1. Darragh O’Loughlin MPSI IPU Secretary General Irish Pharmaceutical Healthcare Association RDS, Dublin: 26 November 2013

2. The voice of community pharmacy Negotiate Advocate Develop Support Defend The IPU

3. Challenging Times Austerity measures FEMPI Act Reduced consumer spending Falling medicine prices & increasing medicine shortages Increased competition: new players, new business models

4. Reference Pricing Reference pricing must be handled carefully Risk of destabilising market Exacerbation of existing supply chain pressures Impact on pharmacists will be significant Undermining patient adherence to medication therapy through clumsily imposed substitution regime

5. Role of Pharmacy Accessible to patients o Self-care – advice & information o Signposting – other healthcare professionals Dispensing o Core competence of pharmacists; essential for patient safety o Efficient and cost-effective service provided for Government Introduction of new services o Emergency Contraception o Flu vaccination

6. Health Policy Shift Healthy Ireland Strategy Emphasis on keeping people healthier for longer Shift to Primary Care: treat at “lowest level of complexity” Opportunity for pharmacy Convenient, accessible, cost effective

7. Why Pharmacy? Issue for government o Don’t yet have shortage of GPs, but waiting times lengthening o DO have shortage of affordable, accessible primary healthcare o Key political commitment remains unfulfilled Opportunity o Government policy – “lowest level of complexity” o ESRI report – emerging shortage of GPs o B&A research – Affordability issues for middle-income earners o Free GP care for all – looks increasingly difficult to deliver o Pharmacists most accessible of all health professionals

8. Potential for Pharmacy Pharmacists are an under-utilised resource presently General Practitioner network overstretched Increased capacity required in Primary Care Pharmacists can support Healthy Ireland o Health Promotion o Health Screening o New Medicines Service o Medicine Use Reviews o Chronic Disease Management o Minor Ailments

9. International Experience UK o New Medicines Service; Medicines Use Reviews; Pharmacist prescribing; Minor Ailments Scheme; MHRA – proactive POM to P switches USA o Medication Therapy Management; Specialist roles e.g. diabetes care, cardiac care; HMOs increasing pharmacist involvement in patient care; FDA – considering massive POM to P shift Canada o Smoking cessation; Renewal & adjustment of prescriptions; Disease monitoring; Limited prescribing rights

10. Canadian solution Shortage of primary care physicians; patients couldn’t access treatment Government eased problem by granting additional roles to pharmacists, previously reserved for doctors o Renewing a doctor’s prescription, but not beyond one year o Modifying a doctor’s prescription with respect to form, dosage, quantity or directions o Substituting another medication from the same therapeutic subclass in the event of a complete disruption in supply of the prescribed medication o Administering a medication (not intravenous) for demonstration purposes o Prescribing and interpreting laboratory analyses for monitoring, but not diagnostic, purposes o Prescribing a medication when no diagnosis is required, especially for preventive purposes

11. The Future Financial position will remain tight given the economic climate/public finances. Pharmacists based in the community are pivotal to the delivery of health care policies – treating patients in the community where the patient lives. Pharmacy profession will deliver a wider range of healthcare services and become more innovative. Pharmacists & Pharma Industry must work together to optimise medicine use and improve patient outcomes

12. The Challenge Need a more accessible, cost effective and integrated health service which delivers for patients Implementing change difficult when resources are scarce New problems require new thinking Stakeholders working in partnership Shared goals + combined effort = mutual benefit

13. The End