PHARMACY SERVICES IN IRELAND Darragh J O’Loughlin Secretary General, Irish Pharmacy Union

Pharmacy in Ireland Small country – population 4.7m Deregulated 2002 – no restrictions on ownership or establishment of pharmacies. Majority of pharmacies pharmacist owned & operated Largest chains: Lloyds 94 pharmacies and Boots 83 pharmacies

Irish Pharmacy Union

Pharmacy Services in Ireland Most pharmacy income comes from dispensing prescriptions State-funded or patient pays, depending on income Four services remunerated by Health Service: Vaccination Speciality Medicines Opiate Substitution Needle Exchange

Vaccination Origin Requirements Payment Review

Vaccination – Origin of Service WHO vaccination targets not met 2009 – H1N1 “Swine” Flu – National vaccination campaign Not enough GPs 1400 pharmacists trained in vaccination technique but not used Pharmacy regulator (PSI) strategy for extended pharmacy services included vaccination Support from National Immunisation Office 2011 – Minister legislated to allow pharmacists supply and administer flu vaccine 2015 – Pneumococcal and Shingles vaccines added to list

Vaccination – Requirements Mandatory Accredited Training – face to face or online Vaccination policies Injection technique Management of Anaphylaxis including administration of adrenaline Cardio Pulmonary Resuscitation and use of Defibrillator Administration – must be in pharmacy Private consultation room Patient consent Allergy status Observation after administration Record-keeping Date, Patient ID number, Batch, Expiry Date Notification to Health Service and patient’s GP

Vaccination – Target Population Flu vaccine recommended in case of: Aged 65+ years Long-term Medical Condition, e.g. diabetes Impaired Immune System Down Syndrome Morbidly Obese: Body Mass Index (BMI) 40+ Pregnant Women Residents of Nursing Homes Healthcare Workers and Carers People in close contact with poultry, water fowl, pigs

Vaccination – Reimbursement

Vaccination – Reimbursement Flu vaccine supplied by Health Service for eligible and at-risk patients Health Service pays pharmacist professional fee of €15 per patient Non State-funded patients must pay fee to pharmacist

Vaccination – IPU Awareness Raising

Vaccination – Review of Service Patient feedback on vaccination service provided in pharmacies – March 2016

Vaccination – Review of Service Patient feedback on vaccination service provided in pharmacies – March 2016

Vaccination – Review of Service Patient feedback on vaccination service provided in pharmacies – March 2016

Specialty Medicines Origin of Service Process Payment

Speciality Medicines – Origin of Service Pre 1996 – Speciality medicines supplied from Hospitals or Health Clinics Inconvenient for patients; expensive for Health Service Incomplete health records in pharmacy and GP 1996 – High Tech Medicines Scheme launched New service to dispense speciality medicines through community pharmacy

Speciality Medicines – How service works Medicine initiated in hospital Patient nominates community pharmacy for supply Hospital notifies pharmacy and Health Service Pharmacy orders medicine through usual supply channels (wholesaler or manufacturer) Medicine delivered to community pharmacy and invoiced directly to Health Service Pharmacist dispenses medicine to patient and notifies Health Service Health Service pays supplier

Speciality Medicines – Advantages Convenience and accessibility for patient Private consultation rooms allows for confidential patient counselling Single comprehensive medication record in pharmacy Pharmacy avoids inventory cost and financial risk Reduction in workload and inventory in Health Clinics Uses existing network of pharmacies – no capital cost for Health Service

Speciality Medicines – Reimbursement Pharmacy receives: Monthly Patient Care fee for all support and advice – €62 .03 No margin on medicine cost Monthly fee of €31.26 in months when no dispensing takes place (max 3 months) Wholesaler / supplier receives: Margin on cost of medicine – 10%

Opiate Substitution Origin of the Service How the service operates Payment

Opiate Substitution – Origin of Service 1980’s – Large increase in Heroin addiction Methadone dispensed from Health Service Drug Clinics Local opposition to clinics opening in neighbourhoods Pharmacy Methadone Scheme launched 1998 Special training for GPs and pharmacists in addiction treatment 40% of pharmacies now provide this service Allows patients to live relatively normal lives

Opiate Substitution – How the Service Operates Patient attends drug clinic for diagnosis and initiation of treatment Patient registers with one pharmacy Central Treatment List of all methadone patients & pharmacies Methadone ID card sent to pharmacy for each patient Patients collect methadone daily/weekly from pharmacy Supervised consumption initially Stable patients get take-out doses

Opiate Substitution – Payment Monthly Patient Care Fee €52 – €60 per patient Dispensing fee per supervised dose €3.60 Security Grant – financial support for necessary security upgrades up to €6,000

Needle Exchange Origins of service How service operates Payment Review

Needle Exchange – Origins of Service 2011 – Elton John Aids Foundation offered to fund NEX service Objective: reduce spread of blood-borne viruses among drug users Funded jointly by Health Service and Elton John Aids Foundation Pharmacies in identified areas of need targeted and asked to participate 107 pharmacies in total

Needle Exchange – How Service Operates Pharmacists who wish to provide NEX service receive training on Policy issues Ethical issues Practical issues Contents of NEX kit Special sticker on door identifies pharmacy as a NEX facility Client places used needles into sharps waste bin Pharmacist supplies NEX kit and records transaction Also gives safe injection and health advice

Needle Exchange – NEX Kit What’s in the pack? single filter syringe with attached needle stainless steel spoon one sterile alcohol swab sachet of citric acid 5ml water for injection information leaflet

Needle Exchange – Payment Project is jointly funded by Elton John Aids Foundation and Health Service Pharmacist receives €5 per kit given out Health Service funds waste collection Hepatitis vaccination provided to all staff

Needle Exchange – Evaluation Liverpool University was commissioned to review the NEX service in 2015 High client satisfaction with Service provision Pharmacy location Opening hours Staff knowledge Availability of needs Provision of information Clients reported receiving advice on Wound care Safe injecting tips Sexual health