Irish Pharmacy Union Presentation to the Joint
Committee on Health and Children, Tuesday,1
July 2014
Background
The Irish Pharmacy Union (IPU), with over 2,000 members, is the representative
and professional body for community pharmacists. The mission of the IPU is to
promote the professional and economic interests of our members.
Community pharmacists in Ireland are highly-trained healthcare professionals and
are extremely accessible to the general public with 85 million individual visits made
to a pharmacy every year.
Expanding the Role of the Pharmacist
With increasing demand for health services and shrinking resources, the healthcare
system is under unprecedented pressure. The service is near breaking point with
hospitals overstretched and GPs struggling with their existing workloads, which will,
according to themselves, dramatically increase with the introduction of universal
healthcare. The current shortage of GPs is unlikely to be solved in the short term,
especially with over 1,000 Irish GPs taking up work in the NHS since 2009, while our
ageing, growing population will put additional pressure on an already creaking
system.
Similar problems have been experienced in other countries and solutions have been
found. In England, Scotland and Canada, for example, where demand for GP services
exceeded the available capacity, the unique skills and expertise of pharmacists have
been used to enhance access to healthcare.
In a recent report, the UK Royal College of General Practice and College of
Emergency Medicine estimated that one in seven GP visits (equating to 51 million
visits annually) and one in twelve attendances at A&E could be dealt with by a
pharmacist, who is the health professional best placed to offer advice and treatment
for minor ailments.
Based on these statistics, the implementation of a pharmacy-based Minor Ailments
Scheme in Ireland could ease the pressure on GPs sufficiently to allow them provide
the additional four million consultations which it is estimated will result from the
roll-out of free GP care.
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But it's not just about alleviating the workload of GPs. Patients benefit too. Data from
Scotland shows that in-depth Medicine Use Reviews conducted by pharmacists with
patients suffering from chronic illnesses reduced hospital readmission rates by a
third.
In Canada, pharmacists' scope of practice has also been extended to include Chronic
Disease Management; this involves monitoring patients with chronic illnesses,
renewing and adjusting their prescriptions to ensure tighter control of their
symptoms and delivering better treatment outcomes.
In response to the shortage of GPs, extending pharmacist services in this way has
resulted in better access to healthcare and a substantial reduction in morbidity and
mortality rates from illnesses such as heart disease and diabetes.
In Ireland, the successful introduction of the pharmacy-based flu vaccination service
has proved that pharmacists have the ability to deliver professional healthcare
services. Evidence for the benefit of the improved convenience and accessibility
which pharmacists provide is seen in the fact that 24% of people vaccinated in a
pharmacy had never availed of flu vaccine previously even though 85% of them were
in an at-risk category. The number of flu vaccinations has doubled in community
pharmacy in the last season and in the season before.
The recent introduction of a Smoking Cessation service in pharmacies has been
broadly welcomed and is making a significant contribution towards the goal of a
tobacco-free Ireland.
Pharmacists rank second only to nurses as the healthcare professionals most trusted
by the public, but unfortunately, Ireland lags well behind other countries when it
comes to allowing pharmacies to offer additional services.
If allowed to do so, pharmacists in Ireland are willing, ready and able to help
alleviate pressure on GP surgeries and on hospitals by providing a broader range of
healthcare services to their patients and the public, in line with what happens in
other countries.
The following services could be implemented without delay and would ensure
immediate benefits for both patients and the State:
1.
Minor Ailments Scheme
The primary aim of a Minor Ailments Scheme is to enable medical card patients to
receive treatments for common illnesses free of charge direct from their local
community pharmacy; such a scheme would be cost-neutral to the Exchequer, as
these patients are already entitled to receive prescribed medicines free of charge
through their medical card.
Community pharmacists deal routinely with minor ailments as part of their normal
practice, giving advice to patients on how to treat self-limiting conditions and
distinguishing between minor illness and major disease. By giving appropriate advice
and recommending effective treatments, community pharmacists play a major role in
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keeping minor ailments out of the GP surgery. Furthermore, they act as a filter for
referral where a GP consultation is needed.
The IPU strongly welcomes the recent announcement by the Health Products
Regulatory Authority (formerly the Irish Medicines Board) that it has drawn up a list
of twelve medicines which they believe should be switched from prescription-only to
non-prescription status, which will increase the options for patients and consumers
in managing their own healthcare with the advice and support of their pharmacist.
We hope to see this list published within the next two weeks.
