Mulling over our local IPU RGM, as well as the developments over the last few months, I am heartened. I feel that the current outlook for the profession is, for the first time in decades, encouraging. There is a positive energy, a sense that we are on the cusp of something exceptional. Indeed, my wife pointed out that something extraordinary had happened. I became enthusiastic for the future of community pharmacy at the breakfast table — note to self, must do better.

Naturally there are the naysayers. But most of the noise seems to be coming from those that are harking back to some mythical golden age. Looking for a solid form of mercury that never existed. I also lived through it. It would be fair to say that I often felt something else. The months that I worried that I couldn’t make my mortgage. The times when dealing with the State was the equivalent of trudging through sand. There are large chunks of Irish pharmacy that I don’t miss from the last quarter of a century. Clinging on to ideals of a profession, that no longer exist, is a hazard of ageing. But as the new colleges of pharmacy roll out a substantial number of well-qualified graduates, the future is in their hands. Our profession is evolving, and like any living entity, it gets better or it gets dead. Our future currently lies in a hybrid professional service, based on our medicine’s expertise. In essence, pharmacy is an intensely personal service. You have patients, often in extremely vulnerable states, that depend on your professionalism and care. You build relationships built on trust and knowledge. While technology will facilitate, it will be the individual interactions that will shine through.

There is no doubt that people are hurting over the increasing restrictions on phased dispensing. It hit both the national and local airwaves simultaneously. The conflation by pharmacists of blister packing, as well as other forms of Monitored Dose Systems (MDS) with phasing, has been a blight on our profession. The State points out that there is little quality international evidence that monitored dosage is positive for patients and therefore will not fund the service. Yet, this is difficult pill to swallow (excuse the pun) because, everyday in our own pharmacies we can see, with our own eyes, those that it helps. The person with arthritis that cannot pop a tablet from a regular blister. The person with extra needs, that can remain living at home with some targeted home help. It is undeniable that MDS needs to be available for certain cohorts, just like there needs to be phased dispensing for others. Sometimes they will overlap. I have confidence that a solution can be found.

The frustration that we all feel with unlicensed drugs seems to increase inexorably. One area where it particularly rears its ugly head is the hardship arrangement. We have been told that centralisation of this chimera would make it more efficient. I beg to differ. While anecdote is not evidence, consider that I recently had a seriously ill medical card patient prescribed droxidopa, starting as a hospital inpatient. We bunged off the hardship application, along with a covering letter from the consultant. A little over a month later we finally received a response. More information needed, in the form of an IRF, the dreaded Individual Request Form. While we all have systems and procedures, it is simply unacceptable that it took over four weeks to make this non-decision. You can only hope that it isn’t a poor harbinger of the future. Fortunately, the patient got stabilised on another medication upon discharge from hospital.

In the interest of balance, I should also tell of a more positive experience with the PCRS. I recently had an unlicensed dose of bicalutamide (150mg) rejected for a patient. The follow-up phone call, from a pharmacist on the Hub, was constructive. They undertook to contact the prescriber and within a few days, the dose was approved. That is a proper patient-centred service, for which we must be grateful. It also begs the question as to why bicalutamide, at less than thirty euro a box, is on the Hub.

Once again, we must salute a giant of the IPU, in the form of Ger Gahan, who is retiring from a long and distinguished career. She arrived into the IPU at a time when data informatics was an exotic, arcane area of pharmacy. Within the categorisation and classification of Irish medicines, she has become a colossus of knowledge and expertise. We went from a price list to a National Health Products Catalogue. More importantly, Ger is one of the most pleasant people you could meet. Any time our paths cross, she manages to retain an encyclopaedic knowledge of the trajectories of my offspring. I am sure I speak for most when I say, Ger, enjoy your retirement. You have done the profession a great service. Thank you.