Letter to Leo – Read by Sheena Mitchell

Listen to this episode to hear Sheena read and explain the letter that she wrote to Taoiseach Leo Varadkar on 16th December 2022.LETTER TO LEO – 16th December 2022 Dear Taoiseach,It’s not often I’m embarrassed to be Irish, but as a pharmacist working within the confines of the Irishsystem 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 chronicallyunderutilised 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 thatthere is a very simple answer to quickly alleviate the massive pressure frontline doctors are currentlyfacing. We are in the eye of the storm, and you are a doctor in a position of leadership and legislativepower. You know that the daily figures counting the infection of influenza, RSV, coronavirus, andStrep A will only continue in an upward trajectory, as these viruses always do in late Winter and earlySpring.Let us help. The community pharmacist is your biggest ally, we are open from early morning until lateat night, and in many cases 7-days a week. A patient does not require an appointment to see apharmacist, and almost half of the population live within 1km of a pharmacy. You led us through apandemic, 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 tosignificantly improve access to patient healthcare. What is more, this model of patient care is alreadyworking successfully in Scotland and further afield. Every day I see patients suffering who cannotaccess a doctor due to the extreme pressure that the healthcare system is under. Together we canmake 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 patientscan buy these items over the counter, but medical card holders need a prescription from theirGP.
• It makes no sense in the current climate to be sending medical card holders into GP surgeriesfor over the counter items. This at a time when we need to free up accessibility to GP forurgent 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 evenmore.

2. Patient Group Directives:Pharmacists could work to carefully developed Patient Group Directives (PGDs) to assess and supplymedicines 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 dropsfor conjunctivitis. Sixteen years later and Ireland still hasn’t caught up, it’s insulting to our professionand injurious to patient care.Taoiseach, surely you can see how important this is. You have an important job to do, going back toyour GP role once a week was admirable during the pandemic but not a long term solution. Now weneed you to lead this country and act to swiftly to ease the pressure on doctors. Introducing a PGDdoes not need to be difficult, we have a roadmap from Scotland. We can’t afford years of planningand preparation by people who don’t work in community pharmacy. We need cooperation betweenhealthcare professionals, their governing bodies, the HSE and the Government, so that patients canget 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 ofimplementing PGDs and working within the boundaries of them.There is no legislation to support the supply by pharmacists of prescription medicines without receiptof a prescription. By law we can administer certain medications in certain circumstances, howeverthe 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 prescriptiononly 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 facilitatepharmacists to use their existing skills to treat common, uncomplicated ailments in patients, withoutany contraindications to treatment. This is in the best interest of patient care and is well within thescope of community pharmacists.Pharmacists are NOT seeking to be doctors, but we ARE looking to be able to improve patient accessto medicines and healthcare in predefined, safe, and approved settings.Sincerely,Sheena Mitchell MPSI