Within
my "other profession" of management consulting we have
a governing body called IMC (The Institute of Management Consultants)
which sets standards of conduct and education, and arranges accreditation,
which is accepted at the International level. Someone contracting
with a consultant who has CMC (Certified Management Consultant)
after their name, is assured of dealing with a management consultant
trained to a recognised standard. The IMC has a national governing
body and various "Chapters" in each state.
Its function equates pharmaceutically to a hybrid of the PGA and
the PSA (which is why I personally believe that an amalgamation
of these two organisations would provide greater benefits for pharmacists).
Within
the management consulting profession we have a range of consultants
with different status.
They are:
*
Internal consultants: these are salaried consultants working within
organisations that are not consultant owned. The equivalent in
pharmacy may be a pharmacist retained by a drug manufacturer to
constantly review one or more processes e.g. the writing and developing
of consumer medical information.
* The contract consultant: this is usually a single agent, self-employed
consultant who offers (as a sole trader, company or trust) to
consult directly to clients, or who will subcontract through a
larger organisation with access to consulting assignments.
This is the model that currently exists for pharmacy consultants,
where they can contract with private clients or contract through
community pharmacies.
This model is the most prolific in the management consulting world,
and there is every reason to believe that this process would be
duplicated as the preferred end model for pharmacy.
It would be severely hampered for the future if it was permanently
tied to a community pharmacy.
* The structured consultant: usually a large organisation structured
as a partnership, company or trust which retains a large number
of consultants as partners, associates, employees or subcontractors.
This type of organisation generally deals with larger clients,
and is usually globally active (through alliances or in their
own right) in concept.
There is generally a specialisation of consultants within this
type of organisation, which often means that a team has to be
put together for a specific client project.
There is a sprinkling of this type of organisation developing
here within pharmacy ranks in Australia, but currently only in
an embryonic phase. This type of organisation requires entrepreneurial
leadership and tight management control.
It is also the type of organisation that would be most affected
by the alteration of the current structure of consultant pharmacist
control.
By virtue of the fact that these types of organisations seek to
constantly expand, by first competing for market share, and secondly,
by developing new services, they generate fear and uncertainty
for smaller single agent consultants.
I do not believe that it is in the interest of consultant pharmacists
as a whole, to try and close out this type of development.
Provided they are regulated to be controlled by pharmacists, they
should be allowed to expand and create opportunities for all.
Traditionally, pharmacists, through the PGA, have sought to dampen
down this type of activity in all areas of pharmacy endeavour.
For example, the initial spectre of Boots the Chemist coming to
Australia some years ago, and Soul Pattinson Chemists expanding,
brought in restrictions through the various Pharmacy Acts, to
block them completely.
I suggest that the better response would have been to encourage
such structures, provided they were controlled by pharmacists.
This meant that Boots and Soul Pattinson may have had to form
alliances with other groups of Australian pharmacists and develop
new models. Much like Priceline is doing right at this moment.
The eventual result was that Boots stayed away and Soul Pattinson
set up franchises, which are still carried on today.
Larger organisations are always feared because of their resources.
Smaller organisations have to copy the best from their larger
competitors and do it better.
The history of small business is a pattern of creative survival,
and I would venture to comment that the advent of Soul Pattinson
franchises raised the competition level and set the stage for
the community pharmacy model that we know today.
Soul Pattinson was reviled and hated by private community pharmacists
initially, but all pharmacy has survived, developed and prospered.
Soul Pattinson set new standards in management, style, and the
provision of services, and Soul Pattinson is now owned and fully
absorbed into traditional pharmacy structures. They were proved
a net benefit, and models that have evolved since e.g. the Terry
White model, can trace most of their roots back to this type of
competitive development.
The
birth of consultant pharmacy could be said to have occurred when
the two parents (PGA and PSA) gave birth to the AACP. I would
also like to believe that I had a hand in the conception process
as I was involved in some very early research (
follow this link). Be patient, there are some large graphics
and the download my be initially slow.
Like all families, the infant has to be nurtured and guided up
to an age when they start to independently think for themselves,
and are looking to flee the nest somewhere post-teenage years.
At this stage you hope you have been a good parent and have prepared
your child for the rigors of surviving in a harsh world. You have
invested in education, shelter, good nutrition and a reasonably
disciplined environment. All you can do is stand back and allow
your pride and joy their full independence, and the privilege
of making their own mistakes.
To continue the analogy, I believe that consultant pharmacy (through
the AACP) has just entered its teenage stage, still needing a
strong parent to take it through the most important development
phase.
Will the parents be forward thinking and think only of the best
future for their child?
Or will they endeavour to tie their child to them permanently,
ending up with a child who knows it has been deprived of its heritage,
becoming disillusioned and distant in the process-never growing,
and serving only the interests of the parents, rather than the
wider interests of the entire extended family.
In
February 2000, the newsletter precursor of this publication published
the following:
"The
AACP, through Guild and Society stewardship, has to this date,
created a solid foundation for consultant pharmacy in Australia.
There is now a need for individual consultant practitioners to
be able to elect their own representatives, control their own
destiny, and allow some creative input from member practitioners.
We hope this comes soon, and that the AACP Pty Ltd creates a shareholding
for each of its members."
This
publication has included many references and articles supporting
consultant pharmacy, and you can verify all of them by using one
of the search engines on the Computachem site. Just insert the
words "consultant pharmacy" in the search engine located
on the front page of this edition, or the homepage to the site,
and you will see literally hundreds of links back to information
on consultant pharmacy.
I wrote the following in April 2001:
"Computachem
E-Newsletter extract, Edition #23, April 2001
One
question that has to be asked...
Have we got the structure of consultant pharmacy right?
