Seán Crowe Sinn Féin	Frances Black Independent

The potential for the expansion of the role of pharmacy was endorsed by the new CEO of the HSE Bernard Gloster, when he appeared before the Oireachtas Health Committee. Committee Cathaoirleach Seán Crowe TD (Dublin South-West Sinn Féin), raised the potential for increasing the role of pharmacy with Mr Gloster. Deputy Crowe said; “In many cases pharmacists are the first step. When people are ill they go to the pharmacist. They may then be able to get a GP appointment and then go to hospital if the system works.”

Mr Gloster replied; “There is potentially a bigger part for pharmacy to play in that than many people might think. When I think about primary care as the place to which we are trying to shift the emphasis of healthcare for the future, there is a tendency to default to GPs supported by the HSE and allied health professionals. However, when we think about primary care, we must think about the full spectrum, and pharmacy must be right up at the top of that.”

Separately in the Seanad, the potential to increase the role of pharmacy was raised by Senator Frances Black (Independent), who stated that to deal with capacity issues, Government “could ease the pressures on GPs by expanding the roles of pharmacists and nurse practitioners”. Senator Black continued; “That is being done by some GPs, but the role of pharmacists could be a good way to deal with this. These are highly qualified, conscientious professionals who are ready, willing and able to take on greater responsibilities. Empowering allied health professionals could make the delivery of essential everyday healthcare more efficient and accessible.”

Stephen Donnelly Fianna Fáil	Róisín Shortall Social Democrats

Minister for Health questioned over the appointment of a Chief Pharmaceutical Officer

The Minister for Health Stephen Donnelly TD (Wicklow, Fianna Fáil), has continued to face questions about the appointment of a Chief Pharmaceutical Officer. Colm Burke TD (Cork North Central, Fine Gael), asked Minister Donnelly to “give full consideration to the appointment of a Chief Pharmaceutical Officer within his Department to develop and coordinate a national strategy for pharmaceutical care”. Similarly, Róisín Shortall TD (Dublin North West, Social Democrats) echoed the call for a Chief Pharmaceutical Officer when asking Minister Donnelly, “if he intends to create a Chief Pharmaceutical Officer position in his Department”.

Responding to both Deputies, Minister Donnelly said; “The Department of Health recognises the key role of pharmacy in the community, and the ongoing significant contribution made by this sector to patients and the public, particularly during the pandemic.”

The Minister for Health continued; “the potential role that pharmacy may play in the development and implementation of future healthcare reform, especially in regard to the aims and vision of Sláintecare, is under consideration.”

However, Minister Donelly stopped short of committing to the appointment of a Chief Pharmaceutical Officer; “At this time currently there are no active proposals to develop a Chief Pharmaceutical Officer role in the Department of Health. The Department has professionally qualified pharmacists among its staff. Furthermore, a number of units within the Department have responsibility for advancing policy in key areas of our health system. They are cognisant of potential deliverables that can be realised by and through pharmacists and pharmacy services, to deliver patient-centred care in line with the vision of Sláintecare.”

Minister for Health questioned on supports for community pharmacy

Colm Burke TD (Cork North Central, Fine Gael) has on numerous occasions questioned the Minister of Health on support for community pharmacy. Deputy Burke first asked Minister Donnelly; “if he will fully consider the allocation of sufficient funds to support future service delivery in the community pharmacy sector”; and continued by asking; “if he will give due consideration to the additional workload placed on community pharmacists in managing medicine shortages when reviewing their dispensing fee”; and finally asked the Minister “the steps he will take to ensure that community pharmacists, as essential members of the primary care team, are totally integrated and embedded into community health networks”.

In response Minister Donnelly stated; “As Minister for Health, I recognise the significant role community pharmacists play in the delivery of patient care and acknowledge the potential for this role to be developed further in the context of health service reform. Their participation in the national COVID-19 vaccination rollout — the largest ever undertaken by the State — and in the recently launched free contraception scheme, are examples of the importance of their role in the functioning of our health service.”

Referencing the current review of dispensing fees, Minister Donnelly continued by saying; “In conducting the review, the Department will be cognisant of proposals regarding extending the scope of practice offered by community pharmacists, ensuring that future healthcare expenditure under the community drug schemes is sustainable, and the role that community pharmacy should play in the reform of health service delivery as envisaged in Sláintecare. On this latter point, it is imperative that community pharmacists are recognised as an integral part of the delivery of both safe and efficient patient health care in the community.”

Minor Ailments Scheme again raised in Dáil Éireann

The Irish Pharmacy Union’s call for the implementation of a Minor Ailments Scheme has been raised twice by Members of Government. Colm Burke TD (Cork North Central, Fine Gael) questioned the Minister for Health; “if he will consider the formation of a Minor Ailments Scheme implementation project group, with the view to enhancing services provided by community pharmacies”.

