s Countdown to Supermarket pharmacies - Advantages and disadvantages? | I2P: Information to Pharmacists - Archive
Publication Date 01/12/2012         Volume. 4 No. 11   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the December homepage edition of i2P- Information to Pharmacists E-Magazine.
This homepage will be utilised for both December 2012 and January 2013 with irregular updates to get us through the holiday period.
This enables all i2P writers to relax before what appears to be a challenging year in 2013.
It is estimated that the pharmacy business/professional cycle (45 years) will be bottoming out over 2013 with more disturbance to pharmacy profitability and its ability to provide regular levels of employment.

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Recent Comments

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News Flash

Newsflash Updates over December 2012 & January 2013

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated.

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Feature Contribution

Countdown to Supermarket pharmacies - Advantages and disadvantages?

Joseph Conway

Editor's Note:
With a researcher's perspective and a pair of fresh eyes, Joseph Conway has mapped out his version of the trends and future directions for pharmacy, community pharmacy in particular.
In presenting his logic he argues from two opposite points of view - a model comprising supermarket majority ownership compared to a more traditional model of pharmacist ownership.
His article is presented in four parts, with supermarket ownership looked at first.
2013 will be an extraordinarily difficult year as the 45 year pharmacy business and professional cycle bottoms out with no soft landing.
The hiatus in pharmacy leadership that is apparent in the lack of a cohesive forward plan leaves all pharmacists (pharmacy owners and non-owners) with no sense of direction, a mix of disjointed "bits and pieces" that is the substitute for a clear and definitive plan
While Joseph has outlined some options, it will be up to individuals to complete the puzzle and fill in all the gaps.

Comments: 6

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Countdown to Supermarket pharmacies - Advantages and disadvantages? - Part Two

Joseph Conway

Editor's Note: Joe Conway continues with Part Two of his four-part series on Australian pharmacy and its direction.
Please post comments at the foot of his article to help expand the debate.
Pharmacy has to change quite drastically to drag itself into the 21st century.
It has hesitated for too long a period of time.


In New Zealand, the launch of Countdown pharmacy seems to have gone down with little fuss. However, from an Australian pharmacy perspective, the issue of concern is that Countdown Pharmacies are at least in part owned by Woolworths.
In part 1, I outlined what I thought were the potential advantages of Supermarket pharmacies in Australia. In part 2, I would like to give my opinion as to the disadvantages of allowing Supermarkets to run pharmacies in store.

Comments: 1

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Countdown to Supermarket pharmacies - Advantages and disadvantages? - Part Three

Joseph Conway

Editor's Note:Joe Conway Introduces Part three of his four-part series on the potential impacts of supermarket pharmacies in Australia (if introduced). Part three discusses impacts for patients.

Countdown Pharmacies are at least in part owned by Woolworths. This raises the possibility that Woolworths is using this Kiwi venture to hone its skills in the area of pharmacy before a possible bid to be allowed to provide such services here in Australia.
People aren’t marching the streets in Australia wanting pharmacies in Supermarkets and the Discount model of pharmacy is already providing Australians with access to cheaper medicines that is the catch-cry of the Supermarkets when extolling their virtues as potential custodians of prescription medicines.
An example of this was Chemist Warehouse supplying the Lipitor® generic Atorvastatin Sandoz® for $0 for a limited time on a valid prescription.
You can’t get any cheaper than that? In part 1, I outlined what I thought were the potential advantages of Supermarket pharmacies in Australia.
In part 2, I gave my opinion as to the disadvantages of allowing Supermarkets to run pharmacies in store.
In part 3 I would like to explore potential patient attitudes in this debate.

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Countdown to Supermarket pharmacies - Advantages and disadvantages? - Part Four

Joseph Conway

Editor's Note: This is the fourth article in a series by Joseph Conway.
He has made a number of assumptions and predictions within the article series, floating the proposal that if Australia adopts the New Zealand model of Countdown Pharmacy, there are a range of advantages and disadvantages.
In this final article Joe blows apart the notion that supermarkets are cheaper than pharmacies by completing a survey of products held by pharmacies and supermarkets in common.
To his surprise, he found that pharmacy is currently more than competitive with supermarkets, taking away the supermarket trumpet call that they would provide cheaper prices than pharmacies.
It would seem that pharmacy can still remain in the race to be competitive, with the point of difference being provision of patient information. The latter service may need to be tidied up, even charged for if there is value for money.

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The Role of the Consumer in Health

Gerald Quigley

The Guild’s least favourite combatant at the moment is the Consumer's Health Forum.
I’ve been a member of this organization for a few years now, and I’ve come to acknowledge their expectations that they, as a representative body for the Australian consumer, should have a say in health.
And I’m beginning to understand now that this organization might, in fact, reshape our role in health.
I can’t get over the wide variety of contacts they have, the panels in which they are involved and more especially, their positioning as the voice of the consumer.
Perhaps we can take a leaf out of their book?

