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Local Pharmacies withdrawing from HSE dispensing Schemes
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In fairness:
- Patients haven't been involved yet. Pharamcists have given the required one months notice and the HSE say that they have contingency plan in place.
This month is alot more than the 7 days notice given to pharmacists of the savage cuts by a HSE press release.
- HSE and Harney have refused to meet pharmacists for over 2 years. First they said they couldn't due to EU until EU told them that their interpretation was incorrect. Then they simply said they wouldn't.
You fail to realise that after 2 years of no consultation and 35-42% cuts announced by press release , pharmacists have no choice.
PS
Funny how the LRC was rolled out within 48hours for electricians who wanted 11% pay increase during a recession and HSE won't meet with pharmacists at all over 2 years.0 -
Sorry for taking your replies out of context smccarrick but I just wanted to reply to the particularly relevant ones to the pharmacy dispute.smccarrick wrote: »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.
I have to disagree with you that there were many courses of action that could have been followed. The options provided by the Minister for Health were to either accept the new terms of the contract or to provide notice of withdrawal from the contract. What also has to be considered is the short time scales involved. A press release was released on June 18th (or 19th?) announcing these cuts to come into effect on July 1st. The HSE did not directly contact any pharmacies at the time (and I'm not sure if they have even written yet about the cuts). So at most if they were following HSE press releases, a pharmacy had 13 days to decide what course of action they were to take. The IPU could not decide or instruct a pharmacy on what decision to make and each choice was supposed to be arrived at individually. These all contribute to the situation we are at where 3/4 of the individual contractors to the HSE drug schemes have decided to withdraw from their contract and I believe over the next week or two, we will begin to see awareness being raised by the IPU on behalf of those members who are withdrawing. Whether that campaign is coming too late, we'll have to wait and see.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?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.
In broad terms you're entirely correct with the above points, but you have to consider that medical card holders are (generally) a cross section of the patients that come into the pharmacy. In that, there are some who do only require medication very rarely (an antibiotic when they have an infection for instance) but at the same time, there are many medical card patients (especially older patients, which make up a large proportion of med card holders) who can have a chronic illness (e.g. respiratory diseases, chronic heart failure, blood coagulation conditions), do require ongoing care and will be equally badly affected by not getting access to their medicines.
It is not a case that LTI patients are being held to ransom over there being zero mark-up on GMS (medical card scheme), the issue is a reduction in mark-up across all schemes other than GMS, an introduction of a sliding dispensing fee system, removal of a set medical card payment for treating GMS patients and the HSE taking a portion of the wholesale discount. The withdrawal is based on the flawed nature and structure of these cuts and the proposed new payment system.
That's the key: the contract a pharmacy has with the HSE covers all schemes, they have to be taken as a package or not at all. So it is not a case of targeting one group of patients to make a stand, pharmacies are withdrawing from all schemes (DPS, GMS, LTI, Psychiatric scheme, Hardship scheme, EU scheme, Hospital Emergency scheme) and while LTI patients will evidently be more affected than other individuals, they are not being singled out.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.
The pharmacist is an expert in medication. Some may even know more about drugs and interactions than some doctors. So it is probably more the pharmacist's job to be concerned with medication than the consultant or the doctor.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?
A brilliant suggestion! This has been proposed to the HSE, with the Pharmacy Ireland 2020 working group report being published earlier in the year. The group were open to submissions from all sides and made a number of recommendations for the introduction of structured roles for the pharmacists outside of dispensing with proper remuneration as you suggested. The HSE has yet to make move on anything. Maybe they know better than everyone else?0 -
I have to laugh at chemists putting on the poor mouth, they make vast sums of money by restricting entry to the market and gouging both the government and the public.
After a quick Google, here's an article that's 5 years old, note the huge sums paid to these shysters
Note the starting pay for Pharmacy graduates, €100,000.
http://www.independent.ie/national-news/chemists-earn-1bn-in-state-payments-483649.html0 -
I think terms like shysters, and five year old articles don't really bring anything useful to the table. Please tone it down if you'd like to continue posting. I'd ask all other posters to refrain from commenting on this post.0
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smccarrick wrote: »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?
pharmacists ARE expected to give advice. clause 9 in their contract requires them to do so, to ensure "the safety of dispensing and administering" of medication which also requires ensuring the patient understands the medication and the pharmacist is also in a position to guide the patient to the safe use of otc medications, any interactions between different prescribers, eg hospital and gp. i,ve a 6 year old asthmatic who was sent home from hospital on an adult's dose of antibiotics. the pharmacist wouldn't dispense it until he got hold of the hospital doctor who prescribed it, did so the following day eventually as the hospital doc was gone home. no one in the hse was willing to take the blame for changing the prescription. also my father went into him complaining of "heart burn". the pharmacist noticed a cold sweat on my father and sent him straight to the gp who in turn sent him to hospital. 3 days later he was diagnosed with a mycocardial infarction...a small heart attack. the pharmacist could have sold him the gaviscon my father asked for but instead he used his judgement, refused the sale and referred him higher. ALL FOR FREE!!! the should get paid, not go out of business0 -
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smccarrick wrote: »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.
