Hansard debates

                                   Reference

  Hon. D. M. DAVIS (Minister for Health) -- I move:
  That,  noting the  Australian  Health Practitioner  Regulation Agency  2012-13
  annual report, particularly as  it relates to  the registration of pharmacists
  in  Victoria,  this house requires  the  Legal and  Social  Issues Legislation
  Committee  to inquire  into and  report by  14  October 2014  on the  role and
  opportunities  for  community  pharmacy  in primary  and  preventive  care  in
  Victoria.
Our community pharmacists  are  a very important  group in the community.  Every
High  Street  in  the  state  pretty  much  has a pharmacy, and generally  these
pharmacies are run by local people. There are of course some larger chains.

Pharmacists are trusted and respected by the community as people who have a high
level  of tertiary qualifications  enabling  them to  provide  strong support to
their patients.  They  act primarily through  the  dispensing of  medicines  and
advice, dispensing medicines primarily through prescriptions  written by GPs and
other specialists. Those prescriptions are filled by pharmacists, and support is
provided by the federal government through the  pharmaceutical  benefits scheme,
which is an  important  scheme.  An  opportunity is there for our pharmacists to
play a significant and wider role.
Changes have been made where the pharmacist's  role  has  been  enhanced in some
jurisdictions,  particularly in Queensland and the Northern Territory,  for  the
administration of  vaccinations.  There is also  potential for an  enhanced  and
wider  management  role, including  in  the post-acute  setting  and  aged care,
particularly in the country -- that is, in rural and regional areas.

Potentially there is also a wider role for  them in  reducing some  pressures on
our hospitals and emergency  departments by providing  advice and referrals that
may be timely or appropriate. As pharmacists encounter patients they may well be
in a  position to provide them with useful advice  about where  they might  seek
further treatment.
Pharmacists  are  not  only  in  the  community  setting but also in  our  major
hospitals, both  public  and  private, providing  a  very important  service  as
hospital  pharmacists, and on  some occasions they are  in our community  health
centres as  well. This reference  seeks  to look at  opportunities for community
pharmacy  in primary  and  preventive  care in  Victoria,  drawing  on  what  is
available in  other  jurisdictions,  particularly  some  of the other Australian
states, as I have outlined.

I note that there is a  lack of remuneration for any  expanded service role, and
that  is something the committee may wish to examine. There  is a range of views
about the roles of pharmacists  in  these  circumstances,  and  the  role of the
committee  in this context is to look at the registration context,  noting  that
the registration of pharmacists, like that of all health professionals, is aimed
directly  at securing public safety  and ensuring that  those who are registered
provide  safe and  effective services in  a way  the community  is able  to feel
confidence in.  The  Australian  Health  Practitioner  Regulation Agency and our
national  registration arrangements do  that, following on from  the regime that
previously operated in Victoria.
I  note  that  the Victorian Pharmacy Authority provides regulatory arrangements
relating  to  pharmacy  premises. It is not my intention that  this  inquiry  be
fundamentally focused on the  question  of  the role of pharmacy premises and so
forth and the ownership of pharmacies. 

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There are longstanding debates about this.  The Productivity Commission  has had
things to say about those matters and I am not, through this  reference, seeking
to relitigate or redebate those points that I regard as currently settled in the
Victorian context. But it is fair to say that pharmacy  faces  some  significant
challenges in  terms of workforce.  A number of pharmacies  are facing difficult
times, and in that  context,  with  a  highly trained professional group that is
well dispersed throughout the community, is trusted and  can  be  relied upon by
the  community,  and is registered  with  an appropriate level  of oversight and
regulation, there is  the  potential to  ask  what other activities  pharmacists
could undertake to contribute to the health system in our community.
I know a number of medical groups  have divergent views, and I am not prejudging
these  matters in any way. I know that  these groups  -- the  Australian Medical
Association in particular and others -- will make their views known.

In  a sense  this  process  would  seek  to  see  if  through  the  registration
arrangements  there is any  impediment to or  other  restriction on  pharmacists
doing  more safely or trialling  different approaches and  different scopes in a
safe  way that  would  be consistent  with  their registration requirements  and
rules.
Community  pharmacy  could  provide  more  personalised   medication  management
services  targeted to  a cohort of older Victorians who are at risk  of hospital
admission or  readmission  and enable  them  to remain living  independently for
longer and with greater choice. That might be  in the home or it  could be in an
aged-care  service,  so there may be some opportunities there, and  I  would  be
interested in the community's views in that context.
The issue of immunisation has been discussed in other jurisdictions.

