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PHARMACISTS REGISTRATION BILL 2001 (No. 71)

Second Reading

Mrs JACKSON (Denison - Minister for Health and Human Services - 2R) - Mr Deputy Speaker, I move -

That the bill be now read the second time.

Mr Deputy Speaker, I am pleased to bring this matter before the House. The registration and regulation of pharmacists and their practice in Tasmania is currently provided for by the Pharmacy Act 1908. This act has not been reviewed for many years, and clearly the profession and the scope of practice have changed significantly since the early 1900s.

The act has been reviewed by the Department of Health and Human Services in consultation with professional associations representing the industry; the Pharmaceutical Society of Australia (Tasmania Branch); the Pharmacy Guild of Australia (Tasmania Branch) and the Pharmacy Board of Tasmania.

I would like to put on the record my appreciation of a lot of hard work that has gone into this legislation from those particular bodies because I know I have met with them many times and I know they have met many more times with the department over the last two or three years, so I thank them for their input into this legislation.

The review also took into account recent developments with other health professional registration acts in Tasmania and interstate, and national competition policy requirements including the national review known as the Wilkinson Report. The bill now before the House is the outcome of this review, and reflects the comprehensive consultation process undertaken during the review.

The major areas provided for in the bill are:

the Pharmacy Board;
professional registration;
disciplinary procedures; and
corporate and business structures.

The Pharmacy Board currently comprises seven pharmacists elected by registered pharmacists. However, these days it is recognised that the essential purpose of government regulation of professions is the protection of the public, and that there should be public representation on boards. The bill therefore provides for a Pharmacy Board comprising five pharmacists and two consumer representatives, all appointed by the Governor. In all States and Territories, the occupation of pharmacist is regulated by the registration of eligible practitioners.

The Pharmacists Registration Bill 2001 continues a registration scheme, to prevent unregistered and unqualified persons from engaging in the provision of pharmacy services, in the interests of public safety. Registration under Tasmanian legislation will continue to entitle pharmacists to seek registration and to practise under interstate legislation. As the entry requirements are uniform across the States there are no problems regarding the quality of registrants and few problems in regard to the scope of practice. Mutual recognition is also provided for under the Trans-Tasman Mutual Recognition Agreement between the Commonwealth and New Zealand.

The bill will also ensure the protection of the public by providing the Registration Board with improved disciplinary powers to ensure that the board can deal effectively and quickly with pharmacists who do not meet acceptable standards of practice. The bill lists a range of matters which may constitute grounds for complaint by a member of the public, and also covers matters that may constitute professional misconduct.

The Registration Board will have improved powers in relation to assessing the skills and competence of individual pharmacists on an ongoing basis - such as on annual renewal of registrations. The board will also be able to develop and enforce a code of practice for pharmacists, to guide their professional practice. Compliance with the code will be part of pharmacists' professional responsibility. The bill maintains the current restrictions on the ownership of pharmacies - namely that they must be owned by a registered pharmacist and that a pharmacist may not have an interest in more than two pharmacies. It does however permit pharmacist owners to incorporate their business if they wish to do so. However, the bill continues to allow Friendly Societies to operate pharmacies - such as the Queenstown Medical Union. In such cases a pharmacist employed by the organisation supervises the day-to-day operation of the dispensary. In the interests of protecting the public, the bill requires all pharmacies, whether owned by a pharmacy or by a Friendly Society, to have a registered pharmacist on the premises when the pharmacy is open.

The current act allows the making of regulations over advertising and the board has, in the past, made regulations in this area. The regulations are not overly restrictive, but the power is removed in the bill. Reliance will be placed on fair trading and trade practice controls, which are administered by the Office of Consumer Affairs and the Australian Competition and Consumer Commission. Restrictions over the type of pharmaceutical products that may be advertised are imposed under nationally uniform controls under the Poisons Act - these cover limitations on advertising prescription and other restricted drugs to the public. This would not, however, prevent the board treating some levels of advertising as unprofessional conduct under the Code of Practice and taking action under the disciplinary processes.

