From the Minister for Health to former Dublin GAA manager Jim Gavin, and ex-HSE CEO Tony O’Brien, in addition to international and local pharmacy experts, the IPU’s 2023 National Pharmacy Conference provided both much debate, and a lot to mull over. Over 150 pharmacists were present, and attendees really added to the excellent atmosphere, as the audience were highly engaged in the event. This was the IPU’s first in-person national conference in four years, and the general refrain heard in the conference venue of Johnstown Estate in Co. Meath, was that it was fantastic to be back to meeting people face-to-face at our National Pharmacy Conference, after several years of online events. The conference kicked off on Friday evening 20 October with an informal meet and greet, before formal proceedings began on Saturday morning, chaired by the IPU’s Acting Secretary General, Derek Reilly.
There was a lot to take away from the international pharmacy presentations of both Adam Osprey and Lars-Åke Söderlund. Mr Osprey is from Community Pharmacy Scotland, and gave a detailed presentation on Pharmacy First, which is of particular importance to Irish pharmacists at present, given possible movement towards a Minor Ailment Scheme here. He began by describing Pharmacy First as both:
Mr Osprey went in-depth on the learnings from the Scottish experience, and emphasised that one “big learning is the need to ensure good communication with other healthcare professionals”. He said while patients got to grips with what could and couldn’t be provided in the service fairly quickly, there remains issues with other healthcare providers, and he gave the example of treatment for UTIs. There are rules around who can get that support, and pharmacists continue to receive referrals that are outside the criteria.
Ultimately, the additional money coming in from Pharmacy First is allowing pharmacies to invest in extra staff, which in turn allows for extra time with patients, in addition to better infrastructure, including digitalised services.
Digital health was a key theme of the presentation from Vice-President of the International Pharmaceutical Federation (FIP), Lars-Åke Söderlund. He provided a thought-provoking presentation on the future of community pharmacy towards 2030, and the impact of digital health therein. His overarching theme was a shift in how we perceive healthcare, and he quoted a World Health Organisation report on Reforming Health Service Delivery for Universal Health Coverage when he said “For Universal Health Coverage to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people, with people.”
A key issue he focussed on was self-care, which Mr Söderlund said recognises individuals as active agents in managing their own health care. He said despite the importance of self-care, at present it is “everyone’s job but nobody’s responsibility”. He called patient engagement “the blockbuster drug of the century” — it leads to better health outcomes, but most of all, engaged patients will produce valuable data that can inform better healthcare strategies.
This led onto a detailed discussion around the potential of digital technologies in the practice of community pharmacy, which culminated in a vision of someone who walks into a pharmacy in 2030, and the potential technology can play in monitoring the impact of, and adherence to, medication through tools already in use such as pharmacy apps and Apple watches. It was a good example of how close we are to the vision outlined in the presentation — although the final slide entitled ‘Take a shower with your pharmacist’ did provoke much mirth in the room.
While Mr Söderlund did assert that ”technology won’t replace the pharmacist”, his accompanying line that ”pharmacists who don’t leverage technology will be outplaced”, was very credible following his detailed, and thought-provoking presentation.
In response to Mr Söderlund’s presentation, IPU Acting Secretary General Derek Reilly said eHealth solutions are so close, but we need to ensure pharmacy is central to every discussion in the eHealth realm and emphasised the need for a Chief Pharmaceutical Officer to drive home the role of pharmacy in all discussion in the Department of Health.
The next speaker was former HSE CEO Dr Tony O’Brien, who had been in the headlines and promoted much radio debate the week preceding the conference, following his scathing appraisal of Budget 2024 in the Sunday Independent. Mr O’Brien wrote that, “Budget 2024 was the most malevolent and destructive for health funding in a decade”, so it was an excellent opportunity to hear his thoughts on the health service. Like the majority of those who have worked in the healthcare sector, he sees enormous opportunities to be gained from allowing pharmacists to provide additional services, with changing demographics, the cost of secondary care, continuity, and the reach and close proximity of pharmacies to the general population all named as being strongly in favour of this argument. He said there is “no other part of the health system where its possible to walk in off the street and speak to a senior healthcare professional”. He said at present secondary care is overused, the balance of cost is wrong and needs to be changed, and primary care needs to be developed. He said the ‘reach’ part is vitally important given our ageing population, because as we age, we need to be able to access services where we are.
However, he also expressed some caution, with economies of scale and workforce issues being among the issues he believes pharmacists must bear in mind. He also emphasised the need to appreciate the “ying and yang” relationship between GPs and community pharmacists, expressing that strengthening one must not weaken the other.
He also emphasised the need for pharmacy to plot its own course, and not be solely driven by fixing problems with the system. While we have clear and present problems, the solutions shouldn’t be the solutions for today and today’s problems, but for long-term strategic reasons. Therefore, it is vitally important that there’s a balance between what pharmacists can give, and what they need. He also cautioned not to perceive the HSE as the enemy in this, as the HSE wants to deliver these systems.
