Early Career Pharmacist WHITE PAPER 2017 PSA Australia's peak body for pharmacists
PSA would particularly like to acknowledge the work of the following individuals from the Early Career Pharmacist Working Group & White Paper Advisory Group in the development of the Early Career Pharmacist White Paper: Taren Gill, Early Career Pharmacist Board Director Elise Apolloni James Buckley Lauren Burton Jackson Crawn Amanda Cross Jennifer Culverson Jessica Dawson Jacquie Kiel Angelica Lagoda Kayla Lee Jacinta Johnson Rebecca Negrulji Colleen Niland Kristi-Lee Rigby Matthew Schmidt Sam Turner Pharmaceutical Society of Australia Ltd., 2017 This paper contains material that has been provided by the Pharmaceutical Society of Australia (PSA), and may contain material provided by the Commonwealth and third parties. Copyright in material provided by the Commonwealth or third parties belong to them. PSA owns the copyright in the paper as a whole and all material in the paper that has been developed by PSA. In relation to PSA owned material, no part may be reproduced by any process except in accordance with the provisions of the Copyright Act 1968 (Cth), or the written permission of PSA. Requests and inquiries regarding permission to use PSA material should be addressed to: Pharmaceutical Society of Australia, PO Box 42, Deakin West ACT 2600. Where you would like to use material that has been provided by the Commonwealth or third parties, contact them directly.
Foreword On behalf of the PSA Board, I am pleased to introduce this ECP White Paper developed by the Early Career Pharmacists of the Pharmaceutical Society of Australia. The recommendations contained in this report are a high priority for the PSA to implement to ensure a bright future for all pharmacists. The rationale highlighted for the recommendations contained in this White Paper shows a considered approach by ECPs and highlight that remuneration and the sustainability of the pharmacy industry is a high priority for them. In addition, new career paths and recognition of the expertise, skills and training of pharmacists is necessary to underpin the activities that ECPs would like to perform in the future. Encouragingly, collaboration both within and outside of the industry is seen as important along with the development of specialty areas of practice to create innovative future roles within the profession. I commend this White Paper developed by ECPs to the entire profession to identify what ECPs would like to see for the future of the profession. It has been a great honour to be appointed as the first designated Early Career Pharmacist Board Director of the Pharmaceutical Society of Australia. At the start of my term I asked the question What does success look like for an Early Career Pharmacist? To answer this question and explore the issues and challenges that Early Career Pharmacists are currently facing, PSA undertook the development of the ECP White Paper. This paper has been developed by ECPs, for ECPs, and I would like to take this opportunity to thank all of the ECPs across the country who sent in submissions, participated in the White Paper survey and attended local consultation sessions. I m proud to be releasing this White Paper and hope that you will join PSA in our efforts to bring the profession along to implement the recommendations for a brighter future for pharmacists across Australia. Ms Taren Gill PSA Early Career Pharmacist Board Director Dr Shane Jackson PSA National President 3
Contents Introduction 6 Consultation Process 7 Key Recommendations 8 Current Challenges facing Early Career Pharmacists 9 Improving Pharmacy Sector Remuneration 10 Fostering and Supporting Innovative Pharmacy Practice 12 Utilising Pharmacists' Full Scope of Practice in Australia 14 Conclusion 16 References 17
Introduction The ECP White Paper is the first of its kind in Australia s history The 2017 Early Career Pharmacist (ECP) White Paper represents the Pharmaceutical Society of Australia s firm commitment to developing a comprehensive, practical and sustainable long-term plan for early career pharmacists to have successful, satisfying and rewarding careers, whilst making significant contributions to Australia s health system. The ECP White Paper is the first of its kind in Australia s history a culmination of robust consultation with early career pharmacists practising across all areas of the pharmacy sector. The Australian pharmacy sector is undergoing significant change, as a result of a strong reform agenda from Government at both federal and state/territory levels. Regardless of the role they hold, early career pharmacists are the group who stand to be impacted the most by any reforms. The pharmacist workforce in Australia is already highly respected for its professionalism and deep expertise in medicines. The challenge to seeing pharmacists working to their full potential is to correct structural and funding barriers, which currently result in minimal participation by a highly skilled pharmacist workforce in key Australian health initiatives; where collaborative models of care including pharmacists have demonstrated value. 6 This White Paper, under the auspices of PSA but developed by early career pharmacists, for early career pharmacists sets out a vision to positively shape the future of the profession to ensure that early career pharmacists are supported to have satisfying, productive and enduring careers. PSA, as the peak organisation representing all pharmacists in Australia, looks forward to continuing an open dialogue with all early career pharmacists as we move forward with implementing this important White Paper.