The current act requires pharmacy premises to be registered and licensed by the Pharmacy Board. The reason for licensing premises related to security of drug storage and health and safety issues around drug handling. A variety of reports in recent years have suggested that licensing of pharmacy premises is unnecessary and this provision has not been included in the bill. General obligations in relation to preventing access to restricted drugs by persons entering the pharmacy falls under the Poisons Act. The board will continue to have the right to examine premises and deal with problems that might arise from the use of unsatisfactory premises.

A national review of pharmacy legislation has also been undertaken over the past two or three years. This review has covered legislation in all States and Territories, as well as the Commonwealth Government's legislation relating to the Pharmaceutical Benefits Scheme.

The Council of Australian Governments - COAG - has been considering the recommendations of the national review - contained in the Wilkinson Report - and will be making suggestions to the States and Territories on implementation of the findings. The new bill incorporates the majority of the recommendations of the national review, however some issues are still under consideration by COAG.

The major recommendations which have not been included in the bill are as follows:

The recommendations propose slightly freer ownership limitations with allowance for family shareholding. The bill allows for businesses to incorporate but only between pharmacists.
The recommendations propose the removal of the limit on the number of pharmacies an individual pharmacist may own or have an interest in. The bill retains the current limitation of two.
The recommendations propose that Government undertake professional standard setting and that the board undertakes the administration of the rules. The bill provides, as in other Tasmanian registration acts, that the Code of Practice be developed and promulgated by the board.
The recommendations propose 'nationally consistent or uniform legislation' to regulate pharmacists. The bill is similar to interstate legislation in this regard, with eligibility for registration being compatible, a capacity to adopt similar codes of practice and similar disciplinary powers. However it is very unlikely that uniform legislation could be achieved.

The major pharmacy associations are aware of these issues, and strongly support the introduction of the current bill pending the finalisation of the COAG process. I commend the bill to the House.

Mr CHEEK (Denison - Leader of the Opposition) - Mr Deputy Speaker, we support this bill, but I want to point out a few things in it which do concern us. We certainly know that it has been around a long time. I know my former colleague, Peter McKay, had a bill which was very similar to this one, ready to go about three years ago. But, Mr Deputy Speaker, we certainly put on the record that we value pharmacies and pharmacists in the community. We realise what an important role they play and it is very important to have a registration bill which protects the community and also protects the rights of pharmacists. Although you will never get complete agreement on every single item, I think there certainly has been a lot of consultation on this and at the end of the day I think most parties are reasonably happy with it.

It does maintain for pharmacists an exclusive right to ownership of their pharmacies which I think is quite reasonable and of course that the pharmaceutical services are only undertaken by registered pharmacists. Looking at the specific issues where we would have concerns and the primary issue is one that goes right across government; the membership of the boards that are in the bills that have been put out by government for the registration of the medical professions. Of course in this particular case, the pharmacists would like to have more members on the board. The board previously was seven but of course they were all practising pharmacists and now it has been cut back, Mr Deputy Speaker, to five pharmacists and two consumer representatives. It seems to be a very dogmatic attitude from the State Government about the constitution of boards that they have to be seven. I think that is very blinkered and short-sighted because it surely depends on the workload that has to be undertaken by any particular board, whether that is in private enterprise, professional bodies or whatever.

If you are a practising pharmacist and you have board duties it is a heck of a workload and there is a lot to be done when you look through what they are responsible for as a member of this board. It is a huge workload, because they are responsible for administering the whole of the pharmaceutical industry in Tasmania, making sure that it operates effectively. They have to oversee disciplinary processes. They have to license people. They have to make sure the community is protected and there are a lot of issues that they are responsible for which are in the bill. To expect to reduce the board by two pharmacists I think is totally unreasonable. Why on earth would you be dogmatic and say you have to have seven on every board because that is what we are having in government?

You take the dental registration bill; I am not sure how many practising dentists there are in Tasmania but I think it is only 70 to 80 or 100 - I do not know, perhaps Mrs Jackson can tell me. There are 440 pharmacies - is that right or is that a wrong figure too?

Mrs Jackson - Pharmacists.

