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An open letter to Leo Varadkar

It’s not often I’m embarrassed to be Irish, but as a pharmacist working within the confines of the Irish system 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 chronically under-utilised 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 that there is a very simple answer to quickly alleviate the massive pressure frontline doctors are currently facing. We are in the eye of the storm, and you are a doctor in a position of leadership and legislative power. You know that the daily figures counting the infection of influenza, RSV, coronavirus, and Strep A will only continue in an upward trajectory, as these viruses always do in late winter and early spring.

Let us help. The community pharmacist is your biggest ally, we are open from early morning until late at night, and in many cases seven days a week. A patient does not require an appointment to see a pharmacist, and almost half of the population live within 1km of a pharmacy. You led us through a pandemic, 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, and our range of services has so much potential to significantly improve access to patient healthcare. What is more, this model of patient care is already working successfully in Scotland and further afield. Every day I see patients suffering who cannot access a doctor due to the extreme pressure that the healthcare system is under. Together we can make 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).


  • Save GPs time. Let us prescribe approved items for medical card patients. Private patients can buy these items over the counter, but medical card holders need a prescription from their GP.
  • It makes no sense in the current climate to be sending medical card holders into GP surgeries for over-the-counter items. This at a time when we need to free-up accessibility to GPs for urgent 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 one-in-seven GP visits; here, it could be even more.


  Pharmacists could work to carefully develop Patient Group Directives (PGDs) to assess and supply medicines 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 drops for conjunctivitis. Sixteen years later and Ireland still hasn’t caught up; it’s insulting to our profession and injurious to patient care.

Taoiseach, surely you can see how important this is. You have an important job to do, going back to your GP role once a week was admirable during the pandemic, but not a long-term solution. Now we need you to lead this country and act swiftly to ease the pressure on doctors. Introducing a PGD does not need to be difficult; we have a roadmap from Scotland. We can’t afford years of planning and preparation by people who don’t work in community pharmacy. We need co-operation between healthcare professionals, their governing bodies, the HSE and the Government, so that patients can get 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 of implementing PGDs and working within the boundaries of them.

There is no legislation to support the supply by pharmacists of prescription medicines without receipt of a prescription. By law, we can administer certain medications in certain circumstances, however the 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 prescription-only 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 facilitate pharmacists to use their existing skills to treat common, uncomplicated ailments in patients, without any contraindications to treatment. This is in the best interests of patient care and is well within the scope of community pharmacists.

Pharmacists are NOT seeking to be doctors, but we ARE looking to be able to improve patient access to medicines and healthcare in predefined, safe, and approved settings.


Sheena Mitchell MPSI