Picture credit - the Health and Social care board
Northern Ireland’s community pharmacy sector is suffering an estimated shortfall of £20 million. With the collapse of the NI assembly and no health minister, there is no end in sight in this funding crisis, and continued cuts to rural support mean critical pharmacies like Siobhan McNulty's (pictured, left) are being forced to reduce their opening hours and risk closure. Emma Rosser investigates
Siobhan McNulty, Melvin Pharmacy, Garrison, Fermanagh, Northern Ireland
'The pharmacy is in Garrison in Fermanagh, Northern Ireland. It’s a very small rural village, but it takes in a large geographical region. The next closest pharmacy is six miles in one direction, twelve miles in another, and twelve miles in another. It’s very remote and according to the Northern Ireland Statistics and Research Agency (NISRA), we are the worst ranked area in Northern Ireland in terms of proximity to health services.
'We don’t have a GP surgery in the village, so a lot of the patients really do count on us. I’ve done CPR outside the pharmacy, we’ve had to go to road traffic accidents, administer epipens and done a lot of life-saving interventions.'
Rural access fund cuts
'We have already lost £10,000 a year from the rural access fund, which helps pharmacies in rural locations. In order to claw that back, we have reduced our opening hours. I had to apply to the Department of Health (DOH) and they initially turned us down and said it would mean that patients would not have proper access to care and would put undue pressure on the out of hours system. Eventually they allowed it.
'We introduced our new opening hours a couple of weeks ago. Previously on a Saturday we were open from 9.30am until 6pm, and on Saturday 5 May, we opened 10am to 3pm. I received 10 phone calls over the weekend – people were ringing me and saying they didn’t have their tablets. I had to go back into the pharmacy ten times for people that needed healthcare advice.
'That doesn’t include the people who sent me Whatsapp messages and private Facebook messages to get advice over the bank holiday weekend. I don’t have it in me to not help people, so eventually I had to put my mobile number on our Facebook Twitter pages so that people could contract me if they needed – so that nobody was left stranded.
'Those are the people who would have been presenting in the out of hours service, had I not have stepped in, so the Department is correct, reducing our hours will have a negative effect. But based on all the cuts to funding I can’t afford to keep a locum and a member of staff there for those extra hours. The effect is being seen already. And then we got a letter saying the rest of the rural fund was to go.'
‘It’s at breaking point’
'I don’t know if it’s going to be feasible for us to remain open, because the amount of money that they are talking about [cutting] is so large. We were struggling with the rural access fund, so to lose it in its entirety with all the other cuts that have been introduced would be catastrophic.
'The Cost of Service Inquiry (COSI) report from PriceWaterhouseCoopers estimates a £20 million funding shortfall in community pharmacy. It’s at breaking point. There are literally no more cuts they can introduce that can be sustained by community pharmacy. We’re probably one of the smallest pharmacies in Northern Ireland, but also one of the most crucial given the access that people have in the area.
'I have made our position known to the DOH and the Health and Social Care Board (HSCB). I know that the HSCB has asked us to pick up more services, like blood pressure monitoring, with the possibility of more funding, which we’re absolutely more than happy to do, but it’s a question of how quickly they can implement the funding.
'I have no desire to close my business. This is my only pharmacy, I am from the area, I know all my patients and I want to be able to tend to them. But it’s now reached the point that if I continue as I am, it’s going to be detrimental to my health because I’m working for next to nothing. I don’t take any pleasure in fighting with the DOH or the HSCB, I just want fair and proper remuneration for my job.'