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Where to From Now?

Ken Stafford
A Consultant Pharmacist Perspective

Issue 76: October 2008
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Three stories appearing in the media recently caught my attention and, for a number of reasons, led me to think about where our profession will go to from now.
Firstly was the suggestion of a “two tier” medication reviews system with differing levels of complexity and recompensed accordingly.
The idea is that the lower level, dispensing bench, review could be carried out by any pharmacist (accreditation not required) leaving the realms of highly complex problems to the accredited consultant pharmacist.

“Good idea” I thought as this would allow for community pharmacy to move, just a little, from relying on the supply chain income towards payment for intellectual input.
Let us be honest about it, many medication reviews do not require all the additional training embodied in accreditation.
Often they take more time to write up than to actually detect significant problems and could quite easily be carried out by any competent pharmacist. (Please note the proviso.)
Every community pharmacist carries out (I would hope) a form of this type of review many times a day as part of the dispensing process.

We are looking here at normal activities such as casting a professional eye over drug regimens and dosage patterns or advising on how to administer medications appropriately – correct use of inhalers, how to instil eye drops most effectively, when it is best to take oral preparation.
If we call ourselves health care professionals these are the activities we should be doing as a matter of course.
OK, not everyone will require even the “medication review lite”, only those meeting certain criteria but imagine if you could claim an MBS payment for this activity in addition to normal returns for supply.
Even $50 for a 15 minute review would improve your sense of professional wellbeing out of sight.
New income stream, better use of all your pharmacy training.

For more complex cases the consultant pharmacist would have to be called in as is the current procedure.
The fee attracted by these cases would be significantly higher, offsetting the reduction in number of reviews being performed by the more qualified consultant, a scenario comparable to the medical specialist versus GP remuneration.
Are we talking a win-win situation here or is someone going to lose?
My feeling is that we are unlikely to find as pharmacy, on past behaviour, will find it just too hard to fight for such a scheme.

The second item relates to pharmacy’s reaction to the latest IRC wages and conditions paper which bundles pharmacy into the retailers section of the proposed award.
The screams of anguish have been quite deafening but really, pharmacy has only itself to blame (although I was surprised to see hospital pharmacists being included) – if the organisation claiming to speak for the profession is made up of community pharmacy owners you cannot really complain that pharmacists are considered to be anything else but retailers. The claim that “medicines are different” rings very hollow when you see the number of “fast food” dispensaries around.
When I hear or read of pharmacists proudly proclaiming their ability to dispense 300+ scripts a day with just one helper I shudder.
If that is the criterion for being a “good” pharmacist we deserve to lose our credibility as health professionals.
No-one, and I mean no-one, can dispense this many prescriptions in a working day and still carry out the professional health care role we expect, counselling, advice on administration and actions/adverse reactions and monitoring of drug regimens.
Something surely has to go!

The old saying that “If it looks like a duck, waddles like a duck and quacks like a duck – it probably is a duck” applies here.
Act like a shopkeeper, look like a shopkeeper then you will probably be treated like a shopkeeper.
We need to change how we look and act if we want a different treatment. How we are perceived is how we will be treated.

The third item was the story about the federal health minister aiming to cut out “six minute medicine” in GP land by encouraging doctors to make better use of other health professionals to carry out simple medical tasks.
These are to include giving injections, providing counselling on chronic disease management and prescribing the oral contraceptive pill.
Once again “Good idea” I thought, “we pharmacists have been suggesting for years that we could take some of the pressure off GPs by doing these things” and read further.
Nurses, psychologists and physiotherapists all rated a mention – guess who was missing? Yep, pharmacists again did their imitation of the invisible man despite claiming expertise in many of the functions mentioned.
Nurses able to prescribe the pill but not pharmacists, what a travesty.
I thought we were the experts on the use of drugs, obviously not.
Looks like we are only good for “sticking labels on boxes”, don’t expect pharmacists to have any others skills and knowledge.
I sometimes feel that I am like a voice crying in the darkness.
“What about us – we are health experts too”.

I am approaching the end of my professional life so am unlikely to be affected too much by the possible adverse outcomes of the latter two stories but I worry about all those “bright young things” graduating from university, B. Pharm certificates in their hot little hands, if we allow the negatives to outweigh the positive aspects of the first item.
Let us make use of the skills inherent in our pharmacists to drag the profession, possibly kicking and screaming, to the forefront of patient care.
We should be using our brains and knowledge of drugs, not our muscles, to generate our income, that way governments and government agencies will, in the future, be forced to take us seriously.

I get tired of hearing that pharmacy is at the crossroads, the old cliché has well and truly passed its use by date.

I will, however, ask “If the profession is at the crossroads where do we go from here?”

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