Speaker 0 00:00:00 Hello and welcome to a very unusual Wonder Care podcast. This podcast is brought to you to try and update you on my campaign to make healthcare more accessible to the patients of Ireland through the expansion of pharmacy services. I have been campaigning for this strongly since December. My colleagues over in the I P U, the Irish Pharmacy Union have been campaigning for this for, I'm gonna say two decades, but certainly since 2014. They've been campaigning for the very same specific things that I've been asking for. The only reason I have not joined the I P U in their journey and quest to try and make change happen is that I don't think that emotionally I could handle failed bureaucratic nonsense meetings where no progress is made despite many promises. So yes, I've gone a little bit rogue campaigning on my own. I think that's important to say because my opinions are my own. Speaker 0 00:01:01 They're not the opinions of the Irish Pharmacy Union, but we are aligned in what we want for the patients of Ireland, and that is the same thing. It is the expansion of pharmacy services and the provision of decent, timely, and accessible healthcare. So the reason I wanted to update you today is because there was a very important meeting between the Iraqis Committee for Health and the Irish Pharmacy Union on the 8th of March, 2023. I kind of wanted to talk you through the meeting. I have selected some sound bites so that you can kind of get the gist of how it went and I can try and explain along the way what my thoughts on this are. I'd like to thank everyone who was in the room from the Irish Pharmacy Union. We had Derma Toy who is the president of the Irish Pharmacy Union. We had Susan owi who is the head of governance and pharmacy services within the Irish Pharmacy Union. Speaker 0 00:01:59 We had Kathy Marr, a community pharmacist from Jule, and a very passionate advocate for healthcare and pharmacy. And we had Sharon Foley who is the Secretary General of the Irish Pharmacy Union. And I would just like to precede my comments by saying that the Irish Pharmacy Union representation today were fantastic. I was really, really happy to hear them put through such a strong argument. I'm just sad that they're still having to argue 20 years later. And then from the Iraqis Committee for health members that were present included Herek, Sean Crowe from Shin Fein, Bernard Durkin from Feal, Colin Burke from Feal, David K from Shin Fein, NASA Horgan from the Green Party, and Gino Kenny from People Before Profit. We also had Roshin short hall from the Social Democrats. And I would also like to thank all of those committee members because as you will will hear, they were extremely supportive and they were just trying to understand what the issue is, what the proposals are, what the barriers are, and what they can do to help drive this campaign forward. Speaker 0 00:03:10 I have never before described myself as a political person. In fact, I probably might have been a little bit averse to the hold world of politics. But yeah, brace yourself for the next little while. I am in the throes of this conversation and I am deeply emotionally invested to the outcome of my campaign. I don't have major skin in the game. I'm a community pharmacist who owns one community pharmacy. There's 1700 community pharmacies in Ireland, my pharmacy as primarily private patients. So what I'm campaigning for mainly benefits public patients. I just want to make that clear in case I'm accused of having ulterior motives. I wanna make it clear that my motives here are patient care. I am worried, genuinely worried for the future of our primary care system, and I truly believe that community pharmacy can play a vital role. We need to be delivering the right medicine to the right people in the right place at the right time. Speaker 0 00:04:11 And it needs to be for everyone. Whether you have medical card or not, we cannot discriminate between medical card holders and private patients by allowing access to private patients to buy products overthe counter, but not allowing medical card patients to get them over the counter unless they go to a gp, which as we saw during crisis moments of which we are going to have a continuing rolling session of over the next decade, they're not gonna be able to access their GPS so they can't have treatment. That's not fair and that's not right and that is why we are here. So the first to speak was IP President Derma Tomi, and I just wanna say I do play quite a little bit of what he said because it sets the scene and provides context so that you know what the Irish Pharmacy Union are asking from our government. I promise the rest of the sound clips from yesterday's session are kept an awful lot shorter. Here we go. This is what Derma Tomi, president of the I P U started Speaker 1 00:05:08 With. So we're proposing a new scheme which holds significant potential to free up capacity in primary care, which we all know is under huge pressure. A minor ailment or a triad service would be a community pharmacy based service. It would be similar to what's been used in Scotland as the pharmacy first model. Under this scheme, public patients with minor self-limiting conditions would no longer have to make or wait for GP appointments. Instead, they would consult with their local community pharmacy. They would receive an assessment of their symptoms followed by either a combination of advice, our medication supply and our referral to other services. Existing legislation for the supply and administration of certain prescription only medicinal products can be amended to provide a route for widening access to the range of treatments available. So this would be available to both private and public patients. The whole uh, of the country would benefit from a wider range of conditions being eligible for assessment and direct treatment in their local pharmacy. Speaker 1 00:06:06 The introduction of the scheme would demonstrate government commitment to enhancing public health access, ensuring timely and equitable access to medicines, delivering quality patient care. And the key point is improving health outcomes. Such a scheme would support national healthcare principles