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February 2004
sees an apparent faltering on a number of pharmacy issues:
1. The sale
of Mayne Pharmaceutical Distribution has dropped off the radar,
with Woolworths declaring that it was not interested in purchasing
the $400 million distribution business and Priceline dropping
out because of concerns that Mayne turnover may be declining.
Priceline
is still the logical buyer for Mayne, but it will depend on how
anxious Mayne is to sell.
My original estimation was that Mayne was just flying a kite,
to see what it could realise for its pharmaceutical distribution
business.
No sale was really imminent.
Until the "price is right" Priceline will just sit back
and wait.
2. The EAN
product numbering system is still stalled at pharmacy wholesaler
level where the three majors do not see the need to drop their
own proprietary product numbering systems.
This leaves retail pharmacy with no avenue to generate cost reductions
along the supply chain.
Of course, individual pharmacies can do what they have always
done i.e. club together as a buying group and deal directly with
manufacturers.
Perhaps the time is right to do just that.
With the proper software, Internet connection and a logistics
provider, a venture down this pathway may produce a suitable stimulus
at the wholesaler end of the business.
3. The down-scheduling
of medicines is being fought on the PR front with the Pharmacy
Guild of Australia doing a very creditable job. It will be interesting
to see how the debate evolves, particularly as consumers are allowed
to buy in.
Meanwhile, those individual pharmacists who are mass displaying
and discounting products such as ibuprofen should look to the
long-term effect they will have on pharmacy credibility and tone
down their merchandising of products that are truly not in the
overall best interest.
While consumers may still purchase the product from a pharmacy,
their personal estimate and view of "their pharmacist"
is sure to take a tumble.
4. Pharmacist
availability is still set to be a major problem in 2004, particularly
in rural/remote areas.
Studies commissioned by the PGA indicate that there will be approximately
a 2 percent increase in pharmacist numbers by 2010 to meet an
ever increasing demand from an ageing population.
There will not be enough pharmacists despite increased intakes
at universities.
There is a
solution to this problem (and others), but it appears unpalatable
to the PGA for the moment.
Allowing pharmacists to incorporate, merge and take over less
efficient practices, would provide an immediate release of experienced
pharmacists to create a middle management structure, from which
can be launched stable cognitive services.
The larger merged unit would provide a scale of economies that
would offset some costs, until cognitive services paid for themselves
in their own right.
Another possibility, that also seems to turn some segments of
official pharmacy off, is the use of registered nurses to leverage
pharmacist resources.
I am often quoted a Canadian story, where nurses were involved
in medication reviews that were regarded as unsatisfactory by
the medical profession.
This could only happen where pharmacists abdicate their professional
role.
Nurses are excellent as support professionals and are able to
gather patient information quite efficiently, because of the sociological
skills taught during their course.
Experimentation should occur at every opportunity.
We are also
seeing moves by the University Dept of Rural Health to establish
bridgeheads in rural areas to bring education to the region (rather
than travel to capital cities). This is an excellent strategy,
but is long term.
The PSA is also networking some of its services into rural areas
in an endeavour to raise the number and quality of accredited
pharmacists available for medication reviews.
It is good to see back up support starting to appear for pharmacists
under pressure.
5. Script
Factories are still increasing at an unprecedented rate, causing
disinteresting work, fatigue, and an environment that really does
not allow a pharmacist to operate properly or create job satisfaction.
Recently,
the PGA called for a tender for a research project to determine
how community pharmacists can increase their cognitive workload
and expand the range of cognitive services on offer.
High script volumes were quoted as one reason for the inability
of cognitive services to progress.
It's a case of the irresistible force meeting the immovable object,
and it is hoped that a range of solutions will eventually be found.
That such problems exist when new opportunities abound, indicates
that the basic culture of pharmacy has not really changed as yet.
New and creative methods for dealing with workloads and creating
interesting work, need to be introduced urgently.
6. Health
connectivity has suddenly become more of an issue with the revelation
that the PGA has somehow managed to patent aspects of MediConnect,
putting the whole system at risk.
MediConnect is due to report the results of its limited field
trials by June this year, but other stakeholders in the system
will be less than happy with the turn of events involving their"trusted"
PGA alliance partner.
Statements emanating from the PGA website also indicates that
the MediConnect system is years away, rather than the immediate
future first thought.
So the promise of connectivity will not provide alleviation for
any of pharmacy's immediate problems, and it has the potential
to tangle workflows further, in the event of system breakdown
(and it will happen).
7. The recent
sad passing of Kevin McAnuff, a highly respected member of the
PGA negotiating team, has left a hole that may be impossible to
fill at short notice. Given that the Fourth Agreement will probably
have to be in place by the end of 2004, pharmacy may be disadvantaged
over the next agreement.
The cracks that are starting to appear in a number of PGA strategies
may prove difficult to reverse, and unless the PGA can in some
way, make itself more representative of the entire pharmacist
community, we may be in for a slump in leadership ratings.
This will affect the perception of government and consumers as
to their total view of pharmacy, so apart from our general woes,
we may be in for a hard time.
8. Legislative
protection may soon be a thing of the past as the Federal Government
punish various state governments for having anti-competitive legislation.
The NSW government has conceded defeat and has agreed to reform
laws that spell the end of liquor licensing, after incurring a
fine of $50.9 million for its restrictive legislation.
The spectre of having liquor for sale virtually anywhere and everywhere
is sure to translate into future social ills, and health costs
will burgeon as a result.
Nobody seems to ever be able to get it right.
So pharmacy legislation has to be on the radar shortly, which
will be another test of fire for the PGA.
If the PGA had engaged the process after the Wilkinson Report,
there would have been no need for panic stations now.
For myself, as long as they leave pharmacist ownership in the
hands of pharmacists, then the sooner we see the disappearance
of approval numbers and be able to form up into Pty Ltd companies,
the better we can restructure for the real issues.
There is also
a rumour that if Woolworths can demonstrate actual pharmacist
support for its version of a community pharmacy, the ACCC may
just weigh in with support for their cause.
Graham Samuels, the head of the ACCC is known to favour big business.
Pharmacy is a big business, but is not structured capital-wise
or managerially to reflect its actual resources.
So all those
pharmacists who have listed with Woolworths may wish to review
their name on the list that is in Roger Corbett's top drawer,
for it is sure to circulate in ACCC circles sooner or later.
Believe me, there will be nothing for any pharmacist dealing with
Woolworths.
You will be beaten to death!
9. And while
we are going to press, Australian and US trade negotiators are
putting the finishing touches to what is euphemistically described
as a "free trade agreement". Despite repeated denials,
the Australian PBS is on the negotiating table, and concessions
will be made as to the process of how drugs appear on the PBS.
The fact that the US is bullying its way into the internal affairs
of Australian government is bad enough, the further fact that
the US will never wish to see a properly functioning free trade
agreement makes a mockery of the vision of free enterprise as
it ought to be.
PBS
changes may create further problems for pharmacists and patients
in the not too distant future.
As we stated in our last issue of i2P in December, there will
be more change in the coming five years than has been felt in
the past 50 years.
Therefore
it is time for the head-down and tail-up position, buckle up the
seat belt and hang on to meet the punishing workload coming your
way.
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