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Menadue writes pharmacy sector a script for change

The conversations must have been lively at the Pharmacy Australia Congress in Sydney over the weekend. Health reform advocate John Menadue really socked it to the audience, judging by his 3,500-word speech.

For the sake of time-pressed Croakey readers, I’ve compressed the speech into several dot points. But it is worth reading in full, and you can do so here.

Here is a summary:

• There is quite a contrast between the community’s need for pharmacists to do more in their professional capacity and the unwillingness of the profession to change.

• The field of prevention beckons pharmacists. But it does not seem that pharmacists are fully responsive to needs and opportunities.

• Do pharmacists really want to collaborate with other health professionals or remain individual business entrepreneurs? Some are dissatisfied that their professional skills are not fully utilised and extended. It is not surprising that many find dispensing medications and running what sometimes seem like gift shops, to be mind-numbing.

• Unfortunately, the Pharmacy Guild of Australia opposes pharmacists working as consultant pharmacists within the GP super clinics. It insists instead that the only pharmacy participation must be via the establishment of a community pharmacy within the clinic.

• 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?

• Discussion of business prospects and protection is relevant to extending the role of pharmacists in healthcare. An extended role of pharmacists will be essential, as future business prospects of pharmacists will be significantly influenced by contracting margins and increased competition.

• Features of pharmacies today which will come under challenge include the geographical restrictions, impending pressures on pharmacists’ margins, and the barring of pharmacies from supermarkets. Australians don’t have great love for the Coles/Woolworths oligopoly but they would love to see more competition. This lack of competition may explain why paracetamol can vary in price from $10.95 for 100 Panadol to $3.95 for almost the same produce sold under the Chemmart brand.

•    It seems inevitable that the highly protected pharmacy sector is going to face major changes.  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.

• 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 apparently find so discouraging and dampening.

• It is quite remarkable that the PGA has consistently opposed direct relationships developing between GPs and accredited pharmacists. It insists that the relationship must be with the patient’s nominated community pharmacy. This is quite contrary to normal health referral practices.

• How can the disconnect between how pharmacists are trained and how most of them work, be remedied?

Menadue concluded: “Despite the rhetoric about prevention, are governments, their bureaucracies and the professions ready to implement prevention policies? The answer to me seems to be ‘not yet’. Some hard thinking is required all round.”

• You can read more about John Menadue’s arguments for reform of both the demand and supply of health services here.

Comments 4

  1. Doctor Whom says:

    One feels both sorry for pharmacists and a bit angry at the as well.

    They cry out to be taken seriously as health professionals yet as others have said they run gift shops filled with high priced cosmetics and shonky “alternative” / “complementary” medicine products. They promote slimming potions and many that do offer advice will wobble around the outskirts of the worst of CAM cons.

    The lack of competition results in huge rip offs for consumers – I’m lucky in an area where I can drive to the cheapest and get a difference between $13 a pack and $28 for the same pack of pretty commonly prescribed medication.

    Their business practices are a bit of a worry to – most pharmacists seem prefer to spend more time handing over stuff to serving wenches than it would take to talk to the customer themselves and zip the credit card through.

    Lets not talk about the 10 minute wait for the customer to get something that is already packed, sealed counted and ready to grab of the shelf.

    Where is the Guild (is it the Guild?) warning pharmacists that scientists (like chemists) can’t take homeopathy seriously and that “slimming” potions don’t work?

    Where is the Guild helping pharmacists set up to do Home Medicine Reviews, or training technicians to do the HMRs?

    How come all there is in a pharmacy is the highly trained pharmacist and then the serving wenches? Surely there are some skills in between that could be useful.

    Where are they helping the few struggling professional pharmacists who do Methadone
    Clinics to better design how and where methadone dispensing is done?

    Where are the pharmacists helping encourage people to pick up FOBT kits for Bowel Cancer screening.

    I’ve been hearing pharmacists want to take on the consultant role to GPs and specialists for over 20 years – why won’t the Guild let it happen for everyones sakes.

    Consultant pharmacists could be the main conduit for drug/medication advice to GPs and specialists instead of Big Pharma reps as it is at the moment. A big win for us all.

    Just as, paradoxically,the Parallel Import Restrictions on Australian Books, has contributed to the decline in Australian book shops, because people go online to buy books cheaper, faster and higher quality, from overseas, so will the PGA end up strangling Australian professional pharmacists.

  2. AustralianPharma says:

    There’s a few things right and wrong with what was commented, I’ve got a couple of minutes to kill so I thought I’d address a couple.

    Homeopathic/diet products etc bad right? When someone comes into the pharmacy wanting one, the pharmacist can discuss the lack of evidence and recommend something useful, if we don’t keep any in our pharmacy, we will never have that chance to speak to these people and offer alternatives. It’s not a black and white issue as doctors might think, as long as it isn’t causing harm, I’m willing to stock it. Doctors writing scripts for drugs just to get the patient out the door and happy that they “getting something” is more destructive. How many scripts do pharmacists see for medications that can cause an impact on a persons life, and they don’t even know what its about. Yes, our job is to counsel patients, but there should be some discussion with the doctor. Occasionally we begin to counsel a patient on a new medication and when they find out what its for, they don’t want it!

    As for pharmacists advice being wobbly, I’m sure some pharmacists aren’t great, just like those doctors that call us at the pharmacy and ask us what antibiotics come in creams…no profession is perfect.

