Here is 2009
New Year, New Perspective.
My current wife was in the pharmacy the other day. She looked at my cert hanging proudly on the wall and said, “You know that next week end you will have been qualified for twenty five years.” My initial reaction was one of dis-belief. To me pharmacists who have been on the register for twenty five years are old folk. The senior members of the profession. So out I went and had a look at the cert. Sure enough it said 15th November 1983. Then it dawned on me, I was old. Well not quite old, but certainly no longer young. Up to this point I would have considered my self to be one on the new breed of younger pharmacists. One of the older cut off points used to be those who had studied pharmacy in UCD and those who studied in TCD. I just made it into the latter.
So how does it feel to be old? Not much different really. I realise that many of today’s pre-regs and new pharmacists weren’t even born when I first pulled on a white coat and called myself a pharmacist. The white coat is long gone but I like to think that many of the experiences that I had are still with me. So later that evening I put on my metaphorical slippers, took out my metaphorical pipe and reminisced by the metaphorical fire side. I thought about the many influences on my pharmacy life. The other pharmacists and pharmacy related folk that I had met and who had some effect on me in the thirty years since I entered the doors of TCD in 1978. During that time I have meet the good, the bad and the ugly. So save their blushes I shall only name the good.
Not surprisingly the first to influence me were the pharmacists and other lecturers in the School of Pharmacy (then in Shrewsbury Road). Many of them are still there and are doubtless casting their influence on the latest crop. Special mention goes to Des Corrigan who was my tutor for my time there. A cheery “hello” goes to all those who still remember me and “sorry about that” to those who can’t forget me.
During my time in college I spent summers and Christmases working behind the OTC counter of HCR in Grafton St. The pharmacy was lorded over by Paddy McCooey who seemed to spend most of his time sitting on a stool behind the OTC counter. Meanwhile Rosemary and Margaret did all the real work in the dispensary. But it was a great working atmosphere and I learned many things in my time there.
The next big influence was my pre-reg year. (Yes we had them then as well.) It was only the second year of the pre-reg tutor and they were thin on the ground. The current batch of pre-regs think that they have it bad with the current round of HSE cuts. This is nothing compared to the 900 cuts in the GMS of 1982. Charlie Haughey was telling us that we were living beyond our means, not his mind you. Michael Woods was Minister for Health and he proceeded to slash all around. I had two pre-reg placements fall through before a friend told me that Lucy Adams in Raheny was on the tutor list and had not taken on a pre-reg. I approached her and she agreed to take me on at short notice. So for the next year I made the journey from Crumlin to Raheny on my bike every day. I don’t think that she would mind me saying that she was, and still is an old style pharmacist. Looking after her patients and her customers was paramount. I think that ultimately it was from her that I got my love for the type of community pharmacy that I practice now. Her son, Pierce now keeps the family name over the door now and I wish them both the best.
Then came a year or two without much impact. Things were looking bleak. Recessions are nothing new. I had been offered a job in Canada and I was within a week of packing up when I got a call from Larry Moloney in Ballyfermot. He was looking for a second pharmacist to help out in his pharmacy. There then followed five and a half of the happiest years of my life both professionally and personally. He was known universally as Moloney. Seldom Larry or Mr. Moloney, just Moloney. He has a wonderful impish sense of humour which infected us all in the pharmacy. He gave me the best grounding in how to run a business that you could get anywhere. I don’t think that he consciously thought me anything, he just just showed me how he did things. Many of the lessons that I learned at his side I still use now and pass on the the pre-regs at my side. One of the best was his attitude that life and pharmacy was really all a game. Sometimes you win, sometimes you lose, but as long as you come out ahead you’re a winner. This was his way of dealing with reps, customers and even the tax man. Particularly with reps, he used to say, “Remember they are playing their game too and if you beat them every time they won’t want to play with you. You have to let them win sometimes.” His death at a relatively young age was so sad.
Moloney was responsible indirectly for me meeting the next great influence. He asked me would I consider joining the Irish Pharmaceutical Union. I agreed and duly joined the employee section. I rapidly got involved with the committees and was soon on the Therapeutics Sub Committee which at that time was chaired by Jimmy Petitt from Charleville. Jimmy had a definite view of what our role should be and did his utmost to get other sectors to see us as professionals. His energy and enthusiasm was infectious. Many of those Therapeutics SC meetings were like going to college all over again. The depth of pharmacological knowledge at those meetings would have put many doctors to shame. Alas he too died at a young age.
After that it was a bit of a plateau. I didn’t get to meet with many who affected me as much as Lucy, Larry and Jimmy. And now the wheel has turned full circle. Without realising it (until now) I am exerting my influence on a new generation of pharmacists. Like it or not I’m now part of the senior generation. I wonder if in twenty five years time if my successor here will be writing about the poker playing motorbiking pharmacist who made them realise that community pharmacy was for them.
I have one consolation on joining the silver pharmacy club. I’m not alone in this silver dawn. There are about forty or so others who joined the profession and that day in 1983. You know who you are. So tonight pour yourself a glass of your favourite tipple and toast the past twenty five years and look forward to the next twenty five.
Making a difference
There are times when most of us sit down and say “What’s the point of all this?” or “How did I end up here!” “What difference is my being a pharmacist making to the world?” It seems that not so long ago we were sitting down to fill out our C.A.O. form, with or without help from family or school. What made us put Pharmacy as choice number one? And it nearly always was the number one choice. Those who got the points for pharmacy usually end up getting their number one choice. Well for me the choice was a simple but a mis-guided reason, money! A pharmacy that I passed on my way to school every day always had a shining new Mercedes parked outside. The callous sixteen year old inside me said “Yes I’ll have one of them.” This sadly was mis-guided as the Mercedes belonged to the doctor who had a surgery over the pharmacy and not to the pharmacist. He drove a more mundane family saloon which he parked around the back. But when I sat my Leaving Cert in 1978 these thoughts were far from my mind.
Even as I waited for my Leaving results I wasn’t too bothered. Like many potential pharmacists I had a choice of alternative careers. I had already been offered a post with the then Department of Posts and Telegraphs and with one of the banks. To this day I still can’t see myself as a civil servant (working for the HSE perhaps) or a banker. So for better or worse I ended up as a pharmacist and I set out to make my mark on the world.
So now twenty five years later I sit down with my metaphorical pipe and slippers and ask what difference to the world have I made. And to be brutally frank, not a lot. But then on thinking about it further I realised that the differences that I have made have been on person to person level rather than on a world scale. As a pharmacist I endeavour to give every one who comes into my pharmacy the best possible service. A lot of the time all you get is a polite thank you and no indication of any difference that you have made to that person. But every now and again there comes along someone like Mary.
