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Some
of the small things in hospital pharmacy practice were
-
sending positive monthly reports to the Medical Director as well
as the Chief Executive Officer instead of meaningless statistics
of issues to wards etc
-
providing support and medication management education for nursing
staff
-
attending the first National Rural Health Conference (the only
hospital pharmacist present)
-
providing hospital locum service with "added value"
consultations
-
proving to CEOs and senior staff of hospitals that there is a
need for some pharmacy practice in each health service or health
district.
The clinical and managerial background of rural hospital pharmacy
practice, together with the knowledge gained of health administration
in the whole region led to small, but positive achievements in
the more remote areas of Victoria.
-
interaction with community health centres, Bush Nursing Hospitals,
very small hospitals
-
provision of medication reviews, hospital accreditation assistance,
consultancy reports
-
the basis for a successful Rural Health Support Education and
Training (RHSET) grant application "Rural Pharmacist Training
and Support Program" by the Monash University Centre for
Rural Health.
-
invitations to be involved in regional and state health planning
Was
this approach to the practice of pharmacy successful?
There
was a crisis in the Mallee/Wimmera region of Victoria. The pharmacy
at Rainbow had been on the market for years. No buyers. The incumbent
pharmacist planned to retire away from Rainbow. The pharmacy was
to be closed. Prescriptions would only be available through a
depot system - scripts being faxed to a neighbouring pharmacy
(60km away) , dispensed there and the medicines sent back by courier.
(Really not much different to mail-order or email pharmacy)
The
nurse-manager of the Rainbow and Jeparit hospitals, and the Chief
Executive Officer of the West Wimmera Health Service were desperate
to retain the pharmacy. It's loss would inevitably lead to the
loss of the General Practitioner, and then the downgrading or
closure of the two small hospitals.
Would
I purchase the Rainbow pharmacy?
Please?
My
small efforts in rural practice and pharmacy outreach had led
to an extremely difficult situation.My home and family committments
were three hours drive away from Rainbow.
I had no money to buy a pharmacy.
I hadn't practiced in community pharmacy since the olden days
after my apprenticeship.
The pharmacy would have to be managed with locum pharmacists.
An impossible task!
The
real difficulty is probably hard for pharmacists in large towns
or cities to understand - I had built up a reputation that pharmacists
were necessary in the provision of health services.
I had to accept the challenge or throw away the years of rapport
that I had built up.
However,
it was a sale of a pharmacy with a difference.
The initiative for the purchase came from the health service and
hospital.
The nurse-manager convinced the town community group that a real
community effort was needed to retain the pharmacy.
In
a moment of weakness I said "OK - but with a few conditions"
A public meeting was held and, despite having no guarantee that
the pharmacy would survive, debentures
were sold to provide $25,000 in three days.
It was matched by a government grant.
This allowed the community to buy the vacant next door premises,
punch a doorway between the two so that the old pharmacy became
the new professional area.
The additional area or annex is now the "front of shop".
In
effect, I own the business, but the community "owns"
the asset to the town that the business represents.
The
professional area is separated by a security door, which can be
locked if the pharmacist is absent. This is a new concept in Victoria,
and the Pharmacy Board (after initial very understandable misgivings)
have given their approval for the alterations to be undertaken
as a project.
One
of the very real problems that the sole pharmacist faces is the
"four wall" syndrome. If the pharmacist knows that the
professional area can be secured, then the possibility is there
for him/her to visit the depot in Jeparit, the hospital, to do
a home visit with the District Nurse or undertake a Home Medicines
Review.
Another
of my conditions was that the pharmacy was to be used for training
and work experience.
This was in fact one of my greatest hurdles - to change the concept
of girls working permanently in the chemist shop to one of pharmacy
assistants gaining experience that may lead to other employment
opportunities.
We
have school students after school, and during holidays.
Almost all have found full or part time pharmacy positions to
help while at university.
After four years the Rainbow Secondary College has acknowledged
the success of this programme and now has officially enrolled
one of the VCE students in a VET retail course along with her
VCE subjects.
We
have found many ways to foster community involvement, community
"ownership" of activities we undertake. The Lutheran
and German heritage from the early settlers of the area has given
us a wealth of artistic and creative work.
They provided an Easter window - absolutely beautiful.
The Catholic Church celebrated its 100 years in Rainbow with a
display including the cope handcrafted in France well over 100
years ago and used at the opening of the church.
Old school photos, desks and slates featured in another display.
Small
things, and perhaps not seemingly relevant to a pharmacy.
But
the pharmacy is dependant on customers, on the community.
If these people feel that the activities we undertake make the
pharmacy their "own" unique business then the threat
posed by mailorder pharmacy is diminished.
This
concept also means that the community is coming inside the "four
wall" barrier. The pharmacist is part of the community without
going outside the pharmacy.
A healthier situation all round.
I
am sure it would work in cities as well - by finding out what
makes your customers unique and special.
The
other problem - locum pharmacists.
The whole project would have failed without their help and support.
Help and support.
The key words for the success of the project.
I had no recent community pharmacy experience.
I was in the position of the nurses in the very small remote hospitals
- needing assistance.
Each locum has contributed to my understanding of pharmacy, and
to the running of the Rainbow Community Pharmacy and also to the
Rainbow community.
The Rainbow bank of pharmacists has grown, and has been able to
help other pharmacies in emergencies.
So,
the purchase of the Rainbow Pharmacy hasn't been a disaster.
This synopsis of the development and changes in the pharmacy practice
may seem trivial, "small things" but I could not have
achieved them without the assistance of the West Vic Division
of General Practice. The next edition will show how this small
rural pharmacy over the last four years has been the testing ground
for some very exciting doctor/pharmacist developments.
The
last problem I have to face is whether or not it will be a saleable
entity in the future.
This
edition will close with a question - would our profession be better
served with other methods of transfer or sale?
If the Rainbow community had not been involved then the pharmacy
assets would have been sold by pharmacy brokers- and closed down.
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