The COVID-19 experience in Victoria has highlighted the need for a Chief Pharmacist role to be created in the State, sooner rather than later, says Anthony Tassone
Victoria stands out as a jurisdiction without the benefit of such a high-level position within the bureaucracy and some of the lessons learned from our response to the pandemic clearly show that a number of decisions could have been better targeted and more effective had the input of a Chief Pharmacist been available.
The role of a Chief Pharmacist would be to ensure that the sector and the profession have strong, knowledgeable and strategic leadership within Government and the bureaucracy on matters involving the pharmacy sector and profession. That dedicated leadership is currently lacking, not because of any complacency or inadequacy on the part of the any health bureaucrats, but simply because they are stretched and unable to specialise in an area such as pharmacy which is multi-faceted and needs specific skills and knowledge.
In calling for a Chief Pharmacist it is stressed that some of the examples listed below are not aimed at finger-pointing but rather as learning from the lessons of our state’s ongoing response to the pandemic and making sure we are better equipped to deal with future emergencies and crises.
And let’s make no mistake about it – there will be more emergencies we have to face so let’s be as equipped for these events as best we can be with 2020 serving up more than it’s fair share of significant events and disasters including the bushfire crisis preceding the COVID pandemic where community pharmacy was on the frontline and there for their patients and communities.
If it was not for community pharmacy turning up day in and day out for their patients and communities throughout the COVID pandemic, we would have had an even worse public health crises on our hands.
One of the first lessons from COVID-19 is that community pharmacists and pharmacy staff must be recognised and respected as essential workers. At present we are told we are essential workers, but we are not always treated as such.
Depending on who you speak to in the public service, it feels there is a confusion as to whether community pharmacy is a primary healthcare provider or a retailer that provides ‘a bit of healthcare’ – so it’s no surprise if there is an inconsistent appreciation of how essential community pharmacy really is.
During COVID-19 this has manifested itself in a number of ways.
Pharmacists and staff undergoing COVID-19 testing should have been treated as essential workers and had their results from the very start of the pandemic. Instead many waited up to a week or more on the basis that their tests were categorised with those of the general population. The problem here seems to be that while a directive the Minister for Health’s office indicated an essential worker status, this failed to be widely communicated to testing stations and labs.
This was not the fault of any of the hard-working staff at the many COVID testing stations across the state, but rather an example of what can slip through the cracks so easily – cracks that would almost certainly have been sealed by the input from a Chief Pharmacist.
When the first wave of the pandemic hit in mid-March, we also saw the panic buying of food and essential items including medicines.
Comments by the Victorian Chief Health Officer reported in mainstream media was a recommendation that Victorians consider having a fortnight’s worth of non-perishables in their pantries as well as a 60-day supply of prescription medication. Again, this suggestion would have had the best of intentions to try to avoid patients having interruptions to their therapy while the state stared in the face of a health crises with many unknowns.
What ensued was an inundation of pharmacies nationally, and especially in Victoria, by patients and the general public scrambling to stock up on prescription medicines and over-the-counter medicines sparking a crunch on the medicines supply chain and sudden shortages and outages for commonly used and essential medicines such as salbutamol inhalers and children’s liquid paracetamol.
The Guild advocated at a national and state level for restrictions on the supply of medicines so that the supply chain could not only have a chance to reset but so there would be enough supply to go around for all. At the Victorian level, through the Guild’s advocacy the Chief Health Officer’s advice was amended to recommend that patients have a 30-day supply of prescription medicines on hand.
But the genie was already out of the bottle and the domino effect had already started.
Understanding the supply chain
If only there was a member of the public service more in tuned with how our medicines supply chain worked and the potential consequences of the best of intended suggestions to ‘stock up’ in case.
The designation of the sector as ‘retail’ rather than ‘healthcare’ at times has also meant that the introduction of Stage 4 lockdown protocols inadvertently included pharmacies, and pharmaceutical wholesalers and distributors in such a way that, if left unchallenged by groups such as the Pharmacy Guild, could have put the community at serious risk.
What this meant was that pharmacies, and pharmaceutical wholesalers and distributors were initially ordered to reduce their workforce headcount and hours of operation by a third.
Had there not been an intervention by the Guild, wholesalers and other industry groups the impact on patients and the community could have been catastrophic. Clearly the decision was made on the basis of a lack of full understanding of the sector and what it does.
Such an oversight may not have occurred had a Chief Pharmacist been available to advise those developing the lockdown protocols. Thankfully the intervention of the Guild and others quickly addressed the potentially dangerous situation and pharmacies and wholesalers were exempted.
Another unintended consequence of the failure to recognise and understand pharmacy in the healthcare category has been that community pharmacies are not eligible to be apply for third round of funding from Business Victoria to support businesses during COVID-19.
Such support is available to other healthcare providers, meaning for instance that general practices can apply, and is intended to target businesses which have been forced to close or which have been seen significant adverse effects from the pandemic.
At the Guild we are working hard to have this decision reviewed so that pharmacies are eligible and this could mean the difference between pharmacies remaining open for patients to access their medicines and health services, or being closed and the community being without these essential healthcare providers.
Working for business
Business Victoria would also have benefited from the advice of a Chief Pharmacist before they contacted pharmacies requesting them to develop a ‘high risk COVIDSafe plan’. This was based on a misunderstanding and misclassification that pharmacies are distributors or wholesalers of medicines and considered a ‘higher risk’ industry during the COVID pandemic. Once again the Guild intervened and had this error rectified.
These are just a few examples and to reiterate none of which is intended to criticise or blame. Everyone in the health bureaucracy and Government have been working under extreme duress and pressure in what has truly been unprecedented times.
However, how much more efficient, and effective would their work have been had they had the expertise, knowledge and understanding that could be gained from a Chief Pharmacist’s input? Not just in a state of emergency or disaster but as ‘business as usual’ – fully utilising the scope of practice and training of pharmacists as part of a broader healthcare team for the benefit of community.
As Sir Winston Churchill once proclaimed, “never let a good crisis go to waste” and nor should the pharmacy profession in advocating for what will make our health system better for the future.
Calls for the appointment of a Chief Pharmacist in Victoria have already been raised with the newly appointed Victorian Minister for Health, Martin Foley, and the Guild looks forward to continuing these discussions in the interests of patients across all of Victoria.
Anthony Tassone is President of the Pharmacy Guild of Australia (Victoria)