s Roadblocks in Clinical Services Provision | I2P: Information to Pharmacists - Archive
Publication Date 01/11/2013         Volume. 5 No. 10   
Information to Pharmacists


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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Roadblocks in Clinical Services Provision

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.

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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He has been involved in researching this perceived problem through the Faculty of Pharmacy at the University of Toronto in Canada and an abstract is published further along this article to which I will add comment.

But before I progress to that point I would like to comment on some aspects of my early pharmacy training that commenced at around the last intake of apprentices under what has become known as “the old phart system”.
In that system, the apprentice was at the bottom of the food chain washing bottles, cleaning shelves and putting away orders. That gradually progressed to making up bulk solutions to facilitate quicker compounding or bulk preparations of a standard formula.
It was seen as drudgery, but it was the pathway to “earning your stripes”.
Above me was an unregistered pharmacist, a dispensary manager (registered) and an 82 year old master pharmacist (an ex-Newington rugby half-back).

I didn’t fully appreciate it at that time, but these were my mentors-not only for pharmacy skills but for life skills as well.

As I progressed I was mentored in the skills of counter prescribing and the diagnostics required to support that practice. There was no later university course covering these subjects and I was advised that you never used the words “prescribe” and “diagnose” in a setting where you could be attacked by members of the medical profession.
Nonetheless, this is what actually happened and I developed skills to the extent that patients asked for me by name when they wanted information on their pharmacy visits.
I always marvelled at the strength of the patient list my master pharmacist had and when an unaligned patient came into the pharmacy, it was like a rugby ruck as all the pharmacists literally ran to offer their services.
Despite his 82 years age barrier, my master pharmacist inflicted many a bruise as he rudely cast me aside with a well-practiced hip roll as he manoeuvred his way to the front of the pack!
And in this I am not exaggerating.

That was my training ground, and as rough as it was, it equipped me to be independent in the “school of hard knocks”.
John, the dispensary manager, was a returned soldier from the New Guinea campaign and he would often enthral me with his tales of how the fight was taken to the Japanese in collaboration with the Americans.
He was very critical of American soldiers who, as he told it, carried all the “garbage” in the world when going out on patrol, gradually discarding it piece by piece as their backpacks weighed them down.
This made it very easy for the Japanese to find allied patrols – all they had to do was follow the garbage!
And for that reason, Australian soldiers would refuse to go out on joint patrols.
The other observation he passed on to me was that because of their independent spirit, if an Australian officer was shot, another would automatically spring up and take charge whether or not they had undergone leadership training.
This seemed to be a natural aspect of Australian military culture which was also missing within their American counterparts-if their officers were shot, confusion reigned because there was nobody else to give orders and casualties became high because of that aspect.
Individualism and self-reliance was something that Australians used to pride themselves on because that was the way Australia had to develop post the First Fleet.
Those stories and many others shaped my pharmacy life and I have never forgotten them.

Moving on, I became a pharmacy manager in different locations and eventually a managing partner in a pharmacy group. This was in the 1960’s around the time pharmacy marketing groups began to evolve.
The fact that marketing groups always seemed to fail irked me and I set out to find the reasons why and as I found answers, those answers helped to transform me into a management consultant.

Making the decision to create a career out of consultancy was one that initially caused a “butterflies” feeling in the pit of my stomach.
I was married by this time, had two very young children with a third on the way and no clients. Also I was endeavouring to provide a service little understood by my fellow pharmacists.
However, an interested Parke Davis sales representative offered to introduce me to a potential client, so I accepted.
And that contact proved successful and resulted in two more introductions to close friends.
When I asked my client why he referred me on when he could have quite easily given them all the information I provided him with, he responded “I paid for my information and they are going to bloody well pay for their own”.
I asked the question because it is quite common pharmacist behaviour to pass information on to friends quite freely.

That gave me my first insight into client behaviour and apart from not having a template to base a consultancy practice on (I was the first pharmacy management consultant) there were significant hurdles to overcome.

Now the point of all the above rambling is to say that while the process was stressful on occasions, never did I vary from my planned pathway. I had the self-confidence to do it (underwritten by a great apprenticeship) and I just got on with it.

I did have input to the PGA/PSA consultancy model, through a researcher retained by them to recommend a format for a consultant pharmacist activity.
I have had to stand back in dismay as to what has been passed off as consultant pharmacy (no independence, no real recognition, not even a client initially-with a discounted payment made by a non-client pharmacy. What a mess!)

As all pharmacists would realise, in all the time since the formation of a consultant association, it has never been representative of consultants (they had no vote and no elected representatives). The range of services has been limited to a medication review service – but no expansion into primary health care activities.
Now the Association of Consultant Pharmacists is in decline with a new SHPA version taking its place.

Over time I developed an integrated clinical nutrition practice operating from home.
Community pharmacy never seemed to be able to accommodate me with a space that was quiet and private.

I have given my story for three reasons.

(i) Pharmacy culture has been dumbed-down and has dampened the spirit of pharmacists.

(ii) Few pharmacists have had independent consultancy practice experience to understand what needs to be in place to deliver a professional service.

(iii) Until recently, PGA leadership has deliberately blocked consultant pharmacist aspirations in favour of a supply chain future for community pharmacy.
Even though they were a 50% shareholder in the Consultant Pharmacist Association it was never meant to flourish because of the threat it supposedly represented to a community pharmacy as an independent business.
Now there is a realisation that an alliance association for both models (community pharmacy + consultant pharmacy) would represent the way forward.

