Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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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.

David Cullinane (Waterford, Sinn Fein)
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I welcome the agreement. The Minister's predecessor admitted a number of years ago that the engagement with the Irish Pharmacy Union was not what it should have been and the State was not making the best use of community pharmacies. A number of years ago, I published a very comprehensive plan that set out a lot of what is in this agreement, and more, in relation to what we could do. It included many of the important schemes, such as the common conditions scheme, which is very important, provides a lot of potential and can be built on. My plan also included more prescribing, on which there was pushback from the Department at the time. It had some concerns about it but I am glad those issues have been resolved. All of that is important, as is pharmacies playing a larger role in vaccination. Everything we can do to take pressure away from our acute hospitals and GPs, is of value to the health service.

Looking at the volume of community pharmacists we have, it should be accepted that we are simply not making best use of them. They are available, they want to do it, and they can and will do more, but they will say they have to be resourced. As part of discussions I had with them previously, the issue of fees was something they wanted to discuss. I always made the point, in a very honest conversation with them, that whatever discussion needed to be had on fees, there had to be a quid pro quo, a return for the health service and for citizens and better use of community pharmacies. There is still more that can be done. I ask the Minister to see this as a start. This is the beginning and a foundation. It is really good and a step forward, but much more can and should be done over the time ahead. We can build on this and on the agreement that is in place.

I will raise one issue on vaccinations. I strongly believe we should be looking at RSV and shingles vaccination. An application is going through the system at the moment to provide shingles vaccination to those over 65 years of age. There is an issue with the funding and costs of that, but it is very important and should be supported. I always agree that there has to be value for money. I know there is a process but, at the same time, we have to look at what the best way is to protect older people, particularly in an ageing population, where that population needs greater supports during the winter months.

It is actually through prevention, such as the flu vaccine, which is already available, but it should also be through other vaccines where people are at risk and older people at risk. I ask the Minister to look at that issue in the context shingles. It may be complicated by the fact it is not off-patent and there is only one provider. That may be the issue but that should not be a block. The Department and the Minister should look at that.

More can be done by pharmacists on health checks. It was something I put in the plan I published a number of years ago for cardiovascular checks. Unfortunately, it is one of the illnesses that is one of the big killers, along with cancer. We have a lot to do with cardiovascular care. There is a need for a more comprehensive cardiovascular strategy. To park that to one side, there is a lot more community pharmacists can do to help, particularly with health checks and monitoring cholesterol levels for those at risk. They can be tell tale signs there is a problem.

I ask the Minister not to do what her predecessor did, which was take a piecemeal approach to this and make announcements that pharmacists would do wonderful things but not have any of the i's dotted and t's crossed. We saw that with the free HRT and other areas where messes had to be cleaned up as well. Very simply, they had to be cleaned up because the Minister went out and made an announcement without having any engagement with the pharmacists or having any agreement in place. That was the wrong approach. The best approach is to engage with pharmacists and have collaboration and partnership and then have a framework in place that actually works. That is the model I certainly support and the model under which more should be done.

This is welcome. I support it and I called for almost everything that is in this but there is more to be done. We can build on it and hopefully, that is what will be done in the time ahead.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Gabhaim buíochas leis an Aire as seo a chur chun críche. It is good news for community pharmacists but in particular, it is good news for the community. That is one of the key points. For far too long, highly qualified medical practitioners were not allowed practise to the best of their abilities. These are some of the small changes that can be taken to recognise how highly qualified, informed and vital they are to the community. Each of us will know from our own family of people who have gone to the pharmacists and identified a problem of which they were not aware or they have helped them in emergencies and pointed them in the right direction or to the need for a change in medication.

This is a recognition of their vital role in the future. My colleague and the Minister mentioned GPs. This will hopefully relieve some of the pressure on GPs but a lot more can happen in this regard and there needs to be greater synergy between the two professions to ensure that it works better than it has. At the moment, a GP will prescribe medication but patients have to keep going back if it is a repeat prescription. The pharmacist can now take that on board but patients still have to get the agreement of the GP. When they ring the GP, there is a cost to them and that is one of the blockages as it can be hugely costly. Even for just a phone call to a GP practice, it is still €20 or €25 to send the prescription to the pharmacist. It is a press of a button for a repeat prescription and there is no need to see the doctor in most cases. The doctor will call patients in once a year or once every two years, depending on what the medication is. That type of blockage and cost to those who need medication needs to be lifted.

I welcome the change that was announced, although I do not have the exact details, to deal with unwanted and unused medication. We have all dealt with family members who have passed and you go into the cupboard and there are hundreds of pieces of medicine that have never been used. The worst thing is we still have not found a way of utilising those thousands of euro worth of medication. It just sits in the press when a person has passed and it is of no use. Even now, if is brought back to the community pharmacy but it will go to landfill, incineration or whatever will happen. The problem is that some of this has not been touched and the seals are in place along with everything else. There has to be a way to use them because of the cost, most of which is to the Exchequer and to the patient themselves. This is a waste of money. It might addressed the issue of overprescribing but it is not just that. Sometimes people forget to take their medicine on a regular basis.

I welcome the agreement. Hopefully, over the next while, we will be able to address the small, practical changes that can happen to make life easier for those who have that interaction with either the GP or the pharmacist. Pharmacists are one of the most trusted medical professions there are. They are always very jolly in any of the pharmacies I go into and happy to help and direct me to the right place. They are happy to share their advice at no cost most of the time because people just go in to have a chat. I wish all the GPs could do the same but they are run off their feet, in most cases. Well done on introducing it at long last but now we have to do all the rest of the work.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Before I get to my contribution, I would like to outline my solidarity with those who have been illegally kidnapped from the Global Sumud Flotilla by the Israelis. I ask the Government to fulfil its obligations to ensue safe passage. There were promises made earlier. We think of Senator Chris Andrews and I believe Barry Heneghan may be taken in the next number of days. We need to make sure we do absolutely everything we can from our point of view to protect the Irish citizens and those who are not.

