This week, the column covers winners and losers from the 8th Community Pharmacy Agreement, what the Federal Government’s not mentioning when spruiking the latest bulk billing data, and the latest data on causes of death.
Columnist Charles Maskell-Knight also links readers into the inaugural Elder Care Support National Yarning Circle on the Gold Coast, new research on how the fast food and alcohol industries influence public opinion and public policy, and a united call from nursing groups for the Government to show courage in implementing scope of practice reforms.
The quotable?
That splashing noise you can hear in the background? It is the Government going to water.”
Charles Maskell-Knight writes:
Health Minister Mark Butler returned from the World Health Assembly in Geneva and signed the 8th Community Pharmacy Agreement (CPA) with the Pharmacy Guild. The Agreement will begin from 1 July this year, superseding the 7th Agreement which still had a year to run.
According to Butler, the CPA “will support pharmacists to deliver more services and cheaper medicines [and is] a win for patients who will benefit from cheaper medicines and more pharmacy services”.
The Pharmacy Guild said that key features included “the phasing-in of the $1 discount for all Australians, funded by the Commonwealth Government”, and “an additional AHI [administration, handling, and infrastructure] payment to community pharmacies for dispensing a 60-day prescription”.
What this means is that the optional discount of up to $1 pharmacies can now apply to the cost to patients will be extended to all patients – but paid for by Government, thus eliminating any possible competitive pressure; and pharmacies dispensing a 60-day prescription will receive an additional $4.80 AHI payment, which will compensate for much of the dispensing fee income they lost.
That splashing noise you can hear in the background? It is the Government going to water.
As Australian Medical Association (AMA) President Professor Steve Robson said several days before the CPA was signed: “CPAs have proven to be anti-competitive and continue to put the interests of pharmacy owners before patients, with several government reports also demonstrating that the CPAs lack transparency and accountability.”
The Conversation published an article by my Croakey colleague Dr Lesley Russell discussing the deal in more detail (also republished at Croakey).
The Government also signed an agreement with the Pharmaceutical Society of Australia to “develop, review and update a number of practice standards, guidelines, codes, and competency frameworks to support community pharmacists to operate to a consistent standard and at the highest level of practice”.
The PSA issued a statement supporting the CPA, as did the Society of Hospital Pharmacists of Australia.
Ministers and government
Minister Butler issued a media release claiming that “newly released data shows the GP bulk billing rate continues to improve each month, since the Albanese Government tripled the bulk billing incentive on 1 November”. The rate for May was 79.0 percent, 3.4 percentage points higher than October last year.
However, Medicare Benefits Schedule (MBS) data released by the Australian Institute of Health and Welfare (AIHW) shows that the proportion of GPs’ fees paid by Medicare has declined from 85 percent in October to 84 percent in April – meaning that people who aren’t bulkbilled are continuing to pay more in out-of-pocket costs.
Aged Care Minister Anika Wells released the Government’s response to the capability review of the ACQSC carried out by David Tune AO. The Government claimed to have accepted all the recommendations. Good news – except it took the Government 14 months since it received the report to reach this point. And, as I have pointed out in a Croakey article here, some of the recommendations were not actually accepted in full.
The Department of Health and Aged Care announced the extension of the National Bowel Cancer Screening Program from 1 July to the cohort of 1.6 million people aged 45 to 49.
It also released (on 30 May) the report on the consultation process about the proposed new Aged Care Act.
The AIHW released a series of reports and updates on deaths data, including:
- GRIM (General Record of Incidence of Mortality)
- MORT (Mortality over Regions and Time
- Deaths in Australia
- What do Australians die from for 2022.
There are many kinds of answers to the last question: direct causes of death were led by lower respiratory tract infections (in eight percent of deaths), and cardiac or respiratory arrest, and sepsis (six percent each).
The most common underlying causes of death were coronary heart disease (10 percent) and dementia (nine percent); while the most common contributory causes of death were hypertension (eight percent), diabetes (seven percent), and coronary heart disease and dementia (six percent each).
Ahpra issued a joint statement with the Medical, Nursing and Midwifery Boards saying that “the emergence of services designed solely to provide customers with access to a predetermined medicine raises concerns that some practitioners may be putting profit ahead of patient welfare”.
