Welcome to the current edition of i2P (Information to Pharmacists) E-Magazine dated Monday 30 October, 2017.
Alarm bells must surely have been ringing loud and clear to all pharmacy leaders regarding two recent news reports.
One concerned a medical centre development application and car parking spaces for health care practitioners, including those attached to the ancillary pharmacy.
While this specific situation may be unique to this particular case, the finding that was handed down by the relevant tribunaL displayed an abysmal lack of understanding of the job of a pharmacist.
Tribunal Member Bill Sibonis stated:
“On the question of whether the pharmacist is a person providing health services, within the particular facts and circumstances of this case, I am persuaded that they are not,” he found.
“Unlike professionals such as GP, physiotherapist, and dentist, the pharmacist doesn’t diagnose and treat people’s health conditions.
“A person served by a pharmacist is not a patient but a customer”.
i2P has often commented in its articles that the use of the word “customer” has been inappropriately used by pharmacists themselves, also by official pharmacy publications and even in academic environments.
We have continually pointed to the fact that pharmacy has both customers and patients, and that a consumer can present at a pharmacy in the dual state of being a patient (presenting a prescription), asking for professional advice and then immediately adopt the persona of a customer by accessing commercial goods and services through non-clinical staff.
i2P has continually advocated for internal pharmacy policies to be developed for the handling of patients and separately for customers, along the lines that:
“The customer is always right, but the patient isn’t necessarily right.”
Clearly, pharmacy leadership has failed to establish a perception of the concept that pharmacists are health practitioners and that they do have patients.
How do they propose to increase awareness of that fact so that future court cases have some clearly identifiable pharmacist definition that can be pointed to?
The PSA Professional Practice Standards VERSION 5 | 2017, does utilise the word “patient” appropriately, and does give a detailed description of the components of pharmacy practice, but maybe there needs to be a succinct statement, continually promoted (as a mantra), that reinforces the job definition of a pharmacist includes diagnosis to the level of competency, that a pharmacist is a health practitioner who does treat people’s health conditions, and those people are real patients!
The second astounding news report concerns the Productivity Commission issuing a report to government on 3 August 2017 (The Shifting the Dial report), recommending the Federal Government to move away from community pharmacy as the vehicle for dispensing medicines, and further recommending a replacement of pharmacists by automatic robot machines, managed by “lesser trained” people (read lower cost).
The relevant section is printed in full as follows:
EMBRACE TECHNOLOGY TO CHANGE THE PHARMACY MODEL
The Australian Government should move away from community pharmacy as the vehicle for dispensing medicines to a model that anticipates automatic dispensing in a majority of locations, supervised by a suitably qualified person.
In clinical settings, pharmacists should play a new remunerated collaborative role with other primary health professionals where there is evidence of the cost-effectiveness of this approach.
HOW TO DO IT
Identify the best dispensing technologies from those that are currently available. Determine the necessary credentials for the supervisor of automated dispensing, but with those qualifications involving substantially less training than currently are required for pharmacists.
Consult with the relevant training institutions — most likely in the vocational education and training sector — to develop courses for such qualifications.
Inform the various university departments of pharmacy about the reduced need for future supply of pharmacists. Determine the locations for automated dispensing, taking into account accessibility and security, but eliminating unnecessary boundaries on locations now endemic in pharmacy planning rules.
Trial the technologies in remote and rural areas where there are currently shortages of pharmacists.
In consultation with Primary Health Networks, Local Hospital Networks, the various medical colleges and any other relevant clinical bodies, define the role of pharmacists in a collaborative clinical model. Identify where it is cost effective to use pharmacists in primary health, taking into account the capabilities of lower-cost health professionals, and the increasingly greater capacity for information systems to provide accurate advice about medicines to GPs and other professionals.
Phase in the changes after the Sixth Pharmacy Agreement has lapsed, using the time to test it in some natural settings to refine the model.
