As we are fast approaching Budget Day on 10 October, the IPU is submitting proposals to Government to ensure they understand the needs of community pharmacists. In this article, Jim Curran, IPU Director of Public Affairs and Communications, provides a summary of the key issues addressed in the IPU’s pre-Budget 2024 submission, which was presented to the Minister for Finance, the Minister for Public Expenditure and Reform and the Minister for Health recently.
In line with the IPU’s ongoing pay restoration campaign and campaign to expand the pharmacist role, this year’s submission to Government in advance of Budget 2024 focussed on increased state investment and resourcing of pharmacies that will assist the sector to deliver pharmacy-based services that will benefit both patients and the State.
The key areas addressed in the submission include:
As our pharmacy readers well know, the community pharmacy sector has experienced a fee freeze dating back to 2009, which was the time of the financial emergency, when the recession and IMF dominated headlines. In fact, since that period, the average fee for dispensing an item of medicine on behalf of the State through the community drugs schemes has reduced from €6.00 per item to €4.58 per item. The average cost of dispensing an item has increased from €3.73 to €4.58 an item during the same period, meaning that the dispensing fee paid no longer covers the cost of dispensing. When we factor in the increasing administration costs involved, it does not take an accountant to figure out that we are at a tipping point, where it is becoming no longer viable to administer these schemes without having a detrimental impact on pharmacy performance.
A recent study by Fitzgerald Power confirmed that one in ten pharmacies are in the loss-making bracket, which does not bode well for their future performance based on the current state payments situation. Many more pharmacies are rationalising service provision, reducing hours and closing at the weekends, in an effort to counteract the rising cost base.
In fact, since 2009:
This reduction in the total payments made to pharmacies has occurred parallel to an increase in the number of items being dispensed annually under the range of State schemes. This means that pharmacists’ workload has increased significantly while revenue for the same service has decreased.
Furthermore, pharmacies have had to deal with significant cost increases for administering State schemes. The average pharmacist now spends a significant amount of time each working day on form filling and ensuring compliance with the ever-increasing administrative burdens of the community drug schemes. This is an ongoing and increasing cost that cannot be borne by pharmacies; it is also leading to difficulties in the retention of professionals in the sector, who want to provide patient care rather than be administrators on behalf of the State.
The IPU has long advocated for expanding the role of pharmacists. It makes absolute sense particularly in the current environment with GP services under intense pressure and overcapacity in our hospital system. In fact, the pivotal role of community pharmacy in primary care has been long recognised in other jurisdictions including our neighbours across the water who have for a number of years been providing key healthcare services to the public including Minor Ailments.
Recommendations:The absence of an Irish CPO makes us an outlier in modern healthcare systems. Those jurisdictions that have created such a position have demonstrated the value it represents. For example, pharmacists in Scotland operate according to a clear national pharmacy strategy which is integrated into the wider health service. Through this simple but effective structure, pharmacists’ specialist knowledge in medicines is utilised to the best effect for the benefit of people’s health and well-being.
A CPO could deliver meaningful and rapid change to benefit patients. Now is the right time to reintroduce this vital role into the health system.
Recommendation:
To recruit a Chief Pharmaceutical Officer (CPO) at a senior level within the Department of Health as a matter of priority so as to ensure that medicine supply is prioritised operationally and strategically at the most senior levels of the health system.
Community pharmacists are keen to play a greater role in providing community-based healthcare which is a cornerstone of Sláintecare. If enabled, they can deliver far more services than are currently delivered; patients, the public and the health service all benefit. However, this cannot be done in isolation. To enable the provision of these key services, our community pharmacies need to be adequately resourced to ensure that they can provide the continuum of care which is urgently required in our communities and which patients are demanding. This includes both financial resources in the guise of adequate funding to support the sector and manpower resources to sustain the sector.
The State urgently needs to invest in enhanced pharmacy-based services which, internationally and domestically, have demonstrated real benefits in terms of patient outcomes, reduced total care costs and, crucially, the additional capacity which can be released in more complex healthcare settings such as General Practice and Emergency Departments.
If allowed and properly resourced to do so, pharmacists in Ireland are ready, willing, and able to help alleviate pressure on the health system and to deliver the sort of health service that the Irish public needs and deserves.
The IPU’s submission to Government in advance of Budget 2024 was presented to the Minister for Finance, the Minister for Public Expenditure and Reform and the Minister for Health in early August, and copies were also sent to all Members of the Oireachtas. Go to ipu.ie to read the full pre-Budget submission.
Jim Curran
Director of Public Affairs and Communications, IPU
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