s Multi-Professional Prescribing- The AMA Lost Out | I2P: Information to Pharmacists - Archive
Publication Date 01/11/2013         Volume. 5 No. 10   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the November 1 2013, Homepage Edition of i2P – Information to Pharmacists E-Magazine.
We are approaching the end of a calendar year, a year many of us would like to put behind us.
In this edition we report on the “dark forces” that are beginning to surround us while the profession and industry find themselves in a weakened position – far weaker than they were this time last year.
Quite a few opportunities exist and quite a few opportunities have been squandered by our leadership organisations and their executives.
What pharmacy seems to not have is a group of mentors capable of guiding the introduction of paid clinical services.
Because this activity requires a paradigm shift in attitude and culture, their introduction has to be driven by local leadership.

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News Flash

Newsflash Updates November 2013

Newsflash Updates


Regular updates from the global world of pharmacy.
Access and click on the title links that are illustrated.

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Feature Contribution

Is a Community Pharmacy an Incompatible Environment for Clinical Services?

Dr John Dunlop (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA)

The recent article “observations on implementing a clinical service”,1 stimulated me to share my perceptions of this well meaning approach to providing a clinical service within a community pharmacy.
Firstly let me admit to being much older than the author of this article, and let me establish that I spent over 40 years in community pharmacy before embarking upon a clinical career.
The perception that a viable clinical pharmacy practice can be undertaken in a community pharmacy is contrary to the reality and numerous assessments described in the researched literature.
Having studied this problem for many years, I have come to the conclusion that a community pharmacy environment, which is predominantly a supply and distribution model, is incompatible with the provision of clinical roles.

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Stuff to Think About

Gerald Quigley

Editor's Note: Gerald recently attended a meeting hosted by Medicines Australia.
He picked up on the undercurrent related to the meeting's real agenda.
There are some sinister elements that sense that pharmacy may be in a weakened state with a large number of pharmacists being focused on survival-both employers and employees.
These elements are looking to exploit pharmacy and limit its independence as part of a wide-ranging agenda.
Your help is needed.

The words which literally grabbed me at this meeting included “caught”, “capture” and “tracking”.
No, we weren’t discussing wild animals or escapees from the penal colonies……we were discussing dedicated, hard-working, committed and patient-focused health professionals in Australia.
I attended the Medicines Australia Transparency Working Group meeting in Melbourne last month.
The discussions were centred on the medical profession, more especially on prescribed medicines from my understanding.
References though were continually made about pharmacists.

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Roadblocks in Clinical Services Provision

Neil Johnston

I have been reading with interest, Peter Sayers' journey into paid professional services and his cautious optimism.
Now, as a feature article in this current edition of i2P John Dunlop, a respected New Zealand pharmacist, expresses doubt that clinical pharmacists are going to make it in a community pharmacy setting.
Further, Professor Austin Zubin at a recent PAC2013 conference in Brisbane identified a problem amongst pharmacists he describes as ‘Paralysis in the face of ambiguity’ as he pondered why pharmacists were not taking up opportunities in primary health care.
“Despite abundant opportunity and patient demand, government recognition etc, across the world, a similar picture emerges of a profession that is its own worst enemy,” he said.
 “The standard response to new opportunities is, ‘I don’t have enough time, I’m not trained for this, I’m not getting paid enough, it’s too costly….”

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A Report on HPV Vaccine at the 3rd world congress on Cancer Science and Therapy in San Francisco October 2013

Judy Wilyman

The University of Wollongong recently provided funding for me to present my research on the HPV vaccine at the 3rd world congress on Cancer Science and Therapy in San Francisco.
On the 22nd October I presented my research that demonstrates that HPV vaccination has not been proven to be safe or effective against cervical cancer.
Japan and India have recently stopped recommending this vaccine due to deaths and disability after vaccination.

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Is the CHF (Consumer Health Forum) representative of consumers?

Mark Coleman

i2P has often commented on the orchestration of various lobby groups and their suspect behaviours when orchestrating their seemingly unrelated activities.
They seem to have gotten their chorus to be sung in tune.
Gerald Quigley referred to these "dark forces" in his article in this month's edition.
Their activities are disruptive, damaging and distracting to say the least and some border on the illegal.
They also have a common thread in that members of the Skeptics Society are common within their membership allowing the various groups to work in concert.
i2P readers need to be aware of these activities because they may have to mobilise their resources to counter behaviours that affect pharmacy-directly and indirectly.

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Are On-Line Shoppers Only Concerned With Price?