In response, Minister Donnelly referenced a meeting he and his Department had with the IPU; “On 24 November 2022, I, along with Departmental officials, met with a delegation from the Irish Pharmacy Union. At that meeting, various proposals regarding extending the scope of practice offered by community pharmacists were discussed. These proposals — including that regarding the implementation of a Minor Ailments Scheme — are currently under active consideration by the Department.”

The implementation of a Minor Ailments Scheme was also raised by Seán Crowe TD (Dublin South West, Sinn Féin) in a Dáil debate on staffing levels, where he mentioned the IPU appearing in front of the Oireachtas Health Committee, saying; “Irish Pharmacy Union representatives were before the Joint Committee on Health two weeks ago and they spoke about the enhanced role that community pharmacies can play in providing capacity in our health service. By operating minor ailment clinics, they could triage a great number of people who may not need to see a doctor or go to a hospital. This would free up appointments in GP surgeries, which would then allow people to see their doctor rather than go to the accident and emergency department.”

Medicine shortages are a frequent topic of discussion in the Dail

Niamh Smyth Fianna Fáil	Holly Cairns Social Democrats	Éamon Ó Cuív Fianna Fái
Peter Burke Fine Gael	Patricia Ryan Sinn Féin

The Minister for Health Stephen Donnelly TD (Wicklow, Fianna Fáil), has fielded a number of questions surrounding medicine shortages in recent weeks.

Niamh Smyth TD (Cavan-Monaghan, Fianna Fáil) first questioned Minister Donnelly on pharmacy shortages, asking; “the reason pharmacies are struggling to issue prescriptions for essential drugs for patients on long-term essential medication, namely, valsartan and Krka”.

In response Minister Donnelly stated that; “The Department of Health has been advised by the Health Products Regulatory Authority (HPRA) of one current shortage of a valsartan-containing medicine (Valsartan 160mg Film-Coated Tablets) from Accord, the company responsible for supplying the product in Ireland.”

According to Minister Donnelly, the company has stated that the shortage is due to a manufacturing issue and is expected to return in September 2023; “Alternative strengths, presentations, and generic medicines are available to ensure continuity of care. A pharmacist can generically interchange most brands of valsartan-containing products without needing additional prescriber involvement.”

Commenting on the larger issue of medicine shortages, Minister Donnelly noted that; “medicine shortages are a feature of modern health systems worldwide, which have been exacerbated by recent worldwide events. There are a multitude of reasons why a medicine may not be available including: shortages of raw materials; manufacturing difficulties; sudden unexpected increase in demand; or product recalls due to potential quality issues.”

When then asked by Colm Burke TD (Cork North Central, Fine Gael) regarding another medicine shortage, Minister Donnelly reiterated that medicine shortages are a global issue; “Medicine shortages and their prevention are not unique to Ireland. Similar increases in demand and medicines shortages have been observed in the UK, throughout the EU and across the world at present. In the case of medicines used most often in Ireland, there are typically multiple alternatives available from various sources that remain available to ensure continuity of treatment. Of the products currently in short supply, alternative treatments are available for every single product.”

Holly Cairns TD (Cork South West, Social Democrats), pressed the Minister for Health about; “the steps he is taking to address concerns expressed in relation to the ongoing issue of medicine shortages”. In response, Minister Donnelly outlined the current approach from his Department; “Management of medicine supply issues necessitates a multi-faceted, multi-stakeholder response to ensure patient safety, continuity of care and protection of public health. To that end, at the request of the Department of Health, the Health Products Regulatory Authority (HPRA) has assumed a coordinating function in Ireland’s response to managing medicine shortages when they occur.”

Minister Donnelly was also asked to comment on specific medicine shortages with Éamon Ó Cuív TD (Galway West, Fianna Fáil) asking the Minister about the drug Rivotril, and Peter Burke TD (Longford-Westmeath, Fine Gael) asking the Minister about the drug Ozempic.

In response to Deputy Ó Cuív, Minister Donnelly stated that; “Cheplapharm confirmed to the HPRA on Monday 13, that 30,000 units of Rivotril (over four months’ stock) was en route to Ireland. Cheplapharm estimates that this product will arrive this week. Supply is expected to resume on the week ending 2 April.”

Patricia Ryan TD (Kildare South, Sinn Féin) questioned the effect that medicine shortages have had on consumers; “how people on medical cards can be charged extortionate amounts of money for generic medicines as they are told the original form is out of stock.”

Responding, Minister Donnelly said; “Under the 2013 Act, pharmacists are obliged to offer the lowest cost product on an interchangeable list. Reference pricing means a single reimbursement price, or reference price, for a group of interchangeable medicines that are on the reimbursement list. This is the maximum price that the HSE will pay community pharmacies for all medicines in this group, regardless of the individual medicines’ price.”

