Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I am glad to have the opportunity to raise this important matter. I, and I am sure most Deputies, have had recent discussions with their community pharmacies, particularly over the weekend. I have been inundated with phone calls, emails and letters, and I have some of them with me. I intend to pass them on to the Minister for Health, Deputy Harris, at the earliest possible convenience.

Alarm bells have been sounded as a result of the recent proposal by the Department of Health that outlined changes to pharmacy fees to commence next year. It has been calculated that the cuts will result in a reduction in income of at least €12,000 per annum if the proposals for changes to the dispensing fee per item, the reduction of the number of items paid at €5, and the abolition of high-tech patient care fees are imposed in January.

This is the polar opposite of what was expected by the Irish Pharmacy Union, IPU, and pharmacy owners. They believed that, rather than the imposition of additional cuts, the cuts imposed under the Financial Emergency Measures in the Public Interest, FEMPI, Acts would be unwound.

Concerns have been raised with me about the impact on rural, isolated, disadvantaged communities and independent pharmacies. That impact will be disproportionate on those in large population centres. Concerns have also been raised about the sustainability of community pharmacies where margins are as low as 4%. Some believe that they will not survive, especially with no alternative funding stream identified. One cannot but support their assessment of the situation. Curtailing services to patients will cause significant issues for GPs, hospitals and the HSE. The pharmacy is often the first port of call for patients and they retain a high level of trust with the public.

Pharmacists are mystified as to how this proposal has come about. During our period of financial austerity, they took the required cuts in the national interest. I am told that they are the only profession not to have had fee restoration. Increased investment, not cuts, was expected at this stage, especially in light of Sláintecare. A new pharmacy contract and investment in improved pharmacy services to benefit our people were expected.

There are 2,300 community pharmacies across the country. In my county of Offaly, 29 pharmacies are providing support for over 800,000 patient visits, with more than 250 jobs required to do so. I understand that the Minister, Deputy Harris, has prioritised a meeting with the IPU this week. I ask the Minister of State to convey to him how urgent it is to find a solution to this matter, which is causing unnecessary worry for pharmacists across the country and their staff. It is crucial that negotiations be entered into in 2020 as expected and in good faith.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Corcoran Kennedy for raising this important matter, which I am taking on behalf of the Minster for Health. The Minister values the important role that community pharmacists play in the delivery of holistic patient care in the health service. He has given a clear commitment to commencing a thorough review of the pharmacy contract in 2020. It will address the role to be played by community pharmacies in the context of Sláintecare and consider all aspects of pharmacy service provision, including delivery of a multidisciplinary model of service delivery for patients, ensuring clarity of roles and achieving optimum value for money.

A new agreement that is fit for purpose and seeks to strengthen our primary care system is required. The vision and approach that underpins Sláintecare needs to be mapped out for the community pharmacy sector. This primary care model will be integrated with other health policies that will require the expansion of the scope of practice and the range of public services provided in community pharmacy. Any publicly funded pharmacy service expansion should address unmet public health needs, improve access to existing public health services or provide better value for money or patient outcomes. Accordingly, the decision to provide such services should be evidence based.

The Minister expects to see discussions on a new contract begin early in the new year because he fully believes that community pharmacy contractors have an important contribution to make to realising the future vision for community care, which needs to be enabled by a modern and fit-for-purpose contractual relationship with the HSE.

The Minister addressed the IPU at its national pharmacy conference in May and gave a clear commitment to move beyond the arrangements underpinned by the FEMPI Act 2009 with a view to optimising the role of pharmacists in the years ahead. In the meantime, however, the Minster is obliged to put in place before the end of this year a new framework to maintain a statutory basis for contractor fees, as the existing regulations will be revoked from the end of this year in accordance with the Public Service Pay and Pensions Act 2017.

Prior to the making of the new regulations, the Minister is required to consult the representative body for pharmacy contractors, the IPU. In that respect, departmental officials wrote to the IPU on 10 October inviting it to discussions on the making of the new regulations. Subsequently, meetings were held in the Department on 24 October and 7 November, following which a detailed submission was received from the IPU. That submission is being considered by the Department in the context of the statutory fee-setting process referred to previously. The Minister is due to meet the IPU this week to discuss these matters further.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank the Minister of State. It is welcome that the Minister is to meet the IPU this week. The conference was mentioned. The comments that the Minister made there have left pharmacists feeling let down and betrayed because they had the impression that the FEMPI measures would be unwound. They also believed that their submission to Sláintecare could save the State €90 million or more on biologic medicines. This contrasts with the proposed cuts, which would take €50 million out of the service.

This situation is causing significant worry. If we are to succeed with Sláintecare and in delivering at community level, it is crucial that the concerns raised by the IPU and pharmacists more widely are addressed as soon as possible so that they will not have this issue hanging over them going into the Christmas period. There will be a knock-on effect on their staff, who feel that they will be impacted, particularly in rural areas, by what they have seen from the Department to date.

Finian McGrath (Dublin Bay North, Independent)
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I take the Deputy's points. I reiterate the Minister's appreciation for community pharmacists in delivering care to patients and I restate his desire for contractual discussions to commence early in the new year so as to enable their role to be further developed in the context of health service reform and modernisation. However, the Minister is also cognisant of the fact that regulations made under the FEMPI Act 2009 expire at the end of 2019 and that a new set of fee regulations will need to come into effect in order to maintain a statutory basis for pharmacy payments from 1 January 2020. Prior to finalising these regulations, a consultation process is under way with the IPU and further discussions will take place this Thursday in Leinster House. The Minister will keep the Dáil informed as that process develops.

I take the Deputy's points regarding pharmacists, fee restoration and investment. She mentioned the 29 pharmacies in her county. I will bring her concerns to the Minister over the next couple of days.