Chris Foster

It’s easy to assume that the on line shopper is attracted to that medium solely by the cheaper prices that may be available.
And, if price was the only criteria, the majority of bricks and mortar stores (B&M) would well and truly be out of business by now.
Yes, as always, there are a number of consumers where price is the sole determinant in the decision to purchase. Traditionally, this has been around 10% to 15% of consumers.
However, what are the real facts?

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I’ve been texting, I mean thinking about texting, as well as dialing, handwriting, and face-to-face talking in our hurry-up worl

Mark Neuenschwander

These days we call the US Post Service [sic] snail mail. But in 1775, Ben Franklin’s innovation sped up letter travel between Philadelphia and San Francisco from forever to a few months.
In 1844, Samuel Morse accelerated message delivery exponentially. Transmitting words at the speed of light, the inventor’s telegraph made Abraham Lincoln our first online president, enabling the commander in chief to chat instantaneously with his generals on the front lines.
In 1862 the transcontinental railroad relegated the year-old Pony Express to mothballs by whisking letters from coast to coast at 30-some miles per hour in under ten days.

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Caring for you Caring for others – a report on the Health Professionals’ Health Conference 2013 3 October to 5 October 2013

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

Evolving from the Doctors’ Health Conference the program of the Health Professionals’ Health Conference included much of relevance to all health professionals including pharmacists. Delegates came from all over Australia and New Zealand as well as several travelling from countries further away including England, Ireland, Hong Kong, Singapore, Canada and USA. Delegates included a range of health professionals and medical students. Notably only two pharmacists attended this conference which had approximately 160 delegates.

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Culture Bonds, Right?

Barry Urquhart

PAY ATTENTION: Applying “automatic cruise” is not a viable or appropriate option for management by business leaders today.
The pathway to success and to the future is littered with numerous, often unforeseen barriers, impediments and filters.
There is a clarion-clear message in this for all. It parallels the findings of a recent detailed study among motor vehicle drivers and into the causes of road accidents.
The consistent and most disturbing primary cause of motor vehicle accidents was not speed, alcohol, climatic conditions or unfamiliarity with the local road network (through these were significant, often independent contributors to the accident statistics).
The highest ranking causal factor was INATTENTION.
Being distracted from the primary focus can, and often does have dire consequences.
On the road these can include receiving and sending text messages, mobile telephone calls, loud and aggressive passengers, external eye-catching activities and simple tiredness, boredom and outright inattention.
The consequences can and do impact on many.

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Treating ADHD with Vitamin B-3 (Niacinamide)

Staff Writer

From Orthomolecular Medicine News Service- Editor: Andrew W Saul

ADHD is not caused by a drug deficiency.
But it may indeed be caused by profound nutrient deficiency, more accurately termed nutrient dependency. Although all nutrients are important, the one that an ADHD child is most likely in greatest need of is vitamin B-3, niacinamide.

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Celebrating youth service at We Day

Harvey Mackay

The atmosphere was beyond electric: 18,000 cheering teenagers, and it wasn’t for a rock star, a pro athlete or even canceling school.
This remarkable group of students gathered in St. Paul, Minn., for We Day in early October to be recognized for their stellar record of volunteering.
And this was only one of more than a dozen such gatherings across North America.
We Day is described as a celebration of the power of young Americans to create positive and lasting change, not only in their communities and around the world, but within themselves.

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Pointless and perilous pathologies

Loretta Marron OAM BSc

Off sex, always tired or feeling low? Why not see a natural therapist to find out what's wrong. They offer a variety of tests to nail your problems - but do they work? Hang on, the experts say "No"!
"Commercially driven, unvalidated, pseudo-medical tests are endangering the well-being of Australians by giving wrong diagnoses and incorrect reassurances of their health",
so say the Friends of Science in Medicine (FSM) Pathology Advisory Group. Consisting of distinguished pathologists and allergists from both Australia and New Zealand, their warning comes with the support of The Royal College of Pathologists of Australasia (RCPA).

Comments: 1

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Multi-Professional Prescribing- The AMA Lost Out

Neil Johnston

You have to scratch your head sometimes, particularly when you see news reports quoting Steve Hambledon (AMA President) stating that autonomous prescribing by “non medical health professionals” (which, of course, includes pharmacists), is “dangerous”.
This statement is just about as ridiculous as an earlier statement indicating vaccines provided through pharmacy were dangerous because pharmacy lacks suitable refrigerators.
This followed the decision by COAG to approve the draft Health Professionals Prescribing Pathway, now only requiring legislative approval and Board Guidelines to become a significant factor in the pharmacy profession moving forward.