    Price? It’s a business. A smaller independent pharmacy may only be able to get a box of paracetamol at a cost price of $4, and they charge $7. A massive chain might get there’s for $0.50c, and charge $2. Doctor clinics can charge their extras just the same, especially when its after hours and less choice for the public and they are trapped and cannot go elsewhere. We all have a business to run. Generally, GP’s are highly paid, this comes from a variety of sources, government and the public. A doctor should know basic economics and not make their patients think they are being subject to highway robbery. The highly paid medical industry puts pressure on the government and private insurance, this all filters down to the public. You’re paying those doctors high salaries as much as you are paying $4 for paracetamol.

    It is derogatory to speak of pharmacy technicians and assistants as wenches as they in the majority of cases they are trained staff, some even ex-nurses. Most pharmacies have one pharmacist, and we have to deal with, maybe, 300 prescription items to be checked, counsel patients with issues who come off the street and want to be seen ASAP (we are not like GPs, who set times, and often have poor time management apparently and run late. If you call waiting a few minutes for a prescription problematic, how do you define waiting an hour?).

    The next comment about waiting 10 minutes. You should be happy with 10min. Most pharmacists don’t even do the ‘grabbing off the shelf’, our function is to check the product against the dose, against the patient, and then follow up and question as needed. We often have (depending on the store) 5 to 20 prescriptions in line waiting. If they are all perfect, it might take less than a minute per script if we are just checking. If we do not have technician/intern pharmacist and we are doing our checking, plus the dispensing, then give it at least a minute. Therefore, if we have 10 scripts in line and you wander in with yours, best case scenario you will wait 10 minutes. However, if there is a problem with the script, such as the doctor has prescribed a person with something they tell us they are allergic to (for some reason this happens often, I don’t understand why GPs do not think to check for allergies, you cannot expect a patient to freely give information unless they are prompted to), then we have to call the doctor to authorize the change. Add some more time to your wait. If someone walks into the pharmacy bleeding, add another couple of minutes. If we have a methadone patient getting angry, add minute for us to go and calm them down. I expect the “why do we need to wait comment” from the public, from medical persons, such as a doctor, its really surprising. The grabbing off the shelf is not the pharmacist’s professional function, ours is effectively, to assess the drug, dose, patient (age/weight), and if new med speak to the patient for counseling, which protects the doctor from malpractice action when they make mistakes. I recently had a patient start metronidazole, and he was surprised when I mentioned no alcohol, as he specifically asked his doctor if it would be okay. More often than not pharmacists don’t take the shot to put down the doctor, we focus on making sure the patient is clear on the issue and that’s all. This doctor obvious didn’t have a clue about the possibility of disulfiram-type reactions and didn’t bother to look it up, or at least say I don’t know about what I prescribe, better ask a pharmacist.

    There are measures in place for pharmacists to be trained from HMRs, some pharmacy companies even fund the training for their pharmacists. We find GPs resistant to this service, which makes the reasonably time consuming and expensive training not worthwhile for the pharmacist.

    Design better Methadone Clinics? Government funding would be nice. Considering what pharmacies make from participating in methadone vs. the problems, safety risks and stolen merchandise, pharmacies that do this are performing a community service for little profit. I’m sure some pharmacies make a few bucks, but mostly this is more hassle, but it is difficult to send patients elsewhere and they stand by the service for their sake.

    Where are the pharmacists helping encourage people to pick up FOBT kits for Bowel Cancer screening? Where are the GPs who have direct communication with their patients? I’d be happy to speak to each person that puts a script in, but you might need to wait an hour and a half for your script. Since you can’t stand to wait 10min, you would really hate that.

    Consultant pharmacists could be the main conduit for drug/medication advice to GPs? I’m not sure who’s going to pay for it, if it’s the government and they are a little penny pinching, well, if it’s not worthwhile you won’t have any pharmacists doing it. If it’s anything like HMRs, from what I’ve heard about frequency of need for it doesn’t make it a great source of income and worth interfering with your standard work schedule, it’s like asking a GP to take a 50% pay cut because it’ll be good for the community. AMA would love that.

    I hope all those reading taking my tone take it for what it is, a little dramatic to highlight some of the obvious issues pharmacists deal with that is not considered by the public or others in the medical community. While I have no expectation of the public to have any clue, it is disappointing to find doctors that share this ignorance. I deal with many excellent GPs and specialists, many which I readily would recommend to customers/patients, and I am always happy to provide drug information to. This post is not against doctors, I think most do an excellent job, like any industry, medicine, pharmacy you have your good and bad. I just had a few minutes between engagements, stumbled upon this, and thought I would post. To the doctors, you should consider pharmacists as your allies, we are always happy to help, can provide you with drug information and advice, especially when your patients come with strange over the counter medications or things they picked up at a heath food store or the net, and if we call you to query a script, its probably for your benefit as well as ours. We are not looking to highlight that you’ve made an error of some sort, we simply need your authorization to make a change.

    As for the direction pharmacy is or should be taking, it needs to keep the pharmacist’s needs in mind just as much as the public. We cannot magically do twice the workload for half the income. The AMA pushes medical payrises and various other industry actions to protect their members, the Guild simply wishes to protect their members as well. I am not saying they are right or wrong for not wanting the speaker to present, but I can understand their frustration with the short sighted comments mentioned above.

    I look forward to Pharmacists and GPs working together for the common goal, the best patient care we can provide.

    AustralianPharma
    http://askapharmacist.com.au

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