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December 2019 Volume 11  Issue 12 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: Further Pharmacy cuts planned for 2020 Page 11

PROFILE: Talking Generics with Teva’s Paul Neill Page 22

FEATURE: Targeting the Tobacco Trap Page 30

END OF YEAR REVIEW: A look at the Key Developments in 2019 Page 42

TEAM TRAINING: Muscle and Joint Pain Page 46

DYNAMIC 100: IPN’s Annual Listing of Ireland’s Dynamic 100 individuals Page 50


more cash margin due to the higher RRP and margin of the premium product! Advertise

New Year, New Opportunity: Resolutions Drive Profitable Growth in Food Supplements The New Year is traditionally a time when people set resolutions that often revolve around heath. Getting to bed earlier, drinking less, eating better, and exercising more. Sales of juicers and smoothie makers increase, diet books are everywhere and regular gym-goers know only too well the New Year phenomenon of having to wait for a machine because the gym is suddenly full of new recruits. For many consumers food supplements form part of their New Year assault on healthy living. So pharmacies are ideally placed to help their existing customers, but also to gain new ones by promoting the New Year new you message. Not only are new consumers likely to enter the category at this time of year, but lapsed users are more likely to reengage with supplements and even die-hard supplement users are more likely to try something new at this time of year. Analysis of Google Trends confirms that more consumers

are searching for diet, nutrition and supplement information between January 6th and 25th than at any other time of year. Search phrases such as ‘multivitamin’, ‘joint supplement’ and ‘vitamin D supplement’ all peak in January indicating that consumers are interested in the category and want to find out more.

them from you? That probably depends on whether you stock the brands and products that meet their needs. If you only focus on the value end of the VMHS category you are not serving all types of VMHS shoppers, which means those people are shopping for their vitamins elsewhere!

The value of the VMHS category

Getting the right brand mix is critical, and that might mean premiumising your offering. Some shoppers will only ever chose the cheapest brand, other shoppers will never choose the cheapest brand. On the contrary some shoppers will only chose the most expensive brands. Shoppers are brand-loyal and will not switch easily. So if you only have value brands, think about premiumising. More of your shoppers might consider buying from you if you stock the products they want. So commercially it is win-winwin. The shopper gets what they want, you get a sale you would have missed out on, and that sale generates a lot

So how can pharmacies capitalise on the New Year new you trend this January? First, recognise the importance of your vitamins, minerals and herbals supplements (VMHS) category within your retail space. According to recent data from Mintel, over two thirds of people have taken supplements in the past 12 months, and three quarters of people have taken supplements at some time in their life. So the chances are that two thirds of your customers are already taking supplements. Are they buying

Premiumise

Does your community know that you sell a great range of VMHS? Consider putting in a New Year New You window display to advertise your category and capitalise on the increased interest in January. Make sure you back this up with social media posts and incorporate into your digital marketing. In-Store Execution In addition to getting the right brand and product mix, consider where and how your VMHS products are displayed. Make sure your regular fixture is neat and tidy, well signposted with point of sale materials and that key lines and brands are displayed at eye level, or on the top shelf of gondola units. Also consider a secondary display. Your regular customers may not go to the VMHS section of your store, so bring the VMHS to them! A simple counter display unit is very effective, or try a well-placed end gondola display or free standing table display. Upgrade to a New You! Premiumising your offering not only brings you new customers, but offers you the opportunity to upgrade your existing customer to better products, which has the added benefit of increasing your


average basket size. Here are some examples: Glucosamine to Solgar 7 Most people are already familiar with glucosamine and chondroitin supplements for joint heath. However, why not upgrade to Solgar 7? This award winning formulation is the next generation of joint supplement after glucosamine. Solgar 7 brings together 7 bio-active ingredients that work to create a fast acting approach for occasional aches and joint stresses brought on by exercise, sport or other physical activity making it ideal for those undertaking more exercise as part of their New Year’s resolutions, or indeed anyone looking for more joint comfort, range of motion or mobility. Turmeric to Solgar Full Spectrum Curcumin The ancient culinary spice, turmeric, has come in for lots of scientific attention in recent years and the market for turmeric products has exploded as more health benefits have been uncovered. For consumers wanting to ensure the best possible absorption, Solgar Full Spectrum Curcumin offers micellised turmeric extract that has shown 185x bioavailability over 24 hours compared to regular turmeric extract providing better and faster absorption of the active curcuminoid compounds.

Vitamin C to Solgar Ester-C Vitamin C remains one of the most popular types of food supplement and is worth over £50 million per year within the category. Being a water soluble nutrient it requires regular consumption to gain the optimal benefits. However, as ascorbic acid, high doses can cause loose stools an even kidney stones. Ester-C is a special form of vitamin C that is pH neutral and has been shown in studies to be retained by white blood cells (immune cells) for up to 24 hours. Given that many consumers buy vitamin C with

an eye on immune support this makes Ester-C the better form of vitamin C in every respect. Magnesium Oxide to Solgar Magnesium Citrate Magnesium helps support energy metabolism and nervous system function and has become popular in recent years, perhaps due to a rise in the stresses and strains of modern life. Magnesium Oxide is a basic form of magnesium and is perfectly fine for many people. However, for those looking to optimise absorption, for example older

consumers or people with digestive issues, magnesium citrate offers an upgrade that provides magnesium in the highly absorbable ‘citrate’ form. In Summary Premiumising your VMHS offering provides a genuine growth opportunity for your retail operation and the New Year is the perfect time to capitalise on consumer interest in the category. New Year, new opportunity!

Google Trends Search terms that peak between Jan 6th and 25th

New Year New You Supplements

 Diet/Nutrition

Solgar Formula VM75: Award-Winning one-a-day multivitamin tablet, delivering 28 active ingredients and 75mg of key B-vitamins that support energy metabolism.

 Multivitamin

Solgar Wild Alaskan Full Spectrum Omega-3: From wild Alaskan salmon. Great daily supplement for those that do not eat the recommended 1-2 portions of oily fish per week.

