Consensus at workforce forum
This is the dawn of an exciting future for pharmacy, Peter Dunne said in his opening address at April’s pharmacy workforce forum.
Richard Townley, Pharmaceutical Society chief executive, agrees, and says the forum, hosted by the society, was a “great day” where consensus was reached on the direction pharmacy needs to take and how this can be achieved.
“There’s an across the board agreement as to what sort of roles pharmacists should be doing, and the potential ways those roles can be carried out. Everybody is united in wanting to move pharmacy forward.”
10 year vision
Society president, Elizabeth Plant, summed up the general feeling of the forum by stating the pharmacy workforce needs to be capable of providing a range of services – not just dispensing – by 2014 (the end of the 10 year Vision for Pharmacists 2004–2014).
Services should include medicine management, health promotion and health assessment, monitoring and screening.
The services will need to be tailored to patient needs within any given location and delivery may be through community pharmacies, pharmacist facilitators and multi-discipline health centres, Mrs Plant says.
Five work streams
Mr Townley says the forum identified areas likely to inhibit change and various organisations have agreed to work with the society over the next year to break down these barriers. The five work streams are:
to develop a vocational map that provides a professional career structure for all sectors of the pharmacy workforce – pharmacists, technicians and assistants
to fully define an appropriate skills and knowledge learning structure which will be aligned to this vocational map, and identify education and training providers at all levels
to coordinate a campaign across the whole health sector to demonstrate the professional capabilities of pharmacists
to clearly define the collaborative roles of healthcare providers on the continuum of medicine management
to address pharmacist workforce capacity issue, in terms of maintaining a supply of appropriately trained and skilled pharmacists for medicines management roles.
Mr Townley says funding pharmacy was also discussed and the forum urged the DHBNZ/pharmacy agents steering committee to urgently provide funding model options.
The society will review the DHBNZ Framework of Pharmacist Services to make changes to MUR reporting requirements and to define minor ailment services that could be funded by DHBs, Mr Townley says.
Community pharmacy
Otara pharmacist Ian Johnson told the forum community pharmacy is an effective solution to many of the issues faced by funders and planners.
Pharmacists can work closely with general practice to reduce the burden on GPs through health promotion, prevention and continuation prescribing.
And another key to lowering health costs is to increase the appropriate use of medicines, Mr Johnson says.
He uses the example of Middlemore Hospital’s Very High Intensive User programme where 1216 patients had 6385 admissions in a year. They account for 23% of total medical admissions, a cost of $18,500 per patient or $22.5 million in total every year. These patients had an average of three chronic medical conditions, took nine or more regular medicines but most were non-adherent.
Mr Johnson says one patient was not compliant because of the wording on the medicine package – take tablets with breakfast and dinner.
The patient believed dinner to be lunchtime so ended up taking too much medicine earlier in the day, and not enough later on. Through a medicine use review, the patient became adherent and now sees medicines as a significant contributor to her wellness, has not presented at Middlemore for some time, and has an ongoing relationship with her community pharmacist.
“Patient focused care means changing the public perception of community pharmacists from retailers to health professionals,” Mr Johnson says.
Other services such as minor ailments and public health programmes – smoking cessation, weight loss, sexual health – are areas to develop in community pharmacy, he says.
Education and training
If the role of the pharmacist is to change and become more patient focused, the way in which pharmacists are educated also needs to change, the forum was told.
“One of the big problems in current undergraduate education is essentially disconnected from pharmacy practice,” John Shaw, head of the University of Auckland School of Pharmacy says.
Other health professions – nursing, medicine, physiotherapy, midwifery – all have considerable periods of clinical practice within the undergraduate curriculum, Professor Shaw says.
A proposed model for debate is extending the length of the pharmacy course and incorporating practical experience at appropriate times during their undergraduate degree, instead of a year’s internship at the end.
“Future roles will involve clinical judgement. Unless you’re learning those skills as you go through your degree it’s very difficult to see that happening.”
Professor Shaw says shorter, more frequent practicums would ensure all undergraduates get experience in the main branches of the profession.
At the moment preregistration training takes place at one site – a hospital or community pharmacy – and students don’t have the opportunity to work in other areas, such as a GP practice or a drug dependency clinic.
Under the proposed model, there would no longer be an employer/employee relationship like the one that exists when students do their intern year. Instead, a trainer/student relationship would develop.
“That is what happens in every other health profession,” Professor Shaw says.
“Trainee doctors spend time on the wards during their undergraduate degree. They aren’t employees of the hospital, they’re students.”
Too many graduates
Professor Shaw says the current number of graduates from the pharmacy schools is in accordance with the number of jobs available. However, he believes there is a distribution issue.
“There is anecdotal evidence of graduates having difficulty in finding jobs, particularly in community pharmacy in Auckland, but large parts of the remainder of the country find it extremely difficult to attract pharmacists.”
Professor Shaw says the new model of education would allow students exposure to different areas of pharmacy, and this would encourage students to follow other paths besides community pharmacy.
Technicians
Pharmacy technicians will need to play a greater supporting part so pharmacists can extend their roles, Mr Townley says.
Discussion at the forum focused on technicians taking on more of the “routine work” of dispensing to free up some of the pharmacists’ time so they can focus on other activities.
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