On the community pharmacy agreement, there is nobody who, if they were asked a number of years ago, would not want it to be the case where they did not necessarily have to go to the GP for X, Y and Z and they could make a journey to the pharmacy to deal with small ailments, particularly colds and flus and on behalf of young children and the multiple issues they deal with. While I welcome many of the changes with the introduction of the CPA, like my two colleagues, this should only be the start of putting a full framework in place and that we can deal with all the services that communities pharmacies should be able to employ. That relates to everything, including emergency medicines or cardiac checks. We all know people who have been incredibly lucky to get in hospital at the right time when they had such a check - others have not been - whether it related to anything from a small procedure right through to quadruple bypasses. However, we could increase the number of people detected before we are dealing with a disaster scenario if we could have those sort of checks done in community pharmacies, which could be very simple, cheap and a lot cheaper for the State in the long run, not to mention much better it would be for society and for that person and their wider family.

There is nobody who will not talk about the high cost of medicines, which is something that needs to be addressed. While trying to provide community pharmacies with greater power to deliver for all the citizens, the fact is that hospitals can be overrun, particularly at this time of year. We all know the issues there have been. With regard to UHL, not a week goes by without a significant number of cases. Even when it comes to Our Lady of Lourdes Hospital in Drogheda, people rarely say anything bad about staff but they talk about staff who are under severe pressure due to the number and nature of complaints. There are a lot of people who end up going to the accident and emergency department because they cannot get a GP appointment.

Even though we have all called for this not to happen, we have even seen cases in which people unfortunately believed that because of these difficulties, their best bet was to ring an ambulance. Such practices do not improve the situation but they definitely put services under more pressure. Obviously, everything that can be advanced needs to be advanced in relation to community pharmacists to take that pressure off.

If we are talking about common conditions, minor illnesses and ailments, that is one thing, but when we are talking about chronic disease management and medicines management, there is definitely a greater role for community pharmacists in delivery. It is like what I said previously in relation to cardiac care, but it probably has a much wider application in this instance. We have to get into the idea of preventative healthcare. I am talking about screening, blood pressure, diabetes, cholesterol checks, and making sure we do this in a proper way. When you speak to your family and your wider circle, you become aware of people who caught things early. Regardless of whether serious medical attention was needed or it was something pretty small, it was definitely a lot less than it could have been. We have all seen the horror cases of those who did not have screening done or did not have checks done, or did not have them done in time, and had to suffer. When we are talking about anything right through from cancer care to cardiac care, we must emphasise that anything that can be done from the point of view of improving circumstances is good.

Deputy Ó Snodaigh spoke about the idea of waste in relation to blister packs, etc. There are many means by which this whole thing can be streamlined, but it is straightforward. This is a very good thing to do. It is vital that the community pharmacy agreement was introduced, but it is just a starting point. We are literally building the foundations. We need to ensure we empower pharmacists to the greatest degree possible to deliver for those out there. If healthcare can be taken away from hospitals and from GPs who are under pressure, and if those preventative pieces can be advanced, it will improve everything across the board for these people and for society in general.

Colm Burke (Cork North-Central, Fine Gael)
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I thank the Minister. I welcome the development that has occurred. The collaboration between the HSE, the Department of Health and the IPU is a welcome development. The agreement that has been reached shows that providing healthcare in the community is extremely important. Progress is being made in this area. Over recent years, pharmacies have been playing a greater role in providing healthcare. It is important for that to continue to grow. What has been agreed is safe, it is equitable and it is about efficient delivery of healthcare.

There is a number of areas in the agreement about digitalisation. We are far behind in that whole area. Compared to the rest of Europe, we are behind most other EU countries in digitalisation. I keep mentioning that in other countries there is one card which allows your GP, your pharmacy or your hospital to access and see your medical records where required. When you go into the pharmacy with the card, they can access your records to see what medication you are on to make sure there will not be a problem with any new medication you are given. The other area where it is important is with regard to non-prescriptive medicine. At present, you can go to ten different pharmacists in a day and get the same drug, even if that drug is addictive. We have no system for controlling that. Digitalisation is so important in such circumstances because it means you cannot get medication from a pharmacy unless you have your own card. That controls it. It is something that we should move to.

Another issue raised in relation to this agreement is about trying to encourage people to get involved in the bowel screening programme. That is extremely important as well.

Another aspect of the common condition service, whereby a pharmacy can provide a consultation and identify the suitable medication if it is a non-prescriptive medication, is that the care is provided at a local level rather than the person having to wait for a period of time to get access to their GP. This service means that the pharmacy can provide the support the person needs.

I wish to raise with the Minister a concern that has been expressed to me in relation to blister packaging, which is very much available. My office is in Blackpool, where a large number of elderly people rely very much on blister packaging. This service, which involves items being put into a blister package for the particular day on which it is used, is only available on a once-a-week basis. I have spoken to people in a pharmacy that has over 60 customers who rely on that service. They get €4.10 for doing the packaging. It can take up to 45 minutes, which is quite a lot of time, to put the package together for each customer. I understand that under this agreement, the fee for this service is being abolished. Pharmacists are concerned because this will affect certain areas. It is fine if you are in an area where you do not have a population that relies on the level of support that these people require. I wonder if this could be looked at. The pharmacies are certainly concerned that the fee is to be phased out from January and will be restricted to a small number of medical items. I ask that this be looked at. I can come back to the Minister with further details on it if she wishes.

There is now a lot more co-operation and co-ordination of medical services, including GP, pharmacy and hospital services, than ever before. It is important that we continue to further develop that. The area of digitalisation is important because we need to make sure the people who are working in the pharmacy behind the counter can access the information they need to make sure the right medication is being provided. We need to ensure that a person cannot go to a lot of pharmacies on one day to get large quantities of non-prescriptive medicines. That is a big issue we need to deal with.

