I was shocked last November when I realised that I had been a qualified pharmacist for 40 years. Somehow it doesn’t feel that long ago that the veterans at the meetings all seemed old. Then I realised that if you are retired, which I am, then to most people at today’s meetings, I am one of those veterans. As I pursued these philosophical musings, there was a double whammy. The IPU is 50 years old, and I have been a member for 41 of those years. In addition, because my father was Mid-West Regional Rep on the first Executive Committee, I remember the start of the IPU.
The introduction of the Medical Card (GMS Scheme) and the foundation of the IPU are interlinked. Prior to 1972/1973, medicines for people in lower income groups were provided from dispensaries, which were manned by doctors and pharmacists. These dispensaries were established under various Poor Law Acts from the 19th century. They were outdated, understaffed and the service was creaking and in danger of collapse. Under the Health Act in 1970, discussions on the introduction of a community-based scheme began. The concept was that eligible patients would attend a GP, would get a prescription, and bring it to the pharmacy of their choice. Pharmacists were represented at those discussions by a Joint Negotiating Committee made up of representatives of the Pharmaceutical Society of Ireland and the Irish Drug Association. Whether the PSI, as a regulatory body, could or should be representing the views of members had been a subject for debate for many years. On the other hand, the IDA, whose role was to represent the commercial/business interests of its members, was not the ideal body to conduct these negotiations on its own. It is a tribute to the leaders of both these organisations that they got together and worked on the introduction of the GMS. Out of this work, the IPU was born, and the Joint Negotiating Committee became today’s Pharmaceutical Contractors’ Committee.
When writing about the IPU over the past 50 years, one option is to review the history of the organisation, its foundation, and its development over the early years. However, a 50th anniversary is also an opportunity to take stock and while acknowledging the commitment and dedication of the founders, the ongoing work and success of the IPU is the greatest tribute to their foresight.
So, what does the IPU mean to its members today? What role does it play in the day-to-day work of community pharmacists? What support does it provide in terms of development of the profession?
The obvious answers are the Product File, the excellent IPU Academy, together with the Technicians Course, Medicines Counter Assistants’ Training, and various post graduate diplomas, and liaison with the HSE and PCRS on the development and administration of the various schemes. But that concise statement completely undersells the work involved in these matters.
We take the Product File for granted, but the fact that this key resource is owned by pharmacists is of major importance. Without it, pharmacists could have found themselves in the position where each computer company and wholesaler developed their own systems and therefore controlled our access to information. In this way, IPU was able to assume a central role in the development of pharmacy technology.
IPU Academy has been a tremendous success story. The website, online courses, support around IIOP Portfolio Development are spot on in helping us to fulfil our CPD obligations. The numbers availing of IPU Academy’s resources speak for themselves. The introduction of a Technician’s Course has been a huge support to pharmacists’ daily work. It has also allowed us to give an opportunity to experienced staff to develop their own careers, while still retaining their presence in our shops. The IPU are involved in Medicines Counter Assistants’ Courses with many of the county ETBs (Education and Training Boards), again helping to ensure the availability of trained support staff. The various management and other post-graduate courses for pharmacists also give us a chance to enhance our expertise in the complex role of a managing pharmacist.
Of course, if the foundation of the IPU was rooted in the establishment of the Medical Card Scheme, then this area, negotiation, and liaison with the HSE, PCRS and Department of Health is of key importance to the members. There is an urgency to this area now because the ad hoc changes over the past 30 years have strained the current system almost to breaking point. When the Medical Card was introduced, it covered a third of the population. The numbers covered now are over 40%, and given the planned extension of eligibility, this percentage is set to grow. Those of us who were involved in the 1996 Contract negotiations had no idea that this contract would still be in place in the third decade of the 21st century. Even though we are working under such an old contract, there has been development and expansion over the past 27 years. Vaccination, provision of EHC and the new contraception scheme have all been introduced and have enhanced the profession’s role and standing in the community. However, we all know that comprehensive reform and streamlining of the operation of the service is urgently needed.
Aside from key services such as those outlined above, the IPU has been to the fore in highlighting the role and promoting the potential development of the role of community pharmacists. High profile PR campaigns over the years have been key in this area. It is a tribute to this work and to each individual practising pharmacist, that pharmacists regularly feature as the most trusted profession in various national surveys.
One area of significant work which is undertaken by the IPU is the provision of advice and support to individual members. PSI disciplinary investigations, HSE probity queries, human resource issues, health, or family business matters, in all of these the IPU is there to advise and support. These kinds of issues are by their nature private and highly confidential, so the role of the IPU may be unknown or underappreciated. But anyone who has had occasion to avail of personal services in this way will know the quality of the service provided.
The IPU was born out of a major development in Irish society, i.e. the introduction of an equitable, community based primary health service. It must have been an exciting time to be involved in your representative organisation and the various committees led by Commandant Jim O’Farrell, Aidan O’Shea and Tim O’Malley (the first three presidents), would have had a busy and exciting time of it throughout the 1970s.
