Local Pharmacies withdrawing from HSE dispensing Schemes

tbh

locum-motion wrote: »

That would land us all in jail very quickly, I'm afraid!

but you'd be jailed for your principals! wouldn't it be worth it? My health seems to be worth it

this is going to be a difficult case to defend in this forum locum, because you're dealing with emotional responses to logical arguments. IF anything, I think the IPU needs to get PR agencies or press officers out there putting their side of the story a lot more than they have been doing up to now. It's early days, I accept that.

lynner83

Drugs Payment Scheme can still operate but refunds will be made by the HSE after payment has been made, so if some people are on highly priced medication they are going to suffer.

are the Pharmacist willing to re-negionate on fees being paid to them??

i know that the hardship scheme which is basically items that are not covered under the GMS listing(Medical Card) but for clients that have a medical card calculates the refund to pharmacist on this basis

e.g.
cost Price 500
mark up 250
dispensing fee 3.16 (i tink)

then when you consider items that are not within that price range it is extremely expensive for the state (Economy) !!!

can any pharmacist please advise if the medical card scheme, Long Term Illness is calculate in the same manner???

tbh

And look, I don't really want this to descend into bashing the pharmacists. I've a great relationship with mine, and I'd genuinely like to help him if I can.

. I know that you have to do something, and I know that it has to be drastic. I know that it makes no economic sense to continue in the scheme, and I know how tempted you must be to show the government up for what they are, and try to open the public's eyes. Honestly, I accept and appreciate all of those things. But like I said before, you are presenting logical arguments, but I am giving an emotional response, you know?

And it's not even that bad for me, I live in Dublin and won't have any problems getting meds. For the guys in the country, I promise you, for the next three weeks, those people are going to be thinking of nothing else. And they aren't going to be blaming the government, they are going to be blaming you! that's the reality. It seems like this was just dumped on us out of the blue, and I think it would have helped your case enormously if you had tried other ways to make your case first, before withdrawing services.

At the end of the day, your action isn't going to stop people getting their meds, they'll get them elsewhere. It'll just be crappier for everyone and then maybe it'll get back to normal, but I promise you - customers won't remember the rights and wrongs. All they'll remember is that, if you feel you need to, you'll cancel your relationship with them. You can't counter that problem with logical arguments I'm afraid.

ixoy

My pharmacy isn't on that list - does that mean they're going to definitely continue with the scheme or is that list not definitive?

tbh

ixoy wrote: »

My pharmacy isn't on that list - does that mean they're going to definitely continue with the scheme or is that list not definitive?

they have to give 30 days notice to withdraw. That list is just a list of those pharmacies who have served notice up to now.

ceegee

tbh wrote: »

It seems like this was just dumped on us out of the blue, and I think it would have helped your case enormously if you had tried other ways to make your case first, before withdrawing services.

The pharmacy owners are giving 30 days notice, twice the amount of notice given to them.
And as has been said repeatedly, the new legislation doesn't leave room for alternative approaches, its take it or leave it. Trust me, it is in no way in a pharmacy owner's interests to pull out, they know they'll lose custom, some of it permanently, but the alternative would mean watching their business get run into the ground (in which case you wont be able to get your medication regardless of whether you can pay for it or not)

mr.impossible

lynner83 wrote: »

Drugs Payment Scheme can still operate but refunds will be made by the HSE after payment has been made, so if some people are on highly priced medication they are going to suffer.

Drugs Payment Scheme (ie you pay up to €100, state pays rest) part of contract, so it can't operate. Drug Refund Scheme should in theory operate (ie you pay whole lot and claim what over €100 back and wait for the healthboard to send a cheque - question is will they pay the old rate or their 'new' rate.

lynner83 wrote: »

are the Pharmacist willing to re-negionate on fees being paid to them??

Certainly. IPU has told HSE willing to re-negotiate all aspects of fees. But want to look at totality of fees (ie mainly medical card vs everything else) and want to re-balance poor payments of medical card vs large payments of other schemes.

lynner83 wrote: »

i know that the hardship scheme which is basically items that are not covered under the GMS listing(Medical Card) but for clients that have a medical card calculates the refund to pharmacist on this basis

e.g.
cost Price 500
mark up 250
dispensing fee 3.16 (i tink)

You have basically got it right. Ironically if the same item was allowed on the medical card the total mark up (ie 0) and dispensing fee would be cost price + €3.80. So you can see there is a clear imbalance in the system which needs to be addressed by negotiation (which isn't likely to happen as hasn't in the past 2yrs eventhough IPU has offered numerous times to meet HSE)

lynner83 wrote: »

can any pharmacist please advise if the medical card scheme, Long Term Illness is calculate in the same manner???

Medical card scheme = cost of item (+VAT if appicable) (zero margin)+ €3.80
Long Term Illness = cost of item (+VAT if applicable) +50% markup (=margin of 33%) + €3.16

Now you don't need to be a mathematically genius to see the top is a crap deal and the bottom is a good deal.
Now if the government said right lads will pay cost + 20% (16.67% margin) + fee on all items on all schemes they would have a deal. So why don't they do it? Because 75% of drugs are dispensed on medical card so it will cost them a lot more.

You might ask why we don't just drop out of the medical card scheme and keep the rest, but we don't get that option, it's all or nothing.

Seriously, if the HSE/DoH agreed to sit down with the IPU this could be sorted out in three days of intense negotiation. Pharmacists would still take a big hit, but it wouldn't be catastrophic for so many (though probably still for some). Long term the goal should be co-operation to reduce unnecessary drug usage and rationalise resources to ensure the most effective cost/benefit ratio. The HSE don't appreciate it, but they need us to do this. Otherwise cost and usage continue to spiral and they will continue to hit (the remaining) pharmacists with a big stick for a problem they have no control over.

