‘The time has come to shed the cloak of siloed health.’


doctor shaking hands

A leading doctor has lashed out at the findings of a WA review into pharmacy, calling pharmacies “basically Dr Google with a shop”

Western Australia’s review into community pharmacy – which looked at a number of issues including ownership, scope of practice and the pharmacy registration and regulation structures in the state – made a number of recommendations, including that the Government acknowledge that there is a potential underutilisation of pharmacists.

Further recommendations include that Western Australia should closely monitor national developments and discussions relating to non-medical prescribing for pharmacists; and that the Government should establish a standing mechanism to provide it was robust, evidence-based advice on the future of pharmacy services.

Particular attention was paid to pharmacist vaccination.

The review recommended that WA allow additional access to immunisation at pharmacies which is at least consistent with that already permitted in other States and Territories; and support national consistency.

“Community pharmacy is seen as a valuable health network and resource, but pharmacists are not always felt to be working at top of scope,” the review noted.

“Pharmacy and pharmacist capacity is considered to be underutilised which appears to be causing a degree of dissatisfaction and frustration amongst the pharmacy workforce.

“As a whole, pharmacists responded to the question of improved integration with the health care system, as being able to be solved by allowing or supporting provision of enhanced medicines-related services as part of the primary care team.

“Submissions to the Review describe a sector that sees itself as capable and ready to assume new roles and provide additional value to the primary care health system.

“It also suggests that pharmacists do see a variety of barriers that prevent this type of innovation and development. It was evident that this is causing a significant amount of industry frustration.

“Pharmacist scope might be extended to include additional vaccinations, health screening, chronic disease management, health promotion, and other medicines-related activities.

“Scope extension might also include some models of prescribing. Pharmacists could offer medication management reviews and related services in collaboration with General Practices.”

The Australian Medical Association was unhappy with the review, calling it a “wish list for pharmacists who want to be doctors,” as reported by the ABC.

AMA WA president Andrew Miller said that pharmacists should go to medical school if they want to diagnose and treat illness properly.

“We do not go down to a shop to find out what the symptoms in our body might be causing,” he said.

“Pharmacists are not doctors, and to try to short-change patients by suggesting they can be is not going to be good for anybody’s health.”

“They’re basically Dr Google with a shop,” Dr Miller told 6PR’s Gary Adshead.

“They’re very good at what they do in terms of the way they look after people’s medications and dispense them.

“But you can’t diagnose someone’s problems standing in a shop. You need to see a doctor. That’s proper health care in a first world country.

“If pharmacists need to expand their business they should look at other avenues.”

He told Mr Adshead that pharmacists should “stick to their knitting”.

He also took to social media to attack the pharmacy sector.

 

Pharmacy Guild WA branch director Matt Tweedie told the AJP that the AMA has it wrong on a number of levels.

“Andrew and the AMA need to be corrected on their view, and the first thing is that this was not a report commissioned or written by pharmacy,” Mr Tweedie said.

“It was commissioned by the Government. Everyone, including the AMA, had input.

“Our submission drew on national and international evidence, and I would hope others did too, but at the end of the day a commissioned, whole-of-stakeholders review considered everyone’s point of view, and on balance made some strong recommendations on using this community infrastructure and its trained, professional workforce to the top of its scope.

“And it’s not about an expansion of scope. It’s about utilising a workforce that has a scope they’re not allowed to use. So they’re wrong, there.”

He said that the AMA appeared to be “fixated” on the idea that the review was making recommendations about business and remuneration.

“At no point did it raise it, consider it, or take submissions on it, and it doesn’t make any recommendations on it,” he said.

“A raft of these recommendations can be implemented with no change to what government pays or any move to different remuneration models. It’s about increased access for the community to safe, professional, high-quality advice.”

He said that at the grass-roots level, pharmacists and GPs work productively and collaboratively every day.

Mr Tweedie said that the Guild was very supportive of the review’s finding that community pharmacy is an underutilised asset.

“We should be making better use of a trained workforce that sees one million Western Australians every week. If we don’t, we’re failing the community, in my view.”

Of particular significance was the recommendation on vaccination, he said, particularly following Health Minister Roger Cook’s recent announcement that pharmacists would be able to vaccinate children aged 10 and over against flu.

“It just makes sense to adopt the same approach as the United States, Canada, other health jurisdictions in the world that moved to this years ago.

“We are so far behind in respect of immunisation that it’s no longer acceptable. We have a community that needs protection, that should be protected, and deserves to be protected.

