Quest for balance

“Love” is not too strong a word.I’ve been writing about community pharmacy for more than 30 years, and during the past decade I’ve been trying to hear from more patients. To tell their stories. Who better to attest to the importance of the pharmacy team in their health journey?Almost without fail, I get goosebumps when I learn about the difference their pharmacy makes. Some of these patients have been traumatized by health issues or by events that subsequently affected their health. All of them, including the two interviewed for this article, describe their pharmacy team—and the words “pharmacy team” are intentional, as many speak highly of the whole team, not just one individual—as a reliable, reassuring presence in their lives, in ways that go beyond medication management.“They know me. They understand me and can support me. That has a real calming effect,” says Sue Languedoc, a loyal customer of the FreshCo Pharmacy (formerly a Safeway Pharmacy) in St. Albert, Alberta, for more than 20 years.Without exception, patients emphasize the value of being able to get expert advice on the same day, if not within minutes. “If I have questions, if I’m feeling a little bit of anxiety about something, I know they’re there,” says Languedoc.Echoes Linda Chilton in Oakville, Ontario, about her team at Total Health Pharmacy: “Anytime I need help, or I have a question, I call or go in. I feel totally comfortable doing that.”As the monthly and sometimes weekly visits and calls build over time, the chats inevitably go beyond health matters. Langduoc, Chilton and other patients over the years tell me about how they can laugh, talk about family, share confidences and occasionally shed a tear at their pharmacy. Love, indeed, is not too strong a word.“I trust them,” says Languedoc simply.The pharmacy conundrumElected officials, too, are recognizing that community pharmacy’s uniquely accessible environment—both geographically and as a readily accepted safe space—is still a largely untapped care channel to prevent Canadians from slipping through the cracks of an overburdened and under-resourced public healthcare system.Too many are already slipping through the cracks. The 2022 OurCare survey (funded in part by Health Canada) found that 22 per cent of Canadians do not have a family doctor or nurse practitioner they can see regularly for care. That’s more than nine million Canadians today.Health Canada’s analysis of supply and demand for healthcare services, published in its January 2025 report, Caring for Canadians, found that the country currently needs almost 23,000 more family physicians, 28,000 more registered nurses and 14,000 more licenced practical nurses. It also noted that other health professionals, including pharmacists, “can be important contributors to primary care.”As detailed in the Gazette’s Winter 2024 edition, virtually all provinces and territories have steadily expanded scopes of practice for pharmacists and other non-physician healthcare providers. In pharmacy’s case, expansions began more than a decade ago. Recent years have also seen more public funding to reimburse pharmacies for the new authorized services in primary care and public health, and claims data validate the readiness of both pharmacists and patients to provide or receive those services.However, funding for services is far from universal and varies widely across jurisdictions. Moreover, pharmacy’s main sources of public funding to operate and provide services—i.e., the dispensing fee and a markup based on the drug price—have been stagnant or even declined in most jurisdictions over the past decade.The coming Canada Health Act Services Policy will help level the playing field. Announced by federal Health Minister Mark Holland in January 2025 and scheduled to take effect on April 1, 2026, the policy clarifies that medically necessary services “should be covered by a patient’s provincial or territorial health care plan whether the service is provided by a physician or a physician-equivalent.”While the clarification to the Canada Health Act is welcome—and long overdue—the road to implementation within each province and territory is far from clear. And highly unlikely by April 2026, predicts Shelita Dattani, Senior Vice President, Pharmacy Affairs and Strategic Engagement, Neighbourhood Pharmacy Association of Canada. “Funding commitments are the jurisdiction of the provinces and territories. It will take extensive consultation with healthcare providers and economists to determine the best way forward,” she explains.Indeed, Neighbourhood Pharmacies is advising governments to take a stepwise approach. “While pharmacy urgently requires fair compensation for providing medically necessary services, we’re advocating for the modernization of our funding model across jurisdictions,” says Dattani.“We need to begin dialogue about where pharmacy services should be funded and whether the drug plan budget, which pays for drugs, markups and the dispensing fee, is the most appropriate place,” continues Dattani. “The source and the model of funding for services should align better across healthcare providers.”Increased awareness is an important stepping stone. For example, Neighbourhood Pharmacies’ first Pharmacies on the Hill Day in November 2024 connected 25 member-representatives with more than 20 elected officials, senators or senior staff at Parliament Hill (see sidebar, page 11).“I was struck by how little they know about how we’re reimbursed,” recalls Christine Kamel, owner of Total Health Pharmacy, part of the OnPharm-United network of independent pharmacies. “They were surprised to learn that it’s not a blanket fee-for-service kind of model, similar to physicians.”This disconnect contributes to an increasingly difficult position for community pharmacy, caught between the opportunity to do more for patients and the reality of operational sustainability.