‘You can walk backwards in those footsteps’

Is it okay to start off just with your introduction please?

You can walk backwards in those footsteps. Been 12 years now since pharmacist prescribing was implemented in hospitals in Victoria a formalized way and we'd have it in informal ways in other hospitals previously. And over that 12 years that's now gone across pretty much every state and territory or almost every state and territory to have pharmacists charting in medicines. And in that setting too, we've still seen changes there. Those things still evolve.

So what was put in place as a collaborative charting model is now a collaborative prescribing model. South Australia leading the charge there to have. So if you attend South Australian hospital emergency departments, your pharmacist might be writing the medication chart and the doctor's signatory is not necessary on that because the pharmacist has actually been

credentialed to chart those medicines. And I guess it's really, whilst we have, there's a lot of huge amount of value and changes happen in the autonomous prescribing space too. I think it's really worth looking at what that partnered prescribing process delivers because that's not a limited formulary. That's everything from lithium to warfarin to beta blockers to whatever that patient needs to safely lithium to hospital.

That's what those pharmacists are now prescribing for patients or charting in other states. So it's been I guess scope of practice and top of scope have some of the real buzzwords of the year, but whether it's community hospital or whatever sitting, we're all looking to get the most out of our practitioners and I think with that decade long experience of those collaborative models from hospital-based settings, those are now rippling apps to the entire healthcare sector.

I think there's a lovely model there for that prescribing journey in that it kind of, by definition it has to start with those multidisciplinary settings where you have people working tightly together, that tight coupling of doctor, pharmacist, nurse, patient, all in the same place at the same time. That's where you get to do to bring about those kinds of changes and tweak the model as you go.

And if you look at things like autonomous prescribing, community pharmacy, the birth of that probably is in the UK where again, they've had pharmacists embedded in GP practices prescribing medicines at first under collaborative models and now under autonomous models as well because they were able to build that multidisciplinary trust where the doctor could say, okay, I've diagnosed the patient now go to the pharmacist in the clinic room next

door and they'll prescribe and you'll be actually coming back to them every month and they'll be dialing up or down your doses. So those collaborative models have been so important to bring us to this point where we're now in 2024. I think other things that I look at and I guess perhaps looking at our organization at AdPha in 2024 has been the completion of what we started on last year with our transformation 2024 agenda.

So that culminated with our rebrand in August, but the rebrand was a component of a journey building on the establishment of our recognition model and expanding our residency programs through scap, really strengthening our support for specialty practice models, things like stewardship models and our specialty practice standards, collaborative prescribing and championing I guess those collaborative models of care to truly benefit the professional and patients.

So there's been a lot of change in AdPha as well, not just the name. And I guess the other big ticket item for 2024 was the 8CPA being signed and also granting additional investment for new and improved pharmacy programs. And so I think that's a really exciting moment in time to have happened this year. Certainly we're looking forward to playing a significant role in ensuring that that funding is appropriately targeted so that patients can receive care when and where they need it.

We've also seen some welcome change around pharmacist remuneration in various settings, New South Wales most recently, but there's still much more that can and should be done in that space. So hugely transformative year. It's been quite a joy to play a part in some of those things.

To me it's just remarkable that an hour of time that a pharmacist might spend at the beginning of a patient's admission to hospital where they work with the doctor, they talk to the patient, they chart, all they're doing is charting the medicines. It sounds so simple, but having the pharmacist do that means that that patient will spend 10 to 15% less time in hospital overall. So you get about, for your average patient, you're getting 10 to 12 hours of their life back and you're getting 10 to 12

hours of health system time back for that one hour investment upfront. So it's one of those no-brainers I think for the kind of changes that the healthcare system needs to see.

And it's certainly been part of our conversation with the government around scope of practice that it's a very rich tapestry of the kinds of things that we're talking about here and there, all the way from improving access to care where access is a block and obviously things like access to treatments for UTI falls under that, getting access to care all the way through to creating health system capacity through collaborative models of care because it's very easy to look at some of

this stuff and say, well, you need to throw money at it, you need to have more people who have been upskilled to do something. But it's then looking at what does that payback for the health systems such a huge payback.

And I think there's lots of answers around removing barriers to expanded scope, ensuring we have appropriate indemnity and protections as we expand our scope, looking at increasing opportunities to collaborate and looking at requirements around training and retraining. So I think that's part of the answer to how people meet that moment. I do a little work with pharmacy students in undergraduate degree, and I guess we know too from work that our colleagues in NAPSA do.

We know there's still this plurality of students who see themselves working in hospital five years after graduation, but the gap's closing, which is great. We know young people don't want to be locked into a preference to a degree. This is part of what advanced pharmacy is about. Advanced pharmacy is about saying, yes, there's this hospital model, it's multidisciplinary, it takes place within this particular setting, but what the practice actually is is actually not related to the building.

The practice is something that's now expanding in a way. We do have people who are working side by side with medical nursing staff in a range of settings or practicing that team-based care. So hospital has to be a porous doorway to those other models of care like aged care, general practice, pharmacy, informatics, policy and regulation.

