Menadue writes pharmacy sector a script for change

The conversations must have been lively at the Pharmacy Australia Congress in Sydney over the weekend. Health reform advocate John Menadue really socked it to the audience, judging by his 3,500-word speech.

For the sake of time-pressed Croakey readers, I’ve compressed the speech into several dot points. But it is worth reading in full, and you can do so here.

Here is a summary:

• There is quite a contrast between the community’s need for pharmacists to do more in their professional capacity and the unwillingness of the profession to change.

• The field of prevention beckons pharmacists. But it does not seem that pharmacists are fully responsive to needs and opportunities.

• Do pharmacists really want to collaborate with other health professionals or remain individual business entrepreneurs? Some are dissatisfied that their professional skills are not fully utilised and extended. It is not surprising that many find dispensing medications and running what sometimes seem like gift shops, to be mind-numbing.

• Unfortunately, the Pharmacy Guild of Australia opposes pharmacists working as consultant pharmacists within the GP super clinics. It insists instead that the only pharmacy participation must be via the establishment of a community pharmacy within the clinic.

• The evidence is compelling that the highly protected pharmacy business model which is comfortable and financially rewarding for owners up to this point is going to come under challenge. The history of protection in Australia is that protected sectors are very vulnerable and risk not fully appreciating their vulnerability until it is too late. Why is it that so much effort goes into political lobbying in Canberra and comparatively little effort into utilising more effectively the enormous professional talents within pharmacy?

• Discussion of business prospects and protection is relevant to extending the role of pharmacists in healthcare. An extended role of pharmacists will be essential, as future business prospects of pharmacists will be significantly influenced by contracting margins and increased competition.

• Features of pharmacies today which will come under challenge include the geographical restrictions, impending pressures on pharmacists’ margins, and the barring of pharmacies from supermarkets. Australians don’t have great love for the Coles/Woolworths oligopoly but they would love to see more competition. This lack of competition may explain why paracetamol can vary in price from $10.95 for 100 Panadol to $3.95 for almost the same produce sold under the Chemmart brand.

•    It seems inevitable that the highly protected pharmacy sector is going to face major changes.  The lesson of protection in Australia is that if you want to have a seat at the table when protection is being reduced, you must accept the need to change.

• Perhaps pharmacists might consider two categories of registered pharmacists. One would compose many of the long-established pharmacists who are reluctant to move away from the distribution model. The second category could be younger and differently trained pharmacists who will respond to a new model of professional practice which substantially extends their role into disease prevention and enhanced therapies. It would seem a possible way to overcome the environment which new and highly motivated pharmacy graduates apparently find so discouraging and dampening.

• It is quite remarkable that the PGA has consistently opposed direct relationships developing between GPs and accredited pharmacists. It insists that the relationship must be with the patient’s nominated community pharmacy. This is quite contrary to normal health referral practices.

• How can the disconnect between how pharmacists are trained and how most of them work, be remedied?

Menadue concluded: “Despite the rhetoric about prevention, are governments, their bureaucracies and the professions ready to implement prevention policies? The answer to me seems to be ‘not yet’. Some hard thinking is required all round.”

• You can read more about John Menadue’s arguments for reform of both the demand and supply of health services here.