Ultan Molloy reflects on the Minister’s showing at the IPU Conference, the next generation of pharmacists, and the concept of installing defibrillators in your local fast-food joint

The Minister for Health, Simon Harris, I believe got a standing ovation at a doctors’ conference recently, with a new GP contract and reversal of FEMPI perhaps deserving of such a response. Simon spoke about lots of good stuff to the Irish Pharmacy Union conference attendees recently, and then bounded out of the room, as an alternative to taking some questions from the audience.  I know, I know… he had campaigning to do, and other things on that day given competing priorities, as did I. However, I chose to remain at the conference and involve myself with colleagues and ask a couple of questions to the panel because, as an adult, I could make that choice. I chose what was important to me at that time. 

There is most definitely a hierarchy in community healthcare, with GPs at the top of the pecking order. I believe that GPs are seen as essential to patient care, with pharmacists very much in a support function that varies in people’s minds, from sticking labels on boxes, to engaging actively in patients’ clinical and pharmaceutical care. The value of the latter being considered intangible, or perhaps negligible, as the evidence has not been engaged with by health ministers who might, for example, leave conferences when such evidence is being presented. Pharmacists know they add value, and many have positive, communicative and engaging relationships with other healthcare professionals in their communities.  

Perhaps cultural snobbery has the medical profession in a revered position. My own ego indeed wanted to study medicine some time back, which didn’t happen, for reasons I may get into another time. I wouldn’t have been a great GP in many ways, truth be told.  The ongoing, often unreasonable, demands of patients at close quarters is what I find one of the most stressful parts of working as a community pharmacist.  

Knowing who the best person is for a particular job based on knowledge, skills, attitude and personality is something I feel I am good at, however, and indeed enjoy.  Health professionals are running businesses, teams and themselves in order to deliver for patients. Retail community pharmacy businesses and GP practices both have the demands of time constraints, teams of people to manage, patients to care for, with demands and expectations to manage, etc. In fact, I’d suggest that we have much more in common than not. Maybe it is implied, or ‘understood’, that pharmacists do not practice and improve their professional skills, and that GPs are so busy practicing their profession, rather than running GP businesses.  

We continue to hear about how busy and overworked GPs are, and yet fail to hear about how evidence-based services have been commissioned through community pharmacies that will relieve much of this pressure. A learned GP recently suggested on Twitter that paracetamol is simply better than ibuprofen, and the latter shouldn’t be used as it “is” nephrotoxic, which of course received any amount of ‘hurrahs’ and likes from her colleagues. No reference to dose range, mind you, or oversight from pharmacists, but then again — what would we know about medicines and their use? When such ignorance exists around the role and professional training and skills of community pharmacists within the medical profession, it is challenging to expect much collaboration and support in order to drive patient care and outcomes in the community. The word ‘colleague’ is a platitude in many cases, and misused by other healthcare professionals in an effort to appease our often delicate egos. You’re the best lads, and the best girls, like good little colleagues, unless of course you challenge at the wrong time, ask uncomfortable questions, or perhaps seek explanations for some bizarre hieroglyphics… that’s when you’ll be made all too aware of the hierarchy in primary care.  

Let’s hope that Simon takes some time away from his sweet dreams of self-affirmation and standing ovations and considers the untapped potential that awaits, frustrated, at his doorstep. 

what to stop?

I see the PSI has another consultation happening around further regulation of community pharmacy in some capacity or other.  More administrative and regulatory demands, and yet pharmacists are expected to get involved more and more at the coalface with patients. It can’t be more, even if it’s just a ‘little bit’ more, like the IMVO’s ‘sure, it’s just another step in the dispensing process’. Something has to STOP, in order for something else to START. Much like E=mc2, time can neither be created or destroyed. The 168-hour week will remain just that. Of course I want, and I’d imagine most pharmacists want, safe, quality and effective patient care but there are a limited number of things that you can do in a day’s work.  

A group that focuses solely on the regulation of community pharmacy, or indeed any single aspect of the profession or business, without fully considering and appreciating the impact of proposed changes will affect patient facing care, will continue to drive pharmacists from our profession. I spoke to a pharmacist working in our local town recently whose wife had gone back to study medicine.  

In her case, seven out of eight of her pharmacy classmate friends have chosen alternative directions than pharmacy practice after graduating from pharmacy. This is the crisis that is facing our profession and will be the crisis that will result in further patient care issues. 

Stressed-out and overworked pharmacists will miss something important and patients will end up back in hospital, or worse. What could be worse, you may ask!  

The future

What would make the pharmacy profession more attractive is every pharmacy stakeholder’s question to consider. Competing demands of budgets, regulation, business, etc, can leave us forgetting about the patients’ care and clinical needs in the midst of all of these. 

I’m perhaps more optimistic that the next generation of pharmacists coming through know better what they’re getting themselves into. Their placements will start earlier, and hopefully the misfits will be supported and encouraged to leave earlier, and to give their precious energies to something better aligned for the sake of themselves, the pharmacy profession, and members of the public. Darragh Connolly, the IPU President, said he was optimistic about the future, given his experience of the pharmacy students he met recently. This is certainly encouraging. 

Maybe we can also encourage those considering pharmacy as a profession, such as our TY placements, to consider deeply their own aptitudes, interests and abilities in advance of taking up precious third-level places, or indeed occupying them unnecessarily. Many other young people would be only delighted to have the opportunity to qualify as a pharmacist and to stay in the profession. The reality of the job of a pharmacist is what needs to be clear, ideally before those CSO choices are put down on paper.  Career guidance people have a lot of responsibility and I only hope that they’re not the ‘runt of the litter’ of secondary school teachers, which was my own experience in the distant past.

It has become increasingly clear, as also noted by Darragh, that effective and committed support functions in our pharmacies are critical for patient care and professional success. Technicians, OTC teams, dispensary teams and administrative staff are an integral part of delivering safe, enjoyable, supportive and effective patient care. Good staff are hard to come by and I know I for one probably don’t say ‘thank you’ enough for their work, their kindness and their support.

The cause and the cure

We have a defibrillator in the pharmacy and staff are trained to use it. We thankfully haven’t had cause to use it on ourselves, or a patient, to date, but it’s there looking pretty anyway. The local camera club near where I live, which I founded incidentally some years back, decided to contribute to the local community on foot of selling calendars for 2019. They paid for a defibrillator to be installed in the locality and its official unveiling had some of my Irish music companions playing on accordion, guitar, piano and singing, all set up with a PA in the corner of the room. It was a fun launch, by all accounts.  

I was chatting to Fintan Moore at the IPU conference last Saturday evening, and he noted that the health promotion budget for the HSE was dwarfed by the consumer promotion budget for McDonald’s in Ireland, by something like a multiple of three. We know that 73 per cent of statistics are made up on the spot, but you get the gist of what we’re highlighting here!   

So anyway, back to the defibrillator story.  What you need to know is that the defibrillator was installed in the local Supermacs, with a rather mischievous friend of mine noting, “ …sure, where else would they put it? The cause and the cure all in one place”.  λ