The potential benefits for pharmacies and their patients through being able to work to full scope of practice is highlighted at Pharmacy 777 Shoalwater in Western Australia.

The community of predominantly elderly patients and maturing families serviced by the pharmacy presents the pharmacists and staff with unique challenges to meet their patients’ specialised needs in a highly competitive area.

Co-proprietors Julie Ng and Sam Afsar said the community had significant health needs that required specialised support.

“To meet these needs, we provide a wide range of services including compliance support (Home Medicines Reviews and dose administration aids), diabetes services, vaccinations, and integrative health offerings,” Julie said.

“In addition, we offer sleep apnoea services, health checks, mental health service, mobility aids, wound care, compounding, hospital discharge support, transplant support, express deliveries, and Call`&’Collect.

“And while most of these services have been provided by pharmacies before, our innovation has been in their comprehensive and detailed implementation.

“We noticed a big barrier for our patients was the confusion around and the lack of follow up pre and post-hospital discharge. We tailored a comprehensive support service to ease their transition into and out of hospital. Helping to reduce medication misadventure and readmission rates.

“We also offer specialized support for a large number of transplant patients, with a focus to help improve compliance and reduce complications in the short and long term. This was implemented in collaboration leading transplant specialists in WA

“This is a holistic patient-centric approach and focusses on the right service for the right patient, shadowed by adequate follow up.

“Each Pharmacist has undergone specialised training to champion various health services.

“But over and above all of these offerings, I would say our focus on integrative health has been key to our success.

“We have three integrative pharmacists, including the only pharmacist in Australia with a Fellowship in the Australasian College of Nutritional and Environmental Medicine.

“We help patients with gut-health, anxiety, stress, and mental health via paid consults and an exclusive specialised supplement range.

“We also have a network of referring integrative practitioners.”

Close cooperation and collaboration with other health professionals is a key ingredient in the pharmacy’s business plan.

“We have an amazing referral network with our allied health which supports our professional services as well.”

Mr Afsar said Pharmacy 777 Shoalwater was a prime example on how potential full scope of practice in a community pharmacy setting could help a pharmacy’s business performance transform completely.

“We were a struggling business six to seven years ago with our competitors going hard on price,” Mr  Afsar said.

“By establishing an efficient workflow; a united, engaged team; tailor-made professional services for the unique needs of the community; and most importantly giving back to the community that has given us so much has brought us to where we are today.

“Our approach is not only about tailoring our services to the community, but to respect and treat each patient as an individual.

“We have undergone two major renovations to implement an efficient workflow to reduce wait time and allow pharmacist-patient interaction.

“We now have two dedicated consult rooms so all our services can run smoothly.

“We don’t generically market our services but rather target each patient’s individual needs after assessing their barriers to healthcare, risk factors and what services we can deliver to provide the most benefit to the patient in front of us at that moment.

“We follow up with our patients, and when there’s been a gap in our services, we have worked hard to fill that need by creating new services or facilitating referrals.

“Our patients and allied health network all appreciate the changes we have made over the years to have a clear ‘health’ offer.

“The biggest strength will always be the team we have built.

“We started with six staff members, and now we have 17.

“Our team strives to be better on these three critical elements of community engagement, professional services and business development as we continue serving our community.”

Engagement with patients and people in the region underpins all the services and to underpin this approach the pharmacy has developed a loyalty program designed to help support and engage the community’s needs.

“A proportion of every purchase from its members goes back to a local cause,” he said.

“We have supported struggling local sports clubs, the children’s ward in the hospital, and the local RSL to name a few.

“We are part of every local club in Shoalwater and some of the surrounding suburbs.

“We host education seminars every six months on various topics where we bring local allied health professionals together.

“Some topics include pain, immune health, diabetes, and heart health.

“We promote these events via social media, local newspapers and instore and they are very popular, filling up to the capacity of 60 participants every time.”

“We throw a Christmas party for our patients every year to celebrate. We make a special effort to send personalised birthday cards and a small gift to our top 200 patients.

“We love the bond we have built with a lot of the elderly patients living alone.”

