I got some good news in my pharmacy recently. I am getting an uplift in all my GMS fees. Again. The introduction of the new agreement in relation to medicines optimisation service is, to my mind, a good solution to a vexing problem. It is fair to say that this agreement will not agree with everyone. If you sit down and do your sums, you will see that it probably suits the majority. As always, negotiation is the art of the compromise.

Ever since pharmaceutical care became formalised, the mission of community pharmacy has never been clearer. It was a light bulb moment. Suddenly we had moved beyond the pack, label and wrap. We had ascended the escalator into a proper professional position. Most importantly, no longer did we see ourselves as subservient to any other profession. We had a clear and unambiguous role, the management of medication safety and related issues for patients.

While there had to be a mindset change to deliver on this model, it wasn’t a large one. We had a set of ideas, a structure, a destination. It is my belief that this led directly to the introduction of the new contract in the 1990s. A seminal moment for the profession of Irish pharmacy. For the first time, our professional input was not only acknowledged, but actually required, for us to do our jobs. In the subsequent three decades, while much has changed, the broad strokes have not. We, community pharmacists, deliver quality pharmaceutical care to our communities every day. However, it hasn’t been all sweetness and light. One of the great bugbears of our profession has, traditionally, been the challenge of collecting relevant data that reflected what we do. It is an absolute requirement, when entering a negotiation with anybody, that you know your facts. And, just as importantly, that you are able to communicate them to the person across the table.

I have been on the record as stating that it has never been a more exciting time to be practising as a pharmacist. Of course, it has also never been more complex. While we can all expound at great length the negative space that surrounds some of our daily work life, it would be hard to get out of bed and face the public if this was an overwhelming state. Like many of you, I actually like my job. Over the last few years, the blindingly obvious became clear to us all: While we all work in community pharmacy, some of us work in very different ways. Economic necessity has meant that particular business models suited some more than others. What has always been very obvious is that, as a profession, we have been poor at valuing our professional input and time. Moving from the markup mindset has been a challenge. Most of us can quite readily point out that to get a plumber into the pharmacy will set you back a considerable callout charge. If we go to an accountant, we know that we will not escape without a four or five figure invoice. We accept this. Yet, until recently it appears that the average pharmacist did not accept that professional charges are a two-way street. For instance, over the last decade I have been charging my customers for a blister packing service. I know that I was not alone. I also know that quite an amount of pharmacies did not charge to provide this service. This has obviously blown up in the last six months and has become source of contention. In situations like this, I think it is great to go back to first principles: Are blister packs a good idea? Isn’t that the biggest question that is suddenly facing us, in this case? We have little evidence that they are. Indeed, there is considerable set of arguments stacked against the idea of re-blistering. In my pharmacy, I always resisted, unsuccessfully, the demand for this service. I found it, as you all do, labour intensive, professionally unrewarding, and subject to frequent frustrating changes. Yet, we live in a real world, where there is demand. There are situations where patients will genuinely benefit from a blister pack. Perhaps the largest cohort of such users are the vulnerable that avail of home help services. The carers that will not touch a medicine but will quite happily supervise the patient taking their medicine. Yet, even in this case, does the medicine really need to be re-blistered? Would it not be just as easy, and maybe even better, to have a medicines administration chart? Perhaps we need to formally engage with the providers of home help services to help move the needle. In the meantime, the IPU has produced some very useful medicines optimisation supports. We shouldn’t lose sight of the reality, that this issue is only one part of a quickly evolving landscape. We should manage and move on.