s In the midst of change – everything remains the same | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2010         Volume. 2 No. 6   
Information to Pharmacists

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Feature Contribution

The New Competitors- Wholesalers, Manufacturers, Pharmacists and Nurses

Peter Jackson

As manufacturers get pressure from funders of their products such as the Pharmaceutical Benefits Scheme (PBS) in Australia, they will look at reducing costs in the supply chain.
Quite commonly this will take the form of direct distribution to pharmacies (and other business formats) rather than through wholesalers.
Wholesalers in turn face a series of challenges that includes developing a range of efficiencies, the battle for pharmacy numbers, manufacturer strategy, generic strategy and vertical integration. However, this may not be enough and wholesalers may need to develop a strategy involving industry dynamics.
While there will be modest industry growth over the next decade, new products will not be the major generator and research indicates that growth of branded products will be driven by primary care.

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English Pharmacists See Opportunity - Australian Pharmacists Hesitate

Staff Writer

The health systems of England and Australia have many similarities.
However, one NHS rule that we have escaped here in Australia is the 48-hour waiting time guarantee for a GP appointment.
Introduced by the former Labor government, it is now being scrapped as an initiative of the new government to eliminate bureaucracy and targets that had no clinical justification.
Patients in England will no longer be guaranteed a GP appointment within 48 hours under a scaling back of all NHS targets.
Instead, doctors will be allowed to prioritise patients, affecting up to 189 million consultations a year.

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Remote Dispensing Expands Globally

Peter Sayers

Systems for dispensing prescriptions remotely have been available in Australia for some time, but have yet to gain traction.
These systems are characterised by having a TV link to a “live” pharmacist who is located remotely from the machine.
One of the first remote dispensing machines built using Australian technology and manufacture was ExpressRx.

Comments: 3

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How to measure competence?

Dr Linda Bryant (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA)

The concept of ensuring that our workforce is competent is an excellent idea. At a time of rapidly changing clinical information, our undergraduate degree of 30 years ago (now doesn’t that make you feel old!!) is simply inadequate. For those of us that went to University we learned Knowledge, Understanding, Thinking and problem solving. The rest of us were taught on the job. Our work experience, built on this foundation, helped make us competent. The problem is – measuring that competence over time.

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Community pharmacy’s crystal ball is fogging up

Neil Retallick

At the Generics Conference held in Sydney a couple of years ago, when PBS Reforms I was the Government’s latest and greatest initiative to contain the cost of the PBS, a number of speakers addressed the impending impact of WADP or Weighted Average Disclosed Pricing.
Two of these speakers had developed mathematical models to chart the revenue and gross profit dollars that would be generated in the dispensaries of community pharmacies over the following years through to 2012 and 2013. In both instances, the speakers presented data that showed the dispensary revenue and gross profit lines decreasing quite dramatically as the effects of WADP took hold of PBS medicine prices.
These soothsayers saw gloom and doom in their crystal balls, or their spreadsheets if that’s what they preferred to use.

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Quackery, Skeptics and Acupuncture….

Chris Wright

The reaction to the little piece about Naturopathy and my doctor (published in a June i2P update) has caused some not entirely surprising flame bursting by those who believe a remedy must be science based.
Hmmm, a good point.

Comments: 2

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Show me the Money!

Peter Sayers

Well, we are past July 1 and there has been no official statement on how, when and where the 15 cent payment for electronic prescriptions materialises.
Government does not appear to have specified how it wants a pharmacy claim presented, and system vendors may not have included a module to create an acceptable audit trail as yet.

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In the midst of change – everything remains the same

Neil Johnston

Pharmacist survival strategies have essentially remained the same for well over a century.
In simple terms when pressure is applied to dispensary margins more OTC opportunities are developed.
A conscious decision is made to expand the range of inventory items in niche markets and then key items are discounted to expand market share within that new market.

Comments: 2

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Sublime treachery, delivered par excellence

Chris Wright

It’s probably all been said but that astonishing ascent of the Member for Lalor Julia Gillard has nailed yet another nail in the coffin of our long cherished democracy.
Again, the power-crazed toe-cutters of the Labor Party were unable to muster the restraint required to allow an elected comrade see out the full game.
The bitter hatred (which is often factional but not necessarily in this case) that lurks behind closed doors was just too much. In the end those who read from the Graham Richardson manual on dealing with personnel superfluous to current requirements acted with rare brutality and “Kevin 07” became “Kevin gone to political Heaven” in a blink.

