HSE hits the North Print
Wednesday, 19 August 2009 15:33
News that inflation has dropped to below the base rate, that utility rates are set to fall and that tax relief may be favourably revised are insignificant to those pharmacists in the Republic of Ireland who face a 34 per cent cut in payments. The Minister for Health and Children, Mary Harney, has slashed payments made for dispensing on the community drugs scheme by over a third and although the Irish Pharmacy Union has appealed to the Minister to urgently negotiate a solution to this matter, no meetings have been arranged.

Consequently, the IPU reported that almost 1,100 pharmacists wrote to the HSE, announcing their withdrawal from the schemes, which include the heavily depended upon Medical Card Scheme and the Drugs Payment Scheme. Pharmacists have made it clear that they are prepared to take a cut and have proposed a plan that will save Ä85 million on the community drug schemes, explained Liz Hoctor, president of the IPU.     They have responded to the publication of a contingency plan by the HSE, stating that it was ëtotally inadequate in terms of meeting patients needs for medicines.

Meanwhile, as pharmacies across the Republic fight to remain open, the Minister and the Health Service Executive (HSE) have turned to pharmacists in Northern Ireland to carry the burden of their inability to negotiate with pharmacists. Northern Ireland pharmacies within border counties could stand to gain from the continuing disputes, after the HSE ran a number of advertisements in local and regional press, appealing for help to meet patient need in the Republic. This has been the HSEs most significant attempt to counter the threatened boycott, by offering medical card patients from the Republic a way of accessing medicines even if it means a very long journey for some.

Terry Hannawin, chief executive of the Pharmaceutical Contractors Committee, however has not welcomed the HSEs attempts to use Northern Ireland pharmacists as a scapegoat for their disputes.
 
"We are deeply concerned by the way that the HSE in the Republic has treated community pharmacists. They are faced with the imposition of a disastrous 34 per cent cut in fees paid, he said. We know that the last thing any pharmacist would want to do is to withdraw services, but in the face of such treatment our colleagues in the Republic feel they have no alternative.  They have our support and good wishes.
 
We have seen advertisements in Northern Irish newspapers taken out by the HSE seeking expressions of interest from community pharmacies in Northern Ireland to provide a medicines dispensing service while this dispute continues.  
 
This attempt to cobble together an arrangement involving pharmacies in the North raises all sorts of practical and technical problems, safety issues and possible legal barriers. But even if they could be overcome, this is frankly no solution.

He continued to explain that the correct solution is to return to the negotiating table with representatives of community pharmacists in the Republic, find a fair way forward and resolve the dispute as quickly as possible. We urge the HSE to do that in the best interests of patients and the public, Terry said. We cannot recommend that pharmacy contractors in Northern Ireland participate in the scheme proposed in these newspaper advertisements."

So has there been any evidence of such practice in Northern Ireland? Peadar McGovern, pharmacy contractor at Derrylin Pharmacy, spoke recently about how he had experienced an increased interest from Southern clients. "They would have been pricing medicines for the last two years, so we would have seen a good increase in trade from the South, he told The Herald.

In fact, it's a very important sector at the present time and more than compensates for any levelling off in our own local business. Along with that, once those from the south check out the price of medicines, they will also buy toiletries in the shop."

Similar reports came from Belcoo Pharmacy, where pharmacist Joe McAleer said he had certainly seen people from the Republic coming in to collect their prescriptions. Its all down to the price difference, he said. People are waiting to see what will happen but, definitely, people are noticing the difference in price, especially with generic drugs.

Furthermore, it begs the question that if the HSE were taking the picket lines seriously, why had officials not responded to the IPUs calls for emergency action?

A spokesperson told NIPinF: The situation in relation to ourselves is that we administer the schemes, whereas the decision to introduce changes to payments came from the Minister for Health so it is the Minister who informed us that from 1 July that these are the new, reduced rates. With regards to the 1,660 individual pharmacists who we hold contracts with, it is their decision to withdraw. Around 800 have informed us that they will not be participating in the community drugs schemes and we have to accept their decisions. But it is ultimately the Minister who is responsible for renegotiating these rates.

However Paddy Burke, head of the HSEs Primary Care Reimbursement Service, said that measures were in place to ensure that patients received their medicines, after geographically determining where higher numbers of pharmacies had withdrawn. He also insisted that even if pharmacists disagreed with the cuts, if they had not notified of their intention to pull out of the schemes, then they would still be contractually obliged to continue dispensing and remain open.

Paddy then dismissed claims from the IPU that over 1,000 pharmacies would pull out of the scheme. ëëAs far Im concerned 900 will be dispensing as, in the absence of a response, they must work their contract, he said.

The Ulster Chemists Association has not given a formal comment, although has written to the IPU in support of their continued campaigning and lobbying. In response, David Giles, a pharmacist from Newcastle-Lyons Pharmacy in County Dublin said: I wish to express my sincerest thanks to the UCA for the good judgement it has shown in the current dispute between the IPU and HSE. The support you have shown really means a lot to us and fellow pharmacists in these difficult times.

Ten days before it was anticipated that over 1,100 community pharmacists would be withdrawing from the Community Drug Schemes, the IPU held a special meeting in Dublin to discuss the pending crisis. At the time of going to print, it was unclear how the outcome of this meeting would affect pharmacy by 1 August.

The pharmacy sector down south is not short on evidence to prove its public, and economic value. An independent report by Pricewaterhouse Coopers found that the services provided by pharmacists to patients across the country saved an estimated 3.9 million patient visits to a GP and more than 500,000 A&E attendances.

Liz Hoctor added: For the past 18 months pharmacists have being battling with the HSE to protect services for our patients and try and maintain a viable profession. This report supports our argument that pharmacists are in the frontline of delivering primary healthcare and the importance of the job performed by pharmacists.

Not only do we have the confidence of patients who visit us in huge numbers every day, but we are saving the exchequer millions of euro in avoiding unnecessary GP and A&E visits. We welcome the reports findings which dispels many of the misleading characterisations of our profession especially in relation to profit margins. There are many small pharmacies providing vital health services to patients, which would be less that the average profit margin and their future should not be jeopardised.

Speaking during the IPUs recent AGM, where a vote of no confidence in the governments health policies was taken, the president said that government initiatives had manifestly failed and she urged a fundamental review of health strategy. We fear anything up to 5,000 job losses within the pharmacy sector and increased problems for patients trying to get access to medicines. Statistics suggesting that up to 11 per cent of patients who do not hold medicine cards are cutting back on medicines due to financial constraints.

Were noticing that patients are opting to reduce the frequency with which they take prescribed medicines even though the effectiveness of prescription medicines can be reduced by such changes. For example, a patient may have been prescribed medicines to take on a daily basis and they may start taking them every second day, to try to make the medicine last longer. However, a patients health is likely to suffer in the long term by doing this. It would be helpful to patients if I could offer my patients a cheaper generic alterative, where it is safe and appropriate to do so.