Ultan Molloy does some soul-searching and asks the question, what exactly are we ‘entitled’ to in life?
This is a word that has come to the fore of my thinking in recent months, for a number of reasons. I have been on the receiving end of tantrums from our toddlers, other pharmacists (employees and owners), customers, and indeed I have been known to partake from time-to-time myself. So, what’s it all about?
Laura, as a medical device engineer, has found the attitude of some pharmacist locums and employees in terms of facilitating contractual arrangements frustrating to experience, and seemed to come from a place of entitlement. My follow-on to the preposition was to look for clarity on what that meant, and it has led to an amount of soul-searching for me on many fronts.
We have a high value on education in the household I grew up in. Both of my parents are teachers, and they continue to do so, whether you want to hear it or not! What’s washed-off on me, and my ego, has been a thirst for knowing and perhaps an underlying sense that the more I know, the more I will be… fill in the blank — loved, respected, admired, etc.
A number of college degrees later, I’m considering the volume of what will not be known, and the opportunity cost that is involved in gaining some more letters after one’s name, or another qualification.
What has come clear, and in line with a healthy ‘attitude of gratitude’, is that there is very little that we are actually truly entitled to in any aspect of our lives. We still have people who are starving to death in the world. I’d imagine that they’re not feeling entitled to food and nourishment. How would you feel if your hot meals were taken away indefinitely? Consider your relationships, your financial situation, your health, and perhaps your business in the same context, and I, for one, found the whole exercise quite wholesome.
We have 28 per cent of the country’s workforce officially unemployed, I heard one source cite on the radio. Are they entitled to a job? I’m sure after studying for a number of years, many of them feel that they are. That the situation is unfair. Do we expect things to be ‘fair’, and are we entitled to ‘fairness’? This word seems to come up in discussions around payments to pharmacists and pharmacy contractors.
Recent months have taught me that we are not entitled to a reasonably well-paid job in a comfortable working environment. We are lucky to have one. We are not entitled to a roof over our heads, hot food, our health, a loving family, or even to grow to full-term in utero, as has been facilitated in recent months in our country.
Having opened a new retail community pharmacy business last September, I realise now that we are not entitled to the local business. We will have to win it if we are to get it. Just as the two incumbents aren’t entitled to hold on to their present customer base. Likewise in our other pharmacy, we are not entitled to repeat custom and the time I’ve had to engage with customers in our new store has shown me we can go a long way further to ensure our present customer base feels better cared for in our other store. Not being merely a ‘conduit for drug delivery’ is going to need to be brought to the fore in our future community role, if we are to get a reasonable contract. I’d like us to get what I consider to be a reasonable pharmacy contract that will support our business, our team, our customers and my family, at least to the level it is at the moment. A contract that I consider to be reasonable may not, however, meet what is delivered. I hope that we prevail and grow in both our outlets, all the while remembering (to paraphrase Mary Harney some years back) that “the government isn’t responsible for poor business decisions and investments by pharmacists”. “Poor” being defined in hindsight, of course, as often as luck and ‘success’ are lauded without a robust foundation.
‘They just want their medicines’ is far too simplistic a starting point. A basic service level of safe, effective medicines at a reasonable cost (not the cheapest, not the most expensive, is ‘reasonable’ to my mind), and when they need them, is what a UK chain operator suggests their customer wants. Better? Do they want a relationship? Do they want to feel cared for and understood? Do they want fast service, more information, or a bit of both? Do they want 30s, 31s of everything, their tablets split for them, or coated tablets so they don’t get stuck in their throat? Do they want strawberry rather than vanilla-flavour nutritional supplements? Do they want cheap medicines, and yet have access to the local pharmacist whenever they want them for chats about the medicines they brought back from Spain, or when their child is sick?
As our toddlers are starting to learn, what you want and what you’re entitled to may not always match-up. It’s perhaps time that some of the rest of us started to understand that as well. That we showed some gratitude and appreciation for what we have, and made an effort to understand where the value really is.
We will have a new pharmacy contract, sometime, I’m sure. The customers who appreciate and get the most value out of our service, ie, the elderly, those with chronic and debilitating illness, and those other regular visitors to our counters who need us for social and emotional support will not be the ones who are drafting our new contract.
Our starting point is clear. Our value isn’t.
1. There are enough pharmacies and community pharmacists to serve the Irish population as things stand, with ready access to a pharmacist and long opening hours. We could probably manage with fewer. Patients get their medicines quite quickly now, and price competition has been good for the public, and maybe the fact that these things will become an issue doesn’t mean that they’re an issue now.
2. With over 80 per cent of medicines dispensed under contract to the Government, the Government has the power. The politicians will argue that the Irish people are entitled (there’s that word again!) to the best value for their money. Fast, cheap medicines is as much imagination as has been shown by any politician in relation to community pharmacy in the last 10 years. Perhaps because a healthy 30-, 40-, or 50- something is coming from a point of view where fast, cheap medicines is what they would most value themselves. They are not one of the complex cases of comorbidities, specialised medication regimens, medical devices, complex delivery channels with intensive professional support, care and counselling that is supported by a €3.50 dispensing fee on a box of aspirin. This is at a time when some pharmacists’ wages are costing businesses in excess of €50 per hour, and that’s before all the other overheads. Oh, and by the way, that comes out of the profits; to clarify for Fergal Bowers and co, those are the differences between what we purchase things for, and what we sell things for.
3. What we do at the non-patient-facing end of the retail community pharmacy business does not have any demonstrable and experiential value for someone presenting to have a prescription dispensed. The ‘why is it taking so long’ is as much a result of us poorly managing customer expectations, as pharmacy market competition turning the sector into a fast-moving-consumer-goods model. Why is it that patients will wait two days for a even-minute slot to see a GP? They’ll wait months and part with €200+ for 10 minutes with a consultant, after taking a day off work to do a three-hour return trip. We know some of the ‘why’, don’t we? Specialist knowledge, perhaps. We have some of that, don’t we, or at least we used to? All the while, 10 minutes can be too long to wait for a prescription for some customers. Some of us really have given them a stick to beat us with.
I’m not optimistic about our new pharmacy contract. I believe that the horse has bolted for the most part, and our professional service in communities has become a retail business, rather than a community pharmacy. The fundamental issues of demonstrating clear value for many of our service users, and return on investment for the PCRS, remain poorly answered, if at all.
The power lies elsewhere and knowing who has the power at the start of a negotiation is fundamental. “It’s not fair, we are entitled to… ” some pharmacists may say. Who said it should be fair? Just because you think you’re entitled to something because you’ve a certain level of education, or have invested tens of thousands to set up a business, doesn’t mean that you are. Pharmacy owners are not entitled to any particular return on their investment, however much they may feel that is what they had expected, hoped for, or deserved.
We have often taken a back seat to GPs in primary care, covering ass when errors occur when we have some indication of the patient’s ailment and prescriber intention, and ‘sucking it up’ so as not to upset sometimes fragile egos or abrasive administrative staff since the inception of the last pharmacy contract. Where does the power lie there?!
Pharmacists have specialist knowledge in terms of clinical and professional knowledge, as well as of the trade, and running a pharmacy in all its increasing complexity. So, why is this so poorly understood and poorly demonstrated? How do we represent ourselves and demonstrate this, to one person at a time, so that the future can be brighter for our service users, our teams, our profession and ourselves? That is the question that needs to be answered.