Editorial

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Welcome to the May 2012 homepage edition of i2P-Information to Pharmacists. Rollo Manning has been having some time out having staples removed from the site of his open heart surgery.He is now at home recuperating in Darwin, having arrived home last Friday, beating a cold and hasty retreat from Canberra.We all wish him a speedy recovery and hopefully, he will be fit enough to contribute by next month.
This month, Pharmedia discusses the toll that is taken when someone complains about you to an authority without good cause. Well, the good news is that you can now take action to protect yourself if such a complaint is made, and that may even include action for defamation. Read about a recent case involving two doctors, with Mark Coleman drawing on personal experience to illustrate.

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Pharmacist prescribing is GO! …. Not so the funding

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

Linda is a New Zealand Clinical Advisory Pharmacist working as part of a team with GP's and nurses, in a medication advisory role. New Zealand clinical pharmacists get some encouragement to work independently in a variety of settings not necessarily tied to a community pharmacy. Through her company, Comprehensive Pharmaceutical Solutions, she contracts to Primary Health Organisations, lecturing postgraduate students in Clinical Pharmacy and undertaking evaluations of services. Linda's PhD thesis involved investigation into the barriers of implementing Comprehensive Pharmaceutical Care (clinical medication reviews) in primary care.

Pharmacist prescribing has been on the radar for some years in New Zealand, and we finally have sufficient traction so that the Postgraduate Certificate for prescribing is starting to 2012. 
The prerequisites to undertake the 600 hour (two semester) course are:

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*  A Postgraduate Diploma in Clinical Pharmacy or equivalent
*  Registration in the Pharmacist scope of practice and hold a current Annual Practising Certificate issued by PCNZ
* At least two years of recent, appropriate and relevant post-registration experience within a collaborative health team environment, in community or hospital care based setting
* Demonstration that Competence Standards 1, 2, 4 and 5 of the Pharmacist scope of practice are applicable and part of their current practice
* Demonstration of reflection on their own performance and take responsibility for own CPD
* Having identified potential Designated Medical Practitioner(s) to provide supervision, support and shadowing opportunities for the pharmacist to the education provider
* Having discussed and identified their possible role(s) as a prescriber within the collaborative health team environment they intend to practice
This is a truly exciting advancement for Pharmacy, and a move to advanced pharmacy practice.
From experience already in the primary care environment, working with general practitioners and undertaking clinical medication reviews, the ability to prescribe will add to patient convenience and enable more rapid alteration to medications, without having to wait for the general practitioner to review the recommendations and see the patient to enact the changes.

Prescribing is not the end in itself for medication reviews, but the final step that will improve convenience for the patient and efficiency in the system. It is the final step in a consultation to optimise medicines use, resolve drug therapy problems and reduce drug related morbidity and mortality.

So, what’s the problem? 

The Clinical Advisory Pharmacists Association (CAPA) has made numerous attempts to negotiate for funding, presenting the need for funding to advance clinical pharmacy practice in primary care, but has had no support from our representative body – the Pharmaceutical Society.
Pharmaceutical spend is negotiated and controlled by community pharmacy, and independent pharmacists are not recognised.
We are consequently left with a golden opportunity to move the profession forward, but no funding to make this happen as the focus of the Pharmaceutical Society has been on community pharmacy and not the clinical services of independent pharmacists.
We have a number clinical advisory pharmacists already employed in Primary Health Organisations, similar to the Australian general practice divisions, and though the prescribing pharmacist should be in the collaborative environment of the general practice – pharmacist prescribing is a role that is not currently funded.

This is something to be learnt from, but perhaps has already been overcome in Australia. 
With the availability of funding for Home Medication Reviews paid directly to independent pharmacists (i.e. not filtered through a community pharmacy) these pharmacists should now have the ability to work within a general practice, and hence be ideally situated to prescribe when Australian pharmacists obtain prescribing privileges. 
The need though, is for the representative body for pharmacists to push the concept of pharmacists working in general practice as the environment in which pharmacists should be prescribing so that the pharmacists will have a consultation room available, and the general practitioners will come to accept the prescribing pharmacist as part of the team.  If we don’t move quickly the nurse practitioners will take the role and pharmacy will again be sidelined.

Do not leave your positioning too late, or like us, you will have the opportunity but not the funding to move into advanced pharmacist practice.

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