s Access all Areas - Is This a Positive for Pharmacy? | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

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

Newsflash Updates

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
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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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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Access all Areas - Is This a Positive for Pharmacy?

Neil Johnston

articles by this author...

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.

That pharmacy is in need of a renewal process is not in dispute.
That every man and his dog become instant pharmacy experts when a debate on pharmacy is opened is an expected phenomenon.
And when it is perceived that the "experts" have little knowledge of pharmacy but want to reduce pharmacists' incomes (already and constantly under siege), without engaging the range of aspirations pharmacists already hold, they wonder why it suddenly becomes a non-event.
If a discussion paper emerged that had genuine pharmacist input I would think that most pharmacists would participate in discussion of it.
In other words don't insult our intelligence by placing us in a pecking order that is uninspiring or menial in its approach.
But do approach us with intelligent conversation that has no hidden agendas and is honest in its approach, and do not try to impose your view of the pharmacist's role from your limited perspective.
Then we can all get on with some form of positive collaboration.

And by the way, don't forget the one million plus pharmacy consumers who signed a recent PGA petition to preserve their pharmacy from dishonest governments trying to fill a budget by suppression of negotiated PBS payments.
We do seem to get some things right.
These pharmacy consumers that are actually real people, are not able to join a supposedly representative consumer body like the Consumer Health Forum (CHF), yet this entity purports to represent all consumers and is seeking to change pharmacy to their view of the world.
They also provide unqualified comment.

A paper just published by the Grattan Institute and authored by Stephen Duckett and Peter Breadon titled Access All Areas has just been released.
The paper highlights the deficiencies in primary care and endorses the use of pharmacists and physician assistants to fill gaps.
While there appears to be a space for pharmacists in this paper, it appears to be limited, terminating in a "dead end".

Stephen Duckett is a co-author to the above paper.
He is an economist, a former head of the Brotherhood of St Laurence in Australia and was sacked as chief executive of a Canadian health service after refusing to stop eating a cookie rather than talk to the media.

He was dubbed the "Cookie Monster", after he left a meeting with health care leaders in Edmonton eating a cookie and refused to talk to waiting media about the health crisis in the Canadian province of Alberta.

Stephen Duckett, was headhunted in 2009 from Australia to be in charge of the newly created Alberta Health Services. But his tenure ended abruptly after a video went viral of him munching on a cookie as he walked past the media and ignored their questions except to tell them "I'm eating my cookie".
He issued an apology the day after the incident saying he deeply regretted his behaviour and said he respected journalists' right to ask timely questions in the public interest.

Currently he is Director of the Health Program at Grattan Institute and Professor of Health Policy at La Trobe University. He has held top operational and policy leadership positions in health care in Australia and Canada, including as Secretary of what is now the Commonwealth Department of Health and Ageing.

So one would assume that he still maintains influential contacts within the health bureaucracies here in Australia.
Stephen Duckett has recently taken on the mantle of pharmacy expert within the Grattan Institute and started the attack on the manner of PBS pricing transparency procedures as negotiated between the PGA and the Australian government. His arguments seemed to have influenced the government to secretly set aside provisions of that contract, severely impacting on pharmacy cash flows.
This, in fact, triggered the PGA petition response
The following is an extract from Access All Areas:

The first step is to make much better use of pharmacists’ skills.

Pharmacists are highly trained, have deep expertise in medicines,and are located in communities throughout Australia.
But their role is far more limited in Australia than in many other countries.

With the agreement of GPs and patients, pharmacists should be able to provide repeat prescriptions to people with simple, stable conditions. They should also be able to provide vaccinations and to work with GPs to help patients manage chronic conditions.

 We also need to increase access to other services, including diagnosis, which currently only GPs can provide. Australia should introduce physician assistants, health workers who practice medicine under the supervision of a doctor. There is good evidence that physician assistants could expand the care available in under-served areas, without compromising quality or safety, and at an affordable cost.

 The proposals in this report only apply to the seven rural areas with the worst shortages of GP services. They can be in place within five years. In 2011-12, they would have resolved the worst shortages for just $30 million. The costs would mostly have been offset by fewer, or less costly, hospitalisations as a result of better population health.

Too many people have waited too long to get primary care. But the solution is surprisingly achievable, if we’re willing to adopt new responses to an old problem.

The problem is simpler to resolve than what is stated in the Grattan Institute paper, and that is to accredit pharmacists in differential diagnosis, independent prescribing and the giving of vaccinations.
Then improve collaborative arrangements between GP's and pharmacists, because the development of Physician Assistants all but eliminates collaboration- and it is a high cost solution.
If conflict of interest is perceived in any of these activities, then limit accreditation(s) to non-owner pharmacists.

Already nurses are doing what Physician Assistants are proposing to do.
I believe pharmacists have had sufficient training in prescribing through our basic training course- we are already the experts in drug management.
This single educational upgrade is all that is required to create a very strong primary health care provider very quickly.
But note in the above excerpt, immediately the word diagnosis is introduced the text quickly takes you to the Physician Assistant without any further role here for pharmacists.

