Welcome to the July edition of i2P, and of course, the first week of the new financial year.
Note that we are developing a new range of categories for you to follow e.g. health politics, hospital news, an expanded IT offer and we will be developing the category of anti-ageing medicine
Also, out of interest, could I refer you to the e-publications category located immediately below our columnists. If you click on the link contained there, you will find a range of e-publications that are recommended reading.
The first publication noted is the Pharmacist Activist written by Dr Daniel A. Hussar of the faculty of the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia. He is a pharmacy advocate.
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The ubiquitous Mrs Wright, in her quest to unearth a new erotic shopping experience, ushered this writer to a new Coles store located at the all very nice and leafy suburb of Ivanhoe in Melbourne recently.
This is contemporary retailing at its best, no doubt influenced by the gurus at Westfarmers and the rapidly changing retail climate in Australia, which of course involves the future of Pharmacy in some way….but more about Pharmacy later.
I read some market research recently that ought to concern community pharmacists across the country, as well as the Pharmacy Guild of Australia.
Groups of average Australians were brought together for a series of focus groups to discuss the community pharmacy landscape as they see it.
Some of the feedback was disconcerting.
Some twenty years ago uneasy tremors were running through hospital pharmacy here in Perth. Hospital management had suggested to one of my fellow Chief Pharmacists that the hospital needed a total parenteral and intravenous additive service (IVAS) .
When it was pointed out that this would be very labour intensive and the pharmacy did not have sufficient staff to provide it, the comment was that “nurses would be happy to run such a service”.
In the region where I practice, GP’s are reluctant to comply with a patient request for a Home Medication Review.
The stock standard phrase is “I can do that for you” and so in frustration a patient will turn to me, in a professional, or quite commonly in a social setting, and asks if it is possible for me to perform a review without the doctor’s involvement.
Disgraceful – discuss
The newspapers have been chock-a-block the past few days with dire tales but true about the black hole we are about to enter with the insane policy to re-regulate the ‘workplace’ to suit the union paymaster cliques.
While I never voted for Keating I did admire him a little bit this morning when I read a quote of his from the bad old days.
He said to some union goose: “you are carrying the jobs of (100,000) dead men around your shoulders”.
Giving a dead hand to this union unfettered power play will ensure that the nation will soon look like NSW; where the government is actually the plaything of a few loosely combined public ‘service’ union mugs.
Depending on how large your pharmacy is, in terms of overall staffing, you will soon be touched by the coming dead hand of the new/old order.
The recent furore in the UK over pharmacist Elizabeth Lee receiving a conviction for a criminal offence and subsequently a suspended jail sentence, has really lit a fire under the imbalances that exist when a pharmacy dispensing error is made.
The dispensing pharmacist or the supervising pharmacist under current UK legislation, has been made to bear the brunt of legal responsibility, with pharmacy owners escaping with little pain.
According to an article in PJ Online "In many cases, all that the employer needs to establish is that he had standard operating procedures in place and that the employee or locum had simply not complied with them. In these cases, the employer can walk away leaving the employee or locum to face the, often damaging, consequences".
There is now a rush in the UK to have current legislation amended to reflect a more proportionate responsibility for all parties involved.
The appointment for the first time of a Minister for Indigenous, Rural and Regional Health and Regional Service Delivery is an important strategic recognition of the special needs and circumstances facing people in Australia's rural and remote communities.
People in the bush will expect this position to be part of a permanent increase in the Government's commitment to rural communities.
In welcoming Minister Warren Snowdon to the new position, Dr Jenny May, Chairperson of the National Rural Health Alliance (NRHA), said the appointment will be important both for substantive policy reasons and to boost the place of rural issues on the political agenda.
The following news item was recently published in Science Alert. It would seem that the pristine environment of New Zealand is under attack. The reasons are similar to those findings in Australia surrounding the protection of the Great Barrier Reef.