 Curcumin

 Vitamin D  Joint supplement  Probiotic  Vitamin C supplement

Solgar Ubiquinol: The active form of CoQ10. A powerful antioxidant and involved in energy metabolism. Especially important for heart energy. Best supplemental type of CoQ10 for those over 40. Solgar Vitamin D 2200IU: One-a-day formula providing Vitamin D in the form that is easiest to use by the body (D3) at a dose that is especially suitable during the winter months. Solgar Skin Nails & Hair: Specialist formula designed to provide key nutrients that support skin, nail and hair health, including vitamin C, Zinc and a natural source of sulphur called MSM.

For more details on opening an account or to place an order, please call +44 1442 821 419 or email: enquiries4@solgar.com

solgar.co.uk


It’s not just about tiotropium,

• 95% of patients felt confident or very confident about using Braltus®1*† • Tiotropium is a widely accepted LAMA for COPD2 • Ergonomic and compact inhaler with a clear capsule for visual confirmation of dose delivery to the patient3 For more information about Braltus® please speak with your local Teva representative or contact info@teva.ie. *100 patients with COPD who were switched to Braltus®, and had received Braltus® for an average of 16.5 months, were asked "Following instruction and guidance from your healthcare professional, how confident did you feel about using Braltus®?"1 †

5% were not confident 1

IE Prescribing information Please refer to the Summary of Product Characteristics (SmPC) for full details of Prescribing Information. Braltus® (tiotropium bromide) Inhalation Powder Abbreviated Prescribing Information Presentation: Delivered dose: 10 mcg of tiotropium per capsule. Each capsule contains 16 mcg of tiotropium bromide, equivalent to 13 mcg of tiotropium. Indications: Maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dosage and administration: Inhalation use only. Must not be swallowed. Inhalation should be at the same time each day. Adults: Inhalation of the contents of one capsule once daily with the Zonda® inhaler. See SmPC for administration and instructions for use. Children: Not to be used in children or adolescents <18 years of age. Elderly: No special requirements. Renal Impairment: Mild: (creatinine clearance >50 ml/min), no special requirements. Moderate to severe: Use only if expected benefit outweighs the potential risk. Hepatic Impairment: No special requirements. Contraindications: Hypersensitivity to the active ingredient or any excipients. Precautions and warnings: Not to be used for the initial treatment of acute episodes of bronchospasm, i.e. rescue therapy. Immediate hypersensitivity reactions may occur. As with other inhalation therapy, paradoxical bronchospasm may occur and treatment should be immediately discontinued. Use with caution in patients with narrow-angle glaucoma, prostatic hyperplasia or bladder-neck obstruction; patients with recent myocardial infarction <6 months; unstable or life threatening cardiac arrhythmia; cardiac arrhythmia requiring intervention or a change in drug therapy in the past year; hospitalisation for heart failure (NYHA Class III or IV) within past year. Avoid getting the powder into eyes. The excipient lactose may contain trace amounts of milk proteins which may cause allergic reactions in patients with severe hypersensitivity or allergy to milk protein. Interactions: No formal drug interaction studies have been performed. Co-administration with other anticholinergic drugs not recommended. Pregnancy and lactation: Not recommended. Effects on ability to drive and use machines: No studies on the effects on the ability to drive and use machines have been

performed. The occurrence of dizziness, blurred vision, or headache may influence the ability to drive and use machinery. Adverse reactions: Serious: Hypersensitivity reactions, anaphylactic reaction, bronchospasm, anticholinergic effects (glaucoma, constipation, intestinal obstruction including ileus paralytic as well as urinary retention), atrial fibrillation, supraventricular tachycardia, tachycardia. Common: Dry mouth. Consult the Summary of Product Characteristics in relation to other side effects. Overdose: May lead to anticholinergic signs and symptoms. Legal category: Medicinal product subject to medical prescription. Marketing Authorisation Number: PA 1986/006/001. Marketing Authorisation Holder: Teva B.V., Swensweg 5, 2031GA Haarlem, Netherlands. Job Code: IE/MED/18/0017. Date of Preparation: December 2018.

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Teva UK Limited on 0207 540 7117 or medinfo@tevauk.com References 1. Braltus in real life. November 2018, prepared by Branding Science. 2. Karner C et al. Cochrane Database of Systematic Reviews. 2014; 7: 1–120. 3. Teva. Data on file. Teva market testing. 2015. Date of preparation: October 2019 Approval code: IE/BRA/19/0005 If you have any questions or wish to request further information, please contact us as follows: email at medinfo@tevauk.com or by post at TEVA Pharmaceuticals Ireland, Digital Office Centre Swords, Office 104, Balheary Demense, Balheary Road, Swords , Co Dublin.


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Contents

Foreword

Page 7: Cunningham’s win Pharmacy of the Year

“We will open the book. Its pages are blank. We are going to put words on them ourselves. The book is called Opportunity and its first chapter is New Year's Day.”

Page 8: HIV commitment from Meaghers

This month’s issue of Irish Pharmacy News brings with it a plethora of news educational articles, whilst also featuring a look back at some of the key challenges and opportunities in 2019.

Page 20: Irish Institute of Pharmacy reflections of 2019

Our End of Year Reports begin on page 12 as the Pharmaceutical Society of Ireland reflects and looks forward and is followed by the IPU, IIOP and HPRA, amongst others.

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Page 24: Pharmacy growth on the agenda Page 38: Hickey’s Pharmacy celebrate a milestone in Flu Vaccinations

According to the Fianna Fail Deputy Leader Dara Calleary, who raised the matter during Leaders Questions in the Dáil at the end of last month, the Government intends to cut the Community Pharmacy budget by ¤45 million in the New Year, which will impact on all local community pharmacies and the services they offer.

Page 42: IPN’s End of Year Review

Turn to page 11 for the full story.

