Review of the Professional Programs and Services Advisory ... · affiliated with KPMG International...

ABCD

Department of Health and Ageing

Review of the Professional Programs and Services

Advisory Committee Final Report

June 2010

This report contains 69 pages

Final Report Review of the PPSAC 30 June 2010

© 2010 KPMG, an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International. Liability limited by a scheme approved under Professional Standards Legislation.

Department of Health and AgeingReview of the Professional Programs and Services Advisory Committee

Government

June 2010

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© 2010 KPMG, an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.

KPMG and the KPMG logo are registered trademarks of KPMG International. Liability limited by a scheme approved under Professional Standards Legislation.


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June 2010

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tment) engaged view of the Professional Programs and Services Advisory

mmittee). This Report combines the findings of the s for future administrative and governance arrangements of

ffectiveness of PPSAC in carrying out the functions prescribed to it ommonwealth of

services under

ts under any subsequent

re were three eview process:

with rtment, Guild and PSA observers and program staff.

s established to nds within an d differently by

ent, the lack of

effective functioning of PPSAC.

erceived lack of rcent of PPSAC ient of funding.

filling its terms of reference particularly in relation to monitoring of program performance, accountability, transparency and contestability of program funding.

Differences in perception of the ownership of Fourth Agreement Programs and funding, and the requirement for program management, proposed expenditure of funds, value for money and benefit to health outcomes to be detailed in program proposals created tension and delays in proposal development. Lack of clarity on expectations and agreed indicators of members and stakeholders in understanding the degree of success of the Committee.

Executive summary The Commonwealth Department of Health and Ageing (the DeparKPMG to conduct a reCommittee (PPSAC or the Coreview and presents optioncommunity pharmacy programs.

The objectives of the review are to:

• determine the eunder the Fourth Community Pharmacy Agreement between the CAustralia and the Pharmacy Guild of Australia (the Fourth Agreement).

• determine the ability of PPSAC to deliver pharmacy programs andthe Fourth Agreement

• provide findings to inform future governance arrangemenCommunity Pharmacy Agreement.

A five stage methodology was utilised to undertake the review. Theprincipal data collection activities undertaken as part of the rconsultations with stakeholders; a document review and a testing workshop PPSAC members, Depa

PPSAC was a new committee under the Fourth Agreement that wa“ensure transparent, contestable, merit based allocation of fuaccountability framework”. PPSAC’s terms of reference were interpretekey stakeholders. While its role evolved during the Fourth Agreemconsensus regarding all aspects its responsibilities had a negative impact on the

There were issues with the membership profile of PPSAC, including a pindependence. These concerns primarily related to the fact that fifty pemembers were Guild representatives, and the Guild was the major recipMembership issues also prevented PPSAC from comprehensively ful

PPSAC performance also created challenges for PPSAC




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While PPS

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AC had arrangements in place to elicit stakeholder views they had varying ss, due in part to the lack of consensus in relation to the the work of

urth Agreement ovement in the

PPSAC and its subcommittees were an important mechanism for accessing specialist

their outcomes. er PPSAC to have

y stakeholders. rted that PPSAC strengthened the development of the programs through:

the perspective her interested stakeholder groups, such as consumers and Indigenous

e Guild or the

incorporation of luations into subsequent program

mitigate risks;

ble, merit based

ess of PPSAC,

rogram eligibility asures, there were differing levels of support for its role in

oversighting the funding of projects, encouraging competition in the management and provision of programs, monitoring outcomes of programs and ensuring accountability for program performance;

• significant delays in reaching agreement on the program design and in establishing the programs;

• robu PPSAC membership which has over 50 per cent of members that have some vested commercial interest in the outcomes of the advice provided;

degrees of succethe Committee.

Overall effectiveness Most stakeholders acknowledged that the arrangements under the Fowere an important step towards increased accountability and imprgovernance of the community pharmacy programs. It was also acknowledged that

knowledge and expertise to the overall benefit of the programs and Despite this, a majority of stakeholders interviewed, did not considbeen effective.

A number of strengths of PPSAC and its mechanisms were identified bIt was repo

• providing opportunity to engage and consider program issues fromof otrepresentatives, and to draw on expertise not residing within thDepartment

• adopting a robust evaluation strategy and strong evidence of learnings from Third Agreement program evaproposals

• systematically identifying program risks and potential strategies toand

• providing a framework to fulfil obligations for transparent, contestaallocation of public funds, and monitor program effectiveness.

Factors limiting the effectiveness of PPSAC

A number of issues were raised that impacted on the effectivenincluding:

• while there was consensus on PPSAC’s role in developing policy, pcriteria and outcomes me

stness of governance mechanisms including the


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the perception that some oices were given limited consideration, particularly within PPSAC; and

ms.

rmacy programs

tanding of obligations, diture of public

inister;

ver within the

res. The plan updated on an annual basis. There should also be a high

milestones and and opportunities for integration and potential

program design

holder profile for

mmunity pharmacy programs under the Fifth Community Pharmacy Agreement. These arrangements will include enhanced roles and responsibilities for the Agreement Consultative Committee (ACC), and the establishment of a new committee, to be known as the Program Reference Group (PRG). The PRG will provide advice to the ACC and to the Minister on the policy dimensions of the programs and will incorporate broad stakeholder representation from the pharmacy profession, consumers, other health professionals and program management experts.

• effectiveness of stakeholder engagement strategies andstakeholder v

• limited timely, robust performance information available from progra

Options for the future A number of options for consideration in the future management of phaare identified. These included:

• improving communication and developing a shared undersresponsibilities and accountabilities for the oversight of the expenmonies;

• improving the transparency of advice and recommendations to the M

• initiating strategies to minimise the disruption of staff turnoDepartment and Pharmacy Guild;

• developing a strategic plan which includes performance measushould be reviewed andlevel workplan for committees that includes defined timelines, identifies program dependencies efficiencies;

• involving a broader range of stakeholders including consumers inand management activities; and

• aligning membership of the committees with the key stakecommunity pharmacy programs and services.

New governance arrangements are being established for co


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Contents

8 1.1 8 1 8

10

11 AC’s role 11

of PPSAC in meeting its prescribed obligations 15 re, membership and governance arrangements 22

2.4 Reporting arrangements 29 2 31

33 n 34

37 t Steering Committee 37

Committee 39 3 41

43 mittee 44

enza Working Group 45 3 us Steering Committee 46

issues and options for the future 48 48

4.2 Factors limiting the effectiveness of PPSAC 48 4.3 Options for the future 50

A Detailed methodology 52 A.1 Consultations with stakeholders 52 A.2 Document review 53 A.3 Testing Workshop 53

1 Overview Review objectives

.2 Review methodology 1.3 This report

2 Review findings - PPSAC 2.1 Appropriateness of PPS2.2 The effectiveness2.3 Committee structu

.5 Advice provided to the Minister

2.6 Secretariat effectiveness 2.7 Stakeholder consultatio

3 Subcommittees 3.1 Research and Developmen3.2 Diabetes Pilot Program Steering

.3 Evaluation steering committee 3.4 Hepatitis C Steering Committee 3.5 Home Medicines Review Subcom3.6 Pandemic influ

.7 Rural and Indigeno

4 Strengths,4.1 Strengths




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B s of inquiry 55

C 60

D nformation 63

E Committee structure 65

F Case Studies 67

Key review area

Interview participants

Proposal template i


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Disclaimer

ngagement.

Department of Health and Ageing and is not to be copied, quoted or referred to in whole or in part without KPMG’s prior

t. KPMG accepts no responsibility to anyone other than the Department

This report has been prepared as outlined in the Project Section. The services agement, which an Auditing and ions intended to

sed.

relation to the documentation nd personnel /

keholders consulted as part of the process.

KPMG have indicated within this report the sources of the information provided. We have not sought to independently verify those sources unless otherwise noted within the report. KPMG is under no obligation in any circumstance to update this report, in either oral or written form, for events occurring after the report has been issued in final form.

The findings in this report have been formed on the above basis.

This report is delivered subject to the agreed written terms of KPMG’s e

This report is provided solely for the benefit of the

written consenof Health and Ageing for the information contained in this report.

Inherent Limitations

provided in connection with this engagement comprise an advisory engis not subject to assurance or other standards issued by the AustraliAssurance Standards Board and, consequently no opinions or conclusconvey assurance have been expres

No warranty of completeness, accuracy or reliability is given in statements and representations made by, and the information andprovided by the Department of Health and Ageing management asta




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1 tment) engaged

nal Programs and Services Advisory the Committee). This Final Report combines the findings of the older consultations and testing workshop and presents options

and governance arrangements.

prescribed to it the Commonwealth of

t)

f PPSAC to deliver pharmacy programs and services under

future governance arrangements under any subsequent

y thodology was used to undertake the review. The activities and utlined in Figure 1.

principal data collection activities undertaken as part of the review process. These included:

• consultations with stakeholders

• a document review

• a testing workshop.

Overview The Commonwealth Department of Health and Ageing (the DeparKPMG to conduct a review of the ProfessioCommittee (PPSAC ordesktop review, stakehfor the future administrative

1.1 Review objectives The objectives of the review are to:

• determine the effectiveness of PPSAC in carrying out the functionsunder the Fourth Community Pharmacy Agreement betweenAustralia and the Pharmacy Guild of Australia (the Fourth Agreemen

• determine the ability othe Fourth Agreement

• provide findings to informCommunity Pharmacy Agreement.

1.2 Review methodologA five stage medeliverables are o

There were three


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Figure 1: PPSAC review project methodology

Each of these activities were used to inform a number of reports. These include:

nformed by the stakeholder consultations

ations and

- Diabetes Pilot Program Steering Committee

- Research and Development Steering Committee

• this Final Report, which is underpinned by all three activities including the stakeholder consultations, document review and the testing workshop.

Detail about each of the three review data collection activities is provided in Appendix A.

• the Consultation Report, which was i(submitted to the Department in April 2010)

• the two Case Study Reports informed by the stakeholder consultdocument reviews (submitted to the Department in May 2010)


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1.3 tion to the key achments case

s on the findings of f the existing inistrative and

oject scope.

The findings are grouped within each of the key review areas and review questions that were outlined in the review framework. The review questions were the focus of the data collection through the consultation interviews, the documentation review and the testing workshop.

This report This final report presents a discussion and analysis of findings in relaobjectives and review questions for the project. It also provides as attstudies of two of the PPSAC subcommittees. The final report buildthe consultation report identifying strengths and challenges oarrangements. It also presents some options for the future admgovernance arrangements relating to PPSAC, within the limits of the pr




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2 f the documentation review, consultation interviews PSAC.

2.1 e advice to the Minister for

ll professional programs and services funded under the Fourth

re transparent, ble, merit based allocation of funds within an accountability framework”1. It

further clarifies that the function of the Committee is to provide advice to the Minister on es, including:

and management responsibilities for projects and programs

ance outcomes

nce also provide direction on considerations in assessing proposals for funding:

ncy with objectives of the PPSAC and the Fourth Agreement

including:

- value for money including issues such as performance, relative risk, flexibility and

- encouraging competition including non-discrimination in inviting and selecting suppliers

- efficient, effective and ethical use of resources

Review findings - PPSAC This section presents the findings oand testing workshop in relation to P

Appropriateness of PPSAC’s role PPSAC was a new committee established in 2006 to providHealth and Ageing on aAgreement.

What is the role of PPSAC?

The Fourth Agreement states that PPSAC was established to “ensucontesta

projects funded under the Professional Pharmacy Programs and Servic

• the funding of the projects

• the development of policy objectives, eligibility criteria and performmeasures

• monitoring the outcomes of programs

• any other agreed function.

These functions are reflected in the PPSAC terms of reference. The terms of refere

• consiste

• principles of the Commonwealth Procurement Guidelines

financial considerations

1 The Fourth Community Pharmacy Agreement between the Commonwealth of Australia and the Pharmacy Guild of Australia, November 2005 and amended March and August 2007.