of delivering care that is equitable, accessible proximal to the patient and sustainable. I suppose a key point here is based on information that we have done through studies, is that this potentially could free up to 1 million GP appointments and they could be treated in community pharmacies or referred as appropriate. This would be a clear example of an opportunity to radically reimagine the delivery of timely care within the community and to deliver cost effective, safe and desired health outcomes. The Irish Pharmacy Union proposes their work now begins on this and addressing the immediate issues within the health system. I'd like now like to speak on access to contraception. Speaker 1 00:07:03 I think it's timely in that today's International Women's Day. So in terms of contraception, the Women's Health Action Plan has demonstrated the the commitment of this current minister for health to prioritize the health of women in Ireland, and we wholeheartedly support this. We were delighted with the introduction of free contraception and it's further planned expansion and we believe that reducing barriers to contraception can only enhance patient care. It's been reported on multiple occasions that women both in Ireland and abroad would prefer to obtain their contraceptive from their pharmacist. There's no clinical reason for oral contraceptives to be supplied on foot of a prescription and with proper protocols, this is a very safe and very effective healthcare intervention experience in other countries demonstrates that reducing cost and increasing access is highly effective in nations who might not otherwise engage with health services such as new communities, younger cohorts and ethnic minorities. Speaker 1 00:07:59 Similar to the minor ailment scheme, we recommend that the minister now moves to expand the range of medicines noted in Schedule eight of the medicinal products, prescription and control and supply regulations 2003 as amended to include the full range of oral hormonal contraceptives and injectable lung acting. Contraceptives. Training and governance requirements can then be put in place medicine shortages. Medicines are the most common healthcare intervention within the health system and medicine shortages and the management of the patient's needs as a consequence are a core function and role of community pharmacy. The nature of our medicine supply chain and its globalization means that this is becoming more complex than ever before and pharmacists often have to source medicines from other countries in order to meet the needs of the local population. Giving that pharmacists are experts with unique skillset and unrival pharmacological knowledge. We advocate for the more effective utilization of this skillset to manage medicine shortages at the point of patient access. Speaker 1 00:08:58 This would facilitate therapeutic substitution of medicines without the need to revert to the GP for a prescription. In cases where there is a critical shortage of medicines, again, a relatively simple measure which will increase the speed of supply and reduce the stress both on the patient and also on the pharmacy and the pharmacy team strategy and a chief pharmaceutical officer. As a country, we need to take a more proactive approach to the management of medicine shortages and indeed to pharmaceutical care in general. One of the most fundamental and seismic changes would could be prioritized to unlock the uh potential of community pharmacy is to develop an agreed national strategy for pharmaceutical care. This would help to deliver better health outcomes for patients. This should be owned by the Minister for Health and driven by the appointment of a chief pharmaceutical officer within the department. As with other professions such as medicine and nursing, this person should be appointed at senior level so that the strategy has both power and currency. Speaker 1 00:09:58 It is our view that the proposals outlined above would make a significant immediate impact in terms of better utilizing the limited healthcare resources at our disposal. We are committed to driving them forward. However, we cannot do this without support To fully deliver on better health outcomes, the sector must be adequately reimbursed and invested. June, 2023 of this year is the deadline for the minister's commitment to review the fees paid to pharmacists. These fees have not changed since 2009 and have not kept in line with crippling inflation. Our average dispensing fee now is lower than it was in 2008, nearly 15 years ago. If community pharmacies to do more to deliver essential health services, we need to be able to invest in our teams to provide these services. Our GP colleagues have had the benefit of sub substantive talks resulting in the 2019 GP agreement, which saw saw a substantial reinvestment in GP services and we are sequencing equitable treatment. Speaker 1 00:10:54 Community pharmacy now needs to see a similar reinvestment to support future service delivery. This committee has previously debated the crippling slow progress regarding I C T and healthcare. A modern healthcare system needs functioning, e-prescribing and IC T investment and a move away from legacy based paper solutions without improvements in I C T to help streamline associated processes. There is now an almost unworkable administrative and cognitive burden being associated with dispensing under the community drug schemes. We fully support the HSCs health Vision to deliver connected and complete digital patient records across all pathways and care settings. Progress and eHealth is very much necessary to unleash significant benefits for patients and healthcare professionals. We firmly believe there are peer building blocks to establish eHealth and in particular a national e-prescribing service. Indeed, we've invested in some of these enablers and we want to help the HSE move off the starting line, but we, we need partnership from the HC with a clear commitment to eHealth and this means partnership clarity and targets timelines and budget. Speaker 1 00:12:01 So in conclusion, colleagues, we believe that community pharmacy can and will play a vital role in the development of future healthcare reform in