The effectiveness of en masse withdrawal. An untrusting customer’s run on the bank? A vociferous workers’ union strike? A globally observed ethical boycott? None of the aforementioned attract welcome publicity, but what if your controversial initiative faces virtually unanimous opposition scarcely moments after its unveiling...
With high blood pressure thought to affect as many as one in five people in Northern Ireland, thousands of people throughout the country could be suffering from the condition without realising it. Gordons Chemists have made blood pressure testing a priority for their health promotion strategy, introducing free testing events at ...
But that motto isn’t just for patients. If requests to contribute to community initiatives in health promotion are anything to go by, pharmacy is certainly at the top of most organisations’ lists for those to consult. This month NIPinF has heard about such projects drawing on the expertise of pharmacists from across Northern...
| Southern Discomfort |
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| Written by Laure James - Editor Pharmacy in Focus | |
| Monday, 04 August 2008 13:54 | |
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Once a very attractive prospect for pharmacists relocating from Northern Ireland and Great Britain, the Republic of Ireland's pharmacy sector is now reported as having fallen on destitute times, facing more threatening economic and professional difficulties than ever before. The Health and Safety Executive's (HSE) refusal to communicate with pharmacy organisations has left working relations in tatters and pharmacy multiples have even resorted to court battles against the HSE over loss of earnings, with independents set to follow suit. All this, and a 1996 pharmacy contract in need of revision, without the means to negotiate.  John Corr, recently appointed chair of the Irish Pharmacy Union's Contractors' Committee, told NIPinF editor Laure James about why a breakdown in communication is nothing new in the Republic. "Communication is a very difficult obstacle for pharmacists here, especially when it comes to evolving our role," John said. "With the example of methadone substitution, which had been recognised by patients and other healthcare professionals as a very valuable service, pharmacists felt very exposed in terms of robberies and hold-ups, although the State was not discussing any of these important issues with us. From the point where the HSE was mooted, the Department refused to talk to us since they maintained that pharmacy consultation was a matter for the HSE. Following a hiatus of three or four years, until the HSE was eventually up and running, we finally were given the opportunity to talk to the individual responsible for addiction services." More recently, the HSE had allegedly been found to breach the current contract by reducing payments on the Community Drug Scheme by a significant 8.2 per cent, without agreement; an accusation that is currently before the Commercial High Court. "The HSE cut in payments will damage the service to patients," John insisted. "The HSE has not considered the impact that this will have on pharmacy services and patient care." The Irish Pharmacy Union (IPU) appears fraught with frustration, which is rooted in the HSE's refusal to discuss fee negotiation. "They believe that it will be in breach of competition law and have maintained this since January 2006," John added. "However, the Committeeís previous negotiations with the Department were always referred to the Minister, leaving no issue of competitive indiscretion. The existing contract reflects the reality that pharmacists are currently under-utilised in the Republic of Ireland. Pharmacists are very eager to offer a more service-based and patient-focused approach to community healthcare, although this is impossible given the current difficulties facing the profession." The profession's value has been recognised at a political level, with support from Marian Harkin, MEP, who posed an important question to the European Commission, on EU Competition Law. "Ms Harkin was responded to by Neelie Kroes, the European Commissioner for Competition, who said that under EU Competition Law, the Irish State can negotiate pharmacistsí fees with their representative body, the IPU," John summarised, although lobbying on such a large scale has yet not helped to resolve issues on the ground. Services are also a stumbling block for the Republicís contract. "There are no specific services detailed within the contract. Any service implementation and provision is largely an entrepreneurial move," John admits. "However, those who were once in a position to provide services are finding it challenging to continue, without appropriate remuneration." Aisling Reast, an independent contractor in Lucan, is very familiar with this situation. "I trained and qualified in England although at the time the pharmacy climate there was very pressurised and volume driven," Aisling explains. "Now, it would seem that the pharmacy sector here is hurtling towards the same environment, with little focus on patient care and a misplaced emphasis upon box ticking and meeting quotas." Aisling, who had her first taste of pharmacy aged just fifteen during work experience, concedes that her career aspirations are now very different than when a teenager. "There is no evidential provision for extended services," she explains. "While a high number of contractors have invested into helping to create the opportunities to introduce services, such as installing a consultation room and giving greater time to multi-disciplinary working, the HSE has done nothing.  "It does raise questions over whether pharmacists would have made such an effort had they known that they now would not be providing the services they had once anticipated." In addition to the lack of investment from the HSE into the future of services, their concern with the future of the profession has also been disputed, with seemingly inexplicable cutbacks on training and education. Tutors take on pre-registration trainees without any remuneration, leaving it difficult to find volunteers, and the ICCPE, the Southís equivalent of Northern Irelandís thriving and popular NICPLAD, is barely functioning due to budget cuts. This lack of foresight for the future of community care is coupled with some significant rises in expected standards, due to the new Pharmacy Act. "There has been absolutely no consideration for the future and this leaves pharmacists struggling with uncertainty,î Aisling explained. ìThere are countless pharmacists who are passionate about best care practice and so proud of our profession, but patient safety will undoubtedly be compromised if such negligence continues." If there is such objection to the HSEís policies, why has it not been stopped in its destructive tracks? "Perversely, the HSE is not accountable to the Department of Health and Education here. They are a law unto themselves." With all of these difficulties combined, it could equate to community pharmacies facing closure, a threat that is already beginning to be reported in Northern Ireland. "I have already had to make cutbacks, in terms of staff and service delivery," Aisling admits sadly. "Refinancing is a route a lot of contractors are considering although amidst a recession, when lending is at an unfeasible low, it is not necessarily a good idea. If I were to visit the bank, they would ask me to project my turnover for the next few years and provide a comprehensive business plan. This is something I would have had no problem in doing five years ago, although now I simply do not have the answers." The credit crunch, which seems to have left no individual or business unaffected, has gorged on what Aisling and other pharmacists had depended on; their retail division. "OTC used to subsidise losses in the dispensary but now we are even finding problems there." Furthermore, Aisling estimates the HSE's cutbacks as being nearer a third than 8.2 per cent, as NIPinF had also suggested back in April. "It's not 8 per cent, in real terms what they are taking is much higher. Roughly speaking, they are taking back around 100million EUR from the 300million EUR that had been paid in fees. Cut backs are equating to a significant dispensing loss." From speaking to a number of different pharmacists in the Republic it emerged that although the fiscal difficulties were suffocating their business, a lack of recognition and appreciation of their clinical skills was just as insulting - and potentially the reason for the HSE's decision to make the cut in pharmacy. Hickey's Pharmacy, a multiple group based in the Republic, took the HSE to High Court over pay cuts last month and although a ruling is not expected until autumn, all pharmacists prepared to take such action have the full backing of the IPU. "Two pharmacists have already separately won High Court bankruptcy protection injunctions to prevent the HSE from reducing payments to them," explained IPU press officer Kate Healy. "The Union is calling on the HSE to reverse its decision to unilaterally cut payments to pharmacists and to sit down with the Union to find a process to resolve this issue through negotiations." Aisling believes there are much more sensible and less detrimental ways of cutting costs. "As all taxpayers, we have a vested interest in where the health budget is spent," she said. "There is no question that, if unnecessary spend can be curbed, then it is worth considering. For instance, generic prescribing and substitution is unusually low here, with an average rate of 20 per cent, although some estimates suggest it could be as little as 15. There is clearly overspend on branded drugs. "However, restricting pharmacists in our role as clinicians will only lead to financial pressures being offloaded onto secondary care. Patients with chronic conditions for instance could see their GP, a nurse, two consultants and another specialist, but the only one with their full medical history is their pharmacist. Patient safety will continue to be put at risk if a full spectrum of care is strangled." |