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More cards from the dealer? No thanks, I’ll stick

By Ultan Molloy - 01st Apr 2024

Much like the saying, ‘no news is good news’, perhaps it will turn out that no change would be better than what ends up being inflicted on us when it does happen, writes Ultan Molloy

So we changed contract last month, to a new GMS number, as there had been a beneficial change of ownership of the company which owns the pharmacy. This required a PSI re-registration (and more than €4,000 in fees), and a new contract with the HSE, even though the same company owns the pharmacy, no bank account details have changed, myself and my wife are ultimately still 50/50 owners of the pharmacy, and I find out this morning that the final payment from the HSE on our previous contract number has been made in a cheque ”for security reasons”. Yes, a cheque, which incidentally, will now take five days to clear and have our direct debits bouncing from here to kingdom come in the meantime. Nowhere on any of its documentation did it advise us that this was going to happen. Surprise! Classic HSE stuff. So that’s set me up for the day nicely!

Anyway, what else is going on in the world of pharmacy. We can extend prescriptions for up to 12 months now. No thank you. Patients are not having regular enough face-to-face engagements and reviews with their GPs at present, so I am not going playing ‘GP lite’ in our practice. It is difficult enough to keep our records in line with GP records as things stand.

Enough of experts?

The ‘experts’ recommend it as a good idea for our scope of practice to now extend into taking on what is a GP’s responsibility, and somehow clinically assessing patients, so that we can have a stab at deciding who should have another few months of their prescription-only medicines. I have written about this a few times in different places, and every time I reflect on it, the worse of an idea it appears to be. We do not get paid for it either, of course – sure why would we? More time with patients, more time at the counter, more time on administration, but sure what else would we be at, only twiddling our thumbs looking for something to do.

We had a GP – who had accommodated walk-ins and last-minute patients – depart from a local practice recently, only to be replaced by one who will not see anybody without an appointment. Patients are initially greeted by a secretary, the third in the past 12 months and, should she decide to pick up the ringing phone and communicate with them, she has all the empathy and communication skills of a rhinoceros, to tell them there are no appointments available until two, three, four days ahead, or whatever it may be. “No antibiotics will be given out without seeing the doctor”, a patient was told last Friday morning, and the next available appointment with a doctor was on Tuesday. That is a long time to wait if you are sick, is it not? Off to WestDoc on the weekend, or just suffer through, is the outcome of that exceptional service, I suppose. We get to see it oftentimes then at the counter, of course, and have to do what we can to support the patients’ needs.


Patients are not having regular enough face- to-face engagements and reviews with their GPs at present, so I am not going playing ‘GP lite’ in our practice

We will have more responsibility and an extended role, according to the Minister for Health. I am not so sure that is something to get excited about, however. I was chatting to a colleague in the UK whose already meagre dispensing fees have been cut further, and he has had to complete an independent prescriber course over the last two years. The remuneration for these consultations is basic, and will not cover the cuts made according to himself. Another ‘GP-lite’ scenario in a country where GPs are increasingly scarce and inaccessible.

The vision thing

Time will tell what is next on the agenda for ourselves here in the Emerald Isle, when another gem of a recommendation comes from the ‘experts’ recommending what is best for pharmacists in community pharmacy practice and public healthcare here. We are still outside of the decision makers’ chambers, and there is no Chief Pharmaceutical Officer to guide a vision and logistics on a €1.3 billion spend on medicines each year. I do not know what to say that has not already been said.

We could of course do more clinical work with patients in terms of triage, or prescribing some medicines for minor ailments under protocol. How will this be resourced, though, when the medics have chewed up every last bit of additional funding that has been put into primary care over the past 10 years? A GP’s surgery closes and it is national news. A pharmacy closes, and sure what about it, there are plenty of other ones to choose from. That is the difference really, is it not?

I would like to think that we do a good job of looking after patients in our practice primarily because it is the right thing to do. The rest follows on from that, one would think. It is also easier to move between pharmacies, is it not?; no need for registration, or written commitment, to a particular pharmacy – just get the prescription sent somewhere else. It is a somewhat precarious position to be in as a business owner, but it does serve to drive standards, and if you are a donkey to your customer(s), then the likelihood is that they will not grace you with their presence going forward.

I am going to need to start meditating again I reckon, or at least practise some deep breathing exercises, after writing this piece. Progress and change is so painfully and frustratingly slow when it comes to the public service, and operating under contract to them. Much like the saying, ‘no news is good news’, perhaps it will turn out that no change would be better than what ends up being inflicted on us when it does happen. Time will tell.

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