The ‘three body problem’ comes to mind as I look at the recent news from our Minister of Health. It basically states that you can get much chaos from three objects moving around a central point. In our case, the orbiting satellites are those of professionalism, commercialism and regulation. As I delve into the final set of recommendations from the Pharmacy Taskforce, it is hard not to think of chaotic and eccentric orbits. With community pharmacy at the centre, there are erratic and unstable forces orbiting our nucleus. I have been impressed, as have many of you, in the speed and the efficiency in which the Taskforce has gone about its business. In the space of a relatively few short months, they have delivered what could be clearly described as a blueprint for restoring order to the future of Irish community pharmacy. Of course, we could make much of what it doesn’t cover, but the nature of its remit was never to be a theory of everything. It ticks many important boxes on the checklist of a desirable community pharmacy future. In our welcoming of this, what may sometime be described as seminal work, there is one serious caveat ­— community pharmacy has been struggling.

We have some of the finest minds in the country serving the health needs of the public. We consistently deliver an extraordinary level of expertise and care. It is simultaneously both infuriating and saddening to think that there is so much stress and discontent amongst a substantial part of the workforce. Contrast this with the public view of our profession, which is one of deep confidence and trust. We have consistently been seen as at the top of the pyramid of trusted professions. This is such a tribute to those many pharmacists and support staff who consistently prioritise their patients needs and requirements frequently at their own personal cost. It is within this paradoxical area, that straddles the best and the most difficult parts of community pharmacy, that we have lost sight of what is important.

Going back to the chaotic orbits of issues that surround the kernel of community pharmacy, one very clear aspect is sustainability. The inherent paradox in our profession has always existed of striking that balance between the professional and the retail role that has been forced upon us. From my grandfather’s time, I know that the retail function was a vital cog in the wheel that drove his professional life. It’s hard to believe that up to 50 years ago, the vast majority of medicines distributed in Ireland, were not through pharmacies. This posed a large number of public health issues. While it was addressed with the founding of the medical card scheme and allied complexities, it is fair to say that this was never put on a solid commercial foundation.

One of the weaknesses that many pharmacists have faced is, despite appearances, we are not great retailers. In fact, it would be fair to say that most community pharmacies regard the retail aspect as a necessary evil. Traditionally, the pharmacy made its money on the margin of the medicines that it supplied. We never had a history of providing fully fledged professional services with the associated fee note. This has led us into a rather strange situation. We see many pharmacies that deliberately discount the professional input that they provide to the public. Every time we stand at the counter and provide advice, reassurance, professional input to the public, we do not charge. I challenge any of you to remember how much you paid to walk in the door of your solicitor’s or accountant’s office. While it has been building for decades, since the arrival of COVID, we have seen a reconfiguration of primary care health services. GP services have never been under greater pressure, with the consequent knock-on effect in community pharmacy. We have consistently seen the HSE and the Department of Health signposting patients to visit their pharmacy first.

While we are justifiably proud of the role we have played, and continue to, we have to recognise the harsh commercial reality: community pharmacy services are expensive to provide. There must be a recognition of this in how we deal with the State. Some of our naive commercial models have included, incredibly, freely supplying expensive services, like blister packing, at zero cost to the patient. Simultaneously, for the last  sixteen years we have had a consistent and persistent reduction in our State income. No other health sector workers, nor the administrative or political mandarins, have had such an imposition. It is long beyond time that we pulled up our commercial socks. We must fully stand by the IPU’s campaign for financial reality to be restored to pharmacy. This is an inflection point, where we can finally help resolve our three-body problem.