Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I am happy to update the House on the recently reached community pharmacy agreement and to take an opportunity in this House to recognise the very significant role that pharmacists play in delivering a more accessible and integrated health service across the country.

Shortly after becoming Minister for Health in January, I began engaging with the Irish Pharmacy Union, IPU. It was the first representative body I met, and we clearly set out an ambition together for the future of community pharmacy. When I spoke at the IPU conference in Kilkenny, again, we set out my vision for sustainable reform and expansion of services to future-proof pharmacists’ role in health services through diversification and service expansion. We in the Dáil have already seen that in areas like vaccination, when we ask our community pharmacists to get involved, they step up and the result is increased access for patients and the alleviation of pressure in other areas of our health services.

Budget 2025 provided for free hormone replacement therapy, HRT, medicines and related products for women for the treatment of menopause and also a separate allocation of €50 million - the full year cost in 2026; pro rata in 2025 - to support investment in community pharmacy and the commencement of fee negotiations with the IPU. In this context, in May of this year, I secured an agreement with the IPU to deliver the HRT initiative, alongside free dispensing fees, along with an agreed framework of engagement to commence contract talks with the IPU.

That is why on Friday 12 September, I and officials in my Department were really pleased to complete the community pharmacy agreement 2025 with the IPU and the HSE recently. On that same date, the union's governing committees endorsed the community pharmacy agreement 2025, and on Thursday 18 September, I published the agreement. This is the first national agreement with community pharmacists since the original contract was established in the early 2000s. It follows intense negotiations throughout the summer, between the Department of Health, HSE and IPU. I thank all of the parties that were involved and that engaged so intensively to enable the conclusion of this agreement. It built on the work done by my officials and by the IPU through a series of ongoing engagements and meetings since mid-2023, addressing themes such as the role of community pharmacists, pharmacy funding, service expansion, administrative complexity and digital enablement.

This agreement supports commitments to expand pharmacy services, provides new investment in the sector and supports value for money and modernisation and digital reform. It will support investment of €25 million in 2025 for fee adjustments and service establishment; €50 million in 2026 for full-year implementation, training optimisation programmes and new services; and €20 million in repurposed existing community pharmacy funding. This agreement marks a new chapter for community pharmacy in Ireland, and I thank the IPU for its collaborative approach to these negotiations. Its officials have been strong advocates for their profession, and this agreement demonstrates what can be achieved when we work together in partnership.

We know patients want timely access to care in their own communities. That is why, particularly at an acute hospital and community level, I am putting such an emphasis on productivity and the importance of consistency for our patients as they engage with our services. We must do better, and we can do better. Strategic shifts in approach, like the community pharmacy agreement, will mean that we are better utilising our existing network and freeing up capacity in other pressured areas of our healthcare services.

The programme for Government set out our commitments and ambitions for community pharmacy. It recognises the significant potential for the enhancement of the role of community pharmacists in providing accessible health services. The community pharmacy agreement 2025, in various ways, materially contributes to the delivery of these commitments and our vision for a sector that can grow and expand its services to support patients and build capacity in our health services. The agreement is comprehensive and extensive. It covers a wide variety of key issues in community pharmacy and provides for the participation of community pharmacy in new services, including bowel screening; immunisation programmes; common conditions service; oral contraception prescription continuation; national condom distribution service; medicines optimisation, commencing with point of care testing; and unused medicines return and disposal. I will speak about each of these issues in turn.

On bowel screening, community pharmacists and their teams, as really, genuinely trusted healthcare professionals, can play an important role in supporting increased uptake of the BowelScreen programme, which is an area where we have a concern. They will do this through promoting the programme at population level as well as enhancing access by supporting individuals to participate in the programme. It is, therefore, another point of contact for the programme, which we want people to take up. Pharmacies will be enabled to identify eligible patients, based on age, proactively invite the person to participate in the programme, register them on the programme and order the faecal immunochemical test, FIT, kit. A model of service and ICT upgrades are required before this service can be launched in the second half of 2026. It has been agreed that pharmacies will be paid €5 for each person registered by them for the BowelScreen programme. In addition, an annual €500 allowance will be given to each pharmacy that supports BowelScreen promotion. This is really important. As Deputies will be aware, we have a screening programme and we do not have sufficient uptake within the existing cohort, so we have to look at every mechanism we can to expand uptake. I hope that this will be a measure that makes it more convenient for people to engage in the programme and get the bowel screening that they need.

