NEWSVIEWPOINT


STOCK TAKING


The older I get the more comfortable I am with the accepted fact that people, particularly pharmacy colleagues, do not especially like me. Written by Dr Terry Maguire


W


hat is there to like, you might ask, when this guy Maguire constantly


criticises, interminably complains and excessively pontificates. And perhaps they have a point. I accept I do go on a bit; on occasion I go a bit too far.


This year I am 40 years in pharmacy, 35 years qualified and 30 years a contractor. I came to Queen’s University, Belfast in 1976 to study agriculture and ended up studying pharmacy which taught me an important life lesson; always check which queue you are standing in.


As thoughts of retirement start to replace fantasies of running off with Kristin Scott Thomas, it is I believe a good time to reflect, to take stock and to plan efficient use of my remaining years. So what has sparked this mawkish introspection?


I was asked by my old friend John D’Arcy to provide an overview of the pharmacy market in Northern Ireland for a Numark meeting at the excitingly refurbished Crumlin Road Gaol.


It was while writing some notes for this that I began to think how pointless my task was. Talking to an audience of peers, the majority of who are so much more successful in business than I am, or will ever be, is always an uncomfortable prospect.


My view of how my business might develop is simply that, my view, and answers to the question why others would be remotely interested, deserted me.


So what did I say? Well, I confirmed that it had been a difficult few years. Since 2010 and following government


46 pharmacyinfocus.co.uk


cuts and the over enthusiasm of the mid 2000s, most of our finances were pushed off a cliff.


But, we are businessmen and women and that is what we do; we make it work. No pharmacies closed; we cut our cloth, we cancelled the holiday, we took the pay cuts and some of us even gave up the tenure on the window tables in Belfast’s best restaurants.


To succeed in the future, I argued, it is essential to identify; our real customers, our true competitors and our loyal allies and to consider from where future income streams might flow.


Most of us passively wait and complain until it is too late and then we try to sell our businesses on, at below market price, to someone who might have the energy and vision to save them.


Government, in the form of the Health Service, is pharmacy’s biggest and best customer. We spectacturaly fail to realise this. Pharmacy has remained, from the government’s point of view, underdeveloped.


Chief pharmacists across the four UK regions are focused on a clinical future for pharmacy. Failure to align with the strategy of our biggest customer seems just suicidal as government will redirect income streams elsewhere and we don’t seem to learn this lesson.


Pharmacy, it seems, has known for some not inconsiderable time what its professional future should be; (1) Pharmaceutical Care (Medicines Optimisation),


(2) Supporting citizen Self Care (Common ailments) and


(3) Public Health (Health + Pharmacy).


Pharmaceutical Care was supposed to add value to the service we provide but we have not moved away from a remuneration model based on dispensing.


Medicines Use Reviews (MURs) and Managing Your Medicines are two services that were supposed to get us started and to some degree they have but they are not “Pharmaceutical Care” as defined by Helper and Strand in the 1990s: “the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life”.


The key to Pharmaceutical Care is measurable outcomes. MURs and Managing Your Medicines are of questionable value as they do not consider patient outcomes or provide pharmacists with autonomy to; change, delete or add medicines and dosages.


Medicines Optimisation, a key pillar of government health policy, is set to create the income streams that will support better medicines use yet sadly, due to our reluctance to help, we get the technical and adherence bits.


Will I serve out my days popping pills from one blister pack and transferring them into another?


Self care, another obvious area for income generation, has been cut back. Fact is, we need to be responsible and the unspoken view of DHSSPS is that only with proper controls will we see an expansion of this service.


Take sticky eye (bacterial conjunctivitis) for example, Stick eye is treated by GPs in primary care and results in 50,000 units of chloramphenicol


being dispensed on the health service each year.


The Health Service would need to be assured that, if this common ailment was handed over to community pharmacy, the number of chloramphenicol units is reduced to say 25,000 per year more in keeping with expert clinical guidance as defined by SIGN or NICE.


The service must be patient focused not product focused. The purpose is to manage common conditions not restock medicines cabinets.


Public health, the third sunny uplands from where income streams should flow, has been as dry as a bone expect for smoking cessation services.


My performance, I think, was somewhat like Rupert Murdock’s on his recent wedding night with the ageing model Gerri Hall.


Like him, I knew what I was supposed to do but I didn’t know how I was going to make it interesting or exciting. As expected I was a failure and it was a flop.


So I finished, thanked my audience and the sponsors and took the tour of the Gaol with colleagues making sure I did not get too close to the noose in the execution cell. I never know when I have gone too far. n


These views are entirely those of the author and do not necessarily reflect the opinions of either Profile Publishing & Design Ltd or the Ulster Chemists' Association.


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