Joanne Kissane assumed the position of Registrar and Chief Officer at the Pharmaceutical Society of Ireland (PSI) in January 2023. In this interview with the IPU Review, Ms Kissane explores what are the challenges and opportunities facing both the PSI and community pharmacy, as well as other issues of concern to community pharmacists, including workforce challenges and the fitness to practise process.
I am in the role of Registrar and Chief Officer since early January this year. I am a registered pharmacist and practised as a community pharmacist for much of my career to date. I was the Superintendent Pharmacist with Lloyds Pharmacy for seven years, and subsequently, I became the Head of Operational Excellence for the organisation. Prior to joining the PSI, I was the Director and National Coordinator for APPEL, a joint office of the three Schools of Pharmacy, which manages the student experiential learning placements for the integrated Masters degree programmes in pharmacy. As many will know, I also served on the Council of the PSI from 2015, including for two years as PSI President. I am delighted to be part of the PSI in my new capacity, continuing my long-term interest in ensuring that safe and effective pharmacy services are provided to patients and the public.
The role is busy and wide-ranging; it is both operational, day-to-day as the Registrar, and strategic in the work to be undertaken with and for the Council as Chief Officer of a public body. This requires balance and a reliance on the immense ability and expertise of my PSI colleagues.
Having served as a Council member for many years, how I now work from within the executive is different but continuing to build meaningful relationships and ensuring the effectiveness of my relationship with the PSI Council is essential. I have been getting to know others across the various agencies and health and social care regulators and regularly engaging with the Department of Health to ensure that the PSI is contributing and available, where appropriate, to participate in the ongoing conversations about enhancing and evolving safe patient care.
Based on our engagement with pharmacists and stakeholders and inputs to the recent PSI workforce survey, there are challenges being faced across pharmacy, which impact the PSI’s regulatory role. While the PSI is overseeing a growing number on the register of pharmacists, we are aware of the difficulties in recruitment and retention in patient-facing roles and in appointing supervising pharmacists in community pharmacies. Owners and superintendent pharmacists are feeling this challenge, and we continue to engage with them.
Ireland’s population growth will continue to impact healthcare provision in general, including access to treatment. The need to plan for the right care, by the right healthcare professional, in the right place, and at the right time becomes more pertinent. Planning for the role that pharmacists will play in this is vital by putting the necessary structures and policy in place.
Our ongoing assessment, together with others, of these and other emerging risks for the pharmacy workforce will set out some clear recommendations. Changes will be incremental, but working with many others, will, I hope, deliver positive patient outcomes.
As a health regulator, the PSI is on a continuing journey, enhancing and adapting regulatory approaches to best meet the changing population, health, and technology landscape. We are one part of a broad health system, and that has its benefits and challenges.
Legislative reform is something we are pursuing as an ongoing project. It considers how we believe the public and our registrants, as well as this regulator, could be better served by further meaningful changes that ensure a fit-for-purpose regulatory approach that can respond adequately to the range of services being provided to patients in pharmacies and that will afford the ability to respond more flexibly, and compassionately, to the people we engage with.
As an organisation, the PSI must keep pace with change, maintain a workforce with a variety of skills and experience, and respond in a timely and effective way to patient safety and other matters of concern. There are transformation projects underway within the PSI, and we are required to input to changes at legislative and other levels; however, above all else, we must prioritise the PSI’s primary statutory responsibilities in our commitment to public protection.
In doing any of this work, we see it as essential to continue to harness the support and collaboration of pharmacists and those across the pharmacy sector, as well as growing participative networks of pharmacy service users, to understand their perspectives.
The part that pharmacists and pharmacy teams have played in ensuring access to healthcare throughout the COVID-19 pandemic, and their strength of participation in the national vaccination programmes for COVID-19 and influenza, has demonstrated the commitment and availability of the sector.
There are opportunities to continue to generate a greater understanding of the fundamental role of a pharmacist as a medicines expert, as a gatekeeper to safe, appropriate medicinal treatment and care, amongst the general population and those responsible for health service delivery and policy development.