The implementation of a national Minor Ailments Scheme would benefit the patient
by providing greater access to healthcare advice, would benefit the health service by
targeting resources and would benefit GPs by freeing up their time to treat more
patients with serious or chronic illness.
2.
Medicines Use Review Service
Medicines Use Reviews are most appropriate for assessing compliance and
improving medicines-taking through concordance. The Joint Committee on Health
and Children’s Report on the Adverse Side Effects of Pharmaceuticals recommended
that the role of the pharmacist in community health should be expanded and
provision made for regular medication reviews for all patients.
International evidence confirms that the introduction of Medicines Use Reviews
provided by pharmacists has improved health outcomes, enhanced quality of life and
reduced the requirement for hospital care.
The objective of any review of expenditure on medicines must be to ensure better
health outcomes for patients and to maximise value for money. The introduction of a
Medicines Use Review service delivered in community pharmacies will deliver on
this objective.
Medicines Use Reviews are an advanced pharmacy service in England and Scotland,
where the benefits have been seen. As stated already, Medicines Use Reviews
conducted by pharmacists in Scotland with elderly patients who take multiple
medicines have reduced hospital readmission rates for those patients by more than
30%, resulting in improved quality of life for those individuals and dramatic savings
in the cost of their healthcare. There are also similar services available in pharmacies
in the USA, Australia and New Zealand.
In addition to the two services previously mentioned which we believe could be
implemented most easily and with the best immediate effect, pharmacists can also
provide the following services:
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Health Checks
Health Promotions
Extended Vaccinations
New Medicine Services
Chronic Disease Management
Anticoagulation
Monitored Dosage System
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DUMP Scheme
(see Appendix 1 for further details on these services)
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Allowing pharmacies to provide these services would:
Improve access to professional healthcare;
Reduce overall Exchequer spending on healthcare;
Ease some of the existing burden on GP services and free up crucial resources; and
Improve health outcomes for patients and the public.
Regulatory Issues
a) Pharmacy registration fees
Despite the repeated cuts in pharmacy incomes under the FEMPI Act and other
Government initiatives, and despite the recommendation in the Forfás report on
regulatory costs that these fees be examined, the Pharmaceutical Society of Ireland
(PSI) registration fees for pharmacists and pharmacies have remained at excessively
high levels, far out of line with other countries and almost ten times higher than
equivalent rates in the UK.
b) Enforcement by the Pharmaceutical Society of Ireland (PSI)
Under the Pharmacy Act 2007, pharmacists face both District Court prosecutions as
well as Fitness to Practise (FTP) proceedings for the same breaches of regulation,
even technical breaches where there is no risk to patient safety.
In addition, in less serious cases, when the FTP process has concluded and a
pharmacist is sanctioned by way of admonishment or censure, this is published on
the PSI website. However, there does not seem to be any time limit on how long the
notice remains on the website. This, in effect, amounts to an open-ended punishment
and, as such, is unjust and inequitable.
Given that the Act has been place for almost seven years and Part 6, which provides
for the FTP process, has been commenced for the last five, it is now an opportune
time to assess the manner in which the Act is being implemented, in particular the
Fitness-to-Practice provisions, to ensure that the system is fair, equitable,
transparent, efficient and cost-effective.
c) Bankruptcy provisions in Pharmacy Act
Under the Pharmacy Act 2007, the Pharmaceutical Society of Ireland may not
register a pharmacist who is an undischarged bankrupt. In response to questions
from members of this committee, the Minister has previously said that amendments
to the Act, including an amendment to section 14(1)(f) to remove the restriction on a
person who is an undischarged bankrupt from being registered in the PSI Register of
Pharmacists, are currently being examined and will be considered for inclusion as
part of any future amendments to the Act.
However, given the increasing incidence of personal insolvency among all sectors of
society, it is high time such an amendment was introduced so as to allow an insolvent
pharmacist to continue to earn a living by practising his/her profession. We thank
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the committee for their previous support in this matter and ask that it be kept on the
agenda until the issue is resolved and the Act is amended.
It is our intention as a profession to propose positive solutions to some of the
problems and deficiencies in our health system, in order to provide accessible,
convenient and cost-effective healthcare services for patients and the public and to
relieve pressure on other parts of the healthcare system.
Thank you for your time and your attention this evening and for giving us the
opportunity to outline briefly some of the services which we believe could contribute
to the improvement of healthcare in this country. We would be happy to answer any
questions which the committee may have.