Ausone

lynner83 wrote: »

Drugs Payment Scheme can still operate but refunds will be made by the HSE after payment has been made, so if some people are on highly priced medication they are going to suffer.

are the Pharmacist willing to re-negionate on fees being paid to them??

i know that the hardship scheme which is basically items that are not covered under the GMS listing(Medical Card) but for clients that have a medical card calculates the refund to pharmacist on this basis

e.g.
cost Price 500
mark up 250
dispensing fee 3.16 (i tink)

then when you consider items that are not within that price range it is extremely expensive for the state (Economy) !!!

can any pharmacist please advise if the medical card scheme, Long Term Illness is calculate in the same manner???

GMS scheme accounts for 76% of all medicines dispensed in the state
Pharmacists get reimbursed cost price and a fee €3.60 (I think)
There in no markup, just a fee only.

All other schemes the Govt pays cost + 50% markup + fee.

Overall this equates to about 11% markup on average, this is looking at the PCRS, Financial and Statistical Analyses


Pharmacists offered to take the 8% reduction, AFAIK!
These cuts are something like 35-40%

mr.impossible

tbh wrote: »

but you'd be jailed for your principals! wouldn't it be worth it? My health seems to be worth it

this is going to be a difficult case to defend in this forum locum, because you're dealing with emotional responses to logical arguments. IF anything, I think the IPU needs to get PR agencies or press officers out there putting their side of the story a lot more than they have been doing up to now. It's early days, I accept that.

tbh, I like your thinking outside of the box. Catch is we need to produce a Tax Clearance Certificate (basically a bit of paper from the revenue commissioners to say tax compliant) to the HSE once a year to prove we are tax compliant. Without that they (HSE) won't pays us.

mr.impossible

Ausone wrote: »

GMS scheme accounts for 76% of all medicines dispensed in the state
Pharmacists get reimbursed cost price and a fee €3.60 (I think)
There in no markup, just a fee only.

All other schemes the Govt pays cost + 50% markup + fee.

Overall this equates to about 11% markup on average, this is looking at the PCRS, Financial and Statistical Analyses


Pharmacists offered to take the 8% reduction, AFAIK!
These cuts are something like 35-40%

Fantastic Link Ausone, very interesting to know.

locum-motion

tbh wrote: »

but you'd be jailed for your principals! wouldn't it be worth it? My health seems to be worth it

this is going to be a difficult case to defend in this forum locum, because you're dealing with emotional responses to logical arguments. IF anything, I think the IPU needs to get PR agencies or press officers out there putting their side of the story a lot more than they have been doing up to now. It's early days, I accept that.

Ah, a smiley! I'm very glad. As you say, tbh, there's alot of emotional responses on this thread. It's only to be expected. You guys have all just found out in the last 36-48 hours that there's some kind of ****-storm coming down the track and you're angry and you're panicking. The exact same kind of anger and panic set in amongst pharmacists on June 19th.
48 hours down the line, people are starting to get over that anger and panic, I think. You youself, tbh, are sounding a lot less 'bolshy' than you were even this afternoon, if I may say so. The smiley proves it!

So I appeal once more, and hopefully to more logical heads this time: please, please, please, go and have a chat to your pharmacist. I know most of you have good relationships with them. Hopefully you'll come to understand that we didn't want a fight, and we certainly didn't want to use you guys as a weapon. Please understand that we were left with no other choice.

I firmly believe that these cuts signal the end of my profession in this country. My profession is dedicated to helping patients. A pharmacist is the only shopkeeper who will send you away without selling you anything if that's what's in your best interest. Very often, being a good pharmacist means doing something that results in less money in the till. You can still walk into any pharmacy and get free, professional healthcare advice without any appointment. That's all gone, if these cuts go ahead.

{Customer: "Hello, I'd like to ask about this rash/lump in my eye/headache that won't go away, please."
Pharmacist: "Certainly. That will be €15 please. Now, where's that rash?"}

So it's all the more important that we should get sufficiently paid for that work we do get paid for. So I firmly believe that these cuts have to be fought, and fought hard, with the best weapon we can lay our hands on. It is not only your bad luck, but ours as well, that there exists no other weapon. The only options we had are 1. accept the cuts or 2. give 30 days notice.

I'm sorry, I really am, that it has come to this. But as each pharmacy owner sat down with their accountant to do their sums since June 19th, and probably sat down with their solicitor and bank manager too, 3/4 of them found that the sums just didn't add up to a sustainable business. Even if they could survive, costs will have to be cut savagely, so there'll be redundancies. Or other revenue streams will have to be found, so that effectively all the other crap like hairdryers would be subsidising your prescriptions. And if that's the case, sure why not just forget the prescriptions altogether and become a hairdryer shop? The net result is the same as pulling out now.

My profession is up against a brick wall, tied to a stake with a blindfold on and one last cigarette in its mouth. Lined up in front of us are Fianna Fail, Mary Harney, and - the most bloated of them all - the HSE. They have already pulled their triggers. The bullets are in the air. We're dead if we do nothing. Maybe we're dead anyway. But we're certainly dead if we do nothing.

I apologise if anyone gets hit by a ricochet.


Now: How's that for an emotional response?

Thank you for reading.

lynner83

mr.impossible wrote: »

Drugs Payment Scheme (ie you pay up to €100, state pays rest) part of contract, so it can't operate. Drug Refund Scheme should in theory operate (ie you pay whole lot and claim what over €100 back and wait for the healthboard to send a cheque - question is will they pay the old rate or their 'new' rate.