In the context of delivering universal healthcare in Ireland, there are opportunities to further enhance the role of community pharmacy and to expand on the scope of practice of pharmacists so that pharmacists best utilise their skills and training.
“As an organisation, the PSI must keep pace with change, maintain a workforce with a variety of skills and experience, and respond in a timely and effective way to patient safety and other matters of concern.”
The PSI has some projects in train over several years; seeing these come to fruition will benefit the PSI and those we engage with. The Council decided to extend the lifetime of the current PSI strategy to the end of 2024, as it offers sufficient scope for development and warrants the time for delivery, mindful of the impact COVID-19 had on our work in recent years. During this time, we will also recruit for agreed new posts that will boost our staffing and our ability to further resource our work.
Building on our digital transformation to reduce burdens for all involved is a priority for PSI. It will improve our view of data, enhance our risk-based approach, and support future and forward-thinking for us as a regulator.
Regulators are used to concerns and criticisms being levied against them about over-regulation or failure to take regulatory action. The challenge and opportunity is to get the balance right, and to continue to listen and learn. We greatly appreciate and benefit from the input we receive from experienced pharmacists and many stakeholders as we pursue our work. We have built on the use of advisory groups and consultative fora in recent years. I sincerely hope these types of engagement will continue to support our regulatory work and enable any changes that will take place in future years for pharmacy.
One of my priorities over the coming year with the PSI Council will be to start consideration and consultation on the PSI’s future strategic direction for 2025 onwards. This provides an excellent opportunity to work with many people to ensure our next development objectives will move the organisation forward in a way that is beneficial and relevant within the environment we operate. Inevitably, some of what we’ve already started, such as working on legislative reform, will continue.
Together with the Council, I would like to prioritise further our focus on delivering equality, improving diversity and being inclusive in all our work as a healthcare regulator and an employer. In addition, I would like to further develop and build on our engagement with patients and the public to ensure that the patient voice is actively embedded across our policy and service development and delivery. Furthermore, I hope to review our fitness to practise processes to ensure that the approach is more compassionate to all involved.
This is a key project under our current Corporate Strategy, and significant work has been undertaken since we started last year. The project’s core objective is to gather robust data and evidence to establish a baseline view of the pharmacist workforce in Ireland, and articulate the risks that need to be addressed to ensure the sustainability of the workforce across community and hospital pharmacy.
We have been encouraged by the level of interest in the project, including input from pharmacists, our Council, and other stakeholders. This was demonstrated through the responses to the workforce survey last year, the involvement of pharmacists in our focus groups, and the participation of significant stakeholders from across the health and pharmacy sector in the project’s working group. Although the PSI is leading on this project, it is a complex topic, and we are one of many who have a role to play in addressing the challenges and enabling the opportunities for patient-facing pharmacists so they can play a full role in the future integrated health system.
At the end of June Council meeting, the Council considered the report containing recommendations. It is important that the recommendations and actions included in the report have broad agreement from those tasked with their implementation and we will continue the positive engagement about implementation with the working group members, including with the Department of Health and others, to progress the next steps agreed upon. The report will be published later this year.
While our strategic workforce project looks at the medium to long-terms issues impacting the pharmacist workforce, we know there are challenges across the sector concerning the recruitment and retention of pharmacists in patient-facing roles. We have met with the IPU and Department of Health on several occasions to contribute to efforts aimed at tackling the current acute issues.
One of the options we are exploring is the development of guidance for pharmacies on a delineation model that facilitates the operation of the retail component of a pharmacy in isolation, thereby allowing for flexibility in pharmacist working. We appreciate this won’t be suitable for all pharmacies, and there are other solutions that could be progressed, including by the Department, HSE and pharmacy owners, concerning identifying and actioning improvements to working conditions. Later this year we will publish guidance that clearly sets out the distinct responsibilities associated with the roles of supervising and superintendent pharmacists.
A pharmacist seeking to register in Ireland must have their qualification and training assessed as suitable and equivalent to the standards required for practice in the state. For pharmacists qualified outside the EU and EEA, the route to registration is a multi-stage process in place since 2009.