“I don’t want to pick up the West Australian and see another report on a person with a communicable disease who has had a tragic outcome. It’s totally unacceptable, and totally preventable.”

This is particularly important not only in the light of the disastrous 2019 flu season, but also because of the sheer distances involved in Western Australia, where GP access is often limited or non-existent, Mr Tweedie said.

“There are 40-odd towns in rural and remote areas with no general practice, or towns where people have to travel a long way to get to it.

“We commend the Minister and his Government for moving immediately to do something about it. It’s a common-sense move, and the community are demanding it.”

He told the AJP that he has seen and heard of many instances where consumers have walked into pharmacies to discuss immunisation and asked why they or their child cannot be vaccinated there.

“The only response is, ‘because I’m not allowed to’,” he said. “They get a puzzled look on their face.”

He extended an invitation to the AMA and doctors more generally to work with pharmacy on issues raised in the review, including greater pharmacist involvement in mental health, hospital discharge and vaccination.

“The AMA has been very strong that you should have access to a regular GP who knows you, and knows you well, and we could not agree more,” Mr Tweedie said.

“We don’t care where people get vaccinated, as long as they do, safely.

“We’re entirely supportive of people using their GP and maintaining an ongoing relationship – that’s good health. What we’re saying, and what this review is saying, is that we can make better use of the workforce to complement that.”

The review gives stakeholders an opportunity to continue the “great work” that pharmacists and GPs do together every day.

“Now that all stakeholders have been heard, let’s think about how we can move together positively, and we stand ready to do that with whoever it is we need to work with,” Mr Tweedie said.

“We’re happy to extend a public invitation to the AMA to sit down and work through this.

“The time has come to shed the cloak of siloed health, and move to an integrated, collaborative system that we’ve spoken about for 20 years, but not yet implemented.”

The full report can be viewed here.

Previous Eight-year-old wins $20k with Glucojels
Next Is the 7CPA a chance to lift pay?

NOTICE: It can sometimes take awhile for comment submissions to go through, please be patient.

6 Comments

  1. Kevin Hayward
    06/07/2019

    I decided to take my pharmacy out of the silo after undertaking a higher degree, researching with other healthcare professionals, at my local PG medical school. I find the collaborative working enjoyable and it improves the care I can offer. Years later and in a different healthcare system, I still apply the same philosophy. As an example yesterday whilst seeing a patient I identified an issue of concern, I was able to get her usual GP who was available in the adjacent room to assess the patient , and the nurse to undertake a relevant risk assessment. Whilst this was going on I was able to complete my review with another patient, and then meet with another GP in the practice to discuss with the patient, a plan for de-prescribing. Collaborative working is so productive, and even when I was in my own pharmacy, not co-located physically with the rest of the team, we were able to develop working practices to facilitate it.

  2. Jarrod McMaugh
    06/07/2019

    “Silos” go both ways.

    It is great that we have pharmacists moving in to practice in other settings such as nursing facilities, general practices, and ACCHOs – the benefits this has (and will continue to have) are innumerable – but there needs to be a similar undertaking by other health professionals to engage with community pharmacy.

    Community pharmacy isn’t some anomaly in the health sector; it exists in almost every country (just like hospitals, just like general practice) for a reason.

    Engagement needs to come from without as well as from within.

    • Kevin Hayward
      06/07/2019

      As stated, I was able to achieve similar outcomes as a Pharmacist proprietor, with a proactive, collaborative approach it was not difficult to dispel the image of the Pharmacist as just another retailer.

  3. Peter Allen
    08/07/2019

    I would be happy if certain professional activities like we are
    discussing here were done only by Accredited Pharmacists. Or those who
    have had specific up-skilling.
    There will be those who believe ‘no we are all as skilled as we need to be to do these things’ but I don’t.
    I’m nervous aboout the common diagnosis ‘any conjunctivitis = Chloro.’
    I recall when Emergency Hormone Contraception came out. Only those of us
    who had the training were permitted to prescribe it. II can see the same
    in future for diagnosing and prescribing for UTIs.

    • Kevin Hayward
      08/07/2019

      When I started as a GP practice support pharmacist, we had to undertake a training program, with ongoing quarterly update sessions. I was surprised how much I did not know. Without this training I would not have been able to function in a GP practice effectively

  4. Nicholas Logan
    08/07/2019

    Can’t wait till medicine’s professional bodies see their role as something other than attacking pharmacy.

Leave a reply