Comments: 7

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Cutting Carbon with Hydrogen Batteries

Staff Writer

TELSTRA'S mobile base stations and some exchanges could soon be backed up by energy efficient hydrogen fuel cells that promise to deliver a 20 per cent carbon emissions reduction compared with the diesel generators currently in use.

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The RACGP announces its new President

Staff Writer

The Royal Australian College of General Practitioners (RACGP) is pleased to announce the appointment of Professor Claire Jackson as President-elect.
Professor Jackson is a GP and GP Supervisor in Inala, Brisbane and is Professor in General Practice and Primary Health Care and Head of Discipline at the University of Queensland. She has been chair of the RACGP Council and the RACGP Queensland Faculty. She has had significant involvement in health reform in many areas, serving on the National Primary Care Strategy Expert Advisory Group and providing a commissioned paper for the National Health and Hospital Reform Commission.

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Outliving most of the world, but not healthy in every way, says nation’s health report card

Staff Writer

The national health report card released by the AIHW gives a pointer as to where primary health care funds are going to be directed to, and a guide as to what "specialties" will need to be invested in by pharmacists.
And following similar lines, the education that will need to be provided to back those specialties.
A systematic approach to developing and marketing pharmacy clinical services is long overdue, and leadership is stagnant.
What can be done?
In practical terms - probably nothing until after the next federal elections, but that gives a small window of opportunity for our lead pharmacy organisations to work out a plan of action and support each other in the process.
Political game playing, whether at the local, state or federal levels, is crippling initiative in all sectors of the economy - but in particular, health.
And pharmacy needs to attract some urgent funding to initiate some primary health care projects that can soak up some of the surplus graduates before it is too late, and we lose these valuable human resources.
It would also be interesting to know what impact existing pharmacy activities contribute to the report card statistics.

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Reviewing the Pharmacist Code of Ethics

Staff Writer

Renewing the code of ethics for pharmacists in the wake of the recent changes to healthcare legislation will be among the topics considered at a wide-ranging ethics conference at the University of Sydney (17-18 June 2010)
World-renowned ethics expert and Laureate Professor Peter Singer will deliver a keynote address on World Poverty: What are our obligations?
The Australian Association for Professional and Applied Ethics conference is being hosted by the Faculty of Pharmacy, under the theme Ethics in the Professional Life: Past, Present and Future.

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Study finds antidepressants not working in older men

Staff Writer

A recently published study in the journal PLoS-One has found that more than half of older men who use antidepressant medication or psychotherapy are not responding to treatment.
Lead author, Professor Osvaldo Almeida, Research Director of the Western Australian Centre for Health and Ageing at The University of Western Australia, said the finding was surprising and alarming.

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Tests help predict falls by Parkinson’s sufferers

Staff Writer

A group of tests may help predict which people with Parkinson's disease are more likely to fall, according to a study by Queensland University of Technology (QUT).
The study results were published recently in the American Academy of Neurology's online medical journal Neurology®.

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Cling Wrap Catches Carbon Dioxide

Staff Writer

High tech cling wraps that ‘sieve out’ carbon dioxide from waste gases can help save the world, says Melbourne University chemical engineer, Colin Scholes who developed the technology.

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Tea tree oil offers hope to skin cancer patients

Staff Writer

Tea tree oil may be used in future as a fast, cheap, safe and effective treatment for non-melanoma skin cancers and precancerous lesions, according to researchers at The University of Western Australia.
A three-year study by the University of Western Australia Tea Tree Oil Research Group has found solid tumours grown under the skin in mice and treated with a tea tree oil formulation causes inhibition of tumour growth and tumour regression within a day of treatment. Within three days, the tumours cannot be detected.

Comments: 1

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NPS Replaces TAIS Service

Staff Writer

NPS will discontinue funding the Therapeutic Advice and Information Service (TAIS) for health professionals as of 1 July 2010.

A guide to medicines information resources has been compiled on the NPS website which can be accessed via the health professional web page. Please note that some of the listed resources are freely available and others for a subscription fee.
Follow this link http://nps.org.au/medicines_information_guide.

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Consultant Pharmacists Freed Up

Staff Writer

The following press release issued by the AACP confirms changes to the HMR model that will at last see an opportunity to professionally collaborate with GP’s and to build a relationship with hospitals.That it has taken so long to deliver the obvious is sad.
But not to dwell on any negatives, it now frees up consultant pharmacists to develop independent business models to deliver services in a more economical, timely and streamlined fashion.
It may also open a secondary market for e-document exchanges capable of quickly sharing information for intended recipients.

