A LOT OF PEOPLE ARE CREAKING UNDER THE STRAIN OF THE LATEST LOCKDOWN EXTENSION, WRITES ULTAN MOLLOY

As I write this, I’m told that we have another five weeks of lockdown to look forward to. The craic has well and
truly gone out of it for us. We have had the luxury of getting to know our toddler and two pre-schoolers a lot better, but the roller coaster that is a day trying to care for them has my nerves fried. The appearance and temperament of some young parents who present to the pharmacy counter is a lot more understandable now.

Small gift packs of valium and brandy are not an appropriate offering of course, although one can understand why some appear frazzled, unkempt and detached, while others are full of the joys for having been able to escape for a short period of time ‘for themselves’ to do the chores.

I have a lady in mind when I think about this. She had four young children when we opened in Ballindine, and was regularly getting prescriptions for benzodiazepines. She is no longer getting those. She is still a customer with
whom I regularly exchange pleasantries. It’s like dealing with a completely different person. Such is the challenge of how we see and support one another when going through mental health challenges.

HOW’S THE HEAD?

Two friends had need of support recently. One attended A&E, only to be sent back to their GP. I am told that several calls to Pieta House that evening went unanswered. Family not understanding or denying their issue, and perhaps the unpalatability of it all, meant home support was negligible. It’s presently in hand through
adult mental health services and their GP, although their day-to-day must be very challenging. I know from previous experience, it is.

Another friend asked me did I know if the local GP practice had shut down. Having emailed them twice regarding another prescription for antidepressants, having spent a weekend in bed, several initial phone calls were unsuccessful. He has subsequently been medicated, although availability of support outside of medicines appears to be beyond his present means. We have had a family member who was a ‘frequent flyer’ with mental health services for years.

Several suicide attempts, combined with alcoholism and mental health issues, made life very challenging for all around them. The experience of supporting this person (I’m told) was hugely frustrating, with often a ‘why don’t they just stop drinking’ type rebuff thrown their way when help was being asked for through mental health services. It’s just not good enough as a society, or as a health system supposed to support those with mental health issues.

As the most accessible healthcare professionals, let’s try and be sensitive to what is going on for our patients and customers. Let’s be kinder to our teams, and to ourselves. We have a way to go, and just as the sun is shining outside, there is a light at the end of this.

ROLL ON THE ROLL-OUT

So the news continues to describe the debacle that is the roll-out of the Covid-19 vaccination service. The absence of a Chief Pharmaceutical Officer, which no-one seems to yet be advocating for incidentally, is entirely apparent. Underpromise and over-deliver, or even promise and deliver, would have been entirely preferable to
the present over-promise and under-deliver scenario. It is distressing and confusing for members of the public, and absorbing time and resources dealing with queries, and yet we are ultimately in the dark. How can we trust
what we will be told, in any case? Would you want to take responsibility for passing on HSE promises to patients at this point?

Initially, pharmacists expect to be involved in the vaccination roll out with GPs. Then a former Irish Medical Organisation President who has been no friend to pharmacists and pharmacies appears on the ‘National GP HSE Covid-19 Advisory Body’ and it transpires that GPs will be vaccinating all of the over-70s. No mention of pharmacists and parity, even though a vaccination is a vaccination, and pharmacists are more accessible and available to patients than GPs by a country mile. Pharmacists’ ability to influence at the top table has been clearly
neutered for decades, given an apparent inability to build and maintain the requisite key relationships, a culture of inertia in the health and civil service, the disproportionate influence that GPs appear to have on internal HSE
thinking, and the lack of a Government vision for the pharmacy network.

Thankfully, there has been some progress over the last year, and sincere thanks are due to everyone involved. Proper remuneration for us to resource a public vaccination service is an excellent starting point and has significant scope to be extended, with a bit of common sense and foresight. Oral contraceptive pills
available through community pharmacies, a minor ailment scheme, new medicine scheme, chronic ailments management, anticoagulation clinics, pharmacist prescribing, and many other services could readily be rolled-out by us, the most accessible healthcare providers in our communities. We have the evidence of impact on patient care and the appetite is there on the pharmacists’ side. So what’s the hold-up?

No one profession owns patient care, or the patients. Pharmacists have a ‘clinical’ role, in that they come face-to-face with patients daily. That’s what ‘clinical’ means. Patient-facing. That word isn’t owned by any one profession. Pharmacists also diagnose. We have a range of OTC medicines to treat patients. We have to have the requisite skills and experience to diagnose, ie, ‘identify the nature of an illness or problem by examination of the symptoms’ when patients present to us. We have to have these skills in order to know when to support them with OTC medicines, when to advise them, and when to refer them elsewhere.

ANYONE FOR VACCINATIONS?

I registered for my Covid vaccination some weeks back using a link that a colleague sent on and was then advised that said link was invalid for pharmacists. Then I got an email a fortnight ago to register again using a fresh link. I did, and got a message to say that the HSE would be in touch. After that, I got another email last week from the local health office. I could see everyone listed on the email as it wasn’t blind copied. No sign of the other four pharmacists who work with us, three of them being vaccinating pharmacists, and I see names of retired pharmacists listed. I contacted the HSE and was told that they got their information from the PSI.

