4 yearly review of modern awards - Pharmacy Industry Award 2010
[2018] FWCFB 7621
•14 DECEMBER 2018
| [2018] FWCFB 7621 |
| FAIR WORK COMMISSION |
DECISION |
Fair Work Act 2009
s.156 - 4 yearly review of modern awards
4 yearly review of modern awards - Pharmacy Industry Award 2010
(AM2016/28)
VICE PRESIDENT HATCHER | SYDNEY, 14 DECEMBER 2018 |
Four yearly review of modern awards – Pharmacy Industry Award 2010 – APESMA Work Value Claim.
Introduction
[1] Pursuant to s 156(1) of the Fair Work Act 2009 (the FW Act), the Fair Work Commission (the Commission) is required to conduct 4 yearly reviews of all modern awards. As part of the 4 yearly review of the Pharmacy Industry Award 2010 (Pharmacy Award), the Association of Professional Engineers, Scientists and Managers, Australia (APESMA) has made a claim for the variation of the Pharmacy Award pursuant to s 156(3) of the FW Act. Section 156(3) permits the variation by the Commission of the minimum wages prescribed in a modern award where it is satisfied that this is justified for work value reasons. APESMA’s primary claim is for the minimum wages in the Pharmacy Award to be increased by an amount necessary to restore what was said to be the proper relativity with the C10 classification rate now found in the Manufacturing and Associated Industries and Occupations Award 2010 (Manufacturing Award). The APESMA’s submissions set out the following table explaining its primary claim as follows (noting that the table is based on the Pharmacy Award rates as they were prior to the 3.5% increase awarded as a result of the 2018 Annual Wage Review):
Employee classification under Pharmacy Award | The 1996 CPA rate compared with the | Current rates under the Pharmacy Award | APESMA’s claim |
Pharmacy | |||
First Half of | $853.50 | 130% of current rate = | |
Second half of training | $882.60 | 130% of current rate = | |
Pharmacist | 140% | $998.50 | 140% of current rate = |
Experienced | 150% | $1093.50 | 150% of current rate = |
Pharmacist in | 180% | $1119.20 | 180% of current rate = |
Accredited | N/A | 210% of current rate = | |
Pharmacist | 210% | $1247.20 | 210% of current rate = |
[2] In the alternative, the APESMA sought a 25% increase to all wage rates in the Pharmacy Award. Both as part of its primary and alternative claims, the APESMA also sought a new classification of “Accredited Pharmacist”, to be defined as “a pharmacist who is the holder of an Accredited Pharmacist qualification who undertakes professional services requiring pharmacist accreditation or credentialing”.
[3] In summary terms, the APESMA contended in support of its claims that there had been an increase in the various educational, training and registration requirements for pharmacists, which it submitted was indicative of the increase in the skills, knowledge and responsibility required to perform the role of a pharmacist. It was also argued that the introduction of new types of work (such as professional services) requiring additional skills, knowledge and training, comparatively increased responsibility and accountability for pharmacists. Finally, it was posited that there had been an overall increase in workload, pressure and performance for pharmacists. These changes had occurred, the APESMA submitted, since the work value of pharmacists was last considered in a decision of the Australian Industrial Relations Commission (AIRC) issued on 29 June 1998. 1 The changes relied upon by the APESMA fell into the following five broad categories:
• An increase in various educational and registration requirements which are indicative of the increase in the skills, knowledge and responsibility required to perform the role of a pharmacist.
• The introduction of additional training so a pharmacist can become and retain registration under the legislative requirements for registration of a pharmacist.
• The introduction of new work that requires additional skills, knowledge and training.
• The introduction of new work that has resulted in an increase in responsibility and accountability.
• An increase in workload and an increase in pressure and on skills and the speed with which vital decisions need to be made.
[4] The majority of the changes identified by the APESMA were said to have arisen because of changes in government health and medicines policy and industry initiatives designed to respond to these changes in government policy and to patient needs. The key Federal Government policy changes identified related to the following matters:
• Introduction of the Quality Use of Medicines (QUM) into the National Medicines Policy.
• Medical practitioner shortages, particularly in rural and regional areas.
• Escalating cost to the Australian tax payer of providing a high quality medical service and medicines to the Australian community.
• Increasing number of patients with multiple chronic diseases requiring complex treatment.
• Introduction of many new highly specialised medicines to the Australian market and the extra knowledge required to minimise drug interactions and adverse effects with patients.
• Increasing number of medicines being down-scheduled from prescription only status to pharmacist-only and pharmacy-only status, and the extra knowledge/skills required to safely provide these medicines to the public without a doctor’s review.
[5] The APESMA contended that the introduction of the QUM into the National Medicines Policy in 1999 had been the “major instigator” of changes to the role and work of the pharmacist; in particular, it had changed the role from being someone who was responsible for safely storing and dispensing medicines to a professional playing an increasing role as part of a multi-disciplinary health care team providing a wide range of preventative and primary health care services. The APESMA pointed to the Community Pharmacy Agreements (CPAs) negotiated every five years between the Pharmacy Guild of Australia (PGA) and the Commonwealth Government as evidencing the nature of this change in the role and work of pharmacists. Particular initiatives affecting the work of pharmacists introduced as part of CPAs included Home Medicine Reviews (HMRs), Residential Medication Management Reviews (RMMRs), MedsChecks, asthma management and diabetes management.
[6] The QUM was introduced into the National Medicines Policy in December 1999. It requires all medical professionals, including pharmacists, to select management options wisely, choose suitable medicines if a medicine is considered necessary, and use medicines safely and effectively. Relevantly, it requires:
• identification and implementation of methods to select and communicate the most appropriate medicine or non-medicine option from all available prevention and treatment options, so that the individual gains optimal, cost effective health outcomes;
• identification and implementation of methods to monitor the outcome of the selected treatment option, to allow rapid modification according to response, so that optimal health outcomes are maintained over time;
• provision to patients/consumers of information and counselling to promote quality use of medicines; and
• education of peers and adoption of appropriate standards and models of practice.
[7] Home Medicine Reviews are undertaken by Accredited Pharmacists (discussed later) upon a referral from a medical practitioner, and usually require the pharmacist to conduct the review in the patient’s home and then write a report for the medical practitioner. The pharmacist is required to review what prescription, non-prescription and complementary medicines the patient is taking and to make recommendations for the medical practitioner to discuss with the patient, which might include showing the patient how to take their medicines correctly, explaining why and when to take their medicines and what to expect when taking them, explaining the proper storage of medicines and what problems should be reported to the medical practitioner, checking that the medicines are appropriate to take together and changing them if necessary, clarifying any confusion with generic medicines, and assisting with the patient remembering to take their medicines. HMRs were introduced as part of the third CPA in July 2001, and are intended to reduce the number of persons hospitalised because of their use of medicines. RMMRs are similar to HMRs but are provided to permanent residents of a government-funded aged care facility, and are conducted in collaboration with the resident’s health care team. Like HMRs, RMMRs were introduced as part of the third CPA in 2001 and must be conducted by an Accredited Pharmacist.
[8] MedsChecks and Diabetes MedsChecks were introduced under the fifth CPA in 2010, and involve a structured in-pharmacy review of a patient’s medicines by a pharmacist. It takes about 30 minutes to complete, aims to help patients learn more about their medicines including their effects, proper use and storage and to identify problems patients may be experiencing with their medicines, and requires additional training to be undertaken. Diabetes management is undertaken pursuant to the National Diabetes Services Scheme (NDSS), which is an initiative of the Australian Government which is administered through registered pharmacies. The pharmacist’s role is to provide patients with the equipment and medicines they need to manage their medicines as well as educating and counselling them on initiatives they can take to reduce or eliminate their diabetes such as through weight loss and exercise. The pharmacist must have additional knowledge and skills in the management of diabetes, which is usually obtained by undertaking an appropriate course delivered by an accredited training organisation. As with the NDSS, pharmacies have since 1999 been charged with delivering asthma management services to patients with the aim of educating patients on the proper use of their inhaler device and to assist them to develop an asthma management plan. Pharmacists must obtain specialised training in asthma and its treatment to provide this service, with the training usually taking the form of a course delivered by an accredited training organisation.
[9] Downscaling from the prescription-only category to the pharmacist-only category has occurred with respect to many medicines since 1998, with a total of 33 having been switched between 2000 and 2011. With respect to these medicines, the pharmacist is now required to diagnose minor illnesses to ensure the patient needs the medicine being requested and to determine the appropriate medicine. Prior to dispensing a pharmacist-only medicine the pharmacist needs to determine if dispensing the medicine is appropriate or whether the patient needs to be referred to a medical practitioner. Pharmacists need to counsel the patient as to the illness and educate them on the appropriate use of the medication, and to avoid dispensing drugs (such as pseudoephedrine and codeine-based medications) to those who might be abusing them. The introduction of generic-based medicines into the Pharmaceutical Benefits Scheme (PBS) has also required pharmacies to place heavier reliance upon them for cost reasons, which has added to the responsibility of pharmacists to manage the risk of dispensing them by ensuring accuracy and compliance. It also requires pharmacists to explain to patients the option of using generic medicines, how they may affect them and what the impact and cost differences are.
[10] Other instances of new or changed work relied upon by the APESMA were as follows:
• Clinical intervention: This involves the pharmacist identifying a drug-related problem with a patient and making recommendations to a medical practitioner to prevent or resolve it, including by changing the medication, the means of administration or the patient’s medication-taking behaviour. To undertake this service, introduced under the fifth CPA in 2010, the pharmacist must have undertaken the required training.
• Dose administration aids: Dose administration aids (DAAs) are adherence devices developed to assist medication management by dividing medicines into individual doses and arranged according to the dose schedule throughout the day. They may take the form of a unit dose or multi-dose pack. Since the fifth CPA in 2010 pharmacists have formally provided patients with DAAs, which requires the pharmacist to pack the patient’s medicines into a specially-provided bag, with the pharmacist having to ensure that each medicine is correctly included in the appropriate pouches on order to avoid medical misadventure.
• Staged supply of medicines: This is a program, introduced under the fifth CPA in 2010, for patients to receive their PBS medicines in instalments, particularly patients with mental illness or drug addiction or who otherwise cannot manage their medications safely. Pharmacists are required to have additional skills and knowledge concerning mental illness, drug dependency, drug seeking behaviours, and interacting with and responding to the therapeutic concern of clients.
• Certificates for absence from work: Since the commencement of the FW Act in 2009 pharmacists have been able to provide certificates for absences from work due to illness. Pharmacists who undertake this service must undertake a detailed consultation with the patient to determine the nature of their illness, assess how long they will be unable to attend work, and determine whether it is necessary to refer the patient to a medical practitioner. Pharmacists must have extensive counselling skills and should have undertaken additional training in order to provide this service.
• Inoculations: The Pharmacy Board of the Australian Health Practitioner Regulation Agency (AHPRA) in December 2013 authorised pharmacists to administer vaccinations if they had obtained suitable additional training, and the States have since enacted legislation to facilitate this occurring. Pharmacists are required to have completed a further approved course of study, maintained their authority to immunise, and hold a current statement of proficiency in cardiopulmonary resuscitation and first aid including anaphylaxis training.
• Increase in use of complementary medicines and vitamins: The increase in the use of complementary medicines and use of vitamins has required pharmacists to have knowledge of these products, how they affect various illnesses and diseases and any negative side effects. Additional training is recommended in these medicines if it was not covered in the undergraduate degree.
[11] It was contended by the APESMA that the work environment of pharmacists had become more complex due to the following matters:
• Chronic disease: Chronic diseases such as arthritis, asthma, back problems, cancer, chronic obstructive pulmonary diseases, cardiovascular disease, diabetes and mental health conditions are the leading cause of illness, disability and death in Australia, and 39% of persons aged 45 and over have at least 2 of these diseases. Patients with such co-morbidities are high users of the health system, and half of them have conditions that result in treatment conflict. Pharmacists are involved in not just supplying medicines to such patients but ensuring that they get the best out of their medicines and their conditions are managed effectively. This requires pharmacists to exercise a specific set of clinical knowledge and skills not used back in 1998, as well as social pharmacy skills such as communication skills, inter-professional collaboration, understanding behaviour and understanding psycho-social attributes.
• Quality Care Pharmacy Program (QCPP): This quality assurance program was introduced by the PGA in 2000, and requires pharmacists in QCPP accredited pharmacies to undertake mandatory initial training, ongoing refresher training, implementing and following appropriate policies, ensuring there is evidence of practice in accordance with QCPP standards, and ensuring the pharmacy is prepared for re-assessment every 2 years. This imposes additional responsibilities on Pharmacy Managers in particular.
• Forward Pharmacy Model of Practice: This model of practice, adopted by almost all pharmacies since the introduction of the QUM, makes the pharmacist the main point of contact with patients, and requires pharmacists to exercise additional communication, counselling and customer skills not previously required of them.
• Workloads: There has been a significant increase in the number of PBS prescriptions dispensed within community pharmacies (at the rate of almost 13% per year over the last 10-15 years) without any corresponding increase in the number of pharmacies. This together with the ageing population, the consequential increase in the number of patients taking multiple medicines, and the new work tasks and skills required of pharmacists has contributed to an increasing workload and complexity of work for pharmacists.
[12] The APESMA also relied on changes to the educational and registration requirements for pharmacists. In respect of the former, the changes relied upon were:
• The phasing out from 2000 of the option of undertaking a three year undergraduate degree. The minimum accredited undergraduate pharmacy degree now requires four years of full-time study.