Page 50: The Annual Dynamic 100 – Ireland’s Key Pharmacy Players

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

EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 kelly-jo@ipn.ie

ADVERTISING EXECUTIVE Amy Evans: amy@ipn.ie DESIGN DIRECTOR Ian Stoddart Design PHARMACYNEWSIRELAND.COM

@Irish_PharmNews

IrishPharmacyNews

Elsewhere, as we were going to press, IPHA held their Annual Conference at Croke Park. Deemed to be the biggest to date, it was revealed that patients in Ireland are waiting three times as long to get the same medicines as patients in other comparable European countries. Prices for innovative medicines in Ireland are calculated at the average of the price in 14 EU countries. IPHA analysed the reimbursement dates in these countries for 15 medicines which have completed their pharmacoeconomic assessment in Ireland but have yet to be reimbursed by the HSE.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

ADVERTISING DIRECTOR Debbie Graham: 00353 (87) 288 2371 debbie@ipn.ie

Leading the news this issue is unfortunately not the news our readers will want to end the year on. It has come to light that further cuts could be on the horizon of between ¤20,000 and ¤25,000 each under plans by Government to decrease the fees paid to pharmacists.

24 Irish Pharmacy IRISH News is PHARMACY circulated to all NEWS independent, multiple Pharmacists and academics in Ireland. 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 or transmitted in any form without written permission. IPN Communications Ltd. has 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.

In reading the quote at the start of this Foreword, now is the time of year to reflect on what has, and what can be achieved within community pharmacy in Ireland. With that in mind, we are delighted to bring you the annual Dynamic 100 - a carefully constructed network of the most influential pharmacy professionals, who act as ambassadors and role models for their peers, colleagues and the rising stars of tomorrow. This year we are doing something a bit different. Turn to page 50 for further details. We would like to take this opportunity to wish all of our readers and supporters a very Merry Christmas and a prosperous New Year!

Regulars FEATURE: VITAMINS AND SUPPLEMENTS REPORT: UPTAKE OF FLU VACCINE IN PHARMACY TEAM TRAINING: MUSCLE AND JOINT PAIN BUSINESS CPD: LETTERS TO SANTA PRODUCT PROFILES:

P26 P36 P46 P94 P98

Pharmacy BI Solution. Over 20 Groups with over 400 Pharmacies in the Republic of Ireland trust RWA to help them improve their business performance.

Call 01 693 1433 Email pharmacy@realworldanalytics.com Visit realworldanalytics.com

Ignite Potential.


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News

Cara Pharmacy marks World Diabetes Day Community pharmacists across Ireland were helping to raise awareness during World Diabetes Day, held last month (November 14th). Pictured are some of those from Cara Pharmacy Group who demonstrated how the pharmacy profession go that extra mile in supporting diabetic patients in the community.

Community pharmacy concern on negative effects Following the publication of the European Commission Communication on a European Union Strategic Approach to Pharmaceuticals in the Environment in March 2019, community pharmacists are reinforcing their commitment to reduce and prevent the impact of pharmaceuticals in the environment. PGEU President Michal Byliniak says, “Community pharmacists across Europe share the increasing concerns on the negative effects pharmaceuticals can cause on the environment, and as a result, on public and animal health.

Cara Pharmacists were delivering Diabetes Risk Assessments and offering healthy lifestyle advice to all of their patients

Marking World Diabetes Day, pharmacists in Ireland have issued advice to people living with diabetes and those concerned about the risk. The Irish Pharmacy Union (IPU) has said that Pharmacies can help by providing advice on managing the condition or helping to reduce the risks of developing Type 2 diabetes, which is on the rise in Ireland. Speaking on World Diabetes Day, IPU Executive member Ann-Marie

Horan said, “Diabetes mellitus is a chronic condition that is caused by a lack of insulin, insufficient levels of insulin or a resistance to insulin produced. Insulin is a hormone which is required to convert sugar in the body into energy. In Ireland, over 250,000 people live with diabetes. This is a lifelong condition which can be managed well by following a healthy lifestyle and taking your prescribed medication as well as having the correct support and education in place.”

According to Ms Horan, “Pharmacists play an important role in supporting people who are managing the condition. This can include advice on how to monitor your glucose levels, advice on available treatment options and their side effects, as well as supporting you by providing health promotion and advice on lifestyle modifications. “Local community pharmacies can provide advice on improving lifestyle and advise on how to limit your risks of developing Type 2 diabetes.”

Pharmacists warning on Antibiotic Overuse With World Antibiotics Awareness Week running last month (November), public health in Ireland and internationally is being increasingly threatened by the overuse of antibiotics, according to pharmacists. The Irish Pharmacy Union (IPU) has urged all stakeholders to be proactive in fighting antibiotic resistance. Kathy Maher, community pharmacist and former IPU President, says, “The levels of antibiotic-resistant infections have been increasing in Ireland for many years. It is clear that they are now a real and present threat to public health. One of the most serious infections, CPE, has increased in prevalence by 1,300% in just five years (to 548 in 2018). The rise in these dangerous resistant infections is primarily the result of misuse and overuse of antibiotics. “We are now reaching a tipping point and, if dramatic action is not

taken, we effectively risk returning to the ‘pre-antibiotic era’. This will 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, and could make many surgeries impossible. “It is the responsibility of all stakeholders to proactively tackle the threat we are now facing. The most fundamental advice is that antibiotics should only ever be taken when a bacterial infection has been diagnosed by a qualified

PHARMACYNEWSIRELAND.COM

healthcare professional and antibiotics have been prescribed as the necessary and appropriate treatment.” Ms Maher reminded patients that for many common conditions, such as the flu, colds, sore throats, and diarrhoea, antibiotics have no impact. “For these conditions, you can consult with your pharmacist for remedies that will alleviate your symptoms. However, not only will antibiotics not help, if taken unnecessarily they could increase your likelihood of developing an antibioticresistant infection in the future.”

“As medicines experts they are well placed to increase public awareness, promote the prudent use and correct disposal of pharmaceuticals, and provide advice on the availability of ‘greener’ pharmaceuticals where such information is available.” To reduce and prevent the negative impact of pharmaceuticals in the environment, PGEU asks Member States to take action to increase public awareness on the prudent use and waste collection of pharmaceuticals, and to develop guidelines and information materials for healthcare professionals on the prudent use of pharmaceuticals. Other calls include developing and ensuring compliance with environmental quality standards for pharmaceuticals as a measure to promote greener manufacturing and ensuring appropriate funding of pharmacyled disposal and collection schemes for medicines, where implemented. They also request the European Commission to fund and encourage more research to fill current existing knowledge gaps. PGEU also asks the European Commission to ensure that actions to address the risk of pharmaceuticals in the environment do not jeopardise independent clinical decisionmaking by healthcare professionals on public health grounds and to foster bestpractice exchanges between Member States on measures addressing the negative impact of pharmaceuticals in the environment.