Comments: 1

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The Ten Top Issues we need to think about in 2013

Neil Johnston

No matter where you appear within the “food chain” of pharmacy, uncertainty is the common background theme.
Students are wondering if they will succeed in getting an internship.
Interns are worried about continuing employment and becoming registered.
Newly registered pharmacists are wondering if they are in over-supply with the prospect of reduced (or no hours) of employment at hourly rates not much above pharmacy technicians.
Career pharmacists are wondering about their prospects in a rapidly changing and stressful environment.
Clinical pharmacists are wondering when community pharmacy is going to embrace them as part of a solution.
Senior pharmacists (those that do not want to retire) are wondering if the workplace will ever become friendly to the extent that some of their working day can be in a seated position, to take stress off aching joints. Also to be valued in a mentoring role to other pharmacists.
Owner pharmacists, in varying degrees, are wondering whether they will have sufficient capital to sustain their businesses into the future.

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How Do Your Customers See Your Business?

Chris Foster

Businesses tend to focus on profits with no consideration as to whether these profits are good profits or bad profits.
Good profits would be defined as those profits earned from customers who are delighted with the products or services provided – so much so that they will voluntarily refer your business to their friends and associates - in other words, become an advocate for your business

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In 2012 community pharmacy didn’t get any easier. Time to think about 2013

Neil Retallick

A funny thing didn’t happen recently.
I rang our (Global Pharmaceutical Company) territory manager and she didn’t answer.
In fact, her mailbox was so full I couldn’t leave a message.
Several days later, her manager rang to inform me that she had been made redundant as a part of a company-wide restructure.
Then, a couple of days ago I had a meeting with the State Manager of another Global Pharmaceutical Company.
He told me that 300 jobs had been made redundant in the pharmaceutical industry in the previous five weeks.

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Slow Medicine, Slow Foods - Concepts for Future Good Health

Neil Johnston

A growing number of medical leaders are calling for “Slow Medicine.”
They are calling for a similar rationale which evolved as the “Slow Food Movement” that originated in Italy as a reaction against fast food and industrialised agriculture.
Slow Food links the pleasure of growing and consuming good food with a commitment to community and the environment.
The movement exists in Australia and information about it can be found here
i2P first wrote about slow food here.

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Reach Out, Connect, Engage

Barry Urquhart

Omni-channel and multi-channel are in-vogue phrases and concepts.
They reflect the presence and need for parallel and compatible avenues to reach out, connect with and to engage existing and prospective clients and customers.

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Rationing Healthcare

Steve Jenkin

What level of Individual Responsibility do we each have in managing our Health and Well-Being, given that 40% of "total health" is due to lifestyle choices and behaviour and only 10% Healthcare Delivery? [1]
How much "free" healthcare, taxpayer funded, are we prepared to give individuals?
Should we limit it?
How?
Unlimited Free Goods guarantee unlimited demand for them.

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Lessons they don't teach you in school

Harvey Mackay

Education is a stepping stone to success, but some of the most important lessons aren't taught in class. There are plenty of life lessons that we need to know, and the textbooks often do not have chapters on them.
Here are some lessons you should learn in order to grow both in your career and in your personal life.

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National Go Home On Time Day – do you go home on time?

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

Wednesday 21 November 2012 was National Go Home On Time Day in Australia (www.gohomeontimeday.org.au/). 
This event is an initiative of the Australia Institute (www.tai.org.au), an independent public policy think tank based in Canberra. 
Other supporters are beyondblue (www.beyondblue.org.au) and the ACTU. 
On Wednesday 21 November the address at the National Press Club in Canberra was given by beyondblue CEO and pharmacist, Kate Carnell and ACTU President, Ged Kearney.
A recording of the address, which I recommend, can be viewed at:http://www.abc.net.au/news/2012-11-21/national-press-club-ged-kearney-and-kate-carnell/4384590.
Despite differing political backgrounds both presenters were united in their view that life-work balance is essential to a healthy and productive workforce. 
This is something which, I believe, many pharmacists need to consider and apply to their lives.

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I've been thinking about circumcision, Starbucks and FDR's four freedoms

Mark Neuenschwander

Well before Starbucks began roasting exotic blends, Yuban took a swing at it. Not sure they hit the ball out of the park, but they were getting more for a pound of coffee than number-one Folgers at checkout stands across America. Do you remember Yuban commercials during the 1960s? They concluded with that deep trained-for-television voice saying, “As John Arbuckle says, ‘You get what you pay for.’”

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Chiropractic mallets & other wacko widgets

Loretta Marron OAM BSc

The philosophy behind 'fundamentalist' chiropractic is that spinal 'blockages' cause most illnesses and that removing them will restore health.
A range of chiropractic 'medical devices' are claimed to locate and remove these 'blockages'.
So what types of devices do chiropractors use, are they registered with the federal government, and do they work?

Comments: 2

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It’s Good to See a Unity Theme Emerging

Peter Sayers

I2P has already commented that unless pharmacy leaders become united, the profession will continue a decline that has been building for over a decade.
We are now in the “bottoming-out” phase of the pharmacy business/professional cycle that will become extended if there is no sign of cohesiveness emerging over the next twelve months.
Pharmacy leaders must sort out their various differences and support each other where strengths exist and need to be nurtured.
The last thing pharmacists want to see is a prolonged battle for power, wasteful in resources and energy and depressing for individual pharmacists struggling to find an identity and build their professional roles.
i2P will support any progress towards unity because we can see how close pharmacy is to major destruction, caused by weaknesses created over the last decade through in-fighting and power broking.