So I guess you can boil that down to as an individual, the question is how do I broaden my skills and my experience so that I can take my career as far as I want it to go? I'm a big believer that practitioners on day day 10,000 of their life, they don't want to be the same practitioner as they were on day 1000 or day one. People want those opportunities to advance, to develop breadth and depth of skills. And I guess that's the story for scope of practice too, isn't it?

You don't want your scope on day 10,000 to be the same as it was on day 1000 and day one, which has I guess been part of our story up until this point. And I think that to me is a real driver behind ANZCAP, the Australian New Zealand College of Advanced Pharmacy, which creates those recognized training pathways across both generalist and specialty areas. And we now have 46 specialties

recognized there. And that's about saying, here's the career path that you can have and you can plan it forwards from the beginning or at any point in that career journey. I reflect on the fact that when I was a pharmacy student, which was 25 years ago now, I think there was no easy answer to the question, I want to be this kind of pharmacist. What's the journey that I need to take and how do I get there? Those journeys haven't been mapped out and that's what ANZCAP has

delivered. I think too, it's more than ever in 2024, it isn't about where we work, it's what we're doing for our patients. And so that's that professional inclusivity piece, which is key in everything.

No, it doesn't matter how many IV antibiotics you have if you don't have the fluid that you need to actually administer those medications. And one of the things that's happened in the hospital sector over the last decade or so has been increased automation and use of technology. So most hospitals now would've smart pump capability where you have a pre-programmed drug library. Certainly in my home state, that's a pharmacy role.

The pharmacy role is to program these pumps with all the library of the A to Z of medicines that you administer and the doses and the concentrations and how many milligrams per kilogram peds and things. But what that does is it locks you into knowing you're going to have to use a hundred mil bags or two 50 mil bags or 500 mil bags.

So what we've actually lost through that really important safety thing that we've done with smart pumps is that flexibility to turn around and say, oh, actually we can't give this in a half liter bag because we can't get half liter bags, which we used to be able to just do. Now there's an organization wide response that's needed. So I think the fluid shortage, it seems to be improving, but it's definitely been a challenge and we're still seeing processes put in place to reduce fluid utilization.

My wife had a hip replacement a few weeks ago and she got half a liter of fluid during her entire hospital admission. That is very uncommon. Dehydration was as much of a complaint as pain management, but if you don't have the fluids, you can't just hang a bag of saline like we used to. And so hospitals are also putting in place oral hydration

protocols for both before and after surgery. Sorry, I could go on about the fluid shortage or all day because it, it's like scar tissue, but it is resolved I guess, shortages of opioids as well. All these things have highlighted our dependence on the rest of the world and our connectedness to the rest of the world. All of these shortages have really, I guess been dialed up since the pandemic supply chain disruptions and part of the answer I guess is increasing sovereign manufacturing,

but as we've seen with fluids even that that's not enough. That can't be the whole thing. I guess what I'd like to see to address that challenge is more of a national approach to the clinical guidance that we need around if you can't get this medication, what are the processes that GPS community pharmacies, hospitals go through to triage? What medications, what stock they do have left and make alternative prescribing decisions where they need safe shortages is the challenge.

I remember from 2024 other things, I guess vaping reform, which the government introduced some contentious amendments introduced at the last minute, which means that unfortunately wasn't as warmly received as I think the sector had hoped.

I do still see it as a significant step forward in sparing the next generation from nicotine addiction, but you'd have to acknowledge there's a lot of work to iron out to ensure that that actually gets implemented effectively and that we realize that's both benefits.

Obviously the final scope of practice report, and we know that pharmacists in all sectors through that, we have to find ways of working together and across disciplines, but both within pharmacy, across the specialties and across the settings as well as with our other disciplines that play their part in the medication management journey. And I guess this is obviously where this stuff really dear to my heart. This is why I love our organization.

I think AdPha's DNA is built on those people on the journey of that multidisciplinary collaboration no matter what setting it's in, that's what members what I've aspired to all my career. So that inclusiveness becomes really important. And I guess the other thing about inclusiveness is that evolving role of the pharmacy technician as well.

So seeing where that takes us in 2025 and beyond as a pharmacist scope of practice rises, you also have to rise the scope of practice across all of the profession. Our pharmacy technicians need to be doing more as well and need to have a career journey as well.

We've recently launched our new standards of practice for clinical pharmacy services and key component of that is what used to be a standard of practice for pharmacists with a chapter on what pharmacy technicians can do is actually now a single standard of practice, a single document that talks about how you operate and practice

as a clinical pharmacy service. And every element of that is described in terms of which parts of the workforce can do that either individually or in concert or under supervision because we're now seeing pharmacy technicians taking best possible medication histories and participating in medication reconciliation. So that scope of practice is growing as well.

And I think the end result of that is whether you're a pharmacy technician, pharmacist a patient, what you're seeing is the better care outcomes that happen when we're not working as working in a silo, but when we're working in connection with our colleagues no matter what the setting is. Thank.

It never made sense to me that closing the gap applies when you get your prescription filled at a community pharmacy but not at the hospital pharmacy when you've just been an admitted inpatient. So having that equalization across sectors, that's something we've been lobbying for a long time that's now in place for section 100 medicines and will be in place for all PBS medicines next year.

