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Welcome to the AJP podcast,
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A podcast for pharmacists by pharmacists where we discuss current events,
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relevant topics, and emerging issues. I'm your host, Carlene McMaugh,
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and together with the AJP,
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I'm bringing you the opinions and expertise of different pharmacists to discuss
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their views and insights on topics relevant to pharmacists.
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Please like and rate each episode and subscribe to the podcast so you don't miss
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an episode.
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So is it okay to start off by you introducing yourself?
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Sure. My name is Curtis Ruhnau.
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I'm a community pharmacist from Western Sydney and I'm currently the
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president of the Pharmacists' Support Service.
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Thank you for your time, Curtis.
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I thought I would ask you with the announcement of 60 day dispensing,
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there are a lot of questions and uncertainty in the profession.
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Can you talk through the mental health aspects that you saw in pharmacists and
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in pharmacy staff?
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Yeah, thank you. It's a big question, isn't it?
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I know we certainly felt a lot of uncertainty ourselves
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and as pharmacy owners.
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I know that I was talking to my colleagues, other pharmacy owners,
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and the deepest feeling really was almost a sense
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of guilt that we have a fairly simple connection with
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our staff and our connection with our staff is that they turn up,
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they do a great job, we pay them for that job, and we say, thank you very much,
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we'll see you next week and we'll do it all over again.
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And the worry was with the way 60 day was
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supposed to be implemented,
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a lot of that certainty was taken away from us that we couldn't necessarily just
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assume that we would be able to employ all of our staff on an ongoing basis.
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So that was a real worry for us as pharmacy owners.
And I
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know that the worry was felt very acutely by our employed
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pharmacists as well,
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who looked to us to know whether something's really a problem or not.
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And they looked to us for that leadership to know that everything's going to be
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okay,
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and we couldn't really look them in the eye and say it's all going to be okay at
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that point.
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But as we went through the process and with the leadership that we had
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from pharmaceutical society, from the pharmacy Guild, they said to us,
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this is what you need to do. This is what we need from you.
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Let's just stay the course together and we will come out of this as
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a united profession at the end of it.
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Did your staff talk to you about their uncertainties?
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Did it raise anxiety and stress in them? Did they talk to you about it?
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We talked all day,
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every day about this end of April.
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Last year was a big time for all of us,
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and they could see the stress in
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us and we could see it in them.
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And we talked them through that and we said, look,
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this is something that's coming.
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We don't really know at this point what it means.
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We know that it could be difficult, but for the moment,
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just bear with us while we ride through this wave and
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we'll see where we get to at the end of it. But yes,
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it was a constant conversation with all of us,
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both them and us.
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And I have to say they were wonderful supporting us and I hope they
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felt supported as well.
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So was it through the frequent conversations and were there any other ways that
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you did support the staff and yourself during the time?
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Look,
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it was mainly those conversations because Margaret and I are working
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pharmacists in the business. We were there side by side with them.
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We were talking to our patients as they came in.
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Taking those few minutes as a question came up,
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we just answered those questions with our staff as they brought them to
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us. So I think
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most of it was just on an ad hoc basis, bit by bit.
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We definitely had team meetings, we had meetings,
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smaller group meetings,
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and then larger meetings over video conferencing.
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And we explained to them what it was.
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We told them what we needed them to say to our patients when the patients came
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in. And of course, like most pharmacies in the country,
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we had a range of engagement with our patients.
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Some who got that this was going to be very difficult for us,
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some who just didn't get it at all and some who were
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almost hostile towards us.
We never had any outright hostility,
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but we did have some who thought that it was a bit of a beat up and
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who really didn't want to engage with us in that at all.
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And I think that was one of the benefits of us,
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Margaret and I being working pharmacists, was that we were usually there.
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And so we could say to them, look,
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if anybody seems to be engaging on you on a level that's difficult for you,
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just refer them straight over to us.
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Let us talk to them and we could talk through them with that.
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Did you make any changes to your business at this time?
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The short answer is no.
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We'd just been through a process of changing our roster and
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trying to, we were looking for some efficiencies in the business,
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so we just made some changes.