On the immunisation programme, the training and competence of community pharmacy as medicines experts must be fully utilised. Community pharmacists administer one in every three vaccinations under the influenza and Covid-19 vaccination programmes. The opportunity for an expanded pharmacy role in immunisation has been an important stream of dialogue within the talks. Pneumococcal disease is a bacterial infection that can lead to significant morbidity and mortality, particularly amongst the very young, the very old, those with impaired immunity and those with anatomic or functional asplenia. Prevention of disease through vaccination is now more important than ever. To support increased vaccination, it has been agreed that community pharmacists can administer the PPV23 vaccine to healthy over 65-year-olds. For medical card holders, pharmacists will be paid the same fee as GPs.

It has also been agreed that the IPU will positively engage with the HSE, exploring how community pharmacy could take on a substantive role in schools' immunisation. A programme of work will be developed to explore the scope and nature of this. There is a substantial opportunity for the State to improve the delivery of schools' immunisation and its efficiency through the support of community pharmacy. Service models, fees, legislation and data protection matters need to be addressed as part of this programme of exploration. An enhanced immunisation fund, with a dedicated annual funding of €2 million, has been ring-fenced from 2026 onward. This will be used, in the first instance, to facilitate the participation of community pharmacy in the school immunisation programme and to scope out their potential participation in other national vaccination programmes, as appropriate.

On the common conditions service, which is the area of real excitement and real opportunity for people, since the publication of the final report of the expert task force to support the expansion of the role of pharmacy, my Department has been engaging with a range of stakeholders to implement the recommended common conditions service. This service will enable community pharmacists to manage common conditions by offering self-care advice, safety-netting and, when appropriate, supplying certain over-the-counter medicines and prescribing prescription-only medicines through established protocols. Pharmacies will be enabled to establish the common conditions service from late 2025. Pharmacies will be entitled to charge their patients a consultation fee. However, medicines will be reimbursed by the State in accordance with a person’s eligibility under the community drugs schemes. Patients, including medical card holders, who choose to access the common conditions service, will pay a consultation fee at the rate charged by the pharmacy.

Patients, including medical card holders, who choose to access the common conditions service, will pay a consultation fee at the rate charged by the pharmacy. To incentivise its establishment, a once-off grant of €2,000 will be provided to pharmacies that commit before 1 December 2025 to establish the service by the end of quarter 1 2026.

The huge advantage is medical card patients can continue to go to their GPs as normal, or they may choose to go to the pharmacy and pay a consultation fee. Private patients may continue to go to their GP as normal or choose to attend the pharmacy and pay a consultation fee, which I expect will be of a lower order than the GP fee. It means much faster access for prescribing, where appropriate, for basic common conditions, including basic bacterial infections such as urinary tract infections or conjunctivitis. By enabling people to choose to use the pharmacy instead of their GP, should they wish, we hope to expand access to this primary form of healthcare in this very basic way making life slightly more convenient when accessing the basic prescriptions we all need from time to time. I very much hope it will be in place by the end of quarter 1 2026.

On oral contraception prescription continuation, the continued supply of short-acting reversible contraception by community pharmacists is being progressed in parallel with the common conditions service. That will allow pharmacists to continue a prescription for oral contraception meaning patients can, in effect, have their prescription renewed by a pharmacist rather than reattending a GP. Pharmacists will be required to do various health checks as part of the protocol. Operational guidance will be provided to pharmacists shortly and information will be provided to the public in due course. For those within the eligible age range, this service will be integrated into the free contraception scheme and pharmacists will be paid a fee by the State for this service. That will be implemented following the necessary training and various changes to legislation.

The national condom distribution service distributes free condoms and lubricant sachets to services working directly with population groups who may be at increased risk of unplanned pregnancy, HIV or STIs. As part of this agreement, the service is now extended to community pharmacists who will identify potentially at-risk patients and provide them with relevant products.

