To say that pharmacy began the current fiscal year with a high level of uncertainty – a major contributor to anxiety levels – is to state the obvious.
Every person working within the pharmaceutical industry has been affected, with employed pharmacists complaining about the poor incomes they receive and fresh reports of a potential for community pharmacy liquidations/bankruptcies to become an avalanche over 2017, it is little wonder that anxiety levels are rising.
Chronic anxiety leads to clinical depression which foreshadows depletion in personal health and a corresponding decrease in business health.
Community pharmacy survival can be said to totally rely on community pharmacists maintaining a strong focus on planning the direction they need to take and ensure that they have the financial and informational resources to support and measure their navigation, and all management processes.
If you can’t measure you can’t manage, and a business must always return an adequate net profit and remain cash flow positive – and all elements to be simultaneously present.
Government, in the guise of PBS reform has been the reason for wildly fluctuating cash flows through community pharmacy.
On paper, a business may look good profit-wise, but unless it is backed with a strong cash flow and access to finance providers that will provide reasonable terms – the business will falter and eventually disappear.
The Big Four Banks have pharmacy virtually on a permanent credit watch and have become highly selective as to who they will support and to what level.
While pharmacists may feel individually helpless over some of the “macro” activities that affect their professional and business lives, there is much that is within their power in terms of creating stability by designing a plan that can take care of all the elements that do fall under a pharmacist’s control.
I guess that personal financial resources and their investment return would be a starting point.
Investment decisions are always governed by the return they generate and it is a given that investments that have a reducing return need to be adjusted or disposed of.
At the moment there is an enormous amount of capital leaving community pharmacy to find a new and more stable home.
While this is understandable, given the current atmosphere of anxiety and depression, and valid in terms of preserving and growing existing capital, it is being done without any real attempt to change pharmacy culture to a more relevant format by encouraging a climate of creativity that leads to a range of innovation.
And embracing a commitment to practice pharmacy as a profession, a willingness to experiment and to practice to the absolute limit, all those opportunities that exist within a professional practice licence.
Small pockets of ingenuity and innovation do litter the pharmacy landscape and where they have taken root they have shown positive financial returns.
These new “green sprouts” that should be providing signals for direction, are not being coordinated and supported so they can grow and be evolved into a changing culture that can stimulate professional pride.
For this lack of culture evolution pharmacy leadership organisations must take the full blame.
For example, the PGA has been a total failure in performing the lead negotiation for the PBS system and maintaining viability for pharmacy.
Irrespective of what insurmountable problems that arose during the course of those negotiations, there was little imagination exercised to develop “win-win” solutions and a complete failure to recognise that the PBS, as a product, hit the bottom of its life cycle around 2012 and there was absolutely no planning for a replacement product – even if it meant pharmacy “going it alone”.
And PSA could not have been said to earn any kudos for its lack of leadership in developing professional and sustainable roles for pharmacists, even given that it lost the carriage of pharmacy grants over a long and acrimonious period where PGA/PSA conflict of interest and divisiveness, characterised their internal leadership culture.
Even though recent attempts by PSA to establish the concept of a “Health Destination Pharmacy”, (a positive venture that validated a range of “knowns” from as far back as the 1960’s), was a right step – but it is a case of too little, too late.
Community pharmacy is now mortally weakened through poor leadership and governance and really needs a Donald Trump to turn it on its end, to restore a bit of commonsense balance.
However, the purpose in writing this article is not to dwell on the past, but to ensure that community pharmacy is equipped to become a positive and valuable asset that pharmacists would want to invest in and value as a community resource and a place that can provide solid employment into the future.
To ensure that this can happen, pharmacy leadership organisations will need to grasp the reality of the disruptive processes that are causing problems in all forms of business enterprise, both large and small.
Artificial Intelligence and robotics are seen as the major disruptors of pharmacy, because these tools have the capacity to displace pharmacists completely.
