November ’11 Article in IP

A Brave New Future

There has much spoken and written lately about expanding the pharmacists professional role. Certainly the decision to permit over the counter pharmacist prescribing of the Morning After Pill and becoming part of the ‘flu vaccination regime has to be seen in a positive light. There is little doubt that there are lessons which should be learnt on all sides about how it was introduced and how it was handled by the Department of Health. Possibly some of their motives in relation to the ‘flu vaccine might be brought into question. But anything that improves the professional role of pharmacists and how the public and Department of Health see us has to be welcomed.
From the pharmacists point of view this has to be used as a stepping stone to other roles. Even if we can only promote these other roles on the basis of cost saving. That is to say “We can do it cheaper using our facilities than the current providers.” Or putting it more positively, we can give more bang for your health Euro. It will be a bigger move to say to the paymasters that by investing (spending) your money with us then you can get a better return for your customers (patients). This will be a much harder sell. In times of recession paymasters look for ways to cut back rather than spend in new areas.
I see two major obstacles in expanding our professional role. Firstly we are still stuck with effectively only one pay master, the HSE. I have written about this before and for many of us it can be a little scary just to look at how much of our income comes from one customer. And for the most part it is a customer who does not hold us in high esteem. From a business point of view this is fairly understandable. They know that they have us by the unmentionables and they are ready and willing to squeeze. I am going to annoy a few of my colleagues but as a tax payer I would expect nothing else. I want government to get value for the taxes that I pay and they spend. However I also want decency and fairness. But that’s a whole different article.
What we have to do is to try and develop different pay masters. For now there is only two alternatives. The Private Patient, Joe Public out of his/her own pocket or the private insurance companies. I’m afraid that Joe Public is not a likely mark at present. His pocket is feeling the recession just as much as ours. For him health spending is very much on a need to or a must do basis. He will wait until he is sick enough or the symptoms so bothersome before doing anything as radical as spending money. And as most of the expanded professional role is mainly concerned with prevention this makes it a hard sell indeed.
The health insurers would be much more amenable to us. The bean counters in these companies understand the concept of a Euro spent on prevention can be worth fifty or a hundred Euros spent on treatment later. But we will need to change the mindset. Some of our younger readers will not remember many years ago when the VHI, the only health insurer at the time, covered part of prescription bills. They used the arrival of the medical card and the fore-runners of the DPS to quietly drop this part of their coverage. I don’t remember a corresponding drop in premiums but that’s old history. Since then apart from seeing pharmacists as customers they have forgotten us. We need to show them that we can contribute in keeping their clients healthy and in the process saving the insurers money.
Much of the extended professional role does not require any legislative change. All it requires is some spending to set up. One approach may be to set up a service paid for the most part by the HSE initially and then to offer it out to the insurers. But it would have to be done on some form of co-ordinated basis. I can almost hear the Competition Authority licking their lips as I type. There is no way something as big as setting up a new professional service and thrashing out prices with insurers could be done by each community pharmacy on their own. This would give the insurers a monopoly type position whereby they could just name their price on a take it or leave it basis. Some of the larger chains might be able to negotiate but this would place the small independents at a disadvantage. I already covered this aspect in a previous article so I won’t re-hash it here.
The other big obstacle is how we present ourselves and our pharmacies to the public. Over the boom years many expanded their businesses. They moved into areas that were only loosely connected with pharmacy. That isn’t too big a problem. I have seen many pharmacies which have effectively divided their shop floor. Once you walk past a certain point it is clear that you are in an area dealing with medicines in a professional manner. What does present a problem is some of the products that we promote. How can we present ourselves as health professionals while at the same time recommending homoeopathic preparations. The time has come and gone when we should throw these quack products out the door. I am well aware that many people believe in them but there are also many who believe in little men from Mars and Fr Xmas. The thought of them may be comforting but they do sod all. If the words and actions of some of the docs in relation to vaccination are anything to go by then there will be many out looking for ammunition to fire at us as we expand our roles and the services we offer. Lets at least get this potential booby trap off our shelves.
Well another month has gone by and I haven’t let off a major rant or a broadside against the HSE, PSI or Dr Reilly. I hope I’m not losing my touch. Ah well, there’s always next month.

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