Judgment day looms for community pharmacies

NEXT month is going to be a very important one for the future of Irish healthcare.

The Government's Pharmacy Review Group will deliver it's recommendations on how the industry is to be structured in the years ahead.

Those recommendations are very likely to have far-reaching implications for the elderly and the chronically ill.

Minister for Health Micheál Martin stunned pharmacy owners last January when, midway through the review group's deliberations, he decided to ditch the complex regulatory regime in which pharmacists operated.

Between the introduction of the legislation in 1996 and its withdrawal last year, a health board could effectively halt the setting up of a pharmacy if it believed an existing community pharmacy was under threat.

The way in which these regulations were applied, in particular the Western Health Board's refusal to grant a contract for a pharmacy in Knock, Co Mayo, had drawn some criticism. It was the OECD's criticism of the regime's lack of transparency that led to the setting up of the review group in the first place.

There are concerns that if a totally free market is sanctioned, the impact on healthcare will be grievous.

Irish Pharmaceutical Union (IPU) president Richard Collis said: "Our Armageddon scenario is where you're left with a free market, which will inevitably give rise to dominance in the marketplace by those who are best resourced. That will really change the nature of the service. It will go down the Anglo-American line of a 'wrap and pack' distribution service."

Under the 1996 regulations, the pharmacist was obliged to make himself or herself available to customers to answer their health queries. In an unregulated environment, that requirement would go.

Mr Collis said: "The first losers will be the elderly, the chronically ill and the mother with a young family.

"They are the people who look for advice, who need to have a consistent staffing level in their local pharmacy, to have the confidence to go in there and ask whatever they want to ask.

"The second loser will be the State because where you diminish the level of human contact there is between people in a given service industry, the level of compliance (with prescriptions) is going to drop."

The New York Times has called it the world's "other drug problem". According to the US Chamber of Commerce, 50% of prescription medicines are incorrectly taken while other studies have shown that non-compliance causes 125,000 deaths annually in the US, is responsible for 23% of nursing home admissions and 10% of hospital admissions.

Mr Collis said: "The general perception of pharmacy out there to people who don't use pharmacies very often is that it's a shop, a normal retail operation, but for those who used pharmacies frequently the elderly who consume 50% of the medicines in this country, and chronically ill people it's a different situation. It's a service and it's a service that has a professional base to it."

Darragh O'Loughlin runs a pharmacy in Salthill, Galway. He said: "Somebody would come into me saying I must get a doctor because I have a cough and a wheeze and I've had it for four days now. I tell her, It's a cold and it's going to take six or seven days. Leave it three days and if you're still not better, come back to me and we'll sort out a doctor's appointment. She comes back and says, oh yeah I'm much better now. So that's freed up primary care space. It's freed up the doctor to deal with people who really need him."

He said deregulation would squeeze that level of service out of existence: "In Britain the pharmacist has to do about 400 prescriptions a day just to cover the overheads. You can't give patient care to 400 people a day. At the moment we would do 100-150 a day, and in twelve hours you can do that, you can actually interact with that many people to varying degrees."

Consumers Association of Ireland chairman Michael Kilcoyne does not believe the new regime will bring about any deterioration in healthcare but neither does he favour a totally deregulated market: "I would like to see it much freer than it was but it must be regulated. You can't have everyone setting up a pharmacy but pharmacies should be located anywhere they want."

However, Mr Collis insists the industry must not be commercialised. He points out that 40 years ago there were 600 medicines on the market. Today, there are around 6,500.

"Such an increase would indicate increased complexity for the patient, increased difficulty in complying, particularly for elderly people who are usually on a multitude of medicines.

"The need for a healthcare resource within the community is stronger than it ever was. I think commercialising this sector of primary care is a retrograde step."