Áine MacGrory wonders whether with all the challenges we face, there will ever be a fairy tale ending for community pharmacy
December 25. Tea’s hot, phones down, feet up. Peace — for now. The only hum going on in the background is Walt Disney’s 1959 Sleeping Beauty. I’m not paying it much mind until it comes to Princess Aurora’s birthday party planning.
Fauna — the Green Fairy Godmother — was tasked with making the birthday cake. The cake was rushed. Fauna simply hadn’t left herself enough time to produce an 11-tiered, fully-iced birthday cake with all the trimmings. Rather than admit defeat, she grabs a broomstick to prop it up and carries on adding to the unstable, melting mess.
The cake is collapsing because it hasn’t had time to cool, the icing is oozing out everywhere, no tier spared, and the candles are sliding down the handle of the now ruined broomstick.
What could have been a simple Victoria sponge has now been reduced to a big pile of slop. The result? No cake for anyone.
I chuckled to myself looking at an oblivious Fauna re-adding the same candles that are sliding off conveyer belt style to no avail.
Wouldn’t this be an excellent visual aid to explain the current state of community pharmacy right now?
Fauna, in this case, is our Minister for Health (MfH)*, the collapsing cake tiers are the no longer fit for purpose community pharmacy schemes, the melted icing is the overflow of administrative tasks, and the candles are place markers for the ongoing medicine shortages. What does that make the broomstick? It makes sense to label that as the ‘Free’ HRT scheme being announced as a last-ditch effort to keep this collapsing cake standing long enough to get some more votes in.
No amount of icing and candles are going to cover Fauna’s mess, just like no number of false promises and poorly thought-out schemes are going to conceal the chaos that is the current situation in community pharmacy.
In fairness to Fauna though, she was well intended, just slightly naïve.
The same can’t be said for the MfH, who has left this big pile of slop for the community pharmacists to clean up.
It’s January 3rd and I’m selling cough bottles faster than I can get them on the shelf. Healthmails are filling my inbox, one ding at a time.
Pharmavax was under maintenance all morning, so I couldn’t record the vaccinations until now — what an enormous stride we have made there. No longer a need to inform the patient’s GP, but still the record can’t be updated for payment unless you record the patient’s favourite colour and star sign.
As I begin to enter in the details of the next prescription, I am interrupted by a team member: “There’s a lady out the front who wants to speak to the pharmacist.”
I crane my neck and look out cautiously. I internally groan when I discover it’s Mrs HRT at the counter, scowling at the IPU notice sent around to all members by way of aiding our explanation to the public — I think a labelled image of Fauna and the cake would work better, if you ask me.
I cringe at the mounting pile of baskets. It’s 5pm… we close in an hour. Much like Fauna’s cake, I won’t be standing much longer at this rate either.
“I’ve just been charged €20 for my prescription, but this is for HRT… it’s free now?” she enquires. “YOU are charging me, even though it’s supposed to be free! YOU can’t charge me anymore!”
That targeted ‘YOU’ gets me every time.
I sigh. Her question is valid. What do I say? As lovely an idea as it was for HRT to be free, it simply was not possible, for several reasons. Reasons that were ignored by the Department. Reasons that needed to be pushed harder by the IPU. Reasons that I now must explain to my patients for the fifth time today. I agreed that it was an awful promise to break, but equally a promise that I did not make.
So, who does she speak to about this? The Department of Health? Well, their stance, as reported by the Irish Independent, is that the community pharmacists are the reason for this colossal failure.
The bottom line is, Stephen Donnelly expected us to foot the bill without complaint in a desperate attempt to squeeze in a few more votes. And the icing on the cake? These products he promised for ‘Free’ are either unavailable or severely limited in supply.
Something else that struck me is that fact that HRT is already covered through general medical services (GMS) for medical card-holders, and for non-GMS patients, these products are included in the €80 monthly cap via the drugs payment scheme (DPS). This ‘FREE’ HRT scheme was just a reformat of already existing schemes and simply wasn’t critical.
I believe a far more pressing matter being asked for by the public was getting Ozempic reimbursed on the GMS and DPS scheme. This was a hot topic all year, and something the nation was crying out for. That would have been a far better use of limited resources, offering quantifiable health benefits for the public.
One could argue that would be unwise due to the ongoing shortages and supply issues with Ozempic at the moment, but the exact same could be said for HRT. They are both prescribed off label, so the licensing argument is a moot point here too.
The ‘voice of community pharmacy’ needs to step up now and start fighting fire with fire.
Our response to this catastrophe has been timid and overly cautious. It seems that we are whispering, at a time we need to be shouting from the rafters. Our response to the Department’s attempt at making us scapegoats? A very calm, rehearsed and overly polite suggestion that the MfH’s vision for ‘Free’ HRT for women by January 2025 was “ambitious”. I would not have been quite as polite. This was a display of complete ignorance, an insult to the women of Ireland, and detrimental to the community pharmacy sector.
Pharmacists have been sent long-winded bullet points about an ‘Integrated women’s healthcare scheme’ that doesn’t and won’t exist until, as the IPU have emphasised repeatedly in their communications, substantive progress has been made in the pay claim.
It seems that we are whispering, at a time we need to be shouting from the rafters
There needs to be a national media campaign defending our position and educating the public on the reality of the situation we are in right now. Something that involves and pays for people with the appropriate reach. The likes of Victoria Jones ‘The Menopause Pharmacist’ and Sheena Mitchell, who both lent their voices to our cause.
Why are we so afraid to say we do expect to be paid adequately for the professional services we provide? We are trying to run a business here, and that involves adequate revenue. No other profession is apologising for expecting this. No-one should be expected to work for free or feel ashamed for even suggesting that we need to make a living.
The community pharmacy sector can no longer be expected to continue absorbing the cost of providing these schemes that simply do not work in tandem with the current supply chain and medicine shortage issues we are facing.
So, try explaining all of this to Mrs HRT. I’ve made peace with the idea of getting out of here on time.
I say, “this isn’t right, but me not charging you only serves to damage me, my livelihood and the viability of this business. My business will fail if I absorb this cost, and if my business fails, the pharmacy will close its doors. If that happens, you lose your local pharmacy. I cannot operate on a loss. It is simply not possible.”
I look her in the eyes, imploring her to see my point of view and to understand I am not the enemy here. It’s confusing, it doesn’t make sense, and we have all been let down. She accepts this reluctantly and leaves disappointed.
I go back to the dispensary — it’s 5:20. Twenty minutes spent defusing that situation, zero progress made, and a patient left disheartened.
I sigh and chug my cold tea, made fresh four hours ago. The team just look at me with pity and we roll up the sleeves and gear up to tackle the queue.
‘It’s how much?!’ I hear from the dispensary.
The same team member comes back in “Áine, sorry — someone wants to speak to the pharmacist”.
Here we go again…
*I refer to Stephen Donnelly, who at the time of writing this article was still the Minister for Health.
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.
