s Support services for pharmacists and doctors in the United Kingdom – Part 5 National Clinical Assessment Service | I2P: Information to Pharmacists - Archive
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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Newsflash Updates for July 2014

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Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Support services for pharmacists and doctors in the United Kingdom – Part 5 National Clinical Assessment Service

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

articles by this author...

Kay Dunkley is a pharmacist who has worked in hospital and organisational pharmacy for over 20 years.  She has a broad experience working in public hospitals and in providing support to health professionals through government funded bodies and professional organisations.  Kay also has a strong interest in the health and well being of health professionals and especially the role of peer support.  Kay first became involved as a volunteer with the Pharmacists’ Support Service, a group which has been providing telephone support for pharmacists in Victoria since 1995.  In 2005 Kay became the Program Coordinator for the Pharmacists’ Support Service and has assisted the service to become an independent organisation which is currently seeking to expand to provide support to pharmacists throughout Australia.  In 2007, when AMA Victoria approached the Pharmaceutical Society of Australia (Victorian Branch) with a view to establishing their own Peer Support Service; Kay accepted an invitation to assist.  The AMA Victoria Peer Support Service commenced operation in February 2008.  Kay currently coordinates both of these services and also works part-time as a consultant pharmacist in Residential Care Facilities.

In Australia the Pharmacists’ Support Service (PSS) provides a listening ear and support over the telephone to pharmacists in Victoria, Tasmania, South Australia and the Northern Territory and has plans for expansion to all states of Australia.  The medical profession in Australia has a range of state based Doctors’ Health Advisory Services including the AMA Victoria Peer Support Service which provides peer support over the telephone.  Victorian is the only state to have a state based health program for doctors; the Victorian Doctors Health Program (VDHP).  At present the Medical Board of Australia is undertaking a consultation with the medical profession considering if doctors are willing to pay a levy on their registration to fund health programs for doctors throughout Australia.  If this proposal proceeds it may set a precedent which the pharmacy profession can follow.

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Funding from the Cyril Tonkin Fellowship enabled me to undertake a study tour of services which support pharmacists and doctors in the United Kingdom (UK) in March 2011.  The aim of the visit was to find out how these services support the health and well being of pharmacists and doctors, including the services provided and how they are funded.

The support services visited were Pharmacist Support, including participation in a Listening Friends training weekend; the Royal Pharmaceutical Society; the Practitioner Health Programme; the Royal Medical Benevolent Fund; the British Medical Association Doctors for Doctors program and the National Clinical Assessment Service.  In addition to obtain background material on the environment for health professionals in the United Kingdom visits were also made to the General Pharmaceutical Council; Manchester University School of Pharmacy and Pharmaceutical Sciences and the Pharmacy Department of the Central Manchester University Hospitals NHS Foundation Trust.


This is the fifth and final article in a series reporting on my visit and will detail the services available to doctors and pharmacists through the National Clinical Assessment Service.


National Clinical Assessment Service

Strictly speaking the National Clinical Assessment Service (NCAS) is not a support agency for health practitioners however it does work with healthcare employers and managers and practitioners to assist in the management of performance issues in the workplace.  In summary the NCAS is the NHS body which provides support for NHS services dealing with staff performance issues.  At present the service extends to medical practitioners, dentists and pharmacists.   It is important to note that in the UK the vast majority of healthcare practitioners are employed under the NHS umbrella and there is minimal private practice for doctors.  Pharmacists who work in community pharmacies are also considered to be NHS employees.  The incentive for establishing this service in the UK was the cost to the NHS of ill health and impairment amongst its employees as well as safety issues for consumers.  There is no equivalent organisation or similar service to the NCAS in Australia.



At the time of my visit the National Clinical Assessment Service (NCAS) was a division of the National Patient Safety Agency.  At the time of writing it is currently changing to be hosted by the National Institute for Health and Clinical Excellence (NICE).  NCAS aims to resolve concerns about professional practice by helping healthcare managers and practitioners to understand, manage and prevent performance concerns.  This service includes general governance questions and managing specific concerns about dentist, doctor or pharmacist performance.  Case management services include:


I met with Bill Rial, who was at that time Associate Director (Pharmacy); Helen Dolan, who was an NACS Adviser and pharmacist; and Florence Starr, a Project Support Manager.  Both Bill and Helen are pharmacists.  The following information is a compilation taken from our discussion.



NCAS was established by the Department of Health but works at arms length from the Department.  NCAS was set up as an autonomous division of the National Safety Agency. The organisation is not a regulator and has no statutory power.  There is a multidisciplinary leadership team on the Board.


NCAS works to resolve concerns about the practice of doctors, dentists and pharmacists by providing case management services to health care organisations and to individual practitioners.  The aim is to work with all parties to clarify the concerns, understand what is leading to them and make recommendations to help practitioners return to safe practice.


The NCAS started its work with doctors in 2001, then dentists in 2004/5 and pharmacists in 2007/8.  In the future nurses may also be included (there are about 600,000 nurses in the UK).


NCAS looks at the circumstances of each case rather than the profession itself, there are common drivers behind poor performance across the professions e.g. financial.