line with S launcher care supporting people to stay healthy in their homes and communities for as long as possible. We want to invest in community pharmacy and we need investment in community pharmacy to deliver services with a proven dividend in terms of value for money, improve patient outcomes, and greater access to primary care for all of the population. It's now time for the government to engage with us on a positive agenda for change to deliver convenient, accessible, and cost effective healthcare through a currently under-resourced and underutilized pharmacy profession. Chairman, members of the committee I'd like to thank you sincerely for your attention. My colleagues and I will be pleased to answer any questions that you may have. Speaker 0 00:12:47 Okay, so you can hear there that the views that I have been sharing in the media are very in line with what Dermot has outlined. We then heard from the first member of the Raus Health Committee and that was Colin Burke. He asked some very useful questions in relating to the value of a chief pharmacist role and he also questioned the department's engagement with the Irish Pharmacy Union. On the development of this role, Sharon Foley from the Irish Pharmacy Union spoke about the importance of a chief pharmacist role to support the strategic planning of items like women's health planning in Ireland, et cetera. And it was made very clear that we've been slow to adapt World Health Organization recommendations as a result of having no chief pharmacist to give voice to our profession. You can hear Kathy and Susan speak about examples of women's issues which need the steer of a chief pharmacist at a senior level within the Department of Speaker 2 00:13:48 Health. We know that oral contraception is a very safe medicine that has been available for 50 years. The W H O have said there is no clinical reason for it to be supplied on prescription only. So the clinical group within the HSE are looking at that. We're hoping for positive outcome and we're hoping to see this move very Speaker 3 00:14:04 Quickly and just, just in another issue that's come up to me and it's been raised with me and that's in ion to uh, again, it's in enrich to women's health and that's in enrich that the drug caravan. Uh, my understanding is that that is a prescription. Uh, you can't dispense it on a GP prescription. It has to be a consultant's dis uh, prescription. Can we get some clarification on that issue? Speaker 4 00:14:28 Yes. Susan owi, I might just answer on that. So with that particular medication, it needs to be prescribed in the initial instance by a consultant obstetrician. Um, so mom has to be go to um, hospital, see that consultant and then get that approved by a consultant. Subsequently, prescriptions from GPS will be authorized and can be supplied, but we believe that's a barrier actually to access to that particular medication. You're talking about women in the first trimester maybe not having ready access to a consultant and women with different abilities to pay, having different access levels. Um, so that restriction to that consultant only and having to have that specific approval before the medication can be supplied through a pharmacy, we believe is a barrier we'd like to see that looked Speaker 0 00:15:06 At. Then moved on to the next RTA health committee member to speak, which was David Coln from Shin Fein. David agreed that enhanced pharmacy services would benefit patient care. He also had some discussion about the medicines serious shortage protocol and this soundbite of David and Dermo from the I p's conversation. We'll make it clear what the pharmacy union are looking for. Speaker 1 00:15:30 What we we're looking for is that pharmacists would be empowered to make a clinical decision in their practice to switch from a particular molecule to molecule B, where molecule A is not available or the product A is not available without recourse to the prescriber. And again, this can be worked. True protocols that can be developed for example with those Speaker 5 00:15:50 Protocols for example, have guidelines that would have like a second line of a drug and a third line of a drug. And so it would be very highly regulated, step by step guidelines would be available. So there would be lots of protections which are not in place as part of, that's the whole logic of having a protocol. Speaker 1 00:16:06 Yeah, no, a hundred percent. I mean if you look at antibiotic prescribing for example, there's clear guidelines from the HSE with regard to which is the first line antibiotic, second line. Third line, yeah. So we will be very much AD advocating that we would work according to the protocols, um, that would be set up. Speaker 0 00:16:22 Obviously David agrees that it is very safe and robust logical process. So I call on our government to ensure timely access to medicines to the public by providing the required legislative amendments to bring in a serious shortage protocol. David also supports the call for a role of a chief pharmaceutical officer. He actually goes on to query why it hasn't happened. Sharon Foley from the I P U E explains that the Minister for Health wants a strategic action plan in place first, but how we actually need the officer to be in place to drive that strategic action plan. So it needs to happen now, Speaker 6 00:16:57 But certainly what we would've felt with the medicine shortages recently was that there was no one single entity that had that oversight of all parts of the process and could advise the government accordingly. Okay, Speaker 0 00:17:07 David then goes on to talk about the minor ailment scheme and how that is something that we should not be waiting for a national strategy for pharmacy for. We can get hooked in and get that sorted. Now Speaker 5 00:17:18 Obviously a national strategy can take time and there's lots of elements of what could be in a national strategy, but when we look at what happened during the winter and even the summer in terms of the pressures and our health service, we know that GPS are under fierce pressure and anything that we can do to take pressure away from primary care, from general practice, uh, obviously would be important. Speaker 0 00:17:38 I know