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Pharmacists in Ireland are to be given new prescribing duties following an expert report that recommends they should prescribe for a range of common ailments. The country’s leading pharmacists union has backed the move, but only if a pay dispute is resolved.
Irish Health Minister Stephen Donnelly issued a statementExpert Working Group It includes a checklist of how pharmacists working in community pharmacies will provide treatment for patients for the eight conditions initially listed.
The list includes allergic rhinitis, cold sores, conjunctivitis, impetigo, oral thrush, herpes zoster, uncomplicated urinary tract infection/cystitis and vulvovaginal thrush – a range of conditions that he says can be expanded as the service develops.
The Irish Pharmacists Union (IPU) said it welcomed the panel’s recommendations, noting they would have a transformative impact on community healthcare if implemented.
Common clinical symptoms
The IPU said it had been advocating for the changes, particularly the introduction of the Common Clinical Conditions Scheme, and looked forward to the 18 patient-centred recommendations: “When implemented, they will provide patients with easier and faster access to care through the country’s network of 1,900 community pharmacies.”
A spokesperson for the Department of Health told Euractiv: “The Minister has instructed officials (…) to commence formal fee negotiations with the Irish Pharmacists Union after the 2025 Budget.”
The spokesman added: “The working group also recommends the development of pharmacist prescribing models across the health service. In other countries this involves pharmacists prescribing for more complex conditions in specific settings. The Minister has asked Department of Health officials to look at how these models can best be applied in the Irish setting.”
Self-prescription rights
Enabling pharmacists to prescribe medicines for common conditions, often referred to as “ailments”, means pharmacists can provide advice and treat common conditions. This will enable pharmacists to manage common conditions by providing advice and, where appropriate, prescribing medicines through established protocols.
Clare Fitzell, director of strategic policy at the Irish Pharmacists Union, told Euractiv that the working group’s recommendations provide for pharmacists to exercise independent, autonomous prescribing powers within the scope of their individual medical practitioners’ practice and competence.
She said the initiative is expected to be implemented in a phased manner, starting with the introduction of a common conditions service and giving pharmacists prescribing powers in relation to the service and its parameters.
Fitzer stressed that the task force plans to appoint an appropriately senior chief medical officer as a full member of the Ministry of Health’s management team.
Talking about pharmacy education, she explained how the working group required that continuing professional development training courses be provided for common illness services and that independent prescribing initially required a postgraduate qualification.
The increase in the number of undergraduate pharmacy degrees has allowed the role of pharmacists to expand.
Any proposals to expand or create new pharmacist roles will be planned and take into account the sector’s strategic workforce planning and existing workforce needs.
Fetzer said the task force’s recommendations envision that models of care, service delivery and training must be resourced within the system from a financial, compensation, contractual and governance structure perspective, including clinical reimbursement arrangements.
Reducing pressure on doctors
Minister Donnelly added the move would take pressure off GPs (local doctors) and he hoped the new common illness service would be in place by early 2025. “The service will be expanded over time but we will start with these illnesses first,” he said.
The report comes after the minister accepted the working group’s recommendation last November to extend prescriptions. The measure comes into force on March 1, 2024. It means prescribers can write prescriptions for up to 12 months if they wish.
From September 1, 2024, pharmacists will be able to extend the validity of prescriptions to 12 months from the current maximum of six months, a move that will improve patient care and access to care.
Tom Murray, president of the Irish Pharmacists’ Union, said: “As global medicine shortages continue, we look forward to the introduction of a severe shortages protocol which will allow community pharmacists to find clinically appropriate alternatives when a medicine is out of stock…”
A breakthrough in the wage freeze?
While the IPU generally supports the planned reforms, the Pharmacy Union said: “…despite extensive discussions with the Department of Health (DoH) for over a year under the statutory three-year fee review framework (…), the DoH has yet to put forward any proposals to address our pay demands, the sixteen-year pay freeze or the funding of new services such as the prescription deferral scheme.”
“Over the past 13 months, we have met regularly with Ministry of Health officials and have clearly communicated the urgent need to address core funding issues to ensure the sustainability of our business model.”
“Community pharmacists’ real-world earnings are lower than they were in 2009, and the idea of adding a new scheme to an already underfunded and under-resourced group of healthcare professionals is not credible, feasible or acceptable,” Mr Murray said.
He added: “The IPU has advised members not to implement any new services until progress is made on the pay claims.”
(By Brian Maguire | Euractiv Promotional Lab ）
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