IPN December 2016 by Aisling Twomey

December 2016 Volume 8  Issue 12

Dynamic 100 Issue

THE INDEPENDENT VOICE OF PHARMACY

In this issue:

That Enstilar moment

NEWS:

Role of Pharmacy in Antimicrobials Page 5

PROFILE: Pfizer’s Paul Reid Page 9

CPD: Discover what the NEW foam spray Enstilar can do for your plaque psoriasis patients

An A-Z of common eye complaints Page 53

Extraordinary Delivery

Visit www.enstilar.ie Abbreviated Prescribing Information for Enstilar® 50 micrograms/g + 0.5 mg/g cutaneous foam Please refer to the full Summary of Product Characteristics (SmPC) (www.medicines.ie) before prescribing. Indication: Topical treatment of psoriasis vulgaris in adults. Active ingredients: 50 µg/g calcipotriol (as monohydrate) and 0.5 mg/g betamethasone (as dipropionate). Dosage and administration: Apply by spraying onto affected area once daily. Recommended treatment period is 4 weeks. The daily maximum dose of Enstilar should not exceed 15 g, i.e. one 60 g can should last for at least 4 days. 15 g corresponds to the amount administered from the can if the actuator is fully depressed for approximately one minute. A twosecond application delivers approximately 0.5 g. As a guide, 0.5 g of foam should cover an area of skin roughly corresponding to the surface area of an adult hand. If using other calcipotriol-containing medical products in addition to Enstilar, the total dose of all calcipotriol-containing products should not exceed 15 g per day. Total body surface area treated should not exceed 30%. Safety and efficacy in patients with severe renal insufficiency or severe hepatic disorders have not been evaluated. Safety and efficacy in children below 18 years have not been established. Shake the can for a few seconds before use. Apply by spraying, holding the can at least 3 cm from the skin, in any orientation except horizontally. Spray directly onto each affected skin area and rub in gently. Wash hands after use (unless Enstilar is used to treat the hands) to avoid accidentally spreading to other parts of the body. Avoid application under occlusive dressings since systemic absorption of corticosteroids increases. It is recommended not to take a shower or bath immediately after application. Contraindications: Hypersensitivity to the active substances or any of the excipients. Erythrodermic and pustular psoriasis. Patients with known disorders of calcium metabolism. Viral (e.g. herpes or varicella) skin lesions, fungal or bacterial skin infections, parasitic infections, skin manifestations in relation to tuberculosis, perioral dermatitis, atrophic skin, striae atrophicae, fragility of skin veins, ichthyosis, acne vulgaris, acne rosacea, rosacea, ulcers and wounds. Precautions and warnings: Adverse reactions found in connection with systemic corticosteroid treatment, e.g. adrenocortical suppression or impaired glycaemic control of diabetes mellitus, may occur also during

topical corticosteroid treatment due to systemic absorption. Application under occlusive dressings should be avoided since it increases the systemic absorption of corticosteroids. Application on large areas of damaged skin, or on mucous membranes or in skin folds should be avoided since it increases the systemic absorption of corticosteroids. Due to the content of calcipotriol, hypercalcaemia may occur. Serum calcium is normalised when treatment is discontinued. The risk of hypercalcaemia is minimal when the maximum daily dose of Enstilar (15 g) is not exceeded. Enstilar contains a potent group III-steroid and concurrent treatment with other steroids on the same treatment area must be avoided. Skin on the face and genitals are very sensitive to corticosteroids. Enstilar should not be used in these areas. Instruct the patient in the correct use of the product to avoid application and accidental transfer to the face, mouth and eyes. Wash hands after each application to avoid accidental transfer to these areas. When lesions become secondarily infected, they should be treated with antimicrobiological therapy. However, if infection worsens, treatment with corticosteroids should be discontinued. When treating psoriasis with topical corticosteroids, there may be a risk of rebound effects when discontinuing treatment. Medical supervision should therefore continue in the posttreatment period. Long-term use of corticosteroids may increase the risk of local and systemic adverse reactions. Treatment should be discontinued in case of adverse reactions related to long-term use of corticosteroid. There is no experience with the use of Enstilar in guttate psoriasis. During Enstilar treatment, physicians are recommended to advise patients to limit or avoid excessive exposure to either natural or artificial sunlight. Topical calcipotriol should be used with UVR only if the physician and patient consider that the potential benefits outweigh the potential risks. Enstilar contains butylhydroxytoluene (E321), which may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes and mucous membranes. Pregnancy and lactation: There are no adequate data from the use of Enstilar in pregnant women. Enstilar should only be used during pregnancy when the potential benefit justifies the potential risk. Caution should be exercised when prescribing Enstilar to women who breast-feed. The patient should be instructed not to use Enstilar on the breast when breast-feeding. Side effects: There are no common adverse reactions based on the clinical studies. The most frequently reported adverse reactions are application site

reactions. Uncommon (≥1/1,000 to <1/100): Folliculitis, hypersensitivity, hypercalcaemia, skin hypopigmentation, rebound effect, application site pruritus, application site irritation. Not known frequency: Hair colour changes. Calcipotriol: Adverse reactions include application site reactions, pruritus, skin irritation, burning and stinging sensation, dry skin, erythema, rash, dermatitis, psoriasis aggravated, photosensitivity and hypersensitivity reactions, including very rare cases of angioedema and facial oedema. Systemic effects after topical use may appear very rarely causing hypercalcaemia or hypercalciuria. Betamethasone (as dipropionate): Local reactions can occur after topical use, especially during prolonged application, including skin atrophy, telangiectasia, striae, folliculitis, hypertrichosis, perioral dermatitis, allergic contact dermatitis, depigmentation and colloid milia. When treating psoriasis with topical corticosteroids, there may be a risk of generalised pustular psoriasis. Systemic reactions due to topical use of corticosteroids are rare in adults; however, they can be severe. Adrenocortical suppression, cataract, infections, impaired glycaemic control of diabetes mellitus, and increase of intra-ocular pressure can occur, especially after long-term treatment. Systemic reactions occur more frequently when applied under occlusion (plastic, skin folds), when applied on large areas, and during long-term treatment. Precautions for storage: Do not store above 30°C. Extremely flammable aerosol. Pressurised container. May burst if heated. Protect from sunlight. Do not expose to temperatures exceeding 50°C. Do not pierce or burn, even after use. Do not spray on an open flame or other ignition source. Keep away from sparks/open flames. No smoking. Legal category: POM. Marketing authorisation number and holder: PA 1025/5/1. LEO Pharma A/S, Ballerup, Denmark. Last revised: May 2016 Further information can be found in the Summary of Product Characteristics or from: LEO Pharma, Cashel Road, Dublin 12, Ireland. e-mail: medical-info.ie@leo-pharma.com ® Registered trademark MAT-04851 Date of preparation: September 2016

Reporting of Suspected Adverse Reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, Dublin 2, Tel: +353 1 6764971, Fax: +353 1 6762517, Website: www.hpra.ie, e-mail: medsafety@hpra.ie. Adverse events should also be reported to Drug Safety at LEO Pharma by calling +353 1 4908924 or e-mail medical-info.ie@leo-pharma.com

ALL LEO TRADEMARKS MENTIONED BELONG TO THE LEO GROUP

DYNAMIC 100: Ireland’s Pharmacy Dynamic 100 Page 58

FEATURE: Ireland’s growing obesity issue Page 97

EVENT GALLERY: Totalhealth Awards Page 104

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Foreword

Contents

EDITOR: Kelly Jo Eastwood As IPN was going to press, the Irish Pharmaceutical Healthcare Authority was hosting its 23rd Annual Conference and transparency was high on the agenda. President Mary Dickens declared that 100% transparency on support from the pharmaceutical industry to healthcare professionals to be ‘essential’ and in the public interest.

Page 5: PSI launch Future of Pharmacy Report

Under a new European voluntary code implemented by IPHA in Ireland, payments from pharmaceutical companies to Healthcare Professionals and Healthcare Organisations have been disclosed since 30th June this year.

Page 9: At the helm of Pfizer - Paul Reid

Community Pharmacy is at the forefront of patient care. As are allied healthcare professionals and the organisations they work with. It is this relationship between industry and healthcare professionals which help the latter provide best patient care, whilst helping companies develop and provide medicines.

Page 16: IPU Review

Spotlight your highest impact drivers for 2016

Page 30: Retailing

confidence continues to decline

“Our goal is to achieve 100% consent by healthcare professionals and healthcare organisations to public disclosure of transfers of value. 100% public disclosure is in the public interest,” Ms Dickens stated.

Page 36: How to use

The expectation for transparency has extended beyond personal interactions and is now a reality across all business. Across all industries, transparency has never been more important to a successful business model.

marketing in the battle for your community pharmacy?

Page 58: IPN annual Dynamic 100

Turn to page 6 for more details from the conference, whilst our January issue will carry full coverage. In looking towards Pharmacy business we think about all aspects, from profitability, to accountability, marketing to Continuing Professional Development.

PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street Dublin 2 00353 (01) 6690562

& MAKE DATA DRIVEN DECI58SIONS

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

EDITOR - Kelly Jo Eastwood kjeastwood@hotmail.com

EDITORIAL DEPARTMENT editorial@ipnirishpharmacynews.ie

ACCOUNTS Jon Dickinson accounts@ipncommunication.com COMMERCIAL MANAGER Barry Maguire Barry@ipnirishpharmacynews.ie ADVERTISING MANAGER Nicola McGarvey nicola@ipnirishpharmacynews.ie SALES AND MARKETING Aisling Twomey aisling@ipnirishpharmacynews.ie

Regulars

Irish Pharmacy IRISH News is circulated PHARMACY to all independent, NEWS multiple and hospital pharmacist, government officials and departments, pharmacy managers, manufactures and wholesalers. Buyers of pharmacy groups and healthcare outlets. Circulation is free to all pharmacists subscription rate for Irish Pharmacy News ¤60 plus vat per year.

From pages 14 – 51 of this issue, we feature a range of articles designed to help our readers access the latest information from industry experts and leaders. Pharmacy representative bodies including the PSI, IPU and IIOP give us a unique glimpse into their year-past successes. We also carry industry-authored reports breaking down key tips and advice towards a successful business agenda. On page 44, HSE Chief Information Officer Richard Corbridge gives us an overview as to the current eHealth agenda and what is on the digital horizon for 2017 whilst we also carry articles designed to help your CPD journey. This month features the annual IPN Dynamic 100. This special supplement recognises the contribution made by 100 key players in this fast changing space. Each and every one of the 100 industry professionals have displayed motivating behaviour affecting the development of pharmacy within Ireland, displaying vigorous effective action.

All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system of transmitted in any form without written permission. IPN Communications Ltd. have taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

Inclusion in the Dynamic 100 significantly is an acknowledgement of the expertise, unique capabilities and individual’s preeminent status for consistently enhancing pharmacy within Ireland. Turn to page 58 to see who has the made the list for this year. We would like to take this opportunity to wish all of our readers a very Happy Christmas and a prosperous New Year. See you in 2017!

Feature: Smoking Cessation 38

Feature: Obesity

CPD Optical Health

Feature: Contraception

Event Gallery

102

Spotlight your highest impact drivers & MAKE DATA DRIVEN DECIS IONS

Call us on + 353 1 6931433 www.realworldretail.com Call us on + 353 1 6931433 www.realworldretail.com

104

News news brief HIGH RATES OF DEPRESSION IN PREGNANT WOMEN

Transparency is key says IPHA Addressing the 23rd Conference of the Irish Pharmaceutical Healthcare Association, its President, Mary Dickens declared that 100% transparency on support from the pharmaceutical industry to healthcare professionals was essential in the public interest. professionals and healthcare organisations to public disclosure of transfers of value. 100% public disclosure is in the public interest.

One in six pregnant women – or 16% of pregnant women - attending maternity services across Ireland are at probable risk of depression during their pregnancy, according to a new survey launched by a Trinity College Dublin research team and the Irish Obstetric Services. Ireland has the second highest birth rate in Europe, with an average of just under 68,000 births a year (2014). This means that in one year, over 11,000 women could be experiencing or at risk of depression during pregnancy. There is increasing evidence that depression during pregnancy can have an influence on obstetric health and may compromise the physical and mental health of the infant. However, screening for antenatal depression is not routine in Ireland’s maternity hospitals and perinatal mental health services are grossly under-resourced in comparison to other comparable EU countries, according to the research clinicians. The Well Before Birth study shows that prevalence rates of depression amongst women giving birth in Ireland are high, and may be higher than those recorded in other OECD countries. Veronica O’Keane, Professor in Psychiatry at Trinity, and the lead research investigator, said that women in Ireland should be screened for depression early in their antenatal care plan and should be encouraged to seek help. Professor O’Keane said, “Antenatal depression, as we are seeing with this study, is common. Rates of depression during pregnancy among women in Ireland are at least as high, and probably higher, than in other EU countries.” The Irish study also shows that rates of depression increase with advancing pregnancy. Women in Irish maternity services show rates of 13.8% in the second trimester and 17.2% in the third trimester. This compares with rates of 12% and 14% respectively in a landmark UK study (Avon Longitudinal Study of Parents and Children).

“Stability in supply, predictability in pricing, and a clear pathway for the adoption of new medicines: these are things that matter to the State and to our members and even more to patients who want, need and deserve the solutions that medicines provide.

Billy Kelleher, T.D., Mary Dickens, IPHA President and Oliver O’Connor, IPHA Chief Executive Under a new European voluntary code implemented by IPHA in Ireland, payments from pharmaceutical companies to Healthcare Professionals and Healthcare Organisations have been disclosed since 300th June this year. Individual consent to disclosure is a right for each person under data protection law and not all healthcare professionals have chosen to give such consent this year.

“Our goal is to achieve 100% consent by healthcare

“Patients and their treating clinicians can expect that IPHA and the State authorities will make our Agreement work to deliver fast access to new medicines. So we encourage the HSE, to include timely access to new medicines as a performance indicator alongside financial performance issues. Whilst few new medicines have been released since the agreement – we look forward to improvement in the process and timelines.”

Greater access to medicines on EU agenda Minister for Health Simon Harris has attended an informal meeting of EU Health Ministers where he also had one to one meetings with Health and Food Safety Commissioner Andriukatis; Swedish Minister for Health and Sport, Gabriel Wikstrom; Dutch Minister for Health, Welfare and Sport, Edith Schippers and UK Minister for Public Health, David Prior. The Minister had discussions on areas of common interest and opportunities for collaboration. In particular EU Ministers for Health were anxious to discuss and explore ways to ensure greater affordability and better access to medical products. Minister Harris met with EU Commissioner for Health and Food Safety, Vytenis Andriukaitis. During the meeting he thanked him for his full support for the Irish (Public Health) Alcohol Bill and stated that he was very much looking forward to working closely with the Commissioner on an enhanced public health agenda over the coming years. Minister Harris also raised the particular implications for Ireland, of the UK’s decision to leave the EU. In this context Minister Harris referenced the relocation of the European Medicines Agency currently located in London. The Minister said, “Ensuring

Ms Dickens said, “The doctors, pharmacists, nurses, other health professionals and healthcare organisations we work with are at the forefront of patient care. The relationship between our industry and healthcare professionals helps them provide best patient care and helps our companies develop and provide medicines.

“Already price reductions on hundreds of medicines have happened and savings are being made for the HSE budget.

continuity of and minimising disruption to the work of the Agency when it relocates is essential. A move to Dublin provides a sound, sustainable base for the EMA’s current standards of excellence.” The Minister emphasised Ireland’s position as a leading location for existing pharmaceutical industry in the EU with nine out of the ten largest pharmaceutical companies in the world operating out of Ireland. Ireland also has a strong track record in the research and development field, as well as a highly regarded national medicines regulator in the Health Products Regulatory Authority (HPRA), which already contributes significantly to the work of the EMA. During a discussion on reducing the levels of salt, saturated fats and sugar in food, Minister Harris outlined Ireland’s new obesity policy and action plan ‘A Healthy Weight for Ireland’.

“Food product improvement will make it easier for people to make healthy choices and help in tackling rising levels of overweight and obesity. ‘A Healthy Weight for Ireland’ includes a commitment to agree food reformulation targets with the food industry and to establish a forum for engagement with industry on best practice initiatives towards a healthy food environment. I look forward to working on this with my colleague, Minister Corcoran Kennedy.” Minister Harris also welcomed proposals for EU member states to work together to address the issue of medicines shortages. Medicines shortages are caused by a number of factors and can have a significant impact. The Minister reaffirmed Ireland’s support for collaborative approaches to prevent medicines shortages occurring.

News Pharmacists to play bigger role in health Key enablers are needed to support the development of future pharmacy practice, according to a new report published in Ireland this month. It has been published by the Pharmaceutical Society of Ireland (PSI) on how pharmacists can best meet the needs of patients and the public into the future. The report also identified that leadership by the profession and collaboration between healthcare professionals was a critical element in securing progress in the best interests of patients, the public and the wider health service. The research project, which commenced in late 2015, aimed to develop a vision for Pharmacy by giving consideration to the role pharmacists might play in public health improvements and efficiencies, where there is public benefit, and to determine how the PSI could support and develop pharmacists’ education, training and practice standards to meet these changes in the future care of patients. The report, “Future Pharmacy Practice in Ireland - Meeting Patient Needs”, is published following an extensive consultation and information-gathering process involving patients, healthcare professionals, including pharmacists, other regulatory bodies, and engagement with the Department of Health, HSE, and wider stakeholders. It includes a number of significant recommendations for the planning and delivery of pharmacy care and services in Ireland, anticipating patients’ needs in the future and identifying the role that pharmacy can play to meet these needs and alleviate challenges to the health system. Particularly, the project Steering Group made recommendations for future pharmacy practice in three key areas.

PLAY YOUR PART IN STROKE PREVENTION

1. Pharmacist involvement in health and wellbeing initiatives through structured population health information and awareness campaigns and preventative medicine.

Community Pharmacists across Ireland are being urged to help their customers identify how to take their pulse to help detect an irregular heartbeat, which may help prevent a stroke.

> The network of over 1800 pharmacies in primary care is ideally placed to support and promote patient self-care and prevention through early intervention initiatives as part of the national health and wellbeing strategy. 2. Pharmacists provide support and expertise in assisting patients in the prevention of and improved management of chronic diseases (such as diabetes, asthma) with structured initiatives incorporating pharmacists and, where appropriate, through supplementary prescribing in collaboration with a patient’s GP. > Patients with chronic diseases are already frequent pharmacy visitors, and in recognition of the growing burden of chronic disease and inherent risk of multiple drug therapies, there is opportunity for better integration of pharmacy with the rest of the healthcare team to support patient self-management of their conditions. 3. Pharmacists managing medicines throughout the patient care pathway via structured initiatives such as medication reviews for at-risk and vulnerable patients in the community and local settings e.g. nursing homes; and the greater presence of pharmacy throughout a patient’s care pathway, with the intent of reducing prescribing errors, reducing waste and optimising the impact of medicines for patients.

Dr Ann Frankish, President, PSI

> With increasingly complex medicines available and rising rates of polypharmacy, the knowledge and expertise of pharmacists should be better used to ensure the safety and efficacy of medications in all patient care settings. Dr Ann Frankish, PSI President, speaking about the report said, “We hope that the findings and recommendations will help outline a real vision for the future direction of pharmacy in Ireland, which will valuably contribute to the health and wellbeing of patients. The report acknowledges the available network and resource of pharmacists with the opportunity to make most appropriate use of their knowledge and professional insight to support and promote the national health promotion and wellness strategy and oversee the safety and efficacy of medicines use.” You can read more about the PSI’s work through 2016 and the challenges they envisage for next year on page 24.

Threat to patient safety concerns In the week leading up to European Antibiotics Awareness Day (Friday 18 November), Pharmacists have warned that antibiotics need to be respected as a precious life-saving medicine to be used sparingly and appropriately and only when absolutely necessary. The overuse and misuse of antibiotics is detrimental to the future health of all patients and is putting patients at risk, according to the Irish Pharmacy Union (IPU). IPU President Daragh Connolly commenting on the dangers of the overuse of antibiotics said, “Antibiotic resistance is one of the most significant threats to

patient safety in Ireland. Repeated and improper use of antibiotics is the single most important factor leading to antibiotic resistance in Ireland and around the world. If we allow antibiotic resistance to grow, the antibiotics used to treat infections today will become ineffective or will stop working altogether in the future. This will

news brief

not only cripple our ability to fight routine infections but will also undermine the treatment of more complicated infections, especially in patients with chronic diseases.” He warned that antibiotics will not work on viruses like colds and flu, and overuse can lead to bacteria becoming resistant to the antibiotic.

Atrial Fibrillation (AF) is the most common heart rhythm disorder which carries a fivefold additional risk of stroke but regular pulse checks can help detect it. Dr Angie Brown Medical Director of the Irish Heart Foundation and consultant cardiologist says, “Atrial Fibrillation is a very common cause of disabling stroke in Ireland and by raising awareness of a condition that affects tens of thousands of people in Ireland, and the need for checking your heart rate by regularly checking your pulse; we can prevent more strokes and ultimately save lives.” Today more than 40,000 people over 50 years old in Ireland suffer from Atrial Fibrillation, but the vast majority are unaware of it with just 26% of the population having heard of the condition. The Irish Heart Foundation is running a national radio awareness campaign encouraging adults to learn how to take their pulse or to call the Irish Heart Foundation’s Helpline on Freephone 1800 25 25 50. There are about 8,000 strokes in Ireland annually, approximately a third of which are associated with Atrial Fibrillation. Some people have no symptoms of AF and are only diagnosed at a routine check-up, or following a serious event like a stroke. But there can be warning signs and these include palpitations, tiredness, shortness of breath, dizziness, or feeling faint. According to the Irish Heart Foundation, the chance of developing AF can increase if a person has one or more medical conditions, such as high blood pressure, diabetes and heart disease. AF can affect adults of any age, but it is more common as people get older.

News news brief IMPROVEMENT IN PALLIATIVE CARE FOR CHILDREN Hundreds of children with lifelimiting conditions and their families have had access to improved palliative care thanks to a national policy adopted seven years ago. An Evaluation of the Children’s Palliative Care Programme launched by the Health Minister Simon Harris found new initiatives like outreach nurses are “significantly enhancing” the quality of palliative care being delivered to children with life-limiting conditions across Ireland. About 350 children die before their 18th birthday every year in Ireland. There are an estimated 3,840 children in Ireland living with a lifelimiting condition. They have an incurable illness that often requires special care and at times may need palliative care. Palliative Care for Children with Life-Limiting Conditions – A National Policy was published by the Department of Health in 2009 to provide a framework for improving palliative care services for children and families that need them. The independent evaluation of the CPCP found the new services have:  Improved quality of life for children and their families.  Improved co-ordination of services to children with lifelimiting conditions so they can be cared for in the home setting as far as possible.

Opening up clinical data on new medicines As of last month, the European Medicines Agency (EMA) gives open access to clinical reports for new medicines for human use authorised in the European Union (EU). Vytenis Andriukaitis, European Commissioner for Health and Food Safety, said “Transparency is an essential component in clinical research. Its outcome – whether positive or negative – should be made publicly available. EMA’s transparency initiative will make Europe a true front runner with respect to release of data concerning clinical trials. It will create a bridge from now until the new Clinical Trials Regulation - which foresees additional milestones towards transparency, becomes applicable.” For every new medicine, citizens, including researchers and academics, will be able to directly access thousands of pages from clinical reports submitted by pharmaceutical companies to EMA in the context of marketingauthorisation applications. Clinical reports give information on the methods used and results of clinical trials conducted on medicines. EMA is the first regulatory authority worldwide to provide such broad access to clinical data.

“Transparency on clinical data is a longstanding commitment from EMA and today, we are delivering on our promise to give access to the data on which our recommendations are based”, explained EMA’s Executive Director Guido Rasi. “Our initiative has shaped the global debate towards more transparency. It will benefit academic research and the practice of medicine as a whole.” With EMA’s proactive approach to providing access to the data, patients and healthcare professionals will be able to find out more information about the data underpinning the approval of medicines they are taking or prescribing. It will also facilitate the independent re-analysis of data by academics and researchers after a medicine has been approved. This will increase scientific knowledge, and potentially further inform regulatory decision making in the future. Increased transparency will also benefit innovation. The shared

As a first step, EMA has publishing data for two medicines, representing approximately 260,000 pages of information for over 100 clinical reports. Data will be progressively added online for all applications concerned since the policy entered into force.

At the start of last month (November), Athlone Institute of Technology hosted a number of notable members of the pharmaceutical industry for their annual prize-giving and graduation ceremony. Students arrived with their families to celebrate their achievements and bid farewell to their fellow graduates, some of whom had their outstanding efforts and academic achievements generously rewarded by top pharmaceutical companies. the hard work of all the staff and students highlighted the achievements of this year’s graduates, wished them well in their future careers whether they be in community or hospital practice or continuing their education.

 Increased awareness of children’s palliative care and of the new service in both the public arena and health sector.

“Patients and clinicians have been waiting a long time for clinical trial data. This new approach will at last provide transparent information on all results of clinical trials, positive or negative, as submitted to the EMA”, commented Yann Le Cam, Chief Executive Officer of EURORDIS-Rare Diseases Europe and member of the EMA’s Management Board. “We expect this to enhance trust in the medicines approval system. Access to this new knowledge base can help to accelerate innovation by reducing duplication of research and de-risking some new developments.”

Changing scope for Pharmacy Technicians

 Led to an improved children’s palliative care sector with increased education on children’s palliative care.

John Hennessy HSE National Director of Primary Care said, “The Children’s Palliative Care Programme has made an important contribution to ensure that parents are actively involved in decision making about the care for their child. The evidence from the report confirms the success of the Children’s Palliative Care Programme to date in improving the communications, coordination and the overall quality of care provided to the sickest children we care for.”

knowledge about a medicine helps developers learn from the experience of others and can lead to more efficient medicine development programmes.

Dr Gary Stack, Student Roseann Carbury, Diane Patterson Course, Co-Ordinator and Dr Aoife Guiry Irish Pharmacy News were pleased to sponsor the Student of the year award for the HC Science Pharmacy Technician. The worthy recipient, Roseann Carbury, achieved the highest grade in her class, and is currently at AIT

studying for her BSc Pharmacy Technician and completing her placement at Merlin Hospital Galway under the supervision of Tom Walsh. Pharmacy Course Co-Ordinator Diane Patterson commended

Ms Patterson said, “The scope of practice for Pharmacy technicians on Ireland is ever changing and we have a strong tradition here at AIT in evolving with that. AIT launched their BSc Pharmacy Technician a few years ago and it has gone from strength to strength. “Most recently we launched an Online Special Purpose Award in Clinical Pharmacy and Pharmaceutical Care, our first cohort graduated last month and the second cohort will complete this December.”

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Paul Reid - At the helm of Pfizer With more than two decades of experience under his belt, Paul Reid, Managing Director of Pfizer in Ireland, has a lot of knowledge about the pharmaceutical industry, and a lot to say about biosimilars, medicine pricing and other pressing issues affecting pharmacists today. Mr Reid’s career has spanned across four healthcare organisations in the past 22 years, including Rowa Pharmaceuticals, Nutricia, Aventis (which is now Sanofi-Aventis) and Pfizer. His interest in the industry was first piqued while working on his final year thesis. “As part of my final year thesis, when I was looking to graduate with a bachelor of science in management from Trinity, I completed a thesis entitled Research and Development: Pharmaceutical Companies Response to the Threat of Generics,” Mr Reid explained. “At the time, not many people in Ireland were really talking about the pharmaceutical industry – it was more of a US-based industry, with a lot of success coming out of the US. In Ireland in that time, generics were only in their infancy. So if you were to speak to the general public at the time I completed my thesis, in 1994, not many people would have heard of generics, or known what they meant. “The more reading I did on the subject, the more intrigued I became. As part of my preparation for my thesis, I met with the marketing manager at the time of Rowa Pharmaceuticals, which was one of four generics companies at that time. “We had a long interview, where I was trying to get as much information as I could so I could complete my thesis – and within a week of meeting him, he offered me a job.” Still a young college graduate, Mr Reid moved from Dublin to Bantry, where Rowa is based, to take up the marketing role, and he stayed there for two and a half years. “So that’s how I got into the industry,” said Mr Reid. “I love working in the industry, and it’s very fulfilling, and I’ve worked in nearly every commercial role you can do – I’ve been medical rep, sales manager, marketing manager, product manager, marketing director, business unit director and now managing director for the last

three and a half years in Pfizer. I’m 15 years with Pfizer. “It’s a business that continuously changes. Every year, you face new challenges. I think in particular, when you work in Pfizer, which is such a large multinational company with such a big presence in Ireland, we’re constantly looking for ways of growing the business but we’re also constantly looking at new ways of evolving the business. “It’s a good feeling to be able to speak proudly about what you do, the medicines that you’re bringing to the market, the medicines that are helping make patients better.” Mr Reid said he takes a lot of pride in the fact that Pfizer has a strong vaccination portfolio. “For me, I love the fact that we have a vaccine business as part of our overall portfolio, because then you’re talking about preventing disease,” he said. “Everyone’s talking about the cost of medicines at the moment, and saying that medicines are expensive and asking whether it’s good return for the State and the Government to be funding new medicines. But you can never question funding vaccines – vaccines save money in the long-term because, effectively, you’re preventing illness. “So as a company, we’ve been very big on pneumococcal vaccinations but recently we’ve been adding to our vaccine portfolio, and we’ve a big one in our pipeline, hopefully, which is a meningitis B vaccine. So I’m very much looking forward to the future with vaccines because I think, as a company, we can shout loud and proud about being able to prevent disease, as well as just treating it.” The MD pointed out that his company has also been quite busy of late acquiring new businesses. “In the last 12 months, we’ve acquired Anacor, which is an interesting company, and which will hopefully bring us new medicines – one in particular for eczema, and there haven’t been too many new medicines in that space over the years,” he said. “We’ve also acquired

Mr Paul Reid, Managing Director, Pfizer

Hospira, which also strengthens our business because we’re now bringing in a nice pipeline of biosimilar medicines. “We’ve also bought in some Baxter vaccine business, and we’re pending a final acquisition of Medivation, which will bring in an oncology portfolio, and particularly prostate medicine, which will beef up our oncology presence for the future. “So that’s all really good at a global level. In Ireland, I think what makes us all proud is that we continue to be the number one company, and we’ve many of the

leading medicines in areas such as arthritis, cancer, cardiovascular health, pain and vaccines too. We continue to be one of the leading employers with over 3,000 colleagues, and we have seven sites in the country,” Mr Reid continued. “As a country, within Pfizer, we’ve got a very significant footprint and that gives us a lot of visibility and a lot of recognition for what we do in the country. I think that’s a really good advantage for us working in the company, but I also think it’s a good advantage for the country, in terms of what we’re able to invest here, and how we can grow our

Profile make it to the point where they are accessible to Irish patients,” he said. “But it’s got slower, the timeline from actually looking into and securing funding for new medicines to actually being able to commercialise them and make them available to Irish patients. That length of time has got longer, and it has got more complex in terms of trying to secure reimbursement for new medicines which, typically, tend to be more expensive. “Reducing medicine expenditure is really not what we should be focused on. We should be investing in health, and the State should be investing in health, and medicines are a big part of that. What you’re going to see now, and what you’re going to see over the last number of years is that we’re now living in an era where scientific innovation is much more intense, and treatment options are now starting to emerge for more rare, complex, debilitating diseases.

Ireland should never have the highest nor the lowest price of medicines relative to other EU countries, and I think the agreement now secures that our pricing in Ireland will be closely aligned to the 14 reference countries that are included. operations here, which is all good for people living and working in this country.” At the moment, biosimilars are a topic of huge debate amongst everyone involved in the industry, and Mr Reid believes that there is plenty of room for them within the market, provided that a balanced approach is taken. “In Pfizer, biosimilars are going to be a major area for us in the near to medium term future – as I said, we just bought Hospira and we’re beefing up our biosimilar portfolio,” he said. “Having said that, we’re very wise to the fact that it’s important to get a balanced and appropriate approach to biosimilar medicine. Pfizer’s position is that we believe in informed switches from biologic to biosimilar medicines, based on evidence. “Pfizer supports the current HPRA guidance to Healthcare Professionals on Biosmilar prescribing. Biosimilars are not interchangeable and not for

substitution. The decision to prescribe a Biosmilar should remain a clinical decision to be made by the treating physician on an individual patient basis, with patient awareness, supported by scientific evidence.” Although the new Agreement on the Supply and Pricing of Medicines was announced in the summer, discussions between interested parties are still taking place, while the merit and the implications of the agreement are still being debated. Mr Reid believes it is a good agreement, and that it will lead to both savings and increased access for patients. “I think it’s a really good agreement that has been reached,” Mr Reid said. “I genuinely believe it’s in the best interests of the patients and the industry and the State. It provides for significant savings – IPHA are saying they’re going to deliver E785 million in savings and that’s really coming through price cuts and various other parameters included in the agreement.

“It’s a good agreement, it does provide savings, and it does provide room for new medicines which, for me, is one of the biggest issues we face in the future: getting access and getting funding for new medicines, so that Irish patients will have timely access to innovative and life-saving medicines.

“The day of the old blockbuster model is gone,” Mr Reid continued. “What that brings is increased R&D costs, we’re getting these more complex medicines through the R&D phases, which means companies are investing more and more money into developing these more complex medicines. And that’s going to mean that they’re going to be looking to secure higher prices for the length of patent.

“Ireland should never have the highest nor the lowest price of medicines relative to other EU countries, and I think the agreement now secures that our pricing in Ireland will be closely aligned to the 14 reference countries that are included within the agreement. I think that’s good, and I think it’s good that we maintain the average – we should be at the average of those 14 countries, and not at the lowest. Ireland is not an economy that should be reflecting the lowest prices in Europe.”

“What we should be trying to do is balance that with bringing up savings on our older medicines, and that savings can be used to fund these newer, more innovative medicines, which are meeting unmet medical needs. The debate shouldn’t just be about how to reduce medicine expenditure – it should be a balance between achieving the savings on the medicines that are off-patent and have had their time, versus finding and securing funding for the new medicines that are meeting these unmet medical needs.”

Along with debate over the pricings agreement, there are often stories within the national medial about Irish patients suffering from rare diseases, who are struggling to access proper treatment because the medicines are not available in this country. Mr Reid believes that cost savings from older medicines can be used to fund the creation of the new medicines designed to treat the rarer and more complex diseases. “Most new medicines, most new innovative medicines do finally

Mr Reid highlighted the longstanding relationship his company has with pharmacists, and said he is looking forward to seeing how the role of the pharmacist evolves over the next few years. “We believe that the pharmacists’ role within the community is going to evolve and hopefully evolve constructively because there’s a very clear benefit for a patient to have a pharmacist who’s very well informed and able to provide services in a very accessible way,” he said. “So we’d like to see more of that constructive evolvement of the pharmacy role in the future.”

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*Sisson, G., Ayis S., Sherwood, R.A., & Bjarnason, L. (2014) ‘Randomised clinical trial: a liquid multi-strain probiotic vs. placebo in the irritable bowel syndrome – a 12 week double-blind study’. Alimentary Pharmacology and Therapeutics, 40 (2014 July), pp.51-62

News Pharmacy of the Year title for Mellericks Mellericks Pharmacy in Fermoy, Cork were celebrating after winning the title of ‘Pharmacy of the Year’ at the recent Retail Excellence Awards. Individuals from across Ireland celebrated their dedication to excellence at this year’s Retail Excellence Awards at the Radisson Blu, Galway on November 5th. The Awards, which were presented by renowned Irish television and radio personality Hector Ó hEochagáin, were also attended by Minister Mary Mitchell O’Connor and more than 500 Irish retailers. No less than sixteen members from Mellerick’s were at the award ceremony to celebrate their success. In the aftermath, Pharmacist and owner Orla Mellerick said she was ‘delighted with all the positive comments and well wished we have received’, and that the award is a ‘great boost for the shop and for the town’. Also shortlisted was Niamh Flynn of Molloys Pharmacy and Lifestyle Stores, Ballina and Aoife O’Dowd of Sam McCauley Chemists in Kerry. Both were shortlisted in the Rising Star category.

The European project was meant to be about ‘Free Trade’ and valuing and empowering citizens to make better healthcare choices; amongst many other topics. Higher quality standards are good for society but implementation is varied. As the UK, our near neighbours, teeter on the Brexit cliff, it seems timely to cast a wider eye over how different countries are diverging not converging in their policy implementation. Ideally, informed patients make good choices on their healthcare and pay a fair price for products and services with reasonable access. In the real world, other “interests” distort this picture and culturally each country ploughs its own furrow. Consumers should have reasonable right of access, but should also be protected from themselves. In UK supermarkets /petrol stations you can buy many packs of Paracetamol and Ibuprofen for just £1. This offers great access, not to mention price but is it safe? How may deaths from Paracetamol over-dosage, annually, is an acceptable number? NSAIDs can cause gastric bleeding and hospitalisation. Hospital A&E departments struggle when there are 20 different “Anadin” variations on sale in this island. Taking an accurate history in a crisis over dose is made yet more challenging

by industry commercial advertising reasons. In Newry there’s no effective limitation on number of packs purchased whilst in Dundalk, pharmacies price and access barriers are set at a higher safer level. Self-appointed consumer advocates like Conor Pope proclaim medicine prices as their mantra but access and standards seem less important. Medicines are not ‘smarties’ and need quality standards, but that is a cost the consumer must ultimately pay for. If you trivialise medicines and look only at lower prices and better access, the consumer becomes de-sensitised to their responsibilities. The cheaper / better model is now being over turned on its head on alcohol with the advent of minimum unit pricing and increased vigilance on age restrictions and customer quotas. Every country /culture strives to get the balance right between light touch, right touch, and heavy regulation. Industry, retailers and the regulator have financial interests on shifting these tipping points in their favour. We now live in a world of ‘heavy regulation’ in financial services and in all of the professions, but this tide will turn eventually because

of costs , innovation stifling and the fact that regulators need appropriate regulation themselves. Westminster has its own pan regulator, so why not in Dublin? Pan European drug licences fast track product access to new drug products. Unfortunately that reciprocity has not regularly occurred. Individual country licences can be expensive and take a long time to market. A small state like Ireland with 4.6M people will be last to market behind more populous states like Germany , France, Italy , UK and Spain with ~ 80,60,60,60,40 million consumers each respectively. You could not blame companies chasing volume when faced with cost, bureaucracy and delay. The HPRA and Hawkins House between them have over 1500 well paid and pensioned staff. So there is an ensconced interest to Brussels efficiency for the good of Irish citizens. If there is no lab tests in Ireland it becomes a self-serving paper exercise at great cost annually. In Portugal and Spain seemingly light touch regulation allows tourists to acquire benzos and hypnotics without prescriptions in date and at low prices, so allowing self-harm.

In France branded vitamin supplements are only sold in pharmacies , consumers are not best served by this restriction. In Southern European countries low prices have led to extensive parallel exporting to Northern Europe with the correct licences and fees. Ironically Medicine shortages are now a reality in Ireland and significant exporting will happen when free trade opportunities present themselves. The lack of a product license for nasal cannabis Sativex in Ireland has forced Multiple Sclerosis patients to continue purchasing on the street, as UK doctors need a domiciled address to legally prescribe. The inherent contradictions of different patterns will only grow in time between countries. Consumers will win or lose in different scenarios but we need to get real as a society when “vested interests” are quoted as a problem , all parties have a perspective to bring for the public good.