News Pharmacy Regulatory Risk Regulatory bodies, such as the Pharmaceutical Society of Ireland, have a duty to recognise and respond appropriately to risks and potential harms that relate to their area of accountability, with the purpose of protecting the health and safety of patients and the public. To achieve this the PSI believes in maintaining a clear understanding of the current and emerging risks that may arise in the practice of the pharmacy profession and the delivery of pharmacy services, consistent with their regulatory responsibility. The PSI has developed a Statement on Regulatory Risk, which sets out how they define, identify, analyse and respond to risk across all our areas of responsibility. By implementing this strategic risk-based approach in our regulation of pharmacists and pharmacies, their work aims to prevent harm to patients by making pharmacy a safer environment. The Regulatory Risk Statement supports the PSI’s mission, vision and values and outlines how they will ensure: • They have everything in place to address risks arising within their field of regulation, • A reduced risk of harm to the public by the effective mitigation of regulatory risk, and • It is fulfilled in a way which will meet the high standards expected of public bodies. The Statement covers an initial three-year period (20192021), and during this time the Statement will evolve in line with any developments within the pharmacy domain. The PSI is committed to assuring public trust by evolving how we meet their responsibilities and exploring new ways of regulating that are proportionate, effective and efficient. In other news, the PSI is aware of recent burglaries and similar incidents in pharmacies. They have published Guidelines on the Premises Requirements of a Retail Pharmacy Business, which contains guidance on security. You can view this at www.thepsi.ie

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Trust is Key in Pharmacy Services New research has shown that trust, expert advice and convenience is important to people in Ireland, with 70% of those surveyed saying it’s important that they trust their pharmacist when buying healthcare products and 57% of respondents stating they really value advice and help from staff when buying a new medicine. Boots Ireland have launched a new Prescription Ordering Service which is available through the Boots app In light of this, Boots Ireland have launched a new Prescription Ordering Service which is available through the Boots app for customers across Ireland. The service will allow for more personal interaction between the customer and their pharmacist in-store due to efficiencies with the fulfilment of the prescription ahead of the customer visiting the pharmacy. Of those surveyed, 68% want to pick up their prescriptions as quickly as possible, avoiding long queues. The Boots Prescription Ordering Service will help reduce the wait time in stores by allowing customers to pre-order their prescriptions through the Boots app before going in to their chosen Boots to collect their medication making it easier for customers to collect prescriptions when time is limited, like during lunch breaks or before or after work.

carers, with 35% of people taking full responsibility for the health of their entire family. The new service will allow Boots customers to manage once-off and repeat prescriptions for themselves, their family members and those they care for as well as shop for a wide range of healthcare products when visiting the pharmacy which was found to be important to 42% of people.

The research also revealed that people in Ireland are a nation of

Caoimhe McAuley, Director of Pharmacy at Boots Ireland said,

“We are constantly striving to offer our customers the best quality service. Giving our customers the ability to pre-order their prescriptions will save them valuable time and ultimately allow our pharmacists more time to interact with customers and give them advice while discussing their medication with them. The launch of our new service is another step in our vision to have an even greater impact on peoples’ health in Ireland.”

Cunningham’s Pharmacy of the Year Congratulations to Cunningham’s Pharmacy in Athlone, who last month were awarded the title National Pharmacy of the Year at the Retail Excellence Awards 2019. This was the first time Cunningham’s Pharmacy attended the REI Awards. Managing Director and Pharmacist Paul Cunningham said, “We were so thrilled to bring home the National Pharmacy of the Year Award! Thanks to all our wonderful teams at both our winning Monksland store and our equally brilliant Dublin Road store. “Never mind winning our award, it was such a privilege to be amongst such amazing retailers. On behalf of everyone at Cunningham's Pharmacy i would like to thank Retail Excellence for putting on such a great event.” Pictured at the awards ceremony in Killarney were L-R: Hector O'Eochagain, Dora Reilly, Lorna Lawless, Sarah Shine, Gillian Murray, Marie Kilroy, Kevin Lyons, Hilary Cunningham, Paul Cunningham, Leah Burgess. Missing from the photo on the night, Kayleigh Nally and Pauline Meares

PHARMACYNEWSIRELAND.COM


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News

Meaghers state HIV Commitment Meaghers Pharmacy Group, under the leadership of Managing Director Oonagh O’Hagan, are supporting the promotion of pre-emptive use of antiretroviral medication for at-risk populations to combat new HIV infections across Ireland, with specialist training for its staff across its networks of pharmacies. A State investment of ¤5.4million in the pre-emptive use of antiretroviral medication for atrisk populations has galvanised key stakeholders to collaborate in ensuring patients and health professional alike know what this investment will mean for them.

like Mylan, is deeply committed to safeguarding those most at risk of HIV get the pre-emptive intervention they need. This really is a game changer and we are delighted to work with stakeholders such as Mylan to get this done.”

With ten people being newly diagnosed with HIV in Ireland every week, Meagher’s and manufacturer of PrEP, Mylan, are committed to ensuring that the funding provided by the State is adopted by all those at risk of developing HIV.

With Meagher’s Pharmacy Group roots in Baggot Street, Dublin, Meagher’s is committed to continue its longstanding relationships with people across the HIV community, building on its current reputation as a trusted source of professional advice and PrEP medication in Dublin.

Speaking at the launch of the workshop programme, Oonagh O’Hagan said, “The Government has committed to rolling out this programme countrywide in 2020, with 6 clinics already due to provide the service in the next month. Meagher’s, with partners

Pointing out that the number of people diagnosed with HIV in Ireland rose by 8% last year with 531 diagnoses in 2018, David Delaney of Mylan believes that all stakeholders have a part to play in

turning this situation around and that the ¤5.4 million investment in PrEP by the Irish Government could be a crucial turning point. “We are privileged to work with Meaghers on this project – beating HIV requires us all to listen to patients and health professionals alike and the workshops we are announcing will deliver that. “It also requires more testing, more prevention and more treatment – more than 8 million people, about 40% of all patients on HIV treatment worldwide, depend on Mylan every day, and we are committed to the fight against HIV. We know that developing vital drugs doesn’t matter if people can’t access them, so it is vitally important to make sure everyone in Ireland knows that these drugs are freely available from the HSE.”

