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THE CAVALRY AREN’T COMING

By Fintan Moore - 07th May 2023

Just as no single snowflake is to blame for the avalanche, every single individual admin task is justified or protected by somebody somewhere, writes Fintan Moore

I once heard Ireland described as a ‘democracy swamped by bureaucracy’, which is an apt and poetic way of putting it. This applies in spades to the daily operation of a pharmacy. The sheer number of paperwork tasks required for dispensing, administration, claiming, stock management and regulatory compliance is staggering. Every new initiative from the HSE brings with it another associated work burden. The recently introduced Contraceptive Scheme is a case in point. It used to take about a minute or less to dispense a repeat pack of a monthly OCP, but due to the claiming process, that time frame has trebled, and all for less money than we were earning previously. Of course, it’s a popular scheme, and it’s a socially good thing, but that doesn’t change the fact that it’s made our working life worse, not better; and that’s before we start getting to the point where our claims for payment inevitably start to be rejected as women who collected six packs in one dispensing lose a couple of them and come back early for a resupply.

So we hear lots of talk about the challenges facing community pharmacy and of intentions to ease the administrative blizzard, but what specifically is going to change? Just as no single snowflake is to blame for the avalanche, every single individual task is justified or protected by somebody somewhere. We will always need to have legal compliance with CD recording, audit compliance for Government payments, varying claiming processes for different schemes, supply chain paperwork to get supplies, proof-of-competency requirements for vaccination schemes, etc. What can we actually point to as something to be eliminated, before we get to the practicality of the associated organisation agreeing to the cull? The obvious bête noire is the Hardship Scheme, which costs the HSE more money to operate than it saves them, but it still exists because somebody in there wants to keep it and isn’t letting go. Of course, we’ve too many other schemes, but which ones can be eliminated? We can’t merge LTI patients into the GMS scheme, or methadone patients into the DPS. The only way forward would be to rip-up the entire model and replace it with something fitfor-purpose, but that suggestion isn’t even on the planet, let alone on the table. The paperwork slush is sadly here to stay and there’s nobody coming to save us — so just keep shovelling.

JUMBO BREAKFAST ROLLS

The Jesuits used to say, ‘Give me the child for the first seven years and I’ll give you the man’. Given the track record of the Church when it comes to the treatment of children, that maxim doesn’t sound too good any more, but the same philosophy now seems to have been adopted by junk food companies. It seems like they’re keen to suck in new customers from the youngest age possible with marketing ploys, advertising and product placement, all directed at primary school-age kids. Of course, the theory is that these are ‘treat’ foods and parents should ensure that they be eaten in moderation, but that’s easier said than done. There has been an evolution in society to the point that children now live in an environment which surrounds them with unhealthy food, and bombards them with encouragement to eat it. It’s difficult for parents to keep their kids eating well, and oftentimes the parents themselves don’t even know what choices to make.

A huge number of young children get their breakfasts from supermarket deli counters, eating their potato wedges and sausage rolls on the way to school, along with some sweets and a soft drink. Similar poor-quality food gets bought again after school, and consumed as snacks in the evening while watching a screen. The chances of these kids becoming overweight or obese are hugely increased, and this pattern is almost guaranteed to continue into adulthood, along with the associated health problems, such as diabetes and heart disease. It may well be that this pattern of behaviour is so engrained that it can’t be turned around, but a discussion should at least be started.

PLINK PLINK FIZZ

I’m aware that codeine addiction is a serious problem, and there’s been a lot of talk about it recently. We seem to be on a slide towards a decision to make them POM, which would provide some clarity on the issue from a pharmacy point of view. The most popular codeine product is, of course, Solpadeine. In recent weeks we’ve been unable to source any dispensing packs of the soluble version and have limited supplies of the capsules. An unusual phenomenon, I’ve noticed, are the patients who are used to the soluble tablets and will not accept capsules under any circumstances.

The really curious thing is that they’re willing to switch from Solpadeine to Panadol Extra Soluble or Solpa-Extra Soluble rather than take a capsule, thereby eschewing codeine altogether. Whether it’s the psychological appeal of the ritual of dissolving the tablets, or an obscure addiction to sodium bicarbonate, I have no idea, but hopefully it’s an opportunity for people to learn that they don’t need Codeine as much as they thought they did.

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