..Information to Pharmacists
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Your Monthly E-Magazine
FEBRUARY, 2004


CON BERBATIS

Pharmacy Researcher

A Tribute to Kevin McAnuff

Editor : The following three summaries of the late Kevin McAnuffs career , tributes from a variety of sources and his largely unrecognised national contributions to pharmacy in Australia are reported by long-time friend and pharmacy practice researcher, Con Berbatis.
McAnuff was no ordinary pharmacist.
He was a driver of a transformation in Australia's modern community pharmacy practice which had its direct origins in the CAPS group in 1989 and evolved into the Third Community Pharmacy Agreement (2000-2005) .
McAnuff was preparing for the Fourth Agreement in Canberra, away from his home in Perth, at the time of his sudden passing.

KEVIN MCANUFF 1945-2004 : CAREER

Kevin McAnuff graduated in 1969 from Curtin University's School of Pharmacy.
He joined the military soon after where he met the AACP's Bill Kelly who recalled a recent reunion where Kevin was an entertaining speaker.
He operated a community pharmacy in Shenton Park in the 1980s and the Brentwood pharmacy since 1991.
In 1985 he was elected to the Pharmaceutical Council of Western Australia and in 1991 became its president .
The Council has the legislated roles of a board and examiners combined with control of the Pharmaceutical Society of Western Australia.
Around 1990 he and Harry Zafer forged links with the Guild reform group C.A.P.S. (Community and Pharmacy Support Group), formed in Sydney in early 1989 (Bruce,1990).
In 1992 Zafer was elected president and McAnuff vice president of the WA Branch of the Pharmacy Guild . They joined Guild national council with CAPS figures Sydney's John Bronger and John Dornan. "These placed him in the centre of pharmacy politics" (Beahan,2004).

His Council, Society and Guild duties required McAnuff to frequently meet and speak to a range of senior politicians, bureaucrats, attorneys, university academics, government and hospital pharmacists, the hierarchy in pharmacy wholesalers and the pharmaceutical industry.
He encountered many entrepreneurial and assertive community pharmacists who were challenging the status quo of managing, marketing and franchising pharmacies and a host of other issues such as the re-scheduling of drugs, the formula for devising the PBS dispensing fee, methadone dosing and issuing sterile needles, mandatory CE and widening pharmacy's primary care services.
McAnuff's personality was best conveyed by Michael Beahan, a former Senator, a 1990s director of the WA Pharmacy Guild and presently the Pharmacy Guild's national Director of Government Relations: "..Kevin was often seen as the hard man of pharmacy - tough , uncompromising, and unforgiving , frequently brusque and sometimes downright rude ….(with) the twinkle in his eye as he pursued his cause …this was Kevin's way of pressing his case" (Beahan, 2004) .
Kevin was intelligent, able to hold statistics and with me was quick to question research data and the interpretations.
McAnuff's leadership qualities , quick repartee and good grasp of complex issues prepared him for his most important contribution to pharmacy nationally - a key member of the negotiating team for the Third Agreement (2000-2005) and of the management committee implementing initiatives of the Agreement..
He passed away while in Canberra preparing for the Fourth Agreement. " He will be sorely missed in the coming negotiations" (Beahan,2004).

FAREWELL TO A PHARMACY TRANSFORMER

Western Australia and Australia has lost Kevin McAnuff one of its key pharmacy leaders who died suddenly in Canberra on Sunday 18th January (The West Australian, 20 January 2004).
Mr McAnuff, 58, was president of the Pharmaceutical Council and Pharmaceutical Society of WA for 12 years and a national councilor of the Pharmacy Guild of Australia.
He fought to cut the red tape for community pharmacists.
Mr McAnuff was one of a new breed of smart pharmacy leaders , assertive with honed negotiating and public relations skills . He had a broad grasp of the political, legal, management, professional and educational components which comprise contemporary pharmacy. Kevin was never phased by adversaries whether they be high bureaucrats, eminent academics or pharmacy moguls.
Pharmaceutical Council registrar Bob Brennan said Mr McAnuff had been a member of the Council for 19 years and had advocated fiercely for the protection and improvement of the profession.
Pharmacy Guild ( WA branch) president Harry Zafer said pharmacists had lost a champion whose sense of right was unconditional. " His commitment to family, pharmacy and the community was huge and he had a clear and uncompromising sense of values," he said.

Pharmacy Guild of Australia national president John Bronger said Mr McAnuff had contributed greatly to community pharmacy in Australia. "He could be your best friend but that would not stop him arguing and hammering a point with you," Mr Bronger added. "He was a great thinker , a great worker and a great pharmacist."

