QUB Centenary Presentation

1. QUB Centenary Presentation Dr Martin Henman October 25th, 2008

2. Health Strategy • Quality and Fairness – A health system for you • Launched November 2001

3. Department of Heath & Children • The Department of Health and Children's statutory role is to support the Minister in the formulation and evaluation of policies for the health services. • Also the strategic planning of health services. • This is carried out in conjunction with the Health Service Executive, voluntary service providers, Government Departments and other interests. • Minister for Health and Children – responsible to Cabinet • Three Ministers of State with responsibility for specific areas • Chief Pharmacist

4. Health Services Executive Role: Day-to-day management of health service Main Divisions in HSE Prof Brendan Drumm - Chief Executive Officer. HSE reports to a Board appointed by the Tánaiste & Minister for Health & Children, Ms Mary Harney, TD. • Primary, Community and Continuing Care • National Hospitals Office • Population Health • Support services • Cost of Health Service - €13 billion • 65,000 employees; 35,000 others

5. DELIVERY OF HEALTH SERVICES • HSE should determine type & location of Health Services available in Country  Region  Locally • Responsible for checking Quality of services • Responsible for of materials • Responsible for negotiating the terms services e.g. Community Pharmacists, Hospital Consultants

6. Corporate Pharmaceutical Unit • ‘promote best practice in relation to the use of drugs and devices’ • ‘evaluation of and propose changes to schemes for medicines’ • ‘standardisation and quality assurance’ • ‘primary contact between Industry and HSE’

7. HSE Drug Expenditure 2005 • Hospitals €280m • Community Schemes €1.89.414b

8. Health Service in Ireland • ‘Mixed’ system • State & Private provision & funding • Public employees & Private contractors • Under pressure • Increasing population • Increased economic growth → increased expectations • Access to information & technology from outside Ireland • Current dilemmas • State (Public) vs Private provision • Planned competition vs Open competition

9. Primary Care (Ambulatory Care) • Majority of service provided by Independent Practitioners • Each has Public & Private Patients • Public patients – health care costs met totally by State • ‘Poor’ & elderly • Certain chronic illnesses e.g. diabetes mellitus, epilepsy • Private patients – pay all or some of health care costs • Usually pay for Physician visit • Some medicines costs may be met by State

10. Organisation of Primary Care • Team – GP lead • Mostly GP employees or independent • Health Centres • Network – all independent • Planning for low population density & distribution of Primary Care services

11. Role within Primary Care • Medicines Supply • Prescription/Medication Review • Patient Counselling • Medication • ‘all such matters as the pharmacist, in the exercise of his/her professional judgement, deems significant’ • Cost – effectiveness & wastage

12. Community Pharmacy • Independent Contractors who provide services • Contract with Health Services Executive Services • Supply of prescription drugs • Non-prescription medicines supply • Medical foods & medical devices • Non medical/non pharmaceutical goods Ownership • Pharmacy ownership – ‘independents’ & chains, 1,450 pharmacies • 2 main chains – Boots & Unicare • one vertically integrated group - Unicare

13. Present Position • Pharmacy Review Group – Govt established committee • No limit on number of Pharmacy contracts • Published report – ambiguous conclusions • Dept Health & Children obtaining ‘legal advice’ • Unrestricted development of chains continuing • IPOS – Independent Pharmacy Ownership Scheme • Wholesaler support for ‘Independent Ownership e.g. Catalyst • Health Centres being privately developed e.g. Touchstone • Govt advised to seek ‘simplification’ of medicines payment schemes and a ‘reduction in payments to well-off professionals’

14. OPD • Tabs/Caps; Liquids • Original Packs e.g. Combined Oral Contraceptives • Course of treatment – 21 days • Doses individually wrapped • PIL • Pack dispensed - labelling • Broken Bulk • Pack of 100 -1000 tabs/caps • ‘Count & Pour’ • New container - labelling

15. Source Of Information About Medication Other Than Doctor (Base: All Visited Doctor/Hospital in Last 12 Months) % 53 Pharmacist Friends/family 13 Nurse 13 Other doctor 12 Internet 5 The company that makes the medicine 1 Health programmes on radio/TV 1 Medical dictionary/ reference book 1 Relevant patient association for the medical condition 1 Magazines 1 Other 5 Don't know 15 Irish Patient’s Association 2007 survey 13.

16. (Base: All Visited Doctor/Hospital in Last 12 Months) Chemist - all Chemist - Incidence Of Explanation Of Last Prescription Medical Card Holders Don't Recall Those on Long Term Medication Yes No What the options were in terms of different types of medication available to treat your condition 27 57 16 28 55 17 31 58 11 65 24 10 66 22 12 When to take your medication 66 28 6 61 28 11 How long to take your medication 60 27 13 60 34 7 47 36 17 What to avoid (e.g. alcohol drugs) when taking your medication 50 32 17 51 37 12 34 48 19 Any side effects 34 45 20 36 51 13 Irish Patient’s Association 2007 survey 12.