Needless to say Mary is not her real name. She is a resident in a nursing home. She has been and still is suffering from severe chronic back and bone related pain. Some time back she returned to hospital for an out-patient appointment. She was prescribed a new pain killing patch. When she returned the nursing home contacted me and asked me to send up some of the patches. A quick check revealed that they were an unlicensed medicine, not readily available and not covered by the medical card. I telephoned the home to inform them of this and I told them I see if I could get them. No big deal, I’ve sorted out ULMs many times. We all know the drill. Ring the wholesalers to find out about availability and price, fax and then post the details to the Health Board looking for an order form. When that is forthcoming fill out the paper work for the wholesaler and sit back and wait. So I did all this and everybody came up trumps and by the following afternoon I had the patches. I delivered them to the nursing home that evening on my way home making sure that they were all acquainted with the directions for their usage. I didn’t think much more of it until the month end when I processed the paper work in order to get paid.
Then it arrived. A typed thank you letter and a hand written thank you card from Mary. Two sentences from the letter summed it all up. “ I slept all night with the patch………..Jordans Pharmacy will not close down as long as I’m alive.” Now I’m a bit of a hard chaw but even I was touched by this. A few weeks later I was in the nursing home sorting out a few bits and pieces. I called over to talk to Mary and again she was full of thanks. I tried explaining that it was all just part of the job for me but she was having none of this. I made the difference as she now gets a nights sleep. I was a bit embarrassed as there was no mention of the doctor who diagnosed and prescribed the appropriate treatment or the nurses who apply it every night. To me it was just doing my job but to Mary it was the difference of a restful night and a sleepless one.
I don’t think that this is an unusual case. We all as pharmacists do things like this every day. Everything we do for our clients is done with the goal of making their lives better. It doesn’t matter if it is making them feel better physically or mentally or just making their lives easier by taking some of the hassle out of it. Much of the time we may never see or hear of the client again and as often we will follow the client through their illness to recovery. It’s hard to know exactly how much difference we as pharmacists are responsible for with each individual but rest assured we did make a difference. Mary’s case was slightly exceptional as she put her gratitude into concrete form. And in that way she made a difference to me. Her thank you card made me feel good inside. As I put away my metaphorical pipe and slippers for another day I can say to myself “Yes I did make a positive difference for at least one person.”
I keep it pinned up over my desk. So now when I get days when the HSE take another swipe at pharmacy and does it best to close us down, I take a look at Mary’s letter and card. I flex my shoulders and stiffen my chest and and let roar “Come on Professor Dum Dum, give it your best shot!”
Too many cooks spoil the broth.
As I sat down to write this I was listening to our great leader, (blessed be his name) tell us that not only are we up the muddy creek without a paddle but that we are without a canoe as well. As is my national duty I was listening intently when I heard the line that struck me as the same old deja vú all again.
“The Government spends over €1bn annually on a range of professional services across all Departments . In view of the need for an equitable sharing of the burden of the adjustment to address the deterioration in the public finances, the Government will pursue a general 8% reduction on fees to legal, medical, veterinary and other professionals engaged by the public service. This will raise €80 million in a full year. The process will be carried out by engaging in consultations through appropriate channels.”
This sounds remarkably like the 8% reduction in wholesaler margins announced previously. However the amounts don’t match up so there must be some other devious plan in action. Does this mean that the GMS fee is now €3.31 and the DPS fee €2.90? Also will it include mark up as the HSE considers mark up to be professional fee? Will be be a 42% mark up on the DPS and a 25% mark up on the Psychiatric scheme or will it be 8% off the mark up? Perhaps by the time that this goes to print some more details will be available. Either way I can see this ending up in the High Court again. Wouldn’t it so much handier if SWMBO Harney just had some negotiations with the IPU. Just think of how much you will save on legal bills alone. Just think of the good news headline “Harney makes deal with IPU, State to save millions.”
I’ve been thinking about Mary Harney a lot lately. It’s not something that I enjoy doing. I’m trying to get behind her motivation, what makes her act the way that she does, what makes her tick. No not thick for she is certainly not that. What did pharmacists ever do to her to make her so intent on destroying the profession? I know that we made her look stupid in the High Court. But that was only after she had a go at us first. I know that there are many things in pharmacy that needed (and still need) modernising and updating. But when did totalitarianism and dictatorship replace democracy and consultation? And what happened to social partnership? Oh and by the way, consultation does not mean just talking to your sycophants who will tell you what you want to hear. As the old ad on TV used top say “It’s good to talk.”
This is where we meet the dividing line between democracy and politics. The P.D.’s put their plans for government up and and the public voted. They favoured a free and open market. Let the markets decide if something should prosper or fail. In this case the markets (or democracy if you wish) decided that the P.D.’s should fail. But then politics took over. Your mate Dig Out Bertie needed two more votes in the Dáil. None of the Fianna Fáil ministers wanted to touch Angola otherwise known as the Department of Health after the mess you made of it. Even after they got rid of Bertie our blessed leader left you there in Health. You must have a great set of negatives. You have become what must be most democrats worst nightmare. You have power but no accountability. The electorate have already rejected your policies but you still sit there imposing your rejected ideology on us. Your party is defunct and you have stated that you will not be standing at the next general election. This is in itself may not be all that bad. Sometimes we need to have somebody who does not worry about re-election to do what has to be done. You need to break eggs to make an omelette. However usually one chef is enough to make an omelette but you decided that it needed 100 level 7 managers who do not know anything about cooking. The resulting Humpty Dumpty sized omelette has a bit too much bile in it for any of us egg lovers to stomach.
I know that it is a bit late for Christmas but I thought if pharmacists were to get her a nice Christmas present or maybe a Valentines gift it might change her attitude. But what to get her. It has to be something that she would want and preferably something practical. It would also have to be in keeping with her ideology. I mean you wouldn’t give any of our so called Green Ministers a eco unfriendly present. No after some thought I would give her a new pair of Jack Boots. The pair that she got off Uber Fuhrer McDowell must be worn out by now. I’d also make sure to get a size bigger as she was always a bit too big for her boots.
Hold on to your hat folks, we’re in for a bumpy ride.
John Burke FPSI
It was with sadness that I learnt of the death of John. He was one of natures and pharmacy’s true gentleman. I first met him over 20 years ago when I was involved with the Irish Pharmacy Union. He was a founding member of the IPU and at that point in time he was a Trustee of the union. I spent many pre-AGM dinners huddles around tables with him and some like minded people planning for the following days AGM. Later on I took over the running of his pharmacy after he sold it to Unicare when he finally decided to retire. I’m not religious but John was, so for you John
“Ar a Dheis Dé go raibh a h’anam”
I like many others was outraged when the PSI announced just a few weeks before Christmas that we were going to have to cough up €2,500 to register our pharmacies. Also they wanted a library full of paperwork to accompany this. All this at the busiest time of year for most pharmacists and it meant that there was not a lot most of us could do at the time. At the time I emailed the PSI to ask them how this figure came about and what the money would be spent on. After a bit of back and forth via email and phone I asked for a copy of the PSI’s “Business Plan” (their words not mine) for 2009. I was told that the Business Plan would be published when the PSI’s accounts some time in March 2010. For the most part I left the matter lie for then as it was a busy time and as per the PSI’s diktat my patients needs are paramount.