That this recommendation has been produced without any consultation with stakeholders, and attempts to destroy a major “core practice” of pharmacy needs to be viewed in a broader context of Big Pharma world domination.
i2P has been publishing regular reports of how the overall government plan proposed involves eradication of any health modality that does not embrace an “illness model” requiring drug solutions and to financially destabilise Australian communitypharmacy so that global retailers can take over the community pharmacy function.
In Australia, front organisations representing this view are orchestrated by Skeptics Australia.
Through academic extensions, the Productivity Commission has long been influenced and involved, to virtually decimate community pharmacy.
This Productivity Commission recommendation also reinforces i2P belief that ownership controls of community pharmacy will be relaxed circa 2026 (our best estimate).
Global supermarkets and pharmacy chain groups, will then become the ultimate providers of robotic dispensing services.
The Pharmacy Guild of Australia has responded to the Productivity Commission “Shifting the Dial” Report and said in a Media Release:
Productivity Commission: Shifting the dial to dumb
Date: 24 October 2017
The Pharmacy Guild of Australia completely rejects the ill-informed recommendations of the Productivity Commission in relation to community pharmacy, which would see the dumbing down of a revered health profession and inferior care for patients.
The recommendations in relation to the community pharmacy model undermine the credibility of the Commission’s report on Australia’s productivity performance – “Shifting the Dial” – released today.
In an astounding piece of short-sightedness, the Commission actually recommends a reduction in the qualifications and training required to become a pharmacist, creating a sub-class of under-qualified people to “supervise” automated dispensing.
This displays an appalling misunderstanding of the complexities and responsibilities required in the safe dispensing of prescription medicines.
The idea that this dumbed-down model should be tested on rural and regional communities is an affront to Australians living in those areas, and flies in the face of the need to deliver better health services to rural and regional Australians – not inferior services supervised by vending machine attendants.
The community pharmacy model in Australia serves health care consumers remarkably well, with 5700 community pharmacies and their highly trained staff serving the needs of patients face-to-face.
Local pharmacists are among the most accessible and highly trusted health care professionals in our health system.
This irrational recommendation to deprive Australians of this direct personal care from highly trained medicine specialists should be roundly rejected by governments and by the community.
The complete lack of meaningful consultation with relevant stakeholders– let alone the Australian consumers who make 350 million visits a year to local pharmacies – before making such radical and unworkable recommendations is breathtaking.
Make no mistake – this is the declaration of war on community pharmacy that is intended to reduce the influence of pharmacy in health policy, and to eventually slot it into a hand-maiden role in a medicalised illness model controlled by Big Pharma
This model is not the model that would benefit Australia’s health consumers, but it would benefit the power and profits of Big Pharma through their paid control of the medical profession.
And to “top” all of the hypocrisy promoted we have the Professor Stephen King (chair of the King Review into pharmacy) stating, at a meeting of economists, that location rules are “a goldmine” and it could be a good idea to make pharmacists compete for the right to dispense PBS medicines.
In other words, the chair of the pharmacy remuneration and regulation review panel has told a meeting of economists that he considered making pharmacies tender on price for a PBS contract, and describes the current location rules as “the equivalent of falling down a goldmine” for pharmacy owners.
While all the above is speculative comment and advice the Australian government has to heed in formulating policy, all the negative elements are able to be pointed to when final decisions are made in respect of Australian community pharmacy.
The stark choice is that the model of pharmacy required by government becomes a quality and collaborative health service that actually delivers health (not just illness management) or becomes a poor quality dispensing service that can never deliver health and quality outcomes – pharmacy consumers are proposed to be shoe-horned into a system of permanently ill customers.
It is just so ridiculous you have to breathe deeply to rationalise all the garbage that is flowing from some very devious people with dark and hidden agendas.
Make no mistake, Australian pharmacy is now engaged in a fight for its very survival survival.
i2P has been warning of this eventuality since its initial publication in the year 2000.