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And so that was difficult having just made changes and then thinking that
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what we'd set in place for the next year or year and a half was going to have to
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be rethought within a matter of weeks. So that was difficult,
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but no, essentially we made no changes there. And then on the spot,
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what we did was we went back and we looked at our numbers and we
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said, look, we're okay at the moment.
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We've got our plan for the way we thought our business was going to be.
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Let's just keep going with that. And then we,
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as staff changes happened, we then adapted those into it.
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So we had a staff member who left, we didn't fully replace them,
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Margaret and I stepped up to do a bit more of that work,
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which we might've hired somebody else to do.
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So there were changes as time went on,
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but those changes were really six and eight months down the track from the
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announcement of what was going to be the 60 days.
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So no, not a lot of changes straight out,
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but we thought we were in a pretty good space to be able to cope with that
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given what we just put in anyway.
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So with 60 day,
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how is this reflected in the PSS calls and the types of concerns that
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pharmacists were having?
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There was a couple very,
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initially it was great.
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We actually had the guild reach out to Kay Dunkley,
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the executive officer of PSS, and say,
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you might be getting some calls because there's a major change that's coming
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and it looks like it could be difficult for some pharmacists to deal with.
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So that was wonderful. Again,
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great leadership by Anthony and Trent at the Guild to reach
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out to Kay and alert us.
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That gave Kay the opportunity to mention to the PSS
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volunteer pharmacists that they might be getting calls around this.
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And we certainly did get a bump in calls initially, but I think again,
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because of the leadership that I mentioned earlier through the pharmaceutical
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Society, through the guilt that our pharmacists
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employed pharmacists and really our whole profession knew that we needed to be
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united through this and that this was the time for clear
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action but not for panic. And that was reflected in the calls.
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We still had a few calls, but after that initial announcement,
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there really weren't a lot of calls related to 60 day dispensing.
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So then my next question would be,
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were they alleviated following the eight CPA announcement or has there been a
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change in questions or phone calls to PSS now I.
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Because the calls had settled down fairly quickly around 60 day
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and 8CPA? No,
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it's probably early days to say whether there's really been
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any change in those calls,
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but I've certainly noticed in conversations with my colleagues,
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there's a level of anxiety that seems to have dropped over
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the announcement of the 8CPA,
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and that can only be good.
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An increased anxiety in the profession can't be good for anybody.
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And having that 8CPA drop,
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that level of anxiety can only be good for our profession
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and for our pharmacy employers. And then in turn, of course,
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for the pharmacists that work with them,
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ultimately trying to make sure that we are doing our best for our patients.
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So yeah,
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while I can't say that there's been a big change in that reflected in
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calls through PSS,
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certainly conversations with my peers and colleagues,
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it's been nice to have that come through and know that we
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now again have a little bit of certainty coming through,
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albeit that that certainty is tinged with a bit of a worry about
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what if this happens again,
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because 16 months ago we thought we had certainty,
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and I know a lot of our younger pharmacists with the increased scope of practice
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that we were looking at back in February and March last year,
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a lot of younger pharmacists were looking to get into community pharmacy,
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and that turned around pretty quickly at the end of April.
So
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yes, it's nice to have that,
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but there's always the worry that somebody will come along with another
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bright idea and decide to drastically change the rules
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and the paradigm under which we operate in community pharmacy.
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That's an interesting point. So it sounds like currently with 8CPA,
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it probably met some pharmacist expectations,
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probably exceeded some pharmacist expectations,
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but there is some overarching concerns still for the future.
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I would think so, yes. I know I certainly do.
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I am at a point in my career where I am definitely looking to make
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sure that I leave the profession in as good a state as I possibly
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can for those leaders who will come through after I'm
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finished.
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And I want to make sure that I've done everything that I can
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do to make sure that they have all of the skills and all of
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the tools that they need in order to be able to lead our profession.
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So yeah,
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I'd like to think that our profession is in a pretty good
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state,
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but I still think there's a little bit to go that we need to
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just see how this all settles down over the next year or so and
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make sure that we actually get what it
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looks like is coming for us. And if that comes through, then yes,
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I think the future for our profession is actually quite bright as it should be
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because pharmacists really should be everywhere that medicines are.