Come January and I decided to do a bit of bolting the stable door belatedly. I took some time to read the rules for registration from the PSI’s own website. I noted that no where in the regulations was it stated that pharmacies had to provide maps of their location, plans of their pharmacies or copies of their Memorandum and Articles of Association. Never mind a copy witnessed by a solicitor or accountant. The bit about an accountant was the piece that triggered my curiosity. We are well aware that at times we need to have certain documents witnessed by a solicitor. But the only documents that I have needed to be signed by an accountant have been company accounts. I checked the draft regulations and some of these things were mentioned but they were not in the final signed version of the regulations. I wrote again to the PSI again seeking a copy of their Business Plan. I also complained that they had made no provision for a phased payment or reduced payment for pharmacies that were experiencing financial hardship. I also asked them if they intended to apologise and compensate pharmacists who were put to great effort and expense in providing documents that they had demanded with no basis in regulation. In reply I got what I describe as a PFO letter. A bland re-stating of some of the facts and “I have nothing further to add.”
It was around this time that I learnt that they had commissioned a report from Pricewaterhouse Coopers on the level of PSI fees. I wanted badly to see a copy of their report. Based on my previous experiences I reasoned that another approach was needed to procure a copy. I decided to use the journalists friend, the Freedom of Information Act. As an arm of the Department of Health the PSI is now subject to the FoI Act. So I wrote to them, sending them the appropriate fee when requested, and asked for a copy of the PWC report, it’s terms of reference and the Business Plan for 2009. I also asked for a copy of any documents which may be needed to understand the first two. As an aside I also asked how much the report had costed.
And just two weeks ago I received a shiny CD in the post from the PSI. The cover letter informed me that the report has cost €66,000 (ex VAT mind you). I don’t commission many of these reports so I cannot comment on it’s value for money. It represents about €40 per pharmacy. This probably represents a good price as I am told that many ladies of the night will charge you a lot more that that to screw you. As for the content of the report, well I can only partially comment. This is because the PSI neglected to include one of the appendices. This was the one with the works sheets where I am assuming all the various costs within the PSI were allocated. Whether this was by oversight, neglect or design I couldn’t possibly comment. I have written back asking for a copy of this and I eagerly await their response.
As for the “Business Plan” I was informed that this was being prepared for publication and would be available on the website “in the coming days.” Sixteen days later and there is still no sign of it. As the PSI have now indicated that they intend to make this public they now have no valid reason (in my opinion) to refuse me a copy. We have to remember that it was on the basis of this “Business Plan” that SWMBO Harney approved the fees for 2009. As I have written above I have written back asking for a copy of this and I eagerly await their response.
Next years pre-reg graduates might like to know how the charge of €1,500 came about. It is in line with the university student registration fee. Now they might want to ask what do we get in return for the €1,500? I’m afraid I do not have an answer. If there is one there is no sign of it in the report. You will be aware of what the various universities have provided for the last four years. If the PSI provide even close to the same level of services then €1,500 might be good value. However if current experience of the pre-reg year is anything to go by I wouldn’t have high hopes.
It’s nice to know that the PSI have a deep sense of irony. As I sat reading the report I let out a little smile when I read “Some of the highlighted and priority issues include ……………. Transparency around the process for arriving at registration fees” Considering the hoops that I have had to jump through to get this much information I feel that I can describe the process as being as transparent as a brick wall.
One last thing that I will give you from the report is that they expect a challenge to the new regulations, particularly Fitness to Practice. They are building up a reserve fund to fight these challenges when and not if they occur. It is interesting to note that the Dept. of Health see the PSI as a model for other professions and that they seem willing to use the PSI as a test case for Fitness to Practice in other professions. In other words pharmacists are to be the guinea pigs (and the paymaster) for the Dept. to test out their model.
I would like to finish this article with a witty observation or a “with one great leap our hero was free” type of comment. Alas it is not to be. One consolation is that it looks like they are going after all of the health sector. I read yesterday in the Irish Times that HIQA are to charge €190 per bed to inspect nursing homes. So a 30 bed home would be paying €5,700 per annum to have their inspection. HIQA were reported as saying this is similar to the UK and the nursing home body were saying that this is four times the equivalent UK charge. It looks like the same old dejá vú again.
No speaky da inglish!
Those of you who follow my various rantings will know that one of my pet peeves is foreign pharmacists ability to speak English, properly. This is not to say that all foreign pharmacists practising here cannot speak English properly. But there is a sizeable number who cannot and it does not seem that anybody is doing anything about it. Not wanting to be the hurler on the ditch I tried to get to the bottom of what was going on. And to be fair to the PSI, I could not place all the blame with them. Across Europe regulatory authorities cited the EU Free Movement Directive as the reason for automatic recognition of each others qualifications without any language requirement. Most of them pass the buck and say that it is the responsibility of the employer. So I downloaded a copy of this Directive and then I made my first mistake (in this matter at least), I tried to read it. This directive could replace all the Dalmane and Rohypnol in my pharmacy. I did however discover the high esteem that pharmacists are held in the EU. Pharmacists, doctors and other medical professionals were included in the same paragraph as leather workers, upholsterers and saddle makers. High praise indeed.
My next move was out lined in an earlier article. I emailed the Offices of the Commissioner for Health, Consumer Affairs and Languages. I asked them what was their opinion of an EU Directive being used as the reason for automatic recognition of qualifications without any language requirement. After some reminders the press office of the Commissioner for Consumer Affairs replied that it was not an issue for their office. I responded that it is a consumer issue that a healthcare professional may not be able to communicate properly with them because of a lack of local language skills. Patients as consumers pay for their healthcare either directly to the healthcare professional or indirectly via taxes or insurance. All I got was that they could not contribute any information on the matter. At least the Commissioner for Consumer Affairs replied. The Commissioner for Health and for Languages have not replied yet. Obviously healthcare professionals and the safety of the public are held in high regard by the EU.
All the above took place about eight months ago. So last week I decided to see if matters had progressed any. I had already asked a M.E.P. to follow up my emails to the Commission to see if there was any replies. So far nothing. I also emailed the pharmacy regulators all over the E.E.A. asking about language requirements for an Irish pharmacist who wished to register in their country. Hats off to the Nordic countries and Switzerland. They all replied within 24 hours to my inquiry. The general gist of the replies was the same.
“There are no language skills necessary for registration to practice.
However, the employer might demand language skills.”
Still the same passing of the buck. The Germans came up trumps with a start declaration that
“One of the requirements for the Approbation is that the person has knowledge of the German language”.
No messing around, you want to practice in Germany then you must be able to speak German.
However the reply from Hungary also gave me some hope.
