The Productivity Commission Recommendation to decouple pharmacists from dispensing mirrors a progressive Scottish community pharmacy culture

Community Pharmacy Scotland (CPS) is the organisation which represents community pharmacy owners throughout Scotland in almost every aspect of their working lives, and is the voice of these vital healthcare professionals north of the English Border, as they deliver pharmaceutical care to the people of Scotland.
It is therefore, the Scottish equivalent of the Pharmacy Guild of Australia (PGA).
Scotland for well over a decade, has led the way globally in enhancing the professional service delivery role of a community pharmacy.
i2P has written about the pioneering activities of Scottish pharmacists and has pointed to their business model as one that would adapt to an Australian environment.
See: Scottish Pharmacy – A public/private partnership that encourages pharmacist clinical development .
It would be worth a visit to this article to refresh a view of the Scottish inspirational business model – future vision and actual accomplishments to date.
Much like their Australian counter-parts Scottish Community Pharmacists are independent contractors who supply pharmaceutical services to the Scottish NHS.
Community Pharmacy Scotland is the recognised body, which negotiates with the Scottish Executive Health Department on behalf of all pharmacy contractors, the terms and conditions of service and their remuneration and reimbursement for the provision of NHS pharmaceutical services.

Through their own unique skills and professional expertise, Community Pharmacists are increasingly important front-line healthcare providers in the modern NHS – as health educators, as primary care health campaigners, and as the best-qualified experts in the most effective use of medicines and drug technology.

CPS Scotland appears to have won many professional benefits for its members and has proactively provided a collaborative style of leadership that has minimised inter-professional rivalries and jealousies, and there appears to be a higher level of trust in dealings with government.

CPS provides information and advice to Scotland’s 1256 community pharmacies in respect of any matter concerning the provision of pharmacy services.
It also undertakes the role of engaging with members of the Scottish Parliament, Health Boards and other relevant bodies both in Scotland and throughout the United Kingdom in promoting, representing and safeguarding the interests of Scottish Pharmacy.

CPS is also keen to continue to build a high visibility presence with the general public in promoting the role, which Community Pharmacy can fulfil in delivering, alongside other healthcare professionals, a modernised Pharmacy Care Service at a time of major change within NHS Scotland.

CPS has 21 members of staff led by a Chief Executive who reports to the Board, which is the body that directs the affairs of its Council.

CPS is actually a new-look organisation, formerly called the Scottish Pharmaceutical General Council (SPGC), and it takes a proactive, open-door approach to better reflect the changing and developing role of its members.

Key to that is working with Government, the Scottish Executive Health Department, NHS Scotland, NHS Boards and other stakeholders to develop new pharmaceutical care services and to ensure that the framework exists to allow the owners of Scotland’s 1256 community pharmacies to deliver these services.

As in Australia, Scottish Community Pharmacy is at the heart of every community and plays an important part in the drive to ensure the health professions can provide the services for the health needs of the people of Scotland.

In September 2017, CPS announced a new vision statement that involves decoupling the dispensing process from pharmacists (but not from community pharmacies).
In other words, technician managed dispensing with pharmacist responsibility only at the end of a dispensing process, providing an accuracy check and a health literacy service that would evolve to a better level of patient compliance.

This well thought out vision seems to have been taken up and adopted by the Australian Productivity Commission – but without prior consultation with any of the stakeholders that would be affected.
How the Scottish model could be adapted for Australian needs is the big question, given the competing agendas of the Australian health scene.

The Productivity Commission recommendations are not necessarily incompatible with Australian pharmacist aspirations, provided community pharmacy is at the centre of this future vision and that pharmacists are allowed to embrace a practical clinical services role, primarily involving health literacy services (patient education) as a core skill and properly remunerated.
Access a copy of their recent report “Shifting the Dial”.

Given that i2P has consistently drawn attention to the fact that the PBS is in the final throes of its product life cycle, why would you be surprised that it is currently at the status of a “loss leader” and will be continued to be squeezed on price until it dies, or is resurrected in a new format?

The Productivity Commission, through its recommendation in isolation, has created suspicion within Australian Community pharmacists that there is an agenda to strike at the “core” of Australian community pharmacy, possibly involving the privatisation of the Pharmaceutical Benefits Scheme (PBS) as well as other areas of health funded under Medicare (despite protestations by government that this is not intended).
i2P believes that government is going down the path of privatisation and that Australian community pharmacy will have to contend with an influx of many global predators, that would include Amazon, Boots, CVS, Walgreen, Walmart and Countdown (Woolworths NZ).

The CPS statement on their new vision follows:

Our Vision of the Model of Community Pharmacy practice in Scotland

Wednesday, September 20, 2017

Pharmacists are the experts in medicine and pharmaceutical care

CPS’ vision of practice for community pharmacy in Scotland retains our setting at the heart of our communities and draws specifically upon the procurement, safety, patient supply and clinical appropriateness of prescribed medicines skills from a pharmacist’s broad range of expertise.

To deliver care effectively, the pharmacy retains, maintains and is responsible for all aspects of medicines supply. Patients are required to register with a pharmacy for all services with the pharmacist accountable for all of this.

The pharmacist is decoupled from the technical aspect of procurement and assembly of medicines within the supply process to allow their full clinical skill to be devoted to a patient facing informative role, ensuring maximum benefit and safety is derived from prescribed therapy.

To enable this to happen the pharmacy support structure will have to perform the supply accuracy check.

For some pharmacies, this will be delivered using technology alone, some with staff only and some with a hybrid approach. The dispensary team employed in this model will have the ability to oversee the accuracy of the supply process.

The decoupling of the pharmacist from the technical aspect of supply further facilitates the management of common clinical conditions from the community pharmacy setting, utilising the principle of “pharmacy first” supported by pharmacist triage, access to clinical records and effective onward referral routes.

With people receiving more and more healthcare interventions in or closer to their own home, CPS recognises the need to adapt practice to this changing environment and calls for flexibility in supervision arrangements to allow professional judgement to be exercised in the safe supply of medicines from the pharmacy in the absence of a pharmacist. This will allow them to interact with the patient and the wider primary care multidisciplinary team.

Community pharmacy has a significant role to play in improving Scotland’s overall public health record through supporting government priorities and being the supply route of choice for public health initiatives that involve the direct use of medicines, including vaccination.

CPS want to see this vision realised and is willing to work with Scottish Government colleagues to devise a financial model that meets our aspirations and provides a fair return on pharmacy owner investment.

So it would seem that the PGA leadership team needs to acknowledge that the PBS, in its dying phase of its product life cycle, is wasting pharmacist skills if they continue to be grafted to this model of activity.
The Scottish CPS has, over the past decade, evolved Scottish pharmacy culture to a better place.
It has thus displayed a better and stronger pattern of leadership, giving direction for its members.

That it states as one of its policy approaches it “takes a proactive, open-door approach to better reflect the changing and developing role of its members” indicates that it has positioned itself creatively by adopting a “bottom up” communications process that has allowed it to innovate and become global community pharmacy culture leaders in the process.
Only leadership organisations can effectively change the culture of the pharmacy profession, provided they have the right input.

Australian pharmacy leaders should heed the Scottish approach and turn the Productivity Commission recommendation of the decoupling of pharmacists dispensing, into a viable redesigned economical service – controlled by community pharmacy with an expanded professional services “core”.
Get ahead of the action.

How should this happen?
PGA and PSA – ask your own members!

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