Do you want fries with that?

It has been a quiet (if wet) summer with little happening on the HSE battlefront.  However we can always rely on the multiples to give us a story to stir things up.

Boots have taken an old McDonalds burger joint and turned it into a drive thro pharmacy.

http://www.guardian.co.uk/uk/2008/aug/20/health 

http://www.marieclaire.co.uk/news/health/270929/first-boots-drive-through-opens.html 

It just beggars belief that they could carry any sort of professional service like this.  How do you counsel somebody via a hatch?  Does the pharmacist drop everything to run to the hatch as soon as a car pulls up.  What about the poor sods inside the pharmacy who are waiting at the dispensary counter ?  How do you handle somebody on long term meds when you have to say to them “You know that you shouldn’t be driving while taking this medication!”  How do you handle delicate or personal counselling?  Shout out the hatch a little less loudly.

I wonder if they will be carrying out OTC sales via the hatch.  The potential for pharmacist intervention is limited at best.
McDonalds do this by having a limited inventory which doesn’t need to be individually labelled with directions and patients name.   “FOR BEST EFFECT THIS SHOULD BE EATEN AT THE SAME TIME AS CHOLESTEROL LOWERING MEDICATION IS TAKEN”

This reminds me of many years ago when a patients loudly complained that their prescription wasn’t coming out fast enough.  An older hand beside shouted back “If you want it done fast bring it to McDonalds, if you want it dispensed correctly shut up and wait.” Some things in life are worth waiting for.

At the end of the day all the multiples care about are sales, profits and shareholder dividends.  Everything else is secondary.

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The Dorgan Report, What a waste of taxpayer money!

So the Dorgan Report is out.  And what a waste of time and money it has proved to be.  He recommends a flat fee for an interim contract that nobody has taken and nobody is likely to take.  The report is flawed in my view as Dorgan does not show how he came about the figures for the flat fee.  Essentially all he says is this is what the HSE thinks it should be, this is what the IPU says it should be.  And on the basis that you never give everything that is asked for he basically splits the difference. It might have more credibility if they published the figures that they were working off.

“The fee should also facilitate, and not discourage, the
necessary discussions on the future contract for pharmacy
services. “

By saying the above what he is essentially saying is that “I don’t want anybody to be so happy with my recommendation that they have no incentive to do nothing.”   It’s all academic anyway as the interim contract is far too flawed for anybody to realistically consider accepting it.  By taking this contract we are being asked to put our balls (and ovaries) on a plate, offer them up the great gods of the HSE and DoH&C and say “Please treat us nicely”.  We are being asked to give up all our rights and entitlements (many not yet paid) and let the HSE change the fees at 3 months notice.  That can up change down as well as up.

In fairness to Dorgan he does take a dig or two at the HSE

“It appears that the totality of this change
was not fully evaluated, in relation to both the cut in wholesale
margins and the loss of margins on private prescriptions. The
economic analysis commissioned by HSE (paragraph 4.7) excluded
both these factors in assessing the impact on individual
pharmacies, and set a lower dispensing fee than was indicated by
the analysis in any event (€5 as opposed to €5.93). “

i.e. they didn’t even do their home work on their own figures.

“We have been troubled throughout our review by the dichotomy
between a remuneration model built around drug dispensing and a
service provision model that is, or needs to be, built around wider
professional, retail and advice services in the community pharmacy………….It is not clear to us that a flat dispensing fee, particularly for a short-term interim contract, adequately addresses this dichotomy.  “

i.e. this is poorly thought out attempt to deal with this issue.

And how interim is the the interim contract likely to be.  What’s the chances that the HSE will decide that once the interim contract in place they don’t need to do anything else.  Yes they might have talks with the IPU on a new contract but they are masters of delay and postponement and it might take years for any outcome.  In the mean time they have everybody by the balls.

The interim contract represents the HSE’s ideal contract (ideal from their point of view).  And I think that they are thick enough to actually believe that it is attractive to pharmacists.  They listened to their own “experts” and believed what they heard because it suited them.  It’s time for them to take their head out of their arses because that is where they can stick their interim contract and €6 flat fee.