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JOINT COMMITTEE ON HEALTH AND CHILDREN debate -
Tuesday, 1 Dec 2009

2008 Annual Report: Discussion with Pharmaceutical Society of Ireland.

I welcome Dr. Ambrose McLoughlin and his colleagues from the Pharmaceutical Society of Ireland. Dr. McLoughlin is no stranger to this committee room and he will be aware of the following. I draw the attention of witnesses to the fact that members of the committee have absolute privilege but the same privilege does not extend to witnesses appearing before the committee. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official by name or in such a way as to make him or her identifiable.

I thank the society for the paper which it circulated to us and which members have studied. I would ask Dr. McLoughlin to make a five minute presentation or synopsis of that paper and we will go to members for questions. I am a little worried that we might be interrupted by a vote in the House but we will make the best of the time that we have.

Ms Noeleen Harvey

I will speak first. This is the first report of the Pharmaceutical Society of Ireland, PSI, as established under the new Pharmacy Act 2007. The council now has a non-pharmacist majority and our focus is on patient safety. With me are the following: Dr. Ambrose McLoughlin, who is the CEO; Dr. John Hillery, who is a non-pharmacist member of the council; and Mr. Tom McGuinn and Ms Kate O'Flaherty who are on the staff of the council.

Dr. Ambrose McLoughlin

The first full year of the operation of the Pharmacy Act 2007 was 2008. The Act was passed by the Oireachtas in April 2007 and commenced on 22 May. We put in place in 2008 the first registration system for pharmacists and pharmacies in the Republic of Ireland. We also commenced some serious work in respect of the future development of pharmacy by putting in place the first statutory code of conduct for pharmacists, which further underpins the reprofessionalisation of pharmacy and brings a robust regulatory system into place.

On 1 August last we commenced the sections related to complaints, inquiries and discipline. This provides the public and patients with robust protection and also facilitates the development and expansion of the role of pharmacists and pharmacy services in line with an initiative we have commenced which is Pharmacy Ireland 2020. We seek to bring about safe pharmacy services that are affordable, deliver high patient value and value for money for taxpayers.

The PSI has also been extremely successful in leading a bid to bring the annual congress of the International Pharmaceutical Federation, FIP, to Ireland in 2013. We are grateful to the Minister for Health and Children, Deputy Harney, and the Taoiseach for supporting our efforts in this regard. If the bid is successful, some 3,000 delegates will come to Ireland to attend the congress.

We have a full system of inspection and enforcement in place. We work effectively with all of the other regulators. We have an agreement in place with our colleagues in Northern Ireland and work across the European Union with other regulators through the health care professional borders network.

We have a strong commitment to patient safety. There are only three priorities for the PSI, namely, patients, patients and patients. We take the matter extremely seriously. We have put in place a modern corporate governance system in line with the recommendations of the Department of Finance and our ruling council comprises a non-pharmacist majority. We try to minimise the risk to patients and keep the public and patients in our focus when it comes to professional development and learning.

We are reviewing undergraduate pharmacy education in Ireland. In partnership with the Ministers for Education and Science and Health and Children, Deputies Batt O'Keeffe and Harney, and their respective Departments, we have initiated a national pharmacy internship programme for the first time.

I will now focus on continuing professional development. As stated, our registration system covers all retail pharmacy businesses in the country. A total of 1,703 pharmacies are registered, as well as approximately 4,400 pharmacists and 500 pharmacy assistants. To date in 2009 - members will appreciate that these figures are significant because the PSI only commenced its inspection and enforcement duties earlier in the year - some 277 inspections have been carried out of retail pharmacy businesses. There are a number of serious investigations under way and two successful prosecutions were pursued in the courts in 2008 and 2009.

Our principal focus is to improve standards in practice and the professional conduct of pharmacists. Our main commitment is to modernise pharmacy in Ireland. There is an opportunity for pharmacists and pharmacies to help resolve some of the difficulties and challenges faced by the health service in areas such as chronic disease management, pharmaceutical care and treatment, minor ailment schemes, reclassification of medicines, medication error reporting and health screening in pharmacies. We would also like pharmacists to have full prescribing authority under protocols and on a formal basis.

Pharmacy can contribute to vaccination programmes in the future. In this regard, some 800 pharmacists have been trained to provide services in this regard. We would like there to be greater utilisation of clinical pharmacy services in the hospital sector. I would be happy to take any questions which members wish to pose.

