PN1

VICE PRESIDENT HATCHER: Yes, can I take the appearances? Mr Irving, you appear with Ms Knowles for APESMA?

PN2

MR M IRVING: Yes.

PN3

VICE PRESIDENT HATCHER: And, Mr Seck, you appear with Ms Ballard for the Pharmacy Guild?

PN4

MR M SECK: Yes.

PN5

VICE PRESIDENT HATCHER: We'll grant the parties permission to be represented by lawyers in the proceedings. Mr Irving?

PN6

MR IRVING: We've got a lot to work through this week. I've got seven points that I wish to address during the course of an opening. I'll just outline what those seven points are and then perhaps if I can proceed.

PN7

The first is to explain a little bit about the industry and the second is the legislative framework of pharmacy work in Australia. The third is the legislative framework of this application or these proceedings. The fourth addresses the rates. The fifth is identification and broad way of the work value reasons, and I shan't go into any detail about that, that's been dealt with, ad nauseam, in the submissions made before you already. The sixth is to say something about the accredited pharmacist classification and the final is to deal with some administrative issue, witness order, documents produced, some exhibits that we still can't find, et cetera.

PN8

But if I could start by explaining a little bit about the industry. I've created a folder of documents, they're not being tendered but there's a folder of documents through which I propose to address various issues during the course of the opening and during the course of the proceeding we'll seek to tender particular documents when the time arises, if that assists the Commission.

PN9

Some of these documents are found in the exhibits, some of them aren't. Many of them are a complete surprise to my friends and the Commission and they have no notice of anything in the folder, so it's put on that level of generality to start with.

PN10

The first is behind tab 1 are three documents which explain something about the nature of the industry and the players in it. The first tab is a review of pharmacy remuneration or regulation in 2016. It's a document which was produced by the department. It outlined the position of the industry, as it existed in 2016.

PN11

If I could take you to page 11 of that document, this is a snapshot, an overview of the industry, or part of the industry, as it existed in 2016. There were 5511 pharmacies, as is stated there on page 11. The pharmacies on page 14 and 15 drew most of their income through filling out prescriptions under the Pharmaceutical Benefits Scheme. On page 15 there's a graph that sets out about 61 per cent. So the income that is earned by pharmacists or in pharmacies, by and large, is government funds, coming through the PBS, and it's supplemented by selling a couple of things.

PN12

First, shampoos and the like, second, there are also other schedules, rather than just filling out your prescriptions, there are other schedules which they can supply drugs under. There's a Poisons Act, or a Poisons Standard, and there are certain schedules, schedules 1 through 14, different types of drugs and different types of schedules. Schedules 2 and 3 concern medications that can be given by a pharmacist. One of the issues in this case is about what's called down-scheduling, the movement of drugs between different schedules.

PN13

At 15 there is also a mention of five different industry brand names. There are three broad sectors in this area, in terms of employers. The first is what might be called the banner groups, Terry White, Amcal, Family Care, Pharmasave and the like, they, by and large, are franchises which own or have arrangements with a number of pharmacies and operate under a similar banner.

PN14

Then the second group is what are called the discount pharmacists. Discount drug stores, Chemist Warehouse, My Chemist, they are folk who are, by and large, paid close to the award, according to the evidence that's going to be led. That is, sometimes it's been 1 or 2 per cent, sometimes it's been 5 per cent of the actual award rate.

PN15

VICE PRESIDENT HATCHER: Does evidence suggest they have any different standard of service that the branded pharmacies?

PN16

MR IRVING: They get their money through different sources in that they earn more money from the retail aspects than they do from the dispensing of medications.

PN17

There are a number of different players, before I leave this document, in the industry, which are mentioned on page 8. One of which is the Pharmacy Guild of Australia, represented by Mr Seck, and they are the national peak body representing the business and professional interest of community pharmacy, the employer group, if you like. They might view themselves in a different way, but that's a very broad and perhaps not completely accurate description, but probably right.

PN18

The second is the Pharmaceutical Society, the PSA, they're the professional body. They play a role in setting the professional standards. The third is the Society of Hospital Pharmacists, this application doesn't concern hospital pharmacists. The fourth is the Australian College of Pharmacy, sometimes called the AACP or the ACP, but also sets professional standards, which we'll come to.

PN19

They're the four bodies and the way in which money flows in this sector is largely through what are called the Community Pharmacy Agreements. That is to say, each five years the government sits down with the PGA and negotiates an agreement, and the agreement is that, "We will fund this type of PBS payment to this extent and what's more, in this five year agreement you will do the following things. You'll roll out this program for medications in the homes, you will give vaccinations to kiddies, you will do whatever." So these Community Pharmacy Agreements, negotiated with the employer body, end up being the driver of funding within the sector.

PN20

These agreements, as is stated there, have evolved over time, with the current agreement seeking to ensure that pharmacists receive fair and adequate remuneration. "Pharmacists" in that sentence doesn't mean the employees. The CPA doesn't concern the money that goes to the employees, it concerns the money that goes into the pockets of the employer. There's no suggestion, in any part of our application, that this is an appropriate arrangement by any stretch, it's just the background by which this industry operates.

PN21

Another important part of the background, which is unusual or struck me as unusual, is what's called the location rules, which are discussed in page 28 onwards. This is a guild, this is a guild from in the days from our history books. To be a pharmacist, to own pharmacies you've got to be a pharmacist, you've got to go through the ranks. Another aspect of the old guild system is you restrict entry. That is to say that one cannot have new pharmacists popping up on each corner competing with each other. The way in which that's achieved is through what are called these pharmacy location rules. There's a lot of them, they're technical by the guts of them is that, pursuant to the CPA negotiations, there is an agreement between the employer group and the government limiting new employer entrants into the field.

PN22

Now, that's obviously going to have an impact upon rates of pay, ultimately, down the line, but it's just one of the odd things about this market and the industry and how it's structured and operates.

PN23

VICE PRESIDENT HATCHER: Does that have flow on effects to the labour market for a pharmacist?

PN24

MR IRVING: Yes.

PN25

VICE PRESIDENT HATCHER: In what way?

PN26

MR IRVING: Well, a couple of things - - -

PN27

VICE PRESIDENT HATCHER: Presumably it restricts employment because it limits the number of pharmacies that can offer jobs.

PN28

MR IRVING: Yes, and it limits the number of pharmacies that can offer jobs, but what used to happen over the last, say, 500 years, is you would do your time and you would ultimately become a master pharmacist and own your own pharmacy, a pharmacists dream. What's happened is that with restrictions on entry, the holders of the golden tickets is more valuable, as Professor Clarke comes along and is going to give evidence about, "Well, what's happening is that pharmacies now are being sold for millions of dollars." So little old pharmacists, who used to be able to ferret away more money each week, in the hope of and in the dream of getting pharmacy at the end of the day, when you're on the sorts of wages that these people are, the prospect of buying a million dollar pharmacy is relatively low.

PN29

So one of the consequence of that is, what do we do with employees who are near the top of the range, who used to, we would hope, go on to become pharmacy owners but are now, by virtue of these things going out of reach, are now stuck on the same wages for ever. When I say, "stuck on the same wages", the evidence of the economist comes along and says, "Look, if you look at the average wage of a pharmacist now, after five years, and you look at the average range for a pharmacist after 25 years, they're the same." They're just stuck in this never-ending desert. That's one of the consequences.

PN30

Another consequence is, who hangs around? We're about to look at the pharmacy numbers, but as an employees, as a new employee wanting to go in to become the lowest paid graduates in Australia, as these people are, they go into their field and then by the age of 30, 35, the number of pharmacists just drop off. They drop off by something like the first 15 years, between 25 and 40, constitute, I think, somewhere around 17,000 pharmacists and the next 15 years is only 7000 pharmacists. Part of the reason is, who stays? Who stays when the rates are so low for so long and there's no pay points like there are in other industries and a very flat career structure?

PN31

Could I just go back a couple of points, a couple of documents to the Pharmacy Board of Australia registrant data, which is behind the same tab, I hope or anticipate. It might be behind the same tab, a couple of documents on. The Pharmacy Board are the registration board, that's one way of looking at them. To be a pharmacist you've got to register as a pharmacist and this simply sets out the numbers of pharmacists currently. It's a document that looks something like that, Pharmacy Board of Australia, it's behind tab 1, registration data. Hopefully it's found its way into - - -

PN32

VICE PRESIDENT HATCHER: I see it. I've got two copies of - is there another copy? I've got two copies of it.

PN33

MR IRVING: Yes, I can give you my copy. I've coloured in a couple of things, but I'm sure they won't influence your judgment too much.

PN34

What I wish to draw from this document is as follows. There are, on page 5, a list of - there are 30,984 pharmacists registered in Australia, 28,000 are general, the provision tend to be, or almost always are, the interns. You can see the registration by age group and the extent to which it just drops away.

PN35

I think that's the most direct evidence of the number of pharmacy registrants in Australia. Not all of them are employed in community pharmacy, which is the subject of this case, some of them are hospital pharmacists, the evidence suggests that it's about 20 per cent in hospital pharmacy.

PN36

VICE PRESIDENT HATCHER: That doesn't necessarily show people dropping out of the workforce, does it? It may show an expansion of the workforce, which is moving its way up through the age brackets.

PN37

MR IRVING: Sorry, an expansion of the?

PN38

VICE PRESIDENT HATCHER: It may not show people dropping out of the workforce, it may show that, at some point in time, there was an expansion of the numbers of people graduating and that is moving its way through the age brackets, as one passes.

PN39

MR IRVING: There might have been a bubble. There might have been a bubble and this could be working its way through, that's true. And it would only be looking at the registrant data from 2002 onwards, which would indicate whether or not that bubble exists. I've looked at that, I don't think there is a bubble, but we'll find it and rather than give evidence from the Bar table, I'd prefer to have a document. That's the first thing about the industry structure.

PN40

The second thing I just want to mention about the legislative structure which is governing this employment. If you look behind tab 2? Tab 2 sets out three extracts from the National Health Act, the guts of them are as follows.

PN41

Section 85 says that:

PN42

Benefits shall be provided by the Commonwealth in accordance with this Part in respect to pharmaceutical benefits.

PN43

That is, PBS benefits are delivered under this part.

PN44

Section 90 is the next section I want to take you to:

PN45

Subject to this section, the Secretary may, upon application by a pharmacist for approval to supply pharmaceutical benefits.

PN46

That is, if you want to get the benefits of the PBS then you've got to be an approved pharmacist.

PN47

Section 92A(f) says you can be an approved pharmacist, subject to conditions, and we're going to tell you about the conditions set out in regulations and legislative instruments. The legislative instrument is behind tab 3.

PN48

So to get your PBS, 60-odd per cent of your income, you've got to go through this, Standards of practice, at paragraph 5:

PN49

The approved pharmacist must, in dispensing prescriptions for pharmaceutical benefits -

PN50

Paragraph 5(c):

PN51

Comply with the Pharmaceutical Society of Australia's code of ethics for pharmacists, as existing at the reference time.

PN52

So when we talk about these code of ethics, it's not just some goal in the future, it is a legislative requirement. You've got to comply with the code to provide the benefits and the benefits deliver most of the money. You've got to comply with the PSA's professional practice standards, and these things are all in evidence.

PN53

Section 6 says:

PN54

An approved pharmacist must maintain the currency of knowledge, in accordance with the PSA's national competency standards, as existing at the reference time.

PN55

Paragraph 7 says, now these approved pharmacists are the pharmacy owners, an paragraph 7 says:

PN56

A person who's an approved pharmacist, in respect of the pharmacy at a particular premises, must ensure that a pharmacist, who is not an approved pharmacists, who supplies benefits complies with the conditions.

PN57

Which is to say the owners have got to make sure that the code of ethics and the professional standards and the national competency standards are all complied with. These are not hopes and expectations, these are legislative requirements.

PN58

VICE PRESIDENT HATCHER: You showed us before, in tab 1, that about two-thirds of the industry is dominated by five players, so how does that work, in respect of - when you've got one of these key players, how does that work in terms of the requirement for an approved pharmacist?

PN59

MR IRVING: Franchises. So what happens is one can own a limited number of pharmacies, I think it's about six, by the final submission I'll have nailed exactly what it is, four to six, and so Joe Bloggs is a pharmacist who owns four pharmacies, as part of the Amcal brand, which has 500 pharmacies. As an approved pharmacist he or she has to make sure that the employees comply with all of these standards.

PN60

Now, there's reference there made to the PSA ethics, which are contained in annexures GM26 and GM28, I shan't take you there at the moment. There's reference there of the PSA professional standards, which are contained in paragraph 24 and 25. I'll get back to this later, but the datum point, by and large, in this case, is 1998. That is, we're looking at work value by reference to 1998.

PN61

There were no professional standards in 1998. There were no competency standards in 1998. There was an ethical standard, but its core was different. Professionally dispense medicines, that was the guts of a pharmacists role. Indeed, you look up the dictionary so what a pharmacist is, they're the dispensers of medicines. As will become apparent, that from 2000 pharmacists in Australia stopped having that as their focus and their core. There was a paradigm shift, a fundamental shift.

PN62

The fundamental shift came about because of - - -

PN63

VICE PRESIDENT HATCHER: What was that date again?

PN64

MR IRVING: 2000. The fundamental shift came about because of what was called the National Medicines Policy, its annexure GM3. It was a revolution, not just in Australia, there was a revolution worldwide. There was a revolution worldwide in that you'll see, in Dr March's statement, he explains, "Well, the UN started to set standards, in 1985, to say, "This the goal for each country. We're going to improve health by developing in each country this new approach to medicine and how its dealt with by partners within the health care system. Not just doctors writing a script but partners, in terms of the hospitals, the GPs, the pharmacists, the other health professionals working within a partnership. For the pharmacists role, it's not just to dispense the correct medicine but choose and administer the most appropriate medicine.""

PN65

The exact terms are set out in the National Medicine Policy, but it's significant. It becomes, instead of a dispensing role, one in which, "What's the most appropriate for this patient?" That requires picking out what the patient needs, where the patient is, in terms of their health care. You need to talk to them, not just for the purpose of what the doctor's script says, but you need to talk to them and find out, "So how long have you been on this? What other drugs are you taking? What other complementary medicines are you taking? What's your lifestyle like? How is that affecting this, that and the other." Of course, (indistinct) thousands, we always talk to patients, that's been happening for 2000 years, but now you're doing it for a different purpose, now you're doing it to find out what's the most appropriate medication and you're doing it pursuant to legislative standards, which impose upon you a level of responsibility which did not previously exist.

PN66

2000 is an important hinge date in the context of this. From 2000 changes just started to flow through. If you're going to have a big change you're going to have to change the students you get through, you're going to have to teach them different things so we had a change from instead of a three year university course to a four year university course. We had a change from instead of the subjects being dedicated to the memorisation of the drugs that can and cannot be administered, and the compounding of drugs, but more focused on communicative skills.

PN67

Dr March gives evidence about how all these university courses were reshaped around the country and now we've got the modern pharmacist, a different beast to what went before. Sure they also dispense, but they do not only a whole lot more besides, but the do the old things in a different way.

PN68

Getting back to the regulatory regime, tab 4 contains the Health Practitioner Regulation National Law. This will probably be familiar to most of you, it is a Queensland law which is then adopted through each of the states, in almost identical form. It sets up APRA, which has 13 national boards. The boards are listed in section 31, I haven't reproduced the whole Act, but section 31 is immediately after the index, on about the sixth or seventh page of the document.

PN69

So you've got a national board, about chiropracty and dental and medical and nursing and midwifery and pharmacy, et cetera, there's 14 boards. One of the functions of the board is to set certain standards, and you can see, in section 38, the National Board develops registration standards and the National Board, in section 39, develops codes and guidelines. This is what you must do to be registered for the first time. This is want you must do to continue to be registered. These are the codes that you must comply with. Section 128, which is the final page of the document, deals with a registered health practitioner undertaking CPD by an approved registration standard, and professional indemnity insurance arrangements.

PN70

I'll come back to CPDs during the course of the case and professional indemnity, but the guts of that section you need to understand at this case is this. The requirement to comply with CPDs is a new one, it came in in 2000. It was initially 20 units, which was basically 20 hours. It then increased to 30 units, it the increased to 40 units, about 40 hours. The types of work that need to be done to meet these units has changed over time as well. It used to be you used to be able to watch a YouTube video or whatever, and simply engage in didactic learning. It's not as bad as the lawyers, but it's similar.

PN71

Now you've got to do a certain amount of units, 20 units of this sort of basic learning and now 20 units of the more complex learning, which involves an assessment. On whose time is this done? Of course the pharmacists, not the employer, the employee has to find their own time to do this. Who pays for it? Who's got to pay for these courses? Well, the employees just reach into their pocket.

PN72

What about professional indemnity insurance? What is there about paying for professional indemnity insurance? Well, to be an employee you've got to have your own insurance. So these new standards mean they reach into their pocket again. Changes in the conditions under which work is done include changes in the legislative scheme impacting upon who the work is done.

PN73

That is what I wish to say - sorry, I should also take you to tab 7, which is an extract from the Pharmacy Board, it's just, rather than traipsing through all the regulations it's just a nice diagram of what you've got to do. You've got to complete - to be a pharmacist you've got to complete an improved program of study. There's 21 universities in Australia, all of them set four years prep. You've got to complete an internship.

PN74

Internships have been around since Eve was a girl, but they're different now. We're now talking about 1824 hours of work, which is 45.6 weeks. There are examinations throughout the course of it, written examinations, oral examinations, about a whole range of competencies. The pass mark is not 50 per cent it's 60-odd per cent for some of them.

PN75

There are various requirements imposed by the Pharmacy Board, hurdles that just get higher and higher and higher over time. You've got to complete your internship and after a year you are a fully-fledged pharmacist. You've got to meet national registration standards, codes and guidelines. And to renew your registration each year you've got to have ensured you've met your CPD learning points et cetera. You've got to establish your own learning plan. You've got to be in a position to answer any audit, if and when it arises.

PN76

So this is the circle of continuing obligations which didn't exist in 1998. I've included, in the folder, certain PBA standards. They're government documents, it might be useful if my friends have a look at them over the course of the next couple of days and if they want to can be tendered with out objection they can be tendered without objection.

PN77

I said that I was going to deal with seven points. I've dealt with the guts of them, which is the industry and the legislative framework of the work, and now I want to look at the framework of the application, the legislative framework of the application, if I could.

PN78

I drafted up a document, which is called APESMA's Submissions in Reply, which may or may not have found its way - yes. I dealt there with the statutory foundation of the claim, partly because it appeared that it had slightly gone off the rails, in terms of what the legislation appeared to require, or at least in my view it did.

PN79

This is the process before the Commission today is part of the four year review, performing a legislative function, not prompted by any particular application, you're performing an obligation that the legislature has imposed upon you independently. There is a variation to the modern award, which is being agitated, and as it's a variation to a modern award it must be in accordance with the modern awards objective.

