Danielle Barron reports from the PSI Council meeting of 26 June 2023, during which several new members as well as new President Katherine Murrow, and Vice-President Rory O’Donnell, were welcomed.
Opening the meeting was Shane McCarthy, former chair of the Preliminary Proceedings Committee (PPC), who delivered a presentation on the Annual Report for both 2021 and 2022 from the Committee. Noting that “very few complaints are vexatious or in bad faith”, he outlined the typical procedure for complaints. Mr McCarthy pointed out that while some complaints are withdrawn, the Committee will still consider whether or not further action is warranted and can still proceed regardless — the public interest is the “primary focus”, he asserted.
The PPC has been dealing with a large volume of cases in recent years and 2021 saw 59 cases before the Committee, a substantial increase on 2020’s figure of 37. As a result, the PPC met nine times, with an extra meeting to deal with the growing backlog of cases. Of these, 34 out of 59 concluded with no further action. Of the remaining 25, five were sent for mediation, and five to the health committee, and 15 to the Professional Conduct Committee.
Some 58 complaints were received in 2022. According to Mr McCarthy, the volume of cases is not the only issue contributing to the backlog, as he noted that cases in the last two years have evolved to become more complex. He cited issues with the dispensing of Solpadeine® and fertility drugs as instances requiring more attention. This means the KPI of 100 per cent of cases reached within six months has not been achieved.
Council member and pharmacist Sean Reilly queried whether the situation had further deteriorated or if more resources were needed, noting the current KPI is 25% as per the registrar’s report. Mr McCarthy responded that the workload of the committee is “much more severe”, pointing out that a dossier of files could be 2,500 to 3,000 pages to read in order to prepare for a meeting, while complaints themselves are frequently 400 or 500 pages. He accepted that there could be a change in the allocation of resources in terms of work practices that could help alleviate the burden, but stressed that “the throughput and workload of the committee is still high”.
The PSI’s John Bryan acknowledged the backlog is an issue and said that there are plans to hold 11 or 12 meetings (versus the typical eight), in 2023 as a result. Mr Reilly also pointed out that complaints in relation to the sale of Solpadeine could be as a result of a communication issue, in which case they are “unfair” to the pharmacist in question. “Ultimately these complaints arise because of people’s reaction in the shops”,
he said, although he added that with codeine “under the microscope” in terms of its availability over the counter, “the problem might solve itself”.
PSI Vice-President Rory O’Donnell suggested that there could be an argument for “splitting” the PPC, with the result that they could deal with more cases. “I would argue wholeheartedly against that approach,” was Mr McCarthy’s response, noting that there is a necessary mix of expertise on the Committee; “In my view it would be wrong for the composition of the PPC to be different.”
Council member Ann McGarry asked whether the requirement for more meetings of the PPC is sustainable into the future; Mr McCarthy agreed that this is of concern, given the “heavy burden” of preparing for the meetings. He also noted that there is “no sifting process before us”, with every complaint that is made having to come to the PPC, “whether meritorious or not”. He also pointed out that the number of complaints withdrawn are “relatively few and far between”, so the volume of misunderstandings that lead to potentially unnecessary complaints is relatively small. Registrar Joanne Kissane noted however, that the PSI is looking to triage complaints as part of changes to the Pharmacy Act.
Ms Kissane then delivered her Registrar’s report, welcoming new Council members as she began.
The recently published Workforce Intelligence Report was to be presented to Council for approval during this meeting; this represents the “culmination of a significant amount of work” and outlines the risk to the sustainability of the patient-facing pharmacist workforce. Ms Kissane noted that the PSI had provided a medicine availability update on Semaglutide (Ozempic®) to registrants at the end of May and had provided commentary to various media outlets on same. Meanwhile, the PSI remains active in terms of the response to COVID-19, participating in fortnightly pharmacy workstream vaccination programme meetings and approving training in new vaccines.
Further discussion took place on the issue of the PPC backlog, and John Bryan reiterated that they are looking at overhauling internal processes so that complaints could be processed in a more timely fashion. There was concern expressed about the impact an outstanding complaint would have on a pharmacist — “justice delayed is justice denied,” said Mr Reilly. It was noted, however, that the situation had seen a recent improvement after efforts to improve the backlog, and eight cases had been discussed at the most recent meeting, which brought the KPI up to over 50%.
In relation to the Workforce Intelligence report, Ms Kissane said it was hoped to invite the Minister for Health Stephen Donnelly to launch the report and she added that engagement with the Department of Health overall has been very positive. This was praised by Council members who acknowledged how difficult it is to obtain a meeting with the Health Minister. Ms Kissane noted that strategic workforce planning and the findings of the strategic intelligence report are “well aligned with some of what the Minister wants to do”, and their discussions had covered areas where pharmacists are looking to support Sláintecare and be part of an integrated healthcare system.