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AC were quite n of programs and

advice on program policy and eligibility criteria. Several stakeholders also focussed on the Committee.

es raised by stakeholders in relation to PPSAC’s role included:

o oversight

le.

of PPSAC in monitoring of

redetermined by

• Around half of the stakeholders interviewed thought that the Committee was still its role and that its role had changed over the term of the Fourth

ocussed on e by the Guild

review” and interfered with what had already been agreed with the Government.

ence

were d ion with the Guild M assessment of

e aga rm of reference.

sment of PPSAC performance against terms of reference

- accountability and transparency2.

The understanding of those interviewed in relation to the role of PPSdiverse. The most commonly identified role related to the desig

the monitoring of outcomes and program implementation as a role ofSome of the key issu

• The majority of stakeholders agreed that it was appropriate for PPSAC tthe design of programs.

• A small number of stakeholders identified accountability as a core ro

• The majority of Guild stakeholders did not support the roleoversighting implementation, expenditure of funds and ongoingprograms, with a view expressed that program expenditure was pthe Fourth Agreement for disbursement to community pharmacies.

developing Agreement from one of oversight of development of programs to one fmonitoring programs. This change in role was seen as a negativrepresentatives who perceived that PPSAC had turned into a “house of

Terms of refer

Terms of referenceand signed off by thePPSAC’s performanc

Table 1: Asses

eveloped by the Department in collaboratinister in mid 2006. Table 1 contains aninst each te

Terms of Reference Assessment

Provide advice and recommendations to the Minister on the funding of the projects and management responsibilities for projects and programs under the Professional Pharmacy Programs and Services

programs was provided to the Minister after each in letters from the PPSAC chair to

the Minister.

Advice on funding of projects and management of

PPSAC meeting

Provide advice and Advice on eligibility criteria and policy was provided

2 Operating Guidelines, Fourth Community Pharmacy Agreement August 2006.


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Terms of Reference Assessment

recommendations to the Minister on the development of policy objectives, eligibility criteria and performance outcome measures for programs to be funded under the Professional Pharmacy Programs and Services

PSAC chair to the

Performance measures agreed by PPSAC were predominantly process measures with some impact

to the Minister in letters from the PMinister.

measures.

Provide advice and recommendations to the Minister on monitoring the outcome of programs funded under the Professional Pharmacy Programs and Services.

Advice on funding program evaluations and the identification of Program performance indicators was

provided to the Minister.

The Committee will also perform any other functions agreed between the Minister and the Pharmacy Guild in relation to the Professional Pharmacy Programs and Services.

Not required.

In assessing proposals for funding consider consistency with objectives of the PPSAC and the Fourth Agreement

onsidered in Fourth Agreement objectives were cassessing proposals.

In assessing proposals for funding consider principles of the Commonwealth Procurement Guidelines including:

• value for money including issues such as performance, relative risk, flexibility and financial considerations

• encouraging competition including non-discrimination in inviting and selecting suppliers

• efficient, effective and ethical use of resources

Value for money, competition and efficient, effective and ethical use of funds were considered by PPSAC to varying extents. PPSAC recommended a mix of direct, select and open tender processes for program implementation and evaluation teams depending on the program or service under consideration.

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stakeholders that PPSAC should inform policy views to inform

ived that the current prescribed role of ern raised related to PPSAC having a role

The extent to which PPSAC fulfils its prescribed role

d its prescribed le 1).

delivered on its se. The most ing on program ose who were to

PPSAC processes were not the only d that although outlined in the

raisal criteria to PPSAC was not r the successful

h a pharmacy organisation were more satisfied with the performance of PPSAC in fulfilling its

rmined that PPSAC had provided a commonsense review of would produce

versight working Pilot program.

revision of the program proposal to address issues with appropriateness and evidence of benefit to

Stakeholder views on changes that should be made to the current role were mixed. Most of the ministerial appointees and the Department stakeholders were satisfied with the role outlined in the Fourth Agreement, PPSAC terms of reference and the Operatin

Guild stakeholders who thought PPSAC’s role was inappropriate suggested that the Committee should play an advisory role in relation to program design. Some (though not all) thought that PPSAC had a role in ongoing oversight, assisting in the

Appropriateness of the prescribed role

There was strong consensus among all and be a consultative vehicle for eliciting a balance of stakeholder advice to the Minister.

Most (but not all) Guild stakeholders percePPSAC was not appropriate. The main concin determining and approving expenditure on programs.

Review of documentation demonstrated that, in general, PPSAC fulfillerole as outlined in the terms of reference and operating guidelines (Tab

However, overall, stakeholders indicated that PPSAC had not fully prescribed role, though the reasons for this view were quite divercommon reason identified was the delays in developing and agreedesign and the subsequent delays in distributing program funding to thimplement programs. It was noted, however, that cause of delay in the implementation of programs. It was also notethere was some guidance on information for inclusion in proposals program proposal templates, there were no directions or agreed appassess the proposals. One stakeholder also expressed the view that really held accountable by either the profession or the Government fodelivery of the Community Pharmacy Programs and Services.

Those stakeholders who were not pharmacists or associated wit

objectives. This group detethe program designs and assessed the degree to which the funds spenta demonstrable improvement in health outcomes. An example of this oto provide accountability is the Hepatitis C Public Health PromotionStakeholders thought that the PPSAC process had successfully initiated

health outcomes.

Changes to the prescribed role

g Guidelines.


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engagement of appropriate s

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takeholders in the program management process, as well itself. There were a range of views about

on PPSAC

s of committee e

• strategies to achieve greater clarity on program proposal requirements such as

PPSAC was a new committee under the Fourth Agreement and its role has developed lved, consensus cts its role and nd performance

portant aspect of the role of PPSAC that was identified at the testing workshop , which is a static document, elivery environment. For this

as seen as important that PPSAC did not adhere rigidly to the program ent but instead applied its

collective expertise to assessing the currency and appropriateness of each program

2.2 The effectiveness of PPSAC in meeting its prescribed

s how the PPSAC fulfils its obligations in relation to:

public interest

• accountability – i.e. submission to appropriate external scrutiny

• transparency – i.e. meaningful consultation with stakeholders in Community Pharmacy Programs and communicating clear accurate information.

Accountability framework

Review ccountability framework has a number of elements:

as providing policy advice within the programhow this might be achieved including:

• a more representative stakeholder group

• provision of more detailed information on roles and responsibilitiemembers during their orientation to the Committe

early integration of evaluation measures into program design.

Implication of findings on PPSAC role

throughout the term of the Agreement. While the PPSAC role has evoamong key stakeholders has not been reached regarding all aspeobligations, particularly with regards to consideration of financial ameasures..

An imwas that it enabled the translation of the Fourth Agreementinto the current context of policy priorities and the service dreason it windicative funding allocations identified in the Agreem

proposal.

obligations This section explore

• stewardship – i.e. manage resources efficiently and effectively in the

of documentation demonstrates that the PPSAC a


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ntification of cost and

nce through status reports

expectations of ittees and program management in monitoring program performance and

effectiveness in delivering on the objectives of the Fourth Agreement. There was also limited use of outcomes and impact measures in the program performance indicators

indicator data with the exception of program

t programs and reement. Most

es set out in the

ould not fulfil its of the Fourth

Committee. Concerns primarily related to the s being Guild

not be members as perceived to d independence grams, eligibility d a commercial

interest in the outcomes of PPSAC’s deliberations.

There were a number of issues relating to assessment of value for money, performance history, risk and flexibility that flowed from the fundamental perception that the Fourth Agreement money was for exclusive use a view ptions that may have been more cost effective or used other service providers were not considered, even if they were able to deliver the same or increased benefit to health outcomes at a lower cost. An example of this is the development of business rules for the Section 100 program

• review and refinement of program proposals including idebenefits of the proposal

• identification of performance indicators within program proposals

• oversight and monitoring of a program performa

• periodic review of program expenditure against funding allocation

• independent evaluation of the programs.

There is variability in the clarity of communication around the subcomm

and regular reporting of performanceexpenditure.

Stewardship, accountability and transparency

The documentation review and stakeholder consultations indicated thaexpenditure of funds were consistent with the objectives of the Agstakeholders agreed that there was a strong alignment with the prioritiFourth Agreement and programs.

There was a view held by the majority of stakeholders that PPSAC cobligations in relation to stewardship of funds due to the natureAgreement and the membership of the membership of PPSAC where, fifty percent of PPSAC memberrepresentatives, and the Guild was the major recipient of funding. It was argued thatthose having governance oversight and review of the programs should of an organisation funded to deliver the programs. This situation wpresent a direct conflict of interest and a threat to the transparency anof the process. The second point of conflict was in developing procriteria and business rules where the majority of the committee ha

by community pharmacy, withexpressed by some stakeholders that alternate o


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June 2010

and the splitting of the supply from the QUM component. It was reporteddevelopment process was not open and transparent and did not service delivery arrangements. These new business rules charrangements so that the QUM component of service de

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that the policy support flexible anged current

livery under Section 100 must be delivered by a community pharmacy unless there was none within 30 kms. This

an integrated

ated separately berations of the

arency of processes to elopment of the ders other than mittee members ules.

dent evaluation would not have valuators have

e Department’s r, many are only inform program

g of program keholders. One ant Traineeship program and

achievement of objectives where in essence recruits were limited to a very small ained a large number of pharmacy

assistants. There were also restrictions around requirements that scheme participants e thus excluding have an interest his instance the

commercial interests of community pharmacies were regarded above the potential

Assessing value for money and health benefit to consumers

There was evidence within the PPSAC minutes that members questioned the quantum of funding allocated, particularly in relation to proposed budgets for the administration of programs, for example further explanation was required prior to recommending the propose opment program.

However, there was a fundamental difference of opinion between the Guild and non-Guild representatives around the validity of the PPSAC role in assessing value for

disrupted standing arrangements and existing relationships whereservice was provided by some hospitals in rural and remote locations.

Some stakeholders thought that these arrangements were negotibetween the Guild and the Department without reference to the delirelevant subcommittee, raising concerns about the transpdevelop some business rules. A further example relates to the devHMR business rules with the exclusion of pharmacist service provithose from community pharmacies. Again it was perceived that comwere not privy to out of session negotiations regarding these business r

PPSAC agreed that each program would be the subject of an independuring the Fourth Agreement, and that fund-holder/program managers a role in the selection of tenderers for these reviews or evaluations. Ebeen selected via open tender processes or from approaches to thpanel of evaluators. Almost all programs are being evaluated, howevejust delivering findings now and this was noted to be too late to improvements and Fifth Agreement discussions.

There were some concerns regarding transparency of reportinperformance information reported by some (but not all) pharmacist staexample is the Aboriginal and Torres Strait Islander Pharmacy AssistScheme where reports appeared to support good uptake of the

number of participating pharmacies, one of which tr

were employed in a community pharmacy prior to entering the schemIndigenous health workers employed in other health care services whoin training as a pharmacy assistant. The perception was that in t

increase in community health benefits of wider eligibility criteria.

d administration costs for the Research and Devel


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se differences

predetermined s in relation to some extent by y accessible to

s such as the er pharmacists.

d in the Fourth nt Program and

through another exercise to assess others with one ample where a

amount of money was recommended without PPSAC consideration of

s was critical to rograms and the ability to assess

value for money.

onger focus on en a consumer

pment Steering

the Fourth Agreement is set up discourages service me instances failing

r flexible services that support evidence based programs across the continuum of care. One example cited by a number of stakeholders was the

Review (HMR) to deliver HMR

care from hospital to community.

ansparent program funding

In general most stakeholders agreed that individual funding decisions within the committee process were transparent and that efforts were made to demonstrate the reasons for recommending funding go to the Guild or other organisations rather than going to

Minutes of PPSAC meetings provide examples where PPSAC required additional justification for direct sourcing of program management or implementation of discrete

money or health benefit to consumers. Insights into the cause of thewere posed by some stakeholders and included:

• It was thought by some stakeholders that a number of programsthrough the Fourth Agreement may not support specific policieintegrated and flexible service delivery options. This is supported tothe business rules and Medicare reimbursements that are onlcommunity pharmacy owners. However it was noted that programRMMR and some rural programs provided access to funding by oth

• Evidence for the efficacy and cost effectiveness of programs outlineAgreement is established through the Research and Developmetherefore it was not necessary for PPSAC to go value and health benefit to consumers. This view was contested bystakeholder citing the Pandemic Influenza Program as an exsignificant evidence of its effectiveness.