Overall, this is a welcome development from the Department, the HSE and the IPU. It will be of assistance. We have a growing population. We are training more GPs than ever before but people do not necessarily need to go to a GP for a lot of the care they require. That is why this agreement is giving support to pharmacies and the people involved, every one of whom is highly trained and highly specialised and can provide the care that is required by the person who calls to them to get advice. It is important that we, from a Government point of view, support those people who provide that service to the community and the people who live in it.

Pádraig Rice (Cork South-Central, Social Democrats)
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Before I start, I would like to put on the record again my concerns about the amount of Dáil time that is given over to statements. Since the Government was formed, we have dealt with only two pieces of health legislation on the floor of the Dáil, and only one of those was new legislation. The other Bill, the Mental Health Bill, was restored from the previous Dáil. This is not good enough. We need law reform in a host of areas and I would like to see some of those progressed. In fact, only last week I published a Private Members' Bill. I would be happy to work with the Minister to use Government time to progress that legislation, if necessary.

Catherine Ardagh (Dublin South Central, Fianna Fail)
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It is a matter for the committee.

Pádraig Rice (Cork South-Central, Social Democrats)
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Absolutely. We talk a lot about productivity in healthcare. We also need productivity in Parliament.

Returning to the topic at hand, the community pharmacy agreement, first I want to say that I welcome the investment in community pharmacies. In recent years, we have seen a real and tangible expansion of the services on offer in community pharmacies and that should be acknowledged. The Minister and her predecessor are to be commended on their work to date in progressing the recommendations of the expert task force, which was established in 2023.

It was not too long ago that such changes were extremely difficult to get over the line. A prime example of that was the introduction of the pharmacy-provided flu vaccine over a decade ago. At that time, there was considerable pushback from the sector but thankfully it is now standard practice for community pharmacists to deliver the flu vaccine as well as Covid vaccines. In fact, community pharmacists now administer one in every three vaccines in the flu and Covid vaccine programmes.

I welcome the news that community pharmacists will begin administering the PPV23 vaccine under this agreement. However, my understanding is that this vaccine will only be provided free of charge to medical card patients over 65, unlike the flu vaccine which is free to anybody over 60. Is this the case? One dose of the PPV23 vaccine is recommended for all people aged 65 and over but uptake is low, at below 36%, according to the HSE. Prevention of pneumococcal infection through vaccination should be a priority. According to the HSE such infections are responsible for 50% of community-acquired pneumonia, with an overall mortality rate as high as 25%. It should be a no-brainer to offer this vaccine to all those over 65 and high-risk groups free of charge. The expansion of the PPV23 vaccine into pharmacies is welcome but it should not come with a means test.

Speaking of charges, I have concerns about the arrangements for common condition service, primarily the consultation fee. Just last week I asked about this by way of a parliamentary question to the Minister. In her response she said that the common condition service will be a fee-paying service with pharmacies entitled to charge a consultation fee which will not be reimbursed by the State. There are two issues here. First, there appears to be no agreed maximum rate for consultations and second, the fee will not be reimbursed by the State. I cannot understand why medical card holders, at the very least, are not covered by this new service. The common conditions service is a positive development but to realise its full potential and to maximise the potential of the entire pharmacy sector, medical card patients should have access to this new service free of charge. I accept that for eligible patients under the HSE drugs scheme, the medication dispensed will be reimbursed. However, one of the main arguments for the common conditions service was to divert medical card holders away from overstretched GPs, where possible. Why would medical card holders with a common condition go to a pharmacy at a cost when they could go to their GP for free? When the Irish Pharmacy Union first proposed this scheme, it estimated that nearly 1 million GP consultations with medical card patients could be dealt with more appropriately by pharmacists. I cannot see how this will be the case under this scheme because although it may no longer be necessary for medical card patients to go to their GP surgery with common conditions, that will still be the only place where they can do so free of charge.

Another major issue with this agreement is the ending of phased dispensing for certain groups and the limiting of eligible medicines, as reported in the Irish Examiner last week. Phased dispensing was put in place in 1996 and is now being discontinued to cut costs, seemingly. This will impact some of the must vulnerable patients who should not have been used as a bargaining chip. We are talking about patients who need help to safely manage their medication such as those with reading difficulties, mobility issues, the very elderly and those living with addiction. This cost-cutting measure risks patient safety. The Minister needs to go back to the drawing board if this is the case.

There are so many aspects of this agreement that I would like to speak about but I want to prioritise the issue of access to the free HRT scheme. It is completely unacceptable that trans women are being excluded from the scheme. There can be no excuse or justification for this decision. I and others have been raising this with the Minister for a couple of weeks now and I am disappointed with the response. Instead of accepting that the exclusion of trans women is wrong and changing course, the Minister has dug in, further disadvantaging one of the most marginalised groups in society. It really is simple. Trans women should be included in the scheme. To employ one interpretation of the scheme for trans women and another for cis women is wrong. It is particularly galling this week when we had representatives of the trans community in the Oireachtas to celebrate the tenth anniversary of Gender Recognition Act. Free HRT should mean free HRT and I urge the Minister to do the right thing and reverse that decision.

Another issue I want to speak about is free contraception. The role of pharmacists in providing free contraception could be expanded. Great progress has been made in recent years and I hope this momentum continues. The IPU has been making a compelling case for prescription-free contraceptives and pharmacies have been providing emergency contraception without prescription since 2011. There is no clinical reason for not extending this to oral contraception, as recommended by the World Health Organization. We should be making contraception more accessible, particularly for hard-to-reach groups. We should be streamlining the free contraception scheme so that patients can visit a pharmacy for oral contraception without having to go to their GP first. This new agreement was an opportunity to remove that barrier to prescription-free contraception and ease operations.