The register. Christ. Clearly not the most sensible place to get local information from, when a couple of hours phoning the local pharmacies would get detailed and accurate information on the pharmacists working there, and who would be vaccinating. Anyway, so then I go and register for the Swiftqueue system, as it’s not integrated with the HSE system, and finally I get booked in for a vaccination an hour’s drive from where I live. I get a text. It’s good to be booked in. Hurray!

Then emails come through from both the IPU and through Healthmail from someone else in a local HSE office advising us to complete and return forms in order to get vaccinated. “No form completed, no vaccination.” This
is after having received the above confirmation text, so now the question is, do I now need to complete paper forms also? I’m told by email I don’t have to. Fingers crossed, when I have arranged pharmacist cover for my vaccination this coming week, I will actually receive a vaccination on presentation at the hospital clinic.
I think that I am relatively computer-literate and communicative. Can you imagine what could be ahead for patients you try to book? Yes, the mess of all this may well be just beginning.

Hopefully not. The UK are three months ahead of us vaccinating and I have friends in Australia and New Zealand who are back to normal life. Another five weeks. Let’s hope we surprise ourselves and indeed everyone else with our efficiency when we get the Covid-19 vaccination service ramped-up and available through community pharmacy.

SOCIAL MEDIA

So, offering strong opinions that may insult or offend someone can get one in hot water, it appears. I had an acquaintance who was elected to a Government board last week for a few hours, before he got a call to say that comment(s) in his social media stream were inappropriate and unfitting for someone who was to be the chair of a State board. I don’t know the comment, or condone it either way, but it really is a sign of the times.

One has to be appropriate publicly, like when one is arrested in the US, ‘what you say can, and will be, used against you in a court of law’. Being beyond reproach is a high bar, isn’t it? No allowance for articulating one’s frustrations, lest they offend or upset someone directly or indirectly. What we say can be so readily misinterpreted also, and one can be held responsible apparently for the interpretation of others too. It’s not a particularly empowering position, is it?

While pointed attacks are not particularly helpful, neither is publicly whinging about our present position in relation to the vaccine roll-out. Calling bullshit on protectionism and limiting paradigms, developing a shared vision for the pharmacy network, winning the trust and respect of those who influence policy, and
building those relationships over months and years, behind closed doors, is what will move our profession forward.

‘ARE YOU AN INDEPENDENT PRESCRIBER YET?’

I trained in the UK, completed clinical training in hospital, an MSc in Biopharmacy, and worked as a senior pharmacist in ‘aseptics’ in a large London teaching hospital, and came back to pharmacy in the dark ages in Irish hospitals. A supply function, filling boxes, and answering the odd supply chain query from a nurse on the ward. Things have progressed somewhat since 2000 in Ireland in relation to pharmacists’ clinical involvement in hospitals, ‘clinical’ in this case referring to patient-facing as is its definition. A word so often used and abused in order to control patient care, to suggest a hierarchy of importance or indeed ownership of patient care. I’m not convinced they have progressed significantly in community pharmacy either.

Why do so many pharmacists, having gleaned five years of knowledge and training in order to look after patients, return to college to study medicine, or leave to pursue other careers? We simply cannot put our best foot forward
daily for patients in the present system. The untapped potential is frustrating, and the present debacle with the vaccines tells a story of how pharmacists are seen by those (primarily) middle-aged men, many with medical degrees, determining policy in the our health sector.

There is clearly no-one in place with a vision for pharmacy in the Department of Health. Yes, I’m feeling frustrated and undervalued, but the future can be made brighter for all community pharmacists, community healthcare providers, and ultimately for the patients who want accessible, professional healthcare and advice. Anyway, so my college friend in Wales, who incidentally has worked alongside checking technicians for years now, asked me yesterday in a text, “am I an independent prescriber yet?” A what, you may ask, as did I. So he tells me it’s “where you do a masters in prescribing and run clinics like a GP.

The Government are really pushing us to do it. They basically want dispensing to go to Amazon or similar, shut hundreds of shops, and whomever is left will become prescribers due to the lack of GPs. In five years, all students leaving uni will also be prescribers.” Now, how’s that for a future to look forward to for patients or pharmacists? While pharmacists having a prescribing function would be invaluable for patients, potentially less accessibility is not what anyone should want, when we have the most functional and cost-effective part of the health system infrastructure already in place.

THE HOME STRAIGHT

It doesn’t feel like it sometimes, but I’m optimistic we are on the home straight with the effects of the pandemic in Ireland. The days are getting longer, the weather is improving, and children will be back to school soon. I suspect
that most pharmacists reading this will be vaccinated by the time this is published, and I predict that we will go from a very limited vaccine supply situation, to an excess of vaccines in hand in the coming months! We will then soon be saying to one another, over the two pints each we have ordered when the lights flash for closing, ‘isn’t it better to be looking at it, than looking for it!”

Ultan Molloy
Ultan Molloy

Ultan Molloy is a business and professional performance coach, pharmacist, facilitator and development specialist. He works with other pharmacists, business owners and third parties to develop business strategies.