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