Liz Kelso, Head of Service and Lead for Vaccinations, Primary Care Contractors, gave a presentation to members on the Commons Conditions Service.
The following outlines comments and queries raised by members and responses from HSE representatives:
- Clarification on selection criteria
A list of 53 conditions was compiled by combining the conditions covered across seven regions and countries, including Scotland, Wales, England, British Columbia, Ontario, and New Zealand. From this combined list, a shorter list was then developed, with the conditions highlighted in green selected as the most appropriate for the Irish context. These conditions were selected for the initial launch, with the expectation that future phases will expand the programme. The remaining conditions from the original list of 53 will be reviewed to determine which additional conditions should be included in the next rollout.
- Whether pharmacists can now charge consultation fees for minor conditions that were previously dealt with informally over the counter, such as advising and providing treatment for conjunctivitis
Pharmacists are not expected to start charging for simple over-the-counter advice that was previously provided informally without cost. The new consultation service is intended for more structured assessments carried out in a consultation room, where pharmacists evaluate whether a prescription medicine is needed. For straightforward cases that would normally be handled with basic advice or over-the-counter products, it is expected that no fee would be applied. It was also noted that if reports emerge of inappropriate charging for such basic advice, this would need to be reviewed, as it is not the intention of the scheme.
- Consultation fee, and whether fees are fixed or vary between pharmacies, whether the HSE provides any subsidy and how the funding model works
Pharmacists provide this as a private service rather than one funded by the HSE, so there is no direct payment to pharmacies for the consultation itself. The HSE only reimburses the cost of medicines where the patient is eligible under existing schemes. As it is a private service delivered by independent contractors, there is no set consultation fee and neither the State nor the Irish Pharmacy Union can fix one. Pharmacies are free to set their own charges, which are typically understood to be in the range of about €25–€35, although this can vary.
- Hope that scheme is expanded sooner than the stated five years
Decisions on expanding the list of conditions are made by a group consisting of senior clinicians. This includes GP representatives on the clinical subgroup, including input from the ICGP and GP representation is also included on the oversight group.
- Approach being taken in other jurisdictions is to select specific conditions rather than a list of medications – clarification on whether this reflects a decision to focus on treating particular conditions that are commonly managed over the counter
Both the conditions and the specific medicines associated with each condition are defined within the scheme. Pharmacists can only prescribe within an agreed scope, with more complex or higher-risk medications excluded. Decisions on what is included are made by senior clinicians, based on factors such as clinical risk, appropriateness, complexity and potential side effects or complications. It was also noted that while some conditions may appear straightforward, clinical assessment is required to ensure patient safety, and all decisions are ultimately based on clinical judgment.
- Whether children who have free GP access up to a certain age would still have to pay a fee if they attend a pharmacist for diagnosis or confirmation of conditions
Children with GP visit cards should still attend their GP, where consultations are free under the scheme. However, if they choose to attend a pharmacist instead, the consultation would not be free. The pharmacy service is currently intended primarily for privately paying patients, with the option used at the discretion of parents, for example when GP access is less convenient. It was also noted that while this is the model for the initial phase, future changes are not ruled out.
- Clarification on whether GPs might be allowed to sell medicines in light of pharmacists being permitted to charge for consultations
Approximately 45 GP practices are dispensing medicine to their patients, which represents approximately 3% of all GMS practices across the country. As GP’s retire / resign, or as new pharmacies become established in the areas, these numbers may decrease further.
- Clarification on what is meant by a ‘community pharmacy’
Community pharmacies include all pharmacies that dispense medicines, ranging from large chains such as Boots and Chemist Warehouse to small independent local pharmacies. To operate, these pharmacies must have a contract with the HSE and be registered with the regulator (Pharmaceutical Society of Ireland (PSI)).
- Request for list of participating pharmacies
A ‘pharmacy finder’ tool is available on the HSE website, where users can search by address or postcode to locate pharmacies providing the common condition service. Of approximately 1,800 pharmacies, around 1,600 are currently listed, with a small number not yet included due to incomplete registration details.
- Lack of awareness of service – details on how it is being publicised and promoted to the public
The communications campaign was led by the Department of Health, which included radio and social media advertising earlier in the year. Information is also available on both the Department of Health and HSE websites. There is also the possibility of further promotion following evaluation of the service.
- Provision of a generic promotional message that could be shared via local social media channels to help increase public awareness
HSE communication teams were involved in supporting the campaign. Materials can be shared with members.
- Are GP practices informed of the service and can they direct relevant patients to it where in cases where there may be delays in getting an appointment
GPs were formally notified via a circular sent to all HSE-contracted GPs, outlining the service and the conditions included, so they should be aware of it and able to support appropriate signposting.
- Concern that busy community pharmacies may become more burdened by the new service, potentially increasing waiting times for patients
Participation in the service is voluntary for pharmacies. Pharmacies that choose to provide the service are expected to ensure they have appropriate staffing levels, have completed the necessary training and have sufficient capacity to deliver the service effectively.
- Any lessons from other international regions examined during the review process, particularly regarding how they structured the rollout of the service, including consultation fees and pricing arrangements
Funding models for community pharmacies differ significantly across jurisdictions, including the UK, making it difficult to directly replicate approaches in Ireland. Differences in healthcare systems, contractual arrangements and funding structures mean that international models cannot simply be transferred into the Irish context. However, it was noted that clinical learnings and evidence from other regions have been carefully considered and incorporated where appropriate, with expert groups reviewing the evidence and informing decisions on the Irish rollout.