John Gormley (Dublin South East, Green Party)

I welcome the opportunity to speak on this Bill. The Health Service Executive has indicated to the Irish Pharmaceutical Union, the representative body for pharmacy contractors, that it could not negotiate fees or remuneration with the union for pharmacists operating State schemes as this would contravene the terms of the Competition Act 2002 in regard to price fixing.

I have received representations on this matter, as I am sure has the Minister, and on the basis of these I believe the HSE should engage fully with the IPU. The IPU has traditionally negotiated fees on behalf of pharmacists for services provided under the publicly funded drugs scheme over the past 34 years. The HSE is being over-zealous in its approach and it should take seriously the very constructive proposal of the IPU to establish a group of representatives from both sides with an independent chairperson. A negotiating process could then be agreed. If this is not done, the existence of community drugs schemes could be put at risk.

The role of the pharmacist has not been developed properly in Irish society. I agree with Deputy Dennehy, who said the pharmacist is often the person to whom we speak about an ailment and often the very first point of contact. The pharmacist is a highly qualified health care practitioner and is readily accessible in a familiar and informal environment. Recent studies have shown that 75% of patients use the same pharmacy on a regular basis. Community pharmacists can help to remove the pressure from hospitals, including accident and emergency units, and help support general practitioners. Pharmacies should be integrated fully into our primary health care service and this can be done in a responsible way.

The pharmacist can play a very constructive role in administering a structured medicines management regime. Pharmacists themselves have proposed this. It would reduce the wastage in the current system and save the State some money. It would not only benefit the patient but also the HSE.

The IPU has made proposals on medication reviews, with which proposals I am sure the Minister is familiar. Clause 9 of the pharmacy contract requires pharmacists to review each prescription, prior to supply, for potential drug therapy problems, interaction, side effects and incorrect dosage or duration of action. However, once drugs are supplied there is no follow-up. We need to check compliance and for this reason, and others, the IPU has been advocating the introduction of the medication reviews. They are now a normal part of the work of pharmacists in other jurisdictions and they have been shown to have benefits, particularly in the United Kingdom. Preventable drug reactions are implicated in up to 17% of hospital admissions in older patients and many of these admissions could be prevented if patients had a better understanding of the medication they are taking.

The IPU commissioned some independent research in August 2006 which found that one in five Irish patients is on two or more medicines. Some 23% of these patients are concerned that they are not taking their medicines correctly. A study in the United States has shown that a structured medication review practice can reduce the cost of drug-related morbidity and mortality in the order of 60% due to the reduction in GP visits, drug costs, accident and emergency unit visits and hospital admissions. Research in Sweden and Denmark shows that medication reviews resulted in savings of €129 million and could save up to 174 lives per annum. We therefore ought to consider them.

Some of my proposals could be implemented on a pilot basis. I was talking to a general practitioner yesterday evening and he said there was potential in so many areas to address the issue of prescriptions. In this regard the Minister quite rightly raised the issue of the prescription of antibiotics at the Joint Committee on Health and Children. The general practitioner suggested that initiatives in this area could be implemented on a pilot basis to see how we get on and that we would not have to introduce them in full immediately.

When the Minister stated some days ago that we must change people's mindset regarding prescriptions, she was correct, but she stated it would be 12 years before we could get to grips with this problem. This seems like a very long time. We should run a pilot scheme for two years, for example, and consider some of the innovations in other countries. The Minister saw what was being done in Sweden recently. Let us examine this and determine whether we can do the same on a pilot basis. Perhaps we can involve pharmacists in this process.

Responsibility for all these matters extends across the board. The mindset of the patient must be borne in mind in this regard because some patients simply expect to be prescribed an antibiotic when they go to the doctor. General practitioners also pose a problem in that they often dispense antibiotics because, as one general practitioner said to me very candidly some days ago, people will vote with their feet. If they do not get their antibiotic from one doctor they will go elsewhere and the first doctor will lose custom. How do we deal with this problem? The role of the pharmacist, who is the last in the line, is also part of the equation.

There is a pilot medicines disposal scheme called Disposal of Unused Medicines Properly, DUMP. We need to consider disposal because there are so many unused medicines languishing in medicine cabinets in people's homes. These include tranquilisers, paracetemol and antidepressants and some of these drugs have been used in suicides and parasuicides. They are quite dangerous to leave around and this is why the DUMP scheme, which has been piloted by the HSE in the south west since January 2004 and which has collected 13.5 tonnes of medicines to date, needs to be expanded. The HSE Dublin mid-Leinster area, has recently undertaken to fund DUMP schemes through community pharmacies. I do not know the extent to which the scheme is up and running but it should be encouraged and expanded.