“According to Article 53 of Directive 2005/36/EC (which has been transposed to our national law by Act C of 2001 on the recognition of foreign diplomas and qualifications)persons benefiting from the recognition of professional qualifications shall have a knowledge of languages (in this case the Hungarian language) necessary for practising the profession in the host Member State. “
It was at this point that I realised that there had been an amendment to the Free Movement Directive. So I set off to down load 2005/35/EC. In EU terms this was a light weight. Only 121 pages. It also sought to limit itself to the professions of nurse responsible for general care, dental practitioner, veterinary surgeon, midwife, architect, pharmacist and doctor. Article 53 was almost exactly as quoted by the Hungarian regulator.
“Knowledge of languages
Persons benefiting from the recognition of professional qualifications shall have a knowledge of languages necessary for practising the profession in the host Member State.”
The Hungarian government has transposed this into law so it begs the question why doesn’t all the other EU governments do likewise. I read the Directive a bit further and came upon Article 63.
Member States shall bring into force the laws, regulations and administrative provisions necessary to comply with this Directive by 20 October 2007 at the latest. They shall forthwith inform the Commission thereof.”
So at least the EU recognises that a medical professional should at least be able to speak the same language as their patients. At last some common sense. So I tried to find out if the Irish Government had transposed this into Irish law. But as I write everybody seems to be on an Easter break and I can’t get any reply.
Mind you none of this deals with a working knowledge of Irish pharmacy law or a basic understanding of the myriad of schemes that now make up Irish pharmacy services. I suppose that if they can speak the native language then at least somebody can explain it to them. To this end I for one was insulted by the latest circular from the PSI. I like many of others who sat the rigorous forensic exam do not need to be reminded on the emergency supply regulations and how to apply them. If the PSI thinks that it is important to know them then maybe they should have ensured that pharmacists know them before they register them and allow them to practice. But hey, lets be fair to them. They are probably too busy thinking of emails on spurious subjects or making up nice copybooks to send out. They have a lot of out money still to spend. But that will be another article for another day.
A good idea in principle.
In some of my other articles and blog entries I have been rather scathing of the PSI and some of their actions. So when this morning the PSI’s Code of Conduct for Pharmacists arrived I felt a sense of déjà vú. However I decided to approach it in a positive frame of mind. Just because the PSI is promoting something doesn’t automatically make it a bad thing. The key point with the Code of Conduct is how it will be used. Will it be used as the PSI states in it’s leaflet as a statement of ethics and principles which govern the practice of the profession? Or will it be used as another stick with which the PSI will use to beat the profession? As I read the leaflet further I feared that it will be the latter.
After stating the principles of the code the leaflet then goes on to state that section 33 of the Pharmacy Act defines professional misconduct as “any act, omission or pattern of conduct that is a breach of the Code of Conduct…” It then goes on to state the various penalties that the Council may impose on any offending pharmacist. In the next section that these guidance notes are “neither exhaustive nor exclusive…. …..Decisions must be made on a case by case basis.” So on the one hand they are saying keep to these principles or we can strike you off but on the other hand we won’t let you know exactly how these will be interpreted.
Then I started to read the six principles. I won’t repeat them here as by the time that this is published you will all have received a copy of them. In general I think that they are good guidelines for any profession. However they make bad guidelines for a penal code. Ethical guidelines leave room for two people to have differing views and yet both can still be right. A penal code is more black or white.
As I was writing this I was reminded of the old maxim “What’s the point of having laws? The good folks don’t need them and the bad folks won’t keep them.” There seems to be an inherent belief from the PSI that we are all looking for ways to do bad things. That we need to be controlled, regulated if you will. They seem to forget that we are all professionals who have regulated ourselves for nearly 100 years with very few ill effects. They set great store by all the new rules, regulations and laws and yet they will allow EU/EEA pharmacists to practice in Ireland without displaying any knowledge of the same rules, regulations and laws.
There are some points in the principles that I like and will make for some interesting situations. Under principle one the leaflet states “Not purchase or supply any product… …where there is a reason to doubt the safety, efficacy or quality..” I wonder will this mean that the PSI inspectors will now be visiting all those pharmacies who stock and heavily advertise all of those miracle weight loss products. Whatever about their quality their efficacy has never been properly proven. I will not name them all these products here (the list would be too long) but I can see a lot of pharmacies being in breach of principle one straight away.
I also like the statement that pharmacists should “Encourage the rational and proper use of medicines.” I would love to see some interpretation of how this does not conflict with the demands of many of the multiples that all staff should link sell medicines. “Nobody leaves unless they have bought at least two products.” That they should recommend certain products based on margin to the employer rather than on appropriateness to the patient. That staff (pharmacists included) who do not meet these criteria when approached by “secret shoppers” will get negative appraisals.
I welcome the we should “Actively influence and participate in health policy development, review and revision.” Perhaps we should also notify the HSE, IMO and the Department of Health of this.
I realise that at my stage of life that I am too bolshie to let others tell me what to do. So I decided to look at the principles from the point of view of somebody who does not have my freedom. I cast my mind back to when I was an employee pharmacist. And just in case the Aricept® wasn’t working I talked to a few other employees to see what they thought of the principles. On the whole they welcomed them. They too were concerned that a failure to keep to the principles could be a hanging offence but exactly what constituted such a failure was not clearly defined. They also raised some other issues which posed some problems for them as employees especially in today’s employment situation.
First amongst these was “Not practice under conditions which compromise their ability…” This is preceded by “Report… …to relevant authorities on matters affecting… …patient safety.” For some this would mean reporting their own employer. The PSI would need to follow up the code of conduct with a whistleblowers charter. As well as the physical conditions that they have to work under, imposed by their employer they would also need to take into account the level of support staff (if any) and the facilities to take a proper break away from the dispensary. They might also ask themselves how alert are they at the end of a twelve or thirteen hour shift even if it is willingly worked. Lorry drivers are not allowed to drive that long without a break but nobody seems to mind about pharmacists.
The other issue that they were concerned about was “Ensure that their professional judgement is not impaired by personal or commercial interests including incentives, targets……” This part itself didn’t bother them but they felt that this should have included “or negative implications or threats of negative implications if these targets are not met.” While owners need to be able to manage their businesses they too should not make it even harder for their employees to keep to them. In my view placing these types of sales targets on pharmacists is unprofessional. However it is hard to see how even the PSI with it’s now vast resources could police this.
So now I take up my school teachers pose and pass judgement. A good idea in principle but the day to day implementation is imprecise and vague. I would award the PSI four out of ten for this. Barely a passing grade and must try harder.
Has the pre-reg year out lived it’s usefulness?
A while ago I mused in an article about the joys of being qualified 25 years. Then it occurred to me that the current pre-reg set up is also 25 years old. The graduates of 1981, (how are you all doing?) were the first group to have to do their pre-reg year with a pharmacist who had done the tutor course. Prior to this any pharmacist in any pharmacy would do. I wondered how has the pre-reg year changed or evolved in the time since. Certainly some of the content has changed as new laws and regulations have been enacted. But this is something all pharmacists have to know about not just pre-regs. I realised that the pre-reg year today is essentially the same as 28 years ago. This begs the questions has it out lived it’s usefulness and is it time for a radical overhaul?