you've all heard me talk about minor AM and scheme and exactly what it is over the past four or five months <laugh> nonstop. So I suppose I thought you might like someone else's take on it and this is Susan from the Irish Pharmacy Union explaining exactly what a minor ailment scheme is. I Speaker 4 00:17:58 Suppose to describe what a minor Aman scheme is and just to, at the very outset to find a minor ailment that's really just a condition that's minor in nature, it can re, it'll resolve on its own. So it's self-limiting. We often say it can be re simply diagnosed in the community pharmacy setting and it can also be managed with either advice or treatments. Um, and essentially a minor element scheme is where a patient would come to a community pharmacy, um, there would be an assessment of their symptoms and on foot of that assessment of symptoms you would either give, well you would always give advice and self-care advice. There may be a referral or there may be a live treatment. But if you think about it as the assessment of the symptoms and the management of the condition that's being presented to you, um, you can make an assessment. Speaker 4 00:18:36 This is something that community pharmacists do every day you make an assessment of those symptoms. You see if this is something that is mild and self-limiting, if it's not, if there's any red flag symptoms, then referral can happen. Um, but at the minute we are restricted in pharmacy to the range of medicines that are currently available over the counter and we're also restricted to providing that service to people who have an ability to pay. So at the minute it's not equitable in terms of the, a number of people that can access the service. Um, and also in terms of the range of medicines, there are other medicines that are currently available on prescription that do treat minor self-limiting conditions and it would make sense to make those medications available. Speaker 0 00:19:11 David goes on then to say and comment on the fact that healthcare in Ireland is not AC equitable at the moment. Like it's not fair that medical card patients have to come into the pharmacy, then go back to the GP to get the medical card's prescription and then bring it back to the pharmacy, whereas a private patient can actually just buy an over-the-counter product and that is in a way price discrimination. So I don't think that's something we should be accepting either. Obviously today I couldn't go because I'm not a representative of my profession officially. I think many of my profession have endorsed my views and have sent me many messages of support. So I have no doubt that I am in reality representative, but I can understand that the health committee want to meet with an official union. So I am gonna take this little bit of credit that you're about to hear just because I can. Speaker 5 00:20:06 I just had one supplementary, I should have mentioned Sheena Mitchell who's on a lot of work in this area as well. I know you that you guys have engaged with her. I'm not sure she's a member of your she body, but she has lot of work and wanted to commend her and uh, have you engaged with her on the proposals that Speaker 4 00:20:20 She has? Yes, so Sheena will see would be able to tell you from the frontline. So every day she's seeing patients that are coming in. She can, she knows what they need to get to treat their minor condition, but she can't give it to them either because they're a patient that doesn't have the ability to pay or because it's a medication that's not currently available. Speaker 0 00:20:35 <laugh>, yay. Thanks for the shout out in Lester House. My day was made. As I said, I have common goals with the I P U and I just don't have their patience to follow the correct political pathways because I think our government, well very specifically our Minister for Health is talking the talk, but he's not walking the walk and I feel that I'm in a better position to put pressure on our government by enabling the public to understand what pharmacies can offer and then basically highlight whether our government are willing or not to adopt those protocols and to adopt the expanded pharmacy role. It is clear that it is in the patient's best interest. So I feel that I serve the people of Ireland better by informing you of what's going on and I will continue to do that until the pharmacy services are actually working. Speaker 0 00:21:33 It's no good making empty promises to someone like me. I want action and I want it now as a human, I just cannot accept our current health system is good enough when a reasonable solution is on the table. As I said earlier, I won't accept resistance due to ulterior political agenda. It has to be patient first. The next committee member to speak was Roshin Shortall. Roisin was speaking to Dermot 12 years ago about the resistance that was faced when community pharmacies suggested the rollout of the flu vaccine in Ireland in community pharmacies. Roshin was commenting that she can't believe that was 12 years ago and that we may still be facing similar type resistance now even though it's safe to say that we've long since proven ourselves Speaker 7 00:22:20 At that time also, um, recall trying to get uh, approval for pharmacists to provide the flu vaccination and uh, I remember being shocked at the resistance that there was to that and again, that seemed to be like a no-brainer, but there was certainly resistance and to a large extent this kind of thing is very often regarded as business and losing business from other sectors. So I mean thankfully, you know, we are at a stage where the flu vaccination is available locally in in community pharmacies as was obviously the the Covid vaccination, although there was also kind of delays in making that available for pharmacists and indeed publicizing that, which I thought was very regrettable at the time. Speaker 0 00:23:10 She then went on to say that she thought we may have scoped to do different type of vaccinations and was there more that we could do on that front. Kathy Meyer from the I P U explained that yes, we have the skills and the legislative support to provide vaccines, but vaccines like shingles and pneumonia are not currently