Pharmacists are in limbo. More than two years after the Minister for Health, Mr Martin, unilaterally tore up regulations governing the sector, there is still no clear indication of the Government's intentions for the State's 1,200 pharmacies.
Copious reports on the industry have been compiled by both sides, most notably the Mortell report commissioned by Mr Martin, but Ireland remains the only state in the enlarged European Union with no regulation governing the opening of pharmacies.
Gathering tomorrow in Dublin to elect a new leadership, which will guide the organisation for the next two years, Irish Pharmaceutical Union (IPU) members hope this term will see the introduction of a modern strategy for the pharmacy sector.
"In all my dealings with the current Government, there has been absolutely no strategic medium-term or long-term view of pharmacy," says Mr Karl Hilton, the IPU vice-president who is due to be elected president at tomorrow's annual general meeting. "I honestly do not know what the indifference to pharmacy stems from."
However, Mr Hilton is keen to look on the positive side. While the Minister has yet to make any decision on the Mortell report - which he published without comment on his website in March, 13 months after it was submitted to him - Mr Hilton feels that there is movement on the creation of a proper fitness-to-practise code and an openness by politicians to some of the ideas being put forward by the pharmacists.
"I would like to think the next two years would be ones of partnership, the term in which we finally hammer out a strategy for the sector."
Top of the agenda undoubtedly is ownership. The IPU wants the Minister to introduce legislation confining pharmacy ownership to pharmacists or to companies in which pharmacists hold a majority stake.
This, the IPU says, is in line with practice in most EU states.
Addressing ownership and the need for a fitness-to-practise regime would, Mr Hilton argues, allow the IPU to let go of a derogation under which foreign-trained pharmacists are not allowed own or supervise pharmacies in Ireland.
"A lot of our members are affected by this, young people who feel they are being discriminated against because they have qualified at universities outside the State," he says. "The irony is that pharmacists trained in Australia or New Zealand - even those close to retirement age who have not opened a pharmacy in years - can open an outlet here because of a bilateral arrangement."
A proper fitness-to-practise framework is necessary, he argues, to ensure consumers can be confident in their pharmacist and in their ability to communicate with them. It would also address the lack of a defined disciplinary structure - one of the issues cited by those opposing pharmacists' proposals to widen their service offering.
Addressing ownership and fitness-to-practice issues would also ease opposition to the abolition of the derogation from those who feel it is the only thing protecting the company from an influx of company chemists and cheap labour.
The IPU knows it still faces an uphill battle on ownership. The Mortell review suggested limiting ownership to 8 per cent of the community pharmacy contracts in each health board area. It also said nothing about limiting ownership to pharmacists.
Leaving aside the fact that a subsequent decision to abolish the current health board structure makes nonsense of this proposal, the IPU says it would allow one entity to own up to 100 outlets, a move it strongly opposes.
Another key area for Mr Hilton is expanding the role of the community pharmacy. "One of my objectives over the next two years is to sit down with Government and try to introduce a structured programme of further professional activities that we can carry out."
These would include medication reviews with customers, the prescription of drugs for minor ailments such as skin infections and uncomplicated respiratory or urinary tract infections. Generic substitution and health promotion are other areas of opportunity, the IPU feels.
It argues that, apart from consumer benefits, such moves would save the State money by reducing waste and cutting costly medical bills. A report for the IPU carried out by PricewaterhouseCoopers last year estimated that pharmacists save the State about €175 million a year by forestalling more expensive care. New research being published tomorrow says the new initiative proposed by the IPU could save a further €100 million.
However, Mr Hilton is wary of examining the sector purely through economic glasses. Yes, drug costs in Ireland are rising, but that is not necessarily a bad thing, he insists.
First, Ireland is still the second lowest consumer of drugs in the 15-state EU. Also Government policy initiatives - such as free medical cards for all people over 70 and the removal of people from institutional to community care - add to the bill.
He points to the fact that the ill-fated 1996 regulations did see pharmacies opened in 56 towns and villages that had no service. Since their abolition, not a single pharmacy has opened in a marginal or rural area, the IPU says.
On competition, the IPU notes that Ireland has one pharmacy for every 3,200 people, the third-highest ratio in the EU and well ahead of the 1:4,500 average.
It also points to customer satisfaction, claiming that 400,000 people visit pharmacies every day in Ireland with little or no complaint.
"To some degree, maybe, we are an easy target for the Government and those looking at things from a purely economic point of view but there is much more to community pharmacy than that and we are not going to sit idly by and be an easy target," says Mr Hilton.