For a system to last so long there has to be some benefit to the participants otherwise it would just fall into disarray. From the graduates point of view there is not much choice. Do it or you won’t qualify. The benefits to the tutor pharmacists are as varied as there are tutors. They range from cheap labour to a philanthropic desire to help shape the next generation of pharmacists with many shades of in-between. When I started first taking a pre-reg I was working for a chain and for me it was a way of getting extra staff for my branch. Now that I have my own pharmacy and have to pay every body out of my own pocket I look at things slightly differently. Nowadays I see having a pre-reg as a way of keeping myself on my toes. There is nothing like having a different pair of eyes look at what you are doing and asking “Why?”
“Why are you doing this?”
“Why do you do it this way?”
“Why don’t you do this instead?”
Instead of doing things by rote or by habit you have to stop and ask yourself the same question. And occasionally you find yourself stuck for an answer. On more than one occasion I have changed my dispensing routine as a result of one of these conservations. I also like to pick their brains for the latest scrap of pharmaceutical or pharmacological information. A lot has been discovered since I left college and continuing education can only go so far.
While this is good on an individual basis what bothers me the most is the lack of structure for the year. Apart from the two assessment exams during the year and the forensic exam in November we are all, tutors and graduates alike, left to our own devices. To date I have dealt with this by discussing with the graduate what we both want to get out of the pre-reg year and trying to work towards that. My usual rule of thumb is that by the end of the year I am happy to leave my pharmacy in the hands of one of our newest pharmacists while I take a well earned holiday.
But what are the alternatives? At present nobody seems to be in charge. The unseemly scramble for places this year and last as harder economic times bite does not bode well. From next year the pre-regs will have to pay €1,500 for the privilege but with no guarantee of a place. What will they get for their money? Their name put on a register and come back and sit the forensic exam in a years time. Just as the PSI is bound by regulation to seek value for money I suspect that the pre-regs will soon become more vocal and look for their value for their money.
One alternative would be to incorporate the pre-reg year into the degree. Make it a five year degree as has already happened with some courses in the UK. It should be noted that these degrees in the UK now are Masters degrees. Or why not go the whole hog and make it a Doctor of Pharmacy. This seems to be the norm in the US now. Certainly it would go some of the way to help ensure that we get the level of recognition that we as pharmacists have earned the right to.
But what should be included to make a 4 year degree into a 5 year Masters or a 6 year Ph.D. One option is the include the on site training as separate modules in the longer degree. This would mean that the on site training with a tutor will need to have stated learning objectives and probably some examination at the end of these periods. As all pharmacists are entitled to work as hospital pharmacists a compulsory hospital module would be appropriate. Or the 4 year degree could be left as is and the 5th and or 6th year could become specialist years. Much like the current format of Masters or Ph.Ds.
But is there the will or ability to take on this massive change in the training structure? The PSI who bear ultimate responsibility for training do not seem to be doing anything about this. Incorporating the degree will mean that many tutors would have to be willing to take students for 3 and 6 month periods. This would not suit many of the smaller independents. And I would hate to see training of new pharmacists become the preserve of the chains who would be in a better position to accommodate this.
For all of it’s faults there are some positives that can be said about the current pre-reg set-up. One thing that can be said of pharmacists who have come through the Irish set-up is at least they will have been examined in Irish Pharmacy law and know it and can speak proper English unlike some of the EU pharmacists who have come here to cash in. I’ll stop now before I stir it up any more.
Tell it like it is.
This months column is not so much about pharmacy as the media portrayal of pharmacy. From my earliest days I have always been a news junkie. It started with newspapers and then moved on to magazines. Next came radio, then TV and now the internet. I had a great faith that they would tell it like it was. And I think for the most part that faith in the media was justified then. The black art of media manipulation only really came of age in the late 70’s and early 80’s. One of my first awakenings was the reporting of the conflict in Northern Ireland. I was able to see and read one side of the story on British media and another still sanitized version in the Irish media. I fairly quickly realised that there are at least two sides to every story and the truth usually lying somewhere in between but it could be somewhere else altogether. The internet has been a boom to those who want to hear about both sides of any given story. Discussion forums, independent news sites and even the participants own websites themselves can carry details or even their own version. So cynical are the public at this point in time that I think that now they assume that any PR will be heavily biased in favour of the group putting it out and they discount it as such. It makes it kind of hard for groups like pharmacists who are used to giving out plain unadulterated facts to start spinning a line. We are used to telling patients the facts and advising what is best for them even when it is not in our own interests.
But why do we get such bad press?
For myself it is an effort to write a 1,000 words to a deadline. I could see how a journalist might take a short cut such as copy and paste from a press release. Generally you would have a 50/50 chance that he/she would copy from your PR as much as from the opposition. But bearing in mind the HSE’s threat the last time to withdraw all it’s advertising from Newstalk if they ran any more unfavourable pieces I think that it is more likely that the editor will err on the side of the biggest advertising budget. Just as a side issue I wonder how much the HSE spent on all their ads with their made up list of pharmacies. I couldn’t see any editor say no to that type of advertising spend. But some of it is also in my opinion just lazy journalism. It is not possible for me to know if in some cases if they just ignore or don’t bother to check facts. I heard one RTE reporter state that 1,150 pharmacies had pulled out and that the HSE had said that 867 would continue as normal. He either didn’t know (unlikely) or chose to ignore the fact that there are only 1,600 pharmacies in the country. Or another bugbear of mine is when they accuse the pharmacist of charging rip off prices. Despite having been informed several times that the Department of Health sets the base prices and sets the margins that pharmacists must charge somehow we are responsible for the prices. At times I just want to grab them by the lapels, shake them back and forth and then slap them across the face a few times and say “Why don’t you get it!”
It could also be that they have bought into the years of propaganda from the HSE and the Department of Health and see us as the cause of all world evil and Ireland’s economic difficulties in particular. I am reminded of the story of a reporter who while walking down the street saw a young boy being attacked by a dog. His mate who was wearing a red football shirt picked up a stick and beat off the dog. The reporter rushed up and said I have a great headline for this. “Man. Utd. Supporter saves little boy.” “But the boy said I don’t support Man Utd, I’m a Liverpool supporter.” The next day the headline ran “Scouser Scum Kills Family Pet!” To some in the media we will always be the Scouser scum.
I think that there more than this at play here. While the HSE would like their PR to sound credible I think that certain elements actually believe that it is true forgetting that it comes from their spin department. Pharmacists traditionally have not been very good at putting their case forward. Mostly we prefer to work in the background sorting things out. We prefer to deal with our patients on a one to one basis rather than dealing with the larger type issues. Many in the media have taken this inability to articulate our case as proof that we do not have a case to articulate. They are also too used to looking at the big picture to realise that pharmacy operates on the personal level. Most would also be capable enough that they would not need to use many of the pharmacy services that a lot of our patients need. While they may pontificate from their high horses about pharmacy rip off they fail to see how much we are appreciated and needed by many of the more vulnerable in Irish society. It is almost as if there are two parallel worlds operating in Irish Pharmacy. The world that is written about in the media and the real one. I know from talking to my patients and customers that they support me in my action. And I know from talking to my colleagues that they are getting the same feedback. Many in my area which could best be described as retired working class understand the notion of a strike. Of standing up for what you believe in and defending your position. Many would have been involved with strike action, either directly or indirectly in the past and like pharmacists they did not enjoy doing it but they knew that it had to be done.