Questions around the free contraception scheme raised in the Dail

Catherine Murphy Social Democrats	Hildegarde Naughton Fine Gael

A number of questions have been raised over the free contraception scheme. Colm Burke TD (Cork North Central, Fine Gael) first questioned the Minister for Health on the potential for contraceptives to be supplied to the public without a prescription. He asked Minister Donnelly; “if he will consider the expansion of medicines noted in Schedule 8 of the Medicinal Products (Prescription and Control of Supply) Regulations 2003, as amended, to include the full range of oral hormonal contraceptives and injectable long-term contraceptives”.

This call was later echoed by Róisín Shortall TD (Dublin North West, Social Democrats) who noted that prescribing contraceptives without a prescription is “in line with WHO best practice”.

Responding to Deputy Burke, Minister Donnelly stated; “In order to enable pharmacists to supply the specified products alluded to in your question without the need for a prescription, detailed clinical consideration is required in the first instance to ensure that various patient safety issues are fully respected. Following previous engagement with representative groups, my officials at my direction are currently engaged in a process, which includes obtaining recommendations from relevant clinical experts within the HSE as to the clinical appropriateness of making some forms of currently prescription-controlled contraception, available through pharmacies without the need for a prescription. This process is ongoing.”

Responding to Deputy Shorthall on behalf of the Minister for Health, Minister of State with responsibility for Public Health, Well Being and the National Drugs Strategy, Hildegarde Naughton TD (Galway West, Fine Gael), referenced the ongoing process described by the Minister for Health and stated that; “Thereafter, and with due consideration of the policy position adopted and underpinned by appropriate clinical recommendations and advice, the modality of giving effect to this decision will be considered. Any mechanism introducing this change, or indeed giving effect in a given instance to any other policy decision, must be robust, appropriate in the given context, and legally sound.”

Minister Naughton was further questioned by Catherine Murphy TD (Kildare North, Social Democrats) regarding the coverage of the free contraception scheme. Specifically, Deputy Murphy asked; “if the copper coil is covered under the free contraception programme and if not, the decision-making process that led to it not being included”.

In response, Minister Hildegarde stated that it was her “understanding that the ‘Ballerine MIDI Intrauterine Device’, a copper coil, was included on the Reimbursement List in January 2023.”

Minister for Health questioned on ePrescribing

	Neasa Hourigan Green Party

Neasa Hourigan TD (Dublin Central, Green Party), has asked the Minister of Health for “an update on the business case for the National ePrescribing Project, and if it has been submitted to the Department of Public Expenditure, National Development Plan Delivery and Reform”.

Responding to the Deputy, Minister Donnelly said; “The ePrescribing programme is already established with a governance group in place and regular project board meetings. The project is being led by pharmacists who, working alongside other clinicians and technical teams in the HSE, have the knowledge and expertise to deliver the solution for Ireland. Stakeholder engagement sessions are currently taking place to ensure the needs of patients, prescribers and dispensing pharmacists are understood and captured in the technical requirements. Funding has already been allocated within the 2023 national service plan/ ICT capital plan on the basis the project will proceed. The project does require dedicated resources to complement the core team already in place (existing HSE staff), and that is being addressed through 2023 national service plan allocations.”

Minister Donnelly continued; “When the procurement is complete, and actual costs are known, the business case will be updated, and submitted for final approval. Establishing a full ePrescribing solution in place for Ireland is a core component for electronic health records (EHRs), is fundamental for the delivery of an eHealth programme — and recognised as such by the HSE and this Department. There will be considerable support for the business case when complete. The project will focus on deploying ePrescribing in the community first (GP prescriptions, community pharmacy dispensing), and will be complemented by hospital discharge and other prescriptions afterwards.”

Colm Burke TD (Cork North Central, Fine Gael) reiterated the call for ePrescribing, asking the Minister if; “he will consider the implementation of a fully functioning and funded national prescribing service”.

In response, Minister Donnelly stated; “The purpose of a national prescribing service is to provide guidance to prescribers in making optimum use of available medicines. In Ireland, the Health Service Executive’s (HSE) Medicines Management Programme (MMP) performs this role. Their remit is the enhancement of safe, effective, and cost-effective use of medicines in Irish healthcare.”

Codeine restrictions raised

Colm Burke TD (Cork North Central, Fine Gael) has questioned the Minister for Health on potential plans to restrict access to medication, specifically, “if he has considered restricting the over-the-counter sale of codeine”. Responding to the Deputy, Minister Donnelly said that the HPRA is currently conducting an independent review of the method of sale and supply of codeine-containing medicinal products.

According to the Minister, following the completion of this review the Department of Health will engage with stakeholders to assess the recommendations made.