PN80

The objective, ultimately, is this, to provide a fair and relevant minimum safety net of terms and conditions. That's the objective. One needs to take into account certain things which are listed. None of them are determinative, some of them might not be relevant in this case. For example, the objective about effect on the national economy. When you're dealing with 20,000-odd employees the effect on the national economy is going to be so insignificant that the consideration is going to be neutral. One takes it into account by not giving it weight.

PN81

The objectives, set out in section 134, and if I could just go there and take you through them? Perhaps I better do it this way. I'll do it through 156. If I go to 156(3):

PN82

In a four year review of modern awards the Commission may make a determination varying a modern award only if the Commission is satisfied that the variation of the minimum wages is justified by work value reasons.

PN83

"Justified", there needs to be probative evidence. If, at the end of this, you don't think there's any evidence about work value reasons you can dismiss any change.

PN84

The work value reasons justifying the amount that the employees should be paid, doing a particular type of work, being reasons related to any of the following:

PN85

Nature of the work, level of skill and responsibility and the conditions under which work is done.

PN86

Conditions under which work is done includes the legislative framework, we say. Change in legislative framework, change in conditions.

PN87

The nature of the work, in some respects it's set against us as well, there've been pharmacists since the Egyptians were at it, nothing's changed, they dispense medicines, that's what they do. The work has changed. The nature of the work has changed. The National Medicine Policy has meant it's changed. They've retrained all of the students for the last 18 years because they knew it would have to change and they changed it. When one looks at the legislative regime and the practice standards in existence now, it defines - it tells you what a pharmacist is. It sets out all of these criteria and only one of them is about dispensing.

PN88

Obviously the work value reasons and the very phrase "work value" draws upon the old principle 6 of the National Wage Case principles. However, there are differences between the tasks that you are undertaking and the old work value exercise.

PN89

The first difference is this: the old principle 6 referred to the nature of the work, the level of skill responsibility and the conditions under which work is done. Tick, tick, tick, all the same. It then proceeded to say:

PN90

There is a strict test of the alteration in wage rates, and that's that the change in the nature of the work should constitute such a significant net addition to work requirement as to warrant the creation of a new classification.

PN91

Not mentioned. No mention of significant net addition, no mention of strict test, no mention, indeed, of change. It will be rare to be able to justify any alteration in wage rate on work value reasons unless you could prove change. But change is not a necessarily element, though, of course, if change is proved the extent of the change is going to be relevant in the assessment of how much should be awarded.

PN92

VICE PRESIDENT HATCHER: It's a necessary element of your case, isn't it, that when the modern award was made it didn't set rates which appropriately remunerated for the work value of the employers?

PN93

MR IRVING: That primary case, yes.

PN94

VICE PRESIDENT HATCHER: Is that the price on analysis of the process by which the modern award was made and the extent to which it strikes true from predecessor awards?

PN95

MR IRVING: It will require some analysis of whether or not the work value was assessed as part of that process. And I understand, from the history that is set out in the submissions, that did not occur four years ago. At the end of the day, the question for the Commission here is not whether or not they were appropriately set four years ago, or in 1998, but what is a fair and relevant rate, having regard to the value of the work.

PN96

Now, if there's been change in the last week, or the last four years, or the last 10 years, they're all relevant facts which will feed into and inform that assessment. But they're part of the story and not the end of the story and it distracts from the ultimate statutory task to assess a fair and relevant rate.

PN97

VICE PRESIDENT HATCHER: It suggests, doesn't it, to the extent that you're relying on changes before the modern award was made, that the rates, in the award when it was made, did not meet the modern awards objective. They weren't fair and relevant because they didn't reflect the work value of the employers to whom they applied.

PN98

MR IRVING: Yes. And the process by which - let's take a step back. One way of looking at 156(4), in the context of the scheme, is to say this, when these modern awards were made that was your chance. That was your chance to prove work value reasons. If you missed that window, if you missed that window, then when you turn up four years later, for your modern award review, you can point to changes in the last four years and that's it, because that was an assessment made four years ago and you're stuck with that, whether or not you ran a work value case at that time or not.

PN99

That is one approach to how we deal with these work value changes, and there's a certain attraction of that. There's a certain attraction to that in terms of the Commission and how it operates and how modern awards operate, which is to say otherwise you're going to get a traipse of dozens of people wandering up here saying, "We want to reopen what happened four years ago, eight years ago, whatever and nothing's been properly valued for 20 years or so, let's improve our rates that way." It might be an attractive mechanism but I don't think it's the correct statutory approach.

PN100

Ultimately, one is looking at what's fair and relevant and in circumstances where an application, these reviews aren't done pursuant to application, they're done pursuant to statutory edict, "Thou shalt do these reviews." One needs to address the significance of what happened four years ago, in light of the reality that work value considerations were not raised and agitated as justifications for a different rate, by anyone, by PGA, by APESMA, by the Commission, of examination, by anyone. The notion that there was a thorough assessment, at the time, of work value just doesn't appear to be borne out by the previous approach.

PN101

I'm not sure I've directly addressed your Honour's question or dealt with the concern implicidant, but - - -

PN102

VICE PRESIDENT HATCHER: No - - -

PN103

MR IRVING: Just to run through, quickly, section 134 of the modern award objective. One needs to take into account relative living standards and the needs of the low paid, they're separate things. The low paid here, as defined by the most recent annual wage review, at paragraph 360, are those who are being paid less than two-thirds of the EEH survey, or the Characteristics Employment Survey and in that category are the interns. So in this case, the interns, at the moment, are low paid, we're talking about people with four year degrees, and pharmacists and those above the pharmacist classification are slightly greater than low paid.

PN104

The relative living standards involves a comparison, according to paragraph 52 of the most recent annual wage review, comparison with other groups that are deemed to be relevant and focuses on the comparison between award reliant workers and other employed workers.

PN105

We'll be drawing some comparisons with others, during the course of this case, but given that pharmacists are the lowest paid graduates in Australia, virtually everywhere we look we see a better comparator to us. Whet her one looks at teachers or engineers or psychologists or nurses, they're so far behind the game that any comparison will help.

PN106

The need to encourage collective bargaining is the next consideration and the evidence is that collective bargaining is virtually non-existent in this sector. There is one collective bargain with an organisation called National Pharmacies, other than that there have been a smattering of old agreements under the New South Wales system, as I understand the evidence.

PN107

We're talking about dispersed workplaces. We're talking about retail. We're talking about small businesses, employers, and we're talking about predominantly women. All of these factors are the perfect storm of the low bargaining environment, or low collective bargaining environment.

PN108

If collective bargaining doesn't exist, granting this application won't hinder it. Collective bargaining has been around for now, what, 25 years and the collective bargains aren't out there. So it's not as if granting this application will prevent employers achieving their true dream of getting a collective bargain in the industry.

PN109

Need to promote social inclusion through increased workforce participation. As I previously outlined, pharmacy, in some respect, is a young person's game. The figures I took you to before had 17,000 in the 24 to 40 category and 7000 in the 40 to 55 category. The low rates means that it's not a career and that affects workforce participation.

PN110

The principle of equal remuneration for work of equal r comparative value. One of the things that comes through the economic evidence is this is not one of the areas in which women are paid 85 cents in the dollar, it's actually where one of the areas where they're paid 100 cents in the dollar. What the actual rates are for women is not just similar to men but at the same level as men. When one goes through the stats of when women started to enter the pharmacy workforce, it was a large explosion in the 2000s of women entering that workforce and then as the wages ghetto started to emerge around the same time.

PN111

So that's, broadly, what we say about how the various modern various modern award objective considerations are taken into account in the context of this case but, at the end of the day, it's an assessment of what's fair as well as having regard to the three considerations, the nature of the work, the level of skill and the conditions under which the work is done.

PN112

Could I now say something about the - and I should say I anticipate to be another 20, 25 minutes, if that's of some assistance. If I could say something about the current rates of pay, the wages? Each year there's a survey that's done by Professionals Australia, which are attached to the statement of Mr Crowther. They survey the actual wages of pharmacists, by reference to various categories and what's happening out there in the field. It is the best information there is, it is imperfect information and equals 320-odd, I think, in terms of the survey numbers, so it's not a tiny amount but it's not as if it's as good as having 20 per cent of the workforce giving answers.

PN113

What it reveals, in terms of the wages of pharmacists in Australia is this, over the last five years the wages of pharmacists, the actual wages of pharmacists, have decreased by 1 per cent. I'm not talking a blip over a six month period or a one year period, over the last five years the actual rate, not real, the actual rate has gone down. When compared with real wages, compared against inflation, or compared against the average wage increase elsewhere in society, over the last five years the decreases have been about 5 and a half per cent for pharmacists and 8 per cent for pharmacists in charge. In the last 20 years the decreases have been 11.59 per cent for pharmacists and 7 and a half for pharmacists in charge.

PN114

Those numbers - - -

PN115

VICE PRESIDENT HATCHER: What annexure was that?

PN116

MR IRVING: That's AC21, of Crowther.

PN117

VICE PRESIDENT HATCHER: Yes.

PN118

MR IRVING: One thing that Mr Crowther also does, if one looks at page 9 of the statement, is to identify where workers are, where the lower decile, quartile, or median is for the various rates of pay. That's an indication of the extent to which the workers are award reliant. What they show is the median for interns is about 1 per cent of the actual award rate and for pharmacists it's about 20 per cent above the award rate and various others about 16 and 19 per cent. So what happens is, in the better pharmacies there is an amount of about 30 per cent above award. In the discount pharmacies there's about 10 per cent above the award, for the pharmacist through to the pharmacy manager levels.

PN119

Crowther, in his reply statement, annexes a report about the graduate salaries across Australia and they show that pharmacists are the worst paid, by some considerable margin. We're talking about, compared with, say, scientists get 130 per cent of pharmacists rate when they get out of university. Engineers get 145 per cent and nurses get 135, teachers get 143, psychologists get 130. So it's not as if they're missing out by five or so per cent here, they are way behind of their four year degree educated and they come out with a student debt. Indeed, the award rate for fifth year pharmacists is still below the first year of scientist and engineers and nurses and psychologists.

PN120

Now, what does one do? The current application is an application to restore the relativities that existed in 1998. That was the last time the relativities were set by the Commission and they've been flattened, as a result of flat wage increases since then.

PN121

One option for the Commission is to restore those relativities, in the amounts sought in our primary claim, but there are alternative ways to set a fair and relative wage. One is to maintain the current relativities and increase everyone by 10 per cent, 20 per cent, 25 per cent, 50 per cent, whichever figure you select as being fair and relevant, that's another way. There are innumerable ways. One could say, let's put in pay points. Nurses, teachers, scientists, they all have pay points which increase - and in circumstances in which employees have to engage in compulsory CPDs, you know they're getting better because they've got to get better under the law otherwise they can't keep their registration, so it would justify increased pay points.

PN122

Another way is to, and one way which we've suggested, is to insert a new classification of this accredited pharmacist, which will sit below the highest level but deals with a certain type of classification or accreditation that I'm about to outline. So these are - - -

PN123

VICE PRESIDENT HATCHER: Does the cost of employed pharmacist wages somehow feed into the PBS system and the way in which pharmacy businesses are remunerated by the government?

PN124

MR IRVING: No. It plays into the profit levels of the banners and the discount pharmacies and, presumably, whatever franchise arrangements might exist. It might go directly out of the pockets of the employees, it might go partly out of the pockets of the international franchisors, or whatever. As I understand it, there's nothing in the CPA, the Community Pharmacy Agreement, which, or in the regulation, which would result in an increase in pharmaceutical benefits for ordinary people.

PN125

Of course, we can't rule out the possibility that some pharmacists will increase the price of some goods, such as shampoo, to cover this but, as I understand it, and I'm a relatively new entrant into this case, as I understand it, the pharmaceutical benefits, the cost of pharmaceutical benefits is regulated by law, and so an increase in rate of pay will not result in medicines costing more, but I don't want to mislead the Commission if I'm wrong, perhaps we'll check that.

PN126

Accredited pharmacists. There is an application for the creation of the classification of accredited pharmacist. There's been criticism made that it's not clear enough. To meet that criticism I should explain what it is we contemplate.

PN127

An accredited pharmacist is a pharmacist who is accredited to conduct home medication reviews or residential medication management reviews, also known as HMR or RMMR.

PN128

By way of explanation, one of the many changes that have flowed on in the last 10 or so years it's been, or 20 years, has been the creation of these different levels of medication reviews for patients. Sitting down, going through more detailed histories and figuring out how certain drugs interact. Some of them are done at the home of patients themselves. To conduct these different types of medication reviews, sorry, pharmacies at which these reviews are conducted get more money, through the CPA, for doing it. So they're funded, funded to the extent of something like $183 million a year. But to do the reviews one needs to do a special type of accreditation. It's detailed accreditation, we'll go through, in the course of the evidence, outlining precisely what's required and the legislative requirements, but it is a far higher and more detailed assessment than other types of accreditation processes which are undertaken by pharmacists.

PN129

The proposal is that the pharmacist who reaches that exalted stage of further study to acquire this should be paid more. Their employers are paid more for the work they're doing. Their employers are getting the payment because its more skilled and requires more responsibility with higher level of accountability. They're already getting it. The question is, should the employees receive a benefit for the exercise of those skills and acquiring that knowledge?

PN130

That's the - - -

PN131

VICE PRESIDENT HATCHER: Just before you move on from that, that skill can be exercised by persons at various classification levels? Is there some restriction upon - - -

PN132

MR IRVING: The training - the accreditation can be acquired by people who are at any of the levels, other than interns.

PN133

VICE PRESIDENT HATCHER: Doesn't that suggest, if the proposition has merit, underlying merit, that it would be better to deal with it by way of allowance, rather than a classification? That is, an allowance on top of whatever classification you otherwise happen to be in?

PN134

DEPUTY PRESIDENT DEAN: That proposal also has - - -

PN135

MR IRVING: There are many different ways of setting a fair and relevant rate. In our reply submission we raise the possibility of saying, "Well, an allowance is one way of skinning that cat", but it would be an allowance on the possession of the qualification rather than the exercise. So a person with training might only go out and do these medication reviews one hour on Monday and three hours on Wednesday and so trying to attach it to each time it's exercised would be unwieldy. A more appropriate approach would be to attach the allowance for the possession of the qualification.

PN136

VICE PRESIDENT HATCHER: How do you go about getting the qualification? Is it self-initiated or does the employer arrange it?

PN137

MR IRVING: They're a self-initiated one. You make an application to the AACP, which is the - not the professional body, which is the PSA, but the Australian Association of Community Pharmacists, they run a course. They're not the only ones who run the course, but they run a course. The qualification consists of 60 hours of CPD, done in two different ways, one of which is, there are different levels of assessment, there's a written examination and an oral examination, from recollection, and will provide the material to (indistinct).

PN138

VICE PRESIDENT HATCHER: There would have to be a criterion, surely, that the employer requires you to have the qualification? That is, you can't be that you get a pay rise just by going and doing that, even if the employer doesn't need you to exercise the skill?

PN139

MR IRVING: I understand that, your Honour, and I will speak further about the statutory framework. It may well be that, from recollection, I'll need to check, from recollection an employer puts up their hand to do these sorts of reviews. That is to say, to get access to that bucket of money they say we're going to do 100 medicine reviews. So that initiation might well be the prompt, so to speak. Any employee of an employer who provides X service might be a way of dealing with it.

PN140

Now, I'm not going to run through work value reasons. I'm not going to run through what we said about it, they're all set out in the evidence. I've mentioned the educational changes that have occurred over the course, and the changes to the CPDs and the internship.

PN141

There are three points that I just wish to mention about work value changes. The first is this, down my way in Victoria we used to have a dinosaur called a gallimimus. Gallimimus is a chicken mimic and it was sort of a velociraptor type creature, huge, but you could see by the hip structure and the feet and the head that this was a creature that truly did end up evolving into a chicken. It is set against this world, all of these changes are evolutionary, it's just part of the flow of things. But if you compare the creature at the beginning and the creature at the end, they're very different creatures. It might well have been evolution that got them there, it might well have been a change a year, half a dozen changes a year, but from the beginning to the end we're dealing with very different creatures. That's point 1.

PN142

Point 2, it is said, in the evidence of the employers, we have always done these tasks, these are just old things done in new says. But when one trains an employee to figure out what is the best option for the client, not the prescribed option, one draws upon a different depth and range of knowledge and skills. The question of, "How are you?" might mean something for someone's who is dispensing napkins, but the question, "How are you?" for a trained health professional who is trying to pick up signs of mental distress, signs of exhaustion, signs of a whole range of possible symptoms that will feed into their informed decision about what's the best course for this person. Old things done - the dispensing is done in a new way when it's informed by that sort of depth of soft skill knowledge.

PN143

Dr March gives evidence about how that became a core part of the curriculum and it infuses the interactions that are occurring, on a daily basis, between pharmacists and their patients, and you can't switch it off. Once you've got the skill to listen, to understand, to connect together the pieces of information to make the best judgment, you can't just say, "I'm going to switch that off." It's something that informs them every day.

PN144

The third thing is, old things new accountability. It might be said, "Well, you've always kept up to date, therefore CPD is nothing new." But now we've got a legislative requirement. Now we've got an obligation to do these things and keep records of these things. They're the three arguments which form the themes which are said to undermine the work value reasons that are identified by the union.

PN145

Now, having said that, they're the points that I wish to raise with the Commission, before moving to the administrative points. Many of the witnesses who have been called by the union are employees who are working today and work arrangements have changed. Most of the Sydney witnesses are - we're going to start with Mr March then move to Carmel McCallum and then two of the anonymous witnesses. There's been orders made about, as I understand it, about the anonymising of all of the witnesses for the employer and some of the witnesses for us. We don't seek to disturb them.

PN146

So Anon 1 and Anon 2 are giving evidence. Would it assist the Commission just to say what their names are?

PN147

VICE PRESIDENT HATCHER: I think we'll need to do that.

PN148

MR IRVING: Sorry?

PN149

VICE PRESIDENT HATCHER: I think we'll need to do that, to keep track of what's going on.

PN150

MR IRVING: Anon 1 is Ms Thompson, Anon 2 is Mr Walls, Anon 2 is Cardin Le, Mr Le. So they're the three witnesses who are anonymised on our side. There was an order to produce documents, issued to the PSA. They produced a couple of thousand pages. They were produced to the Commission some time ago.

PN151

We were going to call a witness from the PSA to simply annex the documents or to identify the documents when we tendered them. We chose a better course, which was to just annex them to a statement of Dr March, a reply statement of Dr March, which we filed last week. As a result of which, our friends were deluged with thousands of pages of additional material, but it was additional material which they had had access to, pursuant to the orders made by the Commission, for six months, a year, or whatever. So that's the bulk of the material that's annexed to the statement of Dr March.

PN152

One of the annexures, CM22, appears as a document which says:

PN153

This is found in the bookshelf.

