compliance and medication optimisation
- Supporting GP prescribing
- Liaising with outreach services and hospitals when patients with complex medication regimes are discharged from hospital
- Updating GPs on new drugs
- Quality or medication safety audits; and
- Developing and managing drug safety monitoring systems.
“Supplementary activities, depending on the needs of individual practices, could include activities such as patient education sessions, mentoring new prescribers and teaching GP registrars on pharmacy issues,” the AMA states.
9. A working relationship delivering real patient outcomes
One example of the incentive delivering exceptional patient outcomes is Market Street Medical Practice in Wollongong, where Pharmacist Karina Bronska was included as a member of the multi disciplinary care team for a period of 26 weeks during 2018.
After conducting medication reviews, particularly with older patients, the pharmacist identified a significant number of medicine-related issues, leading to enhanced medication management by patients and their doctors. In particular:
- 96% of reviewed patients had potential drug related problems identified (such as drug–food interactions, and double-up of medication following hospital discharge)
- Most drug-related problems involved antidepressants, hypoglycaemics, or complementary medicines
- 88.5% of reviewed patients were found to be taking more than 5 medications
“The data was amazing, because it showed just how many patients have issues with their medicines,” she explains. “The patients found it really helpful to have someone to sit down with them and explain their medicines. Many of them told me how much they appreciated being able to ask questions without feeling they were taking up the doctor’s time.”
Market Street Practice’s Dr Charlotte Middleton says the biggest benefit she found was that she was able to check with patients not only what medications they were taking and why, but also how they were taking them - as well as possible interactions with complementary medicines.
“We have a large population over the age of 65 here, so polypharmacy is a big issue,” she explains. “There’s a real need for patients to have someone sit with them and go through all their medications.”
“GPs often don’t have the time to go into that level of detail,” she adds. “Having pharmacist involvement improved patient outcomes at every level, and from the practice’s perspective, it led to improved patient satisfaction. Patients feel like they are having personalised medicine and are really being cared for.”
The non-dispensing pharmacist Workforce Incentive Program commenced from 1 July 19
AusDI, Australia’s trusted medicines information database, in combination with IM Gateway and Don’t Rush to Crush, offer ideal companion content to support the role of the non-dispensing pharmacists in tackling medication management in General Practice. To find out more visit: ausdi.com