being supported by the Department of Health and so they won't reimburse pharmacies first. So in practice it's near impossible to deliver a service. Kathy made the point that all women should have access to free contraception, not just the 17 to 25 year olds that currently do and the 30 year olds that will from September. It was also pointed out that it's not just the price that's a barrier in the provision of healthcare to women. Sometimes it's about the simple access to it. Kathy pointed out that the World Health Organization provided guidance which stated that the oral contraceptive pill does not need a prescription to be accessed. Speaker 0 00:24:08 Rosin very kindly then suggested that they mark International Women's Day by endorsing that request. In a letter to the minister, I've posted a quote of this on my social media Wonder Care I r l Roisin then asked about chronic medication management and if there was a possibility that pharmacists would have a role in the provision of that service. Susan from the i p explained how allowing pharmacists to support patients more in the community in relation to things like blood pressure management, all of this can lead to better adherence and compliance to medicines and therefore better patient outcomes. Roshin also spoke about the pharmacist recruitment issues and Dermot explained the impact of Brexit. Basically the highlights of that were that we need to make the quality of the job better to attract young pharmacists by removing old legacy systems and current bureaucracy. I have to say I completely agree with that. Speaker 0 00:25:08 We also need to allow quicker access to non EU pharmacists who fit all of the requirement criteria. Currently they're held in limbo for up to two years where they're neither student nor professional. Apparently the government have also committed to doubling the pharmacy places in Ireland. Dermot emphasized that this needs to happen this September. We cannot afford to face delays on the matter of bureaucracy. Any pharmacist will tell you that there is nothing more tedious than spending literal hours trying to figure out if you're gonna be paid for something. So it's kind of driving pharmacists towards the reaction of prescription come in for a patient and you spend more time trying to figure out actually if it has a code or if you have to use one of the many ridiculous schemes like hardship to try and claim payment for it. Or if you then have to go and check the special pharmacy suite, which shows certain patients are approved for certain items and you know, often this needs to be consultant initiated and the consultants don't submit the approval documentation necessarily. Speaker 0 00:26:16 So then we have to chase that up and all of the time you're doing that, your patient is standing out in the pharmacy like they could be post heart attack just on their way home from hospital and this is what we are doing. It's fairly criminal when you think about it. Okay, so next up from the health committee to speak was NASA Horrigan. So she spoke a lot about the importance of accessible contraception and again how asked how the government can help with pharmacist recruitment. The Irish Pharmacy Union reiterated the importance of actioning this increase in university places. NASA also engaged in a conversation around e-health records and the lack of funding coming from the Department of Health to ensure that appropriate communication is happening between GPS pharmacists and hospital prescribers. As it currently stands, many of these conversations have to happen over phone and again, we waste ten, twenty, thirty minutes waiting on hold. Speaker 0 00:27:17 We're trying to track down a hospital doctor or the hospital pharmacist to try and get clarification on the medication because it often happens where prescriptions are written for patients and there's been a change, but they haven't noticed if some items have been discontinued or the dose is questionable and not in the normal dosing range. And we have suspicions that it may not be safe for that patient. There's just so many reasons that we as pharmacists trying to do our job to clinically assess the suitability and safety of the medication for the patient standing in front of us who's wary from the secondary care healthcare system and we have to hold them there while we're making ridiculous phone calls. If we were using technology to it's sole purpose in being convenient, then we would have access to that information through a national cloud system immediately and that would lead to safer practices and faster and more appropriate patient care. Susan o Dwyer explains the importance of e-prescribing here. Speaker 4 00:28:21 And so e-prescribing, we talk about digital transfer prescriptions at the minute we have digital transfer of prescriptions, but we don't have e-prescribing. So a proper e-prescribing system, the doctor would write a prescription. That prescription is coded so there's a code given to the patient. So there's an identifier, there's also a code for the drug. So you've got identifiers for those elements then that's transmitted to a national service, be that the cloud if you want to describe it that way, but it's pushed to a national system, then the patient can go wherever they want. So they have the choice of movement, free movement, they can go to whatever pharmacy they want to at whatever time. If the pharmacy that they were chose to go to initially was closed, they could go to another one and then they go into that pharmacy, they ask for their medication, they ask for their prescription, the pharmacist can pull that down. It comes into their system, it's coded. Speaker 0 00:29:03 She also asked the HSE to engage the I P U in relation to the National health products catalog, which would help the HSE to set up e-prescribing in a quicker and faster manner. The i p are happy to help by providing this catalog, so you kind of have to wonder why that hasn't happened already. Sharon Foley from the I P U explained that the HSE would have to move on this as it has to be a national central system for security reasons, we are behind countries like Estonia who already have systems like this in place. Okay, next up to speak