• A number of stakeholders acknowledged that evaluation of programthe ongoing assessment of the effectiveness of p

• Consumer representation on PPSAC could have facilitated a strhealth outcomes from a consumer perspective. However, even whrepresentative was present (as in the Research and DeveloCommittee) consumer priorities were not always given priority.

• The way PPSAC andintegration and innovation, instead reinforcing “silos” and in soto delive

extensive delays in changing business rules for the Home Medicinesprogram to allow accredited hospital or consultant pharmacists services or provide input into them in order to support better transfer of

Mechanisms to encourage competition and ensure contestable, tr

open tender.


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tasks prior to making a recommendation to the Minister. For examplprogram management of the Research and Deve

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e, awarding the lopment Program to the Pharmacy

he Evidence to without a competitive tender.

e the programs Guild for the following reasons:

ting community pharmacists

ement the Guild had the right to manage

• the Guild staff had a successful track record with corporate knowledge, skills and

eports of Third

the commercial bility to recruit a tage. Therefore ment reinforced ld.

ied that there was a fundamental issue with a rsement of funding to an organisation that had a 50

per cent representation on the Committee itself. It was viewed by a number of interest of the openness and ed by evidence

SAC sponsored by the Guild or a Guild/PSA collaboration.

Criteria to evaluate program proposals

A proposal template was developed by the Department and the Guild in March 2006 and was subsequently signed off by PPSAC. The information template for new and ongoing programs was similar and required completion of the following information:

• Iden the proposal addresses.

Guild, and also, within the Research and Development Program, tPractice (E2P) project to the PSA

Guild representatives were strongly of the view that the right to managsat with the

• the Guild was uniquely positioned as the key group represen

• as the party negotiating the Fourth Agrethe expenditure of the funds identified in the Agreement

experience to more manage the programs effectively

• evidence of successful program management from evaluation rAgreement programs.

While acknowledging the skills, experience and communication networks of the Guild,a number of stakeholders contested this view. Some thought that advantage that the Guild had through previous Agreements and their alarge number of staff was the main factor in their competitive advancontinuing to support the Guild as the only option for program managethe lack of contestability and commercial advantage enjoyed by the Gui

A number of stakeholders identifcommittee oversighting the disbu

stakeholders that PPSAC could not act independently of the vestedGuild and of community pharmacy owners and that this inhibitedtransparency and created a bias in decision making. This is supportfrom the documentation review with all proposals presented to PP

tification of Fourth Agreement priority area/s which


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•

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ct Outline - including a brief description of the aim and type of older activities,

cluding health

reement - relating program objectives and outcomes to the objectives of the program as set out in the Fourth

included in the

was agreement onsideration for

bers in recommending funding. All stakeholders were satisfied that the five priority areas identified in the Fourth Agreement (medication management review,

e-Health) were at the proposal stablished rules

ave assisted PPSAC to identify gaps and deficiencies.

the process for rce of significant

blishing programs. Guild staff or PPSAC members involved in developing program proposals expressed a significant level of frustration with the proposals and

was only one t and approval process, and that following a decision

by the Minister funding agreements and often a number of sub-contracts needed to be e to a range of

• the need for more detailed information that was not contained in PPSAC proposals to be provided to the Department to enable the Department to fulfil its financial management obligations for Commonwealth funds, and

• a hig

All stakeholders involved in the development of the Practice Change Program expressed a high degree of frustration with the inability of the current mechanisms to

Program/ProjeProgram e.g. education campaign, funded health service, stakehincentives program.

• Program/Project Outcome - outcomes of the program/project inoutcomes and activity measures.

• Relationship to Fourth Community Pharmacy Ag

Agreement.

• Program/Project Costs - including project and administration costs.

The template also provided guidance on critical information to be proposal. This information is listed in Appendix D.

While there were no explicit criteria used for evaluating proposals therethat the objectives and priorities of the Fourth Agreement were a key call PPSAC mem

rural pharmacy, indigenous access, better community health and reflected in the advice to the Minister. Stakeholders also reported thtemplate facilitated the process for evaluation of proposals however eand criteria for assessment of these proposals would h

Most stakeholders expressed a high degree of dissatisfaction with agreeing program proposals. It was agreed that this process was a soudelays in esta

perception of inconsistent level of detail required by the Department.

However, stakeholders noted that PPSAC consideration of proposals step in the program developmen

negotiated. The negotiation of these agreements was often lengthy dufactors, including:

h turnover of program managers.


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get this program up and running effectively. A range of pharmacidentified this failure as a key reason for the limited success of many oPharmacy Programs. The objectives of the program were to assist i

21

ist stakeholders f the Community n developing the

skills and understanding of community pharmacists in change management and issues pensing and into service delivery. There were

a diverse range of views on the reasons for this identified below:

eement on the benefits of the program

al to clearly articulate the program and its benefits

ing the program identified in the template

ying the original losophy and the evidence based research that supported its value in

id have a set of consistently for

s of the Fourth did not support

m staff on the ement for them for money and

delays in proposal development. This is exacerbated by differences in understanding of proposal requirements including the need for robust mechanisms to monitor program performance and delivery of benefits identified by the program.

Delays to PPSAC program signoff could be minimised by: strategies to address issues with differences in expectation around program proposal requirements; increased guidance to the Guild on proposal requirements; and the development of agreed appraisal criteria to assess program proposals.

related to expanding their role beyond dis

• lack of agr

• inability of those developing the program propos

• lack of adherence to the defined processes and protocols includproposal not addressing those areas

• the program proposal was business focussed rather than identifintent, phifacilitating implementation of programs.

It was noted that the Research and Development Steering Committee dcriteria for assessment of research project proposals that was appliedall research areas.

Implications of findings regarding PPSAC obligations

The review found that the current membership of PPSAC, conditionAgreement and existing processes for seeking program proposals transparency and contestability of funding programs.

Differences in perception of Guild PPSAC members and prograownership of Fourth Agreement Programs and funding, and the requirto justify Guild program management, expenditure of funds, value benefit to health outcomes creates tension and




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June 2010

22

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2.3

This section discusses the current structure and membership of PPSAC and its lores whether it is fit for purpose and its effectiveness in supporting its

role and obligations.

orted by a series of subcommittees which were established to assist with specific programs or tasks as

ers. Each of the seven subcommittees were and were time limited in duration. In total seven ring the Fourth Agreement including the following:

• Research and Development Steering Committee

mmittee

ittee

gers for each of SAC and the

by the Department. The Department also provides ice to the Minister. PPSAC reports directly to the Minister but also

n the Community Pharmacy Programs to the ACC.

mittee structure se of delays in

establishing programs. There were some subcommittees that struggled to find a role once programs were up and running and others that were unsure of their role and how they fitted within the overall structure.

Current membership

The current membership of PPSAC is five Guild appointed members and five Ministerial appointees. The PPSAC Operating Guidelines specifies that Ministerially appointed Members are appointed on the basis of their individual skills, knowledge and

Committee structure, membership and governance arrangements

committees, exp

Committee structure

The structure of PPSAC is illustrated in Appendix E. PPSAC is supp

determined necessary by PPSAC membestablished for discrete purposes subcommittees were established du

• Rural and Indigenous Steering Co

• Evaluation Steering Committee

• Hepatitis C Steering Comm

• Diabetes Pilot Program Steering Committee

• Home Medicines Review Program Steering Committee

• Pandemic Influenza Working Group.

Each of the programs themselves were supported by program manathe Fourth Agreement programs. Secretariat support for PPsubcommittees is provided independent advprovides status reports o

The majority of stakeholders were satisfied with the PPSAC sub-comalthough a couple thought it overly complex and as such, the cau


Government

June 2010

23

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m

Chairs since the Guild appointee.

g the life of the committee. This es to Ministerial ere not seen to

ependence and . Depending on cic could have a e current model

d five ministerial appointees has the potential to set up an within PPSAC

most committee h the significant

input it had into Committee deliberations through information briefs to members and

or members), o

of nomination.

hat PPSAC should have been more representative than it ough the details of the preferred membership differed between

stakeholder groups. The need to have members at the table who were interested in understanding of the requirement for

ntability was identified.

fulfil PPSAC’s

• health economics

• evaluation and performance measurement and statistics

• accountability frameworks

• capa nding of large government programs.

expertise. Further, they hold the appointment at the discretion of the Minister for a terof two years however they are eligible for reappointment.

The PPSAC Chair is appointed by the Minister. There have been two inception of PPSAC. The past Chair continues on the Committee as a There have been several changes in membership durinincludes three changes to Pharmacy Guild appointees and two changappointees. All stakeholders consulted agreed that these changes whave negatively impacted the functioning or effectiveness of PPSAC.

There was a broad agreement that the current membership lacked indwas not appropriate to effectively fulfil the terms of reference of PPSACthe program that was being considered, all members except Ms Kurindirect interest in the programs being considered. It was noted that thwith five Guild members anadversarial structure although it did not necessarily play out that way meetings. While the Department was not a formal member of PPSAC members and observers agreed that it functioned as a member throug

participation in PPSAC discussions.

Some pharmacist stakeholders (who were not Guild representativesexpressed concern with the lack of transparency and openness of the process tidentify PPSAC members and expressed the need for an open process

Appropriateness of skills, experiences and perspectives

There was broad agreement tis currently, alth

community pharmacy programs and have antransparency and accou

Skills and capabilities that were identified as useful and necessary torole and governance obligations were:

bility in managing and governance of the fu


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June 2010

ABCD

There was strong consensus that the Department should have formal The rationale for this included its interest as a key stakeholde

24

representation. r, its specialist knowledge

d increase the re 2).

o a broad, but not unanimous view, that there should be consumer the ability of a

dge required to actively participate.

The following groups were identified as those needing to have representation on

• indigenous health services including Aboriginal controlled services

works

• pharmacist representation (discussed in more detail below).

rmacists on the re of the view that it was appropriate for the Guild to be

entatives of the pharmacy profession as they were the party ams

the broader stakeholder group acknowledged ht that there should be representation from a

• The Pharmacy Guild

• Pharmaceutical Society of Australia

• Australian Association of Consultant Pharmacists

• The Society of Hospital

• Pharmacist registration boards

• Association of Professional Engineers, Scientists and Managers, Australia.



of government policy directions and the potential to simplify antransparency of the advice development process (see Section 2.5, Figu

There was alsrepresentation on the Committee. Some concerns were expressed withconsumer to understand the programs and have the level of knowle

PPSAC:

• consumers

• General Practitioners and General Practice Net

• aged care

• Community service providers including allied health and nursing

There were two views about the appropriate representation of phaPPSAC. Guild stakeholders wethe majority represnegotiating the agreement and represented the group for which the funding streare intended.

Other pharmacist stakeholders as well as the important role of the Guild but thougnumber of pharmacist groups including:

Pharmacists of Australia


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June 2010

ABCD

25

ere structured, with decisions and actions identified. Progress against actions were reviewed at the

-face with the nce.

meetings were ed out the business put forward. It was viewed by

some stakeholders that the current membership meant that there was lack of diversity scussion. It was

k” exercise in developing

Most stakeholders agreed that there was little PPSAC activity between meetings. This ding:

on was delayed or at times not

• limited engagement and at times delayed responses by members to out-of-session

iting.

e were delays in

step towards improving workflow out of session it had a number of issues including access and the

it had not been

The PPSAC Operating Guidelines make provision for the Chair to invite individuals or experts to attend a meeting to deliver papers or provide advice or organisational views on particular issues ("Observers"). It further notes that Observers cannot endorse recommendations, although they may contribute to discussions at the discretion of the Chair.

Meeting minutes demonstrated that PPSAC relied on Observers, usually program managers, evaluators or other subcontractors to provide a more in depth view of the progress of programs and their implementation status.