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Remembering a legend, Zig Ziglar

Harvey Mackay

When I was cutting my teeth in the sales game right after college, I made sure to read or listen to everything I could get my hands on from a handful of sales and motivational legends - Napoleon Hill, Earl Nightingale, Dale Carnegie, Norman Vincent Peale, Jim Rohn and Zig Ziglar.

I, like many people around the world, was saddened to hear about the recent death of my friend Zig. He was one of a kind. I was fortunate to share the stage with him several times - and I will be forever grateful for those opportunities.

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Is the Guild getting value for money in radio?

Gerald Quigley

Recently, whilst I waited to be interviewed on a regional Victorian afternoon radio program, I was put “on hold”, so I was able to listen to the messages going out to the radio public.
I was staggered however, to listen to a Pharmacy Guild sponsored message, outlining the best option to help the obesity issue………..bariatric surgery!

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A Basic Right to Good Health

Neil Johnston

Everybody has the right to good health.
Governments spend $’s billions ensuring that their constituents have access to:
* Good Food
* Clean air
* Clean water
These are the basic elements of self care that are all components of human rights
However, industrialisation has caused contamination and adverse effect on health as pollutants have made their way into these basic elements of food, air and water, often being unwittingly ingested in micro-amounts over long periods of time.

Comments: 2

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Gilding the Lilly

Mark Coleman

According to recent reports in Bloomberg, Eli Lilly has been consistently bribing officials for a period of up to 20 years, in countries such as China, Russia and Brazil.
The mechanism employed is through the use of “offshore marketing agreements” that established bank accounts that could be accessed by employees based in those countries.
Little, or no checks were performed on these offshore accounts as to how the money was spent – just as long as business flowed from that type of investment.
The American Securities and Exchange Commission has fined Lilly an amount of $29.4 million under the Foreign Corrupt Practices Act.

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More street-smart ideas for success

Harvey Mackay

Sometimes the columns that get the biggest reaction are those that offer the simplest advice.
A couple weeks ago I wrote about street-smart ideas and was inundated with requests for more.
A few readers shared their ideas too.
Because I truly believe in the importance of street smarts for success, I'm continuing the list.

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Understanding the Elements of a Paid Pharmacy Clinical Service

Neil Johnston

In 1975 I began life as a marketing and management consultant.
I specialised in two primary services:
* Inventory management- because every pharmacy was overstocked due to manufacturer pressure and poor pharmacist management expertise.
* Income tax management-because pharmacists were unable to pay their income tax, because the overstocks had soaked up their liquidity.
Pharmacy in 1975 was characterised by successful looking pharmacies, profitable on paper, but choking to death because of a lack of liquidity and management controls.
I am wondering whether that may sound familiar today.

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Our ageing Pharmacists offer too much value to be consigned to the dust heap!

Gerald Quigley

I read a recent article written by Harold Mitchell, the media mogul, philanthropist, and all round great bloke.
If you want a great read, try his autobiography.
I was lucky enough to sit beside him at a function years ago, and he left a lasting impression on me.
Harold explains in his article that he had spoken at a function attended by Australian former business icons, like the chairman of Qantas, managing director of Ford, managing director of the ANZ Bank, CEO of the NAB and a number of top-end medicos.
They all had the feeling that they could do more, but society had pushed them aside because of their age.

Comments: 2

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Every company should have a Santa Claus attitude

Harvey Mackay

Do you believe in Santa Claus?
Whether you ever did - or still do - there's something about the jolly old elf that wise businesses should consider emulating if they want to establish a year-round aura of good will.
Santa has a number of attributes that easily translate beyond the holidays.
Here are some that I think are worth noting:

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Supporting Senior Pharmacists

Neil Johnston

Being a senior pharmacist and also being very conscious of the limited roles that pharmacists in a senior age bracket are afforded, I was pleased to read Gerald Quigley’s comments on the subject in this edition of an i2P update for December 2012.
A quick search of the Internet revealed there was no association in Australia to represent senior pharmacists (but there were doctor groups).
The UK seemed to be the only country where a formal group has been established for retired pharmacists under the umbrella of the Royal Pharmaceutical Society.
It is known simply as the Retired Pharmacists’ Group.

Comments: 3

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The Pharmacist and the Consumer

Gerald Quigley

I had the privilege of attending a recent symposium called by the Consumers Health Forum of Australia, to assess the Community Use of Medicines from the Perspectives of Carers.
The key objectives of this project included:

* Providing strategic advice regarding consumer perspectives on QUM issues

* Supporting consumers to contribute to, and participate in, NPS advisory groups

* Developing and building diversity around key topical health areas

There are approximately 2.6 million carers in Australia.
They are recognized by the Carer Recognition Act 2010, which defines carers as people who provide unpaid personal care, support and assistance to other individuals who are in need of support due to disability, medical condition, terminal or chronic illness, mental illness, or who are frail and aged.

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The Workplace Future

Neil Johnston

For many of us in the workforce (including me) there was at one stage, a vision  we could retire around age 55.
However, with the many shifts and vagaries that have occurred within the Australian economy, most have abandoned that dream as their savings depleted.
In fact those depletions have contributed to the thought that it might be more prudent to work for as long as possible. This thought has also been fuelled by the knowledge that lifespans are increasing and that it is difficult to sustain a social structure outside of a workplace because most of us have been defined by our work and it is difficult to embrace major or abrupt changes as we age.