Internationally  vaccination by  community pharmacists  has  become commonplace,
with  experiences  reported  as  overwhelmingly positive.  Pharmacists  commonly
administer  a  range of  vaccines  in countries including  the  USA, Canada, the
United Kingdom and New Zealand. As I said, these are being piloted in Queensland
and the Northern Territory. The Pharmacy  Board of Australia has  now recognised
that vaccination is  within a pharmacist's scope of practice once guidelines and
training requirements are established. As I understand it, this process is under
way.  In  addition  to  increasing  accessibility  and   reducing   costs,   the
availability of pharmacist vaccinators  may mean the risk  of a major  influenza
pandemic  is  able  to  be  managed more effectively. But I seek the community's
input on a number of those matters.
The issue of avoidable hospital admissions  is another area of interest in terms
of the role pharmacists could play.

Certainly  when  patients  are  discharged  from  a  major  facility  the  local
pharmacist  has,  as  has  the local  GP, a  significant role  to play,  and the
linkages and  arrangements that can be struck in that context are important. The
provision of certain advice about wound care may also be a role that pharmacists
could play, and  the  role of referring and directing patients to other services
is a critical one.
Accessible service delivery models in regional and  remote areas are potentially
also an important addition. A community  pharmacist could facilitate initiatives
such as telehealth. In some towns the pharmacist is a major service provider and
in   some  cases  virtually  the  only  permanent  service  provider.  In  those
circumstances the question is: what  role could pharmacists  usefully and safely
play in the community's interest?

I think this is one of  those references where a number of factors are aligning,
including trials in other states and a desire by community pharmacists to extend
or enhance their role in the provision of some  primary  and  preventive  health
services which may  well be efficient  and  safe. Equally there  are significant
financial challenges  for the community  pharmacy sector with the  likelihood of
reduced employment for both pharmacists and  their staff. In those circumstances
it may be that the pharmacy will play a greater role.  The committee should look
at  this and examine what is in the community's interest,  what is  feasible and
what reasonable  steps could  be taken  in this  area to weigh  and balance  the
evidence that is put to  it and  seek some  logical consensus which could inform
government policy into the future.

  Ms  HARTLAND  (Western Metropolitan) --  I am also somewhat  surprised by this
reference, mainly because  it  does  not  appear  to be going to the appropriate
committee. I will move an  amendment later  that this reference should go to the
Legal  and Social Issues References  Committee rather than the  Legal and Social
Issues Legislation Committee. As I understand it, if you make a reference to the
Legal  and Social Issues  Legislation  Committee, you  need  to actually present
legislation or it needs to refer to an annual report. The minister might be able
to  direct me, but  I  have read the  Australian Health Practitioner  Regulation
Agency (AHPRA)  annual  report,  and I  cannot  find a  reference  to  community
pharmacists in it.

In his right of reply  I would very much like the  minister to direct me to  the
page in the AHPRA annual report that refers to community pharmacies.
What I  found really interesting during the minister's contribution  was that he
talked at length about the idea of trialling vaccinations at pharmacies. I  have
done quite a bit of reading on this, and  I know that it is occurring in England
and has occurred in the United  States. It is something we should be looking at.
I would have thought that references to a committee, especially from a minister,
should be succinct and  have an achievable  outcome rather than this  incredibly
vague, 'Let's look at what they might or might  not be doing' reference that  we
have here, which is:

  That,  noting the  Australian  Health Practitioner  Regulation  Agency 2012-13
  annual report, particularly as it  relates to the  registration of pharmacists
  in Victoria,  this  house requires the  Legal  and Social  Issues  Legislation
  Committee to  inquire into  and report  by 14  October 2014  on the  role  and
  opportunities  for  community  pharmacy  in  primary  and preventive  care  in
  Victoria.
That is  really vague.  I agree  with Ms  Mikakos that this  reference is  about
keeping the committee busy rather than doing beneficial work.
I also find interesting the number of references that  have been attempted to be
moved in this house that have been rejected by the government, as Ms Mikakos has
pointed out, yet now we  have an  extremely vague reference that does not really
say what we should or should not do.  It is basically an attempt to keep us busy
until October.

