Mr. Finbarr Murphy:

I will deal with the first two questions from Deputy Carthy. I will deal with the issue of the decoupling of prescribing and dispensing in the context of the human health service. We do not believe the decoupling of prescribing and dispensing veterinary medicines would benefit the agricultural industry or lead to a reduction in antimicrobial usage. The implementation of such a proposal would have a number of negative impacts.

It would decrease competition in the sale of veterinary medicines. It would unfairly exclude veterinary practitioners from the veterinary medicine market, within which there is strong competition. It would reduce the element of choice and convenience for the consumer. It would be detrimental to animal health and welfare. Currently, there is no economic basis for clinical work in large animal practice. We do not want to see the cost of clinical veterinary services giving rise to animal welfare issues. It would threaten the viability of rural veterinary practices. The sale of drugs is one service area which gives rise to an income stream to support veterinary practices. Private veterinary practitioners operate without any State subsidy. There is no subsidy available for the employment of vets, for computerisation, for practice staff such as veterinary or administrative support staff, or for professional indemnity or practice premises.

One can contrast this with the supports available to maintain GP services in rural areas. The State subsidises the provision of this service to the tune of approximately €120,000 per GP per annum. In-direct subsidies through the payment of a rural practice allowance are valued at €20,000. The allowances for the employment of practice secretaries, nurses and practice managers amount to €93,000. In addition to this, there is a 95% reimbursement of medical indemnity costs. Ultimately, decoupling will leave some of the most isolated farms in rural Ireland without veterinary services. Any policy decision to take away the dispensing of veterinary medicine from veterinary practitioners would lead to a loss of veterinary and veterinary support staff from veterinary practices, which are of significant value to rural areas and local economies. Our policy choices need to support the veterinary infrastructure footprint nationwide and not reduce it.

Between vets and support staff, there are about 6,000 people employed in veterinary practices. Furthermore, experience has shown in EU member states where veterinarians are not allowed to dispense veterinary medicines, this did not lead to reduced use or reduced sales. Neither did it lead to a lower frequency of antimicrobial resistance. The Berenschot report ordered by the Dutch ministry examined in detail the effects of decoupling prescriptions and sale of veterinary medicinal products by veterinarians. It concluded restricting the sale of antimicrobials by veterinarians would not be effective. On the contrary, it recommended strengthening the position of the veterinarian as gatekeeper for antimicrobial use in animals.

It is the view of both Veterinary Ireland and the Federation of Veterinarians of Europe that separating the veterinary prescribing of antimicrobials from the right to dispense antimicrobials is not the solution to combating antimicrobial resistance. The human health model of when the doctor prescribes and the pharmacist dispenses medicines was mentioned earlier. We need to be aware the human health model is a very costly model versus what exists under the animal health model. The State spends more than €3 billion a year in the cost of drugs for General Medical Services, GMS, patients and reimbursements under the drug payment and long-term illness schemes. It buys coverage for 53% of the population. GPs are directly reimbursed in excess of €600 million a year in fees and allowances in respect of medical card patients, including €160 million in allowances for the employment of support staff. Pharmacists receive €400 million per annum in fees. That amounts to in excess of €1 billion in State support for GPs and pharmacists. Therefore, it is important stakeholders recognise the veterinary service is provided in a very lean and efficient manner. Changing the model would ultimately make the provision of veterinary services more expensive while reducing the service for farmers and the public.

Deputy Carthy commented on our claim that vets are available in every parish in the country, 24 hours a day, 365 days a year. I concede there may be local areas where issues arise occasionally. The issue he referred to in County Donegal arose in the context of a lay corporate purchasing and closing down of a practice, and the vets did not really have a say in it. By and large, we are fortunate to have extensive coverage of veterinary practitioners in every parish in the country. We have approximately 1,000 vets employed in food animal practice.