Department of Health and Ageing acting secretary Philip Davies said Mr McAnuff was greatly respected and had a strong interest in regulatory reform to help community pharmacists.
Mr McAnuff, who lived and ran a pharmacy in Brentwood , leaves wife Pat and children Michelle a pharmacist and Anthony.
The funeral was held in the chapel at Thomas Aquinas College set in Australian verdant flora with tall silver gum trees in Manning a near-south suburb of Perth overlooking the Canning River just three kilometres south of its junction with the Swan River .
Almost 1,000 attended the funeral from 10 am to 12 noon which proved a moving tribute to Mr McAnuff's family life as well as pharmacy career.
Amongst those who travelled across the continent to pay their respects were national Guild President John Bronger, national PSA president Jay Hooper, NSW Pharmacy Guild President Si Banks , Victorian Pharmacy Guild President Bill Scott, the AACP's newly appointed CEO Bill Kelly and the Queensland Guild's Michelle Bou-Samra.
The Guild's Executive Director Stephen Greenwood , Health Economics Director Dr Michael Tatchell and the Director of Economic Analysis Vasken Demirian had flown from Canberra .
Curtin University School of Pharmacy's Prof Michael Garlepp, colleagues Assoc Prof Colin Marshall , senior lecturer Jeff Hughes and lecturer Con Berbatis were present along with Graham Greenhill a former PSA pharmacist of the year.
The pall bearers included Messrs Bronger, Zafer, Scott and John Dornan (Guild, NSW). Both Scott and Dornan are colleague Agreement negotiators.
The funeral party moved to the McAnuff house two kilometres further south situated on the leafy banks of Brentwood Creek a tributary of the Canning.
The McAnuff family were organised and gracious hosts.

Selected notices for Kevin McAnuff :

'The West Australian' January 22-24, 2004

Pharmacy Guild (WA) president , national Guild vice-president and close friend Harry Zafer :
"…a pharmacy champion, my champion friend, pharmacy's fearless warrior, who won so many battles and challenged so many entrenched views…."

Australian Medical Association (WA):
"…Highly respected by the medical profession for his work in areas of common interest, he will be greatly missed…"

NAPSA
"…thanks to a man who fought to secure a bright future for his profession which will be enjoyed by many for many years to come…"

Con and Rita Berbatis
" Tribute to a colleague student…The fruits of your work will live long in pharmacy practice and research. …Farewell friend."


Editor's Note:
Mr McAnuff was a member of the Pharmacy Guild's national council, its Health Economics Committee, a negotiator in the Third Community Pharmacy (Government) Agreement ( 1 July 2000 to 30 June 2005), the Management committee to implement its initiatives and part of the Fourth Agreement team at the time of his passing.
The Second and particularly the Third Agreements transformed pharmacy practice by revising the formula for PBS dispensing fees and widening the third party remuneration base for a new set of community pharmacy services .
Kevin McAnuff has been a key figure in pharmacy and Guild history for over a decade. The following report is an initial attempt to explore the unique background and talent underlying his key role in national and state pharmacy. While elections will determine his replacements at the State level , finding a new Fourth Agreement negotiator will be more problematical.

SOME POST-MCANUFF CONSEQUENCES FOR PHARMACY IN AUSTRALIA

The 1990s was a period of transformation in the structure and processes of pharmacy and the late Kevin McAnuff was a natural 'change agent'.
The First (1991-1995) , Second (1995-2000) and Third (2000-2005) Community Pharmacy/ Government Agreements were the instruments to facilitate the transformation (Tatchell, 2000) .

The Pharmacy Guild's DR Michael Tatchell is unique in having participated in all the negotiations since 1985 including the three Agreements and hence is pharmacy's most direct historian of these developments. In Tatchell's words the Third Community Pharmacy (Government) Agreement became a "watershed as far as agreements …." between pharmacy and the Commonwealth government because the focus moved from a preoccupation with remuneration of existing services and government savings to a "strong emphasis on new pharmacy programs and services " ( Tatchell, 2003).

The negotiating team with McAnuff were the PSA's John Daffey (national PSA president to Dec 2002) and the Guild's John Dornan (NSW) , Bill Scott (Vic) and Jeremy Hampton (Tas.) with technical advisers DR Michael Tatchell and Vasken Demirian of the Guild's Canberra office.
John Dowling replaced fellow Taswegian Hampton in 2002 and Queenslander Tim Logan was appointed in late 2003.

The Agreement was " a breakthrough in that it returns to pharmacy those PBS savings that would previously have disappeared into consolidated revenue" (Tatchell, 2003) .
It acknowledged pharmacists broadly as healthcare providers with fees for new services, which was often pressed by McAnuff.
His background impressed on him that community pharmacists' primary health care role was a long historical one and was much wider than commonly accepted .
He campaigned for pharmacists to be educated adequately and be remunerated for these services because they saved the government health expenditure.

The WA registrar's Mr Robert Brennan's "…. he advocated fiercely for the protection and improvement of the profession…" portrays McAnuff's passionate flagging of pharmacists' achievements in various activities in the Pharmaceutical Council's monthly newsletter and urging them to strive harder .
The Third Agreement talks commenced in 1999 and continued for 12 months before being finally signed off in May 2000.
Tatchell (2003) lists 10 major achievements of the Agreement including :

* the Quality Care Pharmacy Program was introduced to ensure within a few years high uniform standards of pharmacy facilities, staff and procedures . A magnificent campaign under chairmen Queensland's dynamic Kos Sclavos and Tim Logan resulted in 50% of Australia's pharmacies enrolled by January 2002 and over 70% 12 months later
* the Rural Pharmacy Maintenance Allowance has succeeded in attracting most eligible pharmacies to provide access to pharmacy services to people living in rural and remote areas and is one of the agreement's "success stories " .
* fees for residential aged care medication reviews and domiciliary reviews have become implemented nationwide at a fast rate and are landmarks of Australian pharmacy.

