A wide range of issues affecting pharmacy were raised in Leinster House in recent weeks, including expansion of pharmacy services, medicine shortages, regulation of pharmacy technicians and vaccinations. In this article, Brian Harrison, Director at MKC Consulting, provides an overview of the issues raised.
Following the announcement in October of new legislation that will empower the expanded role of pharmacies in Ireland, there has continued to be a consistent focus on the sector in Leinster House in recent weeks.
Deputy Brendan Smith (Cavan-Monaghan, Fianna Fáil) was one of a number of Deputies who asked the Minister for Health Stephen Donnelly TD (Wicklow, Fianna Fáil), about measures that he would look to introduce to expand the role of pharmacists in Ireland.
The Minister spoke about the pharmacy fee structure, outlining that “there has been constructive engagement between Department officials and the Irish Pharmacy Union”.
The Minister highlighted that this engagement has “advanced” in recent months in relation to the “range of initiatives to support an enhanced role of pharmacy”. The Minister also outlined the work of the Expert Taskforce and how the work is continuing to progress to uncover the key stages of “expanding the scope of pharmacy practice”.
During a hearing of the Oireachtas Health Committee Mr. Paul Flananagh, Principal Officer of the Department of Health spoke of the important and imperative work of pharmacists, “who are experts in the use and management of medicines and have been playing an expanded role in the delivery of seasonal influenza vaccinations for some years now”.
Mr. Flanagan outlined work underway by the Department of Health looking at expanding the role of pharmacists. In addition to that, he outlined that “an amendment to the Irish Medicines Board Act 1995 could be made to let pharmacists sell and supply approved medicines without the need for a prescription”.
Deputy David Cullinane (Waterford, Sinn Féin) raised a number of points during the discussion in relation to the role of pharmacists in extending prescriptions. The Deputy welcomed the work of the Taskforce and asked the question on the delivery of extension of prescriptions given to pharmacists and the possibility of plans for a Chief Pharmaceutical Officer role to be put into place, as it is something that the Irish Pharmacy Union has been calling for.
Ms. Anne Marie Seymour, Principal Officer, Department of Health updated Deputy Cullinane on recent changes that will permit pharmacists to extend prescriptions for a “legal validity of 12 months”. Ms. Seymour advised that the Department has a plan to implement this by March 2024.
As the winter approaches concerns around medicine shortages are becoming increasingly prominent. Senator Martin Conway (Fine Gael) said that as the shortage situation continues to linger, “it is putting pharmacists in an awful situation, as they are advising people to take their prescribed medicines”. He added that, “people cannot afford to pay for alternative medicines”, which leads to the patients not taking the medication for a couple of weeks.
Responding on behalf of the Minister for Health, Seán Fleming TD (Laois-Offaly, Fianna Fáil) said he recognised that medicine shortages were an issue felt up and down the country, but highlighted that it was not a situation that was “unique to Ireland”, and added that there is need for a “more comprehensive response from the HSE”.
Senator Conway also called for the appointment of a Chief Pharmacist Officer within the Department of Health and stated that there needs to be “far more intensive engagement both with the IPU and pharmacists in general”. The Deputy concluded his response by reiterating that the first step would be to appoint a Chief Pharmacist Officer.
In another session where the Minister for Health was present, Deputy Pádraig O’Sullivan (Cork North Central, Fianna Fáil), asked the Minister about his concerns around medicine shortages. The Minister stated that medicine shortages are not just occurring in Ireland but that his Department is currently working on streams to better manage medicine shortages.
He specified work on a Medicines Shortage Framework, Pharma Package, Medicines Substitution Protocol (MSP), and Exempt Medicinal Product (EMP). In addition to these schemes, the Minister emphasised that staff within the Department of Health are continuing to work on the “proposed pharmaceutical legislation revision being delivered under the European Pharmaceutical Strategy”.
Deputy Louise O’Reilly (Dublin Fingal, Sinn Féin), raised these concerns with the Minister in relation to a shortage of pain medication. The Minister responded noting that the company who is responsible for supplying Solpadine is currently enduring a shortage of the 24 pack presentation, and added that this is affecting multiple markets and not just Ireland. The Minister, in addition to his response, advised the Deputy that, “HPRA publishes a list of medicines currently in short supply on its website, including the reason for the shortage and when its expected date for the return of supply is”.
Deputy Róisin Shortall (Dublin North West, Social Democrats) raised questions relating to the regulation of pharmacy technicians specifically asking the Minister for Health “if he intends to amend the Pharmacy Act 2007 to provide for the statutory regulation of hospital pharmacy technicians”.
The Minister responded that currently under the Act, “there is no statutory requirement for the PSI to oversee, approve or accredit the education and training of pharmacy technicians”.
The Minister explained to the Deputy that the title of “pharmacy technician” and those who are in that role are “not subject to a statutory professional regulatory regime”. The Minister emphasised the “value of the work that pharmacy technicians do” and alluded to the Workforce Intelligence Report conducted by the PSI which looked to examine recruitment challenges of pharmacists both in the “community and hospital settings”.
One recommendation that stemmed from the report was to develop a “national strategy for the future role of pharmacy technicians within the health system”.
Concluding his response, the Minister explained that while there is work to be done in the realm of pharmacy technicians, that there are “no plans to amend the Pharmacy Act to provide for statutory regulation of pharmacy technicians at this time”.
Following the announcement of Budget 2024 there has been a keen focus on funding for Irish healthcare.
Deputy Róisín Shortall (Dublin North West, Social Democrats), asked the Minister for Finance, Paschal Donohoe if the health service budget for next year was “sufficient to meet patient needs and progress Sláintecare reforms”, and further questioned if “the Minister accepted the fact that was a problem with the allocation made this year”.
