Fintan Moore has been writing for this magazine since the very first edition — in word count terms it equates to about five novellas — and while the recent pandemic made for some interesting times, he is still standing, and waiting to see what unfolds in the next chapter
The year 1999 was a busy year in my world. I left a safe and solid employee position to buy my own pharmacy in a small shopping centre in the middle of a housing estate beset by antisocial behaviour. Joy-riding was a nightly occurrence, and more than one car was burnt out in our car park. As the estate matured over the following few years the trouble waned and petered out, so my pharmacy became a safer bet – at least physically.
Commercially, it wasn’t helped by deregulation, and it took a hit along with everybody else from the various cuts to fees and reimbursement levels. Covid made for interesting times but they are now fading into the past, and for now I am still standing and waiting to see what happens next.
The other change in 1999 was the launch of this magazine. I was invited to write an opinion piece and I have done one every month since then. My total word count over that time is about 250,000, which equates to about five novels (shortish tomes, not Harry Potters). Funnily enough, my first ever words were: “There are moments in the life of the retail pharmacist when Ginsberg’s Theorem seems very appropriate. Ginsberg reckoned that
1. You can’t win.
2. You can’t break even.
3. You can’t even quit the game.”
I quoted Ginsberg in the context of a general complaint about the unfairness of a system in which shoplifting is effectively decriminalised but an accidental wrongful accusation of shoplifting will cost a retailer thousands of euro, if not tens of thousands. And 25 years on, nothing has improved on that front. However, I think Ginsberg’s words apply to pharmacy generally – you never get ahead of all the problems. The best you can do is manage them as they occur, and try to continue with as much good humour as possible.
Dealing with the public can be tough but there are two mantras I hold on to. The first says ‘If anybody is rude or unpleasant, remember they have to live with themselves all their life – you just have to put up with them for a few minutes.’ And if that doesn’t quite work, the second says, ‘Don’t let the bastards get you down.’
Victims of our success
Talk to any community pharmacist these days and they will all say the same thing, which is that the time required for the average prescription has got longer. It’s hard to put a metric on it, but I reckon that we are looking at something like 20 per cent. Some of the extra time required is due to the processing of Healthmail prescriptions – printing them, scanning them, filing them, dealing with all the patients asking if their prescription has come in yet (repeatedly asking in many cases), and sending queries back to prescribers (also repeatedly at times).
‘If anybody is rude or unpleasant, remember they have to live with themselves all their life – you just have to put up with them for a few minutes’
Dealing with stock shortages is another drain on time, including trying to source supplies, finding alternatives, substituting generics, and explaining all of this to patients. Regulatory changes such as the despised FMD scanning and the administrative load of HSE scheme compliance also take a toll.
However there is another factor at play, which is that patient needs have become more complex because the increased availability of a wider array of treatments is keeping people alive with illnesses that would have been fatal 10 or 20 years ago. There was a time that our experience of looking after a patient with a cancer diagnosis commonly led, in a short timeframe, to us dispensing ever higher strengths of MST as the condition deteriorated until the patient passed away.
Nowadays, patients with cancer, and also those with many other conditions, have a better chance of surviving, but that creates a requirement for a higher level of pharmacy care. Dispensing high-tech items takes more time than regular ones due to the ordering and claiming process. There are also separate and diverse ordering processes for Medtronic supplies, Accu-chek Libre, Fampyra, and the ever-growing number of ULMs, which often only have one particular supplier. All of that partly explains why we often feel like we are running to stand still.
Future talk
Whatever about the last 25 years it is hard to know what to predict for the next quarter of a century. Perhaps the changes will be minimal, or perhaps we will be replaced by robots that can use advanced artificial intelligence to interact with patients, listen to their questions and counsel them appropriately. If that ever gets to the beta-testing stage, I have a few patients I would happily recommend to use as guinea pigs.
For the more immediate future there is a fair bit of talk about enhancing the role of the pharmacist but we are creaking at the seams already, so we will need to improve capacity, and widening the role of technicians to do vaccinations could be a way forward to free up a pharmacist’s time. Strangely enough, if we had never been deregulated we would be in a better place because even though we would have fewer pharmacies they would be bigger and better resourced. But we are where we are, and in the immortal words of Slade – ‘Here’s to the future. It’s only just begun.’