17. REGULATORY BODY • The Pharmaceutical Society of Ireland • Membership necessary for use of title of ‘pharmacist’ – Register • Register of ‘retail pharmacy businesses’ • Annual re-certification • Code of Ethics • Practice Standards • Inspection of Premises • Accreditation of Pharmacy Degree courses

18. REPRESENTATIVE BODIES • The Irish Pharmaceutical Union • Trade Association • Negotiates terms & conditions under which pharmacists will provide medicines & other services with DoHC & HSE • Represents Community Pharmacists – e.g. raises concerns about security with An Garda Siochana • Promotes role of Community Pharmacist in health service • http://www.ipu.ie/ • Professional Journal – IPU Review

19. Pricing Structure • * Manufacturer sets Trade Price in accordance with • IPHA/HSE agreement. • * Product is sold to wholesaler at Trade less 15%. • Wholesaler may pass on all or some of 15% to Community Pharmacies – Wholesaler discount • Wholesaler’s also may give additional discount to certain customers • Separate arrangements for Hospitals – also being changed

20. Payment to Pharmacists by Health service • Based upon Dispensing • Cost of product + fee(s)

21. Community Pharmacies & Mark up • GMS pricing is a formula – GMS cost price plus Pharmacist’s fee • High Tech Medicinal Products Scheme – Patient Care Fee – Product cost paid by HSE direct to Wholesaler/supplier • Non-GMS pricing – Cost Price plus 50% mark up

22. Pharmaceutical Price Regulation in Ireland - New agreement 2007 • HSE & Manufacturer’s (represented by IPHA) • Price Freeze for duration of agreement • Prices of new medicines based on average price in nominated EU countries • Price reductions for off patent medicines and medicines due to go off patent within 6 months of agreement – affects pharmacist mark up on supply of medicines under non-State Schemes • New (novel) medicines may be subject to Pharmacoeconomic evaluation – i.e. to assess the costs and benefits to Health Service

23. (HSE) Expert Advisory Groups • Role • health care reform • operational policy development, and ensure appropriate policy implementation • Children, Diabetes, Mental Health, Older People, Cardiovascular services, Disability, Maternity services and Oral Health

24. Non-HSE bodies responsible for some aspect of Health Services

25. Ireland http://www.hiqa.ie/

26. Health Information and Quality Authority • Setting Standards in Health and Social Services • Monitoring Healthcare Quality • Social Services Inspectorate • Health Technology Assessment • Health Information • All health and social services system, except Mental Health Services.

27. Health Technology Assessment Systematic processes for evaluating the clinical and cost effectiveness of its health services • HTA is for purchasers of healthcare, providers and users of services: • Does this treatment work? • For whom? • At what cost? • How does it compare with alternative treatments?

28. National Pharmacoeconomic Centre • Provides advice & carries out analyses for Govt

30. IMB • Product Authorisation • Clinical Trials • Inspection of manufacturing & compliance • Human meds • Veterinary Meds • Blood, blood products, tissues & cells • Certification for Export • Importation & distribution • Classification of medicines • Controlled drugs & precursor chemicals

31. Pharmaceutical Industry • Representative Bodies • Irish Pharmaceutical and Healthcare Association – R & D companies • Association of Pharmaceutical Manufacturers of Ireland – Generic manufacturers

32. Advertising • Advertising of medicinal products in Ireland is regulated by the Medicinal Products (Control of Advertising) Regulations, 2007. • Based on Directive 2001/83/EC as amended by Directive 2004/27/EC relating to medicinal products for human use.

33. UKTransnational

34. Patient Safety • Commission on Patient Safety and Quality Assurance • Established by DoHC • Recommended ‘Patient Advocates’ but not Patient Safety Authority • Hospitals • Many have established ‘Audit and Quality Review’ sections/units/department

35. Ongoing Research • Diabetes Awareness through Community Pharmacies – Trevor Hunter • CAWT – collaboration with Prof C Hughes • Medication Review • Weight Control – Catriona Bradley • Psuedo-patient • Insitutionalised elderly medication review • Collaboration with RCSI & QUB • Pharmaceutical Care in Intellectual Disability – Bernadette Flood

36. Research Interests • Role of Pharmacist • Community Pharmacist in a Public/Private service • Hospital Pharmacist • Reimbursement options for Pharmacists • Pharmaceutical Care • Brief Interventions • Chronic Disease • Integrated Medicines Management & ePatientRecord • Medicines regulation, Pharmacovigilance & patient safety • Patient’s experiences of medicines & of pharmacy • Pharmaceutical Education – UG & CPE/D • Competence & its implementation • Moral development & professionalisation • Research skills • Pharmaceutical Policy