Retailing in pharmacy as restrictions are eased - Hay fever COVID-19 Pharmacy Business Survey - Irish Pharmacy Union
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IRELAND’S OFFICIAL PHARMACY PUBLICATION JUNE 2020 COVID-19 Pharmacy Business Survey Hay fever Retailing in pharmacy as restrictions are eased HIQA’S EVIDENCE SUMMARIES | VETERINARY PHARMACY 2020 | LOCAL HERO
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JUNE 2020
07 A Note from the Editor
IPU News
The latest news and events
13
from Butterfield House
8 Dates for your Diary
8 IPU Academy COVID-19 Webinar Series
8 New designs to IPU Website
The IPU Review is published
monthly and circulated to Irish 9 Pharmacy in the Media
pharmacists. The views expressed 10 Pharmacists welcome decision to make flu
by contributors are not those vaccination available without charge to
of the IPU nor is responsibility
accepted for claims in articles children aged 2-12 and all at-risk groups
or advertisements. 10 Government’s commitment to combat flu is welcome
but requires more ambition say pharmacists
Subscription:
€100 (Ireland North & South) and 11 10% fall off in prescriptions for ‘the pill’ during
€150 (including postage overseas). COVID-19 crisis
Publisher:
11 New Contract Administrator Appointed
Irish Pharmacy Union 12 Pharmacies struggling to cope with soaring costs
(IPU Services Ltd), while providing frontline care during COVID-19 crisis
Butterfield House,
Butterfield Avenue,
Rathfarnham, Dublin 14,
D14 E126
21
Tel: (01) 493 6401
Fax: (01) 493 6626
Email: ipureview@ipu.ie
Website: www.ipu.ie
Editor: Jack Shanahan MPSI
Editorial Associates:
Siobhán Kane, Ciara Browne
and Jim Curran
Advertising: Siobhán Kane
Email: ipureview@ipu.ie
Tel: (01) 493 6401
©2020
Features
Copyright: All Rights Reserved,
Irish Pharmacy Union.
Printed by Rymar Print.
13 IPU COVID-19 Pharmacy
IPU Review is a Registered Trademark
of the Irish Pharmacy Union.
Business Survey
17 Retailing in pharmacy as
restrictions are eased
21 HIQA’s evidence summaries to support
national response to COVID-19
17
IPUREVIEW JUNE 2020 3
Together we have built a distinctive health database. The power of knowledge gives it life. Pharmacy Transactional data is the most effective way to get relevant market knowledge. Join the 73% of the Country’s Pharmacies that already benefit from HMR. For more information: pharmacywatch.ie@hmr.co.com or 01-4136821.
26 51
26 Local Hero
28 Veterinary Pharmacy 2020
53
32 CPD: Strong Opioids and Pain
Management in Palliative Care
40 Life in the Pharmacy under COVID-19:
A Student Perspective
44 Let’s talk about hay fever
48 Report of PSI Public Council Other News
Meeting of 23 April 2020
67 40% discount on Wild Roots Festival
51 Managing Migraine for pharmacists and pharmacy staff
67 Fears that people with COPD may
53 www.ipu.ie gets a makeover not be seeking medical attention
68 Asthma Society commits to stopping
57 Clinical Tips: Vitamin D asthma deaths by 2030
Supplementation during COVID-19 68 UL launches dedicated Institute for
the Study of Infectious Diseases
59 High Tech: Cuprior® 70 Irish Heart Foundation launches phone
support service for newly discharged
60 Political Report: Government stroke survivors
formation talks rumble on 70 Funded PhD opportunities available
in UCC’s School of Pharmacy
40
62 Pharmacy in the Community
71 Product Information
64 International News
28
IPUREVIEW JUNE 2020
44 5
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A NOTE FROM THE EDITOR Jack Shanahan MPSI
Embracing Healthmail
– warts and all
It feels like we all have lived a few lifetimes since the
crisis arrived. As I write, all the omens are positive.
The hard work has paid off handsomely.
H
ospitals are Prescription Writing’. Yet errors. An ideal system store them for their natural
getting back to some problems persist. We would take the prescription lives. The current mechanism,
some version see prescriptions signed by message, parse it, extract all where a prescription
of normality, secretaries. We see parts of the the relevant information and is emailed directly to a
COVID wards prescription missing. One GP present it for pharmacist to nominated pharmacy, is
are closing and some parts practice insisted on putting review. This requires that all far from ideal. It is a closed
of the country haven’t seen the practice GMS number the information is structured system that provides no added
a case in weeks. We have on private prescriptions and and coded in a way that the benefit to patient safety. For
all become historians of the Medical Council number computer understands. It instance, it is not possible
Spanish flu, remembering that on GMS forms. A helpful is not rocket science and to generate a summary
it was the second wave that phone call from me only has been replicated on medication record for a
caused the mayhem. So, with compounded the issue with an systems around the world, hospital. There is no ability
that salutary lesson looking ‘I am right, and you are wrong’ but it does require some to cancel, amend, recall or
over our collective shoulders, attitude. I even got an email, important building blocks. otherwise edit a prescription
where do we go in pharmacy? stating simply ‘Medication as One is a unique global patient where the pharmacist may
It is useful to bear in mind, before’. Deep breath and offer identifier. It exists, but it is have discussed and resolved
as Albert Camus stated in La thanks to Mr Camus for giving treated like the fifth secret of a therapeutic issue. Equally,
Peste, “there are more things me perspective. Fatima. The Individual Health there is no mechanism for
to admire in men than to Notwithstanding the Identifier has been in the a patient to repeat their
despise”. pedantic, serious structural very safe custody of the PCRS, prescription in a pharmacy
In our case, the top ticket issues persist with the current where they have protected other than the one it was
item has been Healthmail. incarnation of Healthmail. it with efficiency and zeal. sent to originally. Electronic
It literally is a warts and all The first is that it is still a While most normal people prescriptions have a way to
system. I love it and hate it paper-based system. We would think that a PPSN go before they are an effective
in equal measure. While it need to print the message number, which is assigned tool for patient safety, as well
has succeeded in its primary that arrives in the pharmacy. almost at birth, would suffice, as improving efficiency. We
objective, infection control The vast bulk of printing privacy concerns have long have taken a first step. It is
by reducing direct contact, it has transferred from the since knocked this idea on vital that this interim solution
checks very few boxes of an surgery to the pharmacy. the head. Nevertheless, it does not become permanent.