Like many pharmacies COVID-19 brought its own challenges.

“During the pandemic we opened a COVID hotline, so our vulnerable, elderly clientele could reach out with any enquiries or for support.

“We also send our team to specialised training on sleep, geriatric health, integrative health.”

Co-proprietor of WholeLife Pharmacy and Healthfoods Pease Street Cairns, Frank Pappalardo, says being a critical provider in the Far North Queensland health services sector has significantly broadened the pharmacy’s scope and reach.

Mr Pappalardo, who owns the pharmacy with his brother Vince, said the vast geographical area serviced by the pharmacy and its team meant its patient base was diverse and the pharmacy had adapted to meet their needs.

“We work with a range of patients including disadvantaged, remote and challenged groups. We have partnered with health professionals and the community to ensure that no one goes without the health services they need and deserve,” Mr Pappalardo said.

“We are very community focussed and examples of this engagement include our partnering with Wuchopperen Health Services to support the health needs of Indigenous peoples with medications, onsite Imprest, first aid needs and patient care advice.

“We are also supporting remote communities in Far North Queensland, Torres Strait and other islands with fly-in pharmacy deliveries, while also aligning with medical professionals to support remote communities with telehealth prescriptions and other products.

“In addition, we also support the customised medication needs of more than 500 Cairns prison inmates and have an opioid substitution program for more than 100 patients across two locations, including providing electronic methadone dosing.”

Mr Pappalardo said the pharmacy’s current structure was a direct result of patient demands which, coupled with extensive research, helped the pharmacists and staff better understand that its customers wanted more from their local pharmacy.

“The result is that we now support our customers in achieving a balanced and individualised approach to their health and wellbeing by combining traditional pharmacy services, contemporary health services and complimentary products,” Mr Pappalardo said.

“Also, as a result of this focus on our patients, our store is home to a collaborative team of 13 pharmacists, a specialised oncologist pharmacist, two naturopaths, a dietician, and a sports nutritionist all providing integrated medicine and preventative health services.

“And all of this is found in a single destination stocking more than 12,000 products.”

Mr Pappalardo said the pharmacy’s innovative offering included one of the largest robot dispensing systems in Australia which provided efficient dispensing to support its pharmacists in prioritising patient care.

“We also have in-house local medication packing connecting patients with the packing team as opposed to outsourcing to major cities,” he said.

“In addition, we have an in-house compounding laboratory that provides specialised and individualised medication including vet, paediatrics, female pessaries and troches, creams, capsules, hormone replacement therapy, and bespoke products such as baby teething gels.

“Collaborative compounding with local skin clinics for cosmeceutical and dermatology creams, anaesthetics and creams for local dentists is another feature of the pharmacy.”

Mr Pappalardo said these services were further expanded by dedicated pharmacists to manage medication for multiple eye specialist clinics.

It also boasted one of Australia’s largest medicinal cannabis clinics including compounded THC and CBD oil blends with same-day despatch Australia-wide.

“And to further provide an holistic approach to patient care, we have two naturopaths including a herbal dispensary with personalised patient programs, one dietitian and one sports nutritionist on staff supporting health and wellness needs of our customer base,” he said.

“Members of our team with specialised qualifications undertake further study to ensure they have the latest knowledge to service our patients’ needs.

“Our pharmaceutical team hold additional accreditation in medicinal cannabis dispensing requiring training to be undertaken and renewed in a capital city each year.”

Teamwork is a central focus of the pharmacy.

“Being a united team is critical and our 65 employees have a unified approach to providing the best possible service,” Mr Pappalardo said.

“We have a robust training program for new employees and a continuous education program through our Sharepoint library that comprises a professional services program across key dedicated areas including eye care, smoking, weight management, pain management, respiratory health, sleep health. Plus, we have a broad level of expertise across our team including other accredited allied health professionals; two naturopaths, one dietitian and one sports nutritionist.

“We top this off with collaborative management and our management team hold monthly review sessions to understand performance and store optimisation opportunities.