That puts me in my box so, I think I will go back to work for as long as it takes until my lower revenue stream stops being able to provide for the running costs of my business. How selfish of me to panic about such a stupid matter as a revenue steam. Sure what would it matter to me if that revenue stream weren't able to pay my salary? I foolishly thought I was doing this job, which I admittedly like, to pay my mortgage and to put bread on the table and provide for my kids' future. When in fact what I am doing is ensuring somebody gets their insulin and test strips without being inconvenienced. I hope you will forgive me when I go out of business and have to close my doors. At least I can go out in the knowledge that I did my best for as long as possible to convenience you. After all that is what my job on earth is.smccarrick wrote: »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.
My prime objective in life is the dispensing of prescriptions not matter what. God, my programming chip must have malfunctioned. Sure doesn't everyone have to follow their programming chip. I thought I was like everybody else, but now I know I am a servant to everybody elses needs and have to put mine last. I am so sorry.smccarrick wrote: »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.
You are so right, once I am paid even 1 cent I must perform this duty.smccarrick wrote: »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?
Unfortunately the IPU aren't allowed to coordinate the action of it members, according to our government this is anti-competitive.0 -
Unregistered wrote: »I have to laugh at chemists putting on the poor mouth, they make vast sums of money by restricting entry to the market and gouging both the government and the public.
After a quick Google, here's an article that's 5 years old, note the huge sums paid to these shysters
Note the starting pay for Pharmacy graduates, €100,000.
http://www.independent.ie/national-news/chemists-earn-1bn-in-state-payments-483649.html
Oh fantastic! Can I print that out and show it to my boss? Pity I am self-employed and take €40,000 out of my business for my self. Retail Ireland salaries are all out of kilter too, must show them that article, feckers are ripping all the graduated off. ps can I borrow your time machine, Ireland 5yrs ago sounds a great place.0 -
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mr.impossible wrote: »That puts me in my box so, I think I will go back to work for as long as it takes until my lower revenue stream stops being able to provide for the running costs of my business. How selfish of me to panic about such a stupid matter as a revenue steam. Sure what would it matter to me if that revenue stream weren't able to pay my salary? I foolishly thought I was doing this job, which I admittedly like, to pay my mortgage and to put bread on the table and provide for my kids' future. When in fact what I am doing is ensuring somebody gets their insulin and test strips without being inconvenienced. I hope you will forgive me when I go out of business and have to close my doors. At least I can go out in the knowledge that I did my best for as long as possible to convenience you. After all that is what my job on earth is.
Since when is insulin for a diabetic a convenience? Or blood testing strips, or glucagen? Its a matter of life and death in very many cases. I'm really sorry that you're getting paid less- but you are actively putting people's lives at risk- if they are not in a position to pay the full cost price of the requisite medicines they need upfront. I have no idea what Novorapid, Lantis and glucagen cost- I imagine its substantial.
I had a lot of sympathy for you- up to your current post. You really have no idea of what you're putting people through though- do you? Its a financial matter for you- its people's health and in some cases possibly their lives- for your customers. Can I put it more plainly. Calling it a 'convenience' is derisable, and indeed offensive.mr.impossible wrote: »My prime objective in life is the dispensing of prescriptions not matter what. God, my programming chip must have malfunctioned. Sure doesn't everyone have to follow their programming chip. I thought I was like everybody else, but now I know I am a servant to everybody elses needs and have to put mine last. I am so sorry.
Sarcasm doesn't impart anything whatsoever in this instance- and delibertly deriding the legitimate concerns of your customers as 'conveniences' is almost bizarre. Your prime objective in life can be whatever you choose it to be. Your stated profession is that of pharmacist to the public- and the public have a legitimate expectation that you will fulfill whatever those duties would normally be expected to entail. You do not have a quibble with your customers- you have a legitimate argument with the HSE and the government. If you choose to move away from your chosen profession and practise in a different area instead- by all means do so. I don't see where anyone is suggesting you are a servant to anyone else- or that your needs are in any manner subservient to theirs. You do however have responsibilities associated with your chosen profession- responsibilities which I would suggest you care little for.mr.impossible wrote: »You are so right, once I am paid even 1 cent I must perform this duty.
Who is suggesting this? I didn't. I acknowledged that the rates paid for medical card customers are derisory- but that the LTI rates are substantial by anyone's terms. The LTI customers have been diagnosed with long term medical conditions- and require ongoing care and medication. You are using these pawns to further the legitimate argument you have against the paltry medical card rates. This has been acknowledged as largely true by other posters who have identified themselves as pharmacists on this thread- never mind elsewhere. The points I made were and continue to be- specific to the LTI and EUR100 a month schemes- as in my eyes- they are the vunerable people who are being abused in this case. Certainly- you will inconvenience very many other customers- but you might actually kill some of these.mr.impossible wrote: »Unfortunately the IPU aren't allowed to coordinate the action of it members, according to our government this is anti-competitive.
And what would you call the proposed action in that case? The curious matter of the pharmacists who just happened to simultaneously decide to take similar action action against their customers? Sorry- against the HSE and the government- but you can't hurt them directly- so you picked the target that you have access to- customers who expect to be able to collect prescriptions and medications from pharmacies?