Think Pharmacy for Winter The public is being urged to work with their pharmacist to tackle illnesses that are more prevalent in winter such as coughs and colds. The Irish Pharmaceutical Healthcare Association (IPHA) and the Irish Pharmacy Union (IPU) are making the call in a newly launched self care awareness campaign, entitled ‘Be Well this Winter – Think Pharmacy.’ The campaign will be rolled out over a four-week period and involves social media video content based on a series of emoji characters. The first video is about colds and will be followed by cough, sore throat and first aid over the coming four weeks. This is the third iteration of the ‘Be Well’ campaign, which enjoyed an impressive reach with 667,000 impressions on Facebook and Twitter. The campaign also involves the distribution of posters to retail pharmacies to actively promote self care throughout the winter as well as the valuable role of the pharmacist in supporting it. Self care is defined as the care taken by people of their own health and wellbeing (at the lowest level of complexity) with appropriate support and advice from a healthcare professional. Self care supports people to stay healthy, especially during more vulnerable times, and empowers people to manage important elements of their own and their loved one’s healthcare needs.

Oonagh OI’Hagan, Managing Director, Meaghers Pharmacy Group with Amárach Research Chairman Gerard O’Neill

Impact in Pharmacy Meanwhile, the Pharmacy Group were delighted to last month pick up the CX Impact in Pharmacy Award. Oonagh said, “This award is particularly meaningful for us in Meaghers as it acknowledges the incredible hard work and dedication from all our store and online teams. This award is a group effort and a massive thank you to the entire Meaghers team for always putting the customer first. “This award recognises our achievements over the past 12 months in measuring and managing Customer Experience

excellence in our pharmacies and online. Our aim is to continue to innovate and keep the customer as our central focus.”

PHARMACYNEWSIRELAND.COM

The team picked up the Award at the recent CX Impact Awards.

While many people are known to take a more conscious approach to self care during the winter months, and particularly during the flu season, this campaign is designed to highlight the ongoing benefits of self care throughout the year. IPHA Consumer Healthcare Division Chairman John Sheehy said, “The value of self care to our society is immense and it is hoped that this latest campaign will encourage people to manage their own health this winter in a more pro-active way.”


PrEP Pre-exposure prophylaxis (PrEP)

ARV

Emtricitabine/Tenofovir disoproxil Mylan 200 mg/245 mg film-coated tablets

PRESCRIPTION ONLY MEDICINE. FURTHER INFORMATION IS AVAILABLE ON REQUEST OR IN THE SUMMARY OF PRODUCT CHARACTERISTICS. Mylan Ireland, Newenham Court, Northern Cross, Malahide Road, Dublin 17, Ireland. www.mylan.ie Job Code: EMT-2019-0027 Date of Preparation: November 2019


10

News

Pharmacy Based service would improve COPD outcomes Calls have been made for the introduction of a New Medicine Service in community pharmacies in Ireland, similar to the proven service already available to patients with chronic illness in other countries. Speaking to mark World COPD Day the IPU has said that such a service could significantly improve the outcomes for patients newly diagnosed with COPD and a range of other conditions. The New Medicine Service involves a structured pharmacistled intervention, delivered within the community pharmacy setting, consisting of advice and support for patients prescribed medicines for a specific chronic disease. A successful pilot conducted in Ireland found a 9% improvement in optimal adherence to treatment plans. A New Medicine Service operates in many other countries including the UK, Australia, Canada, Denmark and Norway. In addition to COPD, it can assist patients who have been newly prescribed

medicines for certain long-term conditions or therapies such as asthma, Type 2 diabetes, hypertension and chronic pain. Speaking about World COPD Day, Kathy Maher, community pharmacist and former IPU President, said, “COPD is an umbrella term that describes a series of progressive lung diseases. They are associated with it being difficult to empty air out of the lungs due to the airways being narrower than normal, leading to airflow obstruction and difficulty breathing. It is estimated that as many as 500,000 people in Ireland may suffer from COPD and it is known to be Ireland’s fourth biggest cause of death after lung cancer, heart disease and stroke.” Ms Maher continued, “A condition as common as COPD should,

where possible, be treated outside of the hospital setting. That is why it would often be an ideal case for a pharmacy led New Medicine Service. This would allow the pharmacist to monitor a patient, ensure they were taking medications as directed and identify any challenges with a new treatment. “Economic analysis of a similar service which has operated in the UK since 2011 found that it offers the NHS increased health gain at reduced overall cost, and provides short-term savings of £75.4 million and long-term savings of £517.6 million.” Ms Maher concluded, “The IPU is calling for the nationwide rollout of a New Medicines Service to be announced and implemented without delay.”

Success for Clonmel in Patent Rights case Clonmel Healthcare have succeeded in a counterclaim against MSD in the High Court, Irish Pharmacy News learned when going to press. MSD had claimed Clonmel Healthcare was breaching its 2005 supplementary protection certificate (SPC), which governs MSD’s authorisation for their drug ‘Inegy’ whilst Clonmel Healthcare had counterclaimed that the SPC breached a 2009 EU SPC regulation. Clonmel produces the Ezetimibe/ Simvastin generic and said the combination of the two active ingredients of Ezetimibe and Simvastin was not protected by the underlying patent.

Clonmel also contended Ezetimibe was the only compound that is protected. The combination drug was previously authorised and therefore MSD’s 2005 SPC was invalid, it said. Mr Justice McDonald said his judgment addressed the invalidity claim. He concluded that the combination of Ezetimibe and Simvastatin is not an invention covered by the patent. “There is nothing in the evidence or

in the materials before the court to explain how the combination can be said to be an invention in itself,” he said. He held the combination was not protected within Article 3(a) of the 2009 SPC regulation. Clonmel was therefore entitled to a declaration the SPC was invalid and must be revoked. In light of his findings, the judge also said there was no basis for him to make a reference on the matter to the Court of Justice of the EU.