Consultation Process PSA convened the White Paper Advisory Group (WPAG) to support the development of this paper in collaboration with the Early Career Pharmacist Working Group. Both groups contributed valuably to this paper through: providing input to the analysis and drafting of the White Paper; and leading a targeted consultation process including: release of a discussion paper The consultation also elicited over 300 responses to a targeted survey and written submissions from early career pharmacists. The analysis of these results gave rise to a series of recommendations formed by the Advisory Group, and which relate to actions to be taken by the profession collectively, led by PSA as the peak body. an online survey face to face sessions with ECPs and the broader pharmacy sector. This process provided an opportunity for PSA to consult with early career pharmacists, and indeed the sector more broadly on important policy decisions impacting the future. The White Paper Advisory Group held consultation sessions in each State and Territory between February and March 2017 as part of PSA s Remuneration and Reform Roadshow. 7
Key Recommendations The Early Career Pharmacist White Paper has 10 key recommendations for the pharmacy profession as a whole, to action. These recommendations have been informed by extensive consultation with ECPs practising across all sectors of the profession, and are listed below in no particular order. The pharmacy profession has a collective responsibility to: 1 Take decisive action to ensure a robust and sustainable community pharmacy sector. 2. Negotiate to raise the Pharmacy Industry Award rates 3. Advocate for, and pursue alternative remuneration models for pharmacy services. 4. Identify and propose new roles and models of practice for pharmacists with supported pathways to enable progression in these areas. 5. Work with researchers, policy makers and practitioners to ensure that evidence is translated to the delivery of evidence-based services by frontline pharmacists. 6. Ensure productive collaboration between pharmacy organisations to shape the profession in a positive way. 7. Engage with consumers and other health professionals through an awareness campaign which promotes the full extent of a pharmacist s scope, skill and expertise. 8. Recognise all practising pharmacists as clinical pharmacists, regardless of practice setting. 9. Explore the development and recognition of specialties within pharmacy practice. 10. Develop Quality Indicators for individual pharmacist practice. 8
Current Challenges Facing Early Career Pharmacists During consultation for the White Paper, it became apparent that many early career pharmacists in Australia are dissatisfied with their careers, and are becoming disillusioned with the sector more broadly. Indeed, only half of all respondents to the ECP Survey indicated that they were satisfied with their current position with similar sentiments expressed regularly on social media and at various meetings and conferences. Early career pharmacists also expressed dissatisfaction with an apparent lack of opportunities and support for career progression, with many ECPs noting that they desire opportunities that allow them to innovate, to further develop and diversify their practice, including access to community pharmacy ownership. Inadequate remuneration was the single largest issue identified by early career pharmacists. Inadequate remuneration was the single largest issue identified by early career pharmacists. 9
Improving Pharmacy Sector Remuneration Both the 2015 and 2016 PSA member survey demonstrated that PSA members feel that inadequate remuneration is the biggest challenge facing the pharmacy profession. Recommendation 1: The profession should take decisive action to ensure a robust and sustainable community pharmacy sector. PSA is cognisant that up to 60% of the pharmacist workforce is comprised of early career pharmacists*, who represent the highest proportion of community pharmacy employees, and the lowest proportion of pharmacy owners. Indeed, over 80% of respondents to the ECP Survey indicated that their principal place of practice was a community pharmacy. Furthermore, almost 60% of respondents indicated their desire to continue to practice in community pharmacy in the future. As such, the Pharmaceutical Society of Australia as the peak organisation representing all pharmacists in Australia is committed to ensuring a viable and robust community pharmacy network. Many of the recommendations made herein informed by consultation with ECPs practising across all areas of the pharmacy sector do aim to address the need for a viable, robust and sustainable community pharmacy sector in Australia. * Registered pharmacists with less than 10 years of experience post-graduation [Pharmacy Board of Australia. Registration Data March 2016 At: http://www.pharmacyboard.gov.au/about/statistics.aspx ] 10 Recommendation 2: The profession should negotiate to raise the Pharmacy Industry Awards Both the 2015 and 2016 PSA member survey demonstrated that PSA members feel that inadequate remuneration is the biggest challenge facing the pharmacy profession. Similarly, early career pharmacists identified the lack of appropriate remuneration as a major issue in the profession. Remuneration is, unsurprisingly, a key factor for early career pharmacists in determining job satisfaction with 70% of ECPs rating it as either very important or extremely important in determining their level of job satisfaction. Additionally, the majority of ECPs have rated the profession s actions to date in addressing and improving remuneration for pharmacists as poor. More than 80% of survey respondents indicated that they believed that remuneration for early career pharmacists could be improved by re-negotiation of Pharmacy Industry Award rates. ECPS were in overwhelming agreement that this is an important action for the profession to take. Many ECPs indicated that they believe that the current pharmacy award rate is low in comparison to other healthcare professionals, and that while it is important to recognise that wages need to be balanced to ensure a viable community pharmacy network, it is also important to retain talent within the profession. Remuneration should adequately reflect the level of care and time provided to patients by pharmacists as well as the responsibility required of the profession. It must also be noted however, that ECPs recognise that simply increasing the Pharmacy Industry Award rate is not a silver bullet, nor a holistic solution to the remuneration issues being faced by the profession as a whole.