Meeting effectiveness

Review of minutes and agenda papers demonstrated that meetings w

commencement of subsequent meetings. Meetings were face-toexception of the December 2006 meeting which was held by teleconfere

There was general consensus among members that the PPSAC constructive and effectively carri

of views. This in turn limited the opportunity for robust debate and dithought that at times PPSAC went through a “tick and flicadvice and reviewing proposed programs.

was a point of frustration to many with a range of issues identified inclu

• information requested for circulation out of sessiprovided until the next meeting

papers

• only a small number of opportunities for out of session comment

• the utility of the PPSAC Quickplace website

• preference of some to provide comment in person rather than in wr

Other challenges identified in the efficient functioning of the Committeobtaining program information and documentation for review by the Committee.

While the establishment of the Quickplace website was seen as a positive

user interface which decreased its useability. At the time of this reportupdated for at least 12 months.


Government

June 2010

Most stakeholders agreed that meeting Observers added value toproviding a level of detail about policy and implementation issues not avCommittee members themselves. However there appeared to be a chaand level of participation over time. Initially it appeared that their pameeting was restricted to only those items that directly involved theexample a progra

26

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the meetings, ailable from the nge in their role

rticipation in the Observer. For

m manager may come into the meeting only for the agenda item wards. This appeared to change over having a role equal with members in

Monitoring and responding to indicators of performance

ms for reporting

enda papers for

meetings

ntation progress of programs.

rogram evaluations were aluations. PPSAC tasked the aluations and oversighting the

relating to evaluations are discussed in more detail in Section 3.3.

bility of PPSAC ified:

• some delays in getting performance information to the Committee

gn

• delays in initiating external evaluations prevented a formative approach to the evaluation of many of the programs. Issues cited were delays in engaging evaluators due to the lengthy tendering process, delays in establishing the Evaluation Steering Committee, and limited evaluation expertise among PPSAC and

PPSAC response to the performance of the Community Pharmacy Programs was limited by the quality of the information provided to them. However there were also

which they were to speak to and then left aftertime with one member describing Observers asCommittee discussions.

Review of documentation demonstrated that there were four mechanison program performance to PPSAC. These were:

• stand-alone agenda papers

• program status reports distributed to PPSAC members with the ageach meeting

• verbal reports by Guild or Department program managers at PPSAC

• reports or presentations of formal external evaluations or impleme

It was noted that there was a focus by PPSAC on ensuring pin place and monitoring outcomes of program evEvaluation Steering Committee with setting up the evprocess for contracting with the external evaluator. Issues

There was a high level of dissatisfaction among stakeholders with the ato monitor and respond to performance. The following issues were ident

• performance measures were not incorporated into the program desi

those developing the programs.


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June 2010

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concerns expressed by some that, where there was evidence that properforming against their objectives, PPSAC was slow to responresponding to the findings of an independent qualitative study of the HMfound significant issues with implementation, particularly with regardthose most at risk of medication misadventure; timeliness and effectivand widespread ambivalence among health professionals towardstakeholders saw this as a failure of PPSAC to respond to program issthe issues with uptake of the program were not identified as a problemactions being driven by the Department. Secondly, although the reviewover a year ago and recommendations had come through the subcommto ad

27

grams were not d, for example R Program that

to: targeting of eness of HMRs; s HMRs. Many ues. Firstly, that by PPSAC with was completed ittee processes

dress the issues, no action had been taken at the time of the consultation April 2010) to modify the HMR business rules. It was noted that PPSAC mmendations regarding changes to the HMR program at the April 2010

ions to consider

considered. A f programs and

ogram proposals including risk mitigation strategies. One s circulated out-ed strategies for ram relating to

f the Program. The evaluation approach was response to the issues identified to determine the significance and impact ram’s effectiveness.

nsider relevant stakeholders however viewed the

process undertaken to review the program proposals and problem solve issues as an

with relation to ic approach to

There was strong agreement among all stakeholders that PPSAC did not take a strategic approach to achieving its objectives. PPSAC was described as “reactive” with acknowledgement that the significant workload of the Committee restricted the time available

There was no overarching plan for rollout of programs and consideration of how projects and programs interrelate and how this might be better managed from the perspective of pharmacists participating in the programs. There was also perceived to



interviews (midsigned off recomeeting after at least one out-of-session and two in-session discusschanges.

Risk management

Review of documentation demonstrated that risks to programs wereformal risk assessment was completed as part of the development odocumented within prexample of an additional response to program risk was a paper that waof-session to PPSAC members for advice in 2008. The paper addressmanaging potential risks to the Patient Medication Profiling Progmedication image availability and uptake omodified in on the prog

Stakeholders agreed that PPSAC did not systematically identify and comitigation strategies when formulating advice. Some

ad hoc mechanism for identifying and managing risks.

Strategic focus

Documentation review demonstrated that PPSAC considered strategiesspecific programs however it did not consider an overall strategachieving its objectives or identifying and managing strategic risks.

to undertake formal strategic planning.


Government

June 2010

be little consideration of how one program may build or integrate with others.example the Diabetes and Asthma program

28

ABCD



For s have synergies and one stakeholder

efficiencies for

rmacy sector of onsideration for

ctor. There were eholders who thought that closer attention to the wider strategic

positioning of community pharmacy programs in the healthcare reform agenda would rogram on maximising health outcomes for investment

d the pharmacy

in the case of

eholders that conflicts of interest were

of conflicts of e a member had such that voting

anism for decision making so members with a declared conflict

of the Guild and nisation and its dressed by the ceived it as an

ip and governance arrangements

eement was not fulfil governance and independent oversight of funding and

program decisions. Membership issues prevented PPSAC from comprehensively fulfilling its terms of reference particularly in relation to monitoring of program performance, accountability, transparency and contestability of program funding. There was a perception that consumer priorities were not as important as those of other stakeholders.

Due to the large workload in establishing and signing off program proposals PPSAC tended to be reactive rather than proactively planning a strategic approach to achieving the objectives of the Committee.

thought that a more coordinated approach should have deliveredpharmacists and reduced program implementation costs.

There was also criticism by pharmacists representing the broader phathe Guild’s focus on community pharmacy owners and on the lack of cthe broader positioning of the pharmacy profession within the health sea number of stak

have improved the focus of the pas well as providing longer term benefit to community pharmacy anprofessional as a whole.

Confidentiality and conflicts of interest

All members completed deeds of confidentiality on appointment, andproxies prior to attending their first PPSAC meeting.

There was general agreement among stakmanaged appropriately within the Committee processes and meeting minutes demonstrated that there was a standing agenda item for disclosureinterest at each meeting. Committee members were satisfied that whera conflict this was openly acknowledged. Committee processes were was not used as a mechwere not excluded from the advice development process.

As discussed previously there was a larger issue of the vested interestcommunity pharmacy owners to make decisions that benefit the orgamembers. Some stakeholders thought that this was not satisfactorily adcommittee processes to manage conflicts of interest while others perinsignificant issue.

Implications of membersh

The structure of the PPSAC membership as outlined in the Fourth Agrfound to be appropriate to


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June 2010

Risks and mitigation strategies were comprehensivel

29

ABCD



y identified on a program by overarching risk

at programs are consideration of their integration with

viders (particularly those who are not community pharmacy ce that this has led to a general disengagement of members

2.4 ss of reporting

directly to the Minister at regular intervals, no later than six weeks after each meeting. They further

alth and Ageing agreed during

the advice and r signing by the

he Minister. On f 11 occasions

in the operating idelines. There was no documentation evidence of letters to the Minister after two

y have been due to the

nce ister. None of the stakeholders

interviewed were aware of PPSAC assessing its performance. Some noted that the s the only performance assessment of the Committee undertaken to

date.

Stakeholders identified the following measures of success for PPSAC:

• timely and coordinated implementation Community Pharmacy Programs

• level of uptake and recruitment to Community Pharmacy Programs

• expenditure of funds

program basis within the individual program proposals, however, an mitigation strategy for the programs or committee was not developed.

The nature of the arrangements under the Fourth Agreement mean thoften rolled out in an ad hoc manner with limitedand impact on service proowners). There was evidenof the pharmacy profession and broader stakeholder groups.

Reporting arrangements The following section explores the appropriateness and effectivenearrangements and the quality of advice provided to the Minister.

Assessment and reporting of PPSAC performance

The PPSAC Operating Guidelines state that the Committee will report

state that the reports will take the form of a letter to the Minister for Hefrom the PPSAC Chair recording advice and recommendations meetings. The Secretariat is responsible for keeping a record of recommendations agreed during the meetings and preparing them foChair.

Review of letters to the Minister identified that there was variation in the time periodbetween the meeting and when letters were signed for sending to taverage advice was provided within 31 days, however, on three oreviewed, letters were not sent within the six week timeframe outlinedgumeetings in September and December 2008 which machangeover of the Chair.

There is no specified requirement or indicators for assessment of PPSAC performanoted in the documentation other than reports to the Min

KPMG review wa


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June 2010

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d and improved health outcomes.

to PPSAC at each meeting. These reports

• funding including total allocation, expenditure to date and the proportion of total

rrangements

• progress update which included description of activities and process or participation

ith the reports

uation Steering rated that PPSAC set expectations that

ions, which were to be undertaken by an external independent evaluator. Delays in establishing the Program

ive and so were owever, it was ird Agreement

ittees

rmal reporting ver there were

reports both formal and verbal that occurred at various times when specific issues

Feedback from PPSAC to the subcommittees after their establishment appeared to be informal through PPSAC members sitting on the various subcommittees. This was facilitated by the arrangement where all but one subcommittee was chaired by a member of PPSAC. The exception was the Diabetes Pilot Program Steering Committee chaired by a General Practitioner although it did have three PPSAC members.

Members of subcommittees who were not members of PPSAC expressed a high degree of dissatisfaction with the reporting arrangements, having a view that the

• demonstrated public goo

Program evaluation and reporting

Status reports on programs were provided were of a consistent format and contained the following information:

• program description

funding allocated expended

• program management arrangements including status on evaluation a

measures where available.

During the review, most stakeholders expressed dissatisfaction wprovided for a number of reasons outlined in Section 2.3.

Program evaluations were managed by PPSAC through the EvalCommittee. The documentation review demonstthere was to be a robust framework for the program evaluat

evaluations meant that for many of the programs these were not formatnot able to deliver ideas for iterative improvements of the programs. Hnoted on multiple occasions that evaluation findings from the ThPrograms informed the Fourth Agreement Program designs.

Reporting mechanisms existing between PPSAC and its subcomm

The documentation review identified that there were no regular foarrangements between the PPSAC and its subcommittees. Howe

arose or when subcommittees submitted advice to PPSAC.


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June 2010

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little feedback from the main PPSAC on the subcommittees.

Implications of the current reporting arrangements

to the Minister.

C performance ding the degree

committees did managing the

to commence able

of understanding within them of their role, responsibilities, accountabilities and Also there were different levels of understanding of ong members of PPSAC and the various

on may have been an implied requirement, and feedback

2.5 Advice provided to the Minister Appropriateness of advice to inform key decisions

sentative was not available for interview so KPMG is unable to report on the Minister’s satisfaction with the current arrangement and the appropriateness of the advice provided by PPSAC.

Development of advice

Stakeholders described the process to develop advice to the Minister which is demonstrated in Figure 2.

various committees operated in silos withrecommendations and advice developed by

There were some delays in reporting the outcomes of PPSAC meetings

The lack of clarity on expectations and agreed indicators of PPSAcreate a challenge for PPSAC members and stakeholders in understanof success of the Committee.

While the ad hoc reporting arrangements between PPSAC and its subnot support a high level of accountability, it was a way of effectively Committee capacity given the high workload and time imperativesprograms. The effectiveness of some subcommittees was diminished by the varilevels links with programs and PPSAC.performance requirements amsubcommittees. While reporting by exceptithis was not stated explicitly, creating ambiguity around reporting processes.

The Minister’s repre


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June 2010

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32

Figure 2: Process for development of advice to the Minister Source: stakeholder interviews and testing workshop.

