Written by Denis O’Driscoll – LloydsPharmacy Superintendent Pharmacist
With one million COVID-19 vaccines having been administered in community pharmacies in Ireland, Denis O’Driscoll, Superintendent Pharmacist at LloydsPharmacy, explains why pharmacists now need to be brought into the decision-making circle.
The status of the community pharmacist in Ireland has skyrocketed since the onset of the pandemic. GPs and hospitals experienced huge levels of crisis and concern during this period, being completely overrun. With these routes to healthcare less widely available for everyday ailments, questions, and appointments, people increasingly turned to pharmacies. Healthcare professionals in community pharmacies remained fully open throughout the crisis and freely accessible to the public and were depended upon every day for medical advice. And as a result, the past two years have seen pharmacists gain significant trust from Irish society.
Despite this, pharmacists continue to sit outside of the ‘inner circle’ within government structures. During the pandemic, we became familiar with the Chief Medical Officer and other key influential personnel on the national stage; yet despite pharmacies playing such an instrumental role as healthcare professionals during this time, there isn’t an equivalent ‘Chief Pharmacist’ post within the Department of Health.
Therefore, there wasn’t the appropriate level of influencing and direction for the pharmacy profession during the pandemic. It is imperative that the role of the Chief Pharmacist be considered so the profession can be given the voice and opportunity to influence policy in a collaborative manner. This lack of presence within the policy structure suggests that pharmacists are overlooked when key decisions are being made and are merely brought to the table as an afterthought.
COVID-19 Challenges
When I joined my current role with LloydsPharmacy in 2018, conditions within community pharmacy were very different. But COVID-19 hit like a tsunami, and pharmacy colleagues were forced to work more closely together despite the need for social distancing, to ensure that patients received the best possible care. The determination and dedication that is shown by pharmacy teams is indicative of the drive to provide a ‘patient-first’ service. It is commendable that during and since the pandemic there has been no record of workplace transmission of COVID-19 in LloydsPharmacy.
Without our people who worked so diligently we cannot survive and thrive through the pandemic. Everyone went above and beyond the call of duty and worked together selflessly and cohesively when it was becoming more challenging every day. And by and large, communities recognized the efforts being made by pharmacy teams on a daily basis.
When COVID-19 arrived in Ireland and lockdowns loomed, the phones rang incessantly. You just couldn’t keep up with the volume of calls. We were inundated with requests. Patients were afraid to leave their homes, stocks of medicines were not arriving in pharmacies quickly enough to keep up with demand and managing a steady supply of inventory proved extremely challenging. Patients were exhausted, the system was completely overrun, yet pharmacy colleagues remained at the coal face. The national electronic prescription transfer system known as Healthmail was not fully implemented within community pharmacies. The public were incredibly stressed, and the bigger picture that we were all trying to navigate was having no idea how long this crisis period would last.
But rather ironically, the hectic nature of day-to-day pharmacy work did not change dramatically as lockdowns lifted. Although there were fewer emergency scripts from GPs and hospitals, more and more patients were coming in and asking for advice. People now had more trust in their community pharmacist. Patients were semiprepared for another lockdown to happen, and we would experience a rush of people looking for their scripts ahead of national announcements. I would say that pharmacies are in fact much busier locations after lockdowns lifted. It is important to recognize the significance of how the public view community pharmacy. Our position has increased enormously with the public trusting us even more for our opinion and advice. Prior to COVID-19, community pharmacists were more isolated within the wider healthcare ecosystem whereas now we are more visible and should take the opportunity that this gives us.
Therein lies one of the key learning from the pandemic: we, as pharmacists, need to respect ourselves as a profession and recognize the key role we play as healthcare professionals.
Post-pandemic Landscape
For all the services we’ve provided communities with right across Ireland over the last number of years, many pharmacists are still facing a real crisis, the biggest challenge being maintaining services for our patients. It appears that the number of pharmacists wanting to work in community pharmacy is decreasing, with greater numbers wanting to locum rather than take full time permanent roles. Therefore, maintaining consistency for patients and providing an excellent patient-centred service is a constant concern and challenge.
The beauty of pharmacy as a degree is that it’s very well respected. Attracting graduates to a career in pharmacy is not an issue, but there is a ceiling in terms of career progression within community pharmacy. In other roles for pharmacists such as industry, hours can be more attractive, and appear to have greater potential for career progression.
We have a lot to bring to the healthcare system but often it is just about ensuring that we are there at the beginning so that the voice of the profession can be heard.
For example, recent legislation has been passed that entitles those within the 18-25 age to access free contraception. And even though pharmacists are required to deliver this service, there has been very limited consultation with the profession since the legislation was passed into law. So, the question is, are the government including all the necessary stakeholders for the successful implementation of innovation in health care?
It seems like pharmacists are not being considered as a key stakeholder in healthcare policy. Therefore, it is time to look to have a Chief Pharmacist position in the Department of Health to ensure that the pharmacy profession is central in health policy.
Looking Ahead
Where we can, we need pharmacies to find out what else their employees – especially pharmacists – are interested in beyond their day job. To consider supporting and offering greater opportunities for pharmacists within community pharmacy to find areas within their work that interest them. For example, one of our pharmacists is amazing at troubleshooting and interrogating data, another likes being involved in improving and designing education programmes within the pharmacy. We need to try and nurture these skills and provide new opportunities to retain our pharmacists. Of course, this can still present challenges in terms of workload, and it will not work in every case. But it is the type of outside-the-box thinking that needs to happen.
We need pharmacists to want to come back into community pharmacy as a career, so it needs to be made more attractive. Therefore, certain HSE contractual obligations and the Pharmacy Act legislation require an overhaul. Since legislation was first written into effect, pharmacists’ roles have completely transformed – we as pharmacists experience it, and so does the public. There is a need to shift the regulations, so that our evolved role and the digitizing of the pharmacy environment is considered a priority. This is without doubt, the major challenge that our Regulator, the Pharmaceutical Society of Ireland, has alongside other key stakeholders such as the Department of Health in changing this legislative framework.
Employees across all sectors are now demanding a better work life balance, which arguably locum pharmacists have come to enjoy, but the public expects us to be open and more readily available now. That said, during the pandemic we had to reduce our opening hours and people understood and continued to come to the pharmacy when they needed to.
We want people to be happy in their workplace, and to return to community pharmacy, and the challenge is how this can be made more attractive for pharmacists: flexible working hours, benefits, terms, and conditions of employment, appropriate renumeration. Then there is the bigger picture the current workloads placed on community pharmacist need to be eased changes to legislation: the need for paper copy retention surely is something that should be a thing of the past! A strong and vibrant community pharmacy presence is an essential element of the overall healthcare eco system. We urgently need policy makers and regulators to engage with our sector to start addressing these issues by looking to pharmacists for their counsel and expertise – just as the rest of society did with the pandemic hit these shores.
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