LETTER TO LEO – 16th December 2022
It’s not often I’m embarrassed to be Irish, but as a pharmacist working within the confines of the Irish
system today, I am. I spent five years in university developing my medical expertise in pharmacy.
Despite this training my skills and those of my pharmacy colleagues, are being chronically
underutilised in an Irish healthcare system at breaking point.
I find this very frustrating, as my time spent working as a pharmacist in Scotland has shown me that
there is a very simple answer to quickly alleviate the massive pressure frontline doctors are currently
facing. We are in the eye of the storm, and you are a doctor in a position of leadership and legislative
power. You know that the daily figures counting the infection of influenza, RSV, coronavirus, and
Strep A will only continue in an upward trajectory, as these viruses always do in late Winter and early
Let us help. The community pharmacist is your biggest ally, we are open from early morning until late
at night, and in many cases 7-days a week. A patient does not require an appointment to see a
pharmacist, and almost half of the population live within 1km of a pharmacy. You led us through a
pandemic, the healthcare system can’t take any more, and the patient always has to come first.
Instead of making promises, chairing working groups, and discussing policy, now is the time to act.
Pharmacists want to help, we are qualified, our range of services has so much potential to
significantly improve access to patient healthcare. What is more, this model of patient care is already
working successfully in Scotland and further afield. Every day I see patients suffering who cannot
access a doctor due to the extreme pressure that the healthcare system is under. Together we can
make a big impact to improve this situation.
Today, I am asking you for urgent action on both the implementation of a Minor Ailments Scheme and the introduction of Patient Group Directives (PGDs).
1. Minor Ailments Scheme:
- Save GPs time. Let us prescribe approved items for medical card patients. Private patients
can buy these items over the counter, but medical card holders need a prescription from their
- It makes no sense in the current climate to be sending medical card holders into GP surgeries
for over the counter items. This at a time when we need to free up accessibility to GP for
urgent patient assessment and diagnosis.
- It started as a cost issue, I know. However, it is costing more money sending them into a GP,
and it’s potentially costing lives by removing that appointment from an urgent sick patient.
Figures from Scotland already show us it could remove 1 in 7 GP visits, here it could be even
2. Patient Group Directives:
Pharmacists could work to carefully developed Patient Group Directives (PGDs) to assess and supply
medicines to treat the following conditions:
- Bacterial Skin Infections – using oral antibiotics
- Conjunctivitis (eye infections) – using antibiotics
- Cystitis – uncomplicated – treated with antibiotics
- Impetigo – using local antibiotics
- Shingles – using antiviral medicines.
As a newly qualified pharmacist working in Scotland in 2006, I was able to supply antibiotic eye drops
for conjunctivitis. Sixteen years later and Ireland still hasn’t caught up, it’s insulting to our profession
and injurious to patient care.
Taoiseach, surely you can see how important this is. You have an important job to do, going back to
your GP role once a week was admirable during the pandemic but not a long term solution. Now we
need you to lead this country and act to swiftly to ease the pressure on doctors. Introducing a PGD
does not need to be difficult, we have a roadmap from Scotland. We can’t afford years of planning
and preparation by people who don’t work in community pharmacy. We need cooperation between
healthcare professionals, their governing bodies, the HSE and the Government, so that patients can
get the care they need now.
Pharmacists go into the profession because they are passionate about health and their communities.
Pharmacists are skilled, and caring healthcare professionals who are more than capable of
implementing PGDs and working within the boundaries of them.
There is no legislation to support the supply by pharmacists of prescription medicines without receipt
of a prescription. By law we can administer certain medications in certain circumstances, however
the administration and the supply of routine treatment are two very different things.
We need an exception put into the Medicines Act that allows for the provision of certain prescription
only medicines, approved as part of a Patient Group Directive. This requires emergency legislation,
to avoid further delays to accessible healthcare.
Every PGD would be developed, assessed, and signed off by a senior doctor. This will facilitate
pharmacists to use their existing skills to treat common, uncomplicated ailments in patients, without
any contraindications to treatment. This is in the best interest of patient care and is well within the
scope of community pharmacists.
Pharmacists are NOT seeking to be doctors, but we ARE looking to be able to improve patient access
to medicines and healthcare in predefined, safe, and approved settings.
Sheena Mitchell MPSI