While the award-winning program has gone quiet in the past year, insiders say it never really took off in the first place… AJP investigates
In a recent journal article, University of Canberra (UC) pharmacy researchers conducted a narrative review to evaluate the effectiveness of clinical services provided in Australian community pharmacies.
Their review brought them into a discussion about the PSA’s Health Destination Pharmacy (HDP) project, a program that aimed to facilitate the transition from traditional pharmacies to integrated health hubs.
The pilot phase of HDP ran between 2011 and 2013 with 14 community pharmacies, and results from this pilot were very positive.
HDP was officially unveiled in at PSA’s annual conference in 2015, and further launched with some fanfare through a national roadshow during 2016.
Everything was looking up for the program: it won several national and international awards, including the International Pharmaceutical Federation’s 2016 Pharmacy Practice Improvement Program Award, and scored hundreds of thousands of dollars in funding from several business partners including Pfizer Australia, Bayer, Reckitt Benckiser and Blackmores, among others.
HDP aimed to provide a “whole-of-business change program [that] provides everything a pharmacy needs to transform into a health destination,” explained then PSA CEO Dr Lance Emerson.
Those in the program were “performing more than three times better on key metrics than non-Health Destination pharmacies, according to independent research,” he said.
However the UC researchers pointed out that according to the PSA, up until the beginning of 2017 only about 30 pharmacies had signed up to participate in the program – representing approximately 0.5% of pharmacies in Australia.
“Future research is needed to investigate the low uptake of the program,” they suggested, adding that “understanding the barriers for pharmacists to participate in the ‘Health Destination Pharmacy’ might also be useful for the implementation of similar projects in the future.”
HDP committee member Glenn Guilfoyle, who has been running a retail pharmacy specialist consultancy for nearly 15 years, told AJP the uptake never went beyond the number shared in early 2017.
“Being a committee member and being on the inside, from my point of view it wasn’t a sudden decline – it never really took off in the first place,” he said.
“As far as I remember, there were only ever something like 25 pharmacies enrolled.
“And then after about a year, as pharmacies started to come around to their first anniversary – it was basically a three-year program – we started to see pharmacies pulling out and saying, ‘no thanks I’m not paying and going into the second year’.
“So whilst no new pharmacies were coming in, pharmacies were pulling out. By the end of the second year, we were down to half that number.”
He said some pharmacists were just not interested enough to keep paying the thousands of dollars that the PSA was charging for the program.
So what exactly happened in those few years between the exciting launch of what seemed to be a well-designed, evidence-based program, and pharmacies pulling out after their first year?
Need for a more hands-on approach?
Those who advised on HDP said while some parts of the program were very well designed, there were other parts that fell down – such as in the amount of coaching time provided, and lack of customisation options.
“A lot of the content and a lot of the design of the program itself was very good,” said Mr Guilfoyle.
“To make these changes, pharmacists need a lot of interventionary hand holding. And the basis of the program was that the HDP coach went to visit them once a quarter – so once every three months.
“Well, in pharmacy, that’s not going to cut the mustard,” he told AJP.
“A lot of pharmacists expect the world and don’t want to pay for it. And so therefore, when they weren’t seeing the benefit because the intervention was too far between, then it was pretty obvious that they were going to start pulling out, in my opinion.
“It’s not all the PSA’s fault,” he said, but added: “The hubris of the PSA was that ‘no, no, our coaches are so good and our content is so good, and our program is so good, it can’t fail.’
“PSA definitely had the right intent, they definitely had the vision and I think they definitely tried to break new ground. I applaud them highly, highly, highly for all of that,” said Mr Guilfoyle.
“But at the end of the day, it was the execution that was not realistic and not well planned enough.”
Fellow committee member John Koot, who is well known as the managing director of Willach Australia, said packaging up HDP as a “one size fits all” program was a mistake.
“It created a bigger financial commitment based on promises and ‘maybes’ from the owners and they were not comfortable with that,” he said.
“Any program needs to be based on a menu format whereby the consultant and the prospective member talk through the issues and deal with them in a structured manner. Not a big all-inclusive program.
“The program was also packaged up with an overall yearly cost,” explained Mr Koot.
“[This] created a comparison with many commercially available programs on the market and created a ‘competition’ between this program and say the wholesaler owned banner groups programs. This in turn made it very difficult for the major banners to support.
“It created competition where there should not have been any, it made all the major players nervous.”
Mr Koot said in some ways the program did not fit in step with commercial reality.
“In my view there were not enough people with real community pharmacy experience on the management committee,” said Mr Koot.
“People who have real experience having to make a living from a pharmacy, who have experience in managing pharmacies, dealing with customers, landlords and suppliers. This created too many ‘nice to have’ decisions which simply do not work in the real world.”
A personal experience
Pharmacist Ben Jackson owns an Amcal Plus pharmacy at Westfield Belconnen – which was the first pharmacy in the ACT to have been transformed into a HDP.
When AJP spoke to him back in August 2016, Mr Jackson said he signed up to the program because of uncertainty surrounding the industry.