Innovating for Life Patients in Ireland are waiting three times as long to get the same medicines as patients in other comparable European countries, an analysis by the Irish Pharmaceutical Healthcare Association (IPHA) has found. IPHA, which represents the originator biopharmaceutical industry in Ireland, released new figures at its ‘Innovate For Life’ conference held at the end of last month in Croke Park, Dublin. Next month’s issue of Irish Pharmacy News will carry full coverage from the event.

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Polypharmacy Medication Safety With the fourth annual #MedSafetyWeek having taken place last month, this year’s campaign focused on polypharmacy, with the overarching message that reporting side effects helps protect patients when taking multiple medicines. Medicine regulatory authorities across the world took part in a social media campaign to raise awareness of medicine side effects, and the importance of reporting them. The HPRA participated in the annual social media campaign to highlight the importance of reporting side effects. #MedSafetyWeek is a joint effort between 57 medicine regulatory authorities across the globe. Polypharmacy is defined as the simultaneous use of four or more prescription, over-the-counter or traditional medicines at the same time. Polypharmacy increases the likelihood of a patient having side effects, due to the increased risk of interactions between medicines, and with foods or herbal products. Although polypharmacy is common in older people, anyone who routinely uses multiple medicines at the same time can be affected. This includes people with longterm chronic conditions, who regularly take multiple medicines. Regulators such as the HPRA rely on the reporting of suspected side effects to make sure medicines on the market are acceptably safe. Patients, including their carers, and healthcare professionals are asked to report their suspicions of side effects through our online report form. The participating medicine regulatory authorities encouraged healthcare professionals to review their patients’ medications intake, especially when prescribing and administrating multiple medicines, as well as being vigilant to monitor, detect and report suspected side effects. Reporting plays an important role in helping the HPRA monitor the safe use of medicines to protect public health through effective regulation. This campaign forms part of a global initiative led by Uppsala Monitoring Centre (UMC) – the World Health Organisation (WHO) Collaborating Centre for International Drug Monitoring.


News Pharmacy Update on Health Ireland Levels of smoking are dropping to 17% of the population whilst obesity is still a major concern with 60% of people either overweight or obese. These are some of the statistics from the latest Healthy Ireland Survey which will inform community pharmacists about the wellbeing and overall health of their visiting consumers. Minister of State for Health Promotion Catherine Byrne TD launched the annual Survey, funded by the Department of Health and conducted by Ipsos MRBI. The prevalence of smoking has dropped from 23% in 2015 to 17% in 2019 which means there are now an estimated 165,000 fewer smokers than there were five years ago. Plain packaging with health warnings, introduced under a new law in 2018, was cited by 25% of smokers as a good motivation to quit. Minister for Health Simon Harris said, “Our aim is to achieve similar positive trends in the future with the other risk factors which impact on people's health and contribute to chronic disease, such as obesity, alcohol, physical inactivity and nutrition, through continued partnership working. “The findings from the 2019 Survey report will help us monitor how well our policies are working, as well as identifying ways we can better support people to be healthy."

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Further Pharmacy Cuts on the Horizon? Community pharmacists could be hit by cuts of between €20,000 and €25,000 EACH - under plans by Government to decrease the fees paid to pharmacists from the 1st January next year. According to the Fianna Fail Deputy Leader Dara Calleary, who raised the matter during Leaders Questions in the Dáil at the end of last month, the Government intends to cut the Community Pharmacy budget by ¤45 million in the New Year, which will impact on all local community pharmacies and the services they offer. Pharmacists have voiced their ‘shock’ and ‘disappointment’ at the decision, which comes despite repeated assurances from the Minister for Health Simon Harris that cuts to pharmacists’ incomes that were imposed during the financial crisis would be unwound. The IPU was meeting with Minister Harris as IPN was going to press, and will be urging him not to implement these cuts on 1 January and, instead, to keep his previous promises to commence new pharmacy contract talks so that all issues including investment in expansion of services can be discussed properly. IPU President and community pharmacist Daragh Connolly said, “The cuts are nothing less than a betrayal of clear commitments that the Government has made publicly to the pharmacy profession. Further cuts to pharmacy funding are not reasonable or rational and they

Fianna Fail Deputy Leader, Dara Calleary

don’t tie in with Sláintecare. Pharmacists around the country are deeply concerned and are wondering why these brutal and unjustifiable cuts are now being proposed, especially when our previous submissions setting out how, with no adverse impact on patient care, pharmacists could help the State save ¤90 million or more per year on biologic medicines have been ignored. We are calling on Minister Harris to stop the cuts and start new pharmacy contract talks now.” “For many pharmacies, this range of cuts could take between ¤30,000 to ¤35,000 out of their income, which will lead to redundancies in pharmacies and lead to pharmacy closures in so many areas,” Mr Calleary said. The Mayo TD also stated, “The Minister for Health gave very solemn assurances at the conference of the Irish Pharmacy Union last May that he would address the FEMPI cuts, which took 30% out of the incomes

of our community pharmacists around the country. He said that he wanted to move beyond FEMPI to a higher terrain and to move discussions on a new pharmacists' contract. He said "Let's get that done this year." It was the usual practice from the Minister - tell them what they want to hear, run away and have no follow up.

Educational Award for IPN Partner 4Front

While overweight and obesity in men has dropped slightly since 2017 overall figures show that 60% of those surveyed were found to be overweight or obese, with just 37% of adults having a normal weight.

Irish Pharmacy News is delighted that our Educational Partner www.4FrontPharmacy.ie has scooped the prestigious 'Educational Project of the Year in General Practice / Pharmacy at the Irish Healthcare Awards in Ballsbridge Hotel in Dublin on 21st November.

New data on sun protection shows that 92% of participants report using some form of protection when exposed to the sun for more than 30 minutes, with sunscreen and sunglasses being the most commonly used forms of protection.

www.4Front Pharmacy.ie is a leading edge online training platform for community pharmacy teams, proven to drive patient safety, staff engagement and increased sales through raising the quality of pharmacy / patient interactions. In addition to hosting the Online MCQ Assessments for IPN Clinical CPD articles, and contributing pharmacy business CPD articles, in its inaugural year, 4Front Pharmacy has created 62 audio

visual, assessed and verified learning modules for community pharmacy teams. They have done the work, so you don't have to, saving poor pharmacists valuable time.