Mr CHEEK - 440 pharmacists, sorry. If you are looking at something like the Medical Council which has 11 members on it, is that going to be cut back as well, to seven? They have an even bigger workload, a higher workload than I would think that the pharmacists have on this board. So it seems to me it is a rather strange attitude when you cannot say we can have this as nine, you keep your seven, we will put two consumer representatives on there. Then they will be happy and their workload will be lightened. I do not know whether the health minister realises how hard they work in their own businesses. To have to do the board work on top of that, means a big workload. You can say they do not have to do it but the fact is they do it for the good of their profession and the community and I do not think they should be asked to do excessive duties which really go way beyond what any person should be required to do.

You may well say they can form committees to carry out a lot of this work but, as we all know, this Government is very fond of forming committees and committees are sometimes a good way of stopping things happening. It is nothing like getting somebody to carry out the work themselves, especially if they are very dependable and good, not only as businessmen but also as professional pharmacists.

I think the whole concept of that is wrong and I would like to know from the minister the reasons why the Government is insisting on seven on every board without taking into account the individual specifics and dynamics of each industry. It just seems rather strange to me. I know my former colleague Peter McKay, who was an excellent health minister, one of the best - and I hear what a good job he did all the time as I go round the industry - was going to have nine members on the board and he was quite happy to have that. Surely there is not a problem. The Government is being very dogmatic and any request from the Pharmacy Guild or the Pharmacists Association I think has been met with a rather blunt refusal.

Mrs Swan - Do they want more?

Mr CHEEK - No, the pharmacists in fact want the existing number they had on there. They had seven on their original board and now they have two consumer representatives put on there so they want to keep their seven and make the board nine because they have a heck of a lot to do. If you are imposing an artificial limit on a statutory board without taking into account workloads and other specifics, I think it is the wrong way to go.

Really when you look at the workload involved for this board, you have to look after the registration and the ongoing monitoring of pharmacists and their skill and competence levels; you have to consider and inspect the appropriateness of pharmacists' premises; you have to investigate complaints and undertake disciplinary action where necessary; you have to prosecute offences under the act; and very importantly, you have to monitor standards of education and training and advise the minister and liaise with her as well. So it is a very heavy workload for people who work very hard in any case.

We certainly do not want to discourage people going on the board. I think it is a great pity if pharmacists are going to say that the workload is too heavy and they cannot do the job because the best people will be lost to the profession and that is something we on this side of the House would regard very seriously and I would think quite rightly.

The other thing about the boards is that I really do not see why some pharmacists at least cannot be elected. Why do they all have to be appointed by the Government? Why is the Government such a control freak in this case; why do they have to have absolute control over who goes on that board? I know in other States - I think in NSW but I am not absolutely sure about that - they have half elected by pharmacists and half appointed by government. I would like to see all of them elected by the pharmacists because surely they should put on whom they want in that instance. Of course the consumer representatives would have to be appointed by the Government but why would you not let the pharmacists themselves decide who they want on the board? Or failing that, at least a half-and-half situation would be much better.

So the board is a major cause for concern and we note that there may be other changes as well when COAG finally makes recommendations. I do not know if the minister has any opinion on this at all but I guess, if family shareholdings can be increased, if there can be more shareholders from a family, it would not seem to me to be a real problem.

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More pharmacies is another matter, of course, in a small community like Tasmania. Of course, they can still be incorporated so at least there is that. In this modern day and age you would not want it to be anything else apart from that. We certainly support the right of pharmacies to have exclusive rights to ownership.

I note in one section where, if a pharmacist dies or if a pharmacist becomes bankrupt and needs an administrator to go in, there is a limit of 12 months. Then, if that is the case, they can administer their pharmacy for a maximum period of 12 months before they sell it off to another pharmacist or decide what to do with it. It really would not want to be any longer than that, otherwise you could have somebody coming in to say, 'We'll stay on there a bit longer and build it up. It's a bit down at the moment. We'll get a better price for it.' That could cause all sorts of problems too. I understood that was not always the case with an administrator in there; there was not a limit on it but I note in the bill that I have that it is 12 months and that is the same for somebody who dies. They can have that period of time before it is sold or somebody else takes over. That seems eminently fair too.