As I said, overall, great progress has been made and I hope this momentum continues. With continued political will, we can further enhance the role of community pharmacists and maximise their potential across every village, town and city. This would be in keeping with the principles underpinning Sláintecare and the Minister will have my support in advancing these aims.

Sinéad Gibney (Dublin Rathdown, Social Democrats)
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The relationship that many of us have with our pharmacists is often a very important one. To demonstrate that, there is only a handful of people on my Christmas baking list beyond my family, but my pharmacist is right up there at the top. I really welcome that in recent years we have seen the expansion of the role that pharmacies play in communities. They can be such a hub for support for many people and communities.

In preparation for today's statements, I spoke with a local pharmacist, Ms Rebecca Goodwin from Roebuck Pharmacy, who was very helpful to me in explaining to me her feelings on this agreement. As we have heard from many Deputies today, this is a really positive step. It is a first step and is absolutely the right thing to do. We need to make sure that we have that two-way conversation between the Department and the Minister and the pharmacies themselves. I thank the Minister and the Department for the work they have done to get to this point. I also want to acknowledge the work of the IPU. Obviously, as a representative body, it has a tricky job in representing both independent pharmacists as well as the larger chain pharmacists. It has done a good job in getting us to this point.

My colleague, Deputy Rice, has outlined a lot of the details in this agreement that need to be examined further. I would echo Deputy Ó Snodaigh's points around waste. I have been very frustrated by this at times. When one has medication and one's dosages go up and down, there is nothing one can do with medication that has not been used. Pharmacists are not able to take it back. It is really important that we examine the issue of waste within the pharmaceutical sector and make sure that is not happening.

In terms of the points raised by Deputy Rice, I would emphasise the access piece. Obviously, the Social Democrats are very proud of Sláintecare and the work done on it by our co-founder, former Deputy Róisín Shortall. The ethos of making healthcare as accessible as possible is absolutely at the forefront for us and must be at the forefront in this kind of work. For too long we have had disjointed relationships across our healthcare system. Community pharmacies do really vital work in giving advice, providing vaccinations and simply keeping us all well. That work needs to be further supported and integrated into the healthcare system. We have heard details of the HRT scheme and the kinds of difficulties that arose earlier in the year when the Department attempted to roll it out. There were many issues but the work done by way of this agreement will prevent those kinds of difficulties from arising in the future.

Finally, I want to raise an issue that I have not heard mentioned today in this debate, namely the place of origin of pharmaceuticals. A number of people in my constituency have raised with me that they want to choose where their pharmaceuticals are from. In particular, there are certain products on the market that are from Israel and they would like to be in a position to refuse to take those. I appreciate that this is not simple and that some pharmaceutical products and medications cannot not be replaced with others. That said, is this agreement a place where we could potentially look at promoting Irish pharmaceutical products above those from other companies and making sure that consumers have the option of accessing the best medication to suit their medical needs while also matching their ethical concerns?

Overall, I welcome this agreement and thank the Minister for her work on it.

John Lahart (Dublin South West, Fianna Fail)
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First, if I may, I want to mention two constituents of mine, Thomas McHugh and Louise Heaney, at least one of whom has been taken by Israel Defense Forces, following the actions of the IDF against the flotilla.

Our minds are very much with them. Their families and a lot of constituents have been in touch with my office this afternoon. I wanted to put their names on the record and say that we will do whatever we can to support them and their families through this. This is not the appropriate debate, however. I raised it. It was also raised with the European Union Commissioner, Maroš Šefčovič, who was before the trade and foreign affairs committee this morning.

Moving on to the pharmacy agreement, I welcome it. Previous speakers spoke about pharmacies. Certainly, I grew up with pharmacies in my parish and area. The relationship people had with their pharmacies was often akin to the relationships they had with the local postmaster or postmistress. Indeed, in my home parish of Ballyroan, where I am originally from, Mr. Michael Shannon, who has passed away, was the local pharmacist. His son, Criofan, continues that pharmacy in Ballyroan and Templeogue. The pharmacist who turns up at family funerals is the kind of connection a lot of pharmacies have with the people who come to their shops.

On several occasions when I have called into a pharmacy with a small ailment – thankfully not too often - I know the pharmacist knows what the answer is, but he or she does not have the legal right to either prescribe or dispense. A kind of generic over-the-counter response is given instead because they cannot use those qualifications, even though they have a fair idea of what it is.

I asked a local community pharmacist in my constituency for their thoughts on the agreement. They said the new changes around service provision are excellent and that the expansion of the role of pharmacists is brilliant. It allows for increased timely access to care for easily resolved health complaints, like thrush and cold sores. It will result in a reduced burden on GP appointments, which is really important in the city, given the number of people, particularly in expanding areas in my constituency, who cannot access or become part of a GP’s patient list. This pharmacist said that it actually empowers pharmacists and maximises the use of their qualifications, which is all in line with the Government, the Minister and Sláintecare’s vision for pharmacy. It makes every contact count.

With regard to some of the new initiatives like the stool screening, this pharmacist would have described that as a sub-optimal health incentive and it is great that this will see improved uptake through pharmacies. That is positive reaction from the ground.

There were pharmacists in this House from both my party and the Minister for Health’s party who made points in the past two Dáil terms about not using and maximising, as the pharmacists put it, the qualifications of pharmacists, which would take the strain off some of the other parts of the GP system. I commend the Minister on following through on this in a way that is going to have an impact.

Clearly, this agreement has been welcomed by the Irish Pharmacy Union. It has been in and around the Houses. I was a member of the health committee. Over the years, it may have felt like a poor relation in the health sector. This enhances its role and visibility.