The report of the Audit and Risk Committee was delivered by Geraldine Campbell. The discussion centred on the constraints that have limited the PSI’s capacity to undertake inspections. These include limited resources, with the inspection team operating with the equivalent of 2.4 people, as opposed to the optimum number of six. Ms Campbell explained that as a result of this “depleted team”, there has been a move towards “risk-based inspection”, and much fewer “random inspections” have been carried out.
Gráinne Power then offered an update on the Business Transformation Project Programme Board, which has been consistently delayed. The Programme is described as “a digital services transformation project, which focuses on the design and development of a new improved secure and effective ICT system”. At the time of this PSI Council meeting, progress had moved on somewhat, with the deployment of Phase 1.1 due to take place by the end of July. Dr Cyril Sullivan queried if the project would be back on track by the time of the next meeting in October, noting that “considerable extra resources” had been deployed to get it to this stage. President Kissane said the hope had been that phase 1.1 would be delivered by Sept 2022, but more than 50 bugs had been identified in phase 1.1. The consistent delays “do not inspire confidence”, she admitted, and the time and resources required to manage the rollout of the project was impacting on the organisation. “It is a major concern for us,” she stated.
Council member Martin Sisk asked whether there was scope for exercising their contractual rights, if the delays did constitute a breach of contract. Ms Kissane said this was being kept under regular review, but she added that the relationship between the PSI and the contractor had not deteriorated despite them missing four separate dates for deployment. At this stage, she admitted, it was difficult to accept a given date. Cheryl Stokes of the PSI explained that, to date, €70,000 had been spent on Phase 1.1, with total costs for the project at €640,000 so far.
The report to Council from the Performance and Resources Committee was given by Ann McGarry who sought approval for the management accounts of the first quarter of 2023.
Gráinne Power then delivered the report from the Regulatory and Professional Policy Committee and requested the approval of Council for the Workforce Intelligence Report and Survey Analysis Report. In relation to this, the Registrar said there is ongoing engagement with the Department of Health and HSE, and she noted that the working group has agreed that they will transition into an implementation group, “so the commitment is there”. The decision to appoint a Chief Pharmaceutical Officer rests with the Department, added the President.
Ms Power also sought approval from Council for the report on the development of a CPD model for Pharmaceutical Assistants. Sean Reilly asked if the assistants themselves were on board with this and was assured there had been both “engagement and agreement”; Ms Power noted that the move was “taken quite positively”.
The last item for decision from the RPP committee meeting was the report into the compliance of community pharmacies with the published PSI guidance on the safe supply of non-prescription medicinal products containing codeine. Pharmacist and Council member Maria Louisa Power explained that in a survey of 100 pharmacies, 81 pharmacies did dispense the medicine despite the “secret shopper” having presented in a way that should avoid the product being sold to them. It was noted, however, that many of the pharmacies did “attempt” to be compliant, asking the right questions etc; Vice-President Rory O’Donnell commented that the results show that “is everyone asking all the questions? No . . . (but) professionals are trying to do the right thing”. To this point, it was acknowledged that there was high (if not total) compliance in almost three-quarters of the pharmacies surveyed. Mr Reilly commented that, while strict prohibition is not ideal, “tight regulation is not being complied with”, and he suggested that many pharmacists simply “do not know what the right thing is”. The Registrar said there is a need to make sure there is better counselling of patients in those circumstances, and what they are looking for is an improvement in pharmacies with medium and low compliance. The report was approved and will be provided to the Department of Health and the HPRA.
The Vice-President outlined the report of the Special Purposes Committee, and also sought approval for a number of appointments to the advisory committees and the BTP Board, as well as the PSI Disciplinary Committee.
He also asked for Council’s approval for the revised standing orders of Council, which was a source of dismay to some members. Mr Reilly spoke of his disappointment that the “any other business” section of the agenda was to be removed, saying in his view it wasn’t “understandable or merited”. He said the meetings were moving to “prescription only” and asked for the rationale behind the decision given that most other Councils include this as part of their meetings. Pharmacist member Mark Jordan echoed this, saying he did not understand how it would work in practice as AOB may come up in light of documentation or recently added papers.
Vice-President O’Donnell broadly supported the move to abolish AOB, saying he could recall occasions when views were sought that were not necessarily relevant to Council business. Maria Louisa Power asked that the document be reworked in light of the appointment of the new President and Vice-President, which was agreed upon. Ms Kissane said they are hoping to review the Council rules and there may be an opportunity to amend the necessary legislation at that time.
Danielle Barron
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