Editorial
Welcome to the first homepage edition of i2P for 2012.
In many ways it has been a slow start to the New Year because of having to deal with the “leftovers” from 2011.
One of those items for i2P was that a third-party provider to the site did not advise of a code change to the security section in our subscribe panel, creating a range of frustrated subscribers not able to get on board.
We apologise to all those potential subscribers who were unable to register with us in the second half of 2011, but if you try once more you should have no problem.
Columns
Rollo Manning: Pharma-Goss
Linda Bryant: Inside NZ
Loretta Marron BSc: Health Watch
Barry Urquhart: Marketing Focus
Mark Neuenschwander: I`ve been thinking about...Recent Comments
Past Editions
Volume 1 Number 1
Volume 1 Number 2
Volume 1 Number 3
Volume 1 Number 4
Volume 1 Number 5
Volume 1 Number 6
Volume 1 Number 7
Volume 2 Number 1
Volume 2 Number 2
Volume 2 Number 3
Volume 2 Number 4
Volume 2 Number 5
Volume 2 Number 6
Volume 2 Number 7
Volume 2 Number 8
Volume 2 Number 9
Volume 2 Number 10
Volume 2 Number 11
Volume 3 Number 1
Volume 3 Number 2
Volume 3 Number 3
Volume 3 Number 4
Volume 3 Number 5
Volume 3 Number 6
Volume 3 Number 7
Volume 3 Number 8
Volume 3 Number 9
Volume 3 Number 10
Volume 3 Number 11
Volume 2012 Number 1
Health Politics
Neil Johnston: Friends of Science in Medicine
Peter Sayers: Confessions of a Frustrated Pharmacist
James Ellerson: $75.5 million in 5CPA lying idle. Why is it so?EPublications
Competition between health professions
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Introducing current ideas, perspectives and issues, to the profession of pharmacy | |
Editor’s Note: The turf war between GP’s, nurses and pharmacists has been heating up over recent times. Of course it is due to the stimulus of federal budget submissions – a time when all health professions have to be visible (and audible) to ensure that their share of the “pie” is secured. Pharmacy has always been in the primary health care space, but has often had an “invisible” presence because it has operated outside of the main streams of patient care, not being integrated with other health care providers. We, as pharmacists, know what we can do and how we can provide it, and we are often surprised when our profession is overlooked in various government programs and activities. In part, this is because doctors have tended to “drown out” any proposed pharmacy initiatives, aggressively construing any forward activity as being an intrusion on their turf. Pharmacies only represent infrastructure to deliver services, and an excellent infrastructure at that. There is a great potential for a genuine partnership to develop between infrastructure providers (pharmacy owners) and professional service delivery (clinical pharmacists within their own service business structures). Nurses have suffered similarly and it is only in recent times that the general practice nurse has been perceived as a valuable asset and one that drives doctor funding submissions to carve out a section of the federal budget that includes expanded practice nurse numbers. However, nurses have been able to gain extra training and qualifications and are able to practice independently as clinical nurse practitioners, being able to diagnose and prescribe for a limited range of conditions. They too are looking for a suitable infrastructure and environment to work from as well as productive partnerships to integrate with other health professionals. The pressure cooker is heating up and something has to give. The following recent news extract is illustrative of this problem. The news item is taken from Pharmacy News dated 26/02/10 and is written by PGA national president, Kos Sclavos.
And to attract funds there has to be some well thought out plan that coherently thinks through the best methods of utilising those funds, particularly in the area of primary health care.
However, an alternative reason is because pharmacy is represented by a trade union of employers (PGA), a minority but wealthy group of pharmacists that dominates any negotiations with the federal government.
The actual services have to be provided by pharmacists and specialised technical staff and it is here that cracks appear in the development of pharmacy practice, because they are competed with and unsupported by the PGA.
i2P has asked Mark Coleman to provide a comment following this news extract.
“It is no coincidence that on the same day a damming media report comes out about drug companies continuing to wine and dine doctors, the AMA puts out a media release calling for doctors to be able to own pharmacies.
A good try for a diversion tactic because it is almost impossible to justify $454,500 being spent on one dinner for a group of doctors. The AMA has been angry ever since the PSA proposed prescribing rights for pharmacists.
If the business case for drug manufacturers to seduce doctors is so strong now, when there is a separation of prescribing and dispensing, imagine how lucrative it would be for the drug manufacturers if the prescriber had a financial interest in what is dispensed.
