Rollo Manning: Do we need pharmacists?

THE pharmacy profession has been stuck at a “crossroads” since it began moving from compounding of recipes prescribed by doctors in the 1950s to selecting a manufactured product from the dispensary shelves.

Was the move to manufactured products the turning point for the profession to be recognised as pharmacotherapy advisers?

Or was the viability of a retail shop more important, requiring intensive efforts against supermarkets encroaching on the market for cosmetics, toiletries and personal hygiene products that were traditionally bought from the local chemist shop?

The role of pharmacists and their place in primary health care has been on the agenda at pharmacy conferences for the past 40 years — and still has not been resolved.

The profession reached the crossroads without knowing which way to go — professional or retail.

This remains unresolved, with the profession unable to separate sectional interests intent on making money (mainly the owners of pharmacy businesses, all of whom are pharmacists) from the clinical role in primary health care (always on the minds of young graduates).

The money-makers are well in front and little has been seen of the “clinical practice model” predicted in 1978 at the Pharmacy Guild’s 50th anniversary conference.

This is not in the best interests of health consumers.

Millions of dollars are spent each year on the education of pharmacy undergraduates who are then relegated to the role of shop assistant without the opportunity to put their hard-earned skills and knowledge into practice.

The PBS bill of $9 billion a year — and rising — includes about $2.5 billion going to approximately 5000 agents across the country.

Surely this makes the PBS a small business support mechanism.

Does Australia really need 5000 businesses owned by pharmacists to act as agents for the PBS?

Are there areas, especially in the cities, where pharmacy businesses are simply vying with each other for the PBS business?

The PBS is propping up pharmacies which would otherwise be ailing retail outlets.

There is no audit or contractual obligation on the part of the pharmacy businesses to provide the value-added services expected of them by the federal government and the taxpayer.

A tender process would pin this down and allow for an appropriate number of agents prepared to add value to be selected.

At a time when the future direction of health funding is undergoing change, it is appropriate to review the role of the pharmacist and resolve, once and for all, the vexed question as to when the crossroads lights should turn green and where the open road should lead — to the clinical consultant in pharmacotherapy or the shopkeeper.

It is more than 20 years since a comprehensive review of the PBS remuneration structure was conducted by the Pharmaceutical Benefits Remuneration Tribunal.

In that time health care delivery has fundamentally changed, with a concentration of effort towards multidisciplinary teams within super clinics.

Is there a place in that team for a pharmacist?

The case for pharmacists to play a recognised role in primary health care could be influenced by what other health practitioners — especially doctors — think.

Surveys show pharmacists are trusted by the public, but how do other health practitioners see them?

You can give your opinion on the future role of pharmacists in a survey I am conducting. Results of the survey will be published in MJA InSight.

Rollo Manning is a pharmacist and public relations consultant with 50 years’ experience in the pharmaceutical sector.

Posted 15 November 2010