My Job: Ireland's changing pharmacies
Significantly Integrating Safety Can National Digital And Care The Enhance Infrastructure Munity Into Health Patient Pharmacies
The role of the Irish pharmacist has changed a great deal in recent years, and continues an ongoing transformation in its provision of services in 2024. “The role has changed fundamentally, and the pace of change is increasing,” Tom Murray explains.
Elected President in April, he will lead the Irish Pharmacy Union (IPU) at a pivotal time for the profession, with major changes to the role of pharmacists expected in the coming years. “The role of pharmacists is changing thanks to the work of the new Expert Taskforce. Our profession is ready and excited to implement new changes, which may include independent prescribing powers, the provision of a service for common clinical conditions and enhanced contraceptive care.”
Tom has been a pharmacy owner based in Donegal since 2001. Having first qualified as a pharmacist from Manchester University in 1995, he has previously served in a number of roles with the IPU, including as Chair of its Finance Committee. “Pharmacists will be able to practice at full scope, which will increase the services they provide to the public. This is something the IPU and pharmacists themselves have advocated for and which the public supports.”
Allowing pharmacists to practice at full scope will take significant pressure off the healthcare system, he says. “For instance, providing consultations for common clinical conditions will save approximately one million GP consultations a year and because of pharmacy accessibility this will make it a lot easier for the public to get treated for conditions such as athlete's foot; cold sores; constipation; dermatitis and mild eczema.”
Tom adds that there are more services pharmacists can deliver if adequately resourced to do so, including chronic disease and medicines management and optimisation. “The key word here is 'resources' — the State has criminally under-funded the sector for the provision of services, in particular dispensing under the community drug schemes where there has been no increase in fees for 16 years.”
The recently launched Digital Health Framework 2024-2030 marks an important moment for healthcare in Ireland. “Over the past decade, community pharmacies have embraced new technologies, ensuring patients continue to receive timely and accurate care. Progress, however, has been significantly hindered by a lack of strategy and interoperable HSE systems, resulting in significant administrative burdens for community pharmacists and other healthcare providers.
"By integrating community pharmacies into the national digital health infrastructure, we can significantly enhance patient care and safety, by moving from manual processes, and freeing up time for valuable patient interactions. The Digital Health Framework's emphasis on expanding ePharmacy services and patient engagement aligns with the IPU’s mission to provide accessible and efficient healthcare.
“We are committed to supporting the implementation of these initiatives within pharmacies, and to ensuring that pharmacists have the investment, tools, and the training needed.”
Top priority for Tom Murray will be working to address the funding crisis within pharmacy. “Eighty per cent of community pharmacists’ time is spent delivering State services in administering the community drug schemes. The fees paid for providing this vital service have been frozen for 16 years; we have a regressive fee system which means pharmacies are dispensing at a loss for significant portions of each month.”
He points out that during the 16 years of this pay freeze, inflation-linked costs of running a business have all risen — including heat, light, power, rent, rates, and staff costs. “This is unsustainable and cannot continue. The State urgently needs to recognise the need for investment in core pharmacy services to make the service sustainable and to allow us to invest in future services which cannot happen without the current service first being underpinned.”
Over 90% of pharmacists are facing burn-out due to the increased administrative burden they work under, and the level of administration foisted on pharmacy has been increasing exponentially over the last number of years.” He cites as an example that since the introduction of Healthmail — the secure clinical email service allowing healthcare providers to send and receive clinical patient information securely — pharmacists now print an average of 78 million pieces of paper annually.
“That's 78 million at our own cost for paper and ink, and for our time to process. It is frankly ridiculous in this day and age that a country that boasts a first-world tech environment does not have the capacity to digitise core aspects of the health service with pharmacists having to deal with reams of paper on a daily basis.
"The solution lies in having a co-ordinated plan within the health system that delivers an integrated ICT system. This will facilitate the provision of a more accessible service, reduce patient safety risks, and remove a range of administrative burdens that currently have a negative impact on the capacity of community pharmacists to deliver care and supports directly to patients on a daily basis. Ultimately, administrative tasks take away from our time with patients and the goal is to increase the care we provide to our patients.”
Community pharmacies are largely family-owned businesses, often part of the fabric of the local communities they serve. A recent Ipsos MRBI poll confirmed that pharmacists are the most trusted profession, according to the public.
“This trust together with the fact that 87% of the population live within 5km of a pharmacy and of course, the fact that community pharmacies provide a crucial and fantastic local service, highlights our importance to local communities, particularly in rural areas where a lot of local services have closed and the pharmacy remains a central hub.”
The role that community pharmacy plays in supporting the community cannot be overstated, he says: “We provide employment, contribute to the local economy, and provide a natural caring environment where patients, often elderly or vulnerable receive empathy and whereby many see us as a crucial piece of social infrastructure.”
Tom highlights the concern that a growing number of pharmacies are under economic pressure, particularly those in rural areas due to increasing costs and no increase in State-paid dispensing fees. A recent IPU survey confirmed that one in 10 pharmacies is currently loss-making, and many of these are based in rural areas.
“This is a huge concern, and it is imperative that the sector is adequately resourced and that the dispensing fee paid by the State to pharmacists for dispensing medicines is increased without delay. Failure to do so will mean excessive pressure will continue to be foisted on pharmacy businesses.”
Despite the challenges of the profession, Tom readily agrees it is a career with great personal satisfaction. “Pharmacy is a vocation. We are, by nature, problem solvers and it is incredibly rewarding when we impact patient care positively, be that through drug prevention interactions, counselling or supplying medicines. The role is so vast now that there are rewards in it for everyone who practices,” he believes.
“Pharmacists qualify with a huge amount of clinical knowledge and a vast skillset that can be utilised to deliver patient care and professional satisfaction. Allowing pharmacists to practice at full scope is better for healthcare in Ireland and better for the profession.”