The review of documentation confirmed stakeholder views of the adviprocess.

ce development

drafted by the of Chair letters

eeting’s agenda period until the

s required up to d ready to put

ken to develop considered the process to be lacking in transparency

because they were not given the opportunity to review draft letters prior to their being signed and sent to the Minister. PPSAC members also provided feedback about the fact that the process did not include a step for feeding back to the Committee the final form of proposals approved by the Minister. As a result it was difficult to keep track of whether the programs were being implemented as intended. PPSAC did not know which elements formed the final version.

There was also dissatisfaction with the provision of separate briefings and background information to Ministerial appointees.

As described in the PPSAC Operating Guidelines, Chair letters weresecretariat and finalised in collaboration with the Chair. The final versionto the Minister was forwarded to PPSAC members with the next mpapers, and at times out-of-session where there was a substantial timefollowing meeting. There was evidence that some program proposalthree iterations and in-session discussions before being considereforward to the Minister for a decision.

There were varying levels of satisfaction with the process undertaadvice. Guild stakeholders




Government

June 2010

Guild members were also concerned that the additional brief for the Mby the Department and submitted with the PPSAC advice diminishedsome cases made redundant the value of their input into the process. held the view that this was a valid step in the process agreed inGuidelines, as the Department was not represented on PPSAC, and tcritical to ensuring that programs developed were in the public intereboth broader polic

33

ABCD



inister prepared the value or in The Department the Operating his advice was

st and reflected y and issues related to value for money and the delivery of health

ndard approach for ministers in obtaining advice, who generally request advice from a range of sources including the relevant

istrust among PPSAC members and the Department ementation of

ing off advice is

2.6 The PPSAC Secretariat within the Department provides a range of support functions to

committees.

The PPSAC Operating Guidelines identify that the Secretariat responsibilities includes:

Chair

t the PPSAC eeting agenda,

nformation such older comments

supported the view that the secretariat was required to drive the PPSAC agenda as there was little input into this from members other than the Chair.

There was a mix of views on the timeliness and efficiency of the secretariat support. Some members thought that the secretariat was very efficient in organising meetings, supporte rovided information required to fulfil their role. However others thought that the Secretariat processes were overly bureaucratic and caused significant delays to the progress of program development and implementation. The development of documentation to support proposals or to

outcomes. It is also noted that this is a sta

government department.

Implications findings regarding advice development

Current processes engender dand could be improved. There are multiple reasons for delays in implprogram proposals of which issues with the process for review and signone.

Secretariat effectiveness

PPSAC and its sub

Secretariat processes

• liaising with Members

• preparing agenda papers in consultation with the Members and the

• preparing outcome reports of each meeting.

Documentation review and stakeholder interviews identified thaSecretariat within the Department organises meetings, develops the mdrafts meeting minutes, coordinates reports, and facilitates access to ias program proposals and Medicare data on program uptake. Stakeh

d the efficient and effective use of their time and p


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June 2010

34

ABCD



nd

There was strong consensus that the quick turnover of staff in the Department was following issues

reted their role, mmittee functions

wledge of the programs, thus up to speed”

entification of a

that the PPSAC meetings were effective at addressing da. However, some views were expressed that nd changeover in Department staff contributed to

ns between the

2.7 holders

unity Pharmacy e membership lders to provide lied on PPSAC

separate advisory groups set up for individual programs, for example the QUMAX Program Reference Group.

There was almost unanimous agreement that the subcommittees were a valuable method of engaging key stakeholders and getting the different perspectives into the development of programs and business rules. This was seen by those interviewed as critical to developing practical and implementable programs that are more likely to deliver health benefits to consumers. However, satisfaction with the operation of different subcommittees varied.

inform PPSAC agenda items, was cited as a significant burden by both the Guild athe Department.

detrimental to the efficient functioning of the committee with the identified:

• there was variation in the way different Departmental staff interprequirements of program proposals and the co

• that there were differences in capability and knoslowing processes down until staff “were

• when staff were turning over and in the period prior to the idreplacement activity was reduced and progress slowed or halted.

Implications of findings on secretariat effectiveness

There was general agreementthe business presented on the agenprocesses were overly bureaucratic adelays in PPSAC processes and increased the complexity of interactioDepartment and the Guild.

Stakeholder consultation Identifying the expectations of stake

The primary vehicle for consultation with stakeholders in CommPrograms was the subcommittees. Review of subcommittedemonstrated that this mechanism drew on a broad range of stakehoinput into those programs that had a subcommittee. Other Programs remembers for input, or


Government

June 2010

ABCD

Key stakeholder groups with interests in community pharmacy

35

interest in the unity pharmacy programs:

acy employees,

senting pharmacists including the Pharmacy Guild, the PSA, the AACP, the SHPA and other registration, professional and industrial pharmacy

• a range or organisations providing health services within the community, those he acute, sub-acute, community and aged care interfaces and

e areas

aight islanders

rofessionals.

Fourth Agreement a consultation program on of research priorities. PPSAC minutes

d by PPSAC in March 2010 a nt in the Fifth ted that summit

munity pharmacy researchers, the Guild and the PSA.

ntment with the rofessional programs among a broad range of pharmacy

professionals. There were a number of barriers preventing PPSAC from fulfilling expectations of stakeholders. Many of these have been discussed in the previous sections however the main issues are:

• delays in program development and implementation

• a perception that programs have not been designed to deliver the best evidence based care while maximising value for the health dollar with the interest of patient health outcomes as a priority

Stakeholders consulted identified the following groups that have anPPSAC or in the delivery of comm

• pharmacists including academics, consultant pharmacists, pharmhospital pharmacists, pharmacy owners

• organisations repre

bodies

• consumer organisations

managing tparticularly including those delivering services in rural and remot

• organisations delivering health services to Aboriginal and Torres Str

• the Department

• health professionals including, medicine, nursing and allied health p

In addition, during the early phase of thewas initiated to assist in the identificatidemonstrated that the outcomes of this consultation were considereidentifying priorities for the Research and Development Program. Insummit was held to inform priorities for research and developmeAgreement. The Research and Development program manager reporparticipants were primarily com

Fulfilment of stakeholder expectations by PPSAC

A number of pharmacist stakeholders identified a growing disenchacommunity pharmacy p




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June 2010

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ABCD



• difficulty in designing stakeholder engagement strategies that effectively elicit the reasonable level

unity pharmacy

consumer input and that at times, even when ideration.

While PPSAC has arrangements in place to elicit stakeholder views they are having varying degrees of success. Underlying issues with the structure of PPSAC membership creates ongoing difficulties with stakeholder perceptions of the work of the Committee.

• a perception that that some stakeholder voices are not heard, particularly those notaligned with the Guild

views of a diverse range of stakeholders in what at times requires of understanding of technical and policy issues effecting comm

• a perception that there was limitedinput was provided, the consumer voice was not give adequate cons

Implications of existing stakeholder strategies


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June 2010

37

ABCD



3 dings of the documentation review and presents

sub-committees

t impacted the effectiveness of all

• the need for a more clearly defined role for subcommittees

in silos with limited exchange of

always deliver

ise.

little stated about sub-committees in the Fourth Agreement. However the

rposes and with directly to the

Committee through an agenda item when required. The PPSAC Steering Committees’ ittee and their

mittees at their plains that steering committees provide strategic advice to PPSAC and

assist in progressing its work plan.

ides an overview of issues relating to the effectiveness of all the PPSAC sub-committees and working groups, a more detailed review was undertaken

ring Committee d

an attachment

3.1 Research and Development Steering Committee Structure and membership

There w ttee was well structured with effective use of the Steering Committee to set up the program and determine objectives. The Steering Committee had representatives from a diverse range of stakeholders including pharmacist peak bodies, rural pharmacy academics, government, educators, consumers and health economists/ researchers. Generally

Subcommittees The following section outlines finstakeholder views on the appropriateness and effectiveness of PPSAC and working groups.

A number of common issues were raised thasubcommittees. These include:

• that the subcommittees primarily worked information between PPSAC or other subcommittees

• the reliance on nominations from peak organisations did not committed subcommittee members with relevant expertise

• delays in filling membership vacancies or accessing relevant expert

There is PPSAC Operating Guidelines state that PPSAC may co-opt expert advisors orestablish working groups, steering groups or sub-groups for discrete puspecific timeframes, as required. It also specifies that they will report

documentation describes the objectives/priorities of each subcommmembership.

PPSAC background information provided to most of the subcominception ex

While this section prov

of two of these sub-committees: the Research and Development Steeand the Diabetes Pilot Program Steering Committee. The results of this more detailereview are documented in two case study reports, which are provided asto this document.

as a strong consensus that this Steering Commi


Government

June 2010

Re

38

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search and Development Steering Committee members were satisfied with the mber of issues were identified. These

within the membership

nt funding and

economics expertise early in the committee’s existence although this was rectified with the recruitment of additional members

ntified that a consumer would add nels

tion of projects

e ee. Despite an h its functioning

and achievement of objectives. It was felt that a robust performance management and nd an evidence

ce was suboptimal issues were responded to quickly and actions were taken to get

effective way of workload of the research and development program, providing

and refinement better quality research and more

constructive outcomes.

The Research and Development Steering Committee reviewed its performance against the terms of reference approximately half way through its existence. At a recent meeting it considered lessons learned for future programs and has produced a lessons learned report.

Member ogram manager and that this facilitated the efficient and effective implementation of the Program.

Steering Committee membership, however a nuwere:

• limited formal research experience

• lack of experience with the selection process for large research grathe criteria for assessing research proposals

• limited evaluation and health

• insufficient consumer participation. It was idesignificant value to all of the project pa

• limited understanding of the methods and rationale for NHMRC selecwhich created tension in selection of research scholarships.

Functioning and effectiveness of the committee

All stakeholders interviewed that were involved were very satisfied with theffectiveness of the Research and Development Steering Committambitious program of work there was a high degree of satisfaction wit

evaluation framework was put in place with an independent reviewer, abased approach was taken to practice evaluation.

Project teams were held accountable to deliver on their objectives. Where performan

projects “back on track”.

Stakeholders were in agreement that the advisory panels were a verymanaging the enormous detailed oversight of each of the commissioned projects with feedbackof projects leading to the delivery of better quality of

s particularly noted the contribution of the Guild Pr


Government

June 2010

39

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f interest were hin the Steering Committee processes. Where Steering

Committee members had a conflict of interest this was proactively managed; for excluded from

satisfied that a robust hile appraisal

eived issues with the degree of impact with respect to odology.

3.2 f a case study provided as an

ral agreement that the Steering Committee fulfilled its terms of ception of ongoing monitoring of the program. However one

the purpose of the Steering Committee was quite undefined and ws including the g functioning of of when it had

alian Diabetes SA, SHPA, the

Diabetes Pilot was effective in Ps and that all

members of the Steering Committee added value to the program design.

The following concerns were also raised in relation to the membership. First, while it was acknowledged that Diabetes Australia is a peak body representing those living with Diabetes, it was thought that they would speak with a different voice than a consumer. Second, sta a representative from the Australian Diabetes Society would have improved the robustness and the evidence based approach of the program design. This view however, was not supported by all members interviewed. Third, although the Diabetes

Management of conflicts of interest

There was strong agreement among stakeholders that conflicts omanaged appropriately wit

example, members reported that in some instances individuals weredecision making on project funding.

Research and Development Steering Committee members were set of criteria were applied to the assessment of project proposals. Wcriteria were used consistently, there were percon consumer health outcomes and the research project methodologythe level of research evidence delivered by the proposed research meth

Diabetes Pilot Program Steering Committee The Diabetes Pilot Program Steering Committee is also the focus owhich contains further detail on its activities. This case study report isattachment to this final report.

There was genereference with the exmember thought that this was also reflected by other comments during stakeholder interviesecretariat and program managers. This created problems with ongointhe Steering Committee and meant that there was little understandingachieved its objectives.

Structure and membership

The Steering Committee consists of fourteen members made up of representatives from key stakeholder groups, including Diabetes Australia, the AustrEducators Association, the Australian General Practice Network, the PGuild, consumer representatives and Departmental representatives.

