Professor Mary Horgan:

The Royal College of Physicians of Ireland welcomes the opportunity to inform the committee about the work in which it is involved to ensure safe prescribing.

The RCPI is Ireland’s largest postgraduate medical training body, with more than 11,000 trainees, members, fellows and licentiates working at home and abroad. The college is committed to helping doctors to enhance their skills, competencies and professionalism throughout their working lives. The RCPI includes six of the 13 postgraduate medical training bodies, including the faculty of occupational medicine, the faculty of paediatrics, the faculty of pathology, the faculty of public health medicine, the Institute of Obstetricians and Gynaecologists and the Irish committee on higher medical training, which includes medicine. It also has two joint faculties, namely, the joint faculty of intensive care medicine of Ireland with the College of Anaesthetists of Ireland and the Royal College of Surgeons in Ireland and the faculty of sports and exercise medicine, which is a joint faculty with the RCSI. The college also provides lifelong learning and continuous professional development for members and allied health care professionals. The RCPI leads 20 ground-breaking national clinical programmes in conjunction with the HSE that are helping to transform health care in Ireland. The college is also a passionate advocate to improve the health of the nation.

As for medical training and education, the prescribing of medicines is a fundamental part of the interaction between doctors and patients and is an integral part of the postgraduate medical training programmes and continuous professional development courses provided by the RCPI. Every year, the RCPI delivers over 200 courses to approximately 7,000 participants to equip health care professionals with the skills to meet the demands of a rapidly evolving society. As a college, our objective is to deliver world-class specialist training to the 1,200 doctors in our basic and higher postgraduate medical training programmes across all the specialties alluded to above, which are in the main delivered in hospitals across Ireland. As these trainees are responsible for a substantial amount of prescriptions given to patients in hospitals, it is fundamental that they are equipped with the knowledge and skills to do this safely and effectively. All of our courses on safe prescribing are mandatory for doctors in our basic specialist training programmes, which is a programme just after intern year. They include awareness of prescription pattern monitoring and the audit of usage and effectiveness trends for prescribed medications and the economics of prescribing. All the doctors who come to the RCPI already will have some knowledge of prescribing as it falls within the remit of undergraduate medical schools. As I have just completed a term as dean of the medical school in University College Cork, UCC, I am aware of this.

In our basic specialist training programmes, safe prescribing is embedded in our curriculum and focuses on prescribing in various medical speciality areas such as obstetrics and gynaecology, general internal medicine and paediatrics. We also deliver a clinical pharmacology training programme for a small number of specialist doctors at a higher level. Our courses are designed to support doctors to prescribe the right dose of the right drug for the right diagnosis to the right patient at the right time. Trainees learn about the elements of safe and appropriate prescribing, adverse drug reactions and to how report them to the Health Products Regulatory Authority, HPRA, risk management and legislation related to prescribing in Ireland. A mandatory course has also been developed for doctors in haematology and oncology that covers the essentials of chemotherapy. Doctors learn about the essentials of chemotherapy, including classification of chemotherapeutic agents, the principles of chemotherapy, standards and the mechanics of chemotherapy and common supportive medications, pharmaeconomics, which is very important, and drug access. In addition to safe prescribing, trainees are taught to help to combat the rise of antibiotic-resistant bacterial infections. I am an infectious disease physician and this is a particularly challenging area of our job in hospital-based medicine.

Antibiotics are the most commonly prescribed drugs and our course outlines the general principles regarding antibiotic prescribing, the mechanism of action and spectrum of activity of commonly prescribed antibiotic, the rates of antibiotic resistance in Ireland and key aspects relating to antibiotic stewardship. This online course is approved by the national hospital antibiotic stewardship committee. Value for money and efficiencies are addressed through an online introduction to the health economics landscape in Ireland that focuses on health service funding models, equity, cost effectiveness analysis and health technology assessments. These courses have all recently been reviewed and updated and are generally updated every three to five years. RCPI is committed to providing world class postgraduate medical training and education for the next generation of specialists and will continue to explore how to enhance this experience in all areas, including prescribing of medicine.