Dispensing with the niceties


The pharmacy dispute over the State drugs scheme is already leaving many people with chronic conditions stranded, but its potential impact could yet be greater

THIS DAY LAST week, the ongoing pharmacy dispute began, with the withdrawal of several hundred pharmacies from the State drugs scheme, the system that issues prescriptions to medical card holders and those on the drugs payment scheme. Prior to the dispute, 1,521 pharmacies had a contract with the Health Service Executive (HSE) to dispense these prescriptions.

At its core, the dispute is about money. Last year, participating pharmacists were paid a total of €540 million to dispense drugs under the community drugs scheme. As part of an ongoing series of cutbacks, the Government decided to reduce the payments it made to pharmacies to carry out this service.

Towards the end of last month, Minister for Health Mary Harney declared that even with the new cuts in payments from the Government, participating pharmacies would still keep a margin of 25 per cent on the drugs they dispensed.

“I believe that pharmacists will still continue to be adequately rewarded for the huge skill that they bring in dispensing medicines to our patients,” she said.

Projected savings as a result of lower payments by the Government are estimated to be €55 million for the remainder of this year, and €133 million for next year, but the decision proved to be highly unpopular and controversial with pharmacists.

To date, almost one-third of the participating pharmacists have withdrawn from the scheme, though it’s difficult to know exactly how many. The numbers are changing on a daily basis, as some pharmacies that gave notice of withdrawal did not then do so. The HSE website, with its lists of pharmacies that are continuing to dispense, is changed and updated regularly, which has led to widespread confusion. Phoning the related HSE information line on Thursday elicited nothing more than advice that the best way of finding out whether a pharmacy was still operating the scheme or not was to call it directly. In practice, the service requires that every name on the list be checked at source.

AMONG THE MOST commonly needed repeat prescriptions are those for drugs treating diabetes, high blood pressure, asthma and epilepsy. According to its health promotion and research manager, Anna Clarke, the Diabetes Federation of Ireland has been “inundated” with calls from around the country.

“There is utter confusion from people about which pharmacies are open, and when,” she says. “Most of the calls we’re getting are from elderly people. They’re used to going to the same pharmacist for years; someone who knows them, and their medical history. Any change is not welcome if you’re elderly. Change causes distress. Distress causes higher blood-sugar levels.”

There are 200,000 people in the State with diabetes, half of whom require insulin. Clarke thinks that if the current situation continues, it will be a fortnight to three weeks before the real impact of the dispute makes itself evident, once prescriptions start running out.

Ireland has the highest number of asthma sufferers in Europe – 470,000 – and the fourth-highest in the world, with one asthma-related death a week. “We don’t know what to advise people who are calling us, as the list keeps changing,” says communications officer Siobhán McCarthy, of the Asthma Society of Ireland.

At Brainwave, the Irish Epilepsy Association, the organisation had many calls just prior to the start of the dispute. “We encouraged people to get their prescriptions filled for two months. With epilepsy, it’s crucial to have an uninterrupted supply of medication,” explains Peter Murphy, Brainwave’s resources manager.

There are 37,000 people diagnosed with epilepsy in Ireland. Some of these cannot drive, for safety reasons. “If the dispute goes on, people in rural Ireland will have to travel for medication, but those who can’t drive themselves because of their condition will have to rely on family or neighbours to take them,” says Murphy.

To cope with the shortfall in pharmacies, the HSE has set up several dispensaries around the country, all of which have been approved by the Pharmaceutical Society of Ireland. According to the HSE, the dispensaries are all staffed by “fully qualified and licensed pharmacists with a supervising/chief pharmacist working with pharmacy technicians”.

Noel Stenson, who operates the only pharmacy on Achill Island, at Achill Sound, is one of the pharmacists who has withdrawn from the scheme. His, he explains, is the only pharmacy for 40 miles. The majority of Stenson’s patients, 95 per cent of them, are medical card holders, so virtually all of his clientele are affected by the dispute.

“There are two contingencies for my patients,” he says. “They both involve round trips of 120 km, to either Boots in Westport or the HSE dispensary in Castlebar. Then there’s an average three- to four-hour wait on top of that, assuming they have stock; otherwise, they have to come back again.”

According to Stenson, the dispensaries (particularly when they are dispensing to patients of whom they have no prior knowledge) make it a requirement that they see an actual prescription before they will make it up, so there is no time to be saved by phoning ahead.

Stenson’s pharmacy, although not dispensing, is still open. “My patients are suffering enough, so I want to be here if they need to talk to me. I encourage them to come in after they’ve got their prescriptions, just to make sure they’re 100 per cent looked after. Thankfully, I haven’t seen an error yet in any prescriptions.”

Fidelma Trant operates one of the five pharmacies in Listowel, Co Kerry, all of which have withdrawn from the scheme. She has been in business for seven years, and estimates that she fills between 1,500 and 2,500 prescriptions a month, with most of those requiring three items of medication. “It would be more or less the same at the other pharmacies in the town,” she says. “Between us, we’d have about seven pharmacists and 15 technicians.”

There is an HSE dispensary in Listowel, and Trant is directing all her patients there. “They only have one technician and two pharmacists there; sometimes just the one pharmacist, because everyone needs breaks and lunches.”

She doesn’t consider it possible for the HSE dispensary to service adequately all the patients that the five pharmacies were previously attending to. “Everyone who goes there is left waiting for anything from two to four hours, or told to call back later, or come the next day,” she says. “My patients are telling me it is totally haphazard, because there is no queuing system.”

IF YOU LIVE in a city or a large town, the concentration of pharmacies makes it easier, eventually, to find one that is still dispensing under the scheme. You don’t have the 120-kilometre round trip that the people of Achill are currently having to make. But you still have to go out of your way to find an operating pharmacy.

On Thursday, Mary Kelly, whose local pharmacy in Finglas is no longer dispensing through the drugs scheme, tried three other chemists in the area to fill her prescription for blood pressure medication.

“I couldn’t find one, so I had to give up and come into the city centre. It’s my whole morning gone,” she says.

Boots, in the Jervis Centre, agreed to fill her prescription, but due to the pharmacy’s backlog by the time she arrived at 1.30pm, staff told her it would be 6pm before they could do it. “I’m going on holidays tomorrow, so I haven’t the time to come back later,” Kelly says. “I have enough medication to keep me going for the two weeks of the holiday.”

What will she do when she comes home? “I suppose I’ll have to come back into town and go through all this again, except next time I’ll be waiting here even longer. Unless, of course, the dispute is all over by the time I come home.”