You will note that you are posting in the 'Long Term Illness' forum- not a general forum- it is a reasonable assumption that a substantial number of the posters here suffer from long term illnesses- and many of them are on the LTI scheme (many are on the EUR100 a month scheme- thanks to the random nature of what is defined as a LTI, and what is not).0 -
Just to point out a few things:
Pharmacists can't reject Medical Card (GMS) and keep other schemes. It's all or nothing. You can give 30 days notice to your contract (I have) and then you are out of everything state subisidised (GMS,DPS,LTI,Hi-Tech,Psychiatric,Methadone,Health Amendment Act etc.).
Yes, it does mean problem with medical card affects everything else, but that is the way government plays it. Why they insist on paying two completely different rates for the same job is beyond me. Maybe it saves them money. Current average mark-up across all schemes is 11% (a lot less then many other industries with far less regulation).
It is a fallacy to believe that medical cards patient's don't have long term illnesses. Most heavy users of the scheme do. In fact many have the same conditions as does on the LTI and DPS. Just their limited means gives them access to the medical card. Thus you will have medical card patients receiving insulin, epilepsy drugs, cholestrol, blood pressure etc. Many of these patients are on 8+ drugs every month. Do I feel ****ty telling them from August on they can find somewhere else? I sure do. Why don't I put up and shut up so? Because I would rather feel ****ty telling them face to face I am unable to dispense medication free of charge than saying nothing and winding up the business and leaving them a note on the door. I owe that much to them. Maybe I am wrong, but I justify it to myself by saying that yes they maybe hugely inconvenienced, but they will be sorted out and will get their medication some how. If this works out and the HSE sit down with the IPU, the long term outlook for pharmacy will be improved. If this does not work out and my profession goes down the tube I won't want anything to do with pharmacy ever again and I won't be around to look after the patients anyway and frankly I will be past caring.
2 years ago we had something similar (though this time it is way worse) and we gathered signatures and lobbied politicians (I have been to the Dail a few times and have spent many evenings emailing and telephoning TDs) and where did it get us - back to the same position only worse and the HSE still isn't talking to us. Mary Harney has it in for us, no matter what the facts. She thinks there are fat cats out there needing redress and she does not give a flying fig who gets hurt along the way (whether it be me or you).
I can fully appreciate why you are taking this personally, and I would too, but I am taking it just as personally and frankly I don't care anymore.
Patients are bang in the firing line, you might think it is unjust and not fair (and it is) but that won't stop it happening. You are grown adults, no matter what your illness is, and only you can make sure you come out of this one unscathe.
Mary Harney (with the full backing of FF/Greens as they are happy to have the flak diverted from them) and the HSE are fully willing to take this to the end of the line. They don't give a feck about me and they don't give a feck about you either. I think they have underestimated what an essential service pharmacy is and think they can do with out us.
Mark my words, if they win or if pharmacists back down, either way you the patients will have lost. Either way you are going to receive a ****tier (though short term cheaper) pharmacy service. And when in a few years time drug expenditure keeps rising (as it will, as nobody is going to be tackling the fundamental problems in the healthcare system) we will be in a worse position than we are in now.0 -
Unregistered wrote: »pharmacists ARE expected to give advice. clause 9 in their contract requires them to do so, to ensure "the safety of dispensing and administering" of medication which also requires ensuring the patient understands the medication and the pharmacist is also in a position to guide the patient to the safe use of otc medications, any interactions between different prescribers, eg hospital and gp. i,ve a 6 year old asthmatic who was sent home from hospital on an adult's dose of antibiotics. the pharmacist wouldn't dispense it until he got hold of the hospital doctor who prescribed it, did so the following day eventually as the hospital doc was gone home. no one in the hse was willing to take the blame for changing the prescription. also my father went into him complaining of "heart burn". the pharmacist noticed a cold sweat on my father and sent him straight to the gp who in turn sent him to hospital. 3 days later he was diagnosed with a mycocardial infarction...a small heart attack. the pharmacist could have sold him the gaviscon my father asked for but instead he used his judgement, refused the sale and referred him higher. ALL FOR FREE!!! the should get paid, not go out of business
That is fantastic - I'm delighted the pharmacist did a good job and helped your father.
At the same time can we also acknowledge that the pharmacist will get paid? Did your father maybe go back to get any necessary medication? I'm not for a minute suggesting that this would be the primary reason a pharmacist would help but the goodwill will flow back to them.mr.impossible wrote: »That puts me in my box so, I think I will go back to work for as long as it takes until my lower revenue stream stops being able to provide for the running costs of my business. How selfish of me to panic about such a stupid matter as a revenue steam. Sure what would it matter to me if that revenue stream weren't able to pay my salary? I foolishly thought I was doing this job, which I admittedly like, to pay my mortgage and to put bread on the table and provide for my kids' future. When in fact what I am doing is ensuring somebody gets their insulin and test strips without being inconvenienced. I hope you will forgive me when I go out of business and have to close my doors. At least I can go out in the knowledge that I did my best for as long as possible to convenience you. After all that is what my job on earth is.
Seriously? You're comparing a reduced revenue to insulin? I'm not denying it's a very bad thing for you but if you take insulin away from a type 1 diabetic it's a tad more serious.0 -
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Any pharmacist here - what percentage of your profits is derived specifically from Long Term Illness medication? Any ideas?