We recognise on this side that this legislation is necessary and it has been around a long time. I do not really know why it could not have been brought in three years ago when Peter McKay did it because I do not think it was very different except that it was better as far as the constitution of the board goes. I guess Mrs Jackson will say that she was waiting on the Wilkinson report. Maybe that is the reason. There is a national review going on but I think Peter McKay's position on his bill, as I remember it, was pretty much the same as this, so it has been kicking around for a long time. We are glad to see it in here at long last and we are comforted by the fact that the Pharmacy Guild and Pharmacy Association appear to be happy with it. I have rung around a few people and they seem to be happy with it. They are happy that they have retained exclusive rights and that is something that they would be concerned about, not only for their own individual investment but also for the protection of the community because pharmacies do play such an important role.

Summing up, Mr Deputy Speaker, we support the bill but we do have a lot of concern about the constitution of boards generally, in the Government insisting that they be the same number of seven and not taking into account the workload of each individual profession and industry. I think that is a very short-sighted and blinkered view of the world. It does not matter where you are, some people may need a board of 15, some people may need a board of five. You cannot expect people who work hard during the day and run their own businesses to be working all hours of the night to run a board, when with just a little bit more understanding, they could have two more pharmacists on there, a board of nine - seven plus two - and I think everybody would have been completely, blissfully happy then. Now they are just reasonably happy and contented with the bill and there has been consensus on it. We support it.

Mrs JACKSON (Denison - Minister for Health and Human Services) - I thank the Opposition for their support of this bill.

These arguments put forward by the Leader of the Opposition are identical to the ones he put forward in the last bill - the Dental Bill I think was the last - and probably the one before that. I explained the reasons on the Dental bill. If you want me to, I can go through it all again.

Mr Cheek - Different workloads?

Mrs JACKSON - No, it is not really. I also listened to the Pharmacy Board and their arguments on that, as you have, but I was able to work my way through those arguments and explain to them why it was that the Government had decided on this balance and, although they will not agree, they understood I think. So I will try to get you to understand now why -

Mr Cheek - Well, that'll be difficult.

Mrs JACKSON - I know; you said it. It will be difficult but I will have another go. As I say, the Pharmacy Board understood what I have said, maybe you will too. Right?

Mr Cheek - I don't think they did actually because they don't necessarily agree with you.

Mrs JACKSON - No, but there is a difference also, Leader of the Opposition, between understanding and agreeing. If you had listened to what I said, you would have heard me say they understood what I was saying. I accept that they perhaps did not agree with me but at the end of the day they accepted that the Government had the right to do this -

Mr Cheek - They've got the right to do it, but is it right?

Mrs JACKSON - and they were not that upset. In fact they were more interested in this legislation coming before the House and being passed because you are right in saying that it has taken some time and, again, that is not my fault. It is because the Liberal Prime Minister of this country has refused to allow COAG to make a decision on this. This is what we are still waiting for, for COAG -

Mrs Swan - COAG - Michael Field's sign code.

Mrs JACKSON - No, the meeting - you know, COAG meeting led by the -

Mrs Swan - Yes, but didn't he scribe his signature?

Mrs JACKSON - Yes, perhaps you could just listen and you might learn something, right? Golly, I find it very frustrating - I am sorry, I am not a good teacher, I accept that. But, really, you are trying to deal with people who do not understand basic things and they are members of parliament and I find it very annoying.

Mr Cheek - It's your duty to explain it.

Mrs JACKSON - Let me explain to you, COAG meets on a fairly regular basis -

Mrs Swan - Yes, but who signed it?

Mr DEPUTY SPEAKER - Order, I will give the member the opportunity for questions in committee. At the moment we have been going along beautifully, it has been uninterrupted and I would like it to continue that way. The minister has the call.

Mrs JACKSON - I accept that the COAG process was signed at the time of the Field Government and subsequent governments - I accept that.

Mr Cheek - So it's Michael Field who signed it, not John Elliott.

Mr DEPUTY SPEAKER - The Leader of the Opposition obviously was not listening. I would ask that the minister be heard without interruption.

