AUGUST ,Edition # 31, 2001

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Two separate, unrelated, incidents occurred last Saturday that led me to think about community pharmacy as a "profession" rather than a retail business.
The first took place at the pharmacy where I "moonlight" one day a week.
In the middle of a very busy day a customer came in, handed in an empty "dosette" and said,
"I'm going away tomorrow and need this refilled. I'll pick it up in the morning."
As the pharmacist usually refills the device during the week, it was the first I knew of it so I contacted a "weekday" person to get some information.
One of my questions was,
"How much do we charge for the service?"
The answer was, to my surprise,
"We don't charge the patient anything, it's a free service".
Meanwhile, in another place, my wife and son were taking our puppy to the vet to see about a limp she had recently developed. She was examined and diagnosed as having a slight muscle strain for which we were given 21 anti-inflammatory tablets. The whole process would have taken about the same time as we spent later in the afternoon filling the dose administration aid (don't you love bureaucratese?) and cost us $60.
Later that evening, as I reflected on the day, a topic for this column came to me. This is:
"why is it that people expect pharmacy to offer so many free services, and why does pharmacy actually supply them?"
Have we so devalued ourselves that we are unwilling to demand payment for providing a professional service.
During that one day I had "consultations" with at least as many ill people as the average doctor, all of them "free" unless I actually sold the person something.
Our community colleagues, for a number of reasons, are recognised as being the first contact for health advice by a large percentage of the population. These reasons include ease of access, trust and a professional image, but I fear that the main one is that the consultation carries no charge.
Why does the Australian public accept that it has to pay a vet, lawyer, accountant, plumber or electrician an up-front a charge for service but will baulk at paying pharmacists a reasonable fee for their expertise?
Some years ago I was part of a committee, set up by the Pharmaceutical Society, to try to establish Pharmaceutical Care in Australia, a service where pharmacists would be rewarded for applying their skills to improve health outcomes of patients. (Does this sound familiar to those advocating consultant pharmacy and medication reviews?) We were so enthusiastic that the project would finally break down inter profession barriers and that the health care team approach I wrote about in my last article would finally become a reality in the community.
American experience indicates that where pharmaceutical care is effectively employed there is better use of medicines, some cost savings and improved results. (This has been recognised to the extent that there is talk in the US about giving pharmacists the equivalent of a provider number to claim from the Medicaid system for such a service).
Pharmaceutical Care in the US shows that pharmacists not only gain professional kudos but that there is often an increase in customer numbers as the benefits of the service become evident.
At last, we thought, a chance to be seen as legitimate health care professionals and to gain remuneration as such.
A tremendous amount of work went into developing an Australian version of the system, one pharmacist here in WA even selling his pharmacy so he could work with the Society in its endeavours.
What went wrong?
The project foundered because of the funding problem raised above.
It was considered that Australians, unlike our American friends, would be unwilling to pay a realistic amount for such a service, Government at that time had its own pharmacy agenda and the private health insurance industry seemed to be disinterested.
Thus an opportunity for community pharmacy to move into a clinical professional role was lost.
We do not even have the excuse that the medical profession opposed such a move, as there was support from all of the medical bodies involved on the committee. The major stumbling block appeared to be pharmacy's reticence about promoting its expertise in drug matters and demanding payment for service (as opposed to payment for dispensing prescriptions).
Pharmacy must stop undervaluing its skills and providing free services.
How can you, for example, justify the discrepancy in dispensing fees between PBS and private scripts?
If a fee of $7.00+ is appropriate for private items why does the profession accept about half that for PBS scripts? One of the fees must be wrong because, unless I am confused, the same dispensing procedure is followed!
Why devalue our service simply because the PBS works as a monopsony where we have one major customer (the government).
Let's get serious about our professionalism, if a vet can charge $60 to attend to a dog, pharmacists should be willing to charge for advice on pharmaceutical matters in humans.
As was stated in the last Newsletter, the campaign "Ask your family chemist-he knows", was so successful that it raised the ire of the medical profession, to the extent we were forced to let it lapse. Like Professor Julius Sumner-Miller I ask "Why is it so?"
We are highly trained health professionals so let us act as such and demand payment commensurate with the services we provide.
For too long we have been under valuing our role in Australian health care, it is about time we stood up for ourselves and said "Enough is enough."

Note that the views expressed in this column are my own and may not reflect those of the Department.
Ends

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