 KEN
STAFFORD
Consultant
Pharmacist Perspective
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To
Dream the impossible (?) Dream
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The anticipation
was building as I opened my treasure, a 100 year old copy of The
Australian Journal of Pharmacy.
What prized bits of history would I find as I perused the crinkled
pages of my profession's past? Would I be able to see the genesis
of clinical services to the community or pharmacy's first tentative
steps out from the restrictive supply functions that had dogged
pharmacists for many decades?
As I contemplated the role of pharmacists today I eagerly looked
for pearls of wisdom from the writers, skilled practitioners I'm
sure, to indicate how pharmacy's leaders of that time had guided
the profession to its current status.
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Much
to my surprise, all I could see was a number of writers complaining
about the unfairness of, and methods they could apply to prevent,
attempts by "large retailers" called, I think, Woolworths
or Coles to break into the profession.
There was much discussion about how this intrusion could destroy
the viability of "community pharmacists" (whatever they
might be).
Other articles decried the imposition of something called the FTA
and its possible effects on the "PBS".
I shook my head and compared this to the role of the modern pharmacist
practitioner who is considered to be a complete health consultant.
We now take responsibility for the management of chronic diseases
where the doctor will refer a patient to us with a prescription
that states "hypertensive treatment as per the pharmacist".
Pharmacists now determine the actual medications to be administered,
following guidelines agreed on with the prescriber.
Our expertise in the use of pharmaceuticals was recognised some
years ago and the pharmacist practitioner-medical practitioner team
is the norm.
The skills of each group being used to complement each other to
provide for Quality Health Care with agreed outcomes and monitoring
procedures.
It has been many years since pharmacists attained prescribing rights
for simple acute conditions such as minor eye infections or infections.
Using appropriate algorithms I can prescribe antibiotics or analgesics
for patients and, using available technology, obtain real time payment
from the government agency.
Pharmacists now do many of the simple hands on functions that doctors
claimed to take up too much of their time.
We often administer vaccinations and are involved in monitoring
many medical parameters for patients, such as BP, BSL, cholesterol
level etc, and refer them to medical practitioners if required.
Pharmacy has now become the gatekeeper for the medical profession,
reducing its workload and permitting more focussed health care.
Pharmacists now are recognised as providers of high quality medico-pharmaceutical
care and are remunerated by the national health scheme for carrying
out this role.
As I read on, I wondered what had happened to turn the profession
around in the intervening years since my old AJP was published back
in 2004!
As you will have realised, this scenario is a figment of my imagination
but it is, however, one possible path our profession can tread in
the years to come and I can only dream.
I must admit that the concept is not my own but one put to me by
young colleagues who are well aware of the pressures on and threats
to pharmacy as we know it.
The imminent entry of the majors, the propensity of community pharmacists
to "shoot themselves in the foot" and the disillusionment
of young pharmacists relating to the fall in professionalism and
ethics are all acknowledged and there is a desire to see pharmacy
change.
Many of them are distressed by the continued drive for profits by
the "fat cat" entrepreneurs and the lack of willingness
by the public (and government) to pay for services currently provided
free.
There is also a concern that pharmacy is being driven into unsafe
practices by the need to create and run dispensing assembly lines,
churning out up to 1000 scripts a day with only one pharmacist on
duty. How the hell can such a pharmacist find the time to counsel
and advise the string of customers coming through?
If this is all pharmacy has to offer, the sooner all scripts are
dispensed by machines the better for all concerned.
There needs to be a basic change to pharmacy courses to address
the expectations of the modern patient with more emphasis on alternative
therapies.
Why should a pharmacist have to refer a patient to a naturopath
when schools of pharmacy could incorporate some naturopathy units
into the pharmacy course?
Many modern health problems relate to lifestyle and dietary behaviours
- pharmacy schools should include more on these topics into the
course.
Pharmacists could then become the "pharmacist practitioner"
of my dream who has the knowledge and skills to become a complete
health care advisor.
Legal barriers to prescribing by pharmacists must be broken down.
As someone asked me "Why does a pensioner have to go to a doctor
just to get a script for paracetamol tablets?"
In 99.9% of cases it isn't necessary so why can't the pharmacist
dispense them, swipe the pension card and claim PBS payment in real
time?
All we really need now is for young, laterally thinking, pharmacists
to be given the chance to drive the profession towards one that
will reward them for being highly skilled health care providers.
As long as we remain so reliant on the monthly PBS cheque pharmacy
will be chained to the dispensary, working very long hours for government
and public who refuse to pay for consultant services. Sure, HMR
payments are a start but what about the many hours of free time
we all spend providing free health advice?
Many patients see the pharmacist as the first point of contact when
they feel unwell simply because the consultation is free and pharmacists
are more readily available than doctors.
Much still needs to be done to break down the "not on my turf"
mentality of the medical profession which continually complains
of having too much to do but raises it hackles if pharmacy proposes
taking over some of its simple functions.
This will be a major task for our younger colleagues.
Finally, just imagine how much easier it would be to show how we
add value to health care if pharmacists could, after an appropriate
consultation, prescribe simple medications and claim both the consultation
and drug from the HIC.
Payment for professional services would, I'm sure, give pharmacy
some protection from the Woolworths and Coles of this world.
Do I dream the impossible dream?
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