Professor Tom Fahey:

Going back to prescription pattern monitoring and the audit and usage of effectiveness trends for prescribed medicines, I will try to summarise some of the issues. Prescribing is such an important and, I can see from the questions, impassioned issue for everybody in Ireland. I want to put things in the context of initiatives that are going on at present and how we might build on them. There are some very good and important initiatives in respect of prescribing under way Ireland at the moment. I will mention two. On prescribing guidelines, there are two clinical care programmes that I think do pretty good work.

There is no particular conflict of interest in my saying so. The medicines management programme does good work because it provides guidance on prescribing practice that is based on current evidence. Deputy Durkan asked what will happen in terms of Brexit. We have evidence-based prescribing guidance already but we need to build on that through the medicines management programme.

Professor Horgan is better able to talk about antibiotic resistance than I am. We have a good clinical care programme in the primary and secondary care sector that provides very good evidence on first and second line antibiotic prescribing. To build on such initiatives, and returning to the reason for my attendance here this morning, there is an e-prescribing issue. We are falling behind other countries, and European countries in particular, in the aggregation and usage of prescribing data and in how we might continue to improve both the equality and safety of prescribing. That is what we need to take away from today. We have a base of good initiatives but we need to develop a national system where access to public data on prescriptions, retained as part of the Primary Care Reimbursement Service, PCRS, must be more widely available. I mean anonymised data that researchers or postgraduate training bodies or quality improvement bodies can access and use in realtime for prescribing, reflection, practice, audit and feedback. We should prioritise the initiative.

Lastly, there was a question about the high-tech drug versus a generic substitution. We are going in the right direction in terms of generic substitution. The preferred drugs initiative, via the medicines management programme, reflects this. Again, we can do more about that by reducing or enhancing the amount of drugs that we prescribe generically.