..Information to Pharmacists
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    Your Monthly E-Magazine
    APRIL, 2003

    Published by Computachem Services

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    TIM LOGAN

    A Pharmacy Guild Perspective

    Quality Care Kickbacks...Kick Right Back!

    I would like to beg the indulgence of the readership of this e-magazine: it is rare that tit-for-tat duels between contributors can remain interesting for long.
    I would much rather be involved in more productive epistles, but the misinformation generated by John Skyllas in the last publication cannot be allowed to stand uncorrected.

    I will address the most glaring errors of fact:

    Pharmacy Fridge sales
    Rollex have never had a monopoly on 'compliant fridges' - they were (and are) the only Guild-endorsed vaccine fridge.
    Others brands are certainly able to meet the standard, but the Guild's commercial division, Gold Cross, gets a small commission on this brand, just like they do for promoting any Guild-endorsed product (see the middle pages of your 'Pharmacy Review').
    A proportion of this money is paid back to the Guild for the benefit of it's members.
    The commission is paid out of the existing RRP not, on top of it.
    The price of the fridges reflects the small market, and the specialised nature of the equipment - any artificial inflation of the price would quickly lead to competitors (and we list the other QCPP compliant fridges on the QCPP website) getting all the sales.

    Independent refrigerator tests are important to the integrity of the cold chain and the cold chain standards in the Program.
    The QCP Division has no involvement in this service, other than requiring it for accreditation.
    The NSW branch of the Guild provides the service, and any meagre profits generated are used to fund services that benefit NSW members.

    More importantly, every accredited pharmacy having a specific purpose vaccine refrigerator, three-yearly external testing and regular in-pharmacy monitoring of temperatures will help the Guild to argue that vaccine distribution should not take place in less rigorous circumstances (eg, at doctor's surgeries not possessing a vaccine fridge).

    Accreditation assessment fees
    The Guild does not receive a portion of the assessor's accreditation fee.
    The only financial transaction between the QCPP division and QCP assessors is the assessors' payment of an annual fee (currently $50) to the QCP Division.

    Shopfitters
    The QCPP is not specific at all in it's standards for pharmacy appearance and layout, but has guidelines for professional services areas, dispensing areas, unpacking areas, retail floor plan and entrances. These guidelines reflect Occupational Health & Safety concerns, Dispensary regulations, Pharmacy Acts, and the common sense ideal that a perhaps a refit every decade is not such a bad idea.
    To say that most pharmacies need to make expensive alterations to be accreditable is a wild generalisation unsupported by any data that I am aware of.
    That some may need to update a decade-old fitout is self-evident, and quite proper.

    ·QCPP Revenue
    QCPP revenue is used to fund the costs of operating, maintaining and promoting the program.
    Roughly half of the expenditure is on the salaries of the people who work in the QCP Division.
    As Chair, any expenses I incur attending meetings are re-imbursed, and I am paid the equivalent of about $35 per week as recompense for phone calls, and the time I take from running my accredited (and re-accredited!) pharmacy to monitor, and occasionally collaborate in, the running of the Division. To imply that the rigour of the program is designed to keep me in a job that pays $35 per week is risible!
    There is a saying to the effect that the aim of any good manager should be to make himself redundant ('cos the system runs so smoothly, management isn't needed!).
    I would certainly be delighted if I could achieve this aim in the Division.

    The funding shortfall between annual membership fees and annual QCPP operating costs is being met from charging a fee that is payable on re-accreditation.
    The QCPP has to be self funding, and when the Guild realised that further revenue was required to cover essential operating costs, it persuaded the Federal Government to introduce a re-accreditation incentive to offset the re-accreditation fee.
    And not only that, the Guild managed to ensure that the level of the incentive covers not only the re-accreditation fee but also the assessment fee and the next three annual membership fees.
    Without recognition of the burden of these costs on pharmacy owners, the re-accreditation incentive would not have been introduced!

