Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

Movements to increase the professional role of the pharmacist and to delegate all mechanical dispensing functions to technicians are far more advanced in the UK than in Australia. Government plans in the UK have earmarked pharmacists to take on increase responsibility for prescribing, medicines management and a larger role in the management of chronic disease.
All of these moves prompt the question of how far away are we in Australia from seeing similar roles established here.
How far behind the pace-setters are we?

Repeat dispensing of course already exists and this creates a great opportunity for patients to talk to someone about their health, given their next appointment with a doctor may be anything up to six months away.
But if simple problems exist, that could be fixed with a dosage change or changing the directions for administration the patient has to be sent away for new prescriptions.
Models being put in place in the UK may negate this need by allowing pharmacists to make these changes once a doctor has decided how a patient is to be treated.
Moves are also afoot to allow pharmacist supplied non-prescription items to be subsidised by their NHS. Tight constraints can be expected on the Pharmaceutical Benefits Scheme (PBS) if the last Federal Budget is any guide, so we probably can’t expect a similar move in Australia for some time.

The Pharmaceutical Society of Australia (PSA) and the Pharmacy Guild of Australia(PGA) have strongly pushed Pharmacy Self Care as a way for pharmacists to get involved in the management of patient’s with some chronic diseases.
Asthma and diabetes in particular have been targeted in pharmacies, as areas where pharmacists can have some benefit.
Even in the public health system pharmacists are now expected to play a role in hospital based priority health care programmes, targeted at patients who are at risk of re-admission or long term chronic health problems.
So we’re certainly part of the way there but still lagging behind the UK in one way, i.e. the level of government support.
The management of chronic disease has become an increasingly large part of the Federal Government’s health programmes but these have been almost entirely aimed at General Practitioners with very little pharmacy input, outside of already existing pathways.
So there seems to be a difference in the vision for the Australian health system and that of the UK.

The Home Medicines Reviews (HMR) are a step in the right direction in terms of getting pharmacists out of the dispensary.
Not everyone is happy with the way it has been implemented and funded, and most pharmacists believe in particular that a greater payment should be made for each review if a recent AusPharmList poll is accurate.
This service could hold the greatest potential for pharmacists to impact on the care of patients with chronic diseases and it will be interesting to see how strongly these are promoted in the coming months as the system comes fully online.
The Medications Assistance Service being rolled out by the PSA may see a privately funded service for more basic medication concerns to complement the more in-depth HMR scheme as discussed in a previous article.

Technicians are growing in importance all the time, as an efficient means of freeing up scarce pharmacists for patient contact and management functions.
Yet we still lag well behind the eight to one, technician to pharmacist ratio, that is common in the UK.
In some parts of Australia, there are even artificial limits placed on the number of technicians a pharmacist can employ.
This will surely need to change.
The UK has introduced a system of pharmacists screening prescriptions on clinical grounds, and then leaving all dispensing, and responsibility for accuracy to accredited technicians.
It will be interesting to see if we are this brave in Australia.

This week in a meeting with Hospital Pharmacists, the NSW Health Minister asked where the profession would be in five years time.
We bravely suggested items such as pharmacist prescribing, automated dispensing, and greater convergence between professional groups.
The over-riding factor in how these sorts of measures can be implemented may well the vision of health administrators, if they are prepared to bite the bullet and look to overseas for inspiration.