Three Bioethicists Critical of Pharmacy Retailing

Three bioethicists have combined to criticise the concept of community pharmacy conducting retail front of shop activities, while simultaneously working in the best interests of the patient.
Their comments are published in Croakey here.
The bioethicists, Wendy Lipworth, Christopher Mayes and Ian Kerridge (all medical academics attached to the University of Sydney) discuss what is at stake when therapeutic and commercial boundaries are blurred, and deliver a warning to other health professionals who might consider the addition of merchandising to their professional portfolios.

The president of the Pharmacy Guild of Australia (PGA), George Tambassis has labelled the arguments of the ethicists as “ideologically-driven” and we at i2P tend to agree with him.
Pharmacy has always provided logistics services for health professionals, patients and customers as part of its core business, and indeed relies on a “balance” of professional income to total income to sustain viability in the market place, as well as maintain economical prices for dispensed medicines.

Pharmacists are consistently and highly regarded for trust and ethics, confirmed by many polls.
This can only be achieved when the professional elements are observed – patient first, organisation second and remuneration last.
These professional elements have been successfully performed throughout community pharmacy practice for as long as I can remember (and that represents 60 years of being a pharmacist).

There is a potential argument that pharmacist trust might be exploited by pharmacists with unsuspecting patients.
But it does not happen, so the argument by the bioethicists is spurious.
Patients are actively seeking more services from pharmacists and that certainly would not happen if breaches of trust were occurring.

Certainly, some models of pharmacy e.g. warehouse pharmacies, sit uncomfortably with some community pharmacists because they are disruptors of the pharmacy market.
But their customers and patients seem to like them, and that means that the competitive pressures generated by retail ensure that all consumers are well served.
That the warehouse models may only provide a basic patient service is not the point here – it is obviously adequate and accepted by their health consumers.

Retail pressures are not the only forces at work in the professions, as we are reminded by Seth Godin, a prominent global thought leader:

The professional pushes back

The architect refuses to design the big, ugly building that merely maximizes short term revenue.
She understands that raising the average is part of her job.

The surgeon refuses to do needless surgery, no matter how much the client insists. He doesn’t confuse his oath with his income.

The marketer won’t help his client produce a spammy campaign filled with tricks and deceptions, because she knows that her career is the sum of her work.

The statesman won’t rush to embrace the bloodlust of the crowd, because statesmen govern in favour of our best instincts, not our worst ones.

There are plenty of people who will pander, race to the bottom and figure out how to, “give the public what it wants.”
But that doesn’t have to be you.
Professionals have standards.
Professionals push back.”

Few pharmacists would disagree that the community pharmacy model needs improving to immunise itself against disruptive processes, and that the major process disrupting the model is PBS policy change.
Many pharmacists have been diligently working to improve their business model to better reflect today’s challenges.

There are many opportunists and skeptic elements working to damage pharmacy, and they seem to come from a very dark place, trying to impose a set of values on others rather than concentrate on their own ethical situations, many of which are compromising, using pharmacy criticism to deflect attention on themselves.
Many of these people have agendas that are hidden or ideologically driven.

Pharmacy does not need replacement – only improvement.
It also needs proper recognition for the work that it performs.

i2P has been proposing model improvements that have slowly gained traction over time.
Perhaps it is time to review those suggested improvements in detail.

Firstly, i2P proposes that new activities be formally created within a community pharmacy and titled clinical pharmacist, clinical assistant and patient registrar.
Preferably these people should be involved under contract (incorporated as a company) to a community pharmacy to provide an “arms-length” professional service delivery.

The clinical pharmacist is charged with servicing patients from a pharmacy perspective and because of age-related demographic changes, should be specialised and geared to aged care (chronic condition care), infant and maternity care, men’s health and women’s health. Specialty areas such as pain management and the use of medical marijuana should also be considered.
Services may also include briefing pharmacy dispensing patients on dispensed medicines.
The clinical assistant helps in clinical service delivery (including retrieval of front of shop recommendations by the cliniucal pharmacist) and is actively involved in a “pharmacy-in-the-home” service (ageing in place service for the elderly).
The patient registrar looks after patient registration, patient records, and the provision of supporting reference material for pharmacist consultations.

Community pharmacies should concentrate on becoming infrastructure providers and deliver office space, conference space, diagnostic equipment, robotic dispensers etc.
Income from professional services is shared 70 percent to practitioner companies and 30 percent to the pharmacy.

To ensure “arms-length”, cross investment from pharmacy to clinical services company (and reverse) should not exist.

Clinical pharmacists that are not involved with conflict of interest activities (no financial interest in a pharmacy or as employed pharmacists) should be registered as prescribers to provide more efficient services for patients, particularly in the area of prescription renewals.

i2P believes that collaboration is required between pharmacists and all health professionals, but strongly suggests that these collaborative process begin between pharmacists first, to provide a strong framework to leverage all activities from.

Community pharmacies hosting clinical pharmacist companies need to evolve to ensure that blurring of boundaries is prevented and that all processes are transparent.
Collaborative expansion can then be entered into in the form of hosting of other allied health professionals, complementary health professionals and public health systems, making community pharmacy a true and diverse health hub, but completely transparent in its operations.

The King Review into pharmacy may uncover some positive directions for community pharmacy, but they should remain in that context.
Community pharmacy is a highly successful model that has been disrupted by government and technology – it just needs modification to improve its delivery capacity, and dismantling by some unproven ideology is not a consideration.

Pharmacists are the experts in pharmacy and they are quite capable of working through to their own solutions.
All others may complement with idea improvements.

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