s GP Consortia, Medicare Locals - So What's it all About? | 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

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

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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GP Consortia, Medicare Locals - So What's it all About?

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.

Change is one of those activities that we often appreciate seeing in others, but it is always uncomfortable when it is happening to us personally.
Yet, as one philosopher once said “In the midst of change, everything remains the same.”
Government is renowned for taking an existing process, breaking it up and giving the reformatted bits a different name, and sometimes even a different owner.
Down the years, pharmacy has remained resilient, but it is beginning to show signs of stress due to poor vision, poor management, a heavy dependence on government and a “greed is good” syndrome.
It is the latter that weakens the moral fibre and strength of pharmacy.
Changes in UK pharmacy are often reflected by adaptation into Australian pharmacy.
So when a major change is signalled in the UK, it is useful to consider what impact it may have in Australia and in what format.
i2P asked Mark Coleman to consider the import of the following article that appeared in PJ Online on the 26th October 2010.
His comments appear below the article.

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PJ Online article:
Evidence for pharmacy services needs to be gathered

An evidence base for pharmacy services needs to be collected within the next 18 months to two years so that data to support the continued commissioning of enhanced services by GP consortia exist when primary care trusts are abolished.

This was the view of some stakeholders at the All Party Pharmacy Group meeting held in London yesterday (25 October 2010), who called for a systematic approach to development of an evidence base.

However, other participants argued that GP consortia may not have much control over who provides services if the Government goes down an “any willing provider” route, as it has indicated it intends to do. Under an “any willing provider” model, several approved providers can offer a service to patients at the same time but have no guarantee of numbers they will treat.

Georgina Craig, lead for the NHS Alliance pharmacy commissioning network, said that it would be up to providers to decide whether or not to choose the any willing provider model and get on and deliver the services.

Kevin Noble, community pharmacy lead at Isle of Wight NHS Primary Care Trust, said that the trust had adopted the any willing provider model and that it was working well for pharmacy. Last year, for example, pharmacies provided more than four times as many consultations for emergency hormonal contraception than all other providers put together.

Ms Craig said that she believed the any willing provider model to be a good model for community pharmacy, and emphasised that pharmacy already operated in this sort of system given that patients chose where they took their prescriptions and pharmacists competed with each other to provide a good service.

“If that model is extended across public health services, across the NHS and across all providers, if pharmacy is really a place where people prefer to have services provided, then the model would work very well for pharmacy,” she said.

Chief executive of the Pharmaceutical Services Negotiating Committee Sue Sharpe pointed out that an any willing provider model worked, in part, because pharmacists had the confidence that they were able to provide services.

Vice-president of the APPG Baroness Cumberlege stressed that there was no point in complaining about competition because it was going to happen.

“The any willing provider model is a moment of real opportunity for pharmacy. Once GP consortia are sorted in terms of geographical areas, it would be a great pity if pharmacists within those geographical areas did not get together and say ‘look, this is what we can offer’,” she said

We have to ride the wave or risk getting left behind, she added.

Mark Coleman



I have been asked to comment on the above article.
I have to admit that until this article was sent to me I had no idea that the concept of “any willing provider” existed at all.
I will give it my best shot, for during research into this subject, it became apparent that a variation of this model may well be implemented in Australia in the not too distant future.

The background to its emergence lies in the restructure of some aspects of the NHS in the UK involving Primary Care Trusts (PCT’s).
PCT’s provided a range of multidisciplinary health services that included pharmacy.
Under the PCT umbrella, pharmacists provided a range of services from a base of dispensing, branching into clinical services e.g. the management and monitoring of patient anticoagulation therapy with a high level of independent decision-making, through utilising agreed protocols requiring minimal or nil reference to a GP.

PCT’s have worked reasonably well to this date, but criticism has occurred in that services were not uniform across the country and not all individual services were of comparable standard between PCT’s.
So in true bureaucratic fashion all the elements of PCT’s are being reassigned into a new life and structure called “GP Consortia”.
However, to eradicate some of the past problems, services will be developed into a descriptive standardised list and the twist will be that any health provider (or group) can bid to provide for the listed service, generating competition between health providers.

This has generated some uneasiness among health providers who are not used to the full blast of competition (including pharmacists) but if you examine some of the comments in the above article you will note that the new model is very suitable for pharmacy as it parallels the traditional model of providing services.
In some areas e.g. emergency contraception, pharmacy appears to be well ahead of other providers for this niche service.
This is in contrast to recent media releases surrounding the same service here in Australia, where pharmacy is quoted as rating poorly by patients seeking this service.
Alarm bells should be ringing quite loudly in response to this poor rating and steps taken to rectify the deficiencies, because it is a service that Australian pharmacists should be more than competent to provide.

In this edition of i2P there is an article published as Medicare Locals - Extending and Coordinating Primary Care that outlines a new primary care organisation utilising the old Divisions of General Practice, to build a new multi-disciplinary service that appears to have remarkable similarities to the GP Consortia Groups emerging in the UK. See also the New Zealand version .
At the recent PAC conference held in Melbourne, Warwick Plunkett, president of the Pharmaceutical Society of Australia said:

“PSA will be a significant funder of a major long-term, awareness campaign which intends to change policymakers’ outdated views of pharmacists,” Mr Plunkett said.

“Currently pharmacy is not part of the health reform process, it is not integrated into the primary health-care environment, there is a lack of payment-for-service model, and a lack of definition of the role of pharmacists”

Given that I happen to agree with the second sentence in this statement one wonders where the PSA has been all these years and why they let the PGA run all over them.
They will certainly have to improve and do what they say they will do, if pharmacy is to have any place in Medicare Local.

Comments on GP Consortia from industry leaders in the UK include:

*  “Pharmacies need to work together rather than against each other, adding that, in the future, patients will not be the only customers that pharmacists have to meet the needs of — they will have to meet the needs of manufacturers and the NHS as well.”

* “What pharmacy needs is a central vision and a nationally co-ordinated framework of services that can be commissioned and negotiated locally”

*  “ In the new NHS structure, efficiency savings should not come from low-value contracts, which have been a major cause of workplace stress for pharmacists and their staff.”

The above three comments seem, to me, to be an ideal platform for the PSA to adopt.
There is a need to begin a dialogue with all the pharmacy groups (Chemist Warehouse all the way down to the small independent) and to begin the process now of working together.
A negotiated policy framework would be a good start and PSA is in the best position to achieve a harmonious result, because they are involved in the professional service process- a less competitive role compared to commercial services.
They also need to talk to manufacturers to see what support is available from that source, and a separate liaison with DoHA is a given and should be ongoing.
Something like a 5CPA for professional services outside of the PBS would seem to be a primary objective.

The comment relating to a central vision and a nationally coordinated framework of services that can be commissioned and negotiated locally, is also extremely important.
Local branches of pharmacy organisations are thin on the ground. Doctors, on the other hand, have always had strong local groups and have demonstrated repeatedly the viability and strength through their local Divisions of General Practice (now evolving into Medicare Locals).
Pharmacy will now have a huge battle on its hand to have any presence within any local primary health care organisation, and the PSA will need to lobby politically now rather than later.

Work will have to be done to build the levels of confidence in professional service delivery and a list started for pharmacists to contribute to and assist in fleshing out actual services. This could build "grass roots" momentum.
Failure to be inclusive in this area will invite disaster.

And what must also be factored in, is the recruitment of nurses into general practice that now are looking to dominate traditional pharmacy activities. They are a formidable force.

Why do I get the feeling that pharmacy has squandered the chances it already had?

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