As pharmacies and Health Minister Mary Harney row over fees, ALISON HEALYlooks at proposals to change the face of the services those pharmacies deliver
WHAT DO you do if you develop a mysterious skin rash? Go to your GP and wait in line. But if you live in Scotland and are exempt from prescription charges, you can go to your local pharmacy where the pharmacist will treat it and give advice on how to manage it.
If you live in Australia, you can have your blood pressure or cholesterol measured by your pharmacist. Australian pharmacists are involved in programmes on obesity, smoking and alcohol use. They are also paid to visit patients’ homes and residential care settings to review medication.
The role of the community pharmacist in Ireland is “unrecognised, under-utilised and undervalued” according to the Pharmaceutical Society of Ireland which regulates the sector.
It believes money could be saved and patient care improved if pharmacies were used more efficiently.
It says pharmacies should be leading the way in areas such as obesity management, smoking cessation, immunisation against flu and pneumonia, and cardiac assessment.
“Four million visits to GPs and accident and emergency departments were avoided in 2007 because of patient pharmacy consultations,” the society states in a submission lodged with an expert group which is looking at how the system of funding the health service could be improved. The pharmacy regulator is looking for a five-year plan for the sector.
Ironically, as the regulator is proposing an expansion of pharmacy services, a major row is brewing between pharmacists and Minister for Health Mary Harney over a cut in their fees.
By last Thursday, more than two-thirds of pharmacies had signalled their intention to stop dispensing drugs to medical card holders from August 1st, due to a cut in their fees.
The changes are provided for from July 1st in a new Act and involve a reduction in the “wholesale mark-up” reimbursement price paid for delivery of drugs to community pharmacies from 17.66 per cent to 10 per cent. The dispensing fees paid to pharmacists will also change and a €33 million payment made collectively to pharmacists for dispensing to patients over the age of 70 is being abolished.
Irish Pharmacy Union president Liz Hoctor says the cut in fees will result in an average loss in income of 34 per cent and could cause up to 5,000 job losses. She says the protest is now State-wide, which highlights the strength of feeling from pharmacists.
The withdrawal of services will mean that medical card holders may not be able to have their prescriptions filled by their regular pharmacist and may have to travel long distances in rural areas to find a pharmacist who is not involved in the dispute.
Ms Hoctor describes the cuts as “excessive and unsustainable” and says there are better ways to save money. The union welcomes the plans put forward by the pharmacy regulator and says its members have been making similar proposals for some time.
In March, the union made a set of proposals which it says would result in a €83 million saving to the State. It includes a proposal that pharmacies should be allowed to offer patients the choice of a cheaper generic medicine where applicable.
Currently, pharmacists must dispense the drug specified on the prescription and cannot substitute a cheaper generic drug.
Ms Hoctor says other countries have made massive savings since generic substitution was introduced.
Finland has allowed substitution with cheaper alternatives since 2003, she says, and now 14 per cent of prescriptions involve generic substitutions.
She says it is difficult to understand why the Minister for Health has not seriously considered this measure, in the face of such strong international evidence.
Ms Hoctor says the union has been offering to meet Ms Harney since March to discuss how cost savings could be made but is still waiting for a response.
Ms Harney had anticipated last week’s backlash from pharmacists over the cut in fees and wrote to Fianna Fáil backbenchers last month explaining the reasons behind it and urging them to support the plan.
In recent days she has pointed out that the cost to the State of pharmacy services has doubled since 2002. She has also signalled the possibility of setting up a tendering process for the distribution of subsidised drugs by pharmacists.
This could mean that just one pharmacy in each locality would dispense drugs and medicines to medical card patients.
The Competition Authority report on pricing in the retail sector released last week said pharmacy price reductions for consumers must come from the State reducing the prices it pays for medicines.
“The mark-up paid to pharmacies for medicines under the State’s Drugs Payment Scheme – which effectively is also the mark-up paid by private individuals for medicines – should be brought down from 50 per cent, one of the highest in the EU,” the report says.
The pharmacy regulator is not getting involved in the row over fees, saying it is a matter for the Minister and the Irish Pharmacy Union. But its submission to the expert group says significant cost savings could be made in several areas.
Its chief executive, Dr Ambrose McLoughlin, says up to €75 million could be saved if pharmacist-supervised self-medication programmes were developed. He says one-quarter of the population has a chronic disease and this accounts for 78 per cent of healthcare spending, 80 per cent of GP consultations and 60 per cent of hospital days.
If pharmacists were allowed to play a greater role in healthcare provision, many of these people would not need to visit their GPs or AE departments so frequently, he says.
Dr McLoughlin points to the five years’ training that pharmacists undergo and says it makes no sense that this expertise is not exploited, particularly when the country is facing such difficult economic challenges.
He says money could also be saved if patients with ongoing conditions such as heart ailments could nominate a pharmacy of their choice for their medication.
This happens in cases where patients receive “high tech” drugs, such as some cancer or multiple sclerosis drugs. Dr McLoughlin says this would result in a higher level of compliance with the treatment as patients would develop a relationship with their pharmacist.
He points to the US and Canada where pharmacists immunise patients against pneumonia and influenza and says the uptake is very high because of the convenience involved.
The society also wants to see changes to hospital pharmacy services, which they describe as “very underdeveloped by international standards”.
Countries such as Britain have developed advanced clinical pharmacy practitioners in areas such as cancer services and infection control. The submission also says that pharmaceutical care in prisons must be brought up to international evidence-based standards.
The patients’ group Patients Together has given a broad welcome to the pharmacy regulator’s suggestions for the sector.
Its spokeswoman, Janette Byrne, says it would be convenient for patients if pharmacies could do blood pressure and inoculations “once it doesn’t incur extra expense on the patient”.
She says it may not suit every pharmacy to provide such services. “Hygiene and privacy of patients would have to be respected,” she says. “A lot of chemists are very small and I’d worry about the space they would have to provide these services.”
The pharmacy regulator says it is optimistic that its suggestions for the sector will be taken up by the Minister for Health.
But observers believe the future direction of Irish pharmacies may well hinge on how Ms Harney and the Irish Pharmacy Union handle the fees dispute in the coming weeks.