Mrs JACKSON - The COAG process was agreed to a number of years ago. What I am talking about here is the regular meetings that COAG have and one of the things that they did have on their agenda at one stage was the ownership of pharmacies. If you remember, back in the 1996 election, there were two issues with pharmacies and newsagents, and because of their constituents they have said that they would support the ownership of those by the people concerned and that they would not become part of, say, a large conglomerate such as Woolworths or Coles. They were to be stand-alone and they would, in a sense, be protected. Since that time, of course, we find that position is contrary to the National Competition Policy and contrary to most, if not all, other forms of business that cannot be protected in that way.

Since 1996 this has tried to be resolved and one of the things that the Commonwealth Government again did was set up the Wilkinson inquiry and that has reported but that report has not been acted on. I think that report came out about 18 months ago and that report still has not been acted on by COAG - nothing to do with Michael Field. Michael Field has not been in Parliament since 1996 and has not been a member of COAG since 1992. This report actually came out about 18 months ago and it still has not been considered by COAG.

We were going to wait until that decision had been made before we put this legislation forward but, as has rightly been pointed out, the profession has been waiting a long time for this legislation and I thought that they should not have to wait any longer. When the COAG decision is finally made about this we can always revisit this legislation if we so desire and if that is necessary, if that is the agreement that we are bound by and we do have to do that. But at this point in time I do not see that we would necessarily have to do that. I know the Labor Party went to the last election in this State saying that we supported the ownership of pharmacies, that owners should be the people who operate pharmacies and that they should be operated by pharmacists. I personally hope that we will continue to support that. But the only reason, I am sure, we would have to change that is if we were bound through this process of COAG, and also if it was shown that it was not in the public interest. Then we would have to do that. That seems to be some time into the future because, as I say, we have been waiting a long time.

On the size of the boards - I would like you to listen to this so that I do not have to go through this again next time.

Mr Cheek - You may well have to, I warn you now.

Mr DEPUTY SPEAKER - Order. Well, let us give it a chance and see.

Mrs JACKSON - If you listen, you have a better chance of understanding, I will give you a clue, it is one thing I learnt when I was in teacher training: if you actually listen you have a -

Mr Cheek - You sound like a teacher.

Mrs JACKSON - Yes, well I was a teacher. I was a bloody hard student I can tell you, but I had some of those too - but if you listen you do have a better chance of understanding so I will go slowly and, if you listen, we will give it a chance.

The Nursing Board is the registration board for nurses. There are 6 000 nurses in this State and they have five nurses on that board and two consumers. They have a lot of work, they have hundreds of complaints they have to investigate -

Mr Cheek - They don't run their own business though.

Mrs Bladel - Don't be so disrespectful, you are so disrespectful of the forms of this House, you should be ashamed of yourself.

Mr DEPUTY SPEAKER - Order. I will ask the Leader of the Opposition to not interject. Listen to what the minister has to say and, again I make the point, if you want to go into committee, I am really happy to do that.

Mr Cheek - I think I might now.

Mr DEPUTY SPEAKER - That is your choice but at the moment the minister has the call and the choice is for her to be heard in silence.

Mrs JACKSON - You can do what you like because you are such easy prey - I am sorry, I should not enjoy it, but it is pretty easy prey.

Mr DEPUTY SPEAKER - I would ask the minister not to encourage interjection, that would help.

Mr Cheek - Have you got a blackboard?

Mrs JACKSON - There are 6 000 nurses in Tasmania, all hardworking, many of them as we have pointed out in this House unfortunately having to work double shifts, so I do not know how much more hardworking you would like them to be. A large majority are extremely hardworking. There are five nurses and two consumers on the Nursing Board.

The Dental Board has four dentists, two consumers and one dental therapist and there are 160 dentists. It is also a very complex area. They also work very hard and also run their own business.

Mr Cheek - And they also wanted more dentists on there.

Mrs JACKSON - As I put it out last time, these boards are about looking after the public interest; that is why we set them up under legislation, the Government, the Parliament. It is why I as minister appoint those people because they are there to protect the public interest, that is their sole reason for being - to protect the public interest.