• Since 2010 the Australian Pharmacy Council has accredited a number of undergraduate degrees of more than the minimum four years’ duration which provide extended and more intensive training.
• Undergraduate degrees now cover areas of training not covered before 1998, in particular in relation to the counselling and education of patients in relation to the patient’s diagnosis, the reasons for prescribing, and the safe and effective use of the prescribed medicine included any potential adverse effects. This arose largely in response to the introduction of the QUM.
• In 2010, formal recognition was given to the higher qualification of Accredited Pharmacist. The holder of an accredited pharmacy undergraduate degree who is a registered pharmacist can obtain the qualification by undertaking a higher course of study, and the qualification allows a pharmacist to undertake HMRs.
[13] The changes in registration requirements identified by the APESMA were as follows:
• The requirements for intern pharmacists to obtain registration had changed since 1998, In 1998 intern pharmacists were required to have completed 1824 hours of supervised practice, but now in addition they have to undertake further study conducted by an approved provider and undertake an oral examination and a written examination conducted by the Pharmacy Board of Australia.
• On and from 2010 the Pharmacy Board has developed Compulsory Professional Development (CPD) requirements for pharmacists to maintain their registration, and the CPD options for further training have been changed and expanded.
• Competency standards for pharmacists were introduced in 1999 which were mainly focused on the safe dispensing of medicines, but which have since been expanded to cover matters such as inoculations, medical certificates and HMRs.
[14] In addition or in the alternative, the APESMA contended that its claim should be granted on the basis that flat-dollar increases to award wages had eroded the basis upon which the work value of pharmacists had originally been assessed, namely identified relativities with the C10 rate in the Metal Industry Award 1984 (now the Manufacturing Award), and that these relativities needed to be restored in order for the rates of pay to correctly reflect the work value of pharmacists.
[15] The APESMA’s claim was opposed by the PGA, Australian Business Industrial and the NSW Business Chamber (ABI/NSWBC), and Business SA. The PGA’s case in opposition to the APESMA’s claim was, in summary, as follows:
• The relevant datum point for the assessment of any change in work value was the making of the pre-reform Community Pharmacy Award 1998 on 24 December 1996, which was the last occasion when a federal industrial tribunal had determined the work value of pharmacists.
• The PGA accepted that the role of a pharmacist inherently involved change, as health services, treatment methods, medical information, community expectations, technology and procedures were changed or refined to better deliver health care services to the community.
• The PGA specifically acknowledged that elements of the competency standards and Bachelor of Pharmacy course had changed since 1998 to assist in the provision of better health care standards, that the provision of Government funded health service provided by pharmacists had been introduced to improve community health outcomes, and that community pharmacies had become more patient centred and focused on the delivery of primary health care to the community.
• However, the PGA contended that the resultant changes to the work of pharmacists had been evolutionary in nature but had not resulted in a significant net addition to the work value requirements of a pharmacist.
• The changes to the Bachelor of Pharmacy course content and duration commenced prior to the 1998 benchmark, were minor in nature, and did not contribute to a significant net addition to work value.
• Some changes to the competency standards had increased or altered the work value of some but not all pharmacist classification levels, but have not resulted in a significant net addition to work value.
• Pharmacists have always been engaged in continuing professional training, and the mandatory CPD requirements did not involve a significant net addition to work value.
• Pharmacists have since 1994 been required to achieve the competency standards for registration in their respective States and Territories, and so this did not represent a significant net addition to work value.
• The requirement to keep abreast of changes and developments is a requirement of a professional role and did not constitute any change in work value.
• The evolution in health care services required to achieve the community’s health care objectives has evolved since 1998 due to improved technology, research/medical information and treatment information, but these did not involve any significant net addition to work value. Patient interactions and clinical interventions had always been part of the pharmacist’s role.
• Both down-scheduling and up-scheduling of medicines occurred from time to time, but in any event the pharmacist had always needed to understand the nature, purpose and effect of those medicines and advise on managing conditions.
• Most of the changes relied upon by the APESMA did not involve genuinely new work, apart from perhaps inoculations, clozapine clinics and the provision of absence from work certificates.
• There had been no significant net addition in workload since 1998 in circumstances where the number of pharmacies had increased by 13% but the number of registered pharmacists had increased by 43%.
• Offsetting any changes was the fact that certain tasks were no longer done or were only performed in limited circumstances, such as compounding, and technology had simplified a number of tasks such as PBS claiming processes, automated scanning and dispensing of prescriptions, stock administration, dose administration and availability of patient information.
• HMRs and RMMRs fell within the core clinical skill set of a pharmacist, and only about 10% of pharmacists were accredited to perform these.
• It would be inappropriate to establish a new Accredited Pharmacist classification because the role was directly linked or related to several government-funded programs which might not continue, and instead the inclusion of a higher duties allowance should be considered.
• There was no demonstration by the APESMA on what the actual increases to work value were for each classification such as to justify the proposed increases to minimum rates, nor how the modern awards objective in s 134(1) would be achieved by the grant of the claim.
[16] ABI/NSWBC likewise contended that the changes relied upon by the APESMA did not satisfy the test for a significant net addition to work requirements to justify the wage increases sought, and that increases of that magnitude would not meet the modern awards objective and the minimum wages objective.
APESMA’s Evidence
[17] The APESMA relied on the evidence of the following expert and lay witnesses:
• Professor Ines Krass and Professor Parisa Aslani, who provided an experts’ report in two parts entitled “Work value of a community pharmacist” (Report); 2
• Professor Philip Clarke, who provided an expert’s report “providing data and information on aspects of pharmacy ownership, pharmacy revenues and business sale prices”;
• Dr Geoffrey March, President of Professional Pharmacists Australia;
• Ms Amy Thomson, Emergency Medicine Specialist Pharmacist and Specialist in Poisons Information in New South Wales;
• Mr Cameron Walls, Pharmacist Manager in Victoria;
• Ms Katerina Malakozis, Pharmacist in Charge in South Australia;
• Mr Cardin Le, Pharmacist in Charge in New South Wales;
• Mr Leon Wai Hon Yap, Clinical Hospital Pharmacist in Queensland;
• Ms Jennifer Ruth Madden, Locum Pharmacist in New South Wales;
• Ms Carmel McCallum, Locum Pharmacist in New South Wales; and
• Mr Alex Crowther, Surveys Manager of APESMA.
[18] The APESMA also tendered a large range of documents relevant to matters referred to by their witnesses. It will only be necessary for us to directly refer to some of the Community Pharmacy Agreements tendered by the APESMA.
Professor Krass and Professor Aslani
[19] Ines Krass is Professor of Pharmacy Practice at the University of Sydney, and Parisa Aslani is Associate Professor of Pharmacy Practice at the University of Sydney. The APESMA commissioned them to prepare the Report via a “Commissioned Research Brief” which contained as its research proposal “To investigate changes in work value of a community pharmacist comparing 1998 with 2016”. The brief noted that the Commission was undertaking a 4 yearly review of the Pharmacy Award, that the APESMA’s position was that the rate of pay received by pharmacists was not reflective of the work they do, that the current award minimum rates of pay do not reflect the skill, responsibility and complexity of the work they currently do, that the APESMA had lodged a claim seeking increases in the award rates of pay for pharmacists based on the proposition that there have been significant changes in work since 1998, and that it was necessary for the APESMA to adduce evidence addressing the relevant legislative provisions and demonstrating the facts supporting the proposed pay increases. The brief requested a literature review to identify changes in work value between 1998 and 2016 and semi-structured interviews with a sample of community pharmacists to explore their understanding and experiences of change in work value between 1998 and 2016.
[20] Professors Krass and Aslani prepared Part I of the Report, which was the requested literature review. They also prepared, with the assistance of Dr Vivien Tong, Part II of the Report, which was based on the requested semi-structured interviews. Professor Krass gave evidence before the Commission concerning the Report.
[21] The Preface to Part I of the Report discloses that the literature review was “conducted to explore the range and evidence for cognitive pharmaceutical services delivered by pharmacists in community settings”. The definition of “cognitive pharmaceutical services” (CPS) used was derived from one proposed for use in relation to professional pharmacy services as follows:
“A professional pharmacy service is an action or set of actions undertaken in or organised by a pharmacy, delivered by a pharmacist or other health practitioner, who applies their specialised health knowledge personally or via an intermediary, with a patient/client, population or other health professional, to optimise the process of care, with the aim to improve health outcomes and the value of healthcare.”
[22] The Preface went on to say that although the definition encompassed services which could be delivered by other health care professionals within a pharmacy setting, the focus of the Report was on the roles, responsibilities, and value of community pharmacists with respect to the provision of cognitive pharmaceutical services in community settings.
[23] The background to Part I of the Report included the following (omitting footnotes and references):
“Facilitating quality use of medicines: evolution of community pharmacy practice in Australia
Pharmacists play a vital role in supporting QUM, one of the four key components of the National Medicines Policy, which denotes ensuring medication use by patients is judicious, appropriate, safe and efficacious. The National Competency Standards Framework for Pharmacists in Australia, published by the Pharmaceutical Society of Australia, is underpinned by the National Medicines Policy.
Community pharmacy contributes to the facilitation of quality use of medicines. With the emergence of the concept of pharmaceutical care, patient-centred care within pharmacy practice has gained momentum, challenging the traditional dispensing-oriented role of pharmacists. Evident expansion of the provision of cognitive pharmaceutical services (CPS), within the community pharmacy setting is occurring both nationally and internationally. Pharmacy practice in Australia has since undergone a significant paradigm shift over the last two decades.
Pharmacy education
Accredited pharmacy programs in Australia should deliver a curriculum which helps equip pharmacy graduates with the necessary foundation for commencement of the intern training program, and then to progress on to achieve the competencies set out in the national competency standards for pharmacists. When comparing the overall indicative pharmacy curriculum components in place in 2008 versus those currently implemented (effective from January 2014), several notable differences are evident, reflecting changes in pharmacy practice. Along with changes to pharmacy curricula and subsequent training to upskill graduates to ensure they are workforce-ready, pharmacists are now also required to engage in continuing professional development (CPD) throughout their careers. To be able to provide some of the remunerated CPS, pharmacists must also undertake further training to gain accreditation, in addition to any upskilling necessary to ensure that core professional competencies are maintained.”
[24] The Prelude went on to discuss “Government funding: supporting the viability of Australian community pharmacy” as follows (omitting footnotes and references);
“In Australia, 5-yearly Community Pharmacy Agreements (CPAs) commenced in 1990 between The Pharmacy Guild of Australia (PGA) and the Australian Federal Government, have secured funding to support community pharmacy initiatives in promoting QUM and the viability of the industry. Over the years, increased funding has been allocated to the provision of CPS in community pharmacy. While the Second CPA (2CPA) (1995- 2000) pledged a modest amount of funding of up to $4 million for CPS, the current Sixth CPA (6CPA) effectively saw a doubling of funds pledged compared to the previous CPA to facilitate remuneration for CPS provision, yielding:
• $613 million in funding to support community pharmacy programs, which comprise many cognitive pharmaceutical services,
• $50 million for the Pharmacy Trial Program, along with
• ‘access to additional funding of up to $600 million over the Term to support new and expanded Community Pharmacy Programmes’.”
[25] The Prelude identified that when the provision of CPS are remunerated, this usually occurred via fee-for-service from government, with most such remuneration being provided to the pharmacy/pharmacy owner. Some CPS, such as DAAs and vaccinations were paid by the user of the service. The overall majority of CPA funding however remained directly linked with the dispensing/supply of medicine products to patients via the PBS. PBS reforms and price disclosure, which were aimed to reduce PBS expenditure, along with a proliferation of discount pharmacy business models, had led to financial pressure across the community pharmacy sector. An increase in CPS provision had been identified as an additional revenue source. The UTS Pharmacy Barometer, an annual report issued since 2012, highlighted in 2016 that 59% of pharmacist respondent had reported beginning to provide new CPS in the last 12 months, and 80% of employer pharmacists were providing CPS. Further, the Pharmacy Guild Customers’ Experience Index reported approximately 80% of respondent customers listed at least one of the six services as being provided by their local pharmacy: blood pressure monitoring, weight management, diabetes screening and management, vaccinations, addiction intervention and mental health support, with blood pressure checks and vaccinations the most frequently reported to be used.
[26] In relation to remuneration of pharmacists, the UTS Pharmacy Barometer reported that employed pharmacists perceived an imbalance between wages and workload expectations, and also said that an oversupply of pharmacists was leading to lower wages and devaluing of the skills of the profession. Pharmacy employers also complained that low award rates allowed discount pharmacies to pay low wages, which placed competitive financial pressure on other pharmacies which sought to pay higher wages for good pharmacists. The UTS Pharmacy Barometer reported that 68% of employed pharmacist respondents had received no change to their remuneration over the last 12 months. Pharmacy owners reported that 75% of employed pharmacists were paid $30-$40 per hour, which was broadly consistent with the APESMA’s 2015 Remuneration Survey. This reflected that pharmacy owners were cutting salaries and reducing staff in order to compete with discount pharmacies. One study identified the view of Australian pharmacists as being that they “saw minimal opportunities to negotiate salaries” as they were easily replaceable with other pharmacists willing to work for lower remuneration. This position of reduced wages and the devaluation of the skills and the value of employee pharmacists was attributed to the oversupply of pharmacists. More than half of the respondents believed that pharmacists providing CPS should be more highly remunerated than those with dispensing-oriented roles, and there were some indications that there were increasing job opportunities for “professional services pharmacists” providing CPS.
