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- Issue 72: June 2008

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Medical Super Clinics - what an opportunity for pharmacy!

Ken Stafford
A Consultant Pharmacist Perspective

Issue 72: June 2008
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The Pharmaceutical Society of Australia (PSA) certainly “set the cat among the pigeons” with its position paper on pharmacy within the proposed medical super clinics didn’t it?
The Pharmacy Guild, of course, has come out strongly against the suggestion by PSA that pharmacy services within these clinics be provided by contracted or staff consultant pharmacists and funded by Medicare rather than by local community pharmacists.
The heat of posts on this topic appearing in another pharmacy web site is very significant as it shows how an issue can demonstrate deep divisions within the profession.
In some posts PSA is congratulated for at last “showing some backbone” in taking on the Guild by proposing a model for pharmacy services within super clinics breaking away from a community pharmacy based one while in others posters write about “elitist” pharmacists being created.

Wonder what they mean by elitist, almost certainly this is a poorly hidden attack on the increasing number of consultant pharmacists, all of whom have worked hard to gain accreditation and continue to work hard to maintain competency.
A case of good old fashioned Australian tall poppy syndrome maybe?

Let us take a step back and look at the proposal by PSA rationally.
What is so wrong with the clinics employing appropriately trained, experienced, pharmacists to provide input into the treatment of the numerous chronic medical conditions that generate the majority of visits to the doctor?
We must realise that this is precisely what most pharmacists, be they community, consultant or hospital, do in the daily course of their jobs.
We have all spent  many hours advising both prescribers and patients on the appropriate use of medicines to treat chronic disease, often without specific remuneration for the service, so is it so wrong to employ pharmacists to do this as their sole responsibility?
Personally I would love to be able to work in a position like this.
A few years ago I wrote an imaginary historical article for a pharmacy journal being published in 2106 (I think), looking at how our profession had progressed in the “past 100 years”.
In this I envisaged that the pharmacist author’s working day consisted primarily of offering advice on a range of health topics from a pharmaceutical view point.
The supply function (dispensing) was no longer the primary focus of the pharmacist, his day consisted of applying his professional knowledge to ensure better health outcomes.
This is almost exactly what PSA appears to be proposing.

I can understand why the Pharmacy Guild is concerned about the proposal as it seems to be attempting to sideline community pharmacy owners as providers of services to the clinics.
This is a threat to the Guild’s clients, the 5500 pharmacy owners in Australia, and also to its mantle as the voice of pharmacy in the country.
PSA, however, is possibly more representative of the 18-19,000 pharmacists, most of whom have been neglected by PGA over the years.
PGA is recognised as being probably the most effective lobby group in Canberra but it’s primary remit is to represent pharmacy owners rather than all pharmacists.
Employing staff pharmacists in medical super clinics is most unlikely to have any significant negative effect on community pharmacies as they should have almost no impact on script dispensing numbers and NO impact of front of shop trade.
Realistically, there will not be that many of these super clinics therefore their impact on community pharmacy would be minimal and having pharmacists “on-site” should reduce prescribing errors, overcome administrative difficulties and have a beneficial effect on doctor-pharmacist relationships.

As a “non-aligned” consultant, the proposal to place pharmacists within medical super clinics for their intellectual professional input strikes me as a major positive step for pharmacy.
As a hospital pharmacist I expected, and received, recognition as a health care professional and PSA’s proposal  has the potential to take this recognition out into the community.
What a wonderful opportunity this could become for our profession.
In future we might even find that pharmacists start to appear in government thinking when new health initiatives are being formulated.
A time might come when I stop having to be the lone voice crying forlornly “don’t forget pharmacists, they have to be included” when bureaucrats are talking health.

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