Mary Seery Kearney (Fine Gael)
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I wish the Minister of State a good morning and thank him for being here. I appreciate that nobody from the Department of Health is available and I appreciate the Minister of State taking this matter. As long as he will have a meaningful reply, I will have no problem.

There is in place legislation, the Public Service Pay and Pension Act 2017, under which the Minister for Health is obliged to engage with pharmacists every three years for a review of the operation and effectiveness of the sector and the rates that are payable to pharmacists. Since 2009, the rates paid to pharmacists have been frozen. That was almost 15 years ago. At the same time, costs for pharmacists have gone up incredibly. These are highly qualified people within a medical profession. They are the first port of call for many people in communities. We encourage that. Pharmacists have small consulting rooms in their pharmacies. They have been instrumental in the roll-out of the vaccine programme and we saw how vital they were during the Covid-19 pandemic. They are also employers and retailers. They are contributing to rates and employment in our communities. They are contributing in every way. At a time when we are under pressure for GPs, many of whose lists are closed, pharmacies are more valuable now than they have ever been in the history of the State.

I know from the personal experience of my family that pharmacies are the first port of call for a piece of advice if there are any changes to, or queries about, medication. For anything like that at all, our local pharmacy has a wealth of knowledge. The pharmacists are accessible and personable and offer in-person contact and follow-up. It is not reasonable for those people to have gone so long with a pay freeze and a freeze on their services. If anything, we should be incentivising pharmacists to open more pharmacies. They should provide a community place and threshold before somebody goes to a primary care centre, GP or accident and emergency department. There are many things that can happen at a pharmacy level.

We have had supply issues. I have spoken with our local pharmacist, Ms Ann-Marie Horan, who as it happens is also involved in pharmaceutical representation. In that context, she explained to me that when there is a shortage of supply, pharmacists are qualified to and capable of varying the drug a person has been prescribed and recommending an alternative. However, the pharmacists must email or fax GPs - and it is shocking that people have to fax at all in this day and age - and wait for a renewed prescription when in actual fact they have the competence, qualification and capacity to vary the prescription. When I have inquired about that with the Taoiseach, I have been told there are limited circumstances where that can happen but it is being reviewed for extension. At a time when we are looking at extending the services pharmacists provide, now more than ever the Minister needs to engage. The deadline by which the Minister should have engaged with pharmacists in this effectiveness, operation and rate review is 30 June. By the point I received this representation, no action had been taken by the Minister. I hope the Minister of State will give me better news on that front and we will see demonstrable action from the Department of Health to recognise the value of pharmacies in our communities.

Niall Collins (Limerick County, Fianna Fail)
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On behalf of the Minister for Health, I thank Senator Seery Kearney for raising this important matter. The Minister recognises the role community pharmacists play in the delivery of patient care. Community pharmacy is often the most accessible avenue 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 community pharmacy will play in the development and implementation of future healthcare service reform, especially with regard to the aims and vision of Sláintecare. The focus of Sláintecare is to develop primary and community care that makes 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 and appropriately governed services delivered by appropriately trained professionals which will support this aim. In that regard, various approaches to extending the scope of practice of community pharmacists are being progressed by the Department. This includes the introduction of a minor ailment scheme and an enhanced role for pharmacists in the current contraception scheme for women. The implementation of these necessitates engagement with a wide range of stakeholders and full consideration of all the relevant legislative and operational issues involved.

The Department recognises the need for the availability and retention of pharmacists so that pharmacy 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 are working, examine their perceptions of the sector and 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, the 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 1 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 a review and Department officials held a meeting with the Irish Pharmacy Union in that regard on 20 June 2023.

The Minister believes there is a real opportunity to work collaboratively with community pharmacists and with other healthcare providers to make a significant difference to patient outcomes. Of course, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services and provide better value for money.

Mary Seery Kearney (Fine Gael)
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I thank the Minister of State. To be fair, that was a meaningful reply and I appreciate it. There are a couple of things to say in response. I welcome the acknowledgement of how vital pharmacies are. The language used by the Minister of State was better than mine. He referred to the value of pharmacists in the accessible and vital link they provide in our communities and in the whole healthcare system for our country.

I value the fact there has been engagement on this issue. Where we have a little disparity is that the Minister of State said in his contribution that the regulations and fee structure were put in place in 2019 and took effect from 1 January 2020. What that does not reflect is that the fee structure was set in 2009, which is almost 15 years ago. With everything that has increased since then, we need a review. My plea is that we need to review that upwards. This fee structure came into place in 2020, since when we have experienced Covid-19. We saw during the pandemic how extraordinarily vital pharmacists are in our local communities.

Niall Collins (Limerick County, Fianna Fail)
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In the interests of clarity, I will point out that the regulations governing the pharmacy fee structure made under section 9 of the Financial Emergency Measures in the Public Interest Act 2009 expired at the end of 2019. Under the aforementioned Public Service Pay and Pensions Act 2017, those regulations were replaced on 1 January 2020 to maintain the statutory basis for the contractor payments and to prescribe the fees payable from that date. The current pharmacy fee structure was put in place and, as I said, came into effect on 1 January 2020. Since then, the overall spend on fees paid to community pharmacists under the community drug scheme has continued to rise year on year.The State has also paid for additional services provided by community pharmacists, including administering the Covid-19 and flu vaccinations and participating in the free contraception scheme, which was launched in September 2022. This demonstrates the substantial investment made by the Government to ensure community pharmacies are remunerated for the services they provide on behalf of the State. The statutory review of pharmacy fees is ongoing and departmental officials held a productive meeting with the Irish Pharmacy Union on 20 June. The Minister believes there is a significant opportunity work collaboratively with community pharmacists and other healthcare providers to make a substantial difference to patient outcomes.

Martin Conway (Fine Gael)
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I thank the Minister of State, and Senator Seery-Kearney for raising this important issue. We realise how busy the Minister of State is, so we thank him for coming to the House.