[27] Part I of the Report identified the aims of the literature review as being to identify the range of CPS and health services delivered by community pharmacists, changes in services over the past 20 years, changes in policy, legislation and reimbursement, changes in professional expectations and guidelines, and pharmacists’ skills, knowledge and expected competencies reflecting educational changes in training at undergraduate, intern and postgraduate levels. The focus of the literature review was said to be “The evidence of benefits surrounding implemented CPS that are currently or have been previously remunerated as part of previous CPSs in the Australian context”.
[28] The Findings section of Part I of the Report identified in a table the present CPS provided in community pharmacies, and explained in each case the nature of the service provided, the skill or training required, the patient outcome benefits and the economic outcome benefits. The CPS so described were: Medication management reviews (HMRs and RMMRs); MedsCheck and Diabetes MedsCheck; Clinical Interventions; Medication Adherence Programs; DAAs; Staged Supply; Continued Dispensing; Continuity of Care, including through Community Pharmacy Liaison Services; Aboriginal and Torres Strait Islander (ATSI) QUM Service; Chronic Disease Management; Healthy Lifestyle Support; Smoking Cessation; Screening/Monitoring Activities (Health Checks); Compounding Services; Vaccination; Sleep Apnoea Services: Sexual Health Services: Mental Health Services: Palliative Care Services; Maternal and infant services; Wound Management; Advice on minor ailments; Provision of Pharmacist-Only (Schedule 3) medicines; Complementary and alternative medicine; Opioid Dependence Treatment; Return of Unwanted Medicines; and Absence from Work Certificates. The Report discussed studies which had analysed outcomes and the uptake of the identified CPS, noting that a number of them had not yet been the subject of substantial research evidence.
[29] The conclusions in Part I of the Report were, in summary, as follows:
• The roles and responsibilities of community pharmacists have expanded over the last 20 years, with a movement away from dispensing-oriented roles to increasing CPS provision in community settings.
• Fundamental responsibilities related to the dispensing and provision of therapeutic goods have provided a foundation upon which CPS can be expanded.
• Changes to legislation and funding in Australia have aided the facilitation of CPS provision and accessibility of these services to consumers in community settings.
• Pharmacists are now being remunerated for services for which funding was not previously available. Funding arrangements under the CPAs have formalised and refined pharmacists’ skills into distinct, targeted CPS.
• Each community pharmacist will likely provide multiple CPS as part of their practice of the profession and thus, increasing their work value (when considering that the evidence available for individual CPS to date is promising in terms of various different factors).
• In many instances, additional training is required to be completed by pharmacists in order to provide specific CPS interventions e.g. HMR accreditation, training to administer vaccinations, and other associated training to ensure professional standards and guidelines are met.
• With an ageing population and thus, potentially more complex medication regimens, medical conditions and potential disease burdens among the patient population, pharmacists’ diverse roles can help address the breadth of health and medication-related issues experienced.
• Each CPS provided by community pharmacists and/or in the community setting potentially contributes to improved patient health outcomes and/or economic outcomes for the health care system. Evidence from the literature also highlights the positive impact of CPS on clinical outcomes.
• There is also evidence to suggest that CPS provision is inclined to be cost-effective in many instances, which can yield savings from both the health care system and for patients as well. However, further research is still required to better ascertain the cost-effectiveness of CPS provided by community pharmacies from the perspectives of the health care system, patients, and also from the service providers where possible.
• To better determine the impact of currently implemented CPS within the Australian context, further Australian health and economic outcomes evaluations are necessary to more adequately determine the current work value of Australian pharmacists based in community settings. This will help to ensure that cost savings to the health care system are being appropriately invested back into remunerating pharmacists who provide these valuable services.
• Additional full economic evaluations are required within the Australian context to establish the extent of cost saving that CPS provide to the health care system. Evidence from the systematic reviews included in this review provide evidence to support the expanding role of community pharmacists and reinforces the need to ensure the implementation and expansion of evidence-based, value-added CPS.
[30] The objectives of Part II of the Report were set out as follows:
• to investigate and describe the cognitive pharmaceutical / health services currently provided by community pharmacists;
• to determine the reimbursement / revenue received by community pharmacists for the delivery of cognitive pharmaceutical / health services in their practice;
• to determine the self-reported patient health and economic outcomes of the cognitive pharmaceutical / health services delivered by the pharmacists;
• to determine the self-reported health system economic outcomes of the cognitive pharmaceutical / health services delivered by the pharmacists; and
• to investigate the training received by the pharmacists in delivering the cognitive pharmaceutical / health services.
[31] Part II of the Report was prepared by inviting a random sample of pharmacists in the APESMA’s database to participate, and also by purposive sampling of pharmacists who were known to the research team as engaging in the provision of CPS, with variation sampling to capture pharmacists from a range of ages, years of practice, practice settings, cultural backgrounds and employee/employer status as well as to ensure gender representation. A total of 25 interviews were conducted, of which 14 were face-to-face and 11 by telephone.
[32] The key conclusions reached in Part II of the Report from the interviews may be summarised as follows:
• pharmacists perceived that a core set of services were applicable across the sector, but that the actual services provided varied between pharmacies with smaller pharmacies having to structure and prioritise service provision;
• additional support by way of an increased number of pharmacists and other staff enabled the provision of CPS;
• the role and responsibilities of pharmacists differed in terms of services provided;
• the core 6CPA-funded services reported as being delivered in community pharmacies included DAAs, HMRs, MedsChecks/Diabetes MedsChecks, clinical interventions and stage supply;
• pharmacists were responsible for checking DAAs, where DAAs were seen to facilitate improved patient adherence to medicines and QUM;
• MedsChecks allowed pharmacists to assess patients’ understanding and use of their medicines, and were seen as a timely way to identify and address medication-related problems;
• HMRs enabled a detailed assessment and recommendations to be provided on a patient’s medication regimen, and positive feedback received on HMRs and the implementation of recommendations were reported;
• clinical interventions encompassed a broad range of potential medication-related problems, and were primarily viewed as a change in the documentation process rather than a change in practice;
• non-6CPA CPS that were more commonly reported as being provided included point-of-care testing such as blood pressure/cardiovascular disease and/or blood glucose checks, pharmacist-delivered immunisation, and opioid substitution therapy;
• a range of other CPS were also reported including other point-of-care testing services, services provided to aged care and related facilities, chronic disease management (with and/or without diagnosis) and medication-oriented services;
• flu vaccinations were associated with a number of perceived benefits such as improved accessibility and uptake of flu vaccinations, increased convenience and perceived cost-effectiveness, and professional satisfaction;
• the most ubiquitous free service for patients was blood pressure checks; pharmacist involvement in these checks varied between pharmacies but pharmacists were involved at some point in the process, particularly in interpreting blood pressure readings;
• sleep apnoea diagnostic services were offered by some pharmacies;
• services provided to facilities such as aged care facilities commonly centred on DAA provision for residents;
• training varied significantly between undergraduate training, self-directed learning and completion of accredited training courses;
• accreditation courses were more likely completed for pharmacist-led immunisation, HMRs, and compounding;
• non-specific training typically included training received from company representatives and/or self-directed learning;
• financial support received for training undertaken by pharmacists varied; the most common course that was financially covered by employers was pharmacist-led immunisation training, but training opportunities received by staff potentially varied depending on their role within the pharmacy;
• reimbursements received for CPS varied; services typically provided at a charge to the patient included flu vaccinations, opioid substitution therapy, diagnostic testing of sleep apnoea, and absence from work certificates, while the common CPS offered free of charge to patients was blood pressure/cardiovascular disease checks;
• contributions for DAAs together with the funding received from the 6CPA was still regarded as insufficient to cover the costs involved in providing the service;
• a few participants noted that they had to decrease the fee-for-service for pharmacist-led vaccinations due to increased competition;
• pharmacists were cognisant of the notion that fee-for-service, although desired, should not act as a barrier for service uptake among patients, and user-pay funding models were not deemed appropriate for all CPS such as blood pressure checks;
• encouraging customer loyalty and maintaining rapport with other service users (such as aged care facilities) were motives for providing services for ‘free’;
• perceived benefits of CPS included improved patient accessibility to services and convenience, cost-effective facilitation of QUM, improved patient adherence, satisfaction, and loyalty, and improved patient rapport, health management, patient education and empowerment; however, it was noted that it was difficult to determine the true impact of CPS;
• reimbursement received by pharmacists for the provision of CPS was regarded as insufficient;
• CPS provision contributed to the need for increased wage costs for the pharmacy such as by employing an additional pharmacist, which were then offset via earnings from other aspects of the pharmacy such as the dispensing of prescriptions and/or sale of consumables;
• the perceived viability of community pharmacies had been impacted by PBS reforms;
• services were not regarded as a primary source of stand-alone income for pharmacies but rather, had flow-on effects for other aspects of the business which contributed to profitability;
• pharmacists had seen and experienced an evident expansion of services being provided in community pharmacies, and a certain level of service provision had become the status quo across the sector;
• an increased scope of practice for pharmacists has led to perceived opportunities for further role expansion in future;
• the quality of services might not be uniform across all community pharmacies;
• pharmacists’ roles and responsibilities have changed, where there were now increased opportunities for clinical involvement and inter-professional collaboration in the provision of patient health care;
• reforms such as accelerated price disclosure and emergence of discount pharmacy models of pharmacy have impacted the sector, and created an impetus for the industry to evolve, so that sole reliance on pharmacy as a supply function was no longer viable;
• decreased revenue generated from dispensing prescriptions had led to increased service provision, used as a point of difference;
• perceived positive changes to the profession included the impact of increased competition leading to innovation and increased CPS remuneration via the 6CPA;
• perceived negative changes to the profession included the price-focused paradigm shift impacting the fee-for-service sought, decreased viability of community pharmacy, and the devaluing of pharmacy due to discount pharmacies and price reductions;
• the core work value of community pharmacists centred on accessibility of health care and advice, and the resultant broader impact on the community;
• pharmacists were perceived to be undervalued by others, influenced by discount pharmacies, and it was perceived that governments should better recognise the value of, and appropriately remunerate, pharmacists;
• a positive outlook on pharmacy stimulated support for increased scope of practice as well as ongoing provision of CPS;
• continued engagement in providing CPS by pharmacists was primarily motivated by patient satisfaction, professional satisfaction, view of the optimal direction towards which pharmacy should be heading, altruism, wanting to provide a service to the community to promote health, and duty of care;
• the service-oriented ethos of the community pharmacy or positive professional experiences involving senior members of the profession contributed to the service-oriented practice of several participants;
• external factors such as decreased profit margins for dispensing medicines and that other pharmacies were also offering services were also motivators for CPS provision;
• pharmacists recognised that there was limited profit earned for many CPS, and pharmacy proprietors noted that many services were being operated at a loss to the pharmacy;
• as pharmacist roles were perceived as having expanded, there was support for recognition of this expansion both professionally and financially;
• the government was seen as an important stakeholder in facilitating the increased remuneration of pharmacists;
• in general, employee pharmacists did not receive additional reimbursements for delivering services within the community pharmacy on top of their wages;
• some pharmacists felt that their wage received as an employee pharmacist was inadequate and did not reflect their knowledge, skills and contribution to health care; and
• a multitude of factors were acknowledged as impacting on pharmacist wage levels; several pharmacists reported negotiating their wage level, and believed that the onus was on the pharmacist to demonstrate their value to their employer and to negotiate their wage accordingly.
[33] The authors of Part II of the Report concluded that because the provision of professional services had become part of the status quo for the practice of the profession, “[t]his change indicates that there has also been a likely shift in the work value of community pharmacists”. In cross-examination Professor Krass affirmed this conclusion, saying:
“… I think the notion is that we were coming from the understanding is that the salary levels have not changed; in fact they have declined as I understand it. They have declined very significantly, and yet pharmacists are being expected to do more. The scope of their activities, the skill required to actually execute those activities has increased and changed over time, and that has not been reflected in the remuneration that they've received, and I would argue beyond that, if I might indulge you, that the community pharmacy agreements have delivered remuneration directly to the community pharmacy, but there's been no commensurate payment to the pharmacists themselves. So the employee pharmacists have been expected to do that – to expand the range of activities that they deliver, but that has not been reflected in any change to their salaries.
When you say you would argue you're advocating that as a position or are you advocating that as the outcome of the semi-structured interviews?---That's what I found out from the interviews, yes.” 3
Professor Clarke
[34] Professor Philip Miles Clarke is Professor in Health Economics within the Centre for Health Policy at the Melbourne School of Population and Global Health in the University of Melbourne. He was commissioned by the APESMA via a research brief to provide a report on the current financial status of the community pharmacy industry covering: changes in the income received from government by community pharmacies since the late 1990s; any increases or reductions in remuneration received and the reasons for these changes; the profitability, or otherwise, of community pharmacies within Australia and an analysis of the reasons for their profitability; and whether a work value increase in the minimum rates of pay specified in the Pharmacy Award as proposed by the APESMA would have a significant negative impact on the financial sustainability of community pharmacies.
[35] In his report, 4 Professor Clarke explained the regulatory framework in which community pharmacies operated. They are protected from competition by two sets of government regulations that form part of the Community Pharmacy Agreement, which is negotiated every five years between the Federal Government and the PGA and regulates most aspects of the pharmacy sector. The CPA provides for ownership rules which disallow non-pharmacists from owning a pharmacy in Australia and effectively prevent supermarkets and international pharmacy chains from owning pharmacies in Australia, while location rules restrict the establishment of new pharmacies within regulated distances (typically 1½ kilometres). Professor Clarke gave evidence that the ownership and location rule restrictions have prevented new entrants into the pharmaceutical sector, in that the number of pharmacies in Australia has remained relatively static for almost 50 years, over which period the number of medical practitioners had more than doubled. The result was that ratio of the number of persons per pharmacy had increased from around 2000 to 4000.