Minister Donohoe responded by highlighting investment into the Department of Health; “since 2019, the Government has prioritised investment in the health service, and Ireland continues to spend more of its national income on health than the majority of European countries”.
Deputy Shortall acknowledged that “there was clearly momentum with the progress being made” but noted that “as a result of the allocation” to the Department of Health, this “progress will be slowed down”.
The Minister for Finance responded by outlining progress that has been made in relation to Sláintecare and how they are now “making progress on assisted human reproduction” and pointing to “free contraception for women up to the age of 31 and the drugs payment scheme”.
Deputy Pádraig O’Sullivan (Cork North Central, Fianna Fáil) asked Minister Donnelly “if he intends to create a Chief Pharmaceutical Officer position” in the Department of Health.
The Minister confirmed that “there are no active proposals to develop a Chief Pharmaceutical Officer role in the Department of Health”.
While the Minister recognised the “substantial role pharmacists play in the delivery of patient care”, he also advised the Deputy that there is “potential for this role to be developed further in the context of healthcare service reform”. Recognising the role that pharmacists play, the Minister further spoke to the establishment of the Expert Taskforce and how its requisite is to make “further recommendations to support the expansion of the role of pharmacy”.
Deputy Marc Ó Cathasaigh (Waterford, Green Party) sought updates from the Minister for Further and Higher Education, Research, Innovation and Science, Simon Harris TD, on whether any progress had been made in the “assigning of new schools of veterinary medicine and pharmacy”. The Deputy spoke about his “strong regional interest in the South East Technological University”, as that University has received strong bids for both courses.
Minister for Education and Skills, Simon Harris, noted the Deputy’s comment as a number of institutions had put forward “proposals”, which came from a recent Higher Education Authority (HEA) expression of interest process in relation to the development of courses in both the veterinary medicine and pharmaceutical field.
The Minister explained that his Department, “asked the system what it could do in terms of pharmacy places”, as he also emphasised that there is “a substantial capital cost associated with the development of any new school in pharmacy”. The Minister spoke about the scale of the expansion if it was to occur, and finished responding by stating that he will be working with the Minister for Health on the pharmacy piece, and plans to make progress in the NDP review.
The topic of pharmacy faculties and course development was again raised by Deputy Matt Shanahan (Waterford, Independent) who asked Minister Harris to give an update on the “ongoing process that decides the approval of pharmacy courses development”. The Minister reiterated the “substantial cost” related to the development of courses, adding that it would take some time to “identify options for building capacity in a number of key disciplines, including pharmacy”.
Deputy Carol Nolan (Laois-Offaly, Independent) asked the Minister for Health “to address concerns that some older persons who do not hold a medical card are being asked to pay extra money at their chemist in order to get their medication put into a blister pack”. Deputy Nolan also questioned if reimbursement is an option for such matters.
Responding to the question, Minister for Health, Stephen Donnelly TD said, “medical card eligibility is primarily based on an assessment of means and is not granted on the basis of any particular condition”.
The Minister also spoke to the reimbursement issue, saying “there are no reimbursement arrangements under the GMS and DPS schemes for the filling of blister packs”, and that it is “entirely acceptable for a pharmacy to provide a patient’s medicines in such systems”. In saying this, the Minister also emphasised that this is an arrangement that needs to be made with the patient and is “not State funded”.
As the Winter Flu season approached and as flu vaccinations began, the question of reimbursement for the shingles vaccine was raised to the Minister for Health. Deputy Joan Collins (Dublin South Central, Independents 4 Change) asked the Minister, “the reason as to why there is no scheme in place to reimburse the cost of the shingles vaccine”.
The Minister for Health’s response included highlighting that the “shingles vaccination is not currently provided as part of the national immunisation programme but that it is open to any individual who is aged 50 years and those who wish to receive the vaccine can consult with their GP or pharmacist”.
In other discussions on the vaccinations, Deputies Cathal Crow (Clare, Fianna Fáil) and Michael Moynihan (Cork North West, Fianna Fáil), asked the Minister if there was an intention by him and his Department “to introduce an adult immunisation programme”.
The Minister’s response included highlighting that “COVID-19, influenza and pneumonia vaccines are currently available to a certain group of adults who are most vulnerable to the respective diseases”. The Minister explained that these are available as part of the adult immunisation programme and added that the programme itself “is based on advice of the National Immunisation Advisory Committee (NIAC)”.
While currently there are vaccines available, the Minister added that NIAC as the advisory body continues to “revise recommendations to allow for the introduction of new vaccines and to be kept aware of changes in the patterns of disease”, and “once a recommendation comes to them and is considered by the Chief Medical Officer”, that NIAC can receive the go ahead “to carry out a health technology assessment”.
Within the same discussion, Deputy Michael Moynihan raised it to the Minister for Health if he, his Department and the HSE had considered an information campaign around vaccines and “the benefits of immunisation from a public health point of view”, as he referred to the “negative information and negativity regarding immunisation and vaccines”. The Minister agreed with the negativity that has been put online regarding vaccines and referred to social media platforms working well during the COVID-19 pandemic, and concluded his remarks by suggesting exploring social media further to prevent false information from being a danger to public health.
Deputy Pádraig O’Sullivan (Cork North-Central, Fianna Fáil), also asked the Minister for Health for the number of winter flu vaccines that had been administered as of October 2023. The Minister referred to NIAC as they closely monitor recommendations that “allow for the introduction of new vaccines in Ireland”. The Minister also stated that the “vaccination rates for the current flu season are not available yet”, but are to be published in “due course by the Health Protection Surveillance Centre”.
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