Recommendation 3: The profession needs to advocate for, and pursue alternative remuneration models for pharmacy services. Early career pharmacists recognise that the diversification of pharmacy funding sources is essential for the long-term sustainability and future prosperity of the pharmacy profession. Community pharmacies are the biggest employers of early career pharmacists. As the main driver of community pharmacy remuneration, the Community Pharmacy Agreements (CPAs) have a direct impact on community pharmacists wages. Currently, remuneration for pharmacists is largely through the volume of dispensing and generic substitution. Historically, the remuneration derived from this has cross-subsidised pharmacies offering nonremunerated quality use of medicines (QUM) services. However, feedback from pharmacists indicates that as a result of PBS reform, and the introduction of PBS saving measures including the $1 discount, many pharmacies are under increased financial pressure and are no longer able to offer non-remunerated QUM services to consumers. Indeed many ECPs identified that they wish to provide innovative, high-quality pharmacist services to consumers but were not able to as a result of a number of barrier. The two largest barriers identified by ECPs were a lack of resources i.e. staff, time and space, and the cost associated with these services. As such ECPs are calling for remuneration structures which allow pharmacists to better utilise their clinical knowledge and ensure that clinical activities associated with medication supply are strengthened, removing the incentives to operate in an environment which rewards volume in many cases, at the expense of high quality clinical services which focus on consumer need. ECPs also believe that remuneration for pharmacists should recognise their professional input along a professional services continuum from dispensing through to medication management and chronic disease monitoring based on the individual consumer,1 and should not be restricted by setting. 80% of surveyed ECPs believe that pharmacists should be remunerated through the Medicare Benefits Schedule (MBS). A MBS payment is an appropriate remuneration mechanism for the provision of medication management services provided by pharmacists, in the same way that GPs and other health professionals clinical services are recognised. Medicines advice is just one such service, and an MBS payment would allow it to be delivered based on consumer need and the complexity of the presenting consumer s situation and/or service provided. 80% of surveyed ECPs believe that pharmacists should be remunerated through the Medicare Benefits Schedule (MBS). MBS funding for the provision of pharmacistdelivered vaccinations and Chronic Disease Management services were the two services that ECPs identified as services they see as a priority for funding through the MBS. Remunerating pharmacists through the MBS also brings pharmacists into line with other health professionals. Pharmacists are currently the only AHPRA registered allied health practitioners not eligible to provide services through the MBS. Considering the evidence for pharmacists interventions on certain chronic disease markers2, compared to a number of practitioners and items that are remunerated on the MBS, the exclusion of pharmacists should be viewed as an oversight and rectified by Government. This would accord with recommendations from both the MBS Review and the Primary Health Care Advisory Group.3 11
Fostering and Supporting Innovative Pharmacy Practice Early career pharmacists in Australia have a strong and significant interest in working in collaborative models of care. Recommendation 4: The profession should identify and propose new roles and models of practice for pharmacists with supported pathways to enable progression in these areas. As stated previously, almost 60% of ECPs have a desire to continue to practice in community pharmacy in the future. However, many ECPs also have a strong desire to practice in a number of other areas of practice, including; general practice, education and training, hospital pharmacy, medication management and review, Aboriginal and Torres Strait Islander peoples health, research and public health promotion. Early career pharmacists in Australia have a strong and significant interest in working in collaborative models of care. Many ECPs view models such as Pharmacists in General Practice, and the Government s Health Care Home initiative as an interesting and potentially satisfying career option. To ensure that these models of care utilise pharmacists to the full extent of their scope, and are appropriately supported by service frameworks and remuneration, PSA is continuing to progress a strong advocacy agenda with local, state and federal Government. While there is significant appetite among ECPs to practice in innovative models of care, less than half of all ECPs surveyed indicated that they felt supported to progress to the next stage of their career, with close to 60% of ECPs identifying the lack of clear pathways as one of the key barriers to progressing in their career. 