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- Issue 81: April 2009
- Issue 80: March 2009
- Issue 79: February 2009
- Issue 78: December 2008
- Issue 77: November 2008
- Issue 76: October 2008
- Issue 75: September 2008
- Issue 74: August 2008
- Issue 73: July 2008
- Issue 72: June 2008

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A Moment in History for the "Friendlies" and the PGA

Neil Johnston
Management Consultant Perspective

Issue 81: April 2009
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In a low key move, the Pharmacy Guild of Australia (PGA) and the Australian Friendly Society Pharmacies Association recently signed a Memorandum of Understanding (MOU).
By this single move, the Australian Pharmacy landscape has immediately changed to reflect a new sense of political unity and stability.
Under the MOU the PGA is recognised as the single negotiating body for pharmacy and the Friendly Societies derive the flow on benefit of government funded programs, to which previous access was difficult.
At i2P we have always recognised that Friendly Society pharmacies, and in particular the National Pharmacy Group, have represented an efficient pharmacy model, successfully integrating pharmacist and non-pharmacist management deployed to sensible delegations, and under a corporate umbrella structure.
And the model has survived and prospered given the range of difficulties and distractions thrown at it over the years.

As a sensible initiative by the PGA we commend them, and hope that this may be the start to a more embracing policy that ends up being a force for pharmacy unity, rather than that of division, as we have consistently seen to this point.

Perhaps the National Pharmacy Group model will now be accepted as a genuine mainstream model, well worth emulating (with minor modifications) by traditional PGA members.
Only one major area now needs to be tidied up and that is the representation of non-pharmacy owners who see themselves more as small business contractors rather than employee pharmacists.
These people have also been starved of government funds to develop clinical and other programs – programs that can only be successfully delivered in alliance with pharmacies or other clinical settings such as GP super clinics.
Representation for clinical service contractors could be provided by the Pharmaceutical Society of Australia (PSA) or failing that, they would have to establish their own infrastructure.
To do the latter would require a large injection of capital, but if the PSA don’t get a “wriggle-on” that is what will happen.
Since the PGA has been the gatekeeper for pharmacy funding there has been a skew of funds towards pharmacies only that has resulted in a lack of clinical services or a flag waving exercise that substitutes for a clinical service.
Delivered with heavy-handed bureaucracy, a lack of creativity and at a high cost they are not seen as giving value- because the public do not pay for them, and to put it bluntly, major pharmacies do not support them.
Also, it is not very inspiring to know that these services are increasingly imported from other countries when the expertise to develop the same services does exist in Australia, but is given no impetus.
Services such as these would find a development home among pharmacy services contractors if they had access to funds and a political infrastructure to work out of.

Another positive move has seen PSA representation on the PBS negotiating committee increase, albeit overshadowed by the fact that the PSA component is seen to be diluted because some of these people are also PGA members i.e. they have a dual citizenship and it is thought that their votes would skew towards PGA imperatives.
Nonetheless there seems a new willingness for these organisations to work together and for this to happen, there has to be a softening of PGA attitudes in general.

Coming into 2010 we see pharmacy under attack on an almost continuous basis, be it Choice, Skeptics, GP’s, Big Business including Colesworth and overseas predators waiting for an opportunity (e.g. Wal-Mart).
The complaints range from lack of evidenced-based sale of products, unethical advertising or supporting services that have no validity e.g. homeopathy.

Another major problem that is emerging is the wide open corridor that has been created for nurses to intrude on the primary health care space traditionally held by pharmacists.
This is occurring unimpeded because the clinical pharmacists have been deliberately suppressed in their ability to grow, receiving no grant or seed funding, and having their progress tied to a community pharmacy facing an uncertain future.

Because of PGA attitudes to clinical services we have not seen progression in this area due to PBS increased workloads and demands that have pinned owner pharmacists down to an uninteresting job that competes with patient interests.
Thus, we still see pharmacies measuring their output in terms of script numbers processed, rather than patients fully serviced.
And you will note that this is where most external criticism focuses i.e. the lack of value-adding for patients whether it be patient information (in the form of CMI or counselling), pharmacist input into S3 selling and a failure to anticipate demand created by lifestyle illnesses and other chronic conditions, that are expanding rapidly as the 60+ aged group of population correspondingly expands.