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Vitamin C plays vital role in battle against cancer

Staff Writer

New research from the University of Otago, Christchurch, shows that vitamin C can help curb the growth of cancer cells.
The study, led by Associate Professor Margreet Vissers of the University’s Free Radical Research Group, is the first real evidence of a connection between vitamin C and tumour growth.
Associate Professor Vissers says “Our results offer a promising and simple intervention to help in our fight against cancer, at the level of both prevention and cure”.
The article is in the latest edition of the prestigious Cancer Research journal.

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Gut flora study gives insight into obesity

Staff Writer

A UQ academic's research into whether nature or nurture influences the development of gut flora has been published in Nature and may hold the key to understanding obesity.
Dr Florent Angly said the fundamental research was significant since some forms of obesity could be caused by the action of microbiota.

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At last - a peak national pharmacy group in formation

Staff Writer

A forum initiative developed by the Pharmaceutical Society of Australia (PSA) has seen discussion on the early stages of the first truly representative peak national pharmacy body.
It is presumed, when eventually formalised, that this body will be capable of generating national policies that will bind its membership and provide a cohesive single face for the "whole of pharmacy".
It is also presumed that this group will have provision to absorb emerging and new pharmacy organisations.
PSA is to be congratulated on taking the lead role in the establishment of the initial forum that is certain to win support by all pharmacists in whatever sector they work in.
In the current climate of severe political and commercial pressures on pharmacy, one wonders why it has not happened a lot earlier than this, because the disparate ambitions of various pharmacy organisations up to now has definitely worked against the best interests of the pharmacy profession as a whole.
i2P has often commented on this issue and the need for a peak body that is truly representative of pharmacy.

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Youth lead the adoption of e-health

Staff Writer

The ‘net’ generation, spanning 13 to 33 year olds, has embraced technology as the norm and is expected to adopt e-health as just par for the course in their highly connected lives according to several leading youth health experts.
Jonathan Nicholas, Chief Executive Officer of the Inspire Foundation, the organisation behind the web-based mental health support service for young people, ReachOut.com said, “As an organisation that uses the internet to connect with young people, we see a number of benefits for young people flowing from the proposed e-health record.

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US ‘Renaissance’ in pharmacy’s role as a vital health resource

Staff Writer

Pharmacists in Australia may be forgiven for feeling invisible as they search for roles and activities that gainfully utilise their experience and skills.
New projects and programs often mention "allied health" and nurses, but not pharmacists.
There are probably two major reasons for this problem:
* The Pharmacy Guild of Australia (PGA) has allocated resources exclusively to PBS-centric activities.
This has led to a reduction in jobs for new pharmacists and a surplus human resource. This is in stark contrast to all other health professions that seek to increase their practitioner numbers.
* GP lobby groups have promoted the use of practice nurses in key areas normally in the pharmacy domain. This has had the effect of increasing the number of "short" consultations, with the GP providing evaluation and the practice nurse to complete the work.
GP lobby groups have also been active in suppressing pharmacy initiatives particularly in the concept area of medication continuance.

In the US the opposite is occurring, mainly because of the fractured health service that exists in that country. However, while it can be said that Australia's health system may be better, it seems to be dysfunctional for the moment.
This may represent an opportunity for pharmacy if it can be properly articulated to politicians.
It appears that governments only turn to pharmacy when they need bailing out.
The end result always sees pharmacy disadvantaged as policies and promises are inevitably changed.
The following story recently appeared in Drug Store News

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Complementary and alternate medicines

Neil Johnston

There are many views held in pharmacy as to the efficacy and value of complementary and alternate medicines.
At i2P we endeavour to cater for all perspectives by publishing the views of skeptics such as Loretta Marron, who takes a “no holds barred” approach, and insist that the only perspective for medical professionals to prescribe/sell drugs be evidence-based.
On the other side, we recently published an article by Chris Wright (a regular i2P author), who is not a pharmacist but has a good working knowledge of pharmacy.
He opted to take acupuncture treatment from his GP instead of consuming anti-inflammatory drugs.
His GP gave him the choice.
Chris’s article drew strong comments from the “evidence-based perspective”.
(Follow this link to view comments at the end of the article)
Chris chose acupuncture because he felt it would work for him.

i2P asked Mark Coleman to make a comment which appears below the news item that originally appeared in Pharmacy News on June 24 2010.
Acupuncture is mentioned in the last line of that news item.

Comments: 1

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In the midst of change – everything remains the same

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.

Pharmacist survival strategies have essentially remained the same for well over a century.
In simple terms when pressure is applied to dispensary margins more OTC opportunities are developed.
A conscious decision is made to expand the range of inventory items in niche markets and then key items are discounted to expand market share within that new market.

