As the Federal Government enters final negotiations for the First Pharmacy Programs Agreement (1PPA), rural health advocates are calling for a dedicated funding pilot to support Resident Clinical Pharmacists in Australia’s most isolated towns.

While national pharmacy bodies campaign to “Uncap Care” by removing monthly limits on Home Medicines Reviews (HMRs), the Remote and Isolated Pharmacist Association Australia (RIPAA) warns that while uncapping care solves an access problem in high-volume areas, it fails to address the structural stability of clinical services in targeted “thin markets.”

The Value of Embedded Care

In many Modified Monash (MM) 5–7 communities, the primary challenge is not a “cap” on services, but the financial sustainability of maintaining a permanent clinical presence.

“Lifting a cap on HMRs does nothing for a town that only has ten reviews a month,” says RIPAA President Fredrik Hellqvist. “While visiting consultants provide a necessary service to many regions, the current transactional model inherently favours those who can aggregate high volumes of work into single trips. What our communities need is a funding model that also supports a Resident Clinical Pharmacist—someone embedded in the town who understands the local patient history and provides the daily continuity of care that thin markets require.”

A Proposal for 1PPA

RIPAA is calling for the allocation of 1PPA funds to a Thin Market Resident Pilot. This model proposes:

• A Clinical Maintenance Allowance: This should provide a fixed baseline of funding that secures the pharmacist’s time for ongoing clinical outreach, aged care support, and complex medicine management. This moves the model away from a reliance on the high-volume ‘bursts’ of activity that currently dictate clinical viability.
• Locality-Locked Funding: Prioritising this funding for pharmacists whose AHPRA Principal Place of Practice is within eligible rural and remote thin market areas. This ensures taxpayer dollars build local workforce capacity and rewards clinicians who choose to live and work in the communities they serve.
• Integration with Aged Care: Using this Clinical Maintenance Allowance to solve the “Aged Care On-site Pharmacist” (ACOP) underspend by providing the necessary financial floor to recruit and establish locally resident pharmacists to fulfill these roles in targeted small-town facilities that currently lack a permanent clinical presence.

Building a Structural Bridge

“We are calling for a pilot that recognises healthcare in the bush is most effective when it is a residency, not just a transaction,” says Hellqvist. “The 1PPA is the perfect vehicle to test a ‘Floor and Ladder’ model, acting as the structural bridge to ensure these programs are equitable in practice, not just in theory. RIPAA has developed a detailed framework and preliminary costing for this model, demonstrating its viability as a targeted, value-based investment.

Without an equity measure functioning as a Clinical Maintenance Allowance, the reach of 1PPA programs in remote areas will remain patchy and transient—and the cost of that failure is far higher than the investment we are seeking. By securing the ‘floor,’ the government ensures that ‘Uncapping Care’ isn’t just a benefit for our cities, but a reality for the remote communities who form the backbone of Australia.”

“RIPAA believes that these communities deserve access to embedded clinical pharmacy services that support medication safety just as much as those in our capital and regional cities,” says Hellqvist. “Investing in a resident clinical presence isn’t a subsidy; it is a value-based strategy to prevent the far greater costs of medication misadventure and avoidable hospitalisations in the bush.”