Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Pharmacy’s Future Professional Services

Neil Johnston

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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.

The recent “Great Debate” at the 2009 Pharmacy Australia Congress had an excellent topic choice (“The answer to our future is increasing front of shop sales, not professional services”).
The answer is, of course, that pharmacies need both activities as “core business” to survive – it just depends on what balance is required for each unique pharmacy practice sufficient to allow for differentiation and emphasis on specialties (whether professional services or retail activities).
However, it could be argued that policies in recent years have tipped the balance in favour of supply services that favour retail activity.
Little research or effort has gone into the development of professional services (there is actually major amounts of unspent grant money from the Fourth Agreement), so many pharmacies see little relevance in promoting services they may not have the training for, or the infrastructure to deliver the necessary training (which comes at a cost).

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Another speaker at PAC, John Menadue, had this to say about the life expectancy of protected business models:

”But change will inevitably come. Based on my discussions and reading the literature, the evidence is compelling that the highly protected pharmacy business model which is comfortable and financially rewarding for owners up to this point is going to come under challenge. The history of protection in Australia is that protected sectors are very vulnerable and risk not fully appreciating their vulnerability until it is too late. Why is it that so much effort goes into political lobbying in Canberra and comparatively little effort into utilising more effectively the enormous professional talents within pharmacy?

You may well ask what has discussion of business prospects and protection got to do with extending the role of pharmacists in healthcare. I suggest it is a key issue. An extended role of pharmacists will be essential, as future business prospects of pharmacists will be significantly influenced by contracting margins and increased competition.”

Why is the profession so out of step with itself that at times, it seems “hell –bent” on self destruction?Pharmacy is valued for its supply service both by patients and other health professionals.
Pharmacy is not so valued for its professional services because they are not readily identifiable and pharmacists seem to have minimal confidence in their own abilities.
Yet they have excellent credentials in drug information and management and ought to be great prescribers, but this latter activity is not clearly defined or promoted. Conflict of interest issues arise also.

Another reason for the lack of professional services is that they are cognitive oriented and require quiet, unstructured patient-centred environments for survival and growth.
Dispensing services are akin to manufacturing and create a pressure environment simply to get each patient transaction completed with maximum efficiency and accuracy.
This type of activity is counter productive for professional services, and it has to be said that even with the introduction of computers, more pressure has been visited on the pharmacist as governments become increasingly hungry for information that suits their purposes, diverting attention away from patient care.

One other piece is missing from the professional services equation, and that is the people who actually perform the service.
Mature aged pharmacists are the logical choice in the first instance, because they have both skills and experience,
Opportunity is being lost here as senior pharmacists are forced to retire because the only work available to them is dispensing.
Many are willing and capable of working well into their senior years, but age discrimination is being felt by many senior pharmacists. In fact, this form of discrimination is being experienced across the board in all workplaces nationally.

Skilled technicians, young pharmacists and robotic dispensing equipment will not allow opportunity for a senior pharmacist wishing to provide a dispensing service.

The majority of patients for the next 30 years will be people over the age of 60, who will constitute a significant percentage of the total population. 
These patients would have more affinity with a mature-aged pharmacist rather than someone younger - a distinct marketing advantage if it is recognised.
They will have shared a similar background and experiences and may even share some of the lifestyle illnesses that are expanding rapidly as people live longer and apply more preventive measures to sustain their health.
Using senior pharmacists as a conduit to this market seems sensible.

But many pharmacy environments are hostile to senior pharmacists.
Seniors are often forced to stand for long periods of time without a break, or without a variation in work that would enable them to sit down.
Intellectually, senior pharmacists have a lot to offer and have the capacity to make a difference to patient care
Certainly, they cannot maintain a physicality that younger employees can deliver, but given tasks matched to their capabilities it has been proven that they more than pay their way.
Disrespect and discrimination against senior pharmacists increases with age as the ability to keep filling “sausage machines” with completed prescriptions fades.

