I work as a GP in Ireland. I have only one list on my desk. It is the list of local chemists and their phone numbers. Ireland is fortunate to have family pharmacists in every town and city, with a proud tradition and heritage, who have earned the patient's confidence and trust in a system that keeps the population well and healthy.
They sort out minor illnesses, keep the regular prescriptions straight and are invariably hugely helpful to doctors in the area. It is a complex, sensitive job and, in my experience, they do it superbly. However, I am deeply depressed about their future.
I fear that we are going to lose them and we are going to lose them because of a lie. The lie is that competition is a God and a God who must be worshipped without question. Words such as appropriateness, cost effectiveness, suitability or quality are not considered by the fundamentalists who insist that they should bow their heads to competition. And because they bow their heads we, the Irish nation, must hand over our chemist shops to foreign multinationals.
Drugs bill
The drugs bill for Ireland remains high, so the simplistic view would be to use cheaper drugs. The price of drugs in Ireland has already fallen significantly. Logic would suggest that the price of drugs at supermarkets will drop still further. Will it make a difference? I doubt it.
Consider the difference between going to your local pharmacist and going to a supermarket. In the chemist shop a skilled healthcare professional who knows you, your circumstances, your history and your doctor will discuss your case with you.
It may be that the best medicine is none at all, or you may need a quick phone call between the GP and pharmacist in a legal and ethical exchange of information. You may be sent back to the doctor. It is all appropriate to your needs and circumstances.
A timely intervention may save the health service a fortune and save you a stay in hospital, or even save your life.
Or you can go to the mega store where a a newly qualified young pharmacist will chuck into a shopping basket whatever he thinks you need, along with your vodka and cigarettes and your battery chicken. He will know nothing about you, your circumstances or your medical history.
Question of trust
Can we rely on the big chains to be appropriate in their care? Can we trust these soulless conglomerates to look after our sick, our babies and our elderly?
The big stores are already incorporating pharmacies. Think about the effect in any small town. The family chemist will close, like the record stores, the pubs, the butcher shops and the bookshops have done already. Decent sustainable jobs will go. Every euro spent in the megastore will go straight out of the town and out of the country. The megastore will be like a giant parasite sucking the life out of the town. And when every sign with a local name over the shop window has been taken down and the windows are boarded up, we can ask where is your competition now?
And not only the shops will suffer. There are a several Irish companies making generic medications. They will have to compete with bulk buying of the cheapest products the multinational can source at rock-bottom prices. The safe, ethical Irish factories will all simply go bankrupt.
The whole idea to move the pharmacies into the superstores was typical of the Thatcherite philosophy that applied to government policy of the past and should play no part in the thinking of a beleaguered nation where every job is vital. Why should we sacrifice our jobs to make a foreign multinational richer?
I know it is difficult for many people to balance the family shopping, but surely quality of care and service and common sense come into equation, and somebody somewhere in authority should realise that cheap means cheap, and not best. Especially when they are responsible for the health of the nation.
When it is all over and the delicate web of family businesses in Ireland is gone, we will see the wreckage of a new colonialism – the colonial power of the multinational that cares only about money. And we will wonder again, where is the competition now?
Dr Pat Harrold is a GP in Nenagh, Co Tipperary