The AMA release is laughable because they continue to take no responsibility in ensuring the PBS remains effective and efficient.
There is clear overseas data suggesting that when the prescriber has a financial interest in the dispensed item over-prescribing occurs.
Translated to the Australian setting, this means a cost blow out to the PBS.
Instead of the doctor saying, “You just need to rest for two days”, we will see doctors
take a quick glance to dispensary shelf to see which medicine is in abundance and an item will be dispensed. This is Quality Use of Medicines, AMA style.”
Mark Coleman
I have been asked to comment on the above material, so I will start out by noting the comment by Kos Sclavos “The AMA has been angry ever since the PSA proposed prescribing rights for pharmacists.”
That is a very divisive comment and does nothing to unify the profession of pharmacy.
Such comments should be privately conveyed if there is any concern.
The fact that some PSA activities may not harmonise with the PGA “party line” is irrelevant. A more constructive protocol for a dialogue between the PSA and the PGA should be in place, where any disagreements can be suitably discussed.
The proposal relating to pharmacist prescribing has been around for some time in the guise of medication continuance (a PGA proposal), also dependent and independent prescribing based on the UK model.
Whatever happened to the concept that appeared to have universal pharmacist support- “doctors diagnose – pharmacists prescribe –and nurses administer”.
Since that concept was first mooted, both pharmacists and nurses have progressed in their professional development. To create more relevance, a separation between dispensing and prescribing needs to occur to avoid conflict of interest.
Pharmacists specialising in prescribing need to be given a range of prescribing rights, while pharmacies retain the right to dispense.
A prescribing pharmacist should not have a pecuniary interest in a pharmacy, to avoid conflict of interest.
Pharmacist prescribing has been a fact of life in the UK for many years and this model could be adapted to Australian conditions.
However, the PGA would not endorse independent pharmacist prescribers because they would not be able to control them – and that does not suit the PGA view of the world.
The fact that doctors have ambitions to own pharmacies is not a new one, but the conflict of interest that would ensue, I believe, would prevent any government from endorsing that process.
Nurses have been able to persuade some pharmacy owners to allow them to contract their primary health services within a pharmacy environment.
This is simply filling a gap that pharmacists have been unsuccessful in filling for many years.
Leveraging pharmacy infrastructure in this manner not only concentrates primary health care within a pharmacy, but also generates income streams in the form of rentals, shared fee structure etc.
I would encourage any pharmacy owner to integrate with any suitable practitioner in the primary health care area – it can only stimulate opportunity.
The PGA has called for a halt for this type of development through its own members and that is disappointing. The PGA has no right in determining restrictions on professional interaction and growth.
A model type that has been utilised in the medical profession for some years now where a non-medical ownership of the practice infrastructure creates a return by a 70:30 split in patient fees (30% goes to the infrastructure manager). This has enabled young doctors, or doctors who have no interest in practice management, to operate in an independent fashion with a high level of freedom.
Some variations on this theme are emerging in pharmacy, but the model is not a developed model at this point in time, nor is it necessarily fair to the pharmacist who may have to take high risk for a minimal return.
This type of practice may create future opportunity, but it needs a lot of working on before it can be endorsed.
Compact robotic dispensing machines are also fuelling doctor interest in pharmacy ownership. In this instance, the pharmacy is represented by the actual machine and is intended to be located within the doctor’s surgery.
What this does to the concept of approval numbers and the PBS requirement to keep a good spread of inventory is a question that flows on to a new set of problems for pharmacy as rules may have to be relaxed.
If doctors are allowed to own pharmacies with relaxed rules, would this also set a precedent for the Colesworths of this world?
In Canada, vendor robotic machines are a reality and are set up in very public places outside of a pharmacy environment. They are actually supervised using a telepharmacy/Internet approach so technically are owned by a remote pharmacy.
It is known that this model machine was being investigated by an Australian doctor group the week that the AMA generated its press release on wanting to own pharmacies.
This type of pressure must eventually generate changes as evidence builds as to their low cost of operation and convenience.
For the moment, the PGA is holding its own in the battle with the AMA.
However, its approach to the profession of pharmacy is divisive and is not serving the development of pharmacy practice excellence.
The creation of genuine partnerships between pharmacy owners and professional service pharmacists is the only way to create forward movement.
Competition through other health practitioners was predicted by i2P back as far as the year 2000. Why are some people so blind?
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