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A Bespoke History
John Bell
Pharmacists have traditionally had a strong service role that waxed and waned over decades but is now returning to make them indispensable dispensers of medications and broader healthcare.

The impetus for a more clinical and professional role for pharmacists came in the 1960s, partly from a change in pharmacist training – from an apprenticeship system to a university-based degree. Interestingly, not all pharmacy owners accepted this change because many felt the new graduates had insufficient understanding of the commercial world.

A role beyond the provision of medicines has been part of pharmacy practice for centuries and included the treatment of minor (sometimes major) ailments, delivery of first aid and the compounding of medicines. Until the late 1800s and early 1900s, the benefit of counselling and advice far exceeded any benefit from the medicines supplied, most of which were of dubious value.

From old-fashioned service to dispensary admin

Ironically, early 20th century advances in science, therapy and technology and the advent of preformulated proprietary medicines, together with stringent government controls, probably stifled the development of new and necessary skills and services.

In my first year at university in 1961, pharmacy students were cautioned against discussing the effects of prescribed medicines with patients; and dispensed medicines were not routinely labelled with either the brand or generic name. But 10 years later, community pharmacists began adopting novel and more comprehensive systems of recording. Medication record cards replaced handwritten and pharmacists were handing out prescriptions personally and counselling patients on appropriate use.

CPAs to MedsChecks

From the 1980s, research in the US, Europe and Australia demonstrated the cost-benefit of so-called cognitive services delivered by pharmacists, which was finally acknowledged by the Australian Government in the second Community Pharmacy Agreement signed in 1995.

Since then, clinical interventions, MedsChecks and diabetes MedsChecks have become recognised and remunerated as core activities for any community pharmacist to undertake. Similarly, funding is provided for trained and accredited pharmacists delivering HMRs and Residential MMRs. The pharmacists’ role in influenza vaccination is now recognised Australia-wide, where we also now offer professional services in smoking cessation, sleep apnoea, weight management, falls reduction, cardiovascular risk reduction, diabetes management, wound care and infant health.

The right bespoke service for your community

However, developing a successful new professional service relies on many factors and sufficient time must be dedicated to scoping and planning the service. A detailed needs assessment and situational analysis may allow pharmacy owners and managers to identify service gaps and ensure that the proposed service will have an established customer base. The needs analysis should include consideration of the health needs of the population in the local area and any specific skills, talents or interests of the pharmacy staff.

Remember, funding for services can come from sources other than patients, such as primary health networks and professional bodies; especially when there is a clear service gap and an evidenced-based, positive patient or health system outcome.

Recent examples of pharmacy student-developed community based programs include intraocular pressure measurement for glaucoma screening, education around the use of natural and herbal medicines, a personalised training and exercise program and an app-based pill-testing and harm minimisation program.