Pharmacy role expanding to include substitution of cheaper generic drugs

The role of the main street pharmacy is broadening, with pharmacists now administering flu vaccinations, supplying the morning-after pill, and providing consultation rooms for medical checks.

In the new year, a new law will also give pharmacists the job of deciding when they should substitute cheaper generic drugs for branded ones prescribed by GPs.

It would be welcomed by the Irish Pharmaceutical Union which represents the profession if, as seems likely, pharmacists eventually take on more health screening and chronic disease management too.

While their role has been expanding, so too has regulation of their profession. In late 2009 the Pharmaceutical Society of Ireland came into being as the statutory pharmacy regulator.

Its job is to register, regulate, inspect, discipline and assist the professional development of the 4,500 pharmacists and 550 pharmaceutical assistants who own, manage and work in the country’s 1,700 pharmacies.

It’s a €1.9bn a year business, with about 1.6m visits being made to pharmacies every week.

In the three years since it was set up, the regulator has received 164 formal complaints about pharmacists — a rate of one a week. Of those, 150 have so far been examined by the preliminary proceedings committee and 110 were found not to warrant further action.

Of the other 40, one was referred for inquiry to the regulator’s health committee, which investigates a pharmacist’s ability to practice where there are concerns over a physical or mental ailment. The complaint was substantiated but the hearing was in private so details are not available.

The others were referred to the professional conduct committee but only half of them have been dealt with to date. Three complaints were withdrawn prior to hearing, two complaints were not substantiated and five cases were handled by the pharmacist agreeing to certain undertakings rather than proceeding with a full hearing.

Ten complaints were substantiated and, as PCC hearings are public, several were reported in the media. They included pharmacists reprimanded for selling an out of date cough bottle, having dirty premises and dispensing inaccurate dosages of medication.

Those transgressions were relatively minor but there were also two more serious cases, involving drugs dispensed without prescription. Both pharmacists involved were disqualified from acting as superintendent pharmacist at their own pharmacies for 12 months.

The sanction against one, Lorna Mullins from Charleville, Co Cork, has to be affirmed by the High Court so full details of the case are not yet available but documents relating to an earlier case, against Mark Wright of The Medical Hall, Tyrellspass, Co Westmeath, have been disclosed.

Mr Wright admitted that during one seven-month period in 2011, he dispensed controlled drugs on 15 occasions to nine patients without prescription.

They included diazepam (usually prescribed as Valium), morphine, Oxynorm, Oxycontin, and Targin (all powerful painkillers), as well as Ritalin (for hyperactivity in children).

When he supplied the diazepam to one patient, he gave a greater quantity than GPs would prescribe, and he allowed the name of a local GP to be printed on the label, making it appear she was the prescriber.

The committee of inquiry accepted this was inadvertent and happened because she was the last GP entered on the label printer so her name was on the default setting, but the breach was serious enough to prompt her to become a complainant.

A number of veterinary medicines were also dispensed without prescription. Oisín Quinn, barrister for the PSI, told the hearing the breaches were not one-off events.

The record of the hearing states: “It was systemised to the extent that a record called The Medical Hall was created to allow for prescribed medications to be systemically dispensed without prescriptions.”

Barrister for Mr Wright, former justice minister Michael McDowell, was recorded as telling the hearing his client put the breaches down to carelessness and “to facilitating terminally ill patients who were unable to get to their doctors’ surgeries to collect prescriptions” and “to facilitating patients who had failed to obtain repeat prescriptions by the time their prescriptions had run out”.

Both sides agreed Mr Wright co-operated fully with the inquiry and preempted sanctions by stepping down from the role of superintendent pharmacist at his pharmacy once he came under investigation.


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