Certainly. IPU has told HSE willing to re-negotiate all aspects of fees. But want to look at totality of fees (ie mainly medical card vs everything else) and want to re-balance poor payments of medical card vs large payments of other schemes.



You have basically got it right. Ironically if the same item was allowed on the medical card the total mark up (ie 0) and dispensing fee would be cost price + €3.80. So you can see there is a clear imbalance in the system which needs to be addressed by negotiation (which isn't likely to happen as hasn't in the past 2yrs eventhough IPU has offered numerous times to meet HSE)



Medical card scheme = cost of item (+VAT if appicable) (zero margin)+ €3.80
Long Term Illness = cost of item (+VAT if applicable) +50% markup (=margin of 33%) + €3.16

Now you don't need to be a mathematically genius to see the top is a crap deal and the bottom is a good deal.
Now if the government said right lads will pay cost + 20% (16.67% margin) + fee on all items on all schemes they would have a deal. So why don't they do it? Because 75% of drugs are dispensed on medical card so it will cost them a lot more.

You might ask why we don't just drop out of the medical card scheme and keep the rest, but we don't get that option, it's all or nothing.

Seriously, if the HSE/DoH agreed to sit down with the IPU this could be sorted out in three days of intense negotiation. Pharmacists would still take a big hit, but it wouldn't be catastrophic for so many (though probably still for some). Long term the goal should be co-operation to reduce unnecessary drug usage and rationalise resources to ensure the most effective cost/benefit ratio. The HSE don't appreciate it, but they need us to do this. Otherwise cost and usage continue to spiral and they will continue to hit (the remaining) pharmacists with a big stick for a problem they have no control over.

thanks for the info!! its totally astonishing to see actually figures!! when u consider overheads etc!!

The_Conductor

mr.impossible wrote: »

Medical card scheme = cost of item (+VAT if appicable) (zero margin)+ €3.80
Long Term Illness = cost of item (+VAT if applicable) +50% markup (=margin of 33%) + €3.16

So- in other words-

there is as good as no mark up on the medical card scheme- but there is a remarkable markup on the LTI scheme.

The LTI card holders- very obviously have a long term medical condition- which requires ongoing medication- whereas the medical card holders may or may not periodically require medication.

The LTI holders,

1. Do have an ongoing need for medical treatments
2. Are a profitable customer for a pharmacist
3. Definitely will be immediately hit as a result of the action
4. By virtue of inelligibility for medical cards- are very possibly in fulltime employment- paying taxes and levies like all other employees- and very probably cannot afford to pay for their medications upfront- as is being suggested by the IPU
5. In the case of LTI sufferers who aren't covered under the LTI scheme- may also be paying an ongoing contribution towards their costs anyhow.

versus

Medical card holders

1. In most cases only have a periodic need for medication
2. I am not aware that they make any contribution whatsoever towards their health care costs
3. Its entirely possible that a significant period may elapse before the proposed action affects them at all.

If you are going to hold up patients to ransom- which is what the proposal entails- if you have any heart at all- surely you wouldn't target those who are highly profitable and 100% definetely need your services.

It just doesn't make any sense at all......

Ps- any figures for the EUR100 a month scheme- what are the margins on that? There are significant numbers of patients on this scheme because their illnesses- despite being life long conditions- simply aren't on the LTI scheme.

I can appreciate the beef that Pharmacists have with the HSE/Department of Health - but deciding to use patients as pawns cannot be a good idea- and most certainly is going to result in significant resentment towards pharmacists by the public at large.

If you're beef is the low margin on the medical card scheme- which is what I believe it is- why drag everyone else into the equation too?

Most relatively sane people believe that criteria for elibility for the medical card are set at artificially low levels- which accounts for the large tranche of public customers for the pharmacies. If you go down the road of hiking up the cost of these patients for the public purse- the obvious response- is restrict eligibility and find a scapegoat. You know as well as I do- that this is the mindset of the HSE and the Department of Health- and the government at large. Many other organisations or groups of people have been fed to the wolves to satisfy public opinion by slippery politicians- pharmacists certainly aren't going to be made an exception.

If there was a concerted effort by Pharmacists to be seen to be doing their best towards patients- despite a dispute with the HSE and government- it would go a long way towards rehabilitating the battered opinion many patients have of their local pharmacists.

Vis-a-vis the proposal that patients pay for their medications at cost from the pharmacy and reclaim the cost (or a balance- in the case of those paying EUR100 a month), at the end of each quarter- you know from history that this is simply unworkable.

There are many of us out there for whom paying the EUR100 a month is a burden that means we occasionally go without our medicine- to suggest that we- along with those under the LTI scheme on insulin, budenofalk and other medications can afford to pay what could be in some cases be thousands a month, and then randomly wait for reimbursement- means people will do without- and people will die. I fear for my health- my wife, a type 1 diabetic- fears for hers- in my mind, to my pharmacist- I am a poker chip which can be gambled with at the HSE.

You have said nothing whatsoever to put my mind- or the minds of other sufferers of longterm illnesses or medical conditions, at ease.

ixoy

I'm a little confused - there's a 50% markup on medicines for LTI and the government wants a reduction on that... surely though there's still a profit margin on LTI anyway? Something in the order of 30% under the new scheme.

Isn't that 30% worth more than the 0% you'll get otherwise - not to mention that you'll now have less customers to buy any other products in your shop and the fact you'll have infuriated many of your customers.