PN154

Which no doubt it still is, but we can't actually find the competency standard from 2001 and so we apologise to the Commission and the other side for not being in a position to produce that document. If anyone's got a copy of that competency standard we'd love to see it.

PN155

Yes, I think in terms of administration, yes. There is one other matter, which is this, the union engaged a couple of professors to provide a report, which has duly been filed. We wrote to the other side a few weeks ago and said, "Who do you want for cross-examination?" They identified each of the individuals, didn't identify the professors. That was clarified a week or so later, we contacted the professors and now we're having difficulty pinning them down. One of them has said she's unavailable and the other one I haven't (indistinct).

PN156

VICE PRESIDENT HATCHER: So this is professors Aslani and Clarke, is it?

PN157

MR IRVING: Correct. Now, the way I pitched it suggests it might significantly be their fault, but it's not. It falls upon us to produce witnesses and we've been trying and we will continue to try. I'll get an update at lunch time about whether or not contact has been made, but there are a couple of options which might need to be raised after lunch, including the issuing of a subpoena and including whether or not we need them to be cross-examined or to what extent they need to be cross-examined. So that's a possible problem on the horizon. Unless there's anything further about - - -

PN158

VICE PRESIDENT HATCHER: Mr Seck, did you want to make an opening submission at this stage, or some later stage?

PN159

MR SECK: I don't wish to make a detailed opening submission, your Honour, but I do wish to just respond to some of the housekeeping issues which have been raised by my learned friend. Just dealing with the first issue, that is, Dr March, I think, as my learned friend has identified, we were deluged with what was described as a reply statement, from Dr March, last week and that contains probably 53 or 52 annexures, which are quite substantial. Most of which is not truly in reply and ought to have been adduced in chief.

PN160

Now, as we had understood it, what was being proposed by APESMA, at an early stage, was that they would subpoena or get someone from the Pharmaceutical Society of Australia to provide evidence. Indeed, I think in the indicative timetables which had been supplied to the Bench, a timeslot had been provided for some anonymous PSA witness to provide that evidence, even though that evidence had yet to be filed.

PN161

Two things arise from that. Firstly, it's obviously made it difficult for us to get on top of that material within a short timeframe. I understand my learned friend says orders for production had been made and the documents had been produced, that's so, but we had not been formally served with those documents, in the sense that they were sought to be relied upon, nor was any statement or affidavit from a witness to, in effect, speak to the relevance of those documents and how they operated.

PN162

We now have that from Dr March, and I have endeavoured, during the weekend and last week, to get on top of the detail of that material but what I would say is that whilst I've endeavoured to do that we're obviously at a disadvantage in being able to reply to it, because it's come up in chief for the first time.

PN163

I don't wish to unduly delay the cross-examination of Dr March and I'm certainly prepared to cross-examine him today, but can I reserve my position, your Honour, depending on matters arising out of cross-examination, that we may need to respond to it once we get on top of that material in a bit more detail. So whilst I'm prepared to cross-examine him today, or any time this week for that matter, we do wish to reserve that position.

PN164

In relation - - -

PN165

VICE PRESIDENT HATCHER: We'll be flexible, but on the basis of promises made by the parties, this case will start and finish this week.

PN166

MR SECK: Absolutely, your Honour, and that's certainly our intention as well and we don't wish to take up to much time unnecessarily on it. It may be that we don't need to get further evidence in reply.

PN167

VICE PRESIDENT HATCHER: Sure.

PN168

MR SECK: But as the Bench will appreciate, one of the issues in this case is trying to identify any work of value changes, to use the short expression, from the date in point back in 1998 to what, in fact, applies now. What Dr March has annexed to his affidavit is a whole series of documents which purport to apply now but when one reads through it, there are documents which exist way back prior to 1998, which indicate there's been an evolution of each of those competency standards or professional standards or guidelines. I'd like to reserve my position on that, depending on the outcome of the cross-examination of Dr March. So that's the first point I just wish to raise, your Honour.

PN169

The second point, and this is really just a housekeeping issue and it's a matter for the Bench. As I understand it, the orders made, in effect, de-identifying or anonymising the witnesses Anon 1, 2 and 3 in fact expired last week and I think there was going to be an application to renew those orders and I think they were meant to be done last week and they weren't done last week, for obvious reasons, so it's a matter for the Bench and for my learned friend, I suppose, whether or not they wish to continue those orders.

PN170

The only thing I wish to say is it's not apparent to me yet the basis for the orders de-identifying those witnesses. Ordinarily these are public proceedings and if one is to be presenting oneself as a witness there has to be good reasons for anonymising one's name and those reasons may exist, but that's a matter for the union and the Commission to make. I don't wish to be heard further on that point.

PN171

In relation to the last issue raised by my learned friend, that is, the three experts. As I understand it they wrote two reports, there's a part 1 and a part 2. Part 1 has two authors, part 2 has three authors. It's not apparent to me, and we said this, I think, in correspondence, which person was responsible for which parts, but we needed at least one person available for cross-examination. Now, if one person's not available for cross-examination, bearing in mind that the nature and content of the report is in the form of anonymous individuals providing answers to semi-structured questions then, subject to instructions I may have, our position is that we would object to those reports being tendered, unless someone is provided and made available for cross-examination. I'm open to hearing further suggestions from my learned friend in terms of dealing with the issue.

PN172

Other than those housekeeping issues, I don't wish to open any further. It might be more appropriate that I open after the applicants finish their case. May it please.

PN173

VICE PRESIDENT HATCHER: All right. We might take a short morning tea adjournment then we'll commence with the first witness.

SHORT ADJOURNMENT�� [11.30 AM]

RESUMED�� [11.54 AM]

PN174

VICE PRESIDENT HATCHER: Dr March?

PN175

MR IRVING: Yes, Dr March first. We have a copy of the folder with all of the annexures to provide to the Commission. We've collected together all of the witness statements from our side and all of the annexures in nine folders, unfortunately, for you. I call Dr March.

PN176

THE ASSOCIATE: Could you please state your name and full address?

PN177

DR MARCH: Geoffrey John March, (address supplied).

<GEOFFREY JOHN MARCH, AFFIRMED�� [11.56 AM]

EXAMINATION-IN-CHIEF BY MR IRVING�� [11.56 AM]

PN178

MR IRVING: Could you please state your full name?‑‑‑Geoffrey John March.

PN179

And your occupation?‑‑‑Currently retired.

PN180

And your address?‑‑‑(Address supplied)

PN181

Could you turn to volume 1 of the materials which are in front of you, and if you go behind tab 2, which is about two-thirds of the way through the documents, sorry, tab 1.8, I apologise.

PN182

VICE PRESIDENT HATCHER: My tab 1.8 has a statement of Mary McCallum.

***�� GEOFFREY JOHN MARCH�� XN MR IRVING

PN183

MR IRVING: As does mine.

PN184

VICE PRESIDENT HATCHER: I see, it's behind that one. It's got an annexure label on it for some reason.

PN185

MR IRVING: You have a statement in front of you - - -?‑‑‑I've got one.

PN186

I apologise your Honour. Do you have a copy of your statement, statement of Dr Geoff March, your original statement?‑‑‑I've got the original statement, yes.

PN187

Does the Commission have a copy of that statement?

PN188

VICE PRESIDENT HATCHER: There's two statements behind tab 1.8, the second of which is Dr March's statement of 10 December 2017, although for some reason it's got annexure A1 handwritten on the top.

PN189

MR IRVING: Are the contents of that statement true and correct?‑‑‑Yes.

PN190

I tender that statement.

PN191

VICE PRESIDENT HATCHER: All right. So the statement of Dr Geoffrey March, dated 10 December 2017 will be marked exhibit 1.

EXHIBIT #1 WITNESS STATEMENT OF GEOFFREY MARCH DATED 10/12/2017

PN192

MR IRVING: That is a statement with four annexures, is it, Dr March, your CV, annexure GM1?‑‑‑Yes.

PN193

The next one is the UN Guidelines for Developing Drug Policies?‑‑‑Yes.

PN194

The next one is the National Medicines Policy 2000?‑‑‑Yes.

PN195

The next one is the National Strategy for Quality use of Medicines?‑‑‑Yes.

PN196

Is that commonly called QUM?‑‑‑Yes.

***�� GEOFFREY JOHN MARCH�� XN MR IRVING

PN197

Okay. All right. If I can take you to your next statement - - -

PN198

COMMISSIONER SPENCER: Sorry, there's also a GM5.

PN199

MR IRVING: Sorry, yes, there's a GM5 which is the accreditation standards as at 2014?‑‑‑Yes.

PN200

Finally, there is a reply statement, do you have that in front of you?‑‑‑Yes.

PN201

Could I take you to paragraph 25(a)?‑‑‑Yes.

PN202

And that says that that competency standard is attached, it's not, in fact, attached is it?‑‑‑That's correct.

PN203

So we should delete 25(a). With that change, are the contents of that statement true and correct?‑‑‑Yes.

PN204

Does that have all of the attachments from GM6 through to GM47 attached to it? Perhaps that's an unfair question?‑‑‑I'm just going through them.

PN205

I have no further questions - sorry, I'll need to tender that as well.

PN206

VICE PRESIDENT HATCHER: Yes. So the reply statement of Dr Geoffrey March, dated 30 April 2018, will be marked exhibit 2.

EXHIBIT #2 REPLY STATEMENT OF DR GEOFFREY MARCH DATED 30/04/2018

PN207

MR IRVING: Thank you.

PN208

VICE PRESIDENT HATCHER: Mr Seck?

CROSS-EXAMINATION BY MR SECK�� [12.00 PM]

PN209

MR SECK: Thank you, your Honour. Dr March, I gather from your statement that you ceased practicing as a pharmacist in 1997, that's so?‑‑‑No.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN210

When did you cease as a pharmacist?‑‑‑It would have been last year I handed in my practicing certificate.

PN211

In terms of practicing within a pharmacy environment, when did you - when was the last time you were employed working in a pharmacy?‑‑‑In a community pharmacy? It would have been 1996.

PN212

After 1996 you moved into academia, that's so?‑‑‑That's correct.

PN213

So in terms of the last time you can say you directly worked in a pharmacy environment it would have to be some time in 1996, that's so?‑‑‑Partially. Part of my role at the School of Pharmacy at the University of South Australia was also to look after student placements. So I'd actually go out and visit pharmacies, talk to the pharmacists, assess the progress of students. So I actually was still very much in contact with the profession because I was a lecturer in pharmacy practice and I oversaw the whole student placement program within the school.

PN214

But in terms of the last time you worked in a pharmacy it was 1996?‑‑‑Probably about 1998/99, when we were undertaking the research, which is under the Community Pharmacy Practices Project, when we wanted pharmacists to actually do the work that we wanted them to do, work with patients directly, I would then take over the role of that pharmacy role while they were doing the patient care activities.

PN215

Was that between 1996 and 1998?‑‑‑Partly. It also probably dropped over into the next year as well, so that project was for some time.

PN216

How often would you be working in the pharmacy doing those things?‑‑‑Not a lot. It would have been, at a guess, probably seven or eight times during the year, during that project.

PN217

Now, you also say in your witness statement, Dr March, that you're currently the president of the Professional Pharmacists Australia division of APESMA?‑‑‑That's correct.

PN218

How long have you held that position?‑‑‑Many years now. It would be over 10 years. Sorry, I don't have the particular number, I sort of don't take those stats into account.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN219

That's all right. Given your role, you're not presenting yourself as an independent expert but as someone who's had experience in the pharmacy industry as well as being president of the PPA division of APESMA, that's so?‑‑‑I'm a witness, I'm not sure what you mean by expert, but I can give you my experiences.

PN220

Now, you've referred to, in your first witness statement, your policy reforms that have occurred since the 1980s, and it starts at about paragraph 19?‑‑‑Mm hm.

PN221

Those policy reforms have led to changes in the education of pharmacists, that's correct?‑‑‑I'll listen to your next question but there certainly has been a number of policies we've developed through the leadership of WHO in this area, they thought there was a need for change.

PN222

Over time the need for change, at a policy level, got implemented through the introduction of government policies, competency standards and professional standards within the community pharmacy industry?‑‑‑I think the principal policy driver was the National Reticence Policy.

PN223

Listen to my question, Dr March. So from the 1980s, over time, those policies were implemented by the introduction of competency standards and professional standards, that's right?‑‑‑Those professional standards and competencies occurred after 1998, to the best of my knowledge.

PN224

When you say they occurred after 1998, to the best of your knowledge, have you - you've read through professional standards and competency standards prior to 1998 as well?‑‑‑I actually couldn't find any competency standards prior to 1998.

PN225

You say you weren't able to find competency standards before 1998, I gather from that answer you actually looked for competency standards which existed prior to then?‑‑‑That's right. As I said, I've come across the 2001, which I had in my workplace.

PN226

Can I take you to your second statement, Dr March, which is exhibit 2 in these proceedings, and I want to take you to tab 23?‑‑‑Second statement, tab 23.

PN227

COMMISSIONER SPENCER: Dr March, do you have two folders there?

PN228

MR SECK: If you go to the second folder, sorry?‑‑‑The one in 2, sorry, that's why I couldn't find it.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN229

So I apologise, Dr March, I'm working off a previous version, so it should be tab 23 to your second witness statement and the document is - it's annexure 23 and the document in annexure 23 is the National Competency Standards Framework for Pharmacists in Australia?‑‑‑Mm hm.

PN230

You've seen this document before, that's right?‑‑‑Yes.

PN231

In preparing for these proceedings have you read through the documents annexed to your affidavit?‑‑‑Yes.

PN232

If you go to - you see in the bottom right-hand corner of the document, there are page numbers?‑‑‑Yes.

PN233

I want to ask you to go to appendix 1, which is at page 98?‑‑‑Yes, I see it.

PN234

The appendix is headed Development of National Competency Standards Framework, do you have that?‑‑‑Mm hm.

PN235

Do you recall reading this document as part of your preparation for this case?‑‑‑I must admit, I did not read that section.

PN236

I'll take you through it, but it suggests that there was a National Pharmacy Competency Standards Project, which commenced 1992 to 1994, does that accord with your recollection as a practicing pharmacist, that there was a project around that time period?‑‑‑As a practicing pharmacist, no.

PN237

You'll see, and I won't read it all out, the project commenced in February 1992 and it involved a steering group of about 100 senior members of the profession who attended a conference in Perth in October 1992. Are you a person who attended pharmacy conferences, on a regular basis during that time period?‑‑‑I attended some, but to be honest I can't remember where I went for the few I did.

PN238

Did you, during that time period, keep up to date with professional changes that were occurring in the profession?‑‑‑In '92 I would have - I was working for National Pharmacies, I looked at probably the journal that I followed would be the Australian Pharmacist which was published by the PSA. But, personally, that was probably as far as I'd go at that stage of my career.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN239

Now, if you go down you'll see there's a quotation section, in italics, but above that it talks about a draft document, in December 1993, which was prepared by the steering group, for a presentation at the Australian Pharmacy Conference, do you see that?‑‑‑Yes.

PN240

There's a resolution that's made, which is set out in the italics, and the relevant resolution, the first three paragraphs is in the form of recitals, and I just want to take you to the last paragraph which says:

PN241

This meeting endorses the document Competency Standards for Entry Level Pharmacists in Australia as a satisfactory statement for levels of competence expected of a pharmacist at entry to the practice of pharmacy and recommend that the document, as amended by the conference, be forwarded to the national office of Overseas Skills Recognition and further recommend that the governing bodies of the organisations participating in this steering group of the project and the Australian pharmacy registering authorities be requested to endorse the document.

PN242

Now, were you aware of this competency standard before we just read it here?‑‑‑To my recollection no, I don't, actually.

PN243

Did you do any research to identify whether or not this competency standard existed in 1993?‑‑‑Well, I did look for earlier competency standards but, as I said, the only one I found was the 2000-2001.

PN244

VICE PRESIDENT HATCHER: Mr Seck, I think if you read it, it's February 1994 when the conference adopted it.

PN245

MR SECK: Your Honour's right. So it's February 1994 where it's adopted, so I may have misled you there, Dr March?‑‑‑That's okay.

PN246

So when you did your research, in terms of the competency project, do you recall reading this particular document, the National Competency Standards Framework for Pharmacists in Australia?‑‑‑In what year?

PN247

This document here, which you've got in front of you, 2016?‑‑‑No, 2016? Well, I did read it, but I'm afraid I - obviously I looked at it and it's my mistake.

PN248

So your answer earlier, where you said there were no competency standards in 1998 you acknowledge is incorrect?‑‑‑It is incorrect, based on this.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN249

If you go to the heading below that, it says, First Review of Competency Standards for Entry Level Pharmacists, 1996, I gather you weren't aware of the review process of the 1994 standards?‑‑‑No.

PN250

But you referred earlier, in one of your answers, to the 2001 standards, that's right?‑‑‑That's correct.

PN251

If you go to the top of the page 99, you'll see there's a review of the - the second review of the competency standards, which occurs in November 2000, which commences in November 2000, does that accord with your recollection?‑‑‑Look, it's obviously something I missed, because my recollection was that 2001 was the first one I'd ever read.

PN252

You'll see, in the second paragraph about the third line from the top, it says:

PN253

A number of further revisions are suggested, including a change of title to omit the words "entry level". This is recommended on premise that competency standards required for initial registration are appropriate for maintenance of registration as the pharmacist in any practice context for protection of the public.

PN254

Again, given that you weren't aware of the 1994 competency standards, you weren't aware that there was a change in the title as well?‑‑‑True.

PN255

Okay. So - - -

PN256

VICE PRESIDENT HATCHER: But does it follow from that that the 2001 revision was the first competency standard which applied to pharmacists generally, as distinct from entry level pharmacists?

PN257

MR SECK: I don't think it necessarily follows from that, I think what follows from that is that there was a change in the title, that's the way I read it. Because whilst the premise was that this is the competency standards for entry level pharmacists, it obviously flowed through and applied to all pharmacist because every pharmacist, at one stage, is an entry level. So the way I read it, your Honour, was it was a mere change in the title, but it didn't necessarily mean it didn't apply to other pharmacists beyond an entry level, it just set the minimum standards?‑‑‑Well, the effect of the change appears to be that the standard has to be maintained at all stages following entry to maintain registration, as distinct from something you simply have to meet when you enter.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN258

I think maintain at the time, so after you went you have to maintain it as part of your annual registration requirements. So I don't think it's a one time only standard, as it were, I think it's a standard which has an ongoing operation.

PN259

VICE PRESIDENT HATCHER: From 2001?

PN260

MR SECK: From 2001 but potentially prior to - in 1994. This is one of the issues, your Honour, which I identified beforehand, because we were served with these late it might be we need to look at what existed in 1994 and in 2000 to ascertain whether or not your Honour's point is correct, or whether or not it might have had a more general ambulatory operation to all pharmacists, in spite of its title.

PN261

VICE PRESIDENT HATCHER: All right.