ideal electronic prescription The PCRS insists that we still exists and there really is no
transmission (ETP) system. have a ‘bundle’ sitting in the reason, other than inertia, as
Interim solutions have a storeroom awaiting a courier to why it couldn’t be adopted
terrible habit of becoming at some stage in the future. relatively rapidly. The other
permanent. It is worth The administrative burden building blocks include a
bearing in mind the UCF has transferred lock, stock and National Product File, which
printer is almost thirty years barrel, to the pharmacy. Aside exists in everything but name
old; initially it was to be from the cost of printing, and is distributed by the
phased out before the turn of which is quite high, there is IPU. The rest are prescriber
the last century. the considerable expense of and location information
Perhaps the most obvious both process and time. This which are already in place,
issue is that many of the reflects a key missing part kind of. The litany of missed
prescriptions are arriving of the system, as it currently opportunities for rolling out
with various administrative exists. It is missing an electronic prescriptions are
problems. The IPU produced essential property of machine truly uniquely Irish.
a fantastic checklist of readability. It is a ‘dumb’ Once we get over the
Healthmail prescription message, that the pharmacist technical requirement
requirements. It really was must transcribe onto their for a machine-readable
the equivalent of a one system. This obviously keeps standardised prescription, the
page ‘The Idiots Guide To the door open to transcription next issue is somewhere to
If you have any comments, queries or issues to raise, send
your “Letters to the Editor” by email to ipureview@ipu.ie.
IPUREVIEW JUNE 2020 7
IPU Academy
COVID-19
Webinar Series
Log into IPU Academy to participate in the COVID-19
webinar series. All webinars will start at 7.30pm.
If you miss the live webinar broadcast, please note that
a recording of each webinar will be available on www.
ipuacademy.ie, such as our webinar from 25 May on
Dates forry
Medication Safety during COVID-19.
Date Topic Speaker
your Dia Monday
25 May
Medication Safety
during COVID-19
Breda Heneghan
Monday How to fight an Professor
JUNE 2020 8 June Infodemic Siobhan McClean
How to fight an
8 June inar, Tuesday Five Steps to Rachel Dungan
Infodemic web
ca de my.ie 16 June Successful Pharmacist
www.ipua Consultations during
Donor Day,
ne World Blood COVID-19 (and beyond)
14 Ju od.ie
www.giveblo
Week, More information is available on www.ipuacademy.ie.
Men’s Health
15 – 21 June rg
www.mhfi.o
Five STEPS to
16 June armacist
Successful Ph
during
Consultations
w eb inar,
COVID-19
ua ca de my.ie
www.ip
health events
ans for these
Campaign pl -19.
due to COVID
may change
New designs to
IPU Website
Taking on feedback from members and IPU staff, we
have made some design changes to the website to give
it a fresh new look. Go to www.ipu.ie and you will see
we have a new look to our public homepage. We have
also made design changes to the members’ homepage,
which you will see when you log in. Turn to pages 53-55
for an overview of these changes.
8 IPUREVIEW JUNE 2020
IPU NEWS
Pharmacy in the Media
We issued a press release calling for the flu vaccine to be free to everyone for the 2020/21 season
and ease the pressure on the health system. There was media coverage in the Irish Examiner and
on IrishHealth.com, TheJournal.ie, Midlands 103FM, FM104 and 4FM. There was also coverage in
The Times and on Today FM’s The Last Word.
On foot of the Taoiseach’s announcement, we issued a subsequent press release welcoming
the Government’s commitment to combat flu in Ireland but also saying that more ambition is
needed.
The Taoiseach, the Minister for Health and the Chief Medical Officer have all acknowledged
that having to deal with both coronavirus and a flu outbreak at the same time would be too
much for the health system. The Minister for Health announced some extensions to the current
seasonal influenza vaccination programme: an extra €50 million funding; extend flu vaccination
without charge to all children from ages 2 to 17 years inclusive; and free flu vaccination to
everybody in the at-risk categories from ages 6 months to 69 years. We welcome these proposals
but have advocated that Government needs to be more ambitious and allow free flu vaccination
to all people 6 months of age and older.
There was a great article on TheJournal.ie about how pharmacy is playing a key role in the care
of the community during the COVID-19 crisis.
The recent IPU COVID-19 Pharmacy Business survey, which showed that pharmacies are
struggling to cope with soaring costs while providing frontline care during this crisis, garnered a
lot of media attention. It was featured on RTÉ Radio 1’s Morning Ireland and there was national
coverage in The Irish Times, Irish Independent, Irish Examiner, The Times, Irish Daily Mail and on RTÉ.
ie. There was also coverage on Newstalk and multiple regional radio stations, as well as online
media including TheJournal.ie and BreakingNews.ie. IPU Executive Committee member Caitriona
O’Riordan was also quoted on BreakingNews.ie. Former TD Kate O’Connell MPSI also discussed
the survey results on RTÉ Radio 1’s Today with Sean O’Rourke.
HMR analysis identified that there has been a significant drop in the number of prescriptions
being dispensed for oral contraception since the start of the COVID-19 crisis. Following this, we
issued a joint press release with the HSE’s Sexual Health and Crisis Pregnancy Programme. IPU
Executive Committee member Caitriona O’Riordan was mentioned on Newtalk’s Down to Business
with Bobby Kerr and there was coverage in national newspapers such as the Irish Examiner, Irish
Daily Mirror and Irish Daily Mail.