LegacyUser

ElBarco wrote: »

Up to this I would have said we should do all we can to support locally owned businesses. After this they can shag off

would anyone accept 34% reduction in income? i spoke to an accountant at a do the other night and he said no pharmacy or any business would survive a reduction like that. my local pharmacist is great at giving advice and always telling us what we can give when the kids are on antibiotics. would a hse dispensary system do that or would you be waiting 2 or 3 hours for your prescription. wake up and smell the coffee and support your local pharmacist who knows you and your medication. understand the situation. talk to an accountant who would be independent. or else be willing to travel to buy a bottle of calpol if you live in the country. the pharmacists are taking 100% of the hit with no reduction in costs. the drug companies are still in bed with the hse on agreed prices. the min wage is still the same. where i live we lost the post office and will lose the pharmacy. we have to travel 4 miles to get post office services. we have a gp who is a gent and knows everyone in the village. our pharmacist is only here 3 years after we campaigning for one. he is loved by everyone and now may have to close due to insufficient payments. oh! and by the way, he drives a 2002 ford focus. not an bmw or merc like some people might think

The_Conductor

locum-motion wrote: »

You guys have all just found out in the last 36-48 hours that there's some kind of ****-storm coming down the track and you're angry and you're panicking. The exact same kind of anger and panic set in amongst pharmacists on June 19th.

The anger and panic is not the exact same- I am panicking as to whether I will be able to find the medication I need- my as to whether she will be able to get her insulin and her BM testing strips. You are panicking about a lower revenue stream- we are panicking about our health.

I do not go into my pharmacist for free professional healthcare. I have a diagnosed longterm medical condition. I require medication to assist it. I do not need advice from my pharmacist. If pharmacists want to dispense medical advice- perhaps they should seek recompense for doing do- but not on the backs of those who simply need to avail of the services one would expect in a pharmacy- the dispensation of prescriptions.

I do accept that pharmacists do a lot of what could only be described as social good, for their communities- and have traditionally supported this work via the markup they get on medications- but you are using one good deed that you are not officially charged with- to defend withdrawing a service that you are in fact paid to supply.

Some pharmacists are making every possible effort to ensure their customers do not run short of supplies in the shortterm- fair play to them. Unfortunately- this is not a coordinated concerted effort- its the good nature of individual pharmacists recognising the impossible positions they are imposing on the most vunerable of their customers. Why can the IPU not recognise this?

The_Conductor

Unregistered wrote: »

would anyone accept 34% reduction in income? i spoke to an accountant at a do the other night and he said no pharmacy or any business would survive a reduction like that. my local pharmacist is great at giving advice and always telling us what we can give when the kids are on antibiotics. would a hse dispensary system do that or would you be waiting 2 or 3 hours for your prescription. wake up and smell the coffee and support your local pharmacist who knows you and your medication. understand the situation. talk to an accountant who would be independent. or else be willing to travel to buy a bottle of calpol if you live in the country. the pharmacists are taking 100% of the hit with no reduction in costs. the drug companies are still in bed with the hse on agreed prices. the min wage is still the same. where i live we lost the post office and will lose the pharmacy. we have to travel 4 miles to get post office services. we have a gp who is a gent and knows everyone in the village. our pharmacist is only here 3 years after we campaigning for one. he is loved by everyone and now may have to close due to insufficient payments. oh! and by the way, he drives a 2002 ford focus. not an bmw or merc like some people might think

Most people have suffered significants in their net income thus far this year. Year to-date my wife and I are a *net* 820 a month worse off. This is not a million miles away from your 34% reduction in income. I still pay my EUR100 a month to the pharmacist- and I need my medication. If I were to pay for my medication as the IPU are proposing- the price that is currently being flagged- is in fact greater than my total after tax income. I can't afford to visit my consultant or go to the dentist now. If the IPU have their way- I also won't be able to afford my medication either.

Ps- what the hell is wrong with a 2002 Ford Focus- its a decent enough car, handles well, and I've driven thousands of miles for work in it. Where are you coming from with your ascertain that the public think pharmacists are driving around in Mercs and BMWs like Dail deputies- you are delibertly trying to portray a beal bocht.

ElBarco

Unregistered wrote: »

would anyone accept 34% reduction in income? i spoke to an accountant at a do the other night and he said no pharmacy or any business would survive a reduction like that. my local pharmacist is great at giving advice and always telling us what we can give when the kids are on antibiotics. would a hse dispensary system do that or would you be waiting 2 or 3 hours for your prescription. wake up and smell the coffee and support your local pharmacist who knows you and your medication. understand the situation. talk to an accountant who would be independent. or else be willing to travel to buy a bottle of calpol if you live in the country. the pharmacists are taking 100% of the hit with no reduction in costs. the drug companies are still in bed with the hse on agreed prices. the min wage is still the same. where i live we lost the post office and will lose the pharmacy. we have to travel 4 miles to get post office services. we have a gp who is a gent and knows everyone in the village. our pharmacist is only here 3 years after we campaigning for one. he is loved by everyone and now may have to close due to insufficient payments. oh! and by the way, he drives a 2002 ford focus. not an bmw or merc like some people might think

Should anyone accept being told that a vital service was being withdrawn beacuse of a dispute? Vital medication we rely on? I understand that the dispute is bad for you, really I do.

You should also understand that people will be annoyed with you. I'm annoyed, I've spoken to my pharmacist and told him I'm annoyed. I do have a good relationship with him and I'd support a campaign of lobbying the HSE. I will not support what is being done.

I'm not disputing the fact that pharmacists do good work. I don't believe they should be put forward for sainthood on this - they do tend to sell a bit of product on the back of it. And, I'm guessing, there is at least some margin on that product.

tbh

the IPU should have consulted with patients FIRST, before they took the nuclear step of withdrawing services. From a strategical point of view, that would have made more sense - get your customers onside, and THEN take on the government.

