Madam, – In 2005, an amendment to the Health Acts occurred to allow optometrists to use atropine eye drops without having to have them individually prescribed on every occasion. Using this loophole in the law, Boots pharmacists began dispensing emergency contraception last week.
This development provides an invitation to multinational companies to cherry-pick the simple consultations from general practice. Such strategic decisions have as much to do with market share and footfall as with improving health services to patients.
In Australia in the late 1980s, I worked in one of a chain of “super clinics”. The ethos in the clinic was to focus on satisfying patient demand. It attracted simple complaints such as sore throats, coughs and colds. Pharmacy, X-ray and blood testing services were on site. The “super clinic” promised short waiting times and improved convenience. Blood tests and X-rays resulted in an extra fee to the GP who ordered them.
The ability of the GP to manage uncertainty and not over-investigate or overprescribe was simply not valued. There was an absolute aversion to risk which was presented to the public as a better service to the patient. Patients could ask for any tests and this provision was seen as evidence of patient empowerment rather than the commercial entrapment that it really was. I was there on a temporary contract. Had I become a partner, it would not have taken me long to get used to the added advantage of being paid for every test I ordered. Outside the clinic, local GPs were left to deal with the terminally ill, the bereaved and the complicated consultations that were less commercially attractive.
Applying market forces to health fosters greed disguised by a cloak of good intentions and can give the impression to the public of an apparently improved service. Boots’s recent initiative may signal that we are at a crossroads in Ireland where quality of patient care becomes secondary to the commercial opportunities it presents.
We need to start a debate about this new direction in health care policy and its implications. The morning after might be too late. – Yours, etc,