The official organisation for consultant pharmacists is the Australian
Association of Consultant Pharmacists (AACP), a tightly controlled
company structure with two management voting shares, held by the
Pharmacy Guild and the Pharmaceutical Society respectively.
Each organisation appoints a number of delegates to the board
of the company, and it is this group that develops standards and
opportunities for consultant pharmacists.
To this point, the organisation has performed well, creating practice
guidelines, professional development, and identifying a range
of clinical activities which are reimbursed by government.
But it does need a boost.
It is time to open the company up to member shareholders so that
they can begin to plot their own destiny. Certainly, leave Guild
and Society representatives (one from each organisation) as permanent
appointments to the board, but let the members elect those people
to represent them who give best value.
And while we are about it, why not offer shareholdings to accredited
hospital pharmacists who would surely bring a valuable talent
resource to the organisation.
There is a need to open and expand the points of view within the
AACP in a more creative and dynamic fashion, particularly in the
area of non government subsidised activities.
As was pointed out at the commencement of this article, consultant
pharmacy was flourishing in a private capacity well before the
advent of the National Health Scheme.
Here then, is an opportunity to think "out of the square".
There is also a need for regional groupings to provide a network
of support and share experiences. Perhaps this is the greatest
need, because regional groups can best configure educational requirements
and delivery systems for their own particular areas, and can configure
liaison services between public and private hospitals, also nursing
homes, where appropriate.
One size does not fit all, and the achievements of regional groups,
shared nationally, will provide a continual input, generating
the growth spurt required.
It is my prediction that regional groups, promoting within their
areas of influence, could provide the stimulus for future pharmacy
recruits, as their profiles increase.
The mix and balance of government subsidised services and privately
developed services will provide enthusiasm, increased morale and
maybe, just maybe, a return to some of that fierce independence
and pride that this writer experienced at the commencement of
his career.
It would be great if this could really be our legacy to future
pharmacists, having lost our way in the recent past. The process
appears to be under way, but needs an injection to promote a bit
more vigor."
Follow
this link for the full article.
After
a number of postings on AuspharmList, Jay Hooper, the president
of the PSA has presented a summary of PSA's views and explanations
which appear quite reasonable.
Perhaps the posting that gives most concern is that of Jessica
Graves, National Director of AACP.
She states:
"The AACP is not involved in the discussions about payment
models and so far has not been notified of any changes to the
current model. I spoke to a representative of the HIC and was
told that the current payment system would continue at least until
the middle of next year."
There seems little doubt that payment models are being discussed
by the principal players, and that AACP members have not been
polled on their preferences.
The proposals being discussed to fetter consultant pharmacists
to payments through community pharmacists should be dropped immediately.
It would also seem to me that the AACP role should be upgraded
for these types of negotiations, to groom it, so that it can effectively
take over its own affairs.
The principal players (PSA, PGA, AACP, and the trade union APESMA)
should sort out their roles now, so that a combined front can
continue to be presented to government.
Membership and costs associated by joining each of these organisations
is an issue with pharmacists. There is also duplication of human
and other resources, that needs to be addressed.
If the popular model for consultant pharmacists (single agent)
is allowed to survive, the PGA should be seeking ways to represent
these pharmacy businesses industrially.
It is inevitable that when pharmacies are allowed to incorporate,
there will be a gradual merger between suitable pharmacies, resulting
in a lesser number, but much larger and more sustainable community
pharmacies i.e. PGA membership must gradually decline.
It (the PGA) should be looking to create suitable membership for
consulting businesses.
On the other hand, APESMA obviously sees consultant pharmacists
as actual or future members, as it would seek to represent internal
employee consultants or single member contractors.
So it obviously has a role in determining payments to consultant
pharmacists.
Perhaps it is also time for the major players to reinvent themselves.
I have already suggested that the AACP open up its ranks to members
as shareholders, thus increasing the voting power of members to
direct their own destiny.
I would further suggest that the PSA, PGA and the AACP set up
an umbrella organisation to provide the conduit for a single pharmacy
voice, still allowing each entity to remain intact, and deliver
the expertise that each entity has developed over the years.
It would then be seen to all pharmacists that they had a voice,
depending on which membership is selected.
This as a prelude to some form of amalgamation in the future,
first in allowing the umbrella organisation to provide services
that would reduce overheads (negotiation services, management
or specialty consultant services, secretarial, office space, Internet
services etc.), leading up to a merger of each entity as a division
of a single organisation.
The
AACP is a minor player politically at the moment, but because
of the nature of consultancy (problem solving) it will take centre
stage in the years to come.
And this is the real issue.
The major shareholders of the AACP have been known to suppress
revolutionary thoughts within the AACP and there has been skirmishing
around the issue of membership.
If the major players do not allow the AACP to develop in its own
right, you will gradually see member disaffection, major discord
and eventually breakaway members setting up their own organisation.
This is not in the interests of any pharmacist, no matter what
flavour.
It should also be remembered that supply pharmacy is a structured
and reactive process.
On the other hand, consultancy requires unstructured time, and
is a cognitive process.
They are opposites and cannot successfully coexist, unless they
are managed separately at arms-length, for one process destroys
the other, and this has been the schizophrenic nature of pharmacy
down the years.
Supply
pharmacies should be competing with each other to provide suitable
environments for consultant pharmacists, and seek their income
in the form of rental of space, and the supply activities that
result from the consultant process. Supply pharmacies need to
be constantly alert to leads and referrals as a method to bind
consultant pharmacists, not through payment channelling.
For information on this particular topic you could read the articles
of Peter Sayers who has written about constructing various practice
models ( follow
this link ).
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To
all the readers of i2P E-Magazine, a thank you for your
support, and I wish you a happy and safe Christmas for all
your families.
Neil Johnston
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NEIL
JOHNSTON