I am delighted with the opportunity to speak on this issue, which is important not only to society but also to the health system. A delicate situation has arisen involving the Health Service Executive and the Irish Pharmaceutical Union, IPU. On 14 October, up to 140 pharmacists withdrew methadone services from approximately 3,000 patients as a protest against the changes due to come into force on 1 December 2007. A pharmacy is currently paid the cost price of the drugs under the general medical card scheme in addition to a fee of €3.26. There is no mark-up on the cost of these medicines and all the costs of operating the pharmacies' GMS medications are paid for from the €3.26. It has been said the pharmacists receive fees of up to €18 on occasion, as indicated recently by the Minister, but three out of every four chemists to whom I have spoken claim they never received this payment. One chemist indicated today that he has been in business for 15 years but has never received it.
In practice, the GMS scheme is loss making for the pharmacy but is cross-subsidised by other products. From 1 December, the HSE intends to pay pharmacies 8% less than the cost price of the medicines. Pharmacists have described this as a breach of their contract with the HSE. Drugs payment scheme customers will also be affected because the HSE said it no longer intends to pay pharmacies based on the cost price of medicine.
The pharmacists have been more than willing to negotiate, they have come to the table with a very open mind and are willing to discuss virtually any issue with the HSE. In February 2007, the Minister for Health and Children and the chief executive of the HSE both indicated the need for an independent process for the setting of pharmacy fees. Discussions were held under the independent chairmanship of Mr. Bill Shipsey but he has since suspended his efforts to find a resolution. We are thus in limbo and will end up with two unhappy parties and a crisis on 1 December.
I understand Mr. Shipsey met the IPU and HSE representatives last Wednesday but nothing has happened since. It appears to me, having spoken to pharmacists around the country, that the process is really only a smokescreen and that the HSE will continue to force through its proposals without any really meaningful talks. The HSE has argued that the IPU, as a collection of business undertakings, is precluded under the Competition Act 2002 from negotiating fee-related matters with the HSE. It is not in a position to negotiate directly with the IPU. I accept that the HSE has difficulties but do not accept the complete lack of flexibility regarding its unwillingness to discuss the issue with local pharmacists. It will not engage with the pharmacists as a group or as individuals and this is very unfair.
Pharmacists provide a vital service to the community and work long hours. In many ways, they represent the last bastion of local retail outlets and are genuinely local. More often than not, they are involved in the local community and provide what the old corner shops used to provide some years ago, namely, a means of interaction with members of the community. Pharmacies are now part of the social infrastructure and provide medicine to GMS scheme patients and those who are eligible under the drugs payment scheme. They provide this service on behalf of the HSE and this should be recognised rather than punished.
It is simply not realistic to demand that pharmacists dispense medicine at a loss. In many cases, they are small businesses with high overheads and must compete with new entrants to the market. A pharmacy with a high GMS turnover will be particularly affected if the proposed change comes about. Pharmacies should be supported and, in order to increase competition, pressure should be put on the wholesalers rather than the retailers. The HSE has not been able to negotiate sufficiently good terms with the wholesalers but the retailers and customers should not suffer as a consequence.
The HSE has not carried out an economic assessment of its proposals on the retail sector or heeded the recommendations of the Indecon report, which recommended consultation and dialogue. Why has the report not been published? I ask that this be done as soon as possible. It is not enough to hide behind the Competition Act 2002 and it is imperative that the HSE and IPU, on behalf of small pharmacists and those with a high GMS turnover, find a way to reach a mutually beneficial conclusion that avoids further action and does not put patients in further danger.