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And it looks like this 8CPA,
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both the guild negotiated part of it and the part that
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involves the PSA,
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I think that's really promising for our profession,
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and I'm really keen to see where these two or three
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different aspects of the 8CPA actually take our profession in the
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next five years. That will be really exciting to see.
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From what you've seen so far, what are some of the opportunities that you see?
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Yes, we do have the 8CPA and then there's still the wholesalers agreement,
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and then there's the PSA strategic agreement. But from what you've seen,
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what opportunities have you seen for your pharmacy and community pharmacy in
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general?
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I guess now we're talking about remuneration for dispensing and we're talking
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about services and we're talking about scope of practice.
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So there is a lot of discussion out there. What are your thoughts about it?
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So my understanding of being a pharmacist has really crystallized into
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I am somebody whose job is to help improve people's health literacy.
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The vehicle by which I do that is their medication.
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But if they don't understand why they're doing something,
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then they're much less likely to do it and they're certainly much less likely to
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do it well. So with that,
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having the 8CPA,
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the parts that relate to the dispensing and the supply and the
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understanding of how people are using their medication,
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to have that being recognized and
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remunerated as a separate part by itself is wonderful.
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But what I'm really excited about is the other stuff which is coming,
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which I see helps me and my colleagues to
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actually help people to understand their health,
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to understand their medication, and to improve their health literacy.
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So I'm really excited to see all of those things,
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many of which probably won't be delivered in our community pharmacy,
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but they'll actually be delivered by independent pharmacists doing their thing.
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They'll
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be delivered by pharmacists working for different organizations,
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whether that be for GP surgeries or aboriginal health
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organizations or nursing homes or other health
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organizations.
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I'm really excited to see what that new part of the 8CPA,
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which is really being steered by PSA and their team.
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I'm really excited to see what that will do because while
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I live and breathe and bleed community pharmacy,
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I know that that's not the right environment for every pharmacist and nor should
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it be.
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There's a lot of pharmacists who do very well and do amazing work outside of
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the walls of a community pharmacy,
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and I want to see them recognized for the wonderful work they do.
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I want to see them remunerated appropriately for the
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work that they do.
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And I know a lot of the work that we do is done for the
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love of it, not because it makes money,
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but it needs to do both.
It needs to pay people appropriately for the
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level of skill they put in,
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but also for the years that they've spent getting through to
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that appropriate point.
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And I think of our credentialed pharmacists,
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and I'm not a credentialed pharmacist,
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but I thank God that they are out there because they do a job that I can't do.
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And frankly, I'm not really sure I even want to do.
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I love being a community pharmacist.
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I love being on the floor with my patients day to day,
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but I need those credentialed pharmacists who can dive deeper into
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what a blood test result might mean for somebody's complex
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medication regimen and what their other non-drug things that they're
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doing, their non-prescription things, whether they be the alcohol,
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the cigarettes, the cannabis, the vaping,
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the other herbs and drugs and
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medicinals that they might use that are not coming from a pharmacy.
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I need a credentialed pharmacist to go through that with them because I simply
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don't have the time or even the skills to go through that,
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and I want them to be able to do that.
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So I'm really looking forward to seeing them being appropriately
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remunerated, not just for the time that they spend,
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but for the skills that they've spent developing, getting to that level.
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You mentioned before about younger pharmacists and being interested in
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community pharmacy and then seeing the changes and reconsidering,
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what do you think this means for younger pharmacists now,
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the ones that have just graduated, they've given them more hope?
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Look, I think we're almost at a point where our
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profession could look like fireworks off in all sorts of different directions,
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bright, shiny, something to look up at and be amazed at.
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I really see so many different directions for pharmacists to be able to
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head,
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but I also see that community pharmacy also has a bright future,
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and I would love to see those pharmacists really
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being able to appreciate where they are and being
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appreciated for the unique skillset that it takes to be a community pharmacist.
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And just like our colleagues,
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the doctors know that general practice is a specialty
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community pharmacy is a specialty and it's not an easy one.
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And there are days when it's not a fun one,
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but it's really rewarding when you know that you are making a
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difference to people's lives and you get those people coming back
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day after day,
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year after year and relating a story to you where you've helped
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them identify a problem and that has been a turning point for them.