What now follows is the abstract from Professor Zubin’s research published in the Canadian Pharmacy Journal. Read his findings with interest.


Can Pharm J (Ott). 2013 May;146(3):155-61. doi: 10.1177/1715163513487309.

Responsibility and confidence: Identifying barriers to advanced pharmacy practice.
Frankel GE, Austin Z.

Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.


Despite the changing role of the pharmacist in patient-centred practice, pharmacists anecdotally reported little confidence in their clinical decision-making skills and do not feel responsible for their patients. Observational findings have suggested these trends within the profession, but there is a paucity of evidence to explain why. We conducted an exploratory study with an objective to identify reasons for the lack of responsibility and/or confidence in various pharmacy practice settings.


Pharmacist interviews were conducted via written response, face-to-face or telephone. Seven questions were asked on the topic of responsibility and confidence as it applies to pharmacy practice and how pharmacists think these themes differ in medicine. Interview transcripts were analyzed and divided by common theme. Quotations to support these themes are presented.


Twenty-nine pharmacists were asked to participate, and 18 responded (62% response rate). From these interviews, 6 themes were identified as barriers to confidence and responsibility: hierarchy of the medical system, role definitions, evolution of responsibility, ownership of decisions for confidence building, quality and consequences of mentorship and personality traits upon admission.


We identified 6 potential barriers to the development of pharmacists' self-confidence and responsibility. These findings have practical applicability for educational research, future curriculum changes, experiential learning structure and pharmacy practice. Due to bias and the limitations of this form of exploratory research and small sample size, evidence should be interpreted cautiously.


Pharmacists feel neither responsible nor confident for their clinical decisions due to social, educational, experiential and personal reasons. Can Pharm J 2013;146:155-161.


Themes and supporting quotations from pharmacist interviews illustrating the six potential barriers (extracted from the paper):

Hierarchy of the medical system

Three participants directly acknowledged the hierarchical structure of the medical team as a barrier to gaining responsibility and confidence, and 2 others felt that “asking permission” for clinical decision making was necessary to make decisions. Pharmacists felt that they did not have a “place” in the hierarchy and therefore could not take responsibility for their patients. In addition, pharmacists did not feel responsible for their decisions due to the fact that pharmacists cannot prescribe.

Role definitions

Several participants voiced a concern that the public views the pharmacist as a “pill dispenser” rather than a clinical decision maker. Hospital pharmacists viewed their own role as “information gatherer and disseminator” versus responsible clinician. Participants felt the role of the pharmacist has not been clearly defined to the public or other health care professionals. Therefore, the educational background of the pharmacist goes unappreciated and unrecognized. Overall, role definition of clinical confidence and responsibility were characterized as underdeveloped.

Evolution of responsibility

By nearly unanimous response, pharmacists did not feel they were prepared for taking responsibility for their patients and were not confident in clinical decision making after their entry-to-practice education. Pharmacists who continued their education through a hospital residency, Doctor of Pharmacy degree program or through practical experience expressed an increased feeling of responsibility and confidence. Exposure to new and challenging situations that forced pharmacists into clinical decision-making activities built confidence and responsibility. Most pharmacists felt that the medical model of graduated responsibility through clerkship and residency with increased amounts of hands-on experience would better prepare pharmacy students for clinical practice.

Ownership and confidence building

Pharmacists commented that to build confidence, ownership of decision making and accountability for those decisions must take place. Until pharmacist prescribing is initiated, sense of ownership and responsibility will not thrive. In addition, several pharmacists suggested that faculty should be teaching and assessing accountability in pharmacy education. Participants thought that accountability for decisions would promote responsibility and clinical reasoning skills. Overall, pharmacists felt that knowledge, experience and continuous education contributed most to building confidence.

Quality and consequences of mentorship

The quality of mentorship received in the undergraduate pharmacy program was identified as a direct predictor of confidence and responsibility upon graduation. Pharmacists exposed to well-rounded mentors advocating for patient-centred care expressed increased confidence in their own decision-making abilities and willingness to approach greater responsibility. On the contrary, pharmacists who observed meek, hesitant, apologetic mentors learned self-doubt and indecisiveness.

Personality traits upon admission

Some participants stated that pharmacy and medical students are not similar at baseline. Some felt that pharmacy students are more likely to identify with absolute sciences rather than to take the “clinical side” of practice. Other participants acknowledged that pharmacists are reluctant to make decisions in clinical grey areas, whereas physicians are comfortable in these settings. It was hypothesized that this innate discomfort with ambiguity may be tempered by earlier introduction of clinical decision making in the pharmacy curriculum.

Professor Zubin touches on points I have described, particularly in ownership and confidence building, and the quality and consequences of mentorship.
Because of my mentors and management consultant training I have had no problem moving into a clinical role.
As far as personality traits are concerned, this is subjective.
Given the right environment where clinical pharmacists could be trained in a community pharmacy setting, attitudes could be rapidly changed as the confidence factor was improved.
One idea to resolve this may be to have a number of “training pharmacies” operating within the community setting and a system where established clinical pharmacy practices could siphon off pharmacists that passed through such a system.
As these pharmacists would be fee generators, they would virtually generate their own income with the more successful being partnered into a structured clinical practice.

Whatever your thoughts it is time to move on from the current community pharmacy model – so just get on with it!

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