The Boards were particularly concerned that “practitioners are cashing in on rising demand for the prescription and use of medicinal cannabis, bulk produced compounded medicines, or soon to be banned compounded semaglutide and related products”.
A quick online search brings up quite a number of clinics with business models that appear to revolve around a telehealth consultation leading to a script for a medicine that the same clinic happens to have available for delivery.
Ahpra and the Boards reminded practitioners of “their long-established responsibilities when prescribing and dispensing medicines, and how they continue to apply in the context of evolving business models” and announced the establishment of “a new unit [to] focus on responding to practitioners who may not be complying with their codes and obligations”.
The Australian Bureau of Statistics (ABS) released the latest microdata set from the National Study of Mental Health and Wellbeing, “a survey that is collected on an irregular basis and… provides information on the prevalence of selected lifetime and 12-month mental disorders, by the major disorder groups”.
First Nations peoples’ health
The National Aboriginal Community Controlled Health Organisation (NACCHO) held its inaugural Elder Care Support National Yarning Circle on the Gold Coast.
Andrea Kelly, the Interim First Nations Aged Care Commissioner, spoke at the event, and said “the Elder Care Support program is a groundbreaking initiative that not only enhances the care for our Elders but also builds a strong First Nations health workforce. By focusing on culturally safe practices, we are paving the way for better health outcomes for Aboriginal and Torres Strait Islander people”.
The event included interactive workshops designed to provide practical knowledge and skills covering the My Aged Care Portal, the new Aged Care Act, and strategies for improving access to services.
The peak aged care providers group, ACCPA, announced it is offering First Nations nurses free places in its Nursing Transition to Practice Programs, with the aim of improving culturally safe care for older Aboriginal and Torres Strait Islander people.
The programs are available to graduate registered nurses, graduate enrolled nurses and transitioning registered nurses, and provide mentorship and professional development as well as experience in the field.
CEO Tom Symondson said: “We are committed to taking meaningful action to support career development for First Nations people. By empowering First Nations nurses through our programs, we are actively contributing to the betterment of our community and the broader aged care sector”.
Consumer and public health groups
The Public Health Association of Australia issued a statement highlighting research published in the Australian and New Zealand Journal of Public Health showing how the fast food and alcohol industries influence public opinion and public policy.
Industry tactics include generating news coverage promoting unhealthy foods and co-opting not-for-profit organisations to push back against Government marketing reforms.
Professor Kathryn Backholer, an author on both research papers, said: “Australians are trying to make the best food choices for the health of their families, but this research shows how companies are undermining this by ensuring that junk food marketing infiltrates every aspect of our lives.
“The advertising industry is also using sneaky tactics to ensure that Government doesn’t introduce reforms that protect children from unhealthy food and alcohol advertising”.
The National Rural Health Alliance expressed concern at Bupa offering three free virtual GP visits annually under general treatment (“extras”) policies.
Alliance CEO Susi Tegen said: “While this might appear beneficial for consumers in reducing the cost-of-living crisis, a reduction in private health premiums and increased support on out-of-pocket costs is much more meaningful. Primary care is not the core business of private health insurers.
“Entering the primary care part of the health system without collaboration or being part of the existing primary care team can exacerbate the healthcare accessibility challenges already prevalent in rural, regional and remote communities.”
National Seniors Australia released a report on private health insurance (“Why seniors love to hate private health”), including results from a survey of its members, and made two policy recommendations. (Disclosure: I reviewed a number of sections of the draft report, but was not involved in the formulation of the recommendations.)
The survey results show a wide range of views of private health insurance, ranging from people making considerable sacrifices in other areas of their lives to afford it, through to people questioning its value.
A common view was that it did not offer value for money – it is clear that older people do not appreciate the massive cross-subsidy their premiums receive from younger people through community rating.
National Seniors recommends increasing the Government premium rebate for lower-income and lower-wealth older people as an interim measure, pending “a full review of the private health system, to be initiated by government as a matter of urgency to ensure it is operating efficiently and providing adequate benefits for consumers”.
Trade unions
The consultation period on the Scope of Practice Review second issues paper closed on the weekend.
