Kieran Baker extended interview

Kieran Baker MPS

Pharmacists are generally resistant to working with the aged care sector. It requires around-the-clock attention to detail and on-call availability with a growing list of non-funded services provided. This is not unique to pharmacists, as the role of the GP has a huge administrative burden together with the growing number of non-clinical nursing staff in RACFs. These three workforce factors have landed Australian aged care, post-royal commission, with an aged care sector on its knees.

Despite this situation, could the announced funding of $345 million to engage embedded pharmacists in 2023 be a panacea for industry reform? Historically, every time government-funded programs are announced, corporate and wealthy individuals come knocking. Look at speech pathology, the NDIS and aged care, to name a few instances. What will the embedding of pharmacists (of which the workforce doesn’t currently exist) achieve for a struggling sector? In an ideal world, the answer would’ve been a solution, co-designed by nurses, pharmacists and GPs.

I’m Kieran Baker, a community pharmacist, proprietor and clinical councillor who has been involved in the aged care sector for the past decade. My business-as-usual day ranges from DAA preparation; drug chart interpretation/reconciliation; clinical consulting and reporting; logistics and workforce management as well as constant problem solving. To put it into perspective, there’s a lot of unpaid work, a lot of after-hours work and a lot of pharmacy staff and roles needed to deliver a great product.

Lately this involves COVID-19 and flu outbreak management, long hours ensuring medication management principles are put in place and consistently practiced at RACFs whilst staff are increasingly hard to keep healthy.

From my first years in pharmacy supply services to aged care, I saw a client and an industry that was in need but was appreciative of what we did and how we could assist. So, I saw a huge potential in myself and pharmacists in general for adding value to aged care clinically, in management consulting/operations and continuously improving practices via collaboration.

Under the measure announced by minister Hunt of $345M funding, every government funded residential aged care facility will be able to employ or engage an on-site pharmacist or community pharmacy service. Now this already currently happens in the form of a supply pharmacy and a consultant pharmacist so this will likely just be a redistribution of funding for aged care involved pharmacists. From various accounts, we expect QUM and RMMR funding will be re-labelled. GPs are planning for a greater administrative un-paid burden and nurses are hoping to have some relief from their overworked and underpaid roles from the care staff right up to management.

The other key drive from our peak pharmacy bodies, is towards full scope of practice. Overseas this includes prescribing and deprescribing within our capacity, ordering and interpreting pathology tests and expanded range of vaccinations and primary care e.g. wound care practices.

Just like a GP who registered more than 20 years ago and has a surgical background and can do virtually any primary care needed for patients, pharmacists have been doing aspects of the list above in many shapes and forms for many, many years. GPs specialise in a few key areas now that serve their locale, as do pharmacists. An overlapping of practice, in a free market, would only better empower the choice of consumers, and improve the levels of service provision, capitalism 101.

An on-site pharmacist, with expanded scope of practice could for example, in collaboration with the allied health team, deprescribe antipsychotics, prevent unnecessary use of antimicrobials and closely monitor medication management. Oddly enough, these are three of the key statement points, that the royal commission into aged care recommended. From here, the other foci should be on polypharmacy and prescribing cascades, overuse of pain medication and one day, management of the incoming challenges with more complex patients vis a vie opiate addiction, marijuana and nicotine use/addiction, CBD/THC products, biosimilars and of course infection control.