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The past president of the Pharmaceutical Guild of Australia (PGA), John Bronger, was once quoted as saying he could see a future need for the PGA and the Pharmaceutical Society of Australia (PSA) to amalgamate into a single peak organisation.
No guidelines were ever promoted publicly as to how this might occur, but the lopsided process that exists today for the management and direction of the pharmacy profession has been underscored by the announcement of the government initiative to establish 31 GP superclinics throughout Australia.
The PSA see this government move as an opportunity for individual pharmacists to work as clinical pharmacists in a pharmacy model that need not be underpinned with a community pharmacy.
The PGA is incapable of seeing pharmacy develop in any other way that does not contain a pivotal community pharmacy model at the centre of the universe, controlling all things pharmacy.
If the PSA succeed in establishing their view of the world, the nexus on who controls Pharmacy becomes less oriented towards the PGA while simultaneously opening up more interesting job opportunities for pharmacists.
And that would be a desirable and balanced outcome.
Pre-dating the John Bronger utterance regarding a combined PSA/PGA peak body for pharmacists, i2P E-Magazine had promoted similar thoughts for a peak body that allowed for all pharmacy organisations (not just the PGA and the PSA) to hold shares in, creating a platform where each organisation had input and diversity of opinion, while simultaneously upholding the peak body as the sole negotiator for agreements structured with the federal government, and medical organisations such as the AMA or any other organisation that impacted on pharmacy generally.
The PGA has seen little reason to look at an amalgamation pathway because it has controlled a lot of the money flowing into pharmacy, particularly in the area of government grants.
It sees itself as strong and controlling its destiny, deeming there is minimal need to see who may be hurting via their blinkered policies.
So we have come to the realisation that 35 percent of pharmacists exert control over all pharmacists – a situation that has made the silent majority very unhappy for quite some time.
Consider, for example, the excellent opportunity that existed when consultant pharmacists were established as a sub-group of the profession.
i2P supported the establishment of the consultant concept because it could envisage a framework for independent professional practices or a structured alliance with community pharmacists working on an equal footing.
These consultancy practices could have provided additional members for the PGA that could have adjusted, with very little difficulty, to accommodate that type of membership.
Instead, the PGA moved to develop a model for all pharmacy services that could only be delivered through a community pharmacy, and one that disallowed the development of independent practice.
Their consultant pharmacist model became both expensive to run and destroyed the concept of a consultancy.
In simple terms, who is the client in the convoluted process that has evolved?
The community pharmacist?
The federal government?
Or was it really the patient?
In a normal consultancy you have a client who selects a consultant and arranges to pay for their services either directly, or through a third-party arrangement organised through them.
Clients can approach a consultancy service directly, or be referred on through some other agency.
The real client of a pharmacy consultant is obviously the patient – but patients have never been empowered by the system.
Thus you have consultant pharmacists who earn, in real terms, far less than they would if they worked as a locum.
Simply because the gross income was never designed to cover the practice expenses required to provide an ongoing independent service.
By not recognising consultant pharmacy independent practices, the PGA has destroyed the initiative and creativity that would have flowed from this type of venture.
And it is a decision that the PGA will have cause to regret because it is obvious that pharmacy professional services have not been able to germinate and take hold in a community pharmacy environment.
There has been no income stream separate to the PBS income stream that has enabled the development of new professional services.
Instead, we have a diminishing PBS income rapidly becoming unable to support the existing level of pharmacists, and certainly not providing interesting work.
Currently, community pharmacies have the need to employ additional pharmacists and to develop new services not dependent on the PBS income stream.
In practice, we have the reverse where PBS margins and profit returns have been progressively shrinking, to the extent that it is now uneconomical to employ pharmacists in the dispensing stream.
So what was the point in all those tertiary educational establishments developing their pharmacy schools and injecting more pharmacists into a system that is unable to absorb them?
i2P has previously pointed out that potential members for the PGA will gradually diminish to a point where PGA “muscle” will become ineffective.
Small pharmacies that are currently under pressure will be progressively absorbed by larger pharmacies, or they will disappear.
Larger pharmacies have a lesser need to rely on PGA services because they can provide their own resources internally.
Also, nobody really believes that the Colesworths and the Wal-Marts will not appear circa 2010 or a date close by as pharmacy owners, and they certainly will not be PGA members.
So what membership potential is left to recruit?
It could have been a large group of professional services companies that could have spearheaded a range of clinical services that could be promoted through community pharmacies under contract.
These companies would have paid for the cost of developing these services.
Revenue streams could have been leveraged off the returns from medication reviews initially, until new revenue streams materialised.
Each new revenue stream developed represents employment opportunities for pharmacists that are not a charge on PBS income.
More pharmacists can be usefully engaged in interesting work rather than trying to squeeze more sausages out of the dispensing machine.
So what is likely to evolve?
I think it is fair to say that no matter what the PGA says or does from this point on, independent practitioner companies need to organise themselves into their own umbrella group, something along the lines of how the PGA and the PSA coexist currently i.e. PSA provides professional standards and education while the PGA provides business support and political initiatives.
Consultant pharmacists already have a PSA-like organisation, all they need to do is develop another organisation to provide business and political support.
The time is right for this to happen - it only needs leadership to emerge with the commitment to see the job through.
It would be nice if PSA were able to provide this facility as a sub-section of PSA, otherwise it would have to be developed separately, which would involve a longer lead-time to come to fruition.
If not, the alternative must be to forge a separate organisation.
New pharmacy organisations are considered to fracture or dilute the fabric of existing pharmacy structure (as viewed by existing pharmacy bodies).
This need not be the case if a new peak pharmacy organisation was to emerge in parallel.
Far from being detrimental, specialist groups of pharmacists forming around innovative means of developing and expanding segments of pharmacy professionalism, can only benefit the whole of the profession.
Being shareholders in a peak body and being able to influence decisions would ensure a place in the sun.
The wasteful efforts used to inhibit or derail progressive start-ups, often employed by the PGA, need to be neutralised.
For the moment, supermarket pharmacies are seen to be the only means of survival.
This business model is set to become very congested at the point where other retailers are able to throw their hats into the ring.
Better that a niche market, fulfilling the aspirations of clinical pharmacists should emerge.
Because the structure for independent practitioners needs to be supportive to professional endeavours, it will not arise from existing pharmacies because of their pre-existing culture constraints.
Young pharmacists (representing energy and fresh ideas) should unite in this endeavour, carefully selecting mentors from the young-at-heart (but experienced) pharmacist sector.
Don’t leave it too long – just do it!