News news brief PEARRL FOR PHARMACY KICK OFF

Closing the Year with New Store Launches Irelands only independent co-operative Pharmacy group Haven Pharmacy has welcomed four additional pharmacies to the Haven brand in closing off the year. They are: • Paul Kenny, Haven Pharmacy Kennys, Tramore, Co. Waterford

The EU funded PEARRL Network, led by the School of Pharmacy, UCC, was formally launched at a recent kick-off meeting in Frankfurt.

• Dan Ryan, Haven Pharmacy Frawleys, Roscrea, Co. Tipperary

PEARRL (Pharmaceutical Education And Research with Regulatory Links) is a European Training Network (ETN) for innovative drug formulation strategies and biopharmaceutics tools with regulatory application. The PEARRL ETN brings together 18 leading European institutions and is co-ordinated by Dr Brendan Griffin from the School of Pharmacy, University College Cork (UCC). The programme is funded (¤ 4 million) under the European Union’s Horizon 2020 research and innovation programme (Marie Sklodowska-Curie actions).

Haven Pharmacy Tramore

The PEARRL project brings together European Pharma industry, academia and regulatory agency partners in a multi-sectorial team to deliver a unique research and training programme, enabling 15 early stage researchers to focus their efforts on this complex paradigm for the next four years. From antibiotics through medicines which prevent gastric ulcers to stem cell research, the research in the pharmaceutical sciences has made great strides over the last century. Whereas average life expectancy was under 40 years at the beginning of the 20th century, the worldwide average today is around 70 years of age. However, developing a new drug is a long, costly and complex process and every step of it is has to be carefully reviewed. Drug development requires many different disciplines such as medicine, pharmacology, chemical engineering or bioinformatics working hand in hand. Even so, at the end of the long process of drug development – often over 10 years - and after consuming considerable human and financial resources, the new drug’s safety and efficiency in the targeted patient population may not meet the stringent requirements expected by regulatory authorities such as the European Medicines Agency (EMA) and therefore not be approved and become available to patients.

•

Mary Scannell, Haven Pharmacy Scannells, South Main St, Bandon, Co. Cork

•

Mary Scannell, Haven Pharmacy Scannells, Riverview Shopping Centre, Bandon, Co. Cork

There was a tremendous atmosphere at the launch days with some great local celebrities like Henry De Bromhead (racehorse trainer), Tipperary Hurling captain, Brendan Maher, the Cork Lady Footballers and Paralympian Corkman John Twomey to cut the ribbons the newly branded stores. There were spot prizes, goodie bags and face painting and a great day was had by staff and customers alike. Being part of the Haven Pharmacy brand means that these independent pharmacies can benefit from: • Strong cost efficiencies from being part of a proactive and growing buying group • The sharing of the latest thinking amongst their co-operative community

Haven Pharmacy Scannells, South Main St, Bandon

• Work practices and support provided to the pharmacies such as category management, retail space planning, local marketing & PR toolkits, staff training to name but a few. All of this is delivered while still retaining their autonomy and independence to deliver on the needs of the changing Pharmacy consumer - and their own local community. These latest four stores brings the total number of Haven Pharmacies to 52. Haven Pharmacy is committed to growing its’ network on a consistent basis and continuing to deliver excellent, expert care to each of its customers.

Haven Pharmacy Frawleys, Roscrea

If you are interested in joining the Haven Pharmacy group, please visit http://havenpharmacy.ie/ contact-us/pharmacist-interestedbecoming-member/ or email niamh.mcdermott@indepharm.ie

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Review: IPU

Minor ailments to the fore in 2017 2016 has been another extremely busy year for the IPU. The year began with another successful involvement in Operation Transformation with over 1,000 pharmacies participating in the Million Pound Challenge, which launched in January and which significantly raised the profile of pharmacy within the community. on key policy issues including a submission on the Department of Health Statement of Strategy 2016-2019, a submission to the Oireachtas Committee on the Future of Healthcare, to the Department of Housing, Planning, Community & Local Government on Primary Care Centres, the Programme for Government, a Pre-Budget submission and a number of submissions to the PSI, among others. Daragh Connolly M.P.S.I IPU President In advance of the General Election, the IPU published a pre-election document titled ‘PharmacistsDelivering in the Community for the Community’ highlighting key concerns of the pharmacy sector including Expanded Role for Pharmacists; Reclassification of Medicines; Unwinding of FEMPI; PSI Fees, Bankruptcy Restrictions and Health Centres Pharmacy Threat. The document was forwarded to all the political parties and distributed by members to their local representatives. The campaign proved successful as all the main parties included pharmacy issues in their party manifestos and a number of specific pharmacy-related issues were included in the Programme for Government. The political lobbying continued throughout the year with a number of meetings with the current Minister for Health and his predecessor, where the unwinding of FEMPI and expanding the role of pharmacists were top of the agenda. In a submission, we highlighted to the Ministers and Senior Officials in the Department of Health the significant contribution to savings that pharmacy has made through FEMPI (in excess of ¤1bn) and called for a substantial unwinding, comparable to those achieved by other sectors. Worryingly, the amounts initially indicated for return to pharmacists bear no relation whatsoever to the magnitude of the cuts, which is utterly unsatisfactory to us. The IPU will continue to fight for a fair and reasonable return and we expect and demand equitable treatment under the process. As part of our lobbying campaign, the IPU forwarded submissions

We have participated in a number of health campaigns including a promotion on Sexual Health in April, in partnership with the HSE, Sexual Health and Crisis Pregnancy Programme and the Irish Family Planning Association. In June we ran a promotion on Men’s Health, in partnership with the Men’s Health Forum of Ireland and the HSE. We are also actively involved in the European Antibiotic Awareness Day with the HSE, ICGP, RCPI and RCSI. It is vitally important that we continue participating in these key health initiatives and we will continue to be involved in further campaigns in 2017. As well as meetings with the Minister for Health and Senior Officials in the Department of Health, the IPU continues to liaise closely with other key stakeholders and we have regular meetings with political parties, the European Commission, HSE, HPRA and PSI, among others, to discuss a range of issues that are of concern to pharmacists. The IPU’s Contract Unit continues to liaise with the HSE PCRS in pursuit of greater transparency and fairness in its dealings with pharmacists and we continue to advocate for key policy changes such as exploring and proposing new sources of revenue for pharmacists and ensuring that pharmacists are not over-burdened by excessive or unnecessary administration. We have assisted Members in dealing with Inspections and Fitness to Practise Issues and have produced a range of SOP templates, which members can download from the IPU website and personalise for their pharmacy. We are in the process of finalising a tool to assist members in completing their Pharmacy SelfAssessment which is now required by the PSI.

As part of our campaign to expand the role of the pharmacist, we launched a pharmacy-based Minor Ailment Scheme pilot on 1st July, in partnership with the HSE and the Department of Health. The Pilot ran for three months and was rolled out in 19 pharmacies, across four towns in Ireland: Kells, Co. Meath, Roscommon Town, Edenderry, Co. Offaly and Macroom, Co. Cork. At the time of writing the pilot is being evaluated to establish the effectiveness of the service with a view to rolling it out nationwide. The IPU Training and Business Departments continue to introduce new training initiatives and business services that are beneficial to pharmacists and pharmacy business. Continuing Professional Development is actively supported and promoted by the IPU with over 100 courses held in 2016 alone by IPU Academy, with programmes now accredited by Trinity College Dublin. We are participating in eHealth Ireland’s ePharmacy Programme, which brings together communities connecting the whole range of health, wellbeing and social care stakeholders interested in developing a joint health agenda. eHealth Ireland invited the IPU to participate in the ePharmacy Committee and stakeholder group to design a National Primary Care ePrescribing Solution. The IPU Product File successfully achieved ISO Certification for 9001 (Quality) and 27001 (Information Security). The process highlights the value of the IPU Product File and its position as the definitive pharmacy product catalogue in Ireland. Stakeholder organisations representing all activities in the medicines supply chain from industry to pharmacy, including the IPU, are working collaboratively to establish a medicines verification organisation for Ireland and select an IP Service Provider to implement a system of medicines verification. This year, we established a Social Justice Group to advocate on relevant social issues such as harm reduction in illicit drug use. One of the first actions by the Group was to make a detailed submission on the National Drugs Strategy. The

Social Justice Group will continue to assist in guiding the policy of the IPU in the area of harm reduction and other social justice issues. In 2017, the IPU will continue to push for an increase in the number of medicines available without prescription, in line with other countries such as the UK and New Zealand. This would enable people to access treatments for minor and self-limiting ailments, with the support and advice of a pharmacist, and would allow GPs to focus their scarce time and resources on patients with more complicated illnesses. Medicines that could be reclassified as OTCs (over-the -counter) include sumatriptan for migraine, newer anti-allergy medicines like fexofenadine, and a wider range of analgesics, which are already available without prescription in the UK and elsewhere. We will also continue to lobby for Emergency Hormonal Contraception to be made available without prescription to GMS patients through pharmacies in the form of a sustainable EHC Service. A New Medicine Pilot scheme will be launched in early 2017. The objective for a New Medicine Service (NMS) is to provide support for people who have been newly prescribed a medicine for certain long-term conditions or therapies (asthma, COPD, Type 2 diabetes, hypertension, antiplatelet/anticoagulant therapy, statin therapy and chronic pain). It consists of a structured intervention at initiation of therapy with follow-up in the short-term to improve medicines adherence and increase effective medicine-taking. What has been outlined is just a flavour of the work that the IPU has and will continue to do on behalf of members. In 2017 and beyond, the IPU will continue to champion the cause of pharmacy, by promoting the pharmacy agenda and seizing every opportunity not only to secure the future of community pharmacy services, but to enhance the role of the pharmacist at the centre of primary healthcare in Ireland. Daragh Connolly M.P.S.I IPU President

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Review: Pom P POM to P switching in Ireland: What’s the hold-up? Headline: POM to P switching in Ireland: What’s the hold-up?

A number of medications wereSub-Heading: approvedAfor re-classification from prescription-only to pharmacy only in the last three number of medications were approved for re-classification from prescription-only to pharmacy onlythis in the last three years. However, years. However, relatively few products have actually made move. Some patient groups are being encouraged to consult their local pharmacist for healthcare advice rather than wait for a GP appointment. The pharmacist can then recommend a medication that is available in their shop without prescription. This is the new ideal for some areas of healthcare in Ireland. It is intended to give patients greater autonomy, choice and accessibility in terms of their healthcare, and to give pharmacists the opportunity to develop their skills in areas of patient advice and interaction that do not involve filling prescriptions1. This may be applied to certain conditions. However, the medications or products associated with their treatments are historically available on a prescription-only basis. This leaves the patient dependent on a doctor’s diagnosis and written confirmation that they are in need of treatment before acquiring them. Any change in this situation would therefore require an official amendment in the legal status of the drugs or other therapies in question. In other words, they would need to be classified as pharmacy-only (P) over-thecounter medicines rather than prescription-only medications (POM)1. This confers the benefit of skipping a potentially unnecessary GP appointment, thus saving healthcare service resources. Furthermore, the reclassification to pharmacy-only rather than general sale medicines empowers the pharmacist to ensure that the patient is in genuine need of the product before it is recommended or sold. This subject has been previously covered by Irish Pharmacy News (Dec 2013 edition1) and now warrants a re-visit to assess the state of POMto-P switches in Ireland today. The Health Products Regulatory Authority (HPRA) has recognised the need for certain medicines to be switched from POM to P status. This body has been constructing initiatives by which medicines can be legally reclassified as pharmacy-only OTC products. The process was originally proposed in 2010 by the Irish Medicines Board (as the HPRA was then known)2. This has resulted in the re-classification of 34 medicines that the HPRA deems safe and appropriate for non-prescription availability since 20133. It contributes to a total of 641 P medications available for sale in Ireland4. The HPRA

relatively few products have actually made this move. The HPRA’s Find a Medicine Database. It contains information on POM, P and general sale (GSL) medications available in Ireland.

actively invites and engages with treatment2. Alternatively, they may the- respective manufacturers of be potentially severe conditions, The HPRA’s Find a Medicine Database. It contains information on POM, P and general sale (GSL) medications these available medications the treatment windows for which in Ireland. so that they can switch the method of sale and preclude a wait for a prescription supply (MoSS) classification for (e.g. malaria)1. They may also be Some patient groups are 3 being encouraged to consult their local pharmacist for healthcare advice each formulation . very prevalent conditions that rather than wait for a GP appointment. The pharmacist can then recommend a medication that is require frequent re-fills of the available in their shop without prescription. This is the new ideal for some areas of healthcare in This highlights a major barrier to product in question2. Examples of Ireland.to It isPintended to give patientsthe greater autonomy, choice and accessibility in terms of their POM reclassification: these conditions may include pain healthcare, and to give the opportunity to develop their skills in areas of patient advice will and ability of pharmacists the companies of1.the joints and/orto soft tissues and interaction that do not involve filling prescriptions This may be applied certain conditions. (or other bodies) that hold the that istreatments related to inflammation, However, the medications or products associated with their are historically available on marketing authorisations (MA) (e.g. cases of rheumatoid arthritis a prescription-only basis.pharmacyThis leaves the patient dependent on a doctor’s diagnosis and written for each potential that respond to the administration confirmation that to theyswitch are in need only product theof treatment before acquiring them. of NSAIDs) herpes labialis (i.e. classification of their products. coldsores) certain fungal infections Re-classification would require and migraine5. these companies to engage Any change in this situation would therefore require an official amendment in the legal status of the

drugs or other therapies question. In other words,In they would the needHPRA to be classified as pharmacywith regulators andin their criteria 2014, approved for switching2. The company in 12 additional medicines or question may also have to conduct formulations for re-classification5. new risk minimisation procedures However, less than 10% of these (e.g. produce new professional drugs have been reclassified4. educational material so that a Additions to the overall list since pharmacist may dispense the new this year have been increasingly P medication in a fully-informed scarce, and the vast majority have manner) and complete new been herbal or vitamin products4. paperwork2. Re-classification also In some cases, the process of requires a report from a clinical transferring the active substances expert on the lack of necessity on the 2014 list has progressed in for prescription control for the an indirect manner4. For example, product in question2. Finally, clomitrazole & hydrocortisone re-classification also affects the formulations (marketed as type of advertising a company Canesten® HC) are on the list and may conduct in relation to their yet have not been re-classified4. product. In some cases, they may However, other Canesten® now release marketing material products (1% and 2% clomitrazole to the general public2. These are cream) did secure a license for potentially resource-intensive tasks sale as a P medication in 20164. that some manufacturers may be However, familiar names such as ill-equipped to undertake. Nurofen® (200mg ibuprofen, which was not on the 2014 list) have also Medicines that are eligible for been licensed as pharmacy-only reclassification are defined by this year4. This begs the question: the 2010 HPRA guidelines for the if producers such as Imbat Ltd can transition of active substances submit licensing applications to from one MoSS category to classify new or updated products another2. They are typically as pharmacy-only, why not put the intended to treat mild conditions effort into re-classifying a product that are not severe enough to in line with new guidelines and the require a physician’s intervention, yet require rapid relief or needs of the target market?

Persuading a company to re-classify a heretofore prescription-only product to pharmacy-only may be difficult. It appears that those marketing drugs with long-held, wellestablished safety profiles (e.g. older NSAIDs) are most likely to be awarded new or varied licenses for P medications. However, this re-classification may result in many advantages, particularly for patients. Some may be short on the time and resources needed to keep a GP appointment and would be served just as well by visiting a pharmacy. Here, they could obtain an appropriate treatment that the pharmacist is empowered to discuss and recommend without the need for a prescription. These patients may be unaware that this option is open to them. However, recent public health initiatives (e.g. the IPU’s “Ask your Pharmacist First” campaign) have the potential to improve on this issue. On the other hand, offering advanced health advice and an expanded pharmacy-only drug category may translate into an increased workload for pharmacists. The HPRA’s current efforts to switch some medications from POM to P may be welcomed by many pharmacists, particularly those who want to see their role expanded to that of a more complete allied health professional. Dispensing pharmacy-only over the counter medications may result in more independence, increased health awareness and improved treatment choices for many patients. Sources: 1. IPN. Push the button! - Pharmacy must drive switches market. Irish Pharmacy News. Vol 52013:16-17. 2. HPRA. Guide to Reclassification (Switching) of Legal Supply Status for Human Medicinal Products. In: Authority HPR, ed2010. 3. HPRA. Legal Classification / Method of Sale and Supply. 2014; http://www. hpra.ie/homepage/medicines/specialtopics/legal-classification-method-ofsale-and-supply. Accessed 16/11/16, 2016. 4. Find a Medicine. Health Products Regulatory Authority; 2016. Accessed 18/11/2016. 5. HPRA. List of active substances (or combinations of active substances) which HPRA can consider switching from POM to OTC – July 2014. 2014. 6. Lynch K. REGULATION OF RETAIL PHARMACY BUSINESSES (AMENDMENT) REGULATIONS 2016. In: Health, ed. 52 St. Stephen’s Green, Dublin: The Stationery Office; 2016.

Review: Independents

A Future for Independent Pharmacies? Independent pharmacies, their market share and the trends that may define their fate in 2017 There is a pervading and inescapable perception that the local independent pharmacy, a long-held institution in Irish society, is in decline. This is often linked to encroachment by chain pharmacies, seen as replacing the independent pharmacistowned shop with ever-increasing frequency. This may be an issue for pharmacists who wish to carry on a family business, and for patients who still value the ‘community pharmacy’ experience. It follows that this may be a particularly pressing issue for more isolated and/or rural patients, who rely on pharmacies in more remote locations into which big chains are less likely to expand. In addition, the ability of small independent pharmacies to start and maintain a business may reflect the overall strength of the pharmacy market in Ireland today. Worryingly, many pharmacies in Ireland appear to be shutting down (based on cancelled Pharmaceutical Society of Ireland (PSI) registrations). How many of these are independent pharmacies? These are concerns that are prevalent in 2016 Ireland. So how likely are they to persist into 2017? We may be able to get a better idea of how many independent pharmacies are likely to open in 2017 by looking at relevant figures from this year. The overall picture of operational pharmacies in Ireland is offered by the PSI’s Pharmacy Registration Database, which is openly available to the public. In order to comply with the Pharmacy Act (2007), pharmacists in Ireland must register their place of business anew with the PSI if they have established a new pharmacy, relocated to new premises or acquired one from a previous owner. New pharmacy registrations last a year from the date it was acquired. The IPS keeps records on pharmacies registered from 2009 onwards. The current number of registered pharmacies in Ireland is 1901, setting the average yearly number of registrations over the last seven years at 272 (correct at time of writing). However, the PSI Annual Report (2015) shows that the number of new registrations over the last three years is much less than this. Conversely, the PSI Communications Office observes a year-on-year increase in the actual number of pharmacies operating in Ireland. The PSI Annual Report does not distinguish

newly registered community and/or independent pharmacy registrations from all other types (e.g. hospital pharmacies). According to this document, however, there were 42 brand-new openings (as opposed to new registrations arising from transfers of ownership or relocations) in Ireland in 2015. This does not differ greatly from the number of new openings in 2014 (47), and contributes to a total of 144 new registrations in 2015. This number appears encouraging: however, it does not take the number of registrations that were cancelled in the course of said year. The PSI observed that this was a “notable” (direct quote taken from the report) number: 112 (compared to 70 in 2014 and 72 in 2013), resulting in a net increase in operational businesses of 32. It translates to an increase to 1880 registered pharmacies in 2015, up from 1848 in 2014. Do these trends continue into 2016? Despite the fact that conclusive published figures cannot yet be reported, we can see that the current number of registered pharmacies stands at 1901. This is based on the records publically available on the PSI website (public.thepsi.ie). It suggests an interim increase of 21 in registered pharmacy numbers. However, the actual number of registrations this year is also approximately 144 (correct as of 15/11/16). That puts the number of cancellations at approximately 123 – another notable increase compared to last year. When we asked the PSI for more detail on these figures, they advised us that there were 33 brand new registrations in 2016. This implies a decline in the number of new openings of all types, including those of independent pharmacies.

A of comparison of the newinregistrations, registrations of number registrations that weretotal cancelled the course of said year. The PSI observed that brand-new openings remained open (expressed this was a “notable” (direct and quotepharmacies taken from thethat report) number: 112 (compared to 70 in asand percentages) from 2014 2016. in *Interim figures derived 2014 72 in 2013), resulting in a nettoincrease operational businesses of 32.from It translates official PSI records. to an increase to 1880 registered pharmacies in 2015, up from 18482 in 2014.

Total registrations

Cancelled registrations 2014 2015 2016*

Brand-new registrations

New pharmacies that remained open

100

A comparison of the total new registrations, registrations of brand-new openings and pharmacies that remained open (expressed as percentages) from 2014 to 2016. *Interim figures derived from official PSI records.

returning abroad (18), study leave (4), or other reasons (30)”.

pharmacies. Of these, 682 of these are single pharmacies owned by pharmacists, and 65 Do trendsReport, continue2015 into 2016? Despite the fact that conclusive published figures PSIthese Annual are single shops owned by noncannot yet be reported, we can see that the current number ofThis registered pharmacies pharmacists. equates to 747 This information imply that stands at 1901. This may is based on the records publically available on the PSI website truly independent pharmacies, economic circumstances a increase (public.thepsi.ie). It suggests anare interim of 21 in registered numbers. compared to 968 pharmacy chain-owned factor in the theactual rate of new of pharmacy However, number registrations this year is(704 also pharmacist-owned approximately 144 (correct as shops openings in 2015. Looking at of 15/11/16). That puts the number of cancellations at approximately 123 – another notable and 264 non-pharmacistthe preliminary figures for 2016, owned). In more otherdetail words, 43.6% of increase compared to last year. When we asked the PSI for on these figures, it seems the downward trend is community pharmacies in Ireland they advised us that therethere were 33 continuing. However, is brand little new registrations in 2016. This implies a decline in werethose single-shop businesses this the numberfrom of new openings of all types, of independent pharmacies. evidence official sources that including this definitively affects independent year, and 40% were pharmacistowned independent businesses. pharmacy market share. In comparison, the IPU listed 1609 pharmacies as community The Irish Pharmacy Union offers pharmacies in 2015. 756 of these annual reports that do distinguish were single pharmacies (689 of community pharmacies from which were pharmacist owned), other pharmacy types in Ireland. whereas 853 (675 pharmacistAccording to the 2016 report, 1715 of all pharmacies are community owned) were chain pharmacies.

The PSI pharmacy registration database, found at public.thepsi.ie

The PSI did not report the reasons behind pharmacy registration cancellations in 2015. They did, however, document the cancellation of individual pharmacist regulations. There were 140 of these in 2015, “with 36 of these being removed due to failure to apply for continued registration and pay their annual registration fee and failure to apply for voluntary cancellation in accordance with Section 59 of the Pharmacy Act 2007. In circumstances where a pharmacist indicated a reason for cancelling registration, this was mainly due to emigration (29), retirement (23), -

The PSI pharmacy registration database, found at public.thepsi.ie

264 non-pharmacist-owned). In other words, 43.6% of community pharmacies in Ireland 264 non-pharmacist-owned). In other words, 43.6% of community pharmacies in Ireland were single-shop businesses this year, and 40% were pharmacist-owned independent were single-shop businesses this year, and 40% were pharmacist-owned independent businesses. In comparison, the IPU listed 1609 pharmacies as community pharmacies in businesses. In comparison, the IPU listed 1609 pharmacies as community pharmacies in 2015. 756 of these were single pharmacies (689 of which were pharmacist owned), whereas 2015. 756 of these were single pharmacies (689 of which were pharmacist owned), whereas 853 (675 pharmacist-owned) wereofchain pharmacies. in decline, as is the number of A comparison pharmacy ownership in 2015, 853 (675 pharmacist-owned) were chain pharmacies.

compared with that of 2016.

Pharmacy Pharmacy Ownership Ownership in in 2015 2015

Single shops - Pharmacists Single shops - Pharmacists Single shops - Non-pharmacists Single shops - Non-pharmacists Chain shops - Pharmacists Chain shops - Pharmacists Chain shops - Non-pharmacists Chain shops - Non-pharmacists

Pharmacy Pharmacy Ownership Ownership in in 2016 2016

A comparison of pharmacy ownership in 2015, compared with that of 2016. A comparison of pharmacy ownership in 2015, compared with that of 2016.

Individual pharmacies that are not affiliated with chains and may or may not be owned by independent pharmacists are still valued in their communities. There is evidence

that patients may perceive them as sources of more personalised service and advice compared to chain pharmacies. However, their share of the market may be

new shops being established by independent pharmacists or bodies.

The apparent downward trend in new pharmacy registrations may be worrying for many. It may have particularly striking implications for independent pharmacies throughout Ireland. On the other hand, the total number of pharmacies in Ireland is exhibiting a steady rise. This indicates that the community pharmacy market is robust enough to surpass the current rate of cancellations, which experienced a sharp spike in 2016. This warrants close attention, as does the risk that this may be repeated in 2017. In addition, it appears that two out of every five shops in Ireland are owned by individual pharmacists.

The rate of new pharmacies being established in Ireland may be assessed through the use of the PSI registry database. According to publications based on these, the total number of pharmacies has increased year-on-year for the past three years. However, by analysing this information, we can see that the numbers of new openings has decreased slightly but steadily over the last three years. New pharmacy openings fell by approximately 9% over the last two years. The number of new registrations Sources: remained reasonably constant between 2015 and 2016. However, 1. Valentine A. Irelandâ&#x20AC;&#x2122;s familythe number of cancellations owned pharmacies under threat increased dramatically in 2015, from big chains. The Irish Times. resulting in a total new pharmacy 15/11/2016, 2016;Life & Style. count of 42 and 33 respectively. If this trend continues, the number of 2. PSI. PSI Annual Report 2015. new businesses registering for the Pharmaceutical Society of first time in 2017 (and remaining Ireland;2015. open throughout the year) could be as low as 24. The relatively 3. IPU. ANNUAL REPORT OF low rate of pharmacy openings IPU EXECUTIVE COMMITTEE. may be linked to issues such as emigration among pharmacists. On Butterfield House, Butterfield the other hand, IPU figures indicate Avenue, Rathfarnham, Dublin 14 Ireland: Irish Pharmacy that approximately 40% of all Union;2016. community pharmacies are owned by individual pharmacists (although 4. IPU. ANNUAL REPORT OF Formatted: List Paragraph, Bulleted +to Level: 1 + Aligned at: the same number was nearer Formatted: List Paragraph, Bulleted + Level: 1 + Aligned at: cm + Indent at: 1.27 cm IPU EXECUTIVE COMMITTEE. 43% in0.63 2015). This 0.63 cm + Indent at: may 1.27 cmbe more Formatted: Font: 12 pt Butterfield House, Butterfield encouraging the Formatted:for Font: 12 ptindependent Avenue, Rathfarnham, Dublin pharmacy in terms of market 14 Ireland: Irish Pharmacy share, but does also suggest that Union;2015. as few as 10 non-chain-affiliated pharmacists will keep new shops open in 2017. 5. public.thepsi.ie

Review: IIOP

Building firm foundations Director of the Irish Institute of Pharmacy, Dr Catriona Bradley, gives an overview of the ePortfolio success in 2016 whilst looking towards building on a firm foundation for the next twelve months. 2016 was yet another significant year in the development of the new Continuing Professional Development (CPD) system for Irish Pharmacy. The Irish Institute of Pharmacy (IIOP) is tasked with the development of the CPD system by the Pharmaceutical Society of Ireland (PSI) in accordance with legislation which was introduced at the end of 2015. (Pharmaceutical Society of Ireland (Continuing Professional Development) Rules 2015 S.I. 553/2015.) Use of the ePortfolio rose steadily throughout the year, with over 50 information events and webinars

being provided throughout the year by the IIOP to support pharmacists in engaging with the new CPD system. The first ePortfolio review process commenced in October 2016, representing a significant step in the professionâ&#x20AC;&#x2122;s CPD journey. In March, the IIOP issued a call to the pharmacists, inviting them to participate in the development and piloting of the practice review process. Over 100 pharmacists came forward to shape the development of this new process. This work continues in preparation for the first call of pharmacists, which will be issued in 2017.

Dr Catriona Bradley, Director, IIOP

The work during 2016 continues to build towards a firm foundation for the IIOP, and indeed for the pharmacy profession more generally. The team at the IIOP would like to thank the hundreds of pharmacists and other colleagues who have supported the work of the Institute during 2016, as peer support pharmacists, steering group members, pilot participants, accreditation team members, training providers and project team members for the ePortfolio review process, as well as colleagues in the Pharmaceutical Society of Ireland and the Royal College of Surgeons, Ireland. We look forward to continuing this work in 2017.

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BROLENE 0.15%W/W EYE OINTMENT + BROLENE 0.1%W/V EYE DROPS SOLUTION - PRODUCT INFORMATION Presentation: Eye Ointment containing dibrompropamidine isetionate 0.15% w/w. Eye Drops containing propamidine isetionate 0.1% w/v. Indications: As an anti-infective for use in local infections of the superficial structures of the eye due to sensitive micro-organisms. Dosage and Administration: Eye Ointment - Adults and children: apply the ointment topically to the eyelid or conjunctival sac once or twice daily. Ointment must not be used for more than 2 days. Eye Drops - The usual dosage is 1-2 drops into the affected eye up to four times daily. Contraindications: Hypersensitivity to ingredients. Use of contact lenses. Precautions and warnings: If there is no significant improvement within 2 days medical advice should be sought. In the event of a sensitisation reaction treatment should be discontinued immediately. Should erythema or other evidence of increased inflammation occur application should cease immediately and medical opinion should be sought. Problems of visual acuity occur or development of its symptoms should result in the doctor being consulted immediately. Brolene Ointment contains wool fat, which may cause local skin reactions (e.g. contact dermatitis). Interactions: None stated. Adverse Effects: Eye Drops & Ointment: Hypersensitivity may occur, in which case treatment should be discontinued immediately. Eye Drops only: Eye pain or irritation, usually in the form of a stinging or burning sensation, may also occur. In such cases, use should be discontinued immediately and a physician should be consulted. Pregnancy: Safety has not been established, use should

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only be considered if deemed essential by the physician. Pharmaceutical precautions: Both products should be stored below 25Â°C. Legal Category: P. Product Licence Numbers: Eye Drops: PA 540/94/1; Brolene Eye Ointment: PA 540/94/2. Further information is available from the Marketing Authorisation Holder: Sanofi Ireland Ltd. 18 Riverwalk, Citywest Business Campus, Dublin 24 or contact IEmedinfo@sanofi.com Tel.: (01) 4035600. Date of preparation: May 2016. Please refer to the Summary of Product Characteristics which can be found at www.medicines.ie/ before prescribing. Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Suspected adverse events can also be reported to Sanofi Ireland Ltd. directly by emailing IEPharmacovigilance@Sanofi.com or calling 01 403 5600. Date of preparation: August 2016 SAIE.PPD.16.06.0079a

Review: PSI

Strategy, Planning and Engagement With the Pharmaceutical Society of Ireland’s current Corporate Strategy 2013-2017 coming to an end in the coming year, the organisation will be looking towards the next strategy period, and planning and consulting with a broad number of people so that they can prepare the PSI to meet the regulatory challenges of 2018 and beyond. professionals, regulatory bodies and pharmacists, and with the support of the Department of Health and the HSE. Pharmacy Self-Assessment Following research, consultation and pilot phases, 2016 saw the publication of a new pharmacy self-assessment and quality management tool with the roll-out of the Pharmacy Assessment System.

Niall Byrne, PSI Registrar & CEO

To do that, they plan to do significant work directed to consolidating and developing the organisation internally. This will include improving many of the PSI internal technology systems and external communication systems. The body will also examine the PSI’s regulatory risk approach to ensure that their system of regulation, including registration, inspection and enforcement, can effectively meet responsibilities, manage risks to public safety and welfare, and provide assurance to patients and members of the public that pharmacists and pharmacy services can be trusted. Reflecting on Achievement 2016 was a busy year for the PSI, witnessing a number of publications, launches and new appointments. In August, the organisation launched their Patient Charter – You and Your Pharmacist. This as an important patient initiative under the PSI Council’s commitment to ensure the health, safety and wellbeing of patients and the public. The Charter is a reflection of the standards set out in the Code of Conduct for pharmacists as they relate to people availing

of the professional services, advice and care provided by a community pharmacist. At the launch the Minister for Health Simon Harris commented that the document would ‘empower patients to work with and harness the growing expertise of our community pharmacists in keeping people well and managing ill health.’ Irish Pharmacy News has learned that this document has been distributed by the PSI for display to more than 2050 places including pharmacies, hospitals and other care services, libraries and citizen information centres. As previously reported on page 4, the PSI more recently launched the Future Pharmacy Practice in Ireland – Meeting Patients’ Needs report. This includes a number of significant recommendations for the planning and delivery of pharmacy practice in Ireland that addresses pharmacists’ contributions in support of national health and wellbeing policy, the management of rising levels of chronic disease, and the need for enhanced pharmacist contribution in relation to managing medicines throughout the patient pathway. The report has been written in view of extensive consultation with patients, healthcare

The Assessment System is a practical tool to facilitate the supervising pharmacist and the wider pharmacy team to critically review their pharmacy’s practice. This forms part of the PSI Council’s changed policy for routine pharmacy inspections. Its use, from January 2017, will demonstrate to the PSI, and the public, that pharmacies can be relied upon to provide safe and effective services every day. Following the Minister for Health’s introduction of legislation to enable wider access to some prescriptiononly medicines at a time of emergency, and to increase the number of vaccinations that pharmacists can provide, the PSI worked with the Irish Institute of Pharmacy (IIOP) to put in place the training requirements, and guidance to prepare and support pharmacists for this enhanced role from 2016 onwards. Furthermore, the first-time selection of pharmacists from the register for CPD ePortfolio review took place this Autumn. The selected pharmacists will be called on by the IIOP to submit an extract of their eportfolio CPD undertakings. The review takes a sample from the register each year to examine that pharmacists are appropriately engaging in CPD and maintaining an appropriate level of knowledge in their area of practice. Looking Ahead As well as continuing projects already commenced, such as

supporting the implementation of the Pharmacy Assessment System in pharmacies, PSI will continue to implement a riskbased approach to conducting pharmacy inspections. They will examine the regulatory requirements that apply to hospital pharmacies under the Pharmacy Act 2007. In the area of education and training, the body will be monitoring the ongoing roll-out of the CPD system for pharmacists and the implementation of practice reviews, as well as managing the ongoing accreditation of the 5-year Master’s Degree programmes in the three schools of Pharmacy. 2017 will also see the publication of a Customer Charter that will set out the service levels and expectations that all of the PSI’s service users can expect when engaging with them.

Key Statistics

2016 registration statistics (as at 1 Nov 2016) 1901 registered pharmacies 5749 pharmacists 385 pharmaceutical assistants This compares to 1880 pharmacies, 5645 pharmacists and 423 pharmaceutical assistants registered at the end of 2015 New Appointments

Dr Ann Frankish was re-elected by the PSI Council as its President in July 2016, and Rory O’Donnell was elected Vice-President. Also in July, the PSI Council announced the appointment of a new Registrar and Chief Officer, Niall Byrne.

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Review: Profitability

Full Pharmacy Potential - Powered by Data At the recent Connecting Patient to Pharmacy event at the K-Club, Real World Retail launched their Hierarchy of Business Needs, based on Maslow’s theory of human motivation, which allows owners and managers to visualise how maximum business potential can be achieved, to self-evaluate and decide on priorities. With ever tightening PCRS Income, it’s important to focus on all the business areas where you can derive more profitability. This concept allows you to access all the information you need about your business in an easy, visual and actionable way. Because there are different areas of focus within a pharmacy there are two defined pyramid hierarchies – one for dispensing and one for retail / front of shop.

Hierarchy of Business Needs | Dispensing

DISPENSING HIERARCHY OF BUSINESS NEEDS Compliance This is where 90-95% of the company effort is expended. This is advising and dispensing to patients, training, complying with SOP’s and so on. Operational Efficiency This is where business efficiency kicks in. On Generic Penetration, smaller groups and independents are still leaving margin behind by dispensing brand rather than generics, and for medium size

groups, dispensing preferred generics as opposed to regular generics is where there is a business gain. Identifying and dealing with Dead stock is another area where there is typically 4,000 per store lost, this can be prevented with a sensible level of focus. Keeping stock levels to an average of 3 weeks are typical of the business angles to drive profitability in this level of Operational Efficiency Business Development Knowing where your scripts are coming from and collaborating

with your local GP’s is a strategic business driver. It is vital to be always aware which surgeries are growing for you and identifying and resolving any that are falling back. Nursing or Care Homes too, deserve careful consideration, pharmacies with good disciplines will do well here but it is vital to know your real margins from each Home to consider justifying the extra workload. You will be mindful of each of these areas on Business development, but those pharmacies that are measuring their results as opposed to making assumptions will be those that will perform best.

Patient Focus If only we had more time for this? When we measure the business results from this, it is very apparent that extra investment in this area has the greatest payback of all. Following up on overdue patients from a patient care point of view gives the pharmacist valuable lessons as well and welcomed by the patient. Converting one-time patients into regulars by means of consultations and services has significant multi-year payback. Having your system shortlist your patients based on risk criteria

Review: Profitability Hierarchy of Business Needs | FOS Retail

means that your natural patient care is focused on those that will benefit most. All of these initiatives are a win-win for you, your local GP and the Patient and combine really good business practice with patient care.

shows, catalogues or Rep’s, serve the customers, re order, increase/ reduce prices, make sure that you have the right level of staffing are basic retailing tasks that will invariably take up 80-90% of the working hours.

Advanced Performance Drivers

Operational Efficiency

This is about deploying the right information to the right people based on the jobs that they do and the decisions that they make. The vast majority of people then have the information to self-manage, they can see their KPI’s and they can deal with their exceptions and focus their time. Support Offices can then empower more which leads to greater job satisfaction and more thinking time. Finally, benchmarking pharmacies against each other and groups against other groups drive a higher level of business motivation and performance, after all, most people would like to think that they are at least as good as their peers?

Firstly, be organised. Have a weekly meeting. Have the information at your fingertips – sales versus last year, top sellers, slow sellers, what areas are working well or underperforming. How are your promotions doing, could they be better? What does your patient care look like, what % of the time is there an OTC item with a prescription? Replenish stock from suppliers to ensure very good availability. Ensure that the hours worked are lined up with the busy times of the day and week. Keep an eye on Refunds. Most of all, take action!

