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KEN STAFFORD Consultant Pharmacist Perspective |
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To
Dream the impossible (?) Dream
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The anticipation
was building as I opened my treasure, a 100 year old copy of The
Australian Journal of Pharmacy. |
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to my surprise, all I could see was a number of writers complaining
about the unfairness of, and methods they could apply to prevent,
attempts by "large retailers" called, I think, Woolworths
or Coles to break into the profession. There was much discussion about how this intrusion could destroy the viability of "community pharmacists" (whatever they might be). Other articles decried the imposition of something called the FTA and its possible effects on the "PBS". I shook my head and compared this to the role of the modern pharmacist practitioner who is considered to be a complete health consultant. We now take responsibility for the management of chronic diseases where the doctor will refer a patient to us with a prescription that states "hypertensive treatment as per the pharmacist". Pharmacists now determine the actual medications to be administered, following guidelines agreed on with the prescriber. Our expertise in the use of pharmaceuticals was recognised some years ago and the pharmacist practitioner-medical practitioner team is the norm. The skills of each group being used to complement each other to provide for Quality Health Care with agreed outcomes and monitoring procedures. It has been many years since pharmacists attained prescribing rights for simple acute conditions such as minor eye infections or infections. Using appropriate algorithms I can prescribe antibiotics or analgesics for patients and, using available technology, obtain real time payment from the government agency. Pharmacists now do many of the simple hands on functions that doctors claimed to take up too much of their time. We often administer vaccinations and are involved in monitoring many medical parameters for patients, such as BP, BSL, cholesterol level etc, and refer them to medical practitioners if required. Pharmacy has now become the gatekeeper for the medical profession, reducing its workload and permitting more focussed health care. Pharmacists now are recognised as providers of high quality medico-pharmaceutical care and are remunerated by the national health scheme for carrying out this role. As I read on, I wondered what had happened to turn the profession around in the intervening years since my old AJP was published back in 2004! As you will have realised, this scenario is a figment of my imagination but it is, however, one possible path our profession can tread in the years to come and I can only dream. I must admit that the concept is not my own but one put to me by young colleagues who are well aware of the pressures on and threats to pharmacy as we know it. The imminent entry of the majors, the propensity of community pharmacists to "shoot themselves in the foot" and the disillusionment of young pharmacists relating to the fall in professionalism and ethics are all acknowledged and there is a desire to see pharmacy change. Many of them are distressed by the continued drive for profits by the "fat cat" entrepreneurs and the lack of willingness by the public (and government) to pay for services currently provided free. There is also a concern that pharmacy is being driven into unsafe practices by the need to create and run dispensing assembly lines, churning out up to 1000 scripts a day with only one pharmacist on duty. How the hell can such a pharmacist find the time to counsel and advise the string of customers coming through? If this is all pharmacy has to offer, the sooner all scripts are dispensed by machines the better for all concerned. There needs to be a basic change to pharmacy courses to address the expectations of the modern patient with more emphasis on alternative therapies. Why should a pharmacist have to refer a patient to a naturopath when schools of pharmacy could incorporate some naturopathy units into the pharmacy course? Many modern health problems relate to lifestyle and dietary behaviours - pharmacy schools should include more on these topics into the course. Pharmacists could then become the "pharmacist practitioner" of my dream who has the knowledge and skills to become a complete health care advisor. Legal barriers to prescribing by pharmacists must be broken down. As someone asked me "Why does a pensioner have to go to a doctor just to get a script for paracetamol tablets?" In 99.9% of cases it isn't necessary so why can't the pharmacist dispense them, swipe the pension card and claim PBS payment in real time? All we really need now is for young, laterally thinking, pharmacists to be given the chance to drive the profession towards one that will reward them for being highly skilled health care providers. As long as we remain so reliant on the monthly PBS cheque pharmacy will be chained to the dispensary, working very long hours for government and public who refuse to pay for consultant services. Sure, HMR payments are a start but what about the many hours of free time we all spend providing free health advice? Many patients see the pharmacist as the first point of contact when they feel unwell simply because the consultation is free and pharmacists are more readily available than doctors. Much still needs to be done to break down the "not on my turf" mentality of the medical profession which continually complains of having too much to do but raises it hackles if pharmacy proposes taking over some of its simple functions. This will be a major task for our younger colleagues. Finally, just imagine how much easier it would be to show how we add value to health care if pharmacists could, after an appropriate consultation, prescribe simple medications and claim both the consultation and drug from the HIC. Payment for professional services would, I'm sure, give pharmacy some protection from the Woolworths and Coles of this world. Do I dream the impossible dream? |