[36] In relation to pharmacy revenues, Professor Clarke referred to a performance audit of the administration of the Fifth CPA by the Australian National Audit Office (ANAO), which quantified the remuneration received by pharmacies from the Commonwealth Government for dispensing and mark-ups. The audit found that payments received by pharmacies from the Government had tripled from around $750 million in 1991 to over $2 billion by 2013, even after adjusting for inflation. Professor Clarke said that this growth in remuneration is due to much higher volumes of dispensing as a result of a combination of population increase, ageing, and expanded prescribing from newer classes of drugs. In addition to increases in the dispensing fees paid to pharmacists, government payments were now around 20% higher in real terms than in the early 1990s due to greater pharmacy remuneration form mark-ups.
[37] Professor Clarke outlined the findings of the ANAO report that more than 18% of pharmacies in Australia receive more than $1 million in remuneration from dispensing drugs listed on the PBS, with 140 more pharmacies moving into the top-earning bracket when the 2012 and 2013 financial years were compared. He stated that the high profitability of established pharmacies meant that business sale prices were very high, with the cost of inner-city and suburban pharmacies running into millions of dollars. These prices locked out many pharmacy graduates from ever owning their own business due to inflated business prices, and also mean that new entrants are saddled with levels of debt that turn what should be profitable businesses into marginal ones. Professor Clarke gave evidence that this creates a cycle of rent seeking: the ownership and location rules protect existing owners, forcing the next generation of owners to buy their businesses at inflated prices and thus seek ever more protection from competition in order to be profitable or even viable.
[38] In cross-examination, Professor Clarke acknowledged that not all pharmacies are part of the PBS (which is the scheme under which pharmacies are remunerated by the Government for dispensing scripts for scheduled medicines). He accepted that the practice of simplified price disclosure has reduced the benefits that pharmacies were getting, beyond the standard remuneration. Professor Clarke clarified that whilst the location and number of pharmacies in Australia is currently frozen, the number of pharmacists operating within the pharmacies has increased. However it remained the case that the pharmacist to population ratio is falling. Professor Clarke was of the view that this affected the labour market bargaining power of pharmacists, in that if employment opportunities for employed pharmacists are supressed by restricting the number of pharmacies, this may impact on the price of a pharmacist’s labour. Alternatively, in the presence of a monopoly, or some degree of monopoly by the employer, the bargaining powers change and that places downward pressure on wages of pharmacists. He stated that ultimately, the impact of the regulatory restrictions on the labour market would be determined by demand and supply factors.
[39] Professor Clarke conceded that the available data concerning the profitability of pharmacies is imperfect and is ultimately based on averages rather than looking at the specific profitability of individual pharmacies. He acknowledged that not all pharmacies would be highly profitable and highlighted the lack of good public data in relation to the profitability of pharmacies. However the rules and restrictions applicable to pharmacies provide a regulated operating environment that protects existing pharmacy owners. There is a significant spread of remuneration to pharmacies from dispensing drugs listed in the ANAO report with only 18% being in the top income bracket, and an increase to wages could affect low-income pharmacies, and in turn have consequences for the employment of pharmacists.
Dr Geoffrey March
[40] Dr Geoffrey March is the President of Professional Pharmacists Australia, a division of the APESMA, and is also a National Assembly member of the APESMA. He has held various academic and professional appointments throughout his career, including as a Lecturer at the School of Pharmacy and Medical Sciences at the University of South Australia until his retirement in 2016. He was a registered pharmacist from 1977 until he retired from the profession in 2016, and worked as a practising pharmacist until 1997.
[41] He provided two statements in support of the claim. In his first statement dated 10 December 2017, 5 Dr March referred to his period of practice as a pharmacist, and said that when he commenced practice as an intern in 1976, he was ethically prevented from discussing or describing medication to patients, and his training and practice involved a focus on the drug itself, how it worked, dosages and formulation. He was not trained to appreciate consumer wants, desires or needs, and it was expected that the consumer would accept his directions.
[42] Dr March described a process of policy reform commencing in 1987 when the World Health Organisation issued a resolution calling upon all member countries to develop a national medicinal drug policy. In 1988 the Australian Government committed itself to the establishment of such a policy. The Australian Pharmaceutical Advisory Council (APAC) was subsequently established as a multi-disciplinary representative body, and in 2000 it published the National Medicines Policy. The QUM strategy was also introduced in conjunction with the policy in 2000. A second committee established by the Australian Government, the Pharmaceutical Health and Rational Use of Medicines (PHARM) committee, also provided advice to the Minister and Department for Health and Ageing concerning strategies for the QUM in Australia.
[43] In line with the principles of the National Medicines Policy, the strategy for achieving QUM was based on a partnership approach, in which a “medication team” consisting of consumers, doctors, pharmacists and nurses who each have a role to play in ensuring the medicines are used wisely in an environment that both supports and is conducive to the QUM. The strategy was implemented by pharmacists in a number of ways, including in interactions with individuals patients, community groups and organisations.
[44] Dr March gave evidence that he was part of a research team that investigated the development and implementation of a pharmacy practice based on the philosophy of pharmaceutical care as the QUM strategy where pharmacists in collaboration with the consumer and the consumer’s medical practitioner worked to identify and resolve medication-related problems. One outcome of this research was the implementation of the HMR program, firstly in aged care facilities and eventually in the community.
[45] Dr March considered that the developments he described caused the “practice paradigm” in the pharmacy profession to change from pharmacists dispensing medication for a medical condition to a focus on the person suffering from a medical condition for which medication may or may not be appropriate. In terms of the University education of pharmacists, it was no longer sufficient for pharmacists to be trained only in all aspects of medicines including their formulation and action on the body. They also needed the ability to apply that knowledge through the use of “soft” skills - for example, by effective communication with customers and collaboration with other health professionals. New courses were added to the pharmacy curriculum to teach students the necessary skills to become patient care practitioners. These “Applied Therapeutics” courses covered topics such as pharmacists’ roles and responsibilities; understanding the health system; the role of standards, guidelines and ethics in practice; communication theory and skills development; cultural sensitivity; behavioural theory and application; problem solving skills including the basis of the pharmaceutical care model; inter-professional learning and collaboration; literature researching and critical evaluation skills to facilitate access to independent information; and understanding the roles and responsibilities of various professional bodies.
[46] By the time of his retirement in 2016, Dr March stated, pharmacy students were being taught to accept responsibility for the outcomes of the prescriptions and over-the-counter medicines they were dispensing by being able to effectively communicate with customers, exploring behavioural strategies to assist consumers in changing behaviours, developing the skill to identify and resolve medication related problems, and communicating effectively with other health professions. These changes in the curriculum preceded changes in practice in the community setting, so that as at 2000 relatively few pharmacies had established a practice involving medication review and it was a challenge to find pharmacists who were beginning to practice in a more patient-centred manner or providing specific patient care services or student placements.
[47] Dr March also described the commencement of the accreditation of pharmacy programs in 1998 with the creation of the New Zealand and Australian Pharmacy Schools Accreditation Committee. The latest Accreditation Standards introduced in 2014 include a learning domain relating to the health consumer, which was an acknowledgement of the supremacy of the consumer in practice.
[48] In his reply statement dated 30 April 2018, 6 Dr March further detailed the changes in education as a result of adopting a more patient-centric approach. He said that the new patient-centred approach started to be implemented partially in universities in around 1998 and was rolled out in the following few years. In a formal sense patient-centred care became a core part of practice with the National Medicines Policy in 2000. QUM was at the heart of the policy, and it emphasised: selecting management options wisely; choosing suitable medicines; using medicines safely and effectively; greater engagement with the patient; understanding the health-care system and inter-professional learning and collaboration; making more complex judgments in applying standards, guidelines and ethics’ communication theory and skills development, cultural sensitivity, behavioural theory and application, and problem-solving skills; and literature research and critical evaluation skills. Dr March set out that pharmacists were now required to engage on a higher level with patients and were not only required to consider the impact of medication on patients, but also matters such as the availability of other therapies, and costs for the individual, the community and the health system as a whole.
[49] In terms of the impact of the proposed variation on collective bargaining within the pharmacy industry, Dr March stated that, with the exception of one chain of pharmacies, no other community pharmacies have consistently entered into enterprise agreements. He noted that the majority of community pharmacies are geographically diverse and have fewer than 20 employees. He stated that this made it difficult to commence bargaining with these pharmacies.
Amy Thomson
[50] Amy Thomson 7 is an Emergency Medicine Specialist Pharmacist employed by NSW Health at the Mona Vale Hospital NSW and a Specialist in Poisons Information at the NSW Poisons Information Centre at The Children’s Hospital Westmead. She is currently classified as a Pharmacist Grade 3 at Mona Vale and a Pharmacist Grade 2 at NSW Poisons Information Centre.
[51] Ms Thomson stated that her duties as an Emergency Medicine Specialist include:
• the provision and development of clinical pharmacy services;
• obtaining detailed medical histories from patients;
• undertaking medication reviews;
• preparing pharmaceutical care plans;
• providing information to nursing and medical staff on relevant aspects of drug usage and availability; and
• strategic planning for the pharmacy department.
[52] In relation to her appointment as a Specialist in Poisons Information, Ms Thomson stated her main responsibilities include:
• the assessment of patients exposed to various toxins and advice on treatment;
• advising on the treatment of bites and stings and on the side effects and interactions of medications; and
• answering general queries relating to poisoning, pesticides and chemical safety.
[53] Ms Thomson was awarded a Bachelor of Pharmacy at Sydney University in 2010. She described in detail the content of her undergraduate course, which she said had a focus on the quality use of medicines and how to improve patient outcomes. Relevantly, students were taught how to perform professional services and to integrate into the health care team, why pharmacists as experts were essential to the health care team, and how best to communicate to patients and doctors to improve patient outcomes. As examples of training in this area, Ms Thomson said she did a laboratory exercise about the appropriate use of amitriptyline for different patient groups, particularly the elderly; participated in role plays communicating key health messages to the general public; and learnt how to communicate with medical prescribers.
[54] Following the completion of her degree, Ms Thomson obtained provisional registration with the Pharmacy Board of Australian Health Practitioner Regulation Agency (AHPRA). Ms Thomson set out that for her intern year she was required to complete 1824 hours of supervised practice, make and complete a training plan including obtaining 40 CPD points, undertake a written and an oral examination (with an overall pass mark of 65%), and complete the University of Queensland Pharmacy intern training course. The written examination included areas such as professional and ethical practice, the supply of prescribed medicines, the preparation of pharmaceutical products, and the delivering of primary and preventative health care. There was also a role play element based on a scenario where a patient presented a script for a medication, under questioning disclosed she had a history of seizures, and contact had to be made with the prescriber to recommend alternate treatment. Skills taught in her intern year included detecting, diagnosing and treating minor ailments, detecting more serious conditions, when to refer patients to another professional and how to treat the more serious condition.
Cameron Walls
[55] Cameron Walls 8 is a Pharmacist Manager at a pharmacy in Wodonga, Victoria. He completed his degree in pharmacy at Charles Sturt University in 2009, and gained full registration as a pharmacist in 2011. He worked in two other pharmacies before his current position. He is classified as a Pharmacist Manager under the Pharmacy Award. He is paid $44 per hour Monday-Friday, $55 per hour for Saturdays and overtime, and $65 per hour on Sundays.
[56] In addition to managing the business, Mr Walls undertakes duties providing prescriptions and medicines (typically dispensing 130-150 prescriptions per day), and performing services such as providing medical leave certificates, in-Pharmacy medication reviews, supervision of daily medication collection, screening and provision of sleep apnoea treatments and weight management consultations, and ensuring the pharmacy operates within the relevant legal framework and professional standards. He is required to supervise or be involved in the supply of Schedule 2 and Schedule 3 pharmacy-only medicines where the patient does not require a prescription. It is necessary form him to ensure that such medicines are safe for the person taking, by considering their medical conditions, other medications they are taking, their age and gender and any other relevant information; it is also necessary for him to make sure that the treatment is likely to be effective, considering the nature and severity of the condition, the treatment options and, when required, to recommend an alternative treatment or make a referral to an alternative healthcare provider.
[57] Mr Walls also gave evidence that his duties now increasingly involve the provision of “professional services” which do not necessarily involve the sale of medicines or products. These include such services as:
• pharmacist vaccinations;
• providing medical leave certificates;
• opioid replacement therapy;
• dose administration aids;
• staged supply;
• clinical interventions;
• sleep apnoea screening and treatment;
• weight loss programs;
• in-pharmacy medication reviews (MedsCheck and Diabetes MedsCheck);
• HMRs; and
• blood pressure, blood glucose and cholesterol screening.
[58] He stated that with the exception of vaccinations and HMRs, he had personally provided all of these services, and that that many of these professional services required training and accreditation in addition to his pharmacy degree. He set out that he had received specific training to provide opioid replacement therapy in accordance with Victorian legislation, sleep apnoea screening and treatment, and a specific weight loss program.
[59] In addition, Mr Walls stated that as a Pharmacist Manager, he had developed skills in human resourcing, stock control, and financial analysis. He stated that his pharmacy degree did not provide him with these skills nor had he received any formal training from his employer. Finally, Mr Walls set out that increasingly, the responsibility of managing pharmacies is being undertaken by pharmacists who do not have ownership of the pharmacy, and that the training of interns is now falling on employees within the pharmacy, rather than the owner of the pharmacy. In that connection he has taken on the role of Preceptor, which involves supervising the learning and competence of an intern pharmacist during their registration year.
