October ’11 Article

On sitting back and re-reading last months article I cannot but feel that I was a bit hard on Dr Reilly. Hard times lead to hard decisions. The fact that he (or least some Dept. of Health lackeys) were prepared to meet with the IPU and discuss the upcoming ‘flu vaccine campaign has to be taken as a good sign. By the time that this is published pharmacists will be busy involved with vaccinations or sitting in their pharmacies going “Well that vaccination course was a fine waste of time!” I sincerely hope that it is the former. I have come across many pharmacists who this that all this is just a ploy to put pressure on the docs to accept reduced fees for vaccination. Having done the course myself I hope that at some stage we are going to be vaccinating.

As I wrote elsewhere the drive to save money in all government departments will be so strong that mumblings from quangos such as the Competition Authority about talking to representative bodies will be pushed aside. And saving money is what it will all be about for the next few years. For now the government is trying not to upset too many sacred cows. But the sums involved mean that many a sacred cow is looking at a trip to the abattoir. I have a feeling that many of the cuts that pharmacy has seen to date are just the start.

Some of the proposed cuts may not be too bad from our point of view. Compulsory generic substitution will be relatively easy to handle on pharmacies part. Yes we will always have those patients for whom the generic will not work for and they must have the branded product. As well as a little TLC I will also be giving them the contact details of their local government TD. I also look forward to having to explain this to some of the docs.
Reference pricing is one that I don’t relish. I can foresee that this will lead to many further shortages of various drugs in Ireland. It may even end up as counter productive. Many drug companies may just decide that the price calculated by the HSE/Dept. of Health is not enough to justify any involvement in the Irish market. And then they pull the product. They may not actually pull the product from the Irish market. It will most likely just go “Out of stock”. A situation that we are already well familiar with at present. It will most likely only be available via the ULM route. And as we all know this generally means more expensive. And if the GMS won’t pay the ULM price then there will be a marked reduction in the number of pharmacists willing to go to the trouble of sourcing a ULM and then losing money into the bargain. Most likely scenario will be that patients will be switched to a more expensive alternative or end up back in hospital because of sub-optimal treatment.

For the East coast area at the moment the big story is the end of the Psych Scheme. I am aware that this was finished for the rest of the country last year but by some fluke remained in Dublin. However just because they have got away with it for other parts of the country does not mean that it was a wise decision. I have already looked at my patients who avail of the scheme and I can pin point about 25% who will stop taking or reduce their consumption of their psychiatric meds. Ultimately this will result in more in-patient stays for these people. This will undoubtedly cost the state more. Penny wise and pound foolish.
For the GMS card bearing patients there will be very little money saved for the state. The payment rates are similar so we will now be just paid via the GMS in Finglas rather than the local Health Board. Where these patients will suffer will be in the delay by GP surgeries in translating their Psych clinic scripts onto GMS. While many surgeries are quite efficient in this respect there are also many who are not. There is also the issue of co-ordinating visits to the Psych clinic with surgery opening hours. This will be significant in areas that don’t have 9-5 Monday to Friday GP service. One possible way to partially alleviate this element would be to include the Psych clinics under the Hospital Emergency Scheme. For now what we have is the usual HSE tactic of hit the weakest hardest and expect pharmacists to clear up the resultant mess. We can live in hope.

So how can we find our way out of this morass? One way would be to diversify the services that we offer. Cholesterol testing, diabetes screening and a whole range of other blood tests. There are two main issues that would have to be dealt with if we moved there. Firstly, who pays? There is a limited enough group of patients who would pay themselves. Our Private patient cohort. Medical card patients would want/expect the state to pay and this brings us back to the HSE/GMS. Why should they pay us to do this when they already have a country wide system of hospitals with diagnostic labs already paid for by the state. The main positive for the HSE would be patient convenience. I can already hear the titters at the back by the suggestion that the HSE may pay to help convenience patients. Also this would further the HSE’s grip over our businesses. Many of us are in a situation whereby a huge chunk of our revenues come from one customer, the HSE. Do you want to be even more beholden to this entity. One avenue that might be explored would be having VHI or BUPA pay for these services for their clients. But I think that this is still a good way off. Secondly many of our GPs are also providing these kind of services. Do you want to risk upsetting your relationships with your local GPs?

So for now it’s batten down the hatches. It looks like we’re in for a stormy ride.

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