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Karalyn told Australian Pharmacist there needed to
be an allowance for accommodation.
‘I can spend five or six days out there. At times, I barter
with health and hospitals services because I am doing
their aged care beds at the same time and if able they
will kindly give me accommodation at hospitals.’
In her view HMRs are a perfect example of a program
that needs a flexible funding agreement. She sees
the present HMR program as a very urban model
that does not allow for long distances travelled.
Sitting in a silo
According to Karalyn, because the community
pharmacy agreements (CPAs) sit in their own little
niche and because HMRs are in that niche they have
become contained in a little bubble.
‘It is one of my arguments for why HMRs should be
in the MBS system. It would be far easier to work in
a collaborative partnership with GPs and nurses in
these locations if we were not in the CPA. Doctors
have these perceptions that because we are being
funded out of the CPA bubble we are adequately
funded and it all happens.
‘ They don’t understand that the only money we get
out of the MMR program is for actually performing
the HMR. The money I get paid, the $125 for travel,
comes out of a separate bundle of money under the
Rural and Remote Loading Program.
‘ There is this misconception that the CPA agreement
completely funds what I do.
‘I really enjoy the medication management
programs – HMRs, QUM, RMMRs. It is the form of
pharmacy that I love.
‘I was one of the first people accredited in Australia
because it was exactly how I wanted to practice. I
became a better community pharmacist because of
the advanced practice learning that enabled me to
be an accredited pharmacist.
‘I really enjoy the fact that when I go to a home and
sit down with the patient, their carer and family,
and go through everything, the light bulbs come on
inside people’s eyes.
‘ When you explain things and go through
techniques they are so appreciative that someone
has come and spent the time with them to make
‘ To change how people do things you have to keep
going back and revisiting it to get them to implement
change. When talking to them at an HMR interview
you lay the first seeds and then you ask a few more
questions and then you go back and lay the second
seeds, you talk a bit more and at the end in summing
up I write them a list and I leave it with them.
‘I say well this is what I think you can do to manage better
but all the way through I have been laying down that
scenario. At the end I say I want you to do this, this and this
and they say – “ah that all makes sense” – because I have
given them time in the 30–40 minutes that I am there to
think it through.
‘A very busy GP has 7–9 minutes to get things into
someone’s head and get them thinking. They can’t possibly
get that whole change thing happening.
‘ When we did the evaluation of the HMR project we ran
focus groups and I brought in some of my patients. They all
said how much they appreciated the fact that a pharmacist
came to them, sat down and talked their language and
explained things. Also, the pharmacist was contactable
after the interview. I always leave my business card.’
Karalyn believes western Queensland has many patients
who need help and who are getting bits of healthcare from
everywhere but do not have continuity in their care apart
from the community nurse. Doctors drive or fly in and out
and change often.
‘ Those poor community nurses are really worn out. They are
running around doing the best they can for these patients. I
love being able to support the community nursing services.
I also support the community pharmacies in that region.
‘All this travelling and juggling roles is not making me rich.
[According to her accountant she received payments from
28 different entities last financial year] I am just making a
‘My work in community pharmacy underpins it all. If I
can bring some of my costs down – accommodation for
example – it will be more viable. There needs to be more
money in the medication management program for more
people to take it on.
‘You couldn’t do it if you had kids and a mortgage!’
1. Huxhagen K. Review of Pharmacy Remuneration and Regulation Submission #81; 17-Sep
2016. At: http://www.health.gov.au/internet/main/publishing.nsf/Content/review-
pharmacy-remuneration-regulation-submissions-cnt-2/$file/81-2016-09 -17 -karalyn-
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