from the committee members was Gino Kenny. He asks how pharmacists prescribe in other countries and Susan from the IPU gave examples of patient group directives, which I had written to Leo Raker about in December last year, and she explains a little bit about what they are. Speaker 4 00:29:58 Yeah, so in the Scottish model they use a structure called patient group directions to supply the prescription only products, and that's to a certain cohort patients if they fulfill certain criteria. So for example, they can give acyclovir to treat shingles, they can give phytic acid to treat inigo. So there's a number of different specific conditions that are prescription only medicines but are supplied by the pharmac of foot structure concept consultation. Speaker 0 00:30:21 Okay. Gina also wanted to understand if we're actually able to prescribe anything at the minute or give any prescription only medicines without a prescription. So Susan explained all about schedule eight here Speaker 8 00:30:32 At yeah, is there any medications you can prescribe? Speaker 4 00:30:34 So at the minute we talked about schedule eight with medicine products controlled supply regulations and that is where there are certain prescription only products that you can supply and or administer. So that's how pharmacists deliver flu, pneumococcal shingles, covid vaccines, but also administer certain me, um, emergency medications. So naloxone if somebody has an overdose, um, if there was glucan, if somebody was having a diabetic crisis. Um, there's also salbutamol if somebody's having an asthma attack, so it's medicine's in an emergency situation, pharmacists can and do administer adrenaline if somebody's having an anaphylactic reaction. Um, so you've got that immediate kind of urgent emergency care currently being delivered in the pharmacy setting through that structure. Speaker 0 00:31:12 Gino went on to say that the minor ailment scheme is an absolute no-brainer after asking for a couple of examples on how it might work in practice, this is what he had to say. Speaker 8 00:31:24 This just seemed ludicrous Speaker 4 00:31:25 To me. Yes, we would agree <laugh> Speaker 8 00:31:27 <laugh> why didn't not change it. Speaker 4 00:31:30 That is a question I think for the department, but um, we hope that they'll think about it and maybe, uh, agree that this is, that's something to do. Speaker 8 00:31:37 Something as rudimentary as something like that. Yeah, it sounds like it's ridiculous situation where somebody has to go to a Speaker 4 00:31:41 GP when we talk about care at the lowest envelope complexity at all times. This is a clear example of that. Speaker 0 00:31:46 He also went on to say that he supports easily accessible contraception for women, which is the provision of the oral contraceptive pill without a prescription, which would obviously alleviate some appointments from the GP and would allow women to take more control over their own health story. He also shared frustration on something that has been very, very, very widely shared in the media and that is the absolutely convoluted route to access of caravan. It's clear that providing funding for something and making large media announcements that the government are going to allow carvan access to pregnant women suffering from hyperemesis and then making the access almost impossible to actually get because you need to rely on seeing your consultant before you can get a prescription. You know, many people, especially people in the public system, won't see their consultant until after their first trimester. So it's a case of we'll treat you, but no, you can absolutely go and vomit for two months or three months solid. Speaker 0 00:32:53 After that, Bernard Durkin was the next member to ask the committee questions. He had some concerns that if free contraception was allowed, that maybe protests might start, and he wanted to ensure that anything that's needed to prevent this is asked for. He was advocating for women, it's important to say, and he was advocating for them to be able to access health services safely and quickly. Kathy, a community pharmacist and also from the I P U explained that we have no issues as we have private consultation rooms since 2011 and we haven't seen that issue arrive since the rollout of the emergency hormonal contraception, which we are currently able to provide with their prescription. She also agreed that reducing barriers and promoting access to healthcare is very important in the area of women's health. Bernard also raised emphasis on the importance of easy dialogue between primary and secondary care providers, including prescribers and pharmacists. He showed empathy to pharmacists in relation to the difficulties that we face in terms of reimbursement for our services. Senator Martin Conway was next to speak. Senator Conway asked if we could help with things like cardiovascular screening. It was Susan Dwyer from the I P U who answered that question. Speaker 4 00:34:06 Thank you Deputy Susan Dwier. Um, yes, uh, the short answer is yes. So pharmacists actually are already working in this space. Um, we have a nu nearly every pharmacy will take your blood pressure but actually to do an assessment and a 24 blood pressure assessment that's being done in practice. There are pharmacies that build into that detection of atrial fibrillation as part of that assessment. Um, and those people then are being referred onto their GP either to initiate therapy or to adjust their therapy if the, um, if the readings are saying such. Um, so we think pharmacy is an accessible location. We have the ability to do this, we are doing it, but unfortunately it's not equitable because at the minute those particular services are only provided to people who have an ability to pay for them. And, and if they were provided to anyone on the basis of clinical need, then that's something that would probably improve access and improve the rate of detection and hence then improve. Speaker 0 00:34:55 He also asked if we could provide the HPV vaccine pilot. Speaker 9 00:34:59 What about the HPV vaccine? Is there any pharmacist providing the HPV vaccine? Speaker 4 00:35:04 At the minute, you are restricted in the provision of those