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Quite often product selection bears little relevance to health as all is sacrificed to build sales volume with sufficient margin for survival.
For example, I clearly remember the year 1960 when I was an employed pharmacist in the southern Sydney suburb of Caringbah which was experiencing a surge in population and shopping complexes.

This was also a time of “credit squeeze” , recession and import restrictions on some luxury items.

There were fourteen pharmacies in Caringbah (location rules did not exist) and I remember the pharmacy opposite decided to sell television sets.
That particular pharmacy styled itself as a “Drug Store” and its sales volume of television sets was enormous.

Everybody in Caringbah knew of this Drug Store and while the sale of TV sets was criticised by other pharmacists, the general public seemed to respect the decision by purchasing TV’s in volume.
Maybe the trust factor in pharmacy was one of the reasons for this support.
The Drug Store's dispensing and other OTC sales increased incrementally with TV sales.

Across the road where my selected employer was based, I was given a bleak picture for the future and the probability that my employment might not be secure, as sales were not increasing in volume.
I suggested that we try and emulate our opposition, but to pick a different market such as photographics.

I also entered into a form of enterprise agreement whereby I was paid a 20% commission on all sales generated by me personally and no base salary. That clearly put a boundary around my cost - no sales, no commission.

In 1960, all specialty photographic stores were located in the centre of Sydney with the odd suburban pharmacy developing the market. Import restrictions starved the Australian market with the result that anyone that had any photographic stock whatsoever, could virtually sell it within a short space of time.

I set to work by first asking my employer if he had any privately held photographic equipment he would like to sell. He said that he had a Zeiss Contaflex 35mm camera and that he would be pleased to liquidate it.
He went home for morning tea and brought the camera back, which was placed in the pharmacy display window at about 11.30 am. At 2.30 pm the same day I managed to sell the camera.
The commission on that sale equatede to an amount I would normally have expected for one week’s wages.

I then went out to cultivate all photographic wholesalers and to buy selected items at auctions of Customs seized cameras and accessories.

I also cultivated a number Qantas pilots who lived in the area, and they imported for me a range of Polaroid film (not available in Australia in 1960), also Kodak Ektachrome film, which was also unavailable but highly sought after.

Within two years the business was booming as Caringbah become known as the place to buy photographics.

This surge in business necessitated larger premises.
About four doors down the street a sizable hardware store was about to become available, and a lease was secured.

Business continued to increase in all departments and further expansion was planned.

I was invited to join a partnership that would manufacture photographic accessories such as slide boxes, lens hoods, filters, gadget bags, photoprocessing chemicals etc.
Business was initially good but frustration occurred when it was found that quality assurance did not exist with the average Australian manufacturer.

But that is another story.

A couple of years later import restrictions were removed and Australia was flooded with high quality Japanese photographics at very cheap prices.
The manufacturing business was closed and the retail photographic section was downsized and more emphasis placed on traditional pharmacy markets.
The end result was still a thriving pharmacy employing a range of pharmacists, technicians and sales assistants but with an altered product mix and a new balance.
The cycle was repeating itself once again.

This story is about a different era, but the principles remain the same.

It’s about identifying the market segments that you have some expertise and ability with, and generate a new market-mix in a pharmacy environment in 2010.
It can focus your thoughts in a positive direction, and it will make you a survivor -  less dependent on PBS prescriptions.

You will also be criticised as you do things in a different way, but values are in the eye of the beholder – and critics don’t pay your bills.
It's also about breaking the inertia you often experience in business, which creates stricture on your thoughts and progress.
Retail sales have always subsidised professional activity and prescription to sales ratios of up to 90% reflect the decline in OTC sales and the loss of "balance".
The majority of Australian pharmacies are unbalanced.
This ratio needs to be managed in the range of 45-55% and with a critical mass of sales, there will be sufficient profit to create delegations and create a budget to develop clinical and other professional services.
It will also bring new life to your business as you change to a fresh direction and begin to make some progress.

Return to home

Submitted by James Delahunty on Thu, 15/07/2010 - 08:30.

Neil.Were you refering to Phil Joyce who ended up a director of King Ranch and had a Santa Gratrudis Stud at Bundanoon?
If so he did his apprenship under my Dad in Brisbane.
Cheers James Dela

Submitted by Neil Johnston on Fri, 16/07/2010 - 22:25.

James: You nailed it in one. Given the stream of TV sets going in and out of that pharmacy I am not surprised Phil Joyce developed a range of unusual interests and investments.
Joyce's Drug Store was an institution in Caringbah and it's interesting that he did his apprenticeship with your father.
It must have been an entrepreneurial environment.

Neil

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