Editorial

From the desk of the editor

Welcome to the May 2013 edition of i2P - Information to pharmacists.
Economic turbulence seems to now be arriving in Australia with forecasts of high inflation rates, which also means high interest rates following on.
This type of economic forecast also means that banks will be more fractious with their borrowers. They are already offside with pharmacy due to the high level of bankruptcies over the past two years.
There is a pent up demand for a general wage increase for pharmacists impacting at a point in this month where pharmacy gross profit generally, is in decline.

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Inside NZ- Changing Times for Pharmacists

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Dr John Dunlop (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA) articles by this author...

John has been involved in community pharmacy for most of his professional life. Until he sold up, he owned the busiest pharmacy in New Zealand. He started the first "Dispensary Only" pharmacy in New Zealand which for a long time was the biggest dispensary in New Zealand. John moved on to become a professional services provider through Comprehensive Pharmacy Solutions Ltd (CPSL) as a clinical advisory pharmacist. He holds a range of high profile positions within the pharmacy profession.

Community pharmacists in New Zealand are waiting with bated breath to see the final iteration of the latest pharmacy services contract.
Most have now attended one or two meetings to become better acquainted with the thrust of the new service specifications which aim to move the funding model away from reliance on a dispensing fee to funding for professional services.
These services may include vaccinations, medication reviews, warfarin testing and looking after patients with long term conditions.
There are two levels of service;
a) those requiring a pharmacist to be registered in the basic scope of practice, and
b) those services – such as vaccinations – that will require the pharmacist to up skill and credentialed for the service provision.

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The government is very excited about the implementation of the new contract which changes the reliance on dispensing volumes to payment for other tasks.
Some pharmacies had seen opportunities to orchestrate dispensings weekly to increase volume and hence dispensing fees, rather than the monthly or three monthly stat dispensings sought after by the government.
Pharmacies with large volumes of repeat dispensings will now find themselves disadvantaged under the new contract which will fund repeats for a $1.00 handling fee in many cases.

The new contract is expected to come into force on the 1^st of July.

In the meantime GP's are having a few problems of their own with the advent of the prescribing Nurse Practitioners who are beginning to flex their muscles here.
It seems that these nurses who have achieved a Master’s Degree and gained prescribing rights which may be as encompassing as a general practitioners prescribing if they are practicing in primary care, can compete for the same patient cohort as the general practitioner.

In theory these nurses can set up a practice independent of any medical practitioner and attract funding for patient care in the same manner a general practitioner can which leaves some very interesting questions to be answered.
If a nurse practitioner can independently diagnose and prescribe for any given cohort of patients, what is the difference in levels of care that might be provided by a general practitioner?
From a government point of view a nurse practitioner could attract a salary of around $110,000.00 here compared to a general practitioner’s salary of approximately $200,000.
This is a very attractive alternative for our cash strapped government who have figures supporting an argument that a large proportion of general practitioner visits is for minor health problems.
Obviously there are going to be quite a few arguments about territory and competency, but these won’t be easily resolved, particularly if the nurse practitioner undertakes to refer on those patients they decide are too complicated or fall outside their scope.
How many patients will need to be harmed before a nurse practitioner understands the limits of their expertise will be of concern to the medical profession.

The push toward collaboration and the provision of integrated care fully utilising the skills and expertise of allied health professionals is something we all should support. How pharmacy and the differing levels of pharmacy practice will fit into this new environment is of some concern. Currently we have very few pharmacists practising in collaborative environments, and few if any, of them are interested in becoming political leaders.
This leaves the politics and negotiations to those pharmacists steeped in the knowledge of the “old” ways who have little if any understanding of the advanced roles of pharmacy practice.
How will pharmacists work with nurse practitioners?
Will the nurse practitioner be providing standing orders -or their equivalent -and oversight for pharmacist’s practice?
Where will collaborative pharmacy practice fit in this environment? The immediate future is not likely to be a boring one.

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