I'd be quite worried that some people on the LTI program may now decide not to continue with their medication as the cost would be too prohibitive (even if the HSE reimbursed them). They might think they'd get by without it due to a real lack of choice. Now I know you'd think that the root of this issue is with the HSE and, in many ways, I can understand that. However, what would you feel should be done to help alleviate this threat? What alternatives and contingencies do you think you should try and put in place here?0 -
I have seen on another forum the point about short term pain long term gain versus long term pain short term gain.
If a retailer gets little or no return for taking a risk, say stocking a product they may not sell or goes out of date (food, medicines, fashion) they will not stock those items, if they have a captive audience.
Doctor writes a prescription, you go to the pharmacy (keeping it simple for now, one pharmacy town). The pharmacy may not hold any stock, they could order it in for you for tomorrow. You probably have waited 24 hours for the prescription from the doctor so another 24hour wait could be in store. Gr4anted the pharmacy may stock "household" lines that seem to move quickly but if it expensive, new, unusual, why would they stock it.
If pharmacists get paid less than cost for medical card drugs, what service will we have in a few years?
I probably have not explained the point well. Sorry!0 -
I have seen on another forum the point about short term pain long term gain versus long term pain short term gain.
If a retailer gets little or no return for taking a risk, say stocking a product they may not sell or goes out of date (food, medicines, fashion) they will not stock those items, if they have a captive audience.
Doctor writes a prescription, you go to the pharmacy (keeping it simple for now, one pharmacy town). The pharmacy may not hold any stock, they could order it in for you for tomorrow. You probably have waited 24 hours for the prescription from the doctor so another 24hour wait could be in store. Gr4anted the pharmacy may stock "household" lines that seem to move quickly but if it expensive, new, unusual, why would they stock it.
If pharmacists get paid less than cost for medical card drugs, what service will we have in a few years?
I probably have not explained the point well. Sorry!
I can only speak from my own experiences. I've had my pharmacist not have some items in stock that I regularly need (insulin). They tell me that it's because another diabetic was in just before me and therefore I'd have to wait. In fairness the lead time from uniphar/ud seems to be very short (<8 hours) so it hasn't been the worst thing in the world but I definately don't think that many pharmacists are stuck with a big pile of medication they'll never shift.0 -
smccarrick wrote: »Since when is insulin for a diabetic a convenience? Or blood testing strips, or glucagen? Its a matter of life and death in very many cases. I'm really sorry that you're getting paid less- but you are actively putting people's lives at risk- if they are not in a position to pay the full cost price of the requisite medicines they need upfront. I have no idea what Novorapid, Lantis and glucagen cost- I imagine its substantial.
I had a lot of sympathy for you- up to your current post. You really have no idea of what you're putting people through though- do you? Its a financial matter for you- its people's health and in some cases possibly their lives- for your customers. Can I put it more plainly. Calling it a 'convenience' is derisable, and indeed offensive.
Maybe I didn't make my self clear. I will try again: yes insulin, blood testing strips and Glucagon are essential to a diabetic. Yes they are very expensive. You are an adult (or a carer) who is caught up in an awful crisis. Only you can ensure your health. Nobody is there to monitor that you give the right dose of insulin, in the same way nobody will be there to ensure you get supplies. Make sure you stock up and make sure you have a continued source of supplies to keep yourself healthy.
What I can't however do is continue to supply you with same, regardless for the consequence for me! I furthermore won't act reckless to my own needs to facilitate you!
Like it or not, once I have given the government the required 30 days notice I am absolved from all further obligations to them and by consequence to you. You may think it is a huge conspiracy that 1100 have taken the same view, but could it just be that what they are offering is so bad that 1100 would look at the figures and say 'this isn't worth it'? I took this decision on my own and in my cases I would have made the same decision even if 1499 hadn't.
Don't expect me or anybody else to continue to do something cause you think it right that they do so. The only person who has made you a promise is the government (under the Health Act) and you should make sure they fulfill their obligation.smccarrick wrote: »Sarcasm doesn't impart anything whatsoever in this instance- and delibertly deriding the legitimate concerns of your customers as 'conveniences' is almost bizarre. Your prime objective in life can be whatever you choose it to be. Your stated profession is that of pharmacist to the public- and the public have a legitimate expectation that you will fulfill whatever those duties would normally be expected to entail. You do not have a quibble with your customers- you have a legitimate argument with the HSE and the government. If you choose to move away from your chosen profession and practise in a different area instead- by all means do so. I don't see where anyone is suggesting you are a servant to anyone else- or that your needs are in any manner subservient to theirs. You do however have responsibilities associated with your chosen profession- responsibilities which I would suggest you care little for.
Like it or not once I have served my 30 days notice, I will no longer have a duty to the government to provide medication under their schemes. I will have a duty as a pharmacist to dispense medication, but have the right to charge for it. I am not shirking my responsibility, the government is!smccarrick wrote: »Who is suggesting this? I didn't. I acknowledged that the rates paid for medical card customers are derisory- but that the LTI rates are substantial by anyone's terms. The LTI customers have been diagnosed with long term medical conditions- and require ongoing care and medication. You are using these pawns to further the legitimate argument you have against the paltry medical card rates. This has been acknowledged as largely true by other posters who have identified themselves as pharmacists on this thread- never mind elsewhere. The points I made were and continue to be- specific to the LTI and EUR100 a month schemes- as in my eyes- they are the vunerable people who are being abused in this case. Certainly- you will inconvenience very many other customers- but you might actually kill some of these.
