As I posted in my blog the latest round of cuts by the GMS/HSE is proof of two things. Firstly the HSE is in panic mode and secondly they have no respect for pharmacists. The evidence of this is in the way the cuts were handled. Effective from 1st September although pharmacists were not notified until 5th. And no mention of what happens in relation to payment for prescriptions for these items that were dispensed in good faith between 1st and 5th. Failing to notify pharmacists in time or postponing the cuts until all pharmacists were notified for me shows the total lack of respect that the HSE/GMS has for pharmacists. Whatever about the legality of retrospectively applying cuts this action by the GMS is their way of saying to us “We are the strongest and we don’t care.” The panic comes because savings have to be made for 2012 and they only have 4 months left in which to make them. With reference pricing coming down the tracks the omens don’t look good. In fairness to Dr Reilly (I never thought that I would write that) it’s hard to make substantial savings when 70% of your budget cannot be touched because of the Croke Park agreement. I do not think that the drug savings while they may come eventually will be at the levels hoped for by the HSE/GMS while IPHA and other industry representatives continue to play hard ball. And while we may not like their stance at least the HSE/GMS is talking to them in some sort of meaningful way. Of course I do not expect that we will have much notice of these cuts or any grace period to enable us to be paid at the old price for existing stock. This lack of notice is due to the panic mode and GMS/HSE need to make savings before the end of 2012 and it will be facilitated by their lack of respect for pharmacists.
Questions also have to be asked about the capabilities of those in charge. Whatever about Dr Reilly’s abilities as a Minister he has shown a woeful lack of skill as a communicator. While he may be doing a great job in some areas that we might not be aware of but in this media age perception is everything. His recent reversal of the cuts in PA hours while it may have been politically brave it also demonstrated political naivety to say the least in imposing them in the first place. And what about the Secretary General of the Dept. of Health, Ambrose, late of this parish. It would not be far off the mark to say that he alienated most of the pharmacy profession during his tenure as head of the PSI. His attitude there seemed to be “It’s my way or the highway.” And while that may have worked for him with the PSI I think that a different approach is needed for the Dept. Of Health. Also he has gone from running a body with a budget of less than €10 million and around 25 staff to one with a budget that runs to hundred of billion and nearly 100,000 staff. All I can think of is that he must have done a bloody good interview!
One thing that does bug me is when Fianna Fáil’s spokesman get up and complains about any of the actions of the Dept. of Health or any of the other Departments for that matter. It beats me as to why the reporters or interviewers do not say to the spokesperson “If you hadn’t screwed up the country in the first place then many of these cuts would not be necessary.” Also they had failed to deal with any of the overspending issues with the Dept. For a long time the Dept. over ran it’s budget every year and each time a supplemental budget was put though the Dáil to cover it. This time that will not happen thanks to slash and burn methods imposed by the Troika it is not an option.
So where do we go from here? As it is most pharmacists have done everything possible to cut back on their costs. Just as the Troika has demanded slash and burn cuts by the government we will have to perform further slash and burn on our own costs. Most of us have made as many cuts as possible and I fear that there are few enough areas left to be cut. In short I reckon that the next round of cuts most likely reference pricing will be the final blow for many small pharmacies. This is not make headline news as the job losses will be just be a few here and there but no doubt about it there will be closures and job losses. For for many remote communities this may mean the end of a local pharmacy service. Many of you of a certain age (i.e. as old or older than me) will remember a time when local community organisations advertised for pharmacists to come and open in their area. Offers were made to subsidise them by things like rent free premises or free accommodation. I think that this time round even this will not be enough to make the small local pharmacies viable. A sobering exercise to do in a few years time will be to look at the PSI registers for the number of community pharmacies registered in the years 2010 through to 2015 and their distribution. I fear that it will tell a sorry tale.
I tried hard to think of a positive note to end this piece with but alas nothing come forward. All I can say is that I hope we are alls till making a living and practising pharmacy in few years time.