September’s Article in IP

As published in this months Irish Pharmacist magazine here it is.

If you are one of the many journalists reading this then probably some of it doesn’t apply to you.



It seems that the HSE won’t keep to their word

It has been two weeks now since the strike ended and still it seems that some folk in the HSE/PCRS are more intent on getting revenge for two lost High Court cases rather than getting on with the business of running Ireland’s (un)Health service.
At talks before the end the HSE said that they would resume as normal with no discrimination against any pharmacists. The following morning they started to roll back on their word. First they wanted those who THEY determined had proper terminations to effectively sign a blank contract saying that we would accept whatever they came up with at a later stage. They rowed back on this but as letters withdrawing the terminations came in again they issued the sign this or sod off letters. And this is where it rests for now.
It seems that they are not just content on killing off community pharmacy in Ireland, they want to dance on the grave as well.
If they go ahead with the tendering proposed in the Bord Snip report then you can look to the end of any sort of customer service and a return to the old dispensary system. No choice of pharmacy, poor stocks and non-existent service levels. Also it will be handing Irish tax payers money and control of what is left of Irish pharmacy over to British and German multi-nationals. But then what would you expect from a HSE that willing to let patients suffer and die rather than risk upsetting the great white elephant.

Don’t work too hard!

Since I closed my pharmacy I really have too much free time on my hands. This will be my third blog post today. I could probably do another three or four with the amount of material that I have collected in the last few days. Like myself many of my colleagues and friends have a lot of time on our hands. So we spend our time running up our Eircom and Vodafone bills. Thanks to this dispute I have been in contact with many a long lost friend and classmate. While for the first few days it gave us a chance to catch up on paperwork, that novelty soon wore off and we started chatting to each other.
One of the things that we have been chatting about is what has been happening to our patients since we closed. And some of the stories that have been coming back have been frightening. One colleague of mine took a GMS prescription for an elderly patient to her nearest scab pharmacy. Of the eight items on the prescription there were errors with four of them. Now we all make mistakes. Not one healthcare professional would deny that. But we all strive to spot the mistake and correct it before it reaches or harms the patient. And the busier you are the more likely you are to make a mistake. And in this case the pharmacy was dealing with an estimated three to four times their usual dispensing volume with no extra staff. My colleague pointed out the errors to them and told them that she would be reporting the event to the PSI. However given the PSI’s current performance with inspecting the HSE’s contingency pharmacies I wouldn’t expect much. There is an important point for employee pharmacists in scab pharmacies which are now dispensing multiples of their previous levels. Following the Pharmacy Act the pharmacist can be held personally liable and disciplined by the PSI for any mistake that they may make. So if you are rushed off your feet, take that extra minute to double check. Do you think that your employer will back you up in the event of a serious error? Or will they look to dump this all on you? This is aside from the angst that you will feel if you do harm to a patient.

Unicare did a time and motion study of the work of pharmacists. They broke down the work that a pharmacist does as

Task per item………………………………………. .Time taken (minute) per task

[1]Ordering items……………………………………… 0.5
[2]Receiving items……………………………………..0 .5
[3]Dispensing item……………………………………..3. 5
[4]Advising customer………………………………….1
[5]Down time per item…………………………………0.5
[6]Taking Money……………………………………… .0.15
[7]Paperwork photocopy etc…………………………0.35
[8]Paperwork monthly return…………………………1
[9]Dealing with docs…………………………………..0.6
[10]Dealing with rejects………………………………1.05

Total per item………………………………………. …9.15 minutes

This equates to 6.55 items per hour. If you are lucky enough to have support staff you can eliminate 1, 2, 7 & 8 and maybe 10. This allows for 2.35 or 3.4 extra minutes per item. This gives 6.8 or 5.75 minutes per item or 8.8 or 10.4 items per hour.
I know that these are averages and some items will be dispensed a lot quicker but there are also many items which will take a lot longer. This should give you an indication of how many items you can safely dispense in a day and at what point you start being over worked or over stressed. As we now move into the second week of the dispute I have no doubt that the long shifts at the dispensing bench are now taking their toll. None of us are superman or woman.

I would remind you of a pharmacy in Australia which proudly had a banner which boasted “Every prescription dispensed in less than 4 minutes!” Unfortunately for them they also had the highest rate of complaints and mal-practice claims for mistakes made. Make haste slowly!

