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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Time for a Right Model of Pharmacy - and Unity

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

John has been involved in community pharmacy for most of his professional life. Until he sold up, he owned the busiest pharmacy in New Zealand. He started the first "Dispensary Only" pharmacy in New Zealand which for a long time was the biggest dispensary in New Zealand. John moved on to become a professional services provider through Comprehensive Pharmacy Solutions Ltd (CPSL) as a clinical advisory pharmacist. He holds a range of high profile positions within the pharmacy profession.

After declining for some years, community pharmacy numbers are now increasing, and have almost reached the highest number ever. The diminishing numbers have previously reflected lower profitability, and a move toward amalgamations and closure of what were regarded as uneconomic units.
There may be many reasons for the sudden jump of numbers of pharmacies, but no-one has yet been sure enough of their argument to state a single reason. Certainly the number of prescriptions written and dispensed has increased.

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Access to the general practitioner has been facilitated by increased government payments to doctors and a commensurate reduction in patient fees per visit. There has also been a reduction in the dispensing co-payments for the enrolled population making the cost of pharmaceuticals quite affordable. This has been facilitated to a large degree by the effectiveness of the central medicines purchasing agency PHARMAC, which has successfully implemented a system of reference pricing in New Zealand, keeping the purchased price of medicines to a minimum.

We are also able to own 49% of the shares of any number of pharmacies, as are doctors and the lay public, which makes multiple ownership of multiple pharmacies, a reality. Every pharmacy must have 51% of the shares owned by a pharmacist/s. No pharmacist can own more than 51% of the shares of an individual pharmacy, in more than five pharmacies.

The ability to manage the share holding of groups of pharmacies may have encouraged the retention of previously identified uneconomic units as the buying power of multiple ownership changes the dynamics considerably.

Presumably ownership brings greater financial rewards than being employed in a pharmacy earning between $60-$80,000 per annum. I suppose even a $20,000 gain is worth it in terms of autonomy, even though the legal and financial worries are a bit of a downside. Multiple ownership would add significantly to the annual return and those with good business acumen stand to do very well.

Being focused on the development of clinical roles for pharmacists in primary care, I wonder whether this pre-occupation in shop ownership is good for the profession. The model of community pharmacy hasn’t really changed in years. Perhaps it has become a more sophisticated retail outlet with high profit merchandise marketed with the support of suppliers. The time available to pharmacists in this environment to enhance and expand the models of care has unfortunately diminished to the degree that it is now virtually impossible for community pharmacy to embark upon a focused patient care service, a statement fully supported by the researched literature.

This means that the profession can no longer rely on its lucrative retail sector to work to develop new models of practice. Community pharmacy may argue about having the money available, but there is no argument about the lack of time.

Politicians throughout the Western world are encouraging pharmacy to make better use of its skill set – skills obtained at the expense of governments through the universities. With community pharmacy unable (or unwilling?) to spend time and money on future professional roles, what sector of pharmacy is capable of picking up the banner?

Another problem facing pharmacy is to determine how the profession might fund the development of these new models of practice advocated by politicians all over the world. In both Australia and New Zealand there is a small cohort of skilled and experienced clinical pharmacists that could form the backbone of any new initiative. Unfortunately these pharmacists work in disparate environments, belong to different professional bodies and don’t have a unifying sophisticated organisation to work with government to attract funding for new roles.

Somehow we have recognise as a profession, that there are very different models of practice developing in pharmacy, and maybe we need to pool all of our resources to ensure that the profession develops and survives.

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