The recent IPU National Pharmacy Conference, held in the Johnstown Estate was a stunning success. Aside from the bonus of sleep deprivation, due to excessive socialising, the key metrics of learning, networking, healing and having a good time were all outdone. The recognition of Michael Tierney’s exceptional contribution to the profession, as well as the IPU, through the awarding of the Diarmuid O’Donovan Memorial Medal, was one of the highlights. Yet it was one of many. As the days go by, different ideas will roll around in the attendees’ heads. I have no doubt that some of the seeds will sprout and bloom into potent new developments. There are a few aspects that I would particularly like to focus on, as I feel they are relevant.
The first is that pharmacy is probably changing much faster than many of us realise. The challenges we face in Ireland are replicated, or have parallels, across the world. If we look at Europe, we are seeing an expected shortage of over two million healthcare workers by 2030. These will be across the whole spectrum of pharmacists, doctors, nurses and all the rest. On pharmacist availability, we are all guilty of focussing on problems in our own local sector, perhaps missing the global trends. Pharmacy is becoming a less attractive profession.
According to FIP, there are problems getting young people to select pharmacy as an option. While this could be simply a natural ebb and flow, it is difficult not to be concerned. Yet, as always, out of crisis comes opportunity. A particular phenomenon in Ireland, as well as the USA, has been the effective Uberisation of a sizeable section of our younger workforce. Instead of looking for a steady, stable, income, they are opting for the spailpín fanach lifestyle.
As we often observe, it is hard to blame them. Great income, pick your own hours and less responsibility. While the regulator would disagree about the latter, what is not to like? It doesn’t take a genius to see that this is going to change. Perhaps quite rapidly. It could come from unexpected directions. For instance, there are strong indications that quite a few smaller chains are under severe financial pressure. Their labour costs have exploded, the gross margin is shrinking. Something has got to give; the only question is the degree. Yet, it is hard to avoid the accusation of being guilty of exploring my own biases. The real solution lies in changing the workplace, so that the average young pharmacist wants to work regularly in a particular community pharmacy. It becomes both attractive and professionally rewarding. The old issue of controlling the controllables.
This is where we are going to see changes. It doesn’t take a rocket scientist to see that there are structural issues. This is something that GPs are already facing, where the days of the single operator are dying. Is it a stretch to think that the same is true for pharmacy? All indicators show that people working in a team are happier, more engaged and often more productive. How to deliver a solution recognising this issue is going to be difficult.
One of the key takeaways from the conference was to finally see a growing realisation, outside of pharmacy, that the community sector is a key component of primary care. As the GP landscape continues to evolve, the community pharmacy becomes more and more critical for the proper functioning of primary care. While we have been telling ourselves this for years, the echo chamber of pharmacy can be a lonely place. We finally hear a Minister for Health saying, “I hear you.” It is clear that he knows what we do, is sympathetic to our needs and is willing to move. While this Minister has his own specific set of challenges, he has set a few balls rolling.
As I write, the first set of recommendations will have arrived on his desk from the expert group on the expansion of the role of pharmacists in Ireland. The mood music of the Department of Health and IPU has become, for the first time in decades, something that resembles a tune. While you would not want to get carried away, it is clear that we are very much in a constructive phase. Part of our near evolution is going to be the way technology is going to continuously change our workplace. For us to work smarter, we need the right tools.
The dispensary and point of sale tools at our disposal need enormous development. In both categories, they are stuck in the product supply paradigm, rather than the services that we are continuing to grow. Allied to this, online service and product provision is here to stay. People like, expect, and need, personalised service. Demographics are all pointing to very busy pharmacies. The delivery of right care, at the right time will only continue to grow in the right place. Community pharmacy is going to be an exciting, busy sector. The journey has started.
Jack Shanahan
MPSI
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