I live in Dublin 16 and represent Dublin 16, 24 and 6W. While there was a time when there were late-night pharmacies out as far as Terenure, it is difficult enough now. Sometimes, people have to drive into the city. There are very few late-night pharmacies. I do not know whether this aspect is built into the agreement, but it would be nice to see. When people go to their GPs to get a prescription, it is often in the evening. The latest pharmacy locally for me opens until 8 p.m. I had to travel to Leonard’s Corner Pharmacy in the Chair’s constituency once or twice. There used to be late-night pharmacies, however. Will the Minister speak to the IPU about that? It has to be looked at because not everyone works a nine-to-five job and not every prescription is dispensed between 9 a.m. and 8 p.m.

This agreement represents a landmark development in our healthcare landscape. It is to be commended. The real thing that pharmacies have - and I notice it abroad - is that they are everywhere. In every little village and town where other services have been lost, the pharmacies still remain. While that is clearly in part because they prescribe medicine, they offer some other services as well. Pharmacists themselves would be interested in this.

One of the criticisms of this agreement that the same pharmacist to whom I spoke made was about the proposed fee obliteration. They see this as possibly leading to increased hospital admissions and hospitalisation. That is just some feedback from someone who is otherwise very positive on the agreement. We might get some justification and rationale as to why they think that.

To look at some of the features of the agreement, I commend the pharmacy union and all the pharmacists involved in it. I highlight the strategic collaboration that is contained in the agreement. The €75 million investment by the Government across this year and next year is significant in order to support pharmacists with those fee adjustments, develop the services they are going to offer and train pharmacists and upskill their teams.

I have mentioned the expansion of the clinical role, which is a really positive move. Community pharmacists will be able to contribute more actively to contraception services, immunisation programmes and that bowl screening initiative I spoke about. They will also help with the safe return and disposal of unused medicine. I agree with the previous speaker in that regard. All of us over the years have been given ointments, antiseptic creams or whatever from time to time for various things. They may sometimes have had an antibiotic element. Even the smallest tubes could satisfy the needs of a ten-person family for a decade with the volumes of creams contained in these. They sit in presses for years and years and there is nowhere to bring them back to safely dispose of them.

I also welcome that pharmacies will integrate with the National ePrescribing Project. Anything that joins the dots and maximises the use of data is very welcome, as is the national electronic health record. It makes a huge amount of sense. From people I dealt with in the last Dáil term, I know that if we are admitted, we want to get to the point where people have a card - cards are probably out of date - or some kind of contact with a phone that lets first responders know what kind of medications they are on, who their GPs are and, if applicable, who their consultants are and what operations they have had, as well as any medical devices they are carrying. The national electronic health record forms part of that, as well as enhancing the broader digital health record.

Rather than going on at length, I welcome the agreement. The Minister is not in office for a long time and she has delivered on commitments made by the past two Governments and the work done by her predecessor. I very much welcome the work involved and look forward to availing of and promoting it among my constituents so that they can avail of these enhanced services and facilities that will be available in their pharmacies.

Marie Sherlock (Dublin Central, Labour)
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I welcome this new community pharmacy agreement. We have a particular problem in Ireland whereby allied health professionals have not been able to operate to the top of their licence for many decades, whether that is a physiotherapist within a hospital setting or indeed a pharmacist within the community setting. While this agreement makes progress in this regard, it could go much further.

A second issue with regard to healthcare is that we have a lack of timely access to GPs in our community. It is no surprise that some of the greatest shortages are in rural communities or the most socially disadvantaged communities in urban settings. In the context of GP care becoming increasingly complex, and while we have fewer GPs per capita, there is a real need for pharmacists to be facilitated to operate to a much higher level. Although they have been trained to that level, those skills have not been utilised for a long period of time. The broadened scope of their functions now with regard to vaccination, the prescribing of contraception and the safe return of unused medicines is very much to be welcomed.

3 o’clock

It has been a particular bugbear of mine for a number of years, having had to deal with unused medications following the passing of family members. Some pharmacists have been good enough to take medications but others have not. Because of the inconsistency, there is enormous waste and inappropriate disposal of medication, so I very much welcome the change.

We know that the uptake rate for bowel screening is below what it should be. The target is about 50%. The response to a parliamentary question last week stated it is about 46%. Nonetheless, we need to see a much greater level of bowel screening and an increase in the age range of people undergoing screening.

There is a real issue with free contraception. For most healthy women, having to return to their GP every six months is a cost they should not have to bear. The service is now going to be available from within the pharmacy in terms of clinical consultation on the prescription. That is very welcome. However, we are concerned that there is nothing in the agreement about expanding the free contraception scheme. At the moment it is for women from 17 to 35 years. We believe it should go up to 45 years. The cost of that would be only €10 million, yet it would provide crucial access to contraceptive services.

We know that some pharmacists have done an excellent job in recent years with immunisation and flu vaccination, but I welcome the commitment to pharmacists participating in a catch-up scheme. We would push strongly for the Laura Brennan HPV catch-up programme to be rolled out within community pharmacies. Unfortunately, the Government made a decision to suspend that well over 12 months ago and we very much want to see it up and running.

The downside of the agreement is that we will see a very real and tangible impact on the most vulnerable, arising from the ending of phased dispensing for reasons 1 and 4 in the agreement. I am conscious the HSE has wanted to end phased dispensing for a considerable period, as there was an abuse of it by certain pharmacy groups. The reality is that it is going to have an impact in particular on those who are being cared for at home and who are trying to live independently - people who have a carer coming to the home. Carers cannot physically dispense the medication. They can just hand over the blister pack. Those with a visual impairment are also impacted. One pharmacist told me he only started to use phased dispensing some years ago when a person with a visual impairment came to him and said they wanted their medication to come in a blister pack. Phased dispensing could facilitate that arrangement.

I do not propose to go backwards, but what we need to do is ensure that there is a new support service for vulnerable persons within the pharmacy system so that vulnerable individuals, in particular those with mental health conditions, can access their medication on either a daily or a weekly basis and are not given heaps of boxes once a month or whenever the prescription is dispensed, as that can be dangerous. If we are truly serious about trying to keep people at home and prevent greater hospitalisation, then we have to think very carefully about phased dispensing.