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Appendix 1
Pharmacy Services
This submission to the Joint Committee on Health and Children outlines a menu of
internationally-recognised, extended pharmacy services which demonstrate how
pharmacists can improve public health services and shape future services and
pharmacy roles to deliver quality patient care and improve health outcomes. The
services have been identified to address the goals of Healthy Ireland, which are:
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Increase the proportion of people who are healthy at all stages of
life.
 Decrease the prevalence of unhealthy behaviours that contribute to chronic
disease.
 Increase the degree to which diseases and conditions are either prevented or
detected to allow for successful intervention.
 Focus attention on risk factors and effective interventions.
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Reduce health inequalities.
 Reduce the gaps between the highest and lowest occupational classes and
socio-economic groups.
 Target interventions to address the specific needs of at-risk groups.
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Protect the public from threats to health and wellbeing.
 Have effective and integrated strategies to protect the public from new and
emerging threats to health and wellbeing.
 Be prepared to prevent, respond to and rapidly recover from public health
threats.
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Create an environment where every individual and sector of society
can play their part in achieving a Healthy Ireland.
 Create partnerships that will allow this Framework to be implemented.
In addition to a Minor Ailments Scheme and a Medicines Use Review Service the
following pharmacy services are currently carried out in other jurisdictions around
the world with great success. They are intended to enhance services to patients and
provide cost-effective solutions to problems currently encountered by our health
system. They are complementary to each other but each service could potentially be
delivered in isolation from the rest.
3.
Health Check Service
The average community pharmacy in Ireland is open 50% longer than GP
clinics, with the continuous availability of health professional advice in those
pharmacies. Consequently, pharmacy-based health checks would have
significant advantages in terms of reach, accessibility and cost-effectiveness.
Health checks could prove effective in identifying those at risk of developing a
chronic disease such as diabetes mellitus, cardiovascular disease, osteoporosis
and chronic obstructive pulmonary disease.
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4.
Health Promotion Service
With 85 million people visiting community pharmacies every year in Ireland,
pharmacists are in an ideal position to communicate health promotion
messages. Community pharmacists have delivered a number of such campaigns
in recent years, in conjunction with patient groups, and are now seeking a more
structured health promotion role with the support of the HSE.
5.
Smoking Cessation Service
Pharmacists play an important role and are uniquely placed in the heart of the
communities they serve to intervene with their clients to help them stop
smoking. Most of their clients seek health advice and are receptive to it. In their
professional role, pharmacists can promote smoking cessation by giving advice
on quitting and health related benefits.
6.
Extended Vaccination Service
The pharmacy profession welcomed the decision by the Minister for Health to
introduce legislation in 2011 to facilitate pharmacists in participating in the
seasonal influenza vaccination programme. This has significantly improved
access to such a vital healthcare intervention and we would now like to see
vaccination services extended to include pneumonia, Hepatitis B, cervical
cancer and travel vaccines.
7.
New Medicines Service
A new medicines service aims to provide early support to patients who are
newly prescribed a medicine for a long term condition, with repeated follow-up
in the short term to increase effective medicine-taking. The objective is for the
new medicines service to help people who are prescribed a new medicine for
certain long term conditions to manage their condition and to improve their
medication adherence through providing clinical support at the outset of taking
new medication.
8.
Chronic Disease Management Service
The clinical benefits of pharmacy involvement in chronic disease management
are compelling, with a large evidence base detailing that pharmacists have the
most frequent contact with patients with chronic diseases due to their
accessibility and that pharmacists could provide clinical and cost benefits
through the existing community pharmacy network. It is envisaged that chronic
disease management will be a collaborative initiative between the GP, practice
nurse, community pharmacist and other healthcare providers.
9.
Anticoagulation Service
In Ireland, most patients attend a hospital warfarin clinic to have their INR
tested, typically having to wait for several hours before their results are
confirmed. Indeed, in some parts of the country, there is no such clinic.
Community pharmacists, as experts in medicine, have an ideal skillset to
manage patients on warfarin successfully and are well placed to provide such a
service.
10. Monitored Dosage System Service
Monitored Dosage Systems (MDS) are devices or packaging systems where
doses of one or more solid oral medications can be organised according to time
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of administration. MDS can lead to cost savings through improved patient
compliance, reduction of waste and better medicines management. MDS have
been shown to improve patients’ confidence in medication taking and prevent
previously non-compliant patients from being admitted to high cost healthcare
facilities.
11. DUMP Scheme
A Disposal of Unused Medication Properly (DUMP) scheme is a potential way of
restricting access to means for suicide and deliberate self-harm, accidental
poisoning in children and preventing environmental pollution, as it encourages
patients to return their unused medicines to their local community pharmacy.
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