Joe Haire MPSI, MD and Superintendent Pharmacist Kissane's Pharmacy Group celebrating with 4Front Pharmacy's David McLean MBA and Rachel Dungan MPSI

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PSI End of Year Review Assuring Trust in Pharmacy The Pharmaceutical Society of Ireland Registrar and Chief Officer Niall Byrne gives readers an overview of the PSI's opportunities and challenges during 2019, looking also to the publication of the recent revised Code of Conduct. Mr Niall Byrne, Registrar & Chief Officer, Pharmaceutical Society of Ireland

Throughout this year we continued an extensive programme of activities and engagement to further our objective of assuring trust in pharmacy through effective regulation. 2019 marked the mid-point of our current strategy, which sets important and ambitious objectives for us in pursuit of safe, quality provision of pharmacy care. We appreciate the input and collaboration of our registrants, patient representatives, other regulators and stakeholders to inform and enhance the nature and extent of the public interest work that we do. During 2019 we began work on the development of new standards focused on how superintendent pharmacists can govern better for quality and safety in retail pharmacies. As the regulator, we can also use these standards to assess quality in pharmacies, while the public can use the standards to know what they can expect from a registered pharmacy. We received valuable input through a scoping consultation and from the Standards Advisory Group which we have brought together to guide and inform the standards development process. Work on the standards will continue in partnership with the advisory group during 2020. Professionalism and care have been the themes of our engagement with pharmacists in recent months, marked by the publication of the revised Code of Conduct for pharmacists. The review and update of the Code represented a significant body of work for the PSI over the past two years. We sought to address the many developments in the delivery of healthcare over the past decade in a manner that would support pharmacists in their current and future professional practice, and ensure that pharmacists always

work to provide the best possible health outcomes for their patients. The new Code came into effect in October this year. During the autumn, we held a series of information events around the country to provide pharmacists with the opportunity to discuss the key themes in the code. I consider these events to be crucial opportunities for us and for registered pharmacists to come together and to consider issues of significance for pharmacists as healthcare professionals. I look forward to working with the pharmacy sector and to more of these beneficial engagement opportunities in 2020. Ensuring the continued high standard of education and training for pharmacy is an important function for the PSI. With the new MPharm programme in place now for several years, it was timely to review the accreditation standards, which set down what is expected of the programme provider for the teaching, learning and assessment of the MPharm. We engaged during the review, particularly with the higher education institutions and with students, as well as holding a public consultation. As a result, we made some improvements to the standards and the PSI Council subsequently approved the revised accreditation standards for use in the education of student pharmacists for future years. As for many other public and private bodies, 2019 proved to be a year busy with Brexit preparations. We considered a

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broad array of challenges and assessed the risks that generally and particularly relate to our work and to the wider health and pharmacy sector. We also engaged extensively with the Department of Health and other parties in our preparations. We have prepared amending statutory rules for the efficient registration of individuals with UK qualifications in the event of a no-deal Brexit. Our aim all along has been to ensure that we continue to deliver on our responsibilities with minimal disruption and that we ensure the maintenance of the pharmacist workforce post-Brexit. Looking to 2020, we will continue to respond to the ongoing challenges that may arise from the UK’s eventual exit from the EU. In driving towards greater regulatory effectiveness, we have developed and published a Regulatory Risk Statement. This makes clear how we manage regulatory risk and how we recognise and respond appropriately to risks and potential harms that relate to our area of accountability. We have also undertaken our own quality improvement journey with a focus on building our capacity and effectiveness as a regulatory body. We submitted the organisation for independent, external assessment by an internationally-recognised quality body and we were very proud to achieve EFQM 4 star recognition this year. This is a significant achievement that testifies to the commitment of my colleagues in the PSI to

“There are many important patient safety and public protection issues that PSI plays a part in addressing with our stakeholders and partners to strengthen and enhance our collective commitment to safety and quality within pharmacy services.” our mission and provides clear evidence that the PSI is focused on delivering real public value. We will seek to sustain, and improve upon, these results into the future. We have also made a commitment to digital transformation – part of a process of changing and enhancing our ways of working across the organisation. Beginning in 2020, this process will deliver an improved online registration experience for registrants, and improved digital services. The positive impact of our work in this area will be apparent from late 2020 and into 2021. As we close out another year and another decade, I would like to thank everyone who has engaged and collaborated with us during 2019. There are many important patient safety and public protection issues that PSI plays a part in addressing, and I look forward to further positive engagement with our stakeholders and partners during 2020 to strengthen and enhance, what I genuinely believe to be, our collective commitment to safety and quality within pharmacy services.