PN262

MR SECK: Now, Dr March, you also emphasise, in your first statement, that there's much more emphasis, after 2000, on "soft skills". Do you remember referring to that in your first statement?‑‑‑Indeed.

PN263

When you refer to "soft skills" you refer to, as one aspect of that, the ability for a pharmacist to communicate and address the needs of the patient or the consumer who comes into a pharmacy, is that so?‑‑‑Yes, it's very important that we address the needs, concerns and understanding of the patient, yes.

PN264

That forms part of an integrated team of medical service providers, including pharmacists, in addressing health concerns of patients, that's right?‑‑‑Yes. The new paradigm required all health workers to work with the consumer to get the best out of the medicines.

PN265

Would you agree that that reflected an evolution to pharmacies becoming sophisticated wellness centres, rather than just simply dispensing or retail outlets?‑‑‑I would disagree with the word - - -

PN266

MR IRVING: Sorry, there's a couple of notions tied up with the same thing. It might be useful to draw out the evolution of what the change was, rather than rolling them together.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN267

MR SECK: I'm grateful to my learned friend, I'll disentangle that. Now, in community pharmacists deploying these soft skills, would you agree that part of that was directed in dealing with the overall health and wellness of the patient?‑‑‑I'll answer it this way. I would say before 1998 we had what I'd call unsophisticated skills in dealing with patients. We were focusing on dispensing, we may or may not give some advice around that and that advice tended to be a repeat of what was on the label, maybe a brief explanation of some advisory labels that were attached to the label and that was about it. With the advent of the National Medicines Policy that whole concept flipped. Before it was about the drug, for a disease state and there was a person involved somewhere. With the advent of the National Medicines Policy, which talked about patient care, a clarative process that involved the patient and the health care team to ensure that the patient gets the best out of the medicines. What we now needed to do was not just simply do almost a one-way conversation to the patient about the label reinforcement we actually now had to have a conversation with the patient to actually work out what was in their best interest, what they wanted out of the whole process. We had to collect some information, we had to assess that information to ensure that the patient wouldn't come to harm and the next steps were in the patient's best interest. We'd sit down then with the patient and actually decide, with their input, about what the best way to go. We'd then give them the necessary skills and tools to be able to undertake that plan and part of that would be around that conversation stuff, giving them details about the medicines and so forth. Then, ideally, unfortunately it doesn't happen very much in community pharmacies at the moment, but actually monitor that patient, to see, in fact, whether the aims of the plan are actually achieved or we need to actually intervene early and contact the GP or some other health professional to ensure they're getting the best out of it. So to be able to have those conversations with the consumer, with other health professionals, the GP, we needed to induce a whole set of new skills. They're called soft skills, but they're incredibly important to the care of a patient.

PN268

When you say it's important to the care of the patient, just to come back to my question again, what you're focusing on is the overall health and wellbeing of the patient and not just simply dispensing the medication?‑‑‑Indeed.

PN269

You say that there was a deliberate change which occurred in 2000, yes?‑‑‑It was certainly - yes, I'd say with the advent of the National Medicines Policy we actually had to - pharmacists had to work differently and we actually had to teach the students how to work in this new paradigm.

PN270

You'd agree that it was something which was also occurring prior to 2000, within the community pharmacy sector, in your experience?‑‑‑Look, in any new policy development it doesn't happen overnight. We had the WHO recommending the rationale use of medicines back in 1987, but it took that long for governments and for policy makers to actually develop a program, a strategy, to address those issues. These sorts of things just don't happen overnight.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN271

When you say they don't happen overnight, you also - you're not talking about the policy being the starting point. The policy is obviously a reflection of what had been evolving within the industry prior to its introduction, would you agree with that?‑‑‑Look, I certainly think there were concerns about where the industry was. I was certainly concerned about the fact that the structure wasn't in place for us to be able to undertake good patient care. It was all designed about dispensing a maximum number of prescriptions in the shortest time. These sorts of services take a longer time to occur. With the advent of the National Medicines Policy that gave all stakeholders in the delivery of pharmaceutical services the opportunity to rethink the way that they were practicing and to implement new approaches.

PN272

Can I ask you, Dr March, to go to your second statement, exhibit 2, and go to annexure 24. It's a document entitled Professional Practice Standards, Evaluation Phase, May 1999.

PN273

VICE PRESIDENT HATCHER: Which document was that one?

PN274

MR SECK: Annexure 24 to your second statement. It's 2.2.24 of your folder, I think the second volume of - - -?‑‑‑Yes, I've got it.

PN275

Got it?‑‑‑Yes.

PN276

Have you read this document beforehand, Dr March?‑‑‑Yes, I have.

PN277

It's a document which has been produced by the Pharmaceutical Society of Australia, in 1999. If you go to the - so they've got page numbers in the centre of the page, they initially start with Roman numerals, so if you go to Roman numeral iv?‑‑‑Yes?

PN278

You'll see it has a preamble there. In answer to one of my previous questions you referred to the initial policy change occurring at a global level, with the World Health Organisation, and you'll see there's a reference to the Tokyo Declaration, in 1993?‑‑‑Mm hm.

PN279

That's subsequently endorsed by the World Health Organisation, in 1997, that's right?‑‑‑Yes.

PN280

That obviously flowed through to a local level, in Australia, after 1997, that's so?‑‑‑Mm hm.

PN281

If you go to the background you'll see there's a reference to the Pharmacy Guild of Australia releasing a set of retail standards, do you see that?‑‑‑Yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN282

Also then, in the second paragraph, below the heading Background, the Australian Association of Consultant Pharmacy releasing a framework for standards and quality pharmacy services, so do you see that?‑‑‑I do.

PN283

So you were aware, in 1997, there was already a framework for standards being established?‑‑‑Mm hm.

PN284

And you'll see below that there, that this was a key part of what the PSA was doing through 1996 and 1997?‑‑‑Yes.

PN285

What this document sets out is, in effect, a valuation of the appropriate practice standards which should apply within the community pharmacy sector, that's right? So this is the start of the process?‑‑‑The start of the process.

PN286

You'll see, from the index, and I'll take you back to it, page iii, back in 1999 eleven areas had been identified as being matters which could be appropriately subject of standards? So page iii, the third page of the document?‑‑‑The standards for clinical and pharmaceutical services?

PN287

Yes. You see there's 11 subject matters?‑‑‑Yes.

PN288

These were the 11 subject matters identified by the PSA as being at least, initially, appropriate for standards to be established, correct?‑‑‑Yes.

PN289

Now, if you go to - I want to the example, I think you talked about soft skills and being able to deal with patients, that might fall under the heading Patient Counselling, heading 4. So if you to page 18, this is not the Roman numbers but the actual numbers. Do you see standard 4?‑‑‑Indeed I do.

PN290

Patient counselling and the dissemination and exchange of medicine information, including the skills required to safely and effectively administer medicine by the pharmacist to the patient and/or their carer. This information provided is directed at achieving safe and appropriate use of medicines and adherence to the prescribed treatment regimen, with the intention of optimising therapeutic outcomes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN291

Now, would that be a fair description of what you described as "soft skills"?‑‑‑No. This still talks about patient counselling. It certainly involves some of those skills, but what this area is still looking at is a conversation with a patient that's based around dispensing, it's talking about, if we look at point 2:

PN292

Is carried out by pharmacists.

PN293

Point 3:

PN294

Is provided according to the needs of the patient.

PN295

So the needs are clarified by the patient or carer and the patient understands it's free to accept the advice, there's privacy, CMI and so forth. What I'm talking about is something far more extensive than this. Yes, pharmacists have always had a (indistinct) about having conversations with patients and this is an important part of that role, but this isn't just about the patient, per se, the pharmacist also has to have skills around discussions with other stakeholders, discussions with GPs, developing a therapeutic relationship, having time to work with patients and so forth. This just relates to the patient counselling component. I mean if we're actually going to look after patients, we're going to need to speak to GPs. One of the things I did in my practice was to actually role play a conversation with a GP. It's not easy. When I was practicing as a pharmacist we rarely spoke to a GP, other than around the correction of an administrative issue with the prescription. So these are new roles that we actually have to teach students.

PN296

VICE PRESIDENT HATCHER: Will that role vary depending upon the type of patient that is - for example, you might have someone with a chronic condition who is regularly receiving the course of medicine, as distinct from somebody who's otherwise healthy, has a one-off illness and just goes to the doctor and gets a one-off prescription?‑‑‑I think it gets back to what the patient needs, in that case. But even so, you still need to have a structured process in place that would actually have a consultation, take a history, work out whether this medication is appropriate for the particular patient and then ensure they actually have the tools to be able to carry out what the doctor plans, if that's appropriate, when they go home and are no longer around a health professional. With a person with chronic illness, it's more of a process of monitoring. And, of course, monitoring itself requires a whole series of different skills and tools as well.

PN297

MR SECK: Dr March, I think, just to unpack a few of the elements of your answer there, because it's quite an extensive answer, I think one of the first elements was you said, "Outside simply the dispensation of the medicine and dealing with a particular patient, but a more general discussion with the patient, in relation to their health outcomes", or words to that - along those lines, would you agree with that?‑‑‑There would certainly need to be a conversation with the patient to check their understanding of why they've come to the pharmacy, what their understanding of the prescription, what the doctor's told them and so forth.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN298

If you go to standard 1, which is Health Promotion, on page 3, would you agree what you've just described falls, in part, within the scope of this standard? Particularly the second, third and fourth paragraphs?‑‑‑Third and fourth paragraphs, which are criteria 1.3 and - - -

PN299

No, no, sorry, go to the - it's my fault. Go to the section under Health Promotion and you'll see that there are four paragraphs underneath that. So just - I don't want to read it out to you but I think what you've just described, in part, falls within the scope of what is health promotion, in standard 1, would you agree?‑‑‑Reading that, it certainly - yes, I would agree that's part of the process. Health promotion tends to have a wider view than just giving information.

PN300

If you go to various criterion, it does talk about more than health information, it's health education, and then participating, developing health promotion skills of individuals in relation to activities. I won't read it all out but there are five criteria which are identified there. So you would agree that the criteria that's identified in 1.1 to 1.5 deals with, more broadly, issues outside of just the pharmacist/patient relationship and potentially deal with healthy people and helping them acquire skills and educating them about the best way of dealing with their health issues?‑‑‑Yes.

PN301

This has been recognised as an issue, at least in 1999, do you see that?‑‑‑Mm hm.

PN302

If you go to page 6, you'll see there's a whole lot of references which are used as the basis for developing these criterion standards and would you agree that there were already competency standards for dealing with health promotion, at least in New South Wales, if you look at reference 5 there?‑‑‑Yes, it's there, competency based standards for health promotion in New South Wales.

PN303

And certainly if you look at 6 and 7 there were discussion papers on how best to achieve this, in 1996 and 1998?‑‑‑Yes, certainly leading up to 1998 there were discussions.

PN304

This would suggest that the issue of health promotion and dealing with a community who don't present with chronic illnesses was an issue which was already identified and, at least, part of some people's pharmacy practices prior to 2000, would you agree with that?‑‑‑As I said earlier, the National Medicines Policy was a culmination of many years of work. What you have here is examples of some of that work.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN305

When you say it's a culmination of many years of that work, it's also the culmination of many pharmacists using these skills and performing these activities within the community pharmacy industry, would you agree with that?‑‑‑I'm not sure whether you could say many or not. I don't have any evidence to say that this was widely practiced in community pharmacy.

PN306

Is your point this, that whilst there was a policy change, which occurred at a national level, in 2000, and that led to further development and refinement of competency standards and professional standards, you cannot say, based on your experience, whether or not in the community pharmacy sector in Australia these were things in fact being done on the ground by pharmacists?‑‑‑I can say neither way whether they were or whether they weren't.

PN307

What you're directing your statement to was the policies which were put in place and the education requirements that followed?‑‑‑Yes.

PN308

Now, go to page 8, which is - sorry, page 7, which is Dispensing, and I think one of your answers to one of my questions earlier is that dispensing represented the old model, the new model focused on, to put it shortly, soft skills. One of the soft skills was take a complete profile and understanding of the health of patients, I think that was one part of the answer that you gave, that's right, Dr March?‑‑‑Continue, yes.

PN309

Now, if you go to - you'll see there's a criterion which is set out at 2.1 onwards, I won't read all that out to you, but if you go to criterion 2.2 it says:

PN310

The patients medication history is updated on dispensing.

PN311

Do you see that?‑‑‑I do.

PN312

There is a footnote at the bottom, G2, which says:

PN313

The pharmacist should record medical conditions.

PN314

Then, in the second paragraph:

PN315

The pharmacist is encouraged, whenever possible, to record all medicines that the patient is taking, including prescription and non-prescription medicines. A complete profile is useful in determining the appropriateness of the current prescription and monitoring adverse drug reactions and drug interactions.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN316

Do you see that?‑‑‑I see that.

PN317

That would certainly fall within what you described earlier, would you agree, Dr March, that part of the soft skills which pharmacists have been using includes obtaining a complete health profile if patients?‑‑‑Can I point out something?

PN318

You can do it later, but answer my question?‑‑‑Okay. Your question is, sorry, I wasn't sure what the question was.

PN319

I'll put it again, and listen carefully?‑‑‑Thank you.

PN320

Would you agree that one of the soft skills, which you identified earlier, was taking a complete health profile of the patient in order to determine their current prescription and monitoring their particular drug reaction and interactions, that was one of the soft skills you identified earlier?‑‑‑Yes.

PN321

And you accept that this document, the Professional Practice Standards Evaluation Phase, indicates that this is something already being encouraged, prior to the National Medicines Policy being introduced?‑‑‑I'm still not sure what the question is.

PN322

I'll ask it again?‑‑‑Thank you.

PN323

You accept, from reading this document, given that it was produced in May 1999, that pharmacists were already being encouraged to take the health profiles of patients, prior to the introduction of the National Medicines Policy?‑‑‑I understand. What this particular criterion talks about is taking a medicines history, it's not a complete history.

PN324

Go to page 12 - - -

PN325

VICE PRESIDENT HATCHER: Just so I understand it, your distinction is between a medical history and a medication history?‑‑‑Yes.

PN326

MR SECK: When you say a medical history, Dr March, what you're talking about is more just than the medications being taken by the particular patient, but their overall health history, would that be correct?‑‑‑Yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN327

Now, go to page 12 and you'll see, and it's going to be repeated in relation to each of the standards, that the standards, again, were based on, you'll see the bottom, half-way down the page, references:

PN328

Guidelines and instructions and pharmacy standards which existed prior to 1999.

PN329

Do you see that?‑‑‑I see a number of dates there prior to 1999, yes.

PN330

If you go to, for example, number 5, it talks about pharmacy - it says:

PN331

PGA, Quality Care Pharmacy Program, Pharmacy Standards, Professional Services Section 1998.

PN332

Do you see that?‑‑‑Mm hm.

PN333

So that would tend to suggest that there were Quality Care Pharmacy Program Professional Pharmacy Standards existed in 1998, do you agree?‑‑‑Without seeing what exactly those standards are, I'm not quite sure.

PN334

I think you said, in relation to competency standards, beforehand, that you didn't think that any existed prior to 2001, did you research the existence of professional standards which existed prior to 2000, in preparing your witness statement?‑‑‑I looked at the professional standards established by the professional body, the PSA.

PN335

Did you look at professional standards which were prepared by registration bodies?‑‑‑Yes, the Pharmacy Boards.

PN336

Did you look at professional standards prepared by the PGA?‑‑‑No, I did not.

PN337

Okay. Now, looking at - let's use your example of the PSA, you'll see that there are, in number 1, Dispensing Practice Guidelines, in the form of the Australian Pharmaceutical Formulary and Handbook 1997?‑‑‑Yes.

PN338

You're familiar with that document?‑‑‑I'm familiar with the AMH, yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN339

So when you describe it as the AMH, you - - -?‑‑‑Sorry, Australian - APF, sorry, I meant the APF.

PN340

So you meant the APFH?‑‑‑Yes.

PN341

VICE PRESIDENT HATCHER: So what number are you on now?

PN342

MR SECK: Number 1, your Honour. So you see that was made in 1997, so you're familiar with that document?‑‑‑I have used it, but I have not looked at it recently.

PN343

That contains practice guidelines for how pharmacists are to deal with the dispensing of medication, that's right?‑‑‑Yes, APF covers that.

PN344

To use another PSA document, go to number 3, Pharmaceutical Society of Australia Instructions for Dispensing Medicines, you're familiar with those instructions?‑‑‑The Australian Pharmaceutical Formula Handbook 16th edition.

PN345

Yes. The fact that this is the 16th edition tells me that, and tell me if I'm wrong, there've been many editions of the handbook that go back many years, predating 1997?‑‑‑The APF has been a long established tool for practicing pharmacists.

PN346

When you say it's a tool for practicing pharmacists, it's something which establishes guidelines and instructions for all pharmacists as to how to deal with particular issues in the dispensing of medicines, that's right?‑‑‑It's a reference document, yes.

PN347

Now, if you go to number 4, it says a reference to the Society of Hospital Pharmacists of Australia, now hospital pharmacists are obviously a different group of people to community pharmacists, but would the standard of practice for the safe handling of particular drugs in pharmacy departments be a document to which you would refer, as a community pharmacist?‑‑‑No. So the toxic drugs, the cancer drugs, you would have to be a specialist in that area to actually dispense cancer drugs outside the drugs like methotrexate, which are available on a prescription, as a regular one. Most of the cytotoxic these days are done either in a private hospital, public hospital or a specialist community pharmacy. So as a practitioning pharmacist before then I've never actually been involved in cytotoxic drugs.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN348

Now, I'm not going to go through every particular standard, but I just want to take you through one or two more. If you go to standard 7, Dr March, which is page 38, you'll see this one relates to Comprehensive Medication Review, do you see that?‑‑‑Mm hm.

PN349

It's described as:

PN350

A systematic evaluation of a resident's/patient's complete medication treatment regimen, in the context of other clinical information and the resident's/patient's health status.

PN351

Now, just pausing there, do you agree that suggests that in order to conduct that systematic evaluation of the appropriate medication regimen, this document suggests that hit has to be done in the context of understanding the broader health issues relating to the patient, that's right?‑‑‑Yes.

PN352

And that falls within the scope of the soft skills which you were describing previously, is that correct?‑‑‑Indeed.

PN353

Then it goes on to say:

PN354

It is a process which is conducted with the resident/patient, in collaboration with other members of the health care team and involves communication of and following up on findings and recommendations.

PN355

Now, in answer to one of my previous questions, Dr March, you said part of the soft skills is being able to communicate and deal with other health care providers in providing an overall health assessment to patients. You'd agree this standard, or this draft standard, suggests that this is already a process which is occurring, as part of a comprehensive medical review?‑‑‑It would be part of a comprehensive medication review, yes. I'm not sure if it actually started then, but it would form part of it.

