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A Peak Pharmacy Body

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	Neil Johnston articles by this author...
Introducing current ideas, perspectives and issues, to the profession of pharmacy

Over the years, one of the ambitions of pharmacists was to be able to 100% support a peak pharmacy body that represented all the factions and segments of the pharmacy profession.
Given the many and diverse perspectives that pharmacy can represent, the dream has become impossibly Utopian, as a “one size fits all” organisation has simply not materialised.
John Bronger, a past president of the Pharmaceutical Guild of Australia (PGA) recognised the problem during his reign and then commented that he could foresee a merger between the PGA and the Pharmaceutical Society of Australia (PSA) somewhere into the future.
Since that time the PGA has worked systematically to become the dominant organisation, eliminating influence from as many of the alternative organisations through some form of suppression, to the extent that the PGA executive have become affectionately known as the “bully boys”.

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Never a direct approach mind you, but a process of targeting a key pharmacist in the competitor organisation through PGA members, who may have some other close association with that person. Then the “carrot and stick” approach to neutralise the key person and disrupt the organisational drive.

It is a classic “divide and conquer” strategy that generally serves to suppress the innovation and creativity characteristically flourishing within individuals and small organisations.

Once conquered, the replacement becomes a sterile, “Top Down” bureaucratic system that looks good on the surface but has a negative stimulus on individuals.

It is all “smoke and mirrors”.

During the power grab the PGA alienated many people ranging from academics, employee pharmacists, their own members (remember the “shitty little pharmacies”?) the PSA, and some senior internal managers (remember Kieran Schneeman?).

 However a tougher economic climate, the threat of deregulation and the commencement of negotiations for a Fifth Community Pharmacy Agreement (5CPA) has seen a mending of fences between some of the major power brokers within pharmacy.

We now see the Friendly Societies represented, as they are now accepted as PGA members, the PSA has been given a special “seat” at the table and even some of the supermarket pharmacies are having an indirect influence.

This has triggered other groups such as APESMA and consumer groups to seek a similar participation, and it would not be beyond the realms of imagination to eventually see academic pharmacy groups and industry pharmacy groups forming up behind such an initiative.
What is emerging from this process is a potential structure for a peak pharmacy governing body.

 The realisation that this can actually happen is yet to seep into pharmacist consciousness.

 No matter what part you play in the pharmacy profession, you cannot avoid the fact that we all feed from the same PBS trough directly, or indirectly.

An organisation such as the PGA has been able to skew the structure of pharmacy in such a way as to “cherry pick” available funds for its members and discarding all other residues along with the people that need real support i.e. the 65% of employee pharmacists who have had no real input into the future of their profession.

This is a disgraceful state of affairs that creates disunity, imbalances and uneven development, particularly professional development.

There is one group of pharmacists yet to emerge and be represented, and that is the clinical pharmacists who want to be involved in saving their profession from the intruders from other professional groups, and to see this segment expand.

The core business of pharmacy is to dispense and to value-add to that dispensing.

The latter component has all but disappeared leaving just the supply side as the face of pharmacy, with the pharmacists involved in the supply side having to put up with diminishing wages, diminishing respect, and diminishing working conditions.

 Clinical pharmacists want to claim the “value-added” bit because this involves original research into a service, developing systems to deliver it and a packaging process to market the final service.
Ideally, the service will be delivered in a pharmacy environment, but this will not necessarily be the case overall.

An element of competition should evolve with different environments competing for the pharmacy clinical service (community pharmacy, GP super clinic, public or private hospital).
The PGA can no longer claim that it is entitled to represent all pharmacists because that entails the trust of all pharmacists and inspirational leadership by the PGA

Current PGA policies have seriously damaged pharmacy infrastructure and market share losses in the professional area, and more seriously, has damaged the future emerging leaders of pharmacy by devaluing their services and not having a range of professional programs in place.

Once, I would have stood shoulder to shoulder with all PGA members because I regarded them as colleagues – their problems were my problems (and I did back in the days of CAPS).

New students are already pondering their future and whether they will be able to get a pre-registration position to see them emerge as fully fledged pharmacists.

I have been writing about the workings of pharmacy since the year 2000.

I thought I would revisit some earlier writings and compare them to today’s conditions.

March 2000

ARE THE NURSES AHEAD? A LOOK AT THE ROLE OF THE NURSE PRACTITIONER

With nurses displacing pharmacists in the Morgan Gallup Poll an awareness of the expansion of this discipline is occurring. Nurses have organised themselves industrially to become a potent political force and with the advent of clinical nurse consultants and nurse practitioners, an overlap into other disciplines is occurring.

This is certainly causing concern in some areas of the medical profession and pharmacists should also be concerned, as competition for new community services will be fierce. Only the most competent (and perhaps the cheapest) services will be purchased by government and consumers. Nurses are already mobile in the community, pharmacists are not. However, pharmacists with their 5000 strong community network offer an ideal springboard to develop mobile community services.