I welcome our guests and thank them for their succinct presentation, the main thrust of which relates to the implementation of the provisions of the Act relating to enforcement, etc. Are our guests of the view that having a non-pharmacist majority on the council works well? This aspect was considered important by both the Irish Medical Council and the PSI.

Dr. Ambrose McLoughlin

Perhaps I might ask Dr. John Hillery to answer that question.

We will take the questions of the various members first before our guests reply.

Dr. Ambrose McLoughlin

Dr. Hillery is one of the senior non-pharmacists on the council and might be able to able to assist the Deputy on the question she posed.

I am just interested in discovering how the council is working.

There is a view that pharmacists could do more than they are doing and that their role might be expanded. This matter must be explored because I have met pharmacists and I am aware of the skills and training they possess. In that context, their role must be developed. An issue being publicly debated in the context of the McCarthy report is that relating to a reduction in the cost of drugs. What role do pharmacists have to play in this regard? In the context of their role being expanded, it has been suggested pharmacists could assume responsibility for some of the work done by GPs and nurses in medical practices.

I also welcome our guests. I thank them for their presentation and the detailed document they supplied to members.

I welcome the establishment of a code of conduct for pharmacists. It is hugely important that our guests' guiding principle is, as Dr. McLoughlin stated, "patients, patients and patients." That is as it should be. I am of the view that pharmacists also welcome this code of practice because it places patients at the centre of everything they do.

I agree with Deputy Jan O'Sullivan that pharmacists have been seeking to expand their role for a long time. People in rural towns and villages often go to their pharmacist rather than their doctor. They know their pharmacist and are aware that, if they pay a visit to their premises, the latter will be available to provide advice. There is scope to develop the role of pharmacists in order to allow them to undertake other activities.

What is the role of pharmacists in the establishment of primary care teams? I am aware that there is something of a disconnect in this regard, particularly in the case of pharmacists whose premises are located on the main street and who want to protect their business. Is it possible to include pharmacies within the concept of primary care teams which operate in a particular environment and incorporates various disciplines? There is a difference of opinion about the level of service required. It would make achieving effectiveness and efficiency in primary care centres more difficult if there was a level of disharmony between such centres and pharmacies. Do our guests have any views on the matter?

I welcome the delegation. I recently discovered that not all pharmacies were connected to a computer network. Apart from alcohol, one of the most serious issues relating to addiction revolves around legally prescribed medication. When I inquired as to how it might be possible for a person to have a prescription for 50 tablets filled at one pharmacy and have it refilled at another pharmacy, I discovered that many pharmacies are not connected to the relevant computer network. I understand there was a plan in place to link all pharmacies but that this never came to fruition. People should not be able to have prescriptions refilled prior to the date on which they are due to be refilled.

I am concerned about the notion of pharmacists prescribing drugs. I accept that people obtain advice from pharmacists and that the latter often provide them with medication. Usually, however, a prescription is not required for such medication. I would be concerned that there would not be a technological link with GPs in this regard. Powerful medication is available on the market and one can obtain tablets for almost everything. In that context, controls are extremely important.

Why is Dr. Hillery considered one of the senior lay people on the council? Is it due to the fact that he is a doctor and that an ordinary, average layperson such as Ms Harvey would not be considered senior?

Perhaps Dr. McLoughlin was being ageist.

Dr. Ambrose McLoughlin

I think what I said constituted a slip of the tongue.

That slip of the tongue has historical connotations.

Dr. John Hillery

I am chairman of one of the committees, which is another breakthrough on the regulatory bodies. I presume that is what the registrar meant, rather than inferring that I possessed any greater standing than my colleagues. Historically, it has been extremely unusual for a non-professional to serve as chairperson of a committee. Senator Feeney who was chairperson of the ethics committee when I was president of the Irish Medical Council was the first layperson to be elected to chair a regulatory bodies committee. That is probably to what Dr. McLoughlin was referring, other than the personal high esteem in which he holds me.

Dr. Hillery will understand why I would be suspicious.

Dr. John Hillery

I was surprised myself.

I thank Dr. Hillery for that clarification.

I read through the submission briefly. I apologise for not being here earlier, but I had to attend the Order of Business.

I compliment the pharmacists on getting their inspection regime up and running. A rate of 277 inspections in 2009 is good. I know some of those inspections related to the opening of new pharmacies, but the bulk of them were to assess compliance. Were there any remarkable findings or did any outstanding statistics emerge as a result of those inspections? Can we be told the system is working very effectively?