PN356

But it would certainly suggest that this was something which was occurring prior to the introduction of the National Medicines Policy, do you agree?‑‑‑I think the documentation was there, prior to the start of the National Medicines Policy.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN357

When you say the documentation's there, are you hesitating accepting that at least some pharmacists may have been doing this prior to the introduction of the policy, in 2000?‑‑‑During the 1990s there was several attempts pharmacists providing these sorts of services. They were unstructured and unfunded. It wasn't until we actually got funding that these services were then able to be provided in a regular and sustained basis.

PN358

So is your suggestion, Dr March, is that whilst it was done in an unstructured way, it was done in a much more structured way once the funding was provided to conduct comprehensive medication reviews?‑‑‑Yes.

PN359

When you say it was done in an unstructured way, that would suggest to me that you think some or even many pharmacists may have been doing it, you're just not in a position to say yes or no, that that was, in fact, occurring?‑‑‑No, I can't answer that.

PN360

If you go to page - - -

PN361

VICE PRESIDENT HATCHER: Before you move on, so this comprehensive medication review, that's something that's not done every time you dispense medicine but on certain intervals, is that the idea?‑‑‑That's right. This process came out of the research that I undertook around these sorts of programs and we came up with this style of practice, with these associated standards. So we undertook that, informed the pharmacy community about how we could actually undertake this and the sorts of standards we needed. This is the start of the whole process, yes.

PN362

Does that suggest that it's mainly aimed at people with chronic illnesses?‑‑‑It's mainly people at high risk of medication misadventure. So the initial focus of this was at residential aged care facilities where you have the orderly who are taking lots of medications and, to be honest, in those days they were not well looked after, and we had actually had some evidence about the level of medication misadventure in the older population, and, in fact, that was why the RMMR program was first funded. It was then, after a process of going through various committees, that the Home Medicines Review was eventually funded. Again, for that, there was a high risk requirement for people to be eligible for the Home Medicines Review. So that is correct, these sorts of standards were the beginning of that whole process, yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN363

MR SECK: You say these sorts of standards were the beginning of the whole process, but these standards are, in effect, formalising what appear to be recognised as best practice within the pharmacy industry, would you agree with that?‑‑‑I still think there was a weakness in these standards which needs - which came out in further development, and that was the process of monitoring. Out of our research we had a structured approach to caring of patients, one was to have a therapeutic relationship, collect information, assess that information, care, plan, educate and find the skills. But the last and the most important step was to monitor, because unless we actually didn't find out what the outcomes of this whole plan was, you know, patients could end up worse. So if the outcomes were negative what we needed to do was to actually intervene early. So these standards are fine as they are, but without that final stage, which came later, unless we follow up we don't know what's going on.

PN364

VICE PRESIDENT HATCHER: I think the question was, did this document attempt to standardise what was seen at the time as pharmacist best practice?‑‑‑Yes.

PN365

MR SECK: That would suggest that there were some pharmacists operating at the standard best practice but not necessarily everyone, would you agree with that, Dr March?‑‑‑There may be some, yes.

PN366

If you go to page 43, again you'll see there are references for the creation of this particular standard and there's a reference to the guidelines for comprehensive medication reviews in the APFMH, in number 1, do you see that?‑‑‑Yes.

PN367

From 1997?‑‑‑Yes.

PN368

So you would agree that this is something which the PSA had already been providing guidance on, prior to the creation or the development of the standards, at least in 1997?‑‑‑Yes, that's certainly looking at it, 1997.

PN369

You'll see, in number 2, there's Draft Principles and Criteria for the Conduction of Medication Reviews, unpublished 1998. Now, I gather from that, it wasn't published officially, are you aware of that document, Dr March?‑‑‑No, I wasn't part of the PSA.

PN370

Right. Now, if you go to standard 8, starting at page 44, you see this refers to one aspect of the soft skills you were referring to previously, that is:

PN371

Patient Centred Outcomes Oriented Pharmacy Practice that requires the pharmacist to work in concert with the patient and the patient's other health care providers, to promote health, prevent disease and to assess, monitor, initiate and modify medication use to ensure that drug therapy regimes are safe and effective. The goal of the CPC is to optimise the patient's health related quality of life and achieve positive clinical outcomes within realistic economic expenditures.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN372

Now, that seems to suggest that this standard was directed not to chronic illnesses or patients with health care issues at the time, but to deal with more general issues of promoting health and preventing disease of healthy people, would you agree?‑‑‑It was actually focused towards people who may be at risk of misadventure.

PN373

It would seem to suggest that it's focused on patients other health care providers to promote health, which means they may or may not have health issues at the time, would you agree?‑‑‑Again, that's part of the caring for the patient, yes.

PN374

Again, if we go to page 48, go to Additional Information, on the top, it says:

PN375

The goal of CPC are to resolve existing problems and attempt to anticipate potential problems. Achieving the goals of CPC requires establishment of a new type of relationship, a "therapeutic" relationship between the pharmacist and the patient or patient's carer.

PN376

Now, would you agree that suggests that that confirms the answer or the question I just put to you, or proposition I just put to you that it's dealing with existing problems and anticipating potential problems?‑‑‑Yes.

PN377

DEPUTY PRESIDENT DEAN: Mr Seck, isn't it all in the context of medication? That's how I'm reading this.

PN378

MR SECK: I think at least part of it is to do with medication, Deputy President, so I think medication is probably more dealt with under standard 7, which is the Comprehensive Medication Review.

PN379

DEPUTY PRESIDENT DEAN: But even 8, if you look at the standard, the (indistinct) on page 44, it's talking about:

PN380

The interaction for the purposes of evaluating, managing and monitoring medications.

PN381

Isn't it just all about drugs?

PN382

MR SECK: Which part are you reading from, Deputy President?

PN383

DEPUTY PRESIDENT DEAN: So on page 44, the standard, in bold in the middle:

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN384

Pharmacist instruct your approach to evaluate manage and monitor medications.

PN385

Isn't really all of this just about medications? I have to say, I struggle with the concept of using health and wellbeing in the same sentence as medications, but anyway.

PN386

MR SECK: It's hard to know, only because - the reason I hesitate in saying yes or no to that is because it really depends on the deployment of the commas. The way I read it was to promote health and to prevent disease, because there's a comma after "prevent disease" and then:

PN387

To assess, monitor, initiate and modify medication use.

PN388

Is the last part of the sentence. I would read that, and I'm not saying this is the only way of reading it, Deputy President, is that promoting health, preventing disease and then assessing, monitoring, initiating and modifying the medication are three separate issues.

PN389

DEPUTY PRESIDENT DEAN: Sorry, are you reading the definition or are you reading the bit under Standards, the bold paragraph?

PN390

MR SECK: I'm reading the definition.

PN391

VICE PRESIDENT HATCHER: You might be reading something differently. It's the standard itself.

PN392

MR SECK: The standard itself, pardon me. I accept that's probably the way of reading the standard itself, but I think the standard itself needs to be read in the context of the comprehensive pharmaceutical care definition and the fact that part of what you've just raised, Deputy President, would be addressed in the Comprehensive Medication Review. So I think a fairer way of reading that particular paragraph is to talk about health issues more generally, because that seems to be confirmed in the additional note, which talks about anticipating potential problems, which I think supposes a premise that someone is healthy and there may be problems in the future. But I understand the point you've raised, Deputy President, that's certainly one way of reading that particular standard.

PN393

I note the time, I probably have one more question just relating to this standard, your Honour, and I'll finish. Dr March, if you could go back to page 48?‑‑‑Yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN394

Just go back to Additional Information, number 1, after the first sentence, which I already read out to you, it talks about the relationship moving beyond traditional patient counselling related to a specific drug product, and that it requires building a cooperative network of particular practitioners, again that would confirm that this standard is directed toward the soft skills which you described in your statement, do you agree?‑‑‑Yes.

PN395

Again, looking at the references on page 48, do you accept that the basis upon which the standards appear to have been prepared are based on principles and standards which existed from at least 1996?‑‑‑Yes, I would agree with that.

PN396

No further questions at this point.

PN397

VICE PRESIDENT HATCHER: All right, we'll adjourn now and we'll resume at 2 o'clock.

<THE WITNESS WITHDREW�� [1.01 PM]

LUNCHEON ADJOURNMENT�� [1.01 PM]

RESUMED�� [2.05 PM]

<GEOFFREY JOHN MARCH, RECALLED�� [2.05 PM]

CROSS-EXAMINATION BY MR SECK, CONTINUING�� [2.05 PM]

PN398

VICE PRESIDENT HATCHER: Yes, Mr Seck?

PN399

MR SECK: Thank you. Before lunch, Dr March, I was taking you through the Professional Practice Standards Evaluation Phase, May 1999, which is annexure 24 to your second statement, exhibit 2. I want to just go back there, quickly, to standard 3, which is at page 13, which deals with Dose Administration Aids?‑‑‑Yes.

PN400

Are you there?‑‑‑Yes.

PN401

You understand that one of the bases upon which APESMA advanced a claim for increase in work value is the fact that pharmacists now undertake dose administration aid for, prepare dose administration aids, I should say, that's correct?‑‑‑That's one of the services that pharmacists provide, yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN402

But you understand that's one of the grounds upon which APESMA advances its application for an increase in wages, based on work value?‑‑‑Yes, my understanding is a range of services of which DAA is one of those services.

PN403

You acknowledge that when you look at this document that DAAs were services that were prepared by at least some members of the profession, as of May 1999?‑‑‑Yes.

PN404

And if you go to page 17, there's a reference, again, to the final report of the University of South Australia, do you see that?‑‑‑Yes.

PN405

Now, as I understand it, you're - - -

PN406

VICE PRESIDENT HATCHER: What annexure are you looking at?

PN407

MR SECK: Pardon me, your Honour?

PN408

VICE PRESIDENT HATCHER: What annexures - - -

PN409

MR SECK: I'm sorry, your Honour, I'm just checking one thing. You were a lecturer at the University of South Australia, until recently?‑‑‑That is correct.

PN410

So are you - - -

PN411

VICE PRESIDENT HATCHER: What annexure are you looking at?

PN412

MR SECK: Sorry, pardon me, your Honour. Annexure 24, page 17, sorry, your Honour. Sorry, your Honour, I've just taken Dr March to page 13, which is standard 3 and I am now at page 17, which is the reference. You work within the School of Pharmacy and Medical Sciences, that's so?‑‑‑That's correct.

PN413

I think you were employed there in 1997?‑‑‑Yes.

PN414

You weren't involved in the progression of the Dose Administration Aids final report?‑‑‑No, I wasn't.

PN415

Are you aware of the report?‑‑‑I hadn't seen the report, no.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN416

This is the first time you've seen reference to it?‑‑‑Yes.

PN417

If you go to, backwards in your affidavit, tab 19, you should have a document which is titled Guidelines and Standards Requirements Dose Administration Aid Service, by the PSA, July 2007?‑‑‑Yes.

PN418

Now, again, if you go to, I'm using the page numbers in the bottom right-hand corner, go to page 3 of the document?‑‑‑Which document? Sorry, I missed the document.

PN419

Sorry, tab 19, or annexure 19. Do you have that, go to page 3?‑‑‑Yes.

PN420

Go to page 2, initially. It says it's endorsed in July 2007, in the bottom right-hand corner, do you see that?‑‑‑Yes.

PN421

If you go to page 3, it refers to a review of guidelines endorsed in 1999, do you see at the top left-hand side?‑‑‑Yes.

PN422

Were you aware that there were guidelines in 1999?‑‑‑Not till I read these, no.

PN423

Now, you would acknowledge this, Dr March, that in relation to Dose Administration Aid Services, the fact that there were guidelines which were in existence in 1999 and there were reference to that University of South Australia report, to which I took you earlier, that there must have been some pharmacists providing DAAs as of 1998?‑‑‑Yes.

PN424

What this indicates, does it not, Dr March, is that where there are standards that exist, in relation to particular areas of practice, they're indicative of the fact that there was, at least amongst some pharmacists, and existing practice and what was sought to be done was to establish guidelines or standards so that pharmacists working within the industry could work towards meeting those particular standards or guidelines, that's right?‑‑‑Yes.

PN425

Many of those practices may have existed prior to 1998?‑‑‑I can't answer that, because I haven't seen any research on who was providing services or not.

PN426

You can only talk from your own experience?‑‑‑Sure, yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN427

Now, if you go to another example, tab 15, or I should say annexure 15, one of the guidelines you've included here is guidelines - - -?‑‑‑Sorry, this is?

PN428

Sorry, Guidelines for Pharmacists on Providing Medicines Information, at page - - -?‑‑‑I just wanted to make sure I've got the right one.

PN429

That's all right. You'll see what it talks about is, this is in the first paragraph:

PN430

These guidelines are to help optimise communication about medicines and their use, between pharmacists and patients. They reflect good pharmacy practice and relevant legal considerations.

PN431

Do you see that?‑‑‑Mm hm.

PN432

So that deals with some of the soft skills you were talking about beforehand, in optimising communication between patients and pharmacists, that's right? Dr March?‑‑‑Sorry, I'm just reading it again, to be clear. Yes.

PN433

This document, if you go to the back, was prepared in 1996, if you go to the back page?‑‑‑Yes. Was that a question, sorry?

PN434

That's all right?‑‑‑I wasn't sure.

PN435

I'm putting propositions to you, but I can put them as questions?‑‑‑Thank you.

PN436

Go to the last page and you'll see it says it's endorsed by National Council, July 1996, yes?‑‑‑Yes, I can see that.

PN437

When you were practicing as a pharmacists were you aware of these particular guidelines?‑‑‑1996? To be honest, no, thinking back.

PN438

Now, did you read this document in preparing for the hearing?‑‑‑Yes.

PN439

If you go to page, I'm using the page numbers in the top left-hand corner, page 40?‑‑‑Yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN440

You'll see that this comes from the Pharmacy Practice Handbook 2000?‑‑‑Mm hm.

PN441

So the Pharmacy Practice Handbook 2000, as I understand it, that's not dissimilar to the handbook that we referred to earlier, is that right?‑‑‑Yes.

PN442

That's right?‑‑‑Yes.

PN443

If you go to the third paragraph, on the left-hand side, it says:

PN444

These guidelines do not change the law nor do they set a mandatory standard. Rather, they reflect prevailing community expectations and the pharmacists existing common law responsibility always to take reasonable care.

PN445

So do you accept that in these particular guidelines, at least this one here, is reflective of community expectations and legal responsibilities that exist at the time?‑‑‑Yes, I think pharmacists were required to ensure that they were working to the laws of the land.

PN446

I want to now deal with code of ethics, I think that's another part which you refer to in your affidavit, or your statement?‑‑‑Mm hm.

PN447

Go to annexure 26. Now, one of the points you make in your second statement, Dr March, is that increasingly there are professional standards and ethical obligations placed upon practitioners, which are more complicated than what previously existed, do you accept that?‑‑‑Yes.

PN448

You'll see here, under tab 26, that there is code of professional conduct, which applies or which has been adapted from the Royal Pharmaceutical Society of Great Britain, by the PSA, that's right?‑‑‑Yes.

PN449

Now, at the time you were practicing you would have been aware of the code of professional conduct, that's right?‑‑‑Up until - - -

PN450

Up until when you ceased, which was, I think, 1997, according to your evidence?‑‑‑Yes.

PN451

You'll see this particular code of conduct, at the top, says 1998, yes?‑‑‑Yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN452

Now, that code of professional conduct was not a legal document but was a document that had been promulgated by the PSA as part of self-regulation of the profession, that's right?‑‑‑Yes.

PN453

Now, if you go to the next document, which is annexure 27, it's headed Code of Ethics for Pharmacists, and were you present in the room at the time of the opening given by your counsel?‑‑‑Yes, I was.

PN454

And you would have heard a reference of Mr Irving to the code of ethics being required to be complied with, as part of being able to be registered for the PBS, that's right?‑‑‑I presume he said that. I may have not heard, but - - -

PN455

Tell me if you didn't hear it?‑‑‑I'm not sure.

PN456

Is that your understanding?‑‑‑What's that?

PN457

That in order for a pharmacist to be registered for the purposes of the Pharmaceutical Benefits Scheme, and receiving benefits under that scheme, it is necessary, amongst other things, for a pharmacy owner to comply with the code of ethics, that's right?‑‑‑I'm actually not sure. There are a number of things that the government requires and the board requires of owners.

PN458

That's all right. If you go to page 2 of the document?‑‑‑Two?

PN459

Yes. You'll see the background there refers back to the code of professional conduct from 1998?‑‑‑Yes.

PN460

What this document represents, in 2011, is a revision of what existed in 1998, yes?‑‑‑Yes.

PN461

To the best of your knowledge, prior to 1998 there were previous codes of ethics which regulated professional conduct of pharmacists, that's so?‑‑‑To be honest, no I'm not sure that there were previous ones, I could be wrong.

PN462

So you practiced as a pharmacist from 1977?‑‑‑'77, yes.

PN463

To 1997?‑‑‑Indeed. But you say, in paragraph 14 of your first statement:

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN464

In 1976, when I commenced practice within the pharmacy profession I was ethically prevented from discussing or describing medication of the patients.

PN465

Now, you refer to an ethical obligation there?‑‑‑Yes.

PN466

Do you recall whether or not that was sourced in a code of ethics?‑‑‑Back when I was young. I was certainly told by my preceptor, or my fellow pharmacist that that was true. In those days we didn't really look at those sorts of things, we were tended to be guided by who our senior pharmacist was.

PN467

But you certainly understood that pharmacists acted in accordance with an ethical set of standards?‑‑‑Some sort, yes.

PN468

And it may have been formalised, it may not have been formalised, basically?‑‑‑No.

PN469

But if there were code of ethics which had been developed and how applied to pharmacists, you would say that's a continuation of what had applied to you, albeit in written form?‑‑‑There's no doubt that that would be true. A code of ethics is developed over a period of time.

PN470

So when you say, in paragraph 10 of your second statement:

PN471

The vast number detailing complexity of post 2000 standard guidelines are detailed in the annexures.

PN472

What you are seeking to say there, or to convey there, was because standards, guidelines and ethics in practice after 2000 had become vaster in number or more detailed and complex, there had been an increase in work value, in the work performed by pharmacists, is that so?‑‑‑After 1998, yes.

PN473

What I want to put to you is that standards, guidelines and ethics had, in fact, existed prior to 2000, whether in writing or as commonly understood within the profession, and what has simply been done, after 2000, is to formalise that in written form. Would you agree with that proposition?‑‑‑Well, certainly there were standards and guidelines beforehand, but they were being developed over a period of time, yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN474

And over a period of time includes prior to 2000?‑‑‑Yes, certainly towards the late 1990s there was a lot of work being done.

PN475

Now, when you were at university and after you commenced practice, Dr March, would you agree that one of the fundamental, in fact, the fundamental aspect of being a pharmacist was advising and dispensing medication in a safe and judicious way?‑‑‑When I first went to the university, is that the timeframe?