He also sounded a note of caution in the need for pharmacy representation at a senior level, saying that under the new Health Regions plan which is due to be operational in 2024, Regional Chiefs will be in charge of their areas, and we need to ensure pharmacy is represented in each area.
Mr O’Brien was followed by a CPD session on ‘Promoting a positive pharmacy practice’, which was delivered by highly experienced pharmacists Jonathon Morrissey and Rachel Dungan. The aim of the session was to inspire and empower the audience with positive pharmacy practice and to equip the audience with the tools to do so. They provided the definition of positive pharmacy practice as one in which we:
The session included a discussion on the IPU’s Pharmacy Practice Working Group (PPWG), which aims to help introduce efficiencies into your pharmacy practices and offer some kind of reprieve from the administration burden. Mr Morrissey explained that his pharmacy delivers 25 additional services, aside from dispensing. He said to achieve that you have to change, and you need to ensure there are good systems, otherwise people will burn out and service levels will suffer.
There then followed some practical discussion around management of prescriptions awaiting collection, and management of phone calls. The session set out to provide attendees with the tools to integrate positive pharmacy practices into their working life, and it certainly accomplished that for many present.
The session immediately after lunch was provided by Jim Gavin, former Dublin Gaelic footballer and manager of the five in a row winning team. Mr Gavin is also Chief Operations Officer with the Irish Aviation Authority, and was a military pilot in the Irish Defence Forces. He used all that experience in his session which was entitled ‘The Power of Teamwork – Maximising Results under Pressure’. He explained that our behaviours are influenced by values, culture and environment, but expressed that you cannot “build” a culture, instead you must envision it as a growth process, with constant changes that you adapt to, and learn from. In a refrain similar to the previous CPD session, he also emphasised that we must focus on “controlling what we can control”, and “where the attention goes, the energy flows”. Control, candour and collaboration were key points he discussed, and he noted the importance of candour in terms of creating a psychologically safe space within an organisation to discuss performance. Ultimately, he said, the emphasis is on performance, not accolades like winning trophies.
The Great Debate followed Mr Gavin’s speech, with the IPU’s Head of Professional Services Susan O’Dwyer acting as Chairperson of a panel that included PSI Registrar Joanne Kissane; IPU Review Editor and community pharmacist Jack Shanahan; former Head of Pharmacy Function at the PCRS, Kate Mulvenna; and our three key speakers from the morning session, Adam Osprey, Lars-Åke Söderlund and Tony O’Brien. There was a great atmosphere in the venue, which translated into a lively debate, with lots of questions coming from the floor, and the allotted hour flew by. Among the issues raised were the administrative burden, eHealth and fees to pharmacists.
During the discussion on more digitised services, Tony O’Brien raised the issue of the ill-feted PPARs system, which was the personnel and payroll computer system used by the HSE, which cost €220 million and was abandoned in 2005 before it was fully adopted. He said this controversy has made Government Departments very risk adverse to investment in ICT, despite the glaring need for such investment. He said he made a senior ICT personnel appointment, that was the “right person, right job, no funding”. Mr Shanahan said electronic health records are bogged down in minor details, but no one is looking at the big picture. There are lots of electronic records, but everything is in silos.
A questioner from the floor then emphasised the burnout and stress levels amongst pharmacists, and the difficulty in getting pharmacists to take on senior roles. He asked Ms Kissane if the Pharmacy Act has gone too far. In response, the PSI Registrar said there is significant concern about pharmacists not taking on governance roles, and some actions to help remedy this do lie with the PSI. She highlighted the roadshows currently being undertaken by the PSI, and said the PSI is actively engaged with the Department at the moment on changes to the Pharmacy Act. She emphasised kindness and compassion in regulation, and acknowledged the Fitness to Practise process is inflexible and inefficient at the moment, and that changes are needed.
A final question was asked around pharmacy fees, particularly the way the drugs budget and pharmacy fees are merged together in the Departmental budget, which masks decreases in fees to pharmacists. Kate Mulvenna, formerly of the PCRS, replied that it is very difficult to capture the differences in the system, and said what is not coming across at present is the extra value pharmacists bring in their interventions with patients.
Minister for Health Stephen Donnelly TD then spoke following the Great Debate, and he presented to a packed room. Minister Donnelly opened by congratulating the IPU on their 50th anniversary, and thanking pharmacists for their “perseverance, dedication and contribution to our health service” during the pandemic. He said he knows the health system is not “tapping into the full expertise” of pharmacists, especially given the high trust levels pharmacists have amongst the public. He said his vision is that Ireland is “among the leading countries in the world in terms of an enhanced scope of practice for pharmacists and pharmacies in the coming years”. He then said, “I am firmly committed to working with you in making this a reality”.
