Áine Mac Grory thinks it’s time to get wise and strategise
Three conferences. The same themes kept coming up: Integrated care, multidisciplinary teams, shared-care pathways, digital integration, access, prevention, chronic disease management, medicines optimisation, hospital avoidance, and moving care closer to home.
By the end of conference two, I had noticed something else recurring too: The absence of pharmacists, despite clear medicines-related and multidisciplinary opportunities.
Integration was repeatedly framed as connecting primary, community and acute care rather than operating services in isolation. Yet community pharmacy often seemed to be functioning alongside those pathways rather than being formally incorporated into referral, escalation, follow-up and shared care.
Pharmacies are already geographically embedded community healthcare settings. We are accessible. We see patients regularly. We know their medicines. We know when something has changed, when adherence is slipping, when an inhaler is being used incorrectly, when the hospital discharge does not quite match what went in, and often when a patient is struggling before anybody else does.
So why weren’t we considered?
The Themes Were Everywhere
Polypharmacy. Health inequalities. Access, convenience and reducing patient burden. Multidisciplinary teams. Integrated care. Shared-care pathways. Hospital avoidance. Chronic disease management. Medication management. Prevention. Vaccination. Screening. Early intervention. Patient-centred care. Continuity of care. Electronic health records. Shared care records. Remote monitoring. Clinical governance. Patient safety. Medication adherence. Digital and AI literacy. Sustainability. Medicines supply chains.
I could keep going.
I accept that every one of these areas won’t automatically require a pharmacist, but so many of them have an obvious interface with medicines and with the patients who use them, and yet consideration of community pharmacy didn’t seem to be automatic.
At the Integrated Healthcare Conference, the whole-system outcomes framework explicitly identified medicines as part of proactive care before a crisis, medication harm as something to prevent during hospital admission, and medicines reconciliation as part of safe discharge. Medicines management was embedded at several stages of the pathway, but no pharmacist was identified as responsible for, or contributing to, those activities.
That is what I found difficult to reconcile.
The speakers and research were excellent. This was never about taking issue with what was presented. We heard compelling examples across COPD, heart failure, care of older people and chronic disease management, with reductions in hospitalisation, bed days and readmissions. The recurring ambitions, such as earlier intervention, better access, multidisciplinary working, keeping patients well and avoiding unnecessary hospital attendance, were difficult to argue with.
Listening to the COPD discussions in particular, I kept thinking: Medicines use, adherence, inhaler technique, patient education, earlier intervention, vaccination, chronic disease, keeping people well in the community. Are we really not asking where the community pharmacist might fit? And if not, why not? And there is evidence behind this. Community pharmacist-led interventions have demonstrated improvements in medication adherence and positive effects on clinical outcomes, including in asthma and COPD. If pharmacy is not represented in the rooms where integrated-care initiatives are being presented, discussed and shaped, it is difficult to see how consideration of the pharmacist’s contribution becomes embedded in the thinking of the wider healthcare system.
When an Irish healthcare professional designs an integrated-care pathway, considering whether and how a pharmacist can contribute should become automatic.
It was reasonable to expect that the HSE’s national Integrated Healthcare Conference and the Europe in Good Health: Securing EU Leadership in Life Sciences Conference would be places where the future direction of healthcare was discussed and shaped. And it was, but without any meaningful reference to community pharmacy at all. If community pharmacy isn’t being considered in rooms like these, where exactly are we expecting that consideration to happen?
That, for me, is the cultural change we need.
Connectivity Is Not Integration Either
The digital discussion made the gap even more obvious.
The future described across the conferences is connected: Interoperable records, shared information, digital pathways and clinical decision support, with information following patients between settings. That is exactly where community pharmacy needs to be considered from the outset.
It is not enough for a pharmacy to be technically connected to a record. We need to think about what information pharmacists require to provide safe clinical care, what pharmacists put back into the shared record, how referrals and communication operate across settings, and how digitally enabled pathways incorporate pharmacy from their inception.
Otherwise, we risk building a beautifully connected system that still leaves one of the most accessible healthcare settings standing just outside it.
