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My
very first locum, Trudi Moline, was obtained through an agency
- a fortnight's position starting from the day I took over the
pharmacy on 1st December, 1997. I was there for the first week,
while the previous owner was supposed to be showing me (who had
had no retail pharmacy experience) how to run a pharmacy!
His
suffering from the four-wall syndrome, and me not knowing what
to ask made the hand-over less than useful. The fact that there
were two pharmacists around meant that he took the belated opportunity
of spending the time down the street farewelling all the other
traders in Rainbow.
However,
Trudi was cross about my treatment and during the week came to
feel that she had to help this foolish old pharmacist who was
trying to do the impossible, and keep the pharmacy open. She suggested
names of her pharmacist friends for me to contact. And she has
returned several times for up to four weeks. Her friends have
also been most supportive.
*****Rule
1. The initial locum period MUST include some time for a hand-over.
While I was still in the process of being convinced by the Chief
Executive Officer of the West Wimmera Health Service that I could
actually keep the pharmacy open, I contacted my guru, John Morgan.
John is very much a lateral thinker and was the push behind forward
pharmacy many years ago - a trend that has had far-reaching effects
in making pharmacists more prominent in their own businesses.
John suggested I contact Brian Marchmont. Again we had a hand-over
of sorts. Brian travelled through Rainbow on holidays while Trudi
and I were there. Brian was the perfect gentle soul to help the
residents of Rainbow come to terms with the loss of their pharmacist,
and to show that other pharmacists would care for them equally
as well.
Brian's
wife, Eileen was very much part of the initial planning in those
first few weeks.
*****Rule 2. The locum pharmacists AND THEIR SPOUSES are all
part of the planning team for the Rainbow Community Pharmacy.
The next step was to contact the pharmacists who had been recommended
to me. This wasn't just a request for a locum for X number of
weeks - but an introduction to the Keep the Rainbow Pharmacy Open
project. They were all asked to recommend other pharmacists for
me to contact. The initial contact was not me giving them a set
of dates - but asking when they would be available to give me
some advice and assistance at Rainbow. There is a huge difference
between the two approaches.
*****Rule 3. A locum pharmacist is a TEAM MEMBER of the Rainbow
Community Pharmacy, and as such has to be aware of the aims and
policies of the pharmacy.
About this stage the greatest problem I had to deal with became
apparent. How do you deal with inherited staff who remain loyal
to the previous owner and who are extremely resistant to change?
In
any situation this is difficult - but when the proprietor lives
300km away, and the pharmacy is run by locums the problem seemed
insurmountable.
I
held staff meetings over a meal at the pub. I thought at the time
that the changes were being accepted - but it slowly became clear
that as soon as I had turned the car for home there was a bit
of celebrating and a return to the old ways.
Even
working through the problem with business consultants (part of
Government assistance package for small business), and appointing
a front of shop manager didn't help.
The
result - dismissal proceedings-stressful for the locums, the staff,
the community and myself, and a tad costly at the time.
BUT
what it meant was that I could start with new staff who understood
the aims of the pharmacy, and who enjoyed the stimulation of working
with different pharmacists. An interesting learning experience.
*****Rule 3. The pharmacy assistants have to be dedicated to
carrying out the aims and ideals of the Rainbow Community Pharmacy,
and more importantly convey this to the locum pharmacists.
Constant emphasis on the responsibilities of the locum pharmacist
and the pharmacy assistants is necessary. And the S2/S3 regulations
and QCPP procedures have been extremely useful in keeping the
balance right.
With
complete dependence on locums and with our current pharmacy staff
I feel that we have improved in this regard. There could be a
difficulty for some locums in some pharmacies where the locum
does not want to get involved in the front of the shop, or where
the assistants feel that they have the final say in managing the
business side.
*****Rule
4. The pharmacy staff have to be prepared (trained) to help, support
and work with a locum pharmacist. This includes after-hours entertainment
and hospitality. A real necessity in rural communities - but may
not be as relevant in the cities.
My
aim was to introduce a new pharmacist to our system every three
months, and to try to find younger pharmacists as well. I was
successful in recruiting a young pharmacist, and getting the phone
numbers of all his pharmacist friends and aquaintances. It is
easy to convince older or newly retired pharmacists of the pleasures
of working at Rainbow. However, with young people a whole new
mind-set is needed. The phone calls became a type of update on
the Rainbow project, as well as providing information about the
exciting developments with pharmacy and the West Vic Division
of General Practice.
This
exercise is an admirable way of overcoming the four-wall syndrome
- that contagious disease of which new graduates are terrified.
Even
if recruiting a locum for a one-off holiday, study leave or sabbatical,
putting together an "opportunity package" may help introduce
younger pharmacists to your practice for future partnership etc.
One
of my questions is whether the young pharmacists have taken part
in teleconferences. In the West Vic Division of GPs our pharmacy
group undertakes a monthly meeting with a guest speaker and a
case study (by teleconference). Two of the young pharmacists (under
30 and available for the football team) have so enjoyed the Rainbow
experience that they have continued to work in country areas.
*****Rule 5. Ensure that the locum pharmacist is made aware
of pharmacy opportunities, CE events in the region - OUTSIDE THE
FOUR WALLS OF THE PHARMACY.
One
development from our Rainbow project is a current Locum Pharmacist
Project with the West Vic Division of General Practice. Luckily
one of my young pharmacists, Steve Binos, was just finishing at
Rainbow when the project started. The Division has employed Steve
for the duration of the project. His placements in the region
are coordinated by the Division. The project commenced in June
this year. The Division pays weekend allowances, travel allowances,
CE needs for Steve. The pharmacists pay his wage. He has now had
experience in a regional hospital, a sole pharmacist hospital
and as a sole pharmacist in the West Wimmera Health Service (comprising
6 small towns - 5 with hospitals) During the latter, he also undertook
the provision of NPS "Common Colds need Common Sense"
information to community groups in each of these centres. He also
undertook audits of medication management processes in each centre.
He now has a good understanding of rural health systems.
He
is booked up well into 2003 in our region. The project has proved
already that a supernumary pharmacist can be of immense value.
It has the potential to be self-sustaining.
The
most interesting thing is watching Steve's perception of rural
pharmacy practice change since my first telephone contact in 1999.
In conclusion: I don't believe there is a shortage of locum pharmacists.
I
do believe there are far too many pharmacists who have not a clear
picture of how their professional practice should be developing,
or of what they want the locum (not their locum) to achieve.
Each
pharmacy has its own particular characteristics and strengths.
We should be so proud of our pharmacies that we can "sell"
the way we operate. If we can't do that then we can't expect locum
pharmacists to want to work with us.
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