One particular issue that has exercised me recently has been the growing inability of patients to get a timely appointment with their regular GP. This has led to an explosive growth in walk-in or drop-in private clinics. Whatever your views on the adequacy are otherwise of these services, they are here to stay. They provide an escape valve for many patients including those with medical cards, some who can barely afford the extra cost. A small, but important, issue arising from these clinics is that of medical card eligibility. If a patient arrives to a pharmacy, with a prescription from a drop-in clinic, yet they have full medical card eligibility, is this valid for the PCRS? To date, technically, the answer is no. It is beyond time that this aspect of the medical card system is reviewed. In an era of interminable waits for GP services, where public patients are treated in private hospitals, the day of the medical card number on the prescription has to go. If a patient has a valid medical card and a valid prescription, then it is only petty bureaucracy to argue that it cannot be processed on the medical card scheme. It also begs a greater question — the primacy of the GP in a patient’s care. Way back, the GP was the person that looked after generations of families. Today, we predominantly have practices, where the patient may meet a different doctor every time. Continuity of care is based around medical records being stored in the practice. It begs the question of what happens when these electronic healthcare records go fully online? All we are seeing is more and more fragmentation of care. Makes you really wonder what the challenges of the community pharmacist will be in 2044?

Codeine addiction is a serious business. However, I confess that I was somewhat confused when I read about the rescheduling of the 150ml bottle of codeine mixture. It will be going prescription only from December. Then I saw, in black and white, that the 100ml bottle was going to be still available as an over-the-counter medicine. To my mind, I regard this as a full-on, incontrovertible, Irish solution to an Irish problem. For context, I can safely say that I can count on one hand the amount of codeine mixture that I directly supply to the public in any year. Probably the same as many of you. Through constant haranguing, I have become resistant to supplying this useful medicine. Any person asking for it at the counter gets the equivalent of klaxons screaming, sirens blaring and lights flashing. All the staff go into alert, heads turning in unison towards the customer, with a level of suspicion normally reserved for the most truculent troublemakers.

We have all become aware of the enormous damage that is done to an unfortunate cohort of people with substance abuse disorder. We see it every day, particularly in that smaller group of unfortunates that seem to be travelling from town to town. These are visible manifestations of an important aspect of our profession. We are custodians of medicines. Our responsibility is to ensure that the public has safe, legal and appropriate access to medicines. If we are to believe all the polls, broadly, the public say that we have filled this role well. We are trusted. So, we go back to where I started with this. Why? What is the rationale behind making 150ml of codeine prescription only, when the 100ml bottle retains its current status? While we can all speculate, it is important that we are all clear as to what is happening. Is this the tip of a spear, winging its way towards cleaving codeine from the pharmacy shelves? From a pharmacist’s point of view, you get to exercise professional judgement for each codeine sale. While it may be a nuisance at times, it is our job. It would be a poor indicator for the profession if all codeine products went down the prescription route.