JULY,Edition # 29, 2001

In the last edition of this newsletter I commenced a series on practice management for a future and ideal model for consultant pharmacy.
I started by developing a floor plan, illustrating the spaces that would ideally be needed, the personnel that would occupy the spaces, and the relationship of the space to the rest of the pharmacy.
In this edition, the floor plan is extended slightly.
Taking a marketing approach to the proposed model, it was assumed that all services located in the consultant space were to be chargeable, and completely divorced from the dispensing process.
Having conceptually committed space and capital to the project, we must now backtrack a little to see how this new proposed service would be built on, and linked to all the existing space and services.
It is assumed that there has been a progression within the dispensary so that dispensary technicians handle all dispensing procedures in total, including the preparation of CMI and the reportage of any potential drug/drug interactions that may have been noted within the computer system.
It is further assumed that there has been a commitment to "Forward Pharmacy", so we now add a service desk as an adjunct to the dispensary, where the forward pharmacist will be located, and will be in a position to supervise the pharmacy.
It is further assumed that no charge is made for any of the services generated within the dispensing area (other than normal dispensing charges).
Referring to the model floor plan (below) developed in the last edition, we now expand it to bring to account the functions of forward pharmacy and the use of this function to promote consultant pharmacy.

Private Room		Paneling separating private room and open consoling area is opaque and floor to ceiling i.e. patient cannot be seen from dispensary.
Entrance Area	Open Counseling Area with Privacy Glass Panels	Forward Pharmacy Desk	Dispensary (Technician's area)
			Bench
	Reception Desk

Reception area is completely open, with a chest high opaque panel and a soundproof glass extension, separating it from the dispensary. A soundproof glass panel separates reception from counseling and a floor to ceiling opaque panel is installed between the counseling area and the private room. Forward pharmacy area may be separated from the reception desk with a soundproof, free standing, portable panel

The forward pharmacy desk now fulfills two functions:

* Firstly, it will give patients a complete run down on their medication, and any further assistance or information given to help a patient. There will be strict time limits on this activity, and it will have to be delivered in a cost effective manner.
It will not include detailed medication reviews or other detailed analysis.

* The second function is to actually recommend that the patient make an appointment with a consultant pharmacist, should the patient demonstrate a complexity that is beyond the competence of the forward pharmacist, or would simply take too long.

This is a selling exercise for consultancy, and a proper sales technique should be researched and utilised.
A written referral is generated and details given to the patient.
The appointment process is then initiated by the patient, taking the written details to the consultant receptionist, who creates the necessary appointment.
The appointment need not be an immediate one, because it may not suit the patient, or the consultant may have prior bookings.
The consultant secretary ensures that full information is given to the patient as to what to expect during the appointment, the duration, and the cost.
The secretary will also get a written approval for the consultant to be able to access the patient's dispensing files (under strict privacy rules) so that a certain amount of preparation can be undertaken prior to the appointment.
The consultant secretary should be trained to generate as much reportage as possible prior to the eventual consultant/patient interview.
This simple process outlined above gives a clear delineation between the dispensing service and the consulting service.
The dispensing service has no add-on service charges and is performed in a physically distinct area to that of consulting, where there is a clear obligation outlined for a fee payment.
There must be no blurring of these two service areas physically or in service content, otherwise the patients will become confused, and will not pay, if they see it as a simple extension of the free services they are already obtaining from the dispensary..

One of the emerging problems with the forward pharmacy concept is that it has been too successful.
By this I mean that patients have eagerly accessed the available pharmacist, utilising his/her time to the fullest, while at the same time, generating higher prescription levels and more forward pharmacy.
In the past, margins levied on prescriptions dispensed would have been sufficient to fund an increasing number of pharmacists to cope with additional script volumes. This is not the case today, and a more cost efficient model has to be developed to cope, because it is now not economically viable to employ more pharmacists for straight dispensing, even if you could get them.
The forward pharmacy concept, as it is currently constructed, will eventually collapse under the weight of increased script volume and insufficient return on capital.
Recent announcements by Dr Wooldridge, the federal Minister for Health, indicates that he is going to reduce wholesaler margins for Pharmaceutical Benefits (PBS) listed drugs on the National Health Scheme.
This means an automatic reduction in margin for pharmacists, with no other corresponding offset.
It will be a real cost.
A pharmacist shortage also means that hourly rates will inexorably rise in accord with market demand.
This is why pharmacy technicians must be trained to a higher standard and substituted for dispensing pharmacists. They have the advantage that they can be recruited locally and possibly be trained by Internet learning or Distance Learning programs.
It is possible for one pharmacist to supervise eight highly trained technicians based on British hospital experience.
This model will be more in line with returns from National Health and will enable the holding of the line, without necessarily compromising professionalism.
Forward pharmacy can survive under these conditions.
Consultants doubling up as forward pharmacists are not on, as the forward pharmacist has to be paid out of dispensing revenue.
The forward pharmacist will simply not be able to generate time or resources to double up as a consultant, and the model would then collapse, if this were envisaged.

As mentioned by other writers in this newsletter, technicians will need to be qualified to diploma level and laws changed so that a forward pharmacist does not have to spend every working minute in supervision.
Simultaneously, replacement of margin losses through PBS dispensing will have to be creatively reinstated, but this will form strategy contained in future articles.
While consultant pharmacy needs to be separated from the vicissitudes of the dispensary, it cannot exist in isolation at this point of its development.
Dispensary impacts and problems will seriously disrupt an evolving consultant model if either side cannot be properly staffed and funded.
Remuneration for consultants will not come from profit margins on PBS prescriptions, only from fees generated from chargeable services. Some of those chargeable services will be government funded, but this will be insufficient in total to sustain an adequate remuneration. Therefore, private practice must develop.
However, the dispensary can be a vital marketing tool for the consultant, and vise-versa, as we will see in future editions of this newsletter.
Ends
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