November ’12 Article

The recent round of cuts and the probable future ones have caused me to do some thinking about the future lately. That’s always a bad sign for me. And one of the end results of my think-in is the question is there a future for small pharmacy in Ireland? And the initial answers that I came up with did not leave me in a cheerful mood. As margins are cut back and turnover falls the larger pharmacies have more room to make cuts and reduce overheads. They are also in a better position to put some pressure on their suppliers and service providers. It’s a variation of the old maxim that if you owe the bank €1 million then you are in trouble but if you owe the bank €100 million then the bank is in trouble. However using the banks as an example of what is wrong in pharmacy and the Irish economy is not a very good idea! Mind you it should be remembered that some of the larger pharmacies got stuck with some very bad leases in their desire to be in the some of the best locations. They are also much more dependent on the cosmetic and front of shop trade. And we know from CSO figures that this element of the business is down. But they have more room to manoeuvre and on the whole I think that most of them will survive in some shape or another. This is not the case for the small operator. Many are already operating on the margins. And with the next round of cuts likely with reference pricing for some this may be all it needs to tip them over the edge.
Although they may not make any comment it would suit the HSE/GMS if many of the smaller pharmacies closed. Firstly the transfer of many of the prescription to the larger pharmacies would mean that most if not all of them would then attract the lower fees. Also if there was a lower number of pharmacies to deal with then the GMS could lower it’s staffing to deal with them. They could probably not make them redundant but they would most likely switch them out of the GMS to some other area of the civil service.
Since I’ve never been one to lie down and roll over I tried to think of what can be done or what can we do ourselves to ensure that we come out of this intact. One of the actions that came first to mind was to seek a return to the restrictive licensing of a few years ago. Those of us over a certain age will remember the situation whereby if you wished to operate a pharmacy you had to buy an existing one or demonstrate that there had been a certain growth in population in the area in which you wished to open a new one. I opposed this when the IPU and the Dept. Of Health agreed it originally and I still don’t think that it is a good idea for now. I also remember when it was IPU policy that all pharmacies would be on the basis of one pharmacy, one pharmacist, one contract. This did not go down well with many of our more entrepreneurial members and over the passage of time they got rid of it. I still think that it was a sad day when the IPU dropped this policy. If these entrepreneurs wanted to have a large empire then let them do it outside of pharmacy.
Rather than look for outside bodies to help us I thought about what we could do for ourselves. To start of with we should look to see what are our strong points. Strange as it may seem the fact that we are small is one of our strong points. We are in a position to give a much more personal service. My patients and customers know that when they see my name over the door that when they come in it 90% of the time it will be me that they will see behind the counter or in the pharmacy. And it is the same for most of the small independent pharmacies. The pharmacist lives locally, spends their money locally, their kids probably go to the local school and they know many of their patients and customers personally. I doubt that many customers of the chains have ever met or know who Mr. Boot or Doctor Morris is or what they look like.
I don’t think that we will see the likes of the Essential Small Pharmacy scheme that operates in the UK. Here at least the NHS recognises that a pharmacy is an essential part of the community and in areas where one is not viable they are prepared to subsidise one. It might be nice to start off if the GMS at least conceded that pharmacy was an essential local service. But given their lack of respect for pharmacy I cannot see even admitting that a pharmacy is part of each local community never mind an essential part. I feel that the only role the HSE sees for pharmacy is a high rent paying tenant subsidising the docs in the Primary Care Centres. I believe that there will at least two opening in North Dublin soon.
As I see it the way to survive is by concentrating on a local personalised service. Spend as much time as possible out front and get involved with the local community organisations. Many of us have been doing that all along but now is the time to do it with some added gusto. Talk to key people in your area and let them know that their local pharmacy is under threat and that they need to rally round. This many put many of us in a situation that we are not used to being in but there are big changes on the way and we have to big changes to the way that we operate if we want our practices to survive.
So I’ll finish on a positive note. I feel that there is a place for the small pharmacies but it ain’t gonna be easy. We will have to make changes to how we carry out our business but it is easier for the small guys to make changes. Here’s to hoping that we are all still here come this time next year.

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