Pharmacists are not against reform but the Government has produced the wrong prescription, writes Dr Karl Hilton
Three years after the Government created Europe's most unregulated market for pharmacy services, the long-awaited Pharmacy Bill finally looks set to provide a set of basic standards and rules for the pharmacy market. The question is whether it's a case of too little, too late to save the traditional community pharmacy market here.
Already the spin doctors have been out in force to herald the new Bill as a pro-competition, pro-consumer initiative which will transform pharmacy services in Ireland.
"See how we will scrap those antiquated rules preventing pharmacists not trained in Ireland from opening new pharmacies here!" they cry.
"Wonder at how we have stood up to vested pharmacy interests to tackle the costs of medicines and bring real competition to the sector!"
It's dramatic stuff. But when the story of the Irish healthcare crises of the past decade comes to be written, chances are that history will look unkindly on those policymakers who have driven this reform.
First things first. The pharmacy sector - dominated by small, owner-run community pharmacies dispensing advice and medication to some 400,000 patients and customers each day - is actually one of the better functioning elements of the health services.
For example, Ireland enjoys a higher proportion of pharmacies per head of population than almost any other country in Europe; an average of one pharmacist for every 3,000 people compared to a European norm of one for every 4,500.
The country also enjoys the third lowest per capita spend on medications. This is reflected in the fact that average financial turnover in Irish pharmacies is one of the lowest in Europe.
Compare that to the United States, where unregulated pharmacies fuel the largest consumption levels of medicines at the highest prices in the world.
Unfortunately we're living in an age where theories - particularly economic theories - are more important than day-to-day experiences. So the policymakers have decided that regardless of what was working in practice, it was time to get the theory right and the theory demanded radical deregulation and liberalisation.
Other countries flirted with similar ideas in recent years. But almost all realised the errors they were about to make, or had just made, and reversed policy rapidly.
In Britain, for example, the Office of Fair Trade called for the liberalisation of the pharmacy market but was politely told that no such liberalisation would occur. The trade and industry secretary commented that there was a limit to how far a free market can be allowed to impact on healthcare delivery.
In New Zealand, the government actually anticipated the kind of changes proposed here in Ireland. However, they quickly realised that their pharmacy sector would be taken over by international retail pharmacies and reversed their decision because of concerns about its possible impact on patient needs.
Norway might have had similar thoughts after they deregulated their sector - but by the time they could do anything about it, the bulk of their independent pharmacies had been acquired by just three companies and it was too late to undo the damage.
Throughout the past three years the Irish Pharmaceutical Union (IPU) has stuck rigidly to one core demand: whatever else you do, make sure that pharmacists retain control of pharmacies. This is critical for patients and Government if they wish to achieve greater value for money from their expenditure on medicines.
Our logic is simple. We believe that pharmacy is not an ordinary business; certainly not an ordinary retail business. Our job involves dispensing potentially lethal medicines. Indeed in many instances, the pharmacist may make a professional call not to dispense at all or that the particular medicine is unsuitable for the patient.
It also involves giving advice, cross-checking the medicines prescribed with a patient's previous medication history and their compatibility with other medicines which he/she may be taking, and providing counsel and support in relation to various physical and mental health issues.
Surveys have continuously shown that pharmacies are the first port of call when patients are unwell.
Bearing all that in mind, we believe it's particularly important that pharmacists be personally accountable for what happens in their premises; anonymous big business enterprises cannot be held accountable in the same way.
But that doesn't mean that we're not pro-reform. On the contrary, the IPU has long being calling for greater involvement in the primary healthcare system.
We've urged reforms like those undertaken in other countries, for example, to allow pharmacists prescribe for minor ailments to reduce costs on patients and reduce demands on GP surgeries.
We've proposed to the Department of Health that we develop our role in monitoring the very expensive medicine regimes that many patients are on. Research has shown that over 50 per cent of patients do not take their medicines correctly and some of these end up in our overcrowded A&E departments as a consequence.
Pharmacists can help to improve patient compliance with medicines and prevent much of the waste that is currently occurring.
And we've urged the removal of the derogation preventing foreign-trained pharmacists from opening pharmacies here - but only when a fitness to practise regime is in place and Irish pharmacists are on a level playing field with their European counterparts.
Unfortunately most Ministers in recent times have ignored these calls - concentrating instead on fixing a sector that really wasn't broken.
In the IPU, we refer to the last 10 years as a wasted decade. During that time our colleagues in mainland Europe have taken on increasingly valuable roles within their primary healthcare systems. Here in Ireland, where such imaginative thinking is needed more than anywhere, we've been distracted instead with reviews and economic theories.
The new Pharmacy Bill offers one final opportunity to safeguard pharmacy services for future generations and to ensure the survival of hundreds of pharmacies in rural and marginalised areas across this country. The acid test will be the degree to which the Bill ensures that the control of and accountability for pharmacy services rests in the hands of pharmacists themselves.
This will enable us to create a new vision for pharmacy; one which combines our critical community focus with the ability to play a broader role in the primary healthcare service.
We've wasted one decade in getting this far. Let us all make sure we don't waste another one now.