Seanad debates
Tuesday, 20 June 2023
Nithe i dtosach suíonna - Commencement Matters
Pharmacy Services
1:00 pm
Robbie Gallagher (Fianna Fail)
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I welcome the Minister of State to the House this afternoon. He will be aware that pharmacies are essential providers of healthcare in our communities and have the potential to do much more than they are currently doing in the context of a health system that is under pressure. However, community pharmacists feel they have been asked to provide more services on behalf of the State while receiving less money for doing so. They feel the viability of pharmacies is now being impacted. Since the introduction of the Financial Emergency Measures in the Public Interest, FEMPI, Act 2009, the community pharmacy sector is the only healthcare sector that has not had any pay restoration. Pharmacists claim to be in a worse financial position now than when the cuts were made in 2009 as costs have increased rapidly in the intervening period. In other words, the community pharmacy sector has had a pay freeze for the past 15 years.
Pharmacists point out that revenue generated by pharmacies under community drug schemes has been reduced by 29% while the cost of providing a high quality service has seen a 29% increase in expenditure and wages. Significant hikes in energy utilities, rent, insurance and administration costs can also be added to that. Reimbursement rates under community drug schemes have reduced by 24% and no longer cover the cost of dispensing an item, which has increased from €3.73 to €4.58. The consumer price index, CPI, has increased by 16% whereas the CPI for prescribed medicines has declined by 26%. One in ten community pharmacies, mainly rural ones, is loss making. Pharmacy is becoming a less attractive career choice, exacerbating the ongoing shortage of pharmacists when we need them most. Pharmacists are now seeking a restoration of dispensing fees to a flat fee model reimbursed at €6.50 per medicine. In 2009, pharmacies were paid an average dispensing fee of €6. The dispensing fee was cut and has not been restored, as the Minister of State will be aware. Pharmacists' pay needs to be restored in line with public sector pay arrangements and engagement is needed with the Irish Pharmacy Union, IPU, to discuss fees. We all know community pharmacies have provided an essential service to patients on behalf of the State. We do not have to look back any further than the Covid-19 pandemic to appreciate the service they provided. They were not found wanting when they were asked to take on additional responsibilities in the interests of patient care. They have been patient and deserve engagement on these issues for the benefit of the sector and in the interests of the patients they serve in our communities. I look forward to the Minister of State's response.
Seán Fleming (Laois-Offaly, Fianna Fail)
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I thank Senator Gallagher for raising the matter of the public pay and pensions legislation with regard to the community pharmacy sector and its future. I am speaking today on behalf of the Minister for Health, Deputy Donnelly.
The Minister recognises the significant role community pharmacists play in the delivery of patient care. Community pharmacy is often one of the most accessible avenues to receiving such care and provides a vital link in our healthcare service by ensuring the safe supply of medicines to people. Medicines are the most common healthcare intervention and the use and complexity of medicines are increasing. Pharmacists are the healthcare professionals optimally placed by virtue of their training to ensure the rational and safe use of medicines by patients. The Minister also acknowledges the vital role that community pharmacy will play in the development and implementation of future healthcare service reform, especially regarding the aims and vision of Sláintecare.
The focus of Sláintecare is to develop primary and community care and make it possible for people to stay healthy in their homes and communities for as long as
possible.The Department is open to exploring any evidence-based appropriately governed services delivered by appropriately trained professionals which will support this aim.
In this regard, various approaches to extending the scope of the practice of community pharmacists are being progressed by the Department. This includes the introduction of a minor ailments scheme and an enhanced role for pharmacists in the current contraception scheme for women.
The implementation of these necessitates engagement with a range of stakeholders and full consideration of all relevant the legislative and operational issues involved. The Department recognises the need for the availability and retention of pharmacists, so that pharmacists may continue to meet patient needs and play a full role in the development of an integrated healthcare service.
The Pharmaceutical Society of Ireland is undertaking a project which aims to assess emerging risks to the continued availability of a professional pharmacy workforce within community and hospital pharmacy in Ireland. This will inform how and where pharmacists work, examine their perceptions of the sector and will identify barriers to choosing to work in patient-facing roles.
The regulations governing the pharmacy fee structure are set out in the Public Service Pay and Pensions Act 2017 and in SI 639 of 2019 - Public Service Pay and Pensions Act 2017 (Payments to Community Pharmacy Contractors) Regulations 2019 - which put the current fee structure in place with effect from January 2020. Under section 42 of the Public Service Pay and Pensions Act 2017, the pharmacy fee structure must be reviewed every third year after 2020. The Department is currently carrying out that review and Department officials are meeting with the Irish Pharmacy Union, IPU, later today in this specific regard. The Minister believes there is a real opportunity to work together with community pharmacists and with other healthcare providers to make a significant difference to patients' outcomes. The pay freeze was introduced many years ago under the Financial Emergency Measures in the Public Interest, FEMPI, Acts regime and it has been difficult for a long period up to when that matter was dealt with.
The Senator has mentioned the issue of the dispensing fees. The publicly-funded service expansion should address unmet public healthcare needs, improve access to existing public health services and provide better value for money to all concerned.
Everybody here who has ever had a reason to collect a prescription and to talk to a pharmacist in order to collect something for themselves or for a family member knows of the advice and accessibility one can obtain in a pharmacy. One can walk in off the street and meet a pharmacist. They cannot change one's prescription or anything like that but they can give very good advice on one's healthcare. We all know how difficult, on some occasions, it is to get an appointment with a GP. Some people are now using the local pharmacist as a surrogate. They cannot prescribe or anything like that but their role has been increasing and that needs to be recognised.
Robbie Gallagher (Fianna Fail)
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I thank the Minister of State for his response to me. I welcome the fact that both bodies are meeting today, namely, the Department of Health and the IPU. Hopefully, we will see some progress in that regard. It is estimated that on average there are 70 million patient-care interactions per annum with community pharmacies. This just shows how important they are within our communities. As the Minister of State outlined in his contribution, they are open seven days a week. At a time when it is difficult to get access to a GP, more and more people are turning to the pharmacist as a viable alternative, which I very much welcome. I also welcome the fact that negotiations are ongoing between the pharmacy unions and the Department of Health on expanding the role of the pharmacist vis-à-visa minor ailments scheme and the increased accessibility of contraceptives for women. All those developments are welcome. We are lucky to have the pharmacies in our communities. It is important that we look after them and that they are viable because they provide an excellent service to the community.
Seán Fleming (Laois-Offaly, Fianna Fail)
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I thank the Senator again for those further remarks. We look forward to progress being made at the discussions which are happening today.
I mentioned in passing earlier that regulations governing the pharmacy fee structure were made under the FEMPI legislation and that legislation expired at the end of 2019, thank God. Under the Public Service Pay and Pensions Act 2017 these regulations had to be replaced by 1 January 2020 in order to maintain a statutory basis for contractor payments and to prescribe the fees payable at that date. The current pharmacy fee structure was put in place by the 2017 regulations which came into effect on 1 January 2020.That is why I mentioned this must be reviewed every three years and it is to be hoped those negotiations are progressing well at this stage. Since then, the overall spend on fees paid to community pharmacists under the community drugs scheme, has continued to rise year on year. The HSE's primary care reimbursement service online system shows fees paid to pharmacies under the scheme ranged from €420 million in 2019 rising to €468 million last year.