In 1990 The NSW College of Nursing and the NSW Nurse's Association prepared a joint submission for the NSW Department of Health, to conduct a number of pilot projects. This was agreed to, and an expanded role for nurses was trialled within the health system depending on community need.

The venues were as diverse as Wagga Wagga hospital emergency department to the Mathew Talbot Hostel for Homeless Men, in Sydney. The final report on the project, based on ten separate pilots, was recently released, and highlighted the benefits of strong collaborative relationships between nurses working in a practitioner role with medical practitioners.

It concluded that nurse practitioners are feasible, safe, and effective in their roles and provide quality health services in the areas surveyed. The Australian Medical Association (NSW Branch) did not endorse the report.

Nurse practitioners are now able to write medication orders covering a restricted range of S3 and S4 substances, which are listed in a nurses' formulary. The order for medication must be appropriate to the context of care and the specialty area e.g. a contraceptive pill in a women's clinic. Nurses see this step as simply legitimizing what they are already doing. Is there a parallel here for pharmacy?

June 2000

OPPORTUNITIES IN CONSULTANCY

Many opportunities are opening up for pharmacists to develop specialties and further provide consultation services for patients.

Traditionally, pharmacy has worked in the area of drug interaction and side effects and the opportunity exists to provide formal reviews in pharmacies and nursing homes for a fee. However, with the ageing population and the majority of illness being of the lifestyle variety, an enormous potential exists in preventive medicine, specifically the utilization of nutritional supplements. Other areas of specialty include wound management, intravenous infusion management in the home, asthma and diabetes and the list is sure to grow as competence emerges from within the ranks of practicing consultants.

It is obvious that to take advantage of the above opportunities (and they are only a handful) it is necessary to upgrade knowledge by formal education and personal research to provide a knowledge base that can be sold.

Another observation is that consultants may elect to become "generalists... or begin to develop specialties in a limited number of areas. If this line of thinking is developed, then it is apparent that the model utilized by the medical profession may need to be adapted for consultant pharmacist use i.e. the concept of a G.P with referral to a range of specialists. In developing a consultant pharmacist model, care would need to be taken in the form of language used to describe functions and activities.

Using identical terminology may draw the criticism from the medical profession that pharmacists are trying to be pseudo-doctors. Similarities will inevitably occur, for after all, we are all involved in a health profession in many instances servicing the same patient from a different perspective.

Consultant pharmacists have already experienced pressure while performing medication reviews in nursing homes, with some doctors being highly critical or simply refusing to acknowledge pharmacy input. This should not deter consultant pharmacists, for while they adhere to a code of ethics, and conduct their practices with a high degree of professionalism, they will eventually win out.

Further, if government funding is involved in any health service, then the agency controlling the money will insist on value. While such programs as the "Quality Use of Medicines" are government driven and directed, we will see a continuing and increased use of pharmacists, for they are economical in cost and are highly regarded by the community at large.

July 2000

STRUCTURING A FEE FOR SERVICE

Deciding on a rational approach to develop a system of appropriate charges for consultancy services provided to patients.

To develop an appropriate fee for service, particularly when there are few models around to draw information from, a consultant may need to look at other forms of consultancy outside of pharmacy, to see if there are any parallels. Perhaps the largest consulting group in Australia is the management consultants, and it is from this group that some basic data is drawn.

The model, which may suit pharmacy consultants, is often referred to as "the rule of thirds". Basically, a consultancy practice can be broken down into three major segments;

*applied time

*research

*operations.

Applied time is time spent, which is visible to the client (patient).

One would expect that this time be at least equal in value to that paid to an experienced pharmacy manager.

Research time is time spent in preparing for a client/patient. The time may be generalized to cover material beneficial to all clients/patients or it may be specific for a particular client/patient. This time should be costed at the same rate as applied time.

Operations refers to the cost of actually running a practice infrastructure and covers the cost of staffing, general overheads, marketing costs, finance costs etc. plus administrative time incurred by the consultant/principal. The costs of running a practice can vary depending on type. It is this area that can be initially discounted if the practice is run by a sole operator with a primary office based at home.

To structure an hourly rate it is necessary to determine what will be a net income from applied time and to apportion this amount equally to the other two segments. Assuming that an experienced pharmacy manager may earn $30 per hour, this becomes the benchmark.

A consultancy rate is struck at $90 per hour with research and operations having to be budgeted within their respective apportionment of $30 each. Assuming that an average pharmacy consulting session may run to say, 30 minutes for one structured session, then the advertised cost per session would be $45. Variations can be made to this price depending on total consultancy time sold. (N.B. figures illustrated relate to year 2000 dollars.)

The year 2000 saw positive movement for the development of pharmacy clinical services.

It has been all downhill since then.

There was a momentum building in 2000 that has since been lost.

You might like to give impetus and direction by adding your comments to this article.
You can also pen your own views to article length because we are prepared to print whatever you would like to write (libel-free, that is).

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