Even though we still have variants of Covid-19 doing the rounds with new strains mutating and emerging, the general consensus is that the Covid crisis is mostly over. Fewer and fewer people are wearing masks in retail areas, and even in healthcare settings they now seem to be optional. In community pharmacy we can expect that the various ‘Covid regulations’ will be unwound seeing as they were introduced as emergency measures and as such their raison d’etre is fading. Other non-regulatory changes that were brought in three years ago will also be scrutinised such as the ongoing non-requirement to send end-of-month paperwork to the PCRS in Finglas. However it seems sensible to assess what changes should be retained because they still have value in non-Covid times. For example the Pharmacy Task Force is looking at replacing the emergency provision to allow prescriptions to be valid for nine months with new regulations allowing validity up to 12 months.
There is one particular procedural change that was sensibly introduced relatively early in the crisis which should most certainly be kept as a permanent measure, namely the ending of ‘third-party’ verification of DPS, LTI and High Tech claims using patient signatures on the claim forms. Worryingly, the PCRS is apparently considering the reintroduction of this signing requirement despite it being glaringly obvious that it adds to the risk of disease propagation in the pharmacy. The touching and handling of shared pens and countertop spaces by multiple patients creates a perfect hotbed for spreading infection. There was a sound logic for doing away with this during Covid, but the same logic applies for influenza, pneumonia, and winter vomiting viruses. I appreciate that the PCRS has concerns about fraudulent claiming, but there are three realities that need to be faced: first, patient signatures have limited benefit to prevent fraud; second, fraudulent activity is very easily detectable by any investigators; and third, it is absolutely ridiculous to reintroduce a procedure that will lead to greater circulation of infections with consequent increased demand on medical care and hospital beds. Hopefully sanity will prevail where it matters.
Failure to communicate
One huge and enduring benefit of the Covid crisis was the rapid introduction of healthmail. More progress on the use of emailed prescriptions was made in 20 days than had been made in the previous 20 years, and it has been hugely beneficial for the most part. There can be valid concerns about whether or not the convenience of online consultations creates a risk that some diagnoses will be missed that would otherwise be identified at an in-person appointment. Also, there can still be problems getting in touch with prescribers – to phrase it diplomatically, some GPs are better than others at monitoring their inbox for queries but at least the possibility now exists of crisp and efficient communication even if it is not always availed of.
Surely it should be a simple matter to give every doctor in a hospital a dedicated healthmail address
In my opinion, one missed opportunity in the use of healthmail seems to be that it should be used more effectively to facilitate communication with prescribers in hospitals. Whenever there is a query on a hospital prescription we are still stuck in the same telephone routine of hunt-the-doctor that we were using in the last century. Surely it should be a simple matter to give every doctor in a hospital a dedicated healthmail address using their medical council registration number so, for example, a doctor in Tallaght Hospital with a reg number 123456 would be contactable at 123456@tuh. ie. Doctors have become reasonably efficient at writing their MCRNs on prescriptions, so any queries could be healthmailed in and dealt with promptly rather than tying up the pharmacist and the hospital switchboard.
Mean streets
As we all know, the recent savage and senseless knife assault on a group of children in Dublin triggered a night of rioting, mayhem, and violence in the capital with widespread acts of destruction, arson, and looting. Remarkably, some people seem surprised that this level of riotous criminality could have happened, begging the question of just how little attention they have been paying for the past decade. Any brief period of time spent in Dublin city centre, or conversations with anybody working in a pharmacy there, will make it crystal clear that there is a constant background static of antisocial behaviour. Due to the lack of effective policing, so-called minor crimes such as shoplifting, graffiti, bike theft, harassment, intimidation, and vandalism have effectively been decriminalised. Juvenile offenders are legally almost untouchable, and they know that, so they act accordingly.
After the knife attack occurred, it only required a minimum of online effort by anti-immigrant groups to round up a mob and get them to kick off the chaos. On a criminality scale of one to 10, that night was probably a nine but when the dial is usually hovering at four or five it doesn’t take much to turn it up. The chronic under-resourcing of the garda and justice system is only part of the problem. There also needs to be more funding for drug treatment services, social workers, schools, creches, vocational training courses, sports clubs, health education, and playing facilities. Sadly, much of that would require more vision and long-term thinking than our political leaders may be capable of.
