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Australian Journal of Pharmacy : November 2006
USA and UK lead the way While Australia may be a little hesitant (and some would say even a little politi- cally hamstrung) in its approach to intro- ducing a wider range of specialised pro- fessional services, the same cannot be said for pharmacy overseas. The provision of specialised disease state services in areas such as diabetes, asthma, wound man- agement, anticoagulation therapy, and dyslipidaemia is well recognised in the US and within a competency-based training, credentialling and remuneration frame- work. The Certified Disease-State Man- ager is a sought-after credential among our US colleagues. To see that this is the future direction for pharmacy, we need to look no further than the recent announcement in the United Kingdom of a competency and accreditation-based national framework for ‘Pharmacists with Special Interests’.3 This document outlines how appropri- ately trained and accredited pharmacists will be able to provide a range of services to address long-standing health inequali- ties enabling patients easier access to quality specialised services in community settings. The concept builds on pharmacists’ core roles developing their skills, knowl- Capital Hill Crunch time for PBS reforms ?from page 14 important to keep the Pharmacy Guild onside. That is not going to be easy. Considering the number of flip flops by the Minister on this issue, it’s worth not- ing one issue that may have scarred the entire process. The Minister told everyone assembled at the National Press Club on 2 August that ‘savings harvested in the PBS would be reinvested to make headroom pricing possible to afford new high-tech pharmaceuticals’. Yet later Ministerial utterings indicated there had been a change of heart, due to the fact the PBS was ‘demand driven’, so ‘savings wouldn’t be reinvested’. The Minister attended a fundraiser in Sydney on 23 October organised by a Canberra lobby firm, Parker Partners (run by former Wooldridge policy adviser Paul Cross and latterly a Merck Sharp Dohme appointee), at which some 14 Medicines Australia members were pres- ent. The general mood was upbeat after- ward. A deal was hinted at. But where is the Guild in all this? Vic- tim of a concerted effort by the Depart- ment to hold it out of the process until everything else was signed off, the Guild was apparently locked into an intensive bargaining session with the Department on 23 October while the Minister was hosted by the pharmaceutical industry. The Guild meeting was slotted for one hour’s duration by the Department. It went for a couple of days. The Guild drives a hard bargain, but pharmacy sur- vival is on the line in this. Something good might come out of this, as the Minister has hinted. While everyone wouldn’t be entirely happy, there was promised to be something in it for all…then again where is the GMIA? They have told members that the process is ‘on track’. If they are derailed, there’s a spoiler media campaign already in the pipeline.¦ THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 NOVEMBER 2006 ? 37 edge and experience and allowing them to contribute in specialist clinical areas and at an entirely new practice level in a range of areas. These include diabetes, asthma, wound management, harm min- imisation, anticoagulation point-of-care testing, Parkinson’s disease, medication management for older people, pain man- agement, sexual health and mental health and are all funded through the local pri- mary care trusts (not too dissimilar to our Divisions of General Practice). It is an excellent model of harnessing the skills of pharmacists to deliver easily accessible, quality services to patients. And what about here? So what does this all mean for Australia? What it should mean is that we follow the lead of our overseas colleagues and con- sider just how we can better utilise the skills of the pharmacist in both a general and specialised sense to better address the country’s ever-increasing health needs. We need to look at the current and pos- sible future models of healthcare—and identify the best pharmacy model to sup- port them. The era of providing spe- cialised pharmacy services has been with us for some time with MMRs and they pro- 1. Berbatis CG, Sunderland VB, Mills CR, Bulsara M. Reference database of Australia’s community pharmacies: analysis of national survey (June 2003). June 2005. Pharmacy Guild of Australia. Canberra ACT. 2. Roughhead L, Semple S, Vitry A. The value of pharmacist professional services in the community setting. June 2005. Pharmacy Guild of Australia, Canberra ACT. 3. Implementing care closer to home - providing convenient quality care for patients. A national framework for pharmacists with special interests. September 2006. Department of Health, London, United Kingdom. ¦ vide an excellent base to build on. If over- seas trends are indicative, the call on phar- macists to provide an enhanced range of services is likely to expand—and now would seem to be a good time to prepar- ing ourselves for this. We need to have in place a career path for pharmacists in MMR/DSM/cognitive services provision areas to support a future healthcare model given the increasing health demands, workforce issues, and competing national health priorities. To have the models up and running and in place, and to be proactive for a change, is certainly a strategy that would position us well for the future.