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In the first article in this particular series relating to the New Zealand government's hijacking of the community pharmacy ownership provisions, I pointed out how the press release issued on the 16th January 2002 by Dr Gillian Durham of the Ministry of Health, was a collection of cliches and misinformation, which purported to support some fictitious "mandate".
The press release was totally flawed, but it was followed up with a carefully crafted series of explanations, which indicated that the process had been carefully thought out and over a long period of time.
The difference in tone between the two publications was simply that they were designed to be played to different audiences.

It does not take a great stretch of imagination to envisage that the only way "suitable people" can strengthen the pharmacist advice role, is to employ them. As I stated in the first article, access to medicines is not an issue, because all major population areas are covered by community pharmacies.
The areas not covered would be deemed unprofitable by the "suitable persons", simply because the poulation base would not support such an enterprise, which is the reason a community pharmacy is not there in the first place!

It also does not take much imagination to know that "suitable persons" will be those persons controlling larger retail empires, such as the Coles and Woolworths variety. So the real intent is to use these "suitable persons" to drive community pharmacists out of their current business structures, so that these same "suitable persons" will have enough pharmacists to employ.
Pharmacists are just as scarce in New Zealand as they are in Australia, so they will have to come from somewhere.

"These changes will allow pharmacists to strengthen their key role in advising consumers and other members of the primary health care team on appropriate medicines, medicine interactions, side effects and other health issues. Pharmacists will still dispense and advise patients of appropriate medicine administration."

This statement simply restates what, in part, a pharmacist's role should be, but nowhere does it indicate how a pharmacist's role is to be strengthened within his/her own business structure.
The statement goes on to elaborate on why changes are necessary, and without offering any evidence as to what alternatives may have been available to pharmacists, states:

"Innovation-Medicine Distribution, medicine management services and accompanying services are evolving. The current restrictions hinder innovation and the development of more efficient medicine distribution processes."

One would have to query who is driving this innovation.
The real innovation is being spearheaded by pharmacists themselves.
The major problem, as always, is the fact the governments do not adequately pay for existing services, and certainly do not even consider funding at all for innovation.
Yes, the gap between what is provided and what is being paid for is diminishing, and this is the real reason for a slower rate of innovation.
Does this mean that governments will subsidise the rate of innovation through the other "suitable people" at a higher rate?
Small business in Australia has had to watch global businesses such as the Mitsubishi car manufacturers, be propped up with millions of dollars, to fuel their "innovations".
No doubt the same process happens in New Zealand.

"Capitalisation-There is concern about the growing under-capitalisation of the industry. More women are becoming pharmacists and women are less likely to choose to be pharmacy proprietors than men (29 percent of women and 76 percent of male pharmacists, are proprietors."

Perhaps this is because of the financial structure of a pharmacy, being that of a sole trader or partnership, which is not the most efficient structure. Corporate structures offer a better vehicle to operate out of, but restrictions have traditionally been in place against such an operation.
Women, at some stage of their life, drop out to have a family. To balance a career and continue a nurturing role, has been a perpetual dilemma for most women.
This is why they don't take on the responsibilities of a business ownership.
What would be so different if they were to work for those "suitable persons"?.
But offer them shareholdings in a viable pharmacy company would be a different story.
Here they would not have the reponsibility of managing an enterprise, but they can take up an investment in their profession which could equal or better, investment on an open market.
Also, offering women support roles that do not constitute hours that conflict with family loyalties and responsibilites (consultant pharmacist, locum pharmacist, part-time pharmacist-in-charge) would encourage the retention of valuable human resources, who could upgrade their positions at any given time.
Some of these comments apply equally to pharmacists wishing to sell out and retire.
Should they have the ability to merge with another pharmacy before retiring and leave some of their capital in the merged venture as preference shares or ordinary shares, this would retain capital within the whole structure of pharmacy.
Succession planning is not done very well within pharmacy circles, nor do we set out to retain our human resources in a creative fashion (e.g for use as consultants or directors in the policy/planning area).

Yes, these are valid criticisms of pharmacy, but are not grounds for destroying their ownerships as the New Zealand government is planning to do.
Helping to plan a better pathway ought to be a more viable option for both pharmacists and government.

"Job satisfaction-The erosion of the community pharmacist's role in compounding and counting medicines (increasingly medicines are prepackaged on arrival) has made the dispensing role mechanical. This coupled with the strain of working in small pharmacies (the average pharmacy employs just over two pharmacists) with long opening hours can make a pharmacist's work unsatisfying."