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A Model For Clinical Pharmacist Communication

Neil Johnston

Professional isolation is a fact of life in community pharmacy.
Gone are the days where an average pharmacy could support around four pharmacy job skill levels (apprentice, unregistered pharmacist, registered pharmacist and master pharmacist). Also gone is the collegiate and mentoring environment with the sharing of information and various techniques including the skill of patient interviewing, and the identification of various conditions and how to treat them with remedies compounded and formulated by a clinical pharmacist.
While nobody expects professional development to stand still, what has replaced these skills has not been for the better, with patient personal interest and care becoming the primary casualty.
The four-wall syndrome, a phenomenon that developed in the mid-1960's has slowly strangled job satisfaction parallel with government control through the PBS system.
With the advent of modern communication systems it is now possible to recreate a model of information and technique sharing that could well revive what was previously a vital and viable clinical experience. Like an expanded version of information sharing in a social media format-something like a secure medical Facebook.

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ASMI calls on Government to boost investment and innovation in consumer medicines and support self care reforms

Staff Writer

Editor's Note: Pharmacy has always been at the forefront of primary care and self-care.
Politically, these activities seem to have been hijacked through unusual and unacceptable drug scheduling decisions (children's cough mixtures etc) and the bureaucratic and unnecessary trans -Tasman harmonisation operation.
Decisions in both the above areas have had nothing to do with patient safety or patient care and they are both examples of bureaucratic insults against the pharmacy profession, as there was no problem that needed fixing in the first place.
The proposal by ASMI as part of a Federal Budget Submission is an interesting one for pharmacists and unless there is proper pharmacy representation to ensure that another carving up of the community pharmacy market does not occur, we may yet lose a further opportunity - because of poor pharmacy leadership.
At least we should demand that both PSA and PGA have a major role here and that they should agree the boundaries of their responsibilities.
We can no longer afford nor tolerate continuing disunity.

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Australians double their antidepressants

Staff Researcher

The use of antidepressants doubled in Australia between 2000 and 2011 and they now account for two out of every three psychotropic medications prescribed, a new study by the University of Sydney reveals.
It also shows that over the last decade there has been a dramatic 58 percent increase in the use of psychotropic medications by the Australian population, which has only increased by 13 percent over that time.

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Electronic nose could be used to detect sleep apnea

Staff Writer

An electronic nose, used to detect the presence of molecules in the breath of a patient, could be used to diagnose obstructive sleep apnoea.
A new study, published online in the European Respiratory Journal, could make the diagnosis of the condition quick and inexpensive compared to current methods.

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Bacterial spores could replace hypodermic needles for vaccinations

Staff Researcher

Taking the “ouch” out of injections is a worthy endeavor, but what if they could be avoided entirely?
New research conducted at Royal Holloway, University of London offers the hope of achieving just this, by using a bacterium to deliver a vaccine which can be administered via nasal spray, oral liquid, capsule, or small soluble film placed under the tongue, thus reducing the risk of spreading infectious diseases like HIV.

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Milk that protects against HIV

Staff Researcher

Melbourne researchers have developed cows’ milk that protects human cells from HIV.
The milk contains antibodies which defend against human immunodeficiency virus (HIV).
The next step will be to develop it into a cream which women can apply to protect themselves from contracting HIV from sexual partners.

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Can your gums tell you if you will get arthritis?

Staff Researcher

Adelaide scientists have found that mice with gum disease develop worse arthritis.
The scientists are using this knowledge to investigate whether treating mouth conditions could help relieve arthritis.
As part of  her PhD studies, Melissa Cantley worked with colleagues at the University of Adelaide to develop a new way to study these two diseases and their relationship. She is presenting her research this week as part of Fresh Science — a national program for early-career scientists.

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Australian Prescriber

NPS Spokesperson

The December issue of Australian Prescriber is now online.

This is the largest edition of Australian Prescriber ever published - 40 pages. There will be something for everyone in the wide variety of topics - ranging from common conditions as in Jo-Ann See's review of acne to the infrequently encountered idiopathic interstitial pneumonias reviewed by Lauren Troy and Tamera Corte. Pneumococcal pneumonia is one of the conditions which may be considered for treatment with intravenous antibiotics in the patient's home . David Looke and David McDougall's article will be of interest to health professionals in hospitals and in the community. The quality use of medicines is important fo! r all health professionals . As it is 20 years since Australia's policy was launched, Tony Smith reflects on what has been achieved. Looking to the future, the conference on national medicines policies in our region reports that there is still work to be done.

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Serotonin, more than just the happy hormone

Staff Researcher

Serotonin – often dubbed the happy hormone for its ability to regulate moods – plays a vital and perhaps lesser known role in everything from blood clots to bone density.
Yet despite its significance in the human body, researchers do not fully understand how serotonin is released into the bloodstream.

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First image of insulin ‘docking’ could lead to better diabetes treatments

Staff Researcher

A landmark discovery about how insulin docks on cells could help in the development of improved types of insulin for treating both type 1 and type 2 diabetes.