“We encourage staff to participate with ideas for continuous improvement, striving for best in class across our offering.”

With more options available than ever before, it aimed to provide a market-leading pharmacy for changing customer needs.

“Part of our business strategy is focused on being customer-centric and so we have a dedicated buying team who research the latest products including those that are local, Australia-made, sustainable, and innovative. We have a focus on speed to market for new concepts,” he said.

“We are also innovation-led and we continually implement innovative solutions to increase efficiency and free up staff time to focus on patient care.”

At Thursday Island Pharmacy in far north Queensland, the pharmacist and staff all recognise a very important fact – that their community is the reason for their very existence, and their success.

And according to the ownership team Caitlin Davies, Carli Berrill, Mick and Luci Delaney it is also a matter of huge pride to everyone in the pharmacy.

“Our place within the community is something we are very proud of,” Ms Davies said.

“We have a great relationship with James Cook University and often get asked by students from there about what it’s like working in remote community pharmacy and it’s not simple for us to answer because we are so much more than just a pharmacy.

“As a pharmacy we define our community as the health professionals we work alongside, the community organisations we support, and how we help our local community.

“We think about this a lot, and it comes down to how our pharmacy operates, communicates and sets a standard for us to uphold.”

Ms Davies said she and the staff are in constant communication with doctors, nurses, allied health workers, Aboriginal Health Workers including mental health teams to ensure they were providing the best outcomes for the 15 remote island health centres and the community of Thursday Island.

“We also love to push ourselves to offer something better within our community like visiting the elderly to provide medication information and support, community information events, educational events at the primary and high schools, and the implementation of an annual TI Pharmacy iPad Science/Maths award to all schools in the region to encourage local children to invest in their education and hopefully pharmacy as a future. “

Ms Berrill doesn’t believe in standing still and sees that the pharmacy needs to be continually evolving, not only to grow as a business but to grow with its staff and their community. She proudly points to the fact it is achieving these aims.

In addition, being a leader in the community in general is critical.

“For instance, in the past two years we have identified and implemented many changes to fill gaps in our community,” she said.

“These have included minimising our environmental impact, improved efficiency in how we operate and improved professional services and collaboration.

“One area we identified was the lack of recycling and sustainable options within the community.

“Not only did we start to offer reusable products like coffee cups but we started the conversation to change people from disposable incontinence aids to washables by becoming a Continence Aids Payment Scheme (CAPS) provider and working with our continence nurse.

“We have also started to use the Terracycle program to reduce our footprint through recycling our medication foils from our 900-plus blister pack patients.”

Ms Berrill said she and the pharmacy’s staff were also continually on the lookout for ways to improve. “We have also been able to implement a very successful incontinence service in conjunction with a specialised nurse, install an Alpaca to support our 900-plus dose administration aids patients, and we are starting the process of implementing a full sleep apnoea service to help patients access a service they currently need to travel to Cairns for,” she said.

“When looking at innovation, nothing compares to supporting the development of new software, and that is what we have done. The MedRoutine program, which was designed and developed by our Pharmacist David Paulmert, lets us pull data from multiple programs to create a platform for our outer island clinics to easily order medication and blister packs and is now linked to our local Hospitals to improve the process and safety of discharging patients back to the community.”

Co-proprietors Mick and Luci Delaney said the most important aspect of the business side of operations at Thursday Island Pharmacy, is its team, and they are always looking for chances to offer training and growth.

“We have also implemented a staff bonus structure that allows all of our staff from after-school juniors to full-time staff to share in the success,” they said.

“Why? A business is as successful as its employees, sharing that success will create happier and more committed staff.

“We are in a unique position of being the only pharmacy in a geographically isolated region, however, we remain competitive and adaptable to the world of online shopping.

“How has this shaped our business? It has made us conscious of value and range. It has made us select areas to develop such as sports nutrition, whole foods, specialised hair care and baby. The success of these departments has allowed us to stock more small and local businesses and see them thrive.”

Responding to the changed environment experienced when emerging from COVID-19 presented Capital Chemist Calwell in the ACT an opportunity it seized on.

