This is the unedited article placed in Auspharm on 6th April 2009
Well I’m off to the pharmacy to get my weekly supply of medicines. I said “pharmacy”, but perhaps “nursery” is more appropriate. The pharmacies these days are staffed and run by nurses. Funny, although being in short supply, nurses have spread into new areas of health whilst pharmacy seems to have lost the right to work in even the basic area in which they have been trained as well as other areas in which they still work around the world.
These nurses are busy. As well as dispensing all medicines they treat a range of acute conditions, manage chronic disease, and give vaccinations as well as provide a range of other services. They are so busy they often don’t have time to talk to me about my medicines. Luckily they are all packaged together by dose so I guess I don’t really have to be told much about them.
Nurses started doing all this work as they could offer more services and be reimbursed with a provider number for Medicare. The Pharmacy Guild fought against individual pharmacists being able to obtain provider numbers. With the decrease in remuneration for a script now down to a $1.14, the ability to bring this extra revenue was essential for a pharmacy to survive.
You see a pharmacist sometimes. They supervise a large number of pharmacies and supply the medicines in packets and in packed doses to them all. Every now and then a pharmacist visits the nurses to check to make sure they have the required books and perhaps give a bit of training. One even came to see me once. She seemed nice. But I didn’t really know her so didn’t ask all the questions about my medicines that I wanted to.
The change in pharmacy happened pretty quickly after the government looked at the involvement of pharmacy in looking after one of the sickest and most disadvantaged groups in Australia – our remote indigenous population.
They noticed that large service providers like Territory Health tendered out the S100 medication supply – but it all had to be labelled for an individual patient. Pharmacies even from the coast were looking at supplying the “dispensed” medicines for a $1.14 each thinking they could make a profit on volume.
Pharmacy Boards in various jurisdictions didn’t enforce counselling that should be provided with this dispensing. Indeed, even within the organisations there were differing opinions on whether these were actually dispensed or supplied. Was filling a Webster-pak for a patient from S100 medications supplied for use by a remote community a supply of medication or was it dispensing? A lack of consistency and action by bodies set up for the protection of the public reinforced in the bureaucrats’ minds that counselling was superfluous. Anyway, there is always the internet to look things up on.
The government knew it would not get any serious opposition from the Guild in response to these changes. After all, they seemed perfectly happy to only have pharmacists visit these remote areas and leave “pharmacy” work to nurses and others. I think they found it hard to believe that pharmacy bodies weren’t pushing to have pharmacists doing pharmacy.
This was reinforced with the new Business rules for pharmacists visiting remote areas not allowing funding to cover the entire population that the health service treats.
The submissions to the National Health and Hospital Reform Commission did pharmacy no favours. In the area of indigenous health the Guild and SHPA documents argued that each was the better group to send out visiting pharmacists. None put forward an argument that it was criminal that indigenous communities, some of over 2000 indigenous people, a population group with a much higher disease burden than the rest of Australia did not have full time access to a pharmacist.
The body representing all pharmacists, PSA, became a laughing stock. Their submission did not even mention what pharmacists could offer in indigenous or remote health
“If they can provide no benefit to one of the sickest groups in society are pharmacists required at all?” So went the thinking. And now it has come to pass.
We have only ourselves to blame.
Various commentators from the AMA to Oxfam have stated over the years that indigenous health requires another $400million each year to provide adequate health care to our indigenous population. Yet all pharmacy can offer in reports to the National Health and Hospital Reform Commission with regard to indigenous health is squabbling over who performs visits to remote clinics while our major professional body ignores it all together.
If pharmacy is unable to articulate a role that it can play in remote health with the sickest and most disadvantaged in our community that at least equates with if not exceeds our “usual” role performed in the rest of Australia (retail and hospital), and is not arguing with the rights of other health professionals to perform our role why should we keep the role we currently have in mainstream?
Some comments on what led me to this article will appear tomorrow
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