Dialogue: Clinic role becomes dispensable

Government plans to deregulate pharmacy ownership will lead to a focus on profit, not medicine, writes GRAY MAINGAY.

If you thought the deregulated ghost of the 1980s had been laid to rest, you are wrong. It is back, and this time its target is your community pharmacy.

The Government wants to cut the link between ownership of, and accountability for, pharmacies. It wants to abandon the safety-valve requirement that has served New Zealand well: that pharmacies must be owned by pharmacists.

Instead, it is happy to see overseas corporates employ pharmacists in supermarkets and chainstores, where you will have to shout above the din to hear the pharmacist's clinical advice.

In a flight of fancy, the Government and its officials argue that deregulation will improve public access to pharmacies, raise standards of service, deliver better pharmacy services in remote areas and push down the cost of medicines bought in pharmacies.

None of this was substantiated in the case for change put up by the Ministry of Health just before Christmas. This was short on detail and analysis, long on rhetoric and surprisingly uninformed.

All it had to do was look across the Tasman for the latest research on the issue, the Wilkinson Report, which was published after an 18-month investigation into pharmacy ownership.

Australian Prime Minister John Howard said the report presented a persuasive case for preserving Australia's tradition of pharmacies owned and operated by pharmacists. His Government supports the report's recommendations in this area, and considers the matter settled.

Unfortunately for consumers here, Health Minister Annette King is being advised by her ministry to take the reverse approach, and thereby make a serious error.

Deregulation will lead to fewer pharmacies, less access to pharmacy services, a diminished contribution by pharmacies to delivering primary healthcare and a diversion of focus from good healthy advice to turnover, and to profit that will go overseas.

The logic of deregulation is that it will lead to corporatisation of pharmacies. Entrepreneurial groups will move in to choice locations and set up supermarket-style pharmacies. Dispensing medicine will gradually become of secondary importance to driving profits for corporate shareholders.

In contrast, most pharmacies have designed their business around their clinical role. They have taken advantage of changed pharmacist-technician ratios, employed retail managers and computerised or delegated the day-to-day tasks of the business, so they can concentrate on their main function - dispensing and advising on medicines.

Free services, such as being available to patients, communicating with patients' GPs, visiting resthomes, and conducting community talks and medication reviews, will come under pressure as corporate owners move away from the clinical model of pharmacy towards retailing.

Good advice will be harder to find because superintendent pharmacists in places such as The Warehouse will not have time to provide it. Why should they? There's no money in it.

Nor are they likely to provide the facilities required for the consultations we take for granted. A supermarket chain is no place for the serious, and often delicate, discussions many patients need to have with their pharmacist.

It is highly unlikely that supermarkets will provide a quiet corner for discussion when it can be used to move stock. Are supermarkets appropriate places for our methadone programme and needle exchanges, for example?

The ministry argues that deregulated ownership will provide more points of representation and, thus, greater access by people to pharmacy services. Yet pharmacies are accessible now. They have responded to demand.

Medical centre pharmacies are now common, and pharmacies are frequently alongside supermarkets or in malls. This has happened without deregulation.

But that is likely to change. Rural pharmacies will suffer if the ministry's views are accepted. Their staff will be attracted by corporates looking for more superintendent pharmacists to work in cities; there will be little interest among corporates in setting up in smaller towns where turnover and profitability are low. Rural and poorer areas will miss out as the number of pharmacies falls.

For evidence, look to Britain. The pharmacy supermarket culture has forced the Government there to invest in drop-in centres which provide a more acceptable environment for dispensing medicine and advice.

We understand that Annette King views the future of pharmacy in the wider context of the establishment of public health organisations, the purpose of which is to provide integrated primary healthcare to particular social groups at affordable prices.

Pharmacists have no objection to that; we welcome it. Let's see the plan in detail and we will start talking about the issue, which is relatively simple to solve, rather than taking a sledgehammer to crack a nut.

Pharmaceuticals are not ordinary items of commerce. They are potent and potentially dangerous and should only be available from suitable premises with suitably qualified staff. Whoever sells them should be accountable for their actions.

The minister argues that a licensing regime would suffice: simply ensure that the owner is of good character and that a superintendent pharmacist is available to supervise sales.

That is not good enough. Under that system, the superintendent pharmacist could be dismissed for malpractice and breaching the Pharmaceutical Society's code of ethics, while the owner of the business is untouched.

Under the present system, a deregistered pharmacist would lose his business as well as his right to practise. It is hard to contemplate a more stringent form of accountability or a system which would generate as much public confidence.

The Pharmacy Guild is willing to co-operate on a number of key issues and restore a dialogue in which the outcome is not deregulation and corporatisation.

For example, we are willing to amend ownership requirements while ensuring proper accountability, and have revisited our policies to allow pharmacists to accommodate the minister's concerns.

We now accept that pharmacists can own up to 75 per cent of five pharmacies, with external investment in the balance. There is room to move on that if more external capital is required. And we have moved our position on the establishment of Primary Health Organisation pharmacies, even though they may undermine some of our members' business.

But the minister needs to check the quality of the advice she is receiving from her ministry. Unsubstantiated assertions, contradictory claims and ideological blinkers are no basis on which to dismantle a professional service that continues to serve New Zealanders well.

* Gray Maingay is president of the Pharmacy Guild.