Dáil debates

Tuesday, 22 June 2010

Other Questions

Community Pharmacy Services

3:00 am

Photo of Joanna TuffyJoanna Tuffy (Dublin Mid West, Labour)
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Question 41: To ask the Minister for Health and Children her plans to expand the role of community pharmacists; and if she will make a statement on the matter. [25923/10]

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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I am supportive of an expanded role for pharmacists in the delivery of services at primary care level. Any such expansion of service should be cost-effective, promote the best use of health care resources, be evidence-based, be part of a structured framework of patient care and demonstrate direct benefits to patients.

I am pleased to say there are currently a number of developments taking place in community pharmacy practice; namely, reviews of medicine use, the introduction of private consultation areas in pharmacies and the involvement of pharmacists, both community and hospital based, in ongoing work to implement the recommendations of the report of the commission on patient safety and quality assurance.

With respect to reviews of medicine use, the HSE is currently undertaking a pilot initiative involving pharmacists and GPs working with primary care teams. It is expected that a report on the pilot will be produced by the end of the year. The pilot will take place during the months of June, July and August.

From November 2010 all pharmacies will be required to have a private consultation area in accordance with the Regulation of Retail Pharmacy Businesses Regulations 2008. The purpose of this is to facilitate patients who may wish to have a private consultation with the pharmacist to discuss medication-related issues in private and to receive advice and counselling in an appropriately professional and private manner.

I recently facilitated a meeting between Dr. Barry White, national director of quality and clinical care at the HSE, and the Irish Pharmacy Union to discuss the developing role of pharmacists in public health services and how community pharmacy can contribute to initiatives being undertaken by Dr. White to implement multi-disciplinary treatment guidelines for the management of patients with chronic diseases.

Pharmacists in both community and hospital pharmacy are involved in ongoing work to implement the recommendations of the report of the commission on patient safety and quality assurance, particularly in the area of drug safety, to ensure that medicines are used safely - both high-risk medicines and among high-risk patients - and to improve access by patients to high-quality Irish information on medicines.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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I am intrigued to hear the Minister facilitated a meeting between Dr. Barry White and the IPU.

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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Actually, I attended the meeting. "Facilitated" is the word used, but I organised the meeting.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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I wonder whether that was in order to get around the Competition Act and the difficulties we encountered due to the fact that the HSE could not talk to the IPU. The Minister might provide a reply in this regard.

My other question is to do with reference pricing and generic substitution, a scheme for which was announced by the Minister last week. I am trying to obtain clarity on this. If a GP prescribes a drug that is more expensive than the reference price, who pays the difference for private and public patients?

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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I organised and attended the meeting because I was interested in exploring the role of pharmacists as Dr. White rolls out his clinical pathways. Pharmacists have major expertise and are important professionals in the health care system. I would like to see them more involved in some of the new clinical pathways. The pilot this summer will give us much information about the role of pharmacists. The meeting had nothing to do with the Competition Act. The HSE can meet with the IPU and have discussions about anything except the setting of prices.

With regard to reference pricing, we published the report of the group chaired by Mark Moran, and we will be introducing reference pricing and generic substitution. The intention is that for particular types of drug there will be a generic or reference price drug which will be paid for by the State under both the drug payment scheme and the medical card scheme. The scheme deals only with drugs that provide the same outcome; there is no question of people not receiving the drugs that are appropriate for their conditions. Pharmacists here do not have the power to substitute as they do in other countries. In Ireland, more than 80% of prescriptions are written in their branded form, while in the UK the equivalent figure is 12%. Reference pricing now exists in 25 out of the 27 member states of the EU, and we are now following suit in order to move ourselves into line with these countries. The legislation will be introduced as soon as possible later this year.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I ask the Tánaiste-----I beg the Minister's pardon; that is outdated.

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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I thank the Deputy.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Did the Minister, in the course of any of these contacts, discuss the issue of prescription charges with pharmacy representatives? Such charges are now proposed for medical card holders. Has there been any contact between the HSE and the IPU on the practicalities of operating these additional charges? When is it intended they will be introduced? Will the Minister please note again that I strongly oppose these charges, full stop?

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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I thank the Deputy for promoting me, but it is a different Mary who has the job of Tánaiste.

I have discussed prescription charges with the IPU - not at the meeting I mentioned but at a different meeting - and the union expressed its views. The legislation has been approved by the Government and will be going to the Seanad next week. The intention is to have it operational as soon as possible after the legislation has been passed and signed by the President.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Did the HSE and the IPU discuss the practicalities of implementing these charges?

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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One area in which we have much information is on what drugs patients receive with assistance from the State. For example, all the drug costs of general medical scheme patients heretofore have been paid by the State. The HSE has data on all those patients and the medicines they receive each month and it pays pharmacies accordingly. The intention is that the legislation will provide for a deduction of 50 cent per item prescribed, subject to a cap of €10 per family. No doubt we will be debating this in the House shortly.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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What role does the Minister see for community pharmacists? Does she agree with the basic tenet that I and Fine Gael have been promoting through our fair care policy, which is that patients should be treated at the lowest level of complexity that is safe, timely and efficient?

We are not using the full scope of the primary care team. There are 800 pharmacists trained in the administration of vaccines. There is a role for pharmacists in the treatment of minor illnesses, as the Minister already mentioned, along with health promotion and screening. What specific proposals have been made, and what has arisen from the discussions to date?

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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The fair care policy has not been costed, I am afraid.

Any role for pharmacists must be in the area of appropriate use of medication, but there are other possibilities such as vaccination and screening. In the first instance, however, I am a strong fan of good advice and information for patients about the appropriate use of medication. International data show - this does not just apply to Ireland - that a large percentage of patients with chronic illnesses who are on long-term medication sometimes stop taking their medication, or part of it. This is why the pilot that is taking place in June, July and August, involving pharmacists and ten primary care teams around the country, is concerned mostly with reviewing the safe use of medication.

It was brought to my attention recently that a number of patients with chronic illnesses in the Cork region had had their drugs reviewed and many inappropriate drugs had been given to them. This is not only a patient safety issue but also a quality of life issue; in addition, there are cost implications for the State. Pharmacists have a major role to play in this regard, although, as we have told the IPU, this must be within the limits of the money available at present.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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I ask the Minister to clarify her reply to my other question about generic substitution and reference pricing. If a medical card patient comes to a pharmacy with a prescription for a drug that costs more than the reference drug, and cannot afford to pay the extra cost, does he or she need to go back to the GP to get another prescription? How will it work?

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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I am sorry; I thought I had made it clear. As in other countries, the pharmacist may substitute the generic product-----

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Pharmacists can do it themselves.

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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-----where it is like for like. Under the legislation there must be a legal framework for the system. We will have, for want of a better term, a technical group that will advise on what can be substituted for what. We will begin with a small number of drugs and move on. It generally takes a couple of years for countries to move fully from the old system to a reference pricing or generic substitution system. If for some reason a person wants a branded product even though it is unnecessary for his or her ailment, he or she obviously will have to pay for it.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Is the Minister saying the pharmacist will have the power to substitute products?

Photo of Mary HarneyMary Harney (Dublin Mid West, Independent)
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Yes. That is essential.