Trade unions, particularly in the construction industry are exploring social justice issues for mature aged workers, and the corresponding legislation that would mandate a percentage of employees be in the senior age bracket. Perhaps this could be explored in pharmacy with an extension that a senior pharmacist be an appointed director representing professional service development.
There is no apparent activity by the pharmacy trade union (Pharmaceutical Division of APESMA) in this regard, but is certainly an issue that it should address.

Age discrimination is not limited to pharmacy - it is being experienced by Australian employees across the board. So serious is the problem that National Seniors Australia has begun a campaign with a range of Australian employers.
In a recent press release, National Seniors Australia stated:

"In an effort to stamp out age discrimination, Australia’s largest seniors’ organisation has written to Australia’s top 100 companies asking them to review their employment policies and be open to hiring and maintaining mature age workers.
National Seniors has written to the chief executives of the top 100 public companies on the Australian Securities Exchange asking for their policies on mature age employment and invited them to provide ideas to encourage more employment of older workers.

National Seniors chairman Everald Compton said age discrimination was rife throughout Australian workplaces.
Mr Compton released details of the campaign during his speech “Don’t Ever Retire” at today’s Western Australia Convention in Perth.

A 2009 report by National Seniors revealed nearly two million older Australians (over 55) are willing to work, could be encouraged to work or are unemployed and looking for work.
Furthermore, the Australian economy loses $10.8 billion by not using the skills and experience of older Australians who want to work.

Mr Compton said he hoped the companies would come up with practical suggestions and innovative ideas to combat the problem.
“This issue is definitely a challenging one for business and Government: we want good ideas rather than compulsory regulations,’’ he said.
“Ideas may include changes to awards or taxation, training initiatives, superannuation changes or other incentives to hire workers aged over 50.”

So what’s the alternative?

With the changes under way for the inclusion of pharmacists in primary care there will undoubtedly be a skill shortage within three to four years. And despite the anticipated "glut" in young pharmacists (with many pharmacy owners expressing delight that this will drive pharmacist hourly rates down!), there will also be an "experience" shortage.
It is one thing to be highly trained in academia and another to be able to insert and interpret those skills into the workplacxe.

John Menadue had a suggestion here as well:

"It seems inevitable that the highly protected pharmacy sector is going to face major changes. The 2008 mechanism will eat inexorably into profit margins and the location rule must have a limited life. The lesson of protection in Australia is that if you want to have a seat at the table when protection is being reduced, you must accept the need to change.

As margins are reduced, pharmacists will need to look at business alternatives. That is why the slowness of pharmacists to take up an expanded role, particularly in disease prevention, is of concern.

Perhaps pharmacists might consider two categories of registered pharmacists. One would compose many of the long-established pharmacists who are reluctant to move away from the distribution model. The second category could be younger and differently trained pharmacists who will respond to a new model of professional practice which substantially extends their role into disease prevention and enhanced therapies. It would seem a possible way to overcome the environment which new and highly motivated pharmacy graduates”

I totally support that concept, with some variations.
The "long established" pharmacists he mentions will not necessarily want to stay as dispensers.
There is a sub group that will seek to provide mentoring services to younger pharmacists or seek to be an active member of a pharmacy company board.
These are the important ones because they will "grow" the profession and provide trnasitional services until younger pharmacists catch up (and overtake).
They have the corporate memory of the profession and can make many of the links that others do not see or understand.
These pharmacists also need to be reimbursed directly by government or other agencies for professional services so that remuneration is not directly tied to a pharmacy.

It is suggested that readers of i2P take the time to read John Menadue’s speech, which can be found at .

Nearly all of what he has said has been published in i2P progressively since its initial appearance in the year 2000.

Footnote: I once had a discussion with a pharmacy historian who stated that the profession of pharmacy was notorious for not initiating change.
He commented that change had only come when government or the medical profession pressed for change and challenged me to find one major change that had been initiated by the pharmacy profession.
I initially disagreed with him, but eventually came to the same frustrating conclusion.

That was 30 years ago, and nothing has changed in the interim!

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