Over my entire professional career (spanning 57 years) I have noted tha whenevert any attempt to have pharmacist diagnostic skills recognised immediately causes confrontation, accompanied with absolute hysteria from the medical profession.
You will note in the Grattan Institute paper that this type of role is being developed in the form of a Physician Assistant, which is a very expensive solution.
The funny thing is that pharmacy education is regarded as a good basic education for a medical student prior to transferring to a medical school and becoming a qualified doctor.
In public hospitals, pharmacists are the people that complete the prescriber training for medical interns.

The Physician Assistant role is not a new one and was instigated some years ago, with formal training being developed through one of the Queensland universities.
A lot of interest was generated, but the course had to close because of insufficient support.

When pharmacists first started talking about consultant pharmacists we suddenly saw the birth of medically developed clinical pharmacologists.
My belief is that physician assistant courses are being resurrected because pharmacist interest in delivering a range of clinical services is currently heightened. Clinical pharmacists are currently researching opportunities for practice within community pharmacies given that government is more intent on commoditising prescription activity rather than assist pharmacists in developing an expanded role in primary health care.
Thus in a proven medical model strategy, countering the perceived pharmacy threat through the development of Physician Assistants is their solution.
Where is their space for a collaborative role between clinical pharmacists and medical practitioners?
In reality it has never existed - but it ought to.
Before 1960, pharmacists were the main providers of primary health care, but with the  NHS initial introduction of free doctor visits and free prescriptions, pharmacist opportunity to maintain this primary health care dominance was severely curtailed.
It really was the medical equivalent of a discount supermarket attack on pharmacy and it icontinues non-stop.

The Physician Assistant (PA) profession is hugely popular in the United States with over 80,000 PAs in practice. The Physician Assistant concept has been adopted by many other countries including; Canada, UK, The Netherlands, and South Africa.
Now a course is offered through James Cook University, with a range of other universities throughout Australia poised to deliver full-time courses.
This educational background has been quietly developed and is almost ready to "go live" with even an Association of Physician Assistants having been formed.
It is rolling out like a well-oiled machine and students are yet to enroll in the course.
I am wondering how that fits with the New Australian government’s position on reduced university student intakes?

The Bachelor of Health Science (Physician Assistant) course in Australia is offered through the JCU School of Medicine and provides individuals with previous healthcare experience the knowledge and skills necessary to deliver clinical medical services under the supervision of a doctor or physician.

The interdependent relationship between the Physician Assistant and their medical supervisor is considered a defining feature of the profession, and distinguishes it from other health care roles. Physician’s Assistants are trained to perform many of the tasks previously done solely by medical practitioners, including history taking, physical examination, diagnosis, and treatment. This course particularly focuses on educating healthcare professionals who will provide medical services within a team based practice model in rural and remote locations in Australia.

Keep in mind that the new pharmacy services seem to be only on offer in low primary care access areas (seven in total)and that proposed payments are well under GP payments (up to 50% less than for normal GP fees).
Whatever happened for the equal pay for equal work concept that is at the heart of the Australian industrial system.
Physician Assistants, however, are required to accept the bulk billing fee under Medicare, still well above payments suggested for pharmacists in the "Access all Areas" paper.

I sincerely hope our leadership bodies are dissecting this Grattan Institute report in minute detail to ensure that there is an equitable balance, because it does not exist at the moment
It is not designed to provide any great benefit or recognition for pharmacists.
Indeed it is heading in the opposite direction.

Stephen Duckett was the first academic to condemn PBS payments to pharmacists that involved a phasing in of price transparency.
He did not compare apples to apples preferring a New Zealand model for pharmacy instead of the Australian model- and that model is not travelling too well in its early development.
That model was the trigger for a government to renege on a legal agreement and plunge Australian pharmacy into financial turmoil.

Free enterprise competition is the only system that ensures fair consumer prices for health services.
Managed health care always creates distortions and are manipulated against consumers.
Pharmacy schools and pharmacy governing bodies should invest in education that allows pharmacists to practice competitively against all other health modalities.
Some have already started to provide suitable education.
That means accreditation for vaccinations services, prescribing services and diagnostic services.
Give pharmacists the tools to compete.
We already have all the other skills and the ability to enhance them, coupled with around 5,000 pharmacies to deliver them.

That way we can honour those one million plus pharmacy patients and customers who valued our services provision sufficient to put their signature on a petition.
That type of support is pure gold and it is little wonder the medical profession is working overtime to derail pharmacists at all levels.
That is also the real reason our health services are so expensive and why Australia lags behind all other countries in having an integrated primary health care service.
And it is not hard to fix.

GP’s will always be in short supply because of their propensity to specialise for a higher fee structure.
They do not have the dedication to service the more remote regions of Australia so we will perpetually fail to deliver a universal health system.
It's a cynical system when the medical profession continually rort the public purse to persuade governments to continually fund GP training, knowing that the GP's will jump ship and become specialists located in urban and city areas. That's expensive training and the Abbott government should review this activity.

Medicare simply cannot sustain its current model which is already broken.

Return to home

Submitted by Michael Timmins on Sat, 05/10/2013 - 11:20.

as a pharmacist who has worked in Pharmacy since 1960 and been a practising ph'cist since 1965 I feel that the way for us to survive is to continue giving caring service to all who come to but we must be remunerated in an adequate manner for the free advice that we are continually giving

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