Back to the future: why your community's pharmacist is more important than ever
Pharmacist Jack Shanahan, Castleisland, Co. Kerry, pictured at work in his pharmacy, where he provides trusted healthcare advice, prescription services, and community support. Pic: Domnick Walsh
With more than 40 years’ experience as a pharmacist, Jack Shanahan has witnessed many changes in the profession.
Indeed, given that his family has owned and run a pharmacy in Castleisland, Co Kerry, for almost 100 years, spanning three generations, it’s little surprise he has been immersed in the trade since long before he qualified.
“Community pharmacy has changed a lot. When I used to wander into my grandfather’s practice as a child, there was a lot of compounding going on, which you really don’t see now. At that time, we were starting to see mass- manufactured medicines and we went from compounding to predominantly supplying that medication.”
By the time he entered the profession in the 1980s, “pharmacy was a bit at a loss as to its function”, says Shanahan.
“Academics and pharmacists were struggling to find a trajectory for the profession. But it slowly became apparent where our expertise was: medicine, medicine management, and medication issues.
“As medicine has evolved, it’s become more complex and complicated. There’s much more being prescribed and for more people because we are an ageing population. What used to be a simple process, maybe a two-item prescription, has become a 10-item prescription, which can take many hours. There’s lots going on in the background, people are maybe unaware of, to make sure we provide medicines safely. It is about medication management and safe outcomes for patients.”
Service offerings and the scope of what pharmacists can deliver have also evolved, particularly in the last 10 to 15 years.
“It’s almost back to the future,” says the 64-year-old.
“Again, if I go back to my grandfather’s time when resources were limited and access to doctors wasn’t great, pharmacies were very much a frontline port of call for anything from minor illnesses to more serious problems like getting leg ulcers dressed. Pharmacies were almost like a local
primary care clinic for minor illnesses and injuries. In many ways, we’re going back to that. When I started off, the thought of injecting someone was a pipe dream. But it has come to pass despite a stuttering start.
“Around 2007, when people were worried about swine flu, there was a realisation we needed to up our vaccination game and we stepped into that role. Obviously, when covid came along, that was a step up again and now we do as many covid vaccines as anyone else. I think there was a period when people needed to get used to us doing it.”
The data suggests the public is now very much on board. The Irish Pharmacy Union (IPU) says that one in three influenza vaccines and one in three covid vaccines were administered through pharmacies in 2022/23.
An Ipsos B&A Pharmacy Usage and Attitudes Survey for 2024 showed that almost nine out of 10 people say they are happy to get vaccinated in a community pharmacy.
This backs up another poll around general trust in pharmacists.
The Ipsos Veracity Index, which polls trust in professionals, showed in 2023 that pharmacists were the most trusted professionals in Ireland, with 96% of people saying they trust their local pharmacists.
That was up 3% from the previous poll and might have something to do with the broadening range of services being offered by pharmacists.
“Every year, we carry out research to see how we are perceived and there’s always a high level of trust in pharmacists,” says IPU secretary general Clare Fitzell.
“What we are seeing more of now is people coming to us first and asking us questions. And there’s been a change, in that since we started delivering the vaccines, people take the opportunity to ask lots of questions, either for themselves or someone else.”
Fitzell’s assertion is again backed up by data. In 2024, community pharmacists were the most frequently accessed and most accessible primary healthcare providers with over 78m visitors across the almost 2,000 pharmacies in Ireland.
The Government has taken note and, no doubt, to alleviate stress in other areas of the health system, has slowly loosened restrictions on what pharmacies can and can’t do.
In 2010, private patient consultation areas were introduced and pharmacies were able to offer women the morning-after pill. The first flu vaccines were administered in 2011, followed in 2015 by vaccines for shingles and pneumococcal.
Then, of course, in 2021, there was covid, when the importance of pharmacies really came to the fore.
“There has been an increase in volume,” says Fitzell.
“The number of medicines being dispensed with the community drugs scheme and other services that we offer means we are getting busier and there’s a correlation there with our ageing population, which is a good thing, but we do have more chronic diseases as a result. It means patients and their medicines need more careful management.”
If last year’s report from the expert taskforce on the future of pharmacy services is anything to go by, pharmacists are only set to get busier and, crucially, better.
One of the immediate outcomes of the taskforce’s recommendations has allowed pharmacists to extend prescriptions beyond the previous six-month limit to 12 months under certain conditions.
The taskforce also recommended the introduction of a common clinical conditions scheme, which will allow people to access pharmacy care for minor conditions, while, in light of the global shortage of medicines, pharmacists will be allowed to source clinically appropriate alternative medicines.
This confidence in the sector, its expertise, and its ability to deliver is welcome and while, as Fitzell says, “it will help pharmacists feel they are getting the recognition they deserve”, it needs to be matched by money.
“That does bring its pressures and we’ve sought agreement around our dispensing fee rates. 82% of our dispensary business is State-funded and that fee hadn’t moved in 17 years but under a new agreement, we did get some movement in some areas. That needs to continue.”
Since opening their first pharmacy in Carrigaline in 1988, Conor and Denise Phelan have added 10 branches. Though still mainly based in Cork, they will soon open their second Dublin branch and the future for the business looks bright.
“It’s very much a family business,” says their son Chris Phelan, Phelan’s Pharmacies’ head of operations.
“I was always in and out working the counters when I was younger. I came back full time over three years ago. The growth in services has been huge, particularly with the pressure on the health service; it’s becoming more difficult for people to get face time with their health professional and they’re really leaning on their pharmacists.”
Phelan, 31, points to the incoming, and aforementioned, common clinical conditions scheme, which he says “will definitely take pressure off GPs”.
A new contract which will allow pharmacies play a larger role in the BowelScreen programme is also set to come on board and, for Phelan, there is no getting away from the fact that “there’s simply more chronic illness because of our ageing population”.
Until recently, finding staff for these new branches was quite challenging, but the Government has taken steps to alleviate some of that pressure — another indication of how important pharmacies are becoming to us: “New pharmacy courses in colleges have opened up. So there are more places and now more people are coming through the system. There are also more people from abroad, particularly Britain, so it’s not as hard to find [staff] as it was just a few years ago.”
Three new pharmacy programmes are coming on stream, says Shanahan. “You still need 600 points to get into [the course], so I think people see it as an important service and there’s obviously a desire to work in the field. I’m still at it after 40 years and I still love it.”
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