Editor's Note: This article is the last in the series prepared by Con Berbatis especially for this edition of i2P e-magazine. We are pleased that many of his findings validate much of what we write about in this publication.
We will certainly be using his material as a reference to keep our future writing on track.

1.0 Regulated pharmacy in Australia

Australia has a relatively regulated system of community pharmacies compared to the USA and UK. Just 3% of Australia's community pharmacies are non-pharmacist controlled and Australia has no supermarket or mass merchandiser pharmacies like the USA and the UK (refer Part 1) .
Access to prescription medicines by consumers and the involvement and reimbursement of pharmacies is largely regulated through the Pharmaceutical Benefits Scheme (PBS).
Prescription medicines generate more than 64% of the total income of Australia's community pharmacies and PBS medicines constitute over 70% of this source.
Prescription items dispensed are estimated to be less than 10 per capita in the USA, 12.5 in the UK , approximately 11 in Canada and more than 11 in Australia so that Australia ranks high for access.
The cost per prescription item in Australia is less than in the USA and most other developed countries.
Non-prescription or over the counter medicines (or OTCs) account for almost 14% of the total income of Australia's community pharmacies.
Australia has many pharmacist-controlled medicines compared to the USA.
The public concern to ensure the safety , proper use and effectiveness of non-prescription medicines has been heightened with the number of medicines being re-scheduled from medical prescription (S8 and S4 in Australia) to pharmacist-controlled non-prescription (S3) and to generally available medicines (S2).

2.0 Pharmacy developments in the control of prescription and non- prescription medicines

Prescription and non-prescription medicines account for 78% of the total revenue of Australia's community pharmacies.
Access to them and their optimum use is critical to the discussion on the incursion by supermarkets into pharmacies.

2.1 National cooperation and pharmacy initiatives for prescription medicines

The Commonwealth government together with national and state pharmacy bodies in Australia are decisively moving towards assessing and improving the standards of pharmacies issuing prescription and non-prescription medicines.
The PBS has provided since 1951 a firm and growing foundation for the cost-effective utilisation of prescription medicines.
A comprehensive international analysis made by Australia's Productivity Commission (2001) of pharmaceuticals in Australia compared with other leading developed countries found the PBS compared very well in terms of access, cost to the Australian people and therapeutic use.

There are deficiencies in their provision and utilisation and many of these issues are being addressed by a variety of cooperative efforts by government agencies and various health professional and other bodies including the Pharmaceutical Society of Australia.
A major reform is required because pharmacies are handicapped in the ways they transact Schedule 8 and other drugs because current drug regulations are obsolete.
The current system inhibits pharmacists from being fully informed about patients and exposes them and the public to unnecessary risks to health and criminal acts .
For example doctor shopping , the diversion and misuse of licitly procured drugs is manifestly high in Australia (Berbatis & Sunderland, 2003).
Privacy laws and differences in State regulations and resources inhibit pharmacist from efficiently detecting and preventing these acts .
National legislation is required which limits the prescribing and dispensing of S8s for a patient to one medical and a single pharmacy source and requires the patient to allow the prescriber and dispenser to online medication histories held by the HIC and state authorities so they ca read these before prescribing and dispensing.
Such legislation would empower pharmacists to perform as an online properly informed custodian using the latest technology when dispensing.
This is a fundamental requirement in modern pharmacy and our profession will be hampered until such legislation is enacted.
Of course the principle of fully informed pharmacists is crucial for issuing drugs in all other schedules of medicines is critical and should receive the same emphasis by our national bodies as does counselling.

For example the inception of government-funded fees for medication reviews performed for patients residing in aged care facilities or in their homes by pharmacists has opened the door to wider involvement in primary health care and disease prevention or health promotion .
The acceptance of the Quality Care Pharmacy Program by more than 70% of Australia's community pharmacies with Commonwealth funding of $50 million holds much promise of a firm structure for the widespread and uniform implementation of new pharmacy processes for the achievement of better outcomes in heath-related activities by pharmacies in Australia.
Ongoing research into existing and new health-related services in pharmacies and underwritten by government-pharmacy agreements have provided important data and evidence for future development .

