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Rollo Manning
A Regular Column Reporting the News Behind the News

Issue 77: November 2008
Page: 1 of 1 Author's Profile | Send to a Friend | Printer Version

Is retail pharmacy ready for the future?
This is a question that is on the lips of some leading commentators on pharmacy around the Nation as the health system undergoes a review of how things are done.
Minister Nicola Roxon has called for a greater input to primary health care to take some of the load from the medico centric model that has evolved over the past 40 years.
Pharmacists believe they are well positioned to take on extra work being in the “community” and accessible to all.

There is one element that will be put to the test before any hard decisions are made as to who can do what and that is a track record.

Just for the exercise this writer was attracted by some stories from the pharmacy media over the past month and has recalled the articles that pointed to the fact that not all is well in the land of achievement and outcomes
Here are some examples.

The s2 scheduling of products must be brought into question when these products are causing problems to the authorities after decades of responsibility given to pharmacists’ for their safe supply to the public.
Travelling in countries where there are no such restrictions one cannot help but wonder what perils are inherent in the open market place.
By restricting the sale to pharmacists’ supervision it could be that a barrier is being created that gives the impression of a drug as being something special when in fact it is not.

After 60 years with a PBS designed to meet the needs of the ambulatory patient visiting a doctor and taking a prescription to a pharmacy to be filled it is found that pharmacists should be able to prescribe to avoid owing prescriptions when a continuation of medication is thought to be required.
This is a superficial look at a deep seated problem within the PBS and will not be solved by a band-aid measure to give pharmacists a right to prescribe.
Look below the surface and it will be found that the PBS was not designed, and has not been modified to meet the needs of a nursing home or aged care facility where the patient is bedridden and unable to go to their pharmacy of choice.
There needs to be special supply arrangements for these people and a better system designed to avoid the need for a doctor to visit each patient every time their 30 day and five repeats prescription has run out.
As a clue to any student researchers – have a look at the Section 100 arrangements for remote living Aboriginal people who cannot access a pharmacy of choice.

The alarm bells have been ringing for ten years on the question of the diversion of PBS funded narcotic drugs to the illicit market as a heroin substitute.
This writer was involved with stemming the flow in the Northern Territory back in 1999 when the NT use of MS Contin 100mgm was higher than for the whole of NSW in the second quarter of HIC stats.
This should have been enough to alert all State/Federal authorities that there was a need to put in place immediate recording online of the dispensing of narcotics so doctor shopping could have been stamped out at the time of prescription presentation.
Instead there is now a flurry to act when again the same old problem has reared its head.
One wonders how many millions of PBS dollars have been spent in the interim on morphine as a heroin substitute by addicts posing as pain sufferers.
Pharmacy leaders should have been more proactive in the intervening years to make sure their responsibility to the PBS was being met in curbing these fraudulent activities rather than just dispensing and seeing the payments come in from the PBS – many assuredly knowing it was a fraud.

The dispensing factory thrives as pharmacies approved to dispense PBS strive to gain an advantage against each other by churning out a maximum number of scripts in a given period of time.

In the meantime concern is being expressed at the safety of such practices and the need to protect the public against dispensing errors brought on by over worked dispensers. I.E. Registered highly qualified pharmaco-therapy experts reduced to the role of a keyboard operator.
Bring on automation and machines to take the place of the pharmacist allowing their knowledge gained at university to be passed on to other members of the primary health care team.

That is after all a true professional – not a keyboard operator.

Be part of a team.

The headline opposite is stating the bleeding obvious but how long do we have to continue to read and hear such calls for pharmacists to communicate with doctors (and others)?
Decades after the call in the 1970s for pharmacists’ to become more involved with other health care professionals the call still goes out. When is this going to stop?
When will the profession realise that the cocoon of the four walls is not the place to be?
Academics, economists and policy makers are questioning the value that pharmacists make to primary health care.
So long as the infrastructure within which they work is bound by regulation requiring the presence of a pharmacist every time the door is opened and the Approved Pharmacy system isolates them from the rest of the primary health care world this problem will remain.

It is about time the whole CMI system was looked at again as it seems nobody can get it right. Is there something basically wrong that means statements such as these are being made six monthly by one authority or another. In March it was Senator Jan McLucas, Parliamentary Secretary to the Minister for Health; in the above article it is the Australian Pharmacy Council; and last month again it was Professor Lloyd Sansom addressing the PSA bash in Perth. Really – what is wrong? Or is it too easy to accept the payment per dispensed item on the PBS and bank the money without doing anything.

Compliance – what is that? – how come after all these years there is still the need to devise systems to ensure people are taking their medicines as prescribed. The role of the pharmacist as the custodian of medicines in the community is to ensure the four planks of the National Medicines Policy and the Quality Use of Medicine guidelines are being followed. That should not be too hard but there is still no idea of the number of Repeat Authorizations that are given out ever come back for dispensing. Must there be a fee paid before these most basic of responsibilities are followed through.
As the retail pharmacy industry becomes squeezed by compulsory price reductions on the lucrative generic market competition between pharmacies will become more severe and the likelihood of responsibilities carried out that are not being directly paid for unlikely to be done.
The consumer is the victim in all this as an expensive pharmacy distribution infrastructure struggles to keep up with the changes being asked of it by a health system looking for wellness – not treating sickness.
As Professor Lloyd Sansom said to the PAC Congress in Perth, October 2008:
“Structural change and visionary management will be essential if pharmacy is to fulfil its proper role in health care delivery”
In 2000 the government sponsored National Competition Policy review of pharmacy regulation (February 2000) chose to describe the “community” pharmacy scene as one which:
“By effectively standing still at the beginning of the decade (1990s), the current restrictions (on location of Approval Numbers) arguably have not served the community well. They reflect, and to an extent have locked in, the pharmacy and health care outlook of the early 1990s, rather than looking ahead to needs of the decade ahead.”
There is only 13 months to go before we could say that yet another decade of standing still has passed resting on laurels and enjoying the status quo.
Comment to the Editor or email Rollo Manning on rollom@iinet.net.au
RWM Consultancy
PO Box 98 Parap NT 0804
Telephones 08 8942 2101 or 0411 049 872 1st November 2008

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