We always knew that automation would be disruptive to pharmacy and displace pharmacists.
Nobody really objected to that possibility because high initial machinery costs generally slowed down its introduction, giving time to make structural adjustments to pharmacist jobs.
But it never happened!

It was always assumed that the role of pharmacists would evolve to that of clinical service providers but that expectation was thwarted over a 35 year time frame.
Only now are we hearing “Ask your pharmacist” which i2P supports as a positive, but what advantage did the PGA incur by holding up the introduction of any clinical service until now?
And what was the real intent of the PGA in undermining HMR services and their reimbursement?
No matter what PGA protestations have been offered, the whole saga pre and post the HMR debacle simply has a very strong smell attached to it.

Now we have the Australian Industry Report 2014 reinforcing the impact on all white collar workers in Australia.
It also confirms that while there is some displacement that will occur, innovation will quickly overtake displacement.
Well, in the case of pharmacy that has not yet happened and it is the activity of one leadership organisation that must be held responsible.
We are seeing the uptake of automated dispensing machines slowly but consistently, and pharmacists disappearing from the dispensary without being offered alternate work.
And we are not seeing any planning for the new disruptive 3D-printing technology that will have the ability to create new jobs. This is unacceptable.

The Industry Report summary follows:

Australian Industry Report

Innovation will inevitably lead to some job displacement in the short term, as the price of capital falls relative to the price of labour. But there is a lack of evidence to suggest this displacement is long term. The comparative advantages of being human—the ability to solve problems intuitively, improvise spontaneously and act creatively—allow us to adapt to changing labour markets and occupations. Indeed, in a recent survey of 45 economists, all but one agreed that automation has not historically reduced employment in the United States. The conclusion being that humans have unlimited needs and wants, and therefore there are an unlimited number of potential jobs to fulfil these desires. Our greatest windfall from automation is that higher productivity will eventually deliver cheaper goods and higher disposable incomes, as it did during the Industrial Revolution. There is potential to benefit from these productivity gains, even if the temporary adjustments may be painful.

These findings, published in the inaugural Australian Industry Report 2014 brings an Australian perspective to an increasingly intense debate that has raged for over a year in the US over the question of whether automation and advances in computer software are starting to displace white-collar, middle-class jobs for the first time in accelerating numbers.

The above comments frame many i2P articles that have been published pertaining to the management and professional problems facing pharmacy.
i2P has been a very early researcher and commentator on the need for pharmacy to diversify its footprint and develop a range of primary health care cognitive jobs.
Most i2P writers were aware of this fact as far back as 1978.

Why has it taken the leadership organisations so long to embrace this issue and why is it that the organisation that should be leading the cognitive charge is simply “screwed”.
I am talking about the Australian Association of Consultant Pharmacy that is jointly owned by the PSA and the PGA.
It can never have a voice in opposition to the “party line” of either of these leadership organisations.
And because of the nature of its service structure it definitely needs an independent voice.
This organisation will never be a lead organisation for cognitive services because it simply does not have the appropriate structure and support. It has been set up originally to fail!
Take, for example, its name.
It is the individual pharmacist that creates the cognitive component, yet it describes itself as an association of “consultant pharmacy”.
There is no shareholder vote for its membership (except PGA and PSA), therefore no control by the real invisible members as to its direction.

The PGA has long held the view that consultant pharmacists were a threat to a community pharmacy revenue base and has extended its control over consultant pharmacists by reducing the budget for this service and taking over management of payments.
The political explanations for these events and the relationship between the PGA and the Department of Health and Ageing can only mean that the PGA has compromised itself and no longer truly represents its members.

Hopefully, some of these activties will be revealed in the current investigation into the management of the 5CPA and expose any improper practices.
Until these exposures take place, pharmacists and community pharmacy will not advance, because the money is currently going to the wrong pockets.

That the PGA no longer represents its constituents is evidenced by the vast array of conflict of interest positions it engineers as part of a total power base.
As we all know, no matter what the endeavour, concentration of power eventually corrupts the leadership of any organisation.
Part of that corruption involves the “dumbing down” of the profession to the extent that most of the activity of a pharmacy is assembly line dispensing that is now completely commoditised.

It seems very apparent that PGA and government are wedded in a very unhealthy (for PGA members) relationship, which means when government says “jump!”, the PGA responds with “how high?”
How else can you explain the financial disarray from arbitrary PBS decisions virtually unchallenged by PGA (even though there is a mechanism for challenge) that has resulted in bankruptcies and forced sales for their members?
How else to you explain the disconnect between academic pharmacy that did have a recognition that they should produce cognitive pharmacists, and the PGA which refused to recognise the concept?
No planning or agreement whatsoever because it did not suit government planners who were prepared to sacrifice pharmacist aspirations to an agenda that has led to this current disruptive state.
The PGA was very willing to do government bidding.
Who benefited?

Who benefits when the PGA forces down pharmacist wages through industrial processes?
Not pharmacists, because their take-home pay is lower.
Not pharmacies, because the PBS dispensing fee is based on the pharmacist award rate.
Governments benefit because they get cheaper pharmacy services – but they are too slow to recognise that this is the road to poor quality.
Big Box pharmacies benefit because their business model has a high content of general retail. They simply want the cheapest token pharmacist to be compliant to commercial managers.
The professional stress induced by these commercial pharmacies can be quite significant and can compromise professional integrity.

In the last edition of i2P we ran an article on the five “fail-points” of leaders.
We chose that perspective because it was easier to make a comparison with what was wrong, with what we are experiencing from our leadership bodies.

I2P would suggest the following basic solutions:

* PGA to divest its shareholding in the AACP and give it to the SHPA.
Hospital pharmacists have the strongest contingent of clinical pharmacists and are therefore a source of cognitive service providers and a lobby for hospital interns.
PSA represents all pharmacists and is more representative than PGA.
To complete the AACP conversion, additional shares should be issued for individual pharmacists who qualify to perform cognitive services, thus creating independent practitioners.
Alliance partnership shared risk agreements be established so that cognitive service pharmacists can form part of the “core” of community pharmacy.

* Establish new community pharmacies that are built on compound dispensing leading into the early adoption of 3D drug printing, plus properly structured clinical services.
These pharmacies will not require a PBS licence or PGA membership and can offer an alternative to existing community pharmacies.
Given PBS dispensing will now have to go to complete automation to provide a profit base, even existing community pharmacies will be looking to diversify part of their business into compounding.
Academic pharmacists will more likely lend support to this model.
Newly graduated pharmacists would find more professional satisfaction from these newer environments and will have more of an opportunity to develop their own pharmacy models down the track.

* Form local associations of pharmacists based on health regions that foster strong networks and do not discriminate between owner and employed pharmacists.
These organisations to be based on collegiality, and eventually build in education and research activities to provide more pharmacist opportunities, with links into academia and industry.
There are a few isolated associations of this type in existence already.
They could become a national body by simply appointing representatives of each region to operate as a federal governing body, as these formations evolve.
It’s easy enough to do and it may be the only way to break existing strictures on pharmacy innovation and development.

Ask yourself why has it taken so long to even advertise that you can “ask” your pharmacist for more services?
Why indeed!
Because they have not been properly structured or marketed over a period dating back nearly 35 years and have been ignored by the PGA.
And although there is a belated attempt now to promote clinical services, I remain skeptical as to the type and quality of these services.