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So if you were going to think about the future of pharmacy and what you would
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like to see, as you've mentioned, there's still some work to be done,
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there's still some agreements to be set into place.
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So if you were going to say idealistically, what you would like it to look like,
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what would you say?
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Like I said,
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I'd like to see it that fireworks heading off in all sorts of different
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directions.
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Certainly we're a long way away from
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people looking as pharmacists, being just the person in the dispensary,
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in the local pharmacy down the shops. We're a long way away from that,
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and so we should be.
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So I'd like to think that the future of pharmacy is actually really bright and
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really colorful.
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I think we're heading off and so to,
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I'd like to think that there's a big bright future for pharmacists around
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Australia.
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So I have asked you the majority or all of my questions so far.
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What have I not asked you?
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I don't think there's anything I did want to get across
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that a lot of pharmacy owners were
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really worried and not for themselves,
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but for the people that they employ who have mortgages,
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who have families, and who rely on them.
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The other part of this is that having the future
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restored in community pharmacy means that we can also devote our time to some of
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the things which don't necessarily bring in money,
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but the things which we love to do and which our communities rely on us
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for. And a lot of us as pharmacists do a lot of volunteer work.
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We work in our pharmacy work,
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we work with a local aboriginal controlled alcohol and other drug service,
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and most of the work that we do up there is unpaid,
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and we do it simply because it's a connection with our community and it matters
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to us.
But that was going to get much harder
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when we were losing so much money as 60 day was initially
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proposed. So having had that put back into us,
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and pharmacists should not be immune from the need to do more with
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less. And I think that's a constant throughout,
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really throughout the world,
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is everybody is doing more with less and we should not be immune from that.
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But the way 60 Day was proposed and brought in was really
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counter to the way that things should be done.
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It was done without any consultation with us,
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and that was one of the things that we really struggled with the most.
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And having been able to be consulted on that,
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I think what we've come through with is something that actually works much
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better, not just for our profession,
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but for the patients and the communities we serve.
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And it gives us faith that we can get back out into that community and spend
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that time, even though some of those times won't be remunerated.
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We can spend that time with our community being the pharmacists that we all want
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to be.
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Brilliant. Thank you. That was very,
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very positive because I think everyone was kind of clamping down there for a
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while. Everyone was thinking about how to,
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like a scarcity mindset.
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People were changing so many different things and now it's just nice to reflect
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and see actually you can open your minds again to all of the opportunities
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and the ways you can deliver services and medicines.
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It doesn't have to be the way that it was.
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So many changes were made in some places and it's just
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people are starting to breathe again.
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Very much.
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And I think the other part of it is that old example
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that people have of the guy that turns up to fix something
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and he turns a spanner to something and takes him 30
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seconds and the call out is 15 minutes and 15 minutes back,
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and he bills the company several thousand dollars for it.
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And when they questioned him for it, he says,
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you don't owe me for the half an hour, you owe me for the 30 years.
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That meant that I knew where to take the spanner and how to
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turn it to get everything to work. And I think we've, as a profession,
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we've undervalued the years that we take to get to that point
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and
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having people ask for certification and we just sign it and we do it
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because what we do and now we charge for it and nobody bats an
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eyelid.
They really don't. Even where we are,
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where people don't have a lot of money spare,
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they actually appreciate that we are there and we've never even had
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to have that conversation with them,
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that it's not about the five minutes that I spend with you,
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it's about the 10 years that I've spent getting to where I am,
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where I'm one of those people on that list that can actually sign that for you.
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And
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it's been great that our community understands that that's where we
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are and that we have to charge for those sorts of things, charge for deliveries,
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and they just understand that that's what it is.
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So I think that's been really good part of this as well,
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is that us valuing ourselves as a profession and valuing
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what we've had to do to get to where we are.
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I think that's been a really good thing too. So yeah.
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Thank you.
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Looking up.
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00:25:08.210 --> 00:25:10.250
Looking up and burnouts,
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how if they still the same,
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I guess lots of people after Covid was still talking about being burnt out,
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being exhausted, and then obviously this all happened and yes,
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changes started to happen and there has been,
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I would say more responsibilities put onto a lot of people. So I would say,
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now,
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does this mean that people get to breathe a little bit more and
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maybe reduce that risk?