McAnuff's command of the Third (and Fourth) Agreement issues and his critical approach to them made his presence an exceptional one in the negotiations.
This can be sensed in Michael Beahan's tribute " He will be sorely missed in the coming negotiations" .
John Bronger's recalls McAnuff "… would not stop arguing and hammering a point…" .
The Commonwealth Department of Health's Phillip Davies a government negotiator and adversary in the Agreement talks acknowledged McAnuff had "…a strong interest in regulatory reform to help community pharmacists…"

Tatchell points to issues which need to be assessed in 2004 in "..the lead up to the Fourth Agreement".
These involve a review of the pharmacy location rules, progress in "inter-professional collaboration in the provision of healthcare services ", and the take-up by pharmacies of the " Section 100 program for providing pharmaceutical supplies and services …" to ATSIC communities (Tatchell, 2003) .

A large worry facing pharmacy nationally is supermarket pharmacies .
McAnuff feared the disappearance of independent (pharmacist-owned and controlled) pharmacies .
He knew this may mean the continuing decline in pharmacy: population ratios from 1:2,000 in 1965, 1: 3,000 in 1990 to the present 1:4,000 and down to the present USA ratio of 1 pharmacy : >5200 people (Berbatis, 2003).
This may well occur quickly if the large supermarket public companies introduce pharmacies in the stores with the deregulation of ownership and of PBS dispensing as well as the wide rescheduling of S4s and S3s to S2s.
The Guild and other national and State bodies need to make strategic decisions shortly if pharmacy is to capitalise on the Third Agreement achievements and fend off supermarket pharmacies.
The Guild and pharmacy at State and national levels will need strategists and hard negotiators of McAnuff's ilk to fight these and other challenges.

The Agreements have had a number of permanent structural effects on pharmacy.
First, they have made the Agreement negotiating teams arguably the most powerful force in contemporary pharmacy.
Second, the negotiating process has become formalised into the Steps of
(1) brainstorming to identify the key issues ,
(2) prioritising the issues ,
(3) strategising the negotiations,
(4) rehearsing,
(5) actual negotiating ,
(6) implementing and
(7) managing the Agreement decisions.
Third, the resulting expansion of staff and resources has stamped the Guild's national dominance not just in negotiating, but in lobbying Ministers, vying with medical and other health groups, implementing national policies, widening the scope of remuneration for pharmacists and effectively setting the professional as well as the commercial agenda for community pharmacy.
Fourth, the leaders of pharmacy practice research in universities such as Sydney's Prof Charlie Benrimoj and South Australia's Prof Andrew Gilbert have pushed pharmacy practice or population research out from the shadows and up to the status enjoyed by laboratory researchers over the past decades.
They are seen as the guiding lights for community pharmacy in the future.

The Fourth Agreement is now into Steps 1 and 2.
Time is running short with the federal elections due this year which means the Agreement outcomes will be decided before November with the present Cabinet rather than waiting until June 2005.
The Guild hierarchy will need to now review the composition of the negotiating team and advisers.
With the government side having vast resources and limitless technocrats at its call, the Guild will look well beyond the confines of its building in Canberra to match the opponents.
High on their priorities will be to find another McAnuff, "…often seen as the hard man of pharmacy…hard hitting, incisive, relentless , irreverent … for the profession he loved and defended with passion… " (Beahan, 2004) and the "tough guy" in negotiations.

The 21st century opened with the spectre of the Wilkinson and Galbally reviews recommendations hanging over Australian pharmacy.
The immediate question looming for the Guild is : Who will replace McAnuff in the negotiations leading to the vital Fourth Agreement ?
Or, will sources other than the Guild be tapped for future Agreement negotiators?
It may well be time to invite leading pharmacy practice researchers or administrators as advisors or negotiators for the 4th Agreement talks.
After all, the Agreements now demand the best talent our country can offer.

Con Berbatis , 6th February, 2004.

References
· Beahan M. Vale Kevin McAnuff. www.auspharmlist.net accessed 30 January 2004.
· Berbatis CG. Supermarket and non-pharmacist controlled pharmacies. Part 1: international comparisons. Pharmacy Review 2003; 27 (4): 29-34
· Bruce J. Pharmacy : profitable profession or prescription for poverty? GPO Box 447, Brisbane (Queensland) : James Bruce Publication, 1990.
· Tatchell M. The evolution of Agreements. Aust J Pharm June 2000; 81:588-590.
· Tatchell M. Third Agreement : mid-term review. Aust J Pharm 2003; 84: 138-139.
· The West Australian.. Pharmacists' top man dies. January 20, 2004, page 28.