The only redeeming hope that I see at this time is as much as the media hates us they hate Mary Harney and the HSE more.
War Diary, one correspondents view from the trenches.
This is a contemporaneous account of the great pharmacy war of 2009. As much as possible I will try to write it as it happens. Unlike many of the articles that I have written I don’t know starting out how it will end. The end of community pharmacy as we know it in Ireland, the downfall of the Great Queen SWMBO, a fudged compromise where we we both go away to lick our wounds and prepare to fight again or maybe even a happy Good Friday like agreement with hugs and kisses all round. I should say at the start that some of the names, dates and places have been changed to protect the innocent pharmacists and guilty politicians alike. This is in case this is being read by the Competition Authority or any other of SWMBO’s Gestapo.
But to understand this war we have to go back to Battle of Ballsbridge which happened a year before the recession began. SWMBO had made a grab for the 8.2% margin and battle was joined in a manner of speaking. This was followed up by the threat of a new contract whether we liked it or not. The opening skirmishes were fought by the Donegal Diehards and the Methadone Maulers. Sad to say some of the Maulers were not seen in the ranks again and many were themselves badly mauled. Following this the Butterfield Bashers lead us all up to Ballsbridge and then marched us all home again. TheHiShitEs made some promises and uneasy truce followed. I think that it is fair to say that apart from a few neither side had the stomach for a battle.
Just as soon as peace was restored the HiShitEs started to break their word. The pounding that they got in the High Court made them realise that the rule of law was not in their armoury but on the side of the good guys. In a rare break with tradition they learned the lessons of what happened and determined not to fall there again. In the uneasy peace that followed we waited for their next move. Rumours flew like snuff at at wake, piggy flu turned out to be a red herring but still no definitive move. Then it happened.
Using the cover of the recession SWMBO’s boss Biffo developed the FEMPI Power Ray. It gave whoever used it power over any rule of law that they wanted. Biffo gave it to all his mates and they started to slash and lay waste to the land. Silently without any fanfare SWMBO employed to FEMPI PR. A quiet press release on a web site announced the proposal to cut the heart out of community pharmacy in twelve days time. The sub-text of this was “we only want 900 -1,000 pharmacies in Ireland and this is how we intend to achieve this.”
The response was muted at first. Not many realised the full implications to begin. But soon the ready reckoner’s came out and the true horror sank in. But all was not lost. The Maquis started to mobilise. Using the cover of cyberspace they sprung into action. Everybody used an alias and passwords as you never knew who was watching. Cells began to meet, venues were changed at short notice. We met in flea infested back rooms of pubs. The fear of the Gestapo was everywhere. Not because we were doing anything wrong but just because of the havoc that they could reek. Every man, woman and body corporate had to decide where their line in the sand was. It was remarkable how when faced with adversity that nearly everybody knows where that line should be with very little said to each other. The HiShitEs had well and truly stepped over that line and now they were kicking sand in our faces. What should we do? A few old soldiers from previous wars said what they thought we should do. New leaders emerged from the dispensaries and stepped up to the mark. Stomachs were hardened for the fight, old friendships renewed and old enmities put aside. We prepared for mass rallies that were to prep us with the intelligence that we would need for the upcoming battle.
The meetings were almost secret to begin. But as D-day approached we became emboldened. The Butterfield Bashers came out in public. All along they were working behind the scenes always wary of any move which might alert the Gestapo. The meetings went public and we turned out in numbers seldom seen before. When was the last time that you saw a pharmacy meeting that was standing room only. Details of past actions were read out. We were briefed on the current state of play. All the possible courses of action were outlined. We could drop our pants, bend over and reach for the Vaseline. Or we could fight.
But would we strike on D-day or would we stick to the Geneva convention and give proper notice. Feelings were running high. Hit them hard and hit them fast was the word from the ranks. A blitzkrieg before they had time to organise properly. Opinions were mixed across the country but in the east the majority wanted the short sharp shock. Word was sent to the generals, we wanted them hit now. Everyone was united, from the freelance foot soldiers to the groups lead by the local war lords. Even some of the groups lead by foreign warlords began to rattle the sabres. Lastly some of the old ladies who sat out the last few battles were sharpening their knitting needles. This was going to be dirty.
The troops were mobilised and everyone had their say. The generals gave forth with their counsel. Even though the HiShitEs may ride roughshod over the rules of engagement we would fight fair. You get a much better view of the battlefield from the high moral ground and your enemy has to fight uphill. Within one day over half of the troops were ready. The actions of the first few gave courage to the others. Their actions were posted in cyberspace and heads were held proud.
As the numbers in the ranks swelled past 1,000 SWMBO and the HiShitEs reacted. The state controlled media were rolled out with black propaganda. But all this did was to strengthen the resolve of the troops. The order to activate the FEMPI ray was signed and we all waited.
First up as before was Cowards Anonymous or the CA for short. Not too unexpectedly they struck. Employers and employees alike were the targets. Firstly they pulled in the IPOS Brigade only to find that their evil powers did not work on them. United they stood and it worked. But unpleasant as the experience was they were ready for it. They braced themselves, took it on the chin and said “Is that the best that you can do?” And then went about their normal business. Not all of the HiShitEs and SWMBO’s terror machine worked properly. Some of her appointed friends decided that battle should be in keeping with the rules of war and told her so. “Do things properly or we will not support you.”
The minions of HiShitE Towers worked long hours. Some were even seen there as late as 4:45pm. They were nearly late home for their tea on one occasion. Like Blackadder and Baldrick they had a cunning plan. They still weren’t quite sure what it was but they assured SWMBO that it would work. “It can’t fail, after all we are the experts at running a health service!” And SWMBO was pleased, so pleased that she sat back and ate another roast pig. This time with gravy and dumplings.
Meanwhile the Maquis continued to meet. We came to share our experiences and to pass on the wisdom of the previous encounters. So that we would all be better informed when we made our own decisions. It was raining and we all put up our umbrellas. No conspiracy, it was just the right thing to do.
Word came from Rathfarnham, it was time for our first sortie. So we girded our loins and once more we set off for Ballsbridge. But there was to be no battle. Our forces turned up in such large numbers that the HiShitEs took to the hills. They only stopped running when they were surrounded by their own friendly media. “We’re not afraid of you” they shouted, “And next year we’ll do even worse to you.” But they still wouldn’t engage with us.