The research in pharmacy practice will continue in the forthcoming Fourth agreement .
The results may demonstrate that the value of those pharmacy services proven to be effective in controlled studies in overseas and local settings can be practically replicated in practice ( Roughead et al, 2003; Emerson, 2003 ) .
If the research is successful and accepted by government and other payers, then supermarket pharmacies will be forced to compete with pharmacist-controlled pharmacies for these extra remunerated health services as well as for routine activities and open-selling products.
Australians broadly should ultimately better appreciate, whatever the changed pharmacy structures, pharmacists' knowledge and skills in the consumption of prescription medicines and in the wider arena of primary care as a result of the efforts at the national level of pharmacy in past decades and the four government agreements struck in recent years.

2.2 Community pharmacy initiatives for non-prescription medicines

Community pharmacy in Australia is now being required to prove the necessity of scheduling in order to preserve its exclusive right to supply Schedule 3 or pharmacist-controlled non-medically- prescribed medicines.
The Galbally review of drug, poisons and controlled substances legislation was wide ranging and five of the 27 resulting recommendations related directly to Schedule 3 medicines (Galbally,2000).
The crucial Recommendation 5 required improvements in health and other outcomes flowing from the standards of "higher level and quality counselling " set by the Pharmaceutical Society of Australia be researched and reported by June 2004 so the results can be assessed to evaluate whether restrictions on scheduled medicines are justified .

The first of the studies involved 2033 pharmacies in all states and territories who were trained in a quality improvement program and evaluated over 14 weeks (Benrimoj & Gilbert, 2002).
The methodology included multiple item training programs for pharmacists, pseudo-customers testing pharmacies with a standard OTC scenario and with immediate feedback to and coaching pharmacies by educators.
The resulting significant improvements in standards persisted for three months.. The pseudo-customer methodology is now widely used by PSA (NSW) to train community pharmacists in the provision of S2 and S3 medicines (Neto, 2003).
The study's next phase is to evaluate the costs and clinical outcomes in customers who procure S3s in the pharmacies.
A very impressive feature and consequence of the first study was the insight gained by our leading researchers into the processes occurring nationwide in so many pharmacies and the resulting ability to assess standards and rectify performance.
Together with the wide and high acceptance of the Quality Care Program, the procedures set up by Benrimoj and colleagues promises to extend significantly the traditional inspections employed for over a century by pharmacy boards by assessing specific standards of practice in individual pharmacies and promptly rectifying sub-standard performance.
The resulting quality assurance mechanism of health-related services in community pharmacies should lead to an efficient system analogous to that used by Woolworths to monitor prices and products in their supermarkets, convenience stores in petrol stations and in other outlets.

The National Pharmacy Database Project (NPDP, 2003) reported 78.2 million Australians in 2002 visited pharmacies for self care purchases or primary health care consultations of whom 47% named the products or self-medicated and the remaining 41.23 million clients received medicines, written or verbal advice or referrals to doctors and other health workers for their primary care problem.
These figures surpass by far the estimated numbers of people who have prescriptions dispensed and far exceed the consultations with pharmacists reported by households in the Australian Bureau of Statistics' five yearly national health surveys (NPDP, 2003).
Furthermore, pharmacies suspected 0.86 million clients in 2002 requested dependence-producing OTCs for misuse of whom 0.63 million (73.2%) were refused supply.
These figures are the first in the world to quantify the duty of care activities in pharmacies in clients requesting OTCs (NPDP, 2003) .
These national data are unique in the world and demonstrate prima facie the impressive levels of awareness and responsibility practiced in Australia's community pharmacies .

Pharmacy in developed countries has been jostling for primary health territory since the 19th century. The battle to retain S3s in the USA was lost in the 1980s (Pray & Pray,2003) .
It remains to be seen whether pharmacy in Australia can turn the tide and keep the premises with just supermarket products whether or not they have separate leased pharmacy premises in their stores, at bay from purveying S3s .

3.0 Gains and losses to stakeholders in the development of new supermarket pharmacies in Australia

The following scenarios extend onto the those reported in Part 2 to value pharmacies to gains and losses projected for a range of stakeholders including shopping centres, supermarket groups, pharmacies and the Australian population.

3.1 Gains and losses by shopping centres, supermarket groups, pharmacies to stakeholders in the relocation to 500 new supermarket pharmacies in Australia

The National Pharmacy Database Project found 23.5% of pharmacies were situated in shopping centres and another 41.4% in city, suburb or town shopping strips (NPDP, 2003).
This coincides with the location of most of Australia's supermarkets and discount stores (or mass merchandisers) .

