Chapter 2 The evolution of pharmacy practice
INTRODUCTION
The practice of pharmacy in Australia has changed over recent years from a traditional focus on the product to a greater emphasis on the patient and the provision of pharmaceutical care. The International Pharmaceutical Federation (also known by the French term Federation Internationale Pharmaceutique, hence being abbreviated as FIP) has defined pharmaceutical care as ‘…the responsible provision of pharmacotherapy for the purpose of achieving definite outcomes to improve or maintain a patient’s quality of life…’.[1]
The World Health Organization (WHO) has also recognised the pharmacist’s role in the provision of pharmaceutical care services in their handbook Developing pharmacy practice[2]
As readily accessible health professionals, pharmacists provide primary health care including education and advice to promote good health and to reduce the incidence of illness.
A sound pharmaceutical knowledge base, effective problem solving, organisational, communication and interpersonal skills, together with an ethical and professional attitude, are essential to the practice of pharmacy.[3]
General characteristics required of pharmacists were also identified by the WHO through the concept of the ‘seven-star pharmacist’, and involve the roles of caregiver, decision-maker, communicator, manager, life-long learner, teacher and leader.[4]
DEVELOPMENT OF THE STRUCTURE OF THE PROFESSION
The establishment of pharmacy practice in Australia followed the English tradition applicable at the time of the First Fleet. Pharmacists had no recognised role or status and had to compete with medical practitioners, grocers and retailers.[5]
Australia’s first ‘pharmacist’, John Tawell, arrived in 1815 as a convict and opened his business in 1820, a combination of grocery and dispensary. A specially convened medical board certified him fit to ‘compound and dispense’ medicines.[5]
The practice of pharmacy in the colonies was casual and no qualifications were necessary and activities were not regulated.[5]
Tawell returned to England in 1840 and he was later hanged for poisoning his mistress with a mixture of prussic acid and stout.[6]
The first major legislative controls regulating pharmacy practice were introduced in the latter part of the 19th century. Prior to federation under the Australian Constitution in 1901 most of the six colonies had a licensing system for selling poisons. In order to ensure that the public would be protected from untrained quacks, groups of chemists and druggists got together to establish colonially organised Pharmaceutical Societies.[7] Each new society was modelled on the Pharmaceutical Society of Great Britain (now the Royal Pharmaceutical Society of Great Britain), and these colonial societies were a powerful influence and exerted a significant force on the development of Australian pharmacy. The societies developed the first written standards in education, qualifications and ethics. They assumed a responsibility to maintain the first schools of pharmacy in Australia.
The societies influenced the development of pharmacy legislation in each colony or state. Pharmacy Acts provided some restrictions regarding titles and right to practise as a chemist. However, the enforcement of the legislation was vested in pharmacy boards following a separation of roles.[7, 8]
The separation of roles was a departure from British precedent, where the society had the authority to maintain the register, conduct examinations, and discipline pharmacists. The creation of separate bodies, distinct from professional organisations, was intended to keep the boards independent of the organisations and to clearly establish that boards existed for the public good. On the other hand, the society acted on behalf of the profession. Ultimately, this approach was to be followed by all jurisdictions except for Western Australia, which followed the British model in the society having a combined role of being the professional association and the registering authority. Table 2.1 provides a summary of the dates involved in the foundation of the societies and the promulgation of the first legislation.[7]
The first Australian Pharmaceutical Formulary Handbook was published in 1902 with a range of formulae for non-official formulations.[9] Other pharmacopoeias (Greek pharmakon, a drug and poieo, I make) still being referred to in drugs and poisons legislation include the British Pharmacopoeia (BP), the British Pharmaceutical Codex (BPC) and the Extra Pharmacopoeia (Martindale).
Pharmaceutical Defence Limited (PDL) was formed following a court case against a chemist, Francis Gough, who was sued for damages by a farmer, William Hilton, following an alleged poisoning in 1911. The farmer won the case and Gough had to pay damages. Chemists recognised their vulnerability and were alarmed as they realised that any alleged dispensing error, real or not, whether originating with the prescriber or the dispenser, could lead to a chemist being sued.[10] PDL was hence set up to allow chemists to take out insurance against such happening.
NATIONAL MEDICINES POLICY FRAMEWORK
A major review of medication usage and waste by the federal government Department of Health and Ageing in the 1990s led to the launch of Australia’s National Medicines Policy (NMP) in 2000. The overall aim of this policy is to meet medication and related service needs through achieving both optimal health outcomes and economic objectives.[11] The policy is based on four objectives, namely:
Australia’s National Strategy for QUM was released in 2002 to complement the NMP, and specifically details the range of partnerships and activities to improve QUM.[12] The strategy lists the key partners in achieving QUM, which include prescribers and providers of medicines. In fulfilling both these roles, pharmacists are crucial to the achievement of QUM. The strategy places a specific obligation on pharmacists, as health practitioners and educators, to:
