Áine MacGrory looks at how the pharmacy has become the default setting of the healthcare system
One of community pharmacy’s greatest strengths has always been its accessibility. No referral required. No waiting list. No appointment necessary. Just walk through the door and someone will help.
It is something we should be immensely proud of.
It is also something that has become so normal that almost nobody stops to consider what it actually costs.
Community pharmacy has become the default setting of the healthcare system. When patients cannot get a GP appointment, they come to us. When they leave hospital with unanswered questions, they come to us. When they are worried, confused, frustrated — or simply looking for reassurance, they come to us.
And they should.
The problem is that somewhere along the way, accessibility stopped being viewed as a service and started being viewed as an entitlement.
Many of us have experienced it. A patient enters the pharmacy, hands over a prescription, and immediately takes up position at the counter. The unspoken expectation is clear: ‘I’ll just wait here until it’s done.’
Yet a prescription is not a coffee order. Behind the scenes lie clinical checks, reimbursement verification, stock assessment, assembly, accuracy checking, problem-solving, and counselling. It may be one of 50 prescriptions received that morning.
And somehow, because pharmacy is accessible, the expectation exists that it should also be instantaneous.
We have inadvertently become victims of our own success.
In a world where groceries arrive within the hour and entertainment streams instantly, it is perhaps unsurprising that healthcare has become infected with the same expectation. The difference, of course, is that healthcare is not a takeaway order.
Nobody would expect their solicitor to draft a legal document while they stand over their shoulder. Few would expect an accountant to complete a tax return while they wait at reception. Yet pharmacists are frequently expected to undertake complex clinical and legal responsibilities immediately upon request.
The irony is that the very safety processes patients depend upon are often invisible. Nobody notices the interaction that was prevented. Nobody sees the dosage discrepancy that was identified. Nobody is aware of the phone call made to clarify an ambiguous prescription.
The work that protects patients is usually the work they never see.
Before anyone accuses me of being anti-patient, let me be clear — the patient is not the problem.
Patients have been conditioned by modern life to expect immediacy. We can order dinner, a taxi, groceries, and even a bank loan from our phones. Why wouldn’t they expect a prescription to be ready in minutes?
If anything, pharmacy itself has helped create this expectation. We are a profession of problem-solvers. We squeeze people in. We stay late. We find a way. We dislike disappointing people and many of us will go to extraordinary lengths to avoid conflict or inconvenience for the patient standing in front of us.
These instincts come from a good place. They are part of what makes pharmacy such a trusted profession.
But there is a difference between being patient-centered and being endlessly accommodating.
As our clinical responsibilities continue to expand, we may need to have more honest conversations about what is realistic and set expectations that are compatible with safe practice. Part of that conversation involves technology.
When online prescription ordering was first discussed, I assumed the greatest resistance would come from older patients. Yet one of the most thought-provoking conversations I have had about the change was with a patient in their 30s.
There was no technology gap. Their hesitation had nothing to do with computers and everything to do with experience.
As we spoke, they described a previous encounter with the healthcare system that had left a lasting impression. Living in Ireland without family support, they were navigating a significant health issue largely on their own. They came from a cultural background where doctors were deeply respected, and questioning a healthcare professional’s recommendation would have felt uncomfortable.
Following the discovery of a suspicious testicular lesion, they underwent surgery to remove a testicle. The treatment pathway followed accepted clinical practice, and they were not questioning the clinical rationale.
What troubled them was the experience surrounding it. They were young and vulnerable and did not feel empowered, confident, or reassured about such an intimate and invasive decision.
They recalled feeling isolated and overwhelmed. They described trying to ask questions — but feeling that some of their concerns were dismissed or moved past too quickly. Looking back, they were unsure whether they had truly understood all of the options available to them, the reasoning behind the proposed treatment, or the implications of proceeding.
They signed a consent form. Yet true informed consent requires understanding, confidence, and the opportunity to explore concerns without being made to feel like a burden.
For this patient, the lasting impact was not the surgery itself. It was the feeling that events had happened around them rather than with them.
Their concern was whether moving face-to-face interactions into a digital space would create even more distance between themselves and the healthcare professionals caring for them.
Would it impede their access to individualised care? Would it bring them back to a time when they didn’t feel heard? How could a checkbox on a screen capture uncertainty or hesitation when an entire team of professionals couldn’t?
Patients are not resisting digital change because they are anti-technology; they are seeking reassurance that efficiency will not come at the expense of autonomy, understanding, and human connection.
Their concern about online ordering was not technological. It was human.
The goal is fewer interruptions and better conversations rather than none or less.
As pharmacy services continue to expand, this tension will only increase. Vaccinations, prescribing services, chronic disease management, contraception services, and enhanced patient care all represent positive developments for both the profession and the public.
But every new service brings with it a hidden question.
If pharmacists are expected to do more clinical work, who is managing the growing expectation of immediate dispensing?
Because the same pharmacist who is conducting a consultation, administering a vaccine, reviewing medicines, answering clinical queries, and supervising the dispensary cannot simultaneously provide instant service to every person who walks through the door.
At some point we must have an honest conversation about what accessibility really means.
Accessible should not mean immediate.
Accessible should mean safe, professional, available, and sustainable.
Perhaps part of the answer lies in changing how we think about dispensing itself. Not every prescription is urgent. Not every medicine is needed within the next 10 minutes.
Could we begin developing separate workstreams for routine repeat prescriptions? Systems that encourage advance ordering and planned workflow rather than constant reactive demand? Models that distinguish genuinely acute medicines from routine chronic therapy?
The fish and chipper next door doesn’t serve raw fish simply because someone is in a hurry. Some processes take the time they take.
The same is true in pharmacy.
Sometimes we have to let the prescription cook.
That does not mean becoming less accessible.
The challenge for the future is not how we continue saying ‘yes’ to everything. It is how we continue delivering safe, accurate, clinically robust care while helping patients understand what that process involves.
Because if pharmacy is to embrace expanded prescribing, enhanced clinical services, and a greater role in primary care, the era of accepting a prescription and producing it instantly every time may simply be over.
Perhaps the question is not whether patients are ready for digital change. Perhaps the question is whether we have done enough to show them that what matters most is not changing at all.
The pharmacist is still there. So too are the conversations, the reassurance and the trust. In a healthcare system that often feels rushed, that may be the most valuable service we provide.
Áine is a Superintendent Pharmacist and pharmacy owner with over 18 years of experience working in community pharmacies across Ireland. In 2014, she earned her Master of Pharmacy (MPharm) degree in the UK. Her career journey has encompassed
a variety of roles, including locum, support, and supervising, culminating in her recent transition to pharmacy ownership. She is deeply committed to upholding the integrity and vital role of community pharmacy in Ireland, combining her extensive experience with a passion for patient care and professional excellence.