PN476

After you finished university and when you first started?‑‑‑Back in the 70s, you're talking about?

PN477

Back in the 70s?‑‑‑So say that again, sorry, I was just trying to - - -

PN478

So the most fundamental part of your job was the giving advice and dispensing medication in a safe and judicious way?‑‑‑This is in the 1970s?

PN479

Mm?‑‑‑No.

PN480

So you say you weren't dispensing and advising about the safe and judicious use of medicines?‑‑‑I was certainly dispensing. In those days you rarely spoke to the patient.

PN481

When you say you rarely spoke to the patient, that reflects your own experience?‑‑‑Well, that plus the pharmacist I worked with, yes. But I'm the witness, you're talking about me, yes.

PN482

Would you agree that there would be times when medication was prescribed and you provided the medication to the patient, you would provide some additional information about its safe usage?‑‑‑Very, very rarely. Most of the time we'd be referring the person back to the GP.

PN483

Now, there's - would you also agree that one of the things which has emerged during your time as a practicing pharmacist, prior to 1997, both the dispensing of prescription medicines and the supply of over the counter medication?‑‑‑Sorry, what was the question?

PN484

Would you agree that during the time that you were practicing as a pharmacist two things which you did, or two things which emerged - sorry, two things that you did was the dispensation of prescription medicines, as well as the supply of over the counter medicine?‑‑‑Yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN485

Part of supplying over the counter medicine involved you ensuring that the control and availability of those medicines was regulated to ensure the protection of the public health and safety?‑‑‑That's the reason for the scheduling of medicines, yes.

PN486

The scheduling of medicines you're referring to, you're talking about the schedules contained in the Poisons Standard, that's so?‑‑‑Yes.

PN487

The Poisons Standard has a number of categories, but can I talk about the three major categories, medicine which is prescribed by medical practitioners, pharmacy only medicines and pharmacist prescribed medicines, do you agree that's the three general categories?‑‑‑Yes.

PN488

In determining the appropriate medication regime, during your time as a practicing pharmacist, you would need to assess the appropriate medication to offer the patient, would you agree with that?‑‑‑We'd have a pretty simple conversation, ask what the problem is, provide something.

PN489

So when you say you have a simple conversation you would obviously have to identify the particular health issues of the patient?‑‑‑That's right, you'd ask what's wrong.

PN490

And you would need to identify the duration of the symptoms, the severity of the symptoms?‑‑‑Yes.

PN491

And you would have to ask a whole series of other questions to ascertain the appropriate schedule of medicine, which might be provided to the patient, that's right?‑‑‑Well, to be honest, we probably ask those three questions and made a decision from that, in those days.

PN492

But in the context of that, you would also have to assess the particular health condition of the individual, such as whether or not they had other ailments or were taking other medications at the time?‑‑‑Yes, we may have asked that, we may not have. It just depended on the person and, to be honest, whether we were busy or not.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN493

When you say, "Dependent on the person", that means the amount of information is going to differ from individual to individual and the communication and conversation that you would have had, as a pharmacist, with a patient, would vary, depending on the circumstances?‑‑‑But in those days it would have varied very little. I know it sounds pretty terrible, but the quality of the interactions in those days is certainly nothing like they are today.

PN494

Of course, you're speaking about your own personal experience, Dr March?‑‑‑Yes, of course. I'll put my hand up.

PN495

In determining whether or not you should be advising on the use of a pharmacy only medicine or an over the counter medicine or a medicine which is only available by prescription, you have to engage in a triaging exercise, to a certain degree, would you agree?‑‑‑Well, prescription medicines, we received a script and dispensed it. In those days you rarely ever spoke to a patient, unless to qualify some sort of administrative requirement on the script, like their address.

PN496

What I want to put to you is that what you're seeking to do, Dr March, is underplay the nature and content of the communication which occurred between you and a patient when, in reality, the conversations you had, back in the 1990s, was not dissimilar to the soft skills which you described in your affidavit, do you agree?‑‑‑No.

PN497

I want to ask you questions about collective bargaining. In your reply statement, Dr March, you refer to your experience in dealing with collective bargaining in paragraphs 13 to 22?‑‑‑Yes, I've got them.

PN498

You're speaking in your capacity here as the president of the Professional Pharmacists Australia division of APESMA. That's right?‑‑‑I must admit I understood I was a witness in the case.

PN499

Let me ask the question a different way. Your knowledge about collective bargaining in the Australian community pharmacy sector, is that derived from your role as president of the PPA division of APESMA?‑‑‑Of course, yes.

PN500

As president of the PPA division, you would be responsible for devising strategies for advancing the industrial conditions of your members. That's right?‑‑‑We would certainly work with the staff to work on these issues, yes.

PN501

You have set out here that collective bargaining effectively is dead in the sector but for the collective agreement entered into between National Pharmacies and its employees. That's right?‑‑‑That's correct.

PN502

As part of your role as president, has APESMA sought to enter into collective bargaining negotiations with employers or groups of employers in the community pharmacy sector?‑‑‑We had had off‑the‑record discussions with Chemist Warehouse and that got nowhere.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN503

Have you had any other discussions with any other employer or sought to have discussions with any other employer to the best of your knowledge?‑‑‑Look, I'm unsure on that. I'd have to defer to our senior industrial staff.

PN504

As president, I'm assuming you're involved in conceiving the industrial strategy?‑‑‑Certainly we've talked about trying to get more enterprise agreements, but the industrial staff tell us that they haven't been able to get anywhere with them.

PN505

Right. Now, I'm going to read a document that's on your web site - that is, the APESMA web site - and this is a statement from one of the officers of APESMA, Mr Yap. He says:

PN506

I believe that PPA is the only pharmacy organisation that truly represents the interests of non‑owner pharmacists and I learned quickly that they already have runs on the board when it comes to negotiating fair wage agreements with some pharmacy groups.

PN507

I will tender that shortly, but that's a document which is on your web site from Mr Yap, who is giving evidence in these proceedings. When Mr Yap says here APESMA "have runs on the board when it comes to negotiating fair wage agreements with some pharmacy groups", I gather from your evidence he is only talking about one group, which is National Pharmacies?‑‑‑We did have an enterprise agreement with another group who aren't community pharmacies; that's Hospital Pharmacy Services.

PN508

To the best of your knowledge, they are the only two collective agreements which are in place between APESMA and community pharmacies?‑‑‑To the best of my knowledge, yes.

PN509

To the best of your knowledge, there has only been one other attempt to have discussions with a pharmacy group outside those two employers; that is Chemist Warehouse?‑‑‑Yes.

PN510

If one was to develop a collective bargaining strategy, one would at least work out whether or not employers are willing to entertain having enterprise agreements with their employees. Would you agree with that?‑‑‑I'm sorry, I'm not an expert in this area, but my understanding is because the pharmacies are owned by small groups, they're disparate, it's hard under the current enterprise agreements to actually organise them, but I've been given that advice. I'm not a lawyer in this area.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN511

It seems to me what you're saying is not a legal answer, but an answer that the practicalities of negotiating an enterprise agreement may be more difficult because employers are small businesses and the resources and time necessary to negotiate an enterprise agreement would be disproportionate to the number of employees who might benefit?‑‑‑I didn't say that.

PN512

Were you posing a legal barrier or were you posing a practical barrier to APESMA negotiating enterprise agreements with employers?‑‑‑Again, I find it difficult to answer this because I'm not an industrial expert. I go by advice from the industrial officers. They tell me they tried, but it's very difficult because of the structure of the system we're working in. Should I say rather than tried, considered. I'll be honest.

PN513

No further questions.

PN514

VICE PRESIDENT HATCHER: Any re‑examination, Mr Irving?

PN515

MR SECK: There is probably one more document I need to show. I was just reminded by Ms Knowles.

PN516

In your second statement, Dr March, you recall that Mr Irving asked you at paragraph 25 to cross out paragraph (a). You see that, which is the national competency standards - sorry, the Competency Standards for Pharmacists in Australia 2001 document. Do you recall that?‑‑‑(No audible reply)

PN517

I've spoken to Mr Irving. We've managed to identify a copy of the competency standards in 2001, so I'm going to show it to you just to get you to identify it. Might I provide a copy to the witness?‑‑‑Yes.

PN518

Now, I gather when you prepared your statement you didn't have this document in front of you - - -?‑‑‑No.

PN519

- - - and there was a mistake. Now, I've shown you a document which is entitled "Competency standards for pharmacists in Australia October 2001". Can you just look at it quickly and satisfy yourself that is the document to which you were referring in paragraph 25(a) of exhibit 2?‑‑‑Yes, that's it.

PN520

Can you go just quickly - we'll make copies, your Honour, and I apologise; this is the only copy we have.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN521

Go to page 4?‑‑‑Okay.

PN522

Again, this is a section dealing with the history of competency standards. You will recall I asked you some questions about the shift from the 1994 competency standards which were entitled "Competency standards for entry level pharmacists in Australia" to the 2001 competency standards. Do you recall those questions?‑‑‑Yes.

PN523

If you go to the second paragraph, it says in the third line - I'll read it out to you and for the benefit of the bench:

PN524

A number of further revisions were suggested -

PN525

and this is to the 1994 standard -

PN526

including a change of title to omit the words "entry level". This was recommended on the premise that competency standards required for initial registration are appropriate for maintenance of registration as a pharmacist in any practice context for protection of the public. This change was considered to be consistent with moving toward the implementation of recommendation 18 at the final report of the National Competition Policy Review of Pharmacy legislation, the Wilkinson report.

PN527

Those words are contained in the report which I've just read out?‑‑‑Sorry, whereabouts were they?

PN528

Pardon me. About the second paragraph under the heading 2001 Second Review?‑‑‑Right, sorry.

PN529

Just read the second paragraph?‑‑‑Thanks.

PN530

MR IRVING: If it speeds things up, we're happy to concede that whatever is written in the second paragraph is in fact written in the second paragraph?‑‑‑Yes, it is written.

PN531

MR SECK: Does that reflect your, again, understanding of what happened in 2001?‑‑‑Yes.

***�� GEOFFREY JOHN MARCH�� XXN MR SECK

PN532

I tender the document?‑‑‑You can have it back.

PN533

Yes, we'll have it back.

PN534

VICE PRESIDENT HATCHER: The document headed "Competency standards for pharmacists in Australia, October 2001" will be marked exhibit 3.

EXHIBIT #3 COMPETENCY STANDARDS FOR PHARMACISTS IN AUSTRALIA OCTOBER 2001

PN535

MR SECK: May it please your Honour, no further questions.

PN536

VICE PRESIDENT HATCHER: Mr Irving, any re‑examination?

PN537

MR IRVING: Yes, very quickly.

RE-EXAMINATION BY MR IRVING�� [2.40 PM]

PN538

MR IRVING: Dr March, your PhD thesis was titled "From medicine supplier to patient care practitioner implementation and evaluation of two practice models in Australian community pharmacies - - -"

PN539

MR SECK: I object. It doesn't arise from cross‑examination.

PN540

VICE PRESIDENT HATCHER: Let's see for a minute. I'll allow the question.

PN541

MR IRVING: That titled your PhD?‑‑‑It was.

PN542

You were asked various questions about the extent to which pharmacists prior to 1998 were meeting the practice standards in the 1990 document that my friend took you to. In the course of studying for that PhD, did you come across studies about the extent to which pharmacists were in fact complying with those practices pre‑99 - - -

PN543

MR SECK: I object.

PN544

MR IRVING: - - - compared to post‑99.

***�� GEOFFREY JOHN MARCH�� RXN MR IRVING

PN545

MR SECK: I object.

PN546

VICE PRESIDENT HATCHER: What is the objection?

PN547

MR SECK: Twofold. Firstly, I didn't ask him about his PhD. Secondly, I asked about his experience and his knowledge of what that practice was as opposed to what other people may have said about that. In my submission, it doesn't arise.

PN548

VICE PRESIDENT HATCHER: I'll allow the question.

PN549

MR SECK: May it please?‑‑‑Certainly there were some studies when I was doing this, which indicated that there were low levels of patient counselling in practice. I'll have to rely on my memory on this one, but the better ones were at about 30 per cent; the worse ones were at about 3 or 4 per cent.

PN550

MR IRVING: I have no further questions.

PN551

VICE PRESIDENT HATCHER: Thank you, Dr March. You're excused and you're free to go.

<THE WITNESS WITHDREW�� [2.42 PM]

PN552

MR IRVING: Just to clarify, your Honour, one of the professors will be available to give evidence on Wednesday morning.

PN553

VICE PRESIDENT HATCHER: All right.

PN554

MR IRVING: Ms Knowles will be taking the next few witnesses and I would seek to withdraw for the balance of the afternoon.

PN555

VICE PRESIDENT HATCHER: I don't know if you need to stay for this, but just to clarify the position with the confidentiality orders, the only order relevant to these three witnesses is the one made on 10 January 2018. Is that right?

PN556

MR IRVING: Yes, and no application was made to renew those orders.

***�� GEOFFREY JOHN MARCH�� RXN MR IRVING

PN557

VICE PRESIDENT HATCHER: They only related to the publication on the web site and access, so there's no need to renew them, is there?

PN558

MR IRVING: No.

PN559

VICE PRESIDENT HATCHER: Thank you. The next witness is via telephone, Ms Knowles?

PN560

MS KNOWLES: No, we have Ms Thompson here.

PN561

VICE PRESIDENT HATCHER: All right.

PN562

MS KNOWLES: I might actually just need to find her, if that's all right, your Honour.

PN563

VICE PRESIDENT HATCHER: All right.

PN564

THE ASSOCIATE: Could you please state your full name and address.

PN565

MS THOMPSON: Amy Boyce Thompson of (address supplied).

<AMY BOYCE THOMPSON, AFFIRMED�� [2.46 PM]

EXAMINATION-IN-CHIEF BY MS KNOWLES�� [2.47 PM]

PN566

MS KNOWLES: Ms Thompson, have you prepared a statement for these proceedings?‑‑‑Yes.

PN567

There should be a folder in front of you that is volume 1 of 3. Is that there?‑‑‑Yes.

PN568

If you go to that, to tab 1.1, there is a statement that is 12 pages long dated 10 December 2017. That statement has seven annexures.

PN569

VICE PRESIDENT HATCHER: I think the witness has a redacted version of the statement. It may not be easily recognisable?‑‑‑I think I've found the one that's - - -

***�� AMY BOYCE THOMPSON�� XN MS KNOWLES

PN570

MS KNOWLES: Is that the statement you prepared for this proceeding?‑‑‑Yes.

PN571

That has seven annexures?‑‑‑Yes.

PN572

If you go to tab 1.1.1, that is annexure 1, the Health Employees Pharmacists (State) Award. Is that right?‑‑‑Yes.

PN573

Then if you go to tab 1.1.2, that is the second annexure, the Hospital Scientists (State) Award?‑‑‑Yes.

PN574

Then 1.1.3, that is annexure 3, the Pharmacy Handbook?‑‑‑Yes.

PN575

Then if you go to 1.1.4, that is annexure 4, the "Pharmacy Board of Australia frequently asked questions"?‑‑‑Yes.

PN576

Then I do apologise both to you, the other parties and the bench, but it seems like the remaining AT5 to AT6 and AT7 are all copied in this same tab and they're not separated. I do apologise for that, but if you flick a few pages forward you should find something that is marked AT5. You see that there?‑‑‑Yes.

PN577

That is the "Australian intern written exam" and then if you flick a few pages forward again, you should find annexure AT6, which is the "Pharmacy oral examination practice candidate guide". Is that correct?‑‑‑That's right.

PN578

Then again if you flick - and it's really the last document in this bundle, because I think a few documents unfortunately have been double‑copied, but if you go to the last document in this tab you should find annexure AT7 which is the "Pharmacy oral examination candidate guide July 2017". Do you see that there?‑‑‑Yes.

PN579

Are the contents of your statement and these annexures true and correct?‑‑‑I believe so, yes.

PN580

I tender that.

PN581

VICE PRESIDENT HATCHER: The statement of Amy Thompson, dated 10 December 2017, will be marked exhibit 4.

***�� AMY BOYCE THOMPSON�� XN MS KNOWLES

EXHIBIT #4 STATEMENT OF AMY THOMPSON DATED 10/12/2017 PLUS ANNEXURES

PN582

MS KNOWLES: No further questions.

CROSS-EXAMINATION BY MR SECK�� [2.50 PM]

PN583

MR SECK: Ms Thompson, you are the New South Wales representative on the Professional Pharmacists Australia community. Is that right?‑‑‑I'm just a general representative, not specifically for New South Wales.

PN584

You have, as far as I can tell, not worked ever as a pharmacist in the community pharmacy sector other than as an intern. Is that right?‑‑‑I worked as an assistant and a technician, not as an intern.

PN585

Just looking at paragraph 8 of your statement, you say you worked as an intern pharmacist at the Logan Hospital, Queensland Health, so I gather from that you didn't work as an intern in the community pharmacy sector?‑‑‑No, it was in the hospital.

PN586

Is there a reason why you decided to work in the hospital sector as opposed to the community pharmacy sector?‑‑‑Well, I had been working in community pharmacy for quite a number of years prior to that and I wanted to try something new on graduation.

PN587

It wasn't anything to do with the fact that you didn't enjoy working in the community pharmacy sector?‑‑‑It was really the fact that because I had been working in the community pharmacy for a long time, I wanted to see what else there was out in the big wide world.

PN588

Since you graduated in 2014 and you were working as a pharmacy assistant from 2009, you obviously can't talk with any experience about what happened in the community pharmacy sector prior to 2009. Would that be correct?‑‑‑Yes, so I can only talk from when I started working as an assistant in pharmacy.

PN589

Now, just looking at your duties and responsibilities in your current position as an emergency medicine specialist, in paragraph 12, those duties and responsibilities are obviously significantly - but not in all respects - different from what you would be required to do as a pharmacist working in a community pharmacy. Would you agree with that?‑‑‑I would say that the majority of the skills required would be very similar. Maybe the location is different. For example, 12.1.1:

***�� AMY BOYCE THOMPSON�� XXN MR SECK

PN590

The provision and development of clinical pharmacy services to the emergency department and the short stay unit -

PN591

which is just another section within the emergency department, I mean, that's because I happen to work in an emergency department; but you would still be providing clinical pharmacy services within a community pharmacy if that was your location of work.

PN592

Obviously the context and the working environment in which you use your skills is going to differ depending where you are. That's right?‑‑‑Yes.

PN593

Just looking at all the duties and responsibilities which you set out in paragraph 12, would you agree many of them relate to and are linked to the working environment in a hospital?‑‑‑Only where it's talking about the actual location, not the - sorry, can you repeat that?

PN594

Yes, sure. Well, let me be a bit more specific, because it might be easier to answer this way?‑‑‑Okay.

PN595

If I look at 12.1, the duties there seem to be directed to the hospital environment. Would you agree with that?‑‑‑Yes.