And Then Came Athena – Strategic and Wise
Having almost lost hope of finding community pharmacy meaningfully positioned in any of these strategic conversations, along came the Athena Pharmaceuticals All-Ireland Clinical AI Congress & AI Tech Expo.
Its strapline asked what every healthcare professional needs to know about AI today.
Every healthcare professional? Let’s see…
How pleasantly surprised I was when I saw community pharmacy and pharmacists explicitly positioned within the discussion
How pleasantly surprised I was when I saw community pharmacy and pharmacists explicitly positioned within the discussion. The Primary Care session included a frontline-focused panel on how AI reaches patients through community pharmacy and Irish general practice. Dispensing accuracy, drug-interaction alerts, patient-adherence tools and the evolving pharmacist role were not awkward additions to somebody else’s pathway. They were part of the conversation.
Mr Peter Kidd, Healthcare Systems Engineer and Pharmacist, brought a pharmacy perspective to systems engineering and clinical workflow redesign. And indeed, Kidd has published research illustrating this potential in practice. A recent Irish pharmacist-led discharge medicines reconciliation pilot identified 184 discrepancies across just 50 discharge prescriptions, with the researchers estimating a potential net annual cost benefit of approximately €555,000 when extrapolated across annual ward discharges.
Finally. Now we are talking.
The message went beyond pharmacy. There was discussion about achieving wins for patients and for workers, and about putting the right people in the right place. That seems remarkably simple, but perhaps that is precisely the point. Integration shouldn’t be about squeezing another profession into a pathway after it has been built. It should be about identifying the people, knowledge and access already available and designing the pathway around what patients actually need.
That is a much more interesting conversation.
It was also refreshing to hear pharmacy discussed in the same language being used elsewhere for the wider health service: Safety, flow, quality, productivity, interoperability and workforce capacity. If pharmacists are expected to work at the top of their scope, the systems around them need to make that possible. Access to useful information, clear communication with other clinicians and properly designed digital workflows are not optional extras. They are the infrastructure that allows professional expertise to translate into safer, more efficient patient care.
It was also refreshing to hear pharmacy discussed in the same language being used elsewhere for the wider health service
There was also repeated emphasis on interoperability, clinical leadership, workforce engagement and building trusted workflows rather than simply buying technology and hoping for the best.
Why Was This Conference So Different?
The contrast was striking. At one conference, pharmacy was difficult to find even when medicines, polypharmacy, medicines reconciliation, chronic disease and community care were being discussed. At another, pharmacy was naturally part of a conversation about the future.
That is the bit I keep coming back to.
What are we doing to ensure that pharmacy expertise is present early enough for somebody to ask the question: Could a pharmacist’s involvement be needed here? Sometimes the answer will be ‘no’. Fine. But the question should still be asked.
Upstream, Not Retrospectively
We don’t want to be included retrospectively, once a pathway has been designed, the digital architecture agreed, the referral mechanisms established, and everybody else’s role decided.
By then, ‘integration’ becomes an exercise in trying to find a space in something that was never designed with us in mind. And retrospective inclusion has proven not to work too well.
Community pharmacy needs to be considered upstream: When the problem is being defined, when pathways are being mapped, when data flows are being decided, when governance is being established and when outcomes are being chosen. There is Irish evidence demonstrating the potential of integrating pharmacists into primary care, with pharmacist-led medicines reviews resulting in improved medicines appropriateness and patient-reported outcomes.
That doesn’t require pharmacy to dominate the conversation. It requires pharmacy to be in it.
If the future health service is genuinely going to be community-first, preventative, digitally connected, multidisciplinary and focused on keeping people well and out of hospital, then community pharmacy is surely relevant to that future.
Athena showed that it is entirely possible to include pharmacists positively and meaningfully without forcing the issue. Pharmacy sat naturally alongside general practice, digital health, AI, medicines safety, adherence and systems redesign, because that is where it belongs.
And it was Mr Dave Shanahan (Athena Pharmaceuticals CEO and founder) who hit the nail on the head when he spoke about being intolerant of mediocrity because, ultimately, we allow it. This is something we need to avoid if we are to create a culture that values innovation, critical thinking and those trying to drive change.
Maybe that’s what we have to stop doing?
References on request