And the black ops continued. The threatening phone calls, which became cajoling followed by pleading. But the support troops moved in as word came in of each attack. Their Lord Haw Haw came on to say that we would be defeated by the dreaded 867 army. But who this army was they could not say. Many doubted that it ever existed. They tried to recruit an army of nearly foreign mercenaries. But only a few were willing to take this queens shilling. Next they tried to form a contingency army by re-organising their own forces. But most wouldn’t join in. It would have been laughable if they hadn’t started spending honest tax payers money on building outposts in the wilds of Donegal, Mayo and Kerry. These would become swamped when the real battle commences. It is hard to feel sorry for the quislings who would man these outposts. They made their choices and now they must let their career live or die by them.
What had started out as a fight for survival became a battle for honour, respect, recognition and dignity. We would rather die on our feet than live on our knees. Edmund Burke once said “All it takes for evil to triumph is for good men to do nothing.” Well the time has come and the good men and women of pharmacy are standing up to be counted. We were like the Viet Cong. We were fighting for our homeland and survival. We may be out numbered and out gunned. What we lacked in strength we make up in cunning and guile and an intimate knowledge of the local landscape. We knew the layout of the land of Pharmacy better than they could ever think of. For some it may be a suicidal fight but whatever the outcome in future years they could stand up and say “Come the 1st August I stood up and I was counted.”
And still we continued to meet. To swap stories and information. So that we could all be fully informed when we made out own decisions. Intelligence was going to be vital in this fight and it was gathered from the ground troops and passed back to the generals in the war office.
Spokesmen and women came to the media from the HiShitEs and they sounded as convincing as a second hand car salesman at a liars convention. The names of those manning the enemy outposts became known. Some were known to us and some were new. But they were now marked men and women and their names would go down in the history books in ignominy.
The eve of battle was unerringly quiet. The troops had put in a lot of preparation, long hard hours and all they wanted to do was rest. It was going to be a phony war to start. The bank holiday made for a slow start. But we waited and prepared ourselves. The day of battle arrived and not much happened. A few outbreaks with little being reported as “Dog doesn’t bite man” isn’t much of a headline. On the fourth day hostilities really broke out. Some took entrenched positions behind shutters while others had shutters up and were repelling all comers. As with all battles there were those who didn’t fight. Some were frightened, some were fools and some were evil. It was hard to have a go at those who were frightened, a lot was at stake and this was virgin territory for many. The fools did not realise that by burying their heads in the sand they were leaving their ass exposed. I hope that they had loads of Vaseline. But it was for the evil ones that we reserved out deepest bile. Some proclaimed loyalty to the true cause only to turncoat at the last minute. These thought that they could survive the battlefield by dodging the bullets and then picking clean the corpses of their fallen colleagues. Some even tried to clean out their colleagues even before the battle commenced. Their day of reckoning would come. But first we had theHiShitEs to deal with.
Intell gathering went on all the time. The media had been heavily silenced by SWMBO’s mates and relatives who had infiltrated parts. The threat of no more advertising spend was waved under all their noses. And many just quietly whimpered and rolled over. But the cell meetings went on. Always a different location, sometimes at short notice. It acted as a support group, bolstering each other and swapping stories and experiences. And still the black propaganda came. But that did bother us. In fact it strengthened the resolve of many. We would prevail. Not that those who had made a stand needed much resolve. We had come this far and it was going to take more than a bit of bad PR to put us off.
In a major move by the HiShitEs there was an ambush on two of larger soldiers. They were taken out, albeit temporarily and forced to work for SWMBO’s army. But we bore no enmity towards them. We knew that they were acting under duress and that their hearts were still true. We swapped stories of what SWMBO’s scab dispensing army was doing to our patients. It almost seemed at times that SWMBO’s plan was to reduce the Health budget by killing off patients. Rather than “dead men don’t tell tales” it was a case of “dead men don’t cost the HSE any money.” But by this stage we were already moving into the end game. Positions were entrenched and one last big push was called for. Despite being battered and bruised we put our shoulders to the wheel for one more time.
And then, just like that it was over. They drifted away from the battlefield. We were called together and the brave 500 gathered. There was much anger but there was also a slow acceptance that we had lost. There would be another time for the post mortems. Tonight was a night to be with good friends and colleagues. In the bar afterwards there was no talk of what went wrong. We were too busy planning for the future. What we would need to do to survive. The lessons we learned and the experiences that we shared would prepare us for the next phase of the war.
But for now a short obituary will be sufficient.
RIP Community Pharmacy in Ireland
Died as a result of a crushing from a monolith and an elephant.
Bravely struggled on for 10 days but the end was hastened by friends twisting the knife.
No funeral arrangements yet as HSE has not finished dancing on the corpse.
No flowers please.
Regardless of the final outcome, when I sit back in my retirement (if I live that long) with my grandchildren on my knee and they ask me “Granddad, what did you do during the war?” I can look them proudly in the eye and say “I did what had to be done. I stood up and was counted.”
But like another army of old, “We’ve not gone away you know!”
Don’t mention the war!
As I sat down to write this I said to myself that like Basil Fawlty I will not mention the war. This would be easy. There is so much else happening in the world of pharmacy at present that I would have no trouble in finding something to write about.
To start with we have the fiasco that is the new pre-reg intern program. There are many things that seem to be wrong about this. Firstly the whole air of make it up as we go along is just wrong. Why couldn’t they just sit down and take the time to work out a proper program and implement it next year. It has been a long time since I was deeply involved with academia but to develop a Masters program at less that two months notice seems to me to be a bit overly ambitious. Then there was the whole notion of the compulsory training day for the new program for tutors. Leaving aside the content of the day what do they plan to do with all the tutors (and there are many) who do not attend one of their three planned training days. Say to them “No, you may not take an intern. We have so many willing tutors that we can afford to blow off a few.” Maybe the RCSI and the PSI need to learn a little humility and diplomacy. Maybe it might have been better to have wrote to tutors asking them to attend the training day. Say that for next year it will be compulsory but for now we think that it would be a good idea to attend. But they have called this compulsory and then have no consequence for failure to attend. Now you may just think that I am bitter that I attended while many others didn’t. But I still haven’t covered to content of the “day”. When we were originally notified we were told that this would be a nine to five all day session. By the time my attendance was confirmed this was changed to 10:00AM to 5:00PM. As it was we were out by 4:15PM. And this included a full one hour break for lunch. Frankly what was presented in the morning session could have been put in a booklet to be posted out or emailed. The afternoon session while interesting on a personal development basis had very little relevance to tutoring an intern. There may have been a lack of oxygen at the higher altitudes of the top floor of the RCSI but I found myself opening my mouth wide for air a lot during the afternoon session. Although I am committed to giving my intern the best training that I can I cannot but feel that this day was a waste of a good days locum. And it also occurred to me to wonder how much of pharmacists (and interns) hard earned fees are the PSI blowing on all of this. While I accept that people have to be paid for their efforts who does a value for money audit.
And while I’m on the subject of money I wonder how much the PSI are going to reduce their extortionate fees by for 2010. Their spending habits in 2009 have been such as to indicate that there is loads of spare cash in Shrewsbury Road. There is downward pressure on all costs so they should not need as much to run the office next year. Also with pharmacists and other staff all taking salary cuts how much of a cut will the inhabitants of Shrewsbury Road be taking.
