“The drive to move pharmacy away from a medicines supply role has made “disappointing” progress over the past year, think tank the Nuffield Trust has said.The sector must “seize the opportunities on offer” or its future over the next decade “looked bleak”, the think tank warned in its report on how attitudes to pharmacy have changed since November 2013.”
This is a UK “Think Tank” comment on the state of pharmacy progress in the UK.
What it does not say is that the UK system of “commissioning” for the authorisation of clinical services is tightly controlled by doctors.
The thinking is that if a doctor can perform a new service, whether or not they have the capacity to deliver, any new service is automatically reserved for doctors.
Thankfully, the page is almost completely blank for pharmacy in Australia with the story about to be written.
Don’t get me wrong, the “commissioning” structure in Australia is called the “Medical Benefits Schedule (MBS)” and doctors will fight tooth and nail to keep pharmacists out of this source of service funding, but the political regime in Australia will listen to anything that is cost-saving for any system involving government funds.
Pharmacy has earned “brownie points” because its leaders have been prepared to sacrifice some of their members by the cruel process of accelerated price transparency.
That has gutted most pharmacy owners that are still standing, except for those who did not place so much reliance (up to 90 percent) of their business in PBS dispensing.
The lesson from that experience is “balance”.
Government business of any description should be managed to not exceed 55 percent of turnover.
Read, learn and inwardly digest!
The real message for Australian pharmacists is that when you begin to charge for a professional clinical service, the market to be serviced is the private market that has an ability to pay.
i2P can tell you from data accessed from an early pilot study, that a properly resourced and marketed service will work well.
But you must fund it separately, manage it separately as a division of the pharmacy and ensure that dash flow and profits are re-invested.
Also, allow 12 months for the activity to blossom and flourish.
Do not fund it out of the dispensary cash flow because that will be a recipe for disaster.
Once pharmacy has a successful business model that government can feel, see and touch, you have something to negotiate with.
The value component compared to doctors is the Medicare rebate for a 10 minute consultation which is around $36.
If you can sustain say, a 20 percent differential between your service and a doctor’s, you will have your foot in the door (for negotiating purposes) for a share of the MBS reimbursement schedule.
Some new research indicates that if a pharmacist service is embellished with a nurse overlay in some form, it will be seen as a direct equivalent to a doctor service.
The mechanics of how this should be done has not been thought through by i2P writers at the moment, but I am sure it’s on someone’s New Year resolution list.
The UK report’s authors concluded that, while pharmacists had managed to persuade some local commissioners to fund innovative services, progress across England remained “patchy and lacking in scale”.
The “complex” commissioning arrangements that pharmacy had to operate under appeared to “support the status quo and inhibit innovation”, the authors said.
They cited divisions between the national pharmacy representative groups as preventing the sector from making a “coherent case” to the wider health service.
If pharmacy leaders did not put themselves at the centre of local and national healthcare planning, the sector risked being “overtaken by the inevitable expansion of technology-driven dispensing and supply”, the authors stressed.
NHS policy-makers also needed to show they “meant business” and provide national funding that enabled pharmacists to become care-givers, the think tank said.
Judith Smith, Nuffield Trust director of policy and the report’s lead author, said there had been an “increased understanding that pharmacy has a lot to offer an NHS on an urgent hunt for savings”.
“But we are still not on course for [pharmacy] to become a care-giving profession in the way [it] should.
In most areas, there just hasn’t been a change patients would notice,” she added.In its Now or Never report, the RPS pointed to the government’s Better Care Fund (BCF), a £3.8 billion sum set aside to make health and social care more integrated, as an opportunity for pharmacy to realise its potential for helping reduce medicines-related hospital admissions and pharmaceutical errors in care homes.
But the Nuffield Trust said many local BCF plans still contained “relatively little new roles” for pharmacy in residential and domiciliary care.
However, it noted that pharmacy did have a “significant role” in some of the BCF plans that had been “fast-tracked” by the Department of Health because they were considered to be the most advanced.
The report’s authors also found evidence that the sector was now seen as “part of the solution” to the winter pressures on hospitals and A&E services.
While they could not identify a “clear trend” of newspapers publishing more discussions about pharmacy, there was an “encouraging” rise in the number of references to the sector in parliamentary debates, they added.
The last throwaway comment does have some significance and it explains why doctor-generated press releases that are adverse to pharmacy get continuous airing.
Leadership bodies need to generate positive stories for pharmacy to counter the obvious campaign that is being continuously inflicted on pharmacy by doctors.
The doctors are experienced and savage political operators and work at multi-levels.
Pharmacy may not be in the same league, but it must lift its political game and obtain better media coverage than we currently get.