In these times of immense strain on our healthcare system, it’s imperative that we fully harness the potential of the most accessible component of healthcare: community pharmacies. However, community pharmacy finds itself standing at a crossroads, grappling with a deeply uncertain future.
Simply put, community pharmacy is facing a resource crisis. The prevailing business model relies heavily – approximately 60 per cent – on State payments for administering community drug schemes. The State wants these essential health services delivered locally on behalf of the people; it’s not simply a commercial venture.
Regrettably, these payments for dispensing medicines were cut following the financial markets crisis in 2009 and have remained stagnant for the past 14 years, even before they were eroded by inflation.
In 2009, the average fee for dispensing a medicine stood at €6. Today, it has dwindled to €4.58, a reduction of 24 per cent. Consequently, the revenue generated by each pharmacy under the community drugs schemes has plummeted by a staggering 29 per cent.
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Simultaneously, the cost of dispensing a single item of medicine has escalated from €3.73 to €4.58 over the same period. Basic maths reveals that the dispensing fee paid to pharmacies by the State barely covers the cost of the dispensing process itself. And when we consider the ever-increasing expenses faced by pharmacies on a daily basis – on labour, energy, utilities, rents, insurance and administration – it becomes evident that the graph trends in only one direction.
Many pharmacies across the State are now teetering on the brink, with costs on the rise and revenues falling. This situation is simply unsustainable.
Rural areas, already lacking in other essential services, are particularly vulnerable, with some pharmacies reviewing their operating hours, including the possibility of reducing services on weekends. Consequently, patients are experiencing prolonged wait times for prescription medicines to be dispensed. Pharmacists, placed in an invidious situation, don’t want this to be the case.
One in 10 community pharmacies is currently operating at a loss – primarily those in rural regions – while many others struggle to survive. This number will undoubtedly rise and, unless there is substantial investment in the sector, the number of pharmacies in local communities across Ireland will undoubtedly fall.
What exacerbates the situation is the glaring disparity that community pharmacy is the only element of the healthcare system that has not seen restoration of pay for services provided since the financial crisis. In contrast, average hourly earnings for other healthcare workers have increased by 14 per cent. Moreover, while community pharmacy was previously linked to public sector agreements through Financial Emergency Measures in the Public Interest (Fempi) legislation during periods of imposed cuts in 2009, there is currently no such connection for pay restoration. This blatant discrimination must be rectified.
Addressing this situation doesn’t require complex or costly measures. To ensure the viability of all pharmacies going forward, an increase of a mere 50 cent per item – above the fees received in 2009 – would be transformative. In light of significant funding provided to other sectors, such a request appears more than reasonable.
Minister for Health Stephen Donnelly is legally obliged to review pharmacy services and funding by the end of this month. Despite this looming deadline and requests to meet, there has been no engagement from the Minister.
This neglect of a crucial aspect of the health service is myopic and irresponsible. As the Minister presides over a health system on the brink of collapse, the solution stares him straight in the face. For years, community pharmacy has been a beacon of care, quality and personalised service, readily accessible, with half of the population residing within one kilometre of a pharmacy.
Pharmacies provide an exceptional service and are poised to do even more if provided with the necessary resources. Services such as treating minor ailments, allowing women to access contraception without a prescription, and empowering pharmacists to therapeutically substitute medicines in short supply will greatly support healthcare in our communities and align with the Government’s Sláintecare strategy.
We have never been found wanting when asked to take on additional roles and responsibilities; we are a vital cog in the health service, yet we are consistently considered as an afterthought of the health service
Pharmacists want to engage with the Government in achieving a strategic direction for community pharmacy that will plug the significant gaps elsewhere in the healthcare system and sustain healthcare in the community into the future. But part of this engagement has to include resourcing pharmacy. One is not possible without the other.
Community-based pharmacies bridge any potential gaps between medical expertise or availability and community wellbeing. Their presence is testimony to the power of local care, exemplifying the notion that true healing extends throughout the community, embracing compassion, empathy and a shared commitment to collective health.
However, amid these higher-end goals, morale among pharmacists is shockingly low; there is a very high rate of stress, and patience with those who preside over the healthcare system is wearing thin.
We provide an excellent service to patients on behalf of the State. We have never been found wanting when asked to take on additional roles and responsibilities; we are a vital cog in the health service, yet we are consistently considered as an afterthought of the health service. This needs to change, before it is broken.
A good start would be for the Minister simply to engage with us to end the uncertainty and bring forward meaningful proposals for the future of the pharmacy sector. We are willing and available but is the Minister?
Derek Reilly is interim secretary general of the Irish Pharmacy Union, the policy and representative body of Irish pharmacists
