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Twenty Years Of Pharmacies Being Under-Valued And Unappreciated By Successive Governments Is Coming Home To Roost, Writes Ultan Molloy.

So I’ve been listening to the Against the Rules with Michael Lewis podcast of late on my journeys to and from work. It explores the idea of fairness in various different situation, starting off with referees of sports events. Not a job that I’d want. Having listened to the episode, it appears to be an increasingly difficult role and while the standard of refereeing has got much better, incidents of dissatisfaction and blaming the referee for errors or misinterpretation have increased dramatically. I have heard stories about kids’ parents getting sideline bans for being abusive to amateur GAA referees at kids’ football matches. It can all get a bit heated sometimes, can’t it. 

What’s fair for community pharmacy and our patients? It’s clear that primary care investment is headed to one place. GP practice payments and allowances were €453 million in 2014, and were up to €797 million in 2020, a 76 per cent increase in six years, and yet we’re seeing more and more patients at the counter ‘who can’t get an appointment with their GP’, for free? No, it’s not for free, we’re paying for it, and what has happened to pharmacy income from the Government schemes since the cuts to payments in Pharmacy since 2010? It’s not fair, is it? Perhaps we need a referee! Is there any point through, when we’re not even in the game? There is still no Chief Pharmaceutical Officer in the Department of Health. So no feet under the table there. 

GPs get locum expenses, paid annual leave, sick leave, parental leave, maternity leave, staff wages paid, locum expenses for attending some meetings, out-of-hours payments, and even their indemnity insurance rebated.* I just paid over €5,000 last week, up c. 50 per cent in the past five years, to cover one pharmacy’s insurance. 

Meanwhile, back in the pharmacy ranch… well, I really think we are deluding ourselves if we think that anyone in Government truly thinks that community pharmacies are an integral and valuable part of the primary care network in this country, or has anything that resembles a vision for its future. All the signs are on where the priority is seen to be, given where resources are being directed. And we wonder why pharmacists are finishing college and then going back to study medicine. It reads like it’s a wise move by all accounts, doesn’t it. 

You get more of what you reward. It’s repeatedly proved in studies. It’s human nature, clearly obvious with adults as well as children, and certainly true in business. 

Pharmacies are incentivised to sell and generate prescription volume, when we could be incentivised to reduce medicine usage and volumes, and spend more time with patients. Much like GPs are incentivised to have large GMS panel numbers, but clearly not particularly incentivised to see patients. Even the six-monthly medication reviews that could be appropriately done through patients’ pharmacies are now listed as being done by practice nurses and GPs as part of the HSE’s Chronic Disease Management Programme ran through GPs that is being rolled-out. Pharmacists are out in the cold on that one too. We really have had fantastic influence and representation of the profession at Government level for the last 20 years, haven’t we? All the signs are on the fallout of this now, with a pharmacist recruitment crisis, and net closure of community pharmacies in the first quarter of 2022 for lack of viability. 

It’s clear that primary care investment is headed to one place 

What a legacy. How many of us need to close, though, for it to be ‘an issue’ for patients? Patients are saying to politicians, ‘I can’t get a GP’, but I suspect there are very few saying, “I can’t get a pharmacist’. As I said, you get more of what you reward. 

Many pharmacies have reduced opening hours, sensibly now closing for lunch, and others started closing on Saturdays with cover unavailable, and withdrawing discretionary services. Hopefully the circle-jerk has ended in HQ. Not good enough. And yes, I know a decent fee for vaccinations is something, but it’s not steady income to plan and run a business on, and does not address the fundamental issues above. No sign of a new fit-for-purpose pharmacy contract either. 

Pharmacists need to be paid out the primary care budget as well as, if not instead of, the drugs budget. Pharmacists need to be incentivised to offer a greater level of clinical services to patients, as the most accessible healthcare providers in our communities. Don’t give me this ‘it has to be cost-neutral’ sh*t, or be for additional services, when our patient-facing work volume has increased dramatically in the last number of years. Throwing money at GP practices clearly isn’t working in primary care for patients. Perhaps it has all been too polite at the ‘negotiating table’. 

It’s important to note that many GPs offer an excellent and accessible service for patients. Our relationships with GPs and their surgery teams ranges from delightfully professional, respectful and engaged, to being on the end of bigoted, conceited and obstructive communication and behaviour from a few individuals. ‘Colleagues’ indeed. We have no recourse to address the latter, unfortunately, other than one which would involve a punitive outcome for our business. 

Presently, we have no referee, though, in the Department of Health. We have no ongoing representation either. We have no vision for community pharmacy into the future. What’s ‘fair’ doesn’t even come into it at the moment. 

The question that needs to be asked is, are we even in the game at Government level, and who’s fooling whom? 

Reference: contractor-handbooks/2020-doctors-handbook.pdf