Developing pharmacy roles to increase remuneration

While increased pharmacist remuneration is tied to the development of services, what do these enhanced roles look like across different pharmacy sectors?

PSA’s new report, Pharmacists in 2023: Roles and Remuneration provides a pathway for increased pharmacist remuneration through enhanced patient care. The report, unveiled at the recent PSA19 conference, has been well received. 

As a union representing pharmacists, Professional Pharmacists Australia (PPA) embraced the report: ‘We welcome the contribution of the PSA to refining roles and future remuneration levels,’ PPA President Geoff March said.

SHPA also welcomed the report, and vowed to, ‘stand beside PSA in their call for an increase in total remuneration to the pharmacy sector.’

The report could not have come at a better time. To date, the pharmacy profession has not been broadly successful in advocating for additional funding mechanisms such as through the Medicare Benefits Schedule (MBS) or through Primary Health Networks (PHNs).¹

But as the complexity of pharmacy practice increases with the evolving needs of the health system, pharmacists need to be properly remunerated and supported career pathways which not only require them to maintain their competence, but to build on that competence through an advanced practice framework.

The new report follows on from Pharmacists in 2023, in which PSA described the system changes which need to occur for pharmacists to have greater responsibility and accountability for medicine safety. It also focused on other changes in our health system to better utilise pharmacists, wherever they may be working, to deliver better health for all Australians.²

Fully implemented, these systems changes will ensure that by 2023 patients benefit from pharmacists operating as established and regular members of health teams, are practising to full scope – and are appropriately recognised and remunerated for their role and value.

Pharmacists’ roles have already begun to evolve to meet this shift, such as through supporting population health initiatives (e.g. vaccination) and a growing role in preventative medicines safety, clinical governance and stewardship activities.²

By what does the evolution of these roles look like across the full spectrum of pharmacy into the future?

Community pharmacists

Community pharmacists will have increased medicine safety roles in 2023.

This will occur through:

• access to electronic health records, improving their ability to identify, pre-empt and resolve drug-related problems
• quality metrics, demonstrating and incentivising clinical performance at an individual practitioner level
• secure messaging, improving connectivity with other health providers who contribute to therapeutic decisions of patients
• effective pharmacovigilance systems; informing guidelines, government policy regulators demonstrating pharmacist contribution at a collective level.³

They will have an increased prescribing role in a protocol or collaborative model, such as maintaining supply of existing therapy, deprescribing or dose adjustment. They will have an increased immunisation role, including travel health and childhood vaccination.

There will be increased triage and referral through formalised patient consultations. This role will also increase through greater access to health records and opportunistic identification through an enhanced medicine safety role.

They will also have an increased clinical governance role, focusing patient care on indicators of quality care or indicators of patient health impact. Leadership and oversight at a pharmacy level may require more advanced practice in patient care, leadership and management practice.

They will also be at the centre of a technological transformation, particularly in the shift towards electronic systems such as My Health Record and Pharmacist Shared Medicine List (PSML).³

Hospital pharmacists

In 2023, hospital pharmacists will have greater autonomy in leading medicine safety through collaborative prescribing such as dose adjustment, deprescribing, therapeutic substitution and medicine reconciliation. They will have:

• increased availability through extended operating hours, further embedding hospital pharmacists into the 24-hour care team
• Increased safety impact in clinical governance at a whole-of-hospital level
• Increased availability in all clinical settings, including specialist outpatient clinics, operating theatres and hospital outreach programs
• technological transformation, particularly in digitisation of patient records (e.g. eMMS) and automation of hospital medicine distribution systems
• greater pharmacist accountability and impact on supporting safe and effective medicine use through more advanced practice roles. The evolution of these roles will be supported by improved formal training pathways (e.g. foundation and advanced training residencies)
• more personalised patient medicines approaches.³

General practice pharmacists

In 2023, pharmacists will be routinely embedded within primary care teams in general practice. The maturation of this role will be accelerated through access to the MBS for chronic disease management plans, direct commissioning and other practice changes.

There will be closer collaboration with doctors and an associated increase in autonomy through collaborative prescribing arrangements, increasing accountability for actioning medicine-related recommendations (e.g. deprescribing, dose adjustment etc).³

Residential aged care facility pharmacists

Aged care pharmacists are embedded within residential aged care facilities to oversee medicine safety and quality prescribing. As part of the care team, pharmacists can directly influence medicine use and improve quality of life for residents.

By 2023, there will be a maturation of the role as normative, particularly in clinical governance such as on medicine advisory committees. This will be accelerated through direct commissioning.

There will also be closer collaboration with facility staff and an increased autonomy through collaborative prescribing, increasing accountability for actioning medicine related recommendations (e.g. deprescribing, dose adjustment).³

Aboriginal health service pharmacists

Aboriginal health service practice pharmacists are embedded within an Aboriginal health service’s primary health care team to improve medication management for patients. The role in Aboriginal Community Controlled Health Organisations (ACCHOs) is service specific and adaptive to the needs of the provider in providing health care customised to the needs of their local community.

By 2023, there will be maturation of this role as normative, particularly in relation to case conferencing. There will also be a collaborative prescribing role, increasing accountability for medicines-related recommendations.

This role is considered to be more effective when pharmacists are on-site for at least three days each week, enhancing their integration within the care team at the health service.³

Credentialed pharmacists

Credentialed pharmacists provide medicines expertise as independent consultants. This can include undertaking medicines reviews, as well as providing other consulting services such as clinical governance activities (e.g. drug use evaluations), as credentialed diabetes educators, or provision of medicines education.

By 2023, the role will evolve in advance practice, positively supporting medicine safety, particularly in areas of focused scope. There will be an increased number of pharmacists practising as credentialed diabetes educators, enhancing their medicine safety role. They will also have a collaborative prescribing role, increasing accountability for medicines-related recommendations.³

References

1. 2018 Community Pharmacists Employment and Remuneration Report. Melbourne: Professional Pharmacists Australia; 2018. At: https://www.professionalpharmacists.com.au/community-pharmacists-employment-remuneration-report/
2. Pharmacists in 2023: For patients, for our profession, for Australia’s health system. Canberra: The Pharmaceutical Society of Australia; 2019. Available from: www.psa.org.au/advocacy/working-for-our-profession/pharmacists-in-2023/

3. Pharmacists in 2023: Roles and Remuneration. Canberra: The Pharmaceutical Society of Australia; 2019. Available from: https://www.psa.org.au/advocacy/working-for-our-profession/pharmacists-in-2023-roles-and-remuneration/