12 ECPs indicated that they would like to see support available for pharmacists entering new career pathways providing tailored professional development and practice support (e.g. mentoring and career advice) to enable them to advance their practice and progress in their chosen field. Recommendation 5: The profession should work with researchers, policy makers and practitioners to ensure that evidence is translated to the delivery of evidencebased pharmacist services by frontline pharmacists. Early career pharmacists have a desire to ensure that the services they are delivering are high-quality, needs-based, consumerfocused and evidence-based. To see this vision realised, ECPs wish to see the profession work collaboratively with researchers, policy makers and practitioners to implement and evaluate evidence-based pharmacy services. Research and evaluations conducted in successive Community Pharmacy Agreements over more than a decade have made evidence-informed recommendations regarding better targeting of HMRs, investment in transitions of care periods and greater flexibility in terms of service setting to enable care to be provided where it is required.4 Collaboration and cooperation across all areas of the pharmacy sector will be required to ensure that all pharmacists in Australia are supported to deliver innovative, appropriately remunerated and high-quality pharmacist services.
Recommendation 6: All pharmacy organisations should aim to collaborate productively to shape the profession in a positive way. A key sentiment expressed by early career pharmacists during consultation for the White Paper was the need for all pharmacy organisations in Australia to work together to positively shape the future of the pharmacy sector. Realising the objectives for the 6th Community Pharmacy Agreement, the National Medicines Policy (NMP) and the future of the profession more broadly undoubtedly requires pharmacy s professional bodies to work together to assist in ensuring an evidenceinformed approach to innovation and reform. Most importantly, a collaborative approach between all organisations provides the profession with the best chance of successfully implementing existing and new professional pharmacy programs and models, thereby delivering high quality health services to the Australian public. 13
Utilising Pharmacists Full Scope of Practice in Australia Recommendation 7: The profession should engage with consumers and other health professionals through an awareness campaign which promotes the full extent of a pharmacist s scope, skill and expertise. Dispensing is often wrongly perceived as an administrative task, when it actually represents a key consumer entry point into community pharmacy services. The dispensing and supply of medicines encompass multiple components of professional activities and should be recognised and remunerated as a health service and not a retail transaction. Almost 70% of ECPs indicated that the perception of dispensing as an administrative task impacts on their professional satisfaction. When asked to identify strategies to shift this perception and educate consumers and other health professionals on the full extent of a pharmacist s scope of practice, an overwhelming number of ECPs suggested that a public awareness campaign would be a good starting point. As noted in the Grattan Institute s 2013 Report Access all areas: new solutions for GP shortages in rural Australia, pharmacists are highly trained, have deep expertise in medicines, and are located in communities throughout Australia, however, their role is far more limited in Australia than in many other countries.5 ECPs believe that a robust, public campaign which clearly articulates the scope of practice of a pharmacist may help to address this issue and ensure that the unique skills and expertise of all pharmacists in Australia are utilised appropriately. 14 Recommendation 8: The profession should recognise all pharmacists as clinical pharmacists, regardless of practice setting. In addition to the need to educate consumers and other health professionals on the full extent of pharmacists scope, knowledge and skills, another key sentiment expressed by many early career pharmacists was the need for the profession to recognise all pharmacists as acting in a clinical capacity, regardless of practice setting. Whilst ECPs recognise that there are of course differences in the degree of specialisation and the day-to-day practice between pharmacists across all settings in the pharmacy sector, the majority of ECPs believe all pharmacist roles do in fact require significant clinical input and thus all pharmacists can be considered 'clinical pharmacists'. Distinctions, based merely on practice setting are overly simplistic, unhelpful and should be avoided. However, ECPs are receptive to, and supportive of, recognition of further training and advanced pharmacy practice.