[60] Mr Walls also referred to the introduction of compulsory CPD and learning plans, which has occurred since the graduated. This had increased the burden of work in terms of documenting his learning activities, and all CPD activities had to be done in his own time and at his own expense.
Katerina Malakozis
[61] Ms Katerina Malakozis 9 is employed as Pharmacist in Charge at National Pharmacies in Adelaide, and is paid $48.51 per hour. She gained full registration as a pharmacist in 1989, and has been employed since then in a range of pharmacies. Her responsibilities extend from managing all employees of the pharmacy and ensuring they have proper training, dispensing prescriptions and checking compatibility with other medications, counselling patients concerning how to take their medications and how they work and what to expect from them, performing MedsChecks, administering influenza inoculations, supplying Pharmacist Only Medicine, issuing absence from work certificates, supplying and packing DAAs, providing health information to patients, taking back and disposing of unwanted medicines, operating diabetes assistance functions under the National Diabetes Supply Scheme, acting as Preceptor for interns, and ensuring the safe storage of medicines and providing advice about this.
[62] Ms Malakozis gave evidence that during her period of employment as a pharmacist she had experienced a “dramatic change” in procedures and processes and in her work. At the commencement of her career in 1989/90, the main tasks she performed related to dispensing medication and providing information surrounding prescriptions. The prescriptions also had to be collated and missing scripts identified and removed from the claim, and then sent to Department of Health for payment. These tasks were now performed by dispensary technicians, but the pharmacist still needed to check the claim and personally sign it off. Today, Ms Malakozis said, there was much more work in her daily tasks. Increasingly the general public would seek medical advice from pharmacists rather than from their general practitioner. She stated that pharmacists had become more accessible and now offered services such as providing medical leave certificates, administering vaccinations, providing codeine products, and providing advice in respect of both minor and major health concerns (which often required referral to a GP). Ms Malakozis set out that there is a greater demand by the community to have a pharmacist deal with their health issues before they go to the doctor. Customers also sought advice on weight loss and the use of complementary medicines, and may want their blood pressure, blood sugar and/or cholesterol checked. Other interactions with customers included assistance with medication packs, dealing with requests to get expired scripts renewed, advice about generic medications and dealing with medications that are out of stock.
[63] Ms Malakozis said that she typically was involved in the dispensing of 250-350 prescriptions per day, along with constant requests for advice. All products dispensed were scanned using a Medicare/drug scanner to ensure minimal mistakes, and during this time it was necessary to record customer interactions, review customer history and offer advice and MedsChecks. It may also be necessary to administer first aid, deal with a customer in crisis, contact a GP about a prescription and check PBS claims. She also had the management responsibility to ensure staff complied with the new Professional Practice Standards and Code of Ethics. Generally, the scope of regulation of the profession requiring compliance had significantly expanded, including the introduction of mandatory CPD. The downscheduling of medication, which had increased the number of pharmacy-only medicines, had increased the workload.
[64] Mr Malakozis’ employment was covered by an enterprise agreement, with National Pharmacies having entered into a series of enterprise agreements over 20 years. The current agreement provided for study leave and assisted in contributing towards accreditation of pharmacists to perform HMRs.
Cardin Le
[65] Cardin Le 10 is currently employed as a Pharmacist in Charge at a pharmacy in Wagga Wagga, at which he is paid $37 per hour for ordinary hours, $45 per hour on Saturdays and $50 per hour on Sundays and public holidays. He graduated at Charles Sturt University in 2009 and gained full registration as a pharmacist in 2011. His current duties include rostering pharmacists, dispensary management, stock orders and control, inventory, compounding non-manufactured medicines, and reporting to owners. He stated that during his time working as a pharmacist, he had observed a number of changes to the profession. Mr Le said that the profession had evolved from predominately dispensing medicines and administration to an increased demand for professional services. The services included counselling patients, daily staged supply of methadone to assist with the elimination of drug addiction, providing vaccinations, medications reviews, and QUM.
[66] Mr Le stated that an ordinary day involved dispensing approximately 250 or more scripts, checking Webster packs (a type of DAA), providing consultations for, on average, 20 walk-in patients per day regarding minor health advice or pharmacist only medicine requests, conducting medication reviews and administer walk-in vaccinations.
[67] Mr Le’s evidence was that the demographic of the pharmacy in a rural area was significantly different from other pharmacies in that there is diversity in age, ethnic backgrounds and socio-economic circumstances. Dealing with patients with special requirements, such as ones who spoke limited English, in combination with dispensing their prescriptions and managing the supervision of staff, whilst other customers were left waiting, caused pressure in the role particularly when Mr Le was the sole pharmacist on duty. Mr Le stated that there may be the need to dispense between 250 and 350 scrips during an eight hour shift, some being more complicated than others, and requiring the provision of particular advice to customers.
[68] Mr Le emphasised that there was a significant amount of new work in the role not previously undertaken by pharmacists, compared to when he had commenced practising in 2011. This new work included administering vaccinations, the impact of QUM, down-scheduling of medicines, and the administration of medication to an ageing population. Accordingly, Mr Le stated that there is more work and pressure on pharmacists without any additional remuneration. The evidence was that often prescription choices made it necessary to exercise judgement and skill in relation to the suite of appropriate medication.
[69] In addition he stated that since the completion of the undergraduate degree, further training has had to be undertaken to perform many of the newly required pharmacy services. The further training included training for vaccinations, medication reviews, and down-scheduling of drugs.
Leon Wai Hon Yap
[70] Leon Wai Hon Yap 11 is employed as a Clinical Hospital Pharmacist at the Gold Coast Health and Hospital Service. He completed a Bachelor of Pharmacy at the University of Queensland in 1998, and gained full registration as a pharmacist with the Pharmacy Board in 1999. Mr Yap’s employment is classified as a Health Professional Level 3 Paypoint 6 at $45.40 per hour under the Health Practitioners and Dental Officers (Queensland Health) Award - State 2015, a Queensland state award. Prior to his current position, he worked in community pharmacies from 1999 until 2016. In his last pharmacy in 2016 he was paid $35 per hour Monday-Friday and $40 per hour on Saturdays.
[71] He set out that during his career he had seen changes in both the way he performed his work and the types of work performed. Mr Yap stated that whilst at university from 1996 to 1998, the curriculum focussed on the pharmacology of medicines, basic human anatomy, human physiology, basic medicine compounding, the science behind medicine design and delivery systems, prescription legalities, dispensing, patient counselling, and over the counter prescribing.
[72] Mr Yap stated that in 1999, to satisfy the requirements to be eligible for registration in Queensland as a pharmacist,he was required to complete an open book written exam and to complete 48 weeks of supervised practice. He stated that the exam covered topics such pharmacy law and ethics, pharmacological questions, and pharmacy practice questions. His first job as a pharmacist consisted of serving customers with minor ailments, receiving prescriptions from customers, interpreting and dispensing prescriptions, explaining to customers how to use medications, and providing over the counter medications to treat minor ailments, limited to conditions such as colds and flu, minor aches and pain, hay fever and minor skin irritations. Other duties included collating prescriptions for reimbursement by the government under the PBS, ordering stock and placing stock on the shelves. He provided customers with over-the-counter medicines, but the quantity and variety of these was much smaller than today. The minor ailments he diagnosed and treated were limited to conditions such as colds and flu, minor aches and pains, hay fever and minor skin irritations.
[73] Mr Yap outlined the responsibilities of contemporary pharmacists, and stated that pharmacists were now required to be trained and competent to diagnose, treat, or to decide when to refer a patient to a doctor for, a much wider range of conditions. These new duties related to “bacterial conjunctivitis (Chloramphenicol), Nausea related to migraine (Metoclopramide and Prochlorperazine), medicated weight loss treatments (Orlistat), provision of Proton pump inhibitors (PPI' s) for the treatment of Gastroesophageal Reflux Disease ( GORD ), assessing the requirement for and providing nasal decongestants facilitated with the use of Project Stop, providing Emergency Contraception (the morning after pill), oral antiviral treatments for cold sores (Famciclovir), oral treatments for vaginal thrush (fluconazole) and the provision of Naloxone for the emergency treatment of acute opioid overdose.”
[74] Furthermore, he stated that the provision of Emergency Contraception required pharmacists to be able to determine not only that the product will be appropriate, safe and effective for the particular patient but also to be able to assess and assist in cases where the patient may be underage or there is the possibility that a sexual assault has taken place. He stated that this may require specialist knowledge of local sexual health clinics, sexual assault services as well as the requirements for mandatory reporting of suspected cases of child sexual abuse. Pharmacists also now had to operate a screening and recording database (Project Stop) established by the PGA to facilitate the supply of nasal decongestant products containing pseudoephedrine.
[75] Mr Yap said that the dispensing process had become “slightly faster” due to improved technology and better software, but his patients had increased requirements to assess the appropriateness of a treatment due to the higher prevalence of type 2 diabetes, heart disease, neurological conditions, autoimmune diseases, and the increasing complexity of the medicines used to treat these conditions. He stated that this had resulted in more complex and comprehensive patient counselling, in order to better educate patients on the medicines they are taking. He stated that this was in addition to the demands of patients who were generally becoming more interested in their health and medicines and requesting more information about medicines. The introduction of Quality Standards as part of the QCPP from around 2000-1 onwards placed a greater burden on the pharmacist in charge or pharmacist manager, who usually undertakes the role of QCPP standards coordinator. The introduction of dose administration aids, which occurred since Mr Yap became registered, was an important but time consuming and mentally challenging service. Creating a DAA involved repacking a person’s dispensed medicine into a single disposable 7-day blister pack that sets out a person’s medicines in an easy-to-red and accessible way. The role of packing DAAs is often carried out by pharmacy assistants, although in smaller pharmacies it may be carried out by the pharmacist, but they always need to be checked for accuracy by the pharmacist. The number of persons on opioid replacement had increased in Mr Yap’s experience from 5-19 to 20-40, the legal requirements for dispensing opioid had become more explicit and the types of opioid replacement had increased. Each patient who presents to the pharmacy for opioid replacement has to be identified and assessed as to whether they are able to be dosed, and the pharmacist must then measure out the dose, provide it, watch it being consumed and make sure it is not diverted. In addition, a range of recording requirements must be carried out.
[76] Mr Yap stated that with the establishment of the Pharmacy Board of AHPRA in around 2000, pharmacists are now required to complete a certain amount of hours of CPD. For the most part, this learning had to be done in the pharmacist’s own time and very rarely were pharmacists paid to undertake this learning.
[77] He also referred to the advent of professional services now being provided by community pharmacies. These professional services included HMRs, MedsChecks and Diabetes MedsChecks, and in the case of one pharmacy where Mr Yap was employed, a Clozapine clinic. In order to provide HMRs, a pharmacist had to obtain accreditation, which involved either a face-to-face workshop or online preparatory course, the completion of a communication module, a multiple choice examination and the completion of four case studies by correspondence. In respect of HMRs, a portion of the money the pharmacy receives from the federal government, through 6CPA funding for this service is passed on to the pharmacist. In the case of MedsChecks and Diabetes MedsChecks, he stated that very rarely was any of the money that the pharmacy received as part of 5CPA and 6CPA funding shared with the actual pharmacist performing these services. The conduct of a Clozapine clinic in the last pharmacy Mr Yap worked in involved servicing 30-40 clients per clinic and required a patient’s blood test results to be inspected and signed off on a special monitoring website, and the details of dispensing of the Clozapine entered into the website. This process was time consuming and only commenced about 3 years ago.
Jennifer Madden
[78] Jennifer Madden 12 completed a Bachelor of Pharmacy at the Victorian College of Pharmacy in 1968, and gained full registration as a pharmacist with the Pharmacy Board of Victoria in 1970. She has worked, always on a part-time basis, in community, hospital, military, academic, research and consulting pharmacy roles. She remains registered as a pharmacist and is currently employed as a locum pharmacist with several pharmacies. She is currently classified as a Pharmacist in Charge, and is paid $40 per hour. Her duties include the usual activities of dispensing and supervising the sale of Schedule 2 and Schedule 3 medicines, and providing advice on medications as requested or necessary. She is not required to pay wages or manage stock, apart from during busy times, and would make corrections to Webster Packs when needed. As an Accredited Pharmacist she manages the HMR process, and also works with nursing homes regarding RMMRs to identify suitable residents and request reviews from their doctor as well as performing them.
[79] Ms Madden gave evidence that the university curriculum when she studied pharmacy at that time focused on becoming familiar with medicines prescribed by doctors and becoming expert in over-the-counter medicines, preparations and counter dispensing (for coughs and colds, pain remedies and first aid). She studied pharmacology, physiology and drug scheduling. When she commenced working as an intern in 1969, she said there was very little pressure and responsibility, and she performed typing, compounding and packing of bulk medicines. She did a practical and oral examination at the end of her internship. Ms Madden compared this to her experience of internships in recent years as a tutor and supervisor, and said that the intern year was now intense and demanding with a lot of assignment work and a more strenuous examination at the end.
[80] In relation to the work of a pharmacist, she said that in her experience there had been little change in the work until the advent of computers, initially in dispensing, in the 1980s. Computerised records allowed easy access to a patient’s history of use of medicines, and facilitated analysis of a patient’s profile when dispensing medicines. The introduction of Schedule 3 pharmacist-only medicines in the 1990s added another level of responsibility to pharmacists.