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00:25:40.340 --> 00:25:44.720
But I think a lot of people are still working really,
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really hard.
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We were fortunate, we actually went through Covid overstaffed,
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00:25:51.890 --> 00:25:56.810
and that meant that we actually had staff who had dinner days
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during 2020 and 2021 and
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we just sent them home.
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00:26:04.220 --> 00:26:08.390
And sometimes it was hard to get them to have a day off because they felt like
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they needed to be there with the rest of the team.
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But that also meant that we dug ourselves into a bit of a cashflow hole,
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which we had to fix.
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And they were some of the changes that we implemented early last year.
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And so doing that and then having 60 day coming and
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00:26:28.910 --> 00:26:32.750
realizing that what we'd done probably wasn't enough that we needed to do more
400
00:26:33.830 --> 00:26:34.730
was troubling.
401
00:26:34.790 --> 00:26:39.770
But our team have known that we've been there with them side by side
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00:26:39.770 --> 00:26:44.550
through all of this and we've known they've been with us side by
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00:26:44.550 --> 00:26:49.320
side through it as all.
And that's been a really nice thing
404
00:26:49.950 --> 00:26:54.330
for us to all know that we're there and had a conversation just with one of the
405
00:26:54.330 --> 00:26:55.163
team today.
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00:26:55.740 --> 00:27:00.660
And she's had some tough times and it was really nice to be able to
407
00:27:00.660 --> 00:27:03.810
say, well, yeah, I'm glad you felt supported,
408
00:27:03.810 --> 00:27:08.460
but it was really easy to support you because of who you are as well.
409
00:27:09.090 --> 00:27:13.950
And so don't underestimate
410
00:27:14.520 --> 00:27:19.470
the level of support that you got was also because of the kind of person that
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00:27:19.470 --> 00:27:23.850
you are and the support that you've given us over the last three or four years
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00:27:23.850 --> 00:27:24.990
through Covid as well.
413
00:27:24.990 --> 00:27:29.910
So that's a nice thing to be able to say to people when they're telling you
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00:27:29.910 --> 00:27:33.960
that they've felt supported, but you can also look them in the eye and say,
415
00:27:33.960 --> 00:27:36.000
well, it's not all about me.
416
00:27:37.890 --> 00:27:39.390
We've felt really supported,
417
00:27:39.390 --> 00:27:43.860
and Margaret and I have had some really tough times over the last two or three
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00:27:43.860 --> 00:27:48.660
years as well, and our team have just been truly amazing.
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00:27:49.170 --> 00:27:51.960
Sent us home when they knew that we needed to go home,
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00:27:53.430 --> 00:27:54.720
just stepped up,
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00:27:55.290 --> 00:28:00.240
looked after things when normally prior to that they might've called us
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00:28:00.240 --> 00:28:04.110
in, got us involved. They've just said, no, we can look after this.
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00:28:04.110 --> 00:28:07.620
We don't need you to do this. We got this boss.
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So it's been a really,
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00:28:11.730 --> 00:28:14.760
really cohesive team through this, and that's been really nice.
426
00:28:16.780 --> 00:28:20.950
Thank you. That was very helpful. Thank you.
427
00:28:21.510 --> 00:28:22.350
I think you find there's
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00:28:25.230 --> 00:28:28.590
more than people would give credit to.
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00:28:29.100 --> 00:28:32.850
I think some people don't articulate that well,
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00:28:33.960 --> 00:28:38.880
and I think some bosses don't articulate it and they don't
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00:28:38.940 --> 00:28:43.890
appreciate that the boss really does go out of their
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way to try and make things work for them. And
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00:28:49.050 --> 00:28:53.280
yeah, I'm fortunate that I do through PSS,
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I get this opportunity to speak some of this
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and that is very good.
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But I think there are a lot of people out there who do the same thing for their
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staff,
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but they don't necessarily get the platform that I'm fortunate enough to have.
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So yeah.
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We hope you've enjoyed this episode of the AJP podcast.
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00:29:20.160 --> 00:29:25.020
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00:29:25.020 --> 00:29:25.853
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00:29:26.310 --> 00:29:29.520
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