Under the terms of the Public Service Pay and Pensions Act, 2017 the Minister for Health is obliged, before the end of June this year, to review the nature of services provided by community pharmacist contractors and review the operation, effectiveness and impact of the amounts and rates payable to them.

As part of this review the Minister must consider:

• Terms of existing contractual arrangements;
• The terms of any circulars/documents or understandings with the contractor; and
• The nature of services provided and commitments.

The Minister also has an obligation to have a ‘prudent fiscal policy’ and consider any views expressed or submissions made during the consultation process. The Act requires consultation over a 30-day period but gives no guidance or instruction as to how this ‘consultation’ should take place. In the past we have simply been asked to make a submission without any substantive talks taking place.

In November 2019, after threatening to cut our fees, we had a strong grassroot campaign by IPU members, which succeeding in stopping the proposed cuts with the status quo on fees remaining. The status quo will not do this time, especially as the then Minister for Health, Simon Harris, TD, committed to broader engagement and to adopt a similar approach as was taken with the GP discussions i.e., look at the contract review through a multi-annual lens. This time we will be demanding substantive talks with Department of Health Officials to address the future viability of the community pharmacy network, focusing on the challenges we face to ensure the delivery of a sustainable pharmacy service for the benefit of the citizens of Ireland.

The Pharmacy Contractors Committee and Executive Committee have been working over the course of their current term to position the IPU correctly to ensure successful negotiations. It should be noted that while the Minister is obliged to ‘consult’ over the month of June, a decision in relation to our fees may not be enacted through legislation until the start of 2024.

 

Ongoing engagement with Dept. Health

The Department of Health is currently constructively engaging with the IPU on several fronts including talks on enhanced service provision e.g., increasing accessibility of contraception through community pharmacy following a structured consultation with a pharmacist, a medicines shortage protocol, the development of a Minor Ailment Scheme and various aspects of eHealth. We have never been better positioned to engage with the Department than we are now. As June approaches we still have no firm commitment from the Minister for Health to engage with the IPU on substantive talks relating to our core professional dispensing fee. This is in stark contrast to our GP colleagues, who received significant reinvestment in their service provision as a result of the 2019 Agreement, and most notably, the Department have recently announced a strategic review of General Practice. As outlined in the review documents the intention is for “The Department of Health, with the support of the HSE, will undertake this review and will engage with key stakeholders to identify the challenges facing general practice in ensuring the delivery of a sustainable general practice service within the community and to identify the measures necessary to address those challenges in the context of delivering on the principles of Sláintecare”.

Given our commitment to community care and prior promises made by Ministers, we expect and demand equity of treatment with other healthcare professionals — after all we are the most accessible healthcare professional, with over 70 million patient care interactions per annum.

   

“We will be demanding substantive talks with Department of Health Officials to address the future viability of the community pharmacy network.”

  Increasing costs are threatening the viability of many pharmacies around the country, particularly in rural areas, with clear evidence of reduced opening hours and a growing inability to maintain key services to patients.”  

Over the last 15 years:

• Revenue reduced: The revenue generated by each pharmacy under the community drug schemes has reduced by 29%;
• Higher costs: The cost of providing a high-quality service, have never been higher with a 29% increase in expenditure on wages. This is on top of significant hikes in energy, utilities, rents and insurance and administration costs;
• Reduced dispensing fee: The rate paid to dispense a medicine under the community drug schemes has reduced by 24% from €6.00 to €4.58;

• Increased labour costs: The labour costs of dispensing a medicine have increased from €3.73 to €4.58. This is an increase of 23%, due to higher wage costs and as more resources are required due to the increased administrative burden of the community drug schemes. The average state fee now only covers the cost of dispensing a medicine (€4.58), merely covering labour costs without contributing to other overheads;

• Price compression: The Consumer Price Index (CPI) has increased by 16%, whereas the CPI for prescribed medicines has declined by 25.5% — we are now experiencing significant price compression;
• No say in reimbursement price: The reimbursement price of medicines is negotiated by the State with drug manufacturers, and as such a pharmacist has not ability to increase or pass any rising business costs on to a patient under the community drug schemes — we are now at an inflection point;
• Pharmacists not being treated on a par with other healthcare workers: The average hourly earnings for healthcare workers have increased by 14%. This includes increases for dentists, nurses, consultants, hospital pharmacists and medical officers in addition to catering staff and hospital porters; and
• Significant engagement with GPs: Since the 2019 GP agreement, the additional annual expenditure provided to GPs has increased by €211 million. GP capitation fees have increased by 48.5% (except for under 6s) since this agreement, recognising their important role in the provision of primary care, however, we have had no such recognition. In fact, the Department has recently agreed a strategic review of general practice to identify the challenges facing general practice in ensuring the delivery of a sustainable service, we are seeking equitable treatment and immediate engagement with pharmacists.

 

Community Pharmacy is the only sector that has received no recalibration and restoration of our fees since the financial crisis. This needs to change.

What we are seeking on behalf of IPU members is a flat fee of €6.50 per medicine dispensed under the community drug schemes, and a very modest increase of 8% on the €6.00 average rate that was available in 2009. We are demanding that the Minister for Health engages with community pharmacy ahead of the 30 June deadline.

 

Mobilise now

It is now time for all of us in the IPU to mobilise and begin a grassroots campaign to highlight the consistent failure by the State to invest in pharmacy services over the last 15 years. Increasing costs are threatening the viability of many pharmacies around the country, particularly in rural areas, with clear evidence of reduced opening hours and a growing inability to maintain key services to patients. Over the month of June, in conjunction with MKC our public affairs advisors, we will be rolling out a campaign, with the support of members, to highlight our key messages and demands to public representatives with the intention of getting the Minister to engage with us.

This campaign will continue well beyond June if no progress is made. We cannot expect pharmacists to do more work for the State, for less money, while continuing to bear higher costs. Also, the administrative and cognitive burden of the community drug schemes needs to be recognised. It will soon be time for us to consider rationalising the services we currently provide for free. The State will not invest in community services and improved patient outcomes if we continue to fill the gap. It need not come to that if the Department engages with us in a positive way over the coming weeks and months. Community pharmacists know that investing in community pharmacy will deliver services with a proven dividend in terms of value for money for both patients and the state.

The IPU will be publishing campaign updates via our website and newsletter over the coming weeks.