FRONT OF SHOP/RETAIL HIERARCHY OF BUSINESS NEEDS Basic Retailing Open the shop, buy products from

Business Control and Development This is more strategic. Measure the meterage that you are giving to each department and adjust using your cash margin per metre as a guide. Groups will need to do a more professional store grading exercise so that any store can be

1 of 3 sizes per department to uncomplicate the buying process. The most important thing is to prune old ranges and only then introduce new ones. Plan and execute well on your seasonal buys, good information will ensure that you have plenty of thinking time. Finally, look at your supplier base, prune these too, less is more and make room for newer and more innovative suppliers. These types of strategic initiatives are a huge win-win, we see customer sales growth of up to 20%, stock reduction of 20% and higher margins. Strategic Customer Focus This is looking at your customers as individuals. Focus your ranges based on the type of patients that visit your stores. Do you offer OTC solutions for Diabetes patients based on the typical challenges that they encounter? Is a loyalty system worthwhile, will it encourage sufficient repeat business to justify itself and drive new conversions? Advanced Performance Drivers Reiterating what we said earlier, this is about deploying the right information to the right people based on the

jobs that they do and the decisions that they make. It should not just be Owners/Buyers that are making the business decisions, retail needs to be delegated to maximise success. Finally Operating in the Pharmacy sector is very busy. There are so many moving parts, much more so than most businesses. In the midst of this, you need to be able to take time out to evaluate your business, these 2 Hierarchy of Needs is the easiest way of doing this. Identify your weaknesses and opportunities, put a plan in motion to rectify or maximise these. Make sure that everything is properly measured, have one version of the truth and identify exceptions quickly. It’s amazing what can be achieved when you do this every year, success becomes very incremental and what might have taken 5 years previously can be done in 2 years. We would like to wish our growing list of customers and potential customer’s best wishes for 2017. By John Hogan, Chief Data Scientist, Real World Retail

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Review: Business Retail confidence amongst Pharmacists continues to decline Business confidence among Ireland’s Pharmacy sector has continued to decline with many Pharmacists of the opinion that the business environment is in fact worsening, Businessaccording Environmentto the latest Quarterly Business Trends survey Business Environment conducted by the Irish Pharmacy Union (IPU), among its members. “With footfall, sales and employment down in Q3 it is not surprising that pharmacy owner/ managers are less confident about the business environment and their own business prospects. The uncertainty over Brexit and the recent IPHA Agreement remain key concerns within the sector,” according to Eoghan Hanly, Chairman of the IPU’s Pharmacy Contractors’ Committee. Business optimism among Pharmacy owners/Managers continues to decline with a significant reduction in confidence (10%) when compared with Q2. A sharp drop in sales / turnover in Q3, with overall net figures dipping to 1% for the first time over the last 12 months, was a significant factor in this decline. Business costs remain a concern, with 47% of respondents reporting increases, particularly in rents, wages, insurance and energy costs. Despite an increase in the number of respondents reporting a reduction in footfall numbers from 8% in Q2 to 18% in Q3, there is optimism among respondents (42%) that footfall will increase over the coming quarter, which includes the busy Christmas season. “As we head towards this busy festive period we hope that there will be an upturn in trade and confidence. There is concern, however, that the anticipated increase in footfall, particularly over the Christmas trading period, may not necessarily lead to increased sales and revenue for the sector, indicating that the final three months of the year could remain challenging”, added Mr Hanly. Jim Curran, IPU Director of Communications and Strategy, outlines below the key results, providing an overview of the current trading environment for community pharmacies throughout the country.

Figure Figure11 The latest quarterly trends Figure 1 survey, covering the third quarter of 2016 (July-September) confirms that Pharmacy owners are less optimistic about their business prospects with an increasing number of the opinion that the business environment is getting worse.

This may be explained by quite a sizeable fall in sales/turnover recorded and a decline in the level of footfall in comparison to the previous quarter. The uncertainty around Brexit and the recent IPHA agreement remain key concerns. Business Costs Table 1 Business costs, as always Table 1 remain a concern, with 47% of respondents reporting increases, particularly in rents, wages, insurance and energy costs. Six out of ten reported that they have experienced increases in wage demands since the beginning of the year.

Table 1

Business Qtr3 Business Qtr3 Optimism/Prospects Optimism/Prospects 2015 2015 27% More 27% MoreOptimistic Optimistic 30% Less Optimistic 30% Less Optimistic 40% 40% Same Same 3% 3% No NoOpinion Opinion (3%) (3%) Net* Net*

Qtr4 Qtr4 2015 2015 53% 10% 35% 3% 43%

Qtr1 2016 31% 27% 42% 0% 4%

Qtr2 2016 31% 37% 32% 0% (6%)

Qtr3 2016 21% 39% 39% 1% (18%) (18%)

29% of pharmacy owners have *Net optimistic (21%) (21%) *Net highlights highlights the the overall overall position. position. In In the above table, subtract more optimistic increased investment in their optimistic optimistic(39%) (39%)to toprovide provide the the net net figure figure of (18%). pharmacies over the last three Figure 2 months, 14% plan to increase 2 1, As detailed detailedFigure table 1, business business optimism optimism among among pharmacy owner/managers continues As inin table continues to to dec dec investment over the next quite quite aa significant significant reduction reduction in in confidence confidence since since the last quarter. As outlined previously previously this this three months. Figure by 2bythe explained theongoing ongoingconcerns concerns over over Brexit Brexit and the recently announced IPHA Agreement. explained Agreement. 16% reported that their stock levels were below normal for the time of year, with 14% reporting levels above normal. Reference Pricing (35%), FEMPI Cuts (22%), Economic Uncertainty (14%) and ‘Reduction in Health Budget’ (11%) are the main concerns of pharmacy owner/managers.

11 The survey was carried out in the second and third weeks of October. Of those who responded to the survey, 27% Table 2 employ five or less, 48% have Table 2 Table 2 between six and 10 employees Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 2015Qtr4 2016 Qtr1 2016 2016 Rate Business Environment 2015 and 25% employ more than 10. Qtr3 Qtr2 Qtr3 31% 55% 35%2016 41% 201632% 2015 2016 RateImproving Business Environment 2015 23% 5% 17% 21% 26% Getting Worse As detailed in table 1, business 31% 55% 35% 41% 32% Improving 44% 38% 48% 38% 39% No Change optimism among pharmacy 23% 5% 17% 21% 26% Getting Worse 1% 3% 0% 0% 3% No Opinion owner/managers continues to 44% 38%6% 39% 7% 50% 38% 18% 48% 20% Net decline, with quite a significant No Change 1% 3% 0% 0% 3% No Opinion Not surprisingly, with business confidence levels down there is an increased pessimism of how pharmacy 7% 50% 18% 20% 6% Net owner/managers rate the current business environment. While more respondents still see an improved picture in comparison to those who do not, the fact remains that overall the trend has been declining

significantly since Q4business 2015. Not surprisingly, with confidence levels down there is an increased pessimism of how p

Footfall Footfall Figure 3 Figure 3 reduction in confidence since the last quarter. As outlined previously this could be explained by the ongoing concerns over Brexit and the recently announced IPHA Agreement.

owner/managers expecting to reduce staff in the next three months with only 6% planning to increase their employment numbers. This is worrying, as indicated previously this period will cover the busy trading period around Christmas.

Figure 3

Not surprisingly, with business confidence levels down there is an increased pessimism of how pharmacy owner/ managers rate the current business environment. While more respondents still see an improved picture in comparison to those who do not, the fact remains that overall the trend has been declining significantly since Q4 2015. Table 3 Table 3 Table 3 Footfall

Business Costs 47% of pharmacy owners (49% in Q2 2016) reported an increase in business costs, with increases being reported in rents, wages, insurance and energy costs. Only 1% reported a reduction in overall business costs. ‘Reference pricing’ remains the number one business concern with 35% identifying this as their main worry. There has been a fairly large increase in numbers who have identified ‘FEMPI Cuts’ (22% in comparison to 12% in Q2) as their primary concern.

Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Footfall last three Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 While overall footfall figures Footfall 2015 2015 2016 2016 2016 monthslast three 201530% 201551% 201638% 201635% 201636% remain positive there has been months Increase an increase in respondents who 30% 51% 38% 35% 36% Increase 21% 13% 21% 8% 18% Reduce reported a reduction in their 21% 13% 21% 8% 18% Reduce 44% 32% 37% 52% 37% Same footfall numbers in comparison 44% 32% 37% 52% 37% Same 5% 4% 3% 3% 10% Don’t Know to Q2 (18% versus 8%). This 5% 4% 3% 3% 10% 9% 38% 17% 27% 18% There is no apparent explanation downward trend is not expected Don’t Net Know 9% 38% 17% 27% 18% Net Sales/Turnover for this increase and it indicates to continue, however, as 42% of thatreported the figure respondents are anticipating While an overall footfall figures remain positive there has been an increase in respondents who a reported in the 4overall While figuresnumbers remain positive there has been anversus increase in respondents who reported a previous quarter (12%) was increase in footfall numbersFigure over reduction in footfall their footfall in comparison to Q2 (18% 8%). This downward trend is not Figure 4footfall numbersasin42% comparison to Q2 (18% versus 8%). an This downward trend isdue not to the numbers in a blipnumbers the next three months with reduction only expectedin totheir continue, however, of respondents are anticipating increase in footfall expected continue, however, asonly 42%12% of respondents anticipating an increase in footfall numbers period who had identified 12% anticipating a reduction. over theto next three months with anticipatingare a reduction. It should be borne in that mind that this over the next three months with only 12% anticipating a reduction. It should be borne in mind that thisUncertainty’ as ‘Economic It should be borne in mind that period will also cover the busy Christmas season. period will also cover the busy Christmas season. their main concern, which has this period will also cover the reduced from 19% to 14% in busy Christmas season. this period. There has been a fairly sharp ‘Business Costs’ are becoming drop in sales/turnover in Q3, a real concern with a sizeable with overall net figures dipping increase in those (8%) who into negative territory for the first expressed this as their main time over the last 12 months. business issue. Figure 4 confirms that ‘Front of Conclusion Pharmacy’ sales have remained 3 buoyant with half of respondents 3 The latest survey results would reporting an increase in the last indicate that the uncertainty three months with 19% reporting over Brexit and the impact of a drop. The dispensary side the recent IPHA Agreement is continues to struggle and the influencing business confidence impact from the recent IPHA Table 4 and performance in the Agreement will only contribute to Overall Sales/Turnover Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 pharmacy sector. With footfall, this downward trend. Business Concerns Figure 6 in last three 2015 2015 2016 2016 2016 Figure 6 months sales and employment down it 35% 53% 42% 41% 32% is not surprising the pharmacy The anticipated increase inIncreased 43% 17% 29% 24% 33% owner/managers are less footfall is not anticipated toReduced have 22% 30% 29% 31% 31% Remained the same confident about the business a major impact on sales/turnover 0% 0% 0% 3% 7% environment and their own over the next three monthsDon’t withknow (8%) 36% 13% 17% (1%) Net business prospects. 38% forecasting an increase in their sales/turnover and a As we head towards the busy sizeable 34% predicting Christmas period one would a reduction. There has been a fairly sharp drop in sales/turnover in Q3, with overall net figures dipping into negative hope that there is an upturn in territory for the first time over the last 12 months. trade in the next period. The There has been a slight early indications are that the Figure 4 confirms that ‘Front of Pharmacy’ sales have remained buoyant with half of respondents reporting drop in employment numbers an increase in the last three months with 19% reporting a drop. The dispensary side continues to struggle final three months of the year in Q3 after a number of will remain challenging with an consistent increases in the and the impact from the recent IPHA Agreement will only contribute to this downward trend. anticipated increase in footfall, previous quarters. The anticipated increase in footfall is not anticipated to have a major impact on sales/turnover over the particularly over the Christmas next three months with 38% forecasting an increase in their sales/turnover and a sizeable 34% predicting a trading period, not necessarily The picture remains relatively reduction. leading to increased sales. gloomy with 13% of pharmacy Table 6

31 Qtr3

Qtr4

Qtr1

Qtr2

Qtr3

Review: Profit

Am I protecting my profits? Concentration on maximising productivity and profits within retail Pharmacy sector has been vital in recent years to the survival of many retail Pharmacy businesses. However, how much effort is spent on ensuring these profits are protected? Chances are that if you have noticed that you have a shoplifting problem, or your finance or accountancy team has highlighted an issue then the problem has probably been going on for some time. The two main external influences on profitability are external theft and internal theft. Shoplifters like to get in and out unseen and to steal what they need uninterrupted, resulting in most shoplifting occurrences only coming to light after an empty shelf has been noticed. However if you have an internal theft issue then empty shelves will most likely not be an indication as staff have the knowledge and means to cover up their activities. Although internal theft is less frequent in the retail pharmacy sector, this type of activity can cause serious financial harm to a business. External Theft External theft or shoplifting can happen in any retail pharmacy. Understanding the mind-set of a shoplifter can provide insight into how they view your pharmacy. ‘To catch a thief you need to think like one’ So let’s take a quick look into why a shoplifter steals and what can be done to prevent this type of incident.

Type of Shoplifter

Main Characteristics

Opportunistic

This is when a person enters your pharmacy with the intention of buying/ browsing and not to steal.

As a Professional

This can be an individual or group of shoplifters who steal in an organised manner to sustain their lifestyle. They usually steal to order, supply a market stall or to sell door-to-door.

Personal Need Driven

Desperation can sometimes drive people to theft of necessary items. This may be as a result of living monies being spent elsewhere in the household e.g. to support a drink/drug habit.

Personal Gain

This is where an individual does not necessarily ‘need’ the item stolen but ‘wants’ it. The shoplifter may view the item as desirable however they are not willing to pay the full retail price for it.

To Support a Habit

There are 3 main habits which can be an underlying cause for shoplifting to support a habit. These are Alcohol, Drug and Gambling addictions. Usually the products are sold quickly to supply easy cash to support the habit.

Due to a Psychological Disorder

Kleptomania is a recognised compulsive disorder associated specifically with shoplifting. This condition drives a person to deliberately take items not belonging to them in a range of environments, which may include retail settings.

Peer Pressure

This is mainly present in grouping of adolescents and sometimes in groups of younger children. Looking cool in front of friends and following the trend can often lead young persons to try their hand at shoplifting.

WITH ULTIBRO BREEZHALER EXACERBATION PREVENTION IS IN YOUR HANDS1 ®

One proven treatment for COPD patients,with patients,with * or without 3,4† exacerbations, demonstrating consistent superiority vs Salmeterol/Fluticasone1‡ 1,2

ULTIBRO® BREEZHALER® is indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD).5 * Patients had at least one moderate or severe exacerbation in the previous 12 months. † Patients had no moderate or severe exacerbation in the previous 12 months. ‡ Fluticasone/Salmeterol 500/50 mg BID. Ultibro Breezhaler ▼This This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. See section 4.8 of the SmPC for how to report adverse reactions. ABBREVIATED PRESCRIBING INFORMATION Please refer to Summary of Product Characteristics (SmPC) before prescribing. Presentation: Ultibro® Breezhaler® 85mcg / 43mcg inhalation powder hard capsules containing indacaterol maleate and glycopyrronium bromide respectively and separate Ultibro® Breezhaler® inhaler.Indications: A maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dosage and administration: Recommended dose is the inhalation of the content of one capsule once daily, administered at the same time of the day each day, using the Ultibro® Breezhaler® inhaler. Capsules must not be swallowed. No dose adjustment required in elderly patients, for patients with mild and moderate hepatic impairment or for patients with mild to moderate renal impairment. No data available for use in patients with severe hepatic impairment and should only be used in patients with severe renal impairment or end-stage renal disease requiring dialysis if the expected benefit outweighs the potential risk. No relevant use in the paediatric population. Contraindications: Hypersensitivity to the active substances or to any of the excipients. Warnings/Precautions: Not to be administered concomitantly with medicinal products containing other LABA’s or LAMA’s. Asthma: ♦ULTIBRO® BREEZHALER® SHOULD NOT BE USED FOR TREATMENT OF ASTHMA. Acute use: ♦Not indicated for treatment of acute episodes of bronchospasm. Hypersensitivity: ♦Immediate hypersensitivity reactions have been reported after administration of indacaterol or glycopyrronium. If signs suggesting allergic reactions occur (in particular, angioedema, difficulties in breathing or swallowing, swelling of the tongue, lips and face, urticaria or skin rash), treatment should be discontinued immediately and alternative therapy instituted. Paradoxical bronchospasm: ♦If paradoxical bronchospasm occurs, Ultibro® Breezhaler® should be discontinued immediately and alternative therapy instituted. Anticholinergic effects related to glycopyrronium: ♦To be used with caution in patients with narrow-angle glaucoma and in patients with urinary retention. Patients with severe renal impairment: ♦Should only be used in patients with severe renal impairment, including those with end-stage renal disease requiring dialysis, if the expected benefit outweighs the potential risk. These patients should be monitored closely for potential adverse reactions. Cardiovascular effects: ♦To be used with caution in patients with cardiovascular disorders (coronary artery disease, acute myocardial infarction, cardiac arrhythmias, hypertension), in patients with known or suspected prolongation of the QT interval or patients treated with medicinal products affecting the QT interval and in patients with unstable ischaemic heart disease, left ventricular failure, history of myocardial infarction, arrhythmia (excluding chronic stable atrial fibrillation), a history of long QT syndrome or whose QTc (Fridericia method) was prolonged. ♦LABA’s may produce a clinically significant cardiovascular effect in some patients as measured by increases in pulse rate, blood pressure, and/or symptoms, ECG changes. In case such effects occur, treatment may need to be discontinued. Hypokalaemia: ♦ LABA’s may produce significant hypokalaemia in some patients, which has the potential to produce cardiovascular effects. In patients with severe COPD, hypokalaemia may be potentiated by hypoxia and concomitant treatment which may increase the susceptibility to cardiac arrhythmias. Hyperglycaemia: ♦Inhalation of high doses of LABA’s may produce increases in plasma glucose. Upon initiation of treatment with Ultibro® Breezhaler® plasma glucose should be monitored more closely in diabetic patients. ♦ Ultibro® Breezhaler® has not been investigated in patients for whom diabetes mellitus is not well controlled. General disorders: ♦To be used with caution in patients with convulsive disorders or thyrotoxicosis, and in patients who are unusually responsive to LABA’s. Excipients: ♦ Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. Pregnancy and Lactation: ♦Ultibro® Breezhaler® should only be used during pregnancy if the expected benefit to the patient justifies the potential risk to the foetus. ♦Not known whether indacaterol, glycopyrronium and their metabolites are excreted in human milk. Use of Ultibro® Breezhaler® by breast-feeding women should only be considered if the expected benefit to the woman is greater than any possible risk to the infant. Interactions: ♦Concomitant use is not recommended with beta adrenergic blockers, anticholinergics or sympathomimetic agents. ♦Concomitant hypokalaemic treatment with methylxanthine derivatives, steroids, or non-potassium-sparing diuretics may potentiate the possible hypokalaemic effect of beta2-adrenergic agonists, therefore use with caution. ♦Inhibition of the key contributors of indacaterol clearance, CYP3A4 and P-gp, does not raise any safety concerns given the safety experience of treatment with indacaterol. ♦No clinically relevant drug interaction is expected when glycopyrronium is co administered with cimetidine or other inhibitors of the organic cation transport. Adverse reactions: ♦Very common: upper respiratory tract infection. ♦Common: nasopharyngitis, urinary tract infection, sinusitis, rhinitis, dizziness, headache, cough, oropharyngeal pain including throat irritation, dyspepsia, dental caries, gastroenteritis, musculoskeletal pain, pyrexia, chest pain. ♦Uncommon: hypersensitivity, angioedema, diabetes mellitus and hyperglycaemia, insomnia, paraesthesia, glaucoma, ischaemic heart disease, atrial fibrillation, tachycardia, palpitations, paradoxical bronchospasm, epistaxis, dry mouth, pruritus / rash, muscle spasm, myalgia, pain in extremity, bladder obstruction and urinary retention, peripheral oedema and fatigue. ♦Please refer to SmPC for a full list of adverse events for Ultibro® Breezhaler®. Legal Category: POM Pack sizes: Cartons containing 10 capsules (1x10 capsule blister strips) and one Ultibro® Breezhaler® inhaler or 30 capsules (3x10 capsule blister strips) and one Ultibro® Breezhaler® inhaler. Marketing Authorisation Holder: Novartis Europharm Limited, Frimley Business Park, Camberley GU16 7SR, United Kingdom. Marketing Authorisation Numbers: EU/1/13/862/007 & 003. Full prescribing information is available on request from Novartis Ireland Ltd, Vista Building, Elm Park Business Park, Dublin 4. Tel: 01 2601255 or at www. medicines.ie Date of Revision of API Text: 9th February 2016 References: 1. Wedzicha JA, Banerji D, Chapman KR, et al. Indacaterol–glycopyrronium versus salmeterol–fluticasone for COPD. N Engl J Med. 2016. 374:2222-2234. 2. Wedzicha JA, et al. Lancet Respir J 2013:1:199–209. 3. Mahler DA, et al. Eur Respir J 2014;43:1599–1609. 4. Vogelmeier CF, et al. Lancet Respir Med; 2013:1:51–60. 5. Ultibro® Breezhaler®. Summary of Product Characteristics. Accessed on www.medicines.ie, October 2016.

Date of Preparation: October 2016 IE02/ULT16-CNF057q

Review: Profit Call the Gardaí and report the incident as your staff are your most valuable asset. Adequately training your staff and having a robust security policy in place within your pharmacy not only helps to protect your assets and profit but also provides staff with the confidence to deal with these difficult situations. Internal Theft

Protect your Pharmacy by recogniising any potential shoplifting issues Identifying and dealing with a shoplifter? The first step in protecting your assets and profits is to recognise when you have a potential shoplifting issue by ensuring your staff look out for classic alert signals which may include: • Unusual or unnatural eye movement. • Shaking, twitching or fidgeting due to an increase in adrenaline. • Uneasy or uncoordinated movements due to draining of blood from the head in an adrenaline rush. • Asking of inane questions before they leave, this is to assess if staff have seen them shoplifting. • Unnatural shopping patterns such as placing of substantial high value duplicate items in a basket. • Spending an unusual length of time in the one area of the pharmacy. • Use of groups to block the view of staff members to what is happening. • Deliberate distracting of staff members to take them away from an area used for shoplifting. • Moving items into quiet areas of the pharmacy Ensuring staff know how to confidently and safely deal with incidents of shoplifting once they have been highlighted is vital as left unchecked these incidents will escalate, and dealt with incorrectly these incidents could pose a safety risk to staff members. Safely dealing with confirmed or suspected incidents of shoplifting The most important aspect of dealing with incidents of shoplifting is not obtaining the stock back, it is minimising the

risk of harm to staff when dealing with such incidents. In the event of a suspicious activity where a customer is seen concealing an item of stock which can be confirmed as belonging to the pharmacy an initial direct customer service approach can be used by staff members. For example handing a basket to the customer stating that you have noticed they may need a basket or may be struggling to hold the items they wish to purchase, or in the event that you do not have the provision of baskets asking the customer if they would like you to take the products to the till point for them. It may also be beneficial if the approaches outlined above have not been successful to provide the suspected shoplifter with a window of opportunity to put back or drop the goods concealed. An easy mistake to make is to hover beside the suspected person until they leave which forces them to leave with the goods. Stepping away from the suspect for 30 -40 seconds may provide them with the opportunity to back out of the incident as the rewards involved are now not worth the risk involved of being caught. It is important to remember that you will not be able to deter, prevent or deal with every single incident of shoplifting within your pharmacy, and unfortunately you will have shoplifters who are successful in stealing from you unnoticed and some who have no fear of the consequences of being caught. When this does occur staff members must understand that they must follow up on these incidents with the Gardaí and they must never be allowed to follow a shoplifter out of the pharmacy as they may be physically harmed. Shoplifters may have accomplices waiting outside, they may be carrying weapons or they may become violent if they become aware that they are being followed or when approached.

How much trust do you place in your employees? You have to trust your employees for your business to succeed don’t you? So how does a pharmacy effectively prevent, detect and respond to an issue of internal theft without effecting the morale of the pharmacy? Although the above reasons for theft also apply to internal or staff theft, there is also an additional reason why people steal from their employers. Low morale has been shown to be another factor people consider when committing these types of theft incidents. The daily routine activities of an employee presents them with opportunities to steal cash and stock, which in itself is not always a setting for theft, but combine this with a motivation to steal and an absence of controls or supervision and this significantly increases the risk of a theft occurring. Finding the correct balance of controls, supervision and detection techniques is essential to ensure that the culture and morale of the pharmacy is not adversely effected. Controls It is often necessary to entrust certain employees with a higher level of accountability in the pharmacy, for example conducting cashing up processes and lodgements for the pharmacy. However having these accountabilities in place is of no use if the keys to the cash safe are kept on a hook in the pharmacy with no controls in place. Security controls, rules and equipment are required in all retail sectors in order to set out clear expectations and guidelines for employees and to ensure that opportunities for internal theft are minimised. However controls and rules are of no use unless they are enforced, monitored and followed up on by management. Preventative measures are only effective if employees view such measures as a risk, therefore honest and open communication with employees regarding the reasons for controls should be briefed openly within the pharmacy ensuring that feelings of mistrust are minimised. Measuring the controls and preventative controls is essential

and management or accountable employees within the pharmacy should be trained in identifying adverse activity or patterns of theft. Regular checks for adverse activity within the following areas as a minimum should be built into routine management tasks: • Cash discrepancies including comparisons of Z-totals to lodgements • Notable changes in daily or weekly sales or during holiday of employee • Levels of refunds, voids and sales • DPS refunds or reported overcharging issues by patients (this could indicate original sales not processed and money has been taken) • Adverse stock shortages • Customer and employee accounts • Adverse invoice amounts What to do if internal theft is suspected A range of resolutions can be employed to confirm or disprove suspicions of theft. Internal security resources, external consultants, covert cameras and existing CCTV and reports can be utilised to effectively provide the necessary evidence required to successfully resolve an issue of internal theft. In all cases it is essential that investigations are carried out in a professional manner ensuring that employment and criminal legislation is taken into account during the investigation, as failure to do so could leave the pharmacy open to legal action. If in doubt seek advice from a specialist. Unfortunately internal theft happens and cannot be totally eliminated. All we can do is to minimise the opportunity for internal theft to happen within the pharmacy by ensuring firstly that open communication with employees regarding controls and the management of these controls and secondly that trained accountable persons conduct regular checks for indications of suspicious activity. Don’t take the easy route and explain away suspicions, act on them and investigate. Aisling Daly MSc Director at Tonic Consultancy Ltd. www.tonic-consultancy.com Highly experienced security, risk and profit protection professional with a proven track record in obtaining industry leading results. MSc in Security and Risk Management

Review: Marketing

Is it marketing, or simply being sociable? There has never been a better time for pharmacies to compete against major retailers in the battle for the hearts and minds of their local community. and online comments on social media, with Facebook being the number one platform for research. If you store has an exclusive brand or a good range of cosmetic branded products, then Instagram is also a great platform for you to use to engage with your customers although more difficult to target geographically. 2. Content is King

If you own one or more independent pharmacy stores that service your local community you are to be congratulated! You have survived a major storm and you’re still in business. However, you still face some huge challenges. You can’t compete on price for the majority of well known OTC brands. You can’t compete on product range. You can’t compete on advertising spend. You can’t compete on commercial rental negotiations. BUT, you do have an ace up your sleeve. You are independent, so you are in control of how you can move your business forward and how you communicate without being dictated to by head office. And, what’s more imporant, is that you have a great opportunity to truly connect with your community which, in turn, will have a positive impact on your traffic flow and bottom line. To being with, there is still a traditional approach that still applies to community marketing. Identifying an activity, sport or latest trend in your local town that your brand can get involved in is a great starting point. Try and gain a complete picture of your local communities demographics and identify small pockets of target customers that you can cultivate and nurture a relationship with rather than go for a broad stroke approach. For instance, if your town has a nursing home or sheltered housing unit nearby, sponsorhing some of their activities on an ongoing basis will draw in them, their families and friends as well as allowing you to place appropriate branding and promotional messages on site. And then there’s everything that you can do on-line… If you’re not a digital native, you can learn how to do your own digital marketing

or you find a local graduate who will do it for you for very little cost. Either way, you really have little choice now but to jump in because social media is the reason why you can really take advantage of your local community position. The following might help you understand a little more about the power of social media and what it can do to drive traffic flow and build your business. Social Media has to be one the most powerful tools for businesses and has completely transformed the way brands do business, through a “new age” engagement with their customers. Whether it’s changing public perception or allowing you to manage your existing community, it’s a force to be recognised and respected. Social will only become more valued over time (might even take over the world, some say……!). There are a number of contributing factors to what sets your social media presence apart from the competition and some key trends that play an integral part to the success of your strategy, which you need to implement to enhance your online engagement with your customers. 1. Which platform? To being with, you need to decide which platform you will create a presence on for your store(s) and once created, you have to maintain! So, if time is precious and you want to experiment for a bit, get to know one platform really well and then the next and so forth so you’re learning as you go and utilising them properly. Facebook and Twitter are still dominating in 2016, but we’ll see more platforms added to the index. Already, 88% of consumers today are most influenced by reviews

The mediums might be changing but the competition for visibility and engagement has never been stronger so anything you put up, qualify first and ask yourself: Is it relevant? Is it targeted to the right customer base? Is the message clear? Your suppliers can help you here as they will have lots of online content on both the OTC brands and pharmacy brands you stock. Try applying your own explanations to your social media platforms about specific brands that might engage more with your own customer base. 3. Real Real-Time Engagement Social media thrives on real-time engagement and each year the window for response becomes smaller and smaller. In general, 70% of Twitter users expect a response from brands they reach out to, and 53% want a response in less than an hour. So, while in reality it’s difficult to run a business and be ‘on-line’ 24 hrs a day, do set yourself some response standards that are more practical for your business. 4. Live Streaming Videos Consumers today want faster access to real-time/ offline events, so live streaming videos are fast becoming the “next big thing”.

bonus is now a necessity! If you’re not thinking mobile first, then you’re already behind. So, if you are designing or re-designing your website make sure it’s mobile enabled. Mobile devices have become the primary interface for most social media users. 80% (an estimated 2 billion) of Internet users own a smartphone. 6. Segmentation Marketing principles Once you’ve established your following on Facebook, Twitter, Instagram or Pinterest, you need to ensure that you’re sending the relevant message to each type of follower and not applying a ‘one size fits all’ approach as this will inevitably mean you will switch off followers with irrelevant messaging. So, if you’ve had a good response from teenagers on Instagram for a new nail polish range, please don’t send them a promotional offer for vitamin pills… 7. Social Analytics Personalised data-driven marketing plans are at the forefront of digital strategies and social media analytics and reporting tools will help you dig deeper to get the most out of your efforts. Each platform will have some analytics built into their reporting mechanisms. Investigate what they can provide free of charge. However, numbers shouldn’t replace creativity; relationship building is fluid and unique to the individual and number crunching is purely analytical, so you do need to create the right balance between the two. 8. Getting there first!

Live stream goes that one step further by revealing a more realistic and authentic side to your business. It’s unedited and unfiltered which is more appealing to followers, and will positively impact their engagement with your store. Every smart phone allows you to take relatively good quality video these days and it means your online, traffic driving promotions get that much more traction.

Look into other local, independent retailers and see what they’re doing through social media. I guarantee you the majority haven’t engaged yet with your community. Be the first to crack this in your area and it will definitely create results for you.

5. Mobile First Approach

Charley Stone is the Group Managing Director with marketing talent house, Alternatives.

What was once considered a

So, social media is essential for local businesses today and without it, you’ll never get the edge over the large retail chains…

Feature

A smoke free Ireland: within reach?

Written by Sean Murphy

With Minister for Health Simon Harris recently reiterating the Government’s commitment to creating a smoke free Ireland by 2025 and the HSE providing new methods to find and access smoking cessation services, IPN looks at the role pharmacists can play in achieving this aim. While road safety adverts still manage to convey a sense of horror while getting its message across in a very potent way, one of the more recent adverts to hit our screens that had a powerful impact features the now-deceased Gerry Collins. As part of the Quit campaign’s “1 in 2” message, we all witnessed the man describing his smoking, his lung cancer, his expected death and the family he’ll leave behind. “I wish I was an actor [but] the reality is that I’m not an actor. I am dying. I’m dying from cancer as a result of smoking,” he tells us. The final version of the advert signs off with the message that Gerry sadly passed away after the filming of the advert and that one in every two smokers will die of a tobacco related disease. It is an incredibly moving 30 seconds of video. According to recent statistics, the message, most certainly, is definitely getting through. A decline In recent years, smoking rates in Ireland have consistently declined. According to figures from the World Health Organisation, almost one in every three adults were regular or occasional smokers in the late 1990s. By 2016, this was less than one in five. In real terms, this means that there are well over 100,000 less smokers in Ireland now than there were 10 years ago. A myriad of social factors and public health initiatives have contributed to this. The most significant of which may have been the public smoking ban introduced by the Government in 2004. Research published in PLOS ONE indicated that “3,726 smoking-

related deaths were likely prevented” as a result of the ban, which saw a comprehensive ban on smoking in workplaces, including restaurants, bars, and pubs. Increasing taxes on cigarettes on an almost annual basis in the Government’s budget has simultaneously raised tax revenue and encouraged more people to give up. Banning the sale of packs of 10 and the introduction of graphic warnings on cigarette packs has also played a part. Proposed new legislation, which is vehemently opposed by tobacco companies, will see plain cigarette packaging brought in. Going further back, the banning of all tobacco advertisements has played an important role. All of these factors contribute to, and will contribute to, a decline in

smoking among young people and the general population. From a cultural point of view, certainly, the appeal of smoking as “cool” has lessened significantly in the meantime. By and large, role models for children and young people do not smoke in 2016 (at least not publicly). Figures show that significantly less young people smoke now than they did 15-20 years ago. A battle not yet won Despite these encouraging statistics, there is clearly a lot more that can still be done. Regular smokers now may only represent one fifth of the adult population, but smoking causes an estimated 5,900 deaths each year. Up to ¤2 billion annually is spent on treating tobacco related

disease in Ireland. The lobby group, Action on Smoking and Health, calls this “a national scandal.” Upon publishing the Government’s Tobacco Free Ireland plan, then-Minister for Health James Reilly pointed out that “for the industry to simply maintain the size of its customer base in Ireland, it is estimated that 50 Irish children have to start smoking every single day.” The tide is certainly turning against Big Tobacco in Ireland, but concerted action is required. The initiative has set the target for Ireland to become tobacco free by 2025. In practice, they indicate that will mean a smoking prevalence rate of less than 5%. As the current smoking rate is considerably higher than this target, this is a daunting task.

New study. New data. New perspective?

Think of what they could achieve if their mind was freed from it

* The primary safety endpoint was the composite measure of 16 moderate and severe neuropsychiatric adverse events, including anxiety, depression, feeling abnormal, and hostility (rated as severe), and agitation, aggression, delusions, hallucinations, homicidal ideation, mania, panic, paranoia, psychosis, suicidal ideation, suicidal behaviour, and completed suicide (all rated as moderate or severe).

Reference: 1. Anthenelli RM, et al. Lancet. 2016;387:2507–2520.

Prescribing information: CHAMPIX® Film-Coated Tablets (varenicline tartrate) ABBREVIATED PRESCRIBING INFORMATION – IE (See Champix Summary of Product Characteristics for full Prescribing Information) Please refer to the SmPC before prescribing Champix 0.5 mg and 1 mg. Presentation: White, capsular-shaped, biconvex tablets debossed with “Pfizer” on one side and “CHX 0.5” on the other side and light blue, capsularshaped, biconvex tablets debossed with “Pfizer” on one side and “CHX 1.0” on the other side. Indications: Champix is indicated for smoking cessation in adults. Dosage: The recommended dose is 1 mg varenicline twice daily following a 1-week titration as follows: Days 1-3: 0.5 mg once daily, Days 4-7: 0.5 mg twice daily and Day 8 – End of treatment: 1 mg twice daily. The patient should set a date to stop smoking. Dosing should usually start 1-2 weeks before this date. Patients who are not willing or able to set the target quit date within 1-2 weeks, could be offered to start treatment and then choose their own quit date within 5 weeks. Patients should be treated with Champix for 12 weeks. For patients who have successfully stopped smoking at the end of 12 weeks, an additional course of 12 weeks treatment at 1 mg twice daily may be considered for the maintenance of abstinence. A gradual approach to quitting smoking with Champix should be considered for patients who are not able or willing to quit abruptly. Patients should reduce smoking during the first 12 weeks of treatment and quit by the end of that treatment period. Patients should then continue taking Champix for an additional 12 weeks for a total of 24 weeks of treatment. Patients who are motivated to quit and who did not succeed in stopping smoking during prior Champix therapy, or who relapsed after treatment, may benefit from another quit attempt with Champix. Patients who cannot tolerate adverse effects may have the dose lowered temporarily or permanently to 0.5 mg twice daily. Following the end of treatment, dose tapering may be considered in patients with a high risk of relapse. Renal impairment; Mild to moderate renal impairment: No dosage adjustment is necessary. Patients with moderate renal impairment who experience intolerable adverse events: Dosing may be reduced to 1 mg once daily. Severe renal impairment: 1 mg once daily is recommended. Dosing should begin at 0.5 mg once daily for the first 3 days then increased to 1 mg once daily. Patients with end stage renal disease: Treatment is not recommended. Hepatic impairment and elderly patients; No dosage adjustment is necessary. Paediatric patients; Not recommended in patients below the age of 18 years. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Warnings and precautions: Effect of smoking cessation; Stopping smoking may alter the

CHAMPIX offers significantly greater quit rates vs. bupropion, NRT patch and placebo at 12 and 24 weeks, with no significant increase in the risk of neuropsychiatric events in patients with or without a stable psychiatric history compared to placebo*1

CHANGE THEIR MINDSET TO QUITTING

pharmacokinetics or pharmacodynamics of some medicinal products, for which dosage adjustment may be necessary (examples include theophylline, warfarin and insulin). Changes in behaviour or thinking, anxiety, psychosis, mood swings, aggressive behaviour, depression, suicidal ideation and behaviour and suicide attempts have been reported in patients attempting to quit smoking with Champix in the post-marketing experience. A large randomised, double-blind, active and placebo-controlled study was conducted to compare the risk of serious neuropsychiatric events in patients with and without a history of psychiatric disorder treated for smoking cessation with varenicline, bupropion, nicotine replacement therapy patch (NRT) or placebo. The primary safety endpoint was a composite of neuropsychiatric adverse events that have been reported in post-marketing experience. The use of varenicline in patients with or without a history of psychiatric disorder was not associated with an increased risk of serious neuropsychiatric adverse events in the composite primary endpoint compared with placebo. Depressed mood, rarely including suicidal ideation and suicide attempt, may be a symptom of nicotine withdrawal. Clinicians should be aware of the possible emergence of serious neuropsychiatric symptoms in patients attempting to quit smoking with or without treatment. If serious neuropsychiatric symptoms occur whilst on varenicline treatment, patients should discontinue varenicline immediately and contact a healthcare professional for re-evaluation of treatment. Smoking cessation, with or without pharmacotherapy, has been associated with exacerbation of underlying psychiatric illness (e.g. depression). Champix smoking cessation studies have provided data in patients with a history of psychiatric disorders. In a smoking cessation clinical trial, neuropsychiatric adverse events were reported more frequently in patients with a history of psychiatric disorders compared to those without a history of psychiatric disorders, regardless of treatment. Care should be taken with patients with a history of psychiatric illness and patients should be advised accordingly. Patients taking Champix should be instructed to notify their doctor of new or worsening cardiovascular symptoms and to seek immediate medical attention if they experience signs and symptoms of myocardial infarction or stroke. In clinical trials and postmarketing experience there have been reports of seizures in patients with or without a history of seizures, treated with Champix. Champix should be used cautiously in patients with a history of seizures or other conditions that potentially lower the seizure threshold. At the end of treatment, discontinuation of Champix was associated with an increase in irritability, urge to smoke, depression, and/or insomnia in up to 3% of patients, therefore dose tapering may be considered. There have been post-marketing reports of hypersensitivity reactions including angioedema and reports of rare but severe cutaneous reactions, including Stevens-Johnson Syndrome and Erythema Multiforme in patients using varenicline. Patients experiencing these symptoms should discontinue treatment with varenicline and contact

a health care provider immediately. Fertility, pregnancy and lactation: Champix should not be used during pregnancy. Women of child bearing potential should avoid becoming pregnant during treatment with Champix. It is unknown whether varenicline is excreted in human breast milk. Champix should only be prescribed to breast feeding mothers when the benefit outweighs the risk. There are no clinical data on the effects of varenicline on fertility. Non-clinical data revealed no hazard for humans based on standard male and female fertility studies in the rat. Driving and operating machinery: Champix may have minor or moderate influence on the ability to drive and use machines. Champix may cause dizziness and somnolence and therefore may influence the ability to drive and use machines. Patients are advised not to drive, operate complex machinery or engage in other potentially hazardous activities until it is known whether this medicinal product affects their ability to perform these activities. Side-Effects: Very commonly reported side effects were nasopharyngitis, abnormal dreams, insomnia, headache and nausea. Commonly reported side-effects were bronchitis, sinusitis, weight increased, decreased appetite, increased appetite, somnolence, dizziness, dysgeusia, dyspnoea, cough, gastrooesophageal reflux disease, vomiting, constipation, diarrhoea, abdominal distension, abdominal pain, toothache, dyspepsia, flatulence, dry mouth, rash, pruritis, arthralgia, myalgia, back pain, chest pain, fatigue and abnormal liver function tests. Other side effects were, diabetes mellitus, suicidal ideation, seizures, cerebrovascular accident, angina pectoris, atrial fibrillation, electrocardiogram ST segment depression, myocardial infarction, haematemesis, haematochezia, Stevens Johnson Syndrome, angioedema and decreased platelet count. For full list of side effects see SmPC. Overdose: Standard supportive measures to be adopted as required. Varenicline has been shown to be dialyzed in patients with end stage renal disease, however, there is no experience in dialysis following overdose. Legal category: S1A. Package quantity; Marketing Authorisation numbers: Pack of 56: 0.5 mg tablets HDPE Bottle (EU/1/06/360/001), Pack of 56: 1mg tablets Card (EU/1/06/360/016), Pack of 53: 11 x 0.5 mg and 42 x 1mg tablets Card (EU/1/06/360/023) Marketing Authorisation Holder: Pfizer Limited, Sandwich, Kent, CT13 9NJ, United Kingdom. For further information on this medicine please contact: Pfizer Medical Information on 1800 633 363 or at EUMEDINFO@pfizer.com. For queries regarding product availability please contact: Pfizer Healthcare Ireland, Pfizer Building 9, Riverwalk, National Digital Park, Citywest Business Campus, Dublin 24 + 353 1 4676500. Last revised: 06/2016 Ref: CI 18_0 Date of preparation: August 2016

PP-CHM-IRL-0038 ©Pfizer 2016

Feature opportunity to advise smokers to stop and some pharmacists with specialist training will be able to provide them with treatment.” So what can the pharmacist do? A pharmacist located in one of Ireland’s biggest university towns told IPN: “Most people don’t realise the effectiveness of NRT (nicotine replacement therapies). We get so many people, especially younger people from the college nearby, who started it as a social thing and have progressed to a pack a day. They’re sceptical that these replacements will help them give up at all. What we can do then is give the right advice and the right NRT to give them the best chance of giving up the smokes for good. And it works. More people should be made aware of the help we can give on smoking cessation.” The NRTs referred to here include the adhesive patch, chewing gum, lozenges, nose spray, and inhaler. Each offers nicotine in a targeted way that, when used alone or in combination together, can be a potent replacement that enables people to wean themselves off cigarettes.

