Why are there not rural pathway connectors for pharmacists? asks Karalyn Huxhagen
I commend the PSA report ‘Medicine Safety: Rural and Remote Care’ to all new and evolving pharmacists as a ‘It is time to make a difference’ in the practice of pharmacy.
So many of the issues and solutions proposed in this report have been part of the hundreds of research projects, meetings, workshops and inter departmental reports I have been part of in my career. We need the youngsters of the profession to offer freshness, ideas, hard work and intellect to the research and programs that make the proposals of this much needed report become a reality.
We have come close to solving some of these issues at times only to be sent back to the drawing board by such catch phrases as ‘Pharmacy is given funding in the community pharmacy agreements—go and solve your own problems’.
Some of my more infamous toe to toe discussions with people such as Barnaby Joyce and George Tambassis have resulted in my blood pressure rising, but no improvement in provision of services to those who need us most. This is not because they did not care, but because I did not have an overall solution to present as an enabler to go forward and solve the issues raised.
The reason that I and many others never gained traction and improvement was because we were small in number, and we were fighting hard for a group of people scattered across the length and breath of Australia.
HealthWorkforce Australia tried very hard to be a gatherer of ideas and solutions and we felt we gained a helping hand only to lose their structural support in a government reshuffle. For example, under HWA we proposed an extra elective component of the Bachelor degree of pharmacy that enabled pharmacists to gain extra skills to use in rural and remote Australia.
Skills such as suturing small wounds, cannulisation, advanced wound care for burns and many more areas that a pharmacist working in a remote community may be called upon to assist with.
There are many pharmacists who have given their life and their soul to rural communities. I work in some of these communities and see how hard they try to be the bandage that holds the community together when everyone else is leaving town. The pharmacy becomes the bank, post office, dry cleaning depot, depot for tyres and sheep dip.
I see the mental toll of being the lynch pin in these communities. I see how hard they work to gain doctors’ and other health professionals to their community. They advertise worldwide for help.
A rural generalist pharmacist was one of my main advocacies that came about after being part of the clinical senate for JCU when they were redefining the rural generalist pathway for doctors. I kept saying at the clinical training meetings why do we not apply these same pathway connectors to pharmacy, nursing, and allied health such as physiotherapists.
For much of what we read in this report we do not need to reinvent the complete set of pathways and learnings. All disciplines have the same battles. You only need to attend one or two National Rural Health alliance conferences to hear that you are not alone in searching for a better solution for the patients in rural and remote Australia.
For me, one of the biggest hurdles of current times is the ‘blockage’ between Commonwealth programs and State and Territory Health regulations and departmental short sightedness.
Five years ago, I was granted permission to provide medication reviews in remote hospitals for their aged care beds. I have been fighting for the last four years to have that contract renewed as QH only give twelve-month contracts.
The local hospital wants me, the PHN wants me, the CEO of the hospital and Health service wants me but every time my contract goes to the ‘contracts department’ it never comes out the other side. The issue is that the format of the contract is not ‘recognised’ by the Queensland Health Department as an appropriate contract.
The Pharmacy Programs Administrator who governs my contracts tells me the contract must be in the format I sent. QH contract lawyers dismiss the contract as not approved.
This is not an issue about my work, my professional ability or anything to do with me or the hospital where the aged care bed residents are in dire need of a pharmacist review (especially as they are currently using fly in fly out locum Doctors). It is about a person with a pen and no understanding of the end result of their audit pen being blind to any other format of a contract other than their standard format.
They have put this position out to tender on the QH website for four years and received no applicants. But still as of 19.3.21 my current application has been relegated to the NO pile!
My issue is not a single person being blindsided. I see it across Qld with the disparity between Commonwealth funded programs and State funded programs and privately funded programs. Some of my work I have multiple contracts just because the funders are multiple. It is a nightmare in logistics.
The PSA report is an arsenal of research and proposals to use in the discussion roundtables that must occur to remedy the issue of rural and remote health.
This is not a community pharmacy agreement problem. It is a problem of patients not being given safe and equitable health care.
I hope the evolving generation of pharmacists can take this work and build the foundations to remedy the issues. Many of us are tired and worn but we have never given up our zeal to make a difference.
We just need a new groundswell of support to lead the report into a change in health care delivery and a recognition of the capability of the pharmacist as a health provider.
Karalyn Huxhagen is a community, consultant and locum pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management. Karalyn currently has many roles within the Health and Hospital Services and Primary Health Network sector in Queensland.