Generally stakeholders were satisfied with the membership of the Program Steering Committee. It was felt that the Steering Committee building relationships with other groups such as allied health and G

keholders perceived that the inclusion of an endocrinologist or


Government

June 2010

Pilot Program did not have a specific Indigenous health focus, it was areview given the higher burden of disease in the Indigenous community, that t

40

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lso noted in the he

Indigenous representative or established stronger linkages to the PPSAC Rural and Indigenous Steering Committee.

teleconference ember 2008. At its November meeting the Steering

Committee scheduled future meetings for 20 May 2009 and 26 November 2009, rial business for munication with

y and progress s. The minutes indicate that the Steering Committee

progress of the olving to make that updates on through written

members on the status of the DMAS program. There were two sources of feedback ld) and Reports

n Team (Sydney University). Evaluation of the valuation team

May 2008, and g Committee by

and no formal

One stakeholder expressed concern about the value for money aspects of the business efit in terms of are no existing

the program was rolled out in high population areas where there was perceived to be a duplication of services. This created tension between the Guild and other service providers including Diabetes Australia who provide a similar service. It was thought that more could be achieved by working collaboratively with other stakeholders rather than establish n of care provision.

There was concern expressed by more than one Steering Committee member regarding the quality of the research that went into developing the Diabetes Pilot Program proposal which included RADS. They noted that the initial proposal had

Steering Committee could have included an

.Functioning and effectiveness of the Steering Committee

The Steering Committee met twice in face-to-face format and once bybetween December 2007 and Nov

however, these meetings did not take place due to a lack of any matethe Steering Committee to consider. After November 2008 the only commembers was by email from the secretariat.

Steering Committee members were satisfied with the group’s efficiencon business made through meetingdiscussed the progress of the pilot, development of stage 2, and evaluation at each meeting, considering various aspects and resrecommendations to PPSAC as required. The minutes also indicate the DMAS project were provided to Steering Committee members reports and verbal updates at the meetings.

Through the meeting process, there was fairly comprehensive feedback provided to

provided. These included reports from Program managers (the Guifrom the DMAS Stage 1 ImplementatioDMAS program was conducted by an independent evaluator. The epresented their evaluation approach to the Steering Committee at theinterim and draft final evaluation findings were circulated to the Steerinemail out-of-session.

Stakeholders reported having a ‘lack of closure’ about the programnotification of the end of the Steering Committee.

rules of the program. This member perceived that the greatest benhealth outcomes was to have the program focus on areas where therecommunity diabetes services such as in regional rural and remote areas. Instead

ing a separate service which leads to fragmentatio


Government

June 2010

included the provision of point of care testing within community pharRADS was, however, always subject to National Health and Medical Re(NHMRC) approval of blood collection methodology. The proposal deto have been unaware that in December 2006, the Minister provapproval for this element of the Pilot Program pendin

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macies. Use of search Council

velopers appear ided conditional

g the amendment of the NHMRC e 2 Diabetes to

rotocol. It was

tisfied with the iat support and the level of information provided. Members felt they were well

knowledged that much was left to the Department who he Steering Committee. One Steering

entation prior to

Some stakeholders identified that there was an overarching conflict of interest for some in developing the Diabetes Pilot Program as both

d the Guild (representing community pharmacy owners) had a the outcomes of the deliberations of the Steering Committee

ovide a similar

3.3 ring committee

e, one DoHA tive and two

lso the Chair of

hnical expertise was perceived to cause delays in progressing the

development of the evaluation framework. Some dissatisfaction around the membership of the Committee is evident from the meeting minutes. At the August 2007 meeting, it was documented that members reported perceiving the Committee membership to be too small and lacking a reasonable representation of “independent experts with particular skills in evaluation and/or health economics”. In response to this, the Committee sought, and was approved by PPSAC, to add two further ‘independent experts’ to the Committee. One of these roles was filled by the following (April 2008), meeting. The other additional in Committee’s final meeting in May 2009.

Evidence Based Guideline for Case Detection and Diagnosis of Typinclude capillary glucose testing as part of the diabetes case detection preported that the NHMRC guidelines have since been promulgated.

Generally Steering Committee members interviewed were very sasecretarprepared for meetings but acappeared to direct the overall business of tCommittee member was concerned with delays in distribution of documthe meeting.


Steering Committee members Diabetes Australia ancommercial interest inbecause they compete for the same funding (as they essentially prservice).

Evaluation steeStructure and membership

The membership was comprised of one PPSAC representativrepresentative, two Guild representatives, one PSA representaindependent experts. The Chair of the Evaluation Committee was aPPSAC in its initial years.

One person interviewed however, thought that there was insufficient tecin evaluations which in turn

dependent expert role was only filled on the


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June 2010

It is possible that recruiting a Committee member with evaluation expemore d

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rtise was made ifficult by the relatively small size of the pool of evaluation providers, some of

dependent and be free to tender for any evaluation.

procurement of various outputs

ovided advice on the

at the ee business out rograms.

with the delays luations. While to some extent it was perceived that the

ommittee, there en built into all ould lessen the d allow earlier

f the Evaluation the first PPSAC cedure focussed ond meeting on tion framework

delayed the commencement of many program evaluations.

tified evaluation iscussed during that a portion of members played ittee’s workplan,

as priorities for evaluation and timing of evaluation activities.

The operating guidelines state that there were to be a minimum of two meetings each year. For the first two years the Committee met this standard, with four meetings in 2007, and two meetings in 2008. However there was only one meeting in 2009 and no meetings in 2010. Despite this, the Committee’s workplan clearly identifies evaluation activities evidence that the final 2009 meeting was intended to be the Committee’s last, as the minutes reflect plans for a future meeting at an unspecified date.

whom may have wished to remain in


The Evaluation Steering Committee provided oversight for the evaluation services for a number of programs as well as reviewing theof program evaluations including draft and final reports It also prscope and specifications for program evaluations, providing expert advice onevaluation measures and management of the specific issues and challenges thevaluators may encounter. There was some consideration of committof session including review of evaluation frameworks for several of the p

Across PPSAC programs overall, stakeholders reported dissatisfactionin establishing program evadelays were due to the limited direction from the Evaluation Steering Cwas also the opinion that basic evaluation measures should have bePPSAC program designs from their inception. It was thought that this wnegative impact of the delays in engaging external evaluators anmonitoring of program performance.

There were delays in establishing the committee with the first meeting oSteering Committee occurring on 6 March 2007, almost a year after meeting. One member thought that the initial meeting was entirely proand the real business of the committee did not commence until the sec16 May 2007. Delays and difficulty in reaching agreement on the evaluain turn

There was a work plan for Evaluation Steering Committee which idenrequirements for specific programs, was updated regularly and was dcommittee meetings. From review of the meeting minutes, it appears the work was very much driven by the secretariat, and that Committee a more ‘reactive’ role. For example, the secretariat drafted the Commwhich specified issues such

which extend in to the 2010 period. There is no


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June 2010

One of the challenges facing the Evaluation Steering Committee relaongoing management of the evaluation process. This issue was raisedthe July 2008 meeting, where members raised concerns that the Termdid not provide guidance as to the Committee’s role once the evaluacommenced. In response to this, amendments to the Terms of Refereand accepted by the Committee at its final May 2009 meeting, identiwould provide members with “a report at each Evaluation Steeringprogress, problems, resolutions and outcomes of each evaluation

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ted to its role in by members at s of Reference tions had been nce were made fying that DoHA Committee on project”. This

however, did not clarify whether the Committee was to note these reports, or be in a rovide advice on issues. Given that this meeting was the

n the committee inutes that disclosures of conflicts of interest

meetings as a standing item. There is also clear were identified, mechanisms were put in place to

One standard mechanism put in place was to circulate agenda h that members

3.4

o Departmental perts, including

those from Hepatitis Australia, the Australian Liver Association, the Australian Injecting Australia Society for HIV Medicines Inc. The

member. The Chair was fourth and fifth

titis C steering


The Hepatitis C Steering Committee met five times over the period of the Fourth Agreement, commencing with two meetings in 2007, one in 2008 and two in 2009.

The meeting format of this Commit ms of structure and mode, with two meetings being held by teleconference. It should be noted however, that the Committee operated only under Terms of Reference, and had no operating guidelines. As such, it appeared that meetings were structured and timed as the work required,

position to comment on and pCommittee’s last, it was not clear how these Terms of Reference were put in topractice.


Members were satisfied that conflicts of interest were managed withiprocesses. There is evidence from the mwere discussed at each of the seven evidence that when possible conflicts manage this conflict. papers and conflict of interest disclosure forms prior to the meeting succould identify possible conflicts before the meeting.

Hepatitis C Steering Committee Structure and membership

This Steering Committee was comprised of three Guild members, twRepresentatives, one PSA representatives and four subject matter ex

and Illicit Drug Users League and the Committee was Chaired by a Guild representative who was also a PPSAC The Chair was the only PPSAC member on this Steering Committee.consistent for the first three meetings, and a new Chair appointed at themeeting. This Chair was also a PPSAC member. None of the stakeholdersinterviewed had specific issues with the membership of the Hepacommittee.

tee was variable in ter


Government

June 2010

rather than because of pre-determined requirements. One HepatCommittee member expressed dissatisfaction with the timing of thethought that

44

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itis C Steering meetings and

they did not link in well with the timings of the PPSAC meetings. It was as slower than

he first meeting. were challenges in consulting with stakeholders to

hat this also caused delays. There was a perception that departmental priorities had changed and that this was not communicated in an open

ent of conflicts of interest

ndard committee mmencement of

3.5 Review (HMR) Subcommittee was formed in response to the dent review of the HMR program, the Campbell Report. There

respond to the s, eligibility and ht that it should

two consumers, member, a representative from the Australian Association

ospital Pharmacists of Australia, the RACGP, AGPN and DOHA. The Chair of the HMR

agreement amongst stakeholders that there was appropriate representation of stakeholders and a good mix of skills and knowledge on the HMR Subcommittee and working groups. The involvement of two consumers who had a strong voice was viewed very positively by members.


Stakeholder s very focussed on patient outcomes and was very solutions focusse er of program improvements.

perceived that the subsequent proposal development and approval wdesirable.

The need to consult with various stakeholder groups was identified in tHowever, it was reported that there strengthen the program, and t

and transparent manner.

Managem

Members were satisfied that conflicts of interest were managed in staprocesses. Disclosure of conflicts of interest were discussed at the coeach meeting.

Home Medicines Review Subcommittee The Home Medicines findings of an indepenwas agreement that the role of the HMR Subcommittee was to Campbell Report and to identify improvements to the business rulemanagement of the HMR program. One Subcommittee member thougalso have addressed issues not identified by the Campbell Report.


The HMR subcommittee membership included two PPSAC members, two Guild members, a PSAof Consultant Pharmacy, the Society of HAMA Council of General Practice, the subcommittee was also the Chair of PPSAC.

There was

s reported that the HMR Subcommittee wad, identifying a numb


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June 2010

The effectiveness of the Committee meetings was due in part to the PPSAC for providing advice on

45

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timelines set by changes to the program. There were only two

hed to address

e expressed dissatisfaction advice to the PSAC meeting,

that turnover in staff at the Department hampered the e and created time delays as staff became familiar with

the role of the

the consultation vided in the final e PPSAC level)

t that the recommendations were not in the community pharmacy owners s proposed a more flexible service model

d hospital pharmacists for HMRs. It also provision of HMR services by consultant pharmacists or hospital

improved health

3.6 oup Structure and membership

, the PSA, the PPSAC members, one of whom was the

d with the structure and membership of the Pandemic Influenza Working Group.

There were significant delays in developing and approving the Pandemic Program. Some stakeholders expressed concern regarding the robustness, evidence base and value of the pandemic program.


While conflicts of interest were managed within committee processes, a couple of individuals thought that in developing and approving the program, the commercial

subcommittee meetings however, three working groups were establisspecific issues between the two meetings.

Stakeholders that participated in the HMR Subcommittewith delays in PPSAC considering the Subcommittees advice andMinister on HMR changes. These were agreed at the April 2010 Pseven months after the last HMR. Subcommittee meeting.

There was strong agreement efficiency of the Subcommittethe program stakeholders, issues in management of the program, andsecretariat.