The pharmacist’s role To coincide with the introduction of the Tobacco Free Ireland initiative, the Irish Pharmacy Union (IPU) highlighted the role that pharmacists can play in these smoking cessation efforts. Pharmacists in Ireland can play a vital role in assisting smokers kicking the habit for good, by giving advice on how to do it and the health-related benefits associated with it. A HSE spokesperson told IPN: “Smoking Cessation services are provided by the HSE in locations nationwide, in hospitals and in primary care, and these offer personal or group support courses for quitters […] Pharmacists and other healthcare professionals also play a key role in helping smokers to quit.” Pharmacists, as highly accessible healthcare professionals,

certainly have the potential to play a key role in aiding smoking cessation and, under this and other initiatives, there are many ways they are doing it. As well as offering the essential tools, pharmacists can provide hands-on advice that people looking to quit smoking on their own don’t get. In October, the HSE launched an initiative that would make finding these services a lot easier with their online smoking cessation clinic locator. With over 74 such clinics dotted around the country, the HSE’s comprehensive map will show people where their closest one is located. A HSE spokesperson says: “The HSE are now making it even easier for you to quit smoking. You may be thinking about quitting, you may have tried before – in fact most smokers make a few attempts before they

quit for good… Well, you can quit and you don’t have to try alone.” Numerous studies have suggested that smokers who avail of community pharmacy smoking cessation services are considerably more likely to quit than if they go alone. One of the more recent studies, published this year in the Journal of the American Pharmacists Association highlighted the “prime position” that pharmacists were in regards to smoking cessation and pointed out that “quit rates range from 12% to 46%” with pharmacists support. Although many want to quit, the success rates when people “go it alone” can be as low as 1-2%. According to guidance issued by the National Institute for Health and Care Excellence (NICE) in the UK, “Smoking cessation fits neatly within this role: all pharmacists will have the

The gum, for example, offers differing strengths dependent on the amount that people smoke. Patches, meanwhile, offer a controlled release of nicotine while inhalation cartridges can be used as and when the urge to smoke kicks in as it simulates the act of smoking. Similarly, oral spray offers fast craving relief. “Combining them in a way specific to that particular person can be very effective,” the pharmacist adds. “Pharmacists are uniquely placed to analyse each case and offer advice and therapy that can give the best chance of success. An all-purpose patch or gum will certainly help but, with the advice we can give, we can give them a much higher chance of quitting for good.” Some pharmacists are fully embracing the potential to reach potential smokers, not just in person on site, but online as well. If anyone was considering giving up smoking and wanted to see what help is out there, a quick google search reveals that many pharmacies provide the detailed information that people need to inform them about the benefits of quitting and the benefits of seeking help.

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Patch: Smart control technology for 24 hour craving control

*4mg only Product Information: NiQuitin Mini 4 mg Mint Lozenges (nicotine) and NiQuitin Clear 21mg/24hrs transdermal patches (nicotine). Indications: Treatment of tobacco dependence by relief of nicotine withdrawal symptoms and cravings. Use with behavioural support. Legal category: GSL. PA 1186/18/12 and PA 1186/18/3. Licence Holder: Chefaro Ireland Ltd. First Floor, Block A,The Crescent Building, Northwood Office Park, Dublin 9, Ireland. Information about this product, including adverse reactions, precautions, contra-indications and method of use can be found at: http://www.medicines.ie/medicine/14492/SPC/NiQuitin+Mini+4mg+mint+lozenges/ and http://www.medicines.ie/medicine/12138/SPC/NiQuitin+CLEAR+21+mg+24+hours+transdermal+patch/ Date of revision: August 2016.

Feature To name a few, Walsh’s Pharmacy, Life Pharmacy and Staunton’s Pharmacy all provide both information on the dangers of smoking and the services that people can avail of to make them quit. It’s another way that pharmacists can reach out that goes beyond the confines of their pharmacy. Walsh’s, for example, with a range of locations across Galway, highlight that “no matter how young or how old you are, it is never too late to give up cigarettes” and that the “range of products available to those with a desire to give up smoking has never been so plentiful”, before pointing to their own range of the products detailed above. In a world that is increasingly placing more emphasis on digital interactions than faceto-face, this is an effective way of providing that service before a person even comes in to try some of these methods. They don’t wait until the person comes to them, pharmacists are reaching out too. The new smoking cessation? In recent years, a controversial new product that’s marketed heavily as a replacement for tobacco is the e-cigarette. It may not be approved anywhere as an NRT, but opinion across policy groups and healthcare professionals is divided. When the Welsh Assembly banned the use of e-cigarettes in public places, condemnation soon followed. Diverse groups such as Action on Smoking and Health, Cancer Research UK and British Heart Foundation Wales all criticised the move, saying the move will be “potentially damaging rather than enhancing public health” and that there is “insufficient evidence” to introduce a ban. The Royal Pharmaceutical Society in the UK, however, took a different view. It said: “If we don’t act now, there is a danger smoking will become the ‘normal’ thing to do again. E-cigarettes could become the gateway to tobacco. We do not believe this is a risk worth taking. Nicotine is an addictive substance and e-cigarettes are currently not licensed and regulated, so we don’t know what’s in them or their long-term effects on health.”

While anecdotal evidence points to a decrease in cravings and its ability to replace smoking to a certain extent, it’s clear that we shouldn’t quite roll out the red carpet for e-cigarettes just yet. They may have a place in NRT in the future, but further time is needed to fully establish the potential risks of this increasingly popular product. Giving up is the hardest thing to do Pharmacists will play a vital role in helping to make Ireland smoke free by 2025. Pharmacists we spoke to from Kildare, Dublin and Meath all agreed that, while their work was helping to contribute to this laudable aim, more coordinated efforts are needed to ensure this becomes a reality. Pharmacists are the most immediately accessible of healthcare professionals and should rightly be on the frontline on issues like this. They can offer these effective services but that alone will not make Ireland smoke free. No matter what assistance is given, however, the reality is that giving up smoking is extremely hard. Junior Health Minister Michael McGrath made headlines over the summer with his comments on smoking. He may have been criticised for advocating a return to indoor smoking in special areas in pubs, but he also admitted his own smoking habit. Admitting to smoking “in the region of 15-20 cigarettes a day”, he added:”I’m addicted to nicotine, every day I try to give up the cigarettes but the bottom line is we need a new approach.”

of years smoke-free now – and it’s definitely a freedom. I don’t even think about cigarettes anymore.” A smoke free Ireland? When figures showing a sharp decline in the numbers of young people smoking were published, Kathleen O’Meara, Head of Advocacy and Communications at the Irish Cancer Society, said: “We’re less than years away from this target. Although it is ambitious, the figures released show that, with the right commitment from Government, it can be achieved. “We need to continue the momentum not only by

preventing young people from taking up the habit, but by encouraging current smokers to give the habit up. We will see a tobacco free generation in Ireland – it’s a question of ‘when’ and not ‘if’.” O’Meara nails it perfectly with her last comment. Ireland is heading that way, certainly. 2025 is a good target because every year Ireland is smoke free means thousands more lives saved. Getting there faster should certainly be the aim. Pharmacists will play their role. It’s time for all policymakers, lobby groups and government figures to stand united.

TDs and Senators told not to ignore the facts Dublin-based GP Dr Garrett McGovern has told politicians that vaping products are not a gateway to smoking but can be an alternative for those looking to quit smoking and this should be borne in mind by regulators. Oireachtas members, key stakeholders and representatives from the media gathered recently for a high-level briefing on Vaping in 2016: why consumers need sensible regulation. The event, was organised by Vape Business Ireland (VBI), a business alliance committed to an open debate about the regulation of vaping products in Ireland. The seminar which was addressed by guest speakers including GP Dr Garrett McGovern and Gamucci Ireland General Manager, Michael Kenneally. Dr Garret McGovern spoke about the huge potential vaping products can play for those looking to quit smoking. “Not only is vaping an alternative with 99% of vapers being exsmokers, research in the UK has estimated vaping to be a 95% less harmful than combustible tobacco products,” he said. “There has been no evidence to suggest that vaping is a gateway to smoking, the scientific facts must not be disregarded. Therefore vaping products should not be blocked by policy makers from offering an alternative to smoking.”

Wanting to give up smoking is essential. Changing attitudes is the first step and while a great deal of work has been done, momentum needs to be maintained.

The briefing came just days before the seventh session of the Conference of the Parties (COP7) to the WHO Framework Convention on Tobacco Control (FCTC), which took place 7-12 November 2016 in New Delhi, India. COP7 brought together the WHO FCTC’s 180 Parties, which was attended by Dr Fenton Howell from the Department of Health.

Commenting on the recent HSE news of the service that will help smokers locate smoking cessation clinics, Eric Weinmann, who was a 60-cigarette a day smoker, said: “There were a few times I was nearly in tears trying to stop smoking. But the service at St James’s showed me how to change my way of thinking and focus on the positive aspects of quitting. The persistence was well worth it. I’m another couple

WHO has made recommendations to profoundly restrict vaping products through heavy regulation, therefore preventing them from becoming viable alternatives for smokers. Lucy Cronin, VBI Secretariat, who spoke about regulation at the briefing, was critical of the Department. “The lack of communication and consultation by the Department and Minster Harris in the lead up to such a serious decision is very disappointing,” he said. “This could severely impact the vaping business sector in Ireland and the hundreds of people they employ.”

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Dosage: Dosage:Smoking Smokingcessation: cessation:Gum: Gum:The Thechewing chewinggum gumshould should be be used used whenever whenever there there isis an an urge urge toto smoke smokeaccording accordingtotothe the“chew “chewand andrest” rest”technique technique described described on on the the pack. pack.Not Not more morethan than15 15pieces piecesofofthe thechewing chewinggum gummay maybebeused usedeach eachday. day. Nicorette Nicorette Gum Gum may may be be used usedfor forup uptoto33months monthsduring duringwhich whichtime timethe thehabits habitsassociated associatedwith with smoking will be lost. If not successful after 12 weeks the patient should be encouraged smoking will be lost. If not successful after 12 weeks the patient should be encouragedtoto make make aa fresh fresh attempt attempt toto stop stop smoking. smoking.Inhaler: Inhaler:The Thefrequency frequencyofofuse useshould shoulddepend dependononthe the previous previous smoking smoking habit habit ofof the theindividual. individual.Nicorette NicoretteInhaler Inhalershould shouldbebeused usedwhenever wheneverthe theurge urge to to smoke smoke isis felt, felt, up up toto aa maximum maximumusage usageofof66cartridges cartridgesper perday. day.InInthe thetreatment treatmentofofnicotine nicotine dependence, dependence, aa course course not not exceeding exceeding three three months months isis suggested, suggested,the thepatient patientstopping stopping smoking smoking completely completely atat the the start start ofof the the course. course.Patch: Patch:Light Lightsmokers smokersare arerecommended recommendedtoto start start at at Step Step 22 (15 (15 mg) mg) for for 88 weeks weeksand anddecrease decreasethe thedose dosetotoStep Step33(10 (10mg) mg)forforthe thefinal final4 4 weeks. weeks. Temporary Temporary Abstinence: Abstinence:During Duringperiods periodsofoftemporary temporaryabstinence, abstinence,the thepatient patientshould should use Nicorette Gum or Inhaler when required to relieve nicotine cravings and withdrawal use Nicorette Gum or Inhaler when required to relieve nicotine cravings and withdrawal symptoms. symptoms. Gradual Gradual cessation: cessation: For For smokers smokerswho whoare areunwilling unwillingororunable unabletotoquit quitabruptly. abruptly. Use Use the the gum/inhaler/Lozenge gum/inhaler/Lozenge whenever wheneverthere thereisisaastrong strongurge urgetotosmoke smokeininorder ordertotoreduce reduce the the number number of of cigarettes cigarettes smoked smoked as asfar faras aspossible possibleand andtotorefrain refrainfrom fromsmoking smokingasaslong longasas possible. possible. The The number number ofof cartridges/gums/lozenges cartridges/gums/lozengesisisvariable variableand anddepends dependsononthe thepatient’s patient’s needs. needs. Not Not more more than than 15 15 pieces pieces ofof the thegum, gum,66cartridges, cartridges,15 15lozenges lozengesshould shouldbebeused usedper per day. day. IfIf aa reduction reduction inin number number ofof cigarettes cigarettes per perday dayhas hasnot notbeen beenachieved achievedafter after66weeks, weeks, professional professional advice advice should should be be sought. sought. Reduced Reduced tobacco tobacco consumption consumption should should lead leadtoto complete cessation of smoking. A quit attempt should be made as soon as the number of complete cessation of smoking. A quit attempt should be made as soon as the number of cigarettes has been reduced to a level whereby the smoker feels ready to quit completely, cigarettes been reduced to a levelcessation” whereby as the given smoker feels Combination ready to quit completely, then start has as outlined for “smoking above. therapy then start as patch outlinedand for2mg “smoking cessation” given above. Combination (15mg/10mg gum or Inhaler):as Step 1: The Nicorette Invisi 15mgtherapy Patch (15mg/10mg patch and 2mg gum or Inhaler): Step 1: The Nicorette Invisifor 15mg Patch would be applied daily on waking for 16 hours and removed just before bedtime a total of would be applied daily on waking for 16 hours and removed just before bedtime for a total 8 weeks. The Nicorette 2mg medicated chewing gum or Nicorette Inhaler would be used adof 8 weeks. The the Nicorette 2mg chewing Nicorette where Inhaler he/she would be used libitum when smoker feltmedicated an urge to smokegum or inorsituations feels thatad libitum when the smoker felt an urge to smoke or in situations where he/she feels that breakthrough cravings may occur, up to a maximum of 15 pieces of gum per day or 6 breakthrough cravings may up to8 weeks a maximum of dose 15 pieces of Invisi gum 10mg per day or 6 cartridges per day. Step 2: Afteroccur, the initial the lower Nicorette Patch cartridges day.forStep 2: After initial 8The weeks the lower dose Nicorettechewing Invisi 10mg should be per used a total of 4theweeks. Nicorette 2mg medicated gumPatch or should beInhaler used would for a total of 4adweeks. Nicorette 2mg felt medicated Nicorette be used libitumThe when the smoker an urge chewing to smokegum or inor Nicorette where Inhalerhe/she would feels be used ad libitum when the smoker felt up an tourge to smokeof or situations that breakthrough cravings may occur, a maximum 15in situations where he/she feels that breakthrough cravings may occur, up to a maximum of pieces of gum per day or 6 cartridges per day. Step 3: Use of the Nicorette Invisi Patch should15 pieces of gum perthe day12or week 6 cartridges per program. day. Step The 3: Use of the Nicorette Invisi Patch should be stopped after treatment Nicorette 2 mg medicated chewing be stopped after Inhaler the 12 can weekcontinue treatment program. Nicorette 2 mg medicated chewing gum or Nicorette to be used forThe a further 3 months during which time gumhabits or Nicorette Inhaler continue usedContraindications: for a further 3 months which time the associated withcan smoking willtobebelost. Use during in non-smokers, the habits associated with smoking will be lost. Contraindications: Use in non-smokers,

Use nicotine or or anyany ingredient in the formulation. Children under Useininpersons personshypersensitive hypersensitiveto to nicotine ingredient in the formulation. Children under the Special Warnings andand theage ageofof1212years years(Lozenges) (Lozenges)or orunder under1818years years(Quickmist). (Quickmist). Special Warnings Precautions: smoking outweigh anyany risks associated withwith correctly Precautions:The Thebenefits benefitsof ofquitting quitting smoking outweigh risks associated correctly administered therapy (NRT). A risk-benefit assessment should be be made administerednicotine nicotinereplacement replacement therapy (NRT). A risk-benefit assessment should made bybyananappropriate conditions: - appropriatehealthcare healthcareprofessional professionalforforpatients patientswith withthethefollowing following conditions: Cardiovascular smokers with a recent myocardial infarction, unstable or or Cardiovasculardisease: disease:Dependent Dependent smokers with a recent myocardial infarction, unstable worsening worseningangina anginaincluding includingPrinzmetal’s Prinzmetal’sangina, angina,severe severecardiac cardiacarrhythmias, arrhythmias,recent recent cerebrovascular should be be cerebrovascularaccident, accident,and/or and/orwho whosuffer sufferwith withuncontrolled uncontrolledhypertension hypertension should encouraged non-pharmacological interventions (such as as counselling). If If encouragedtotostop stopsmoking smokingwith with non-pharmacological interventions (such counselling). this butbut asas data onon safety in this patient group areare thisfails, fails,Nicorette NicoretteGum Gummay maybebeconsidered considered data safety in this patient group limited, andand hepatic limited,initiation initiationshould shouldonly onlybebeunder underclose closemedical medicalsupervision. supervision. Renal Renal hepatic impairment: with moderate to to severe hepatic impairment and/or impairment:Use Usewith withcaution cautionin inpatients patients with moderate severe hepatic impairment and/or severe or or its its metabolites may be be decreased severerenal renalimpairment impairmentasasthetheclearance clearanceof ofnicotine nicotine metabolites may decreased with the potential for increased adverse effects Gastrointestinal Disease: Nicotine maymay with the potential for increased adverse effects Gastrointestinal Disease: Nicotine exacerbate oesophagitis, gastric or or peptic ulcers andand exacerbatesymptoms symptomsin inpatients patientssuffering sufferingfrom from oesophagitis, gastric peptic ulcers NRT with caution in in these conditions andand NRTpreparations preparationsshould shouldbebeused used with caution these conditionsPhaeochromocytoma Phaeochromocytoma uncontrolled both NRT andand smoking, causes thethe release of of uncontrolledhyperthyroidism. hyperthyroidism.Nicotine, Nicotine, bothfrom from NRT smoking, causes release catecholamines Therefore, Nicorette should be be used withwith caution catecholaminesfrom fromthetheadrenal adrenalmedulla. medulla. Therefore, Nicorette should used caution ininpatients with uncontrolled hyperthyroidism or pheochromocytoma. Diabetes Mellitus. patients with uncontrolled hyperthyroidism or pheochromocytoma. - Diabetes Mellitus. Patients to to monitor their blood sugar levels more Patientswith withdiabetes diabetesmellitus mellitusshould shouldbebeadvised advised monitor their blood sugar levels more closely andand NRT is initiated, as as reductions in nicotinecloselythan thanusual usualwhen whensmoking smokingis isstopped stopped NRT is initiated, reductions in nicotineinduced catecholamine release can affect carbohydrate metabolism. Patients with diabetes induced catecholamine release can affect carbohydrate metabolism. Patients with diabetes mellitus of of insulin asas a result of of smoking cessation. - Smokers whowho mellitusmay mayrequire requirelower lowerdoses doses insulin a result smoking cessation. - Smokers wear in in chewing Nicorette Gum. TheThe chewing gum maymay weardentures denturesmay mayexperience experiencedifficulties difficulties chewing Nicorette Gum. chewing gum stick dentures. dependence: Nicotine in any stickto,to,and andmay mayin inrare rarecases casesdamage damage dentures.Transferred Transferred dependence: Nicotine in any dose a dependence syndrome after chronic useuse andand is highly toxic doseform formis iscapable capableofofinducing inducing a dependence syndrome after chronic is highly toxic after Nicorette Gum is ais rare side-effect andand is both afteracute acuteuse. use.However, However,dependence dependencewith with Nicorette Gum a rare side-effect is both less harmful and easier to break than smoking dependence. Danger in children: Doses of of less harmful and easier to break than smoking dependence. Danger in children: Doses nicotine children thatthat maymay be be fatal. nicotinetolerated toleratedbybysmokers smokerscan canproduce producesevere severetoxicity toxicityin in children fatal. Products where they may be be handled or or ingested by by Productscontaining containingnicotine nicotineshould shouldnotnotbebeleftleft where they may handled ingested children. Nicorette Inhaler should be used with caution in smokers with chronic throat children. Nicorette Inhaler should be used with caution in smokers with chronic throat diseases and bronchospastic disease. Nicorette Inhaler should be used with caution in diseaseswith andchronic bronchospastic disease. Inhaler should used with smokers throat diseases andNicorette bronchospastic disease be Nicorette Invisicaution Patch in smokers with chronic throat diseasesanyand bronchospastic disease Invisi Patch should be removed prior to undergoing Magnetic Resonance ImagingNicorette (MRI) procedures prior to undergoing Effects: any Magnetic (MRI) procedures toshould preventbetheremoved risk of burns. Undesirable EffectsResonance of SmokingImaging Cessation: Regardless prevent risk aofvariety burns.ofUndesirable Effects: of Smokingwith Cessation: oftothe meansthe used, symptoms are knownEffects to be associated quitting Regardless habitual of the means used,include a variety of symptoms are known to be associated with quitting habitual tobacco use. These emotional or cognitive effects such as dysphoria or depressed tobacco use. These include frustration emotional or effects such as dysphoria or depressed mood; insomnia; irritability, or cognitive anger; anxiety; difficulty concentrating, and mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, restlessness or impatience. There may also be physical effects such as decreased heart rate;and restlessness or impatience. Theredizziness may alsoorbepresyncopal physical effects such ascough, decreased heart rate; increased appetite or weight gain, symptoms, constipation, increased appetite weight gain, dizziness or presyncopal symptoms, constipation, gingival bleeding or oraphthous ulceration or nasopharyngitis. In addition,cough, and of clinical gingival bleeding aphthousmay ulceration nasopharyngitis. addition,Adverse and of Drug clinical significance, nicotineor cravings result inor profound urges toIn smoke. significance,Nicorette nicotine may cravings in profound urges to smoke. Drug Reactions: causemay doseresult dependent adverse reactions similarAdverse to those Reactions:withNicorette may cause by dose similar those associated nicotine administered otherdependent means andadverse are dosereactions dependent. Most to of the associatedeffects with nicotine by other are dose dependent. Most of the undesirable reportedadministered by the subjects occurmeans during and the early phase of treatment. Gum: undesirable effects reported by the subjects occur during the early phase of treatment. Gum:

Immune System Disorders: Hypersensitivity - Common Anaphylactic reaction - Not- Not known. Immune System Disorders: Hypersensitivity - Common Anaphylactic reaction known. Nervous System Disorders: - Very Common, Burning sensation, Dysgeusia, Nervous System Disorders:Headache Headache - Very Common, Burning sensation, Dysgeusia, Paraesthesia – Common. EyeEye Disorders: Blurred Vision, Lacrimation increased – Common. Paraesthesia – Common. Disorders: Blurred Vision, Lacrimation increased – Common. Cardiac Disorders: Palpitations, Tachycardia - Not known. Vascular Disorders: Flushing, Cardiac Disorders: Palpitations, Tachycardia - Not known. Vascular Disorders: Flushing, Hypertension – Uncommon. Respiratory, Thoracic and and Mediastinal Disorders: Cough, Throat Hypertension – Uncommon. Respiratory, Thoracic Mediastinal Disorders: Cough, Throat irritation - Very common. Bronchospasm, Dysphonia, Dyspnoea, Nasal Congestion, Sneezing, irritation - Very common. Bronchospasm, Dysphonia, Dyspnoea, Nasal Congestion, Sneezing, Throat tightness – Uncommon. Gastrointestinal Disorders: Hiccups, Nausea - Very common. Throat tightness – Uncommon. Gastrointestinal Disorders: Hiccups, Nausea - Very common. Abdominal pain: Dry Dry mouth, Dyspepsia, Flatulence, Salivary hypersecretion, Abdominal pain:Diarrhoea, Diarrhoea, mouth, Dyspepsia, Flatulence, Salivary hypersecretion, Stomatitis, Vomiting – Common. Eructation Glossitis, OralOral mucosal blistering and and exfoliation, Stomatitis, Vomiting – Common. Eructation Glossitis, mucosal blistering exfoliation, Paraesthesia oraloral – Uncommon. Dysphagia, Hypoaesthesia oral,oral, Retching – Rare. Dry throat, Paraesthesia – Uncommon. Dysphagia, Hypoaesthesia Retching – Rare. Dry throat, Gastrointestinal discomfort Lip Lip painpain - Not known. SkinSkin and and Subcutaneous Tissue: Gastrointestinal discomfort - Not known. Subcutaneous Tissue: Hyperhidrosis, Pruritus, Rash, Urticaria Disorders – Uncommon. Erythema Not known. Hyperhidrosis, Pruritus, Rash, Urticaria Disorders – Uncommon. Erythema - Not known. Musculoskeletal andand Connective Tissue Disorders: PainPain in jaw – Uncommon. Muscle Musculoskeletal Connective Tissue Disorders: in jaw – Uncommon. Muscle tightness - Not known. General Disorders andand Administration Site Site Conditions: Fatigue – – tightness - Not known. General Disorders Administration Conditions: Fatigue Common. Asthenia, Chest discomfort andand pain,pain, Malaise – Uncommon. Allergic reactions Common. Asthenia, Chest discomfort Malaise – Uncommon. Allergic reactions including angioedema - Rare. Inhaler: Immune system disorders: Common – Hypersensitivity. including angioedema - Rare. Inhaler: Immune system disorders: Common – Hypersensitivity. NotNot known - Anaphylactic reaction Nervous system disorders VeryVery common Headache known - Anaphylactic reaction Nervous system disorders common Headache Common Burning sensation Dysgeusia Paraesthesia Eye Eye disorders Not Not known Blurred visionvision Common Burning sensation Dysgeusia Paraesthesia disorders known Blurred Lacrimation increased Cardiac disorders Uncommon Palpitations Tachycardia Vascular Lacrimation increased Cardiac disorders Uncommon Palpitations Tachycardia Vascular disorders Uncommon Flushing Hypertension Respiratory, thoracic and mediastinal disorders disorders Uncommon Flushing Hypertension Respiratory, thoracic and mediastinal disorders VeryVery common Cough Throat irritation Bronchospasm Dysphonia Dyspnoea NasalNasal congestion common Cough Throat irritation Bronchospasm Dysphonia Dyspnoea congestion Sneezing Throat tightness Gastrointestinal disorders Very common Hiccups Nausea Common Sneezing Throat tightness Gastrointestinal disorders Very common Hiccups Nausea Common Abdominal painpain Diarrhoea DryDry mouth Dyspepsia Flatulence Salivary hypersecretion Stomatitis Abdominal Diarrhoea mouth Dyspepsia Flatulence Salivary hypersecretion Stomatitis Vomiting Uncommon Eructation Glossitis OralOral mucosal blistering and and exfoliation. Paraesthesia Vomiting Uncommon Eructation Glossitis mucosal blistering exfoliation. Paraesthesia oraloral Rare Dysphagia Hypoaesthesia oraloral Retching Not Not known Dry Dry throat Gastrointestinal Rare Dysphagia Hypoaesthesia Retching known throat Gastrointestinal discomfort Lip Lip painpain SkinSkin andand subcutaneous disorder Uncommon Hyperhidrosis Pruritus RashRash discomfort subcutaneous disorder Uncommon Hyperhidrosis Pruritus Urticaria NotNot known Angioedema Erythema Muscoskeletal and and connective tissue disorders Urticaria known Angioedema Erythema Muscoskeletal connective tissue disorders . Uncommon PainPain in jaw NotNot known Muscle tightness General disorders and and administration . Uncommon in jaw known Muscle tightness General disorders administration sitesite conditions Common Fatigue Uncommon Asthenia Chest discomfort and and painpain Malaise. conditions Common Fatigue Uncommon Asthenia Chest discomfort Malaise. Patch: Immune system disorder Uncommon Hypersensitivity Rare Anaphylactic reaction Patch: Immune system disorder Uncommon Hypersensitivity Rare Anaphylactic reaction Nervous system disorder Common Headache Uncommon Paraesthesia Cardiac disorders Nervous system disorder Common Headache Uncommon Paraesthesia Cardiac disorders Uncommon Palpitations Tachycardia Vascular disorders Uncommon Flushing Hypertension Uncommon Palpitations Uncommon Hypertension Respiratory, Thoracic and Tachycardia Mediastinal Vascular Disordersdisorders Uncommon DyspnoeaFlushing Gastrointestinal Respiratory, Thoracic Mediastinal Disorders Uncommon Gastrointestinal disorders: Common Nauseaand Vomiting Rare Gastrointestinal discomfortDyspnoea and/or pain Skin and disorders: Common Nausea Very Vomiting Rare Pruritus Gastrointestinal and/orUncommon pain Skin and subcutaneous tissue disorders common Commondiscomfort Rash Urticaria subcutaneous disorders Very common Pruritus Common Rash Tissue UrticariaDisorders Uncommon Hyperhidrosis Raretissue Angioedema Erythema Musculoskeletal and Connective Hyperhidrosis RareRare Angioedema and and Connective Tissue Disorders Uncommon Myalgia Pain in Erythema extremity Musculoskeletal General disorders administration site Uncommon MyalgiaApplication Rare Painsiteinreactions extremity General disorders andand administration conditions: Uncommon Asthenia Chest discomfort pain Malaise site conditions: Uncommon Application Holder: site reactions Asthenia Chest (Ireland) discomfort and pain Malaise Fatigue. Marketing Authorisation McNeil Healthcare Limited, Airton Fatigue. Marketing Authorisation Holder: McNeil Healthcare (Ireland) Limited, Airton Road, Tallaght, Dublin 24, Ireland. Marketing Authorisation Number: PA 823/49/1-4, Road,21,Tallaght, Dublin Marketing Authorisation PA 823/49/1-4, 14-15, 22, 24-25, 26. 24, DateIreland. of Revision of the Text: July 2015 Number: (Gum) November 2015 14-15, 21, 22, 24-25, 26. Date of Revision of the Text: July 2015 (Gum) November (Nicorette Icy White Gum). March 2016 (Inhaler, 15mg and 10mg Patch). Legal Category:2015 (Nicorette Icy White Gum). March 2016 (Inhaler, 15mg and 10mg Patch). Products not subject to medical prescription. Further information available uponLegal requestCategory: from Products not subject to medical Johnson & Johnson (Ireland) Ltd. prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd. IRE/NI/16-1864a IRE/NI/16-1864a

Feature

Winter skincare to boost sales The skin is the body’s largest organ. Nevertheless, the importance of its functional role is often underestimated, and its care is taken for granted. Establishing a skin care regimen is important to maintain healthy, hydrated skin, and incorporating preventive measures can help reduce or eliminate exacerbating conditions that may make unprotected skin more susceptible to dermatologic problems. Community Pharmacists receive frequent requests for information about various skin care products available for cleansing, moisturising, and protecting the skin. As accessible health care professionals, Pharmacists are in a key position to educate patients about appropriate skin care, especially the necessity of using moisturisers several times a day to improve the skin’s appearance and texture and sustain its protective function. To understand the importance of moisturising the skin and factors that may make the skin more susceptible to dryness, Pharmacists must be familiar with the skin’s physiology. Such knowledge allows you to make appropriate recommendations to patients about skin care products. Winter plays havoc with skin and lips, especially for customers with conditions such as eczema, rosacea and psoriasis. As Pharmacists, there is nothing much you can do about the weather. Lower humidity in the atmosphere and central heating combine to dry out skin and damage its protective barrier layer. It is important to recognise this as you can offer a point of difference and help increase customer loyalty with good advice. It is important that all your staff are well trained on the variety of different skin conditions that are more prevalent in winter. These skin conditions differ from those in the summer months. It is vital that staff know what are the common conditions, and what advice to give to customers. Most people experience dry skin in the winter because during this time, skin doesn’t produce enough moisture to compensate for the drier air and lack of moisture. If dry skin is neglected, it can become red, flaky and itchy. Dry skin patches can develop into a more serious inflammation called dermatitis; and once the protective skin is disrupted by dermatitis, the skin is more susceptible to bacterial, yeast or fungal infections and allergic reactions on the skin. The most common conditions which tend to worsen during the winter months are eczema, dry skin and psoriasis. Patients may find that rosacea flares up in the

winter, those will acne may suffer too. Front of shop is a key factor make sure that you have a clear and prominent skincare fixture. The average skincare category accounts for less than 5% of total OTC space. Make this space work for you, ensure that the range stocked provides maximum return as well as offering customers a range of skincare solutions. Consider the layout of your Pharmacy and ensure that skincare brands are unobstructed and visible to customers. Customers often search for a solution for their condition, so signposting products for eczema, psoriasis and rosacea specifically will help shop them navigate the shelves easily. Consider grouping relevant seasonal categories together, such as cold and flu with dry skin, to help with in-store navigation. CONDITIONS Eczema Eczema is the general term used for several skin conditions but it more often refers to atopic dermatitis, which causes a dry and itchy red rash on the skin. Scratching the skin can cause it to ooze and form crusts or bleed. There is no known cure for eczema but treatments to relieve itching and control symptoms are available. Corticosteroids

and immuno-suppressants can be used for chronic sufferers. Emollient therapy and a good daily skin care routine is to be recommended for less severe cases. Dry Skin Dry skin affects millions of people and is especially common in children under 10 and people over 60. Between these ages significantly more women than men suffer from dry skin. Dry skin can be particularly uncomfortable during the winter months. For customers with dry skin, there are a variety of treatments available which can complement each other, such as emollients and bath preparations as well as creams. If the customer has dry skin, don’t use harsh, alcoholbased products as these can irritate skin and dry it out. If they have oily skin, avoid oil-based products and choose water-based ones instead. If the skin is red or inflamed, apply a cool compress or an over-thecounter hydrocortisone cream on the area for a week. If these don’t provide relief, the patient should be referred to a doctor. Psoriasis Psoriasis is a dry skin condition, it is important to keep it wellmoisturised. Emollients and moisturisers can help in several ways, including reducing itching

and scaling of the skin. There is also evidence that certain topical treatments work better on wellmoisturised skin, although at least half an hour should be left between applying an emollient and another topical treatment. Water and ‘detergents’ such as shower gel and bubble bath can dry the skin out, so some customers might find benefit from using an ‘emollient cleanser’ instead during the winter months. Rosacea Rosacea is a common, lasting skin condition. Its symptoms are usually patchy redness and inflammation, especially on the cheeks, nose, forehead, and chin. It often starts between the ages of 30 and 50 and affects more women than men. Rosacea is typically experienced year round with additional flare ups in winter. This is due to the drying effects of the season. Cold winds on exposed skin can aggravate these conditions. Strong heat in buildings and at home can aggravate rosacea and cause dryness of the skin for sufferers. Moisturing and gentle cleansing are extremely important for skin with rosacea. For very dry skin, a creamy, low-foaming non-soap, fragrance-free cleanser may be ideal, as these types of formulas often leave behind a thin film that helps skin hold moisture.

