Welcome to the March 2011 edition of i2P.
The month of February has seen free enterprise in the pharmaceutical industry breaking out of the mould that is regulated health and upsetting any semblance of balance within community pharmacy.
Government negotiated price reductions with Big Pharma collided head-on with the new business model from Pfizer Direct and its potential to destabilise the entire supply chain process and the supply of medicines under the PBS.
This process has been described in eloquent detail by Neil Retallick, in his article “New landscape, new directions, new Government role in community pharmacy?”
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Rollo Manning has experienced pharmacy practice from all sectors of the industry – retail, administrative, policy and remote Aboriginal practice. He spent 10 years with Glaxo Australia and was the first Director of Public Relations at the Pharmacy Guild National Secretariat in Canberra.
Primary health care (PHC) professionals are those at the front line of treatment of individuals for either acute or chronic diseases. Pharmacists are not members of the front line team – that is the domain of doctors, nurses and Aboriginal health workers. So can pharmacists become front line professionals in primary health care (PHC)?
Pharmacists are on the next level down for action with dieticians, dentists, psychologists, podiatrists, optometrists, speech therapists, physiotherapists, public health educators and other specialised practitioners.
Primary health care (PHC) professionals are those at the front line of treatment of individuals for either acute or chronic diseases. Pharmacists are not members of the front line team – that is the domain of doctors, nurses and Aboriginal health workers.
So can pharmacists become front line professionals in primary health care (PHC)?
Well only if they can convince the policy makers that their role in PHC is fundamental to the diagnosis and primary treatment protocols for the patient. There is no doubt that the prescribing of medicines is one of the favoured options for treatment but so is diet, emotional well being, dental treatment, improved eyesight, foot treatments or massage therapy. Over crowded housing and clean sanitation are just two of the social determinants that need attention.
Pharmacy as a profession (and as individuals) has to understand that they are but one member of the secondary line of help and concentrate on doing that well. Then their knowledge and contribution to the holistic problem surrounding Aboriginal and Torres Strait Islander (ATSI) health may be recognised.
At the present time they are not even out there in the workforce – let alone contributing.
In 2006 a workforce analysis of all persons employed in ATSI health showed a total of 9,342 persons with only 0.1% being pharmacists or nine persons. This figure is validated by the 2006 Census which found that of 15,261 pharmacists registered only 11 identified as being in “ATSI health”.
The review of pharmacy Indigenous programs done as a research project from the 4th Community Pharmacy Agreement stated the following:
“There was broad recognition that it would be preferable for pharmacists to have more time to become a more active member of the health care team of the AHS and where pharmacists have been directly employed in the AHS, there was a high level of satisfaction reported. However the direct employment of pharmacists within AHS is not feasible given current workforce levels.”
The “current workforce levels” refer to the fact that “Pharmacists” do not rate a mention in the National Strategic Framework for the ATSI health Workforce. It does however say that one of its objectives is:
“Enhance the provision of medicines and pharmacy services to Aboriginal and Torres Strait Islander peoples through strategies to improve access to pharmacies and medicines through the Pharmaceutical Benefits Scheme and linkages to the pharmacy initiatives detailed in the Regional Health Strategy.”
The Pharmacy Guild and NACCHO are the two peak bodies in this area and it is expected they would advocate for pharmacists to be included in the overall workforce planning.
The “gap” in life expectancy for ATSI people will only be closed with a multi disciplinary approach and multi skilling of workers on the front line. Pharmacists cannot contribute to this while they are just not out there doing it. The s100 Support Allowance is the only money available and this is a total of $3 million annually from the 5th Community Pharmacy Agreement and only provides for a one or two day visit to remote Aboriginal health services in six month period.
The pharmacist’s role is seen primarily as one of supply – not even dispensing.
Until pharmacists are out their doing it nobody will know what they can do and who would be attracted to the ranks of registered pharmacists without knowing what it means.
By example is the only way and funds must be made available to at least trial positions in selected health services to see what a difference it can make to the outcome of primary health care given a pharmacists’ contribution.
Advice for this author from the Pharmacy Guild is that there is NO money available in the 5th Community Pharmacy Agreement and one has to wonder if not there – where is it?
 Commonwealth of Australia. (2008). A blueprint for action - pathways into the health workforce for Aboriginal and Torres Strait Islander people. Canberra, ACT, Australia: National Aboriginal and Torres Strait Islander Health Council.
 Evaluation of Indigenous Pharmacy Programs - FINAL Report NOVA Public Policy 28 June 2010
 National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003
Questions or comments to the author at firstname.lastname@example.org
PO Box 98 Parap NT 0804 or 0411 049 872
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