While it is related to phased dispensing, it was the pharmacist's own decision to use the blister pack service. What pharmacists have been doing for a number of years is using the money from phased dispensing to effectively employ somebody to put the blister pack service together for their patients, again, for the reasons I outlined, for those very vulnerable patients. Those patients are now going to be asked to pay for that very valuable service. As somebody said, it is the Jurassic Park of medical technology and yet it works in terms of allowing people to know that they are taking their medication the right way every day. It also allows families to know that their loved ones are taking their medication in the right way every day. I am concerned that some people will not sign up to pay because they cannot afford it or they will not see the benefit of paying for it. I know savings are specifically allocated within the agreement, arising from the ending of phased dispensing. My appeal to the Minister and to officials in the Department is that we would have a support service for vulnerable persons.

A related issue is the hardship scheme. My experience is that its application has been very inconsistent across areas because it is a discretionary scheme. It is for medical card patients whose item is not on the PCRS list, but it is for the network health offices to make the determination and only if they have the funds to do so. We need to change that and make sure that there is a much more consistent hardship scheme in place and that the criteria are much more apparent, which ultimately makes life easier for pharmacists, by giving them clarity, and most particularly for GPs and crucially for patients themselves, so that they will be able to avail of it. It is not good enough if somebody who is prescribed medication then finds out that they cannot get it after a pharmacist and GP have sent off the forms to see if the patient can get it, and then to have to go back to the GP to get other medication. That is a huge inefficiency that we need to do away with.

One of the final two issues I want to raise is the cost of the drugs payment scheme. The budget is coming up next week and we very much believe that in a cost-of-living crisis, the State can play a key role for those families who are relying on the drugs payment scheme and reduce their prescription costs. It needs to go lower, to €50. The reality is that if it costs €78 million, it would have a very real and tangible impact on those families who are suffering from the cost of living. Those with a disability and people who are not able to work full-time hours because of chronic conditions are most reliant on medication and if they do not qualify for a medical card, they end up forking out a lot of money every month, €80, through the drugs payment scheme, so we want to see it reduced.

The final point I want to make in the remaining minute relates to the shortage of certain medications. We understand there are currently 335 notified shortages. There is a very well-flagged shortage of the Estradot patches, the HRT medication. Ultimately, there is much frustration on the part of women. I have heard pharmacists and women describe all sorts of ingenious and creative ways they have had to come up with to try and make the medication stretch, and to find substitutes. My sense is that there is a lack of co-ordination within the Department in this regard. I know there has been a call for some time for the establishment of a chief pharmaceutical officer role in the Department. Obviously, there is no magic wand for any of these issues, but we need greater leadership to provide certainty to patients regarding product shortages. At the moment, too many women in particular are being failed because of the shortage of HRT, as well as people relying on other medication as well.

Michael Collins (Cork South-West, Independent Ireland Party)
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I welcome the Government's new community pharmacy agreement but, to be very clear, our independent pharmacists and communities have waited far too long for this kind of recognition. This agreement has good intentions but we in the Independent Ireland Party will not stand by and let it become another glossy plan that gathers dust while patients and pharmacists on the ground continue to struggle.

There are positives. Expanding the role of pharmacists to treat common conditions is just common sense. Allowing pharmacies to deliver more vaccinations and to support screening programmes brings care closer to the people. We welcome the increased training grants and the overdue commitment to digital prescribing and shared records. These steps will help ease the pressure on GPs and hospitals, something we have been calling for from day one.

The agreement falls short in key areas. The timelines are simply too slow. Pharmacists can prescribe for just eight conditions in 2025 and must then wait until 2027 or even 2030 for full authority. Patients do not have the time to wait. The Government boasts of fee uplifts, but what about independent rural pharmacies that are barely surviving? We saw this with the free HRT scheme. Pharmacies were left out of pocket and there was uncertainty for patients while the Department was scrambling at the last minute.

We need sustainability guaranteed. Pharmacists must at least break even on every State scheme or services will collapse. Rural GPs are closing. Out-of-hours services are stretched and hospitals are under siege. Pharmacies are often the last health service standing in a town or village. If the Government does not back them properly, it condemns rural patients to endless travel, higher costs and longer waits. I ask the Minister to build in stronger supports for rural pharmacies, which are doing an incredible job for so many communities. Do not make them an afterthought. What about medicine shortages? Families are going from pharmacy to pharmacy, desperate for essential medicines. The agreement mentions better stock visibility and substitution protocols. That is good, but these must be fast-tracked and not buried in working groups.

On accountability, there is no point in signing glossy agreements if the HSE is left unaccountable. The Independent Ireland Party has called for a watchdog with teeth, not another layer of bureaucracy. If the Minister signs off on commitments, she must personally ensure they are delivered on the ground. The Independent Ireland Party will support what is good in the agreement but we will push for faster delivery, fair funding and special protection for rural services because at the end of the day this is not about reports or strategies. It is about patients in west Cork, Limerick or Roscommon being able to walk into their local pharmacy and get the care they need.

On another health issue while I have the floor, I would like the Minister to please ensure Ava's protocol will be developed as a national policy, as recommended by the jury at Ava Barry's inquest. I wrote to the Minister about this earlier. I would appreciate her action and assistance in getting Ava's protocol up and running.

Paul Lawless (Mayo, Aontú)
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I welcome this move, which is positive. Expanding the role of healthcare professionals in our community is fundamentally important. Let us be honest: this should have been done a long time ago. Offering, for example, screening programmes is a positive move, as is offering immunisations. The integration in the ehealth system is obviously positive and will help pharmacists deliver in their communities. I wish to be clear that it is important that this be delivered upon because too often we see the Government delivering flashy documents announcing positive things but its delivery is lacking. Recently, the Government announced the HRT scheme to much fanfare, many TikTok videos and many press releases, etc., and just a few weeks later, we see significant issues with the supply of those medications. It is important that this long-overdue initiative happen.

