Seanad debates
Monday, 21 June 2021
Nithe i dtosach suíonna - Commencement Matters
Pharmacy Services
10:30 am
Sharon Keogan (Independent)
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I bid the Minister of State, Deputy Feighan, good morning. The minor ailment scheme is an internationally recognised extended pharmacy service which allows pharmacists to improve public health access, shape further future services and broaden pharmacy roles to deliver patient care and improve health outcomes. At present, private patients who want to access non-prescriptive medicines for ailments such as hay fever, migraines or skin conditions consult local pharmacists on the best options for them and pay for the over-the-counter medications. However, medical card patients with the same ailment can only access the same medication if they visit their general practitioner, GP and get a prescription. If the Minister were to introduce a minor ailment scheme, public patients would no longer have to make GP appointments, which would save time for both GPs and patients.
Pharmacy-based minor ailment schemes have been introduced throughout the UK to reduce the burden of minor ailments on high-cost settings, including general practices and emergency departments. Some 24 million consultations take place in Irish general practice each year and more than 1 million consultations in out-of-hours co-operatives. With Irish GPs receiving €551 million from the HSE in 2017, this implies a cost €22.98 per consultation. Independent analysis commissioned by the Irish Pharmacy Union, IPU, estimated that the full implementation of a comprehensive minor ailment scheme would save almost 1 million GP consultations per year and free up approximately €22 million worth of valuable GP capacity in an overloaded GP service, the equivalent of almost 100 full-time GPs. I have pointed out previously that more than half a million of the population live within 1 km of a pharmacy and 85% live within 5 km of one. Therefore, why the delay in introducing such a scheme?.
In 2006, the IPU made a submission to the Department of Health and Children on a pharmacy-based minor ailment scheme. In January 2009, the IPU proposed the introduction of a pharmacy-based minor ailment scheme at a meeting of the Oireachtas Joint Committee on Health and Children. In 2015, the IPU centred its prebudget submission on a proposal to introduce a minor ailment scheme. In April 2016, the then Minister for Health, Deputy Varadkar, announced the introduction of a pharmacy based minor ailment pilot scheme at the IPU’s conference. In July 2016, a pilot scheme was commenced and ran at 19 pharmacies in four towns, namely, Kells, Roscommon, Macroom and Edenderry and it ran for three months. In May 2019, the then Minister for Health, Deputy Harris, addressed the IPU members at the IPU conference and declared we know the minor ailment scheme works. He stated I am fed up hearing about evaluating the minor ailment scheme; we know it works. On 2 May 20221, in a video address by the IPU members the Minister for Health, Deputy Stephen Donnelly, stated he also wished to emphasise the important role community pharmacists play in the wider health service in the delivery of holistic patient care. He also stated he was committed to further developing that role in the context of health service reform. He further stated he had listened to and met with the IPU both in opposition and since he was appointed Minister for Health and that he firmly believed that there is much merit in the initiatives it was seeking to progress as the minor ailment scheme.Often in this House we do a lot of talking and very little doing. This scheme works and will support the existing delivery of healthcare to our citizens.
Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for raising this important issue and for the opportunity to clarify the position on the introduction of a minor ailment scheme in community pharmacies on behalf of the Minister for Health.
The programme for Government contains a commitment to expanding the role of community pharmacies in managing patient health, and there have been a number of proposals in recent years to expand clinical pharmacy services, which the Senator outlined. These include recommendations to the Pharmaceutical Society of Ireland's 2016 Future Pharmacy Practice report, and proposals from the Irish Pharmacy Union, IPU, and others. In addition, it is intended that a modernised service contract will include improvement and expansion of pharmacy services for public patients. Important new services, including influenza vaccinations and emergency contraception, have been introduced in recent years. I can now go to a community pharmacy for the influenza vaccination, which is a great benefit.
The Minister acknowledges that community pharmacists have played a pivotal role in responding to the health needs of the public during the Covid-19 crisis, most recently in assisting with the vaccination roll-out, which happened last week. I do not yet have data on the success of this roll-out, but it is very welcome.
New public health services in community pharmacy, as elsewhere, should address unmet public health needs, improve access to existing public health services or provide better value for money or patient outcomes to be funded by the taxpayer. Any new or transferred services should also be based on sound evidence with matching improvements in governance and administration. One such proposal for an expanding community pharmacy service is a paid minor ailment scheme whereby pharmacists treat medical card patients directly with over-the-counter items for specified minor conditions, without the patient needing a GP prescription. It has been suggested that such a service will produce better patient outcomes and reduce GP consultations for general medical services scheme patients with minor conditions. Pharmacist already provide the services for private patients and it is within their scope of professional practice.
As the Senator outlined, the HSE undertook a three-month feasibility study in Kells, Roscommon, Macroom and Edenderry. Five conditions - dry skin, dry eyes, vaginal thrush, scabies and threadworm - were selected, with clinical protocols in place for safe and accountable practice. The pilot was intended to demonstrate the feasibility of delivering such a service, and the HSE report found its operation with regard to IT and the claiming infrastructure was effective. The Senator also said that a larger trial, with a defined outcome assessment, will be required to produce meaningful data on clinical outcomes, patient experience, and the effects on GMS-GP activity for minor conditions. If this matter is to be progressed, more extensive trialling will be required to determine the effectiveness or otherwise of a minor ailment scheme in an Irish healthcare context.
The Minister met with representatives of the IPU last December, when the minor ailment scheme and other issues were discussed. He stated that he wants to see the expansion of the role of community pharmacists through a new contract in line with Sláintecare objectives. In this regard, it is intended that any discussions on progressing the issue will take place in the context of broader consultation with pharmacy representatives on a replacement for the current pharmacy contract.
Sharon Keogan (Independent)
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I thank the Minster of State. As we rebuild our health service after Covid-19, we must remember the resources of community pharmacists and the value in which we hold them in the implementation of community healthcare. Changes were made to allow pharmacists to give the emergency contraceptive to women with a medical card.The IT systems are already in place such that in terms of a mechanism for the minor ailment scheme, very little support would be needed for the sector to implement it. The delivery of community care services must be the only way forward. I urge the Minister to enable this vital piece of community-based coverage. We cannot continue to put this on the long finger. A larger trial is not what this industry needs. The scheme has been already trialled and it was a resounding success in the 19 pharmacies. The data collected from the trial justify this. I urge the Minister for Health, when preparing this year's health budget, to include the costing for this scheme. The last thing we need is another trial. This could result in a vital saving and it will help the already stretched health service in this country.
Frank Feighan (Sligo-Leitrim, Fine Gael)
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I again thank the Senator for raising this important matter. The Minister is keen to expand the role of community pharmacists in managing patient health, but he is of the view that for any new public health services in community pharmacy to be funded by the taxpayer, as elsewhere, they must improve health outcomes and provide value for money and benefits for patients. Any new or transferred services should also be based on sound evidence, which I think is the case in regard to this scheme, with matching improvements in governance and administration.
While the introduction of a comprehensive and resourced minor ailment scheme would require further trialling and consultation, it is the Minister's intention to have a broader discussion with the Irish Pharmacy Union on contractual and service arrangements carried out in due course. The Irish Pharmacy Union has a strong voice, one I always welcome. The delivery of the influenza vaccine by pharmacists has been very effective. There may be some issues arising relating to contracts, but these will be dealt with by the Minister, officials from the Department of Health, the HSE and the IPU.