Once again I am not in a position to refuse medical patients and accept DPS and LTI patients, much as I would like to.
Yes the patients are being abused, but my whom?smccarrick wrote: »And what would you call the proposed action in that case? The curious matter of the pharmacists who just happened to simultaneously decide to take similar action action against their customers? Sorry- against the HSE and the government- but you can't hurt them directly- so you picked the target that you have access to- customers who expect to be able to collect prescriptions and medications from pharmacies?
If a group of people were in the phoenix park and a storm came and they all decided to leave. Would you think it was a conspiracy by the people or a natural reaction to the storm?smccarrick wrote: »You will note that you are posting in the 'Long Term Illness' forum- not a general forum- it is a reasonable assumption that a substantial number of the posters here suffer from long term illnesses- and many of them are on the LTI scheme (many are on the EUR100 a month scheme- thanks to the random nature of what is defined as a LTI, and what is not).
Totally agree. As a point many patients on medical cards have long term illnesses too. Government definition of long term illness is absurd, with patients suffering from asthma/COPD,manic depression,schizophernia etc. not included and then the totally random nature of what drugs they allow.0 -
To clear up the issue of concern for LTI patients. Pharamcists have given a months notice of withdrawal. Unfortunately, they cannot pick and choose the schemes they work under. Its all or nothing so when they want to withdraw from one or some, they must terminate their contract.
There has been four weeks notice and the IPU have issued a list of pharmacists (Boots etc) who will continue to operate the schemes so thats your avenue. Also the HSE have clearly stated that they have contingency (give them a buzz). I've bo doubt they are lying (anyone remember the blantant lies of one Pat O'Dowd on the Pat Kenny show last year on the very same disute)
I can fully appreciate the extreme concern of patients but you have 4 weeks notice and several posters above are suggesting that pharmacists should continue to operate the schemes even if it will bankrupt them with 6 to 8 weeks. Would they do it in their jobs...of course they wouldn't.
What I would suggest is go to your current pharamcist this week and review the situation. They are not fools or uncaring. If they know that they will not be operating the schemes in August, they will assist in every way they ca. Unfortunatelyy, what they cannot do is operate a business in aterminal loss making situation0 -
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If pharmacists get paid less than cost for medical card drugs, what service will we have in a few years?
Perhaps they might focus their newly honed organisational skills at getting better prices from wholesalers and manufacturers. I've had to buy test strips here when my wife misplaced her LTI card- they cost me EUR88 for 2 boxes. I've also bought an identical two boxes (same manufacturer, same product- slightly higher VAT) for EUR62 in Portugal. We're all in the Eurozone and have a common market in goods and services. If there is a difference of this scale to be exploited- surely it would be a hell of a good idea for the IPU to exploit it?
Anyone can do this- but in most cases the medications can only be sold/delivered to a pharmacist (hence my sourcing and having medications from the UK shipped to my local pharmacist that I referred to earlier in this thread).
The argument is the price won't cover the cost of the medications. The other way of looking at this is- do our EU brethern pay the same prices- and if not- why not? Is there a supply line we can exploit? Medicine is a commodity product- a 35c box of paracetamol in Spain has exactly the same ingredients and has come off the same production line as a 1.29 box in Dublin- both from Clonmel Pharmaceuticals. Why doesn't the IPU chase down these sort of issues- instead of threatening vunerable customers?0 -
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.
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".
All very nice in theory.
Entry level is high for pharmacy because you end up with an almost guaranteed highly paid cushy number for sorting pills.
Pharmacist keeping the patient safe is another funny one.
I have used a few pharmacists in the past and the numbers of errors is staggering; forgetting to order tacrolimus was frighteningly common.0 -
smccarrick wrote: »Perhaps they might focus their newly honed organisational skills at getting better prices from wholesalers and manufacturers. I've had to buy test strips here when my wife misplaced her LTI card- they cost me EUR88 for 2 boxes. I've also bought an identical two boxes (same manufacturer, same product- slightly higher VAT) for EUR62 in Portugal. We're all in the Eurozone and have a common market in goods and services. If there is a difference of this scale to be exploited- surely it would be a hell of a good idea for the IPU to exploit it?
Anyone can do this- but in most cases the medications can only be sold/delivered to a pharmacist (hence my sourcing and having medications from the UK shipped to my local pharmacist that I referred to earlier in this thread).
The argument is the price won't cover the cost of the medications. The other way of looking at this is- do our EU brethern pay the same prices- and if not- why not? Is there a supply line we can exploit? Medicine is a commodity product- a 35c box of paracetamol in Spain has exactly the same ingredients and has come off the same production line as a 1.29 box in Dublin- both from Clonmel Pharmaceuticals. Why doesn't the IPU chase down these sort of issues- instead of threatening vunerable customers?
I know I have annoyed you, but I am just trying to rise your ire and point you in the right direction (at what I believe anyway - the current government!). Mary Harney must be delighted with the flak pharmacists are receiving and relieved Crumlin Hospital is off the headlines.
From a business point of view I have been looking into the above and I no doubt reckon it will be the way pharmacy goes in the future. It does take group buying and time to organise though. Plus the HSE will be looking to claw back any savings we make.
