Since the Dáil returned from its summer recess it has been clear that the election is front and centre of every political mind. However, amid budget negotiations and with Government TDs trying to push through last minute vote winners there have been a lot of supportive comments on pharmacy services. As Brian Harrison of MKC Communications reports, fee structures, vaccination programmes and expanding services were all on the agenda.
In the days immediately after the Budget pharmacy fees were raised in the Dáil, with Labour Health Spokesperson Deputy Duncan Smith (Dublin Fingal, Labour) asking the Minister for Health for an update on the “ongoing negotiations on fees for pharmacy dispensing”.
The Minister for Health Stephen Donnelly TD (Wicklow, Fianna Fáil), thanked the Deputy for his “ongoing advocacy and work in this area,” and revealed that he had “allocated full-year funding of €50 million for the negotiations”.
The Minister acknowledged the role of the IPU in ongoing negotiations stating, “the ask from the IPU is a lot bigger than that, it will seek more money, as happens in negotiations, but €50 million is a sizable allocation in the context”.
The Minister further spoke on the process that was in place regarding pharmacy services and fees stating that, “firstly, we needed to get a recommendation on any laws that needed to be changed to enhance pharmacy practice”. The Minister informed Deputy Smith that the laws were now in place and that “we now have a legislative framework to allow pharmacists to extend prescriptions, for medicine substitution protocols and for common conditions”.
Deputy Smith agreed with Minister Donnelly on the importance of pharmacists, who are “highly trained and skilled health care professionals”. He said there is “great potential in unlocking more community care that is in situ and close to where people live (this) is an aim of both the Minister and me”. While the Deputy welcomed the funding allocation, he stated that the “negotiation fee must be addressed”. He also summarised that “before financial legislation was introduced, the dispensing fee was €6 and is now €4.50 with the IPU’s ask in and around €6.50”.
Deputy Smith told the Minister that “a total of 10 per cent of community pharmacies are operating at a loss and up to one third of them are struggling”. He also highlighted that the negotiations are a great opportunity and asked the Minister if he “would be able to match or get close to the figure that the IPU will seek for dispensing fees and other fees”.
Minister Donnelly responded by saying that “it would not be helpful to set out the State’s negotiating position” and noted that “everything can be discussed during the negotiations and that the IPU can discuss the fees that are currently paid and anything else”.
Elsewhere questions relating to pharmacy fees were also raised by several TDs including Michael Lowry (Tipperary, Independent), Steven Matthews (Wicklow, Green Party) and Deputy Michael Healy-Rae (Kerry, Independent) who asked the Minister for Health “when pay for community pharmacies will be restored”.
The Minister responded once again outlining the work between his Department and the IPU and highlighted that, “my Department has been carrying out a comprehensive review of the pharmacy fee structure in the context of its engagement with the IPU and the intended expansion of the scope of the pharmacy practice.”
In addition to an all-important focus on fees, members of the Oireachtas have also been discussing opportunities to expand pharmacy services.
Deputy Richard Bruton (Dublin Bay North, Fine Gael) asked the Minister for Health, Stephen Donnelly, about “his plans to develop the role pharmacists will play in the community.” The Minister said that he “believes that pharmacists can do more for our health services and are highly trusted, highly accessible and highly skilled”.
Minister Donnelly also restated the work of the Expert Taskforce and its development and told the Deputy about the Implementation Oversight Group. He concluded his response by saying that “pharmacist prescribing represents a significant opportunity to leverage pharmacists’ expertise, alleviate pressures on GPs and provide timely care for common conditions”.
Additionally, Deputy Alan Kelly (Tipperary, Labour) asked the Minister for Health about the “estimated full-year costs of fully implementing a minor ailment scheme in community pharmacies”.
The Minister told the Deputy that one of the recommendations from the Taskforce was that “pharmacists should be able to prescribe for a range of common conditions and that the Taskforce recommended an initial list of eight conditions which may be extended over time as the service evolves”. However, Minister Donnelly stated that it was not currently possible to provide a cost for this programme.