Former IPU President and current Vice Chair of the Pharmacy Contractors’ Committee, Kathy
Maher, featured on the ‘Ask the Expert’ slot on the The Pat Kenny Show on Newstalk. We would
like to commend Kathy for the professionalism and expertise she displayed when handling
healthcare queries from members of the public. There has been very positive feedback on
her performance.
IPU Executive Committee member John O’Connell was featured on KCLR FM to discuss hay
fever and to distinguish its symptoms from COVID-19.
IPU member Tomás Conefrey was interviewed on RTÉ One’s Six One News in relation to how
small businesses are struggling during the COVID-19 crisis.
Kate O’Connell was interviewed on Newstalk’s The Pat Kenny Show to discuss businesses getting
back to ‘normal’ when restrictions are lifted.
We issued a press release to welcome the announcement by the Minister for Health to make
the flu vaccine available to all children aged 2-12 and all at-risk groups. There was national
coverage in the Irish Examiner, Irish Sun and Irish Daily Mail. There was also coverage on FM104
and Q102, as well as online media on IrishHealth.com.
Kathy Maher was also interviewed on LMFM to discuss hay fever and staying safe in the sun.
IPUREVIEW JUNE 2020 9
IPU NEWS
Pharmacists welcome decision
to make flu vaccination available
without charge to children aged
2-12 and all at-risk groups
The IPU welcomed the announcement by Minister for Health permitted to administer the vaccine a decade ago. Given that
Simon Harris TD to make the flu vaccine available to all the convenience and availability of the vaccine has led to
children aged 2-12 and all at risk groups. The news follows greater uptake, the IPU believes that pharmacists should be
a recommendation by the IPU earlier this month for the flu allowed to administer the vaccine to people in nursing homes
vaccine to be made freely available to everyone who wants it and workplaces.
during the coming flu season. “Every year there is a spike in hospital admissions due to
Commenting on the announcement, IPU Secretary General people suffering from flu and related complications. We can
Darragh O’ Loughlin said, “While we would have liked to see the and we should do much more to prevent this by making it
scheme extended further, making the flu vaccination available easier for the vaccine to be offered to wider groups of people
to children aged 2-12 and to all at risk groups without charge in a community setting. Increasing the locations where this
is definitely a step in the right direction. It will help increase is permitted to residential services and to workplaces would
our capacity to combat seasonal flu and prevent it from significantly increase uptake and help build a herd immunity.
overwhelming the health system during the winter.” We can’t yet stop the coronavirus, but we can stop the flu,”
Last year, over 1.1 million flu vaccines were delivered in concluded Mr O’ Loughlin.
Ireland, an increase of over 60% since pharmacies were first
Government’s commitment to
combat flu is welcome but requires
more ambition say pharmacists
Media reports last month that Government will implement a more robust fight against
seasonal flu in the 2020/21 flu season were welcomed by the IPU. However, the IPU
says more ambition is needed to prevent our hospitals being overrun with flu
this winter.
The IPU called for planning on flu to start now – it may not hit us for
another few months, but to minimise the impact preparation needs to
start immediately. We understand that Health Minister Simon Harris
has sought an extension to the flu vaccine programme, but Eoghan
Hanly, Vice-President of the Irish Pharmacy Union, called for more
to be done: “Providing the vaccine to at-risk groups is an important
first step, but why stop there? Ireland’s flu vaccine strategy must be
more ambitious. Official advice should recommend that all people
over the age of six months get an annual flu vaccine, and it should
be free – this is the best way to maximise uptake.
“The plans should also focus on access. Allowing pharmacists
to vaccinate has shown that increased access and convenience
increases uptake. Pharmacists have been safely providing the flu
vaccine for a decade but can only do so within their pharmacy.
Increasing the locations where this is permitted to residential services
and to workplaces would significantly increase uptake and help build a
herd immunity. We can’t yet stop the coronavirus, but we can stop the flu.”
10 IPUREVIEW JUNE 2020IPU NEWS
10% fall off in prescriptions for
‘the pill’ during COVID-19 crisis
There has been a significant drop in the number wary of moving around and visiting a pharmacy,
of prescriptions being dispensed for oral while others may have already finished
contraception (the pill) since the start their six-month prescription and don’t
of the COVID-19 crisis. Information realise that pharmacists can currently
released by the IPU shows that extend this. We want to reassure
there has been a 10% decrease everyone that pharmacies are open
in prescriptions for the pill and operating as normal; they
dispensed compared to the have also put in place stringent
same period last year. physical distancing measures
HMR Ireland worked with to ensure there is no risk to
73% of Irish pharmacies in patients.”
collecting this information, Maeve O’Brien, Interim
which showed a significant Programme Lead of the HSE’s
drop off in both the oral Sexual Health and Crisis
contraception that is taken by Pregnancy Programme, said,
women on an ongoing basis “We would encourage women
(the pill), and the Emergency who have a prescription for
Hormonal Contraception, also the contraceptive pill and who
known as the ‘morning after pill’. are sexually active to contact
Community pharmacist and their pharmacist. If you need
IPU Executive Committee member to renew your prescription, your
Caitriona O’Riordan said there are two pharmacist may be able to provide
important messages for Irish women: you with additional supplies of your
contraception, if it is safe and appropriate
n Under new regulations brought in
to do so. Lower numbers of women accessing
because of the ongoing health crisis,
their usual contraception methods may increase
pharmacists can now increase the maximum period
the risk of unplanned pregnancies occurring. We would also
of validity of a prescription from 6 months to 9 months,
advise women who have been sexually active without using
so you don’t have to get a new prescription for your oral
contraception, and not planning a pregnancy, to contact their
contraception; and
pharmacist to arrange an emergency hormonal contraception
n You can get your Emergency Hormonal Contraception consultation. Information on contraception is available on
from the pharmacy without a prescription. We encourage www.sexualwellbeing.ie.
women to phone the pharmacy first so the EHC Ms O’Riordan concluded, “Pharmacists have previously
consultation can be carried out over the phone in advance called for the pill to be made available in pharmacies without
of coming to the pharmacy to collect the medicine. prescription. The drop in use that we are seeing at the moment
further emphasises the importance of improving access to
Ms O’Riordan said, “There could be a number of reasons why contraception. This is about giving choice to women, and
fewer women are currently accessing the pill. Some may be pharmacists are happy to offer that choice currently; we
hope it can be enhanced in future.”