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Niacin Beats Statins Supplements and Diet are Safer, More Effective

Staff Writer

OHMS Newsletter
by Andrew W. Saul, Editor

 Statins for everyone?
If media are to be believed, and if the drug industry has its way, the answer is "you bet."
The American Academy of Pediatrics has stated that kids as young as eight years of age might take statin drugs.
Specifically: "As a group, statins have been shown to reduce LDL cholesterol in children and adolescents with marked LDL cholesterol elevation . . . when used from 8 weeks to 2 years for children aged 8 to 18 years." http://pediatrics.aappublications.org/content/128/Supplement_5/S213.full
Strangely enough, American Academy of Pediatrics projects receive cash from Merck & Co., Pfizer and Sanofi-Aventis, as well as from Procter and Gamble, Nestlé and other large corporations. http://www.aap.org/en-us/about-the-aap/corporate-relationships/Pages/Friends-of-Children-Fund-President%27s-Circle.aspx

Comments: 1

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Chiropractors and GP’s told to team up after published research

Mark Coleman

Recently, the Chiropractors Association of Australia partially funded a study undertaken by researchers at the University of Melbourne, which has provided the best picture yet of the most common conditions treated by chiropractors.
It suggests most chiropractic treatments and consultations undertaken in Australia are evidence based.

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Fart With Confidence

Peter Jackson

Technology derived during the development of protective clothing for use in chemical warfare has now been adapted for everyday consumers to assist them in daily living. The discovery that carbon fibre can absorb and filter flatulence odours and incontinence odours has now been put to practical use in a commercial product called "Shreddies".

Comments: 1

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What Replaced Kodak?

Neil Johnston

At the turn of the 20th Century Kodak  reigned supreme.
Box Brownies were the camera for every occasion and the developing and printing of film was big business for pharmacy.
Kodak liked the alliance with pharmacy because pharmacists understood the science behind the various types of film, the processing chemicals and the nuances of the various printing papers.
Yes, Kodak liked the pharmacy retail environment so much that any pharmacists could order a repaint of their front of shop awning at any time – free of charge, provided the name Kodak dominated in the Kodak colours of red, yellow and black.

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A Catalyst for Change

Gerald Quigley

Editor's Note: Australia, it seems, has had the highest global rate of prescribing for statins.
That seems to suggest that Australian doctors may have been prescribing unnecessarily, and behind that fact, allowing drug companies to influence them to a greater extent than necessary.
Those $10 meals certainly provided a return on investment for drug companies to the extent that the party may now be over as approximately 40 percent of doctors are reviewing their prescribing practices surrounding statin usage in their patients. Gerald Quigley relates one patient experience.

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Pushing the envelope

Harvey Mackay

“Pushing the envelope” is a phrase that originated with American test pilots like Chuck Yaeger and John Glenn in the 1940s.
It described max stress situations for the metal skin (“envelope”) of a jet aircraft.  In other words, the plane was designed to fly safely up to a certain speed for a certain distance at a certain altitude. 
The job of test pilots was to “push the envelope” by making the plane go faster, farther and higher.  The term “pushing the envelope” came into popular parlance in the blockbuster book and movie (1983) “The Right Stuff.”
Naturally, this phrase is near and dear to me.  On my business card, my title is “Envelope Salesman.”  So literally, I am pushing the envelope every day! 

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Medical Debate Censorship Attempt by NSW Government

Staff Writer

Editor's Note: Until today, I had never heard of the organisation Avaaz.
Avaaz—meaning "voice" in several European, Middle Eastern and Asian languages—launched in 2007 with a simple democratic mission: organize citizens of all nations to close the gap between the world we have and the world most people everywhere want.
Avaaz empowers millions of people from all walks of life to take action on pressing global, regional and national issues, from corruption and poverty to conflict and climate change.
The Avaaz model of internet organising allows thousands of individual efforts, however small, to be rapidly combined into a powerful collective force. (Read about results on the Highlights page.)
The Avaaz community campaigns in 15 languages, served by a core team on 6 continents and thousands of volunteers.
Avaaz takes action -- signing petitions, funding media campaigns and direct actions, emailing, calling and lobbying governments, and organizing "offline" protests and events -- to ensure that the views and values of the world's people inform the decisions that affect us all.

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Inquiry into the Promotion of False or Misleading Health-Related Information or Practices

Judy Wilyman

I'd like to draw your attention to an inquiry that is taking place in the NSW parliament. It is titled ˜Inquiry into the Promotion of False or Misleading Health-Related Information or Practices".
This inquiry is being held by the Committee on the Health Care Complaints Commission (HCCC).
This is the consumer watchdog that investigates consumer complaints or concerns.
The aim of the inquiry is to report on possible measures to address the promotion of unscientific health-related information or practices that may be detrimental to individual or public health.