Control of these tools would mean that a major possibility exists where other wealthy and politically powerful forms of business e.g. Big Pharma, may be able to run massive global chains of pharmacies, both Internet versions as well as “bricks and mortar” models from a single administrative source that may not even be Australian based.
i2P has already run articles on holographic imaging combined with artificial intelligence systems that can mimic the body language and voice modulation that can fully emulate you (or any other community pharmacist) so that patients can believe they are really interacting with you personally.
We have also published details of Amazon’s Alexa voice activation system that provides a voice-controlled system inside a consumer’s home that can connect with your virtual image in a pharmacy and address Q & A communications as well as be part of an automated logistics service for prescription drugs and other consumer needs.
We have also written articles on the use of drones to be a part of a logistics service to deliver these needs quickly and efficiently.
The disruption here to whether even a well-located “bricks and mortar” pharmacy building will even be needed in the future is a disruption that should be put through some form of “think tank” right now, rather than wait for it to happen.
These disruptions are not figments of imagination, they are imaginings by predators of the pharmacy profession and have a solid basis. Further, these systems will appear within the next 15 years.
The loss of jobs potential is very serious indeed.
Governments are already looking at how they will deal with an estimated 50 percent unemployment rate that is predicted will exist in 16 years’ time.
Finland, a country that has put in a lot of thought on this issue, is making preparation for a trial of a basic income for its citizens, proposed to be delivered and provided by government at the rate of 800 euros per month per citizen, irrespective of their personal wealth.
This amount may be higher and in fact will eventually be a figure that will prevent poverty and provide a stimulus for higher education or even help fund a start-up small to medium business enterprise.
The basic income package will initially be in addition to existing benefits a citizen may already receive.
It is seen as a method of redistributing the wealth of a country and preserve local economies and a necessary method for preserving and individual’s independence.
The consortium running the experiment — headed by Kela, (the Finnish Social Insurance Institution that runs basic unemployment, health, family, and many other benefit programs), but including researchers at various research centers, think tanks, and universities — plans to file an interim report on March 30 2017 and a final report on November 15 2017 that will lay out how exactly the experiment is to proceed.
It will begin in 2017 and last for two years.
So far, the consortium has already polled the Finnish population and found widespread support for the idea: 69 percent of Finns reported support for a basic income, with the median respondent calling for a minimum of €1,000 a month ($1,083).
Australia already has some income augmentation schemes designed to encourage new enterprise formation. They are restrictive and are difficult to access, but nonetheless provide some method of gathering information and evidence to support continuation and expansion of a scheme of basic income provision.
Our pharmacy leaders need to be alert and proactive as to how community pharmacy may be able to participate and maintain the skills and capacity of its current workforce.
The pharmacists union (PPA) needs also to be proactive here.
The PGA and PSA needs to be involved as to how the new and disruptive technologies that will displace employees, can be introduced with minimal personal disruption and be open to new channels that can be created through research fostered by a variety of “think-tanks” that can generate appropriate ideas.
Artifical Intelligence and robotics cannot be avoided but if allowed to fall into the wrong hands, it will destroy the essence of independent pharmacy as we know it.
The fact that predators outside of official pharmacy can see value in community pharmacy (even at its lower ebb) that we pharmacists cannot apparently see means that we have not remained open to opportunity, preferring to remain in the status quo and relying on legislation to protect the marketplace.
There is value to government and community pharmacy in maintaining legislation such as Location Rules.
But they need to be justified.
Finding new roles for community pharmacies in the public health area may just be such a role that would make sense for regulations affecting the location of a pharmacy.
i2P has already written about a US pharmacy group that has taken on this role.
In so doing, it turned around the failed concept of a “patient-centred home” to a successful new model as a “patient-centred neighbourhood” and has become pivotal for success in managing and delivering primary health care.
Why can’t Australian pharmacy leaders independently investigate this type of model, because it will better suit Australian pharmacy and its collaboration with all health providers?
There is so much that can be done to reduce uncertainty in planning and improve the mental health of pharmacists by lowering anxiety levels that will also generate new confidence levels in those leaders simply willing to make decisions and take on some level of risk.