If the minister had actually  put  forward  a reference on the vaccinations that
could be done by community pharmacies, that would have been a really interesting
thing to do, and it could have been  helpful. This reference is extremely vague,
and it is not necessary.
Greens amendment circulated  by

  Ms  HARTLAND (Western Metropolitan) pursuant to
standing orders.
I move:
  That  'Legal  and Social  Issues  Legislation'  be omitted  with  the  view of
  inserting in its place 'Legal and Social Issues References'.

The clear  reason  why  I am doing  this  is  that the  reference  is  not about
legislation and what it is about is not in the annual report, so it should go to
the references committee.

  Hon. D.  M.  DAVIS  (Minister  for  Health)  --  I  thank  members  for  their
contributions. I indicate that the government will oppose the proposed amendment
by Ms  Hartland. It  is  entirely appropriate  for the  reference to  go to  the
legislation committee. It relates directly  to  the registration of pharmacists,
which is canvassed in  the annual report. One of the 14 boards of the Australian
Health Practitioner Regulation Agency (AHPRA)  is the pharmacy board,  and it is
responsible for the registration of pharmacists at a state and national level.
  Ms Hartland -- What page was that?


  Hon. D. M. DAVIS --  I do not have the  report in front of me, but pharmacists
are registered by  AHPRA, and these matters relate directly to  the registration
requirements and the work of that registration board.
In response to the idea  that  this is in some way a general  reference,  I note
that it is about opportunities for community pharmacists, as opposed to hospital
pharmacists  or  pharmacists employed  in  major  public  settings,  and  I have
enumerated the opportunities  for community pharmacists at length. I am  pleased
to see that both the non-government parties have indicated  that they can see at
least some areas of merit where they could add value in this area.
Pharmacy is a major professional group. It faces some significant challenges. If
those  in the non-government parties  do not understand the significance of this
group, that is disappointing.

If they do not understand the significance of the primary care contribution that
can be made by community pharmacists, that is very disappointing indeed.
The government  will  proceed with this  reference.  We believe it  will provide
useful information. As I said, I 

 Page 1584


have  had  discussions with  the  Pharmacy  Guild of  Australia,  others in  the
pharmacy profession and community pharmacists more generally about these matters
and about the  opportunities.  Ministers for health  at  a national  level  have
discussed a number of these matters as well.  I have pointed to trials and other
arrangements available  in both Australia  and other jurisdictions that could be
examined  for  potential  use  in Victoria. I would welcome  the  input  of  the
committee on those matters.
House divided on amendment:
                                    Ayes, 17
Barber, Mr                    Mikakos, Ms 
Darveniza, Ms                 Pennicuik, Ms 
Eideh, Mr                     Pulford, Ms 
Elasmar, Mr (Teller)          Scheffer, Mr 

Hartland, Ms                  Somyurek, Mr 
Jennings, Mr                  Tarlamis, Mr 
Leane, Mr                     Tee, Mr 
Lenders, Mr                   Tierney, Ms (Teller)
Melhem, Mr 
                                    Noes, 19
Atkinson, Mr                  Lovell, Ms 
Coote, Mrs                    Millar, Mrs 
Crozier, Ms                   O'Brien, Mr D. D.
Dalla-Riva, Mr (Teller)       O'Brien, Mr D. R. J.
Davis, Mr D.                  O'Donohue, Mr 
Drum, Mr                      Peulich, Mrs 
Elsbury, Mr                   Ramsay, Mr 
Finn, Mr                      Rich-Phillips, Mr 

Guy, Mr                       Ronalds, Mr (Teller)
Koch, Mr 
                                     Pairs
ALP vacancy                   Ondarchie, Mr 
Viney, Mr                     Kronberg, Mrs 
Amendment negatived.
Motion agreed to.

  Ms MIKAKOS (Northern Metropolitan) -- I rise to indicate to the house that the
Labor  opposition  will not be opposing this motion and the  reference  to  this
committee. However, we have a number of reservations.

The first one relates to  the fact that the  government has chosen yet again  to
refer to an upper  house committee a matter which is designed to ensure that the
committee does not have to actually deal with some of the pressing issues facing
Victoria. For example, the committee could do  exactly  what  the  Leader of the
Government suggested in  a recent sitting week -- that is, go about its business
as  a  legislation committee  as set  out in  the standing  orders and  call the
Secretary of the Department of Health to  give  evidence  to  the  committee  in
respect of the department's annual report.

