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- Issue 81: April 2009
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Pharma - Goss

Rollo Manning
A Regular Column Reporting the News Behind the News

Issue 79: February 2009
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Pharma-Goss - by Rollo Manning
"...your people will judge you on what you build, not what you destroy"
Barak Obama, US Presidential address. 21 Jan 2009

“Australia must build a strong pharmacy profession and NOT destroy a profession for the sake of the almighty dollar.” – Rollo Manning Feb 2009

The Fifth Community Pharmacy Agreement gives the opportunity for this to start from 1st July 2010 but only under one condition – the Status Quo is dead.

What is the Status Quo?

An immovable situation where an Approval Number to dispense Pharmaceutical Benefit Scheme medicines (National Health Act 1953) is used to pay pharmacists for a variety of professional services introduced to improve the clinical outcome for the patient and not necessarily conducted in the premises of the retail shop..

It worked well until it started to be used for purposes which it was never designed to undertake. The first deviation from the simple act of dispensing was when the time spent counselling patients was deemed by the Pharmaceutical Benefits Remuneration Tribunal during its inquiry into earnings costs and profits (circa 1983).

There are circa 5,000 Approved Pharmacies in Australia and it is probably fair to say that no two are the same.

There are those that give advice on handing out a PBS Medicine and those that do not and have no intention of ever doing it. Then there are those that extend their activity into point of care testing, dose administration aids, diabetic monitoring, and asthma management etcetera.
The problem here is that it is not possible to spread a quantum of money across 5,000 and come up with a workable program. The result is that the amount per pharmacy is too small to do anything worthwhile.
If the same amount had been allocated to those outlets that were prepared to be accountable for what they do it would be well utilized and clear to the consumer the choice they have in terms of range of services.
The current trend to use the Approval Number as a means to pay pharmacists for value added services will lead to a situation where the retail pharmacy becomes the location for delivering clinical professional service for which it is NOT positioned to do.
Just as there is no “average pharmacy”, neither is there a model for pharmacy practice that allows each registered pharmacist to practice their calling in circumstances that suit their motivation and their patients needs.

1. Create a situation where the retail pharmacy takes on a profile which suits the consumer’s needs in terms of pharmaceutical service delivery…
2. Create a situation where pharmacists are free to practice their profession in a range of work based situations and be compensated as a true professional alongside doctors, nurses, radiographers. Medical technicians, nutritionists and others.

The world has changed health care delivery models have changed, the infrastructure which provides health services must match the consumer demand for a variety of service delivery outlets.

The so called Wilkinson Review in the year 2000 (1) made the following observation when analysing the competitive nature of pharmacy businesses:

“The restrictions (on location of Approval Numbers) have not kept up with evolving health care and consumer needs. The PBS location restrictions have been operating, with modifications, since 1990. In that time, there have been considerable changes in the modes of delivery for primary health care services, including pharmacy.
“By effectively standing still at the beginning of the decade, 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.”
It’s time!

How much longer do Australian consumers have to wait for a pharmacy service that suits their needs?
Why is it that Australian pharmacy remains locked in a retail model that tries to satisfy all comers but fails the majority?

How to get rid of the Status Quo?
1. Agree on principles
a. Enter talks with an agreement that the Status Quo is dead
b. Determine to devise alternate models of funding for different types of practice
c. Recognise that the Guild role is a commercial one protecting and enhancing the earning power of its members
d. Recognise that the PSA and the SHPA are the professional development organisations for pharmacists NOT wishing to own a retail shop.

2. Acknowledge the difference between financial gain and professional input
a. The return on investment in a retail business is essential to the owner and partners. Such entrepreneurs have a different motivation for being than clinically motivated pharmacists and will be concerned with factors such as staff costs, rent and product mix.
b. The retail arm of pharmacy practice was originally for the supply of pharmaceutical products to the community and remains so. However as the health service delivery sector has changed so too must the practice of pharmacy with different models initiated which allow pharmacists to interact with the broader primary health care, public health and preventative health measures. Art the same time pharmacists must be able to interact with consumers who want to lead a more healthy lifestyle. The time spent on these activities must be remunerated in a manner that recognises the value they add to the total health service delivery goals. This is not in a retail shop environment.
c. A pharmacist working in the clinical setting will need to be remunerated for the value of their professional time. This is different to remuneration for performing a supply task as in the dispensing of PBS medicines.

3. Devise alternate models of practice.
a. It is not ONE pharmacist but many.
b. There is not ONE pharmacy practice but many
c. There is not one role for pharmacists but a number.
It is only natural that the commercial lobby for pharmacists will try and have the world believes that the activity revolves around a retail shop that has an Approval Number to dispense PBS prescriptions.
But that the same Approval Number is used to make payments to pharmacists for a range of value added services is extending the bow beyond the limit it was originally intended for and will only lead to a complicated set of circumstances that confuses the dispensing role with the clinical services.
It is necessary to keep these functions separate so as to be able to cater for the variety of needs consumers have when dealing with the government sponsored Pharmaceutical Benefits Scheme.

Pharmacists themselves have indicated in a recent poll on the Auspharmlist that they want the clinical functions kept separate. The poll, reproduced below with kind permission of www.auspharm.net.au, showed that 67% wanted the clinical services kept separate to the supply function for PBS by being available independently of a “community” pharmacy..

The content of this article will be the central theme of a presentation to be made by Rollo Manning at the 6th Annual “Future of the Pharmaceutical Benefits Scheme” Forum to be held at the Radisson Plaza Hotel, Sydney 30th April to 1st May 2009. For details go to this link

To read more of Rollo Manning’s views on how pharmacy needs to change go to his submission to the National Health and Hospitals Reform Commission at this link

Comment to the Editor or email Rollo Manning on rollom@iinet.net.au

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