Chain reaction

Former editor David Jordan marks our anniversary edition with a journey back in time and says that, though he was happy working for Unicare, he struck out on his own and his business is now 20 years old

For me there was only one way to mark 25 years of Irish Pharmacist. That was to look at where I was, where Irish pharmacy was 25 years ago, and where we are today. And maybe throw in a few bits in between where relevant.

So first the easy bit: where I was; well, I felt that I was at the peak of my professional powers. Qualified for 15 years and believing there wasn’t really much more for me to learn. Cycling to work four days a week in Ranelagh, wearing a shirt and tie, clean shaven, and a short back and sides. Married with two young children, we had just moved into our ‘forever’ home. Just to rub it in slightly, back in 1997 you could still get a mortgage and buy a nice four-bed home (just) within the M50 on Dublin’s southside on the strength of one salary.

I had recently just stepped back from my involvement with the Irish Pharmacy Union (IPU). In those days, many contractor pharmacists did not hold employee pharmacists in much regard. At best, they were pharmacy owners in waiting. In all my time in pharmacy there has only been one IPU president who was not a pharmacy owner, and for that you’d have to go back a very long time. I’ll buy a pint for anybody who can tell me his or her name.

I was looking for fresh challenges. I found it in my return to biking after a break of 15 years. I renewed an interest in computers with the advent of something called the world wide web; modems that promised speeds of up to 56kb/sec when attached to your landline. Mobile phones were still analogue on the 088 network and coverage was sparse once you left Dublin.

Boom-and-bust cycle

Pharmacy was flourishing as Ireland entered the boom phase of the latest boom-and-bust cycle. New pharmacies had to have an Irish qualified pharmacist in charge for the first three years – this was a bonus for the relatively small number of TCD graduates given that the UCC and RSCI schools of pharmacy were still five years away from opening, and 10 years away from the first graduates.

The pharmacy chains were just starting to grow, mainly by acquisition, and there was still plenty of greenfield sites for those who were interested. Indeed, I was working for the Unicare chain at the time and could see a future for myself there. The thought of opening my own pharmacy hadn’t even crossed my mind.

Making up extemps was still a part of the pharmacist’s role and unlicensed medicines (ULMs) were an oddity. Compare that with today where the Pharmaceutical Society of Ireland (PSI) frowns upon making up extemps in the pharmacy and yet still insists that we have all the equipment needed sitting on the shelves gathering dust. Make up yer minds, lads!

So let’s now move on 25 years and where are we at? Well, Jordan’s Pharmacy is now more than 20 years old. Part of the reason why it happened was the growth of chains. I quickly realised that I couldn’t work in that atmosphere for very long. I am not a fan of the backstabbing, politicking, and brown nosing that is part of corporate life. I’d like to take the opportunity here to give a big shout-out to all those who helped me in the early years when things got a bit hairy at times.

There have been many big changes in the industry as well. At least half of the medicines on the pharmacy shelves weren’t even invented/discovered when I was in college. Keeping up to date has been one long learning experience. Instead of one HSE, we had eight regional health boards, and only three schemes – the General Medical Services (GMS), the Long-Term Illness (LTI), and the drug refund scheme. Computers were just coming into their own and dispensing software was pretty basic to say the least. Indeed, some of it hasn’t moved on very much in 25 years.

Twin challenges

Apart from the normal evolution of things, the biggest challenges and drivers of change have been Covid and Brexit. Pharmacists always did have a high level of respect from the public but Covid changed the way that they see us. For two years we were the only part of the health service that was freely accessible. Indeed, many GPs have retained the restrictions introduced during Covid, leaving their patients more dependent on pharmacists than before.

Brexit and other supply chain issues have made chasing up ULMs and other alternatives a bigger and bigger part of our day, and one that we are not paid for. We only have ourselves to blame for many of the other unpaid parts of our day. Free blister packs, blood pressure reading, BMI checks, and deliveries all incur a cost. There are enough Richard Craniums* out there who continue to provide these for free without adding to them.

The move from the health boards to the HSE brought about a change in culture. It is now all about saving money first and patient care last. Penny wise and pound foolish. Vague rules about what will and will not be paid for. Depending on which person you get at the end of the phone or if there is an R in the month it may be paid today but not tomorrow. That’s why, as far as I’m concerned, I get it in writing or email. If the HSE won’t pay, then the patient does. I’m done being a charity.

On the subject of email, Healthmail – the secure clinical email service – was one good thing that came from the pandemic. It’s far from being perfect but at least it is a darn sight better than what we had before.

We also have the recently announced plans from the Minister for Health Stephen Donnelly allowing pharmacists to extend prescriptions by an extra six months. This is all very fine in principle but with everything the devil is in the detail. First and foremost, the question is who pays? No doubt that extra work (costs) will be involved. Possibly extra training (costs). The PSI will want to have its say with, no doubt, new standard operating procedures and committees to oversee it. A bit of clarification around the insurance (more costs) implications would also be nice. This is all before we throw in the PSI’s love of fitness-to-practise hearings for any of us who scratch our nose the wrong way.

Disgrace

This brings me onto manpower. We all know about the current shortages. Where will all the extra personnel to carry out all these new functions come from? The absence of supervising pharmacists in more than 25 per cent of chain pharmacies – and the inability/unwillingness of the PSI to do anything about it – is a disgrace. And who would blame pharmacists for not wanting to take up a supervising role. All the responsibility and none of the power. Being trained for a role that does not exist. If you are smart enough to be accepted onto and complete a pharmacy degree then you are smart enough to qualify for just about any career that you want. Be a locum for a few years while you complete a second degree and then it is ‘sayonara pharmacy’.

Another change that I have noticed is the level of antagonism that now exists in discourse. Not just in pharmacy but in general. Civility has gone by the wayside. I’ve seen it in several pharmacy groups who are not satisfied with the performance of the IPU. ‘We should be in there with the HSE demanding better terms for pharmacy.’ All I would say to them is this – what do we have to offer in return? Just saying ‘We deserve it’ doesn’t cut the mustard. Threaten to strike or withdraw from various schemes? I was there in 2009 when that was tried. Forget it, it won’t work. The HSE are hard-nosed negotiators. If you want something you have to be able to offer something in return.

I remember when IPU meetings were convivial affairs. A chance to meet up with friends that you mightn’t have seen in a long while. Not so any more. I haven’t been to one in years and can’t see myself returning anytime soon. Be nice to each other lads, we are all trying our best.

Anyhow, it is now time to pass all that on to the next generation. That’s if they can find the time after doing 60-70 hours a week in their own pharmacy.

And where am I at? Still living in our forever home, three adult kids, one emigrated, one living in a shared apartment, and one at home. A 24-year-old bike that gives me much enjoyment and the odd bit of frustration. A 20-year-old pharmacy that gives me the odd bit of joy and much frustration.

There’s so much more that I wanted to write about but I’m already over my limit. I’ve really enjoyed the 25 years of Irish Pharmacist and especially the 10 years when I was a part of it. I just hope that I’m still around to write another piece for the 50th anniversary.

*Richard, a man’s name that is often shortened to Dick. Cranium, from the Latin, indicating the head.