To return to the beleaguered interns again it strikes me that the new set-up favours the larger pharmacies (the chains?) more so than the smaller mostly independents. The more staff you have the easier you can afford to lose one for one of the fabled training days. The more time you have to spare to sit down to do all the assessments. This would be in keeping with the PSI’s thinking to prefer pharmacies with several pharmacists on duty at any one time. Certainly with the downward pressure on pharmacist salaries at present soon it may be as cheap to hire a second pharmacist as to hire an intern or a technician. You would wonder if the PSI’s desire to increase the numbers of pharmacist per pharmacy is one of the motives for the massive oversupply of pharmacists at present. This also dovetails nicely with the HSE’s target of only 1,000 community pharmacies in Ireland. Imagine the savings if the PCRS had to deal with only 1,000 “customers” rather than the 1,600 at present. And if pharmacy owners could employ pharmacists for less then the PCRS could get away with paying pharmacies even less than now. All this assumes that the PCRS could make any savings rather than find that not only do they need the same staff to do less work but that they need a few more level 7 managers to make sure that they are working more efficiently.
So as I wrote above who needs to talk about the war with all this going on. And I really wasn’t going to talk about the war but …………..
I decided to go the the IPU’s eastern region AGM last week. And apart from El Presidentes speech and nominations to committee the only real topic on the agenda was a review of the war and what happened. Now the turnout while not up to recent IPU meetings attendance by remnants of the 500 terminators was notable. Now I am not going to write about what was said during the review. If you really wanted to know then you should have attended. Suffice to say that now we have to put old enmities aside and embrace those who would have stabbed us in the back. But first check that they do not have any more daggers in their hands. And now in the light of recent attacks on the Hardship scheme and the non-payment for whatever reason of Pysch scripts at least we can say “Told you so!”
And now that I have vented that bit of spleen I can go back to not talking about the war. As I finish I find that so far I have slagged off the PSI, RCSI, PCRS and the HSE. To round things off I really should say something nasty about the Dept. of Health, SWMBO Harney, Prof Dumb Dumb and the IPU. But enough spleen venting for one day. I really should get back to preparing for the inspections that any and all of the above must be planning for me at this stage.
Observations on the Great Pharmacy War of 2009.
I was sitting back in my metaphorical armchair chewing on my tobacco free pipe the other evening. I was pondering on all that has come to pass in the last 20 weeks in the world of Irish Pharmacy. Yes it is hard to believe that it was only that long ago that the FEMPI cuts were announced. (OK it will be 23 or 24 weeks before you read this but let’s not be too pedantic.) I thought that I might review the war and examine the good and the bad that came from it and decide what lessons could we learn. It did occur to me that it might be a bit too soon to do this. I had in mind the reply of Zhou Enlai, the Chinese Premier when asked in the mid 20th century about the 1798 French Revolution. When asked for his assessment he is remembered for saying, “It is too early to say.” But I never was one to take advice from one of the greatest minds from recent history so here goes.
As there has been too much negativity of late I will start with some positives. First off it is a re-assurance to me to know that there is about 500 other pharmacists out there who think along the same lines as I do. Most of them can see what is happening to pharmacy and are willing to put all on the line to try and defend their profession and professionalism. Also there are many more who can see what is happening but who through either fear or denial were unable to act. The second thing that I learnt is that Donegal is going to be a great place for a holiday. I imagine that it is going to be a solo holiday on my bike. Picture the scene. The family sits around the table. Daddy announces that this year we are going on holidays to Donegal because it is full of bolshie pharmacists. My object avoidance skills would be put to the test as every loose object on the table flies in my direction quickly followed by a divorce writ. But be assured that despite the views of my family I appreciate all that the Donegal pharmacists have done. Throw in that Donegal was the only county to vote No to Lisbon both times and it is definitely a place I have to re-visit.
The next big positive, from a community pharmacists point of view at least, is the inability of the HSE to properly run a community pharmacy. Indeed the GMS contract itself came about because of the inability of the pre-cursors of the HSE, the Health Boards to properly run the Poor Law Dispensaries. Many of the level 7 managers in the HSE probably don’t know this as it all started back in 1971 before many of them had moved out of nappies. In the early 70’s the Health Boards faced up to the fact that they could not run pharmacies and in reality nothing much apart from the faces have changed and the corporate memory has grown dim. So no matter how much they muck us around on payment rates etc. We must never let them (or the media) forget that they need us. If they think otherwise let them give a contract to DHL or An Post to get the medicines from factory gate to patient. Off the top of my head I can produce a list of patients that I would love for them to try and manage. We all have them. The confused psychiatric geriatric who we will only dispense one week at a time. We wouldn’t even consider monthly dispensing but a new invigorated HSE would probably send three months supply at a time. “Imagine only 4 deliveries a year instead of 52, think of the savings.” It comes back to the old adage of knowing the price of everything but the value of nothing.
The next big positive for me has been the sense of camaraderie and bonding that has occurred. Every fight or battle generates a sense of kinship amongst the participants. And the Great Pharmacy War of 2009 (GPW09) is no exception. I like many others I’m sure, have met with and made friends with many colleagues who we may never have made contact with otherwise. GPW09 also gave momentum to the buying groups. They have always been there but now the drive to make savings and achieve better terms has brought together many pharmacists. Experiences in dealing with the monolith that is the HSE have been shared and successful strategies have been worked out. This I feel may be one of the biggest positives that will come from GPW09.
Least you think I am going all rosy eyed after the dispute there has been some nasty negatives as well. The closures and liquidations of pharmacies has started. It won’t make the same type of headlines that “Local Factory Closes, 100’s out of a job!” does. We won’t get any tears from the HSE even crocodile ones as they have now stated publicly that they want to have only 1,000 community pharmacies in the country. 600 pharmacies closed, another 3,000 or 4,000 on the dole. The view from the HSE that we are little more than transporters of medicines from factory gate to patient. It is back to the 1950’s and 60’s and the Poor Law Dispensary system. And they couldn’t even do that properly.
I don’t want to leave you all with doom and gloom as I sign off on this christmas column. It should be pointed out that Santa is an O.A.P. whose christmas bonus is gone and whose medical card is now under threat. So you can console yourselves that come the morning of the 25th Prof Dumb & Dumber and SWMBO Harney will wake up to a sack of ashes from the white bearded gentleman.
So as I rise from my metaphorical chair I give a little sigh. Those of us over a certain age have been here before. We survived then and like Gloria Gaynor I will survive.
I’ll finish off with a copy of my letter to Santa.
I have tried my best to be a good boy this year. All I want for christmas this year is a high powered rifle. Now I know that you don’t usually approve of violent toys but this will not be a toy. It will be a tool. I want to kill an tough old goat who has been terrorising sick people. I also want to kill a big fat cow who has been trying to hurt my friends. One clip of ammunition should be sufficient..