Mr. Dermot Twomey:

I am a pharmacist based in Cloyne, County Cork, and the president of the IPU. I am joined here today by Kathy Maher, a community pharmacist from Duleek, County Meath. Kathy is chair of our pharmacy contractors committee. Dr. Susan O’Dwyer is head of governance and pharmacy services. Sharon Foley is IPU secretary general. Our colleague, Jim Curran, director of public affairs and communications, is situated in the Gallery. I would like to start by thanking the committee for the opportunity to address it today. This discussion on the potential of, and challenges facing, community pharmacy is both timely and relevant.

The Irish Pharmacy Union is the professional representative and leadership body for community pharmacy. We have a proud tradition, developed over the last 50 years, of representing and advocating for the vast network of community pharmacists working in communities across Ireland. Our members are committed to delivering a high-quality, accessible and professional pharmacy service that puts patients first and optimises the health and well-being of society.

Community pharmacy is recognised as the most accessible element of our health service with an unequalled reach in terms of patient contact and access. There is a pharmacy in nearly every town and village in the country, with 85% of our population living within 5 km of one. Community pharmacy provides a ready-to-go health infrastructure which we believe can be utilised much better. The crucial importance of the sector and the willingness of community pharmacists to support patients was most apparent in the recent pandemic. Pharmacists ensured they remained open and accessible, providing an essential service at a time of great uncertainty. We played a pivotal public health role by delivering Covid vaccinations. To date over 1.3 million vaccinations have been delivered. Community pharmacy is a highly regulated profession with a commitment to patient safety and quality. Structures are in place to ensure that standards of professional competence and ethical conduct are clearly outlined, communicated to patients and independently inspected on a regular basis. Recent research shows that many Irish people view their pharmacist as the first port of call for their healthcare needs. Community pharmacists are voted consistently by the public as one of their most trusted professionals. We are indeed committed to the Sláintecare ethos of ensuring that the right care is delivered in the right place at the right time for all patients. We believe there is tremendous potential for community pharmacy to realise this ambition. We want to utilise our skill sets and facilitate pharmacists to work to their full scope of practice.

With that in mind we would like to outline some concrete proposals and concepts which could transform the delivery of care in the community. We believe these proposals will help to increase capacity in the healthcare system overall and support in the delivery of better healthcare outcomes. The first proposal I will speak about is the minor ailment scheme. The IPU is proposing a new scheme which holds significant potential to free up capacity in primary care, which we all know is under huge pressure. A minor ailment or triage service would be a community pharmacy-based service. It would be similar what is being implemented in Scotland as the Pharmacy First model. Under this scheme, public patients with minor self-limiting conditions would no longer have to make or wait for GP appointments. Instead, they would consult with their local community pharmacy, receive an assessment of their symptoms followed by a combination of advice, medication supply and-or referral to other services. Existing legislation for the supply and administration of certain prescription-only medicinal products prescription can be amended to provide a route for widening access to the range of treatments available. This would be available to both private and public patients, who would benefit from a wider range of conditions being eligible for assessment and direct treatment in their local pharmacy. The introduction of this scheme would demonstrate Government commitment to enhancing public health access, ensuring timely and equitable access to medicines, delivering quality patient care and, the key point, improving health outcomes. Such a scheme would support national healthcare principles of delivering care that is equitable, accessible, close to the patient and sustainable. Our studies indicate that this could potentially free up 1 million GP appointments, where patients could be treated in community pharmacies or referred as appropriate. This would be a clear example of an opportunity to radically reimagine the delivery of timely care within the community and deliver cost-effective, safe and desired health outcomes. The Irish Pharmacy Union proposes that work now begins on this as it will contribute to addressing immediate capacity issues within the health system.

