APRIL, Edition # 24, 2001

 

Are we short of pharmacists or short of properly structured jobs?
The time has come when a comprehensive review has to be undertaken of the job being asked of pharmacists in community practice.
So much is said about the alleged shortage of pharmacists.
The question arises
Are we really short of pharmacists?
Or Are we short of interesting and challenging jobs (for the university graduates) which will make optimum use of the knowledge and skills learnt at university?
Do we utilise their knowledge in the best possible way towards the health care industry of the 21st century?
This is the first of a series designed to allow you to have input to a review of how pharmacists work.
It will look at the key components of a job:

1) The tasks which are performed
2) The challenge it gives to intellectual capacity,
3) The way in which it is paid to properly compensate for qualifications necessary and
4) The place it is carried out in.

By way of background, it is useful to look at statements made in the Final Report of the National Competition Policy (NCP) Review of Pharmacy Regulation, released in February 2000.
The review (conducted by Warwick Wilkinson and a Steering Committee from all States and Territories) evaluated the regulations applying to pharmacy practice and the purpose of that regulation.
It explained that- "…..the most trusted ways of doing things benefit from being evaluated critically, from being validated if they do continue to serve a good purpose, and from being removed if they do not."
If actions and regulations serve a good purpose they should be retained, if not they should be changed or removed.
The fact that the review did not get very far in effecting change may only be temporary, as the principles behind the need for change have not altered.
If there is a shortage of pharmacists for the job they are expected to fill, there is one of two things happening-

1) there are not enough pharmacists being trained, or
2) the job is not appropriate for the qualifications being trained.

The chance of having more people trained to be pharmacists is not high.
So the need to look back at that critical review of the practice of pharmacy is worth revisiting.
The review concluded that- "…..pharmacy as a profession and community pharmacy as an industry have long enjoyed shelter from the full force of market competition. There is competition between pharmacies and pharmacists, but it is competition within a relatively homogenous, conservative and stable professional market. Pharmacists have not had truly to compete against non-pharmacist competitors for generations."
The only competition in pharmacy comes from a population of pharmacies which are conservative (don't like change), are homogenous (all much the same) and are in a stable market environment (the community pharmacy industry).
The fact that pharmacists have not had to compete has given them a sense of security within the boundaries in which they operate.
They have not had to think beyond the boundaries for decades.
This has been assisted by regulation (Pharmacy Acts and Poisons Acts) framed in the first part of the 20th century.
The Acts which describe the way pharmacy should be practiced, and sets the boundaries within which it should operate, are relevant to the health care industry of 50 years ago or more.
The NCP Review also concluded-
"The regulatory framework of pharmacy has been relatively static for many years, indeed many decades. Professionals in general are comfortable with traditions of self-regulation and control, and many pharmacists have felt uneasy, even hostile, to the prospect of change arising from an external process of review."
The place where pharmacy is practiced in the community has not changed in 50 years, so the "chemist shop" is still the cornerstone of the industry. Competition has not forced a review, with few exceptions, and the location of the practice has not kept up with new trends in health care practice with specialised or multi purpose outlets for health care providers and consumers.
The "pharmacy" is still the "retail shop".
This is explained by the critical NCP Review as being due to-
"……the PBS (has) restrictions on where dispensing pharmacies may locate for PBS purposes, ….. influence the shape and operation of the community pharmacy market."
And further adds that-
"The restrictions (on location of Approval Numbers) has not kept up with evolving health care and consumer needs"
The Review Final Report points to the need for community pharmacy practice to keep up with the health care trends in the next decade ahead, rather than being modeled on the past.
It states-
"They (the restrictions) do not help to keep the shape of the community pharmacy industry abreast of current and likely future trends in consumer need and demand for pharmacy services, including:
· · The ongoing popularity with consumers of "one-stop" shop medical centres containing a range of health care professionals under one roof,
· · The development and expansion of care and multi-campus aged care nursing home and hostel facilities, which lend themselves to either on-site dispensaries or the contracting in of specialist pharmacy services not always provided readily by orthodox community pharmacies' ; and
· · Specialist health care facilities such as Aboriginal Medical Services, which could also sustain their own dispensary facilities."
Attention to these "new millenium" trends must be addressed, and not serviced by "tinkering at the edges" of an antiquated structure for community pharmacy which is not relevant to today's and future needs.
The manner whereby pharmacists are paid in the year 2001 for their service is still modeled on the formula of the year 1950, when the Pharmaceutical Benefits Scheme was a very small part of remuneration, and the balance to receive a worthwhile package came from a user pays principle.
The balance of where the remuneration comes from has changed dramatically in the intervening 50 years, so that the NCP Review was prompted to state- "…..the industry's operating and regulatory environment is relatively static and benign and does not in itself foster competition. The greater part of community pharmacies' income (about two dollars in every three in turnover) is underpinned by government-funded remuneration and the fixed retail prices of subsidised medicines dispensed on the PBS."
Against this background, and over the next few issues of Computachem Newsletter, we will analyse the ""job of a community pharmacist", against the above elements, categorised as-

1) The tasks which are performed

2) The challenge it gives to intellectual capacity,

3) The way in which it is paid to properly compensate for qualifications necessary and

4) The place it is carried out in.

Before being able to describe a model of practice it is necessary to determine- What has to be achieved?
How it will be achieved?
How it will be remunerated?
And then......
What is the best physical environment in which all this should take place?

So wipe the slate clean - start all over again.
Forget the Pharmacy Act and Poisons Act, they are ancient history!
Tell us how you would like to see pharmacy practiced.
Remember…
"The only way to understand the future is to have the courage to start living in it!"
Start now!
Send us your thoughts and have your say in moulding the future.
Ends

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