Australian pharmacists and their leadership organizations have historically been seen as conservative and slow to adapt to changing health care needs. Much like other Western economies, Australia is grappling with an aging population burdened with a range of chronic illnesses, which translates to high health care costs. Pharmacists have recognized this issue for over 20 years and understand that they can offer or develop many solutions to assist in managing this demographic. Yet, has this knowledge led to a comprehensive and proactive approach in pharmacy health systems? Unfortunately, the answer is a resounding NO!

Structural Challenges in Community Pharmacy

The core issue lies in the structure within which most pharmacists operate: the community pharmacy. These establishments must balance retail activities with the provision of professional services. The pressure to generate high retail sales is primarily driven by wholesaler-owned franchised marketing groups, as wholesalers derive their income from product sales. This dynamic has resulted in insufficient investment, both financial and intellectual, in enhancing clinical services.

Community pharmacies do earn substantial incomes from retail activities, a success epitomized by the Chemist Warehouse franchise. Two of its co-founders are among the top 200 wealthiest individuals, with the franchise representing approximately one-third of the Australian pharmacy market. Chemist Warehouse owners are advocating for a relaxation of pharmacy ownership rules, aiming to consolidate their franchises and exert greater market control.

While their motivation is understandable, the Chemist Warehouse model may not align with what pharmacy consumers truly need. Surveys commissioned by the Pharmacy Guild of Australia and private polling by i2P confirm that while some consumers are drawn to low prices, many value the personalized health advice and trust provided by independent pharmacists. If independent pharmacies could match or surpass Chemist Warehouse’s retail prices, many consumers would likely switch their allegiance.

The Conundrum for Community Pharmacies

The challenge for community pharmacies is clear: how can they compete with major retailers for retail sales while simultaneously building robust professional services? The simple answer is that it is nearly impossible to do both effectively with the same investment dollar, as retail pressures will invariably dominate.

A Collaborative Solution

A potential solution lies in subcontracting clinical service pharmacists who would fund their own development within independent business structures. However, this concept has been too radical for the Pharmacy Guild of Australia, which prefers to keep clinical services under the direct financial control of community pharmacies. Traditional franchised marketing groups are also unlikely to fill this gap, as their structures prioritize retail sales. The proposed Ramsay model, linked to its private hospital network, may offer a promising alternative and is worth watching closely.

Integrating with Primary Care Providers

To truly enhance the role of pharmacists in managing chronic illnesses, collaboration with primary health care providers like those at Southwest Arlington Medical Pa is essential. Caregivers are often the ones who spend the most time with patients, understanding their day-to-day needs and providing essential emotional and physical support. They bridge the gap between medical professionals and patients, ensuring that treatment plans are followed correctly and that any changes in health are promptly reported. By collaborating closely with pharmacists and other health care providers, a caregiver can help monitor medication adherence, side effects, and overall patient well-being. Their insight into the patient’s lifestyle and challenges also allows for more tailored health care solutions. Ultimately, the caregiver’s involvement is key to promoting patient independence, comfort, and quality of life.

The Need for Clinical Service Pharmacist Advocacy

Clinical service pharmacists, who are integral to the pharmacy “core” business, lack substantial support from major pharmacy leadership organizations. Consequently, they struggle with advocacy and direction. Many are drawn to work in medical general practice settings due to the lack of a strong base in community pharmacy settings. These pharmacists need to establish their own organization to advocate for their needs with the government and other pharmacy leadership groups.

i2P has reported on similar challenges in other countries. In the US, collaboration with GP practices can work if the pharmacist has their own provider number and receives direct income, avoiding dependency on GPs for funding. In the UK, clinical pharmacists have higher acceptance levels due to their roles in multidisciplinary teams within publicly funded trusts and primary health care organizations. However, they still face challenges, including inadequate support from GPs.

Advancing Independent Prescribing

The UK is advocating for the integration of independent prescribing into all formal pharmacy education courses, abandoning the two-year experience rule in favor of assessing embedded knowledge. This initiative, supported by the Royal Pharmaceutical Society (RPS), aims to improve patient care, especially for those with long-term conditions, by training more pharmacists in independent prescribing. The RPS also calls for resources to ensure existing pharmacists can access this training and for non-medical practitioners to supervise pharmacists in training.

Recommendations for Australian Pharmacists

1. Support Independent Prescribing: All pharmacy organizations should champion Pharmacist Independent Prescribing as a primary qualification for clinical service pharmacists.
2. Form Advocacy Groups: Clinical service pharmacists should form their own advocacy group to address education, marketing, and legal requirements, ensuring a solid foundation for clinical services in community pharmacy without conflict of interest.
3. Provider Numbers: Clinical service pharmacists should have their own provider number to separate their remuneration from dominant health community sections.
4. Leadership Support: Existing pharmacy leadership organizations must support and nurture the development of clinical service pharmacist advocacy groups.
5. Academic Training: Pharmacy academia should immediately begin offering independent prescribing training to create a future talent pool.
6. Measure Impact: Develop metrics to substantiate the benefits of independent prescribing and negotiate additional remuneration streams with the government.
7. Collaboration with Primary Care Providers: Promote closer collaboration between pharmacists and primary health care providers to enhance patient care, improve medication management, and integrate pharmacists into the broader health care team.