medications to having a prescription with a written instruction from a doctor to say, please administer this vaccine. And in that situation it can be done. However, it's not at the same way as a flu vaccine. So if you want to get a flu vaccine pharmacy, you can just walk in, you can get it. HPV isn't included in that schedule, so we would see that as a vaccine that could definitely be added to the schedule and delivered in Speaker 9 00:35:28 Pharmacy. Sure, it's a no-brainer. And I suppose from your engagements earlier on, which I was observing from my office, uh, about the chief pharmaceutical officer and the Department of Health, it's, it's, it's mind boggling that that position isn't created. Speaker 0 00:35:40 He also raised queries over what happens in towns where there are no gps, as this is the case in many rural areas. We know about this, I've spoken about this before, 85% of Irish gps are in working in urban areas, and with first 3% of the GPS being over 60, I can imagine this is going to become more and more of a problem in the years to come. Kathy Maher from the I P U who has a rural pharmacy explained that this is when pharmacy services deliver the best value and we also deliver our best efforts. This is because we are happy to engage with our patients to deliver services and our patients come in their droves. Patients trust their community pharmacy. We saw this during the pandemic and so a town without a GP in fact ends up relying probably more heavily on their community pharmacy than one. Speaker 0 00:36:37 With the next committee member to speak was Maria Byrne. Maria spoke very kindly towards the pharmacy profession and she did forward gratitude to pharmacists for remaining open throughout the pandemic and delivering healthcare to patients when there was nowhere else to go. She also agreed that there is no logic in not having a minor ailment scheme and chief pharmaceutical officer after that, Sean Crow, who was the chair, wanted to understand a little bit more about the Sirius shortage protocol and the overall proposals. This was explained to him by Derma Tomy from the I P U. He then went on to ask why we're not moving forward when clearly there is so much need. It was Sharon Foley from the I P U who answered this question. Speaker 6 00:37:22 When you look at other countries like Canada, Scotland and Wales, they're on a journey. Some of their expansion and development have happened over the last 20, 30 years. So change happened slowly. Um, and at this stage now, as I've said earlier, we are so far behind that we need to try and speed that up and certainly there's a huge role for this committee in asking the right questions and keeping that, that, uh, pressure on and that attention and keep naming the need for a national pharmaceutical strategy and development and some of the ideas that we've shown there, there always will be some levels of resistance because the health system, health health systems in general re resist change and when things are different and when, I suppose it's a thing around power and, and where things move and everything, but other countries have shown that it can be done and it certainly benefits the citizens of that country. So it should be done Speaker 0 00:38:07 For myself. I don't accept that resistance to change is acceptable and I don't accept delays. We're not children. There is no logical reason for delays or resistant. So if our progress is blocked, one would have to ask what is driving government decisions if it's not patient care? Dermot from the I P U was then asked what we need. He explains the will is there from the pharmacists. So at this stage we just need the action. Speaker 1 00:38:40 It's been an internationally that every time pharmacy has been involved in a new service, it's been an a, a roaring success. Um, this has been proven with vaccination, it's been proven with, with any of the other services we've provided. It's just getting, getting out of the start blocks is the key point. Um, and as I say, the community farm sector is willing and able and very much wanting to get out of the start blocks Speaker 0 00:39:04 After that. During the summary conclusions Colin Burke asked, where we go from here Speaker 3 00:39:10 Concern about is that, you know, we've got a very good presentation here this morning and I would hate that it would be lost with just a presentation and questions. And I think what we should do as a committee is formally right to the Department of Health looking for some answers to those questions and also, you know, um, that I'm not sure whether we the next time the Department of Health natures here in that we would certainly have a time set aside to deal with this particular part of the issue as well. So I'm not sure what way we could do this now, but I do believe that we need to follow this meeting up with some something constructive from the committee. I mean, the proposals here this morning have been very constructive. It's about improving healthcare and it's about we now as a committee trying to get the Department of Health to move on that. And that's based what I'm looking for, that we, we would actually do a follow up on this. Speaker 0 00:40:06 I love that the health committee genuinely do want to help to make proposals a reality. We just need urgency. We need to take steps in action. Why is it so hard when everyone agrees what we need to do? Is there no one that can just get things done? See, this is why I'm not on a committee. Just do it. Stop talking. We have done that for years. It is time for action that is not a dig at Colin Burke, by the way. I'm just frustrated for the people of Ireland that it is this hard to drive positive change. This shows exactly why we need a chief pharmaceutical officer. Is it this hard to get a simple, easy, good idea across to the Minister for Health for action? Do we have to beg a thousand different times in a thousand different ways to try and actually make a difference to our patient's life? Speaker 0 00:41:00 This is ridiculous. We are a voice that are not being heard. We need representation at a very senior level, just like a Chief medical Officer. We need a chief pharmaceutical officer. Otherwise, primary care is going