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Fintan Moore analyses the common mantra that ‘the patient comes first’ and whether that rings true when it emanates from healthcare authorities

The one consistent feature of every spokesperson for every organisation involved in any aspect of the provision of healthcare is that they all claim that their number-one priority is ‘the patient’. This assertion is made by politicians, regulators and bureaucrats alike. So the obvious question is, why are they collectively useless at actually acting in the interests of ‘the patient’ when it actually matters, like now, with chronic shortages of essential medicines? Ordinarily, I wouldn’t even bother mentioning politicians because we don’t expect them to have a clue, but they’ve been telling the rest of us to get Brexit-ready, so I would expect Simon Harris to have followed his own Government’s advice. I know Simon looks so out of his depth that if you put cement in his armbands, he’d take a week to hit the sea-bed, but surely at some point he must have asked a couple of questions about medicine shortages.

In fairness to him, maybe he did ask and was assured by some official from some department or agency that everything was hunky-dory and that all our patients will have timely access to all the medicines they need. This is of course horse-crap, as every community pharmacist in the country could tell him if he asked. We all know that medicine shortages are already a serious problem, and the situation is getting worse rather than better. On one occasion recently, when I sent my orders to the two main wholesalers, my ‘out-of-stock’ list was longer than the list of what was actually available. If you log into any of the online forums — Pharmabuddy, Irish Pharmacy Forum or Poitigeir — you find that pharmacists are trying to manage supply shortages.

The really frustrating aspect of all this is that often, when a product is out of stock, there are actually identical alternatives available, but the alternatives are of limited use because they are unlicensed, and therefore not reimbursable on the HSE schemes. The most recent obvious example was when Burinex was in short supply, but a ULM Bumetanide 1mg was available at a very similar price, manufactured by a reputable company. So private patients could pay for the alternative Bumetanide once the prescriber had been informed of the change to a ULM etc, but GMS patients had to return to their GPs to get switched to a different diuretic. On what planet could this nonsense ever have been a good idea? All that was needed was the tiniest quantum of common sense and effort, and a temporary GMS code could have been issued for the Bumetanide. 

I’m no expert in the field of medicine regulation, so maybe this kind of approach that prioritises ‘the patient’ requires some kind of regulatory change. If it does, then I suggest the Minister gets the relevant people to sit down in a room with a few pots of coffee and get the ball rolling ahead of Brexit, because that’s when things are likely to really get hairy. While they’re at it, they can take a look at the situation with the various OTC medicines that have disappeared from our shelves because they’re not licensed here in this country, but are readily available in the UK and elsewhere in the EU, and have EMA licenses. Once again, any regulatory agency that truly believes that ‘the patient’ is who really matters should be able to find a workable solution.

Doctor Foster went to Gloucester…

… and no locum was available. The shortage of medicines has not yet reached the point of being critical, but we’re near the point where the shortage of people to prescribe the medicines is. The layer of GPs covering the country is getting spread increasingly thinner, and as older GPs retire, the required replacements are simply not there. This year I have heard of several cases of GPs going on holidays and not employing a locum because none was available, or possibly not affordable. The knock-on effect of this is to see patients suffering delays in treatment until their doctor returns, or clogging up emergency rooms with relatively trivial complaints. The lack of GPs is of course compounded by the ever-increasing demands on their time from the HSE to have them apply for phased-dispensing approvals (apply, appeal, wait for phasing to lapse, reapply, re-appeal, rinse, repeat); apply for ONS approvals (reapply after six months); NOAC approvals; write ‘Do Not Substitute’ on every prescription; apply for increased numbers of diabetic strips, etc. Maybe there’s a HSE masterplan that reckons if they have fewer GPs to see patients, then their illnesses will remain undiagnosed, so fewer patients will be referred on to hospitals and the budget will start to balance.

Dental Enquiry 

We’re all used to getting calls from hospitals requesting medication lists for patients, but every so often a call comes in from a dental practice for the same reason. On chatting to a dentist about this, it was interesting to hear why a full medication history can be useful to them. The dentist reckoned that a lot of patients omit aspects of their medical history, either due to forgetfulness or thinking that they’re not relevant, so the medication list fills in the gaps. It’s obviously important for the dentist to know about bisphosphonates and anticoagulants, but a possible side-effect of calcium channel blockers is gingival hyperplasia. Any patient with dementia might struggle with the demands of ongoing plans and oral care. Some patients with psychiatric problems can feel that there is no point in starting a worthwhile course of treatment or conversely have an unrealistically high expectation of the result. As with any other healthcare professional ringing a pharmacy, the dentist will have patient consent to get a full list of medication, so it’s worth mentioning everything and the dentist can spot what they think is relevant. λ