Co proprietors Lucinda Marks and Elise Thornton said the opportunity arose from lessons learned during the pandemic.

“One thing we did, in response to workflow changes after COVID-19, is that we created a new position in the pharmacy - the Triager,” Ms Thornton said.

“This person is one of the first people patients will present to and is integral in filtering information for our pharmacists.

“The Triager gets all our patient’s information ready for vaccinating pharmacists, ensures patients have access to forward-dispensing pharmacists when appropriate and triages minor ailments and other service requests to ensure everyone is looked after in a timely manner.

“This has resulted in a lot of customer feedback about how easy and comfortable their experience has been in the pharmacy and increases pharmacists’ confidence.”

The pharmacy also identifies the needs of its community by being immersed in that community.

“We achieve this by asking and by listening,” Ms Thornton said.

As such community connections are a priority and through the Capital Chemist group, which has long-term connections with many ACT charities and community groups, the pharmacy has been provided with opportunities such as presenting at the ACT Seniors’ Expo, helping at the Special Children’s Christmas Party and Menslink events, and looking after patients through the Eden Monaro Cancer Support Group.

“Independently we nurture strong ties with our local Men’s Shed, and Veteran’s shed, the Tuggeranong Community Council, our local Netball club and children’s soccer teams, plus the University of Canberra where we present to pharmacy students.

“Each month we run health promotions to raise awareness about community-wide health challenges,” she said.

“At our pharmacy we consciously develop health networks with local health professionals to create collaborative health teams to care for our mutual patients.

“We have formed strong connections with our local GPs, podiatrist and women’s health specialists, having joint referral pathways, and being in regular contact to discuss mutual patients, community challenges and potential solutions.”

Ms Marks said an example of this collective approach to patient care was highlighted at a recent meeting where local GPs raised concerns about the lack of availability of 24-hour monitors for patients who may have underlying cardiac conditions.

“We took this on board and now offer a Holter Monitor hire service which is well subscribed and will continue to grow,” Ms Marks said.

“The relationship has developed to the point of having each other’s private mobile numbers, meaning when urgent cases arise, we can call or text our doctors to ensure the best patient care.”

The pharmacy prides itself on professional innovation and a good example of how it focusses this innovation on patient needs is its head lice clinic developed to meet a demand in the community.

Ms Thornton said head lice were a common problem in the area as it had a high population of school-aged children.

“We recognised the need for alternative pathways of treatment and as a result we now have a dedicated lice clinic,” she said.

“We are the only pharmacy in ACT with staff and a clinic for the treatment of head lice. It’s not uncommon to have patients travel hours for treatment with us.

“They leave lice free, guaranteed.”

The attention to children is also reflected in the pharmacy’s ability to vaccinate “unvaccinate-able” children.

“We have great success with this as we have swift triaging, distraction techniques and a Disney playlist.

“Our attention and success in this area has seen us receive referrals for this service.”

The pharmacy also is on the constant search for new ideas it can implement in the area of pharmacist roles and customer service.

Ms Marks and Ms Thornton also invest in the pharmacy’s people.

“We have proved that when our staff are supported, empowered and cared for and given all the tools they need to do their job with ease and fun it flows on to our patients and in turn to our business.

“Our rostering strategy encourages leave and minimises its impact on other staff and we have strategies to ensure we remain focussed on our core business and on the health and wellbeing of our staff and patients.

“We catch up with our staff individually every month. We ask them what their pain points are and work to remove them, we ask them what they want to change, what they want to learn and what they would love to do more of and we listen and learn from their answers.

“This has led us to continual improvement and business innovation.

“Currently we are piloting a plan to enable pharmacists a weekly flexible work-from-home day, when they are paid for output, not hours, and we have implemented an unlimited annual leave policy and four weeks paid parental leave”

The commitment to a strong set of values is an important foundation for the success of LiveLife Pharmacy Cooroy in Queensland being a central health hub for the local and surrounding community.

Proprietor Jacquie Meyer said the values were important for the pharmacy and its patients.

