Mr. Darragh O'Loughlin:

The Irish Pharmacy Union is the professional representative and leadership body for community pharmacists in Ireland. We are involved in the retail pharmacy sector that people see in every town, village and community. Our mission is to promote the professional and economic interests of our members. Community pharmacists in Ireland are highly trained health care professionals and extremely accessible to the general public. Some 85 million individual visits are made by citizens, consumers and patients, to Irish pharmacies every year.

As a result of the increasing demand for health services and the shrinking resources in the sector, the health system is under unprecedented pressure. It is near breaking point in many respects. Hospitals are overstretched and general practitioners are struggling with their existing workloads. According to GPs, their workload will increase dramatically with the introduction of universal health care and universal access to GP care. The current shortage of GPs is unlikely to be solved in the short term, given that over 1,000 Irish-trained GPs have taken up work in the UK health service since 2009. As the population of Ireland grows and ages, there will be additional pressure on the health care service.

Similar problems have been experienced in other countries and solutions have been found. When demand for GP services exceeded the available capacity in England, Scotland and Canada, the unique skills and expertise of pharmacists were used to enhance access to health care. At the beginning of the year the UK Royal College of General Practice and the College of Emergency Medicine, both of which are based in London, estimated that one in seven GP visits in the United Kingdom - equating to 51 million visits annually - and one in 12 attendances at accident and emergency departments could be dealt with by pharmacists, the health professionals 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 GP services sufficiently to allow GPs to provide the additional 4 million consultations which they have estimated will result from the roll-out of free GP care.

Our proposals are not just based on alleviating the workload of GPs because patients would benefit, too. According to data from Scotland, in-depth medicine use reviews conducted by pharmacists with patients suffering from chronic illnesses who were taking a multitude of medications reduced hospital readmission rates by one third. In Canada the scope of practice of pharmacists has been extended to include chronic disease management. This involves monitoring the condition of patients with chronic illnesses; renewing and adjusting their prescriptions, where appropriate, to ensure tighter control of their symptoms; and delivering better treatment outcomes. The extension of pharmacist services in these countries, in response to the shortage of GPs, has resulted in better access to health care and substantial reductions in morbidity and mortality rates from illnesses such as heart disease and diabetes.

Irish pharmacists have successfully introduced a pharmacy-based flu vaccination service in the last three winters. This has shown that pharmacists have the ability to deliver professional health care services outside what might be considered usual pharmacy services. Evidence for the benefits of the improved convenience and accessibility pharmacists provide is seen in the fact that 24% of people vaccinated in a pharmacy had never availed of the flu vaccine previously, even though 85% of them were in an at-risk category. The number of flu vaccinations carried out in community pharmacies doubled between the winter of 2010-11 and the winter of 2011-12 and doubled again between that winter and last winter. More and more patients are seeing convenience as a key driver of vaccinations.

At the beginning of Lent this year the IPU, through its member pharmacies, introduced a smoking cessation service, which was launched by the Minister for Health. This service has been broadly welcomed as making a significant contribution towards the ultimate goal of achieving a tobacco-free Ireland. Public surveys have shown that pharmacists rank second only to nurses as the health care professionals most trusted by the public. Despite this, Ireland, unfortunately, continues to lag behind other countries when it comes to allowing pharmacists to offer the additional services people want. Irish pharmacists are willing, ready and able to help to alleviate pressure on GP surgeries and hospitals by providing a broader range of health care services for patients and the public, in line with what is happening in other countries. Nobody is trying to reinvent the wheel.

I would like to refer to two specific services that could be introduced quite easily and which would be of immediate benefit to patients and the State. The primary aim of a minor ailments scheme would be to allow medical card patients to receive treatment for common ailments free of charge directly from their local community pharmacies. Such a scheme would be cost-neutral to the Exchequer because these patients are already entitled to receive prescribed medicines free of charge with their medical cards. Community pharmacists deal every day with minor ailments as part of their normal practice. They give advice to people on how to treat self-limiting conditions. They work with the public to distinguish between minor ailments and illnesses that have the potential to be more serious. They recommend effective treatments that can be secured without a prescription. As a result, they help to play a role in keeping these minor ailments out of the GP surgery. Furthermore, they refer to GPs, where appropriate. If a medical card patient wants to access a non-prescription medicine for a minor ailment, he or she has to go to the GP to get a prescription. The proposed minor ailment scheme would allow medical card patients to access non-prescription medicines directly from pharmacists without the need to go to the doctor.