Dr. Ambrose McLoughlin

To clarify, the PSI council has a committee system structure. One of the committees is an inspection and enforcement committee which is led by assistant Garda commissioner Nóirín O'Sullivan. Several of the other committees are led by senior, experienced people from the business and professional sector. This has been very important in securing and ensuring we could deliver on the necessary work. It is a significant achievement that the Houses of the Oireachtas signed off on the legislation in April 2007 and by July 2009 all of the legislation had commenced. I am grateful to the Minister, the Department of Health and Children and all Members who were instrumental in helping us with the legislation. I would like to express my appreciation with regard to the variety of people working on the council.

I would now like to deal with the questions asked. We need to expand the role of pharmacists in the context of achieving care at the lowest level of complexity. We need to support both home and self care. Pharmacists in other jurisdictions have many more roles in pharmacy and health care than in Ireland, but our 2020 project will see significant expansion in this regard.

Reference was made to the fact that there are pressures on the existing system. We consulted widely with focus groups, from patient advocacy groups to other professionals and there is a strong lobby in favour of expanding the role of pharmacists, including into the role of prescribing. However, this would be in the context of formal protocols and signed off and approved standards that are published, verifiable and can be audited.

I accept the point made by Deputy Lynch in terms of efficiency. We need an e-patient card to enable all of the medication that is prescribed and dispensed for every patient, whatever the ailments, to be traced. However, until we have that, we recommend that patients, particularly those who need regular medication, do as they would do with their general practitioner or consultant and use just one pharmacist or pharmacy. This will ensure that until we reach the point of having e-cards, patients will get better value care as a result of having one principal practitioner who is accountable for their care and treatment.

The issue of the role of pharmacists on primary care teams was raised. In the current economic era, we favour the concept of a primary care network where doctors, pharmacists and other professionals work together. The issue of cost must be uppermost in the minds of Oireachtas Members in terms of the difficult decisions to be made. We favour the establishment of protocols, backed up by forms so that we get cost effective prescribing and dispensing that are agreed and signed off by health professionals. This is being done in other jurisdictions and has delivered high-quality care to patients in a cost effective way. It also avoids many of the difficulties that otherwise would be experienced with contractual matters and other issues. There is now evidence-based prescribing available for many of the diseases that patients present for which they need medication and we strongly commend that. We are working with the Department, the professions and other regulators to ensure this is applied. It will take some time for everybody to get their heads around this process because it is a major change in terms of trying to drive more cost effective solutions. We need cost effectiveness rather than just cost at the centre of everything we do for patients. It is the effect and the outcome for patients that matters. There is solid evidence throughout the world that if these methodologies are applied in health care, we will get value for patients and the public, and value for money.

Dr. John Hillery

The question was asked as to whether the majority non-pharmacy combination on the council was working. As committee members are probably aware, Ireland is taking a lead in this area, both on the Medical Council and now on the PSI council. At my first meeting, one of the more senior members of the pharmacy profession - who was leaving the council - commented at the end of the meeting how surprised and gladdened he was to see how effectively the change worked for the profession. The same is proving true for the public. However, we must wait longer to see how it rolls out. People seem to be working well together and there is a kind of creative tension. I see it as a positive development. There was some resistance among the professions to the change, but it has been a positive change.

Mr. Tom McGuinn

I agree with the comments made by Dr. Hillery. The pharmacist member who made the comment was a senior member of the profession and was well qualified to make a value judgment. It was great to hear that was the experience and outcome.

Ms Kate O’Flaherty

The role of the pharmacist is now enshrined in legislation. This brings greater clarity for patients as to what they are entitled to expect from pharmacists. The legislation also recognises the role of pharmacists by expressing it in such a strong form. We hope to improve that relationship and service to patients.

Dr. Ambrose McLoughlin

I thank the Chairman for inviting us before the committee and assure members of our best efforts in the years ahead. No doubt we will receive an invitation in due course to return.

We look forward to engaging with the Pharmaceutical Society of Ireland on an ongoing basis. We wish it well in its work.

We should congratulate the society on commencing all of the legislation in such a short period. We seldom see that type of efficiency.

I ask members to return after the vote to meet the next group.

Sitting suspended at 4.50 p.m. and resumed at 5.10 p.m.
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