A particular issue is the strain on our healthcare system. In Mayo University Hospital, the emergency department is experiencing peak presentations. One of the reasons and drivers behind this is the fact that GP access has gone into freefall. That is what is happening. GP availability and primary care was one the key functioning aspects in our health service. It was one aspect of the health system that was working well, but in recent years we have seen that collapse. That has pushed a significant burden onto emergency departments across the country. A total of 40% of GPs across the country are over the age of 60. This problem will present itself in the most acute way in rural areas. Expanding the role of pharmacies across the country is fundamentally important. I urge the Minister to make sure this agreement is delivered upon and does not become just a flashy document that sits in a filing cabinet like so many other Government announcements. On the topic of GPs, we need to train more of them. I ask the Minister to consider also expanding the role of pharmacists, similar to the role in Britain.

Michael Fitzmaurice (Roscommon-Galway, Independent)
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I welcome the opportunity to speak on this. I agree with the agreement. It is a step forward. Pharmacists are highly qualified people. Doctors around the country are under pressure. An awful lot of people, especially those who do not have medical cards, cannot get an appointment for weeks. If a person has a chest infection or something simple that can be diagnosed quickly, they still have to go to a doctor first, get the prescription and go to the pharmacy. We need to eliminate a lot of that where possible. I am not saying it is for everything. Doctors are needed for their job as well. A person might have a sore ear or a bit of flu. There is an awful lot of stuff that we can trust pharmacists with. We should be moving forward and doing that. It will take pressure off doctors, who are under ferocious pressure. There is a shortage of local GPs, with new patients looking for them. In many parts of Ireland at the moment, if someone wants to see a doctor, they may have to wait a week or two.

We need to do something like we did whereby people can now go to a level 2 hospital and urgent care centre rather than having to go to the likes of an accident and emergency department. If we can do the same with pharmacies for the more simplified cases rather than making people go to the doctor, that would be a great idea. It might get people seen more quickly for certain cases. It will also help doctors see more urgent cases quicker.

I support the agreement. As previous speakers said, there is no point in us announcing something or saying that an agreement will be this, that or other. We need to do it rapidly, get it going, move on and facilitate this as quickly as possible because it is a step in the right direction.

Gillian Toole (Meath East, Independent)
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I wish to convey my most sincere thanks to the Minister, Deputy Carroll MacNeill, to the officials at the Department of Health, in the Health Service Executive, and in particular my former colleagues, as I am no longer practising, in the Irish Pharmacy Union, in particular Kathy Maher, the contractors committee and the executive, who have done sterling work over the years, which is now being recognised. This is a case of tús maith leath na hoibre. I take on board suggestions that colleagues made. I assure them that they are embedded in this agreement, and in conjunction with the soon-to-be formed strategic collaboration group, all the suggestions that have not been addressed will be through that structured format, which did not exist prior to this.

It is an excellent start, 16 years since the financial emergency measures in the public interest, FEMPI, adjustments after the 2009 contract. There is massive potential here. This is a case of community pharmacy moving forward in conjunction with the medical profession. That is across the board. It is not one or the other; this is a collaborative effort. This will ease pressure on general practitioners and accident and emergency departments. It is all about getting the right medicine to the right person at the right time. Community pharmacists are medicine experts. There is a medicine optimisation process with a commensurate fund. Members have expressed a fear of phasing, and that phasing may be scaled out. That is not at all the case. Under the medicine optimisation process, for patients at high risk or medicines that have the potential for misuse, phasing will be continuing but it will be limited to a defined set of medications.

If issues develop where patients are considered to be unsafe or where their care has to be reviewed, that will be possible to review under the strategic collaboration group. There are a huge number of opportunities, such as medicine usage reviews, and the issue of waste was addressed. On medicine usage reviews, I carried out a pilot with Dr. Martin Henman from Trinity College Dublin, TCD, 30 years ago. It was a paper-based effort but it was fantastic. We would sit down every three to six months with patients and review their medicines, including even things they had at home.

It was called a brown bag and it was on an ad hocbasis. Again, there is potential to bring this forward and have that as an actual process. The disposal of unwanted medicines properly has a beneficial cost impact, but also a positive environmental impact relating to water quality and human health in general. It is something I called for at county council level in the past. I am delighted to see it coming forward. On chronic disease management, a Sláintecare initiative, many of my colleagues in County Meath were involved in a Healthy Meath chronic disease management programme, which produced fantastic results. There were calls for cardiovascular screening and other initiatives. The sky is the limit, starting from this agreement, assessing patients' needs and factoring that into future projects. On the management of common diseases, this will be a game changer in reducing delays in access to general practice and accident and emergency departments. That is to be welcomed.

There is one query that I have which is relevant to medicines availability and also future services, reviewing and analysis the early stages of this agreement. It is the issue of the chief pharmaceutical officer. What is the timeline for the appointment of a CPO to the Department of Health? Are there any plans to appoint a chief pharmaceutical officer to the Health Service Executive? These personnel will be key to the collaboration and co-operation piece under the strategic plan. I am no longer practising but having practised for 35 years it is in my heart. The impact in communities, the accessibility with on average 54 hours a week without an appointment must be maximised, and the profession is willing and able.

Keira Keogh (Mayo, Fine Gael)
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I welcome our guests from America in the Visitors Gallery.

Christopher O'Sullivan (Cork South-West, Fianna Fail)
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They must have been over for the Steelers game.

To answer Deputy Toole's question at the outset, the chief pharmaceutical officer commitment will be fulfilled. I do not have a timeline on that but it is absolutely a commitment that we will follow through and fulfil.

I would like to thank the Deputies for their contributions today, especially those who spoke in support of community pharmacists and the work they do in delivering a more accessible and integrated health service in Ireland. The community pharmacy agreement marks a significant milestone in the strategic collaboration between 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 in Ireland’s healthcare system. 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.