Y For Co ug h AN AT HOME syrup

ON THE GO pastilles

Buttercup Bronchostop Cough Syrup contains thyme herb extract and marshmallow root extract. A traditional herbal medicinal product for the relief of coughs, such as chesty, dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use. Adults and children over 12 years: 15ml every 4 hours. Max dose 90ml per day. Not recommended for children under 12 years. Seek medical advice if symptoms persist after 7 days or if dyspnoea, fever or purulent sputum occurs. Contraindications: Known hypersensitivity to ingredients, rare hereditary intolerance to some sugars. Caution: Contains methyl parahydroxybenzoate and propyl parahydroxybenzoate, which may cause allergic reactions. Side effects: Stomach disorders. TR 2006/1/1. TR Holder: Kwizda Pharma GmbH, Effingergasse 21, A-1160 Vienna, Austria. RRP (ex.VAT) 120ml €6.99 200ml €9.99 SPC: www.medicines.ie/medicine/16380/SPC/ Buttercup+Bronchostop+Cough+Syrup Buttercup Bronchostop Berry Flavour Cough Pastilles contain thyme herb extract. A traditional herbal medicinal product for the relief of coughs, such as chesty, dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use. Adults and children over 12 years: 1 - 2 pastilles every 4 hours. Max dose 12 pastilles per day. Not recommended for children under 12 years. Seek medical advice if symptoms persist after 7 days or if dyspnoea, fever or purulent sputum occurs. Contraindications: Known hypersensitivity to ingredients, rare hereditary intolerance to some sugars. Caution: Contains 0.6 g fructose per 2 pastille dose – to be taken into consideration in those with diabetes mellitus. Side effects: Stomach disorders. TR 2006/1/2. TR Holder: Kwizda Pharma GmbH, Effingergasse 21, A-1160 Vienna, Austria. RRP (ex. VAT) 10s €3.99 20s €5.99 SPC: www.medicines.ie/ medicine/16381/SPC/ Buttercup+Bronchostop+Berry+Flavour+Cough+Pastilles/

Review: CPD Journey

CPD – Log it, or Lose it Regardless of our individual career path, we are always learning, and seeking out information. We identify and fill gaps in knowledge highlighted through our everyday work routine. Pharmacists working in Ireland are required to formally record learnings which enhance their practice. the CPD cycles, a Pharmacist can gain a full understanding and record of their work. Saying you have done your CPD does not make it so. ‘Log it or lose it’ suggests we rethink the value and scope of the ePortfolio. Can we view the tool as an opportunity to meet PSI requirements but also a complete digital record of our learning?

Continuing professional development (CPD), ensures that all registered Pharmacists comply with this expectation. ‘Every Pharmacist shall on a regular basis carry out a selfassessment of his or her learning needs, having regard to the Core Competency Framework for Pharmacists, with a view to identifying learning activities appropriate to the needs of his or her professional practice.’ (PSI, 2015, Pharmaceutical Society of Ireland (continuing professional development) rules; S.I. No. 553 of 2015).

In this editorial, I question whether the ePortfolio as a tool is being maximised, and the benefits acknowledged? Are Pharmacists logging their daily CPD efforts? I suggest that failing to do so can result in a loss of profit from that work. CPD works on the premise of self-reflection.

CPD can ensure Pharmacists are up to date on relevant information, technical progress and legislative change, ‘with a view to protecting, maintaining and promoting the health and safety of the patient’. (PSI, 2015, Pharmaceutical Society of Ireland (continuing professional development) rules; S.I. No. 553 of 2015).

The hard work is done, the knowledge sought out. I posit that the ePortfolio as a tool can facilitate the complete immersion into the learning. By bringing the material through the journey of

The Irish Institute of Pharmacy (IIOP) has been established to oversee the development and management of the CPD system in Ireland. It provides a support system to help Pharmacists meet their requirements. This includes peer groups, training and information. The online ePortfolio tool provided by the IIOP facilitates the recording of CPD. This is available via login, to all registered Pharmacists.

If the efforts are not logged is the learning absorbed? If not absorbed will it be implemented to the point of improving practice?

One could suggest that community Pharmacists exist in a learning environment which offers a plethora of CPD opportunity. Pharmacists read PIL leaflets when dispensing new drugs. They discuss unfamiliar illnesses with patients and GP’s at length. They read articles in Pharmacy publications. Where a Pharmacist can identify and outline that their actions have enhanced their practice it counts as CPD. Over the last number of months our company has offered CPD webinars with 4front.ie and in-house training sessions to Pharmacists. Feedback suggests there is still a percentage of Pharmacists who have not started to log their CPD using the ePortfolio. We can question why this useful tool is not harnessed to keep a full record. Is there a misconception that CPD must be sought out via official training courses? Is the self- driven and reflective task de-prioritised on the list of

abundant daily duties which form a large part of a Pharmacists day? Do we assume the entire Pharmacist population is tech savvy and confident in using online programs? Feedback submits that a fear exists around the online system. Some expressed a worry around the privacy of the material entered. Others articulated their discomfort with working online, saying they did not feel at ease navigating it. Confidence levels appeared to increase when people attended a webinars. This suggests Pharmacists should actively seek out helpful resources to take away the mystery and fear, and help them get started. “I wanted to become familiar with the Irish CPD system because this is a professional skill for life. At the end of the call I don’t fear CPD anymore, feel 9/10 confident I can do this and how I can implement CPD into my day” (Webinar Attendee – What counts as CPD and how to fit it into our day delivered by Rachel Dungan) When we spoke to Locums they reported they found it more difficult but equally important to keep on top of recording CPD. On a practical level Locums often spend more time commuting from Pharmacy-toPharmacy. A Locum must work closely with the host Pharmacy team throughout a shift to understand and meet the needs of unfamiliar patients. This leaves little time for reflective thinking. Working in a transient role was also reported to offer less meaningful exposure to non-clinical CPD opportunity. ‘I find it hard to get the time to log my CPD. This is my biggest challenge as a Locum. I do not want to go online during my locum shift as I am there to do a job. I have made a start though and try to do a little bit when I can.’ (Pharmaconex Locum). From our experience with CPD we believe it is vital

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As part of our commitment to provide highly skilled & quality candidates, and to support our Locum Pharmacists we offer a host of extras. CPD Webinars: We have partnered with Rachel Dungan from 4front.ie to help Pharmacists get their CPD off the ground and continuously develop their skill-set.

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Live CPD Sessions: Join us in our Dublin ofﬁces for free clinical CPD courses. Dispensing Systems Training: Ensure you are equipped to tackle any system with our comprehensive training on McLernons, TouchStore & QicScript. Locum Heroes: We want to reward Locum triumphs by offering a €250 meal voucher, once a quarter to a Locum who is highlighted to have exceeded expectation. (T&C’s Apply)

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Review: CPD Journey that Pharmacists continue to raise the standards, regardless of their work style. Pharmacists are knowledgeable and trusted healthcare professionals. The pursuit of CPD only cements that perception among the communities they serve. LinkedIn, the popular professional networking site offers the ability to record your work history in real-time. A clear benefit of the platform is the redundant necessity to keep track of our career time-line. We can consider the ePortfolio in a similar way. It presents a unique opportunity to keep a live record of your learning achievements. The ePortfolio is a digital record which can be accessed at any time and from any location. Logging the information through the CPD cycle process helps to organise the material and encourages reflection of the learning outcomes. There is one key difference. A LinkedIn profile is public while your ePortfolio is private until you decide to export cycles for review. Aside from the ePortfolio review we believe this tool can be viewed as a real chance to keep track and take pride in all the great work you do to enhance your Pharmacy practice. This stored information fulfils PSI requirements but also becomes a reference point and memory bank. Log it or Lose it…so what are the benefits of logging your CPD on the ePortfolio on a regular basis? An up-to-date Live Record Like recording your work history in detail on LinkedIn, the ePortfolio gives you the chance to store your ‘learning history’. This digital record then becomes a memory bank of all that has been achieved. The tool itself acts as a reference point when it comes to self-reflection or review of your current situation.

Focus Pharmacists are busy people. A full day can pass by quickly when talking to patients. There is little time for self-reflection throughout the day. Logging learnings that evening can ensure they are not forgotten. Setting aside a little time can also guarantee that you identify all items you have learned which count toward CPD. In some cases, a person might have progressed their CPD more than they realise during the working day. Yet, if this reflection period and time to log is not given they may lose the gain. When the information is recorded formally it is easier to distinguish outstanding areas or knowledge gaps. This allows you to seek out knowledge with focus. Fulfil PSI Requirements The ePortfolio is not going away and the spotlight on this practice may intensify after findings from the review. The ePortfolio is designed to improve patient care. I have yet to meet a Pharmacist who did not rank this with the utmost importance. If one can look beyond the necessity to complete this task it will make room to see the huge benefit it has to offer. Pharmacists can engage with a multitude of support resources like webinars, information evenings, training sessions, websites such as the PSI and IIOP and employers. There is ample occasion to fully understand and engage with CPD. Logging the information learned must come next. Once the Pharmacist begins to log they are fulfiling their obligation but also enhancing their ability to care for patients with an extra confidence. In a busy day how can we make time to log our CPD? Time is always a challenge. We don’t always finish working when we leave work. Other

commitments such as family and extra-curricular activities mean there is very little time left in the evenings. Logging onto a computer can be the last thing we want to do. Below we offer some suggestions on ways to get around the time crunch and ensure your CPD endeavours are logged, not lost. Keep a notebook Keep a small notebook in your bag. If you have been exposed to a CPD opportunity or have identified a gap in knowledge jot it down quickly. You don’t need to write the detail. Just write down some keywords which can jog your memory later when you have the time to log it properly. Keep the ePortfolio open on your phone and desktop Keeping the software open on your mobile phone and desktop will make it available to you for quick entries during your commute or working day. Schedule a re-occurring appointment with the ePortfolio in your calendar Is there an evening during the week you have some spare time? Does the weekend work best for you? Try to set a regular

Like recording your work history in detail on LinkedIn, the ePortfolio gives you the chance to store your ‘learning history’.

time slot for logging CPD. If you commit to this time by placing it in your calendar you are more likely to stick to it. Keep distractions to a minimum so you can focus on getting the best from the time. Can’t find a regular calendar time? Jot it down and tidy later Making a start is better than nothing. If you can’t seem to find a set time to work on your ePortfolio take time where you can. Jot everything down to ensure nothing is forgotten. If you do not have time to perfect it or complete the cycle go back to it later and tidy it up. Getting the information down will clear more brain space for extra CPD. Meet with peers to discuss findings Peers can offer great support to each other. Meet for a coffee to question findings, compare logging methods or talk through where you accessed your CPD and how it helped your practice. Everyone can learn from group discussion and support. In summary I suggest the ePortfolio is not just a necessary legal task, but an opportunity to hold a digital record of development and learning throughout your Pharmacy career. A tool to help you truly absorb and engage with your learnings, and a mechanism for identifying gaps. When used to the maximum you can ensure you don’t lose out on the benefits of pro-active learning. In essence, log it or lose it. Norabeth Hogan is the Marketing and Communications Manager with PharmaConex Ltd.

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Review: Brexit

Brexit and the implications for Irish Pharmacy

It is fair to say that the outcome of the UK ‘Brexit’ referendum has created a huge amount of uncertainty London Since was selected as theQuintilesIMS headquarters theactive Pharmaceutical for the EU andFurthermore, for Ireland in particular. the referendum havefor been in trying to division understand how this decision will impact the pharmaceutical sector. In this article we will try to highlight Unified Patent Court and that may no longer materialise with Italy for one, publically b some of the key issues and how they might impact the Irish pharmacy sector.

for Milan to become the new alternative location.

The uncertainties for the pharmaceutical industry post-Brexit can be examined under the following four banners; trade, regulatory, scientific and commercial.

border prescription. Following this

some time the UK market has been predominantly an import market. In 2015, the UK bought ¤36.4 billion worth of pharmaceuticals, ¤3.5 billion of which came from Ireland.

industry because so much of the legal, regulatory and policy infrastructure is at a Europe or a European Union level. There will be some international agreements, such as the Falsified Medicines Directive, which have been forged at a European rather than an EU level and which we therefore expect to continue in its current form. The case for the European Patent convention, is also at a broader European level.

EMA is a decentralised agency of

the pharmaceutical industry. He

has accentuated the strong the consider European Union, located in legislation is enacted A final pointlogic, onif no regulation, we must the process of also data and information tr London. The Agency is responsible support which the Irish medicines then prescriptions from Britain and for the scientific evaluation, regulator – the Health Ireland will no longer be post-Brexit.Northern This has major implications for multinational businesses withProducts a footprint i supervision and safety monitoring Regulatory Authority – would be legally valid in Ireland or any other of medicines developed to provide to thewith EMA. locations country. the EU and EU UK, for multinational pharmacy chainsbyand for able pharmacies pharmaceutical companies for use Trade: A key consideration that is of Ireland As part ofon the Government’s Regulatory and Northern Ireland, in the EU. The republic as EMA wellheadquarters as implications data transfer in re likely to have a significant impact is efforts, an interdepartmental group have to be in an EU country and the question of tradeto agreements will have a significant impact including the Department of the therefore Brexit will most likely scientific Brexit research and development. between the UK and the EU. For on the UK’s pharmaceutical Taoiseach, Department of Health, necessitate a move from London.

On 25th October 2016, Minister for Health, Simon Harris, confirmed that Ireland will formally bid to host the EMA post-Brexit. Minister Harris said, “The Irish Government believes that Dublin would be a very suitable location and that a move to the Irish capital would minimise the disruption to the business of the EMA, thus ensuring continued protection of EU citizens and providing reassurance to the industries which it regulates.” Minister Harris highlighted that Dublin was an English-speaking location and that English was the working language of the EMA and

Department of Foreign Affairs and Trade, Department of Jobs, Enterprise & Innovation, Health Products Regulatory Authority, IDA Ireland, Science Foundation Ireland, and the Health Research Board is expected to produce a detailed proposal to promote Dublin as the new location for the EMA by early 2017.

Scientific: The pharmaceutical industry relies intensely on international scientific effo collaboration. For Britain, the question of scientific capital, both financial and human c must now be considered. Key medium to long term concerns for pharma are the po loss of scientific funding, potential impact on movement of The scientists and other highly Irish Pharmaceutical For Ireland, Brexit has a significant Healthcare Association (IPHA) have personnel, and possible barriers to scientific collaboration. Currently about 16% impact on the supply chain and also come out in support of such increased parallel trading from However, key regulatory elements a move. CEO, Oliver O’Connor the UK and NorthernUniversity Ireland in funding e.g. Horizon 2020, comes from the EUstated butthatthis funding for scie will be directly affected. Of these, “IPHA looks forward to the short term. The EUR / GBP collaborating with the Government the European Medicines Agency currency exchange rate has universities and start-up companies is now under threat. TheandUK also risks becoming det the relevant state agencies (EMA) is the most prominent. The been shown to correlate with import-export rates.from In Irelandother important aspects of scientific infrastructure. For Ireland in particular, In the short term, a key issue for the UK is potential medicine shortages, as increasing costs and the weakened pound sterling impact local UK supply.

approximately 7% of retail pharmaceutical market is parallel traded, largely from UK.

Short term the weakened pound sterling has resulted in a significant increase in parallel importing from the UK. However given the ongoing fluctuations in exchange rates this is a constantly changing area. That said, if “Brexit means Brexit” then circumstances may change entirely and new trade agreements with Britain will need to be agreed before any trading whatsoever can continue between Ireland and the UK. Furthermore, in terms of the packaging of pharmaceuticals many packs are dual pack registered (DPR) – identical in the UK and Ireland – and there will be a need for regulatory realignment of these packs. Most notably for pharmacy, a prescription written by a doctor in any EU country is valid in all EU countries and is known as a cross

border funding between the UK or Northern Ireland and the Republic of Ireland could significant difficulties and may impede scientific research and collaboration. Notwithsta

The UK is a global leader in Health Technology Assessment and Real World Data collection and use. Housing the headquarters of some of the world’s largest pharmaceutical companies it is an extremely important European and global centre for research and development regulation and healthcare technology assessment. These assets may be at risk following the to ensure that we maximise our efforts to get this prestigious EU institution re-located to Dublin.” Another consideration is that major Japanese pharmaceutical companies have highlighted their desire to be closely aligned to the EMA. They warned that an EMA relocation could force Japanese companies to reexamine their business activities in the British capital. If Ireland were to win the EMA bid, key stakeholders such as these may also move to Dublin. However a move to Dublin is far from a certainty with Austria, Denmark, France, Germany, Hungary, Italy, Malta, Poland, Spain and Sweden all competing to house the Agency. The cost of this relocation must also be considered as the new host country may have to contribute UK referendum decision and the commercial to the cost of breaking the EMA’s lease in central London, may be vulnerable in the mid to long term. at ¤19.4 million.

attractiveness of the UK pharmaceutical marke

for launch may be re-assessed registered in Ireland from the EU, 16% of UK University funding e.g. Additionally, EU level networks in Given the already hardening environment for access, the traditionally high priority of the UK many of whom were from the UK. and the UK risks becoming less Horizon 2020, comes from the the UK on pharmacovigilance and attractive as an early launch EU but this funding for science Health Technology assessment for launch may be re-assessed and the UK risks becoming less attractive as anbase. early launch Also, as with other third-level country or as a corporate in universities and start-up (HTA) now face uncertainty. The courses, students who wish to companies is now under threat. country or as a corporate base. study pharmacy abroad may have In conclusion, Brexit has led to a European Network of Centres The UK also risks becoming for Pharmacoepidemiology and to pay very costly non-EU fees huge degree of uncertainty and detached from other important Pharmacovigilance (ENCePP), to study pharmacy in Britain and will pose significant challenges aspects of scientific infrastructure. also based in London, is a Northern Ireland in the future. for Ireland. However within the For Ireland in particular, cross network coordinated by the EMA, pharmaceutical sector there border funding between the aimed at developing standards Commercial are some opportunities these UK or Northern Ireland and the for pharmacovigilance and opportunities could help in Republic of Ireland could cause 4 pharmacoepidemiology According to QuintilesIMS global mitigating against the negative significant difficulties and may data, the UK is currently 3% of impacts of the UK’s decision to impede scientific research and Furthermore, London was all global market value and all leave the EU. collaboration. Notwithstanding selected as the headquarters global market value growth for the potential cross border funding for the Pharmaceutical division prescription medicines. However, issue is there an opportunity of the Unified Patent Court and as a developed market economy for Ireland to become a more that may no longer materialise with with a sophisticated healthcare significant contributor in the area of Italy for one, publically bidding system, it is more important to the clinical research? Can Pharmacy for Milan to become the new launch of new chemical entitles About QuintilesIMS play a role in research particularly alternative location. than that 3% suggests, and it in the area of Real World Evidence QuintilesIMS is a leading integrated is also a more important information and technologyA final point on regulation, we must data collection? contributor to the growth of enabled healthcare service provider consider the process of data and speciality medicines. Going forward, a key negotiating worldwide, dedicated to helping information transfer post-Brexit. point between the UK and the rest its clients improve their clinical, This has major implications for After the US and Germany, the of the EU will be free movement of scientific and commercial results. multinational businesses with UK had the highest number of people. Restrictions on freedom of Formed through the merger a footprint in both the EU and new chemical entities launched movement are entirely conceivable of Quintiles and IMS Health, UK, for multinational pharmacy from 2010-2014 and it is seen and could impact the ability of QuintilesIMS employs 50,000 chains and for pharmacies with globally as an attractive launch scientists to live and work in the people across the globe, including locations in the republic of Ireland country for pharmaceuticals. The UK and move freely from the 3,500 people in the UK and and Northern Ireland, as well as UK is a global leader in Health UK to the EU. Uncertainty over Ireland and conducts operations implications on data transfer in Technology Assessment and immigration and a weakening in more than 100 countries. relation to scientific research Real World Data collection and currency may also make recruiting Companies seeking to improve and development. use. Housing the headquarters and retaining employees from the real-world patient outcomes and of some of the world’s largest EU problematic for the UK. enhanced clinical trial outsourcing Scientific pharmaceutical companies, it is through treatment innovations, an extremely important European The EU also supports the The pharmaceutical industry relies care provision and access can and global centre for research coordination of many intensely on international scientific leverage QuintilesIMS’ broad and development, regulation public health initiatives and effort and collaboration. For range of healthcare information, and healthcare technology cross-border cooperation on Britain, the question of scientific technology and service solutions assessment. These assets public health, including dealing capital, both financial and human to drive new insights and may be at risk following the UK capital, must now be considered. with antimicrobial resistance. approaches. QuintilesIMS provides referendum decision and the Key medium to long term concerns solutions that span clinical to commercial attractiveness of the For Irish pharmacies, Brexit could for pharma are the potential loss commercial bringing clients a UK pharmaceutical market may be mean increased restrictions on unique opportunity to realize the of scientific funding, potential vulnerable in the mid to long term. UK pharmacists registering and full potential of innovations and impact on movement of scientists practicing in Ireland which will advance healthcare outcomes. and other highly skilled personnel, Given the already hardening impact recruitment. In 2015, there Learn more, visit environment for access, the and possible barriers to scientific www.QuintilesIMS.com traditionally high priority of the UK were 178 pharmacists newly collaboration. Currently about

Eye-opening treatment for minor eye infections Preservative FREE

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Medicinal product not subject to medical prescription. Please consult the summary of product characteristics for information about dosage, method of use, side-effects, precautions, and contraindications, which can be found at:

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CPD 73: OPTICAL HEALTH Biography - Sinead Ryan graduated from the University of Brighton in 2008, and completed her pre-registration in Chelsea and Westminster Hospital NHS Foundation Trust, London. She worked in a number of clinical positions in London before returning to Ireland in 2011. She completed her higher diploma in community pharmacy from Trinity College Dublin in 2014. Sinead is currently working as a community pharmacist in Limerick.

1. REFLECT - Before reading this module, consider the following: Will this clinical area be relevant to my practice. 2. IDENTIFY - If the answer is no, I may still be interested in the area but the article may not contribute towards my continuing professional development (CPD). If the answer is yes, I should identify any knowledge gaps in the clinical area. 3. PLAN - If I have identified a knowledge gap

- will this article satisfy those needs - or will more reading be required? 4. EVALUATE - Did this article meet my learning needs - and how has my practise changed as a result? Have I identified further learning needs?

Red eye is a presenting complaint of both serious and non-serious causes of eye pathology and is one of the most common eye problems that pharmacists deal with in over the counter consultations. Due to the delicate nature of the eye and the possibility of serious complications, it is important to refer patients where there is any doubt as to the nature of the disorder. Red eye is a clinical sign caused by the dilation of the superficial ocular blood vessels, in the eye. Dilation of these vessels can result from infection, allergy, inflammation or elevated intraocular pressure. Redness (hyperaemia) of the eye can occur alone or present with accompanying symptoms of pain, discomfort, discharge and loss of visual acuity. The most common cause of red eye is conjunctivitis. There are a number of other causes of red eye, which we will explore in this article. The aim of this clinical feature is to discuss distinctive signs and symptoms of common red eye conditions that present in a pharmacy setting and the rationale for their management. It can also be used as a reference and staff training guide for OTC staff. Pharmacists and OTC staff need to take a comprehensive optical and medical history to ensure that the patients are referred appropriately while others are treated with over the counter (OTC) medication. 1. BLEPHARITIS It is one of the most common eye problems. It is a chronic inflammation of the eyelids, which can cause red or watery eyes, discomfort and

Disclaimer: All material published in CPD and the Pharmacy is copyright and no part of this can be used within any other publication without the permission of the publishers and author.

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the 4 previous steps, log and record your findings.

A-Z of OTC Red Eye Conditions This information may be used and collected each month as an ongoing comprehensive programme for management in Pharmacy. The modules are suitable for use by anyone working in community pharmacy wanting to improve their effectiveness as a successful leader and manager for their continuing professional development. Why CPD? Continuing profession educational development (CPD) is a legal requirement for pharmacists. Journal-based educational programmes are an important means of keeping up to date with professional developments and from a significant element of your CPD.

Published by IPN. Copies can be downloaded from www.irishpharmacytraining.ie

an oily or flaky discharge around the lashes. The oil glands in the eyelid may become blocked or infected (Meibomian Gland Dysfunction) which can give rise to similar symptoms. Patients complain of a gritty, itchy, uncomfortable red eye that is worse upon waking. Patients should be advised that they should wash the eyelids with specialised blepharitis lotions/gels (e.g. Blephasol®) or eyelid scrub wipes (e.g. Ocusoft or Blephasol® wipes). Non-irritating baby shampoos are recommended as lid cleansers in the past, however, some ophthalmologists advise against their use due to SLS (Sodium Lauryl Sulphate) allergy and the drying effect on the eye. Resting a warm compress such as a warm facecloth over the affected eye may soften and release any gland blockages. Commercial Warm compress products (e.g. Eyebag®) can also be used. While patients should experience some relief within one month the treatment generally needs to be continued for a few months. Ocular lubricants can be helpful to relieve the symptoms of associated dry eye. Key counselling point – Patients need to be reminded that this is a chronic eye condition and that frequent cleaning of the edge of the eyelids and warm compresses need to be continued daily for several months. 2. CONJUNCTIVITIS The majority of patients presenting to the pharmacist with red eye will have some form of conjunctivitis. The conjunctiva is the membrane covering the eye (except for the cornea) and the inner surface of the eyelids. Conjunctivitis can result from either an infection (viral or bacterial) or an allergen. Conjunctivitis is subdivided into three types- bacterial, viral and allergic conjunctivitis. Staphylococcus or Haemophilus bacteria most frequently cause bacterial conjunctivitis. The adenovirus is most commonly implicated in causing isolated viral conjunctivitis. Pollen is the usual cause of seasonal allergic conjunctivitis. Non-allergic conjunctival irritation can result from foreign bodies - wind, dust, smoke, fumes, chemical vapours and other types of air pollution. Each of the three types of conjunctivitis presents with

60 Second Summary Red eye is a presenting complaint of both serious and non-serious causes of eye pathology and is one of the most common eye problems that pharmacists deal with in over the counter consultations. Due to the delicate nature of the eye and the possibility of serious complications, it is important to refer patients where there is any doubt as to the nature of the disorder. The aim of this clinical feature is to discuss distinctive signs and symptoms of common red eye conditions that present in a pharmacy setting and the rationale for their management. The majority of patients presenting to the pharmacist with red eye will have some form of conjunctivitis. The conjunctiva is the membrane covering the eye (except for the cornea) and the inner surface of the eyelids. The main treatment for dry eyes is artificial tears which are available OTC. There are a number of products on the market with good ocular surface wetting properties which increase the moisture and lipid content of the ocular surface. Infection with herpes simplex is extremely common — about 90 per cent of the population carry herpes simplex antibodies. Primary infections with herpes simplex usually occur between the ages of six months and five years. This may involve typical symptoms of a viral illness (eg, swollen lymph glands, malaise, sore throat) or the infection may be subclinical. Giving the correct advice depends on the pharmacist and pharmacy staff being able to determine the most likely condition(s) which involves asking the right questions. Careful history taking and an awareness of signs and symptoms that are triggers for referral can ensure pharmacists safely and effectively manage red eye ophthalmic conditions.

debris. If this course of action does not resolverecommended. the symptoms then the patient should be referred for a course of topical antibiotics with a typical course of treatment lasting 5 to 7 Key is counselling Point – Patients should be advised t days. In general, the use of topical steroids only prescribed by a consultant omega 3 such as fish oil supplements and flaxseed oi ophthalmologist to their associated CPD 73: due OPTICAL HEALTHside effects. from dry eye syndrome and can be taken alongside oc

Conjunctivitis

2. Conjunctivitis

Conjunctivitis – Chamydial

C. Conjunctivitis – Chamydial

Episcleritis

5. Episcleritis

which are available OTC. There are a number the three main symptoms of redness, discharge C. CONJUNCTIVITIS – CHAMYDIAL The of patients presenting to the pharmacist with red eye will have some form of thanThe Chlamydial conjunctivitis is less common types ofa conjunctivitis. It found is more and majority discomfort. ofother products onisthe market ocular episclera layer ofwith thegood eye underneath Chlamydial conjunctivitis is less common than presents conjunctivitis. The conjunctiva is the membraneprevalent covering inthe eye (except for the cornea) younger adults and frequently in patients with systemic chlamydial surface wetting properties which increase layer presents as redness (hyperaemia) as a result of A. CONJUNCTIVITIS - ALLERGIC other types of conjunctivitis. It is more prevalent the moisture and lipid content of the ocularand and the inner surface of the eyelids. Conjunctivitis can result from either anred, infection (viral infection. eyeand appears the discharge can vary from alayer. watery to mucopurulent found in this Episcleritis is subdivided into two s in youngerThe adults frequently presents in surface.in A few examples of these products Allergic conjunctivitis is usually a bilateral is subdivided or bacterial) or an allergen. Conjunctivitis three bacterial, viral and in someinto cases thetypeseyelids are swollen. ItThe can present neonates, born to mothers with patients with systemic chlamydial infection. ® are Geltears (Carbomer 940/Polyacrylic ocular condition caused by pollen or other allergic conjunctivitis. Staphylococcus or Haemophilus bacteria most frequently eye appears red, the discharge can varycause fromthat a 50 active chlamydial infection. It is estimated per cent babies® acquire the infection (Dextran 70), Artelac Acid), Tearsof Naturale a) Sectorial episcleritis is where one part ®ofifthe eye is allergens. Typical symptoms are red, itchy to mucopurulent in some cases the bacterial conjunctivitis. Theand adenovirus is mostwatery commonly implicatedand in causing isolated (Hypromellose), Lacri-Lube® (Liquid Paraffin), eyes associated with tearing burning that b) Diffuse episcleritis is when the entire eye is affected eyelids are swollen. It can present in neonates, Liquifilm Tears® (Polyvinyl Alcohol). Patients viral conjunctivitis. Pollenthe is patient the usual cause of seasonal allergic conjunctivitis. Non-allergic gradually disappear when is no born to mothers with active chlamydial with mild dry eye may benefit from instillation longer in proximity to the particular allergen. conjunctival irritation can result from foreign bodies - wind, dust, smoke, chemical infection. It is estimated that fumes, 50 per cent of Episcleritis is artificial commonly self-limiting and resolves of one of these tear drops up to four The condition is often associated with runny vapours and other types of air pollution. Each of the three types of conjunctivitis presents babies acquire the infection if the mother has treatment. rare cases episleritis has been associa times a day. In However, in moderate to severe nose, itching of the soft palate of the mouth an active infection at the time of birth. Patients with the threeApproximately main symptoms ofof redness, and sneezing. 70% patientsdischarge and discomfort. cases of dry eyes artificial tears would need to with suspect chamydial conjunctivitis should be rheumatoid arthritis. Recurring episodes of episcler with allergic conjunctivitis also have hay-fever, be instilled more frequently. To overcome this referred. of the three types of conjunctivitis asthma Features and/or eczema. issue, preparations containing a longer-acting polymer, polyacrylic acid/PVA (e.g. Liquifilm Key Practice Point Chlamydial conjunctivitis Cold compresses and tear substitutes are Tears®) or carbomer 940 (e.g. Geltears®) or should be suspected in an infant younger than useful in relieving burning and dry eyes in high weight and concentration of sodium 30 days presenting with conjunctivitis as patients with a mild allergy. While first and hyaluronate, eg Hylo Tear or Hylo Forte) onset is typically between 5 and 14 days second generation oral antihistamines are should be used for patients with moderate to following birth. effective in treating allergic conjunctivitis, severe dry eyes. These products have a longer topical ophthalmic products are superior in D. CONJUNCTIVITIS – VIRAL retention time in the eye and symptom relief is treating the ocular symptoms and reduce obtained with fewer instillations. Patients who Viral conjunctivitis is usually caused by an systemic side effects. Products containing wear contact lenses or are allergic/sensitive or adenovirus that is a highly contagious organism Sodium Cromoglicate 2% (e.g. Optichrom) can intolerant to the preservatives in dry eye drops with an incubation period of 4 to 10 days. be used prophylactically throughout hay-fever should use preservative free and contact lens Typically the patient presents with a red eye season in adults and children. Xylometazoline compatible drops. The single dose unit eye with watery discharge with follicular (white 0.5% and Antazoline sulphate 0.5% can be drops (e.g. Minims) in order to reduce exposure used in adults and children over 12 years to lesions) changes on the cornea and tender to preservatives which reduces eye irritation. reduce symptoms. If OTC medications do not lymphadenopathy. Quite often it presents Lubricating ointments are retained longer than provide effective relief within 7 days or the unilaterally. General hygiene measures, ceasing the liquid dry eye drops. The patient’s vision condition worsens patients should be referred contact lenses’ wear and ocular lubricants are can become blurred after instillation of ointment for further investigation. important in reducing the length of and this could affect activities such as driving viral conjunctivitis. Key Counselling Points - Advise the patient so they are not generally recommended for day to wear wrap-around sunglasses and allergen Key Counselling Point - Patients should be time use. They are, however, a useful adjunct to avoidance to reduce symptoms/flare ups. Eye advised to wash hands, remove contact lenses artificial tears if used at bedtime (e.g Vitapos). A. containing Conjunctivitis - Allergic should not be drops Xylometazoline and avoid touching the eye area. If the patient does not respond to artificial used for periods exceeding 7 days in order to tear substitute treatment after two months 3. CORNEAL ULCER avoid rebound nasal congestion. Allergic conjunctivitis is usually a bilateral ocular condition caused by pollen or other then the patient should be referred for further investigation. corneal ulcer cantearing appear and as a white/ allergens. Typical symptoms are red, itchy eyesAassociated with burning that B. CONJUNCTIVITIS – BACTERIAL greyish opacitytoonthe theparticular surface ofallergen. the cornea gradually disappear when the patient is no longer in proximity The In certain cases where the patient is elderly, Bacterial conjunctivitis is usually a self-limiting accompanied with a red eye appearance condition is often associated with runny nose, itching of the soft palate of the mouth and the symptoms of dry eye can be caused by condition with a fairly rapid onset of redness (hyperaemia). This can possibly be caused drooping of the lower eyelid. Ectropion is where and discharge. The discharge is usually sneezing. Approximately 70% of patients with by allergic conjunctivitis also have hay-fever, overuse of contact lenses or a history of the lower eyelid droops away from the eye and purulentand/or sticky discharge sleeping with contact lenses. The presence asthma eczema. with the lids stuck turns outwards. Entropion is where the eyelid together and crusted. Bacterial conjunctivitis of an opacity on the cornea would require turns inwards towards the eye. It usually occurs tends to cause a papillary reaction which is a urgent referral as this condition can be as the patient becomes older when the tissues diffuse subconjunctival oedema. This can be sight threatening. and muscles of the eyelids become weaker. quite marked causing the eyelids to swell with Key Counselling Point - Patients need to be The drooping eyelid can disrupt the drainage a puffy appearance around the eyes. Antireminded to remove contact lenses and seek infective eye drops and ointment are indicated of tears which can make the eyes red, irritated, urgent medical attention. for bacterial conjunctivitis. Drops are used dry, gritty and more vulnerable to bacterial during the day and ointment at night. Although infections such as conjunctivitis. If the patient 4. DRY EYE CONDITIONS ointment gives a higher concentration for a is experiencing these symptoms, it is advisable more prolonged time, the blurring of vision for them to have the condition checked by The eye is covered by a layer of fluid called the associated with ointments means they should their general practitioner. In mild cases, it may tear film which keeps the surface moist and only be recommended at night time. Drops and comfortable and protects the eye from infection. not require treatment. In more severe cases, ointment should be combined with cleaning Any change in the composition or amount of the a minor operation to tighten and correct the and eye-washes to remove the crusts and eyelid defect may be recommended. tear film can lead to discomfort. There are many debris. If this course of action does not resolve factors which can affect the tear film including Key counselling Point - Patients should be the symptoms then the patient should be illness, allergies, diet, atmospheric conditions advised that products containing high levels referred for a course of topical antibiotics with a and certain prescription medications e.g. of omega 3 such as fish oil supplements and typical course of treatment lasting 5 to 7 days. anti-cholinergic medicines. Patients with dry flaxseed oil have been found to protect the In general, the use of topical steroids is only eyes can complain of dry, gritty red eyes. eyes from dry eye syndrome and can be taken prescribed by a consultant ophthalmologist due The main treatment for dry eyes is artificial tears alongside ocular lubricants. to their associated side effects.

pinguecula becomes inflamed, refer for medical treatment . An inflamed pinguecula can be be an underlying systemic autoimmune condit treated with a mild steroid eye drop (e.g, Prednisolone 0.5 % Minims). condition should be immediately referred as it

response.

Key Counselling Point – Advise the patient to use UV-A and UV-B wrap-around sunglasses to CPD 73:deterioration OPTICALespecially HEALTHwhen travelling abroad. prevent further

Key Counselling Point – Advise the patient to seek

Pinguecula

8. Pinguecula 5. EPISCLERITIS

Red Eyes (Cosmetic)

9. Red Eyes (Cosmetic)

Scleritis

11. Styes

hydrochloride (e.g. Optrex® Red Eye, Murine® Key Counselling Point - Counsel patients A pinguecula is a slightly raised yellow-white conjunctival lesion that typically appears onof red Irritation and the Redness Eye Drops). Naphazoline with cold sores handasked hygeine to avoid Pharmacists areon often for and treatment where patient’s main concern is by Stephylo Aeyes stye (hordeolum) is usually caused Theconjunctiva episclera is a(white layer of found the ofthe theeye eye). If it travels into the cornea (pterygium) ittheir cancold affect thecause acts onredness alpha-adrenergic receptors in the walls touching their appearance eye area whilst the sore the cosmetic of eyes. The of the should be established and follicle in severe infection underneath the conjunctiva. Inflammation of of bloodand vessels causingcases them the to constrict andcan be as is active. patient’s vision. sometimes is connected to the patient’s lifestyle,the for gland example, the iscustomer maygland) had had this layer presents as redness (hyperaemia) as of Zeis (sebaceous or are the gland o therefore redness reduced. These drops 7. MEIBOMIAN CYST or they were in a smoky environment. a result of dilation of the blood vessels that are less sleep than normal There are a with number of eyeand contraindicated ineyelid patients glaucoma swelling on the margin and in severe cases Pinguecula common andis can be a sign conjunctival ageing. In addition, they can ® ® found in thisare layer. Episcleritis subdivided into of drop Red who Eye,are Murine products containing naphazoline hydrochloride (e.g. Optrex are not suitable for patients contact The opening of the meibomian glands is located bacterial in origin, yellow discharge (pus) can be see two subtypes: appear earlier in patients who live in countries with high UV exposure. On examination, the lenses Alternatively, contactinlens Irritation and Redness Drops). acts on wearers. alpha-adrenergic receptors the near the eyelash margin.Eye Each eyelid Naphazoline contains wearers can use products containing Euphrasia, conjunctival will show degeneration of collagen fibres in the conjunctiva, conjunctival between 50 andvessels 70 meibomian They a) Sectorial episcleritis is where one part of the walls of blood causing glands. them to constrict and therefore redness is reduced. These a natural plant extractathat can also relieve Without treatment stye usually self-limiting an are modified sebaceous glands that secrete eye is affected. thinning, discolouration of the conjunctiva and occasionally calcification. drops are contraindicated in patients with aglaucoma and are not suitable for is patients who redness in the eye (e.g Hylo Fresh) lipid material onto the tear film which prevents Products containing Propamidine (Brolene® and are contact lenses wearers. b) Diffuse episcleritis is when the entire eye is the tears from evaporating. Blockage of these Key Counselling Point - Remind patients to If the infe Pingueculae are benign lesions and no treatment is usually indicated. However, if a compresses (Eyebag®) may be helpful. affected and inflamed. glands can cause an inflamed lesion called a remove contact lenses that cosmetic pinguecula becomes inflamed, refer for medical treatment An inflamed pinguecula can be patient will need to and be referred as ared topical or s meibomian .cyst. eye products are not recommended for long Episcleritis is commonly self-limiting and

treated mild steroid eye drop (e.g, Prednisolone 0.5 % Minims). resolveswith itselfawithin three weeks without

Small meibomian cysts (less than 0.5cm) often treatment. In rare cases episleritis has been spontaneously resolve. If the meibomian cyst associated with systemic conditions as to usedoes Key Counselling Point – Advise the such patient UV-Anot and UV-B wrap-around sunglasses(e.g. to resolve, then warm compresses ® rheumatoid arthritis. Recurring especially episodes ofwhen travelling prevent further deterioration ) can be placed against the cyst for Eyebagabroad. episcleritis can be associated with systemic a few minutes to warm the oils and free the diseases that should be referred to a doctor. obstruction that is causing the lesion. This Topical steroids and topical NSAIDs can be should be done every evening. If this action fails prescribed for severe cases. to resolve the meibomian cyst or if the cyst is larger than 1cm the patient should be Key counselling Point - Using 2WHAM and referred for further investigation. A hospital TASTER questioning techniques check the visit may be necessary for the cyst to be incised patients history and family history of systemic and removed. conditions such as rheumatoid arthritis. 8. PINGUECULA 6. HERPES SIMPLEX KERATITIS A pinguecula is a slightly raised yellow-white Infection with herpes simplex is extremely conjunctival lesion that typically appears on the common — about 90 per cent of the population conjunctiva (white of the eye). If it travels into carry herpes simplex antibodies. Primary the cornea (pterygium) it can affect the 9. Redwith Eyes (Cosmetic) infections herpes simplex usually occur patient’s vision. between the ages of six months and five years. This may involve typical symptoms of a viral Pharmacists are often asked for treatment of redPinguecula eyes where patient’s concern arethe common and main can be a sign is illness (eg, swollen lymph glands, malaise, sore ofof conjunctival ageing. In addition, they can the cosmetic appearance of their eyes. The cause the redness should be established and throat) or the infection may be subclinical. earlier in patients who live in countries sometimes is connected to the patient’s lifestyle,appear for example, the customer may had had high UV exposure. On examination, The sleep patientthan will usually an in a smokywith less normalpresent or theywith were environment. aredegeneration a number ofof eye the conjunctival There will show uncomfortable eye and, perhaps, blurred ® Red Eye, Murine® drop products containing naphazoline hydrochloride (e.g. Optrex collagen fibres in the conjunctiva, conjunctival vision. Other signs include pain (usually mild), thinning, discolouration of the conjunctiva and Irritation and Redness Eye Drops). Naphazoline acts on alpha-adrenergic receptors in the redness, tearing and light sensitivity. There calcification. may be walls of accompanying blood vessels herpetic causing vesicles them toonconstrictoccasionally and therefore redness is reduced. These the eyelid periocular skin.inThe patientwith may glaucoma Pingueculae lesions and no who drops are or contraindicated patients and areare notbenign suitable for patients have had a herpes simplex infection in the eye treatment is usually indicated. However, if are contact lenses wearers. before. Patients presenting with signs of Herpes Simplex keratitis should be referred.

