March 2014

March 14

The wishful optimist.

Looking back over my last few articles I could not but feel that it was all gloom and doom. This isn’t a true reflection on how I feel. Yes I do rant on about the bad stuff, I rail against unfair treatment and my funeral coat gets many airings. But I like to think that I’m an optimist. Look on the bright side but prepare for the worst. So this month I will try to concentrate on the good news.

In relation to pharmacy good new is hard to find. But there are a few nuggets to be found. The best one that I’ve found is that after nurses we are the profession that the public trusts the most. Before I get on to the reasons why this might be I think that it is encouraging that the public considers us to be professionals. Even if some of our own do not appear to have the same image of themselves.

I think that one of the reasons that we are so trusted is that we are seen as somebody who can approach doctors on behalf of the patient. How many times after speaking to a patient have you had to ring the prescriber? The reasons are multifarious. I usually try to let the patient know that I am ringing the doc and tell them the reasons why. Although they do not see this in a confrontational way they do see somebody giving their time on the patients behalf.

Another reason is our accessibility. It’s a bit like “Open All Hours” with Albert and Granville. When ever you want us we’re there. No appointment necessary, no fee to pay. Years of experience and knowledge just waiting to be tapped. Whatever about no appointment, no fee may prove to be the undoing of us. The old model was that folk came in for the advice and spent money elsewhere in the pharmacy. Whether on prescriptions or other front of shop goods. But now thanks to FEMPI and reference pricing apart from the sub €144 cohort of private patients, prescriptions are break even at best. FOS is under severe pressure and is likely to be for the next few years. It’s all well advice being free but once any added service involves input of pharmacist time, staff time or materials of any kind we should be charging the patient. This includes blister packing, blood pressure monitoring and MURs. How many of your patients are using these services (at your expense) not because they need them, but because they are free. Doctors have charges for everything from a sick cert to a death cert. St Vincent de Paul give it away for free. Do you want to be seen as a professional or a charity case? If you want to see a doctor outside of office hours you have to pay a premium price. Shouldn’t this be the case for pharmacists too?

Location of pharmacies is another reason to be cheerful. 1,800 pharmacies may be too many for a small nation such as ours but we are in every town in the country. This is something to be impressed upon TD’s, county councillors and local chambers of commerce. If they want their town to survive they will need a pharmacy and government policies are closing pharmacies down. They have lost their Garda stations, their local hospitals and their banks. The loss of the local pharmacy could be the death knell for many communities.

The next reason to be cheerful is a bit of a parsons egg. Pharmacist salaries are falling and are likely to fall further. Good news if you are a pharmacy owner, especially for the chain but bad news if you are an employee. This also plays into the pharmacy regulators desire to have two pharmacists present at all times. Especially if you are doing vaccinations, cholesterol testing and any other service that could be seen as taking the pharmacist away from public view. This has now reached the farcical level whereby I have a SOP in place for the staff for when I go to the toilet. This too is good news for the chains and the larger pharmacies as it will make it increasingly more difficult for an independent to open a new pharmacy. The scale of operation required to afford two pharmacists would put this beyond the reach of many employees. This is akin to the situation with credit unions. Most started in a small office in a community centre and built from there. Now it is way beyond the capability of many communities to start a new one. Effectively we will have regulation of new openings by means of prohibitive cost. Except if you are a chain or a multi-national who would have little problem with funding. This could mean that any new openings would only be by the chains effectively undermining independent pharmacy in Ireland.

While in the short term it is hard to be optimistic in the longer term are are reasons to be cheerful. I’m thinking of the current log jam with GPs in community practice. We can relieve this pressure by performing many routine tasks which can be carried out in pharmacies. Flu vaccination was the first. There are already pharmacies piloting warfarin/INR testing. We can provide the morning after pill to those who are willing to pay. It is only a matter of reimbursement that would enable us to do the same for medical card holders. There are a range of minor illnesses that pharmacists can successfully treat and it is only a matter of getting the GMS to pay for it. This is not going to happen in the short term as the HSE has shown an inability to look past one years budget. We need to be pressing for these thing now so that when the HSE are in a position to look at long term gain that we are set to move in and provide the services.

So take a Prozac and put on your happy face. Behind those rain clouds there is some sunshine trying to break though. But as this is Ireland it will probably rain again some time soon.


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