And yes, I am less bolshy about this, but in my defense, my first post was looking for information, I've never come to this issue just swinging my fists. I accept that the pharmacists have a compelling argument, I just resent being dragged into it.

What can the pharmacists do now? I would suggest a massive PR campaign, demontstraing the fact that they have their patients interests at heart. Tell people what you are planning to do. Tell people how they can get their life-saving medicine during this action. PLEASE!

ceegee

ixoy wrote: »

I'm a little confused - there's a 50% markup on medicines for LTI and the government wants a reduction on that... surely though there's still a profit margin on LTI anyway? Something in the order of 30% under the new scheme.

Isn't that 30% worth more than the 0% you'll get otherwise - not to mention that you'll now have less customers to buy any other products in your shop and the fact you'll have infuriated many of your customers.

Its 20% markup, which then needs to have rent, rates, wages, etc taken out of it. In a lot of cases these will add up to more than 20%, meaning a loss for the pharmacy

tbh

just to say as well, I think, given the stakes involved for both sides, the mutual respect that has been shown on this thread is remarkable. There is obviously a very strong relationship here, it'd be a shame to jeopardize that.

mike65

Being discussed rte 1 right now.

ixoy

ceegee wrote: »

Its 20% markup, which then needs to have rent, rates, wages, etc taken out of it. In a lot of cases these will add up to more than 20%, meaning a loss for the pharmacy

And with a dispute it's 0% markup and thus a -20% drop, no? Isn't there a better way to object?

What are the alternatives then for the patient? Will Boots dispense all the medication? Can we go to a HSE outlet to get it? Can we buy it in the pharmacy and get the full reimbursement from the HSE?

Soapy Joe

smccarrick wrote: »

Most people have suffered significants in their net income thus far this year. Year to-date my wife and I are a *net* 820 a month worse off. This is not a million miles away from your 34% reduction in income.

Hello I am the pharmacist who posted yesterday as a guest - thought I would return with a name to help identify myself.

This whole situation is very difficult for me, and I am sure other pharmacists. I became a pharmacist as I wanted to combine my interest and basic understanding of science with my desire to work with and for people in a caring profession. I worked for twenty years in various capacities before deciding to get my own business. Since then I have continued to try and put patient care first - before business considerations.

However, you really have to understand the way that I feel I, along with other pharmacists have been treated. Mary Harney (and possibly Fianna Fail) and the HSE have NO desire to talk to pharmacists about this. They intend to push this through come hell or water. And yet unfortunately the idea that 820 Euro worse a month off is similar is a gross underestimation. Both my wife and I are also already taking a hit in tax and mortage relief - of a similar figure. But let's not forget that a pharmacy is a business - it has also taken a hit due to the economic downturn, Sterling/Euro differential and the fact that the Pharmaceutical Society (also modified by Mary Harney) is now demanding more money and more regulations. So the business is plodding along, and I am making less that if I went back to working in another capacity - let's say in a hospital. And I have all the stress and time involved in running a business. Then they decide, with two weeks notice, to take 35% off the business. Add all the other stresses to this and they say - take it or leave it - no negotiation (understand that - no negotiation). So I have three options -

1. Take it and either go bankrupt or work hard for the rest of my days to clear the debt.
2. Walk away - but I could not sell a pharmacy in the present turbulent days.
3. Or leave it - and hope for some common sense.

As said before, I cannot expect you to understand, or care - especially where your health is at risk. But ask youself this - why are so many pharmacists feeling the same as me? And why are the likes of Boots not?

DrIndy

As another healthcare professional - the (in)famous NCHD - I can offer an overview that maybe other cannot.

The pharmacists have been given a back-against-the-wall offer. Take it or leave it.

If you do not accept our forced price reduction - piss off. The result of this is that the current offer results in collapse of their business - and no option out - they leave it.

This is typical of the HSE and irish government.

In the health service, the frontline of the service is led by highly trained professionals with international experience and the opportunity of working internationally. The backroom is led by civil servants who after the merging of the health boards have continued their roles with even less to do than before. The centralising of the health care delivery by creation of the HSE was designed to streamline and rationalise health care delivery across the nation without regionalisation and role duplication and result in a more streamlined civil service leading health service. THERE HAVE BEEN NO REDUNDANCIES since the creation of the HSE. The most recent redundacy notion in the HSE was rejected as it would cost €75million to deliver and €68million to leave the status quo - hence they are now attacking the front line services.

The frontline employees are the actual people who deliver the health care - we are higher paid because we are higher trained (entry level is much higher than most other courses) at the same time - we are internationally recognised regulated professions - meaning we can work in any country in the world with the minimum of additional exams/training. This means that if ireland want to deliver a quality health care service, they need to offer a salary which competes with the rest of the world. If you want the best - you need to offer a similar competing salary - or we end up like south africa (which has fantastic medical schools) where almost every healthcare professional who can pass an international healthcare exam has left.

There is considerable jealousy between civil servants who administer the HSE and public servants who deliver the front line services. There is never, ever a feeling of teamwork and this is why every union engages in industrial action before a deal is made - we are not greedy - we just have a huge mistrust for the the aims and attitudes of the HSE which is at its core - NOT interested in the delivery of health care that health care professionals (who are trained in and love their work in delivering) but simply backhanded screwing one bunch over to save money.

The caveat is often put that "lets flood the market with graduates and pay them less" - but would you want beavis doing your complex 10 hour cancer or transplant surgery and butthead giving you monkey pills in a pharmacy - or do you want someone who is intuitive and dedicated with a true interest in your welfare doing this? Don't you want the world expert from Sloan Kettering (the foremost cancer surgery hospital in the east coast) doing it?