to continue to suffer because there is only so much we can bang our heads off the door of less strous <laugh>. This is no way to run a country and this is a ridiculous expectation of what it is like to do good for the people of Ireland. It should not be so hard to make change. I do not accept that it is this hard to make change. Good Lord. Right after that little rant we hear from Sean Crow who provides a little bit of a summary and I suppose gives the outcome of the meeting the action points. I'll let you hear, Speaker 10 00:42:02 Uh, we've passed them motion there in relation to the oral contraceptives, but also update in relation to the minor illness game and try and find out about that. We'll also try and find out half the minister, uh, responsible in relation to pharmacy student places. Again, that was one of the, the issues that was raised with, with members the idea of the possible prescribing rights. And we maybe we can get an update in relation to that. I think it's important if we certainly when the next opportunity that we get when we're bringing the minister in, we will try and, uh, get, you know, maybe get some, some, some, some sort of answers in relation to, but we will attempt to try and get some sort of written replies in in the meantime, Speaker 0 00:42:47 It is very difficult to know whether we should be optimistic or not. The ironic part of all of this is last Friday I spoke to Pat Kenny on News Talk. I was in studio and I ran through the whole of my proposals and explained that they were in line with the IPUs, but that I just became completely impatient of the, I suppose, bureaucratic processes and that I was just calling for people to actually help me drive this change for the public to help me drive this change for the media to help me drive this change. Anyway, pat got it. Okay. He's a clever man. I explained what I was talking about and he understood straight away, fast forward today, this meeting is going on right in Lester house. The art pharmacy union are there knocking their heads off the wall. Again, explaining to, to be fair, a very positive and helpful health committee. Speaker 0 00:43:43 I am absolutely delighted with all the comments they made. They clearly see the good in what we're doing, but you can even hear the defeatist attitudes in their voices when they're like, yeah, we'll try and get the minister to write you a letter. We'll try and get him to listen to us when we next get him in. It's all a bit desperate, really. And in the meanwhile, minister Steven Donley is on the Pat Kenny show and he's trying to put out fires in relation to the consultant contracts and, you know, that's what the conversation was about. And at the end, pat asked him, what about the pharmacists? I had this pharmacist in here last week and she said this, that and the other. I am excited to let you hear what Minister Donnelly said. Here it is. Speaker 11 00:44:30 And the, the range of services available at pharmacies be expanded. We had a pharmacist on during the week saying, we are the poor relation as far as the Department of Health is concerned. There's so much more we could do. Ease the pressure on gps. You know, if someone is needs to go to a gp, the pharmacist will surely tell them. But o oftentimes, for example, if someone has to get an over-the-counter prescription or medicine on the GMs, they have to go to their doctor, get the doctor to sign off on something that if you have the money, you can buy it over the counter without any prescription. Not for long, not for lot. They are so right. We, we significantly underutilized our pharmacies, our pharmacists are so well trained, they're such highly skilled professionals and we only tap into a fraction of what they're capable of. Speaker 11 00:45:15 So as you've just said, someone on a GMs uh, uh, uh, someone with medical card in order to get the over-the-counter medicine for free has to go and talk to a gp. That's a waste of their time. It's a waste of the GPS time when they should just be able to go into the pharmac just like anyone paid. So that's gonna come, that's gonna come. Um, we're looking at a minor ailment scheme as well. We're looking at, um, prescribing for pharmacists. In fact, the Rcsi students now are the first students who are going to graduate as pharmacists who've been trained in prescribing. It's something the NHS already does. I wanna see that rolled out. Um, much more broadly. Our, our a as you, as you and I have talked about before, pat, we're in the middle of a fundamental reform of our healthcare service where we are shifting as much care as possible into the community, enhanced community care, chronic disease management, um, much more investment in general practice, much more investment in pharmacies. We need all of our healthcare professionals working to the, to the extent of their license and their ability. And the pharmacists who say that are I, I fully agree, uh, and aware of it. And we're we are, we are moving in in the right direction. Speaker 0 00:46:21 No, not great problem. Solved, open the champagne job done. No minister, we have heard you talk the talk before you've sat at the table with the Irish Pharmacy Union and told them absolutely great. All sounds lovely and nothing happens. I don't accept that. You can say publicly. Oh, yep. That's on the way. When you haven't engaged with the one group that you need to engage with to make this happen, look what you can't say. Oh yeah, that's happening. You might want to tell the Irish Pharmacy U Union if in your head this is happening because can I tell you, minister, the reality is it's still not happening. You're lying <laugh>. So either fix that lie and make it happen. Or stop pushing political agenda to try and appease people like me who are actually trying to drive real change for the people of Ireland who are actually trying to drive better healthcare into our communities. Because we all know what's gonna happen next winter. It's gonna be a disaster. And every single winter it's going to get worse. It's gonna get worse. We're gonna have less gps. Why can we not get organized? Honestly, it can't be that hard to run a country. I'm just saying you're being handed the solutions. Just do them.