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Well, how’s everyone! Great to be back from my holidays at this point… I wish! Taking a break last month from writing a piece was as much due to overload as to lack of inspiration. Work ‘on’ your business, not ‘in’ your business the wise man, or more likely woman, once said. Not really an option at present, is it, for many proprietor pharmacists. I can’t remember what I wrote about the last time, but we limped through the ‘festive’ period and into the New Year on about 50 per cent staff, thanks to Covid, close contact rules, etc, and our team were mighty. This was at a time when November was the busiest month since we opened in terms of items, in both pharmacies, and December and January didn’t let-up much either with high prescription volumes, counter consultations and Covid vaccinations. I’m exhausted reflecting back on it, and I’m just exhausted. 

It’s an employee’s market somewhat at the moment, although perhaps not as much as my anxiety and burnout are telling me. My fear, to be clear, is that the business will no longer be viable due to increased outgoings. I will have failed my family, and have no income, and a bucket-load of debt! The Fitzgerald Power Irish Community Pharmacy Wages Report 2021 shows average weekly earnings across the board up 5.4 per cent in 2021 on 2020, and average hourly total labour costs up 3.2 per cent. Wages can account for upwards of 25 per cent of the total cost base for running a pharmacy, and with some locum agencies whipping-up a frenzy of far green hills and ‘all you can earn’, it has been difficult to take stock and manage that feeling of things becoming out of control, the impending financial pressure, and the skilled workforce pressure. The average hourly pay rate for locums in Connacht/ Ulster appears to be around €35ph (from €25ph upwards), with it increasing to €45ph for Munster, and €50+ ph for Leinster/Dublin. It’s not immediately clear to me if that’s inclusive through payroll, or before holiday entitlement, etc, but I’m assuming it’s before 11.05 per cent employers’ PRSI. Anyway, so why does this matter, says you. It matters because the higher/highest rates of pay for pharmacists could make more pharmacy businesses unviable. ‘But sure, haven’t you been cleaning-up for years?’ Not quite, for the last number of years, and the stress and uncertainty associated with being an employer vs the present return on that investment, and time to enjoy it, has me seriously questioning why I’m bothering. My three-year-old is repeatedly asking me to come home when I’m on the phone, or not to go to work in the morning, as I hadn’t seen her at all the previous day, given an hour-long commute each way. This has me questioning my priorities, and why I’m bothering at all. I’m reminded of a colleague saying to me recently that being an owner, being a manager and being a pharmacist are three different jobs. 

My fear, to be clear, is that the business will no longer be viable due to increased outgoings 

Anyway, let’s take a pharmacy on €1m turnover, so about €3k a day turnover, allowing for Sundays. Let’s assume a 45 per cent margin, as I think I may need to consider raising some prices; that gives the business €1,350 in profit to cover expenses for that day, and indeed, daily over the year. If the pharmacist gets €50 per hour for their nine hours, that’s one-third of that gone already. That’s before c. 8 per cent holiday entitlement and c. 11 per cent, so that’s another €90. Total cost to the business is €540 of that €1,350, leaving €810 before anyone else is paid who’s working that day, their 8 per cent holiday, and 11 per cent employers’ PRSI to be paid by the company, loans, rent, professional fees, overheads, etc. It doesn’t add-up to anyone in their right mind taking a day off, or does it? €35 per hour inclusive and you’ve left most of €1,000 to cover other staff and business outgoings. The tax system also creates an anomaly here, in that if someone on €12 per hour gets another €1 per hour, most of the extra €10 per day that they own ends up in their pockets. If someone on €39 per hour gets another €1 per hour, half of the extra €10 or so per day ends up with Revenue in tax. So, are we being forced to choose between the impact of increasing the rates of lower-paid workers and have more day-to-day support team members, and contain costs at the upper end of the hourly rates? The upper end, where disposable income is more plentiful, and half of any wage increase through inflation or otherwise ends up being paid by the recipient in tax. The ‘cost’ to the business, the team and the customers is more than just a monetary consideration. 

The work is complex in the community, and having been abused and lambasted for suggesting that some locums offer limited value past keeping the doors open for a day, I won’t be suggesting any such thing here. The word ‘some’ was very much overlooked the last time. Indeed, I was somewhat mercenary in the past before I moved from employee to employer, through a combination of entitlement, youthful arrogance, and a value vacuum in my make-up that had me that way. It felt like the only satisfaction I could get out of many a day’s work was looking at the bank balance afterwards. I’ll have to do some thinking on that one. I realise now also that as an employer, I am not entitled to have things the way I want them or feel they should be, ‘just because’. 

Can we do better as employers, past ‘throwing money at the problem’ in order to make working in community pharmacy more attractive? The wages report mentions additional benefits available to employees, such as company pension, sick pay, employee health insurance scheme, and paid maternity leave. Percentages for these four are c. 46 per cent, 22 per cent, 3 per cent and 8 per cent, respectively. I’ll need to take stock when we get some visibility on our 2021 accounts and see what we can do to make things more attractive and equitable for our employees based on predicting consistent annual recurring income. I don’t know what we will do, or indeed what we can do. I’m apprehensive about it too. It’s a lot easier to put benefits in place than it is to remove them when things get tighter down the line. Much like when one puts wages up, or if you try to put them down. The experience is very different for everyone involved. 

A Swedish colleague with whom I worked with in Hammersmith Hospital in London over two decades ago and I were chatting recently about the eight paid sick leave days a year offered in the department, and how they were seen, across the board, as an additional eight days’ holidays. It just takes one or two people to start regarding them this way, and the house of ‘loyalty and commitment to the team’ cards falls to the lowest common denominator. 

The pharmacist shortage has been in the national media in recent days as I write this. I’m not sure if it strikes a chord really, or if anyone cares, past those of us who are actually feeling the impact day-to-day working in the sector. How long has the writing been on the wall for this, I wonder? Third-level places allocated to pharmacy being used as stepping stones to other degrees such as medicine, or finding one’s feet, or one’s full self. I don’t know. I didn’t know what I wanted to do ‘when I grow up’ when I was 18, so I don’t lay the blame there, although I’m sure more could be done to educate potential pharmacy students about what they’re getting themselves into, and to streamline selection for places to study pharmacy in university. 

What would make community pharmacy more attractive as a profession? It’s a complex, community-based, patient-facing role in most cases. You’re working as part of a team, required to manage that dynamic, deal with ongoing interruptions, and yet show attention to detail, diligence, and problem-solving skills. “You have to be able to plamás them,” a pharmacist colleague suggested recently, that it’s all about winning people over, and those relationships. Where would you even start when making such a person with these required skills and attributes? 

The IPU/B&A January 2019 Perspectives in Community Pharmacy report shows job satisfaction is low in community pharmacy, at 5.4 out of 10, or 54 per cent. The interactions/patient care/helping/rewarding / being part of a team offering the most satisfaction day-to-day. Excessive regulation/paperwork/red tape/long hours/ no breaks/public respect/recognition offering the least, and making the role less attractive. Just one-in-three would recommend community pharmacy nowadays (three years ago), and one-in-three are optimistic about the future. It’s not great, is it? ‘What’s been done about it over the last three years?’ is another question one could ask. That could be a question for consideration in the next IPU/B&A survey, or the PSI’s annual report!