New Contract
Administrator appointed
The IPU is pleased to announce the appointment of Linda Ahern as Contract Administrator.
Linda comes from a community pharmacy background and has worked as a pharmacy
technician for almost a decade. Throughout those years, Linda developed many skills and
has a wealth of experience with daily dispensary tasks, such as with claims, payments and
communicating with the PCRS. She hopes to bring these skills to the IPU and to support
their members in the best way possible. She can be contacted at linda.ahern@ipu.ie.
IPUREVIEW JUNE 2020 11IPU NEWS Pharmacies struggling to cope with soaring costs while providing frontline care during COVID-19 crisis The IPU welcomed the announcement by Minister for Health purchase further supplies, while many more have had to defer Simon Harris TD to make the flu vaccine available to all payments to creditors, restructure loans, or expand overdraft children aged 2-12 and all at risk groups. The news follows facilities. Worryingly, 30% of respondents indicated that they a recommendation by the IPU earlier this month for the flu had difficulty in ordering key medicines for patients due to vaccine to be made freely available to everyone who wants it reaching their credit limit. during the coming flu season. Speaking about the stark figures, IPU Secretary General Ireland’s 1,900 community pharmacies are struggling to Darragh O’Loughlin said, “Pharmacists are at the frontline of cope with soaring costs and falling revenues. New research our healthcare system. As the various COVID-19 restrictions reveals the extent of the severe cost increases being borne have been implemented, pharmacies have remained open by pharmacies providing front line care during the crisis. The to provide their communities with an uninterrupted supply IPU COVID-19 Business Survey revealed that the vast majority of medicines, service and advice, but this has come at an of pharmacies have been hit by significant extra costs to unsustainable cost to many. enable them to remain open and to provide safe care. The Darragh O’Loughlin said that while pharmacies continue to costs associated with physical distancing are among the most operate in extremely difficult circumstances, they will make significant, with over two thirds (68%) installing new counter every effort to remain open. Minister for Health Simon Harris screens to protect patients and staff, and significant costs has said that he is looking at ways to support pharmacies in highlighted for the implementation of other measures including their work. However, no support has yet been provided, leading signage and security pods. When Personal Protection Equipment O’Loughlin to warn that, if the additional costs continue at the (PPE) is included the average cost per pharmacy is €2,700 with levels currently experienced and urgent Government support some pharmacies spending up to €10,000. is not forthcoming, some pharmacies will have to dramatically Day-to-day operating costs have also dramatically increased curtail their opening hours or close completely. for pharmacies. The survey reveals staff costs, as well as additional security, delivery and sanitisation costs, are increasing by an average of €5,000 per month, equating to almost €10 million per month on average across the sector. The increase in costs comes at a time when retail sales in pharmacies have dropped dramatically due to the restrictions, with falls on average of 36% across the sector, and three- quarters of pharmacies anticipate having to make additional investments to reconfigure their premises or otherwise prepare for when the current restrictions on movement are lifted. This is putting considerable pressure on pharmacies, the majority of which are small family run businesses. The survey showed that one in five pharmacies have laid off staff, while another two in five (38%) will be forced to so in the next two to three months. A quarter of pharmacies have reached their credit limit with medicine wholesalers, impacting their ability to 12 IPUREVIEW JUNE 2020
BUSINESS Jim Curran, Director of Communications and Strategy, IPU IPU COVID-19 Pharmacy Business Survey In this article, IPU Director of Communications and Strategy Jim Curran provides an overview of the results of the recent IPU COVID-19 Pharmacy Business survey, which reveals the extent of the severe cost increases being borne by pharmacies providing frontline care during the crisis, and the steps they have taken to remain open. IPUREVIEW JUNE 2020 13
T
he IPU COVID-19
Pharmacy Business
If you implemented physical distancing, what type of
Survey was
undertaken in the
physical distancing equipment did you choose?
week beginning
20 April 2020 to establish 100%
the impact of COVID-19 on
pharmacy businesses and 80%
82%
to get an estimate of the
60% 68% 74%
costs already incurred, and
the potential future costs 40%
56%
when the public emergency
measures are eased. There 20% 28% 11%
were 190 responses to the
survey, representing 430 0%
pharmacies.
Physical distancing/PPE
The IPU COVID-19 Business
Survey revealed that most
pharmacies had been hit
by significant extra costs to
enable them to remain open
and to provide safe care. The
What personal protection equipment are you currently
costs associated with physical using within the pharmacy environment?
distancing and PPE are among
the most significant, with over
100%
two thirds (68%) installing
new counter screens to 80%
96%
protect patients and staff, and
significant costs highlighted 71% 77%
60%
for the implementation of
other measures, including 40%
signage introduced by 82% of
pharmacies, floor markings 20%
21% 9% 11%
(74%) and security pods (28%).
Over half of pharmacies (56%) 0%
had introduced a barrier
system within the pharmacy
premises. The average cost of
implementing these measures
was €1,500 per pharmacy.
At the time of the survey,
nearly all respondents (95%)
reported using hand sanitisers
within the pharmacy, with
”The costs associated with
over two-thirds using gloves
(77%) and face masks
physical distancing and PPE are
(71%). The average cost of
implementing these measures
per pharmacy was approx.
among the most significant,
€1,300.
When the cost of physical
with over two thirds (68%)
distancing measures are
included, the average cost per
pharmacy is €2,800 with some
installing new counter screens
pharmacies reporting having
spent up to €10,000.
to protect patients and staff,
and significant costs highlighted
for the implementation of
other measures.”
