The Pharmacy Guild says the rise of the big box retailers has killed pharmacies' revenue stream, and core dispensing services have long been under-funded (file image) Photo: RNZ /Dom Thomas
Pharmacy owners are warning more consultation charges for patients may be needed as revenue shrinks, forcing some to close up shop.
The Pharmacy Guild is calling on the government to urgently fix what it calls a "flawed funding model".
Lower Hutt man Bruce was picking up some prescriptions from his local chemist recently, when he asked if the pharmacist could have a look at his daughter's sore toe.
The pharmacist inspected the toe in a consultation room and asked a few questions, before recommending Dettol and some cream.
"So he went and got that and rang it up at the counter and I paid for it, and it was like $45, quite a bit," Bruce said.
Bruce queried the bill and was told it included a $25 consultation fee. Because he had not been warned about the fee, the pharmacy waived it that time.
However, Bruce said in future, he would just take his child to the GP, who did not charge for under-14s.
"From my point of view, why would I pay $25 for that guy to look at her toe and prescribe a mild medication, when I can go to the doctor and probably get something that's going to work 10 times better?"
However, pharmacy owner Joseph Tsou said patients were happy to pay for the prompt attention.
"It saves them having to go to after hours [clinics], or waiting six weeks to a see a GP. At the moment, it's proving very popular with my customers."
Not every consultation would attract a fee, but differential diagnoses could be complicated and time-consuming, he said.
"Many pharmacists are expanding their scope of practice."
Pharmacies' core funding comes from filling prescriptions, but traditionally many have cross-subsidised by selling cosmetics, sunglasses and other knick-knacks.
The Pharmacy Guild, which represents pharmacy owners, said the rise of the big box retailers had killed that revenue stream, and core dispensing services had long been under-funded.
Chief executive Andrew Gaudin said since 2009, government funding had increased by less than half the rate of inflation.
"That's added up to around 20 percent over the last 15 years, which pharmacies are having to absorb, and it's just getting harder and harder with rising cost pressures to do that."
Last winter, under the previous government, pharmacists were paid to treat patients, through the Minor Health Conditions scheme.
The programme was hugely popular, with 157,000 consultations over three-and-a-half months for tummy-bugs, eye infections, pain, fever, and minor skin infections.
More than half of patients who used the service said they would have gone to a GP or urgent care clinic if it had not been available, while another 10,000 people would have resorted to an emergency department.
However, Health New Zealand Te Whatu Ora said there was "no conclusive evidence" the scheme reduced demand on GPs or emergency departments, and it was not clear how many patients would have consulted a pharmacist anyway.
Gaudin believed the scheme was great value for money, and was hopeful the government would roll it out nationwide in future.
"Paying a pharmacist $25 for a consultation is a lot cheaper than the $109 the government pays for a GP visit and certainly a lot cheaper than $503 cost per ED patient."
Pharmacists could not keep "working for free", he said.
"You can't get to a GP, EDs are overwhelmed, so I think increasingly you will see pharmacies starting to charge for that service on a user-pays basis.
"Quite frankly, there is significant unmet need in the community.
"Obviously it's up to individual pharmacies to charge as they see fit, independent pricing decisions need to be made, but I think we will see an emergence of that because we've got to meet the need.
"We can't have patients falling between the cracks out there in the community."
There are 1062 pharmacies in New Zealand - 30 fewer than 18 months ago - although many more independent operators are gone, replaced by big box retailers.
Health New Zealand Te Whatu Ora said it was working on models of care and sustainable funding for pharmacies as part of its primary care development plan.
It expects a new pharmacy contract will be in place by mid-2026.