Comments: 8

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New sensor passes litmus test

Staff Researcher

Edith Cowan University researchers have drawn on their expertise in nanotechnology to update the humble pH sensor, replacing traditional glass electrode devices that have been in use since the 1930s with a new sensor thinner than a human hair.
Electron Science Research Institute Director Professor Kamal Alameh said the sensor could have exciting new applications in the oil and gas and medical industries.

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Structure Sensor 3D Scanner Works with New iPad Air and iPad Mini

Staff Writer

Editor's Note: At i2P we're convinced that 3D printing is going to invade just about every aspect of pharmacy - from tablet and vaccine manufacture, drug testing on a patient's own tissue outside of the body. to design detail for any item of pharmacy furniture.
We are therefore stepping up reportage for this exciting and disruptive technology.


if you were one of the almost 3,000 backers of the Structure Sensor on Kickstarter and were hoping to attach the 3D scanning device to your new iPad Air and iPad Mini with Retina Display, you might be a little worried about compatibility. 
Well, fret not. Occipital, the startup behind the Structure Sensor, has adapted its product to Apple’s latest release.

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New nanoparticle delivers, tracks cancer drugs

Staff Researcher

Chemical engineers and clinicians from UNSW and Monash University have synthesised a new iron oxide nanoparticle that delivers cancer drugs to cells while simultaneously monitoring the drug release in real time.
The result, published online in the journal ACS Nano, represents an important development for the emerging field of theranostics – a term that refers to nanoparticles that can treat and diagnose disease.

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How fat could help solve part of the diabetes problem

Staff Researcher

The pancreas is a large organ that wraps around our gut, and produces the exact amount of insulin our bodies need when we eat – except when we start to develop diabetes, and insulin production slows down. Sydney scientists describe how a fat recycling system within pancreatic ‘beta cells’ determines the amount of insulin they secrete, and so may provide a target for future diabetes therapies.

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Receipt of licence application (DIR 126) from PaxVax Australia Pty Ltd for a clinical trial of a GM cholera vaccine

Judy Wilyman

I'd just like to make you aware of this government action to release a genetically modified live bacterial cholera vaccine into the population. Here is the link to this experiment on the government website http://www.ogtr.gov.au/internet/ogtr/publishing.nsf/Content/dir126
Cholera has not been a problem in Australia for many decades.
I have not seen this mentioned in the media so I hope people will take an interest to find out why this experiment is necessary in the Australian population.

Comments: 2

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Australia’s future healthcare system must be consumer-centric (ASMI 2013 Conference)

Marie Kelly-Davies

The importance of industry, policymakers and regulators putting the consumer front and centre of discussions on Australia’s future health system was a key theme of the 2013 Australian Self Medication Industry (ASMI) Conference in Sydney recently.

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ASMI welcomes community pharmacy support for S3 information-based advertising

Marie Kelly-Davies

The Australian Self Medication Industry (ASMI) is encouraged by strong signals of support from community pharmacy to expand the range of Pharmacist Only (S3) medicines as well as its widespread support of an information-based communications approach to consumers for S3 medicines, as demonstrated by the UTS Pharmacy Barometer released this week.1
Prescription to non-prescription reclassification (‘Rx to OTC switch’) and lifting the current advertising restrictions on S3 communication are key issues that remain high on ASMI’s agenda.

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Dark Forces Emerging - Including Colesworth

Neil Johnston

Editor’s Comment:
The media extract this month comes from a Pharmacy News report that Woolworths is on the move once more with pharmacy in its sights.
We would assume that Coles is also in the mix.
There are many “dark forces” aligned against pharmacy interests. In all my years as a member of the pharmacy profession I don’t think I have seen so many diverse groups waiting in line to “knee-cap” pharmacy activity.
Because many of these “dark forces” overlap and help each other along, I have asked Mark Coleman to clarify these “dark forces” from his perspective, because he has been researching some of these organisations and has written an article about some of them in this edition.
In no way can I see a Liberal Government, the representatives of big business, move to restrain Colesworth, except for minor marginal activities.

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Multi-Professional Prescribing- The AMA Lost Out

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.

You have to scratch your head sometimes, particularly when you see news reports quoting Steve Hambledon (AMA President) stating that autonomous prescribing by “non medical health professionals” (which, of course, includes pharmacists), is “dangerous”.
This statement is just about as ridiculous as an earlier statement indicating vaccines provided through pharmacy were dangerous because pharmacy lacks suitable refrigerators.
This followed the decision by COAG to approve the draft Health Professionals Prescribing Pathway, now only requiring legislative approval and Board Guidelines to become a significant factor in the pharmacy profession moving forward.