[81] Ms Madden said that during the 1990s, the rapidly expanding drug compendium available for prescribing, in conjunction with increased legal obligations, highlighted the need for continuing education which was initially voluntary but is now compulsory, being 40 hours required for continued registration. However it was emphasised that no increased remuneration was provided in response for this compulsory activity. She is required to undertake at least 60 hours of continuing education per year in order to maintain her registration as an Accredited Pharmacist.
[82] She set out that she had been accredited to undertake HMRs and RMMRs for about 15 years, and this constitutes about half her work. The skills required to be an Accredited Pharmacist are those of any registered pharmacist, but the accreditation process requires the pharmacist to show good communications skills at the professional and lay level and a good climical understanding of medicines and medical conditions. To become accredited she need to undertake a course accredited by the Australian Pharmacy Council, which included a communication module and ten case studies involving the preparation of a medication profile in each case. The course took almost a year to complete. She stated that she is required to sit an exam every three years to maintain her registration as an Accredited Pharmacist. Now that she is accredited she can write the report to the doctor based on feedback from another pharmacist or her own knowledge without actually interviewing the patient, but in fact of her 800 clients she only participated in one review without actually interviewing the client.
[83] Ms Madden also identified the additional professional services and duties performed by pharmacists. She stated that she frequently provided clinical interventions to customers, extending from directing a patient who wanted an antiseptic for a dog bite to go to their doctor as the antiseptic was an inadequate therapy, to a scenario involving checking why a patient was now taking a higher strength asthma medicine than six months prior, or intervening in not selling another patient Ventolin for a cough as they had not been diagnosed with asthma. In addition Clinical Interventions occurred with particular doses of drugs where “black box” warnings apply, that is, the medical professional is alerted to a potential problem with a particular drug or dose of drug. Her evidence was that the intervention may only take a number of minutes, or more than 10 minutes and often involved related phone calls to a doctor or carer. These interventions reduce the burden on the health system.
[84] In relating the nature of her changed duties, she stated that in the last two days of work in the community pharmacy, she filled 304 prescriptions between 9.00 am and 5.30 pm. She completed this task with one dispensary assistant and three competent shop staff. In addition she recorded 10 interventions and a range of other discussions with patients. She also checked 50 to 60 Webster packs, made changes to 2 Webster packs and initiated a new pack. In addition she supervised the sale of 20 Schedule 3 medicines and had discussions with two General Practitioners that were time-consuming. She noted that on this day there were no requests for Blood Pressure or Blood Glucose Level checks, no vaccinations or requests from hospitals for patient profiles or supply pick-ups.
[85] She stated that increasingly, pharmacists are often asked to respond to symptom based requests where in contrast previously the pharmacist was not called on as often to communicate about medicines, they were just dispensed. She stated that since the 1980s, in terms of Schedule 3 medicines, there has been significant movement of medications down the Schedule, which has placed pressure on Pharmacists to communicate information about these drugs to assist the patient. There is a need to dispense medications in an informed manner, taking into account the patient’s circumstances.
Carmel McCallum
[86] Carmel McCallum 13 graduated in 1977 at the University of Sydney and gained full registration as a pharmacist in 1977, and retains current registration as a pharmacist. She has worked at a range of community pharmacies, and has previously been an owner of a pharmacy, and is currently employed as a locum pharmacist. She is classified as a Pharmacist in Charge and is paid $40 per hour. Ms McCallum’s duties in her current position extend from dispensing and checking prescriptions; dispensing, checking and signing off DAAs; logging Schedule 8 medicines (including opioids, fentanyl, central nervous system stimulants such as Ritalin, and alprazolam); counselling patients regarding new prescription medications, adverse reactions or when interactions with other drugs may occur; counselling, diagnosing and recommending treatments for ailments as the first point of contact for patients; interpreting patient blood pressure readings and blood sugar levels; pain management and alternative recommendations when drug dependence is suspected; dispensing and delivery of methadone or buprenorphrine under the NSW Opioid Treatment Program; issuing medical certificates; overseeing the general day-to-day performance of staff; managing the supply of drugs at the pharmacy; and ascertaining the entitlement of patients to receive prescriptions under the National Health Scheme.
[87] Ms McCallum gave evidence that she commenced work in 1977 as an unregistered graduate pharmacist in a small pharmacy in New South Wales. She stated that at that time her duties involved handwriting copies of prescriptions into a log book, handwriting repeats and typing labels on a typewriter, and that all her work was checked off by a more senior registered pharmacist. If a product such as creams, ointments or mixtures had to be prepared, it could take ten minutes to an hour and about 70-80 scripts would be processed per day. Ms McCallum stated that she was able to spend up to 10 minutes per patient, and was able to provide them with advice on minor ailments, such as bites, rashes, minor burns, injuries, allergies, upper respiratory tract infections, vomiting and diarrhoea, difficulties with new-born babies, recommending the appropriate treatment which was available over the counter, or other non-drug related action. She also made up proprietary products, such as cough medicine, in bulk.
[88] She stated that over her time in the profession she had observed additional expectations, regulations and increases in workloads for pharmacists. She stated that much of the increased workload has come about as a result of the increase in life expectancy, change in medications, and increases in co-morbidity and lifestyle disease states. Pharmacists now had to oversee the accuracy of dispensing huge numbers of prescriptions. A number of pharmacies were now providing dispensing services in locations near large hospitals with casualty wards operating 24 hours per day. She referred to the up-scheduling since the 1990s of products containing codeine, pseudoephedrine and dihydrocodeine to Schedule 3 and 3R (which required recording), which required the pharmacist to ascertain need, usage, possible interactions, adverse reactions and addiction and misuse issues. The up-scheduling of codeine products to Schedule 4 would be challenging in terms of dealing with patients with addictions. The down-scheduling of products since the 1990s also increased pharmacists’ responsibilities.
[89] Ms McCallum also referred to other changes and new work such as blood pressure measurement (which might lead to a medical referral), training for the Diabetes Medication Assistance Service (although this had not proved successful), an exponential increase in the prescribing of Schedule 8 drugs over the last 6-7 years (which required much longer to be dispensed), and an increase in interventions. She had also dealt with at least six differing digital dispensing systems over the last 35 years.
[90] She stated that unlike most professionals, pharmacists were not able to make appointments for enquiries during the work day, as there was an expectation that pharmacists are available at all times during operating hours. Pharmacists were required to be available at all times of the day during opening hours while on the premises, but the pressure and workloads had increased enormously since 1977.
Mr Alex Crowther
[91] Mr Alex Crowther is employed as the Surveys Manager of the APESMA. In his first witness statement, 14 Mr Crowther said that his duties include the collection of data using online surveying tools for the purposes of creating market research of interest to APESMA, and he conducts regular surveys of remuneration and employment conditions in a number of industries covered by the APESMA. Relevantly the APESMA had published the Community Pharmacists’ Remuneration Survey Report series since 1995. Data published in this series was collected from members of the APESMA’s pharmacy division as well as non-member pharmacists who had previously interacted with the APESMA through online campaigns or social media. He stated that the report series benchmarked the employment conditions and remuneration of pharmacists employed in the community pharmacy sector. It collected and reported data including community pharmacists’ hourly rates of pay, additional responsibilities required of community pharmacists beyond dispensing medicine, sentiment regarding working in the community pharmacist sector, and demographic information.
[92] Mr Crowther’s statement annexed copies of the report series since 1995. He stated the following conclusions, derived from the report series, about wages movement for pharmacists:
• The 2016 Remuneration Survey identified mean hourly rates of pay for permanent employee pharmacists at each of the classifications outlined in the Award as follows: Pharmacy Intern ($23.02), Pharmacist ($32.49), Experienced Pharmacist ($36.66), Pharmacist-in-Charge ($35.95), and Pharmacist Manager ($38.49).
• Mean hourly rates of pay reported by community pharmacists were lower in 2016 than they were for community pharmacists surveyed in 2011, with decreases of 5.49% for Pharmacists, 3.73% for Experienced Pharmacists, 7.94% for Pharmacists-in-Charge, and 1.86% for Pharmacist Managers. Prior to 2011 community pharmacists mean hourly rates of pay had increased steadily.
• Growth in the hourly rates of pay for community pharmacists had also fallen behind growth in the Australian wages generally, as measured by the Wage Price Index (WPI), and the cost of living, as measured by the Consumer Price Index (CPI), for each of the classifications above that of Pharmacy Intern.
• Since 1998, Pharmacists had experienced a decline in the real value of their wages of 11.59%, Pharmacists-in-Charge of 7.35%, and Pharmacist Managers of 3.52%. Pharmacists had also experienced wage growth 21.47% below that of the average Australian, 17.69% for Pharmacists-in-Charge, and 14.29% for Pharmacist Managers.
• The underperformance of pharmacist wage growth relative to both CPI and WPI was largely due to stagnant and declining hourly rates of pay since 2011. Prior to 2011 pharmacists tended to outperform both CPI and WPI year on year.
[93] In respect of the this decline in wages, Mr Crowther noted that as the report series does not use the same respondents year-on-year, this was likely due to a combination of both stagnant wage movement and new entrants to the industry at each classification being offered progressively lower starting packages.
[94] The report series also surveyed whether the respondents were required to provide any professional services as part of their duties, including HMRs, RMMRs, MedsChecks, vaccinations, and other services. The results were as follows:
• MedsChecks services: 85.9%
• Vaccinations: 20.98%
• Other services: 15.41%
• HMRs: 15.41%
• RMMRs: 4.59%.
[95] Only 8.4% of respondents that performed one or more of these services reported receiving additional compensation.
[96] In his statement in reply, 15 Mr Crowther referred to the Graduate Outcome Survey published by Quality Indicators for Learning and Teaching. He stated that this survey provides information regarding commencing salaries for Australian graduates, and that the latest report published January 2018 identified pharmacy graduates were the most poorly remunerated of any professionals. Based on this survey he said that “… compared to other allied health professionals, pharmacy graduates had commencing salaries 26.7% less than Nursing graduates, and 23.6% less than Psychology graduates in 2017. Compared to Engineering graduates, another professional that requires a four-year degree and covered by Professionals Australia, Pharmacy graduates have a commencing salary 31.3% less in 2017.”
[179] The two-part expert Report prepared by Professors Krass and Aslani was problematic in a number of respects. They were commissioned by the APESMA to prepare a report analysing changes in the work value of pharmacists since 1998, and the instructions provided to them by the APESMA gave what we consider to be an accurate summary of the nature of the proceedings currently before the Commission and the process by which work value was to be assessed in the industrial context. It is far from clear to us that the Report was properly responsive to those instructions. The first part of the Report in particular was expressly stated to be concerned only with the delivery of “cognitive pharmaceutical services” and did not attempt to undertake a holistic analysis of the work value of pharmacists, noting that it was part of the PGA’s case that some elements of pharmacists’ work associated with the prescription of medicines had become less onerous. Further, it is apparent that the first part of the Report took a heterodox view of work value, in that the “value” of pharmacists’ work was primarily analysed by reference to its value to the community and the health outcomes it produced rather than being concerned only with the nature of the work and the level of skill and responsibility being exercised. The second part of the Report was based on interviews with a sample of pharmacists, but if suffered from the defects that, first, what was obtained from the interviews was necessarily in the nature of subjective perceptions rather than objective information and, secondly, the nature of the work experience (such as the length of time spent in the profession) of the interview participants was not provided. Nonetheless the Report as a whole contained a great deal of useful information concerning new programs and services in the pharmacy industry and the extent to which individual pharmacists were involved in the delivery of those.
[180] The expert evidence of Professor Clarke provided a valuable overview of the highly regulated nature of the pharmacy industry, but was unable to answer the question posed to him by the APESMA concerning whether the grant of its claim would have a significant negative impact of the financial sustainability of community pharmacies – a question which, it seems to us, could not be answered without him being provided with or having access to data about the extent to which the market wage rates for pharmacists exceed the minimum award rate. Data of that nature was provided in the evidence given by Mr Crowther concerning the surveys conducted for the APESMA. Those surveys gave evidence concerning market rates for pharmacists which we accept, noting that the results of those surveys (showing a decline in market rates over the last five years) were confirmed by the UTS Pharmacy Barometer (discussed in the first part of the Report of Professors Krass and Aslani). Finally, the evidence of Dr March described developments in policy affecting the pharmacy profession and in the training of pharmacists over the last 30 years. We accept as accurate his description of those developments, but not necessarily some of the inferences he sought to draw from those developments.
[181] The evidence adduced by the APESMA referred to a large number of discrete changes which it will be necessary for us to deal with separately later, but the APESMA’s overarching case was that there had been a paradigm shift in the work of pharmacists since 1998 from the traditional role of simply dispensing medicines for the treatment of particular illnesses to a patient-centred approach in which the pharmacist operates as part of an integrated health care team treating the entirety of the patient’s condition through the provision of a wide range of primary and preventative health care services and through direct interaction with the patient. It is apparent that the case was advanced in that overarching way in order to justify the scale of the wage increases sought. We will deal with this overarching case first.