One would have to say that governments have a direct hand in this problem by implementing a subsidised pharmaceutical benefits scheme that creates volume one one hand, and because their budgets are put under strain from their own politically-based decisions, they claw back monies by slashing pharmacist margins on the other. By this process, governments destroy motivation on one hand and reduce the ability of a pharmacy to employ more than two pharmacists on the other.
This is one reason why pharmacists turn to retailing, in effect, to subsidise the government's prescription scheme.
But isn't the government saying that pharmacy retailing is the cause of all the malaise in the first place?
Baloney!
The New Zealand government is cynically saying that the other "suitable persons" have a stronger retail cash flow and profit, and can therefore subsidise the health service to a greater depth. And yes, a pharmacy business stream tacked on the end of a larger business activity can be run on a lower margin, and probably quite profitably.
There is an article in this edition of i2P written by Peter Sayers, and he discusses automated dispensing services and a system that removes the very "drudge" that the New Zealand government is talking about.
It answers most of the statements that the government are using to eradicate community pharmacy.
Would not encouragement to restructure, amalgamate, incorporate and go Internet, as Peter Sayers describes, give a better balanced service, rather than a concentrated one in a supermarket?

Will there be enough in it for the other "suitable persons" to invest back into professional pharmacy development?
Will they have enough motivation and incentive?
Well, history demonstrates around the world....not likely!
Which leads us on to the next part of the government statement:

"More and better quality advice- There are significant opportunities for pharmacists to offer more, and better quality advice when consumers purchase medicines."

I wonder how this will be structured.
If medicines are to be sold below prices currently offered by pharmacists, then there will be less margin to pay for a pharmacist's time.
So it will be self-limiting.
Margin amount will equate to the amount of time a pharmacist can invest.
Larger turnover volumes you say?
Less pharmacist time I say!
And will this work be motivating?
How does the government know?

"More accurate health interventions-There is a growing interest in how to improve the prescribing, dispensing and administering of medicines to reduce drug related adverse events and improve health outcomes."

Of course there is, and it is pharmacist-driven-not supermarket driven!
Where are the matching payments to cover the cost of developing and applying these services?
Not too much is seen at community pharmacy levels!

" The number of pharmacists and pharmacies is slowly declining."

This is a world-wide phenomenon, not just limited to New Zealand.
In Australia, there has been government pressure to reduce pharmacy numbers.
There still is, and there has been a slow and regular decline.
But the number of pharmacists entering universities has been increasing.
Why?
Because the Australian government is encouraging and paying for cognitive pharmacy services, and this is stimulating a reversal of some of the very problems identified by the New Zealand government among their pharmacist ranks.
Ownership restrictions on the number of pharmacies a pharmacist can own, restrictions on incorporation, and restrictions on pharmacy location have tended to inhibit pharmacy development in Australia.
However, there is some hope that these restrictions will gradually disappear.
"Suitable persons" in New Zealand will want as much restriction as possible to crush pharmacists in their current environment.
But watch how quickly it will all disappear when the "suitable persons" are given free reign.

Editor's Note:
When my father came home as a veteran of World War 2, he was working for a major retail chain store. They had a policy then, of promoting veterans as a reward for their service to their country.
My father was offered management opportunities that eventually propelled him to the top of manager training for this chain store organisation.
In the mid 1960's he told me that his company was going to own pharmacies, and told me how they were going to systematically wrest markets from pharmacy by destroying the "chemist only" policy that existed in Australia at that time, and to discount products through the establishment of a chain of supermarkets.
At that time I was a managing partner of a group of pharmacies established in the upper Blue Mountains region of NSW, Australia.
It was a time when Australia had the highest levels of kidney necrosis in the World, induced by the excessive consumption of two products...Bex and Vincent's powders.
Ninety-five percent of sales of these products went through the two major Australian chain stores at that time.
Remember, the "Take Vincent's with confidence" slogan?
I pointed this out to my father, who brushed my criticisms aside.
I asked, "Why do you continue to treat these items as though they were packets of cheese?"
He replied, "Son, we are not interested in that. People buy of their own free will, and as long as our shareholders are happy, we have little to worry about."

I have never forgotten that incident, and it caused a major rift in my family for many years.
In the next edition I will complete this little drama, and illustrate the lengths that my father was prepared to go to further the aims and objectives of his company, at pharmacy expense.

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