Our system doesn't make it easy to import and takes much of the savings out of the process. You need a wholesale license to import and have to relabel the goods and get a PA (Product Authorisation) from the IMB (Irish Medicines Board). Some companies already do this (e.g. Eurodrug, PCO). Savings over the irish brand aren't substantial (of the order of 10-15%) and the HSE pays less of the same order to pharmacies dispensing these drugs (and have said that is fraud to claim for the irish product if dispensing the foreign product).
Factory gate prices are of the order of 1/2 in Spain and France. However it is the DoH which sets prices with manufacturers, which is a whole other story.
I have no doubt in the long run the irish wholesalers (who also don't listen to me as I am a very small customer) will be squeezed as they are the least needed in the chain.
Apologies for burning off my anger on you, if I put myself in your position I would feel like you and maybe if you were in my position you would feel like me. Your medication supply is under threat and you have very little control of the situation - other than do all you can to stock up and find a pharmacy to get continued supplies (maybe contact diabetic clinic too for dire emergencies) and the people responsible (including the likes of me) aren't listening. I feel my livelyhood (and by consequence my families livelyhood) is under threat and the people responsible aren't listening.
ps if you go back to the pharmacy where you paid for the test strips along with the LTI book I am sure they will give you a refund (I certainly would), even in the current situation it should not be a problem0 -
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mr.impossible wrote: »Maybe I didn't make my self clear. I will try again: yes insulin, blood testing strips and Glucagon are essential to a diabetic. Yes they are very expensive. You are an adult (or a carer) who is caught up in an awful crisis. Only you can ensure your health. Nobody is there to monitor that you give the right dose of insulin, in the same way nobody will be there to ensure you get supplies. Make sure you stock up and make sure you have a continued source of supplies to keep yourself healthy.
My own local pharmacy- an IPU member- has specifically refused to allow us to get more than our regular monthly medication. She has said other members in the area have agreed a similar course of action. She also said whether we can afford to pay or not- is not her concern- that we can reclaim it back (without giving any details of what its going to cost upfront- or how we can claim it back). Thats the problem- its simply not possible to 'make sure we have a continued source of supplies'- where are we to get them?
Its all well and good saying- you have a duty of care to ensure your health- stock up on medication and keep yourself healthy- when in the same breath you are undertaking actions where people may have to reasonably make a choice between paying their mortgage or for their medication- you are putting people in very unreasonable situations. Your quibble is with the HSE or the Government- not Brian and Aine, your two customers......mr.impossible wrote: »What I can't however do is continue to supply you with same, regardless for the consequence for me! I furthermore won't act reckless to my own needs to facilitate you!
I do not suggest you act in a reckless manner. You are suggesting its fine for patients to act in a reckless manner however. People are stretched unbelievably already- this is simply a bridge a lot of people can't cross.mr.impossible wrote: »Like it or not, once I have given the government the required 30 days notice I am absolved from all further obligations to them and by consequence to you. You may think it is a huge conspiracy that 1100 have taken the same view, but could it just be that what they are offering is so bad that 1100 would look at the figures and say 'this isn't worth it'? I took this decision on my own and in my cases I would have made the same decision even if 1499 hadn't.
Don't expect me or anybody else to continue to do something cause you think it right that they do so. The only person who has made you a promise is the government (under the Health Act) and you should make sure they fulfill their obligation.
So, in short. You've done your paperwork, and everything else be damned. You've done what you are legally obliged to do- and owe nothing to anyone else. Well- you might just find that when you do decide to end your strike- that your customers just might decide to boycott you. People do not appreciate being used as pawns in someone else's fight. Thats what you've done here.mr.impossible wrote: »Like it or not once I have served my 30 days notice, I will no longer have a duty to the government to provide medication under their schemes. I will have a duty as a pharmacist to dispense medication, but have the right to charge for it. I am not shirking my responsibility, the government is!
So- you've done the paperwork- you've no further obligations. Its all a sodding game of pass the buck. The hurt parties here are the patients who are not going to able to afford their medication. All you're doing is saying- I know you used to be able to get it here- but I can't give it to you anymore unless you pay for it- blame them..... The IPU members may have served notice to cease the operation of the various schemes on the government- but whether you are willing to admit it or not- you are using vunerable people as a battering ram against the government. I have better things to do than burn effigies of Mary Harney- its not my fight- though you'd like me to fight it on your behalf.mr.impossible wrote: »Once again I am not in a position to refuse medical patients and accept DPS and LTI patients, much as I would like to.
You have to accept in that case that your actions are potentially severely detrimental to the health of the most vunerable of your customers. Unfortunate you say- so be it. Its almost as though you are doing a Pontius Pilate on this. Just because you don't pull the trigger does not mean you are totally without responsibility for the action.mr.impossible wrote: »Yes the patients are being abused, but my whom?
Well- who do they have interaction with?mr.impossible wrote: »If a group of people were in the phoenix park and a storm came and they all decided to leave. Would you think it was a conspiracy by the people or a natural reaction to the storm?
Yes- I would suggest it might be a conspiracy if they all chose to leave by the same gate and congregate up the road in the same local to look out the window at the carnage being raged by the weather.mr.impossible wrote: »Totally agree. As a point many patients on medical cards have long term illnesses too. Government definition of long term illness is absurd, with patients suffering from asthma/COPD,manic depression,schizophernia etc. not included and then the totally random nature of what drugs they allow.