For the first time, researchers have captured the intricate way in which insulin uses the insulin receptor to bind to the surface of cells. This binding is necessary for the cells to take up sugar from the blood as energy.
The research team was led by the Walter and Eliza Hall Institute and used the Australian Synchrotron in Melbourne. The study was published today in the journal Nature.
For more than 20 years scientists have been trying to solve the mystery of how insulin binds to the insulin receptor. A research team led by Associate Professor Mike Lawrence, Dr Colin Ward and Dr John Menting have now found the answer.

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Pharmacists’ Support Service welcomes contribution from the Pharmacy Guild of Australia

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

The development and expansion of the Pharmacists’ Support Service (PSS) has been given a significant boost through support from the Pharmacy Guild of Australia (PGA). 
The PGA has now joined the other pharmacy organisation supporting PSS both financially and through participation in the PSS Management Committee.

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Fruit and veg flavanoids give cardioprotective effects - Black tea is one of the highest sources of quercetin.

Staff Researcher

A STUDY published in the journal of Biochemical Pharmacology suggests major flavonoid quercetin is beneficial in reducing the risk of cardiovascular disease (CVD).
The study highlights the cardioprotective effects certain dietary flavonoids have when consumed as part of a normal diet.
Study supervisors Medical Research Foundation and UWA research fellow Natalie Ward and UWA School of Medicine and Pharmacology professorial fellow Kevin Croft say quercetin is one of the most widely abundant flavonoids in the diet.

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New norovirus strain could cause severe gastro epidemic

Staff Researcher

UNSW researchers have discovered a new strain of norovirus that they warn could cause a severe epidemic of acute gastroenteritis in Australia this winter.
Known as Sydney 2012, the highly infectious mutant virus has already caused an epidemic of nausea, vomiting and diarrhoea in Europe, with an estimated 1.2 million cases of gastro in the UK during the colder months.
It has led to the closure of dozens of hospital wards there, and affected schools, age-cared facilities, cruise ships and workplaces, resulting in headlines in the British press such as the Chunder from Down Under.

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Fair Work Ombudsman to Check Claims by APESMA

Staff Writer

Editor's Note: In a flurry of press releases issued by the pharmacists' trade union, APESMA, it would appear that a challenge has been presented to the PGA to put its house in order.
The challenge appears to have the backing of the Fair Work Ombudsman, who will audit a selection of 400 pharmacies from all states and territories.
The press releases seem to indicate a carefully planned campaign is under way and that pharmacy owners need to be compliant before April 2013.

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Prescription Exchanges Becoming Interoperable

Neil Johnston

Editor's Note:
Electronic Prescription Exchanges in Australia have been sputtering along with little momentum, for quite a few years now.
Not surprisingly, the two main players in the field have been the doctors (in the form of the Royal Australian College of General Practitioners) and the pharmacists (in the form of the Pharmacy Guild of Australia).
The former has endeavoured to comply with all the specifications of NEHTA (the organisation established by government to oversee all e-health developments), which has spectacularly blown its budget on numerous occasions, with little to show.
On the other hand, the PGA developed its exchange outseide of NEHTA Guidelines.
Both the PGA (in the form of the eRx system) and the RACGP (in the form of the Medisecure System) have each tried to become the dominant system, a battle that has considerably drained cash resources on both sides.
We have asked Mark Coleman to comment on a media item describing recent developments that was published in Pulse IT.

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Countdown to Supermarket pharmacies - Advantages and disadvantages?

Joseph Conway

articles by this author...

Joe Conway is an Irish born pharmacist who qualified in the UK in 1998.
After completing a residency in a hospital in London, he embarked on a 3 year locum stint that involved working all over the UK, Ireland, and Australia in over 350 pharmacies of all varieties (hospitals large and small, community, even a prison pharmacy).In 2002, Joe emigrated to Australia and worked in the Private Hospital sector gradually moving in to management positions with Slade Pharmacy where he developed a keen interest in Oncology services. In 2006, Joe took up a position setting up a Pharmacy service to a newly built Day Hospital in Frankston, Victoria. The Pharmacy now conducts over 40 clinical trials.
Joe is currently studying for a Master of Biostatistics to help him progress in the area of clinical trials, and think outside the square (or at least be left-field).

Editor's Note:
With a researcher's perspective and a pair of fresh eyes, Joseph Conway has mapped out his version of the trends and future directions for pharmacy, community pharmacy in particular.
In presenting his logic he argues from two opposite points of view - a model comprising supermarket majority ownership compared to a more traditional model of pharmacist ownership.
His article is presented in four parts, with supermarket ownership looked at first.
2013 will be an extraordinarily difficult year as the 45 year pharmacy business and professional cycle bottoms out with no soft landing.
The hiatus in pharmacy leadership that is apparent in the lack of a cohesive forward plan leaves all pharmacists (pharmacy owners and non-owners) with no sense of direction, a mix of disjointed "bits and pieces" that is the substitute for a clear and definitive plan
While Joseph has outlined some options, it will be up to individuals to complete the puzzle and fill in all the gaps.