Approximately 50 years ago, and before that, pharmacies were small one-person affairs dispensing mainly herbal medicines and a few manufactured versions.
It was possible to set up virtually anywhere – even on a residential street corner in a converted home.
When pharmacists graduated from their training facility, they were very quickly enabled to set up a practice with little capital, aided by a very friendly and interested wholesaler.
Thus, little distinction occurred between pharmacy owners or those who were about to become pharmacy owners…it was only a matter of a brief period of time.
Pharmacists then treated each other as equals because your current pharmacist employee may be the future purchaser of your affordable pharmacy or indeed your next competitor!
Fast forward to now and we see a very different culture of pharmacy owners ranging from the very wealthy down to the struggling version, and we see a cultural divide between those that own pharmacies and those that do not.
It is much more expensive to get into a pharmacy practice primarily because of PGA engineered situations such as PBS approval numbers that have ratcheted up the cost of buying a pharmacy, by artificially inflating a licence cost that should not even exist, in order to protect an inflated goodwill cost.
The lament coming from pharmacy owners is that they have capital at risk and therefore everything pharmaceutical should be tied to them to protect that capital.
This is spurious, because even if given the clinical opportunity, pharmacy owners consistently abandon their clinical goals, or are unable to get to a critical depth because they are too busy with the supply side of the business.
Supply needs structured time and clinical services require unstructured time..the two are basically incompatible unless developed as separate entities.

The argument now exists for non pharmacy owners to begin to build small clinical practices that can operate coequally in alliance with a pharmacy or a GP practice.
Practices that have the same business risks as pharmacies themselves, but initially on a much smaller scale and equating to the simple pharmacy structures that existed 50 years ago.
All that is required are the right ingredients…seed capital, grants and market development.

But lest I forget where we started this article i.e. with the Friendly Society Pharmacies, in particular the National Pharmacies Group, coming in under the umbrella of the PGA negotiating process.
This model of pharmacy with its corporate structure and its specialised management team (mostly non-pharmacists) is ideally positioned to create a clinical division within its business structure, and with proper nurturing, can develop proper clinical services with an appropriate support system.

Unless there is an immediate resolve to restructure pharmacy into clinical groupings separately from community pharmacy groupings, pharmacy overall will lose out in the area that it prizes most – that of prescribing.
The long-held wish of a doctor diagnosing and a pharmacist prescribing can never be more than a dream because of the potential conflict of interest.
You cannot be a prescriber and a dispenser simultaneously because of the potential for corruption.
If prescribing is to be a reality then you would need a clinical pharmacist (preferably set up in an independent business) who did not have a pecuniary interest in a pharmacy.
Conversely, you would need to ensure that a pharmacy owner could not have a pecuniary interest in a pharmacist prescriber clinical practice.
That is a model that would work and has a greater chance of being accepted by government.
If it does not evolve, pharmacy will still be wondering for the next 50 years why it has been continually overlooked in primary health care.

Four years ago I attended (by accident) a high level meeting of health officials and clinicians at Murwillumbah, in the Northern Rivers Area of NSW.
I was the only pharmacist present, rubbing shoulders with the “who’s who” of health.
I listened as pharmacy was being dealt out of the primary health care pack and downgraded to allied health.
These were major decisions and official pharmacy had not been even invited!
The group was going to develop a new frontline primary health worker who could be trained in hospitals and GP surgeries, to deliver primary health care to the community.
There was even discussion then as to whether this person would be able to write prescriptions (the verdict was yes!)
I challenged those present that pharmacists were primary health practitioners already deployed and strategically located and that pharmacists would never accept the designation of allied health.
I also postulated that pharmacists should be funded to fill an expanded primary health role.
I was looked upon with disbelief!
I even humbled myself to report these proceedings to a senior management person within the PGA.
That is now history.
Unless we see a nurturing of independent clinical practitioners within their own practice structure or embedded in a model similar to National Pharmacies, Pharmacy will be permanently out of the primary health care funding arrangements and we will see clinical nurse practitioners and physician assistants take over pharmacy’s role.
Those decisions are being taken now as Nicola Roxon has to make good on her government’s election promises.

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