Community Pharmacies Face Financial and Operational Challenges in Expanding Professional Services

The Changing Face of Community Pharmacy: Juggling Expansion, Costs, and a Female Workforce

The expansion of professional services in community pharmacies—including Home Medicines Reviews (HMRs), vaccinations, and prescribing for conditions like urinary tract infections—is creating both financial pressures and workflow challenges for the primarily female workforce involved.

Home Medicines Review Program Sustainability

Women constitute approximately 70% of credentialed pharmacists delivering Home Medicines Reviews, with two-thirds under the age of 40. Many pharmacists balance professional practice with raising young families.

HMR remuneration has remained at $222.77 per review since 2019, with no indexation. Pharmacists report that this fixed rate, combined with unpaid administrative work including driving, documentation, and reporting, reduces their effective hourly income. The Pharmaceutical Society of Australia's 2026-27 Federal Budget Submission advocates for lifting the indexation freeze on medication management funding.

"The current HMR caps of 30 per month limit access, particularly in rural and remote areas," said pharmacist Katie Phillips MPS. She noted that pharmacies or HMR businesses often deduct a portion of pharmacists' earnings. Phillips suggested telehealth could serve as a follow-up method to improve efficiency.

Pharmacist Erica Stephenson MPS, a single mother, stated that the HMR cap causes difficulties when emergencies arise at month-end. She reported that irregular referral patterns undermine financial stability and that the 200 km travel allowance threshold is too high. Stephenson noted she lacks employment entitlements such as superannuation, sick leave, and annual leave.

Most credentialed pharmacists delivering HMRs operate as self-employed contractors, which means they do not receive employment benefits. Cancelled appointments leave these pharmacists without compensation. Unpaid administrative work is reported as a significant burden.

Demand for medication reviews is projected to increase due to an aging population and rising rates of polypharmacy (the use of multiple medications by a patient).

Workflow Adaptations for Professional Services

Community pharmacies are modifying traditional workflows as professional services expand from ancillary offerings to core business functions. Queensland-based prescribing pharmacist Kate Gunthorpe MPS noted that pharmacies are moving away from prioritizing dispensing above all other tasks.

Reported strategies for workflow changes include:

• Mapping busy periods to identify bottlenecks
• Implementing booking systems for consultations
• Ensuring at least one pharmacist remains consult-focused daily
• Training pharmacy assistants for appropriate triage
• Using consistent language to frame consultations as deliberate, core services

Gunthorpe advised that consultations should be presented as clinical assessments that may or may not result in a prescription.

"Pharmacists should charge appropriately for consultations regardless of the outcome, as the service involves clinical reasoning and professional judgment," Gunthorpe stated.

Pharmacies are redesigning physical layouts and staffing models to normalize consulting services. Reported changes include:

• Allocating dedicated private consultation spaces
• Implementing clear booking systems
• Ensuring adequate pharmacist coverage for clinical care
• Redistributing roles and upskilling support staff

Madison Low, a retail manager at TerryWhite Chemmart in Arana Hills, Queensland, stated that pharmacy assistants now play an expanded role in patient care. Through scripting and role-playing, assistants are trained to understand service details, typical durations, and appropriate booking or triage procedures.

Low reported that assistants now guide patients toward appropriate services—such as directing someone with UTI symptoms to a pharmacist for a full treatment plan rather than selling over-the-counter products. Assistants use empathetic communication to build patient trust, which helps identify when a pharmacist review is beneficial.