In October 2018, he is still running the HDP program alongside Amcal’s own ‘Leapp’ program but isn’t quite sure where HDP is heading – or if it will even be around in six months from now.
“To be honest, what worries me at the moment is I don’t even know where Health Destination is going,” Mr Jackson said.
“The uptake was not obviously as good in this environment at the moment, and a lot of pharmacists are resistant to changes. So that makes [the PSA’s] job a lot harder.”
He said the HDP program was fantastic for starting a project.
“Say for instance if I want to emphasise on quit smoking or sleep, they’ve got a good system way of getting the whole thing in place, getting it started,” he said.
“But the problem is that they don’t do well in terms of integrating the staff, emphasising enough staff training to make sure everyone on the floor is referring. This is where the difference is.”
Mr Jackson agreed with Mr Guilfoyle that there was a need for more hands-on support and follow up.
“What happened is that when they started a project, the coach was not given either an app or a program whereby they could follow up. So we get busy and when pharmacists get busy – out of sight, out of mind.
“When I tried to start the HDP … thank goodness I was disciplined, and I was pushing myself to make sure I gave myself deadlines to get things done.
“I told them in the beginning when we did the training, I said, ‘well the coach is not guiding me through enough to follow up’. That’s where the problem was.”
Changes being made
PSA says it hasn’t given up on the program just yet.
The model “continues to be the vision pursued at PSA for pharmacy practice excellence,” the organisation told AJP.
However it is adapting the program after conducting research on the market.
“Following a review of change management services available to pharmacy businesses in late 2017, PSA has been transitioning to a new service model since September 2018.”
“This research was undertaken to review the Health Destination program, and investigate the growing market for change services in pharmacy,” it told AJP.
“The research identified high satisfaction from Health Destination program participants, as well as challenges due to an increase in market offers, and competing demands on pharmacies for investing in their businesses.”
However PSA would not confirm the current number of pharmacies remaining on the program, saying the figure was commercial in confidence.
To support the HDP model, PSA said it continues to offer products and services in coaching, professional service implementation support, training and resources – available to all its members on a fee-for service basis.
Ben Jackson confirmed that within the past few months HDP has transitioned into a ‘pay as you go’ model.
“Pay as you go rolled out about two or three months ago. Even paying for the coach to visit is another one. I personally think it’s the beginning of the end, that’s how I see it,” he said.
However PSA is hopeful that the changes will give the program the boost that it needs.
“All pharmacies involved in the program expressed interest in ongoing support for change from PSA, and will continue to pursue strategies which make their pharmacies destinations for health in their local communities,” the organisation told AJP.
“We continue to be grateful to the partners that helped PSA progress the Health Destination Pharmacy vision, with all partners recently expressing support of PSA’s pioneering approach to implementing change in pharmacy.
“To increase uptake of change management services in pharmacy PSA has always, and will continue to, advocate for investment in this critical area.”
PSA ‘perfectly positioned to do this’
Despite criticism of some specific aspects of the way the program was implemented, HDP committee members congratulated the PSA on its vision, and said that they believe it can still be turned into something great.
“There is no doubt that the future of community pharmacy lies in [the PSA’s] ability to offer bespoke health-related services, conversations and products to their patients, and the PSA is to be congratulated on their vision and willingness to try and build a program to assist independent owners to achieve this goal,” said Mr Koot.
He added that he hopes the PSA will continue to find a way to assist independent pharmacy owners in their quest of becoming a health destination in their community.
“The PSA is perfectly positioned to do this, they have the well-being of every professional pharmacist in Australia as their driving force and a healthy community pharmacy sector is absolutely vital for the profession.”
The initial trial of concept performed during 2011 was very successful, results of which encouraged the PSA to expand the service to all pharmacies, veteran pharmacy industry consultant Bruce Annabel points out.
“The PSA is to be congratulated for doing so,” said Mr Annabel.
“However it was packaged in a way that wasn’t entirely suitable to the majority of the market – although the fundamental ingredients to achieve practice transition were present.
“The logic and need for practice change are so starkly apparent that I do hope PSA continues with the program albeit in a different format.
“There is no reason why the next version of HDP can’t be much simpler, practical and commercially attractive, aimed at those who genuinely want a helping hand to achieve practice change with patient health outcomes the objective.
“The data and my own experiences prove that pharmacies and pharmacists delivering professional service are far more successful, professionally rewarding and financially successful than the rest,” he said.
More hands-on support should be built into any future iteration of the program, Mr Annabel said.
“Facilitators should be pharmacists who have operated the professional patient health service model and spend a lot of time in the pharmacies, particularly in the earlier stages – hand-holding and leading the way.”
He pointed to the PSA’s 2023 vision, which is to achieve: ‘Pharmacists practising to full scope of practice’, followed by ‘Pharmacist development’ and finally ‘Standards of practice’.
“The PSA’s vision for 2023 is excellent but, like so many other great initiatives in this industry, they flounder on the rocks of failure to implement.”