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Ultan Molloy looks at the factors that will be necessary in 2020 to bring the profession forward and reviews his correspondence with the office of the Minister for Health

I am writing this noting that my previous open letter to our Minister for Health was somewhat redundant by the time it was published. I did send it to him; incidentally, he chose to acknowledge its receipt on the day I write this. About a 75 per cent acknowledgement of correspondence rate from public representatives is perhaps reasonable. I have come to the conclusion, having been on the receiving end of an occasional snubbing, or having been ignored, that it is kinder to acknowledge, making a modest allowance for occasionally forgetting to, of course. 

Too many curricula vitae have ended up in the bin over the years without me acknowledging their receipt and thanking the person for their interest in our company. Too many company representatives and sales people have got a response that was curt and ignorant, perhaps on foot of my own stress levels and energy resources. I understand, since ‘it’s business’ and all that, but there really is no need to be so rude in most cases. 

Is it the Buddhists who suggest that kindness and compassion are everything. Now, that’s a noble aspiration for the new year ahead. I know that I, for one, will struggle. 

A vision for the future

We didn’t receive the cuts that we could have before Christmas under FEMPI regulations, with the promise of a new “fit-for-purpose” pharmacy contract being developed this year. We had, however, circa €28,000 in phased prescription fees cut in our pharmacy business, which is highly significant on our modest turnover. This unexplained cancelling of patient eligibility without engagement or explanation appears to have gone under the radar completely for our politicians and our Minister. 

“We have the people to deliver this”, one colleague had posted on a pharmacist social medium in relation to new contract negotiations, and this got me thinking. Credit whom or what you will for this pre-Christmas achievement, or rather a prevention of a further drain on community pharmacy resources, but we have little to show in terms of successes in the sector over the last 10-year period. A flu vaccination service as a professional service offers a glimmer of hope, although it continues to be a financial loss-leader given the cost of training, the cost of providing the service, and the poor remuneration paid following negotiations with the PCRS. Professional services should not be a loss-leader, so don’t even go there with me, in case that’s your retort. If nothing is sacred, then the sector is destined to the same fate as fast-moving consumer goods. As much (medicine) as you can, as cheap as you can and as fast as you can. 

Have we a situation where the profession is represented at the most senior executive levels in the Government? The absence of a Chief Pharmacy Officer representing the interests of pharmacists daily at Government level speaks volumes about the value seen in having that position. 

We have a single representative body for community pharmacists at present. Noting that previous behaviour is the best predictor of future behaviour, we can ask, does it have the capability, capacity and culture to deliver a robust new fit-for-purpose contract for community pharmacy, and the patients and customers it serves? We can ask, thanks to Beckhard, are there clear goals, roles, interpersonal relationships and processes in place in-house in order to deliver for us? We can ask, is there a culture of high performance where results follow from accountability, commitment and trust based on a culture of healthy, respectful conflict?

Of course, what we wouldn’t want in such an organisation is in-fighting at executive level, a culture of cronyism, an acceptance of mediocre performance in key roles, and an apparent unwillingness to hold people to account for poor performance. We wouldn’t want a metaphorical ‘circle-jerk’, a reluctance to listen to and objectively evaluate dissenting opinions, or the group-think, such as in Anglo Irish Bank that contributed significantly to our previous economic crisis. We certainly wouldn’t want a situation where pharmacists could be seen as a privileged, tuxedoed, chicken-dinner brigade, primarily concerned with their business interests over that of patient and customer care, on a win-win-win basis. We wouldn’t want a body that offers much in terms of photoshoots and press for the media, and much less in terms of results for the community pharmacists who pay in order to have their interests professionally, responsibly and diligently represented. 

We would want appropriate corporate governance and leadership. We would want a board that is holding the CEO and their executive team to account for their performance against set ambitious targets and metrics. We would want to see a demonstrated ability to build relationships, communicate effectively and influence policy at the most senior levels of Government. We would want to see an understanding of the perspectives of all the key shareholders clearly demonstrated, and those stakeholders engaging on foot of this. We would want the value of pharmacists as healthcare professionals and experts in the safe and effective use of medicines communicated clearly, consistently and concisely at every available opportunity. 

‘Good is the enemy of great’

Harry Hughes, Chair of the Hughes Group based out of Westport and employing 4,500 people worldwide and turning over €260 million, said their culture embraces a philosophy of “good” being “the enemy of great”. Where does that leave ‘average’, I would ask? To anyone who suggests, ‘well, things could have be much worse if I/we/they weren’t there’, I ask, would things have be significantly better if someone else was there instead? 

To those of you who rest assured of your own brilliance, then maybe consider the foundation for that opinion (see ‘circle-jerk’, ‘group-think’ etc above). To those of you who spend much of their time dismantling and finding fault with yourself, and your own opinion, then maybe it’s time to step up and back yourself. 

A fit-for-purpose contract

I’ve included three of the paragraphs below from the Minister’s correspondence for us to consider starting into 2020. 

“The Minister recognises the significant role community pharmacists play in the delivery of patient care and the potential for this role to be developed further in the context of health service reform and modernisation. Community pharmacy is recognised as the most accessible element of our health service, with an unequalled reach in terms of patient contact and access.

“The comprehensive review of the pharmacy contract in 2020 will address the role to be played by community pharmacy in the context of Sláintecare. It will consider all aspects of pharmacy service provision, including delivery of a multidisciplinary model of service delivery for patients, ensuring clarity of roles and achieving optimum value for money. 

“However, any publicly-funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services or provide better value for money or patient outcomes. Accordingly, any measures to be considered must be evidence-based.”

So meeting unmet patient needs, improving access to present services, better value for money and better patient outcomes. Evidence for these things, please? Anyone working in a community pharmacy has a sense of the value the service brings for patient care. Pilot trials in Ireland, evidence on initiatives through pharmacy from other jurisdictions and the significant impact of the vaccination service on immunisation rates appear not to have addressed the Minister’s concerns to date. Is it therefore a case of ‘There are none so blind as those who will not see’, as quoted to me by a colleague recently, or are there other reasons? Could it be credibility, relationships, communication skills, influencing skills, insufficient evidence, or another variable in the mix, as best efforts to date have clearly not been good enough. 

Good luck to all of us reading this for 2020 and beyond. We will need good luck, and much more than just good luck, if the future is to play out positively for ourselves, our patients, our customers and our communities.