So they got an injunction against Hickeys & Bradleys eh……

So the HSE got a one sided injunction (ex parte to you legal bods) against Hickeys & Bradleys. It’s a strange choice of target. Both of these chains operate in areas which are well served by scab pharmacies. If the HSE were concerned about patient safety and service you would have thought that they would have concentrated on an area like Donegal, Mayo, Waterford or Kerry were there is absolute disarray at their contingency scab pharmacies where they have them.
No I think that the choice of Paddy in particular was based on a desire for revenge for his court case last year. I think that the HSE may have thought that if Hickeys & Bradleys had to re-open that there would be a rash of other pharmacies re-opening as well. If anything it has had the reverse effect. There is a general feeling of sympathy for Paddy and Brain. It has strengthened our resolve not to give in to the HSE’s bully boy tactics. Most of the Hickeys & Bradleys were busy enough as it was so that they have very little over capacity to take on any extra dispensing. So while the HSE may think that their legal ambush on a Friday evening when the court was in recess was a victory, it may well turn out that they have shot themselves in the foot.

What’s the story with methadone this time?

I got a letter from the HSE this morning. It was telling me where to send my methadone patients as I had pulled out of the scheme. They were a little slow off the mark. My contract was terminated on August 1st at which point I was no longer able to be part of the scheme. I stopped dispensing to my patients at that stage. The letter was a copy of an internal HSE fax dated August 5th and it arrived today August 10th. It is just as well that I did some research myself before hand so that I could let my now ex-patients know what to do nearly two weeks ago.
So how were they managing with the new set-up. Having some(!) free time on my hands I got in contact with some colleagues who have contact with the HSE’s methadone program. I also made contact with a few colleagues who were close to the HSE’s temporary clinics to ask them what were things like.
While I expected to hear that things were hectic I never expected the chaos and mayhem that I was told about.
Firstly you have to understand that many of the methadone patients would owe money to drug dealers from all over the city. Normally they would avoid these dealers like the plague. However the limited hours of these clinics (5PM to 7:30PM every day) means that the dealers know that these people have to appear to collect methadone at these times. So they just show up and wait. I have been hearing reports that some of the patients, especially the physically weak ones, have to bring “bodyguards” with them. There have been cases of patients having their take-away dose stolen off them when they leave the clinics. To the waiting dealers this methadone is as good as cash. Also over the weekend there was a report of a stabbing at one of the clinics. This might explain why some of the patients have been seen wearing body armour going into the clinics.
One of my ex-methadone patients explained to me that she hated going near these clinics even in more normal times. Going in and out was like running through a drug dealing alley. All the people she tried to avoid when she gave up drugs were hanging around offering their wares every time she had to visit the clinic.
Bearing in mind the report that said that the cost of looking after a methadone patient in a HSE clinic was twelve (12) time the cost of caring for one in a community pharmacy, it’s nice to know that the HSE is spending our tax money wisely.

So she came out of hiding.

She didn’t look like she had enjoyed her “holiday”. She even sounded a bit frightened. It looks like she insisted on a one to one interview instead of going head to head with Liz. If Liz was facing her she certainly wouldn’t have been able to get in as many lies. The interviewer was little short of licking her feet. It was a bit disingenuous of him to describe the Competition Authority as independent. Set up by Harney and Purcell appointed by Harney, very independent. Mind you she did look a bit rattled when asked about her position after a re-shuffle. When Harney goes it will leave room for two more seats at the cabinet table. Physically at least!
And as for her “1100 pharmacists haven’t given notice”. Down right lies. If this is the case let them go to court and look for injunctions. Once the pharmacists produce a copy of their termination letters (copies held by IPU) she will be laughed out of court the same as the last time that she tried this stunt. I sense that Harney and the HSE are already playing the pass the blame game for when this all falls apart. Contingency plan my arse.
And as for the interviewers treatment of Liz, it was a disgrace. I would love to have seen him that aggressive with Harney. Do I detect a semi-state not wanting to upset their lords and masters too much. Never mind Liz held her own in the circumstances.

Add all this to Ritchie Collis and Keith’s dismembering of Paddy Burke on the Gerry Ryan show this morning, it has been a bad day generally for the HSE.

Overall it’s the patients that I feel sorriest for. But whn you are given a take it or leave it 34% cut with no negotiation are you surprised when most say “I’ll leave it”.