HSV virus typically affects the eyelids, conjunctiva and cornea. If the cornea is infected, the active disease is called herpes keratitis. On optical examination, the infection typically presents as a central ocular ulcer (dendritic lesion). The patient needs to be referred immediately. For a corneal dendritic ulcer, aciclovir (Zovirax®) eye ointment applied five times a day to the affected eye is usually effective. A 1cm line of ointment should be placed inside the lower conjunctival sac and the eye kept closed for 30 seconds after application. Two weeks’ treatment should be sufficient. In some cases oral treatment may be required. Patients who suffer severe or recurrent infections are at higher risk of corneal scarring.

a pinguecula becomes inflamed, refer for medical treatment . An inflamed pinguecula can be treated with a mild steroid eye drop (e.g, Prednisolone 0.5 % Minims). Key Counselling Point - Advise the patient to use UV-A and UV-B wrap-around sunglasses to prevent further deterioration especially when travelling abroad. 9. RED EYES (COSMETIC) Pharmacists are often asked for treatment of red eyes where the patient’s main concern is the cosmetic appearance of their eyes. The cause of the redness should be established and sometimes is connected to the patient’s lifestyle, for example, the customer may had had less sleep than normal or they were in a smoky environment. There are a number of eye drop products containing naphazoline

certain eyelashes are removed to release the term usecases, (unless they are using Hylo Fresh, which may be used long-term and is compatible

with contact lenses). Key Counselling Point – Advise patients that eye drops for the treatment of styes. Remind patients 10. SCLERITIS not to drive after eyeofointments. Scleritis is when theapplying scleral layer the eye becomes inflamed. This presents as severe pain accompanied by photophobia, ocular swelling (oedema) and watery eyes. There can often be an underlying systemic autoimmune condition such as rheumatoid arthritis. This condition should be immediately referred as it may be part of systemic autoimmune response. Key Counselling Point - Advise the patient to seek medical treatment urgently. 11. STYES A stye (hordeolum) is usually caused by Stephylococcus Aureus infection of the eyelash follicle and in severe cases the infection can be associated with the infection spreading to the gland of Zeis (sebaceous gland) or the gland of Moll (sweat gland). It presents as a red swelling on the eyelid margin and in severe cases the eyelid can become swollen. As it is bacterial in origin, yellow discharge (pus) can be seen and sometimes it can be painful. Without treatment a stye is usually self-limiting and will usually resolve within 7 to 14 days. Products containing Propamidine (Brolene® and Golden Eye® eye ointment) and warm compresses (Eyebag®) may be helpful. If the infection spreads and the eyelid swells, the patient will need to be referred as a topical or systemic antibiotic may be necessary. In certain cases, eyelashes are removed to release the infection and the stye resolves. Key Counselling Point - Advise patients that eye ointments are more effective than eye drops for the treatment of styes. Remind patients that eye ointments may blur vision and not to drive after applying eye ointments. 12. SUBCONJUNCTIVAL HAEMORRHAGE A subconjunctival haemorrhage is characterized by red, flat haemorrhage due to bleeding from the surface small blood vessels that run through the conjunctiva. The blood from the bleed can

bleeding disorders, hypertension, the use of to anticoagulants, conjunctivitis, scleritis or drop (us prevent complications from developing. A mydriatic sometimes used in addition to the steroid eye drop. trauma to the eye and the patient should be referred.

Key Counselling Point – Patients should be advised only to us

Key Pharmacy PointHEALTH – In certain cases this can be caused by elevated blood CPD 73:Practice OPTICAL prescribed length and no longer in order to reduce steroid pressure so taking the patient’s blood pressure may be beneficial. irritation, swelling.

Styes

Subconjunctival Haemorrhage

Trichiasis

13. Trichiasis 12. Subconjunctival Haemorrhage presentingiswith should be cover the whole of the sclera (white of the S Severity: mild,due moderate, severe entropian Trichiasis theuveitis inwardincluding growth iritis of the eyelashes. This can occur to ectropian, referred for further investigation. eye) or can be confined to one sector of the A subconjunctival haemorrhage is characterized by red, flat haemorrhage due to bleeding or trauma to the eyelid. In-growing eyelashes can rub previous against treatment the cornea causing T Treatment: e.g. surgery, eye. This condition is in the eye is not painful. from the surface small bloodforvessels that run through discomfort, the The blood from the previous topical Theconjunctiva. patient’spossible eye will be red (hyperaemic). The abrasion and corneal ulceration. They can alsotherapy, triggertrauma. the formation of The most common cause spontaneous typically surrounds iris but removing this is bleed can cover the whole of theissclera (whiteinof the eye) or canMedical be confined to one the sector subconjunctival haemorrhage idiopathic aredness stye. treatment involves the in-growing eyelash eyelashes a E Exacerbating factors: or wind, sunlight,with and eye not always the case. Thecause patient of the eye. This condition is in the eye is not painful. The most common forwill usually nature. The condition is painless clearing itself movements sterile fine tipped medical tweezer. The eye lash will regrow within four to six weeks. More pain (or at least discomfort) in the spontaneous is idiopathiccomplain in nature.ofThe condition is painless within 7 to 14subconjunctival days. In a fewhaemorrhage cases, the redness permanent alternative treatments include electrolysis and cryotherapy follicles. eye. Other may symptoms can include vision R Relieving factors e.g. of drythe eyehair drops clearing itself withinwith 7 tobleeding 14 days.disorders, In a few cases, the redness be associated with blurred may be associated and sensitivity to light. Iritis is diagnosed when bleeding disorders, hypertension, the use of anticoagulants, conjunctivitis, scleritis or hypertension, the use of anticoagulants, Past ophthalmic history white blood cells are detected in the aqueous conjunctivitis, scleritis orpatient traumashould to thebe eye and trauma to the eye and the referred. Exposure to another person with red eye signs fluid of the eye. Detection requires a slit lamp the patient should be referred. and symptoms, contact lens wearer, trauma, so a person with suspected uveitis should Key Pharmacy Practice Point – In certain cases thisbe can be caused by elevated blood surgery, recurrence referred. Key Pharmacy Practice Point - In certain pressure so taking the patient’s blood pressure may be beneficial. cases this can be caused by elevated blood Past medical history Iritis requires treatment with steroid eye drops pressure so taking the patient’s blood pressure Hypertension, diabetes, COAD/asthma, MS, to alleviate the pain and inflammation and may be beneficial. inflammatory bowel disease, arthritis conditions to prevent complications from developing. A should be noted. Any autoimmune conditions mydriatic drop (usually cyclopentolate 1%) is 13. TRICHIASIS must be noted also. sometimes used in addition to the steroid Trichiasis is the inward growth of the eyelashes. eye drop. Medication history This can occur due to ectropian, entropian or Systemic, topical, over-the counter, herbal, drug Key Counselling Point Patients should trauma to the eyelid. In-growing eyelashes can allergies be advised only to use steroid eye drops for rub against the cornea causing discomfort, the prescribed length and no longer in order Systems review possible abrasion and corneal ulceration. They to reduce steroid eye drop side effects e.g. Respiratory, cardiovascular, digestive, can also trigger the formation of a stye. Medical irritation, swelling. joints, skin treatment involves removing the in-growing 13. Trichiasis eyelash or eyelashes with a sterile fine tipped Five Key Practice Points for patients Family history medical tweezer. The eye lashofwill within Trichiasis is the inward growth theregrow eyelashes. This can occur due with to ectropian, presenting red eyeentropian symptoms Glaucoma, AMD, inherited retinal conditions, four to six weeks. More permanent alternative or trauma to the eyelid. In-growing eyelashes can rub against the cornea causing diabetes, and hypertension treatments include electrolysis and cryotherapy  General hygiene – Wash and dry hands discomfort, possible abrasion and corneal ulceration. They can also trigger the formation of of the hair follicles. before instilling eye drops, do not allow the Social history a stye. Medical treatment involves removing the in-growing eyelash or eyelashes with a tip of the eye drop to come in contact with Living alone (e.g. can they instill eye drops sterile fine tipped medical tweezer. The eye lash will regrow within four to six weeks. More 14. WATERY EYES the surface of the eye. themselves?), driving, smoking permanent alternative treatments include electrolysis and cryotherapy of the hair follicles. Tears are necessary to keep the eye lubricated Symptoms of Red Eye Conditions that  Check if patient is able to instill eye drops and clean. Causes of watery eyes (epiphora) require Immediate Referral especially if they live alone. include: dry eyes (tear production is stimulated  Distortion of vision – including vision loss, by dryness), blepharitis, allergy and infection.  Cease contact lenses wear. reduction or blurring Treatment is usually by tear substitute drops  The expiry date of all eye drops (without and ointments. Warm compresses may also be  Restriction of eye movement preservatives) is 28 days from the date useful. Prolonged excessive tear production of opening (with the exception of the Hylo is undesirable and may also be caused by a  Abnormal/Irregular shaped pupil range, which is 6 months) blocked tear duct. If treatment fails after two  Photophobia months the patient should be referred to a  Check all OTC staff is aware of the symptoms general practitioner for further investigation.  Redness caused by a foreign body requiring immediate referral. This can be treated in hospital with syringing  Severe pain or swelling around the eye or insertion of punctal plugs (synethic plug that History Taking keeps the tear drainage system permanently CONCLUSION This is an example of the questions asked for a open therefore allowing tears to drain). structured ophthalmic red eye history. Symptoms such as redness, dryness, Key Pharmacy Counselling Point - The most discomfort and tearing are signs that are • Presenting complaint Reason for visit common cause of watery eyes is dry eye which common to many ocular conditions. Giving the is the opposite of what most patients believe. correct advice depends on the pharmacist and • History of presenting complaint Patients may need counselling on how a dry pharmacy staff being able to determine the eye stimulates the eye to produce excess tears. TASTER Questioning Technique most likely condition(s) which involves asking the right questions. Careful history taking 15. UVEITIS T Time course (Onset): acute or chronic and an awareness of signs and symptoms (sudden, hours, days, weeks), constant or that are triggers for referral can ensure The uvea is made up of the iris, the ciliary body intermittent? pharmacists safely and effectively manage and the choroid. There are different types of red eye ophthalmic conditions. It is important uveitis and treatment depends on the layer A Associated symptoms: location of red eye to distinguish when to recommend OTC of the uvea affected. The most common form (unilateral, bilateral, sectorial), reduced medication and when a referral may of uveitis is iritis (inflammation of the iris). It vision, blurry vision, gritty sensation, diplopia be necessary. is associated with inflammatory systemic (double vision), pain, foreign body sensation, conditions such as arthritis and Crohn’s itch, discharge, watering eyes, headache, disease but can also be idiopathic. All patients photophobia.

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Dynamic 100 Leading Expansion and Growth As Commercial Director of totalhealth Pharmacy group, John Arnold is responsible for overseeing the operations and expansion. The group has gone from strength to strength and Arnold has overseen the growth in membership throughout the past three years seeing the group grow to 64 pharmacies. The group is owned and managed by the members and Arnold is responsible for implementing the strategy decided by the members. Over the past year along with branding the new members Arnold has overseen the launch of their dispensary based ordering software enabling them to identify the best margin deals in the market place at any given moment. This software enables their members to stay in stock and maintain margin. He has also managed the introduction of their on line training programs for OTC and Vitamins to enable all staff to achieve a greater level of knowledge to assist customers. These areas along with providing assistance for members on improving operational efficiencies give a competitive edge to totalhealth pharmacies. A strategic focus on customer service is vital to any business and totalhealth manage an ongoing training programme to assist pharmacies. “Building a clear brand identity for customers and staff is essential for the group. The pharmacy sector is still in a state of massive change but the future looks bright for the totalhealth members who realised working together does benefit each other. I look forward to 2017 knowing it will be another great year for totalhealth” says Arnold.

John Arnold, Commercial Director totalhealth Pharmacy Group

Change your Health Direction Success After completion of a master’s degree, Sarah Ashe joined Lloydspharmacy as a Purchasing Executive to the OTC Category Buyer in 2010. In 2013 Sarah was promoted to the role of Category Buyer responsible for sales development and management of core pharmacy categories including OTC medicines, Vitamins and Supplements and Children’s Health. In 2016, Sarah has been in charge of a new programme which rolled out the Health & Wellness category in over 30 stores. This was done in conjunction with the highly successful Change Your Health Direction national campaign. Customers are encouraged to ‘Be the Best Version of you’. These initiatives have produced year on year growth for complimentary health categories with 2016 proving the best year on record for sales development at LloydsPharmacy.

Sarah Ashe, Category Buyer, LloydsPharmacy

Supporting Self Care and Switch It’s been a strong year of growth in pharmacy for GSK Consumer Healthcare Country Manager Dave Barrett. The big news of 2016 was GSK’s Voltorol 2% switch and launch in July which was supported by an extensive education program and backed by a highly effective Above the Line execution. This launch was a great example of GSK’s support for self-care and switch, which Dave has also been championing through his role as Chair of the Irish Pharmaceutical Healthcare Association’s consumer healthcare division. GSK’s unique calling card is its products’ roots in science and innovation and 2016 was no different: In a year which saw an even bigger and better GSK thanks to finalising its joint venture, GSK enjoyed strong IMS growth across all key categories.

Dave Barrett, Country Manager, GSK Consumer Healthcare

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Dynamic 100 Educating on Diabetes Research Dr Barry has a PhD in diabetes research, and works travelling the country educating Consultants, Pharmacists, Diabetic Nurses and others about the latest research about diabetes, so that they can choose the best drugs and treatments available for their patients. In doing so, she must know everything about the latest research in the field. Prior to this, she studied Pharmacy and a PhD in University of Brighton, and worked as a locum pharmacist in the Co Clare region.

Dr Michelle Barry, Medical Adviser, NovoNordisk

Establishing Innovation within CPD

Dr. Catriona Bradley, Executive Director Irish Institute of Pharmacy

During 2016 Dr. Catriona Bradley, Executive Director of the Irish Institute of Pharmacy, along with the team in the Institute, have continued their work in establishing a new and innovative CPD system for pharmacists in Ireland. Over the past year the Institute has worked with over 300 pharmacists who have shaped and informed the work of the Institute. Thousands more have participated in the Institute’s training programmes, resulting in the development and delivery of extended services within pharmacy. The ePortfolio review process also commenced during 2016. The Institute provides support to them in the form of information events, interactive web-based resources, helpdesk support and the peer support network. Catriona believes that the success of the Institute has been largely due to the commitment of pharmacists in Ireland to professionalism and patient care. “Pharmacists are proactively engaging with the Institute to shape their profession and we look forward to continuing this collaboration.”

Helping People to Help Themselves Since becoming owner of Whelehans Pharmacy 11 years ago, Eamonn Brady has striven to build and grow his business around his philosophy of placing his customer led, independent pharmacy firmly at the centre of his community and to extend its reach through engagement “outside the front door.” At the core of Eamonn’s vision of his own role is his belief that prevention is better than cure and to “help people to help themselves” through education and information initiatives delivered in a variety of ways ranging from his “Ask the Pharmacist” columns and “condition specific” articles, to the wide variety of subjects covered in public health talks hosted by Whelehans.

Eamonn Brady, Supervising Pharmacist, Whelan’s Pharmacy

Community Pharmacy Team of the Year Jane Brennan is the Supervising Pharmacist of the Brennans Life Pharmacy in Donabate, winners of the Johnson & Johnson Community Pharmacy Team of the Year 2016.

Jane Brennan, Pharmacist, Brennans Life Pharmacy, Donabate

The team at Brennans hold the customer central in everything they do. Their overarching aim is to make a positive difference in the lives of their customers and team members. They achieve this through clear communication and support of each other. Their strength is their great bond, using the dedicated staff’s talents and energies to get their work done to the highest retail standards and in the pursuit of excellence for their community and customers.

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Dynamic 100 Helping ‘Transform’ the Community Andrew is a Pharmacist and owner of the community pharmacy, Andrew Buckley’s totalhealth Pharmacy in Rathfarnham. Andrew’s outlook is to always look after the patient’s needs first and Andrew works closely with the community to participate and organise many community events. Andrew and the team in the pharmacy demonstrate their commitment through various events they organise throughout the year. These include the hugely successful Operation Transformation Community Walk they organise with 150 registered walkers. The walks took place every Monday and Wednesday night at 7.30pm from the pharmacy for the months of January to early March. As part of the Operation Transformation campaign they ran a weight loss clinic also and they gave out free advice and meal plans.

Andrew Buckley, Pharmacist, Buckleys totalhealth Pharmacy

Leading with Influence in Health Promotion Carla is Supervising Pharmacist at McCartans Pharmacy, Bayside since 2013 and has overseen numerous changes in the industry in this time. Most recently Carla and McCartans pharmacy received national recognition when appearing on Operation Transformation and also recently securing the coveted IPN Health Promotion award. However it is Carla’s work in promotion of nutritional advice and expertise that sets her apart as a thought leader and key influence in the Pharmacy industry. Currently completing a masters in Personalised Nutrition , Carla is rolling out a bespoke vitamin and nutritional programme for all McCartan shops based on demographic and community needs in each area. She strongly believes in the expansion of the health promotion role of pharmacist and feels that this programme will be successful in achieving this.

Carla Buckley, Supervising Pharmacist, McCartans Pharmacy

Creating Positive Business Climates Pharmacy graduate Mary Rose Burke will be leading the Dublin Chamber of Commerce into the next phase of development, building on a heritage to create a positive operating climate for Dublin business. Mary Rose has extensive experience in business. Her previous roles include Director of Pharmacy with Boots Ireland and establishing and running various businesses. Commenting on the appointment, Ibec CEO Danny McCoy said, “Since joining Ibec in 2013 Mary Rose has distinguished herself as a highly talented, inspiring and energetic leader whose creativity and positive attitude are among her greatest strengths.” Mary Burke, CEO, Dubin Chamber of Commerce

Combining Technology with Tradition Paul F. Burns developed the revolutionary Multimeds medication compliance tray. With its unique press and go labelled pods, Paul has been able to combine the benefits of sophisticated Pouch technology with the advantages of the traditional blister pack. Pharmacies using the MultiMeds system can now pitch, with confidence, their own unique products and services to the Nursing and Domiciliary Sectors and the HSE and successfully displace the big pouch nursing home players. Paul Says: I take great pride to know that over 70, 000 patients across Europe are benefiting from our Irish made innovation. Working and sharing experiences with our European partners has given us a great insight as to what developments are happening across Europe and this experience has greatly enhanced our strategy of displacing robotic pouch systems and moving the focus to robotic tray filling of MultiMeds. The next year will be an exciting and challenging year for us as we roll out new services and ground breaking products in early 2017 and targeting over 300, 000 new patients to benefit from the system by year end. Paul Burns, Managing Director, Identicare

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Dynamic 100 Actavis Innovation in Independent Pharmacy Last January, when Deirdre Butler returned from maternity leave, she purchased her very own pharmacy business, Higgins pharmacies, Sligo, with her sister. Higgins pharmacies were owned by the Higgins family for two generations, and embodied a patient focussed family ethos, which they aim to emulate. While she was waiting for the sale of the pharmacies to close, she won the innovation award arising from services she implemented in her previous role. One of Deirdre’s aims is to implement the services for which she won the innovation award in her new role as pharmacy owner. As such, she’ll be hosting a presentation for the COPD society in Sligo on November 30th. Deirdre has also undergone training in digital marketing and recognise the potential of advancing a retail business using social media, and having a strong online presence.

Deirdre Butler, Supervising Pharmacist, Foxford Pharmacy

Leading Strategies within KRKA Daniel joined Krka when they entered the market in May 2011 as a medical representative. As his territory and the company grew he was quickly promoted to Product Manager. In this role he now manages the marketing and sales strategies, product launches and a number of key accounts. In November 2015 Krka launched their first OTC medicine, Septabene throat spray. As the Product Manager for this Daniel was heavily involved in the marketing and sales strategies leading to its success, achieving 26% share of the market after just 12 months trading. Krka’s focus still remains firmly in the retail pharmacy sector where they have grown to be the 8th largest volume supplier of prescription medicines in the state. With a simple simple yet effective strategy of delivering consistency, in the quallity, value and supply of their medicines there is no doubt that Krka will be leaving 8th place well in their wake as they continue to grow in this market.

Daniel Byers, Product manager, KRKA

Bringing OTC Care to the Fore Phil Cahill is an OTC healthcare advisor in Adrian Dunne Pharmacy, Trim, County Meath. In January 2016, under her supervision, the pharmacy launched its very own Operation Transformation, with over 60 people partaking including five special needs girls from the nearby Prosper Meath all taking the challenge. Those same five girls come in every week to see Phil and get their weekly weigh in. “It was great fun, and the girls all did great. They lost a lot of weight and are still making great progress” she told IPN. Her pharmacy continues to work with people with special needs, and have now begun a quiet hour every Wednesday, to accommodate customers with autism, which supports the local care facilities in Trim. During the course of a regular day Phil manages the always busy OTC counter. Her main area of expertise is the vitamin and wellbeing section in the pharmacy and her advice is greatly sought after by customers. Phil also assists with the free blood pressure monitoring service that the pharmacy provides and is always on hand to offer advice on all aspects of healthcare. She is a vital link between the OTC counter and the dispensary and ensures that customers receive the best possible customer service. Phil Cahill, Counter Assistant, Adrian Dunne Pharmacy , Trimm

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Dynamic 100 Promoting Fitness to Meet Need In 2016, Nuala Nuala started Park Running Glengarriff, which is a free, weekly timed 5k run, with the aim of promoting health and fitness. So far she’s had terrific results, with over 100 people showing up in one week. “When a parkrun comes to a community, it inspires everyone, young and old, to get out and exercise,” says Nuala.” There are real potential health benefits that come with having a local parkrun, and there’s a great social side to it all too.” Nuala also appointed an Operation Transformation ambassador who is on hand to give support to anyone who wants to become healthier in 2016 and beyond. Having achieved her Masters in Pharmacy in from Robert Gordon University in Melbourne, Nuala Carey opened Glengarriff Pharmacy in July 2010, which employs three pharmacists, two beauticians, and has become an active part of the local community.

Nuala Carey, Pharmacist, Glengarriff Pharmacy

Focusing on Clinical Programmes Over the last year, Dr Carroll has focused on establishing the operating model for the ICPs after recognising the importance of ensuring the plans have the appropriate support and sign-off, appropriate monitoring and actually achieve their targets. The Prevention and Management of Chronic Disease ICP was tested in pioneer areas to test the proof of concept. In 2016, the ICP for Older Persons has selected and worked with at least one integrated care pioneer area to test and deploy a model of integrated care for older persons that aligns with existing improvement initiatives. Further pioneer areas will be developed and will ultimately form an improvement network, linked with international integrated care improvement best practice.

Dr Áine Carroll, National Director, Clinical Programmes

Maximising Savings for Members John is the Chief Executive of The Axium Buying Group, which was founded in 2009 and has become Ireland’s largest independent buying group with 250 members. A pharmacist by qualification, John used his dispensary experience to build a unique and highly innovative ordering system that maximises significant saving for it members. The company have also launched “iGnite” which is a business intelligence system that focuses on growth areas within pharmacies as well as also highlighting missed margin opportunities.

John Carroll , CEO, Axium Buying Group & CarePlus Pharmacy

CarePlus Pharmacy, the pharmacy franchise supported by Axium Buying Group opened its first store in Cobh in February 2015, and now has 30 pharmacies throughout Ireland with ten more due in the first quarter of 2017. Through John’s leadership and passion, the overall group continues to grow rapidly with a focus on procuring even greater savings for each pharmacy member as well as establishing CarePlus Pharmacy as the brand of choice for pharmacists in Ireland. John qualified as a pharmacist from Trinity College Dublin.

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Dynamic 100 Putting Regulations into Practice Saves Life Sarah Chambers qualified as a Pharmacist three years ago, and currently works as Supervising Pharmacist in Hickey’s Pharmacy, Grafton Street, dealing with all aspects of customer healthcare needs. Earlier this year she saved a customer’s life by putting into action new training regulations in the use of epipens. “The relationship between a pharmacist and a customer is truly unique, it’s a long-term relationship built on trust,” said Chambers. “Getting to know my customers personally really helps build that trust and is the part of the job that I really enjoy.” Chambers says she has embraced the recent changes in the world of pharmacy, including the augmented vaccination services and the provision of emergency medicines. Sarah Chambers, Supervising Pharmacist, Hickey’s Pharmacy Dublin

Launch of new Masters in Pharmacy Leonie Clarke was the President of the Pharmaceutical Society of Ireland until July of this year. Earlier in the year she launched a new five-year integrated Master’s degree programme in Pharmacy which will enable future pharmacists to better meet the changing needs of the healthcare system in Ireland. This new programme is intended to keep pace with changing healthcare needs in Ireland and offer an improved student experience through its evidence-based and experiental-based learning approach. Leonie has served on the PSI Council since 2010, studied pharmacy in Trinity College Dublin and holds an MSc by research and diplomas in legal studies and accounting and finance. She runs her own pharmaceutical consultancy, focusing primarily on compliance with medicines legislation, corporate governance and quality management. Leonie Clarke, Director, Metis Consulting

Putting Super into Superintendent Tom Concannon is Superintendent Pharmacist for Hickey’s Pharmacies. Community pharmacy is becoming increasingly complex and Concannon is passionate about creating an environment which enables each Hickey’s Pharmacist to make a real difference for their customers. He has ensured that Hickey’s have embraced the recent changes in the world of pharmacy, including the augmented vaccination services and the provision of emergency medicines. His decision to provide emergency anaphylaxis training across the company has already resulted in two walk-in patients receiving life-saving adrenaline treatment. Concannon also continues to work part-time as a pharmacist in a busy store. He believes that seeing the issues and challenges in the store at first hand improves his policies and helps him to drive innovation. In addition to the introduction of advanced services Concannon realises the importance of getting the basics right also. In the last 12 month he has introduced an e-learning system to deliver and track training across the company.

Tom Concannon, Superintendent Pharmacist, Hickey’s Pharmacies

Celebrating Business Success This year, Tomas Conefrey has taken what used to be a hobby and started using it to his and his businesses advantage in taking it forward with the use of social media. Through his increased of online social media, he has increased the profile of his business, the pharmacy profession. He has invested effort and resources in applying his interest to pharmacy practice. Tomas manages the #1 Irish Pharmacist Twitter account @ConefreyPharmac with over 9,000 followers. The focus of the account is on health promotion and promotion of the role of the Community Pharmacist. Tomas has been a member of Toastmasters International for the last 13 years and believes the skills he has learned there have been of tremendous help in interacting with patients. Tomas Conefrey, Pharmacist, Conefreys Pharmacy Dublin

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Dynamic 100 Presidential Role for Daragh Daragh Connolly was elected as President of the Irish Pharmacy Union (IPU) in April 2016. Daragh has been involved with the IPU since 2002, having experience on Regional & National Committees. Daragh is a native of Dungarvan, Co. Waterford and graduated from the School of Pharmacy University of Portsmouth in 1996. Daragh is a third generation pharmacist following in his grandmotherâ&#x20AC;&#x2122;s (1922) and fatherâ&#x20AC;&#x2122;s (1959) footsteps. After pre-registration at Salisbury District Hospital he worked in Portsmouth before moving home to the family practice in 2001. Daragh is a former President of Dungarvan & West Waterford Chamber of Commerce(10-12) and a former chairman of Indepharm Co-operative 2010 -14.

Daragh Connolly, President IPU

Global Digital Recognition

Richard Corbridge, CIO, HSE

Richard Corbridge is a globally recognised expert in healthcare strategy and technology. Since December 2014, Richard has been the Chief Information Officer for the Health Service Executive in Ireland and Chief Executive Officer for eHealth Ireland. In these two years, Richard has implemented a unique identifier for health, fully digitized the referral process, put in place Irelands first clinical information officers council, began the first epilepsy genomic sequencing programme globally and started the implementation of a national lab system and a national maternity EHR. He has also brought a focus to the delivery of a number of key strategic programmes including the beginning of ePharmacy for Ireland, digital cancer care. For the last three years Richard has been named in the top ten most influential CIOs in Europe.

Leading the Efficiency Journey Adele is the Customer Success Manager for Real World Retail Pharmacy customers. She goes above and beyond her duties to motivate and support each customer on their journey to becoming more efficiently managed. Adele, through her strategic mind, patience, and hard work ensures that her customers use our insights as a tool for patient care and business development. She strives to help them drive their business by developing true insights from their PMR data. With her wide industry knowledge, she very often has the answer to the question before you have even thought of the question! In 2016, she has presented to industry professionals on how they can make the most of their data, and how they can make minor adjustments to their day-to-day management style to allow for greater efficiency and better cash management. She has studied the data of new customers, and worked closely with their management teams to set out a strategy that will help to scoop up extra profit and increase the patient care experience. Adele has taken her knowledge of Irish pharmacy and applied it to the UK market where she is now guiding 300+stores to be best practice pharmacy retailers.

Adele Curran, Customer Success Manager, RwR

Security, Risk and Profit Protection

Aisling is a Director of TONiC Consultancy, and has a MSc in Security and Risk Management. She is a highly experienced security, risk and profit protection professional with a proven track record in obtaining industry leading results. After six years in Business Aisling has been instrumental in focusing the company on providing innovative software solutions, that save clients both time and money, whilst giving them financial and regulatory peace of mind. She has also developed the companies E Learning software package, which due to its functionality and value for money is proving to be very popular, with additional content imminent. Aisling Daly, Director, TONiC Consultancy

Her analytical approach has also helped companies save millions of euro through margin investigations and profit protection strategies.

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Dynamic 100 Heading up Pharmaceutical Healthcare In 2016 Mary Dickens was appointed President of the Irish Pharmaceutical Healthcare Authority. In this position Ms Dickens represents the research-based pharmaceutical industry in Ireland and continues to demonstrate the key role the industry plays as a partner in healthcare provision. In July of this year IPHA agreed a new four year Framework Agreement with the Government for an economic and secure supply of medicines for patients. The Agreement will see total savings of ¤785 million from IPHA member companies, an average of nearly 200m a year. She is the Country Chair and General Manager of General Medicine of Sanofi Ireland Ltd. She has been a member of the IPHA Strategy Board since September 2011 and was appointed to the Board of Directors in November 2012. She joined the Sanofi Group in 1984 as a Medical Representative in the UK and held various positions including Regional Business Manager before returning to Ireland in 1999 to join Abbott Laboratories as Divisional Manager. Mary Dickens, President, IPHA

Leading in Paediatric Care Since opening her own Pharmacy in November 2014, Hilary Dolan has had her hands full, employing three full time pharmacists, and playing an active role in the local community. Earlier this year she organised a paediatric first aid course, for parents in the area, after identifying a gap in the community for this kind of service. “There are a lot of young families around the area, and over 30 people took the course,” she said, speaking to IPN. “They were delighted. The main thing they learned was not to be afraid to call for help.” Hilary won IPN locum of the year in 2012, and was this year nominated for people’s pharmacist. In addition, she has just finished an Assist course in suicide intervention. Hilary Dolan, Pharmacist, The Mill Pharmacy, Sligo

Operating at the Highest with IIOP Sarah recently co-ordinated the operation of the Faculty of Radiologists Professional Competence Scheme. This involved liaising with the Medical Council, working with the other Postgraduate Training Bodies and supporting radiologists with the recording of their CPD activities. Sarah joined the IIOP in 2016, working in the areas of training programme development and accreditation. Sarah has experience in the healthcare area. Previous places of work include Christ Church Cathedral and the Football Association of Ireland. Sarah’s qualifications are in project management and architectural history. Sarah Drumm, Operations Co-ordinator, Irish Institute of Pharmacy

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Dynamic 100 Bernard Digs Deep for Pharmacy Bernard Duggan joined the IIOP team in September 2016 as Operations Director with responsibility for all operational aspects of the IIOP work. Bernard’s key projects have involved the ePortfolio review roll out and the piloting of practice review, as well as ensuring the delivery of new e-learning programmes. Bernard has joined the team at an exciting part of the IIOP’s journey and will continue to support the IIOP’s work in rolling out the new CPD system for pharmacists over the next year. Bernard comes from a community Pharmacy background where he was part of the successful team at Dargan’s Pharmacy for 12 years.

Bernard Duggan, Pharmacist & Operations Manager, IIOP

Keeping Pharmacy at the Forefront As CEO of 4Front Pharmacy Solutions, Rachel’s vision is to empower pharmacists to harness the power of ‘The Coach Approach’ to deepen their leadership and patient-care impact and influence through staff training, online coaching programmes and one-to-one consultations. In June, 4Front launched the L.E.A.D. Online Mastermind Programme, designed to facilitate pharmacists to proactively transform their personal, professional and business mind-set, behaviours and results. Rachel is a continuing professional development leader in both pharmacy and coaching. In Pharmacy, she is IPU Academy tutor, RCSI MPharm Assessor, IIOP Peer Support Pharmacist and participant on the ePortfolio Review and Practice Review Pilot and facilitator of 4Front/Pharmaconex weekly online CPD masterclasses. Rachel Dungan MPSI, MICF, ACC

A strong advocate of multi-disciplinary learning, she is programme coordinator of the Medical Coaching Learning Community and recently appointed to a 3-year term as ICF Global Health and Wellness Community of Practice Leader. Both coaching communities are open to pharmacists and participation counts as accredited CPD. She is ICF Ireland Life/Wellness Coach of the Year for 2016.

At the Heart of Commercial with McCauleys John Eggleston has worked with Sam McCauley Chemists for the last 14 years and is the Commercial Director. Working with other Senior Managers within SamMcCauley Chemists, Eggleston has successfully relocated and extended several pharmacies within the Sam McCauley Group over the last 12 months. The increased retail space along with an expanded retail offering has resulted in substantial increases in sales and at the same time offered further efficiencies. Eggleston has also been instrumental in controlling wage costs, introducing new retail and cosmetic brands and delivering higher margins. As a member of the Board of Sam McCauley Chemists he has helped and contributed greatly to the strategy and growth of this dynamic company.

John Eggleston, Commercial Director, Sam McCauley Chemist

Juggling with Success Paul Fahey has been juggling two roles in 2016 - his two professional roles as owner of Haven Pharmacy Fahey’s in Tullamore and Business Development Officer of Pharmapod. Working in the pharmacy allows him to achieve an insight into the medication issues that patients and pharmacists have to deal with on a day to day basis. This combined with his Information Technology expertise allows Paul to bring a practitioner’s perspective to the design of Pharmapod’s software which facilitates pharmacists in managing compliance.

Paul Fahey, Pharmacist, Fahey’s Pharmacy, Tullamore

Fahey is also a member of various HIQA Expert Advisory Groups is also a Chief Clinical Information Officer (CCIO) for eHealth Ireland which is currently looking at the whole area of ePharmacy. Paul is a member of the Indepharm Co-Operative which is Ireland’s largest independently owned pharmacy co-op and which now has 52 pharmacies branded as Haven Pharmacies nationwide. Paul is also a Board member of the Pharmacy Benevolent Fund.

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Dynamic 100 Leading Retail into 2017 David Fitzsimons is Chief Executive Officer of Retail Excellence Ireland (REI). David was involved with the establishment of REI in 1995, when he worked with South Dublin Chamber of Commerce. David oversees the strategic direction and operations of this non-profit organisation. REI is Ireland’s largest retail industry body representing the interests of 1,300 leading companies who employ 110,000 people and operate 16,000 stores in the Irish market. David with 500 pharmacy store members established Pharma Medicines Insights to assist pharmacists deliver targeted and appropriate patient healthcare interventions. David sits on a number of global retail committees including the NRF Global Retail Council. David Fitzsimons, CEO, Retail Excellence Ireland

Leading the Way in Chronic Health During 2016 and continuing, Fleming Medical has been developing the world’s first smart wound care dressing that will enable more accurate wound care assessments, plus a reduction in patient discomfort. As pioneers in its field, Fleming Medical is constantly searching for new and ground breaking ways of enhancing patient care –it is the link between academic research and its practical application to continuing healthcare needs. Established in 1986 by its founder Mark Fleming and based in Limerick, Fleming Medical has a team of over 50 staff and a customer base spanning across Ireland, the UK and a wide range of countries worldwide.The company prides itself on innovation and leads the way in chronic health conditions through the adaption of wearable technology to healthcare solutions.