“These are: Laugh and Enjoy the Day; Inspire Others, Fully Engage and Enrich their day,” Ms Meyer said.

“This applies to not only staff engagement but for our customers.”

Further highlighting the staff commitment to patients was a special training program they undertake.

“Our staff undergo an inhouse developed customer service training program called ‘making a difference’, which ensures all of the staff are confident in our service standards,” Ms Meyer said.

“We also have our staff trained in Pharmacy Guild training courses to ensure up-to-date knowledge across all areas of the pharmacy.”

The co-operation with, and development of relationships with the local private hospital also has helped to establish and cement LiveLife Pharmacy Cooroy as a pivotal element in meeting the community’s diverse health needs.

In addition to providing the community with the range of Community Pharmacy Agreement services, the pharmacy has partnered with the local private hospital to provide a range of services, medication, management, and education to patients and staff.

Ms Meyer said the services provided included routine chart reviews, patient education and counselling, consultations with prescribers, occupational therapists, physiotherapists, and social workers.

“Providing hospital services through the community pharmacy significantly reduces the medication management errors with hospital admissions/discharges,” Ms Meyer said.

“Our pharmacist also conducts education sessions to nursing staff, and special interest patient groups.

“Importantly, we sit on a multitude of advisory committees, and we are an integral part of the overall hospital service.

“And we do all this whilst being centred around the community pharmacy as the provider to the hospital.”

Ms Meyer said the pharmacy further expanded its community role by looking at all opportunities.

As part of this community approach, LiveLife Cooroy also partnered with the local palliative care hospice in the region, Katie Rose Cottage, and provides medication supply, management, nursing staff education, and Medicines Advisory Committee representation.

Ms Meyer said these connections and relationships “ really set us apart and provide a unique engagement with the patient throughout their entire health journey,” she said.

“The unique ability for our community pharmacy to service the hospital significantly highlights the integral part that we play in the healthcare system.

“It is good for the patient and very rewarding for us as health professionals.

“My pharmacists are trained to service the hospital and I feel we are breaking the industry-wide stigma around hospital pharmacy by providing a high level of hospital service through the community pharmacy.

“Our pharmacists are trained in mental health first aid, which means they can provide assistance in the mental health ward.

“The collaboration and renumeration that we achieve through our involvement with the hospital leads to increased business upon discharge as well as community recognition and of course a strengthened relationship with the patient. “

The pharmacy provides a range of extra services and has embraced, and developed, technology.

Its extensive delivery service is now managed by an in-house app developed to track, plot and record delivery services without the need for a third-party provider.

Further highlighting its commitment to strong and pragmatic collaboration, the pharmacy this year has developed its inaugural Health Expo for the region, which brought over 30 local healthcare providers together in the one place for community accessibility.

“And like many others we have answered the call from COVID-19. Our pharmacy has stood up as the centre for excellence in the region and we have a fantastic team who all have their patients’ health care needs at the forefront.

“We are ready for what is to come next with advanced scope of practice, and we can’t wait to embrace it.”

Ms Meyer summed up the pharmacy as one providing a large range of advice and services to all areas of health and wellbeing for its community.

“We are the central point for not only for natural health advice, general pharmacy enquiries, medication management, vaccinations and Community Pharmacy Agreement services, but hospitalisation services and discharge planning back into the community.

“Our pharmacists are providing the entire spectrum of healthcare in Cooroy and it all centres on our community pharmacy.

“Our passion for our community is clear and our staff are fully engaged with our residents and their health needs.”

Ms Meyer said the pharmacy’s health promotion activities, education seminars and information presentations highlighted the vast array of patients that it accessed.

“And we continue to access them and grow the numbers of people we provide services to,” Ms Meyer said.

The challenge for two young early-career pharmacists taking over a rural pharmacy at the height of the pandemic would be enough to deter most pharmacists.

However, it’s a challenge taken on by Alexander Look with Nicholas Wong when they bought Ouyen Pharmacy in north-west Victoria in 2021.

Both partners agree that when they took over the pharmacy in the town of just over 1000 residents, they saw a gap in the provision of some health services.

