Editorial

From the desk of the editor

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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Revive, Renew and Refresh – the Clinical Cycle is Starting

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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.

For all good ideas to get off the ground there is a need to establish a sound education base, a strong infrastructure and the right rules to allow the idea to grow and bloom.
And underpinning all that is a required investment in human capital, also the realisation that “What can’t go on, won’t go on”.
I am referring to the great idea that pharmacy should build on its once pre-eminent position in primary health, and underpinning that idea with a population of pharmacy practitioners specialising in lifestyle illness. Their capabilities to include the delivering of a quality service the general public would value and pay for, without subsidy.
There is a need to revive, renew and refresh the concepts for that good idea.

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Education in pharmacy is reasonably sound but is in need of some form of revival. It is university-based and recognised with a range of degrees and the quality is good. There are many supplementary courses designed to allow pharmacists to hone specialties and there is now enough competition between pharmacy schools to cater for any specialty that gains popularity,
One such emerging school is found at the University of Technology Sydney under the stewardship of Professor Charlie Benrimoj well known for his tenacity and drive in developing innovative pharmacy services.
To me, this looks like the tipping point for a revival.

The UTS appointed Professor of Pharmacy Practice, Shalom (Charlie) Benrimoj has been charged to develop the new pharmacy school which will be the first school launched under the University’s new strategy to expand its offerings in health disciplines.

Professor Benrimoj said UTS had a well-deserved reputation for offering highly practice-oriented education and was an ideal setting to develop graduate-entry pharmacy degrees that are research-led, student-focussed and career-relevant.

"As a new school, UTS has been in a unique position to employ best practice at every stage of development," Professor Benrimoj said. "Working with key professional partners and an educational designer, our pharmacy academics have created an innovative and rigorous graduate entry curriculum.

"The programs utilise cutting-edge tools to integrate pharmaceutical science with clinical practice, technology and interdisciplinary skills. UTS pharmacy graduates will be competitive in the workplace. Not only will they have a strong foundation in pharmaceutical science, they will also be skilled in understanding its relevance and applying their knowledge in real-life situations."

Professor Benrimoj said the University's student focus and purpose-built facilities would offer students an enhanced learning experience. "Small cohorts and class sizes together with each student being assigned an academic mentor will set the UTS programs apart," he said.

"Students will also benefit from UTS’s investment in infrastructure – learning in a state-of-the-art simulated pharmacy, purpose built dry labs and comfortable student spaces for group and individual study."

The research interests of Charlie Benrimoj encompass the future of community pharmacy and professional cognitive pharmaceutical services from community pharmacy. These include the provision of drug information to consumers, clinical interventions, patient medication reviews, disease state management systems, Pharmacy and Pharmacist only medications, change management and international pharmacy practice. His research interests also involve the clinical, economic and implementation aspects of cognitive pharmaceutical services from community pharmacy in current and emerging health care systems.

This looks like the “missing link” in current pharmacist education and training to underpin a fee for service clinical model.
More information can be found at http://www.pharmacy.uts.edu.au .

The second link in the practitioner chain is infrastructure, and this is badly in need of a renewal to accommodate pharmacy professional services.
Logically, this infrastructure should be found in a community pharmacy, but other forms could be considered.
Barriers currently exist in the form of the Pharmacy Guild of Australia who see clinical services being delivered by “top down” computer systems.
Would-be-practitioners should be working on this aspect because they will have to invest in the “last mile” of infrastructure themselves because it will be different to what is currently available. They will have to “own” it and gradually increase their investment to match a growing service.
The investment may be modest and initially may simply be a modular and portable interview station that takes up minimal room in an existing pharmacy. It will need to be private and have the capacity to store reference materials, patient records and have a wireless-enabled computer system.
Investment in sophisticated clinical software could be costly and an independent communications system that is encrypted and portable will also have to be considered.
And apart from that type of infrastructure, some of the services may need to be integrated and coordinated on a shared basis, using pharmacy staff and other pharmacy facilities.
The designing and planning of this infrastructure backup has to be “packaged” so that it is visible and supported by both parties - the pharmacy owner and the practitioner pharmacist.

In the second quarter of 2012 pharmacy owners will begin to get nervous as economic conditions tighten around them. Firstly the internal “PBS Reforms” version of economic tension, and then the general “macro” version as unemployment increases, banks tighten up their lending and pharmacy customers begin to default on their credit arrangements –the whole cascade of events that will unravel rapidly.
Those practitioner pharmacists that have a plan of action ready are likely to be snapped up quickly, provided there is a reasonable return for the pharmacy owner.
The return can be measured as a tangible or an intangible – it depends on how the value multiplies into the pharmacy environment.
Pharmacy owners need to maintain their return on invested capital, but few have looked outside of their four walls to see how this could be done fairly and equitably with non-owner pharmacists.
The wheel is about to turn so both sides need to be prepared.

The realisation that pharmacists are on the brink of being automated right out of their current professional model looms very real.
Unless there is a massive investment in human capital with real jobs being created, the pharmacy professional direction is looking bleak.
There are massive dollars being invested in pharmacy but it all revolves around the PBS.
That is all that pharmacy is offering so government directs its energies and dollars to refining the PBS product that shortly will be returning an almost nil dividend.

So pharmacy needs to create a renewal link that creates a vision for all pharmacists to embrace. This is the entry point where investment needs to be made in the form of human capital – top thinkers from within and without the ranks of pharmacy.
This is also where the right rules are decided and documented.
There is a desperate need for a pharmacy think-tank that can generate a range of scenarios, a technique that is accepted universally as a means of dealing with turbulence, complexity, tipping points and disruption.
A group of thinkers that can transcend the petty politics of our existing representative organisations, creative enough to embrace the entire profession of pharmacy and perceptive enough to take testimonies from the existing experts – the individual pharmacists themselves (“bottom up” approach).
Problems can be solved and everyone has the power, even at a personal level, to take action, develop solutions and remake our world of pharmacy as it can and should be.
All that is needed is a road map.

Meanwhile, our entire world seems entangled in systems increasingly dominated by power, greed, ignorance, self-deception and denial, with spiralling inequity and injustice.
Viewed against a backdrop of climate change, failing ecosystems, poverty, crushing debt levels and corporate exploitation, it will require some clear-headed thinkers who can project into the future and weave a pathway to raise pharmacy to the level it needs to be.
I prefer to take “the glass is half-full” optimistic approach to a better future and work towards a solution – what will you do?

Footnote: If any pharmacist or pharmacy owner is interested in developing a scenario, i2P has input that might be of assistance.
Please share your thoughts privately with the editor at neilj@computachem.com.au .
We are also seeking interest from pharmacies that would be willing to use their pharmacy as a test bed to trial professional services; also individual pharmacists who would be interested in developing a practitioner role as clinical primary care pharmacists.

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