If the following assumptions are made in relation to the introduction of supermarket pharmacies in Australia from 1 July 2004:

(1) national legislation was enacted for deregulated ownership of pharmacies from 1 July 2004 and permitted PBS approvals to be transferred to pharmacy premises within supermarkets ;
(2) 10% (500) of Australia's pharmacies which operated for the 12 months to 30 June 2004 were purchased and re-located into shopping centres of 10,000 square metres or more net lettable retail area with 250 transferred each into Woolworths or Coles supermarkets over the 12 months to 30 June 2005;
(3) the pharmacies were replaced by other speciality stores resulting in an average rental one half that received from the pharmacies, the difference being $300 per square metre or a loss of $60,000 per shopping centre ;
(4) a further loss of rental income from shopping centre lessees affected by the loss of pharmacies and in the vicinity of pharmacies per shopping centre equating to $40,000 per annum ;
(5) the 500 independent pharmacies had double the average annual sales of community pharmacies hence accounting for 20% of annual pharmacy sales ;
(6) the pharmacies were purchased for $2.3 million total each and an average 2.5 years rental payout for the remaining lease was arranged with the shopping centre owners;
(7) the lettable area of the original independent pharmacy was 200 square metres and the gross rent was $750 gross per square metre with $150 per square metre expenses for outgoings such as rates, taxes, cleaning, insurance, promotion and security ;
(8) the lettable area of the supermarket in the shopping centre was 3,500 square metres and the rent was $150 per square metre excluding outgoings;
(9) the new supermarket pharmacy occupied just 100 square metres and was located to the rear of the supermarket furthest from the checkout registers;
(10) in the relocation one full time equivalent pharmacist and two FTE non-pharmacist staff (one speaking English and another important non-English language) resulting in total annual $120,000 labour savings to the supermarket pharmacy ;
(11) the cost of relocation and stock, new fixtures and fittings was $250,000 per supermarket pharmacy; (12) the added value from the improved percentage earnings on sales was based on Method 4 above; (13) the added values for al stakeholders are realised by 1 July 2005;
(14) 50% of the supermarkets open just six days weekly and purchased pharmacies which had operated seven days weekly and extended hours and
(15) each pharmacy client spent on average $150 weekly in the shopping centre.

Based on the above assumptions the consequences for the 500 shopping centres are:
(i) capital losses of $0.645 billion based on valuations at 1 July 2005 derived from reduced net rental income of $100,000 yearly capitalised at 7.75%,
(ii) payout for 500 leases at 2.5 years at $120,000 per annum, totalling $150 million.

By 1 July 2005 the estimated total capital loss for the 500 shopping centres is $0.645 billion and an funds received $150 million from premature lease payouts.
In addition, across 500 shopping centres an estimated 25,000 pharmacy clients and regular shoppers were lost resulting in a $195 million yearly fall in retail sales due to lost shoppers of which $117 million were supermarket sales resulting in a loss of earnings of $2.5million yearly and resulting loss of $60 million in market capitalisation in Coles and Woolworths based on an average P/E applied to loss in earnings of $2.5 million yearly.

For Coles and Woolworths by 1 July 2005 the total costs would include $1.15 billion for the purchase of 500 pharmacies at $2.3 million per pharmacy; $150 million payout of leases and $125 million relocation costs.
These costs are debt funded and paid 12 months on 1 July 2005 based on an interest rate of 5.5% pa for 30-day bills.
A further $200 million loss in capitalisation due to a loss of shopping centre customers.
The resulting increased market capitalisation realised by 30 June 2005, according to the above assumptions and by applying the calculations used Method 4 , is $1.62 billion for Woolworths and $2.78 billion for Coles-Myer Ltd.

Based on the above assumptions the estimated gains and losses from the relocation of 500 pharmacies from a shopping centre to a supermarket location to the three major direct financial stakeholders
(a) the shopping centres,
(b) the pharmacy owners and
(c) Coles and Woolworth are summarised in Table 6.

The net capital gain at 1 July 2005 for Coles and Woolworth is $4.34 billion for an investment of $1.408 billion.
The lessor shopping centres have the most to lose financially and the vendor pharmacies are major beneficiaries.
The lost customers and resulting sales , earnings and capitalisation losses to the shopping centres and supermarkets due to the relocation to the 500 new supermarket pharmacies are summarised in Section 4.2.2.