The location of pharmacies in health centres was discussed in the Seanad and amendments have been made to the legislation in this respect. I do not know what they cover and will have to consider them on Committee Stage. A real threat is posed to community pharmacies by some of the bigger chain pharmacies, which seem to be more interested in locating in health centres. While this may be convenient for the patient, it results in the squeezing out of local, community-based pharmacists. It also leads to a conflict of interest because, if a general practitioner has a share in the health centre, he or she would be encouraged to prescribe, thus leading to over-prescription. The Minister is trying to address some issues in this regard but there is still a problem. The IPU is of the opinion that we cannot stop this happening — there may be constitutional difficulties in doing so. We must, however, address this so perhaps we could examine it in depth on Committee Stage.

The Green Party feels strongly that pharmacists have a role in health promotion. They already do a great service within the community advising people, but that advice could be expanded to include areas such as diet. The advice is usually concentrated on medication but the pharmacist has an important role to play in health promotion as a source of education for patients and as a means of improving lifestyle.

The IPU has run many health promotion campaigns through pharmacies over the years. In March 2005, the IPU ran a campaign with the IPHA called "ask about your medicines", which was designed to encourage patients to ask the pharmacists for more information about their medicines. A copy of that campaign leaflet was distributed and I was impressed by it.

A survey was carried out that showed that 50% of people do not read the information leaflet contained in non-prescription medicines before taking them. This is a matter of concern and that is why it is important for pharmacists to give advice. Only 30% of those who take other medicines at the same time as non-prescription medicines check the label or even ask the pharmacist if it is appropriate to do so. The pharmacists ran a similar campaign in 2003 followed by a survey that showed an increase of 20% in the number of patients asking about their medicines following the campaign. Such campaigns succeed if they are properly promoted.

In 2006 the IPU focused in its promotions on the management of chronic diseases, particularly heart disease and diabetes. The main aim of the campaign is to make people aware of the risk factors associated with these diseases and to encourage them to adopt a healthier lifestyle, with a view to preventing heart disease and diabetes instead of waiting for them to occur and treating them. Clearly, given the rise in heart disease, type 2 diabetes and childhood obesity, which leads to both conditions, there will be enormous strain on the health services.

Primary health care can work across all sectors, from the GP to the pharmacist, giving people advice and going into the schools. The task force on obesity report is gathering dust but that was a good report that covered all aspects of the problem. It makes sense to start at school level and advise kids about diet. We must have joined-up thinking in all Departments because if children cannot run around in the playground because of the litigious nature of Irish society, or even do not have a playground, problems will build up for the future. Such a sedentary lifestyle is unnatural for children. They do not walk or cycle to school and this will lead to further problems in the future.

The IPU has mentioned the substitution of one medicine for another when it is safe to do so. This is restricted at present and pharmacists, who are highly qualified, should be allowed to substitute a generic medicine, which is often cheaper than the branded drug. Pharmacists should have greater autonomy because they are qualified to make decisions in this regard.

We should empower pharmacists and grant them greater autonomy in decisions on community health care. Doing so can only result in better outcomes. Increasing the role of pharmacists by allowing them to use their knowledge and training is important and removes pressure from GPs. Their know-how would only be used where a visit to a GP is not required. The IPU has pointed out that pharmacists in Northern Ireland are engaged in the minor ailments scheme and pharmacists here can make an enormous contribution in the primary health care network in this way.

We currently do not have a chief dental officer or a chief pharmacist. These positions should be filled as soon as possible. Vacancies of this type only create a vacuum that results in a lack of direction in the sector. I urge the Minister to fill those positions.

Sections 63 and 64 of the Bill deal with the conflict of interest between prescribing and dispensing. I hope we can reach a conclusion on that on Committee Stage because this is what pharmacists worry about most. They feel they will be squeezed out and the multiples do not have the same contact with the community. I take the IPU view on the role of the pharmacist but many of them are also talking about their livelihood. They feel that once the super-duper health care centre is set up with a pharmacy in place, the town pharmacy will no longer be viable. I have seen some of the contracts offered to pharmacists to entice them into the centres and some of the larger companies are playing hard ball. We have a liberalised market and many pharmacists fear that Ireland will be seen as the place to come to and the community pharmacists as a result will go by the wayside.

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