The pressure of the Productivity Commission may now stimulate some of the solutions that need to be put in place, such as:
* A process of culture change that can only be orchestrated from the “top end” of the profession.
It must be a system of continuous evolved culture change, driven by “bottom-up” communication derived from individual pharmacists.
* That the culture change represents an encouragement to stimulating creativity and an acceptance of new ideas (no matter how outlandish they may first appear).
* That creativity be converted to innovation and that innovation be supported to develop new systems to structure appropriate directions for pharmacy.
Communications systems and outreach will be the vital enablers from this point on.
i2P did earlier suggest that pharmacy publish its own newspaper given that mainstream media no longer functions as it should and generally reports pharmacy in a negative fashion supporting the Big Pharma view of the world.
Perhaps it is time to consider that proposition so that communication can become proactive rather than reactive.
Delivery of the newspaper through the entire community pharmacy network would ensure a cheap and reasonable distribution process.
Designed appropriately and inclusive for all pharmacists, it would also be a unifying mechanism for the entire profession and its industry extensions.
Our lead article this week looks at the current line up of new global supermarkets proposing to enter Australia in the very near future – all with the ambition to own pharmacies.
New wealthy and powerful entrants are gearing up to dominate the Australian supermarket industry.
What do they know and what has sparked their commitment to Australia?
Well, for one, the vulnerability of Coles and Woolworths with higher than average global margins on their product sales and their inability to negotiate globally from suppliers with a global reach.
Pharmacy is very much in their sights and more supermarket entrants are likely to also engage in intensive lobbying in Australia.
Despite tight pharmacy legislation that protects the existing business model, the Australian Productivity Commission has advised the Australian government to cut out the heart of pharmacy by destroying the method of providing dispensing services.
Pharmacists will need to pull out their fingers, become politically more active, and insist on a massive change in culture generation that embraces creativity and innovation.
It will not be for consumer ultimate benefit which is the code for recommending such a radical change.
You must start the fightback immediately!
Read: Analysis of new and Existing Global Retail Market Entrants and Their Effect on all retailers and Australian Pharmacy, and the Privatisation of Health
Peter Sayers discusses some of the counter moves that involve adopting all the positives in the Productivity Commission Report while adapting and modifying the extreme and destructive recommendations.
It gets down to pharmacists controlling the timing, direction and ownership and creating a new model that looks like the model envisaged by the Productivity Commission, but would be a model that could work for community pharmacy and its patients.
It is evolving in other parts of the globe, in particular Silicon Valley in the US, where elements of this model are already up and running.
It would resolve some of the issues of new pharmacists being able to own their cut-down version of a pharmacy that could exist under existing location rules and could expand clinical services in a Pharmacy-in-the-Home type of infrastructure.
It is also a model that could form alliance relationships more readily with other health professionals collaboratively, as well as with traditional community pharmacies.
i2P has been researching this type of pharmacy for some time, and most of this article was written before the publication of the Productivity Commission report.
i2P was just as surprised at the content and timing of the report as most others would have been.
A strategy of accepting most of the thrust of the report but challenging through a more appropriate pharmacy-friendly version is the direction recommended by i2P.
Read: Why Amazon’s Entry to the Australian Pharmacy Market May Drive Cultural Change, New Innovation and Promote Young Pharmacists
Gerald Quigley is back and he is talking about patient engagement and when delivered appropriately, becomes a strong marketing tool.
Patient engagement is a multifaceted concept that has always been practiced by pharmacists.
Even though it has an overall degree of difficulty, the basic elements of engagement that patients respond to, involves sharing and participating in the five basic human senses to the maximum practical level.
These include sight (vision), hearing(audition), taste (gustation), smell (olfaction), and touch(somatosensation) as the traditionally recognised senses.
Patient engagement can thus be described as a sharing of as many of the traditional senses to the highest level practicable between a patient and a health practitioner.
The process is basic to raising levels of patient health literacy and thus is an enhancement to successful clinical communication that is valued by patients.
