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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.
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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.

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Exploring New Horizons

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Neil Johnston articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

A message delivered to delegates attending the International Pharmacy Federation (FIP) Congress in Lisbon Portugal was for pharmacists to explore new horizons.
One can sense and appreciate this message because pharmacy does seem to be stuck in a time warp without a unified sense of purpose for the future.
Our two major peak bodies, the PSA and the PGA have not closely worked together, with open warfare being declared on occasions.
There does not yet seem to be a coherent positive theme running from either organisation that the "troops" can align with, although there are signs of positivity developing in PSA and a slightly lesser aggressive stance being taken by PGA.
But what's on your horizon and what is your future vision?
To help kick off a discussion, i2P asked Mark Coleman to comment on the media item reported in Pharmacy News on the 31 August 2010

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Pharmacists urged to explore new horizons

Explore beyond the horizon is the message being sent to pharmacists at the International Pharmacy Federation (FIP) Congress in Lisbon, Portugal.
In his opening address to the congress, FIP president Dr Kamal Midha urged members to follow the example set by Portuguese navigators in the 14th Century and sailed out from the port of Lisbon into the horizon to explore new possibilities.

“At that time people believed that the world was flat, so what reassurance would a navigator have had that he would not sail out and fall off the horizon?” he asked.

 “As in all major undertakings, lessons have been learned through risks in exploring beyond the horizon.

“Today, we continue a journey of exploration – not in navigating the seas, but exploring the challenges and critical needs in our schools, our laboratories and in our communities, in the pursuit of global health,” Dr Midha said.

While pushing the line on the horizon further back, the FIP president described the federation as a “collaborative platform” for pharmacists worldwide to learn from each other and address the challenges facing the profession.

Dr Midha added the role of pharmacists and pharmaceutical scientists was constantly evolving, stressing the need for members from different countries to work together to strengthen the profession globally.

“Through FIP we do together, with and for each other, what we cannot do alone,” he said.

Alongside nurturing closer relationships between FIP members, Dr Midha said the federation had worked arm-in-arm with other international health groups including the World Health Organization (WHO) to improve the standing of pharmacists globally.

“This year’s annual report highlights some of the collaborative initiatives with the WHO.

“These include rational use of medicines, strengthening the pharmaceutical workforce and patient safety,” he said.

Mark Coleman


I am asked to comment on the "new horizons" noted in the above media report generated from a recent FIP Congress inLisbon, Portugal.
Now this is a very large topic I have had tossed to me, and I don't want to get bogged down in detail.
To develop some sort of perspective I need to examine what point we have come from, the developments to this current date and then project some future thoughts.

i2P began publication in February 2000 in response to a wide ranging report that became known as the Wilkinson Review. That is a good enough starting point.
At the time it was regarded as quite radical by the PGA, and many of its recommendations were simply ignored or muted.
For example, the opportunity to create company infrastructures was noted, and this looked like it might allow non-pharmacist shareholders and directors to introduce new ideas and capital investment not controlled by wholesaler interests. This was muted by only allowing pharmacist directors and shareholders to be involved in pharmacy companies.
There was also a recommendation to relax the number of pharmacies a pharmacist could own.
To a certain extent this has occurred, but without clear cut guidelines.
Location Rules became "twisted" and many "shonky" partnerships were formed with young pharmacists but with no proper pathway to transition to real ownership.
So the opportunity to develop new company structures to absorb new pharmacists, I think, is one of the tragedies of that time, with the result that pharmacy today has an apparent surplus of pharmacists, plus a disconnect between pharmacy schools and pharmacy owners.
Pharmacy schools lost the conduit they needed to deliver their research and training through to new pharmacist shareholders, who after completing their "apprenticeship" in business would have eventually been in a position to financially back the ideas that would have evolved into a positive activity for pharmacists.

So the "new horizons" that can be immediately looked at are pharmacy schools researching valid income producing clinical services and become a full time resource for a community pharmacy, including the provision of consultancy services to ensure any new activity "sticks".
Consultancies would also generate a new income stream for the pharmacy schools, reducing the need to increase course fees.
The second is a repair job on the concept of pharmacy companies, because in their present state they are going nowhere. Pharmacy companies should be a fertile area for young pharmacists to be recruited - and they need to be asked what ideas they will bring to enhance the professional aspects of a pharmacy before they are recruited. They should earn their shareholding by producing a business plan for the pharmacy they wish to be part of, and then given the resources to implement it.
Pharmacy practice companies, those that perform medication reviews in various settings, would also be valuable shareholders and by osmosis, would also be created as PGA members, giving them a voice that is currently ignored in PGA circles.

Over the past decade there has been a small debate on "walk-in" clinics for community pharmacies.
This idea has not gathered "legs" as yet, but the fact remains that having such a clinic creates a physical and financial commitment to clinical pharmacy, with the big plus of having a high profile area to show off as a primary health care centre.
Pharmacy has not stood still over time. It has efficiently delegated dispensing to IT systems and pharmacy technicians.
What it did not do was have a parallel planning process to create clinical forms of income to take up the slack as pharmacists were delegated from their jobs.
They had nowhere to go and the result is a pharmacist surplus with no new work to create revenue to pay them.
The whole process has been exacerbated in recent years by the PGA inflicting its supply-type pharmacy on the profession and not being open to whole-of-profession solutions.
While pharmacy operates within separate compartments, you cannot maintain balance when one segment is developed at the expense of another.
Government exacerbates the entire situation by not allowing pharmacies to keep the productivity gains they produce for the PBS - even a sharing formula would be better than total rape, which we currently have.
This strips out any surplus capital that could be gainfully utilised to develop the clinical side of the business.

I also note that e-health is beginning to burgeon in the pipeline, but again, pharmacy does not seem to have a coherent plan to attract new innovations before they are dispersed to other areas of health.
For example, developments are occurring in neurology and mental health that involve using the Nintendo game Wii, developed as an "exergame" for stroke rehabilitation and falls prevention.
What would prevent the PSA from setting up a clearing house to attract innovations like this and coordinate a service for clinical pharmacy? This is an ideal service to partly deliver from a "walk-in" clinic or as an outreach to aged care facilities and community nurses.

My horizon is suddenly becoming cluttered as I write, because there are many more opportunities than what I have covered.
It makes me so frustrated to see that we have any unemployment within pharmacy.

In summary, my "horizon" recommendations are:

1. Fix the pharmacy company problem so that they can be attractants for new capital and new pharmacists.

2. Straighten out the disconnect between various pharmacy bodies.
a. Pharmacy schools to equip students with the relevant skills to develop clinical services for a fee.
b. Pharmacy schools to provide consultancies in the clinical skills area.
c. PGA to come onside and see its role as providing physical infrastructure.
d. PSA to get on with its practice education, managed into all geographic areas in a decentralised fashion.

3. Embrace new areas of e-health, not just in developing new IT software.
The Nintendo Wii represents just such an opportunity. When connected to the National Broadband Network other initiatives and opportunities will emerge to create "hands on" services in the primary health care area.

The above are initiatives we can all get involved with without the constant bickering that seems to occur.
Getting ouselves busy in a creative activity will dissipate all the doom and gloom plus, I suspect, the pharmacist surplus.
FIP seem to have delivered the right message at the right time.

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