When I was young, I thought pharmacy was a fairly simple profession. I had seen my grandfather, smiling pleasantly and engaging in consummate customer service. He was followed by my father, having learned well at the feet of the master, providing an excellent dispensing service. He had the additional challenge of adopting computerisation, a novel concept in the early 1980s. This was seen as no bad thing, as it would improve patient safety. In retrospect, how naive was I? My simplistic view of the world, tinted by bias and blindness, was quaint and relatively uninformed. Unfortunately, it is very clear that this view of community pharmacy is hard to shake. It has been a continuous and important battle to communicate what modern pharmacy actually means, as well as what it does. While the supply of medicines is a core function, it is but part of a primary care model that works extremely well. With almost 80 million annual visits to pharmacies in Ireland, we see more people than the rest of the health service put together.

This is why the release of the recent IPU White Paper, Key Enablers for a Sustainable Pharmacy Model, is a critical point in our evolution. This, must be tempered with the knowledge that the shelves of the Department of Health are groaning on under the weight of, long forgotten and ignored, white papers, green papers, committees of inquiry and final reports. Yet, what is different, is that the IPU has put an enormous effort into getting our message on the table. If you haven’t had a chance, it is worth your while making the time and effort to read through this important paper. Unlike many of these types of documents, little of it seems unattainable. It is rooted in current practice, current technology and clearly identifiable goals.

Pharmacy has evolved as a profession. Our role in primary care is second to none. In a health service that is creaking with capacity constraints, we are a beacon of positivity. Yet, it is our very success, our resilience, that appears to count against us. We are facing enormous challenges, of which we are all acutely aware. As the world moves on, we all have to adapt to the new realities. A key enabler is an appropriate infrastructure. Our IT landscape has evolved little from the 1980s. Our systems are inventory management programs for prescriptions. There is nothing wrong with this, but they need to be much, much more. We have to be able to support the complex environment within which we now operate. As our patient care function increased in complexity, we have found ourselves technically poor. Working with disparate systems, the PCRS suite, Healthmail, Pharmavax, our own PMR systems and more, we have all the elements of a technical hellscape. Multiple data entry, combined with little crosstalk and interoperability makes for a very poor IT work environment.

A typical example is the one we all face every day. It is hard to believe, but we frequently face a situation where we do not know if we are going to be paid correctly for a medicine we are asked to dispense in good faith.

While the PCRS are a key part of every community pharmacist’s working day, they are also one of the sources of most strain in anybody’s routine. This is not simply a financial risk. It is also a patient risk, as a pharmacist’s attention is pulled towards the arcane approval process of the State. So, a simple request, that the PCRS actually verify what they will cover, in real time, is not such a complex task. This is covered in the White Paper under operational enhancement.

The big Kahuna is, obviously, resources. There are two major aspects, historic/current and projected. Unlike the rest of the health sector, their managers and political overlords, we have been persistently left behind in the restoration of remuneration after the financial crisis. While the Minister for Health has made many statements acknowledging the inequity of our treatment, it hasn’t moved the dial. Like every business in the State, our costs have dramatically escalated over the last few decades. Yet, we have experienced persistent and continuing pay cuts. This is causing enormous internal strain. The State has frequently asked us to step up to the plate. Over and over again, whether through vaccinations, the pandemic and much more, we have come through. A particular sore point, they didn’t even give us the courtesy of the pandemic payment that almost every other health worker received. Lest we seem ungrateful, we did get a letter of thanks for our pandemic efforts. They paid for the stamp. Now we are looking at a sustainable pharmacy model for the future. It is one that the State needs more than ever. We must stand firmly with the IPU in their negotiations. Literally, our future is at stake.