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Introduction:

In New Zealand, the launch of Countdown pharmacy seems to have gone down with little fuss. However, from an Australian pharmacy perspective, the issue of concern is that Countdown Pharmacies are at least in part owned by Woolworths. This raises the possibility that Woolworths is using this Kiwi venture to hone its skills in the area of pharmacy before a possible bid to be allowed to provide such services here. People aren’t marching the streets in Australia wanting pharmacies in Supermarkets and the Discount model of pharmacy is already providing Australians with access to cheaper medicines that is the catch-cry of the Supermarkets when extolling their virtues as potential custodians of prescription medicines. An example of this was Chemist Warehouse supplying the Lipitor® generic Atorvastatin Sandoz® for $0 for a limited time on a valid prescription.
You can’t get any cheaper than that?
Over a four article series, I would like to explore what I think are the advantages and disadvantages potentially of a Supermarket pharmacy service being allowed to operate in Australia.

Part 1: Advantages of a supermarket pharmacy

Lowest Price AND the best service at the same time:

The evolution of pharmacies in Australian has gone from many sole operators in small pharmacies to one where pharmacies are made bigger by deliberate Government design. There has been an incentive for smaller pharmacies to join together with the thinking that bigger pharmacies can afford to deliver PBS services cheaper due to economies of scale. This process is still happening with big warehouse pharmacies appearing in the last 10 years whose catchcry is that people shouldn’t pay too much for their medicines. What is the next step in this process? Is it to allow Supermarket pharmacies which would be able (if they choose?) to be cheaper than any Discount pharmacy out there currently? If there were a Coles or Woolworths pharmacy tomorrow, they would almost certainly advertise that they provide the cheapest prices on prescriptions and that they would guarantee to be 10% less than Chemist Warehouse (my opinion the current market leader). They could leverage on Chemist Warehouse’s claim to be Australia’s cheapest Chemist and confirm that they will always be lower or at least similar to them in price.

However, Supermarket pharmacies could also offer the best service in addition to the lowest prices. Coles Owners Westfarmers Bunning’s Warehouse model of service or the Woolworths Masters model is ideal (I think) could easily be adjusted to suit pharmacy. If a patient comes in with a query on nutrition, then there could be an expert employed on that. If another patient was diabetic, there could be a Diabetes consultant available to address their issues. The scope for this is limitless and rarer, more specialized queries could be dealt with over the telephone/teleconference (by appointment) with an expert employed/contracted by the Supermarket. (For more on this see section on Consulting rooms)

Do people want this?

Well, with or without a Carbon tax, energy costs are rising in Australia. When faced between the choice of heating their home or taking preventative health medicines, it’s easy to see why someone could refuse to fill a script for (e.g. Atorvastatin 40mg) which Currently costs $35.40 per month on valid PBS script = $424.80 per year (will probably be $15/month in 3 years with Price disclosure) and instead use this money to pay energy bills. It’s conceivable that a high usage drug such as Atorvastatin 40mg could be less than $5 per month or even a token $2 per month (to card members) in a Supermarket pharmacy which has got to increase a patient’s compliance with their statin medication regimen and possibly help reduce the number of individuals developing stroke and other heart problems each year potentially leading to greater long term wider health savings. It’s widely stated that the cost of medications to the patient is a prime reason for non-compliance with medication. Supermarkets should increase patient compliance through cheaper costs of medications particularly to patients not covered by a Pension/concession card. If members of the Pharmacy Guild (i.e. Chemist Warehouse owners) agree that medications should be given out for free sometimes, then what’s the argument against allowing corporates to operate pharmacies who can afford to give out medications for free more often than any franchisee owner is able to sustain?

Convenience for many patients:

Most people in Australia shop at a Coles or a Woolworths for their groceries each week. There are pharmacies near many Coles and Woolworths, but these are open limited hours (not profitable to open late in many cases). People who are working fulltime may have to travel a few kilometres out of their way to get a monthly script filled at one of the pharmacies that do provide an evening pharmacy service. In a Supermarket pharmacy, these people (and probably other groups) would save time and might be more inclined to get their script filled possible increasing patient compliance with further intended health benefits of prescription medication.

Savings for the Federal budget?

The Supermarkets could achieve major savings for the federal budget. The Community Pharmacy Agreement costs the taxpayer reportedly $15 billion over 5 years. It’s conceivable that Supermarkets would agree to do this for virtually $0. This could be a major saving to Government in times when Fiscal austerity is needed and the Mining tax receipts are declining and with uncertainties in the global economy. There could also be savings through more rapid price disclosure as competitive Supermarkets volunteer savings on their generics with the sole aim of pricing competitors out of the market and making medication much for affordable to those who need it.

Continuity of Care?

Countdown pharmacies are reported going to have Consulting rooms in them. This has the potential to change how health services are delivered to the public from a pharmacy. The clientele of these Consulting rooms can be tailored to the needs of the local population. In an inner city supermarket with a younger surrounding population, there could be mostly Consultants with health experts on nutrition, various alternative medicines, Sport’s diet experts, Pregnancy advice, Breastfeeding, some beauty treatment, etc… In a suburban pharmacy with an elderly population, the services provided from the Consulting rooms could include Medication review and management, Podiatry, Asthma, Wound care, Stoma clinic, Walking aids and similar devices, Prostate clinics, Vaccination and whatever else a free market in this area comes up with. The point is that the choices for the services that these Consulting rooms provide could be designed so that that the customers choose what health service they want/need. A health service for the people designed ultimately by the wishes of the people. A health expert (e.g. Nurse, Pharmacist, Physiotherapist, Podiatrist, whomever) could elect to develop and market a clinic for a few sessions a week. These people could include direct employees of the supermarket (pharmacists) and self-employed people who have existing clinics and bring their existing clientele with them. The price to the expert to hire these rooms could be much more competitive than existing arrangements and in some cases be free (if someone brings an existing clientele with them). The customers could develop relationships with such experts and it could be argued that this would give the customers continuity of care as health experts in such circumstances could continue to do this for years ensuring this.