The various bodies representing nurses (Australian College of Midwives, the Australian College of Mental Health Nurses, the Australian College of Nurse Practitioners, the Australian College of Nursing, the Council of Deans of Nursing and Midwifery, the Australian Nursing and Midwifery Federation (ANMF), the Australian Primary Health Nurses Association, and CRANAPlus) presented a joint submission.
The submission is clearly directed at the Government, rather than the Scope of Practice Review. It urges the Government to “stand firm” in implementing the reforms, rather than “succumb to the polished lobbying of the medical and psychological professional organisations (as has happened many times before)”.
It concludes that “change in relation to the most autonomous roles in nursing and midwifery has always been greeted by apocryphal predictions from medical interest groups”.
“To date, the sky has not fallen in when these changes have been implemented,” it says. “However, the retention of some form of appeasement privilege for the medical profession within each change has meant that full scope of practice access for the public to highly qualified alternative HCPs such as credentialed mental health nurses, nurse practitioners, endorsed midwives and allied health professionals has been denied, and expensive locum and fly in medical cover has caused the taxpayer an unnecessary impost.
“It is to be hoped that this Government will demonstrate the courage to implement the changes laid out in this evidence-based Discussion Paper.”
Based on the Government’s record on the CPA, I hope they aren’t holding their breath.
The Australian Association of Psychologists claimed an “advocacy win” for the introduction into Parliament of the Health Insurance Legislation Amendment (Assignment of Medicare Benefits) Bill. The Bill allows patients to enter into a digital agreement with health service providers to assign their right to payment of a Medicare benefit before or after service delivery, getting rid of the previous paper-based requirements.
The Australian College of Nursing (ACN) issued a position statement on the scope of practice for Registered Nurses in a community setting. Interim CEO Emeritus Professor Leanne Boyd said “if RNs work to full scope of practice in general practice and nurse-led clinics, the extra services available would help meet patient demand to access general practice services promptly, especially in places where other health professionals are in short supply and health resources are limited”.
The ACN asked Governments to fund nurse-led activity and assign MBS item numbers; remove existing regulatory, policy, legislative, and interjurisdictional barriers that limit nurses’ ability to work to their full scope of practice; establish an education framework that supports nurse to work and grow to their full scope of practice; and broaden innovative nurse-led and interdisciplinary models of care.
The Australian Dental Association (ADA) issued a statement linking to a recent article in The Guardian UK edition comparing the efficacy of the 2018 sugar tax on sweetened beverages and the 2015 voluntary sugar reduction program. The tax has seen a reduction of 34.3 percent in total sugar sales through sweetened drinks, while the sugar reduction program has resulted in a 3.5 percent drop in the amount of sugar used in the manufacture of the everyday foodstuffs it covered.
The ADA President also issued a statement on the early withdrawal of superannuation to fund dental treatment, but access is limited to ADA members.
The AMA marked RSV Awareness Week with a personal account from President Steve Robson of his family’s experience of nearly losing their toddler son from the illness.
Robson urged “every Australian to think about RSV and if you think your family members are vulnerable make sure you talk to your doctor and find out what you can do to protect them”.
The Australian Primary Health Care Nurses Association (APNA) released the results of a survey that found that nurses in primary care were not carrying out clinical work such as women’s health assessments, diabetes and arthritis education, but were instead regularly working on the “front desk” of primary health clinics initiating patient recalls and ordering stock.
7 June was the first Friday in June, and hence CrazySocks4Docs day, established by cardiologist Dr Geoffrey Toogood as “an attempt to address the stigma around mental health in doctors, and to make it ok for a doctor not to be ok”.
The Royal Australian College of General Practitioners (RACGP) marked the day by calling for “changes to rules that discourage doctors from seeking help for mental health”.
President Dr Nicole Higgins said that mandatory reporting laws which require treating practitioners to report their colleagues if they believe their health condition places the public at risk need to change.
Industry groups
The Australian Healthcare & Hospitals Association (AHHA) announced the release of the June edition of the Australian Health Review, including an article from Professor Claire Jackson AM on primary care reform.
Private Healthcare Australia (the private health insurers lobby group) issued a media release pointing to the very high medical out-of-pocket costs for private hospital services in the ACT, and calling on the Government to do something about it. These costs have been the highest in Australia for many years; PHA’s sudden interest seems to flow from the fact that Senator David Pocock raised the issue in Senate Estimates.
