HSE Wastes More Money On Consultants

The HSE are set to spend a load of public money on consultants basically to get them to say what they want to hear.  The tender looks for a review of pharmacy fees using amongst other things comparisons with other countries and discussions with key stakeholders.   Surprisingly enough the key stakeholders don’t include pharmacists or our appointed representatives the Irish Pharmacy Union.  Neither do the terms of reference include FEMPI which is still in force for pharmacy along with many other parts of the public service.  They might even want to have a look back on the Dorgan Report that did exactly this several years ago.  I guess that they are a bit afraid of their own expert groups opinion.

How much money will be wasted on this self serving report which will in all likelihood have to be scrapped because they won’t even talk to those at the coal face.


Link to tender document




Phased prescriptions

Just a quick piece of background.  When pharmacists dispense a medical card prescription in phases (usually weekly) we get paid an extra fee of €3.27 per phase.  Over the last few months the GMS have been making us jump through hoops to get this.  Despite meeting all the GMS’s self imposed requirements they currently reject payment for about 20-25% of these claims.

Today they introduced a new hoop.  I will quote from another pharmacy forum.

It gets better.
The circular says that a pharmacist can apply for phasing where they carry out an assessment of the patient’s needs and decide that, in their professional opinion, phasing is needed. This professional judgement must then wait until the next working day (i.e. 4 real days in the case of a bank holiday weekend. Days when a patient needs medication.) for the approval of a person who has never met the patient and knows nothing about them except what can be conveyed in a few sentences. If the application is rejected it can be appealed to the local HSE pharmacist who will need written evidence of the assessment which was carried out. Apparently we need to take out a sheet of paper and write down the factors that made us think a confused elderly person living alone on a pick-mix of medicines might not be able to manage. We should also write down the dates of previous occasions when they got mixed up and took too much or too little of their meds. We really have nothing else to do when we get a 10 item hospital discharge script late on a Friday evening.

Meanwhile a doctor can get automatic approval without even having to give a reason and without making any attempt to reduce or rationalise the drug regime in order to make it easier for the patient to manage. In many cases the need for phasing stems from inappropriate prescribing that we have no ability to tackle.

Perhaps they are happy for a confused patient to get a full supply of their medicines, lose them or get mixed up and then have to get duplicate supplies or perhaps for an unstable psychiatric patient to get a potentially lethal quantity of tablets.

It seems that they are doing their best to get the whole medical card system to implode.

Dutch Doctors Against Quackery

Here’s a site that I found via Stephen Barrett MD of Quackwatch.org.  To quote from his newsletter

History of Dutch antiquackery group posted

Atlas Obscura, a site that focuses on “the world’s wondrous and curious places, has posted a history of Vereniging tegen de Kwakzalverij, the Dutch Society against Quackery, which now has over 1,700 members. [Grundhauser E. What’s kept the Society against Quackery going for 137 years. Atlas Obscura, May 19, 2017] The society formed in the late 1800s in an effort to raise awareness of the growing number of quacks operating in the Netherlands. Initially, the group was focused on rooting out fraudulent doctors and suspicious medicines (nostrums). Its members, mostly doctors and other educated men, would chemically test suspect remedies, and if they were found to be placebos or otherwise ineffective, the Society would publish their findings in its journal. In recent years, the society’s focus has been on “alternative” methods, not only in Holland but throughout the world. In the early 1990s, the society fiercely lobbied against homeopathic products, and in 2000 it released a list of the 20 greatest quacks of the 20th century. The society has been sued many times for libel, but has won all but one case and ended up with more members and support as a result of the exposure.

The site in in Dutch but google translate using Chrome gives a good readable version.


New regulations re handwriting benzo and Z drug scripts

It now looks like that from May 4th there will be new regulations in relation to having prescriptions for benzos and the Z drugs handwritten by the GP.   The GP’s know nothing of this and will most likely continue on their merry ways.

I picked up the following from another pharmacy forum.

“Someone has to shout STOP , ENOUGH!!
We are being forced now on a daily basis to break the law in order to provide decent pharmaceutical care for citizens of this country.
It is wrong of the system to place pharmacists in this position. It is not feasible to refuse to dispense a hospital prescription for e.g. diazepam to a patient on the verge of a panic attack on a Saturday evening just because the doctor has no idea of prescription law requirements. It would be immoral to send such a person away on a mission to track down the prescriber who would probably write it incorrectly again (let’s face it), when they are obviously sick, and we obviously know what should be supplied. Sometimes the prescriber may not be contactable for a period of days.
I find it very stressful to know that after a days’ work , I may have broken the law a number of times just to provide care for vulnerable people, and I may be open to prosecution as a result.
No one should be subjected to this sort of psychological stress in the workplace and it borders on abuse, in my opinion.
To criminalise us for doing the decent thing and clearly carrying out the wishes of the doctor is close to a breach of our human rights.
The regulator has lost all sight of what a prescription is supposed to be. It started out historically as a written instruction from the doctor letting us know what they wanted supplied.
What we have ended up with is a bureaucratic nightmare.
This nonsense has to stop. ”

It says it all.

Canice Nicholas MPSI

Dear Colleagues,
My name is Canice Nicholas, I am a father of two and a qualified community pharmacist for 20+ years. I started my pharmacy career in Belfast, locuming for a few years before setting up Cara Pharmacy in 2000 with my now wife of 12 years Ramona. Our company is 100% owned by both Ramona and myself and we have grown the company both organically and through acquisition. We now have 13 pharmacies, 12 in ROI and 1 in NI.
Some may ask why I would put myself forward for the council and over the last few days and speaking to some of my pharmacist friends and colleagues, you might agree with them when they ask me if I’m mad!  I must say that I have been exceptionally grateful for all their their support and good wishes.
I am strong believer that we should always give back to the communities we are involved in, I personally, and the company, have organised many charity events over the years resulting in the ability to make major financial differences to many worthwhile charities.
But now it’s time I feel to give back professionally to my colleagues and peers.
I can safely say that morale within the Pharmacy community is at its lowest since 2009. There has never been so many intelligent young people entering Pharmacy. These young graduates expect and deserve to have a professional, rewarding career but the reality is that for these young people, their future has become completely disillusioned by the profession and they are leaving in droves to pursue new careers.
Having seen the broader picture, having built our business from scratch, suffering many ups and downs a long the way, I feel I have a very clear view of the pressures that our profession is under today.
If elected, (which I hope with your support I will be), I will commit to ensure that the PSI are fully aware of the pressure and stress Pharmacists are under today. No other profession suffer the restraints that we are subjected to yet we don’t even have the legal time to be able to take a comfort break. I will be asking the question ‘why should pharmacists not be allowed to sign in and out as is the case in other European countries’. Research is beginning to show that shorter working hours, more breaks, and more flexibility results in a higher engagement. Yet we cannot even discuss this as a possibility. Ultimately we are looking at a ‘burnt out’ team of professionals, who have so much potential, and so much to give back to our communities.
If elected, what you can expect from me is a pharmacist with business experience, commercial thinking, straight talking, not afraid to ask difficult questions and someone that is committed to the long term future of Pharmacy in Ireland. My core values include honesty, integrity and authenticity. I commit to always being available. And as an added advantage, with the uncertainty of Brexit ahead, I am one of the few Pharmacy Contractors in Ireland that has to work with the PSI and the PSNI.
The role is something I would take extremely seriously, and I am excited about the changes I could bring to the table. I would welcome your No 1 vote, and if elected, I hope I can deliver serious change for our profession that is totally under recognised at the minute.
I would like to thank my colleagues at Cara for nominating me for the role and giving me the opportunity to give back to the profession I am passionate about.