Editorial

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Welcome to the first homepage edition of i2P for 2012.
In many ways it has been a slow start to the New Year because of having to deal with the “leftovers” from 2011.
One of those items for i2P was that a third-party provider to the site did not advise of a code change to the security section in our subscribe panel, creating a range of frustrated subscribers not able to get on board.
We apologise to all those potential subscribers who were unable to register with us in the second half of 2011, but if you try once more you should have no problem.

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Volume 2012 Number 1

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The Three-Ring Circus

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	Peter Sayers articles by this author...
Peter Sayers is vitally concerned about pharmacy professional practice - its innovation, its research and development, and its delivery to create an ongoing revenue stream. Delivery of healthcare is increasingly involved with Information Technology systems. All perspectives in IT must be considered for the impact on pharmacy practice and its viability.

Headlines in pharmacy media over the past month have signalled a new intensity in the emerging turf war between doctors, pharmacists and nurses.
The ringmaster orchestrating in the background is “Big Pharma”.
Consider the headline “GP push for pharmacy ownership” appearing in Pharmacy News on the 23rd February 2010.
According to the article text, the Pharmacy Guild of Australia (PGA) have slammed this as an attempt to divert attention away from another Telegraph article illustrating donations made by one Pharma company to various self-help groups. Plus on the same day hosting an extravagant GP educational event.

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A PGA spokesman is quoted as saying :

“This comes out the same day a report shows that Pfizer spent close to half a million dollars on a two-day master class on Alzheimer’s disease for doctors at the Sheraton Hotel. It’s a clear diversion tactic. No consumer looks upon half a million dollars being spent on educating doctors about Alzheimer’s medicine favourably.
The best way to take attention away is to talk about something else. It’s no coincidence that this has come out today.”

At the time of publication, an online poll in the Daily Telegraph showed just 20 per cent of consumers want doctors to own pharmacies.”

I can agree that while the push for pharmacy ownership by doctors is a diversionary tactic, I think it relates more to moves by pharmacy to obtain limited prescribing rights and to take a seat at the primary health care table.

The fact that the GP’s are serious about owning pharmacies is evidenced by a little publicised meeting between a GP representative group and a manufacturer of a robotic dispensing machine held virtually the same week of the diversionary press release. The GP’s were looking for a robotic dispensing machine that would fit comfortably into their surgeries.

Pharmacists want limited prescribing rights = doctors want limited dispensing rights.

The Telegraph claims are really a beat up on old news. The information quoted has been posted on the Pfizer website for up to 12 months.

The high spend on doctor education as a means of promoting Alzheimer drugs, while raising a few eyebrows, is also stale form of news.
GP’s have always been wined and dined in a lavish fashion because Pharma’s get a good return on their investment for so doing, and the GP egos are suitably stroked so that they feel well disposed to the particular drug being promoted.

Whilst I personally consider this type of promotion as a form of bribery, it is not a reason for doctors to suddenly want to own pharmacies.

If the Telegraph poll is representative, government is not going to worry about changing legislation to suit doctor turf wars. There are no votes in it.
Only 20 percent voted for doctor ownership, so there are no real votes in altering legislation to suit the doctors. In fact in previous conflicts with pharmacy, government has come off second-best because each pharmacy represents a propaganda outlet with strong ties to community opinion – not something to be trifled with, particularly with elections looming.

It’s not often that I hand out compliments to the PGA, but on this occasion they have taken an initiative that has put the doctors on the “back foot”.
If they had done it with a united pharmacist front they would have had my admiration.
But not so – there are limits to the PGA vision.

The reality is that while doctors have claimed the lead role in primary care they have not earned the respect to confirm their position.

In their exalted viewpoint they don’t need pharmacists, nurses or allied health practitioners to assist in a primary care role because they figure they can do it all.
It is well established that GP’s are not coping with their existing workload, which is basically a form filling role.

Simple patient conditions are handled by GP’s and they very quickly shunt complex problems to specialists.

Work that they could have accomplished in their own surgeries is distributed to a range of specialists that continue to multiply – for this is the only pathway to a higher hourly rate.

GP patients are often confronted with incompetency and overcharging.

The following is a personal experience.

I visited my local GP surgery (a fairly rare occurrence) and was told my usual GP was away at a conference, so my choice was to wait until he came back or see the new partner.
I was seeking an extended primary care referral so I was happy to see the new partner, who was a pleasant enough fellow but did not know how to use his computer and its programs.
After 10 minutes he succeeded in printing out two referrals (out of five) and at 20 minutes he said, “I can’t do this today. Go to the receptionist and book another appointment and I’ll resolve this issue in between now and then.”

I was a bit irritated by this, but compliantly I went to the see the receptionist to make a booking.

”That will be $85 today because you had an extended visit, and a second fee will be payable after the next visit”

I pointed out that this visit was not technically a clinical visit, but more of a clerical visit, and should have not taken longer than 5 minutes to produce all the referrals.
The receptionist snapped back “Well you get most of it back on Medicare!” and proceeded to illustrate by body language what she thought of my attempt to grapple with a situation she considered to be above my station in the scheme of things.
For the two visits I paid around $130 for work that should not have taken longer than five minutes, and in fact work that could have been performed by a clerk or practice nurse at a lower hourly rate.

This is not quality medicine, and plugged into Medicare it simply becomes a licence to print money and the taxpayer loses all round.

In the above service alone, a pharmacist could perform that identical referral process, even without access to a patient health summary.
If online access was available to health summaries, a pharmacist could achieve a better or identical result because of the extra interest taken.

And here is the reason why GP’s have consistently opposed the introduction of e-health not under their direct control – because it creates competition and the potential to lose revenue – even though they can’t keep up with their current processes and revenue generation.

Well, they will learn that you can’t have it all, and it is now time that the controller of primary health, the patient, should now take charge.

Also, payment by government needs to be made on outcome, not on billable minutes.
That’s for the lawyers of this world.

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