The long-standing issues surrounding Fitness to Practice procedures remain unresolved. It is still a painful, prolonged and expensive process for anyone who goes offside. This was the situation ten years ago, yet nothing appears to have changed. Fitness to Practice comes in for significant comment in the recent PSI position paper on reform, which is quite a comprehensive piece of work. They lay the blame for two-to-three-year delays in processing cases on the inflexibility imposed on them by the Act of 2007. Having spent four years on Council, they need to be challenged strongly on this assertion. There were instances when Council fell well short of correct process themselves, a profound reluctance to use mediation initially being one. This may be a process that is still underutilised.

Potential progress in the role of pharmacists in Primary Care, elicits no opinion one way or the other in the interview. The role of the Regulator, in terms of the public interest in this area, appears to be entirely passive. Yet, there is evidence that enhancing the remit of pharmacists has provided significant benefits for both the public and the State.  The only mention I could find in the Position Paper, is that evolving pharmacy practices must be underpinned by regulatory safeguards. This is as good an example as one would find of the PSI mindset, it is a police force for pharmacy. It sees itself as having no role in enhancing access and availability of services to the public, whose interests are core to the PSI’s existence. The PSI needs to evolve and acquaint itself with the challenges of Primary Care and how they can work in this area to improve the situation for the public they serve.

There is little or no reference to the administrative burden on pharmacists in the IPU interview. The PSI is not an insignificant contributor in this area. The absurd situation remains where pharmacists are manually entering into the Drug Registers. Yet, the PSI bang on about having “Patient facing Pharmacists”, it is their tardiness that hinders that aspiration. In their position paper they place great importance on the development of a National Mandatory Error reporting system. But no joined-up thinking of how to achieve this, and at the same time loosen the chains of bureaucracy.

There is mention throughout the interview of ongoing conversations, holistic assessments, advisory groups, reports and consultation fora. But there is a suspicion that the people on Council who can increase awareness and understanding of pharmacy in Primary Care, are still a source of suspicion rather than information.

Supervising pharmacists, their scarcity is creating a situation which has serious implications for the public. Pharmacies are being kept open by using locums for cover from one day to the next, causing a disconnect in terms of quality and continuity of service. Remedial action to deal with this situation and its implications for patient safety seems as far away as ever. “Owners and Superintendent Pharmacists are feeling this challenge and we continue to engage with them” — talk but no action. In the interview there is only one tentative suggestion concerning the manpower issue. A proposal that “A Delineation Model” might ease the pressure. The dispensary is closed while the front of pharmacy is open for business. You can make up your own mind about that one.

There is reference in the article about the need for legislative change. This also is given prominence in the Position Paper. The size of the Council is a problem in terms of quorums, this from my experience is valid. Also, a smaller Council of 10 to 12 people would help streamline the workload. There is a view doing the rounds that the people in Fenian St want the election process for pharmacists onto Council be done away with. There is a preference for using the Public Appointments System, a preference confirmed in the Position Paper. This is a process that must be resisted at all costs. The right of pharmacists to have their views heard and listened to at the Council table, was in fact validated by of all people, the Competition Authority, in a letter to Council in 2016. This was in the aftermath of the supposed attempt by a number of pharmacists, four if I recall rightly, at Regulatory Capture. Democracy, as once stated is hard going, the alternative however is worse. Are we to assume that the PSI believe that the ballot box is less reliable than an unelected and unaccountable elite?

The PSI is on a journey, whether they are taking the right route is a reasonable question to ask. The public and pharmacists have a right to expect informed and educated regulation. Seriously, they need to emerge from the bubble in Fenian St and engage with the public, but also with the service providers. Academic papers are all very well, they may deliver in theory, but how do they fare out in reality?

Richie Collis