    I would also point out that any changes made by committees of which I am a part have to be implemented in my own pharmacy at the expense of my own time and money.
    I have a vested interest in making the system as easy to implement and maintain as possible, while maintaining the integrity of the program.
    This philosophy was the basis for the decision to do away with the eight-hour rule, about which Mr Skyllas complained in his article.
    He argues that it created extra work for pharmacists.
    However, the opposite can also be the case, eg a naturopath or beautician working in a pharmacy for two days a week, but who does not handle prescriptions or money, or assist the pharmacist, previously had to complete the whole Staff Certification workbook and be competent in every Team Standard . Under the new rule, they only have to be certified against the Standards which are RELEVANT TO THEIR WORK.
    This actually reduces the workload on that staff member.

    As far as this rule is concerned, from the point of view of the integrity of the Program, it was possible, under the old rules, for an accredited pharmacy to be completely staffed at certain times by people who had not had any auditable exposure to the Standards (ie, a locum on a Saturday morning, with two Saturday juniors assisting them).
    To any reasonable person, this clearly makes a mockery of that business holding itself out as having Quality Assurance in place at that particular moment.
    So I make no apology for that tweak to the rules of the Program.

    As to a locum who refuses to complete the staff certification process, why not require them to do it in the time for which you are paying them?
    Are they so obdurate that they will not follow a lawful request from their employer to carry out a paid task?

    Mr Skyllas is wrong again when he asserts that staff who had been assessed with the old workbooks have to be complete the new books.
    This is not the case: it is only new staff members who are obliged to use the new workbook.

    Part of a Quality assurance process is the maintenance and refining of protocols.
    I can only assume that this is what Mr Skyllas refers to when he complains of the QCP Division 'raising the bar'.
    This process consists of having a regular look at the way tasks are carried out in the pharmacy, to consider whether it can be done better/more efficiently/more economically.
    Some people call it 'sharpening the saw', ie, that if you don't make and take the time to improve or maintain a process, wear and tear will make the process less efficient, and the job will take longer/be more exhausting than taking and making the time to do 'running repairs' would have added.
    Of course, I am well aware of the corollary to this, which states that: "It's hard to think of Draining the Swamp when you're up to your Arse in Alligators!"

    Let there be no misunderstanding: the QCP Division firmly believes that any process, including the QCPP in particular, can be improved from the point of view of all stakeholders.
    We would not have had reviews in 2000 and 2001 if we were labouring under the delusion that the Program was perfect and beyond improvement or repair.
    We aim to balance a robust quality assurance program that has credibility in the eyes of our customers (and the regulators and third part payers) with one that can be implemented with an appropriate amount of sweat, time and money.
    It is the policy of the Division to only consider new Standards if pharmacists are going to be paid for providing the service (especially with new initiatives from the Government, or within our own profession), or if the issue has strategic value to the Community Pharmacy industry in general, and pharmacy owners in particular.
    We will not overburden pharmacy owners with frequent, multiple changes to the Program, but we will conduct a major review in the future, in association with the development of the Fourth Agreement between the Federal Government and the Guild (on behalf of it's members).
    This review will aim to streamline the operation of the Program for the duration of the Fourth Agreement, make sure its administration is efficient and represents value to it's clients, and reflects the views of stakeholders, especially those who have to implement it.

    Informed feedback will be called for and used to make improvements.
    I would like to repeat my invitation to persons who can make constructive comments to feel welcome to share their thoughts with the QCP Division.
    All I ask is that the issues raised be factual, specific, and be accompanied by ideas as to how the desired outcome could be achieved in a different way.

    If I see opinion pieces published based on sloppy research and factual inaccuracy, I will always respond vigorously (not defensively) to set the record straight.
    I really hope that we will soon see an article from John Skyllas that contains no factual errors, absurd generalisations, or slanderous allegations; but that contains practical ideas and solutions that can be used productively in furthering the interests of our profession.


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