Small and medium-sized enterprises (SMEs) are braced for the inflation-induced hurdles laid out before them. Staffing pressures, increased supply costs and soaring energy bills, they are coming faster and becoming harder to overcome. There are tough years ahead for all. But Ireland’s pharmacies, nine out of 10 of whom remain independent, family-owned businesses, have more to bear than most.
Pharmacies will encounter these same challenges, with staffing now particularly acute, but the unique nature of their business leaves them more vulnerable than most.
Without considered and concerted Government action the viability of pharmacies will come under increasing question. The threat is particularly acute for those in rural areas lacking in other services. Seven-day opening, as well as early morning and evening service, will also be under review. If the situation does not improve, while-you-wait prescription services, which we all expect and rely on, may no longer be possible.
Pharmacies are unlike other businesses in two ways. The first is that they are essential to society. This was highlighted through each lockdown when pharmacies and food stores were the only shopfronts with lights on along every shuttered main street in the country. People need medicine to live, that is why 1.5 million of us visit our pharmacies each week. We need pharmacies and therefore they need to be protected.
The second and crucial difference is that unlike any other business in the country, pharmacies have no say in what their biggest customer pays them. The HSE relies upon our 1,900 community pharmacies to dispense life-saving medicines to the population. And, for those with medical cards, the HSE also pays for these medications.
Over the past 12 years there has been a significant increase in the number of medicines dispensed to medical card patients. Meanwhile, the HSE has seen fit to consistently reduce the fee it pays pharmacies for providing this service.
The numbers are stark. In 2009 the fee was an average of €6 per item, providing some €400 million in revenue to the sector. For the last few years the fees have been reduced considerably. There has been a €2.24 reduction in profit per item after labour between 2012 and 2021 — a 35 per cent decrease at a time when inflation is reaching unprecedented levels. All while the HSE is requiring that an ever-increasing number of medicines be dispensed.
Last year pharmacies dispensed 15 million more medicines under this PCRS scheme than 12 years ago. In return, they received some €180 million less in State scheme income. Pharmacies are doing a lot more while receiving a lot less and it cannot continue.
If the HSE was a private business, it could be accused of “abuse of a dominant market position”. But there is no State protection against this abuse that can be seen in other industries. Here the State is the culprit and pharmacists must grin and bear it.
Somewhere in the Department of Health must be a shelf full of the Irish Pharmacy Union’s well-intentioned proposals to expand services over the years, to which no action has been taken
In a country beset with the chronic failures of its health system, our pharmacies are the one shining light. They are easily accessible, half of us live within a kilometre of one, provide an excellent service and are primed to do more. However, this will not be able to continue in the face of declining revenues and increasing costs — staff costs are up 18.5 per cent in the same period.
Rectifying this situation will not be complicated or overly costly. All pharmacies require to future-proof their viability, is 50 cents. An increase of 50 cents per item above the fees we received in 2009 would be transformative. In the context of significant funding offered to GPs and other sectors of society, it seems more than fair.
Secondly, the Department of Health and the HSE need to embrace the sector in all its potential. Ireland’s pharmacies can do so much more. Somewhere in the Department of Health must be a shelf full of the Irish Pharmacy Union’s well-intentioned proposals to expand services over the years, to which no action has been taken.
Pharmacies could overnight be empowered to treat medical card patients with minor ailments such as athletes’ foot or cold sores. This would be faster for the patient, cheaper for the State and free up GP time.
Women could be allowed access the pill directly from their pharmacy without requiring a prescription from a GP. This is safely practised in other parts of the world. This would be faster for the patient, cheaper for the State and free up GP time.
A new medicine service could be introduced where pharmacies monitor patients’ adherence to new medications such as insulin or blood pressure medication. This would be faster for the patient, cheaper for the State and free up GP time. You get the picture.
Pharmacies in Ireland are not trying to reinvent the wheel. Services, such as those outlined above, are tried and tested in other countries, have been shown to have high patient acceptability and are cheaper for the State.
As Budget 2023 takes shape, our Government has a choice to make. It can continue to slash, cut and ignore the only part of our healthcare system that works. Or it can act now to shore it up and to implement the many reforms that would improve patients’ lives and save the State money.
Dermot Twomey is president of the Irish Pharmacy Union