There was a perception among some stakeholders at the time of interviews, that there had been no action on the recommendations proreport of the HMR subcommittee to PPSAC because the Guild (at ththoughcommercial interest. The recommendationthat included direct referral by GPs anrecommended that thepharmacists who are HMR accredited be funded. This was seen by many stakeholders as an example of PPSAC not prioritising the interests of the public and outcomes.

Pandemic influenza Working Gr

Membership of the included representatives of the Pharmacy GuildDepartment and two ministerial appointed chair. No issues were identifie



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June 2010

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hed consideration of benefit to health

3.7 ous Steering Committee was established in early 2007 and has

ams.

agreed at the that there was e and expertise, l and Indigenous

he presence of Indigenous stakeholders including the NACCHO and of the Rural and lso seen as a the committee

ot have a health

Guild and rural and Indigenous ived to be highly successful. One example of

program

enous Steering SAC about the


meetings of the ittee between its establishment in May 2007 and

ular 6 monthly e minutes clear

inutes indicated that an Action log and work plan were used and reviewed at each meeting.

It was perceived by most of the Rural and Indigenous Steering Committee members that this committee was not effective in fulfilling its terms of reference. There were a number of reasons cited for this outlined below:

• There was a delay i with the first meeting only occurring on the 4 May 2007. There was a perception that this prevented input into the formative stages of program design

interests of community pharmacists outweigoutcomes and value for money.

Rural and Indigenous Steering Committee The Rural and Indigenfocussed on implementing rural and indigenous workforce related progr


The Rural and Indigenous Steering Committee membership was December 2006 PPSAC teleconference. There was strong agreementexcellent representation on the committee, appropriate skills, experiencand a strong commitment to improve health outcomes through the ruraprograms. TAboriginal Medical Services (AMSs) was seen as a particular strength Indigenous Steering Committee. Involvement of consumers was apositive however it was acknowledged that there were some aspects ofbusiness that were challenging to understand for consumers who do ncare background.

Where the programs were jointly developed by thestakeholders these programs were percethis collaboration working in practice was the QUMAX

There was a high degree of dissatisfaction with the Rural and IndigCommittee’s interaction with PPSAC and level of feedback from PPadvice provided by the Rural and Indigenous Steering Committee.

The documentation review demonstrated that there were a total of fiveRural and Indigenous Steering Commits last meeting in June 2009. The Steering Committee held regmeetings in 2007 and 2008. Meetings were highly structured and thand decision/action orientated. M

n establishing the committee


Government

June 2010

•

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members interviewed were dissatisfied with the frequency and number of usiness moving

le to input into the development of a meeting agenda and

agement of the

f members and

the reporting of PPSAC. It was f an action item

igenous service reated problems

entation of the programs. For example the lack of engagement with

• Limited information or understanding of what was already in place within the sector (non-community

cuss or make ations about the rural and Indigenous program business rules, rather

een the Department and the Guild.

and addressed ment that good

n was provided to members however, one member expressed dissatisfaction that information sought at meetings was not forwarded as requested. Program proposals were received from the Guild and reviewed by the Rural and Indigenous Steering Committee.


Members were satisfied that conflicts of interest were managed in standard committee processes. Disclosure of conflicts of interest were discussed at the commencement of each me

All meetings and thought this caused a disconnect and prevented the bforward

• Members were not abcancellation of meetings occurred because there was “nothing to discuss” even though the terms of reference specified advice on the ongoing manrural and indigenous programs

• No use of teleconference meetings to keep the engagement omomentum of the Steering Committee going

• There was a perception that there was not a proper process for advice from the Rural and Indigenous Steering Committee up tonoted from the minutes that there was only one explicit occurrence ofor the sub-committee to report to PPSAC

• There was limited understanding of how to engage with Indproviders among community pharmacy program managers which cin the implemAMSs in developing the HMR program and inappropriate implementation strategiesprevented its uptake within this group

meant that in some instances the programs were duplicating other pharmacy) services

• The Rural and Indigenous Steering Committee did not disrecommendthis occurred through separate negotiations betw

All members were satisfied that the meetings themselves were effectivethe work identified in the agenda papers. Generally there was agreeinformatio

eting.


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June 2010

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4 number of strengths of the PPSAC arrangements as well as a number of evented it from functioning effectively. These are summarised below.

4.1 by stakeholders.

• providing opportunity to engage and consider program issues from the perspective

hin the Guild or the Department

incorporation of Agreement program evaluations into subsequent program

onsideration of consumer issues and providing an avenue for input from consumers and specialist expertise in other areas such as provision of

f program risks and potential strategies to mitigate risks

obligations for transparent, contestable, merit based allocation of public funds

4.2 The following factors limiting the effectiveness of PPSAC were identified by a number

Role definition and Fourth Agreement

• There were differing views between the members of PPSAC as to the appropriate role of the committee. While there is consensus on its role in developing policy, program eligibility criteria and outcomes measures there is differing levels of supp

- oversight of the funding of projects including determining value for money and assessing issues of performance risk and flexibility of programs

Strengths, issues and options for the future There were aissues that pr

Strengths A number of strengths of PPSAC and its mechanisms were identified It was thought that PPSAC strengthens the development of the programs through:

of other interested stakeholders groups

• drawing on expertise not residing wit

• adoption of a robust evaluation strategy and strong evidence of learnings from Thirdproposals

• allowing greater c

indigenous specific services

• systematic identification o

• providing a framework to:

- fulfil

- monitor program effectiveness.

Factors limiting the effectiveness of PPSAC

of stakeholders.

ort for its role in:


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June 2010

49

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rams

ity for program

in establishing

SAC in examining the expenditure of funds when funding had been negotiated in the Fourth

posals

ms

as a result of

mbership which al interest in the

older engagement strategies and the perception that some given limited consideration, particularly within PPSAC

• The limited timely, robust performance information available from programs as a

ngaging evaluators

• The disconnect between subcommittees and PPSAC as well as the difference in the committee representation creates issues with maximising the value and effectiveness of the subcommittees.

Overall effectiveness

The majority of stakeholders on balance, did not consider PPSAC to have been effective in its role in the delivery of programs and services under the Fourth Agreement although it was considered to be a work in progress. Most stakeholders

- encouraging competition in the management and provision of prog

- monitoring outcomes of programs and ensuring accountabilperformance.

• Significant delays in reaching agreement on the program design andthe programs. A number of reasons for were identified including:

- lack of agreement on the validity of the role of PP

Agreement

- issues with clarity around information requirements for funding pro

- the ambitious number and range of progra

- delays in operational processes and secretariat functions changeover of staff

- delays in progressing PPSAC business out of session.

• Robustness of governance mechanisms including the PPSAC mehas over 50 per cent of members that have some vested commercioutcomes of the advice provided.

• Effectiveness of stakehstakeholder voices were

result of:

- lack of impact and outcomes measures

- delays in e

- limited evaluation measures integrated in the program design.


Government

June 2010

acknowledged that the arrangements under the Fourth Agreement westep towards increased accountability and improvement in the govcommunity pharmacy programs. It was also acknowledged that PPSAC and

50

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re an important ernance of the

its n important mechanism for accessing specialist knowledge and

4.3 l programs and

e arrangements will ltative Committee

t of a new committee, to be known as the Program to the Minister

icy dimensions of the programs and will incorporate broad stakeholder on, consumers, other health professionals

ure governance

Performance management and accountability

communication and education to develop a shared understanding among ecretariat on obligations, responsibilities and

public monies. Specific

agers and

ertise on performance management as members or expert

and monitoring

• initiate an in depth analysis of problems experienced in establishing program evaluations and develop interventions to enable integration of evaluation measures at the program design phase.

Committee and secretariat processes

Improved communication of correspondence from the Chair to members including distribution of draft letters for signing by the Chair to all members.

subcommittees were aexpertise to the overall benefit of the programs and their outcomes.

Options for the future New governance arrangements are being established for professionaservices under the Fifth Community Pharmacy Agreement. Thesinclude enhanced roles and responsibilities for the Agreement Consu(ACC), and the establishmenReference Group (PRG). The PRG will provide advice to the ACC and on the polrepresentation from the pharmacy professiand program management experts.

The following section briefly outlines options for consideration for futarrangements.

Improve committee members, Guild staff and the Saccountabilities for the oversight of the expenditure ofstrategies may include:

• orientation program for new members, observers, program mansecretariat

• standard criteria for assessing program proposals

• source additional expadvisers to committees

• consider the use of a balanced scorecard approach to reporting program performance


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June 2010

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he disruption from staff turnover within the Secretariat

d program proposal e may include:

• increased guidance to the Guild from the Department on proposal requirements

• clarify requirements for performance indicators to assess process, impact and

on performance management frameworks

al criteria to assess program proposals.

Undertake strategic planning exercise, review progress and update yearly, assessing

milestones and identifies program dependencies and opportunities for integration and

Early involvement of a broader range of stakeholders including consumers, CALD, Indigenous representatives and other professional groups. Align membership of committees with the key stakeholder profile for Community Pharmacy Programs and Services.

Consider strategies to broaden the scope of organisations that are interested in and capable of providing the range of program design and management activities.

Initiate strategies to minimise tand program managers.

Program design and proposal signoff

Strategies to address issues with differences in expectation arounrequirements to minimise rework and delays in committee signoff. Thes

outcomes and monitoring mechanisms

• increased access to expertise

• development of agreed apprais

Strategy and stakeholder management

Committee performance against objectives.

Develop a high level workplan for committees that includes defined timelines,

potential efficiencies.


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June 2010

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A w data collection activities is provided below.

A.1 ucted to capture the view of key stakeholders regarding the

SAC functions, the PPSAC is

l was developed, based on the review framework based fer to Appendix B). Interviews were conducted, wherever

were not practical, by telephone. At the time of this report 34 stakeholders had been interviewed including:

• the chair and at least one additional member of the Research & Development iabetes Pilot Program Steering Committee

• the Pharmacy Guild of Australia

spital Pharmacists of Australia

professional representatives

• Aboriginal and Torres Strait Islander representatives

• pharmacies participating in programs under the Fourth Agreement

• pharmacy academics

• consumer representatives.

• A full list of interviewees is provided at Appendix C.

Detailed methodology Detail about each of the three revie

Consultations with stakeholders Consultations were condeffectiveness and appropriateness of the processes underpinning PPtheir expectations of PPSAC, and the extent to which they perceiveachieving its required outcomes.

A semi structured interview tooon the key areas of inquiry (repossible face-to-face, or where face-to-face interviews

• all ten current members of PPSAC

• representatives from each of the seven PPSAC sub-committees

Steering Committee and the D

• senior representatives from the Department of Health and Ageing

• the Pharmaceutical Society of Australia

• the Australian Association of Consultant Pharmacists

• the Society of Ho

• medical and other health


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June 2010

53

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A.2 umentation was fectiveness and nd the ability of

services. The document review also ulate the findings of the other review

er consultation and testing workshop also described in section 1.2).

were the following materials:

• Terms of Reference for PPSAC and PPSAC sub-committees and working groups

• Meeting minutes from PPSAC and PPSAC sub-committee meetings

PPSAC sub-committee action items and status reports

PPSAC to the Minister since the commencement of the Fourth

he delivery of programs and the services funded under the

nsultations and document review, the urpose of this

• present the findings of the review to date

• seek feedback from the PPSAC regarding the extent to which they perceived these findings to reflect the current state of play, PPSAC’s current strengths, and the challenges facing the committee in the future

• facilitate a shared understanding of issues.

Document review In tandem with the consultation process, a review of a range of docundertaken. The review served to identify issues relating to the efefficiency of PPSAC functions, PPSAC’s governance arrangements, athe PPSAC to deliver pharmacy programs and provided another source through which to triangactivities (stakehold

Included in the document review

• The Fourth Agreement

• The Operating Guidelines for PPSAC

• PPSAC and PPSAC sub-committee and working group meeting agenda papers

• PPSAC and

• Advice provided byAgreement

• Information relating to tFourth Agreement.

A.3 Testing Workshop Following the completion of the stakeholder coKPMG team conducted a testing workshop with the PPSAC. The pworkshop was to:


Government

June 2010

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54

t the PPSAC’s n, recording the

SAC members refully reviewed and considered in refining the review findings. Where

necessary, clarification was sought from individuals or further document review was undertaken. These findings were then used to underpin this Final Report to the Department.