What of Existing Owners who have invested big time?

Supermarkets can’t just operate pharmacies tomorrow without the expertise of the people who have been running pharmacies for years. The location rules have made pharmacies worth a lot as it’s very difficult for competitors to move in. Some Pharmacy owners have used their equity to buy out pharmacies in the surrounding areas and possibly built monopolies for themselves. However, for any Supermarket to succeed and thrive, I think that the needs of such owners need to be addressed as they are a major political force to go against and Supermarkets don’t want to have to fight Pharmacy Owners. The solution to this could be to allow a transitional arrangement (over 2-3 years) whereby existing pharmacies could be bought by anybody and moved into Supermarkets or just operated as they are. This transitional arrangement could ensure that the market price of a pharmacy could be maintained or actually increase for the initial period as there would be incentive to buy. As well as being paid handsomely for their pharmacies, existing owners (and some managers) could be given lucrative contracts to ensure the survival of their pharmacy after they sell it. I think that utilising the existing owners in this way would ensure the integrity of the Supermarket model of pharmacy and might mitigate a major offense from existing owners who want to protect their existing hard earned assets.

What about Wholesalers?

Supermarkets shouldn’t need to reinvent the wheel. They could buyout existing wholesalers and utilise their expertise and resources. This could also mitigate a political backlash from these and may even present a good deal to shareholders of these companies if that opportunity was to arise.

Who is ultimately responsible for giving out medication?

Existing Pharmacy Owners carry a major responsibility for medications given out in their pharmacies. If a Supermarket bought a pharmacy, then who carries this responsibility? This presents a conundrum, but why can’t a Pharmacy Manager be appointed for every store to have this responsibility for this? Such a Manager would have to have the power to override the store manager where he/she feels that refusal of a profitable sale is necessary for the ultimate health of the patients. Also, publically listed companies are under a lot of scrutiny. If a Store manager gave a warning to Pharmacy Manager for refusing a sale for a legitimate medical reason, then, there could be a lot of scrutiny of that Supermarket pharmacy chain for that. This could ensure that Supermarkets comply with exiting legislation and this would be uniform across all Supermarket pharmacies. Supermarkets could even argue that existing owners often have huge bank loans and rental payments hanging over their heads so they might have a major incentive to get sales. They could argue that the Pharmacy Manager in their stores would be under no direct financial pressure (though would have normal KPI’s to adhere to would have performance reviewed) as the continued loss of a profitable sale won’t send them bankrupt like it could to existing pharmacy owners.

What about Employee Pharmacists/Career progression of pharmacists?

A Supermarket/Corporate Pharmacy offers ambitious young graduates more career choices than the current model presents. Currently, in a Community Pharmacy setting, Ownership appears to be the only route to career progression. Even then, many Owners are struggling with massive loans and are stuck in a myriad of paperwork and there is evidence of cracks in the system. Instead of a career progression that involves more interaction with patients, they end up doing BAS statements, doing 5CPA (massive exercise in paper shuffling?), paying staff, keeping the landlord and banks happy, etc… A recent Fairwork audit of wages of pharmacy staff in Queensland found that many owners are struggling to even pay their staff correctly. I think that most pharmacists want to talk to patients and not spend their time filling forms. A Supermarket model could ensure this doesn’t occur and that motivated pharmacists can spend their time addressing medication issues with patients. There could be a dispensary with many early career pharmacists working together in an environment that stimulates learning and questioning of prescribing habits – a lot can be learnt from this. There could also be a Pharmacy Manager and people in the Consulting rooms in close contact who could give advice on the action to take when an early career pharmacist is unsure of what to do. Early career pharmacists could use this time to try and develop their skills and become familiar with patients possibly building up a clientele for the Consulting rooms. It could start with an early career pharmacist taking a patient in for a 20 minute discussion on their medication and in time, the pharmacist could build a business of their own and may want to specialize in a particular area offering a non-management route to career progression as a Community Pharmacist. Other pharmacists may want to progress within the Supermarket system and become the store manager, or enter areas such as Product purchasing, Health Advice, Regulatory affairs, Custom manufacturing, or any other area that a Supermarket could provide. It’s also possible that Supermarkets could pay professional fees and may pay for training needed for career progression of early career pharmacists.

What about innovation?

Supermarkets have the money to develop good ideas that can bring efficiencies to the world of pharmacy. With a fragmented network of small businesses some of whom are struggling financially, current pharmacy owners could find it harder than a Supermarket pharmacy chain would to implement such changes.

