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- Issue 81: April 2009
- Issue 80: March 2009
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Do We Want To Be Pharmacists or Grocers?

John Dunlop
From a New Zealand Clinical Pharmacy Perspective

Issue 80: March 2009
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In New Zealand we have approximately 3,000 pharmacists practicing, and 48,000 nurses – or if you like sixteen nurses for each pharmacist.
I suspect that the same proportion exists in Australia.
The problem with this is that nurses are already embedded within primary health care practice as integral members of the collaborative health care team.
Pharmacists are not!
The opportunities for services being presented to pharmacists are also available to other healthcare professionals, particularly nurses, who it is fair to say, are better positioned to take advantage.

The strengths of modern community pharmacists might include the protected market they work in, their basic pharmacotherapeutic knowledge, owners remuneration, and a measure of public acceptance.
The weaknesses might include the lack of control of dispensing income, a diminishing need for professional skills in the retail environment and a reliance on supply and distribution income.

The status quo is threatened by de-regulation, retail competition, diminishing dispensing profit margins (though this has been more than compensated for in NZ by increased volumes) and the potential for future legislation to negatively impact on the supply role and the current protected market.
What we can be certain of is that there will be changes.

The title of this little commentary is not as spurious as might at first be thought.
In the days of the British Apothecary there was quite a contretemps between the physicians (University Educated) Apothecaries (Apprenticed) and the Chemists and Druggists who supplied the products that the Apothecary used to extemporaneously compound the Physicians prescriptions.

The Physicians wanted to keep everything to themselves, the Apothecaries wanted prescribing rights and the Chemists and Druggists wanted dispensing rights.
The outcome was that the Physicians grabbed the ‘specialist’ high ground, the Apothecary became the general practitioner and the Chemists and Druggists became the subordinate dispensers.

In 2009 pharmacists have been accorded the rights to an intensive undergraduate education and are being offered new pharmacy practice roles.
Most pharmacists work in the community pharmacy environment and few would argue that the dispensing process has become little more than a technical and checking function.
While the undergraduate education programme certainly equips pharmacists to undertake this process, the five years of learning might reasonably be seen as a substantial over-kill for dispensing.
It could even be argued that the undergraduate education is at odds with managing and working in the modern retail pharmacy where subjects such as business management, accounting, marketing, and merchandising are the cornerstones of a supply and distribution business.

Most of the pharmacy dialogue with funders inappropriately occurs between representatives of retail pharmacy and government agencies.
My argument is that the new practice roles are seen as a means of attracting new customers into the pharmacy, rather than as an opportunity to move into the collaborative care model.
The provision of clinical pharmacy services is time consuming, and therefore perceived to be uneconomic.
There is a general lack of awareness of the funding structures for other comparative government funded medical services, which creates unrealistic claims for fees.
Additionally the very nature of clinical pharmacists’ practice is designed to reduce the amount of medication a person takes in order to minimise the potential for drug therapy problems.
It is no wonder that community pharmacy hasn’t embraced these new roles.

Recognising that the profession has coped with major change before, perhaps the time has come for pharmacists to front up and be honest about who they are and what they want to be. Pharmacy practice is no longer just about ‘dispensing’ and supply and distribution.
There are new, funded, successful and expanding roles for pharmacists that can only be practised outside the retail environment. We each need to decide which practice path we want to follow.
All options are legitimate and respectable.

What is not an option is to fail to recognise the need for the independent development of new roles for pharmacists.
In New Zealand we are designated within government circles as the “invisible” profession.
It could be disastrous for the profession to ignore the major threats to pharmacy practice from other health care professional by remaining inactive and withholding support for new practice models.

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