Increasing the scope of practice of New Zealand’s pharmacists - are we falling behind?
In New Zealand, the potential impact of an aging population is an increased prevalence of chronic illness and the associated demands this will place on health providers. This is especially relevant for primary care and pharmacy services. A strong primary healthcare system is recognised internationally as being essential for improving population health and health equity. Due to pressures in funding and the desire to offer high quality health care services, there is an international drive by many governments to reform policy and redesign their health systems.
In NZ, about 75% of pharmacists work in about 1000 community pharmacies. They are funded through the Integrated Community Pharmacy Services Agreement (ICPSA), providing standard dispensing and professional advisory services, along with a growing range of clinical services. Developing pharmacists’ roles has translated into health policy both in NZ and internationally, and is supported by pharmacist professional stakeholder organisations across the globe. There has been a sea of change in community pharmacy funding agreements, with a shift away from payment for dispensing to greater remuneration for more clinical roles; New Zealand is similar in this regard to other jurisdictions such as Australia, Canada and the UK.
The funded Long Term Conditions (LTC) Service was introduced by the government in 2012 to help people with multiple medications better self-manage and to improve medicines adherence. Accredited pharmacists can deliver Medicines Use Reviews (MURs), Medicines Therapy Assessments (MTAs) and the Community Pharmacy Anticoagulant Monitoring Service (CPAMS). To gain accreditation, pharmacists must complete an established, mandatory training course for each specific service requiring this. Training costs and training provider organisations vary and may be funded by individual pharmacists or paid by their employer. In tandem with the above changes, in more recent years, NZ has led the way in the reclassification of some medicines that were previously only available on prescription. This has enabled the controlled supply of a medicine by an accredited pharmacist under a “user-pays” model.
The benefits of collaborative practice or multi-disciplinary teams caring for patients have demonstrated reductions in patient harm, economic benefits for health funders and improvements in patient care.
Literature evidence indicates that many community pharmacists and intern pharmacists are interested in offering more clinical services but need time and a supportive management structure to release them from the core task of dispensing and to facilitate the completion of the specific training prerequisites. Health policy with a greater strategic emphasis on funding extended services and training, and developing technician roles to free up pharmacists’ time, should act as a lever to direct focus.