Mark Fleming, Founder, Fleming Medical

Innovating the Self Care Market The entrepreneur Peter Foley began LetsGetChecked in order to create a fast, efficient and private product-service which allows people to test themselves for conditions such as STIs, prostate cancer, the BRCA genes, and HPV. Earlier this year he announced a ¤2.5m deal with Quest Diagnostics, one of the largest laboratories in the US. This will enable the company to begin to tap into speciality testing, within certain jurisdictions, to add to their services.

Peter Foley, Founder, Letsgetchecked

At present, the company’s kits are available through its own website, or through about 100 pharmacies throughout Ireland. Pharmacists, in working with LetsGetChecked, act as facilitators, which saves members of the public from having to take time off work to attend their GPs.

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Dynamic 100 Award Winning Academic for Innovation Dr Aoife Gallagher is Head of Innovation with the RCSI. The goal of the team RCSI’s Innovation team is to work with RCSI Principal Investigators (PIs) to ensure that RCSI research is given the best opportunity to make economic and societal impact through the provision of customer-orientated industry engagement and research commercialisation services to researchers and industry partners. In 2015, the team launched a new strategic initiative “Building a Culture of Knowledge Transfer at RCSI” to maximize researcher engagement in knowledge transfer activities to achieve this goal. In June, RCSI’s Innovation team has won the Knowledge Transfer Initiative of the Year Impact Award at the national Knowledge Transfer Ireland Impact Awards 2016.

Dr Aoife Gallagher, Head of Innovation, RCSI

Leading Masters of Pharmacy Programme

Professor Paul Gallagher, Head, School of Pharmacy, RCSI

Professor Paul Gallagher is Head of School of Pharmacy, Royal College of Surgeons in Ireland (2010-2018). Paul has in part enabled the reform of pharmacy education through his Directorship of the National Pharmacy Internship Programme and his role leading the response to the tender for establishment of the Irish Institute of Pharmacy in College for the Pharmaceutical Society of Ireland. In 2016, Paul was awarded the Utrecht University Prize for Advancement of Pharmacy Practice and continues to impact on pharmacy education as he leads the implementation of the new integrated Master of Pharmacy programme at RCSI. This exciting and innovative programme provides pharmacy students with the highest standards of professional knowledge and skills required to practise as a pharmacist in all contemporary settings. The programme has been designed by Paul and his team to provide an outstanding student experience that supports graduates to become leaders in healthcare provision and innovation.

Gannon Drives Generics Agenda Sandra Gannon is Ireland Country Head at Teva, and President of generics lobby group the Healthcare Enterprise Alliance. Within these roles she leads the world’s leading generic pharmaceutical company, and specialises in the development, production and marketing of generic and proprietary branded pharmaceuticals as well as active pharmaceutical ingredients. She has been instrumental in driving Teva’s identity within Ireland as the largest supplier of prescription medicines and has helped shaped the future of medicine delivery here liaising with leading pharmaceutical professionals and the HSE medication network.

Sandra Gannon, Country Head, Teva/President, HEA

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Dynamic 100

Leading Service Advances Feargal Garvin has led the Pharmacy team in the Boots store in Drogheda for the past 8 years. As such, during 2016 he has been at the forefront of advances in pharmacy including EHC provision, vaccination, 24 hour blood pressure monitoring. Customer care is at the heart of everything Feargal does at Boots and he enjoys using his skills to help people. Feargal works with patients recovering from substance abuse, running a needle exchange service. He serves on the board of directors of local charity, The Red Door which provides invaluable services to, and helps in the rehabilitation of people affected by substance abuse.

Feargal Garvin, Pharmacist, Boots Pharmacy Drogheda

Making ‘Impacts’ on Care Dr Grimes is a clinical pharmacist, with an interest in optimising medicines use for acutely hospitalised patients. She works at The School of Pharmacy and Pharmaceutical Sciences at Trinity College Dublin, and Tallaght Hospital Dublin. Dr Grimes’s research focuses on interventions to improve patient safety during hospital care, and at times of transition as patients move into or out of hospital. She is Principal Investigator on the Collaborative Pharmaceutical Care At Tallaght Hospital (PACT) project that seeks to improve the integration of clinical pharmacy practice into the inter-professional hospital team, in order to enhance patient safety. Dr Grimes has shared her work both nationally and internationally. Through her academic work, she leads educational programmes, at undergraduate and postgraduate level, to support clinical pharmacy, medicines optimisation, evidence-based practice and inter-professional learning. She is a member of the National Clinical Effectiveness Committee subgroup on Education and Training.

Dr Tamasine Grimes, Associate Professor, School of Pharmacy and Pharmaceutical Sciences, Senior Research Pharmacist, Tallaght Hospital

Simple Solutions Enhance Productivity McLernon Computers are leaders in Pharmacy software programmes and last year installed KODAK SCANMATE i1150 Scanners as part of a retail pharmacy software solution sold to chemists in both the north and south of the country. Said Robin, “Partnering with Kodak Alaris, we offer an additional scanning module for pharmacists to scan prescriptions and store them directly into MPS for easy future retrieval on-screen. It is a very simple solution which saves time, enhances productivity and ultimately allows pharmacists or their assistants to spend more time with patients front of house rather than hunting in filing cabinets for old prescription paperwork.”

Robin Hanna, Sales Director, McLernon Computers

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Dynamic 100 Flying the Flag for Funding Dr Michael Harty is a GP in Kilmihil, County Clare where he has run a single-handed rural practice for the last 32 years. He is entered politics for the first time as an Independent candidate in the General Election, put forward by ‘No Doctor No Village’ – a grassroots campaign for the preservation of rural communities and the transformation of health services. He was elected as a TD in the election and is now Chairman of the Joint Oireachtas Committee on Health. Dr Harty has said that as a member of the Dail he will push for primary care to receive greater funding and support.

Dr Michael Harty, GP, Co Clare

Schooling the Next Generation Anne Marie Healy is Professor in Pharmaceutics and Pharmaceutical Technology at the School of Pharmacy and Pharmaceutical Sciences, TCD and is currently Head of School. Professor Healy has led the School in the development and delivery of its innovative five-year integrated pharmacy programme, which commenced in September 2015; with students set to undertake their first professional placements, as part of the new programme, in February 2017.

Professor Anne Marie Healy, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin

Professor Healy has also continued to expand her research activities in 2016. She received major research funding from the National Institutes of Health (NIH), one of the world’s foremost medical research centres based in the United States, to work on a collaborative project between TCD, UCD and the University of California, San Francisco (UCSF). The project will focus on carbohydrate-based mucolytic therapies for people living with lung disease, and the development of a new dry powder inhaler for patients with cystic fibrosis, asthma and chronic obstructive pulmonary disease.

Harris Secures Largest Ever Health Budget Minister Harris has worked throughout 2016 to enhance health and Pharmacy services. This year secured the largest ever health budget with a total of ¤14.6 billion. After another intensive period of negotiation, he also saw through a finalised Medicines Supply Agreement which will provide substantial additional savings on the future drugs bill over the coming years. The new Agreement, which runs to the middle of 2020, is projected to result in savings – that is, expenditure foregone – of some ¤600 million from IPHA companies, with a further ¤150 million in savings anticipated from non-IPHA companies over the lifetime of the deal. The new Agreement contains a number of features which represent clear additional value over the terms of the previous 2012 agreement. It also addresses a number of issues raised by the Report on the Cost of Prescription Drugs in Ireland, issued by the Joint Committee on Health and Children in 2015. Simon Harris, Minister for Health

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Bayer is a global life science company managed by 3 divisions; Pharmaceuticals, Consumer Health and Crop Science. In all areas of our business, we invent, develop and market new molecules which influence the biochemical processes in living organisms. We are based in Leverkusen, Germany. Bayer has been in Ireland for more than 45 years and employs over 100 people. Our Pharmaceutical division provides quality medicines for diagnosing, combating and preventing disease in Irish patients. We are involved in researching new pathways, new molecules and new technologies in areas with a high level of unmet medical need, such as cancer therapy, cardiovascular and blood disorders, as well as gynaecology and ophthalmology. Our Consumer Health division produces non-prescription medicines

and dietary supplements with brands including Berocca and Alka Seltzer. Our Crop Science division supports the agricultural industry, offering a broad range of innovative products for improving plant health, along with high-value seed products and also includes Animal Health, which focusses primarily on treating infectious diseases and repelling parasites.

Life Science Company

Dynamic 100 Setting New Standards in Care Fortunes Pharmacy is setting new standards in pharmaceutical care. This year they have established a new ‘Carepoint Health Screening’ Service and introduced it to their local community. Specialising in home care services, Yvonne and team strive to provide an efficient, professional and totally reliable service to all customers. At Fortune’s Pharmacy, they believe your health is your wealth. Their new Carepoint Health Screening service helps patients take control of that wealth. Yvonne is a native of Rosslare Strand, Co. Wexford and was educated at Loreto Convent, Wexford and Trinity College Dublin. She holds a Masters Degree in Clinical Pharmacy from Robert Gordon University, Aberdeen. Yvonne has seventeen years experience in Clinical Pharmacy.

Yvonne Hennessy, Fortunes Pharmacy, Wexford

Pioneer, Visionary and Researcher Chair of Industrial Chemistry at UL, Professor Hodnett has over 30 years’ experience in the academic sector in Ireland and overseas. In that period, he has become known as a pioneer, a visionary and a top-class researcher and teacher. As a pioneer, he has led many firsts in his illustrious career including recognising the opportunity within PRTLI he established the first Research Institute at UL– the MSSI. Over the course of his career, he has ¤40M competitive research funding to his name, and has recently been trusted by a cohort of Pan-European research centres from Germany, the UK, Finland, Belgium and Ireland to lead a policy level initiative attempting to secure significant H2020 funding for their sector. Professor Kieran Hodnett, Scientific Director, SSPC

Acquisitions and Dynamic Change Tony launched Actavis in Ireland in 2008. He qualified as a Pharmacist in UCD in 1979 and has since spent 30 years in the industry working in Athlone Labs & Pinewood Healthcare in senior positions involving technical operations, sales and marketing. Tony has spent two years as chair of the generic trade association, the APMI, where he lobbied government continuously for a pro generic strategy centred on substitution by Pharmacists. In 2016 Tony steered Actavis through a year of dynamic change in Ireland following the Allergan acquisition, sale of the generics business to Teva and subsequent divestment to Intas ensuring consistent supply to customers, excellent customer service and new product launches while maintaining Actavis position as the number 2 generic supplier to the Irish market. Tony is highly skilled in strategic planning and has mentored and trained the Actavis Ireland team to continually strive for excellence across functions and will work in 2017 towards building on Actavis position in the Irish market.

Tony Hynds, Managing Director, Actavis Ireland

Meeting Recruitment Demand Paolo founded PharmaConex in 2010. His aim was to provide quality Locums to the community Pharmacy sector. As a Pharmacist himself, Paolo identified a gap in Ireland for this service. The company although small to start went from strength to strength and now employs 14 staff including 3 full time relief Pharmacists. While PharmaConex were historically connected solely to the provision of Locums, Paolo grew the business further to meet recruitment demand. He now employs a team of expert recruiters who work on permanent pharmacy placements. As a result of consistent delivery and efforts to improve service levels, PharmaConex are lucky enough to work with some of the Country’s biggest Pharmacy Networks. Paolo Iacovelli, Managing Director, PharmaConex

Paolo will grow the business further in 2017 with the launch of a new desk. This desk is a response to demand and will provide recruitment solutions for the pharmaceutical industry.

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Dynamic 100 Pharmacist of the Year 2016 Brian qualified with a 1st class honours degree in pharmacy from Trinity College, Dublin in 2002 and subsequently joined Sam McCauleys, Tralee, Co. Kerry in 2006. Brian says he believe in forming strong relationships with his patients and other healthcare professionals in the Tralee area, and is extremely active in his local community raising funds for local charities and University Hospital Kerry. He has organised many in-store information days which include Migrane awareness days, Asthma clinics, Ostomy clinics, Cancer awareness and many others. He also works with the local IT Tralee giving talks to the IMCP students. Brian introduced a Free Carbon Monoxide monitoring service which provides an indicator of the reduction of carbon monoxide levels over time and has proved to be hugely beneficial in the promotion of smoking cessation. Most recently Brian was awarded the Community Pharmacist of the year at the IPN Awards.

Brian Kearney, Supervising Pharmacist, Sam McCauleys, Tralee, Co. Kerry.

Developing Pharmacy Programmes JJ Keating is a locum community pharmacist and Lecturer of Organic and Pharmaceutical Chemistry, in the School of Pharmacy/Department of Chemistry, UCC. Keatingâ&#x20AC;&#x2122;s face is known to many community pharmacists in the Munster area as a tutor of the Irish Pharmacy Union (IPU) Academy, developing and delivering several CPD lectures on various pharmacy related topics on behalf of the IPU as part of their Spring and Autumn programmes. He is a Member of the Steering Group for the Irish Institute of Pharmacy (IIOP), and works closely with the Controlled Drugs Section of the Department of Health and Children in relation to the Irish Misuse of Drugs Regulations and Acts. Keating is heavily involved in the design and delivery of the new integrated MPharm curriculum in UCC. During the summer of 2016, he was a visiting researcher at the University of South Florida at Tampa. He is currently studying for an MA in Teaching and Learning in Higher Education, also at UCC.

Dr JJ Keating, Pharmacy Lecturer, UCC

Leading Curriculum Change Professor Cathal Kelly took up the position of CEO/Registrar in December 2009. A graduate and Fellow of RCSI, Professor Kelly was previously Dean of the Faculty of Medicine and Health Sciences from 2006-2009. Prior to his appointment, he was a Consultant General and Vascular surgeon with a special interest in endovascular surgery in Beaumont Hospital. He combined this role with chairmanship of the surgical division and an academic position in RCSI as vice Dean for curriculum change. In addition to completing his basic and higher surgical training in Dublin, Professor Kelly pursued a research fellowship at the University of Pennsylvania in Philadelphia, USA. Cathal has also won the prestigious Patey Prize of the Association of Surgeons of Great Britain & Ireland for research he conducted at Beaumont Hospital and he has also obtained first place in the intercollegiate Specialty Board Exams. Professor Cathal Kelly, CEO, RCSI

Healthcare Insights Portfolio Growth David is a Director of United Drug Distribution Ireland Limited and has been involved in the Irish pharmaceutical market for over 25 years. His early career focused on the world of OTC and veterinary medicines and developing strategies to work in partnership with the pharmacy sector to build successful local brands. Within his current role David is responsible for the United Drug Distribution business and he and his team work closely with a large number of manufacturers ensuring the local supply chain and customer services functions meet the needs of the local market. More recently he is responsible for an evolving Healthcare Insights offering within the United Drug portfolio, featuring a range of insightful and commercially focused analytical tools for executives within the pharmaceutical industry. He held the position of President of the Pharmaceutical Managers Institute for the period 2015-16, is a graduate of the Institute of Marketing in Ireland and also a qualified Accounting Technician

David Keyes, Distribution and Hospitals Director, United Drug

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Dynamic 100 Leading in the Community Amy opened Kieran’s Avenue Pharmacy in Dundalk Co. Louth in September 2014 at a time when no independent pharmacies were being set up in the country. Since then Kieran’s has established itself as one of the towns leading pharmacies. The business has gone from strength to strength with Amy creating a community within the pharmacy. From a social group that meets in the pharmacy weekly, to Nail Art Camp for children, Kieran’s caters for all ages. Amy has concentrated during 2016 on developing the pharmacy’s presence online through the design of a new online store and the strengthening of existing Twitter, Snapchat, Facebook and Instagram accounts. This has allowed Kieran’s to place itself at the forefront of what’s new in pharmacy and brings the brand to her customers in their own homes. In May 2016 Amy was shortlisted for the United Drug Community Pharmacist of the year award. Amy Kieran, Kieran’s Avenue Pharmacy, Dundalk

Achieving Significant Retail Investment Real World Retail (rwr), the Irish retail analytics start-up, was founded by Conall Lavery with John Hogan in 2013. They announced this year that they have closed a ¤920,000 fundraising round from angel investors and Enterprise Ireland. Real World Retail (rwr) has developed an always on Cloud based analytics solution which is already helping retail and pharmacy customers, over 600 stores, in Ireland and the UK deliver better business results. Based on what they learned from their Irish customers the solution was launched in the UK in early 2016. In this short time, they have added another 300 pharmacies through 7 groups who are benefiting from the insights and business actions suggested by the solution. In 2017 rwr will be bringing in features learned in the UK into its Irish solution which will help their customer drive more profit and cashflow into their businesses.

Conall Lavery, Co-Founder and CEO,Real World Retail (rwr)

Offering Niche Services to Patients Jennifer has worked her way up within McCabes to her current role as deputy superintendent pharmacist of the company. Starting off her career in Pharmacy as a work experience student she pursued her career by training as a technician. Jennifer has been working with Linda O’Connor from Bloodworks this year to be able to provide patients with access to phlebotomy services in the community Pharmacy. There are blood screening services available to her patients that GP’s cannot provide, for example CA125 which screens for ovarian cancer. This service has a three day results turnaround helping people avoid crowded GP surgeries and hospitals and in turn reduces the burden of already overstretched services.

Jennifer Leroy, Supervising Pharmacist, McCabes Pharmacy Swords

Managing Patient Medication Success As part of a Thesis carried out in 2015 for an MBA in Healthcare Management with Imperial College, London, Garvan set out to measure the relationship between increasing a patient’s health literacy, and the positive impact this has on the patient’s health outcomes. The patients who participated in his study and used his newly designed ‘Patient Medicine Consultation System’ showed an increase of 25% in their medicine adherence. Due to the success of the study in 2015, Garvan has spent 2016 formalising his new ‘Patient Medicine Consultation System’. The results of the thesis are being put forward for publication, and following this, he will be ready to launch the new service in early 2017, becoming the first Pharmacy in Ireland to provide the Patient Medicine Consultation to 100% of patients, while simultaneously integrating technology in healthcare management. Garvan Lynch, Pharmacist, Lynch’s Pharmacy, Cork

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HELP FIGHT COLDS AND

FLU

with Echinaforce

Hot Drink

In Echinaforce Hot Drink we combine the benefits of fresh extracts of Echinacea purpurea with concentrated elderberry juice. The beautiful dark purple/black berries of Elderberry are well known as a delicious ingredient in drinks, providing a tart and stimulating taste, making this a pleasant hot drink to consume when suffering from symptoms of cold or flu. When your body is suffering with a cold or flu and you’re aching all over, and you just can’t seem to shift those sniffles, a little something to soothe and comfort goes a long way. So, the thought of snuggling up with a warming drink would appeal to most. Why not try Echinaforce® Hot Drink for some extra warmth and comfort and to help relieve those troublesome symptoms.

Echinaforce Hot Drink Cold & Flu

Contains Echinacea.

Echinacea concentrate for oral solution Traditional herbal medicinal product used to relieve common cold and flu-like symptoms, exclusively based upon longstanding use. Always read the leaflet.

ng thi o So

forting Com

This flavoursome drink can be used to help relieve symptoms of colds and flu such as chills, malaise, aching limbs, headache, feeling hot and a blocked or runny nose. It is important to drink plenty of fluids when ill to prevent dehydration and to help you feel better. At times such as this a comforting mug of Echinaforce® Hot Drink is an ideal way to top up the body’s fluid levels and help on the road to recovery.

cea te Echina ncentra co

) cus u b (Sam Elderberry

Echinaforce Hot Drink Cold & Flu Echinacea concentrate for oral solution. Active Ingredients: 5 ml of concentrate contains: 1140 mg of tincture of fresh Echinacea purpurea herb and 60 mg of tincture of fresh Echinacea purpurea root. Indications: Traditional herbal medicinal product used to relieve common cold and flu-like symptoms, exclusively based upon long-standing use. Dosage and administration: Adults, older people and adolescents over 12 years: Days 1-3: Take 5 ml diluted in hot water five times daily. Days 4-10: Take 5 ml diluted in hot water three times daily. Contraindications: Hypersensitivity to active substances, plants of the Asteraceae (Compositae) family. Do not use in cases of progressive systemic disorders, autoimmune diseases, immunodeficiences, immunosuppression, diseases of the white blood cell system and allergic diathesis. Patients with a history of significant allergy or difficulties swallowing or breathing. Warnings and Precautions: Not recommend for use in children under 12 years of age. If the symptoms worsen or high fever occurs, or if symptoms persist for more than 10 days, a doctor or qualified healthcare practitioner should be consulted. There is a possible risk of anaphylactic reactions in atopic patients. Atopic patients should not use this product. This product contains a small amount of ethanol (alcohol), less than 100mg per dose. Contains sucrose. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. Drug interactions: Immunosuppressant medication. Pregnancy and lactation: Not suitable during pregnancy and lactation. Side effects: See SPC for full details. Hypersensitivity reactions. Association with autoimmune diseases has been reported. The frequency is not known. Legal category: GSL. Registration number: TR0725/009/005 Registration holder: Bioforce (UK) Ltd, 2 Brewster Place, Irvine, Ayrshire KA11 5DD. RRP (ex VAT): i11.80 (100ml). Date of Preparation: October 2016

3812

Available from:

Dynamic 100

Delivering the Heart Foundation Agenda Dr Kate McGarry is President of the Irish Heart Foundation. In taking up this new appointment earlier this year, Dr McGarry set out to help deliver the organisation’s life-changing and life-saving services to more people affected by heart disease and stroke in Ireland. The IHF is at the forefront in educating the public about cardiovascular diseases and about how to manage risk through lifestyle changes. It is currently lobbying the Government on the National Obesity Plan and the National Physical Activity Plan.

Dr Kate McGarry, President, Irish Heart Foundation

McCormack Drives Further Success for McCauleys Patrick was born and educated in Wexford and qualified as a pharmacist in 1988 from Trinity College, Dublin. He is the third generation of his family to become a pharmacist. He has worked in USA , the UK and Iraq before joining Sam McCauley Chemist Group in 1991as a pharmacist. He has the distinction of being held as a “human shield “by the Iraqi regime during the first gulf war in 1990. Key achievements in 2016 under Patrick’s stewardship have included the further expansion of the Sam McCauley Group with a capital spend of almost Euro 2m and the group is now up to 30 stores with further expansion in the pipeline for 2017 Patrick McCormack, Managing Director, Sam McCauley Pharmacy Group

The Sam McCauley Chemists has also been placed 4th out of the top 100 retail brands in Ireland in an independent survey carried out by Amarach consulting based on excellence in customer experience.

Improving IT Systems Oliver McGuinness, Chairman totalhealth Pharmacy Group & McGuinness totalhealth Pharmacy, Roscommon. Oliver McGuinness is a community pharmacist in a 3rd generation family business in Roscommon town and is also the Chairman of the totalhealth Pharmacy Group.

Oliver McGuiness, Chairman, totalhealth Pharmacy

As Chairman of totalhealth, Oliver has spearheaded the expansion of the brand nationwide in 2015, with over 60 pharmacies nationwide under the totalhealth branding. During 2016, the group saw significant improvement in the group IT systems which have resulted in greater efficiencies and savings across the group. Members are enjoying the benefits of being part of a group where they decide the direction and are contributors. They benefit from a host of back office from totalhealth thereby allowing the pharmacist owner to focus on customer service and excellence in community pharmacy services. Looking forward to 2017, McGuinness is looking forward to announcing new members to the group and developing health services across our takecare clinics.

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Dynamic 100 IMS Superintendent Pharmacist of the Year 2016 Pádraig McGuinness is the superintendent of the CARA Pharmacy Group, one of the country’s leading pharmacy chains. He previously held the role of Teacher Practitioner at the University of Brighton, of which he is a graduate. He has also held several posts in pharmacy in Ireland, Northern Ireland and UK. Pádraig is deeply committed to quality improvement and believes that pharmacists have a key role to play in education of the public, allowing them to take control of their own healthcare needs. He is a lead researcher in the CODEMISUSED project, investigating codeine misuse, use and dependence in Ireland, the UK and South Africa. A keen supporter of continued professional development for pharmacists, Pádraig has been involved with peer review of CPD portfolios, both north and south of the border. He was this year’s winner of the “Superintendent of the Year” Award at the IPN Awards.

Padraig McGuinness, Superintendent Pharmacist, CARA Pharmacy

Design Through to Completion With CarePlus since its inception, Stephen is responsible for providing pharmacists with a turnkey solution, from design through to completion. More recently, he was tasked with the rebrand of three pharmacies in Longford, Rochfortbridge and Kinnegard, managing the Pharmacy projects from the first drawing to the final finishing touches, liaising closely with the Pharmacists. The end result has been three pharmacies reaping the benefits of customer satisfaction and increased sales. Stephen has 10-years of experience, with a BA Hons Interior Architecture and a Diploma in Project Management from DIT Bolton St. He was also responsible for the redesign and implementation of the Superquinn estate to Supervalu. Stephen McKay, Head of Store Development, CarePlus Pharmacy

Dr McLoughlin - The Heart of Pharmacy Dr Ambrose McLoughlin is Chairperson of the Heartbeat Trust a national charity focused on controlling and preventing heart failure. Ambrose was a Chief Dental Officer in a regional authority for ten years. Ambrose is well known to the profession of pharmacy and the pharmacy sector, having had a prominent role in securing and implementing the Pharmacy Act of 2007. His contribution to supporting the expansion of Pharmacy Practice in areas such as immunisation is well known and his advocacy for the NFQ Level 9 M.Pharm degree is recognised across the third level sector. The new PSI HQ, at PSI House in Fenian Street in Dublin, is another important legacy. A strong advocate of Patient Safety he managed some of the most difficult challenges in the health sector competently and effectively. He is particularly proud of Ireland’s anti-tobacco policy and of Healthy Ireland.

Dr Ambrose McLoughlin, Chairman, Heartbeat Trust

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Dynamic 100 Leading Patient Care Across Europe Stephen McMahon is the co-founder of the Irish Patients Association. It is within this role and remit that earlier this year, Stephen led the organisation together with 20 founding signatories to call on health authorities and policymakers, healthcare professionals and healthcare providers, to sign up to the Pact for Patient Safety - a pledge to implement procedural and material standards of practice in order to better protect patients from preventable harm as prescribed by the legally binding EU directive on Patients’ Rights in Cross-border Healthcare. Together they represent hundreds of thousands of patients across Europe.

Stephen McMahon, Co-Founder, Irish Patients Association/PACT for Patient Safety

Professional Contribution Award Winner 2016 In 2016, Elaine Lorrigan McSweeney, Claims Processing Manager at Allcare Management, was winner of IPN professional contribution to pharmacy award for her work as technician. This year, she has also written training manual for processing claims effectively, and trained over 100 pharmacists and technicians. She is also President of the IACPT. Her work with Allcare Management Services has highlighted her professionalism and thirst for process improvement across the board but particularly in relation to the Claims process in Community Dispensaries. Her biggest achievement over the past two years has been the reduction in the quantity of rejections that the Allcare group were experiencing prior to her employment.

Elaine Lorigan McSweeney, Claims Manager, Allcare Pharmacy

Building on a Strong Reputation Prompted by the downturn in the economy, McSharry’s began to look at their business in a more strategic fashion than years previously, identifying key pillars of their business strategy, and planning their upcoming annual budget - as well as their financial, HR, and marketing goals months - in advance. Serving the community for 20 years, Ray McSharry continues the strong reputation as a first port of call for patients seeking advice on their families’ health. His practice of giving advice to patients and helping them organise their medicine, even delivering it to patients who find it difficult to visit the pharmacy, epitomises the idea that your community pharmacy is the gateway to the health service. Ray McSharry, Superintendent Pharmacist, McSharry’s Pharmacy Group

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Dynamic 100 Specialising in Allergic Reactions Spanish pharmacist Sergio Martin has been working in Ireland for the last 13 years, the last nine of them managing the Adrian Dunne branch in Whitehall. Since that time he has been responsible for building excellent relationships both with the patients in the Whitehall area and with the doctors, surgeries and pharmacies around. During the 2016 year he has continued providing excellent customer service to patients. From helping a small child with a strong allergic reaction, to going to customer’s homes in his own private time to explain changes in medication and how to take the new medicines. He has offered private and personalised advice to customers both in the shop and in the comfort of their own home.

Sergio Martin, Adrian Dunne Pharmacy, Whitehall

Product Procurement Platform Paddy Meehan worked in community pharmacy for a number of years before developing his first pharmacy buying group business. In 2016, Pharmax was developed which is an independent pharmacy product procurement platform. Pharmax.ie allows independent pharmacists access to brokered medicinal products including originator brand medicines, generics and parallel imports in an efficient and cost effective manner. Members of pharmax maximise their procurement potential through ordering a Pharmax brokered net priced product on a pack replacement basis via their dispensary system. The benefits in terms of cost and time efficiency are significant. Pharmax procurement efficiency will become even more significant to pharmacists in the coming years where stock shortages and margin maintenance will require greater resources and support. Patrick Meehan, MD, Pharmax

Best in Retail Having inherited Mellerick’s Pharmacy Cork in the 80’s from her father, Orla Mellerick has recently faced the challenge of having to help staff of 20-years adjust to the demands of an expanding business. Mellerick’s recently moved from a 600 sq foot location to a 5000 sq foot location. “You have to give them the skillset to that kind of change,” she says, speaking to IPN. “We’ve done retail management courses, nutrition courses, make-up courses: we send our staff on all the courses that are available to them. This is very important when you’re dealing with such an informed client base.” “It’s about doing things to best of your ability…It’s all about the customer – we pride ourselves on our customer service.” In addition, Fermoy Medical, of which she is a co-owner, has been nominated three times for best retail pharmacy by Retail Excellence Ireland. This year, they won the award.

Orla Mellerick, Pharmacist, Mellericks Pharmacy

Baby Health Pharmacy of the Year 2016 Sheena Mitchell is Managing Director of Milltown totalhealth Pharmacy in Dublin 6 and creator of the award winning WonderBaba children’s healthcare brand. Sheena says she feels passionate about delivering an accessible healthcare service to parents by positioning the brand in the heart of the modern communities which exist online. Milltown totalhealth Pharmacy has evolved and expanded in alignment with the growth of the WonderBaba brand and together they form a complete healthcare service from one to one professional advice to the recommended product arriving straight to the parent’s home which allows the symbiosis of the two brands. Sheena Mitchell, Pharmacist, Milltown Pharmacy

Sheena has won the Maternity and Infant Pharmacist of the Year award the IPN Nurofen for Children Baby Pharmacy of the Year award along with social media awards from the totalhealth Pharmacy Excellence Awards.

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Dynamic 100 Helping Community Pharmacy Evolve Ultan is a pharmacist with a successful community pharmacy business in Co. Mayo. He has moved his focus in recent years to working with other pharmacists and pharmacies. Ultan has developed a profitable community pharmacy business in a way that it delivers to their customers, their staff, and to him as the business owner. He works with others in the pharmacy sector to achieve this for themselves and their businesses. Ultan is an executive performance coach and teambulder and through his venture, PharmEvolve, assists others in developing their businesses and personal goals. He works with them to gain clarity and then implementing what they need to apply to move things to their next level. His pharmacy business is a recent nominee for the International Coaching Foundation 2015 Coaching Culture in Organisations Awards and is a recipient of the Retail Excellence Ireland 2015/16 Mark of Excellence.

Ultan Molloy, Pharmacist, Healthwest Pharmacy, Ballindine

Claire lays Claim in Allcare Management Having graduated from Queens Belfast in 2004, Claire Murphy became the Superintendent Pharmacist at the Allcare Pharmacy Group in 2012. In this role during 2016, she has overseen the implementation of health promotion within the pharmacy group, as well as the introduction of an STI screening service. This year she has been instrumental in assisting the group in the implementation of the health promotion and pharmacy group, developing quality management systems to PSI audit system. She has worked extensively with the pharmacy assessment system getting members engaged with self-auditing and maintaining high standards.

Claire Murphy, Superintendent Pharmacist, Allcare Pharmacy

Pharmacy Minor Ailment Scheme In July of this year, Kate Mulvenna in her role as HSE Chief Pharmacist launched the start of a pilot pharmacy-based Minor Ailment Scheme, together with the IPU. The pilot commenced on 1 July and ran in 19 pharmacies in four towns, (Kells, Roscommon, Macroom and Edenderry) for three months. It is now being evaluated to establish the value. The Minor Ailment Scheme is an extended pharmacy service, which allows pharmacists to improve public health access and broaden pharmacy roles. Ms Mulvenna is the HSE appointed Chairperson of the Irish Institute of Pharmacy (IIOP).

Kate Mulvenna, Head of Pharmacy Function, Primary Care Reimbursement Service, HSE

KRKA Counter Assistant of the Year 2016 Linda from Kieran’s Avenue Pharmacy is an award winning Pharmacy counter assistant. In May this year Linda was crowned KRKA Counter Assistant of the Year at the IPN Pharmacy Awards. This accolade celebrated her excellent customer service skills and ability to connect with customers. Having undergone extensive OTC training so that she can offer the highest professional advice to her customers. Linda employs her professional role as a beautician running the in-store beauty room & nail bar. In addition to this Linda runs several workshops throughout the year including nail art camp, makeup tutorials & private masterclasses. This has led Linda to win every window competition that she entered this year. Linda Nevin, Kieran’s Avenue Pharmacy, Dundalk

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LOOKING AFTER YOU AND YOURS SINCE 1970 Here’s to the next 40 years, when we look forward to serving patients in Ireland even further. For over four decades, Clonmel Healthcare has worked with GP’s and pharmacists to improve the quality of life for Irish patients, making us the longest serving Generic partner in Ireland. And with our commitment to the community – including a nurse specialist team – we’re also one of the most trusted names in Generic medicine. Our diverse product portfolio includes single source products that serve both the community and hospital markets, broadening our reach into every corner of Irish life. 2013/ADV/GEN/052 www.clonmel-health.ie

Dynamic 100 Lorraine Leading with Authority Our role at the HPRA is to protect and enhance public and animal health by regulating medicines, medical devices and other health products. We use our scientific and clinical expertise to review and monitor health products available in Ireland or exported abroad. Our aim is to make sure that the products we regulate are as safe as possible and do what they are intended to do.

Ms Lorraine Nolan, Chief Executive, Health Products Regulatory Authority (HPRA)

There were a number of highlights that stand out from 2016 including the publication of our strategic plan for 2016 to 2020, the launch of our Innovation Office to support new product development, and the unveiling of our first ever public information campaign which was focused on promoting the safe use of medicines. The HPRA campaign advised the public that to get the most benefit from their medicine, they should always take the time to read the information printed on the packaging and the product leaflet.

Success with Actavis Academy Bursary Padraic a graduate of DIT & Trinity College Dublin joined Actavis in 2014 and has commercial responsibility for sales, marketing and strategy within the retail Pharmacy market in Ireland. He is also responsible for the retail sales team. This year saw Padraic steer an expanding sales and marketing team through a dynamic year, maintaining Actavis position as number two generic supplier to the Irish market. He put the customer first through in-depth research conducted with Behaviour & Attitudes and developed sales and marketing initiatives based on customer feedback. He has brought an increased focus on customer service and customer relationships along with the launch of the highly successful Actavis Academy Training and Mentoring Bursary.

Padraic O’Brien, Head of Commercial, Actavis Ireland

Bringing Pharmacy to Political Agenda Deputy Kate O’Connell was elected to Dáil Éireann in February 2016 to represent the constituency of Dublin Bay South. After her election, Kate was appointed to the Committee on the Future of Healthcare and the general Health Committee. In the past 9 months Kate has worked tirelessly to bring issues that she dealt with as a community pharmacist to the forefront of the Oireachtas, speaking on issues from maternity services to vaccinations on the committees. In particular Kate has focused on bringing the importance of the HPV vaccine to public attention, in particular due to the decline in uptake over the past year. Kate has worked to keep the work of pharmacists to the fore in the conversation of future healthcare strategy. Kate O’Connell, Pharmacist and TD

New Health Screening Service Olivia O’Donnell joined Molloy’s Lifestyle Pharmacies and Health Stores in January 2016 as Supervising Pharmacist for the Bunree road store. With the changing nature of Pharmacy, patients’ needs in mind, she worked with her Area Manager and the Head Office team to launch a range of new services delivered through the Pharmacy under the brand ‘Health 4 Life’. She is also the first point of contact with regards to interpreting results from ‘Health 4 Life’ tests and providing Pharmacist advice where necessary. The ‘Health 4 Life’ programme includes screening for food intolerances, respiratory allergies, vitamin d levels, cholesterol levels and haemoglobin levels among others. Olivia O’Donnell, Supervising Pharmacist, Molloys Lifestyle Pharmacy

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Dynamic 100 Advocating the Role of Pharmacy Rory O’Donnell is currently Chairman of hmR Ireland and President of the Pharmacy Benevolent Fund. He is a second generation pharmacist, opening his pharmacy in 1993 continuing the tradition of excellence in customer and patient service. Rory has wide experience in working with Pharmacy bodies, both nationally and internationally, and has always been a strong advocate for enhancing the role of pharmacists in patient care, which would ultimately benefit the Pharmacy profession, the health system and patients. To achieve has taken considerable work and co-operation across all Pharmacy organisations and stakeholders. Rory’s professional interests led him to become involved in the Irish Pharmacy Union serving as committee members, Vice President and President in 2014.

Rory O’Donnell, Pharmacist, O’Donnell’s Pharmacy

Leading Ways in Wholesale Stephen is a Director of United Drug Wholesale Limited and has been involved in the Pharmaceutical Wholesaling market for over 30 years. His early career started as a Warehouse Operative in the Dublin Drug Company where he went on to hold various commercial and regulatory roles. Stephen moved across to United Drug in 1998 and has held a number of commercial and general management positions. Within his current role Stephen is responsible for both the United Drug Wholesale business and the Procurement function for all of the United Drug businesses. Stephen and his team work closely and in partnership with both the manufacturing and retail pharmacy sectors delivering a best in class service offering to a wide and varied customer base. He is a Graduate of the Institute of Marketing in Ireland and in his spare time enjoys all sports and particularly enjoys mountaineering, having recently returned from a trek to Everest Base camp - an experience of a life time.

Stephen O’Donoghue, Commercial Wholesale Director, United Drug

McLernons Innovation & Service Development Winner Brian developed the Nu-Life Monitored Dosage system in response to a need he experienced as an end user. Since Brian’s early days developing his first attempt at the Nu-Life Monitored Dosage system, Brian has developed a company, Virginia Medical Supplies Limited. Brian won the McLernon Computers Innovation & Service Development Award 2016. According to Brian, “A pharmacy should be a service, not a trade.” He also said, “Over the years the type of services being requested of Pharmacies has changed dramatically therefore it is important that we constantly review what we offer and that we develop new services.” This year alone O’Donoghue’s launched many new services, including a 12 hour Parent & Baby Advice Centre and Food Intolerance Testing.

Brian O’Donoghue, O’Donoghue’s Pharmacy, Virginia

Developing Care for Customers Naomi O’Farrell has joined CarePlus this year and has been responsible for enhancing their prescription service, which has ensured CarePlus patients receive the best and most efficient service. Naomi joins CarePlus after five years with Lloyd’s Pharmacy Ireland. Her areas of main focus in 2017 will include looking at the health and wellness sector by offering the customer products and services that will help customers live long and happy lives. Naomi will also be responsible for developing ways to support CarePlus customers with chronic conditions and facilitating an active role for the pharmacists in generating better adherence and health outcomes.