On access to contraception, it is timely that I am before the committee on International Women's Day. The Women’s Health Action Plan 2022-2023 has demonstrated the commitment of the Minister for Health to prioritise the health of women in Ireland, which we wholeheartedly support. We were delighted with the introduction of free contraception and its further planned expansion and believe that reducing barriers to contraception can only enhance patient care. It has been reported on multiple occasions that women, both in Ireland and abroad, would prefer to obtain their contraceptive from their pharmacist. There is no clinical reason for oral contraceptives to be supplied only on foot of a prescription; with proper protocols this is a very safe and effective healthcare intervention. Experience in other countries demonstrates that reducing cost and increasing access is highly effective in terms of reaching populations who might not otherwise engage with health services, such as new communities, younger cohorts and ethnic minorities. Similar to the minor ailment scheme, we recommend that the Minister now moves to expand the range of medicines noted in Schedule 8 of the Medicinal Products (Prescription and Control of Supply) Regulations 2003, as amended, to include the full range of oral hormonal contraceptives and injectable long-acting contraceptives. Training and governance requirements can then be put in place.

On medicine shortages, medicines are the most common healthcare intervention within the health system. Medicine shortages and the management of patients' needs as a consequence are part of the core function and role of community pharmacy. The nature of our medicine supply chain and its globalisation means that this is becoming more complex than ever before. Pharmacists often have to source medicines from other countries to meet the needs of the local population. Given that pharmacists are experts with a unique skill set and unrivalled pharmacological knowledge, we advocate for the more effective utilisation of this skill set to manage medicine shortages at the point of patient access. This would facilitate therapeutic substitution of medicines without the need to revert to the GP for a prescription in cases where there is a critical shortage of medicines. Again, this is a relatively simple measure which will increase the speed of supply and reduce the stress on patients and pharmacy teams.

I will move on to discuss strategy and a chief pharmaceutical officer. As a country, we need to take a more proactive approach to the management of medicine shortages and indeed to pharmaceutical care in general.

One of the most fundamental and seismic changes that could be prioritised to unlock the potential of community pharmacy is to develop an agreed national strategy for pharmaceutical care. This would help to deliver better health outcomes for patients. This should be owned by the Minister for Health and driven by the appointment of a chief pharmaceutical officer within the Department. As with other professions such as medicine and nursing, this person should be appointed at a senior level in order that the strategy has power and currency.

It is our view that the proposals outlined would make a significant immediate impact by utilising the limited healthcare resources at our disposal better, and we are committed to driving them forward. However, we cannot do this without support. To deliver better health outcomes fully, the sector must be adequately reimbursed and invested in. June 2023 is the deadline for the Minister's commitment to review the fees paid to pharmacists. These fees have not changed since 2009 and have not kept in line with crippling inflation. Our average dispensing fee now is lower than it was in 2008. If community pharmacy is to do more to deliver essential health services, we need to be able to invest in our teams to provide them. Our GP colleagues have had the benefit of substantive talks, resulting in the 2019 GP agreement, which saw a substantial reinvestment in GP services. We are seeking equitable treatment. Community pharmacy now needs to see a similar reinvestment to support future service delivery.

This committee previously debated the crippling, slow progress regarding ICT and healthcare. A modern healthcare system needs functioning e-prescribing and ICT investment and a move away from legacy-based paper solutions. Without improvements in ICT systems to help streamline associated processes, there is now an almost unworkable administrative and cognitive burden associated with dispensing under the community drug schemes. We fully support the HSE's e-health vision to deliver connected and complete digital patient records across all pathways and care settings. Progress in e-health is very much necessary to unleash significant benefits for patients and healthcare professionals. We believe that there are clear building blocks to e-health and, in particular, a national e-prescribing service. Indeed, we have invested in some of these enablers. We want to help the HSE to move off the starting line, but we need partnership from it, with a clear commitment to e-health. This means clarity on targets, timelines and budget.

We believe that community pharmacy can and will play a vital role in the development and implementation of future healthcare reform, in line with Sláintecare, supporting people to stay healthy in their homes and communities for as long as possible. We need investment in community pharmacies to deliver services with a proven dividend in terms of value for money, improved patient outcomes and greater access to primary care for all of the population. It is time for the Government to engage with us on a positive agenda for change and to deliver convenient, accessible and cost-effective healthcare through a currently under-resourced and underutilised pharmacy profession.

I thank members sincerely for their attention. My colleagues and I will be pleased to answer whatever questions they may have.