Comparing the IPU to the IMO in terms of what has been achieved is a complex matter with many nuances, writes Fintan Moore.

The quote above by the popular rugby referee (an oxymoron if ever there was one), Nigel Owens, was uttered by him during a match involving an Italian player who was consistently questioning decisions with an absence of the respect typically shown to officials by rugby players. Soccer players get a lot more leeway to complain, and they frequently surround and badger the referee, so Nigel reckoned this particular mouthy Italian needed reminding of what shape of ball he was playing with.

When reading some of the online commentary about the performance of the IPU leadership, there seem to be a lot of comparisons to football managers, so it’s worth pointing out that pharmacy is not soccer either. The kind of stuff I’m talking about is pharmacists surmising whether the people in charge of the IPU have been like Arsene Wenger or Louis van Gaal, and if the IMO has been managed more like Manchester United under Alex Ferguson. You get the idea. For the large number of pharmacists reading this who find soccer as interesting as watching paint dry, the above translates roughly into English as ‘Arsene Wenger was a nice guy who had a decent record with limited resources’; whereas Ferguson ‘had an abrasive manner but won lots of trophies with lots of resources’, and Louis van Gaal ‘won nothing with lots of resources’.

Stretching any of this to see something usefully relevant to pharmacy takes the kind of mental acrobatics that are beyond my tiny mind. But then, when it comes to the world of pharmacy, lots of comparisons break down really quickly.

Pharmacists look enviously at the seemingly vast wedges of cash being shovelled at GPs and wonder what the IMO is doing ‘right’ that the IPU is getting ‘wrong’ when we can’t even get FEMPI reversed, despite years of political promises. There are a couple of obvious points be made here, one of which is that enough GPs were disgruntled in recent years to form a breakaway ‘union’, the NAGP.

It was a disaster which quickly crashed and burned, but the fact that it ever slouched to Bethlehem to get born suggests a significant degree of discontent. It’s also true that GPs are exiting the profession and when they
leave, replacements are hard to find, especially in rural areas. The problem of finding locum cover is as big for GPs as it is for pharmacists.

The other thing about doctors generally, and GPs in particular, is that they all stay on-message. It doesn’t matter whether they are starting out as young GPs with loans and overheads and not much else; or if they’ve done well for decades and earned a stash. They will all react the same way when you ask them how the job is going — even a GP who has just flown back from a golfing break in Florida, and driven his Merc back to his six-bedroom house wondering where to book for skiing, will adopt a pained expression and with a rueful shake of the head tell you that things are getting tougher all the time, and the HSE is demanding more and more without giving the necessary resources.

They are so consistent with this mantra that maybe it could actually be true. What GPs definitely don’t do, unlike some pharmacists, is have leaflets dropped door-to-door by the thousands saying that they’re happy to work for less than other GPs, and to ring them to see how much less a consultation will cost, while reinforcing that message with full-page adverts in newspapers.

The money-counters in the HSE and the Department of Health do actually read, so when they see this stuff, it’s easy to see why they’re not falling over themselves to reverse FEMPI for pharmacists.

Vive la France

There was an interesting league table recently produced by the IMVO comparing the compliance rates with FMD requirements across the EU. If there is one single issue that unites this country’s community pharmacists in simmering resentment, I suspect that having to scan medication packs at the time of dispensing is high on the list, so it’s hardly surprising that Ireland had a decommissioning rate among the lowest in Europe, at about 40 per cent, whereas some countries have rates up above 90 per cent.

The more interesting figure was that France is down at 2 per cent, so I wonder how come they can get
away with that. Maybe French pharmacists are like their farmers and blockade roads with burning tyres if they get messed about by the EU.

Joking aside, this is not a trivial issue. Irish pharmacists aren’t just complaining about this for the sake of it, or because we’re resistant to change. The simple fact is that we are consistently told to limit distractions during the dispensing process, so that is the worst possible time for us to have to scan packs. The risk to patient safety could not be more obvious, which has been highlighted from the beginning of this process by reasonable, conscientious pharmacists.

At the very least, a Risk Audit should be carried out by a suitable review group before the end of the ‘use-and-learn’ period in March 2022.

This may be a battle that was already fought and lost, but just because a risk can’t be eliminated doesn’t mean it shouldn’t be analysed.

Furthermore, it makes no sense to end the ‘use-and-learn’ period next March because for the last 20 months, we have not been working in normal circumstances, and this is unlikely to change between now and then. For Covid safety reasons, we haven’t been required to get signatures from patients on LTI, DPS, High Tech or methadone receipts since April 2020.

This has freed-up staff time at the point of dispensing to permit FMD scanning of packs, but when normality resumes, we will presumably be again required to spend time bringing receipts to patients to be signed, which obviously also has to happen at the point of dispensing. Has that extra workload been factored into the decision-making on this?

If we’re to be compared to other countries in Europe, it’s not fair to use a blunt metric of decommissioning rates without giving us context. The following questions need to be answered:

In other jurisdictions, are medication packs scanned only at the time of dispensing, or at other times?
What countries have original pack dispensing?

Do other countries require pharmacists to process prescriptions under several different schemes, and do pharmacists have to check patient eligibility before dispensing?

Is receipt-signing standard practice across the EU?

What countries have a simple dispensing fee with no ‘private’ business? What financial supports for scanning exist in other countries? All this information should be readily available — let’s see what we can learn from the A-students. Wishing you all a happy Christmas, and best wishes for 2022.

CONTRIBUTOR INFORMATION

Fintan Moore graduated as a pharmacist in 1990 from TCD and currently runs a pharmacy in Clondalkin. His email address is:
greenparkpharmacy@gmail.com