The Irish pharmacy iceberg is gliding along, with so much going on invisibly below the surface. As the IPU engages with the Department of Health and the HSE, we are all looking for positive outcomes. Inevitability, this means different things to each of us. But that doesn’t take away from some fundamental truths. We all want a less complicated way of working in pharmacy. We want to see meaningful progress on the issues that are blighting our everyday practice. A fairly typical example eked its way into my working life recently — the ‘special drug approval process’ is utterly unfit for purpose. At its core, it is a mechanism designed by a committee to help the State avoid paying for essential medicines. Twice in the last two months I have failed to get consultants to fill out these bureaucratic forms. In one case, it was a dermatology consult, where the patient was probably not going to die. The second was an order of magnitude more serious.

I received a prescription for rivaroxaban suspension for a young, very seriously ill child. We all know this commonly used anticoagulant, which the State pays under their various schemes for adults, but, in their wisdom, not for children. This barrier to treatment, dressed up as prudence, is to my mind, illogical, discriminatory and creating needless extra stress on parents who are already vulnerable. No consultant prescribes rivaroxaban to a child without serious clinical need. It is not very expensive, but it adds up fast. I am baffled by the process. The fact that a consultant issues a prescription should be justification enough. I cannot fathom how anyone in the PCRS can possibly second guess the medical need for this drug by insisting on a two-page form that states the obvious. This is definitely a system that needs serious surgery.

Getting back to the iceberg, there are some that seemed to think that lurking under the surface is more ‘Jaws’ than a mountain of meaningful change. However, it is hard to be anything less than really positive.

The imminent arrival of three new schools of pharmacy is raising eyebrows countrywide. With the first scheduled to open this year, we are all looking at this from our different perches. First, and foremost, this is an important change. It will effectively double the number of graduates. This will feed much needed pharmacists into the professional pool. Over the last few decades, we have seen an enormous fragmentation of the profession. Despite having many graduates, it is very obvious that many are not working in community pharmacy. Given the demographic shift in Ireland, we know that the future of pharmacy is extremely bright. As we all age, we are going to need pharmacists at the forefront of primary healthcare. We see report after report about the changing face of GP practice, where they are under continuous and predicted pressure. It is of critical importance to the healthcare industry that a thriving community pharmacy network can provide an evolving set of pharmacy services.

There is no doubt that the public have, like the rest of the world, changed how they consume information. Sources of authority are either no longer trusted, or are, at most, regarded with a deep suspicion that previously never existed. I don’t see this changing. Yet, as we all know, online and on the phone, is not the same as face-to-face. Generally speaking, in-person interactions are much more trusted than anything else. We are rapidly getting to the stage where anything that we don’t see and hear, personally, has to be doubted and questioned.

AI will potentially be a wonderful tool for pharmacy, but it isn’t there yet. In all likelihood, we probably haven’t even envisioned how it might support us. At the moment, all most of us see it being useful for, is creating fake content that will inevitably be used to shape and distract our views. Yet, as we know, all current models of AI require training data. Currently it would be fair to say that almost any content that can be consumed, has been devoured by these models. We are now in an age where AI models are hoovering up other AI-generated content, effectively creating a house of cards. We know that AI cannot tell truth from the proverbial hole in the ground. We must always bear the old maxim in mind, ‘garbage in garbage out’. My point is that people will continue to depend on trusted sources for healthcare. There will be a continuing avalanche of creator inspired health gurus and influencers who will capture the imaginations of a percentage of people. Our professional future is helping the vast majority of people who only want to separate fact from opinion. For this, we will need good people.

So, to the doubters, I say bring on these new graduates. Their future is going to be bright. They will be the vanguard of a new generation of healthcare professionals, who will help the public stay healthier and safer.