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"New laws removing restrictions on
pharmacy ownership are expected to give consumers better access
to pharmacists and help pharmacists focus on helping patients
use medicines safely and effectively, the Ministry of Health said
today.
Pharmacists
were sometimes frustrated by the bureaucratic barriers that constrained
their focus on advising consumers, said Dr Gillian Durham, Deputy
Director-General of Sector Policy.
"Freedom
from the paperwork associated with shopkeeping should be a welcome
relief to many pharmacists who at present have to juggle ownership
and management demands with their key primary health role,"
DR Durham said.
"The
Government-mandated move to a population health focus is an opportunity
for all of our primary health care professionals to contribute
to the greater well-being of New Zealanders.
"Pharmacists
-- by their own definition the health professionals New Zealanders
see most often -- clearly have an important part to play in this.
This gives them the opportunity to do so more easily," DR
Durham said.
The
changes replace a restrictive ownership regime, dating back nearly
70 years, with a licensing approach. This means non-pharmacists
can own pharmacies but must satisfy certain legal requirements
to get a license.
A
registered pharmacist will ensure quality and safety by giving
advice and using medicines to improve consumers' health outcomes.
Where the pharmacy is part of a chain, the owner will be required
to employ a superintendent pharmacist overseeing all sites.
"At
the same time we believe this move will give New Zealanders better
access to pharmacists," she said.
"In
other countries people seeing their doctor or doing their supermarket
shopping often have access to a registered pharmacist dispensing
medicines from the same site.
"We
know there are retailers in New Zealand interested in this sort
of approach. We also know that one in 10 people given a prescription
doesn't get it filled at present. If access is one of the reasons
for this then we would expect this change to make a difference
to those people."
DR
Durham said the changes would be phased in over a three-year period.
A
letter providing information about the changes was sent to pharmacists
from the Ministry of Health last night"
End
of press release:
As
a pharmacist, I know that one of the reasons that I maintained
a strong retail section within my pharmacy, was because it helped
to offset sudden and drastic financial changes to the Pharmaceutical
Benefits Scheme, engineered through the Health Insurance Commission.
Without the buffer of the retail section, I do not believe I would
have withstood some of those steep and adverse financial movements.
My strategy was simple, when under pressure from government health
sources, use a little more initiative in the retail sector. My
customers/patients always appreciated any retail improvements
and I retained my sanity. I have always been comfortable with
a sensible range of retails merchandise, and even the "purists"
within pharmacy ranks, still have to factor in a retail segment,
though much diminished and medicinally/surgically focussed.
I guess the end result of having a retail division was, in reality,
it ended up subsidising the Pharmaceutical Benefits Scheme. Many
of my overheads connected to the dispensary, were covered by retail
profits.
However,
the real benefit of having a retail division was that it created
a totally informal environment for customers and patients.
Do governments realise that pharmacy has the only professional
environment where there is no obligation to buy when entering
that environment?
My strategy here was very simple, and it applies to all pharmacists.
Customers came for simple basic needs which could be handled by
sales assistants, or by developing self service techniques. However,
staff were trained to be inquisitive and search out any further
needs of the customer/patient they were attending. The objective
was to convert as many customers in my informal environment into
patients.
This
is the essence of pharmacy, and the reason pharmacists interview
more patients than any other health professional in a given day.
The informality of the environment and the process, relaxes potential
patients, and they often give up information that they would never
share with their doctor.
This fact has often irritated doctors and has made them feel competitive
to pharmacists, rather than to harness this resource as an extra
tool in their professional offerings.
So
when a government talks about "Pharmacists freed from shopkeeping"
they are really saying that we want to reduce your ability to
survive in business, and we want to cut down your flow of patients.
Note that in the press release they talk about "Pharmacists
were sometimes frustrated by the bureaucratic barriers that constrained
their focus on advising consumers"'
You can say that again!
But notice the bureaucratic thinking.
We will not eliminate our bureaucratic barriers, but we will legislate
to give you more time to talk to patients, by creating large,
non-pharmacist competitors, already located in well-serviced areas.