The Guardian reported that Department of Health and Aged Care deputy secretary Penny Shakespeare suggested that patients should use the Government’s Medical Costs Finder website to compare fees with the average costs for procedures before they agree to them. Further questioning revealed that only 20 doctors have their fees listed on the site.
While the site will help patients to understand where their doctor’s proposed fee sits relative to the average, it will not assist them in identifying a doctor who charges less.
Politicians and parliamentary committees
Shadow Health Minister Anne Ruston and Shadow Assistant Minister for Regional Health, Dr Anne Webster issued a media release claiming the Government had “been forced into” the new Community Pharmacy Agreement “following sustained pressure from the Coalition after the Government’s botched implementation of the 60-day dispensing policy”. Apparently the Coalition had been “fighting alongside community pharmacies”.
Who knew?
In another statement, Ruston attacked the Government for the revelation in Senate Estimates that over 68,000 people were waiting for home care packages. According to Ruston (the transcript is not yet available), witnesses said that the Government’s objective was to bring wait times down to six months. While six months is too long, waiting times under the previous Government were often far longer.
The Senate committee inquiry into Excess Mortality will be holding a public hearing on Thursday 13 June. As well as the usual suspects (ABS, AIHW, RACGP, NRHA, etc.), witnesses include the Australian Medical Professionals Society, which at the time this column was finalised had not lodged a submission with the inquiry.
International organisations
The World Health Organization announced on 1 June that the World Health Assembly had reached agreement on a set of amendment to the International Health Regulations, including:
- introducing a definition of a pandemic emergency, representing a “higher level of alarm that builds on the existing mechanisms of the IHR, including the determination of a public health emergency of international concern”; and
- “establishing a Coordinating Financial Mechanism to support identification of, and access to, financing required to equitably address the needs and priorities of developing countries, including for developing, strengthening and maintaining core capacities, and other pandemic emergency prevention, preparedness and response-related capacities”.
However, agreement was not reached on the proposed Pandemic Agreement to improve international coordination, collaboration and equity to prevent, prepare for and respond to future pandemics, and countries agreed to continue negotiations.
Finally
During the week a post appeared in my LinkedIn feed from the Mildura Health Fund, announcing it was returning $7 million to members. This follows returns of $12 million in recent years.
I was struck by this announcement, because in a sector generally characterised by fiscal conservatism, Mildura has been one of the most conservative.
According to Australian Prudential Regulation Authority data, at the end of 2022-23 its net assets amounted to $96.2 million, or 131 percent of annual premium revenue of $73.2 million.
In other words, if it offered existing policyholders a twelve-month premium holiday, it would still hold about four months of revenue in reserve at the end of that time – just a little below the current sector average.
Despite holding the highest level of reserves per policyholder in the sector, it had a premium rise of 2.14 percent approved earlier this year, following rises amounting to 15.6 percent since 2019.
Even after handing another $7 million back, it will still have the highest reserves in the sector.
If Mildura is really concerned about policyholders, it could apply a moratorium on further premium increases for the rest of the decade, and still be comfortably solvent.
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for next week’s column.
Department of Health and Aged Care
Reporting by hospitals of gifts and discounts associated with prostheses
13 June
Department of Health and Aged Care
Aligning the amount charged for the supply of a medical device or human tissue product with the corresponding PL benefit.
13 June
TGA
Companion diagnostics guidance update
17 June
Department of Health and Aged Care
National Immunisation Strategy
19 June (previously 5 June)
Department of Health and Aged Care
Culturally safe aged care for First Nations people
21 June
Department of Health and Aged Care
Overseas student health cover
24 June
Medical Board of Australia
Revised registration standard for overseas specialists
3 July
Department of Infrastructure, Transport, Regional Development and Local Government
National Urban Policy for Australia
4 July
Department of Health and Aged Care
Establishment of a National Aged Care Mandatory Quality Indicator Program (QI Program) for in-home aged care services
9 July
Department of Health and Aged Care
Outline of the National Allied Health Workforce Strategy
9 July
NHMRC
Good institutional practice guide
10 July
TGA
Update to medicine labelling rules
11 July
AHPRA and national registration boards
Criminal history registration standard
30 July
Department of Health and Aged Care
Clinical Categories Review Advisory Committee Report
30 August
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing this column as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK.
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