A new "fertility first" hypothesis published this week by a group of international experts in the American Journal of Human Biology, proposes that the global epidemic of Type 2 diabetes has its origins in the struggle, over millennia, to sustain human fertility in environments defined by famine.
A surprising and important implication for us in the modern world is that this hypothesis gives cause for optimism that the modern epidemics of diabetes and cardiovascular disease will diminish.
Source: Sydney University
A team of Monash University researchers has discovered the importance of a protein, which could improve the way the drug interferon is used to strengthen the human immune system.
Published online in the prestigious journal Immunity, the findings show that the protein promyelocytic leukemia zinc finger (PLZF) is a key player in the body's immune response to disease, increasing our understanding of the function of the immune system.(Source: Science Alert )
China is notable for its authoritarian approach to the Internet and other forms of media communications.
Restrictions on Internet activity may have some long-term implications for Australia, particularly as these restrictions are intruding into the health arena.
Little thought seems to have occurred in maintaining and supporting mature aged pharmacists in the workplace.
Given that this group of pharmacists is the one with the "corporate memory" of the profession, with many having started life as compounding pharmacists and counter-prescribers, there is a wealth of untapped intellectual resource that could be internally utilised in mentoring or even training pharmacists in how to sell a professional service.
This group of pharmacists is concerned with the development of retail clinics proposing to do almost exactly what they were successfully doing 30-40 years ago.
What went wrong?
Well, there is plenty of evidence to illustrate that the process of commoditising medicines is the primary reason for this loss, because if you strip everything out of a process to sell at the cheapest possible price, you get a barren professional offering
Source: Science Alert
It is clear that the Terry White pharmacy group is on the move with the recent purchase of Pharmacy Direct and a restructure of its own management. Terry has had a distinguished pharmacy career and his stewardship will see possibly the strongest pharmacy group in Australia emerge He is opening up the opportunity for equity for senior members of his management team.
The following excerpt extracted from pharmacy media reports explains the process.
Rollo Manning has experienced pharmacy practice from all sectors of the industry – retail, administrative, policy and remote Aboriginal practice. He spent 10 years with Glaxo Australia and was the first Director of Public Relations at the Pharmacy Guild National Secretariat in Canberra.
Comment to the Editor or email Rollo Manning on firstname.lastname@example.org
Comment to the Editor or email Rollo Manning on email@example.com
THE ANSWER TO EMPLOYEE PHARMACISTS PAY PROBLEMS
It is not possible in 2009 to continue a business structure that worked in 1960. Back then pharmacists were registered on the basis of their ability to dispense. No question about that. The knowledge of the product forms (mixtures, creams, emulsions and suppositories) was an imperative. The drug knowledge avoided incompatibilities in compounded medicines and the indexing system of the script book allowed medication reviews to be done routinely.
Fast forward to 2009 – anyone can read a typed script, select stock from the shelf, enter details into a PC and produce the repeat authorization and label.
And yet – the staff deployment and wage structure is still the same.
Today the pharmacy graduate has a vast knowledge of Pharma... – all sorts of things – cology, kinetics, cotherapies, codynamics and so on.
This is NOT the knowledge required for dispensing – it is knowledge to act as a true allied health professional in a primary health care (PHC) system that needs all the multi disciplinary input it can find in the best interest of the client (patient or consumer).
How can pharmacists ever expect to be recognised in the 2009 PHC setting while they are still working with a model of the 1960s?
All concerned with a future of prosperity for the profession must attend gatherings to talk again about where the profession is heading and advocate for a change in the paradigm of pharmacy practice.
Have the retail shops but do not expect them to be propped up by a National Health Scheme that must concentrate on the best interests of the consumer (and taxpayer).
Stop tying PBS Approval to a successful retail business model.
Start establishing professional agencies (Pharmcare agencies) that are the provider of pharmaceutical care to its clients at a cost to the taxpayer for a quality service.
There are too many messiahs out there calling on the wisdom of the past to determine the future.
In the words of Professor Dexter Dunphy – “you can only understand the future when you start living it”.
Pharmacy must start living a future – not just talking about it and living in the past.
