Now that the dust has settled around negotiations for 6CPA and that word “certainty” has crept back into the vocabulary once more, we are supposed to now relax and get on with the job of future-proofing the profession of pharmacy.
But what “certainties” can we count on?
With the current business model still having a flawed PBS reimbursement system at its heart, we have the certainty of “profitless prosperity” for our collective future.
Governments work hard to keep pharmacist award wages to a minimum, so as to contain the PBS dispensing fee.
The Pharmacy Guild of Australia (PGA) has also worked aggressively to keep pharmacist wages to a minimum, and is currently attacking penalty rates.
While there is an argument to modify penalty rates, there is absolutely no justification for containing base rates.
The Fair Work Commission have approved a Pharmacy Industry Award which currently lists the following pharmacist categories:
Pharmacist; Experienced Pharmacist; Pharmacist in Charge; Pharmacist Manager
Now, a pharmacist manager rate also equates to the notional rate owner-managers must pay to themselves in the preparation of a profit and loss statement to ensure that the net profit determination is a true figure.
So it makes no sense for the PGA to argue for a lower hourly rate for pharmacists because it is reimbursed in PBS dispensing fees.
The only entity that wins in a lower pharmacist award is the government.
That begs the question: “Does the PGA work for the government on certain issues and does it truly represent its members’ interests within those issues?”
Now that the national parliament is conducting an investigation into the 5CPA management, it may uncover management practices within the current system that should not exist.
And maybe some other questions may be answered.
For example: “Why does the Department of Health insist on negotiating with the PGA as the sole negotiator for community pharmacy agreements when these agreements affect all of pharmacy?
Why not a negotiating body reflecting all of pharmacy, but under the umbrella of an organisation such the Australian Pharmacy Liaison Forum – a body that has the capacity to develop policy for all of pharmacy as well as form specialist units to represent “all of pharmacy”?
The list of pharmacist categories noted above in the current Modern Award would also appear to be deficient and missing some key categories:
Clinical Pharmacist; Consultant Pharmacist; Specialist Pharmacist.
These categories comprise activities surrounding the “core business” of pharmacy and need to exist to illustrate other pharmacist activities not directly associated with dispensing (but still supportive for the overall pharmacy business).
These newer categories of pharmacist have the potential to be recognised through higher salaries because they have the potential to generate separate streams of income (separate to the PBS, that is).
However, the rates for these pharmacists need not be reflected in dispensing fees for the PBS unless they contribute (as they would in the area of patient advice).
And because of the duality of a community pharmacy in that it has both customers and patients (depending on the nature of each transaction) maybe the Consultant Pharmacist is the person who reviews all of the management systems and processes as well as clinical systems.
Pharmacy management is a complex job and an external review always assists in that type of activity.
This would ensure a correct balance of both human and financial resources.
As well as all the above pharmacist categories, there are two other categories that are outside of Modern Awards, and they are:
Pharmacist Board Director; Pharmacist Shareholder of a pharmacy company.
There is much information published regarding these functions in the wider business community, but not a lot for application within pharmacy.
Legal responsibilities for both need to be plainly visible in simple “how to” guides and the function of a director should be built into succession planning for senior pharmacists.
Courses like this are available.
And the other side of the coin, the attracting of junior pharmacists to become pharmacy shareholders through “employee” or other form of shareholding as a better means to control proliferation of pharmacies.
This form of investment would tend to build larger pharmacies over time with new pharmacists bringing a sense of “renewal” within a pharmacy business culture.
Larger pharmacies that can attract vibrant and innovative pharmacists that can satisfy most professional needs up to and including a succession pathway would seem to be a sensible policy to pursue.
But this also needs leadership with a “whole of pharmacy” perspective.
The opportunity to build a new paradigm pharmacy exists right now and it will happen.
Far better it be a planned and guided exercise – but that needs leadership!
When all of the above is able to be demonstrated as good and progressive policy that embrace both pharmacists, sales assistants and clinical assistants accompanied by good support systems and providing a clear future direction, markers for all business areas for productivity will naturally increase.
NHS England have commissioned a number of investigations into staff wellbeing and provide strong evidence in a paper prepared by the European Picker Institute titled:
“Understanding staff wellbeing, its impact on patient experience and healthcare quality” published in June 2015 and authored by Giuseppe Paparella, Policy Officer, Picker Institute – in association with the Centre for Mental Health.
The finding is that staff wellbeing is strongly associated with productivity gains that translate into good outcomes for patients.
This is supportive for the i2P contention that downward pressure on pharmacist wages, penalty rates and general working conditions will provide more adverse outcomes rather than the opposite. It is neither good policy or good management.
Current policy and the direction being forced through government Department of Health pressure certainly justifies investigation and ultimate correction.
To not do so perpetuates bad policy and will not provide the incentive that will attract the right sort of person to become the future pharmacists we need to sustain innovation and vibrancy.
Pharmacists who belong to leadership organisations are the only people who can correct this problem.
First, you must “own” the problem yourself and second, you must ask the right questions of the executives and directors of the organisation to which you pay high fees to belong to.
Be strategic in your questioning and ensure that the instructions that you give to your leadership reflect a long-term and beneficial aspiration for the whole of pharmacy.
We are long past short-term expediency and selfishness – all recognised as retardants for our profession, but still existing in determined “pockets” of decision-makers.
The message is “Build your ark before it rains”.
“When Noah built the Ark it wasn’t raining.
Noah became the laughing stock of the town.
However, believing in the message he received gave Noah the strength to continue with the boat building task.
Eventually Noah had the last laugh.
Apparently the fourty day and night flood was needed to cleanse the earth of man’s wickedness.”