The agreement will be implemented on a phased basis and will be supported by ongoing, regular structured engagements between the Department, HSE and the IPU. Under the agreement a strategic collaboration group will be established which will provide a structured forum for dialogue and joint consideration of strategic issues shaping the future of community pharmacy in Ireland. The agreement is comprehensive and extensive, covering a wider variety of key issues in community pharmacy. Key achievements of the agreement which the Minister for Health outlined earlier include expanded services. Community pharmacies will play a greater role in the management of common conditions, immunisation, bowel screening, and the safe return and disposal of unused medicines. There is a fee for this for all patients, but of course medical card holders can still go to their GP for free, as they do today. The introduction of this scheme means that anyone can go the pharmacy instead, for a fee. Anticipating that many private patients might go to a pharmacist instead, it may make more appointments possible at the GP, enabling a quicker free appointment for medical card holders. This agreement makes it cheaper for some but increases access for all for a prescription for a common condition. On digital integration, pharmacies will actively support national eHealth reforms, including the national e-prescription service and national electronic health record. There will be new funding, and €25 million in 2025 and €50 million in 2026 will support fee adjustments, service development, and training. On strategic collaboration, a new collaborative framework will be established to support the shaping and implementation of community pharmacy’s role in a more integrated, efficient, and patient-centred health system.

The agreement also introduces new fees and allowances for participating pharmacies, supports training and development of pharmacy teams, and a programme of work aimed at reducing the community pharmacy administrative burden. Fundamentally, this is a forward-looking agreement that will make it easier for people to access care in their communities. It reflects our shared commitment to innovation, public health, and sustainable investment. It will further support community pharmacies in diversifying their health service offerings, business models and revenue streams.

On phased dispensing, there is one important element of the agreement, changes being made to the rule set around phased dispensing, which I would like to outline to the House. This agreement does not remove phased dispensing. Phased dispensing was introduced in 1996 for patient safety reasons. The supply of medication in instalments can support patients prescribed certain high-risk medications who are at risk of medication misadventure if these medications were to be supplied on a monthly basis, as is the norm under the community drug schemes. Where a phased dispensing claim is submitted, the current requirement is that an item must be dispensed across multiple supply occasions. Community pharmacies receive additional payments in respect of phased dispensing.

Monitored dosing systems are systems that enable the individual medicine doses to be organised according to the prescribed dose schedule. These are sometimes referred to as blister packs. The State has never agreed to fund monitored dosing systems. However, a practice has built up whereby the use of monitored dosing systems is charged as if for phased dispensing. The State has never agreed to this. Phased claiming was never intended to be used to submit claims in lieu of the provision of monitored dosing systems. While monitored dosing systems may have a role for some patients there is significant uncertainty around the robustness of the evidence supporting their use. The National Centre for Pharmacoeconomics carried out an evidence assessment which indicated that the evidence was, at best, equivocal to support such a programme. Significant expenditure is therefore being incurred where it was never intended by the State. It has been agreed to introduce improved controls in this regard and to limit the use of phased dispensing to specified high-risk drugs, where a patient safety concern may exist.

Phased dispensing support is currently available under the GMS medical card scheme for the following reasons: reason 1 - at the request of a patient's physician; reason 2 - due to the inherent nature of a medicinal product, that is, product stability and shelf life; reason 3 - where a patient is commencing new drug therapy with a view to establishing patient tolerance and acceptability before continuing on a full treatment regime; and reason 4 - in exceptional circumstances where the patient is incapable of safely and effectively managing the medication regimen. Under the community pharmacy agreement, from January 2026, phased dispensing under reasons 1 and 4 will be limited to a defined set of high-risk medication classes. These are psychotropics; opioids; codeine; and pregabalin and gabapentin. The approved list of medications will be provided by the HSE in due course. For reason codes 1 and 4, by focusing phased dispensing reimbursement on the medication categories on the approved list, phased dispensing payments can be targeted to medications with the highest risk or potential for misuse. Phased dispensing fees will remain payable as per current arrangements under reason codes 2 and 3 and will not be subject to the approved list. The HSE estimates that this will free up over €20 million in funding within community pharmacy. This funding will be primarily redirected towards valued added services.

The salient point here is that appropriate phased dispensing is not being removed in this agreement. The current funding of blister packs when claimed as phased dispensing, which the State has never supported, will be suspended. This is being done in a way which puts patient safety first and allows the State to repurpose €20 million of funding to be used to implement new patient-centred services. It remains open to pharmacies to charge patients for the use of monitored dosing systems as a private service.

In the context of the overall agreement and settlement package, the State has also secured key commitments from community pharmacy in relation to reform, modernisation and the digital agenda.

The agreement will provide the basis for community pharmacy and IPU co-operation with the full ehealth agenda, including national eprescribing programme, shared care record, HSE app, electronic health recording, etc. As these programmes advance and roll out, the co-operation of community pharmacies will be crucial to the success. The Department will also progress a number of regulatory reforms over the coming months to improve efficiency and free up capacity in community pharmacy. The Department, the HSE and the Irish Pharmacy Union are committed to a process of ongoing structured engagement to support the future development of community pharmacy. The continuation of a high-level, enduring, strategic relationship is designed to support the shaping and implementation of the role of pharmacies in a more integrated, efficient and patient-centred health system.

It is recognised that ongoing collaborations, some already under way, on key operational-related matters will also continue. Furthermore, it is recognised that, from time to time and as required, specific programmes of work will be established with their own governance arrangements as appropriate. This multiyear pathway will focus on specific measurable deliverables that ensure service sustainability, expand patient care and enable community pharmacists to practice to their full scope. This landmark agreement sets a pathway forward for a strategic approach to shaping the future of community pharmacy in Ireland, all with the intent of improving healthcare service delivery and patient outcomes.