BIG PROFITS BRING BIG CRITICS
The recent media sniping at the Pharmacy Guild strengthen the call for a review into the infrastructure for supplying PBS medicines to the Australian public is need of a review. It is the opinion of this writer that this must be done before any future agreements are entered in to between the Government and community pharmacy interests.
It is the late 1980s since there was a review of “pharmacy earnings costs and profits” with the base established then being updated by subsequent agreements ratified by the Pharmaceutical Benefits Remuneration Tribunal.
The fact that excessive charging for under co-payment PBS dispensing is happening as revealed in the Daily Telegraph is a sign of the times. However back in 1988 the co-payment was only $11 and hardly a factor in creating significant profits.
But in 2009 with a co-payment set at $31.90 there is a huge market of non-subsidised PBS medicines that are being paid for by consumers. It is not known how big this is despite there being a commitment in the 4th CPA for this information to be made available. A “research” project is underway to determine how this can be done. Really? This is a joke! The answer is on the PC of every dispensary computer - take a sample agreed with the stats experts and you have it.
The generic drug market has also expanded in the last 20 years and this too needs to be factored in.
When a supplier can buy in at $2 and sell for $15 it is a good profit. No wonder there is criticisms of these profits being made by an agency working for the Government in supplying an essential component of a National Health system.
Pharmacists expect more so long as this situation exists.
ALAN JONES AT IT AGAIN
Sydney broadcaster Alan Jones went back in time four years when he supported community pharmacy against the recent calls for change especially the Daily Telegraph mentioned above and then following the front page in the Financial Review pointing to the 5th Agreement and likely problems for the Guild.
As far as Alan in concerned this is all part of the big plot to allow Woolworths and Coles to have pharmaceutical products in their supermarkets.
The rhetoric is the same as in 2005 when the same broadcaster went on the offensive for pharmacists against the threat of NSW legislation (allegedly) opening the door for Woolworths to have pharmacies.
So strong is the opinion of this voice in forming public opinion in Australia that one wonders how such a voice can be so far off the beam.
Sensitive area as is the pharmacies in supermarkets push by the Pharmacy Guild, that one could be excused of thinking that the Alan Jones button on the defence of pharmacies was pushed after the Guild alerted him to the need for another rant.
Money in the past has proved to be no barrier to telling a good story – as false as it may be. However back in 2005 when this writer suggested to Alan Jones that he may be getting paid by the Guild a quick response came back saying the suggestion was “idiotic”. The same will not be tried again in 2009 although the suspicions are still there.
BILL C OPENS PHARMACY OWNERSHIP DEBATE
The introduction of the new National Registration Authority for Health Professionals provides the opportunity for the question of who should own a pharmacy to be opened up as new legislation is needed in every State to ratify the status quo. However the introduction of a Bill to a Parliament always opens up the subject for debate and gives proponents for change the opportunity to put forward an alternative case.
The new Acts of State Parliaments to cover registration will only have the registration and assessment of professional standards. A separate Bill will have to be introduced to retain all those other factors that were in the previous Pharmacy Act and covered subject areas not included in the new laws. Expect some activity from the retail lobby that wants to see a loosening of the rules associated with the ownership of pharmacy.
One thing that one could be excused for putting money on is that Alan Jones will be in the mix somewhere.
The time has come for these business aspects of a retail small business to be included in legislation administered by a business or trade area of the legislature and NOT of a Health Department. That is if there needs to be legislation at all.
The old argument that pharmaceuticals are not ordinary items of commerce fails to draw interest while the discount stores flourish. Also the marketing aspects of pharmaceuticals are debated around the schedule of poisons register which is moving to a wider range of medicine products available in supermarkets.
It is possible to have a supermarket in a pharmacy but NOT a pharmacy in a supermarket. This has to stop and the market place used to decide who succeeds and who fails.
Send your subject suggestions to Pharma-Goss for comment.
Edited by Rollo Manning at firstname.lastname@example.org
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