As I sat down and started this article I felt a bit like the sailors far from shore and knowing that a storm was brewing. We don’t know exactly when it will hit or precisely from which direction. But we know that it’s coming and we know that we have no safe port to run to. We have already weathered many storms and some have been more battered than others. Sadly we have already lost fellow travellers. Some of our colleagues are carrying such a huge load in the form of borrowings that it will not take much more to sink them. But still we sail on. The next big storm will be reference pricing and generic substitution. However I am not sure that the HSE have fully thought this through. I think that they feel that they can just keeping pushing drug prices lower without any bad effects. Yes they may be only paying the same price as the rest of Europe but at some stage many of the pharmaceutical companies will look at the extra costs of carrying out business in a market the size of Ireland and just say to themselves “Sod it. It’s just not worth it any more!” The effect on the Irish market will be two fold. Firstly a number of lesser used treatments will only become available as ULMs, i.e. much more expensive and more difficult and slower to source. And secondly many will just not be available in Ireland at all. While this will not affect a large number of patients initially over time there will be a growing number suffering a much lower quality of life and reduced survival rates for diseases which can currently be managed successfully.
Last month I looked at the future or possible lack of any future for small independent pharmacy in Ireland. I was cheered up slightly when I read that one of the priorities of the HSE’s Service Plan for 2012 was to utilise the existing pharmacy network better. However reading a bit more it would seem that the HSE would like to use the pharmacy network to distribute information and the like. In other words they want us to hand out their leaflets for free. That is to say, free to them but as anyone involved with retail knows every space in your premises has a cost. They have also pencilled in a €112M savings in drug costs. At least this gives us some indication of the savings being sought by the introduction of reference pricing. My leaving cert maths averages this to €60K approx per pharmacy per annum. So they want us to give them some of our paid for retail space for free and then cut the amount they pay us by €60K.
After last months dour piece about the future I thought that this month should be a little bit more positive. So I sat back and tried to think of some positives for Irish pharmacy and any positive things that we as pharmacists could do to improve our lot. One of the positives as mentioned above is our geographical spread. For the most part nobody in Ireland is very far from a pharmacy. Even the HSE recognise this as they seek to spread their health and lifestyle information.
The recent switch away from prescription only for the MAP and ‘flu vaccinations by pharmacists are another positive. It is a recognition that pharmacists have skill sets just waiting to be utilised. But it brings us back to old bugbear of who pays? I cannot see the HSE paying for anything else in the near future. ‘Flu vaccinations were the exception as they were paying pharmacists less to perform the same task as doctors. While giving better value or more bang for the healthcare buck is a good way to go, selling ourselves on the basis that we are cheaper just devalues the pharmacy profession. We also run the risk of endangering the relationships that many of us have built up with the doctors in our area.
And speaking of doctors I am almost ready to change my mind about our esteemed Minister for Health Dr. Reilly. I have been watching him on various TV news programmes and I have been impressed by his performances to date. I know that I gave him a rough ride going back to before the last election but I feel that to a certain degree he has grown into the position. I am still a long way off praising him and he still has a long way to come but let’s just say I feel that matters are improving. I am aware that this might mean that one source of material for my articles and blog pieces may dry up but with organisations like the HSE and the PSI around I will never fear a drought.
One way for the government rather than the HSE to save money in relation to pharmacy would be to carry out a man-power study to look at the numbers of pharmacists needed over the coming years. Does the Department of Education need to fund three schools of pharmacy in Ireland? While undoubtedly in the past we have had shortages of pharmacists from the numbers looking for work now I think that I can say without fear of contradiction that those days are over. Putting on my conspiracy theorist hat for a moment, is it possible that the Dept. of Health along with the PSI would also like to see two pharmacists on duty in each pharmacy at the same time. And their way of achieving this is to flood the market with pharmacists so that salary rates go so low as to make it viable for most pharmacies to be able to afford this. It’s at times like this that my quiet darkened room beckons. I fear that like so many other professions we are now just educating for export.
No doubt that by now you all should have received your flyers about the IPU’s conference in Galway over the weekend of 27th-29th April. Last year’s panel discussion was a great success and this year’s one chaired by Matt Cooper looks like matching up to it. Throw in a chance to meet up with old and new friends and put in some CPD hours and what more could you want? There is even an early bird rate if you sign up early. And you never know you might even see me there!