Community Pharmacy

The Pharmacy Guild of Australia

The Pharmacy Guild is the national peak body representing community pharmacy. It seeks to serve the interests of its members and to support community pharmacy in its role of delivering quality health outcomes for all Australians. The Guild was established in 1928, bringing together several small retail pharmacy organisations then operating in the various states.

The Guild is committed to supporting and maintaining the community pharmacy model as the most appropriate and efficient system of delivering medicines, medication management and related services to the Australian public. A major Guild activity at all levels is close liaison and negotiation with governments, manufacturers, wholesalers and other organisations in or around the health care delivery system.

The Guild provides everything from industrial relations to support for pharmacists, conferences, training and events, and negotiates with state and federal governments for services and remuneration. It also assists with other small business issues such as rents, advocacy and legal advice. The Guild owns its own IT and insurance companies and with other products and services for its membership it has more than 800 staff nationwide – “a lot of resources,” according to Kos. Some of these services deal in other related sectors – for example, the insurance company is a prime insurer of optometrists and physiotherapists.

E-health is a major issue these days. The UK, says Kos, was an early enthusiast for e-health but when it was first introduced a decade ago, there was little in the way of advocacy or support. UK health authorities wasted millions – possibly billions – of pounds on lavish consultancies that taught no one anything; Kos recalls a British counterpart at the time saying, “there was no dialogue – only a monologue.” The Guild was determined to avoid a similar fate for projects in Australia and has had a policy of being proactive. “Most other health organisations go to government and offer to develop something for them but only after receiving some funding. The Guild has a different approach – we invest our own money, establish programmes or prove their worth, then go to government and advise that they should be rolled out as national programmes.”

Unusually, and as a direct result of this pragmatic approach, the Guild derives just 18 per cent of its revenues from membership fees (a typical figure for associations is closer to 90 per cent). It is a not-for-profit enterprise so the companies it runs are administered as separate tax-paying entities. This enables the Guild to invest funds and develop programmes for the broader good of the profession. Fees are kept as low as possible so as to encourage inclusivity – the greater the percentage of pharmacies in membership and using the various programmes, the more cost effective and ‘industry-standard’ those programmes can be made.

It should be borne in mind, though, that these programmes are neither compulsory nor exclusive, and Kos makes the point that there is often some complexity in the market. In the case of software, more than half of the total membership uses a Guild developed system (a dispensing system called FRED: Fast Reliable Easy Dispensing) but some pharmacy businesses have developed their own systems and they too must be supported. Kos cites a current success story in the form of electronic prescriptions: “starting from scratch we use three million prescription records per week, singularly the most successful e-health programme in Australia, and all established without a cent of government money. Other professional bodies don’t have that ability to invest money,” he explains. With IT, sometimes you get winners and sometimes losers. “I don’t say everything we touch turns to gold – but I think members do appreciate that we are having a go, trying to advance the profession.”

At present the big industry issue is the burden of chronic disease and there are a lot of things that pharmacists can do in this realm. “One privilege of this job is that I can get to see all the best health systems in the world,” says Kos. “We pick the best things and try to emulate them here. Fortunately we seem to get more things right than wrong.”

So how good is Australia in healthcare? Kos believes that if you take into account the ‘safety net,’ making sure the largest proportion of the population is included, rural and regional as well as metro with equitable access to systems, “probably the Pharmaceutical Benefits Scheme is the best in the world.” Nowhere is perfect, and Australians lack access to some of the more expensive or experimental new drugs that might be available in some markets which are funded differently (such as by pharmaceutical insurance), but in general terms, he says, “I don’t know of any system that is operating better than ours.”

Would Kos be worried that a change of government might dent that superiority? Reminding us that the opposition leader is an ex-health minister and the prime minister was once his shadow, he explains that, “A lot of politicians know and appreciate that health is important to the Australian public.” The country is not struggling with catastrophic debt, but since the GFC government money has been tight. “That means that in many areas we are probably not investing as much as we should in preventative health. That tends to be the first thing to drop by the wayside if a country is short of funding. But overall I think we have done remarkably well. I don’t think many people realise just how difficult it is for governments to balance their books at the moment.”

In any case, no government can ever truly spend enough on health. But Kos makes the point that it sometimes pays to ‘speculate to accumulate’ when it comes to provision of preventative treatments. He cites the case of epilepsy, which affects around two per cent of the population. Most sufferers can nowadays be productive members of society thanks to advances in treatment, working and paying taxes as well as enjoying life, whereas once they were unable to do so because of their illness. It is vital to stop thinking in silos, Kos explains. The person administering the drugs budget does not instinctively think about the person collecting taxes, but they should both take note and work together, putting the epilepsy drugs on the PBS to achieve the desired outcome that is good for everyone. The Guild has to help span that argument and provide balance.

Where else does the Guild need to act? Not long ago, says Kos, there was a chronic shortage of pharmacists, but action to improve courses and encourage students into the profession has ironically led to a situation where there may soon be a glut in the profession. Another issue is property. “There is a global financial crisis but I don’t know of any landlord in Australia who has adjusted his rents – they still expect the same annual increase and are asking exorbitant rises.” The Guild is proud that its members are the most accessible of professionals and, “we would like to have pharmacies where the people are.”

He warns that a US-style situation may not be far away, where shopping malls are simply too expensive to locate businesses such as a pharmacy. “We don’t want to see that happen here,” he says. Increasingly, the retail footprint must be big enough to support the complementary services that a modern pharmacy provides – related non-scrip medicines, weight control or herbal products, and so on. Currently the Australian model is better suited than that of Europe, Kos says, where many pharmacies are still very small and restricted to dispensing prescriptions alone.

A final caution concerns profitability. Not enough attention is devoted to straightforward business practices, Kos believes. A pharmacy is a business like the newsagent or shoe shop next door in the mall. An important role of the Guild is to “give them support and management tools to run successful businesses, because at the end of the day you can be a great clinical pharmacist, but if your business is not profitable you’ll go broke.”

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January 18, 2018, 8:38 AM AEDT

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