“Governments are publicly championing pharmacy as part of the solution for primary care but often that’s not supported by an appropriate funding model,” says Dattani. “Behind closed doors, when faced with setting budgets, too often they continue to see pharmacy as a cost rather than an area worthy of more investment.”From the ground upIncreased advocacy from the grassroots is key to change mindsets and shift political will. “It can’t just be the organizations like Neighbourhood Pharmacies raising awareness and presenting solutions; it takes a village. The stories of frontline pharmacy teams and their patients resonate more strongly with elected leaders,” says Dattani.The Pharmacies on the Hill Day was informative for all parties, and additional networking opportunities are in the works. Neighbourhood Pharmacies is also working with members to bolster efforts to provide effective community-based advocacy resources to pharmacy teams.Brittany Zelmer, Manager of Professional Affairs, Pharmacy, Sobeys Inc., participated in Pharmacies on the Hill Day and would likely describe herself as an advocate for advocacy. In fact, advocacy training for pharmacy students would be at the top of her wish list.Zelmer’s personal ‘aha’ moment occurred while still a full-time community pharmacist. After participating in several studies that demonstrated the value of pharmacists’ interventions, she realized that was not enough. She also needed to help spread the word. “I realized that I really wanted to get involved to help shape the future of pharmacy and policy decisions by government,” says Zelmer. “The best path to achieve that is to work collaboratively.”She began by joining the Leadership Cohort of the Alberta Pharmacists’ Association (RxA), launched just before the pandemic, which trains pharmacists to become local advocates and establish relationships with elected officials. She then joined the RxA Board and is currently serving as President. Numerous calls and meetings with elected officials later, Zelmer still firmly believes that grassroots advocacy makes positive change possible. “We are making headway. When I talk with MLAs [Members of the Legislative Assembly] today they’re now much more likely to be aware of the training pharmacists have, the expertise they offer, and the scope of what pharmacists can do.”While such a gain may appear too little, too late considering the Alberta government’s cuts to funding for services in November 2024, advocacy is a marathon, not a sprint. “Budgetary pressures are a difficult reality; however, pharmacy fits into all four pillars of Alberta’s restructured healthcare system and we continue to advocate to be positioned accordingly,” says Zelmer.At Total Health Pharmacy, Kamel began to advocate on the political stage after the introduction of national pharmacare legislation in early 2024. She used materials produced by Neighbourhood Pharmacies to set up constructive conversations with her two nearest federal Members of Parliament. And her participation in the Pharmacies on the Hill event confirmed her belief that meeting one-on-one with elected officials is valuable education for both parties.Stronger togetherKamel is also a firm believer that advocacy needs to happen within a pharmacy’s four walls—and between pharmacies.“I share with my staff what I’m doing politically. And I try to give them the tools and the confidence to speak to patients and other healthcare professionals about our services in a way that advocates their value,” says Kamel.Kamel’s perspective as a pharmacy owner has also changed in response to the sector’s political and economic challenges. While competition is part and parcel of any retail business, for the past several years she’s been meeting regularly with other pharmacy owners and managers in her area “to build a sense of community and develop a camaraderie that is separate from what we do to be competitive,” she explains.They may share tips to reduce administrative work or swap opinions about the latest announcements from governments. “Having the attitude that we can help each other, that we can be on the same page, is so important. If we’re constantly just competing, we’re not going to be heard when it matters most,” says Kamel.The benefits of such a business community contributed to her decision to join OnPharm-United in 2021. “I love the fact that we are able to band together as independent pharmacy,” says Kamel.And the fact that OnPharm-United is a member of Neighbourhood Pharmacies, which represents the business of community pharmacy in all its formats, completes the picture. “Each layer of collaboration makes our voice louder,” says Kamel.From national pharmacare to a national strategy for drugs for rare diseases, from boosting vaccination rates to contributing to integrated healthcare-provider roles in primary care, community pharmacy is earning more seats at tables.“Our members are committed to a collective, objective voice to bridge gaps in understanding within governments and between governments,” says Dattani. “And we believe strongly that we are bringing forward the voice of patients as well. They know our value. Investing in pharmacy services improves care. It’s as simple as that.” Karen Welds is a healthcare journalist and has written about community pharmacy for more than 30 years.This article originally appeared in the Neighbourhood Pharmacy Gazette.

Quest for balance

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