Table 6. Financial gains and losses in stakeholders in the relocation
to 500 new supermarket pharmacies at 1 July 2005

4.2.2 Losses in shoppers to shopping centres resulting from relocation to 500 supermarket pharmacies
The loss of pharmacy services deleted included
(i) methadone and other drug dosing, wound care, Dose Administration Aids, clinical testing for body weight and height , screening blood pressure and blood glucose resulted in 50 clients lost,
(ii) the loss of a female staff member who spoke an important other language led to the loss of 25 poor-English speaking customers,
(iii) the Schedule 2 medicines, all herbal medicines and all home testing kits and devices were removed resulting in 25 lost customers ,
(iv) in cosmetics lines just hypo-allergenic and limited special dermal products were retained resulting in lost customers ,
(v) half of the shopping centres lost a pharmacy which offered extended hours which resulted in the loss of an average 25 clients and
(vi) the removal of medication reviews for residential aged care facilities , domiciled patients and other external services resulted in an average 25 customers lost .

A total 150 customers per shopping centre are estimated to be lost in the relocation which results in $1.170 million lost sales per annum per shopping centre or $585 million lost sales yearly over 500 shopping centres of which approximately $351 million sales is attributable to food sales equating to approximately $7.02 million lost annual supermarket earnings .
Applying an average P/E multiple of 24 results in a total market capitalisation loss of $170 million for Coles and Woolworths.

4.2.3 Reactions by shopping centre owners to prevent losses from new supermarket pharmacies

To avert the losses resulting from the removal of 500 independent pharmacies in supermarkets, shopping centre owners will adopt strategies including:
(a) select supermarkets lessees who have no interest in pharmacies in their premises (eg Aldi, FAL), (b) implement clauses in leases for excludng defined services and products (including dispensing prescription medicines and the sale of Schedule 3 medicines) ,
(c) modify the terms of leases by shortening terms to five years with no options and
(d) limit the area of supermarket premises to no more than 2,000 square metres which is just adequate for retailing groceries and fresh foods according to the area and performance of Aldi supermarket stores .

4.2.4 Retaliatory actions by supermarket companies

The companies which own the shopping centres may retaliate to the above actions in section 4.2.3 by implementing one or more of the following or other actions :
(a) appeal to the ACCC or other anti-competition or consumer representative bodies against exclusion clauses ,
(b) develop their own shopping centres,
(c) take over existing public companies or trusts which own shopping centres or develop, or
(d) purchase pharmaceutical manufacturers or wholesalers to improve efficiencies and procure failing pharmacies .

4. 3 Value of pharmacies to Australia's population health

The value of community pharmacies to Australia's population health is approached by attributing an estimated contribution to each of the national health priorities .
In the following table Australia's health priorities and serious risk factors ( by prevalence and diseases affected ) are listed and categorised into proportions estimated to be treated or untreated in official publications (Table 7).

4. 3. 1 Value of pharmacies to Australia's population health in the care of treated patients

Most treated cases in communities or hospitals receive pharmacy services and medications with pharmacy services including preparation, dispensing, counselling , individualised administration and counselling.
For example 80.6 % pharmacies reported to the National Pharmacy Database Project they provide dose administration aids, more than 26.9% pharmacies at least once weekly each seven days supervise the dosing at least once weekly of benzodiazepines and a range of other drugs excluding methadone, 40.9% decline more than once weekly prescriptions for questionable drug, dose, patient contra-indication or other therapeutic reason, 34.% counsel poor-English speaking patients more than once daily and 19.% pharmacies counsel more than once daily in enclosed areas .

For the first time , pharmacies reported detecting nationally for the six months to 30 June 2002 an estimated 7,332 patients with forged prescriptions for S4 and S8 dependence-producing agents and 12,687 doctor shoppers.
Pharmacies use information facilities for dispensing to almost 85,000 patients a day .
An impressive 69.7 % , 40.5 % and 31.3% of pharmacies reported communicating at least once daily with doctors, patients or carers to clarify prescriptions, therapeutic problems and compliance issues with prescription medicines.
The duty of care exercised by pharmacists in routine dispensing , detecting prescription fraud and liaising with doctors and patients or their carers are now quantified and stand as a tribute to our practicing colleagues (NPDP,2003).
The results of the NPDP now provide pharmacy bodies with the data to quantify the millions of health-related services provided in Australia's pharmacies to patients nationwide with prescribed medicines. Supermarkets now have to assure government and other third parties they can match the levels of service reported across a wide range of health-related activities occurring in existing pharmacist-controlled pharmacies.
Pharmacists who may work in supermarket pharmacies will now be in a position to point to these data and insist on the facilities and initiatives used in pharmacies currently are provided in supermarket pharmacies.