Mr Look said the previous ownership had maintained a strong focus on giftware.

“We saw this as being to the detriment of all other health-related products,” Mr Look said.

“As the new owners of Ouyen Pharmacy, we introduced a core range of health products in key health destination categories, increasing stock holding and ranging, which improved patient choice of therapeutic options.

“This came at a cost and we expanded our stock investments four-fold over 12 months.

“But this returned a positive benefit, not only for the business, but for our patients as well.

“We also constructed two private consultation spaces to facilitate in-pharmacy services in line with our strategic plan.”

Mr Wong pointed to the introduction of additional professional services as an indication of the pharmacy’s new direction.

“Additional pharmacist-led services that have been introduced include vaccination, sleep apnoea services, MedsChecks, opioid substitution, and a six-week weight loss program,” Mr Wong said.

“In addition, we connected patients with allied health via co-located services within the pharmacy.”

These co-located services include a permanent on-site pathology collection centre operating five days per week, a weekly visiting chiropractor, a monthly visit by a community paramedic for heart health screenings/consultations, and ad hoc nurse practitioner clinics dealing with diabetes education as well as bone density health.

Mr Wong said part of the philosophy when they took over the pharmacy was to immediately build rapport with individuals and with the community so they fully understood the local needs.

“The next step was to carefully curate the pharmacy’s products and services to reflect these requirements,” Mr Look said.

“Nicolas and I truly believe that a foundation of trust is critical to remain responsive to the ever-changing needs of the community we serve.

“We have also ensured we remain open to the wider community through our regular consultation and engagement with the town’s two main stakeholders – the Mallee Track Health and Community Service, and Ouyen College.

“We hold quarterly meetings with the community service’s  Chief Executive Officer, the Director of Nursing, and the Clinic Manager and these help us in the distribution of health services and resources, including the COVID-19 vaccination rollout and workforce planning.”

Mr Look said these meetings also had helped to cultivate trust and loyalty, which led to exclusive service provider contracts for Mallee Track Health and Community Service’s multiple aged-care facilities, contracts which had previously been held by an external competing pharmacy.

“The services include those in the Seventh Community Pharmacy Agreement, Residential Medication Management Reviews, Quality Use of Medicines services and dose administration aid supply,” he said.

“In addition, our collaboration with Ouyen College has enabled the pharmacy to provide pharmacist-led solutions, including on-site vaccination and periodical auditing and supply of first-aid kits.”

Mr Wong said the pharmacy’s reputation for innovation and its determination to achieve positive outcomes had resulted in fruitful partnerships with businesses in the wider community.

“Business-to-business services have improved Ouyen Pharmacy’s sustainability through diversifying revenue sources and increasing sales volumes,” Mr Wong said.

“And we are always looking for ways to help the community and an example of this is that our services were extended to Murrayville College, which is a remote town 110km from Ouyen, when a very real need was identified.

“No vaccination provider serviced this community, which placed the school at risk of closure due to mandated COVID-19 vaccine requirements.

“In response, we participated in mobile outreach vaccination services which were deployed to the school, resulting in ongoing services to communities and vulnerable individuals in their homes.”

Mr Look is also accredited to conduct Home Medicines Reviews and Residential Medication Management Reviews, and regularly conducts medication reviews.

He said that given Mallee Track Health and Community Service was staffed exclusively by short-term locum general practitioners, the introduction of Home Medicines Reviews services to the rural community had greatly improved continuity of care between patients and the many different health professionals involved in their care.

“It has also led to increased revenue through increased pharmacy sales as a result of higher shop foot traffic, and additional rental income derived from sub-leasing arrangements.”

Mr Wong said the partners’ business approach meant they tailored product and service offering by building upon their relationships with individuals and the community, and harnessing data analytics tools such as Intellipharm.

“This helps to identify current trends and predict future trends, ensuring we are always maximising sales potential,” Mr Wong said.

“Our leadership style engenders a culture of transparency, flexibility, and empathy; empowering each team member to reach their full potential via opportunities to up-skill and progress their careers.”