14 IPUREVIEW JUNE 2020Pharmacy staff What has been the impact of the current public
Day-to-day operating costs
have also dramatically health emergency on your pharmacy staff costs
increased for pharmacies.
There was a significant cost (excluding delivery staff costs)?
increase in pharmacy staff
costs primarily due to the 60%
introduction of split shifts,
longer working hours and
50%
56%
the necessity for increased 40%
cover in the dispensary. The
additional costs are averaging 30%
a not insignificant €2,300 per 20%
31%
pharmacy per month and are
10%
much higher in some cases.
Due to business pressures
13%
0%
one in five (19%) pharmacies Increased Decreased Remained the same
reported having to let staff go
with a further 38% confirming
that they may have no option
but to do so over the following
three months. The indications
If the current public health emergency measures
are that it is mainly front of
pharmacy staff who have been
stay in place, how long do you think you can
temporarily laid-off. support your current employee numbers?
Additional 35%
day-to-day costs 30% 33%
25%
74% of pharmacies experienced 26%
15%
additional cleaning costs and
10%
19%
15% saw an increase in security
5% 12% 3%
costs. 94% of pharmacies 8%
reported that they were 0%
offering a delivery service. Of
these, 59% have their own staff
delivering medicines, 12% are
employing additional staff
and 29% are using voluntary
organisations/volunteers. These
additional costs are costing
pharmacies on average €2,800
per month. Taken together
with the increase in staff
costs, the survey reveals that
Has your front of shop retail pharamacy business been
pharmacies are shouldering
additional monthly costs of
impacted by the current public health emergency?
€5,000, equating to almost €10
million per month across the 100%
sector. 75% of respondents 90%
envisage an increase in costs
in preparing their pharmacy 80% 86%
for when the public health 70%
emergency is over, with an
60%
average cost of €4,100 per
pharmacy anticipated. 50%
40%
Turnover/sales 30%
The increase in costs comes 20%
at a time when retail sales 10%
6%
in pharmacies have dropped 8%
dramatically due to the 0%
movement restrictions
imposed by the COVID-19
response. Almost 9 out of 10
pharmacies (86%) reported
that their front of shop
IPUREVIEW JUNE 2020 15retail business has reduced
because of the restrictions
Have you had to undertake any of the following measures
introduced during the current
public health emergency, with
to ensure adequate cash flow within your business?
respondents confirming
an average reduction 50%
of 36% in sales.
On the dispensary side of 40% 46%
the business, not surprisingly, 42%
over half of respondents (56%) 30%
reported that their dispensary
pharmacy business increased 20% 26%
significantly at the start of
the pandemic, but a decrease
19%
10%
was noticed subsequently
reflecting a dramatic fall-
0%
5%
off in GP visits. One in ten
(12%) reported an increase in
dispensary sales, with 14%
reporting a decrease. It should
creditors
be noted that the survey was
undertaken in the last week
Please indicate how your dispensary pharmacy business
of April, and consequently
there is anecdotal evidence
has been impacted by the current public health emergency
to suggest that, at the time
of writing, the dispensary
business is more reflective of
normal trade (if we can use
100%
such a term in the current
circumstances), in comparison
to the first few weeks of the 80%
public health emergency.
60%
Cashflow/credit limits 56%
A quarter of pharmacies 40%
(26%) reported having had
to restructure their loans to 20%
ensure adequate cashflow
within their business, with a 12% 14% 17%
further 19% increasing their 0%
overdraft facility. 42% have Increased Decreased Stayed Increased
had to defer payment to the same significantly at
their creditors. the start but a
Similarly, a quarter of decrease noticed
pharmacies have reached their since stricter
credit limit with medicine quarantine measures
in place
wholesalers, impacting their
ability to purchase further
supplies. Worryingly, 30% of form of social distancing With costs increasing and unsustainable cost to many.
respondents indicated that measures and introduced income reducing it is no The easing of lockdown
they had difficulty in ordering PPE equipment for the safety surprise that a substantial restrictions should continue
key medicines for patients due of staff and members of the number of pharmacies have over the next number of
to reaching their credit limit. public, at a considerable had to resort to alternative weeks. While this may require
cost. When these are added funding to maintain cashflow, some further modifications
to cost increases in other including increased lending in the premises, it is also
Conclusion areas including staff, security, and overdraft facilities, with an opportunity to look at
The results of the survey are delivery and cleaning costs, many reaching credit limits ways of driving footfall back
a snapshot of the situation the sector is looking at not with their wholesalers. into the pharmacy. I would
in pharmacies at the end of insignificant additional cost Pharmacists are at the recommend, therefore,
April. In the interim period, of over €5,000 per month, frontline of our healthcare that you read the article by
evidence suggests that with many envisaging system. As the various IPU Business Development
dispensary activity has, to further costs in preparing the COVID-19 restrictions have Manager Darren Kelly on
an extent, normalised, but pharmacy for the easing of been implemented, pharmacies pages 17-20 providing advice
that the front-of-pharmacy lockdown restrictions. Also, have remained open to on how pharmacies should
business continues to take a many pharmacies have fixed provide their communities prepare for the staggered
hammering. overhead costs including rents with an uninterrupted supply lifting of the lockdown
Nearly all pharmacies and rates, which have not of medicines, service, and restrictions, to re-establish
have introduced some reduced. advice, but this has come at an the retail business.
