At Lynette O’Brien’s Papatoetoe pharmacy, it’s not just doctors’ prescriptions that are being filled and collected. Among the long list of other services customers can get are vaccinations, gout monitoring and management, and medication to treat hepatitis C. To help deliver these, O’Brien’s pharmacy is fitted out with a couple of consulting rooms and a sterile room.
Most people will simply walk in when they have a free half hour or are on their way to or from the supermarket, says O’Brien. “If someone comes in, we’ll just make it happen. That’s our point of difference.” And this is playing out across New Zealand, with many patients finding it quicker and easier to go to the pharmacy than their GP.
Someone who’s been a driving force in allowing pharmacies to deliver such services is Dr Natalie Gauld. The pharmacist has been a leader in groundbreaking work on medicines reclassifications, which is the regulatory process for making certain medicines available without a doctor’s prescription.
Gauld has worked on reclassifying drugs such as trimethoprim for urinary tract infections, sildenafil for erectile dysfunction, and some oral contraceptives. She has also helped pave the way for pharmacies to deliver new services, such as testing and treating hepatitis C, and monitoring and medicating those with gout and diabetes. In this year’s New Year Honours, she was made an Officer of the New Zealand Order of Merit in recognition of her services to pharmacy and health.
“She’s been a trailblazer,” says O’Brien. “I just think she’s magic with what she’s done for our profession.”
But although she’s a star in her field, Gauld was last year diagnosed with motor neurone disease, which she says will hugely affect her life and her family, with increasing disability and a shortened lifespan. For now, however, she’s still working, although taking more time off to do other things.
Not one to enjoy the limelight, Gauld instead insists that widening access to treatment options through pharmacies is a team sport. Last year, when the Pharmaceutical Society of New Zealand awarded her its pinnacle Gold Award, alongside the people she thanked in her acceptance speech (delivered by her mother), she listed in a handout two further pages of people who had supported her.
“I work with other clever people who are far cleverer and have more mana than me, and I just work with them and we achieve stuff together,” she says.
Meeting urgent need
Gauld says she wasn’t a stellar pharmacy school student and nearly retrained early on as an accountant (like her father and brother). “I wasn’t completely certain about pharmacy in the early days, but actually I find it absolutely fascinating,” she says. “There’s so much opportunity to innovate.”
After completing her pharmacy internship in 1988, she quickly gained a sense of that opportunity. A flurry of reclassification activity had led to many new medicines being available over the counter in pharmacies, and an early job managing an urgent pharmacy gave her insight into the benefits of greater accessibility. “You get to see the people who are quite desperate for something – the woman who comes in at 10 at night who’s got vaginal thrush – and suddenly at that time we were able to help them,” she recalls. “I thought we could do our job so much better.”
She gained first-hand experience of aspects of reclassification while on contract as a drug information and research pharmacist at drug company Ciba-Geigy, following the reclassification of diclofenac tablets (Voltaren) as a pharmacist-only medication. Part of the role involved educating pharmacists about correctly recommending the medication, and collaborating on University of Otago research, which ultimately led to her masters study.
Gauld has worked across a broad spectrum of pharmacy, from hospital to pharmacy wholesale, clinical trials and as a consultant and researcher. It’s experience that is augmented by an ability to research deeply and consult widely. In her Gold Award acceptance speech, for example, she talked about working on the Medicines Classification Committee (which makes recommendations to the health minister on medicines) from 2004 to 2009 when she would source research papers, contact experts and pharmacists and feel the burden of thoroughly preparing to make the best possible decisions.
She also noted how the many reclassifications the committee approved in that time were the envy of Australia, where many were rejected. This led her to begin a PhD in 2008, exploring how and why variation in reclassification occurs across nine developed countries.
Following her time on the committee, she saw an opportunity to drive reclassifications from a pharmacy perspective, initially working alongside Green Cross Health, whose business includes the Life Pharmacy and Unichem chains. Alison van Wyk first worked at Green Cross Health with Gauld on reclassifying the influenza vaccine so it could be delivered by specially trained pharmacists across the country.
“Natalie is an absolute driver,” says van Wyk. “She seeks counsel from detractors, as well as those that are positive, and [she has] the ability to really get to the heart of the matter so that we can actually address that.”
Pharmaceutical Society of New Zealand president Professor Rhiannon Braund says Gauld is recognised as a world leader in medicines reclassifications and is driven by patient need. She has also been instrumental in developing educational resources for pharmacists so that reclassified medicines can be safely and responsibly supplied.
“What she’s done for the profession and for patients is pretty outstanding. And it has set the scene for other things to happen. I think about pharmacists dealing with the antivirals through Covid; that would never have happened if Natalie hadn’t done the groundwork to have pharmacists be recognised for what they could do above their safe supply function.”
New services in pharmacies
In more recent years, Gauld has been partnering with others to strengthen or develop new services in pharmacy, such as co-developing and implementing a hepatitis C pharmacy test and treat programme across 64 community pharmacies (working alongside renowned liver specialist Ed Gane).
She has also been working with a team that includes senior rheumatologist and Associate Professor of Medicine at Middlemore Hospital Peter Gow in revamping treatments for gout sufferers delivered through pharmacy. “I’ve never met anybody who’s quite so disciplined in achieving their goals,” Gow says of Gauld. “She has high expectations of people and inspires them to do the very best.”
Gauld says her motor neurone disease diagnosis last year means she can no longer put in the long hours she has in the past, but the passion of people such as Gow and Gane are part of what still drives her work. Gow also notes that as well as being driven by what’s right for patients, Gauld has a passion for pharmacists.
It’s an observation Gauld herself echoes: “A huge motivation for me all the way through has been pharmacists doing a great job,” she says. “They really want to help the community, and they have stepped up so well with all of these services. If pharmacy hadn’t been so keen to help people, keen to work at the top of their scope of practice, I never would have achieved what I have.”
