Does the free NRT scheme mean employee pharmacists now have another service to advise on, with no increase in pay, writes Áine Mac Grory
I’m almost two months into 2025. It’s been a tough start to the year, but I take comfort from my patients who, while disappointed, were sympathetic towards my plight and as annoyed as me about the misleading not-so-‘free’ HRT scheme. Every interaction so far has been met with responses of ‘but how can they expect you to just take the hit that’s not fair?’, and they’re right. It isn’t fair. I have managed to stamp out those little fires within my patient cohort at least.
The issue continues to be discussed in the media, with a negative light being shone on the community pharmacy sector and no retaliation from our side. The new MfH (Minister for Health) spoke in the Dáil recently to address the implementation delay. There, she stated: “The government set aside money to pay for the products but not the dispensing fee for pharmacists. I have met the pharmaceutical union. I am engaging with it to see if there is something we can do, but the reality is we do not have the budget to carry the dispensing fees… I am trying to find a resolution… I hope the pharmaceutical union will come back with something we can work on.”
I guess this means she didn’t like the idea of the proposed integrated women’s healthcare scheme that was sent to the Department.
Then comes 29 January 29. All snuggled-up for the night and ready to get stuck into the IIOP’s webinar, titled ‘Stop Smoking Medicines & HSE Stop Smoking Services’. What more could you want of a Wednesday evening?
Fast-forward 40 minutes.
So frozen am I with shock and confusion that I can barely pick my jaw up off the floor.
Did I just hear that correctly? I must be mistaken. I gather myself and see my phone lighting up like a Christmas tree. An explosion of angry emojis and ‘what did I just watch?’, and ‘anyone need their blood pressure checked after that webinar?’
The discontent was stemming from the part of the webinar where the question was put to the presenter
‘… if I have a patient come in, how can I get them access to that free NRT?’
The response: ”If you have anybody that’s coming in and looking for free NRT, advise them to come into the stop smoking service… we will arrange for the stop smoking medications to be either posted out to them or through their participating pharmacy they go and get it that way so that’s the way they get the medication… right now you can email … and get the referral to us and we’ll start engaging with the client on that point.’’
On the surface, it doesn’t seem like much but when you consider what that means, it is extremely concerning.
The pharmacists in attendance of that webinar have been instructed to essentially block a sale/dispensing of an NRT product and instead inform the patient of this service, collect and email on their details, and then send them to a clinic which will potentially direct them to a participating pharmacy. That sounds an awful lot like an administrative task and an unpaid referral. There was no mechanism discussed for the claiming of a referral fee.
From the community pharmacist side, it looks like new services are being brought into chains via a loophole and bypassing the independents. The employee pharmacists now have another service to advise on, with no increase in pay.
I fear this method will be used to resolve other service provision hurdles.
Are we at risk of the work-around for free HRT scheme being a referral to the nearest menopause management clinic? Where they receive resources, support and a signpost to collect their free HRT products from a participating pharmacy? Making this another tender process that any pharmacy can partake in, but that realistically only a chain will have the capability to provide.
The IPU members turned to their union to do something. A video message was sent out to address these concerns — “The tender announced is a short-term measure and the HSE QUIT team have clearly stated an intention to provide the service through all community pharmacies.”
An intention? Remind me again, what was the road to hell paved with?
I recall in September 2023, the journal.ie reported: “In a matter of weeks, the cost of nicotine replacement chewing gums, patches and lozenges will be capped at €80 a month under new plans being devised by Health Minister Stephen Donnelly.”
August 2024 – Free HRT for the women of Ireland by January 2025.
One could be forgiven for not holding out hope that in 12 months’ time, free NRT will be brought into all pharmacies based on the track record of intentions to date.
There is a very concerning precedent being set.
I have taken time out daily to explain the current situation to patients asking about a prescription extension and the reason for not implementing, as per the instruction given by my union.
The same union are now saying in this instance, the decision to run and publish the HSE QUIT tender process is a matter for the HSE and any individual community pharmacy that wishes to engage with that tender process or not.
I wanted to engage with the tender process but when the invitation to tender for this service came out, It was clear from the eligibility criteria* that an independent pharmacy was never going to stand a chance at winning that contract.
It doesn’t matter what branch of the HSE this service is coming from. The public doesn’t know the difference. It is blurring the message coming from the IPU with regards to no more engagement with new services until substantial work has been made on the pay claim.
Why should I continue to withhold on prescription extension and expansion of the pharmacy role when the people being tasked to implement IPU strategy are engaging in new services? You lead by example. How weak does my discussion at the counter become when a chain is allowed to provide a nationwide service, but I must send my patient back to their GP to get their six-month script renewed.
I lose the chance to engage with my patient and if I refer them on, I am at risk of losing them entirely, because why would anyone opt to collect only their NRT from one pharmacy and then attend a different one for their prescriptions?
Do I engage in this unpaid referral process? And if I don’t, how does it look for me knowing a patient can get their gum free elsewhere?
It is sending mixed messages.
I saw this as an opportunity of leverage for the community pharmacy sector. The future of pharmacy is service-driven. A strike is not feasible, but halting the progress of a very worthwhile health incentive is. Make it clear to the HSE that we have some power over the implementation and success of these kinds of projects. This could have been a chance at unity. Employees, independents and chains displaying a show of solidarity.
We are being rinsed in the media. There has been no progress shared to date, just acknowledgement of many attempts.
Fine — allow the tender to go ahead if it can’t be paused, but support and advise all non-participating pharmacies to stall referrals until that service has had a fee agreed AFTER substantive progress has been made in the pay claim.
We are up to our proverbial in schemes overlapping other schemes, with patients eligible for more than one. The simple solution is to include NRT on the DPS scheme and, like the emergency contraceptive scheme, issue a code for a stop-smoking service referral when patient details are sent to a stop-smoking clinic. The patient can attend their pharmacy and get the stop-smoking products without delay. This eliminates any need for any tender process and incorporates all community pharmacies instantly. Everything else from the stop-smoking service remains the same and the patient gets all the extra support they need through the clinics. How disempowered are the non-participating pharmacies otherwise?
I am well able to counsel and support my patients on their stop-smoking journey. Why should I lose the opportunity to make that contact count and have a meaningful engagement with my patient? Why should I lose the sale of my OTC NRT? Why am I once again writing an article about another replacement therapy scheme damaging the integrity of the community pharmacy sector?
*‘The Service Provider must be a National Supplier(s) with a nationwide pharmacy presence/partnership with strong logistics network/logistics partnerships. The Mandatory requirement is that the provider has a pharmacy location within 15km radius of a minimum of 91 different Stop Smoking Clinic locations nationwide (approx. 60%) in order to provide a minimum nationwide geographical spread.’
Áine is a Superintendent Pharmacist and pharmacy owner with over 18 years of experience working in community pharmacies across Ireland. In 2014, she earned her Masterof Pharmacy (MPharm) degree in the UK. Her career journey has encompassed a variety of roles, including locum, support, and supervising, culminating in her recent transition to pharmacy ownership. She is deeply committed to upholding the integrity and vital role of community pharmacy in Ireland, combining her extensive experience with a passion for patient care and professional excellence.