16 IPUREVIEW JUNE 2020BUSINESS Darren Kelly, Business Development Manager, IPU Retailing in pharmacy as restrictions are eased In our recent COVID-19 Business Survey, 86% of members reported that their retail sales have decreased, with an average 36% loss of retail to each pharmacy. In the May issue of the IPU Review, we looked at Preparing for the new norm and touched on some retail elements to prepare for the easing of restrictions and to bring increased footfall to your pharmacy. In this follow-on article, Darren Kelly, IPU Business Development Manager, will give additional advice to members on how to prepare your business for the staggered lifting of the lockdown restrictions and assist you in re-establishing your retail business. IPUREVIEW JUNE 2020 17
If you are using • Try to change the
security pods at the offers regularly to give
a different visual to
pharmacy entrance the customers
As the staggered release of Soap............................ 1
restrictions happen, you Moisturiser.................. 2
may look to keep using Vitamins..................... 3
security pods at your front Toiletries..................... 4
door. This will minimise the Baby Wipes................. 5
impact that your retail space
would normally have, but
A
By having the products
there are ways to highlight presented in view of the
s we continue look at. Look at both options some product ranges to
to work from a retailer’s point of view customer and by using the
your customers as they wait number system, the waiting
through this to assist you in developing outside the pharmacy.
extraordinary your own pharmacy’s plan to period will not increase.
time of crisis and enable you to restart the retail Visual Display
the ever-present threat that element of your business. Product mix
social distancing will become A risk assessment of the n Maximise the exposure to The product mix in the
the norm for the foreseeable retail space will need to be the customer by displaying example above could be
future, what can pharmacy completed and this will look products in your window vitamins and supplements, or
do to prepare for an easing, at how you can maintain the that may be in short supply a mix with the product ranges
albeit staggered, of lockdown health and safety of your – soap, moisturiser, wipes, listed above. You choose what
restrictions in our society? staff in any dealings with foot care, vitamins; you feel you want to offer to
customers going • This may mean your customer. During this
forward if you wish moving gondolas COVID-19 emergency, people
Minimise impact to reinvigorate your around, but will help have been trying to maintain
retail business. To to create additional their health with general
Minimise the impact keep-fit, walking, running
assist you in this, use space in the pharmacy
of the emergency on and cycling. As part of your
the floor plan that you for you and your staff
your retail business offering for maintaining the
submitted to the PSI – to help you maintain
going forward by health of your customers
mark it out and work physical distancing
developing a retail you can also assist with their
continuity plan. As out how many people
you would allow into n Put a large number (A4 size) wellbeing. You offer a range
part of any plan, of vitamins and supplements
your pharmacy at on each shelf offer so the
you need to look at that people depend on in the
a time, taking into customer can just say “can
the retail business everyday life to maintain
account the maximum I have No. 1 please”;
realistically; decisions their own levels of health
on opening up the staff you would have • POS is vital to highlight
on the shop floor at and we should ask ourselves,
pharmacy floor the offer to the
any one time. Also, where are they getting these
to customers or customer
allow for fixtures and products during this crisis?
maintaining social • Clear signage outlining Where are they getting
distancing with fittings, and mark the
the price of product their toiletries and skincare
barriers or pods at flow of customers,
so that you make it as products? You may feel that
your front door should sanitation points, bins,
easy as possible for the your energies are focused
be the first area to etc.
customer on different services but
• Try to have banded continuing to be the primary
or ‘2 for the price of’ point for general health and
offers, and round the wellbeing is vital to all your
price to a realistic offer community.
18 IPUREVIEW JUNE 2020”You can adapt/change to suit your
pharmacy, but it is important to ensure
you are engaging with your customers,
so as to maintain the ultimate customer
experience for them from your pharmacy.”
Online retailing If you don’t feel confident engaging with your customers, products listed on the IPU
You may feel that you are with digital marketing, as so as to maintain the ultimate website that can assist you
too small an operation to part of our alliance with customer experience for them with this, see www.ipu.ie >
offer online sales, but do Retail Ireland Skillnets, IPU from your pharmacy. Professional > Coronavirus.
you offer click and collect members have access to To maximise the impact,
for prescriptions in your a free online retail Digital you will need to look at
dispensary, and if so, can you Marketing training (www. If you are using physical social distancing floor and
extend it to the retail space? retailirelandskillnet.com distancing of customers hanging signage in the
Looking at online retailing is > Training Programmes > into the pharmacy pharmacy. Consumers are
always an option and there Retail Digital Marketing). You now used to queuing and
will be some costs involved can register for the training Physical distancing maintaining social distance
in setting up, but you should by emailing your full name As restrictions are slowly but once restrictions are being
look at what the return on and email address to info@ released you will need to gradually released this may
the investment will be. There retailirelandskillnet.com. ensure you maintain social revert to previous times.
are several providers that distancing allowing only 1-2
can assist in this endeavour Staff engagement with people in at one time. It may Visual displays
if you wish to go down this customers be that you need to look at As you might only have a
route. The IPU has just agreed If you are continuing to ask a one-way system in the couple of customers at a
a partner deal with Refill customers to call before they pharmacy. There are number time in the pharmacy you
Assistant to offer members collect their prescriptions, of providers who can assist must merchandise offers in
website development with build into the call a couple with crowd control barriers highly visible locations. This
online retailing capabilities of open questions around such as retractable belt is historically on gondola
that would assist in your whether they need any systems, but this can also be ends but if you choose to
online retailing journey. additional products, such as achieved by moving gondolas move gondolas to assist
Details can be found at www. vitamins, toiletries, skincare, to create a wall to direct your in floor layout then it may
ipu.ie > Business > Suppliers. or foot care products. This customers around the way be at the bays nearest the
should be communicated to that you want them to go counter or a specific hot spot
Digital marketing all staff and they should all in your pharmacy. We have in the pharmacy. Displays
Are you updating your be using these questions in several providers of these
Facebook, Instagram and conversations with patients,
Twitter pages? Assign a for example as follows:
member of staff to ensure “Hi Mrs. Murphy, how are
that there are regular updates you? Yes, we can have your
regarding the business. Ensure prescription ready for you. While
your customers know if we are preparing your script are
you are closing for lunch or there any other items we can
opening early, but also use get for you today? Would you
it to highlight that you offer need any toiletries, skincare, or
retail products at great value vitamins as we can have them
prices and all the customer ready for collection when you call
has to do is call the pharmacy down to the pharmacy?”
