“Pharmacy is first and foremost a commercial enterprise and allowing pharmacists powers to prescribe and treat patients will lead to serious conflicts of interest.”

Monday 2nd November 2015.  The President of the Irish Medical Organisation (IMO) has issued a strong warning of the risks that will arise for patient health and safety if pharmacists are given permission to expand their role into areas which are more properly undertaken by doctors.   Due to economic reasons pharmacists are seeking to expand their professional roles and move their scope of practice into the treatment and management of patients thus undermining the role of doctors and the patient/doctor relationship.   Dr. Ray Walley said that the IMO will strongly oppose attempts to allow pharmacists increase their roles in respect of activities like managing repeat prescriptions, diagnosing minor ailments, Chronic Disease Management and any further expansion of vaccination programmes.

Dr. Walley was speaking at a meeting of CPME, the European Body for the Medical Profession who are considering this matter with a view to reaching a common European position.  The main issues highlighted by the IMO are:

      Quality of Care for patients
       Conflict of interests for pharmacists
       Undermining the role of the doctor
       Damaging the doctor/patient relationship
       Creating risks with no benefit to patients

Dr Walley said   “Pharmacists have a critical role to play in the health services but that is as a pharmacist and not as a doctor. The IMO is in favour of multi disciplinary teams where each professional adheres to the role for which they have trained and respects the roles of others.  It appears that due to an economic imperative pharmacists are now seeking to expand their role and act as doctor.  This is bad for patients.  Shifting tasks from doctors to pharmacists will reduce quality of care and may well cost more for both the patient and the State in the long run”.

Dr. Walley warned in particular of the conflict of interest which would arise if pharmacists were empowered to write prescriptions as well as dispense them; “pharmacy is first and foremost a commercial enterprise and the patient has always been well served by having a clear distinction between the prescriber of medicines (the doctor) and the dispenser of medicines (the pharmacist).  The pharmacist gets paid to dispense and once you blur that distinction you are at risk of a conflict of interest and of undermining the patient’s confidence in the medication they are being advised to take.  The relationship between patient and doctor should not be undermined by anyone.  It is a relationship based on the knowledge of the patient that their doctor has diagnosed their ailment and provided the best independent advice in terms of treatment and sometimes that treatment may not involve medication.  ”

Dr. Walley also warned that moves to increase the role of the pharmacist threatened to reduce the frequency of contact between patients and their doctors; “all the research confirms that the frequency of contact between a patient and their GP is critical to raising health standards.  Barbara Starfield – who led significant research on Primary Care – has found that morbidity and mortality rates were directly related to the supply of GPs in a community and she espoused in particular the importance of continuity of care which is associated with time saving, less of use of lab tests and lower health care expenditure.” 

Dr. Walley also criticised recent moves to allow Pharmacists administer vaccinations such as the flu vaccine.  He said that the move had not brought any benefits and that take-up levels had not changed as a consequence of the initiative; “pharmacists have been allowed administer vaccinations for the flu virus since 2011 but there has been no increase in uptake levels as a result.  In fact the vaccinations rates for the flu vaccine in the key population of over 65s fell slightly from an average of 62% in the years 2003 to 2010 to 57% in 2011 and 2012 and 59% in 2013.”

Dr.  Walley said that the key challenge for Government is to resource GP services properly not substitute them with inappropriate alternatives like pharmacists.  No savings or efficiencies will be generated by such a move and in fact this has the potential of increasing the work of general practice in dealing with situations where patients have been placed on an inappropriate treatment plan where pharmacists offer no follow up or out of hours service.

“This is about patient care, the doctor patient relationship and the IMO will fight to ensure this is not damaged simply out of a desire to increase profits.”