The NHS organisations and community pharmacy employees provide majority of referrals plus a small number from the General Pharmaceutical Council (GPhC), which is the regulatory body for pharmacists and equivalent to the Pharmacy Board of Australia.  There are also self referrals and inspector encouraged referrals.  It has been a challenge to point out to locum agencies that they have a responsibility to make referrals.  Over 25% of referrals relate to health issues, also workplace pressures are common.


Services provided

The NCAS has a phone line service which provides general information and triage on general issues and individual cases.


The NCAS also receives direct referrals.  When a referral is received the advisor team collects lots of detail and provides initial advice and a local plan (as averse to regulatory referral).  The whistleblower is equipped to take the situation forward.  NCAS may make a follow-up call.  NCAS can also deal with an individual health professional.  It is the intention of NCAS to keep professional working and provide impartial advice.  NCAS provides a service for the employer and manager rather than for the employee.  NCAS will monitor progress if a health practitioner requires supervision.  Assessment of an individual is undertaken when the issues are not clear.


Standard NCAS assessment

  1. Occupational health – health screening and if fit to undergo assessment:
    1. Screen for cognitive impairment.
    2. Alcohol screening – Liver Function Tests etc.
    3. Further screening as needed e.g. drug screen.
    4. Behavioural screen:
      1. Psychometric tests.
      2. Psychologist behavioural assessors – four to seven hour interview.
    5. Work place based – intense peer review of practice in own workplace by a team of three assessors:
      1. Assessors - one lay and two clinical.
      2. Employer facilitates informing other staff.
      3. Consent from patients (written to access records and verbal to be on-site).


Each case has four areas:

  1. Clinical skills.
  2. Behaviour.
  3. Work context.
  4. Health.


The regulatory bodies the GPhC, the General Medical Council (GMC) and the General Dental Council (GDC) provide the core standards.  The standards need to be measurable.  NCAS is looking for the minimum level of competency.


22% of calls relate to health concern as the primary concern (the reason for the call).  A secondary concern includes behaviour.

Health often becomes a concern during the process.  The employer has a duty to look after the health of the employee.


Health referrals include:

  • Mental health – a depression screen is undertaken
  • Addiction – less alcohol problems being seen now.
  • Physical e.g. degenerative physical condition.
  • Cognitive function – more cognitive problems are being detected now.


There is a large and extensive panel of NCAS assessors.  They receive a daily fee and are well paid therefore not hard to recruit.  Assessors are trained in use of the assessment instruments and have annual retraining.


A report on each case is prepared.  The report is substantial and uses individual workplace guidelines.  The report will provide examples of acceptable, poor or inconsistent practice.  The report also provides recommendations for the practitioner and the employer or manager.


NCAS assists with implementation of the report including facilitation, hand holding and mediating (there is no case management of the individual).  The process may stop at an earlier stage of standard NCAS assessment if it is clear what the issues are.


NCAS also provides education through statistics, reports, publications and presentations at conferences and external events.


Health issues for health professionals

The NCAS has seen an increasing number of health problems (up to 1/3 of cases seen by NCAS).  Health has a very big impact on performance.  Good doctors make for safer patients but it is difficult for doctors to access care.

A White Paper was prepared in 2007.  As a result NCAS has overseen the development of the Practitioners Health Program (PHP).  Please note that this was described in Part 2 of this series of articles.

A review of literature on health of health professionals resulted in the following report; Invisible Patients, Report of the Working Group on the Health of Health Professionals (March 2010) which provided recommendations on future research and services.  It was noted that there needs to be training of health professionals to look after other health professionals.  It is hoped that the Department of Health will pick up these recommendations.

The NCAS has close liaison with occupational health physicians.  The “good practice guide” covers issues about treating other health professionals. The Royal College of GPs and Royal College of Psychiatrists offer training in relation to treating other health professionals. However there needs to be curriculum development on the topic of health professionals treating other health professionals.

The public is seen to be very supportive of the health of health professionals and values work to address it.


The work and structure of NCAS continues to evolve and up-to-date information about their work can be found on their website, including a number of valuable reports evaluating their work.  The website can be found at http://www.ncas.nhs.uk/



In Australia the availability of support services for doctors and for pharmacists is limited.  The services that are available are also not nearly as well developed or as prominent as those I encountered in the UK.  This is particularly the case for the Australian pharmacy profession.


My vision for the Pharmacists’ Support Service in Australia includes:

  • National telephone and online support for pharmacists.
  • Face-to-face support for pharmacists in all states of Australia.
  • National Benevolent Fund for all Australian pharmacists.
  • Referral service for pharmacists to mental health, drug and alcohol services in all states of Australia.


For the Pharmacists’ Support Service to further expand in Australia we need to secure adequate ongoing funding.  The pharmacy profession can assist the Pharmacists’ Support Service to meet the needs of pharmacists throughout Australia through tax deductible donations.  Anyone wishing to support the work of the Pharmacists’ Support Service by making a donation should direct their donation to Pharmacists’ Support Service c/o 381 Royal Pde, Parkville 3052.  Donations can also be made over the phone using a credit card through the PSA (Victorian Branch) office on (03) 9389 4000 or by direct deposit into the Pharmacists’ Support Service bank account BSB 083155 and account number 481820199 (please include a name and contact details so that a receipt can be issued).


Pharmacists requiring assistance can contact the Pharmacists’ Support Service for anonymous and discreet support on 1300 244 910 between 8.00 am and 11.00 pm every day of the year.

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