and they can order and pay You can adapt/change to
over the phone and collect suit your pharmacy, but it is
from the pharmacy. important to ensure you are
IPUREVIEW JUNE 2020 19Redmond Square
Dispensary
Exit
Natur house Bags & Scarves
Pain Relief NRT Allergy Gastro Cough Misc Bags &
Mouth Foot & Cold OTC Scarves
Photo
\
Processing
Jewellery Fragrance
Barrier First Aid Foot Care Ear & Eye
Misc
Fragrance
Supps Dietry Vitamins Benefit
Sun & Stila
Travel Vitamins
DPC
Sun plastics
Self select Fragrance
Estee
Fuji DPC Lauder
Sally
Cameras Essence Catrice Hansen #Trending L'Oreal Max factor
Lancome Clinique Clarins
\
Note Revolution Rimmel Maybelline Bourjois Sleek
should be planned and soap, toiletries, or feminine as maintaining your regular with all your staff on what
merchandised correctly. Do hygiene products while they customer base. your plans are for the business
not try to overload a display are getting medication, and You should continue to as the restrictions are eased.
as customers will only have reduce what they need to get use social media to update Get staff involved in the plan,
a snapshot of the display as in the grocery stores. your customers that you are take suggestions, and try to
they move around the one- open, but are still maintaining implement what is possible at
way system. Online retailing physical distancing in the that time. If you are prepared
and social media store. Continue to highlight and have a plan, you can
Point of sale Even if you slowly allow offers and services regularly. provide a customer shopping
Highlight offers with signage customers back into your experience in your pharmacy,
be they printed in store or pharmacy the idea of online which in turn will lead to
from a professional printer but retailing should still be an Summary increased sales.
try to introduce colour into option that you look at. As As I said in the May issue of Keep safe and stay well, and
any signage as it will catch the outlined earlier in the article the IPU Review in the article if you need any assistance or
customer’s attention. We offer there will be some outlay, Preparing for the new norm, the further clarification on any
great value in our pharmacies, but the return on investment situation is so fluid that you of the areas raised in this
but we need to tell our can be that you develop a must look to revisit your plan article ,please don’t hesitate
customers, and point of sale is new customer base if you regularly. As part of any plan to contact me directly at
the safest and easiest option. begin to retail online, as well you prepare, communicate darren.kelly@ipu.ie.
Whether printed in store,
or use a local printer try to
develop a consistent message/
image that your customers
see. Put your pharmacy name
and colours on the point
of sale and use the same
font. If printing in-store,
laminate signage to ensure
a professional appearance is
maintained.
Customer experience
If you introduce a one-way
system into the pharmacy,
then the staff engagement
with the customer will
become really important. You
may have counter screens
but the interaction between
your staff and customers
will need to return around
the pharmacy. Using soft
selling skills and ask “is there
anything else we can help you
with? Customers may be very
happy if they can get some
20 IPUREVIEW JUNE 2020PROFESSIONAL Dr Máirín Ryan MPSI, Deputy Chief Executive and Director of
Health Technology Assessment, Health Information and Quality Authority
HIQA’s
evidence
summaries
to support
national
response to
COVID-19
W
In mid-May, the Health Information e have been
developing
and Quality Authority (HIQA) summaries
of the best
published four new evidence available
scientific evidence on COVID-19
summaries on COVID-19. In this for several months. The
summaries aim to inform
article, Dr Máirín Ryan, who is Chair of effective public health
the National Public Health Emergency decision-making in response
to the outbreak. The evidence
Team subgroup on Guidance and summaries answer research
questions posed by the National
Evidence Synthesis, provides an Public Health Emergency Team’s
clinical Expert Advisory Group.
overview of the summaries. So far, 15 evidence reviews
are complete or ongoing, from
asymptomatic transmission to
resuming routine acute care in
the context of COVID-19.
IPUREVIEW JUNE 2020 21Our summaries are Of the seven, five schools. However, no staff Possibility of placental
developed though a thorough investigated intra-familial and member contracted COVID-19 transfer of antibodies
search of bibliographic close contact transmission, from any of the initial school
databases, with identified one examined transmission cases and only one child from We examined if infected
studies screened to match of SARS-CoV-2 in schools a primary school and one mothers transfer antibodies
relevant clinical questions, the and one was a mathematical child from a high school may via the placenta thereby
data extracted and included modelling study estimating have contracted COVID-19 conferring immunity from
studies appraised. This process age-specific transmissibility of from the initial cases at their coronavirus spectrum
is robust to ensure that public SARS-CoV-2. schools. infections to their newborn
health decisions are informed Three of the five studies The mathematical children.
by the best available evidence on intra-familial and close modelling study, estimating We identified four relevant
and information from across contact transmission reported age-specific transmissibility studies. Two studies included
the world. child-to-adult or child-to- of COVID-19, concluded pregnant women with
Part of our work was the family member transmission, that COVID-19 had high laboratory-confirmed SARS-
creation of a database of although at very low rates. transmissibility among adults CoV-2, and one study each with
public health guidance which The study that reported on aged 25 years or older, but laboratory-confirmed MERS-
we update daily with new transmission of SARS-CoV-2 in low transmissibility among CoV and SARS-CoV-1. These
guidance from countries schools came from Australia children or people younger studies included 13 unique
around the world. Our and examined the potential than 14 years. mother and newborn pairs,
database is publicly available spread of SARS-CoV-2 from Overall, the limited evidence and all included newborn
at www.hiqa.ie and used by 18 confirmed cases (nine base to date does not suggest infants who tested negative
stakeholders in the Health students and nine staff) to 863 that children are transmitting for the presence of laboratory-
Protection Surveillance close contacts (735 students COVID-19 at a higher rate confirmed coronavirus
Centre, the National Public and 128 staff) in 15 different compared with other age spectrum infections based
Health Emergency Team, the schools. All individuals had groups, unlike for some other on reverse-transcription
Department of Health, and the an opportunity to transmit respiratory viruses. polymerase chain reaction (RT-
Health Service Executive. SARS-CoV-2 to others in their PCR) tests of nasopharyngeal
At the time of writing, or throat swabs.
our most recent summaries 12 out of 13 newborns
investigated the international had detectable elevated
” Overall, the limited
evidence on immunity and the coronavirus-specific antibody
spread of the virus by children levels reported at birth
or in the following days.
evidence base
and these will be examined
further below. However, the possibility of
SARS-CoV-2 is a recent virus cross-reactivity with other
and therefore, the evidence
is limited, specifically with
to date does not respiratory pathogens cannot
be ruled out, neither can the
regard to the quality of the
studies, their applicability to
suggest that children possibility of false positives
from antibody tests.