And I guess the other advocacy piece is we're finally seeing some move on actually having nationally consistent access to the PBS across the states and territories. So whilst the PBS is obviously everyone accesses that through community pharmacy, not everyone may know New South Wales and the A CT still don't have access to the PBS in public hospitals. So in those states and territories, a doctor can't write PBS script for a patient to then take to their community

pharmacy after discharge to get filled. So that's been again, something we've been advocating for many years and we've finally started to see a shift both at the state and territory level where there's a real eagerness to

implement that. And at the commonwealth level, I guess again, looking inwardly at the organization and what I'm also proud of, I've mentioned ANZCAP already, that recognition program, we've now had two and a half thousand people recognized through the ANZCAP model, which builds on the residency and registrar models we've had in place through SHPA and hospitals for many years, and I was super excited recently we launched our first primary care residency training program,

so that's a pharmacy residency program entirely contained within that primary care setting. That first thousand days of practice that a practitioner has is so important and I don't know about you. I remember being an intern and on day 365 of my internship doing my last checked thing where I was not accountable for what I was doing, somebody else was. And then you go to day one of your registration and you are entirely accountable and the safety nets all get taken away.

And I think to me the residency program is so important in saying actually there is still some scaffolding that you need around you to help develop the self-reflective and the lifelong learning competencies that you've got to draw upon in a career as dynamic as pharmacy you need, everyone benefits from having that in the first thousand days. So that primary care residency is really exciting.

Other things that I've seen as success have been our focus on pharmacy technicians and we had a constitutional amendment voted on earlier this year to establish a pharmacy technician role on the board of the organization. And so that's, I think it was 25 years ago, the pharmacy technician became members probably 10 years ago. We granted them voting rights and now saying, yeah, and you're actually as an equal on our board board of directors as well.

And we right now have the technician competency standards for consultation and that's not an educational standard, that's a competency framework that can be applied in any setting. So it compliments and builds on obviously all the existing work around certificate threes and fours and things. But this is more a competency standard just like the pharmacist's competency standards to support both professional development and the evolution of roles.

What is within someone's competence that someone's individual competence. We actually need a framework to be able to, we've published a bunch of professional practice standards this year, both in pharmacy informatics. Obviously digital health transformation is really is huge. So that informatics practice standards out there as is our women's and newborn health and most recently are transitions of care standards. We all know how risky those transitions of care are.

I've practiced on both side of things. I've been a hospital pharmacist involved in discharging patients where you think, oh, I don't think this is going to go well. I think this patient's going to end up in trouble. And I've been a community pharmacist seeing a patient who's just been out of hospital and thinking, why is there no information? I don't know about any of these changes that have been made. So we know transitions of care, they're risky times,

they need to be done better. So that standards, which I think we just published last week is really important and builds on the clinical pharmacy standards, which I've already mentioned. I love the clinical pharmacy standards document it. It's a beautiful read. Yes, it's long, but it's kind of the end to end description of how you operate a pharmacy service. It isn't about the supply of medicines. That's certainly part of it. That's not what the standards about.

The standards about how you grow competence, how you practice clinically, how you review yourself, and the set safety and quantity standards, really important stuff. Other things that I look back on as a success, we're really focusing on climate health and sustainability.

We now have a specialty practice group in AdPha for Climate and health, and we're also the pharmacy organization that's represented on Monash University's Transitions to Sustainable Healthcare Systems Consortium that also links to probably aware of Meds Aware our deprescribing Action and Awareness week that we do each year. And so next year the focus is going to be on sustainability because deprescribing is and of itself a sustainable healthcare act.

If a patient doesn't benefit from a medicine, then the carbon footprint of making that medicine isn't being well utilized. So if we really want to manage the emissions and the healthcare impact from pharmacy, and a lot of it's unavoidable, but the avoidable stuff is, well, if the medicine was avoidable in the first place, then the carbon is turned. And I guess most recently the transition from SHPA to AdPha has been a lovely success. I think the new brand, it looks very sharp.

It's been very warmly received, including by both the minister and the shadow health minister. Most recently at MM 2024, a conference two weeks ago where we had a thousand delegates descend upon Adelaide. Really lovely events to wrap up the year with. We also announced the winners of our major awards at that.

And although I didn't realize it at the time, I realized that on the day we were handing out the awards, all of our three big award recipients actually came from Regional Australia really representing the innovation that is happening in every part of the healthcare sector. It's been a happy year.

But in the year reflecting so warmly on the way that people have supported each other, people have rallied around, we've got some really amazing things achieved in pharmacy. The practice of pharmacy at the end of 2024 is different to the way we practiced it at the end of 2023. That fills me with a lot of hope and enthusiasm.

Australians. So yes, getting some much needed rest and recharging, being there to meet the moment, think that's how we need to face the end of the year.

I'm reflecting on the privilege for me to be present in an organization and experiencing one of the highs and lows of significant change and seeing people that I just respect and admire, not standing still, meeting the moment. It's very inspiring.