Editor, – While the article by Noel Hayman (Aust Prescr 2011;34:38-40) is factual and highlights the benefit of the Closing the Gap (CTG) Pharmaceutical Benefits Scheme (PBS) incentive payment scheme, it does not highlight the gaps that were not addressed in the implementation of the scheme.
In many locations there is very limited access to mainstream general practitioner services or to an Aboriginal health service and many of the 'general practitioner' services are provided by state hospitals that have the right to prescribe PBS-subsidised medications.
These state hospitals provide general practitioner services and provide PBS prescriptions to Aboriginal and Torres Strait Islander patients but community pharmacy cannot provide a subsidised service as the CTG initiative does not include state hospital services. In August 2010, the CTG PBS initiative was expanded to include prescriptions written by specialists but state hospital doctors were still excluded.
Many Aboriginal and Torres Strait Islander patients become very confused because when they access a mainstream general practitioner they can receive a CTG prescription which is subsidised for them in community pharmacy, but if they access the hospital service after hours the PBS prescription they receive is not subsidised and they have to pay the full PBS price. Many general practitioner practices no longer provide after hours or weekend services so these patients are forced to use the state hospital services outside of normal practice hours.
This disparity of access has been discussed many times and is still a major issue in providing optimal care for Aboriginal and Torres Strait Islander people.
Karalyn J Huxhagen
Pharmacist
Mackay, Qld
Associate Professor Hayman, author of the article, comments:
It is not uncommon after the implementation of government policy that unexpected gaps in delivery become apparent. I have been aware of the problem that Karalyn Huxhagen highlights for some time.
Another gap I have identified is in medical services that are not accredited in quality of practice and therefore their patients cannot access the CTG PBS initiative. While this may be satisfactory in urban settings it is very problematic in rural and remote areas where unaccredited medical services are common. Aboriginal and Torres Strait Islander patients from these clinics are disadvantaged causing the disparity of access pointed out by Karalyn Huxhagen. The CTG PBS policy causes conflict where there is a combination of accredited and non-accredited services in a rural or remote area. Aboriginal patients are forced to go to the accredited service to access the CTG PBS program, leaving their preferred doctor of choice. This leads to disjointed care.
The Department of Health and Ageing is committed to an evaluation process of all CTG programs. Sentinel sites have been established across Australia to evaluate CTG initiatives. I have personally given feedback on the problems outlined in this response. The evaluation process will continue over the next year and hopefully all gaps identified will influence a change in policy, particularly those that will correct the gaps in service delivery and access for all Aboriginal and Torres Strait Islander peoples.