[182] We are not satisfied that there has been a fundamental change in the nature of the work of pharmacists since 1998, or in their skills or level of responsibility, in the way suggested by the APESMA. We consider that the evidence, considered as a whole, demonstrates the following propositions:
(1) The main function of the pharmacist has always been, and remains, the dispensing of prescription medicines. However over time (both before and after 1998) there has been a decline in the proportion of time spent on this work. There have been a number of reasons for this. The process of issuing prescriptions, and making PBS claims in respect of such prescriptions, has speeded up and been simplified due the transformation effected by information technology. That this has been the case is a matter of everyday observation, although it was confirmed by the evidence of the PGA’s witnesses Ms Willis, Mr Pricolo and Mr Loukas, and also to some extent by the APESMA’s witnesses Ms Malakozis, Ms Madden and Ms McCallum and in the second part of the Report of Professors Krass and Aslani. As the federal government has over some decades attempted to control the cost of PBS medicines, issuing prescriptions has become relatively less profitable than it was before and has forced pharmacies to seek revenue and profit from other areas of activity. Additionally, the compounding of prescription medicines has virtually ceased (except in some specialist compounding pharmacies), and in addition the preparation of extemporaneous medicines now rarely occurs. Again, this position was made clear in the evidence of the PGA’s witnesses, and was either supported or not contradicted by the APESMA’s witnesses.
(2) This relative decline in the work of dispensing prescriptions has allowed pharmacists to spend a greater proportion of their time in providing other services to and interacting with patients, and the regulatory framework in which pharmacies operate has encouraged and incentivised this process, consistent with the philosophy articulated by the QUM policy. In the latter respect, the Community Pharmacy Agreements - particularly the Third, Fourth and Fifth CPAs - introduced a number of programs which funded the provision of a range of professional services to the community. All the witnesses to varying degrees gave evidence supporting this proposition.
(3) However, it does not follow that the nature of the work of community pharmacists or their skills or responsibilities have fundamentally changed since 1998 because of the developments described above. Rather, this is a case where, by and large, pharmacists have as a consequence of these developments been required to perform certain work and exercise certain skills more intensely and more frequently than they did.
(4) Interaction and dialogue with patients concerning medicines to be dispensed, including the proper use of medicines and their effects, and the use of “soft” personal and communication skills in doing so, was a feature of pharmaceutical practice in 1998 and remains so today. Ms Malakozis and Ms McCallum as well as Ms Willis, Mr Pricolo and Mr Loukas described interacting with patients and providing them with information about their prescriptions before 1998, and this is consistent with everyday experience. The degree to which patient interaction occurs has always varied from pharmacy to pharmacy depending on business/retailing model that is used, but it certainly cannot be accepted that this was a new class of work or a new skill that was introduced at some time after 1998. We note Dr March’s evidence that university undergraduate courses for pharmacists have added new subjects to the curriculum related to the use of such “soft” skills, but there was imprecision about when this occurred, and it is not clear to us that this was not part of the normal evolution of university courses rather than a radical change required by new developments in the profession. It may be accepted that greater accessibility to information about medications and patients’ medication histories through the use of information technology has added to the therapeutic value of patient interactions, but we do not consider that there has been any intrinsic change to the nature of this work or the skills exercise.
(5) Diagnosis and advice as to the treatment of minor ailments such as colds and flu, minor aches and pains, allergies, skin irritations, cuts and abrasions, and referrals to medical practitioners if necessary, is not new and was a feature of pharmacy practice in 1998. We accept the evidence of Ms Willis, Mr Pricolo and Mr Loukas in this respect, which was not the subject of any substantial contradiction on the part of the APESMA’s pharmacist witnesses. The degree to which this occurs is likely to have increased as a result of the greater accessibility of pharmacists to the public and a concomitant growth in expectations of the availability of such advice on the part of pharmacy customers, but there is no new work or skills involved.
(6) The introduction of federal-government funded programs for the provision of patient services through the Community Pharmacy Programs is not necessarily to be understood as signifying the introduction of new work or a requirement for pharmacists to learn new skills. We think the evidence supports the proposition that many of these programs provided funding to support the systematised provision of services that were already provided by pharmacists free of charge and on an ad-hoc basis. For example, we accept Ms Willis’ evidence that the MedsCheck and Diabetes MedsChecks programs, which were introduced as part of the Fifth CPA and involve a systematised in-pharmacy review of a patient’s medicines, represent a formalisation of work which was performed informally before. The skills required to be exercised, including understanding how medications may interact with each other, communicating to patients about the proper use, effects and storage of medicines, and identifying and responding to problems that may have arisen in the use of medication, are not new and were exercised by pharmacists in 1998 and before. Likewise, we accept the evidence of Mr Pricolo and Mr Loukas that clinical interventions, which are the subject of a formal funding program introduced in the Fifth CPA and involve the identification of any medication-related problem in a patient and the making of a recommendation to the relevant medical practitioner about how to resolve it, are not new, with the change being that they are now recorded for funding purposes and their performance thereby encouraged. That they are not new is confirmed by the text of the Fifth CPA itself, which (as earlier set out) provides that the applicable program had the purpose of increasing the number of clinical interventions provided and documented.
[183] In summary, we consider that although the mix of work being performed and skills being exercised has changed since 1998, and some skills for which pharmacists have always been trained are not utilised in a more intense and systematised fashion, there has not been the fundamental change in the work of pharmacists since 1998 which would justify wage increases of the order claimed by the APESMA.
[184] It is next necessary to determine whether any of the work changes relied upon by the APESMA, considered individually, would justify any increase in the wage rates for pharmacists in the Pharmacy Award for work value reasons. We have already, in the context of our consideration of the APESMA’s overarching case, rejected the proposition that there has been any change in the work value of pharmacists because of the QUM, greater interaction and communication with patients, the diagnosis and treatment of minor ailments, the MedsCheck program, or clinical interventions. We have reached the same conclusion, with one qualification to which we will return concerning the level of responsibility and accountability of pharmacists, about the following matters relied upon by the APESMA:
• Dose administration aids: The Fifth CPA financially supported the provision of DAAs in order to maximise the safe and effective use of medicines, but this did not represent the introduction of a new form of work or require the exercise of any new skill. We accept the evidence of Mr Loukas and Mr Pricolo that DAAs have existed since at least 1998, although their form and the extent of their usage has changed.
• QCPP: This has not in itself required new work or new skills, but has only involved a standardised quality assurance methodology.
• Blood pressure and blood glucose tests: These are not new and were offered in at least some pharmacies in 1998 and before. Blood pressure tests are not even necessarily administered by pharmacists.
• Medical certificates: It is clear that this service, which is offered at some but not all pharmacies on a fee-for-service basis, is new, having commenced in about 2009. However the evidence does not establish that this requires the exercise of any new skill by pharmacists; in particular the evidence did not suggest that the pharmacist is required to actually diagnose the person requesting the certificate on the basis of any form of medical examination as a medical practitioner would.
• Weight management services and smoking cessation services: These services have expanded but are not new, and on the evidence largely involve an explanation of available products for treatment.
• Asthma and diabetes management: We accept the evidence of Ms Willis, Mr Pricolo and Mr Loukas that this work had been performed in 1998 and before, and that any change was confined to understanding and providing information concerning new and updated medications, equipment and treatment methods.
• Sleep apnoea services: The limited evidence on this topic suggests that only a minority of pharmacies provide this service, and although it involves the provision of information and assistance concerning treatment technology which had been developed since 1998, the underlying condition had always been dealt with in undergraduate pharmacy courses.
• Continuing professional development: It is fundamental that any professional must engage in continuing and self-driven education and development in order to stay abreast of new knowledge, technology and other changes in the profession. It is a defining feature of a profession. Accordingly the introduction of CPD requirements merely formalised and systematised something that was (or should have been) already occurring.
• Staged supply of medicines: This program involves the management of patients who, because of mental illness, addictions or other problems have difficulty in managing their medications. The very limited evidence about this does not demonstrate that involves entirely new work (in the sense that pharmacist have always had to interact with and manage the medication needs of patients with these difficulties) or the exercise of new skills.
• Workload and patient profile: The evidence that the overall workload of pharmacists has risen did not rise above the anecdotal level. We find persuasive the evidence of Ms Willis that where the workload of individual pharmacists might be characterised as excessive, it was generally the result of business decisions made by some pharmacy owners to artificially limit or reduce the number of staff to deal with cost and competitive pressures rather than because of any inherent change in the nature of the work. The evidence of Professor Clarke was that there had been, over some decades, a doubling of the number of persons per pharmacy due to the location and ownership rules preventing new entrants into the industry. However it cannot be concluded from this that the workload of pharmacists has concomitantly increased; it is clear that there have been significant increases in the dispensing productivity of pharmacists due to information technology, and the number of pharmacists has grown even though the restrictive arrangements preserved by the PGA and the federal government in the CPAs have stopped the number of pharmacies from growing. The demographic of an ageing and progressively more obese population has undoubtedly led to more prescriptions being issued per person and an increased need to manage chronic disease and multiple medications for co-morbidities, but again it is difficult to conclude from this that the workload of individual pharmacists has increased have regarded to the productivity improvements to which we have referred.
• Increase in use of complementary medicines and vitamins: The evidence does not establish that this involves any new work, skills or training.
• Clozapine clinics: The limited evidence on this topic does not satisfy us that this constitutes an increase in work value for pharmacists generally. It appears to involve the information checking and recording functions which do not involve the exercise of any new skills, and the duties appear only to be undertaken by a minority of pharmacists.
• Four-year undergraduate degrees: The evidence demonstrates that the move from three to four-year undergraduate degrees commenced well before 1998, although it became universal after 1998. We will consider the significance of the requirement of a four-year degree to the wage rates for pharmacists in the Pharmacy Award in a somewhat different context later in this decision.
• Internship requirements: The evidence demonstrated that the requirements for the completion of a pharmacist’s internship, being a prerequisite for registration as a pharmacist, have become more onerous and rigorous. However this is a matter external to the work of pharmacists and does not constitute a change to the qualifications necessary to become a pharmacist.
[185] We are satisfied that the APESMA has demonstrated that there is an increase in work value associated with the introduction of Home Medicine Reviews and Residential Medication Management Reviews that justified a discrete adjustment to award remuneration. We have reached that conclusion for the following reasons:
(1) The performance of these duties requires the higher qualification of Accredited Pharmacist, which may only be obtained after undertaking a training course and successfully completing a communication module, an examination and four case studies.
(2) The performance of HMRs and RMMRs occurs in the patient’s home or aged care residence - that is, a different work environment involving the exercise of distinct personal interaction skills – and must be conducted in coordination with the patient’s medical practitioner.
(3) There is an entirely new level of responsibility in terms of both medical outcomes and the claiming of CPA funding.
[186] However, we do not agree that an entirely new classification of Accredited Pharmacist, as proposed by the APESMA, is either necessary or warranted. Registered pharmacists at any classification level may become Accredited Pharmacists, and any increased remuneration should operate as an equal increment to whatever may be the pharmacist’s classification rate. Further, the holding of the qualification of Accredited Pharmacist does not in itself mean that the employer requires the performance of HMRs and/or RMMRs, and the evidence shows that many pharmacies do not engage in this work. These considerations support the conclusion that the appropriate course is to establish an allowance for Accredited Pharmacists who are required by their employer to perform HMRs and/or RMMRs. We consider that the establishment of such an allowance would be consistent with and necessary to achieve the modern awards objective in s 134(1), in that it is required in order for there to be a fair and relevant safety net for pharmacists performing HMRs and RMMRs. In reaching that conclusion we have taken into account all the matters specified in s 134(1)(a)-(h); each of those matters we consider to be neutral considerations. We consider for the same reason that such an allowance is necessary to achieve the minimum wages objective in s 284(1), to the extent applicable; in that respect we consider the matters identified in s 284(1)(a)-(e) to be neutral considerations.
[187] We propose to invite further submissions about the form of this allowance (such as whether it should be an annual or weekly allowance or an allowance payable each time a HMR or RMMR is performed) and its quantum.
[188] In addition, we are satisfied that, in respect of some of the matters raised in the APESMA’s case, there has been some increase in the work value of pharmacists since 1998, These matters are as follows:
• Inoculations: The work of actually administering an inoculation by injection is new work introduced in recent years involving the exercise of a discrete new skill, and requires the completion of additional approved study, the maintenance of authority to immunise, and the holding of statements of proficiency in cardiopulmonary resuscitation and first aid.
• Emergency contraception: The provision of emergency contraception, as Mr Yap explained in his evidence, requires not just the usual tasks of ensuring that the issue of the medication would be appropriate, safe and effective, but may also require analysis, advice, assistance and referral in cases where the patient is underage or may have been the victim of a sexual assault. We accept Mr Loukas’ evidence that this is new work and involves an increase in accountability and responsibility.
• Downscaling of medicines: The downscaling of significant numbers of medications from prescription-only to Schedule 3 pharmacy-only medicines has increased the work value of pharmacists because it requires the pharmacist, in addition to dispensing the drug, to take on the functions previously exercised by a medical practitioner of diagnosing the patient and determining that issuing the medication would be a safe and effective medical response.
• General increase in the level of responsibility and accountability: While, for the reasons earlier stated, we have not generally accepted that the work and skills associated with patient programs established and funded under the CPAs has led to an increase in work value, we consider that the requirement for pharmacists to document these activities for the purpose of receiving funding and measuring outcomes represents a new required level of accountability and responsibility on the part of the pharmacist. Both the APESMA witnesses and the PGA witnesses acknowledged that this documentation requirement had not previously been a responsibility of pharmacists in 1998 when the relevant services had been provided on an informal and ad hoc basis.
[189] We will invite the parties to make further submissions as to how the above findings should be reflected in an adjustment to remuneration, noting that the evidence demonstrates that not all pharmacists administer inoculations or dispense emergency contraception. It may be necessary for the consideration of this matter to occur in the context of the matters raised in the next part of our decision.