He emphasised the importance of the work of the Expert Taskforce to support the expansion of Pharmacy in Ireland, and said he was due to receive the first report from the Taskforce, in the week following the conference. He said he wants the Taskforce to “help us to expand the role of pharmacists in the short, medium and long-term. I want them to do this in collaboration with all of you.”
In addition to the Taskforce, Minister Donnelly highlighted the medicine shortages protocol; contraception through the pharmacy without the need for a prescription; and a Minor Ailment Scheme.
In closing the Minister for Health emphasised the importance of “close engagement with the IPU”, “constructive engagement”, and that he knows the engagement “is many years overdue”. Addressing the fees issue, he said: “I know there has been a lot of talk about current fees, and I know it has now been 16 years since there has been an increase. We need to find a resolution to that. We don’t have one yet. . . What I want to say is, I hear you. The IPU has been very clear in putting that position forward, it has been putting that position forward for quite some time. What we need to do is to have a conversation about all of these things, in the round. We need to talk about the current fees and we need to talk about the options in terms of expanded practice. We are not expecting you to expand your practice for free. Obviously, these are additional things, and as per the (recent) IMO agreement, you need to be paid, to do.”
In conclusion, he thanked the IPU for our engagement to date and looked forward to ongoing collaboration in the months and years ahead.
Minister Donnelly then waited to hear the response from IPU President Dermot Twomey, who thanked all IPU members for coming to the conference, especially given the struggle to get cover at the time of a pharmacy recruitment crisis. He thanked Minister Donnelly for his role in leading and driving a patient-led and patient care agenda, and highlighted that Minister Donnelly’s agenda and the agenda of community pharmacists are very much aligned: “Putting the patient first requires the health system to enable the patient to be dealt with in a timely manner and not have to endure difficulty in getting appointments with their GP or being at the end of a waiting list in A+E.”
He continued; “Implementing a model of independent pharmacist prescribing for prescription only medicines would represent a significant step forward. Pharmacist prescribing is well established in many countries and pharmacists in Ireland already engage daily in a range of prescribing activities under the provision of current emergency supply legislation. This model of care has the potential to deliver real and meaningful change for patients.” Addressing Mr Donnelly, Mr Twomey said, “We note your commitment to introduce a Pharmacy-based Minor Ailment Scheme. This scheme would need to be comprehensive and robust.”
However, he sounded a note of caution, saying while “there is significant alignment between our respective agendas . . . there is a problem.” He then developed this point by stating; “Community pharmacists have been subject to a pay freeze for over 15 years, and this was after the Government’s own independent review had recommended an increase in the fees.”
“We have outlined in minute detail the complexity of dispensing to your officials. We have given a detailed presentation which I hope you have seen. While doing that we also made detailed submissions on the nightmare that is administration. Our administrative burden dwarfs the dispensing element of our work. . . We need to streamline and modernise where possible like other countries have done and we need the State to recognise it as work and we need to be compensated for it.”
Mr Twomey concluded by saying; “Minister, well done on our various initiatives and your vision for new patient services as I said earlier, we have the expertise to deliver but we cannot move forward to implement new services or indeed sustain existing ones because we are at breaking point. We need to be properly and fairly paid for the work we do, and we need the oppressive regime and the discrimination to end.”
On that note, the conference closed, and the assembled audience prepared for the Gala Dinner, to mark the IPU’s 50th anniversary. Over 250 people attended the dinner, one of the highlights of which was the presentation to Michael Tierney of the Diarmuid O’Donovan medal for longstanding service to both the IPU and the community pharmacy profession. The medal was presented by former IPU President Daragh Connolly, who had been due to make the presentation in 2020 as his last act as President, but the pandemic halted all national conferences until this year. Mr Connolly said in Mr Tierney’s 43 years in the profession, he has served on nearly every IPU committee, but has also given his time to the IIOP, the Benevolent Fund, and the PSI. He praised Mr Tierney’s tenacity when working on the VAT scheme that saved the profession €110 million, and his work that resulted in savings of €115 million to the pharmacy profession through appropriate access to pension reliefs. On behalf of the hundreds of colleagues Mr Tierney has helped over the years, Mr Connolly offered his sincere thanks, and praised his contribution to the pharmacy profession.
The close of the Gala Dinner, which ended at varying times for attendees, marked the end of the 2023 National Pharmacy Conference. We will have pictures from the Gala Dinner in the December issue of the IPU Review.
However, the wait for the next event is short, and we hope to see many readers at the 2024 National Pharmacy Conference and IPU AGM will take place on the Friday 26 and Saturday 27 April 2024, in the Radisson Blu Hotel, Athlone.
Siobhán Kane
Editorial Manager, IPU
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