And yet- while this is a legitimate quibble- its one that no-one has been happy to lobby on behalf of. Unlike most people in this country- the chronically ill, more often than not- have no-one to stand up for them- and instead get used as pawns by people who they thought they could rely on......0 -
smccarrick wrote: »Perhaps they might focus their newly honed organisational skills at getting better prices from wholesalers and manufacturers. I've had to buy test strips here when my wife misplaced her LTI card- they cost me EUR88 for 2 boxes. I've also bought an identical two boxes (same manufacturer, same product- slightly higher VAT) for EUR62 in Portugal. We're all in the Eurozone and have a common market in goods and services. /QUOTE]
Don't wish to be rude but what part of "Pharmacists don't set the prices, the government have total control on that with manufacturers" can you not grasp.
If your local pharmacist got your wives meds for €1/box, he is legally pervented from selling them below the price authorised by the DOH/HSE. All pharamcists are sent the price list by government to charge at and its illegal to uncut it.
Don't wish to be rude but gets slightly grating when people keep blaming pharamcists for drug prices. They have been requesting generic substitution for 3+ years but DOH have requested.0 -
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All very nice in theory.
Entry level is high for pharmacy because you end up with an almost guaranteed highly paid cushy number for sorting pills.
Pharmacist keeping the patient safe is another funny one.
I have used a few pharmacists in the past and the numbers of errors is staggering; forgetting to order tacrolimus was frighteningly common.
If it a pharmacy gives you poor service, use a different one. Complain and let them know you expect a good service or will take your business elsewhere.
This is probably not the case in your experience, but where a customer is not a regular and it is doubtful whether they will be returning the pharmacy mightn't re-order the drug. Make it clear to them you will be back next month or ring the day before to ensure timely supply. Never leave yourself short of medication either. Yes the pharmacy should so their job properly, but it is ultimately you who will ensure your health is looked after. I don't mean this insultingly, but rather than you are empowered!
Entry level salaries are no longer guaranteed high since the dispute in 2007 and continue to dip (will find link to retail ireland salary scales).
Pharmacists have a grave responsibility and thus salaries do and should reflect this risk. A pharmacist rightly bears responsibility for their actions, and this means they will be held responsible for their errors. A pharmacist in the UK was recently handed a custodial sentence for a non-deliberate error which resulted (partly implicated was the judgment) in the death of a patient. The sentence was suspended and the pharmacist resigned, but the precedent has been set (for pharmacists and other healthcare workers). Ironically the pharmacist pleaded mitigating circumstances (very busy UK pharmacy with no back up staff), but the judge (on much reflection rightly I believe) said she put herself at risk by working in those circumstances.0 -
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Unregistered wrote: »smccarrick wrote: »Perhaps they might focus their newly honed organisational skills at getting better prices from wholesalers and manufacturers. I've had to buy test strips here when my wife misplaced her LTI card- they cost me EUR88 for 2 boxes. I've also bought an identical two boxes (same manufacturer, same product- slightly higher VAT) for EUR62 in Portugal. We're all in the Eurozone and have a common market in goods and services. /QUOTE]
Don't wish to be rude but what part of "Pharmacists don't set the prices, the government have total control on that with manufacturers" can you not grasp.
If your local pharmacist got your wives meds for €1/box, he is legally pervented from selling them below the price authorised by the DOH/HSE. All pharamcists are sent the price list by government to charge at and its illegal to uncut it.
Don't wish to be rude but gets slightly grating when people keep blaming pharamcists for drug prices. They have been requesting generic substitution for 3+ years but DOH have requested.
Please reread what I posted. I was not talking about the prices charged to the public (but I did use retail prices to get my point across). I was talking about the IPU as a group negotiating large discounts in wholesale prices- so the pharmacists would not be in a position where they were selling drugs at less than the wholesale cost of drugs (which is what is being argued the proposed cut in prices will do).
The wholesale prices for practically all medications are cheaper elsewhere in Europe. Fine- a pharmacy has a pricelist for patients- surely they are free to pay a lower price- if so offered, by their distributor? Thats the point I was making.0 -
the DOH/HSE have refused to recognise the IPU. You think the manufacturers are going to suddenly start.0
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Guys, if you can't see that your local services are being cut by the present government, then I think I will give up.
Nearly every other sector of the Healthcare system in Ireland has been decimated, and while people have grumbled it as gone ahead and there is no turning back.
When the over 70s got their medical cards withdrawn they did not come to pharmacies to demand their medication free of charge but took it to the government and got (partial) results.
I accept what you are saying is true, that pharmacies are using you as pawns, but just remember who made the first move.
Yes, it would be better for you if we continued the status quo as if nothing had changed. In the short term!
In the long term however the smaller local pharmacies will close and the larger groups will lay of staff and provide you with a poorer service.
Maybe you believe that is the better option (and believe me I understand your fears) and if the majority of patients feel that way I should accept it.
Now I am willing to accept that maybe what I have said I will do come August 1st is morally wrong and I am considering remaining in the status quo, at least until such time as I can find alternative employment or go out of business, whichever happens first. I have already decided that my chances of continuing are slim, so I am looking for an exit strategy anyway.