[190] Finally, it is necessary to deal with the alternative limb of the APESMA’s case, namely that the relativities between pharmacists and the C10 tradespersons rate in the Metal Industry Award established in Commissioner O’Shea’s 1996 decision should be re-established by reference to the current C10 rate in the current Manufacturing and Associated Industries and Occupations Award 2010 (Manufacturing Award) because that was the basis upon which the work value of pharmacists was fixed when the Community Pharmacy Award was made in 1998. It is not in dispute that those relativities have become compressed as a result of flat dollar increases in Safety New Reviews and Annual Wage Reviews from the time the Community Pharmacy Award was made (and indeed from 1993) through to 2010. That means, for example, that the commencing classification of a Pharmacist, which was intended to have a relativity of 140% compared to the C10 rate, now has a relativity of only 123%. 88
[191] It may be accepted that where the work value of a classification has been assessed on the basis of a relativity relationship with the C10 classification in the Metal Industry Award, and that relationship has not been sustained so that the current wage rate for the classification no longer reflects its originally assessed work value, that would constitute a work value reason as defined in s 156(4). The question is whether it is a work value reason that would justify the variation to minimum wages in the Pharmacy Award sought by the APESMA. We consider that it is not. The compression of relativities was the intended effect of the award of flat dollar increases to awards, in that it was considered appropriate to adopt an approach to improve the relative position of lower-paid award-wage workers and to depress that of higher-paid award-wage workers. This may be illustrated by the following passage in the 2009-10 Annual Wage Review decision, the last in which a flat-dollar increase was awarded:
“[336]We consider there is a strong case for a percentage adjustment to all modern award minimum wages. While not all award-reliant employees are low paid, uniform dollar increases reduce the relevance of the safety net at the higher award levels and erode the real value of award wages at most levels. These are particularly important considerations at the commencement of the modern awards system. Nevertheless most of the major parties supported a dollar increase rather than a percentage one.
[337]With some hesitation we have decided on a dollar increase. There are two reasons. The first is that to the extent there is a choice between a percentage increase benefiting the higher levels and a dollar amount benefiting the lower levels we think that the current circumstances favour a greater benefit for the lowest paid. We are required in particular to take the needs of the low paid into account. In light of the fact that award-reliant employees have not had an increase in wages since 2008, it is desirable that we increase award rates by the largest amount consistent with the statutory criteria. Secondly, we have very little data concerning the impact of a percentage increase on costs and employment. We have insufficient information to be confident that a percentage increase would not have disproportionate effects on employment at the higher award levels…”
[192] It may also be noted that this position was one urged by the union movement over a long period of time. Because flat-dollar increases were applied across all awards, the compression of relativities has occurred across the entire award wages system. We do not think that there is any proper basis to attempt to unwind now, in one award only in response to a claim by a single union, a common approach to the adjustment of wages which was taken for deliberate policy reasons with the support of the union movement as a whole. It is obvious, in addition, that if the approach now urged by the APESMA was taken in relation to the Pharmacy Award, there would be no logical reason why this would not sought to be flowed on to every other modern award, with ramifications that need not be spelled out.
[193] Accordingly the alternative basis for the APESMA’s claim is rejected. However we give some further consideration to the issue of pharmacists’ relativities with the C10 rate, and other rates, in the Manufacturing Award in the next part of this decision.
Relativity between Pharmacist Rates and Manufacturing Award Rates
[194] The following table sets out the relative position concerning rates of pay, original relativity with C10 and qualifications as between relevant classification in the Manufacturing Award and the Pharmacy Award (noting that completion of a four-year undergraduate degree and a one-year internship is necessary to qualify for the base Pharmacist grade in the Pharmacy Award):
Manufacturing | Minimum | Original relativity | Current Wage Rate | Pharmacy Award classification | Original relativity to C10 | Current Wage Rate |
C1 | Degree | 180/210% | - | Pharmacist manager | 190% 89 | 1290.90 |
C2(b) | Advanced | 160% | 1132.40 | Pharmacist in charge | 160% 90 | 1158.40 |
Experienced pharmacist | 1131.80 | |||||
C2(a) | Advanced | 150% | 1085.00 | |||
C3 | Advanced Diploma | 145% | 1058.60 | |||
Pharmacist | 140% 91 | 1033.40 | ||||
C4 | 80% towards an Advanced Diploma | 135% | 1005.90 | |||
C5 | Diploma or equivalent | 130% | 979.60 | |||
C6 | C10 (Trade certificate III) + 80% towards Diploma OR 50% towards Advanced Diploma | 125% | 960.00 | |||
C7 | Certificate IV or 60% towards Diploma | 115% | 913.70 | Pharmacy Intern | 913.50 | |
C8 | C10 (Trade certificate III) + 40% towards Diploma | 110% | 889.90 | |||
Pharmacy Intern | 883.40 |
[195] The above relativities do not align for equivalent qualifications, reflecting the difficulty arising from the original use of professional scientists as a reference point. Nor do they consistently relate to the Australian Qualifications Framework (AQF), which ranks educational qualifications above the completion of the Senior Secondary Certificate of Education in ten levels as follows:
Level 1 – Certificate I
Level 2 – Certificate II
Level 3 – Certificate III
Level 4 – Certificate IV
Level 5 – Diploma
Level 6 – Advanced Diploma, Associate Degree
Level 7 – Bachelor Degree
Level 8 – Bachelor Honours Degree, Graduate Certificate, Graduate Diploma
Level 9 – Masters Degree
Level 10 – Doctoral Degree
[196] It can be seen, for example, that the rate of pay for a Pharmacy Intern, First half of training, who must possess a bachelor degree and is thus at Level 7 of the AQF, is lower than that of classification C8 in the Manufacturing Award, who is at Level 3 in the AQF. Similarly the base grade Pharmacist, who is at Level 7 in the AQF, is paid less than the C3, who is at Level 6 in the AQF.
[197] This outcome appears to be inconsistent with the principles stated and the approach taken concerning the proper fixation of award minimum rates in the ACT Child Care Decision, to which we have earlier made reference. However we note that the ACT Child Care Decision was made under a different statutory regime and pursuant to wage-fixing principles which no longer exist.
[198] This matter may potentially constitute a work value consideration relevant to the 4 yearly review of the Pharmacy Award. In the conduct of the review, the Commission is required to discharge its functions under s 156(2) and is not confined to matters raised by interested parties. We will as a first step invite further submissions from interested parties concerning this matter. We will then consider what course, if any, should be taken. One possibility is that this aspect of the review may need to be referred back to the President of the Commission for consideration as to the procedural course to be taken pursuant to s 582, since the matter raised may have implications for other awards of the Commission, including but not limited to the Professional Employees Award 2010.
Next step
[199] Interested parties may file further written submissions pursuant to paragraphs [187], [189] and [198] within 28 days of the date of this decision.
VICE PRESIDENT
Appearances:
M. Irving QC and F. Knowles of Counsel for the Association of Professional Engineers, Scientists and Managers, Australia.
M. Seck of Counsel for the Pharmacy Guild of Australia
Hearing details:
2018.
Sydney:
7 – 11 May.
Printed by authority of the Commonwealth Government Printer
<PR703187>
1 C1790 Dec 727/98 M Print Q2258
2 Part I of Report entitled “Work Value of a Community Pharmacist”, Exhibit 14; Part II of Report Entitled “Work Value of a Community Pharmacist Part II: Semi-structured interviews”, Exhibit 15
3 Transcript at PN1890-PN1893.
4 See Report of Professor Philip Clarke and associated documents, Exhibit 11
5 Statement of Dr Geoffrey March dated 21 December 2017, Exhibit 1
6 Reply Statement of Dr Geoffrey March dated 30 April 2018, Exhibit 2
7 See Statement of Amy Thomson dated 10 December 2017, Exhibit 4
8 See Statement of Cameron Walls dated 15 December 2017, Exhibit 5
9 See Statement of Katerina Malakozis dated 20 December 2017, Exhibit 6
10 See Statement of Cardin Lee dated 13 December 2017, Exhibit 7
11 See Statement of Leon Wai Hon Yap dated 18 December 2017, Exhibit 8
12 See Statement of Jennifer Ruth Madden dated 14 December 2017, Exhibit 9
13 See Statement of Carmel McCallum dated 18 December 2017, Exhibit 12
14 See Statement of Alex Crowther dated 13 December 2017, Exhibit 17
15 Reply Statement of Alex Crowther dated 1 May 2018, Exhibit 18
16 See Statement of Natalie Willis dated 18 April 2018, Exhibit 24
17 See Statement of Angelo Pricolo dated 18 April 2018, Exhibit 21
18 See Statement of Nicholas Loukas dated 19 April 2018, Exhibit 22
19 [2018] FWCFB 4984 at [52]
20 Shop, Distributive and Allied Employees Association v The Australian Industry Group [2017] FCAFC 161, 253 FCR 368, 272 IR 88 at [38]
21 Shop, Distributive and Allied Employees Association v National Retail Association (No 2) [2012] FCA 480, 205 FCR 227, 219 IR 382 at [35]
22 Penalty Rates Decision [2017] FWCFB 1001, 265 IR 1 at [128]; Shop, Distributive and Allied Employees Association v The Australian Industry Group [2017] FCAFC 161, 253 FCR 368, 272 IR 88 at [41]-[44]
23 Re Annual Wage Review 2017-2018 [2018] FWCFB 3500, 279 IR 215 at [21]-[24]
24 Edwards v Giudice [1999] FCA 1836, 94 FCR 561 at [5]; Australian Competition and Consumer Commission v Leelee Pty Ltd [1999] FCA 1121 at [81]-[84]; National Retail Association v Fair Work Commission [2014] FCAFC 118, 225 FCR 154, 244 IR 461 at [56]
25 Shop, Distributive and Allied Employees Association v The Australian Industry Group [2017] FCAFC 161, 253 FCR 368, 272 IR 88 at [33]
26 National Retail Association v Fair Work Commission [2014] FCAFC 118, 225 FCR 154 at [105]-[106]
27 See National Retail Association v Fair Work Commission [2014] FCAFC 118, 225 FCR 154 at [109]-[110]; albeit the Court was considering a different statutory context, this observation is applicable to the Commission’s task in the Review
28 Ibid at [28]-[29]; Shop, Distributive and Allied Employees Association v The Australian Industry Group [2017] FCAFC 161, 253 FCR 368, 272 IR 88 at [49]
29 Shop, Distributive and Allied Employees Association v The Australian Industry Group [2017] FCAFC 161, 253 FCR 368, 272 IR 88 at [48]
30 CFMEU v Anglo American Metallurgical Coal Pty Ltd [2017] FCAFC 123, 252 FCR 337 at [23]; cited with approval in Shop, Distributive and Allied Employees Association v The Australian Industry Group [2017] FCAFC 161, 253 FCR 368, 272 IR 88 at [45]
31 See generally: Shop, Distributive and Allied Employees Association v National Retail Association (No.2) [2012] FCA 480, 205 FCR 227, 219 IR 382
32 Ibid at [46]
33 (1921) 15 CAR 297 at 303-4
34 (1967) 121 CAR 587 at 677
35 (1968) 124 CAR 295 at 308
36 Ibid
37 (1967) 121 CAR 587 at 679
38 (1968) 124 CAR 295 at 308
39 (1972) 147 CAR 172
40 (1969) 127 CAR 1142
41 (1972) 147 CAR 172 at 179-180
42 (1975) 171 CAR 79
43 Ibid at 83
44 Ibid at 83
45 Ibid at 83-4
46 (1976) 177 CAR 335
47 (1976) 176 CAR 17 at 17
48 (1979) 231 CAR 388
49 Ibid at 343
50 (1980) 233 CAR 365
51 Ibid at 372. The whole incident is described in the context of Staple J’s career on the bench in an article by Michael Kirby, The Removal of Justice Staples and the Silent Forces of Industrial Relations, (1989) 31 JIR 334
52 (1983) 4 IR 429
53 Ibid at 451
54 Ibid at 441
55 Ibid at 472-3
56 (1986) 13 IR 108
57 Ibid at 113
58 (1988) 25 IR 170
59 (1989) 27 IR 196
60 Ibid at 199-200
61 Ibid at 200
62 Ibid at 200-201
63 (1989) 30 IR 81
64 Ibid at 81, 84
65 Ibid at 94
66 Ibid at 94
67 Ibid at 95-96
68 Ibid at 96
69 Ibid at 99
70 (1991) 36 IR 120
71 Ibid at 160-161
72 Ibid at 172
73 Print Q7661
74 PR954938
75 See e.g. Buck v Bavone (1976) 135 CLR at 118-119 per Gibbs J; Coal and Allied v AIRC (2000) 203 CLR 194 at [18]-[20], [28] per Gleeson CJ, Gaudron and Hayne JJ
76 Project Blue Sky Inc. v Australian Broadcasting Authority (1998) 194 CLR 355 at 387 per McHugh, Gummow, Kirby and Hayne JJ
77 [2015] FWCFB 8200, 256 IR 362
78 Ibid at [80]
79 Print L413
80 Print M2399
81 Print M6246
82 Print M9831
83 Ibid at p 4-8
84 Print J2540; see also the consequential order in Print J3512
85 Print N7370
86 There was a separate and simplified classification structure for Western Australia.
87 Print Q2258
88 The current weekly wage rate for a Pharmacist under the Pharmacy Award is $1033.40. The current C10 classification weekly wage rate under the Manufacturing and Associated Industries and Occupations Award is 837.40.
89 190% is the original relativity for the Pharmacist Manager Grade 1 classification, which became the Pharmacist Manager classification in the Pharmacy Award.
90 160% is the original relativity for Pharmacist in charge Grade 1 classification, which became the Pharmacist in charge classification in the Pharmacy Award.
91 140% is the original relativity for a Pharmacist in their first year of experience.
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