Other healthcare sectors in other countries will pull the able graduates without strong links from this country - it happens constantly - hence irish nurses work in Saudi, doctors go to australia and america, Physios go to new zealand, OTs and speech therapists go anywhere. Cut salaries and more leave - hence you need to stay internationally competitive.

If you want them to stay therefore you need to provide the competitive environment to remain. This is a background to my point on this issue. This is why pharmacists are higher paid than other people - and it is because pharmacists are a key mechanism on the health care delivery of drugs. Pharmacists are trained in drugs - and often know drugs better than GPs and have more time to consider the significance of cross interaction. They regularily phone GPs and do refuse to prescribe drugs knowing they interact because doctors slip up every now and then and its the pharmacist who keeps the patient safe. Pharmacists do no simply dispense drugs and they do not simply run a "shop".

What the HSE is doing under the auspices of Mary harney is to create an environment of make or break against a vulnerable sector of the health care delivery sector - which the public perceive largely to be glorified shopkeepers without understanding their true role (a pharmacist will not publicly phone a doctor and say they are clearly a muppet for prescribing that drug in front of a patient as it breaks down the doctor-patient and pharmacist-patient trust. It is done as "I just need to check your prescription is right")

For LTI patients - sure your prescriptions are regularily dispensed - no questions asked - but have you any new drugs added which will give you grief? No. But if you did - you have a pharmacist working hard in the background making sure that they were safe.

People do not have enough respect for pharmacists and their role in health care delivery as they are not on the fore-front like me who rocks-on-in in an ED and lashes out stuff, alleviates fear and either makes them better or hands them on with the key message that this doctor will make them better.

They just keep you well. Quietly. Subtly. And for that now they are now turned into pariahs by the spin doctos of the HSE and the public.

A medical group once tried to hire PR consultants to put forward their case to the media, but were turned down by every PR company in ireland due to conflict of interest - the HSE already had every one on retainer.

Maybe the pharmacists have a point? Do you want beavis doling out the wrong drug to you as an overweight butthead giggles at the top of the Department of Health?

ElBarco

DrIndy wrote: »

People do not have enough respect for pharmacists and their role in health care delivery as they are not on the fore-front like me who rocks-on-in in an ED and lashes out stuff, alleviates fear and either makes them better or hands them on with the key message that this doctor will make them better.

They just keep you well. Quietly. Subtly. And for that now they are now turned into pariahs by the spin doctos of the HSE and the public.

A medical group once tried to hire PR consultants to put forward their case to the media, but were turned down by every PR company in ireland due to conflict of interest - the HSE already had every one on retainer.

For me, this is not about how much I respect pharmacists or indeed any front line medical staff. They do a fine job and that's great.

It's about them using patients as a weapon in their dispute with the HSE, at least that's what it's about for me. I don't think it's appropriate and I'm annoyed about it. I don't really care about jealous civil servants or spin doctors.

Also - do you have a source on the PR company thing?

DrIndy

They have no choice. Pure and simple.

Can doctors go on strike? Not without people dying - this is why the HSE had us over a barrel for years. This is why the HSE are doing this now because they know that pharmacists are over a barrel. Patients suffer, Pharmacists suffer (they are there after all to look after patients) and the HSE wash their hands "we have to make savings" so its ok.

I don't have a source except for a very trusted verbal source - so no backup unfortunately.

Soapy Joe

When the initial dispute broke last year a well respected pharmacist had a meeting with Mary Harney - she started the meeting with the words 'Shame on you for bringing patients into this - Shame on you for worrying people'. She said this before they had even taken their seats. Well - that is exactly the way she wants it. We pharmacists do not. But the nature of our work is that any action will impact on patient care - we have no choice on that. So shame on Mary Harney for not sitting down and talking to us - that is the answer. We will talk to her - she will not talk to us.

ixoy

I listened to an interview with Jabba and she did indeed make it sound like she would not talk about it. However, she also claimed the level of subsidies for pharmacists here was far higher than anywhere else in Europe. She also rejected the notion that pharmacies are having a tough living based on the notion lots of pharmacies were opened recently. Her claim was that the cost of medication being dispensed has shot up based both on volume and on new medications introduced.

With regards to generics, she said that generics cost almost the same as regular medicines here due to poor price regulation. She's established a group (:rolleyes::rolleyes:) to look into this and no doubt we'll have a paper published two years from now on it at a cost of millions...

She also said that the HSE would have a way to deliver the medications to patients but they just hadn't yet got the concrete details. Yeah, no rush there Mary - it's only people's very lives. Get a cream bun into you while you wait around.

Can a pharmacist here counter-act her assertions above? Can they also tell me, straight out, if they will operate at an actual loss dispensing LTI medication under the new directives? Does it make financial sense not to distribute anything instead?

The_Conductor

DrIndy wrote: »

As another healthcare professional - the (in)famous NCHD - I can offer an overview that maybe other cannot.

The pharmacists have been given a back-against-the-wall offer. Take it or leave it.

If you do not accept our forced price reduction - piss off. The result of this is that the current offer results in collapse of their business - and no option out - they leave it.

This is typical of the HSE and irish government.

I do agree with you that it is typical of the Irish government- however there are very many courses of action that could potentially have been explored by the IPU- other than pushing the nuclear button of withdrawing the LTI and DPS schemes from customers who have been diagnosed with chronic medical conditions. It would not have taken too big a stretch of the imagination- to involve the customers in the battle- in a manner other than using them as poker chips. Look at the civil disobedience on display out the Houses of the Oireachtais on a daily basis- and the results that it has achieved for so many lobby groups. Whether we like to admit it or not- with the Irish government it really is the case that whoever makes the most noise, gets heard. On a related note- remember the over 70s medical card- do you really think that result was achieved by anything other than civil disobedience?