4. 3.2 Value of community pharmacies in relation to Australia's National Health Priorities

Increasing numbers of treated patients are receiving specialised care in pharmacies, in aged care facilities or in domiciliary care.
In addition, impressively high percentages of pharmacies reported to the National Pharmacy Database Project in July and August 2002 having trained staff in specific areas and another percentage who were planning to have trained staff by August 2003.
The total percentages of pharmacies offering these services to August 2003 are recorded in Table 7.

Table 7. Australia's health priorities : contribution by Australia's community pharmacies.
( Sources : National Pharmacy Database Project, 2003)

* total of % pharmacies in each of anticoagulation, hypertension, hyperlipidaemia services
(1) harm minimisation and psychiatric pharmacy services.

5.0 The value of pharmacy and implications for corporatisation of community pharmacies in Australia

The above estimates based on data from the health-related activities occurring in Australia's community pharmacies demonstrate that the value of pharmacy can now be quantified in other than financial units. In the areas of prescription medicines Australia's community pharmacies participate in a system that ranks as the most accessible and efficient in the world and is backed by millions of services provided by community pharmacies which ensure good therapeutic standards and safety to patients.
That the frequency of primary health care activities exceeds the rate of self-medication in pharmacies in Australia's pharmacies reflects a degree of involvement with consumers and over-the counter medicines, especially Schedule 3 pharmaceuticals, not possible in supermarket pharmacies in the USA or UK.
The early and brave incursions of community pharmacies into liquid methadone and the supply of needles in the 1980s have contributed to the low incidence and occurrence of HIV compared to the USA where HIV incidence and prevalence remain much higher than in Australia and the involvement by US pharmacies in methadone is negligible and patchy in needle supply.
The reported other wide initiatives in disease care and prevention are indicative of a commitment to a wide role which is not a clear or quantified in any other country.

5.1 Rationale for corporatisation of community pharmacies in Australia

The existing fragmented regulated pharmacy structure is a collection of micropsonies ( the PBS is often entitled a monopsony ) and places pharmacies at a disadvantage for competing with large public companies like Coles and Woolworths.
The buying power of individual or the relatively small groups of pharmacies which currently prevail is handicapped by the regulated structure.
The ability to cut costs enormously like Woolworths is doing through honing the supply chain by vertically integrating from the supplier to the retailer and implementing technology at each step is impossible with pharmacy's current structure.
The estimates of values above and in Part 2 clearly illustrate the unfair advantages public companies have because of the legal constraints imposed on an optimal pharmacy structure.
The supermarket pharmacies in the USA and UK are obviously constrained by the non-pharmacists who control them.
For example their small size, often obscure location , low pharmacy staff numbers, the limited facilities for administering doses , screening , monitoring or counselling patients manifestly demonstrate the ignorance of pharmacists' role.
For supermarkets pharmacists to observe non-pharmacist staff in supermarkets who issue OTC medicines without verbally testing patients for contra-indications or proper counselling, or to see displays of packets of cigarettes alongside nicotine replacement therapies and the selling of liquors in the vicinity is demeaning to the profession , an embarrassment to our colleagues who work in these situations and a challenge to the society which allows these insults to remain so prominent in the 21st century.

5.2 Approaches to restructuring community pharmacies in Australia

The main challenge to Australian pharmacy is to formulate a new structure which allows it to compete for the efficiencies in purchasing and other costs relating to medicines in analogous ways that supermarket companies do with foods and liquor.
At the same time allow pharmacies to satisfy national health priorities, professional requirements, as well as their financial aspirations.
Almost certainly the rationale of cost-efficiencies will compel pharmacist-controlled multiple pharmacy ownership to evolve soon over current restrictive ideologies.
The COAG National Competition Policy Review of Pharmacy Legislation or Wilkinson report detailed a proposed corporate structure model of community pharmacy (www.health.gov.au/haf/pharmrev/terms.htm 22/6/1999; revised 18/2/2000) . Appendix 4 contains a 10-page legal report on a possible corporate structure model based on the assumptions
(i) that non-pharmacist ownership and minority share holding is considered an unworkable option outside existing permitted exceptions ( eg friendlies societies);
(ii) pharmacist ownership and control remains a primary feature of the pharmacy industry and profession;
(iii)the proposed model will ensure that pharmacies can operate in flexible, commercial and uniform agreements across the jurisdictions; and
(iv) the restriction on the number of pharmacies owned by any acceptable entity will be removed .
This proposal was not supported by all pharmacy or government representatives.
One deficiency may be the requirement for an owner-manager be present in each pharmacy in the structure.