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The AMA view is that autonomous prescribing encourages fragmented health care and poses greater risks to patient safety.
The PGA view has been that any services requiring a fee for service, should be tied to a pharmacy, and not the individual pharmacist.
Both of these views are archaic and it is time for a Pharmacist Practitioner to be allowed to move “front and centre” within the primary health care system.

Up to the year 1950, pharmacists reigned supreme in the field of primary health care.
Most pharmacists however, were unaware of the market share held by the profession.
Not so their medical counterparts who were plotting to bring in the grand design of the National Health Scheme of which the PBS component would be too good an offer for pharmacists to refuse.

The original PBS was supposed to be for life-saving drugs only and was promised never to become more than 25 percent of total dispensing business. The rest, as they say, is “history”.

In the year 2000 the millennium heralded new aspirations for health professionals.
It also was the year the precursor of i2P (Computachem Newsletter) was born.
The following article was published in March 2000.

ARE THE NURSES AHEAD? A LOOK AT THE ROLE OF THE NURSE PRACTITIONER

With nurses displacing pharmacists in the Morgan Gallup Poll an awareness of the expansion of this discipline is occurring. Nurses have organized themselves industrially to become a potent political force and with the advent of clinical nurse consultants and nurse practitioners, an overlap into other disciplines is occurring.

This is certainly causing concern in some areas of the medical profession and pharmacists should also be concerned, as competition for new community services will be fierce. Only the most competent (and perhaps the cheapest) services will be purchased by government and consumers. Nurses are already mobile in the community, pharmacists are not. However, pharmacists with their 5000 strong community network offer an ideal springboard to develop mobile community services.

In 1990 The NSW College of Nursing and the NSW Nurse's Association prepared a joint submission for the NSW Department of Health, to conduct a number of pilot projects. This was agreed to, and an expanded role for nurses was trialled within the health system depending on community need.
The venues were as diverse as Wagga Wagga hospital emergency department to the Mathew Talbot Hostel for Homeless Men, in Sydney. The final report on the project, based on ten separate pilots, was recently released, and highlighted the benefits of strong collaborative relationships between nurses working in a practitioner role with medical practitioners.
It concluded that nurse practitioners are feasible, safe, and effective in their roles and provide quality health services in the areas surveyed. The Australian Medical Association (NSW Branch) did not endorse the report.
Nurse practitioners are now able to write medication orders covering a restricted range of S3 and S4 substances, which are listed in a nurses' formulary. The order for medication must be appropriate to the context of care and the specialty area e.g. a contraceptive pill in a women's clinic. Nurses see this step as simply legitimizing what they are already doing. Is there a parallel here for pharmacy?

Fast-forward to 2013. While we have seen some expansion for the role of nurse practitioner, it is still “invisible” to most of the general population.
The odd one or two has teamed up with a pharmacy to provide a joint (but limited) primary health care exercise, the concept has not been prolific.

Some nurses found a limited collaboration within GP clinics, but that appears to have been a very controlled environment.
Collaboration of this type has been promoted to pharmacists by the AMA and some consultant pharmacists have taken up the offer.
John Dunlop, the New Zealand writer for i2P was one such pharmacist.
He seems to have found a niche within a medical practice, but his medical associates shyly introduce him within the practice structure as “the clinical pharmacologist”.
That was a title developed within the medical education system for developing a medical counterpart to a consultant pharmacist.
There is the hint of embarrassment about having an associate pharmacist in a medical practice it seems.

Rising above all the petty politics of inter-professional rivalry and the determination of the medical profession to own and control everything involving health is the COAG organisation, Health Workforce Australia https://www.hwa.gov.au/ .

Through this group we now see a plan called Health Professionals Prescribing Pathway – a blueprint for breaking medical domination and allowing allied health professions to grow.
Increasing patient access to medication will mean reduced doctor visits which will mean belt-tightening in GP practices through reduced patient visits

Up to now, the word “collaboration” has been a buzzword that in medical terms meant only collaboration with the medical fraternity.
However the opportunity for pharmacy to collaborate with any other health professional is opening up and this is where patient growth is liable to develop at an intense rate.
Collaboration in its broadest vision will be welcomed by all non-medical health professions that will break the medical monopoly on health services development and delivery.
Collaborative partnerships will embrace more skills than will be found in just medical establishments and we may yet see doctors making a formal application to join in with collaboration groups.

Believe me, the real competition for the future will not be found in wholesaler marketing groups selling products, but in collaborative health disciplines working together to deliver an economical and timely health service (and referring patients to each other).

Whoever is successful at recruiting patients will win the health dollar and a satisfying professional career….and about bloody time!

 

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