From a personal point of view I thought pharmacy was a profession of value, I wouldn't have enter the profession otherwise. Maybe our time has passed and we should accept the brave new world. If nobody else thinks it is worth fighting for, why should I?0 -
Where is this list? I checked the IPU site and can't find it - would have thought it's the very first thing they'd have on it.Unregistered wrote: »There has been four weeks notice and the IPU have issued a list of pharmacists (Boots etc) who will continue to operate the schemes so thats your avenue.
Again - surely they're going to go just as bankrupt by not participating in the scheme at all? Either way, they're losing the patients as I doubt many will be willing to pay full price.I can fully appreciate the extreme concern of patients but you have 4 weeks notice and several posters above are suggesting that pharmacists should continue to operate the schemes even if it will bankrupt them with 6 to 8 weeks. Would they do it in their jobs...of course they wouldn't.0 -
There are a number of Pharmacists on this forum doing their best to defend their side. Has anyone ever seen a poor Pharmacist ??0
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Kristopherus wrote: »There are a number of Pharmacists on this forum doing their best to defend their side. Has anyone ever seen a poor Pharmacist ??
I haven't, but these guys have:
http://www.pharmacistawards.com/BF%20draw%20applic%20&%20letter%20final%20051008.doc
PHARMACEUTICAL SOCIETY OF IRELAND BENEVOLENT FUND
2nd October 2008
Dear Colleague,
The Benevolent Fund wants your help, to assist pharmacists in need. By joining our Annual Confined Draw you could win €4,000 while supporting somebody who has helped shape your profession.
Our social worker makes direct contact with pharmacists, and others associated with pharmacy, who are in need. Along with our Case Committee she works to give them a dignity and quality of life. This could involve providing a ‘fill of heating oil’, or substantial assistance with nursing care.
The Annual Confined Draw has six monthly prizes from €4,000 to €500. To take part, send us a single annual subscription of €250 by standing order, cheque, postal or money order. Whilst enjoying a little gamble, you will be helping.
The Confined Draw is the most important source of income for the Benevolent Fund. Income is also raised through a Golf Classic, contribution from the Pharmacy Awards and direct contributions from members and events, such as the ICGS. You may also benefit the Benevolent Fund in your Will.
Over the past five years the fund has dispersed over €500,000. Last year it struggled to meet demands. This year will put a greater strain on the Fund due to the huge increases in energy costs.
The Committee, depend on you to inform us of persons in need. If you know of a colleague or someone from the wider area of our profession who needs help, call the P.S.I. or the I.P.U. Information is handled in strict confidence.
Thanks are due to all who assist with the Benevolent Fund, colleagues on the Committee, those on the Case Committee, Golf Classic organisers, our Social Worker Mary Dowd and all who made donations or who participated in the Golf Classic, Confined Draw or the Pharmacy Awards during the past year.
Join our Annual Confined Draw today and make a difference to the lives of those in need.
Yours sincerely,
Cicely Roche MPSI
President, PSI Benevolent Fund
maybe you could make a contribution0 -
Kristopherus wrote: »There are a number of Pharmacists on this forum doing their best to defend their side. Has anyone ever seen a poor Pharmacist ??
I can't speak for pharmacies outside Dublin, but an average chemist in Dublin, who owns his own shop, will clear a minimum of 250,000 a year. That's net profit.
Before I have any whingers disagreeing, research what any of the chains paid to buy out individual shops.0 -
Unregistered wrote: »I can't speak for pharmacies outside Dublin, but an average chemist in Dublin, who owns his own shop, will clear a minimum of 250,000 a year. That's net profit.
Before I have any whingers disagreeing, research what any of the chains paid to buy out individual shops.
Wow that's amazing, €250,000 into their ass pocket. Must have been a huge sum before they paid all their overheads.
Have you got the phone numbers for any of these chains as I would love to sell out??!! While you are at it maybe they are looking to buy houses as I read an article in a newspaper I had from 5 years ago that house prices in Ireland are crazy!! Wonder if the guys who paid the big bucks for these pharmacies are loaded now? We should go after those guys who sold out at the top of the market. Maybe if we go after pharmacists we might get a few of them (hope they are still in business, don't want too much collateral damage).0 -
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mr.impossible wrote: »Wow that's amazing, €250,000 into their ass pocket. Must have been a huge sum before they paid all their overheads.
Have you got the phone numbers for any of these chains as I would love to sell out??!! While you are at it maybe they are looking to buy houses as I read an article in a newspaper I had from 5 years ago that house prices in Ireland are crazy!! Wonder if the guys who paid the big bucks for these pharmacies are loaded now? We should go after those guys who sold out at the top of the market. Maybe if we go after pharmacists we might get a few of them (hope they are still in business, don't want too much collateral damage).
I gave you a hint, what did the chains pay individual chemists when they bought them out? You're in the business, you must know. As for five years ago, the price of houses has dropped, I'm struggling to think of any price in a chemist that has ever dropped.
I also love the constant rubbish that the department set prices for chemists, Individual chemists set their own prices for 90% of their stock.What percentage of stock in your shop has less than 100% mark-up?
Government schemes are obviously exclluded.0
This discussion has been closed.
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