It has become clearer with the advantage of the above initiative and the developments in both pharmacies and supermarkets evident in Australia and overseas to identify the preferred requirements for restructuring community pharmacy:
1. Rationalisation and vertical integration from importers, manufacturers and wholesalers to pharmacies should be facilitated for the supply chain efficiencies to enable better bargaining power with manufacturers, savings in the distribution of medicines and competition .
This will facilitate lower prices of pharmaceuticals.
The involvement of Mayne, Sigma and API in structures analogous to those used by Woolworths should be able to be replicated.
2. While pharmacist control of pharmacies is essential for health-related activities, more flexible structures are appropriate for the commercial aspects such as the purchase and distribution of medicines and other pharmacy products.
This means that pharmacies should be allowed to be transformed from the current micropsonic individual or small groups of pharmacies to megalopsonic structure able to negotiate with pharmaceutical manufacturers.
3. Equity sharing by pharmacists needs to be considered to incentivise our young professionals so they can enter the existing ownership structures in a progressive and acceptable ways so they better influence the overall policies as well as the individual practice in pharmacies.
4. The current system of franchising or banner pharmacies has stalled and lacks competition in health-related activities. The system lacks professional dimension and should liaise closely with the QCPP as a reference for the expansion into wider health-related as well as promotional and commercial activities 5. Most importantly, pharmacy bodies should be prepared to act methodically in situations raised by the current corporate activity surrounding the purchase of the pharmacy wholesaler segment of the Mayne Group.

5.0 Observations relating to Australia's community pharmacies and supermarket pharmacies

Based on the above Australian experiences the following conclusions are made to best understand the devilment of community pharmacies in this country:
*Community pharmacy in Australia is regulated to a much higher degree than in the USA or UK in having by far the lowest proportion of non-pharmacist controlled pharmacies (3%)
*Prescription medicines (64%) and non-prescription medicines ( 14%) constitute 78% of the total revenue of Australia's community pharmacies .
*Australia's system of prescription medicines in Australia ranks high internationally on the grounds of access and economic efficiency. The introduction of supermarket pharmacies in the USA and UK have not been shown to improve this situation but the supply chain efficiencies being introduced by Woolworths for food and liquor products, may be applicable by pharmacy .
*The National Pharmacy Database Project (NPDP) has provided quantitative data for the range and rates of health-related activities occurring in Australia's community pharmacies.
These provide reference data for the very substantial work done by independent pharmacies
*The frequency of primary health services in community pharmacies exceeds self-medication activities which is opposite to the situation in US supermarket pharmacies where self-medication dominates due to the combination of a deregulated drug schedules as well as a deregulated pharmacy system
*Primary activities occurring in pharmacies far exceed the results on pharmacy consultation reported by households in the Australian Bureau of Statistics national health surveys.
These activities compare in frequency with the patients receiving OTCs (both S2s and S3s).
*The Galbally report has challenged community pharmacy's right to S3s .
The research conducted into improving the standards of managing OTC medicines and its application in NSW suggests pharmacy is developing the tools required for efficient quality assurance at a national level.
*The National Pharmacy Database Project reported for the first time national rates of detecting and enforcing duty of care in pharmacies for dependence-producing S8 prescription and OTC medicines : 2.3% of clients self-medicating were suspected of misusing dependence-producing OTCs and 73% of these were denied supply.
*The above data on the duty of care activities with dependence-producing OTCs and the results from primary research provide supportive evidence for retaining S3s in pharmacies.
*The preferred composition of Australia's community pharmacies is one that retains pharmacist control of a megalo-psonistic rather than micro-psonistic individual or small groups and facilitates supply chain efficiencies.
Such a restructure needs to be compared rigorously with existing structures in pharmacy.
The aims are to improve purchasing power , promotion and costs are optimised, supply chain efficiencies are able to be implemented and health-related activities can be innovated and conveniently but acceptable evaluated .
These systems have been reported in independent pharmacies but not in supermarket pharmacies.
The above observations are focused principally on data on health-related activities in pharmacy related publications in the cited reports so are limited in their scope.

List of References at this link

For an explanation of terminology used, click here

Declared interest: shares are held in Westfield Shopping Centre Group, Woolworths Ltd and Mayne Ltd

Con Berbatis
31 October 2003

THE END.