Private costs are needed to cross-subsidise inadequate HSE charges and outdated unwieldy schemes, argues Fintan Moore
There’s an old joke about a car full of tourists who get lost while driving the backroads of Connemara. This is in the days before Sat Navs and Google Maps, so they stop to ask directions from an old couple they see walking along. The husband tries to explain a way out of the maze but it involves so many twists and turns that he’s met with blank expressions. Then his wife begins to describe an alternative route but rapidly reaches the same impasse, at which point the husband says, “You know, if I were ye, I wouldn’t start from here at all.”
The existence of a paperwork blizzard means that an awful lot of people are employed to shovel it around the place
What brought that joke to mind was a recent online discussion about how to set a private dispensing fee if calculated from scratch rather than do what we usually do, which is to tinker with whatever figure we have at the time. It’s actually quite eye opening when you factor in all the steps required for a patient to leave a pharmacy with a dispensed item in their hand. To start, the list of business costs runs to dozens of items, including rent or mortgage, electricity, water, rates, insurance, security, repairs, computer software and hardware, telephone, broadband, waste management, service charges, stationery, refrigeration, canteen expenses, cleaning, and more.
And then the professional component requires sufficient pharmacists, technicians, and ancillary staff to deal with receiving and preparing prescriptions with all the required accuracy checks, FMD scanning, regulatory and claiming bureaucracy, maintenance of stock levels, patient counselling, and so on. Furthermore, the private fees we charge need to cross-subsidise the inadequate HSE fees we receive for most of our work.
When you add up all the component parts that are involved in the successful functioning of a pharmacy, it very quickly becomes apparent that we are operating at a fee level that is unjustifiably low, and one that we wouldn’t accept if we were coming to this with a blank canvas. However, as the saying goes, we are where we are, and we won’t be getting a clean slate any time soon. So the best approach is probably to take whatever figure we have and incrementally ratchet it upwards over a period of a couple of years until we get to a reasonable target amount based on the costs involved.
There are other areas of the pharmacy sector that could benefit from the same kind of fresh-start thinking. We currently operate about a dozen different HSE schemes, each with its own set of rules and paperwork requirements. When you step back and look at it, you quickly realise that it is nuts. Even the fact that so much of the administration remains paper-based boggles the mind in the era of computers. Sadly, implementing change on all of this is probably beyond the ken of any of our HSE and Department of Health overlords. The existence of a paperwork blizzard means that an awful lot of people are employed to shovel it around the place, and their trade unions won’t be in any rush to let an outbreak of efficiency lead to job losses.
A grand stretch
We recently heard that the recommendations from the Pharmacy Taskforce regarding the extension of prescription validity have borne fruit, and that doctors will potentially be able to write prescriptions for up to 12 months.
The funny thing about my perception of gaining patients is that very often it’s quite hard to tell whenever I lose one
I must confess that I have mixed feelings on this. On the one hand, it will make our lives easier with a lot of patients who are stable on the same medication and who won’t need nagging as often to get a fresh prescription. But on the other hand, a year seems a long time to go without a check-up. The other interesting feature of the change is how much flexibility we will have to extend six-month prescriptions by a further six months. This could be a legal minefield in terms of liability if a patient suffers any adverse impact during the period of an extended prescription, for instance if a patient on cardiac meds has a heart attack during ‘month 11’. We’ll know more soon enough on what we can expect.
Missing in action
Maybe it’s just a momentary blip but I reckon I’m gaining new patients at a significantly faster rate than I’m losing them. This seems to be down to a combination of chain-owned pharmacies suffering from the impact of staff turnover, and locals realising that healthmail makes my place more convenient than the pharmacy beside their GP that they traditionally have used.
The funny thing about my perception of gaining patients is that very often it’s quite hard to tell whenever I lose one. Occasionally, but not very often, I’ll have a disagreement with a patient and know that they are leaving. Or a patient will request their prescription to be forwarded elsewhere because they’re moving house. Or they go into a nursing home. But sometimes it just dawns on me or my staff that we haven’t seen a patient for months, and when there’s no obvious explanation, we wonder if we did something wrong. On the plus side, sometimes we only realise somebody was ever missing when they return from wherever they went, so we take those ones as a small victory.