Ireland, the lack of peer review
and the scale of evidence are transmitting The passive transfer of
antibodies to the newborn
available to date. As the data
emerges, we will be updating COVID-19 at a higher cannot be confirmed as not
all studies included antibody
testing of amniotic fluid or
rate compared with
our summaries as required.
placenta. Alternatively, as two
studies reported IgM in the
Potential for children
to transmit
other age groups, newborns, it may be that the
foetus contracted coronavirus
We examined the potential unlike for some in utero, developing its own
immune response and clearing
other respiratory
for children to contribute to the virus prior to birth. It is
transmission of SARS-CoV-2 unclear if the antibody levels
and we identified seven
relevant studies. viruses.” reported in these newborns
were sufficiently high to
achieve immunity.
Further research is required.
22 IPUREVIEW JUNE 2020Infectiousness of phase, when there may be long-term immune response antibodies detected up to two
the re-infected intermittent shedding of to other coronaviruses, SARS- months from symptom onset.
non-viable virus particles CoV-1 and MERS CoV was With long-term data on
We examined the evidence of rather than reinfection with examined also. the duration of the immune
infectiousness of individuals a second virus. None of these Sixty-seven studies were response to SARS-CoV-2
who are re-infected with individuals are reported to identified that investigated not yet available, evidence
SARS-CoV-2. However, no have transmitted SARS-CoV-2 the immune response to from other studies suggests
studies were found which to their close contacts, though coronaviruses. that SARS-CoV-1-specific
directly addressed this. only one of the four studies Five separate research IgG antibody levels are
Instead, we identified explicitly conducted contact questions were addressed sustained for one-to-two years
four case series studies follow-up or tracing. focusing on the rate and post-infection and decline
that examined onward Although, as patients were timing of antibody detection thereafter. It is currently
transmission in individuals undergoing quarantine or after infection, the duration unknown how applicable
who retested positive for self-isolation during the post- of the immune response, data from SARS-CoV-1is
SARS-CoV-2 despite having discharge period in all four the reinfection rate and the to SARS-CoV-2.
two previous negative reverse studies, it is not clear whether association between these
transcriptase polymerase their contacts would have responses and the severity
chain reaction (RT-PCR) tests. been in close enough contact of initial disease. Work ongoing
Due to the relatively short to be infected. Seroconversion studies We are continuing to develop
period between the two The evidence for whether reported that while the rate evidence summaries on
consecutive negative test individuals re-infected with and timing of IgM and IgG COVID-19 and you can
results and the subsequent SARS-CoV-2 or other human detection varied, SARS-CoV- find out more about our
positive test result, and coronaviruses are infectious is 2-specific IgG antibodies were evidence summaries and
the limited onset of new currently inconclusive. detected in all individuals HTA documents on the HIQA
symptoms, the evidence after approximately two website at www.hiqa.ie.
to suggest that any of the weeks. However, the adequacy Along with our evidence
patients in these studies were The immune response and duration of this response summaries, we are conducting
definitively re-infected, is to SARS-CoV-2 and is not yet known. rapid HTAs and rapid reviews
limited. other coronaviruses Eight studies reported the of public health measures
While some individuals in duration of the immune
Due to the recent emergence and public health guidance
the studies tested positive response following SARS-
of SARS-CoV-2, studies on to inform NPHET decision
after recovery, this may be CoV-2 infection. Maximum
the long-term immune making and the work of
due to virus re-detection follow-up was 7-8 weeks
response are not yet available. the Health Protection
during the convalescent with IgG and neutralising
Therefore, evidence of the Surveillance Centre.
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taking much-needed PPE away from frontline workers.COMMUNITY Helen O’Rahilly
oc
L oa l
H er Patrick O’Rahilly at his pharmacy
in Finglas East, North Dublin.
W
This essay was written by e’ve
discovered
was packed with display
stands of Max Factor lipsticks
Helen O’Rahilly and was a new
breed
and Pablum and Cow & Gate
baby foods. The interior
originally broadcast as of hero
recently: we knew medics
smelled of Yardley’s Lily of the
Valley for the mammies, and
part of RTÉ Radio One’s were always heroes but joining Blue Stratos for the lads.
them now are cleaners, bus Behind the front-of-house
Sunday Miscellany series. drivers, bin men, checkout cosmetics and perfumes,
Ms O’Rahilly is a former staff, shelf stackers and
truck drivers.
behind a vast 20 by 6 foot
wooden partition, was the
TV Executive with BBC One job perhaps has
been overlooked: the local
inner sanctum where Dad
performed his alchemy.
and RTÉ, who has recently pharmacist. My late Dad
Patrick was one, although in
Powders were measured
and mixed, ointments were
returned to Dublin after 30 his day he was known as a
chemist. That was in his era
blended on a large marble
slab; his deft use of a palette
years in London. Her father from the 1950s to the 1980s knife would have made him a
was Patrick O’Rahilly, MPSI. when he ran a huge corner
shop on McKee and Clune
perfect candidate for a Bake
Off TV show.
He died in 1993. Roads in Finglas East,
North Dublin.
He had a wonderful flourish
as he cut sparkling medicinal
A rented space for 20 plus powders into the emollient
years, it had a doubled- cream of Silcock’s Base. Knee
windowed glass edifice. Inside high to the belt of his starched
26 IPUREVIEW JUNE 2020You can also read
