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

2. 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

3. Irish Pharmacy Union

4. 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

5. Vaccination
Origin
Requirements
Payment
Review

6. 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

7. 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

8. 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

9. Vaccination – Reimbursement

10. 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

11. Vaccination – IPU Awareness Raising

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

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

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

15. Specialty Medicines
Origin of Service
Process
Payment

16. 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

17. 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

18. 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

19. 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%

20. Opiate Substitution Origin of the Service How the service operates
Payment

21. 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

22. 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

23. 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

24. Needle Exchange
Origins of service
How service operates
Payment
Review

25. 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

26. 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

27. 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

28. 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

29. 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