Uniformity of service deliverance:

If a patient was to go on holidays, they could know that any Coles or Woolworths pharmacy would be almost the same (in the dispensary and aisles, but not necessarily in the Consulting Room area). A person would be able to describe themselves as a Coles’ pharmacy person or a Woolworth’s pharmacy person. Many Community pharmacies are currently trying to emulate this with the Franchisee Owner model with people feeling that they belong to a particular pharmacy chain. In the Supermarket Pharmacy chain, there could be an express service where scripts could be quickly sent to another pharmacy when a patient is on holidays. Elderly patients could have a delivery service to their homes. It would be important for people to get to know their driver so that they can feel the personal touch that they get now from some Community Pharmacies. The driver could be part of a network in a suburb and could bring Elderly people other items (milk, newspaper, whatever ordered in person, over the phone, or via the internet) also helping to fulfil that increasing need (due to increasing median age of the population) in the community.

There are many advantages potentially with Supermarkets. You could even claim that Supermarkets could cure cancer. Everybody has the potential to do something great, but what really matters is evidence of what people have actually done. I have tried to put forward a case for Supermarket Pharmacy in Part 1 and in further parts, I will put forward a more negative view of the potential problems with Supermarket pharmacy. In life there are always good and bad points and I think that this certainly applies to Supermarket Pharmacies.

Return to home

Submitted by Peter Feros on Tue, 16/04/2013 - 13:09.

Joe Conway in his article about pharmacy in supermarkets claimed that there are economies of scale in dispensing.
This claim could be based on incorrect conclusions made in the Pharmaceutical Benefits Remuneration Tribunal dispensing cost surveys in 1988 and 1990.
In my article in the Australian Journal of Pharmacy AJP Vol 93 November 2012. pages 67, 68 & 69
' The dispensing economies of scale myth' is exposed.
A copy is available on my web site. www.efficientdispensarydesigns.com.au
Where there are economies of scale for community pharmacy, is in front of shop retailing.
I have experience of these economies being a director of Cincotta Discount Chemist Merrylands.
This pharmacy has annual sales of $32m.
This level of sales is commensurate with the sales of the average Woolworths or Coles supermarket.
By generating annual sale per square metre of over $30,000, the Cincotta Discount Chemist Merrylands, rent is less that 1% of sales.
This pharmacy provides front of shop products at supermarket prices which prices can be checked on the Cincotta web site.
The pharmacy also provides professional services which in 2013 will be part of the franchise services provided to its 19 franchised outlets.
My experience is that the things Joe Conway says supermarkets can do, are already being provided or can be provided by community pharmacy franchisees.
I am a partner in 11 pharmacies. In none is the bookkeeping, pays et al, done by the pharmacists.
The work is outsourced to bookkeeping specialists.
If any of your readers would like to review the Cincotta operations at Merrylands. Then they simply have to phone me on 0418 444 802.

Submitted by James on Sat, 08/12/2012 - 00:17.

I have a feeling that the location and ownership rules will be reviewed. They definitely need to be. I myself believe that only pharmacists should be able to own pharmacies BUT the location rules should be relaxed so that any budding pharmacist can open one. The national limit of 5000 pharmacies needs to be raised significantly too. This maximum was introduced years ago and the population of Australia (ageing and otherwise) has grown since. This will reduce pharmacy values to more realistic amounts also and improve competition. Eg: there are a couple of medical centres that an entrepreneurial pharmacist may want to open next to in direct competition with an existing pharmacy - why should the existing pharmacy be able to capture that market simply due to outdated location rules?

Submitted by Joseph Conway on Sat, 08/12/2012 - 07:27.

If pharmacy Ownership was deregulated and the location rules remained, then, the big corporates who would buy every pharmacy, would fight to keep them. This could be a disaster for the industry making small, knowledge based start-ups very difficult inhibiting the progression of the profession...

Submitted by James on Tue, 11/12/2012 - 18:31.

No, what I'm saying is that ownership of pharmacies should remain with pharmacists but location rules be relaxed. Why should pharmacy be so protected compared to other industries? I think the government are looking at what you mention & they will have more support from pharmacists these days than ever before.

Submitted by Philip Day on Sun, 02/12/2012 - 19:11.

As Joseph would know from my comments on Auspharm, I favour a more corporatized approach to ownership more along the lines of say Boots in the UK rather than the big 2 Coles & Woolies owning them. The advantage would be particularly for young pharmacists in terms of career progression & staffing of rural pharmacies. As I stated on Auspharm rural towns could be served by a Pharmacist working for "Boots" or similar for a year or 2 who could then transfer to another "Boots" in their hometown. A bit like country service as happens to teachers, which is another field I once worked in for a few years.
The current system is really only good for those with family money or who are part of a dynasty of pharmacy owners.
Phil D.

Submitted by Joe Conway on Wed, 05/12/2012 - 19:13.

I think that a corporate structure would definitely help with staffing pharmacies in rural towns. The consistency between stores does make it easier to move staff around different stores and between city and country. However, I feel that rural pharmacy owners are often used as political pawns?
If pharmacy went open, then it would be the richest who would own pharmacies still? Rich people own the most in our capitalist society. I don't think that it matters who owns the pharmacy as an argument in itself. I think what matters is how the pharmacy is run, the service experienced by customers,the health outcomes of those customers, and the cost of that pharmacy service to the taxpayers. If Clive Palmer or James Packer bought a pharmacy, do you think that that pharmacy would be any different from what we have now? At least those pharmacies would benefit from having an owner with money to invest to improve the business as opposed to having an owner who is up to their eyeballs in debt, trying to be everything to everybody, and can't get the capital as easily to invest in their business...

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