Naomi O’Farrell, Health & Wellness Manager, CarePlus

Originally from Mullingar, Naomi has a BA Journalism and Media Communications and completed IPU Technician Course in 2006.

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Dynamic 100 Booming Business for Oonagh Oonagh has just been named as Image Entrepreneur Businesswoman of the Year 2016. In March of this year Meagher’s Pharmacy added two new pharmacies to its business. One of the deals saw Oonagh acquire a nine year licence to operate a pharmacy in the new Whitty Building at the Mater Misericordiae University Hospital. Oonagh O’ Hagan is the owner and Managing Director of Meaghers Pharmacy group which has been named as a Deloitte Best Managed Companies for the past two years in a row. Oonagh has previously sat as Chairperson of Retail Excellence Ireland (REI). Within REI, Oonagh founded Women In Retail (WIR). In May Meaghers scooped two national awards – The Unilever OTC Retailer of the Year Award 2016 and the KRKA Business Development (Chain) Award. Oonagh O’Hagan, Managing Director, Meaghers Pharmacy Group

Leading the Way in Training Having spent 16 years in Pharmacy in various roles including OTC Assistant and Pharmacy Technician, Shirley is in a unique position to really understand colleagues training requirements, and the skills and behaviours required in order for them to do their jobs. She has increased engagement with the business, ensuring L&D attendance at all strategy planning, sales, and project meetings. In 2016 LloydsPharmacy partnered with Carlow IT to develop an exclusive LloydsPharmacy Dispensary Assistants Programme. This is scheduled to launch in January 2017 and on completion will deliver a 19% increase in Qualified Dispensary Assistants for deployment within our business. Shirley O’Neill, Learning and Development Manager, LloydsPharmacy

SJW - A First for the Pharmacy Market Currently Executive Director at DCC Vital, Rory O’Riordan is an experienced executive with more than 30 years in the pharma industry. In 2016 he oversaw the successful provision of a licensed form of St John’s Wort (SJW) to the Irish market. The product was removed from the market by the IMB and Rory set about finding high quality, pharmaceutical grade products and took the product through a very exacting regulatory process and gained the only licenced form of SJW, called PACIFA tablets. It is the only such licence in the country, and means patients can get high quality SJW from pharmacists only. Rory has worked in both branded pharma with Roche, Upjohn and Boots, and in generics for the last 16 years, including VP at Stada AG for a European region. He served as President of the European Generics Association in the mid 2000’s and was also chairman of the national generics association, APMI, in Ireland. Rory O’ Riordan, Executive Director, DCC Vital

Public Votes Make James People’s Pharmacist James O’Sullivan, otherwise known as the People’s Pharmacist 2016 is renowned for going over and above his professional duties to help where he can. Over 5000 people voted James as the winner out of 6 finalists, giving further credence to his reputation amongst his customers. And there is a touching connection between his original nomination and the sponsors of the award. James was nominated by Tricia Doyle and Michael O’Brien from Cloneen, whose daughter Bianca is bravely battling leukemia.Tricia and Michael were so grateful to Jimmy and his staff at the Main Street outlet in Fethard for his care and attention to Bianca’s needs when diagnosed with the serious illness. It was appropriate then that Jimmy was named the Cliona’s People’s Pharmacist of the Year as the award is named after another brave young girl, Cliona Ring, who sadly died from her illness. James O’Sullivan, Pharmacist, O’Sullivan’s Pharmacy Fethard

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Dynamic 100

Leading Bradley’s into 2017 This year Bradley’s Pharmacy in Stillorgan commenced offering eScript to its patients as part of the eScript National Pilot. The eScript pilot is a notification service that safely sends a secure notification of the prescription details directly from the GP’s computer to the patient’s chosen pharmacy Allied to future expansion plans Pagni believes future innovative patient centric initiatives will be essential for future turnover growth. Better internal business intelligence with a real time understanding of how the business operates is a key area of emphasis, to counteract the ongoing financial stresses faced across the sector. Ongoing growth and investment in their online offer, ecommerce and supply of their extensive mobility product range will continue into 2017.

Brian Pagni, Managing Director, Bradley’s Pharmacy

Taking Uniphar to the Top Appointed CEO of Uniphar in 2009, Ger Rabbette took on the job of turning around the company, which had expanded too rapidly during the Celtic Tiger years and found itself loss making with ¤200M in debt. With a new senior team in place, they have completely turned the company around. Today, Uniphar is one of the top 30 Irish indigenous companies with annual revenues in excess of ¤1B, making acquisitions in the UK and Ireland. 2016 saw the expansion of the Manufacturer Services business and the bedding in of UK acquisition Star Medical, resourcing and outsourcing service provider in the health and pharma sector, and its expansion into the Irish market.

Ger Rabbette, CEO, Uniphar Group

Integrating Pharmacy with Education Aisling Reast took up the role of Director & National Coordinator of APPEL (Affiliation for Pharmacy Practice Experiential Learning) in September 2016. APPEL was established to manage the common experiential learning placements for the new integrated pharmacy programmes of the three Schools of Pharmacy in Ireland. It will provide a single interface between supervisors, training establishments, and students. Aisling registered as a pharmacist in 1999, obtained her MSc in Community Pharmacy in 2014 and is currently undertaking an MSc in Leadership. Her pharmacy practice experience includes six years as a pharmacy owner and employment with both independent pharmacies and multiples. Aisling Reast, Director, APPEL

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Dynamic 100 Leading United Drug During Acquisition The past twelve months have been a busy and exciting time for United Drug under Paul Reillyâ&#x20AC;&#x2122;s Directorship. Paul has overall responsibility for all aspects of the United Drug business, including its Pre-Wholesale, Wholesale and Consumer businesses. He has been with the business for the past 6 years, initially as Operations Director. The past yearhas been very busy for Paul with McKesson acquiring United Drug in April of this year. This is an exciting time for United Drug as McKesson is an Industry leader in Pharmaceutical Distribution on a Global Scale.

Paul Reilly, Managing Director, United Drug

Symprove Community Pharmacy Technician of the Year Melissa started working for the Adrian Dunne Pharmacy group in Portarlington at the age of 17 and her success led to her being awarded the Community Pharmacy Technician of the Year title 2016. She wouldnâ&#x20AC;&#x2122;t have thought that 10 years later she would be still working for the same company, but having moved through the ranks of cosmetic assistant, to OTC advisor to working in the dispensary, Melissa felt she enjoyed working within the local community and had a lot to offer in terms of customer service and knowledge. She has also has a strong sense of loyalty to the customers and to the company, which drives her motivation for the good of all those who she works with and the customers she deals with.

Melissa Rodgers, Adrian Dunne Pharmacy, Portarlington

Directing Towards Excellence Mark Sajda MPSI, MBA, has been Director and Group Superintendent Pharmacist with McCauleys for over 16 years and is responsible for ethical business across 30 stores. Mark has held various leadership roles and has been an executive member of the Board of Directors since 2005, and held the position of Superintendent Pharmacist since 2009. Responsible for the recruitment and performance management of pharmacists across the group with excellent skills in developing leadership and group processes. Mark has excellent financial and communication skills, advises the Board on all ethical issues and has been key in helping to develop the strategic direction of the group. Mark Sajda, Superintendent Pharmacist, Sam McCauley Chemists

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Dynamic 100

Limitless Efforts from Daire Daire Scanlon established limitless health and both he and the team have spent 2016 working on new innovations to enhance patient care and will be provided to their patients within the New Year. Daire Scanlon Bsc(Pharm) owner and Managing Director of Scanlons limitlesshealth pharmacies Limerick and Dublin set up all his pharmacies within the last 6 years, all start -ups in greenfield sites Scanlons limitlesshealth mission, it says, is to give value to its customers by spreading access to affordable medications through transparent pricing and technology “Our vision is a society where everyone , everywhere has access to Free advice and prescription medications at the best prices,” Scanlon said. “We have a simple set of fundamental values and driving principles built around an ethos of care, privacy and respect.”

Daire Scanlon, Pharmacist, Scanlon’s Pharmacy, Limerick

Leading the Team to Success Earlier in 2016 the team raised ¤14060 for Tullamore Oncology Unit and the sponsor and support Castletown Camogie. These are just two of the community initiatives undertaken by Ronan Sheridan and the team at the Pharmacy. Keanes Care Plus are a team who care about their customers, patients and their community. They also care about constantly trying to be better in their profession and about being a stronger team day by day. They were shortlisted in 2016 for the prestigious Johnson & Johnson Community Pharmacy Team of the Year Award.

Ronan Sheridan, Supervising Pharmacist, Keanes Care Plus Pharmacy Markethill

Excellence in Patient Compliance Aine is the Supervising pharmacist in McCartans in Maynooth. Earlier this year she undertook a project with pharmacist colleagues regarding a relatively new and inventive method of dispensing patient compliance packs to nursing homes. The new system fulfils PSI and HIQA guidelines ensuring patient safety and increased confidence for nursing staff in providing clear concise guidelines regarding every drug. As a team they hope to roll out this system in the coming months. This year, she was finalist in the young pharmacist of year. “I suppose I work very hard each year in confidence with the patients,” she said, speaking with IPN, “and built up a rapport with patients and other medical professionals.” Aine Shine, Supervising Pharmacist, McCartans Pharmacy Maynooth

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Dynamic 100 New Charity for Ade Stack Following the tragic death of her son, founder of Stack’s pharmacies, Ade Stack was inspired to embark on a project that has opened a house to provide a temporary but very real home for the parents of sick children, called ‘Hugh’s House’. She has created a ‘home from home’ for parents with sick children and ended last year with a People of the Year award for her work. This year has been spent working on opening a second house, just next door. Ade purchased her first Pharmacy in Skerries in 2000. Her second pharmacy, in Darndale North Dublin, followed less than a year later. Stacks has now grown to more than 16 pharmacies.

Ade Stack, Owner, Stacks Pharmacy

Idis Young Pharmacist Award for Katie Young Pharmacist of the Year for 2016, Katie Timoney works within Boots Pharmacy, Tallaght, has this year stepped into the role of Pharmacy Manager within the team and is viewed as a role model by all. She has led the implementation of a number of key innovative services and diligently goes about ensuring her patients receive the highest possible care. She is described as calm and organised under pressure and as someone who is dedicated to her community. A ‘natural mentor’ she is always keen to be involved in the development of her team also.

Katie Timoney, Pharmacist, Boots Pharmacy, Tallaght

Cormac Continues to Lead Celesio 2016 has been a busy year for Mr Cormac Tobin comprised of acquisitions and many innovations under his leadership, giving the organisation greater access to customer groups. Earlier this year, LloydsPharmacy acquired Sainsbury’s pharmacy business for £125m following the announcement of McKesson – Celesio’s parent company – acquisition of United Drug Sangers and then Bupa Home Healthcare. Cormac was appointed Managing Director of Celesio UK in early 2013 after successfully leading the Celesio Group’s business in Ireland, DocMorris/Unicarepharmacy, for six years. Last year Tobin was appointed to the Leadership Team of LloydsPharmacy’s parent company, Celesio AG. The new role sees Cormac continue as Managing Director for Celesio UK while also having regional responsibility for LloydsPharmacy Ireland. Cormac Tobin, Managing Director, Celesio

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Dynamic 100 Excellence Across Generations Nial Tully is a third generation pharmacist working in the same premises his grandfather started in in 1940, and has recently been selected as finalist for the Excellence in Community Pharmacist Award 2016. In 2015, the Tully’s invested heavily in a fabulous new refit and full branding to the totalhealth Pharmacy brand. The result is a stunning retail destination and an investment in the business for many years to come. Nial’s experience as an advisor to the totalhealth group and as managing pharmacist in the family business has given him a depth of experience which is unique in such a young pharmacist.

Nial Tully, Pharmacist, Tully’s Pharmacy

Tackling Codeine Misuse in Pharmacy The CODEMISUSED collaboration aims to estimate and gain further understanding into the extent of codeine use, misuse and dependence in Ireland, the UK and South Africa, in order to design protective mechanisms for pharmacies to be able to track, monitor, support and refer for treatment. Dr Marie Claire Van Hout has over 15 years research experience in the field of substance misuse, participatory health, pharmaco and addict-vigilance. The CODEMISUSED project team are committed to improving the lives of those who struggle with codeine addiction, which represents a wide scale issue for Irish Pharmacists. This year it was shortlisted for the MSD Innovation & Service Development Award for their work.

Dr Marie Claire Van Hout, Principal Investigator CODEMISUSED

Pharmacy Representative of the Year Sean Walsh is a well-known face to many in the Pharmacy sector, especially in Leinster area. He has been a business developer for Uniphar for 14 years, working to maintain relationships with existing pharmacy customers, introducing new initiatives and bringing new customers on board. A strong believer in the idea that providing excellent customer service reaps its own rewards, Sean won the IPN Pharmaceutical Rep of the Year award in 2016. According to Sean, it’s doing the basics consistently well over time and making sure you’re looking after the customers that makes the difference. Sean was also a key part of the team from Uniphar that helped to raise significant funds for cancer research by taking part in the cycle along the west coast in September.

Sean Walsh, Business Development Executive, Uniphar Group

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Feature

Pharmacy’s role in Ireland’s Obesity Crisis Written by Conor Hogan

Obesity is not only the most common nutritional disorder in the world; it is a condition that is gaining in prevalence all the time. According to the World Health Organisation (WHO), the number of obese people globally has ballooned from 105 million in 1975 to over 640 million today. ‘Over the past four decades’, notes Professor Majid Ezzati of Imperial College London, co-author of a study on trends in adult BMI in 200 countries for The Lancet in 2016, ‘we have changed from a world in which underweight prevalence was more than double that of obesity, to one in which more people are obese than underweight, both globally and in all regions except parts of sub-Saharan Africa and Asia’. Moreover, no EU country in the last 40 years has experienced a faster rise in obesity than Ireland, with our rate skyrocketing from less than 6% in 1975 to nearly 26% in 2014. As a result, Ireland has the highest average BMI and the third highest rate of obesity in the European Union. If the trend continues, The Lancet study expects Ireland to be the most obese nation in the EU by 2025, as our rate will have increased even further to nearly 38%. Many serious health conditions have obesity as an implicit cause in their development including cardiovascular diseases, various forms of cancer, type 2 diabetes and musculoskeletal disorders such as osteoarthritis. It often also has a circular relationship with depression, in that obese people are about 25% more likely to suffer a mood disorder, while people with depression are substantially more likely to develop obesity. Consequently, an obese person will on average die 8-10 years earlier, earn 18% less and incur 25% higher health expenditures than someone in the normal BMI range. Just last month, the HSE launched its Obesity Strategy for Ireland. The policy and action plan aims to reverse obesity trends, to prevent health complications and reduce the overall burden for individuals, families, the health system and the wider society and economy. It was launched by Minister for Health, Simon Harris TD, together with the Minister for Children and Youth Affairs, Dr Katherine Zappone TD, and the Minister of State for Health Promotion, Marcella Corcoran Kennedy TD. In the past two decades, levels of overweight and obesity in Ireland have doubled (Morgan et al, 2008). Only 40% now have a healthy weight. Levels of overweight and obesity are much higher in disadvantaged groups.

Overweight and obesity are significant risk factors for many chronic non-communicable diseases. The links between obesity and heart disease, cancers, type 2 diabetes, mental ill-health, respiratory problems and musculoskeletal conditions are well established (WHO/FAO Joint Expert Consultation, 2003; National Obesity Observatory, 2011). The burden of adult obesity in financial terms has been estimated as ¤1.13 billion per annum (safefood, 2012). Rising levels of overweight and obesity are placing an increasing burden on individuals and society. Currently, six in ten adults and one in four children are overweight or obese (Department of Health,

2013; Layte and McCrory, 2009; 2011). According to World Health Organisation (WHO) forecasts, Ireland could top the European league tables in the coming years (WHO, 2015). Obesity-related chronic diseases are dominating hospital activity to the point that this will become unsustainable unless action is taken. The Ministers announced a range of actions which would be undertaken over the coming years to address the growing concerns about overweight and obesity.

• A new clinical Lead for Obesity will be appointed in the HSE • Prioritisation of Obesity services in the HSE service plans for 2017 and subsequent years • Support for introduction of a Sugar Levy to encourage a reduction in the rates of consumption of sugarsweetened beverages

These include

• Agreement on food reformulation targets with the food industry and establishment of a forum for engagement with industry on best practice initiatives towards a healthy food environment.

• Development of a Nutrition Policy

Obesity is a preventable medical condition, however, and the

Feature accessible nature of pharmacies makes them ideally placed to help combat the epidemic. Exercise Promotion As obesity and other weight conditions are caused by an imbalance between a person’s energy intake (calories consumed) and energy output (calories burned), the best way to prevent and tackle the problem is through healthy eating and exercise. As places of regular patient contact, pharmacies are excellently positioned to promote this to customers by providing them with advice and educational materials/leaflets. For adults, WHO recommends a minimum of 150 minutes of moderate physical activity per week (for children it is 60 minutes a day – a target 4/5 of children in Ireland do not meet). Pharmacists should stress this recommendation, and the important role exercise plays in preventing and tackling obesity, though there are things to consider when suggesting exercise to somebody who is obese.

Other elements of this plan include stricter codes on marketing of unhealthy food, clearer calorie posting on products and menus, making PE a Leaving Cert subject, and the introduction of sugar tax in 2018. While there has been some controversy over the sugar tax, with Kevin McPartlan, director of the Irish Beverage Council, saying it “will hit consumers, industry and the economy for no public health benefit”, there has been some evidence suggesting the effectiveness of such a levy. A sugar tax in Mexico, for instance, resulted in a 12% reduction of sugary drink sales, while a similar tax imposed in Berkeley, California resulted in a 21% reduction.

“Someone carrying a lot of weight has an increased risk of suffering an orthopedic injury, so preferable exercises to recommend would be low impact ones such as swimming and cycling,” Matthew Gallagher, a pharmacist at Duggan’s Pharmacy in Renmore, Galway tells Irish Pharmacy News. “It is also worth encouraging the customer to stick with their exercise plan. Even if they have trouble losing weight initially, any increase in aerobic exercise will help lower their blood pressure and cholesterol.”

Consultations and Private Clinics

Healthy Eating/Healthy Weight Plan

For ¤30 per week, they provide ¬nutritionist ¬coaching sessions, weekly support and measurements and blood tests. “Weekly food diaries are reviewed by Glenville Nutrition and the nutritional advice is tailored to the patient,” Oonagh O’Hagan, owner and MD of Meaghers Pharmacy Group, explained to the Irish Independent. The 12-week programme was created in collaboration with Dr Marilyn Glenville PhD, a bestselling health author and former chair of the Food and Health Forum at the Royal Society of Medicine.

As regards diet, encourage the customer to keep a food diary as a way to monitor and reduce their calorie intake, and promote a large breakfast. While it is something of a cliché to say ‘breakfast is the most important meal of the day’, a 2013 study by Tel Aviv University strongly backs this thesis up. It found that people who consumed 700 calories in the morning were more likely to lose weight and less likely to develop heart disease, high cholesterol and diabetes. Types of food to be recommended include whole grains, fruits and vegetables, low fat dairy products, nuts, skinless poultry and fish. Foods to avoid include products high in saturated fat, trans-fats, salt and sugar. The food pyramid is a excellent guide. As part of the recent

‘Healthy Weight for Ireland’ plan, launched by Junior Health Minister Marcella Corcoran Kennedy, a revised food pyramid has been introduced to indicate what we should being eating most of and what we need to limit. While previous food pyramids recommended carbohydrates as the largest number of foods to consume, the new pyramid replaces that with fruits and vegetables.

Many pharmacies now provide private consultations and programmes to reduce people’s weight and improve their nutrition. For instance, Walsh’s Pharmacy provides free individual 30 minute consultations with their resident nutritionist every month in their stores in Oranmore, Spiddal and Galway City. Meaghers Pharmacy, meanwhile, launched their Healthy Eating Programme in 2016 in their stores in Baggot Street, Dublin and Ranelagh Village.

effects. It is important, therefore, that a patient consult a physician first before taking these supplements. Vitamin supplements worth taking include Vitamin D (difficult to get in foods and essential for bone health) and Zinc (very good for preventing a treating a cold). Vitamin C, meanwhile probably doesn’t help much (and can cause kidney stones if overused), while Vitamin B3 is much better for you in foods (and taking too much in supplements can cause liver infections and internal bleeding in extreme cases). Omega oils, which can be found in fish, have been shown to be beneficial for preventing heart disease. Iron can also be a useful supplement as it helps prevent anaemia, and is essential in the formation of haemoglobin which assists in carrying oxygen throughout the body. Diet pills Many people are hesitant to use diet pills/fat binders because they often have a reputation for causing dangerous side effects. Products have been known to cause increased heart rate, dizziness, dry mouth, liver problems, headaches and high blood pressure. For people with a BMI in excess of 30, however, whose weight puts them at serious risk of complications; it might be found that the benefits outweigh the risks. These medications, which are normally for short term use only, should be taken alongside a balanced healthy diet. One fat binder, which is readily available in Irish pharmacies and described as non-disruptive to someone’s daily routine, is XLS. It works as both a fat burner and appetite suppressant, and contains Vitamin A, D and E to keep the body’s vitamin level stable.

Medication and supplements

While The Lancet paints a worrying picture of Ireland’s obesity crisis going forward, the Irish government is now entirely committed to intervention and education. Pharmacists also have a crucial role to play in the fight by promoting healthy eating and exercise, providing consultations and counseling, and guiding people to suitable supplements and medications.

A poor diet cannot simply be corrected by food supplements, which should be considered as dietary top-ups rather than substitutes. Rather, too much of certain supplements can be harmful, and might be accompanied by unwanted side

Obesity is a preventable condition, and many European and western countries have managed to avoid having the increase in obesity rates that Ireland has suffered. As the sugar tax in Mexico has shown, government intervention can have a positive effect. As policies such

as these are introduced, and as people continue to receive greater education on how to manage their health, there is reason to be optimistic amid all of the concern.

LEO Pharma launches Enstilar® in Ireland LEO Pharma has officially launched Enstilar®, the first fixed-combination, cutaneous foam spray for the once-daily topical treatment of all severities of plaque psoriasis for patients 18 years or older. Data shows that Enstilar is a more effective topical combination treatment than those currently available, is generally well-tolerated with more than half of patients in clinical trials experiencing significant visible signs of improvement within four weeks and with some patients seeing improvements at one week. This innovative treatment can also improve patients’ quality of life (QoL).75% of patients feel that their quality of life is significantly impacted by psoriasis, both emotionally and physically. 81% of psoriasis patients using Enstilar® foam spray in trials reported QoL improvements after four weeks6, with more than 70% seeing a reduction in itch-related sleep loss. The symptomatic relief experienced by the majority of patients may be attributed to the cooling effect of the new foam spray. The launch of Enstilar® foam spray in Ireland follows findings in the positive regulatory review of the results of the pivotal Phase 3a PSO-FAST study, which evaluated its efficacy and safety profile across a fourweek period, and the Phase 2 MUSE safety profile study. In the PSO-FAST clinical trial, over half of patients treated with calcipotriol/betamethasone dipropionate foam spray were “Clear” or “Almost Clear” by week 4, as measured by the Physician Global Assessment (PGA) improvement score. Additionally, more than half of patients treated with calcipotriol/betamethasone dipropionate foam spray achieved a 75% improvement in modified (excluding head) Psoriasis Area and Severity Index (mPASI) score from baseline after 4 weeks of treatment.

Clinically proven. Gentle on your system. Reduces calorie intake from

Carbohydrates Sugar Fat

XLS MEDICAL MAX STRENGTH contains Clavitanolâ&#x201E;˘, a patented natural complex which reduces the break down and absorption of Carbohydrates, Sugar and Fat. This results in reduced calorie intake which helps you to lose more weight than dieting and exercise alone. In addition XLS MEDICAL MAX STRENGTH lowers blood glucose levels, which helps in curbing food cravings and blood glucose management.

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Bringing Glamour to Pharmacy Pharmacies across the country can now offer their customers glamorous, top-end hair extension products that have until now only been available in salons. International award-winning Irish entrepreneur and hair stylist Shane O’Sullivan formally launched his Easilocks Home Care Range directly to consumers on 6 October, and the brand is now available in pharmacies nationwide. The new range of Easilocks hair extensions look, feel and perform like human hair, using the latest fibre hair technology. Each piece can be styled, blow-dried, straightened or waved, enabling customers to achieve celebrity glamour at home and for a reasonable price. The Easilocks extensions are reusable, and come in a wide range of shades. Along with the hair pieces, Easilocks has also extended its offering in pharmacies to include professional styling brushes, and a range of hair extension care products, including shampoo and conditioner, which are also suitable for natural hair. The Easilocks Rose Gold Oil, also available to sell in pharmacies, is a high-quality hair treatment oil for both natural hair and hair extensions. The Easilocks Hair Hero 3-in1 styler, which allows customers to straighten, curl or wave their hair, is also available now is pharmacies. Both Mr O’Sullivan and Uniphar – who exclusively distribute the

Easilocks Home Care Range to pharmacies – say the launch of these glamorous products is a great opportunity for pharmacies to expand their range and offer customers high-end beauty products. “We are delighted to work with Easilocks to bring this exclusive range of hair and beauty products to the Irish market,” said Padraig Flynn, consumer buyer at Uniphar Group. “This new product range is a perfect fit for retail pharmacy in Ireland as we see local pharmacy as a go-to retail space for hair and beauty products. “The minute you walk in a pharmacy, the Easilocks products stand out. It looks premium, and it brings pharmacies up a level. Pharmacies are under pressure, with all the cuts coming down the line, so this is another revenue stream that they can tap into,” Mr Flynn added. Julie O’Halloran, marketing executive at Uniphar Group, said: “I think Irish pharmacies are getting so savvy in that space, and that’s why we see an opportunity there, and we’re delighted to work with another Irish company. “Uniphar delivers to Irish Pharmacy twice daily. Yes, there’s a small investment in the initial Easilocks stand, but as we can replenish the stand for pharmacies on a daily basis, there is no need for excessive stockholding.” Uniphar will provide training to pharmacy staff about the Easilocks range, so that they can provide customers with helpful advice about the products. “Once you understand the products, you’ll be able to sell them a lot better, and we’re firmly committed to providing training and support to pharmacists,” said Mr Flynn.

Shane O’Sullivan, Easilocks Owner

100

Stylist Shane O’Sullivan said he has a new-found respect for pharmacies and their efforts to provide customers with a range of beauty products. “We’re so excited about the partnership with Uniphar, and I have such a new-found respect for that pharmacy space, so for us to be able to complement that side of it is great.

Vogue Williams, Shane O’Sullivan, Easilocks Owner, Lorraine Keane and Amanda Brunker

“Through celebrity associations, we gained popularity and we’ve earned our stripes in the professional category – we’re very well respected amongst industry leaders such as the Kardashians, supermodels, and others. We’re so proud that we are seen as their favourite go-to hair brand. “We’re really excited now though because Uniphar has given us the opportunity to then give that kind of concept to the mass market. The products will now be more readily available so that people can have that celebrity experience as well,” Mr O’Sullivan added. Mr O’Sullivan himself brings years of experience in the styling industry to the partnership with Uniphar. He began his career when he was just 13 years old, working in his familyowned salon Easilocks, in Dublin’s city centre. When he was 19, he told his father he was going to travel abroad. His dad said if that was the case, he would close the salon, as he would no longer have his son’s help, and the business

wasn’t performing well. When Shane heard that, he decided to stay – and grew the business into the huge international success it is today, thanks in large part to his successful development of the Easilocks hair extensions and complementary products. He is delighted that customers will now have the opportunity to access celebrity glamour without having to go to a salon and pay a huge amount of money for these high-quality hair extensions, and says the hair pieces can be used for a variety of occasions. “Whether you’re going to a wedding and you want to try a different style, or you want to experiment with celebrity trends, or it’s just Tuesday and you want to change it up, you can use these products,” said Shane. “We wanted to give the average customer the chance to explore that, because it’s fun, it’s fashion and it’s creativity.”

Free eLearning Module Supports Pharmacists in Advising Patients with Scarring and Stretch Marks Authored by Dermatology Specialist Nurse, the training provides opportunity to build knowledge in scaring and stretch mark management with certificate upon completion, which counts towards CPD revalidation. Pharmacists are often the first point of contact and can be a crucial touch point from which to offer intervention to patients through advice and recommendation. Scarring and stretch mark management are not an area that many pharmacists are well informed about. It is not an area extensively covered by their core education and some would not readily associate it with the key activity of supporting the safe supply and effective use of medicines. However, pharmacists are taking on and delivering more clinically focused roles and there is a need, particularly in the community setting to support self-care, health promotion and wellbeing. Pharmacists can provide valuable support to patients

Managing Scarring In Primary Care Module

Managing Patients with Scarring in Primary Care Module The online training module has launched in the UK offering primary care healthcare professionals (HCPs) the opportunity to develop their knowledge and access resources to support patients with scarring.

The training module, ‘Managing Patients with Scarring in Primary Care’, authored by Dermatology In a study conducted by Bio-Oil amongst UK Specialist Nurse, Julie Van Onselen, and supported by pharmacists, 46% believed that they were best Bio-Oil, has been developed following research placed out of all HCPs to offer advice to people with demonstrating the lack of training available to HCPs scars and stretch marks 1. And the need is clearly in the UK relating to wound- and after-care. demonstrated amongst patients, in a recent survey amongst 1,000 people with scars, 37% said they The module, which is available free via the Bio-Oil would like verbal advice from a HCP2. A third (32%) Professional website, addresses four key areas of care would like to receive advice on how their scar will and provides a certificate upon completion: change over time, and over a quarter (28%) would like a HCP to proactively offer advice 2. •The physiology of scars; including different scar types and the healing and maturation process • The psychological and social impact of scars • Current evidence-based treatments,self-care options and emerging therapies to reduce scarring • Practical guidance and resources for discussing scarring with patients Please visit www.bio-oilprofessional.co.uk/ primary-care-training to access the eLearning module, and to collect your certificate. 1 Independent Nurse Survey amongst 982 UK nurses commissioned by Bio-Oil (April 2015) 2 Survey conducted by Opinion Health on behalf of Bio-Oil in February 2016, n=1000 adult respondents in the UK with scars.

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Pharmacists key to dispelling EHC stigma Up until 2011, emergency contraception was not available for women to buy over-the-counter in Pharmacy and any woman seeking it had to first obtain a prescription from their local GP. This changed in February of that year, when HSE legislation was passed that allowed pharmacists to sell the progesterone emergency contraceptive pill as an OTC product. emergency contraception, even if no contraception had been used. However, in spite of any fears or embarrassment, it is positive to see that 93% of the women surveyed said they had a positive experience when requesting the morning after pill. According to the Crisis Pregnancy Agency at the HSE, the level of sexual risk taking by 18 to 25 year olds in particular is quite high in Ireland.

Joanne Kissane, Superintendent Pharmacist, DocMorris

In April 2015, a further step was taken when the Ulipristal Acetate emergency contraceptive pill was made available in pharmacies without a prescription. However, according to a new national survey of Irish women’s attitudes to emergency contraception, stigma still exists around the topic. The research reveals that almost half of women surveyed (45%) said that they felt embarrassed asking for the morning after pill and over 38% said that they would go to another town to purchase it. This is despite 1 in 2 women surveyed (50%), having taken the morning after pill in the past. This research has been carried out by HRA Pharma. Over 53% of women surveyed, who had previously taken the morning after pill, said they didn’t want to feel judged by their healthcare professional and almost half (47%) did not want their healthcare professional to think they had been irresponsible. Of those who have previously taken the morning-after pill, 22% admitted that they had made up an excuse such as ‘the condom split’ when asking for

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The vast majority of young people (aged 18 – 25) who are sexually active are less likely to consistently use contraception than other age groups. The reasons for use of emergency contraception are mainly unplanned sexual intercourse or following intercourse under the influence of alcohol or drugs. Speaking about the research, Pharmacist Joanne Kissane said, “There’s no need for any woman to feel embarrassed about making a sensible choice when it comes to her own health. Pharmacists and all healthcare professionals are there to provide help and support in a sensitive and courteous manner and without judgment, so women should not be afraid to ask for advice.” Irish women’s reluctance to openly discuss emergency contraception is coupled with the fact that many women may not fully understand their own fertility and could be leaving themselves at risk of an unplanned pregnancy. The research found that 65% of Irish women wrongly believe it is possible to easily pinpoint their ‘fertile window’ and therefore avoid falling pregnant at this time. Almost a third of women (31%) admitted to having unprotected sex in the last year, when they were not planning a pregnancy. Joanne explains, “Ovulation is highly unpredictable, and because of this, conception is possible during most of a woman’s monthly cycle, this means there is no such thing as a ‘risk free period.’ Irish women incorrectly believe that they can pinpoint their own fertility and avoid falling pregnant.

This misconception could be due to a variety of reasons including misinformation in publications and online, as well as the recent prevalence of fertility apps, which claim to make it easy to see when your fertility is highest.”

Advise on next menstrual period

Key tips for Pharmacists are include:

• If her period is more than 5-7 days late after taking EHC, or pregnancy is suspected for any other reason, or in case of doubt, advise her to do a pregnancy test or visit her GP.

Listen - When a woman comes into the pharmacy requesting emergency contraception make sure you listen to her needs. Reassure - Tell her she has done the right thing by coming into the pharmacy for advice. Explain - emergency contraception works by inhibiting or postponing ovulation so the sperm will not find an egg to fertilise. Encourage immediate action - Emphasise that emergency contraception is most effective when used as soon as possible after unprotected sex Advice about sex after taking EHC • A rapid return to fertility is likely following treatment with an emergency contraceptive pill • A barrier method of contraception must be used for subsequent sexual intercourse until her next period – even if she is continuing with an oral method of contraception • The emergency contraceptive pill is for occasional use only; it should not be used to replace a regular contraceptive method. If she requires advice suggest a visit to her GP to discuss regular contraceptive options if appropriate. • Oral emergency contraception is not 100% effective and its efficacy is lower than a regular contraceptive method • Emergency contraceptive pills do not protect from STIs. Only condoms protect against STIs Advice on what to do if the woman vomits • If vomiting occurs within three hours of emergency contraception intake, advise that she should take another tablet as soon as possible

• After taking an emergency contraceptive pill, menstrual periods can sometimes occur a few days earlier or later than expected

When to avoid emergency contraception The emergency contraceptive pill can interact with medicines used to treat epilepsy, HIV and tuberculosis, and with the complementary medicine St John’s Wort. These types of drugs are called enzyme inducers. The dose of emergency contraception may need to be increased if a patient is using this medication, and this would need to be determined by a doctor. It is always best to check with a doctor whether any of the patient’s medication may interact and change the effectiveness of the emergency pill. Alison Slingsby, Women’s Health UK and Ireland Marketing Manager adds: “With emergency contraception options like ellaOne available without prescription there is no need for any woman to be taking unnecessary risks. Discussing emergency contraception can be distressing for women and the role of the Pharmacist is to help by reassuring them that they have done the right thing by seeking advice. Pharmacists are there to help and it is important for women to know that they can speak to them in confidence without fear of judgment. It is very positive to see that even though women are embarrassed to ask for the morning after pill and fear being judged, 93% of the women surveyed said they had a positive experience when requesting the morning after pill.”

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Event Gallery

The total sum of success totalhealth celebrate Pharmacy achievements

The totalhealth Pharmacy Group recently held their annual Gala Ball & Pharmacy Awards Ceremony in the in the Radisson Blu Hotel Galway. The celebratory event was attended by over 300 Pharmacists, staff and employees of the totalhealth Pharmacy group nationwide along with industry partners. Dáithí O’Se, Rose of Tralee host and RTE personality proved to be a very popular host and MC for the evening.

Totalhealth Pharmacy recognises that it is the teams in their pharmacies who make the difference delivering fantastic service and value every day in their local communities. The values of totalhealth “trusted local care” are at the forefront in every store, every day up and down the country.

The event was an opportunity for the totalhealth Pharmacy Group to honour and thank the staff from all their pharmacies across the country for the role they play in making the totalhealth Pharmacy brand the success it is.

The key focus of the night was the Pharmacy Award Ceremony which was a celebration of excellence within the group. The winners came from right across the country and that connectivity and partnership among members was truly evident on the night.

Pharmacy of the Year 2016- Social Media: Rose Finlay totalhealth Pharmacy, Tullamore

2016 Community Award: Dáithí Ó ’Sé; Andrew Buckley, Andrew Buckley’s totalhealth Pharmacy, Dublin; Barry Fitzpatrick, Clonmel Healthcare; Oliver McGuinness, Chairman totalhealth Pharmacy Group

2016 Brand Award: Dáithí Ó ’Sé; John Ruttledge, United Drug; Gráinne & Cormac Murphy, Murphy’s totalhealth Pharmacy, Ballaghaderreen; Oliver McGuinness, Chairman totalhealth Pharmacy Group

Customer Service Award 2016: Dáithí Ó ’Sé; Greg Farrell, Actavis; Niamh Murphy and team at Murphy’s totalhealth Medical Hall, Ballinasloe; Oliver McGuinness, Chairman totalhealth Pharmacy Group.

Dáithí Ó ’Sé; Olive Reynolds, Mylan; Ann Gray and the team at Ann Gray’s totalhealth Pharmacy, Limerick; Oliver McGuinness, Chairman totalhealth Pharmacy Group

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Event Gallery totalhealth Pharmacy recognises that their most valuable asset is their staff, they are the first person a customer meets in all their businesses. For that reason totalhealth is continually investing in training to ensure that their staff are knowledgeable and customer focussed. Over 100 staff members have recently completed the totalhealth Medicine Counter Assistant training programme. These staff members were presented with their certificates and badges on the night.

The evening was a spectacle of music, entertainment and enjoyment with the much-coveted Pharmacy Awards having pride of place. Lucky winners went home with fabulous raffle and spot prizes won throughout the night. Jameson’s totalhealth Pharmacy, Bailieborough were the lucky recipients of the proceeds from the Charity Raffle, ¤2,500 which they got to donate to the charity of their choice, Bailieborough Cancer Care group.

Tully’s Pharmacy family Ross, John, Maura, Sheena & Nial Tully enjoying the totalhealth Gala Ball pictured with Dáithí Ó ’Sé

totalhealth Chairman Ollie McGuinness & team from McGuinness totalhealth Pharmacy Roscommon

Róisin, Rosaline & Mark Curley, enjoying the totalhealth Gala Ball pictured with Dáithí Ó ’Sé

Nuala, Brendan senior & junior & Margaret Kieran enjoying the totalhealth Gala Ball pictured with Dáithí Ó ’Sé

Presentation of Certificates- Medicine Counter Assistant Training Programme: totalhealth Pharmacy recognises that their most valuable asset is their staff, they are the first person a customer meets in all our businesses. For that reason totalhealth is continually investing in training to ensure that their staff are knowledgeable and customer focussed. Over 100 staff members have recently completed the totalhealth Medicine Counter Assistant training programme. These staff members were presented with their certificates and badges on the night.

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