If it is the "bureaucratic barriers" creating the problem,
how is it going to improve advice to consumers if these barriers
still exist after the legislative changes?
This is not a free market exercise, but a blatant transfer of
pharmacy assets to the big end of town!
You will not have a business, so you certainly will be able to
talk to the trickle of patients who remain loyal to you.
That is, until you go broke or close down!
One
of the most hilarious sections of this press release is the statement
"Freedom of paperwork associated with shopkeeping should
be a welcome relief to many pharmacists who at present have to
juggle ownership and management demands with their key primary
health role."
Which side of a pharmacy business generates the paperwork?
The reams and reams of procedures and documentation, associated
with dispensing or the selling of restricted substances, is already
monumental.
It grows exponentially, and is a growth industry in its own right!
Surely the best way of freeing up a pharmacist is to eliminate
as many layers of overriding bureaucracy as possible, and simplify
all paperwork.
Notice
the tone of the press release.
It automatically assumes that pharmacists will drop retailing
activity simply because the "big boys" are entering
the fray.
What is going to cover the loss of income if pharmacists did drop
their retailing, and why would they drop it at all?
Why should this process generate more patient focussed time for
pharmacists when they will have to redouble their retailing efforts
to survive?
Depending on circumstances, pharmacists would compete as they
have always done, or they would close down, as is automatically
assumed by the tone of the news release.
The assumption is that pharmacists would prefer to work as employees
under the banner of a Coles or Woolworths equivalent.
Nothing is further from the truth!
Perhaps
the most galling part of this press release is the revealing statement
"We know there are retailers in New Zealand interested in
this sort of approach. We also know that one in ten people given
a prescription doesn't get it filled at present. If access is
one of the reasons for this then we would expect this change to
make a difference to those people."
What does this mean?
Does it mean that other retailers will set up in areas of New
Zealand not currently serviced by pharmacists?
Most viable areas of New Zealand and Australia are already covered
by pharmacists.
Remote and isolated areas are well serviced by mail order and
Internet pharmacies, particularly in New Zealand, where the first
discount Internet pharmacies had their genesis.
It does not give proper reasons for one in ten patients not getting
a prescription filled.
Cost would not be a barrier, because the majority of dispensing
is already government subsidised.
Lack of compliance would probably be the best bet, and the way
to eliminate this problem is to properly pay pharmacists for the
cognitive work they already do, and aspire to do.
In the same breath as talking about access, the press release
describes the scenario of access as a patient being able to see
a doctor or pharmacist in the same site as a supermarket.
Again, as already stated, such retail operators would only be
active in already well-serviced (by pharmacy) areas, and this
is not a valid argument for improved access.
It seems the New Zealand government would prefer to interfere
in pharmacy to a level where it should never be.
Such interference can only have an adverse effect on the personal
lives of all people connected to, and working within, pharmacies
that are currently operating.
This will be to the detriment of the total pharmacy profession
and is not in the public interest.
One
other disturbing aspect of this press release is that for proposed
chain sites, one pharmacist has to be legally appointed as a superintendent
over all sites. Given the UK experience, described in my other
article in this edition (Beware The Ides of March), this will
be a recipe for an operation where the pharmacist will have no
power to manage or control even the basic components of pharmacy
professionalism. In this model, professional discretion and independence
do not exist.
He or she will be overridden and become slaves to the shareholder's
need for maximum profit and a good share price.
It is not in the public interest to develop this type of model,
therefore the government claim to have a "mandate" is
false.
It will not improve location access, and in fact may decrease
location access.
It will not improve price (prescription prices are already fixed
and subsidised).
And sadly, there will be no investment in professional development,
because this will be too intangible for those people pragmatically
driving this type of pharmacy model.
With
the release of the very cynical and inaccurate press release above,
New Zealand pharmacists have the fight of their life thrust upon
them. Any assistance from their "cousins" her in Australia,
would no doubt be welcome.
The Pharmacy Guild of Australia has already taken an interest,
and it is hoped that access to tried and proven, successful political
strategies and approaches, will be given.
In
future editions, I will be looking at the details in the letter
delivered to New Zealand pharmacists to suggest potential responses.
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NEIL
JOHNSTON