OPINION:Perhaps we should hesitate before dismantling a service which in fact works well and delivers value, writes LIZ HOCTOR.
IN THE midst of economic hardships that are affecting society, it’s hard to feel sympathy for pharmacists.
There’s a well-established caricature of pharmacists as wealthy professionals, part of the problem of high medicine costs – not part of the solution.
Like many caricatures, however, this one is flawed. Most medicines in Irish pharmacies are dispensed at cost and the price of medicines is set by the Department of Health and Children and the pharmaceutical manufacturers – not by pharmacists. The average profit margin for a community pharmacist is just 6.6 per cent – €125,000 according to a PricewaterhouseCoopers (PwC) report for the end 2007.
The caricature has stuck though and indeed Minister for Health Mary Harney and her department have encouraged the distortion for what appears to be two reasons. Firstly, it draws attention from failures to control medicine costs. Secondly, it has allowed them to target the profession to try to achieve cuts which should properly be sourced from other areas in the health service and from the medicine manufacturing industry.
The profession sought more than five years ago to engage in a review of our contract with the HSE with a view to expanding services provided by pharmacists and achieving greater value for money.
Pharmacists proposed that they be enabled to offer the patient the choice of cheaper generic medicines, where it is safe to do so. Pharmacists in other European countries have been enabled to do this to save costs, not just for the State but also for patients. However, these proposals fell on deaf years.
The price of medicines is set by agreement between the Government and pharmaceutical manufacturers. Indeed, pharmacists are prevented from offering the patient a cheaper generic by a clause in this agreement. They have no say in this accord. Against the advice of pharmacists, last year the Minister introduced payment cuts on the community drugs schemes, only for the courts to rule against the Minister.
Pharmacists recognise the gravity of the nation’s economic plight. We see thousands of patients, who have recently lost their jobs, now presenting with medical cards. We have also been hit by the economic downturn, an 18 per cent fall in non-dispensary retail sales and difficulties in arranging financing with banks.
Pharmacists are willing to play their part and have indicated to Government that they are willing to accept a cut equivalent to 8 per cent of their fees, which is in line with cuts imposed under this legislation on other healthcare professionals on April 30th this year.
In a submission to the department in March, we offered savings of some €85 million on the medicines bill comprising:
€21 million savings equivalent of 8 per cent of pharmacists’ dispensing fees;
€30 million savings through offering patients a less expensive generic medicine, when it is safe to do so;
€33.7 million savings from the implementation of the Irish Pharmaceutical Healthcare Association agreement, the Barry report and changes to the high tech scheme.
These savings could have been agreed within a short time and would not have a catastrophic impact on employment and patient services, but there was genuine shock across the profession two weeks ago at the scale of cuts announced.
The Minister has stated that the reductions in payments to pharmacists will save the exchequer €55 million in 2009 and €133 million in a full year.
However, the Irish Pharmaceutical Union estimates that the cuts will remove more than €84 million from the community pharmacy sector for the period from July 1st to end December 2009 and not €55 million. In a full year, this would be €169 million and not €133 million, as was stated by the Minister.
Consequently, an estimated loss of €106,000 from the bottom line of each pharmacy a year will occur, and not €82,000 as stated by the Minister. This amounts to a cut of 34 per cent in overall payments to pharmacists from the HSE for delivering an essential frontline health service and virtually wipes out the net profit of pharmacy businesses.
More importantly, the swingeing scale of the cuts will cause untold problems for community pharmacists across the country. It will undermine the business model built up over a generation and will trigger job losses, restricted opening hours and, ultimately, widespread closures of pharmacies.
Some people may be tempted to say so what?
Pharmacists play a critical role in the front line of the health services. A recent study of the sector undertaken by PwC illustrates how vital that role is.
Key findings include:
- There are an estimated 96 million visits to pharmacies each year;
- The advice and services provided by pharmacists across the State removed an estimated 3.9 million visits to GPs and more than 500,000 AE attendances;
- The savings associated with pharmacy services, not directly remunerated by the exchequer, amount to about €460 million;
- The fees and mark-up earned by pharmacy outlets in 2007 from public schemes accounted for just 3 per cent of the total HSE spend in 2007.
Undermining the capacity of pharmacists to serve the community makes a mockery of a model of community-based health care. A reduction in services will hit poor, older and more vulnerable patients most.
We appeal to the Minister to reconsider the cuts she is now imposing. The community pharmacy model serves Ireland well. While the payment system may need reform, traditional personal and professional pharmacy service will not survive this radical surgery.
There are not too many parts of the health services that are working well. Surely we should hesitate before unravelling one of the successful ones.
Liz Hoctor is president of the Irish Pharmacy Union, a representative body for chemists