In the 1990s, the State again had a need to reform and develop community-based health services, and out of that need was born the concept of formal primary care structures. They published a health strategy policy document, and the IPU response to that document, the tone of which was set by PCC Chairman Padraic Staunton, acted as a springboard for significant negotiations, leading to funding for CPD, the High Tech Scheme, the Health Amendment Act Scheme, the Methadone Dispensing Scheme, and later, the Drug Payments Scheme. In the context of all this reform, a more modern, professional contract was negotiated. Looking back, it was again an exciting time to be involved, and I was glad to play a part in the development of what then became referred to as Primary Care.
As I write, we are again at a point where the State needs changes to the way that Primary Care operates. All services are understaffed and facing the pressures and demands exerted by a growing population and significant developments in new treatments. Talks are in progress between the IPU and the Department of Health. Reducing the administrative burden, pay restoration and the development of a Minor Ailment Scheme are all being explored. With the passage of time, the agreements on which the current services are based have become outdated. It follows that if there are any significant developments, both sides will need some contractual reform to underpin the new structures.
The IPU Committees will hopefully have a busy and fruitful period of work ahead. They have the necessary expertise and knowledge in-house, from the dedicated team in Butterfield House. It is again an exciting opportunity to enhance the Primary Care services provided to our communities.
Along with the other veterans, I will be watching developments with interest, with warm goodwill and a fair share of envy!
The subjects that most interested me in school were chemistry and history. The former might lead one to believe that the stars were aligned for a career in pharmacy. Well they may have been, but the most significant factors I believe, were that my father and grandfather were pharmacists, both of whom also worked in Phibsboro, so I never moved too far from the well.
History however, held an intrigue for me, which was a driver for my interest in Union affairs. The powerful and the powerless pervade the pages of history. Position and status were pivotal in influencing matters of policy and practice. Even today, in Western democracies, where the benefits of free speech and freedom of association are enjoyed, the old reliables are still potent influencers: ‘Plus ca change, plus c’est la meme chose’.
The industrial revolution ushered in the dawn of efficient and effective manufacturing processes —archaic by today’s standards, but the profits increased almost exponentially. However, the welfare of the general population stayed relatively static. Thus, the origins of organised labour — a reaction to the enrichment of the few, with little regard for the many, creating serious tensions in society.
Power and all its trapping have altered the moral compass of many who are trusted with it. The results are vividly relayed into our living rooms and detailed in our newspapers, on a daily basis. Churchill once said and I paraphrase, ‘Democracy is bad, but the alternative is worse’. Our system of government ensures checks and balances are in place, to create and maintain relative harmony in society. One of those checks are trade unions, bodies dedicated to representing their membership to ensure equity and fair treatment.
Such organisations utilise the many to act as a counterbalance against the concentration of power. The capacity of individuals to protect their interests in the face of state resources is wellnigh impossible. The need for a collective approach is an imperative, if progress on a professional and financial basis is to be achieved. This approach to labour relations derives from a legal system that is adversarial in nature, consequentially influencing how we interact with the State. These are basically the ideological reasons for my interest and activity in the IPU. However, I am sure there may well be personal issues involved as well, but let’s not go there.
Even within stable democracies, conflicting views can spill over and cause division and mistrust. One has only to look at the greatest military and economic power in the Western world and realise what a fragile flower our system of government is. Active participation in the affairs of state, and the trickle down bodies that constitute a complex matrix of various interests, is imperative. These are the organisations that contribute to the shaping of public policy. Too often, it is the few representing the many, leaving a vast swathe of people, some indifferent, some sceptical, others in the middle, staying on the side lines . . Lobbying is most effective when it is underpinned by tangible commitment to the cause. Tangible is numbers — more ideas, more input, more debate, creating better reflection, and invariably more satisfactory outcomes.
Pharmacy in the 1970s when I began working as a pharmacist, was a much less complicated career than it is now. A rather unflattering description of our work then was ‘Fill, Lick and Stick’. This was not without reason, as pharmacy was really in transition. The age of the apothecary was over, and the pharmaceutical revolution was gearing up. Medicines were pre-packed and had just to be taken from the shelves and labelled. Appreciation of interactions and side effects, despite Thalidomide, was not at the level it is today. Phenergan was the job for baby’s disinclination to sleep at night; Digoxin was made by two different manufacturers — yet the consequences of their different bio availabilities was barely appreciated.
Today however regulation is much stricter, poly pharmacy is no longer an exception, rather it’s the rule. Compliance issues have seen blister packing coming to the fore. Regulatory requirements are oppressive, and the need for patient interaction is greater than ever — the era of ‘Fill, Lick and Stick’ has disappeared with the horse and carriage.
During the last fifty years the IPU has been a cohesive force for pharmacy, representing the interests of the profession with many other bodies besides the Department of Health. It has talked the talked and walked the walk, not without coming up short on occasions, but always endeavouring to do the right thing for its members. The future holds great challenges, but also many opportunities for pharmacy. As in the past, the officers and staff will be the front line offensive, but colleagues, keep interested and be proactive, the greater the numbers the bigger the impact, the more satisfactory the outcome.
Finally, I would like to mention a few individuals who for me epitomised dedication to the cause of pharmacy. I didn’t always agree with them, nor they with I, but that is the formula which works. Men like John Burke, Charlie Roche, Tom Farmer and Enda Ryan, gave wonderful example to those still wet behind the ears. I would also like to mention Aiden O Se, who for I, showed how reflection and background were the essence of preparedness.
Let us all together ensure the next 50 years will show even greater progress in our profession.
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