The IPU strongly welcomes the recent announcement by the Health Products Regulatory Authority, formerly known as the Irish Medicines Board, that it has drawn up a list of 12 medicines which should be switched from prescription-only to non-prescription status. This will increase the options for patients and consumers in managing their health care with the advice and support of their pharmacists. We hope to see the list published within the next two weeks. The implementation of a national minor ailments scheme, using that list as well as existing non-prescription medicines, would benefit patients by providing greater and easier access to health care. It would benefit the health service by targeting resources at where they are needed and would benefit GPs by freeing up their time to deal with patients who have more serious or chronic illnesses that require GP time.

The second service we are proposing is a medicine use review service which would be useful in assessing people's compliance with their medication regimes and improving their medicine-taking through concordance. The Joint Committee on Health and Children recommended in its report on the adverse side effects of pharmaceuticals that the role of the pharmacist in community health should be expanded and provision should be made for regular medication reviews for all patients. International evidence confirms that the introduction of medicine 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 the use of medicines and expenditure on medicines must be to ensure better outcomes for patients and maximise value for money. The introduction of a medicines use review service delivered through community pharmacy delivers on both of these objectives.

Medicines use reviews are an advanced pharmacy service in England and Scotland and their benefits are evident. As I indicated, the medicines use reviews conducted by pharmacists in Scotland with elderly patients who take multiple medicines have reduced hospital readmission rates by more than 30%, resulting in significant improvements in quality of life for the individuals in question and dramatic savings in the cost of their health care. Similar services are also available in pharmacies in the United States, Australia and New Zealand.

In addition to the two services I have described, which could be implemented most easily because they do not require regulatory or legislative change, the role of pharmacists in providing health checks, health promotions and vaccinations could be expanded. As I stated, given that pharmacists provide vaccinations against influenza, there is no reason they should not be permitted to provide other vaccinations, where appropriate. Other services that could be provided by pharmacists include new medicine services, which would involve assisting people who are starting on a new medicine for a chronic condition to understand the medicine, obtain the best outcome from it and ensure they take it; chronic disease management, which would involve working as part of a multidisciplinary team or in collaboration with a patient's general practitioner and other health care professionals to help the person to manage his or her chronic illnesses; anti-coagulation services, which would plug a significant gap whereby people who are on warfarin and other anti-coagulant drugs do not have access to appropriate monitoring facilities in large parts of the country; monitored dosage system services to enhance concordance with medication; and a dispose of unused medicines properly, DUMP, scheme, which is a way of getting unnecessary and unused medication out of homes. Allowing pharmacies to provide these services would improve access to professional health care; reduce overall Exchequer spending on health care; ease some of the existing burden on general practitioner services, thus freeing up crucial resources; and improve health outcomes for patients and members of the public.

I propose to raise a couple of regulatory and other issues. Pharmacy registration fees in Ireland are the highest in Europe and possibly the world. Pharmacists' income has been cut repeatedly through the Financial Emergency Measures in the Public Interest Act and other Government initiatives. Despite the publication some years ago of a Forfás report on regulatory costs which recommended a review of Pharmaceutical Society of Ireland, PSI, registration fees for pharmacies, fees remain at excessively high levels and far out of line with other countries. They are, for example, almost ten times higher than equivalent fees in the United Kingdom. It is, therefore, high time this issue was tackled.

Under the Pharmacy Act 2007, the Pharmaceutical Society of Ireland, the regulator of pharmacists and pharmacists, has fitness to practise and regulatory responsibilities. Pharmacists are frequently prosecuted before the District Court for the same breaches of regulation for which they have faced internal fitness to practise proceedings, even in the case of technical breaches where there is no risk to patient safety. In addition, in less serious cases, when the fitness to practise process has concluded and a pharmacist has been sanctioned by way of admonishment or censure, the outcome is published on the website of the Pharmaceutical Society of Ireland. There does not appear to be a time limit on the period for which a notice remains on the website, which means, in effect, that the punishment is open-ended and, as such, unjust and inequitable. The Pharmacy Act has been place for almost seven years and the fitness to practise process for the past five years. This is an opportune time to assess the manner in which the Act is being implemented, in particular the fitness to practise provisions, to ensure the system is fair, equitable, transparent, efficient and cost-effective.

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 IPU is grateful to the joint committee for the interest it has taken in this issue - the Minister stated that amendments to the Act, including an amendment to the relevant section, are 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 an amendment was introduced to allow an insolvent pharmacist to continue to practise his or her profession and earn a living. We ask that the joint committee keep this matter on the agenda until it has been resolved and the Act amended.

It is our intention, as a profession, to propose positive solutions to some of the problems and deficiencies in the health system, with a view to providing accessible, convenient and cost-effective health care services for patients and members of the public and, where possible, relieving pressure on other parts of the health care system.

I thank members again for their time and attention and for giving us the opportunity to outline briefly some of the services that could contribute to alleviating the pressure on the health service and improving the delivery of health care. My colleagues and I will be pleased to answer any questions members may have.