It has been agreed to establish a rolling annual medicines optimisation programme, with a dedicated annual funding allowance of €4.5 million from 2026. This yearly budgetary allocation is ring-fenced for community pharmacy delivered optimisation programmes. This fund will support the establishment of a proof of concept for the use of point of care testing, POCT, in community pharmacy for respiratory illness. It is anticipated that this would evaluate the role of POCT in reducing GP attendances and, importantly, unnecessary prescribing of antibiotics. It will be a control measure.

On unused medicines return and disposal, enabling patients to safely return their unused medicines to their local community pharmacy restricts access to unused medicines, thereby reducing harms to the environment, the risk of accidental poisoning in children and the risk of suicide or self-harm. A new national service will be established, which will enable people to return their unused medicines to their local community pharmacy. A sum of €4.5 million is being allocated for this. The HSE will commission the service with each pharmacy being required to participate. This service will commence in the second half of 2026.

I will speak about the emergency medicine administration preparedness allowance. To recognise that community pharmacists are authorised to administer emergency medicines, that this service is provided on an ad hocbasis at the moment requiring pharmacists to be trained and ready to respond, and the disruption this may cause to pharmacy practices when they administer emergency medicines, we have provided an annual recurring allowance of €525 that will be made available from 2026.

On training, education and development, as the scope of practice of community pharmacists widens, so too does the need to develop and empower pharmacy support staff to ensure the success and sustainability of these changes. This shift requires upskilling and formal recognition of support staff roles to maintain safety and efficiency. To support improved training capacity, the annual training grant for pharmacies will be doubled from 2026 onward. The grant will increase from €1,270 to €2,540 per pharmacy. Additionally, a contribution of €500 per pharmacy will be made available to support the purchase of mandatory reference texts.

It has also been agreed that the core dispensing fees across the community drug schemes will increase by 10% overall. That change will apply to the following schemes: the general medical scheme; the drugs payment scheme; the long-term illness scheme; the European Economic Area scheme; and the Health (Amendment) Act. Currently, the dispensing fee is a tiered structure when fees are paid based on the number of items dispensed in a month. The top tier will increase from €5 to €5.60 for the first 1,667 items dispensed, which is an increase of 12%, the middle tier will remain at €4.50 for the next 833 items and the final tier will increase from €3.50 to €4.10 for any further items, which is an increase of 17%. This new dispensing fee structure will be backdated from 1 September for all community pharmacy contractors who sign up to the new agreement. My Department is progressing the necessary legislative changes to enable this.

In the context of the overall agreement and settlement package, the State has also secured key commitments from community pharmacy relating to reform, modernisation and the digital agenda, which is something we spoke a good deal about at a health committee meeting yesterday. This is imperative as the full participation of community pharmacy is a critical factor, as we all know, in the successful delivery of these State-sponsored reforms. The agreement will provide the basis for community pharmacy and IPU co-operation with the full ehealth agenda, including the national eprescribing programme, shared care record, HSE app, electronic health record, etc. As these programmes advance and roll out, the co-operation of community pharmacy will be a critical success factor. The Department will progress a number of regulatory reforms over the coming months to improve efficiency and free up capacity in community pharmacy.

The community pharmacy agreement marks a significant milestone in strategic collaboration between the Government, the Department of Health, the HSE and the IPU. It sets out a comprehensive and ongoing pathway to modernise and expand the role of community pharmacy, to enable community pharmacists to work at the top of their expertise and to increase accessibility within our healthcare system more broadly. The agreement will support the delivery of safe, equitable and efficient healthcare, and ensure that community pharmacists are better equipped to contribute to national health priorities through engagement, sustainable funding and integrated service delivery.

We are trying to build a service that not only responds to those who need it most, but does so in a way that puts the patient at the centre because pharmacists are trusted and rooted in every community they serve. We are trying to expand their role in healthcare generally to provide for better accessibility, safer, quicker prescribing and, obviously, the management of drugs, particularly through the unused drugs scheme, as is necessary and appropriate. I am pleased to provide the details of the agreement to the House.

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