DrIndy wrote: »

In the health service, the frontline of the service is led by highly trained professionals with international experience and the opportunity of working internationally.

The doctors and consultants and a large number of the nurses are absolutely brilliant. There is however also a sizeable brigade of allegedly frontline staff who see it as above themselves to have any interaction with patients. I've witnessed a ward manager- a nurse of almost 20 years experience- insist on her nursing assistants calling a NCHD at 2AM in the morning to reinsert a canula- which is just plain wrong. I've also had to remove my wife from one hospital because of a 'don't care' attitude from staff- the nurse on duty put her in a chair to move her to another ward- and abondoned her in a hallway awaiting porters who were off watching a football match in the staff canteen. It was her third move in less than 24 hours- directly from ICD and involving a liver unit and two other various HDUs.

The perception of the public is that front line services are either incredibly good or incredibly bad. I've experienced both ends of the spectrum. It most certainly is not uniformly good.

DrIndy wrote: »

The backroom is led by civil servants who after the merging of the health boards have continued their roles with even less to do than before.

The administrative staff in the HSE are not civil servants. Their unions refused to negotiate with the Department of Health on redeployment administrative staff from the HSE to government departments as civil servants- because the terms and conditions civil servants adhere to- are far more onerous than in the HSE (not to mention the salary scales and 'rights' that administrative staff in the HSE routinely assume are normal).

DrIndy wrote: »

The centralising of the health care delivery by creation of the HSE was designed to streamline and rationalise health care delivery across the nation without regionalisation and role duplication and result in a more streamlined civil service leading health service.

The intention was to reduce headcount by almost 42,000 through abolition of duplicated roles- primarily in admin staff. It didn't happen- and even now in the era of soaring unemployment- is something that should be pushed through- by hook or by crook. It was never the intention that the civil service would have any involvement whatsoever in the scheme though- they were not involved in the old health boards- nor do they have any involvement in the HSE. These are all HSE employees- the same as doctors, nurses, and indeed Professor Drumm.

DrIndy wrote: »

THERE HAVE BEEN NO REDUNDANCIES since the creation of the HSE. The most recent redundacy notion in the HSE was rejected as it would cost €75million to deliver and €68million to leave the status quo - hence they are now attacking the front line services.

Perhaps a massive reverse benchmarking exercise for the admin staff against international norms (or even against the Irish civil service or the Irish public sector)- might open a few eyes. There have been almost 13,000 new posts created by the HSE since its creation. It has never had a year where it kept to its budget- in 2005 having had 6 seperate supplemental increases awarded to it. Its a monster.

DrIndy wrote: »

The frontline employees are the actual people who deliver the health care - we are higher paid because we are higher trained (entry level is much higher than most other courses) at the same time - we are internationally recognised regulated professions - meaning we can work in any country in the world with the minimum of additional exams/training.

There are very many excellent frontline staff in the HSE- who deserve every penny they earn- and indeed many perform daily duties that you simply couldn't put a price on. There are also an increasing brigade of allegedly frontline staff waving their nursing degrees- who seem determined to dream up procedures and formalities- and whose stated aim to 'enter management'. Liam Doran has publicly stated that nursing should not be viewed as a vocation but as an administrative job like any other- and nurses should be entitled to avail of flexitime, a 37 hour week and a list of other 'pie-in-the-sky' privilleges that he imagines are the norm elsewhere in the public and private sector.

Nurses were traditionally considered to be following a vocation. Similarly- you didn't get into teaching- unless you had an aptitude for it. All of this is out the window.

I'm really sorry Dr. Indy- and I don't mean one iota of disrespect towards you- but I disagree vehemently with you about a sizeable brigade of the frontline staff........

DrIndy wrote: »

This means that if ireland want to deliver a quality health care service, they need to offer a salary which competes with the rest of the world. If you want the best - you need to offer a similar competing salary - or we end up like south africa (which has fantastic medical schools) where almost every healthcare professional who can pass an international healthcare exam has left.

To be honest- I really don't think there is any member of the public out there who begrudges NCHDs a penny that they earn- and by god do they earn it. Personally I'd much rather they worked regular hours and received commensurate remuneration for it. I can't imagine its easy doing a 48 hour shift (or longer :eek:) and personally I imagine its detrimental to the health of anyone to be expected to work the hours NCHDs are routinely exposed to.

The issue is the shocking numbers of administrative staff in the HSE. Of the 214,000 HSE staff (or however many there are currently)- how many are frontline staff? We have no problem attracting frontline staff at the current salaries in Ireland- we do seem to be incapable of managing budgets- and of prudent financial planning however. How many more frontline staff could we employ- if we did away with shedloads of procedures and redtape- made thousands of admin staff (which in my eyes would include a large number of nursing managers) redundant- and went and based our management systems on the Australian system? It would be a culture shock- but it works- as you are aware.

DrIndy wrote: »

There is considerable jealousy between civil servants who administer the HSE and public servants who deliver the front line services. There is never, ever a feeling of teamwork and this is why every union engages in industrial action before a deal is made - we are not greedy - we just have a huge mistrust for the the aims and attitudes of the HSE which is at its core - NOT interested in the delivery of health care that health care professionals (who are trained in and love their work in delivering) but simply backhanded screwing one bunch over to save money.

I think you're slightly confused. The admin staff who administer the HSE- are public servants too- not civil servants. I accept that there is precisely zero teamwork- and I know from personally doing LRC briefs the mess that industrial relations are. Personally I think the HSE is past redemption- and should be abolished at the earliest possible opportunity. Management structures for each hospital, clinic and service should be determined- with less than 20% of the current admin overhead- and current employees should be forced to competitively interview- along with anyone else who was interested- for every single job in the new structure. The HSE is in ruins.