To this end, the KPMG team conducted a two hour workshop ascheduled April meeting. At this meeting, detailed notes were takeviews of participants. Following the workshop, the discussions with PPwere ca




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June 2010

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B Key review areas of inquiry

Key review area Review questions

1. The appropriateness role prescribed to PPSAunder the Fourth

role of PPSAC?

PPSAC appropriate to bjectives?

il its prescribed carry out

nctions)?

de to the prescribed rt the achievement

ives as described under the fourth

of the • What is theC

Agreement • Is the prescribed role of achieve its o

• To what extent does PPSAC fulfrole - (achieve objectives and fu

• What changes should be marole in order to better suppoof the objectagreement?

2. The effectiveness of PPSAC in meeting its prescribedobligations

y framework within ommunity

s PPSAC meet its obligation in relation

ources fficiently and effectively in the public interest

on to appropriate

l consultation takeholders in Community Pharmacy

Programs and communicating clear accurate

• How does PPSAC assess value for money and health benefit to health consumers?

• What mechanisms exist to encourage transparent

funding of programs?

• What appraisal criteria are applied to evaluate

• What is the accountabilit

which PPSAC administers the CPharmacy Programs?

• How doeto:

- stewardship – i.e. manage rese

- accountability – i.e. submissiexternal scrutiny

- transparency – i.e. meaningfuwith s

information?

competition and ensure contestable,


Government

June 2010

ABCD


program proposals and how consistently are teria reflect the

Agreement? they applied? Do appraisal criobjectives of the Fourth

3. The appropriateness and the committee

ts

• Is the current structure and purpose and does it suppordelivering on its objectives?

effectiveness of structure, membership and governance arrangemen

membership fit for t PPSAC in

mix of ectives on the he Minister and

minister the programs effectively?

n effectively, cesses in

with section 6.2 of the Operating

ond to indicators e on objectives as outlined in the

espond to nce of the Community Pharmacy

achievement

• What are the observable outputs of PPSAC that and external

mpact the achievement of

y and consider relevant rategies when formulating

advice?

• Does PPSAC develop and implement strategies to achieve its objectives?

• Are conflicts of interest managed appropriately?

• Are PPSAC and its subcommittees cost effective in achieving its objectives?

• Is there an appropriate and sufficientskills, experiences and perspPPSAC to provide advice to tad

• Do the PPSAC meetings functiosupporting decision making proaccordance Guidelines?

• Does PPSAC monitor and respof performancFourth Agreement?

• Does PPSAC monitor and rperformaPrograms on their objectives andof measurable outcomes?

demonstrate response to issuesfactors that may iPPSAC’s objectives?

• How does PPSAC identifrisks and mitigation st

56




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June 2010

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4. The appropriaeffectiveness of PPSAC committees and working groups

PSAC sub- membership fit for purpose?

PPSAC in

• Are there an appropriate and sufficient mix of ectives on the sub-

providing advice

and sufficient mix of on the sub-

es to administer the programs

• Do the subcommittee meetings function ing out the

committee business?

cost effective in

onflicts of interest managed appropriately?

teness and sub-

• Is the current structure of Pcommittees and

• Do the subcommittees supportdelivering on its objectives?

skills, experiences and perspcommittees to assist PPSAC into the Minister?

• Are there an appropriateskills, experiences and perspectives committeeffectively?

effectively and succeed in carry

• Are the PPSAC subcommittees achieving their objectives?

• Are c

• 5. The appropriateness effectiveness of reporting arrangementquality of advicethe Minister

orts provided as ? Is the progress

PSAC or the relevant

• What reporting mechanisms exist between es?

• Is advice to the Minister fit for purpose, providing the information needed to inform key decisions on Community Pharmacy Programs?

ided support merit based allocation of funds?

and • How does PPSAC report on its performance?

s and the provided to

• Are programs evaluated and repoutlined in funding agreementsreviewed regularly by Psubcommittee?

PPSAC and its subcommitte

• Does the advice prov

6. Effectiveness of the PPSAC • What are the key processes in place for the

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Secretariat in organisinmeetings

g g to

secretariat support functions?, respondin

briefing requests, coordinating reports, and provto information

• Is the support provided to the PPSAC and its t timely,

ities of the secretariat nd efficient

t effective in comparison to similar committee secretariats?

iding access subcommittees by the secretariaefficient and appropriate?

• To what extent do the activsupport or inhibit the effective afunctioning of PPSAC and its subcommittees?

• Is the PPSAC Secretariat cos

7. Stakeholder consultatidentify expectations andetermine percefor PPSAC in meeting obligations under the Fourth Agreement

r groups that have an interest in the PPSAC or in the delivery of

rograms?

• How does PPSAC identify the expectations of unity pharmacy

gram?

tions of stakeholders and if not in what way?

SAC in fulfilling

ion to d

• What are the key stakeholde

ived outcomes community pharmacy p

stakeholders? and the commpro

• Does PPSAC fulfil the expecta

• What are the barriers for PPexpectations?

8. Identification of factorlimiting the effectiveness of PPSAC

he effectiveness

role

- structure, membership and functioning of es

- governance mechanisms including reporting

- operational processes including secretariat support

siderations.

s • What are the factors that limit tof PPSAC? Consider factors related to:

-

PPSAC and its subcommitte

- budget and cost con

9. The overall effectiveness of PPSAC in the delivery of

• Is PPSAC achieving its objectives as outlined in

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programs and services the Fourth Agreement

• Is PPSAC effective in delivering on its requirements for delivery of programs and services under the Fourth Agreement?

under the Fourth Agreement?

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C e following ticipants interviewed.

Interview participants Th lists par

Name Role(s)

Helen Kurincic ent Steering gram Sub-

Committee

Chair PPSAC, Chair Research and DevelopmCommittee, Chair Home Medicines Review Pro

Paul Sinclair g Committee, Past PPSAC Member, Chair Evaluation SteerinPPSAC Chair

Ross Maxwell PPSAC Member, Chair Rural and Indigenous Steering g Group, Committee, Member Pandemic Influenza Workin

Member HMR Subcommittee

Peter Brunskil Member, Chair Pandemic Influenza Working Group l PPSAC

Toni Riley Member, Chair Hepatitis C Steering Committee, Member Diabetes Pilot Program Steering Committee, Member HMR PPSAC

Subcommittee

Lisa Nissen PPSAC Member

Alison Roberts PPSAC Member

Jennifer Bergi AC Member, Past Chair Hepatitis C Steering Committee, g Group

n PPSMember Pandemic Influenza Workin

Fiona Mitchell s Steering mittee

PPSAC Member, Member Rural and IndigenouCom

Ian Todd PPSAC Member, Member Diabetes Pilot ProCommittee

gram Steering

John Aloizos Chair Diabetes Pilot Program Steering Committee

Amy Zelmer Consumer representative Research and Development Steering Committee

Yvonne Allinson t Steering Committee, er Rural and Indigenous

Steering Committee – representing the Society of Hospital Pharmacists of Australia on all committees

Member Research and DevelopmenMember HMR Subcommittee, Memb


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Name Role(s)

Peter Davey Research and Development Steering Committee

Professor DebSchofield

orah Research and Development Steering Committee

Erica Vowles PPSAC Observer, Member Research and Development Steering ager for Research and

Development, Diabetes Pilot Program and Asthma Pilot Program, Committee, Guild Program Man

Member Evaluation Steering Committee

Clair Mathews Diabetes Pilot Program Steering Committee

Andrea Kunca Assistant Secretary, Community Pharmacy BraMember HMR Subcommittee, Member EvaCommittee, Member Rural and In

nch, DoHA, luation Steering

digenous Steering Committee, g Committee, Member

titis C Steering Committee Member Diabetes Pilot Program SteerinHepa

Jacquie Mayco oHA (Secretariat), ber Pandemic Influenza Working Group,

ck Director, Pharmacy Programs Section, DMem

Dianne Braggett Assistant Director, Pharmacy Programs Section, DoHA (Secretariat)

Karen Farquha ms Section, DoHA r Assistant Director, Pharmacy Progra(Secretariat)

Phuong Pham Ministerial Adviser (not available)

Audra Millis PSA Observer, Member Hepatitis C Steering Committee

As available Guild Observers and program mangers Pharmacy

Khin Win May Pharmacy Guild Observer, Member Hepatitis C Steering Committee

Magdalena Markezic

Research and Development Program Manager

Grant M ndemic Influenza Working Group, CEO AACP

artin Past PSA observer, Past member Pa

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Name Role(s)

Alison Aylott ttee, rural acy representative

Member Rural and Indigenous Steering Commipharm

Sophie Couzo ommittee, Indigenous resentative

s Member Rural and Indigenous Steering Crep

Elsia Archer and Indigenous Steering Committee Consumer representative Rural

Debbie Rigby Member HMR Steering Committee – representing Australian Association of Consultant Pharmacy (AACP)

Jessica Rynehart Diabetes Pilot Program manager (Guild)

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D chieve. What

t objectives and CPA?)

ing the problem of community

nd/context, transitioning-out of any existing arrangements.)

ups/sectors eg. r. Identify any

dence and an n (eg what is the value-for-

lation, utilisation

Program/Project Sponsor: (Who will be the project sponsor? eg name of ittee.)

ram/project and collaboration of

lders etc. Identify who will be responsible for delivering the outcome.)

the project.)

eveloping the te whether they ementation and

have an impact

Financial Implications/Resource Requirements: (Attach a detailed budget setting out the project costs, including administrative costs, on a financial year basis. Provide information to justify costing such as increases to payments. Identify funding mechanisms required to achieve the project, eg. funding agreement with third party, MBS item, fee for service payment.)

Risk An ving success, eg. Lack of stakeholder support, inadequate technical expertise, workforce issues, low take-up etc. Identify how any risks will be mitigated or managed.)

Proposal template information Program/Project Outcomes: (Provide details of what the project will awill be the outcomes – including health outcomes? How do the projecoutcomes relate to the objectives of the program as set out in the Fourth

Program/Project Scope: (Provide detail on the project scope, includbeing addressed, target population, relationship to/involvement pharmacy, backgrou

Impacts: (Identify the proposal’s impact on consumers and key groconsumers, community pharmacy, other parts of the health sectopotential negative impacts.)

Evidence: (Where available, provide a Systematic Review of evieconomic evaluation of the service in the target populatiomoney compared to other interventions in this population) and popuand cost projections.)

organisation, individual, collaboration, consortium, peak body/comm

Program/Project Governance: (Identify who will manage the progassociated governance arrangements - eg existing/new committee, stakeho

Key Stakeholders: (Identify other key stakeholders with an interest in

Consultation: (Provide details of the consultation undertaken in dproposal, particularly with key stakeholders and consumers. Indicasupport the project, and how they will be engaged in the project implevaluation.)

Links: (Identify other projects that may be related to this proposal, mayon the proposal, or will be impacted by it.)

alysis: (Identify any barriers/threats to achie


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June 2010

Program/Project Performance Indicators: (Specify the key performfor the project, including outcome and process measures eg. reductionwithin target population, increase in medication compliance

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ance indicators in disease state

, number or percentage of key project milestones and

deliverables, eg progress reporting arrangements, evaluation reports.)

)

Exit Strategy: (When and how will the project/program conclude? If applicable, what are the exit strategies, or how will sustainability of the project beyond the conclusion date be addressed?)

services provided. How will these be measured? Identify

Evaluation: (How will the program be evaluated, when, and by whom?


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E This diagram was provided by the Deparment and was prepared in 2007.

Committee structure

PPSAC Evaluation

Steering Committee

PPSAC

Other PPSAC sub-committees

• R&D • R&I • Hep C • Diabetes

Minister

4CPA program managers

(Guild/Dept)

Better Community Health e-health Medication reviews Rural programs Indigenous programs

Stakeholders

Other advisory groups

May be managed by the Guild/Dept (eg RWWG, Indigenous Access Reference Group)

Department


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F Case Studies

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