MAY,Edition # 26, 2001

 

The model for consultant pharmacists as it now exists, relies on funding set aside from a proportion of future increases in NHS dispensing fees. As such, it is intimately tied to the total volume of dispensing done by community pharmacies.

The primary service performed by a consultant pharmacist is that of medication reviews, which is centred on drugs supplied generally under the Pharmaceutical Benefits Scheme (PBS).

The concept of consultancy is a relatively simple one.
It is problem solving.
The technique of consultancy can be applied to a wide range of subject categories, some of the better known being management, finance, human resources, health and in the case of pharmacy, medication.
Being a problem solver requires unstructured time, which allows a consultant to test the different pathways, either mentally or in an applied fashion, to decide on the best possible choice for a client/patient.
This makes a consultant a proactive person, and one who will have to perform a wide range of reading and research to arrive at a conclusion.
Because of the high level of research required, a consultant generally has to charge an hourly rate that reflects the total amount of time involved while at the same time, not be seen to be charging one individual client/patient for the total time spent on upgrading knowledge on a topic specific to that client/patient.
This time has to be averaged in some way.
Quite commonly, the consultant hourly rate will be based on the "thirds" rule, where the base rate is the hourly rate for a senior person in the field in which you are consulting and allowing an extra hour to be charged for research, plus an additional hour to cover overheads and support staff.
If, say, a practising pharmacist was entitled to an award or market rate of say, $40 per hour, then the rate paid to the consultant involved in pharmacy consulting services would be expected to be in the vicinity of $120 per hour.
This would be a fully contracted service, where the consultant pays for every overhead, including worker's compensation, professional indemnity, book keeping, secretarial services etc.

The existing pharmacy consultant model does not pay anything like an hourly rate of $120, and is primarily restricted to government dispensing and within government subsidised services such as nursing homes.

It would be impossible to practice as a consultant if the day were interwoven with a reactive process such as dispensing. The process of consulting and the process of performing highly structured services such as dispensing, are totally incompatible at the same time and in the same environment, by the same person.
Separation and divorce are required if the two functions are to coexist.
This is one of the major reasons pharmacists find it hard to develop a consulting role. It is not the accreditation process, nor the difficulties of medication review, but it is the ingrained habit of a lifetime of responding to the dispensing of a prescription and knowing that this is where the primary income lies.
Technically, divorce should also occur between the community pharmacist (who may have the contract with a local nursing home) and the consultant pharmacist.
A consultant must, at all times, be impartial and not make decisions based on creating a personal benefit or a benefit for a third party (other than the patient). Such a conflict of interest may seemingly arise if a consultant is able to reduce a considerable amount of medication being consumed by a nursing home patient and correspondingly reduce prescription numbers (and income) which would normally flow to the community pharmacist. If pressure was successfully applied by the community pharmacist to the consultant pharmacist, the process becomes both unethical and unprofessional.
If the consultant pharmacist and the community pharmacist are one and the same person, then I believe an ethical conflict exists.
You must be one or the other.
Given that the existing consultant model is controlled by government, is underpaid, with funding tied to dispensing volume, and at this stage is only showing limited opportunities for expansion, it should be noted that the private market is wide open, and consultant pharmacists need to enter a market where the client/patient is willing to pay.
Such a market is the preventive medicine and health and wellbeing model, which is being successfully exploited by a range of alternate practitioners, without any recourse to government subsidies or financial assistance.
While Computachem Services fully endorses and supports the aims and objectives of the Australian Association of Consultant Pharmacists, it should be pointed out that it is not a legal requirement to be accredited for medication reviews before you can call yourself a consultant. However, if you intend to perform medication reviews and want the government to pay, you must be accredited.
Therefore,with no major impediment, you are able to set yourself up in private practice to follow your specialty.
All you need are paying clients/patients.
And this is where the quantum leap of faith comes in.
You cannot arrive at being a consultant until you have done the hard yards of developing your expertise and building your support systems, to deliver an economical model of service that would be recognised by consumers as a valuable service.
The higher the priority the community places on a service, the higher the price it is willing to pay.
With an aging population, longer life expectancy and finite financial resources to treat illnesses, the preventive health market is set to soar.
Developments in this area will include monitoring devices to be continually worn in clothing; replacement therapies for lost molecules in the body as genetic medicine evolves; nutritional therapies to support drug therapies, or as a form of preventive medicine; are just a few opportunities that can be developed.
Genetic counseling may become a valued service and there are courses available, to gain accreditation in this activity.
What is required is a creative explosion within the ranks of those pharmacists wishing to develop into professional clinical services, supportive to, and not competitive with, existing services provided by medical practitioners or other qualified health professionals.
To achieve this vision, a knowledge of the consultative process, practice management, and marketing of services, is required.
To provide some of this knowledge, it is proposed to run a series of articles around the concept of consultant pharmacy and the basics of building a viable practice.

In this article we start with the intangibles that create the essential profile of a consultant pharmacist.

Creativity: the essence of a consultant.
Creativity is the resource that we all draw upon to understand and build our world.
How can we learn to be more creative?
Creative people can become a resource in themselves in answering this question.
A successful consultant pharmacist will constantly be developing his/her creativity skills as a means of solving client/patient problems, or preparing for a future opportunity. It has been said that "luck is when preparation meets opportunity", and it follows that "lucky" consultants are well prepared people, who happen to be highly creative.
Creativity is a human resource that we constantly utilise to create understanding in our business, professional and private environments. Each of us is born with natural attributes: eyes that see, ears that hear, hands that touch, the sense of taste and smell, all overlaid with an insatiable curiosity.
As young children we ask "Why?", because we have to find out about the world around us.
As consultants, we ask "How?", "When?", "Where?", "Why?" and "Is it necessary at all?"....as an extension of this curiosity, to analyse and provide a solution to a client/patient problem.
With experience, this type of value analysis may manifest as a "sixth sense" or the "gut feel" that provide the inner strength to suggest a solution to a client/patient (or their medical practitioner) when you enter uncharted territory.
Some people seem to have a lifelong ability to keep open all those "curiosity channels" and utilise them for creative ends.
How do they do it?
It seems that creative people seem to share certain qualities and follow a similar pattern in the creative process.
There is no absolute recipe for creativity, yet all great artists, scientists, thinkers and consultant pharmacists are bound by a commonality.
They challenge assumptions, recognise patterns, see things in a new way, make connections, take risks, take advantage of chance and construct networks.
All these qualities are keys to unlocking individual creative powers which give new choices, in both professional and private life, reawaken the spirit of adventure and make for interesting, exciting and unusual solutions to client/patient assignments.

It is this creative "quality" that appears to be collectively lost in pharmacy, primarily due to a stultifying existence as an appendage to government health policy.
There has been no escape for pharmacists into that private compartment that would normally be regarded as their own.
Consultancy, in a private capacity, represents a way out.
In so doing an environment would be developed that would be interesting, well paid, and would retain people for extended periods of time.

More in the next edition of the newsletter.
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