DrIndy wrote: »

The caveat is often put that "lets flood the market with graduates and pay them less" - but would you want beavis doing your complex 10 hour cancer or transplant surgery and butthead giving you monkey pills in a pharmacy - or do you want someone who is intuitive and dedicated with a true interest in your welfare doing this? Don't you want the world expert from Sloan Kettering (the foremost cancer surgery hospital in the east coast) doing it?

The inverse of this is- lets give all the nurses degrees- and invite hoardes of people into the profession who do not view it as a vocation and will readily tell you that their aim is an administrative middle level managerial job. I would genuinely be interested to know how many qualified doctors and nurses in the HSE are not considered to be 'frontline staff'. I suspect this is not enumerated anywhere. There are significant numbers of staff (both admin and also in some sad cases- qualified members of the medical profession) who view patients as an inconvience, fullstop.

DrIndy wrote: »

Other healthcare sectors in other countries will pull the able graduates without strong links from this country - it happens constantly - hence irish nurses work in Saudi, doctors go to australia and america, Physios go to new zealand, OTs and speech therapists go anywhere. Cut salaries and more leave - hence you need to stay internationally competitive.

Focus the cuts on the admin grades. Hopefully this will eventually some of them to leave?

DrIndy wrote: »

If you want them to stay therefore you need to provide the competitive environment to remain. This is a background to my point on this issue. This is why pharmacists are higher paid than other people - and it is because pharmacists are a key mechanism on the health care delivery of drugs. Pharmacists are trained in drugs - and often know drugs better than GPs and have more time to consider the significance of cross interaction. They regularily phone GPs and do refuse to prescribe drugs knowing they interact because doctors slip up every now and then and its the pharmacist who keeps the patient safe. Pharmacists do no simply dispense drugs and they do not simply run a "shop".

I am not denying what you are saying. I am simply stating that the current markup on the LTI scheme is 50%. The markup on the Medical Card scheme is neglible. These are two distinct groups of patients- one of whom have a diagnosed long term illness that requires ongoing care. The other of whom may periodically require attention- but not on an ongoing basis. The person suffering from the chronic illness- is being held to ransom over the lack of funding for the person who may or may not get ill at some stage. The rates paid for Med Card patients are crap. Really really appalling. Why use a wholly seperate group of patients as cannon fodder to highlight this though?

DrIndy wrote: »

What the HSE is doing under the auspices of Mary harney is to create an environment of make or break against a vulnerable sector of the health care delivery sector - which the public perceive largely to be glorified shopkeepers without understanding their true role (a pharmacist will not publicly phone a doctor and say they are clearly a muppet for prescribing that drug in front of a patient as it breaks down the doctor-patient and pharmacist-patient trust. It is done as "I just need to check your prescription is right")

Once again I am not denying the accuracy of what you are saying- it is 100% correct. I would once again point out that a functioning part of the system- the LTI scheme- is being held to ransom over a non-functioning part- the medical card patients.

DrIndy wrote: »

For LTI patients - sure your prescriptions are regularily dispensed - no questions asked - but have you any new drugs added which will give you grief? No. But if you did - you have a pharmacist working hard in the background making sure that they were safe.

You are idealising here. I've personally sourced medications that were unavailable in ireland and had them delivered to my pharmacist at cost (think Prednisolone and Neocytamen for examples). Many people under the LTI scheme do in fact have to go to great lengths- even with their pharmacists onboard- to source their requisite medications.

DrIndy wrote: »

People do not have enough respect for pharmacists and their role in health care delivery as they are not on the fore-front like me who rocks-on-in in an ED and lashes out stuff, alleviates fear and either makes them better or hands them on with the key message that this doctor will make them better.

I do have a lot of respect for pharmacists. As a sufferer of a LTI though- you are between a rock and a hardplace- especially if you're advised by your pharmacist to visit your consultant- but you're not financially able to afford it (which is increasingly frequent these days). My wife habitually gets me to ring our local pharmacy- and is constantly terrified of having to deal with one pharmacist there who insists on quizzing her on every detail of her medication. This is a doctors or a consultants job- not a pharmacists though.

DrIndy wrote: »

They just keep you well. Quietly. Subtly. And for that now they are now turned into pariahs by the spin doctos of the HSE and the public.

I haven't listened to the media at all on this (I've been out of the country for a while). I am worried by what I have been told- about being forced to pay for my own medication and then reclaim the cost from the HSE at some distant point in the future. We were in this situation 15 years ago- where you sent all your chits to Cherrywood- and eventually months later got a cheque in the post. I can't afford it- I simply can't.

DrIndy wrote: »

A medical group once tried to hire PR consultants to put forward their case to the media, but were turned down by every PR company in ireland due to conflict of interest - the HSE already had every one on retainer.

That the HSE are allowed have PR firms on retainer- is pure wrong. The entire organisation really should be disbanded, and a leaner meaner health service- based on delivery of care to patients, resurected from the ashes.

DrIndy wrote: »

Maybe the pharmacists have a point? Do you want beavis doling out the wrong drug to you as an overweight butthead giggles at the top of the Department of Health?

No, I don't. However- I would like my pharmacist to give me the correct medication when I need it. Under the current proposals- he/she may very well insist I pay god only knows what for it- come the 1st of August.

I fully recognise the excellent service pharmacists provide in their respective communities- perhaps it is time to put an appropriate price on the services they provide though, instead of there being an unwritten understanding that they are recompensed for these services via the markups on the various prescription dispensing schemes?