Read: Please give me eye contact!
Harvey Mackay is back with an article on “being appreciated”.
Being appreciated is something that most people crave.
Pharmacists are no different.
So, why is it that under-appreciation of pharmacy is so high in the advisory area to government, while simultaneously, pharmacy sustains a very high level of real appreciation from its patient base?
It has to be the way in which we communicate.
From recent events we would have to deduce that government advisers are either very ignorant of how pharmacy actually works, or they are driven by an agenda that runs to a darker agenda on behalf of other competing interests.
We need to expose these agendas.
It would seem that pharmacy should bear some of the responsibility by examining the design and output of communications that could assist government advisers to become more constructive and at least debate issues well in advance of making uninformed recommendations to government.
The current system is now unworkable and in need an urgent repair.
The health of Australians has now become high risk and pharmacy needs to take a tougher stance.
Read: Appreciation increases your value
WHO has made a statement saying that cannabis should be decriminalised world-wide because existing laws cause health discrimination.
In Australia, patients are being actively discriminated against as police are instructed to enforce existing laws and close down “illegal” supplies, leaving critically ill people with no workable solutions for their health problems.
Flawed health policy generates bad laws and lowered community respect for policy and laws.
Yet again, Pharmacy is in a position to provide solutions very simply and simultaneously create opportunity for the profession to treat chronically ill patients efficiently and economically.
Pharmacy leaders need to be proactive in the regulatory area because other health professionals are actively competing to lock pharmacy out of any opportunity whatsoever.
Potential for pharmacists is found in the compounding of THC and CBD in specific ratios to match the best result for patients with chronic illness.
Further pharmacist potential also lies in using cannabinoids in harm minimisation programs involving opioid dependencies and as an adjunct for the management of pain.
Pharmacists also need to be active and have a voice in the regulation of these substances ensuring that maximum patient access can be obtained through the application of Schedule 3 of the Poison’s Act.
Read: Understanding Medical Cannabis – 1. UQ News: Is there need to reform international drug treaties? 2. CannabisCheri: This Is Your Brain On Marijuana: An RN’s Perspective 3. Cannatech News: Using THC To Treat Symptoms Of Crohn’s Disease
“The science is settled”.
So say the people who promote vaccination as some form of extreme medical ideology.
“Scientism is settled” is a more accurate description of the manipulation of the science surrounding vaccines – and it is certainly “unsettling” to hear the dishonest claims that blare out in all forms of media.
“First do no harm” is the concept that underwrites all medical practice.
Australian vaccination policy is so poor and damaging, that it beggars belief that legislators can be so close to manufacturer sales objectives as to guarantee them a market through coercive legislation that involves simultaneous removal of patient choice.
The evidence supporting vaccine policy failure and its lack of safety is becoming so voluminous that it will eventually destroy the unnatural power alliance that desperately tries to hold it all together.
Read: The Safe Vaccine Debate – 1.The Dr Judy Wileyman Report: Newsletters #178 & #179 2. AVN: VaxXed QLD Reaches Townsville 3. Robert Kennedy’s World Mercury Project: The Interwoven Global Epidemics of Mercury Toxicity and Autism
And we conclude the content for this current edition with media releases from three pharmacy leadership organisations.
PSA – http://i2p.com.au/psa-media-releases-1-preparing-pharmacy-assistants-for-changes-to-pain-medicines-2-pros-and-cons-for-pharmacists-in-productivity-commission-3-pharmacists-welcome-new-rural-health-commissioner-4/
ASMI – http://i2p.com.au/asmi-media-releases-1-diamond-award-winners-2-billions-can-be-saved-with-more-non-prescriptions-medicines-3-how-you-respond-to-key-concerns-about-switch-4-call-to-recognise-economic-value-of-sel/
We hope you enjoy reading i2P. Please recommend us to your colleagues and do not hesitate to post comment in the panels provided at the foot of each article.
Editor, i2P E-Magazine
Monday 30 October 2017