That is why we and other States believe - and this also is part of the national push in these areas - that there be some consumers on these boards to also protect the public interest. It is not the number per se, but it is important that the consumer representatives be in a reasonable proportion to the professional people on the board. That is why I have decided to try to contain the number to around about seven, five to two, four to two and so forth which gives you a total of seven.

Mr Cheek - Four to two gives you a total of seven!

Mrs JACKSON - It is not to do with the numbers. Of course we could have more dentists or pharmacists or whatever on these boards, we could have 10 but then, I believe, to follow this principle through, we would then have to have four or five consumers which would make them very large boards.

The other point that you want to remember is that these boards are paid for by the profession themselves, not by government therefore they and many of the members realise that it is going to be expensive. They are going to have to pay more registration fees and, particularly in Tasmania where we do have a relatively small number in some of these professions, the burden falls on a small number of people. So that is the thinking and the reasoning behind this. I pointed out to the Pharmacy Board that I would put in those two members, as I have done on all the other boards. On those boards are people who have skills that will enable them to be of great assistance to those boards and I know for example, the Pharmacy Board pointed out that one of the areas that their board is involved in is training. So I will certainly be looking to put consumers on there who have skills in that area, and who will be able to contribute positively to that board in that sense. I hope that makes it clear why these numbers are as they are, the proportion of consumers to the professionals on these boards. I believe that these boards can do the job that they are required to do with those numbers.

I accept that the Pharmacy Board does do extensive work in training and up-skilling of the profession, that is where I did point out to them that you can form a subcommittee to do this. It does not need the board to be involved and usually I imagine that is how it works anyway. As I understand it, it is some people on the board and other people in the profession who are interested in that particular area or whichever it happens to be, whether it is training or any other aspect that they are looking at, that they set up as everybody does, a group of people that are interested in doing that.

Mr Cheek - Lots of committees.

Mrs JACKSON - Well, Leader of the Opposition, you have never worked probably in those situations; actually working parties and committees can achieve a lot. You have worked in a different work environment. I have worked in those environments as have a lot of people here, and we and they have achieved a lot in the public service it is true. The bureaucracy works a lot on that system and it achieves a lot of good outcomes. In fact, it is where a lot of the outcomes come from. I agree that you do not set up committees for everything and you certainly do not use them as an excuse to do nothing. But a lot of valuable work is done through the committee system - a lot of very hard work by a lot of very dedicated people. A lot of the things that occur in this State now would not have occurred if we had not had that sort of structure. So it does not happen by people just getting an idea and doing it. Even if someone does have an idea, you have to have a structure to implement those ideas. That might be something that you are starting to realise in the last two weeks, that it is not funny coming out with one idea here and another idea there because you have to get people sitting together to see how one idea actually impacts on something else. It is not just one idea.

Mr Cheek - You have to have ideas first; that is where you suffer problems on that side of the House.

Mrs JACKSON - You can be insulting but I think that we have a lot of good ideas in this House. The difference is that we actually know how to implement them. That is the clue. That is the difference.

Mrs Napier - It is not hard to implement our ideas.

Mrs JACKSON - So we know how to implement them - that is our strength and, I would say at this point and time, your weakness.

Mr Deputy Speaker, I commend this bill to the House. I hope I have made clear the reasons for the size and role of this registration board which seems to be the main problem with this legislation.

I just have a note here about those committees and how the board set up their own committees, which they can do under the legislation. They are free to do that as, of course, are most other organisations. The committees were mainly from the board itself. The investigating committee will have three members who will be non-members of the board, but two will be pharmacists, which means greater pharmacist involvement or separate investigations from adjudication of complaints. They can also now form committees of non-board members under the legislation; whereas before the committee members had to be only from the board. Under this legislation, as in all the other legislation we have done like this, they can ask other people with an interest or a special skill or knowledge in a special area to be part of those committees to do that work. The investigating committee obviously is the committee that investigates complaints and they have set that up, and they too must be pharmacists.

Mr Speaker, I think this legislation is good legislation. As I say, I believe it is one of the last pieces of legislation of these registration boards that we have to bring before this House. They are all fairly similar and based on the same principles, and I commend the legislation to the House.

Bill read the second time.