 Page 1582


The  committee  could look at some of the many pressing issues facing Victoria's
health system at the  moment, including the crisis in our emergency departments,
the crisis in terms of the growing number of people waiting for elective surgery
in our hospitals or the ambulance crisis facing the  state at  the moment. There
are many  issues,  the  most  recent  being  the  implications  of  the  federal
government's cuts to the health  budget and  the impact  this will  have on  our
state hospitals and our state health system, which we heard about just today.
Yet  the minister, who is also  the Leader of the  Government, has chosen not to
give the committee such a reference, which would actually be timely  and  useful
in  terms  of providing information and advice to government in respect of these
issues. Instead  he  has chosen to give  the  committee what I think  is  a very
innocuous reference in respect of pharmacies.

Up until this point it was not clear  what the minister wanted the  committee to
look at, given the reference only relates  to  the  role  and  opportunities for
community pharmacies in primary and preventive care.
The point I make is that up to this time the upper house committees have had  59
attempted  references  in  total,  of  which  only  11  were  passed and 48 were
defeated.  The Legal and Social Issues Legislation Committee,  of which I happen
to be a member, has had sent to it only one bill that  was passed by this house,
and that  related to a very  non-controversial bill in  respect of international
wills. The  government has  chosen to  send a reference to a committee which  is
chaired by a government  member and on which it has the numbers rather than send
this reference to the Legal and Social Issues  References Committee, which would
be the more appropriate place for a reference of this nature.

We would be very supportive of any attempt to have the reference go to the Legal
and Social Issues References Committee because that would be a more  appropriate
place for it.
Without disclosing the discussions that members of the committee have had around
this reference,  I believe that the reference itself leaves a lot to be desired.
The minister, in his contribution to the debate on this motion, set out a  whole
lot of issues that he  would like the committee to  look at, yet all or  some of
those  matters could  have been  explicitly set out in the terms of reference --
for example, the  minister referred to trials in other states, immunisation, the
impact on regional areas and on aged care and a whole lot of  other issues which
could have been made part  of  the  reference.  This just demonstrates the haste
with which this motion was cobbled together by the  minister and  his office  in
order to give this committee some work to do.

We know that the  government is keen to have the upper house committees meet. We
had  the absurd  situation during  the last sitting week where a meeting of this
committee was called. There was no business when that meeting was called; it was
called for the purpose  of  not  allowing  general  business  to  be  debated on
Wednesday evening, to curtail debate  and to  have the  house rise at the dinner
break.
This is why we on this side of the house are  extremely cynical when it comes to
the minister's motivations. We  have a hastily cobbled  together motion when the
minister could have put a proposition that he wished us to test  with respect to
the pharmacy sector and  some proposed  reform or  change that he is prepared to
consider. But of  course  the reference  does  not contain any  proposition  for
reforms.  It does  not contain any prescriptive ideas in terms of what  he would
like us to consider.

It  is  clear that this  was  designed to keep the  committee  busy and give  it
something to do so that it can meet on  Wednesday evenings until the election is
called. We are cynical about this for this reason.
Of course we all agree that pharmacists do a terrific job. I have needed to make
frequent use of pharmacies over the last few days. They provide enormous support
to many people in the community, particularly those with chronic illness and the
elderly, who  have many different health  conditions. These are  the  people the
minister and members of  the government  should be standing up for when it comes
to the $7 GP tax that their federal colleagues are imposing. We saw some feigned
outrage from  the Minister for Health earlier in question time when  it came  to
discussing the implications of the federal health cuts. The best he could do was
resort  to quoting Dr Seuss and talking about green eggs  and ham, which had all
of us  on  this  side  of the house perplexed. We  still  have  no idea what the
minister was going on about in his contribution.

If the upper house committees are to do the job they were  intended to do and if
the  government  is to take them seriously, then it is important that government
members give  some  thought to  these  references, provide greater  guidance and
clarity  not just to committee members but also to the community more widely and
the sector the  reference  relates to -- in  this  case it is pharmacies  -- and
actually put  to them some proposed ideas for reform. The minister has not  done
that  in  this case. It is  all about a very  open-ended  reference that is just
intended to keep the  committee  busy. I hope the  committee is able to do  some
good work through this reference, but we really have to 

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question the  lack of  thought the  minister has put into the reference to  this
point. He has failed to  outline in  the reference  any of  the propositions and
ideas he mentioned in his contribution today. Some of  these  matters could have
been set out in the reference itself.