Ultan Molloy considers the ongoing moves towards consolidation in the Irish pharmacy market

The big news this morning, at the time of writing, is that Haven and Total Health will be joining forces into the future for their membership, made up of 127 independent community pharmacy owners. With Uniphar acquiring the Hickey’s pharmacy chain (36 pharmacies), and Lloyds pharmacy (owned by McKesson, which owns United Drug) acquiring Median Healthcare Services (pharmacy services to residential and care homes), the trend of pharmacy market consolidation continues.

The opportunity to provide added value for end-users of pharmacy services should be more readily achieved through a buying group than is possible with smaller owner operators, such as myself. As of recently, neither Haven or Total Health have a recognisable national brand presence yet, based on Behaviour and Attitudes data, in relative comparison to, ie, Boots or Lloyds, so a clear customer value proposition will take further time and work to carve-out through their marketing departments.

Membership of a buying group is possible outside of symbol groups, although there may be an opportunity for vertical integration (ie, owning part of the buying group or platform) and economies of scale, in order to drive margins if you are in a symbol group. What happens to this additional profit and margin then is a key point, and needs to be considered in light of the additional costs associated with being part of the group.

While some consolidation in the market appears to be happening, the end game is far from clear

I can speak little to the technological advances that have been made behind the scenes there, as I am not readily privy to them. Dispensary software is out of the hands of any of the groups on the market at present. An EPOS system that is independent of the dispensary system, even with some API integration if that has happened, still leaves us with the basics of stock management to deal with, which is riddled with human challenges around consistency.

The fundamentals required in order to further unlock business and professional service level potential remain absent in community pharmacy. We do not have visibility of patient diagnoses, notes, lab results, an e-health record, or indeed a fit-for-purpose e-prescribing system, although thankfully technology has been embraced over the last year. Let’s see if the appetite is still there on the far side of Covid to engage with community pharmacists, to co-create a vision for pharmacy in primary care in order to do things better.

My scanned and emailed expression of interest to provide the elusive Covid-19 vaccination service through our pharmacy was met with a request for the paperwork to be posted in, lest the recipient have to print them out. I won’t be holding my breath, but then, you know me by now. So, while some consolidation in the market appears to be happening, the end game is far from clear. Sailing through the fog comes to mind, and this may be better than what is ahead of us when the fog clears.

Navigating the shallow waters

I am feeling both exhausted and frustrated. I’d love to have some energy to apply to our business that I could see delivering growth and development in the coming years. Working today, I felt again that I was being pulled in several directions at the same time. This multi-tasking can drive my anxiety levels through the roof at the prospects of a dispensing error, upsetting a patient, missing an important email to follow-up, forgetting to order printer toner (we couldn’t print our Healthmail scripts today… my bad… so €600 in toner later, it’s in the post with a couple of back-up cartridges), fielding queries from customers, colleagues, etc. You know the craic yourself, perhaps.

A Westport GP’s surgery is repeatedly sending us scripts with errors for a patient of theirs whom we care for. They are not responding to Healthmail or phone queries, leaving us unable to advocate for the patient, or to decipher what the patient is supposed to be taking. Where is our recourse here? Whose problem is it? We can make it the patient’s problem I suppose, and not ours.

Personally, I need a goal, and a line of sight on where I’m headed, in order to get energised. It needs to relate to the bigger picture, and make sense in that context. It needs to be more attractive than my present situation. It needs to make sense to me in some capacity, given what I think I ‘know’ of my own experience. The Dunning-Kruger effect being no doubt alive and well, the ‘not knowing’ what’s in store for us continues to create a vacuum of stress, anxiety, and frustration. It feels disjointed. Disconnected from what could be more accessible professional patient care and outcomes in the primary care network. Local pharmacists are not part of the primary care teams either. Disconnected there, too.

Over the hill

While workplace discrimination can start as early as 35, ageism experienced from the age of 40 isn’t unusual by all accounts. Having recently turned 45, this doesn’t have me feeling like the future is bright, and sure I’ll just do something else if this pharmacy thing doesn’t work out. It feels like I have mentally slowed down to a grind. Well, it certainly seems a lot ‘foggier’ than it used to in the distant past, from what I can remember of it. So, when it comes to what I’ve been plugging away at for the last 25 years, should I ‘go big or go home’, or just get out of it while I’m still ‘young’? Ha — still young indeed!

My other job as personal assistant to two pre-schoolers and a toddler has me understanding with crystal clarity why nature designed us to be fertile from a young age. Societal and career expectations have many couples finding it challenging to get pregnant in their mid-30s. It doesn’t ‘just happen’, as many of us know. Having spent many years with the ‘making sure we don’t get pregnant’, it is more than difficult for many to deal with pregnancy not readily happening after the metaphorical goalie has been taken away.

Often, when the ‘trying’ stops, the pregnancy happens more readily. Correlation and causality and all that; however, we are clearly much more complex than simply functional clusters of biological material.

A changing workforce

We have future pharmacists coming through with expectations that may not be readily fulfilled. Autonomy, mastery and purpose come to mind again as drivers of workplace satisfaction and fulfilment. The workforce that are coming through are less likely to just ‘suck it up’ if the work and conditions aren’t working for them personally. Reading about a consultant pharmacist lead for one of the NHS boroughs in the UK had me considering the limited career progression options that pharmacists appear to have in Ireland. Perhaps I’ve become blinkered to the opportunities and comfortable in my inertia? I need to do some more thinking on that one; or perhaps someone will call me to enlighten me on that matter.

We have a lot of pharmacists leaving the profession at an early stage. A sense of ‘this isn’t what I signed up for’ comes through anecdotally, although (see above), I am not best placed to discern the needs of our future pharmacists. I have had a number of requests to complete surveys on this topic from third-level students and elsewhere, and am yet to see what the results show, and what measures are being put in place to develop and safeguard a future of the profession. What’s the vision? Where is the vision?

Pharmacists are the most trusted professionals, as shown by a recent IPSOS public poll, which is lovely to read of course. However, the trust and professional respect we are shown by other stakeholders often leaves a lot to be desired.

Summer is nearly here!

It will be May when you are reading this. My prediction a couple of months back that we would be flooded with vaccines at this point has not likely come true. My optimism has been worn away by this ongoing shitty virus that has removed many of my opportunities for joy outside of our home environment. ‘How can I miss you if you never go away?’ comes to mind here, when it comes to us having some quality family time away from one another!

We have been very lucky in our work to have kept our businesses open over the last year, unlike many others. Friends in New Zealand and Australia are returning to life as normal, including social gatherings, but I really cannot trust any timeline for a return to normality, even with the worst-case scenario in my head, for fear that our Government or safety/supply issues with vaccines will mess it up.

I shall be optimistic, however, that I am completely wrong in this case. That we will all be pleasantly surprised from now on with how things play out with vaccine supplies and vaccination roll-out through pharmacies. We’ll all be swigging our favourite tipples at social gatherings, hugging everyone who will bear our advances, and having the craic like never before in mid-summer 2021. Wishing you the best as always.

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.