PN596

For example, if you're contributing to the discharge planning process in 12.1.4, that's something you wouldn't do in the community pharmacy sector, would you?‑‑‑No, I disagree with that, because that whole process is generally me calling a community pharmacist and asking for help. Normally that means if I've got someone that - I mean, most of the patients that I deal with on a regular basis who require discharge planning are quite elderly or on a huge number of tablets and have quite a high tablet burden. In order for me to get them home safely, I pick up the phone and call their community pharmacy and say, you know, "We've got this patient. This is the situation. Would you be able to organise their supply of medications? Can you please provide further counselling and explanation to them", because in an emergency department everything is very rushed. I'm sure that most of the things I say would get forgotten once they get home, so my discharge planning is ensuring that follow‑up of care in the community and actually getting them to make sure these patients are okay.

***�� AMY BOYCE THOMPSON�� XXN MR SECK

PN597

Would you agree that there are different aspects to the discharge planning process? You're the one ensuring that the process goes according to plan and then conveying information to the community pharmacist who is there to implement it?‑‑‑Well, yes. The patient has presented to the emergency department. I'm providing the initiation and then basically doing all the follow through, yes.

PN598

All the way up to 12.1.10, I read as being within the hospital environment. Would you agree with that?‑‑‑Well, that includes things like being a preceptor. I believe the community pharmacists have preceptors for their interns.

PN599

You're right, preceptor is probably the one exception. Besides the preceptor?‑‑‑Well, "Pharmaceutical care plans", is just a New South Wales Health term for things like when the pharmacist sits down with the patient and goes through medications. I mean, "Review policies, procedures and strategic planning", that happens in every business I would expect, so I would imagine that those skills would be very similar. "Clinical responsibility for intensive care unit", well, you don't have intensive care units in the community pharmacy so that would be different, but you're still dealing with those clinical skills. Then, "Providing information to nursing and medical staff", is just about medication and teaching, and sharing of information. I think that that would happen regularly whenever you're dealing with those professions. Then, "Working closely with other ward pharmacists", well, I mean, that's just discussing handover of care really. I mean, I suppose if you're working in an environment where you're a sole pharmacist and you never have anyone relieve you, then you wouldn't need to have transfer of information, but if you have a different pharmacist working on different days or overlapping shifts, then you would definitely be providing those clinical handovers.

PN600

Yes. Thank you for that. Don't get me wrong, I'm not saying the basic skills which are involved in what you do is significantly different from what a pharmacist does, but aspects of the duties and responsibilities set out there are in the hospital environment?‑‑‑I work in a hospital. Yes, that's correct.

PN601

Would you agree that the kind of medical issues which you deal with in the emergency medicine context are acute health issues?‑‑‑Not always, no.

PN602

When you say not always, what other kind of health issues besides acute issues would you deal with in an emergency context?‑‑‑Well, I mean, we have patients present for social reasons. For example, if their carer is unwell and is in hospital, often that patient who hasn't had any significant decline but is unable to care for themselves would present to the emergency department and then we have facilities there to be able to make sure that they're okay. I wouldn't consider that an acute situation. Sometimes people present just because they have been feeling sort of, you know, a little bit unwell for the last 12 months and perhaps could have presented to their GP, but it happens to be after hours or their GP can't see them until next Tuesday or that kind of thing, so I wouldn't consider those necessarily acute presentations.

***�� AMY BOYCE THOMPSON�� XXN MR SECK

PN603

All right. But those would be the exceptions more than the rule; would you agree?‑‑‑Look, I don't have the stats in front of me, so I can't really comment on that, no.

PN604

Now, you have also put in your statement your undergraduate training, in paragraph 13 onwards. You have described your undergraduate training in some detail by reference to the annexures. I want to ask you how much has your university training prepared you for your specific role as an emergency medicine specialist within the New South Wales Health system?‑‑‑Well, I guess the undergraduate training gives you a basic overview on therapeutics and on communication, and those are skills that you need in an emergency department definitely. I mean, you need to be able to communicate very well because it's often a highly busy, highly stressful environment. I think the undergraduate training did that quite well. I mean, working in emergency, it's very specialist skills and so not all of that - I mean, that wasn't covered in the undergraduate training but certainly the basics to be able to build off to learn the specialist skills would have been.

PN605

So in building on those basics, I gather from your answer you would learn on the job and when you're dealing with particular situations and dealing with other practitioners, you would learn from observing and from discussing those issues with them, and then eventually build your skills and experience from that. Would that be a fair assessment?‑‑‑Yes, there is definitely lots of on‑the‑job learning.

PN606

To use an example, communication skills. The best way - and tell me if this reflects your experience - in understanding how to communicate effectively with other practitioners and patients in the work environment, is to do it and work out what works and what doesn't work. Would you agree?‑‑‑Yes, I would agree with that, but also we were lucky enough to have a lot of tutorials with real patients and also actors that provided us with those basics. I remember quite vividly there was a tutorial we had where we were really lucky to have patients with various mental health disorders come to our tutorial, including a man with schizophrenia who taught me about ice cream cones, which turns out is marijuana and cocaine, but that experience in the undergraduate degree was very eye‑opening and they allowed us to sort of test out our communication theories, I suppose. All those sort of structured communication ways we had been taught, we were able to actually put to practice in a safe environment.

PN607

What you learn at university, as you say, are the basics or the springboard for developing and refining those skills and practice, and that reflects your experience. Would you agree with that?‑‑‑Yes.

***�� AMY BOYCE THOMPSON�� XXN MR SECK

PN608

You say in paragraph 17 you were given the choice of applying for the industrial major. What is an industrial major?‑‑‑An industrial major was the opportunity to work in industry for 13 weeks. It was sort of 13 weeks of practical experience working in an industrial area related to pharmacy and then we just had a few assessments based off that.

PN609

When you say "industrial area", does that mean a pharmaceutical environment as opposed to a pharmacy?‑‑‑Yes, it was either a pharmaceutical company - for example, Pfizer or one of those big areas, or industrial law, so, for example, a pharmacy union, but not an actual community pharmacy. I think one of my colleagues spent 13 weeks at the Guild.

PN610

Which one did you choose?‑‑‑APESMA.

PN611

So you worked the industrial major doing industrial law?‑‑‑Yes.

PN612

So you have got some experience in this area?‑‑‑Well, 13 weeks is a very small amount of experience.

PN613

You, I think, confirmed beforehand that you sat on the PPA council for APESMA. That's right?‑‑‑Yes.

PN614

The PPA committee?‑‑‑PPA committee, yes.

PN615

In your role as a committee member, is one of the things you discuss the industrial strategies for improving the terms and conditions of employment of members?‑‑‑Yes.

PN616

Is one of the things you discuss collective bargaining?‑‑‑Yes.

PN617

To the best of your knowledge and belief, the collective bargaining which has occurred between APESMA as a bargaining representative and employers has only related to National Pharmacies. Is that correct?‑‑‑That's the only one I'm aware of, but that's not part of my role so I wouldn't want to say for certain.

PN618

When you say it's not part of your role, that's not something which you discuss at a committee level?‑‑‑Well, I mean, we do discuss it, but it's not - I mean, it's left to the industrial officers to know the finer details of it.

***�� AMY BOYCE THOMPSON�� XXN MR SECK

PN619

Do you set the strategy and framework for collective bargaining at a committee level?‑‑‑Normally that's driven by the professional officers.

PN620

When you say "professional officers" you mean the executive team?‑‑‑As in the paid employees of APESMA.

PN621

Right, okay. Do they report to you and ask for your guidance as to the strategy they should be adopting at all?‑‑‑Yes, sometimes.

PN622

Is part of the strategy of APESMA in the community pharmacy industry to increase the number of enterprise agreements within the Australian community pharmacy sector?‑‑‑I can't comment on that.

PN623

You can't comment because you don't know or you can't comment because you don't want to answer my question?‑‑‑Because I don't know.

PN624

You have put here the content of the Sydney University Bachelor of Pharmacy degree?‑‑‑Mm‑hm.

PN625

Do you know or have you had a chance to ever research the content of the degree back in 1998 or beforehand?‑‑‑No.

PN626

No further questions.

PN627

VICE PRESIDENT HATCHER: Ms Thompson, in paragraph 6 of your statement where you talk about your Mona Vale Hospital position and the Westmead position, are they two separate positions?‑‑‑Yes.

PN628

Are they part‑time, full‑time, casual? What are they?‑‑‑They are both part‑time positions.

PN629

How many hours do you work in each?‑‑‑I do 24 hours a week at Mona Vale and 12 hours a week at Poisons at Westmead.

PN630

Thank you?‑‑‑That is what I'm contracted to do, but occasionally I have to work more, yes.

PN631

Any re‑examination, Ms Knowles?

***�� AMY BOYCE THOMPSON�� XXN MR SECK

PN632

MS KNOWLES: No, Vice President.

PN633

VICE PRESIDENT HATCHER: Thank you for your evidence, Ms Thompson. You're excused and free to go?‑‑‑Thank you.

<THE WITNESS WITHDREW�� [3.07 PM]

PN634

VICE PRESIDENT HATCHER: Who is next?

PN635

MS KNOWLES: I call Cameron Wells. He will be on the telephone.

PN636

VICE PRESIDENT HATCHER: Yes. We will just have to take a second to organise that.

PN637

THE ASSOCIATE: Hello, is that Mr Walls?

PN638

MR WALLS: Yes, it is.

PN639

THE ASSOCIATE: Hi, Mr Walls. This is Amy Lewis, associate to Vice President Hatcher of the Commission. How are you?

PN640

MR WALLS: Yes, I'm good.

PN641

THE ASSOCIATE: We're just about to commence. I'm going to read out the affirmation, and once I have read that out, you can say, "I do", but first could you please state your full name and address.

PN642

MR WALLS: Cameron Thomas Walls, (address supplied).

<CAMERON THOMAS WALLS, AFFIRMED�� [3.08 PM]

EXAMINATION-IN-CHIEF BY MS KNOWLES�� [3.09 PM]

PN643

MS KNOWLES: Mr Walls, have you prepared a statement for this proceeding?‑‑‑Yes.

***�� CAMERON THOMAS WALLS�� XN MS KNOWLES

PN644

Is that a statement which is dated 15/12/2017, which is five pages long and 20 paragraphs long?‑‑‑Correct, yes.

PN645

Are the contents of that statement true and correct?‑‑‑Yes.

PN646

I tender that.

PN647

VICE PRESIDENT HATCHER: The statement of Cameron Walls, dated 15 December 2017, will be marked exhibit 5.

EXHIBIT #5 STATEMENT OF CAMERON WALLS DATED 15/12/2017

PN648

MS KNOWLES: No further questions.

PN649

VICE PRESIDENT HATCHER: Mr Walls, Mr Seck, who is the barrister for the Pharmacy Guild, will ask you some questions now. Please tell us if you can't hear him properly?‑‑‑Yes, sure.

CROSS-EXAMINATION BY MR SECK�� [3.10 PM]

PN650

MR SECK: Mr Walls, can you hear me? It's Michael Seck?‑‑‑Yes.

PN651

Do you have your statement in front of you, Mr Walls?‑‑‑Yes, I do.

PN652

You say that you gained your full registration as a pharmacist in April 2011. That's correct?‑‑‑Sorry, I had trouble hearing that. Say that again.

PN653

VICE PRESIDENT HATCHER: Mr Seck, can you move the microphone.

PN654

MR SECK: Pardon me. Is that better, Mr Walls?‑‑‑That's much better.

PN655

I will endeavour to speak into the microphone. You say in your statement, in paragraph 4, that you gained your full registration as a pharmacist in April 2011. That's so, yes?‑‑‑In April 2011, yes.

PN656

Prior to obtaining your full registration, did you work in a pharmacy?‑‑‑Yes, I did.

***�� CAMERON THOMAS WALLS�� XXN MR SECK

PN657

In what capacity?‑‑‑I worked as a pharmacist intern from December 2009 until that date and I also worked as a pharmacy student while I was at uni in Wagga during 2008 and 2009.

PN658

Thank you. You had experience working in a pharmacy from at least 2008 and observing the duties and responsibilities of a pharmacist from that time. Would you agree?‑‑‑From 2011 as a pharmacist, yes.

PN659

But you would have been observing what pharmacists did as part of their job since 2008 as a student?‑‑‑That's correct, yes.

PN660

Would you agree that one of the major aspects of the role of a pharmacist in your experience both observing and working in the role, is the responsibility for the safe and judicious use of medicines?‑‑‑Yes.

PN661

In fact that is probably the primary part of your job. Would you agree?‑‑‑Yes.

PN662

That has a number of dimensions to it, including the dispensation of prescription of medicines on the PBS. Yes?‑‑‑Yes, but there are many different parts of it.

PN663

In doing that job, you would get the help from dispensary technicians?‑‑‑That depends on the nature of the pharmacy.

PN664

In your experience that help has been afforded sometimes, but not all the time. Would that be correct?‑‑‑Correct, yes. Sometimes techs are involved and other times they're not, such as at the moment I don't have a current dispense tech in my role.

PN665

Would there be times where you are to have more than one pharmacist rostered on a shift?‑‑‑Again, that depends on the size of the pharmacy. I have had, yes, situations where has been more than one pharmacist. Most of the time it has been a sole pharmacist on duty.

PN666

Sorry, can you just repeat that answer, Mr Walls. I just misheard you. I didn't hear you properly?‑‑‑Sure. Most of the time that I have practised it has been as a sole pharmacist on duty, but there have been times where there has been overlap in there, as well.

***�� CAMERON THOMAS WALLS�� XXN MR SECK

PN667

It would be fair to say from time to time, but not all the time, you have received some help from dispensary technicians and other pharmacists on shift. Correct?‑‑‑Yes, from time to time I would yes.

PN668

In performing your job you also deal with the supply of over the counter medication available only from pharmacies?‑‑‑Sorry, could you repeat that question.

PN669

Is part of your job, Mr Walls - sorry, I'll speak into the microphone more clearly - you are involved in the supply of over the counter medicine available only from pharmacies?‑‑‑Correct.

PN670

There are also times where you would supply pharmacist‑only prescribed medicines. That's so?‑‑‑Correct.

PN671

When I refer to those three categories, we're talking about schedule medicines as you understand it under the Poisons Standard?‑‑‑Yes, schedules 2, 3 and 4.

PN672

And 4 - - -?‑‑‑And 8, that you mentioned there.

PN673

You need to make a judgment as part of your job to ascertain the appropriate measure to assist a patient in relation to his or her health issues. That's correct?‑‑‑What do you mean by "measure"?

PN674

It could mean dispensation of prescription medicine or otherwise triaging their medical issue by referring them to other health practitioners?‑‑‑Yes, yes, that's part of the role.

PN675

You would do that only for minor ailments and injuries. Anything which was serious, you would direct the patient to a general practitioner or other health provider. Would that be correct?‑‑‑I would say that no matter what schedule the medicine is we still need to be aware of the condition being treated, the appropriateness of the medication and where we think there may be something undiagnosed, yes, that then requires triage to another health service. We send them off, yes, and we use our expertise in that.

PN676

That's a general skill you deploy to all scenarios where you're dealing with a patient in the pharmacy. Would you agree?‑‑‑I would agree with that in varied levels, depending on the type of service that we're giving them and the situation with the customer.

***�� CAMERON THOMAS WALLS�� XXN MR SECK

PN677

If it's a very simple issue like, "I've got a headache", that obviously only requires a very simple response saying, "What kind of headache? How long has it" - and then perhaps prescribing some - - -?‑‑‑I wouldn't say that a headache is necessarily a simple situation. There can be quite a few questions we need to ask, yes. It's hard to define what "simple" is.

PN678

I didn't mean to diminish the level of seriousness involving a headache, but depending on the nature of the medical condition and perhaps the other health issues and other personal issues, you would then ascertain whether or not it required a more simple response or a more lengthy and complicated response. Correct?‑‑‑Yes. We decide what level of response is required depending on the situation.

PN679

There might be situations where you need to identify the appropriate medicine and there is a database which is called MIMS; Monthly Index of Medical Specialists. That's something you use on a regular basis?‑‑‑It is, yes.

PN680

It allows you if there are questions or concerns or any other issues which you might be unsure of, to consult MIMS in order to ascertain more information so you can give the best advice. That's so?‑‑‑Correct.

PN681

MIMS is a database which is, as I understand it, available on the Web by prescription. Is that your understanding?‑‑‑Yes.

PN682

What it allows you to do is access that information reasonably quickly in order to address those issues where you're not sure of what to do. Would you agree?‑‑‑Yes, it's one of the many references that we have access to.

PN683

You also provide more general advice to patients about the proper use of medications and the after‑effects and potential adverse interactions a medicine may have with other medicines that the person may be taking. That's right?‑‑‑Sorry, can you repeat that, please.

PN684

As part of your role as a pharmacist you provide advice to patients on the proper use and dosage of medicines, and their after‑effects and any adverse interactions that medicine may have with other medicines?‑‑‑Correct.

PN685

Is it as part of the general suite of skills you deploy to a whole range of different situations which might be complex or simple in nature?‑‑‑(No audible reply)

***�� CAMERON THOMAS WALLS�� XXN MR SECK

PN686

You agree?‑‑‑Correct.

PN687

Also part of your job is the need to communicate with patients to clearly understand their issues and clearly provide them with the appropriate advice. Do you agree?‑‑‑Yes, I'd say that one of our biggest roles is communicating.

PN688

Also part of your job is recordkeeping?‑‑‑Correct.

PN689

Now, would it be fair to say that a lot of the recordkeeping is done electronically as opposed to being recorded on paper?‑‑‑There is both these days. There is electronic recording in our dispense software, there is electronic recording in our professional services records, but both dispensing and professional services also require hard copies of a lot of that to be kept for a number of years, as well.

PN690

When you say a hard copy, that means a printout or would you handwrite it?‑‑‑Well, that would either be the original prescription provided by the doctor, it could be a consent form that a patient has signed - - -

PN691

That would be a matter of making a copy and then filing it away. Would that be correct?‑‑‑So we would, yes, keep the original copy and store it.

PN692

Now, in paragraphs 15, 16 and 17 of your statement, Mr Walls, you talk about pharmacists providing "professional services". Do you see that?‑‑‑Yes.

PN693

You describe a list of different professional services which you have provided at various places where you have worked?‑‑‑Yes.

PN694

Would you agree that the particular services you provided there involve the application of the skills that we talked about earlier? That is, working out the safe and judicious use of the particular medication and then implementing that for the particular patient. That is what is required in each of those professional services which you identify in paragraph 15?‑‑‑Not all of them.

PN695

Which ones would you say do not involve you exercising a judgment as to the safe and proper use of the medicines?‑‑‑So the leave certificates don't involve the supply of medicines. The vaccinations is more the administration of medicines. The sleep apnoea and Impromy program, I would say don't fall into that category either.

***�� CAMERON THOMAS WALLS�� XXN MR SECK

PN696

So besides that - - -?‑‑‑Besides that, I would say they all involve - how did you put it?