Deputy Fergus O’Dowd (Louth, Fine Gael) highlighted the strain many pharmacies are under by mentioning the specific case of a pharmacy closure “due to the pressures of the sector” and asked the Minister if this will be examined.
Minister Donnelly responded by once again acknowledging “the significant role community pharmacists play in the delivery of patient care and noted the potential for this role to be developed further in the context of healthcare service reform”.
The Minister spoke on the continuous engagement between Department officials and the IPU “to extend the scope of practice of community pharmacists”. The Minister also spoke about the pharmacy fee structure and finished his remarks by outlining that he could not “comment on individual cases but believes that there is a real opportunity to work collaboratively with community pharmacists and with other healthcare providers”.
Deputy Seán Fleming (Laois-Offaly, Fianna Fail) has been raising the topic of a Chief Pharmacist at the Department of Health, and sought an update from the Minister for Health on plans to create such a position.
Minister Donnelly provided an update on the work that has been done to expand pharmacy services, such as the work of the Expert Taskforce. He provided an overview of the Taskforce’s overarching recommendations, specifically that “pharmacists be enabled to exercise independent, autonomous prescriptive authority, with this being implemented in a “stepwise manner” commencing with the “introduction of a common conditions service and the development of a pharmacy model prescribing within primary and secondary care settings”.
In relation to the specific question of a Chief Pharmacist, Minister Donnelly said his Department “will consider this further over the coming months and engage with stakeholders through established structures.”
Patrick Costello TD (Dublin South Central, Green Party) submitted a parliamentary question to the Minister for Health relating to EEA prescriptions being rejected asking, “how this aligns with Directive 2011/24/EU paragraph 36 and Article 11 paragraph 1”.
Minister Donnelly provided a summary of Directive 2011/24/EU, which relates to patients’ rights to cross border healthcare.
The Minister confirmed that “there are no plans at this time to legislate to prohibit the dispensing of EEA prescriptions in the Republic of Ireland”. He added that an official in his Department “explored the available options to enhance the safety standards around online EEA prescriptions and as part of this the PSI (Pharmacy Regulator) approved guidelines”.
The Minister also stated that, “pharmacists in Ireland are authorised to dispense from a prescription that was issued by a registered practitioner practising in another European Economic Area Member State . . . pharmacists operate and practice under a statutory framework of legislative and governance controls with the best interest of the patient being the inherent primary principle”.
The Minister for Health has continued to face a series of questions regarding the availability of HSE reimbursement for certain medicines.
Deputy Michael Lowry (Tipperary, Independent) asked “the reason that Linaclotide was not covered by the drug payment scheme or persons who are in receipt of a medical card”.
Minister Donnelly explained that, “the Corporate Pharmaceutical Unit (CPU) is the unit within the HSE responsible for accepting and considering pricing and reimbursement applications”. This unit received a pricing and reimbursement application for Linaclotide under the Community Drugs Schemes in May 2013. According to Minister Donnelly, “following a Rapid Review by the National Centre for Pharmacoeconomics, the HSE considered Linaclotide for reimbursement under the Community Drugs Schemes, but the applicant (Almirall Limited) disengaged from the process”.
The Minister concluded his response saying the reimbursement of Linaclotide had not been pursued to date, and that the “CPU has not received communication from any pharmaceutical company indicating an imminent pricing and reimbursement application for Linaclotide”.
There have been a number of discussions in the Oireachtas on the shingles vaccination programme. Deputy John Brady (Wicklow, Sinn Fein) asked the Minister for Health, “if the HSE intends on rolling out a free vaccination scheme for shingles under the national immunisation programme”. There was also commentary from Deputy Michael Moynihan (Cork-North West, Fianna Fail) who asked “if the vaccination for shingles could be included in the medical card scheme”.
The Minister for Health outlined that the immunisation programme in Ireland, “is based on the advice of the National Immunisation Advisory Committee (NIAC)”. The Minister added that ,the “shingles vaccination is not currently provided as part of the national immunisation programme, but it is open to any individual who is aged 50 years and older and who wishes to receive the vaccine to consult with their GP or pharmacist”.
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