Change is in progress to introduce a revised Third Country Qualification Recognition (TCQR) route, but this involves many considerations. The policy and approach have been agreed by the Council, and the practicalities of implementation are being worked through. External input has been sought throughout this project; an Advisory Group was convened to ensure the fairness and robustness of the revised route. We have a panel of experts in place with experience in education and assessment to recommend to PSI the content and structure of the examination under the revised route.
One of the fundamental changes proposed is the introduction of a more holistic assessment of an applicant’s qualification. The assessment is intended to allow applicants to address any deficiencies in their primary qualification. In addition, the current process around adaptation periods will be replaced with a formal, quality-assured structure. Earlier this year, we had a public consultation on proposals to amend the existing PSI (Registration) Rules 2008, a step necessary to facilitate a changed process. The Rules have been sent to the Minister for his signature.
The PSI is mindful of the personal and professional impact on all who are involved in the complaint process. Once a formal complaint is made, the statutory process must be followed. In doing this, we strive to make available information that is useful and supportive, and to ensure that matters proceed to a conclusion as quickly as possible.
We use trackers and KPIs to monitor progress of complaints and a ‘callover’ process to see that pending inquiries are reviewed and progressed. This is reported to the Council and published online in the Registrar’s Report after public Council meetings. We continue to focus attention on improving these timelines as best we can. While respecting the independence of the statutory Committees, we work with the Committee Chairs to ensure that complaints progress to a conclusion as smoothly and efficiently as possible.
However, many factors influence this progress. Not all of these are within the control of the PSI or the statutory Committees, such as the availability of necessary documentation or ongoing third-party prosecutions, which often need to be resolved before an inquiry can proceed. And these processes involve people whose needs are considered, for example, the ill-health of a participant, including a registrant, or the availability and work commitments of witnesses and registrants, all of which can impact scheduling. At all times, fair procedures and natural justice are considered in the interest of all parties.
Together with the Council, I hope to review our fitness to practise processes during our next strategy period, to focus on ensuring the processes are compassionate to all those involved while maintaining the necessary patient safety focus.
The PSI’s responsibility is to ensure a framework of regulation is in place that promotes patient safety and professional accountability, and that allows pharmacists and pharmacies to operate safely and consistently, including in relation to any changes in services or adaptation in the role of a pharmacist.
Expansion of the scope of practice for pharmacy is contingent on collective working with the Department of Health, the HSE, the profession, and others, to deliver on Ireland’s envisaged approach to healthcare provision, with new models of care that are person-centred, that focus on care close to home, and which strive towards universal access or equality of care. As the regulator, we have a role in enhancing the provision of quality public healthcare and facilitating an evolving pharmacist role, including supporting an expanding pharmacist scope of practice.
Work being undertaken by the PSI, such as looking at pharmacy governance roles and responsibilities, elements of the legislative reform agenda, addressing some of the workforce challenges, and implementing our own internal system and resource capacity changes, are all intended to support future health system evolution.
The PSI welcomes increased access to contraception where it provides safe and effective health outcomes. There are good examples of the provision of such services by pharmacists available internationally, and such an expansion is in-line with equality of access proposals, timeliness of care and choice for patients, further to Sláintecare proposals and the Women’s Health Action Plan 2022-2023. The PSI will aid any new legislative decisions that may be made in relation to pharmacy; inevitably, appropriate parameters and guidance around such care will be beneficial, including access to any necessary referral pathways, to ensure timely and appropriate care.
” I hope to review our fitness to practise processes during our next strategy period, to focus on ensuring the processes are compassionate to all those involved while maintaining the necessary patient safety focus.”
Community pharmacists provide advice and medicines to support the treatment of minor ailments to patients and the public daily. As one of the most accessible healthcare professionals, pharmacists, as experts in medicine, are well-positioned to provide advice, treat or refer patients to other healthcare professionals for a variety of conditions. The PSI welcomes the availability of care and treatment for patients where it can most suitably and beneficially be provided. These considerations are all ongoing in terms of changes in health service provision and in line with what is envisaged under the Sláintecare plan.
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