PN697

The application of your judgment as to the safe and proper use of the medicines?‑‑‑Yes, and there is a lot of variation to the depth there, but I'd say they all fall into that category.

PN698

You talked about medical certificates being an exception to that?‑‑‑Mm‑hm.

PN699

You obviously have to make a judgment as to whether or not the patient is ill and an assessment as to whether or not the severity of the illness would justify the patient obtaining a leave certificate. Would you agree with that?‑‑‑Yes.

PN700

So there is a degree of judgment involved deploying your skills as a pharmacist in making that assessment. Do you agree?‑‑‑Can you say that one again?

PN701

There would be a degree of judgment involved in performing your role as a pharmacist to determine whether or not a leave certificate should be grated?‑‑‑Yes.

PN702

That is based on your training and experience as a pharmacist. Would you agree?‑‑‑Yes.

PN703

You talked about vaccinations. That involves, as you say, administration of the vaccination. What is involved in that?‑‑‑I haven't done the training for vaccination myself. It's something I've seen others do, so I don't know the ins and outs of it, but the main part of it is actually - injecting the vaccine is the main difference to what pharmacists do otherwise and the management of any adverse reaction.

PN704

The management of any adverse reactions would be part of the deployment of your skills as a pharmacist. Would you agree?‑‑‑I don't think so. It calls on it to some degree, but you need to have first aid training and specific training on the adverse reactions to vaccines, which is involved in the training that I haven't done.

***�� CAMERON THOMAS WALLS�� XXN MR SECK

PN705

I think the last thing you said which would fall outside the general description of making a judgment as to the safe and proper use of medicines was sleep apnoea screening. What is involved in that task?‑‑‑So the patient is given a small machine which they take home and it measures various biometrics while they sleep. They bring it back and we send the data off through to a specialist doctor, and they provide a report based on the biometrics. If a sleep apnoea treatment device is required for that patient, then we provide that device and educate the patient on how to use it. We may change settings based on - individualise for that patient, help them in choosing equipment that's appropriate for them, yes.

PN706

Would it be fair to say then the initial part of it at least is to follow the instructions and provide guidance to the patient as to how to use the sleep apnoea machine, and then to basically return the data to a third party organisation to ascertain the results from that machine? Would you agree?‑‑‑Could you say that again?

PN707

MS KNOWLES: I think there are two propositions.

PN708

MR SECK: All right.

PN709

I think you put a number of steps in the sleep apnoea screening and treatment. I'm going to put it to you in separate propositions. Would you agree that the first part of what is involved in sleep apnoea screening and treatment, Mr Walls, is following the instructions in providing guidance to the patient as to how to use the sleep apnoea machine?‑‑‑That forms a large part of it, but I'd say that - and one thing I didn't mention in the process was identifying potential sufferers of sleep apnoea, and so that's - - -

PN710

Which forms part of your general skills in identifying the kind of behaviours which would be consistent with sleep apnoea. Would you agree?‑‑‑Yes, and it's part of the whole process of screening for all sorts of conditions.

PN711

When the machine is returned to you and there is data, you don't analyse the data itself. That is actually returned to a third party provider to read the data and provide that back to the pharmacy. Is that correct?‑‑‑Yes, well, that has to be done by a doctor. That is analysed by a doctor, a third party, and then we're given a report that we explain to the patient; so that communication I suppose we talked about earlier.

PN712

Right. The significant value add in your job is really once the report is returned from the doctor, reading the report and explaining it to the patient, including any particular treatments which might be appropriate in terms of medication?‑‑‑Yes.

PN713

Would you agree the last bit is consistent with your training as a pharmacist in working out the proper and appropriate medication or measures that should be taken to address the particular health issue?‑‑‑Sorry, can you say that again?

***�� CAMERON THOMAS WALLS�� XXN MR SECK

PN714

Would you agree that the last part of what you just described in the sleep apnoea screening and treatment is consistent with your overall training as a pharmacist in the judicious and proper use of medication and other treatments?‑‑‑Well, for medical device and not medication. But - - -

PN715

But medication may arise from - may be prescribed or you might advise people to use medication depending on what the sleep apnoea results demonstrate?‑‑‑No. There's no - not usually medication involved in the sleep apnoea program.

PN716

I understand. Now, paragraph 17 - sorry, paragraph 16 you talk about, "Many of these services require training in addition to my pharmacy degree." Do you see that?‑‑‑Yes.

PN717

And would it be fair to say that what happens in those circumstances is that you in effect learn on the job or receive instruction or some training as to how to - or the nature of the advice that you should be - that you give to a patient in dealing with one of the issues that you listed in paragraph 15?‑‑‑No. I wouldn't - do you mean for all of the purposes?

PN718

Maybe all of them, but for the ones that you said were not - did not involve your usual skills as a pharmacist?‑‑‑So just the ones that involve the medical knowledge?

PN719

Yes?‑‑‑The MedsChecks and Diabetes MedsChecks, the home medicine review, I have all had external training outside of work. Sorry, I haven't done the home medicine review training, but if I was going to do them, I would have to do quite an extensive course on that. The MedsChecks and Diabetes MedsChecks, I attended several workshops through the PSA on how to perform those. I recently was sent to Adelaide to learn how to do those from other pharmacists.

PN720

But everything else besides the MedsChecks and Diabetes MedsChecks would you agree involves the deployment of your general skills as a pharmacist?‑‑‑Yes.

PN721

Paragraph 17, you talk about having to deploy certain business skills in your role as pharmacy manager; human resource in, stock control and financial analysis. Those matters which you picked up on the job, would that be fair to say?‑‑‑Yes.

PN722

And you've learnt - - -?‑‑‑I wouldn't say I'm very good at them.

***�� CAMERON THOMAS WALLS�� XXN MR SECK

PN723

But you have obviously had to learn it as being the pharmacist manager and you have done that through observation and trial and error, would that be fair?‑‑‑Yes.

PN724

Now, in terms of CPD, which you deal with in paragraph 20?‑‑‑Yes.

PN725

You say that when you initially commenced as a pharmacist in 2011 you weren't required to do CPD, but that was introduced whilst - after you had commenced working as a pharmacist, that's so?‑‑‑For the - the compulsory CPD came into - about the same time that I registered.

PN726

So when you say "Since I completed my pharmacy degree the Pharmacy Board has introduced compulsory CPD." So do I gather from that that from the time that you have commenced working as a pharmacist, you have always been required to undertake compulsory CPD?‑‑‑The - my first year as a practising pharmacist, I believe is when they introduced the compulsory CPD.

PN727

So was there any period of time when there wasn't - was there any period of time when you were a professional pharmacist where you weren't required to undertake compulsory CPD?‑‑‑No. I don't think there has - no - yes, because it's always been - it increased slowly in those first two years. It went from 20 hours to 30 hours and 40 hours, yes. But - - -

PN728

Right. So when you say in the second sentence - sorry to interrupt you, Mr Walls, do you have anything else to say?‑‑‑No, you're right.

PN729

When you say the second sentence in paragraph 20, "This has increased the burden of work for me to maintain my registration by documenting the learning activities that I undergo to maintain my professional knowledge and competence, it hasn't really increase the burden because that burden has always existed during your time as a professional pharmacist. Would you agree with that?‑‑‑So the - yes, as I just said, the first three years of my practice it went from 20 hours a year to 30 and then to 40. Each year of increase by 10. So it went to the current level of 40 hours and the learning plan mentioned in the first paragraph has also been introduced since that time. I don't know what year it was introduced, but it was not there when I first started.

PN730

And the learning plan and documentation of CPD, is that like a document which lists the courses you've attended and the skills that you've required in attending those courses?‑‑‑It's more than that. It's meant to be a document of self-reflection and planning what we - which areas of competency we need to improve, how we are going to address those areas that require development and then one of its components is that it records the ones that we do - the CPD that we do perform.

***�� CAMERON THOMAS WALLS�� XXN MR SECK

PN731

So just to explore the last part, the self-assessment, that self-assessment is for you to write out so you can set out your professional goals in acquiring further skills via training or other areas of learning?‑‑‑Yes. Based on our practice. Yes, our current practice setting.

PN732

Right. Now, if CPD did not exist and I know I am asking you a hypothetical and tell me if it's difficult to answer, you would have, as part of your career planning the kind of skills and experience you would want to acquire in progressing your career. Would you agree?‑‑‑Can you rephrase that? What do you mean?

PN733

Now, I am asking your hypothetical - if CPD did not exist, Mr Walls?‑‑‑Yes.

PN734

As part of your advancement of your career, one thing you would do is to identify the kind of skills and training you wanted to acquire to progress your career. Would you agree with that?‑‑‑Yes.

PN735

And so what is being formalised as part of CPD is something you would have otherwise done in any event as part of your career progression. Do you accept that?‑‑‑I don't accept that as a completely true statement. The development that I might take without a compulsory - without compulsory CPD I think would look different to what I am forced to do by the board regulations.

PN736

When you say "looks different", it means - you not suggesting you wouldn't do; you would perhaps distil it in a slightly different way by choosing different subjects and different - perhaps different courses. Is that what you are saying?‑‑‑Yes. And I may not necessarily do it strictly to the calendar or strictly to the number of hours and with the whole planning and reflection process that's involved.

PN737

But you would go through the similar process, perhaps with different composition in different hours and a different way of reflecting upon your own skills if CPD didn't exist, you would agree?‑‑‑Yes. I would have to do some sort of education - self-education to keep up to date.

PN738

Now, you also talk about your role as preceptor which I understand is like a supervisory or mentoring role for intern pharmacist. That's so?‑‑‑Yes, that's correct.

PN739

Now, as a pharmacy manager, you supervise the pharmacy, but you also supervise the people who work underneath you. That's right?‑‑‑Yes. That's right.

***�� CAMERON THOMAS WALLS�� XXN MR SECK

PN740

And when you are asked to act as - when you are taking on the role as preceptor, is that a voluntary role as a compulsory role?‑‑‑That's - when you are the only pharmacist and the owner hires an intern, it's sort of compulsory.

PN741

When you say it is "sort of compulsory", you have to be - sorry, go on, answer the question?‑‑‑My role - the particular role as preceptor that I have had was in a situation where somebody had just bought the pharmacy and without consulting me they hired an intern and I was the only full-time pharmacist working at the pharmacy and so they asked me to be the preceptor for this person, but I don't think I really had a choice. I enjoyed it but I didn't really have a choice.

PN742

Just to explore wanted to aspects of that, when you say you didn't really have a choice, you do have to actually put yourself forward and sign up to be a preceptor. Is that correct?‑‑‑Yes.

PN743

But you are saying that because you were the only pharmacist working at that particular pharmacy you felt obliged morally to take on that role. Would that be fair?‑‑‑I felt obliged the sake of having the job.

PN744

But no one ever directed you to take on that role. It was just something that you thought became part of it, because you were working in a small pharmacy?‑‑‑It was part of the role.

PN745

Right?‑‑‑The business model involved having an intern for the sake of wages and workload.

PN746

I think you referred - sorry, go on?‑‑‑Yes. So that was part of the role.

PN747

You said you only did it once during your time as a pharmacist. Is that right?‑‑‑Yes, that's right.

PN748

And so you have worked since 2011 is a pharmacist, though only in the last year or so as a pharmacist manager. So it's been since 2016 that you perform the role of preceptor once. Is that correct?‑‑‑Yes.

PN749

Okay. No further questions.

PN750

VICE PRESIDENT HATCHER: Any re-examination, Ms Knowles?

RE-EXAMINATION BY MS KNOWLES�� [3.43 PM]

***�� CAMERON THOMAS WALLS�� RXN MS KNOWLES

PN751

MS KNOWLES: So Mr Walls, you asked some questions about the - it was put to you that your primary role was the dispensation of medicine and you said that there were many different parts to that, in response to that question.

PN752

MR SECK: I object. I didn't put that question to him that the primary role was the dispensation of medicine. I said that it was the judicious and proper use of medicine and within that there were subcategories. So I didn't - that wasn't the question or answer he gave.

PN753

MS KNOWLES: My notes here say that one of the - reads that one of the major aspects and it was, yes, responsibility for the safe and judicious use of medicine, and then it was put that that was a primary role and then another proposition that that primary role involved the dispensation of medicine and that Mr Wall's response to that was that there are many different parts to that.

PN754

VICE PRESIDENT HATCHER: Yes. I will allow the question.

PN755

MS KNOWLES: So what are those different parts, Mr Walls, of the dispensation of medicine that you were referring to there?‑‑‑I've written some of this in my statement, mainly in paragraph 12, but everything from entering the information into our dispense program to generate labels and repeats, to choosing the medication from our stock. It involves checking that medication against other medication that the patient may be taking - - -

PN756

And how do you check that?‑‑‑So through their - the dispensing system or through the - talking to the patient. I will be checking for - - -

PN757

And - sorry, Mr Wall - when you have - when you say "talking to the patient", what sort of conversation are you talking about their?‑‑‑So obviously depends on the situation, but it would be safe to say a conversation, usually in a private setting if possible, to - yes, discuss what medications they are taking and what medical condition s they have; what the particular issue is that they - and what the new medication may be treating, if there is any medication. How - if they are just on regular medication, how they are travelling, what issues they might be having with their regular medications, if they are experiencing side-effects; if they are having difficulty taking the medication due to trouble swallowing or trouble remembering to take their medication, and the (indistinct) of professional services become part of the dispensing process as well that they - they require - they allow us to spend more time with patients to address the issues more thoroughly, and then more - we have to take more notes and records of those services that are provided, for the sake of our records and for claiming - - -

***�� CAMERON THOMAS WALLS�� RXN MS KNOWLES

PN758

Mr Wall, when you say you had to take more notes and records, what you mean by that?‑‑‑For all of the - all of these processes from dispensing to the professional services require recordkeeping (indistinct) entered in digitally, but as well in hard copy in some cases. And so - and then we also have to put in claims to further seek CPA (indistinct) as well, so a five-minute console could mean 20 minutes with paperwork to claim the financial part of it - of the service.

PN759

Okay?‑‑‑Yes, so - - -

PN760

Sorry. Did I cut you off there?‑‑‑I'm just trying to think of where I should go next. Do you want me to continue with different parts of the dispensing process?

PN761

No. I think you have answered my question, Mr Walls?‑‑‑Okay.

PN762

Now, it was put to you - a proposition was put to you that you were - in doing the dispensing you were deploying a general skill and your answer to that was that there was a very level of depth, depending on the type of service being provided?‑‑‑Yes.

PN763

What - sorry, how do you deploy that various level of depth, depending on the type of service?‑‑‑So this was in reference to that paragraph 15? Is that the one you were referring to? The different services? Or are we talking about the different dispensary situation - - -

PN764

This was - these were questions that were put to you about when you need to make a judgment to assist patients dispensing. You said that there was a varied level of depth, depending on the type of service being provided?‑‑‑Yes.

***�� CAMERON THOMAS WALLS�� RXN MS KNOWLES

PN765

And I just - can you explain what you meant by that very level of depth, depending on the type of service being provided?‑‑‑Okay. So the - say it was a regular blood pressure medication, no complications and the patient is stable on that medication and has been for a long time. There is not a lot of input from the pharmacist. Where if there was, say, an antibiotic for a child that we needed to check the dose; if there was an error in that dose, we need to look up what the correct dose would be, contact the doctor and make the adjustment. Then we also need to claim the clinical intervention, explain it to the patient et cetera. If we have a situation where somebody is on a lot of regular medication and they are getting confused with their medication, they need help understanding what the medications for and to see if there is any issues with taking all those different medications together. It can take 15 to 20 minutes to sit down and talk through all those medications with the patient, make sure they understand what they are for and how to take them and whether it's with food or without food, whether there some other particular for that medication, checking if they are having any of the common side-effects and that's usually when you do your meds check, which involves again more - we have to enter all that information that gleans from that conversation into the computer system. Then we need to register that claim in the (indistinct) CPA portal and enter the information again. And then the services such as the home medicines review which is a much bigger process that I haven't done myself, but I can understand that it takes up to about four hours or more to perform a HMR.

PN766

No further questions.

PN767

VICE PRESIDENT HATCHER: Thank you for your evidence, Mr Walls. You are excused and you are free to go, which means you can simply hang up the phone?‑‑‑Thank you.

<THE WITNESS WITHDREW�� [3.53 PM]

PN768

VICE PRESIDENT HATCHER: So I note the time. Is that all we got time for today?

PN769

MR SECK: I think so. I think Ms Knowles had indicated that Ms McCallum was going to be next, but I probably have at least half an hour of questions for her, so if we might start tomorrow morning?

PN770

MS KNOWLES: Ms McCallum is available tomorrow morning. She may not be the first one then, given other people's work priorities.

PN771

VICE PRESIDENT HATCHER: All right. We will now adjourn and resume at 10 o'clock in the morning.

ADJOURNED UNTIL TUESDAY, 8 MAY 2018 �� [3.53 PM]

***�� CAMERON THOMAS WALLS�� RXN MS KNOWLES

LIST OF WITNESSES, EXHIBITS AND MFIs

GEOFFREY JOHN MARCH, AFFIRMED...................................................... PN177

EXAMINATION-IN-CHIEF BY MR IRVING................................................. PN177

EXHIBIT #1 WITNESS STATEMENT OF GEOFFREY MARCH DATED 10/12/2017�� PN191

EXHIBIT #2 REPLY STATEMENT OF DR GEOFFREY MARCH DATED 30/04/2018�� PN206

CROSS-EXAMINATION BY MR SECK.......................................................... PN208

THE WITNESS WITHDREW............................................................................ PN397

GEOFFREY JOHN MARCH, RECALLED..................................................... PN397

CROSS-EXAMINATION BY MR SECK, CONTINUING............................. PN397

EXHIBIT #3 COMPETENCY STANDARDS FOR PHARMACISTS IN AUSTRALIA OCTOBER 2001.................................................................................................... PN534

RE-EXAMINATION BY MR IRVING............................................................. PN537

THE WITNESS WITHDREW............................................................................ PN551

AMY BOYCE THOMPSON, AFFIRMED........................................................ PN565

EXAMINATION-IN-CHIEF BY MS KNOWLES............................................ PN565

EXHIBIT #4 STATEMENT OF AMY THOMPSON DATED 10/12/2017 PLUS ANNEXURES................................................................................................................................. PN581

CROSS-EXAMINATION BY MR SECK.......................................................... PN582

THE WITNESS WITHDREW............................................................................ PN633

CAMERON THOMAS WALLS, AFFIRMED................................................. PN642

EXAMINATION-IN-CHIEF BY MS KNOWLES............................................ PN642

EXHIBIT #5 STATEMENT OF CAMERON WALLS DATED 15/12/2017. PN647

CROSS-EXAMINATION BY MR SECK.......................................................... PN649

RE-EXAMINATION BY MS KNOWLES........................................................ PN750

THE WITNESS WITHDREW............................................................................ PN767