Recommendation 9: The profession should explore the development and recognition of specialties within pharmacy practice. 88% of ECPs indicated that they were supportive of the profession exploring the development and recognition of specialities within pharmacy practice analogous to specialities developed and administered by the Board of Pharmacy Specialties in the United States.6 This overwhelming response seems indicative of early career pharmacists desire to practice in innovative roles and models of pharmacy. Conversely, less than 40% of ECPs indicated that they thought the Advanced Practice Credentialing Program in its current form had a place in the future of the profession in Australia. This response may be as a result of many ECPs not being aware of, or understanding the aim of the program. Indeed many of these respondents noted that there were no tangible or obvious benefits for early career pharmacists to undertake this process, with many specifying that Advanced Practice Credentialing would be more appealing if it were tied to improved remuneration. A significant proportion of ECPs also felt that the process for Advanced Practice Credentialing was onerous and overwhelming particularly for early career pharmacists with many suggesting that clearer expectations and more opportunities to easily access further support and information on the program would be useful. Recommendation 10: The profession should develop quality indicators for individual pharmacist practice. Interestingly, even though the majority of ECPs were averse to participating in the Advanced Practice Credentialing Program, over 60% of survey respondents indicated that a framework to evaluate and benchmark individual practice would be a valuable tool. The Quality Care Pharmacy Program (QCPP) currently exists as a quality assurance program for community pharmacy, providing support and guidance on professional health services and pharmacy business operations. However, it does not measure health outcomes or how pharmacist practice, across all care sectors, contributes to and supports objectives of the National Medicines Policy (NMP), and does not provide provide a framework to benchmark individual pharmacist practice. 88% of ECPs indicated that they were supportive of the profession exploring the development and recognition of specialities within pharmacy practice. Developing specific quality indicators for pharmacist practice is in the long term interest of meeting the objectives of the NMP, and continuing to improve health outcomes for individuals and the population through evaluation and practice improvement processes. It is also recognised among early career pharmacists, that quality indicators for pharmacist practice would be a useful tool for professional development and reflecting on their own practice. Indeed, the framework for the proposed quality indicators already exist; PSA s Professional Practice Standards and Code of Ethics as referenced in the National Health (Pharmaceutical Benefits) (Conditions of approval for approved pharmacists) Determination 2007.7 The development of these quality indicators should involve stakeholders from the pharmacy sector, the broader health sector, the Australian Commission on Safety and Quality in Health Care, and Government to ensure that they reflect contemporary pharmacist practice, including multidisciplinary care. 15
Conclusion Early career pharmacists are the future of the profession. This White Paper has been developed by early career pharmacists, for early career pharmacists. The recommendations contained in this paper aim to inform a comprehensive, practical and sustainable long-term plan for early career pharmacists to have successful, satisfying and rewarding careers, whilst making significant contributions to Australia s health system. Early career pharmacists are the future of the profession and the group who stand to be impacted the most by any changes or reforms in the pharmacy sector. As such, it is critical for early career pharmacists across the sector to engage with the profession and professional organisations to ensure that they have the opportunity to have their voices heard and shape the future of the profession in a positive way. 16 PSA, as the peak organisation representing all pharmacists in Australia, looks forward to continuing an open dialogue with all early career pharmacists as we move forward with implementing this important White Paper.
References 1. Pharmaceutical Society of Australia. 2016. Review of Pharmacy Remuneration and Regulation: PSA s Response to the discussion paper. 2. Tan E, et al. 2014. Pharmacist services provided in general practice clinics: A systematic review and meta-analysis. Social and Administrative Pharmacy 10 (2014) 608 622 At: http://dx.doi.org/10.1016/j.sapharm.2013.08.006 3. Primary Health Care Advisory Group. 2015. Better Outcomes for people with Chronic and Complex Health Conditions. At: http://www.health.gov.au/internet/main/publishing.nsf/content/primary-phcag-report 4. Campbell Research & Consulting: Home Medicines Review Program. Qualitative Research Project. Final Report. In.: Department of Health & Ageing; 2008 5. Duckett, S., Breadon, P. and Ginnivan, L., 2013, Access all areas: new solutions for GP shortages in rural Australia, Grattan Institute, Melbourne 6. http://www.bpsweb.org/about-bps/ 7. National Health (Pharmaceutical Benefits) (Conditions of approval for approved pharmacists) Determination 2007. At: https://www.legislation.gov.au/details/f2007l02703 17
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