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ABBREVIATED PRESCRIBING INFORMATION Product Name: Emazole Control 20 mg Gastro-Resistant Tablets Composition: Each tablet contains 20 mg esomeprazole (as magnesium dihydrate). Description: Light pink oval film coated tablet. Indication(s): Proton Pump Inhibitor (PPI): Short-term treatment of reflux symptoms (e.g. heartburn and acid regurgitation) in adults. Dosage: Swallow tablets whole with liquid, do not chew or crush. Disperse in half a glass of non-carbonated water if difficulty in swallowing. Stir until tablets disintegrate, drink liquid with pellets immediately or within 15 min, or administer through a gastric tube. Do not chew or crush pellets. Adults: The recommended dose is 20 mg esomeprazole (one tablet) per day. It might be necessary to take the tablets for 2-3 consecutive days to achieve improvement of symptoms. Duration of treatment is up to 2 weeks. Once complete relief of symptoms has occurred, treatment should be discontinued. If no symptom relief is obtained within 2 weeks of continuous treatment, the patient should be instructed to consult a doctor. Elderly (≥ 65 years old): As per adults. Paediatric population (< 18 years): Not recommended. No relevant use in this group in the indication: “short-term treatment of reflux symptoms (e.g., heartburn and acid regurgitation)”. Severe impaired renal function: Caution. Severe liver impairment: 20 mg max daily dose. Contraindications: Hypersensitivity to esomeprazole, substituted benzimidazoles or any of the excipients. Not with nelfinavir. Warnings and Precautions for Use: On demand treatment: Contact a physician if symptoms change in character. In the presence of any alarm symptom (e.g. significant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melaena) and when gastric ulcer is suspected or present, malignancy should be excluded, as treatment with esomeprazole may alleviate symptoms and delay diagnosis. Treatment with proton pump inhibitors (PPIs) may lead to a slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter and in hospitalised patients, also possibly Clostridium difficile. Patients should consult their doctor before taking this medicinal product if they are due to have an endoscopy or urea breath test. Absorption of vitamin B12 may be reduced due to hypo- or achlorhydria. Not recommended for long-term use as the following may also occur: Hypomagnesaemia; Risk of fracture. Consider stopping Emazole Control in cases of Subacute cutaneous lupus erythematosus (SCLE) accompanied by arthralgia. Interference with laboratory tests: Increased Chromogranin A (CgA) level may interfere with investigations for neuroendocrine tumours. To avoid this interference, Emazole Control treatment should be stopped for at least 5 days before CgA measurements. If CgA and gastrin levels have not returned to reference range after initial measurement, measurements should be repeated 14 days after cessation of PPI treatment. Contains glucose and sucrose. Interactions: Effect of esomeprazole on other drugs: Co-administration with atazanavir is not recommended. If the combination of atazanavir with a PPI is judged unavoidable, close clinical monitoring is recommended in combination with an increase in the dose of atazanavir to 400 mg with 100 mg of ritonavir; esomeprazole 20 mg should not be exceeded. Esomeprazole is a CYP2C19 inhibitor. When starting or ending treatment with esomeprazole, the potential for interactions with drugs metabolised through CYP2C19 should be considered. Serum levels of cilostazol, cisapride, tacrolimus, methotrexate may be increased. An interaction is observed between clopidogrel and esomeprazole, but the clinical relevance is uncertain. As a precaution, concomitant use of esomeprazole and clopidogrel should be discouraged. Gastric acid suppression by PPIs increase or decrease absorption of drugs with pH dependent absorption (decreased absorption of ketoconazole, itraconazole); esomeprazole inhibits CYP2C19 metabolising enzyme and could increase plasma concentrations of diazepam, citalopram, imipramine, clomipramine, phenytoin (monitor plasma levels of phenytoin), etc. resulting in need of a dose reduction; monitor INR when given with warfarin or similar. Caution as absorption of digoxin can increase. Effect of other drugs on esomeprazole: CYP2C19 and CYP3A4 inhibitors (clarithromycin, voriconazole) may increase the esomeprazole exposure. Dose adjustment not regularly required, except in severe hepatic impairment and long-term use. CYP2C19 and/or CYP3A4 inducers (rifampicin and St. John’s wort) may lead to decreased esomeprazole serum levels by increasing the esomeprazole metabolism. Pregnancy and Lactation: Caution in pregnancy due to lack of clinical data. No studies in lactating women, therefore, not recommended during breast-feeding. Ability to Drive and Use Machinery: Minor influence on the ability to drive or use machines. Adverse reactions such as dizziness (uncommon) and blurred vision (rare) have been reported. If affected, patients should not drive or use machines. Undesirable Effects: Common: Headache, abdominal pain, constipation, diarrhoea, flatulence, nausea/vomiting, fundic gland polyps (benign). Uncommon: Peripheral oedema, insomnia, dizziness, paraesthesia, somnolence, vertigo, dry mouth, increased liver enzymes, dermatitis, pruritis, rash, urticaria, fracture of the hip, wrist or spine. For other side effects refer to the SPC. Marketing Authorisation Holder: IQ Pharmatek Ltd., Gurtnafleur, Old Waterford Road, Clonmel, Co. Tipperary. Marketing Authorisation Number: PA 22777/001/001. Further information and SPC are available from: Rowex Ltd, Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417. E-mail rowex@rowa-pharma.ie Legal Category: Not subject to medical prescription. Date of Preparation: September 2019 Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing medsafety@hpra.ie or by emailing Rowex pv@rowa-pharma.ie


IPHA End of Year Review IPHA - Innovating for Life The Irish Pharmaceuical Healthcare Association reflects on a year of Brexit preparation, startling figure publications and Innovating for Life.

Preparing for Brexit During 2019, IPHA was very heavily involved in collaborative work with other key stakeholders in the planning for Brexit, moves which were recognised by the Government as ‘very significant.’ In February, new figures released by the Association marked Rare Disease Day and showed that just one-third of medicines for rare diseases licensed for patients in Europe are available in Ireland. According to the figures, just 29% of all available orphan medicines licensed by the European Medicines Agency for use in patients in 27 European countries were available to patients here. Orphan Medicines Ireland ranked in the bottom half of the list of European countries, and behind all other western European Union countries, including Denmark, Spain, Sweden, Italy and Austria. The UK and Germany performed best, according to the figures, scoring 92% and 96% for availability of orphan medicines, respectively. The figures, compiled by IQVIA for the European Federation of Pharmaceutical Industries and Associations which includes IPHA, relate to rare diseases medicines authorised by the European Medicines Agency in the years 2015, 2016 and 2017. In March, figures released by IPHA showed 10 innovative treatments approved by the HSE for use by patients spent 890 days awaiting decisions

Oliver O’Connor said, “No one is arguing that every medicine can or should - be reimbursed. But it is clear that the approvals system for new medicines doesn’t work and funding is neither predictable nor adequate. It’s up to all of us to build planned innovation into our health services, treating the discovery, development and delivery of new medicines as one integrated loop.

to being vaccinated, followed by concerns over side-effects.

“The industry has set a simple goal: to place Ireland in the top quartile in the EU28 for speed of access to new medicines. This is consistent with the Government’s own ambitions for outcomes as part of the National Cancer Strategy. We urgently want to work with politicians and policymakers to realise that goal. If we do not Irish patients will be left waiting.”

IPSOS MRBI carried out the survey in the first half of last month, with 975 interviews conducted by telephone with adults aged over 18.

IPHA has argued that the process in Ireland is not that different to many other European countries where the State determines the added value of new products through the Health Technology Assessment (HTA) process and then companies negotiate the price based on that value assessment. Trusting Vaccines In other news just last month, a new survey by Ipsos MRBI for IPHA found almost seven in 10 people trust vaccines and believe the medical evidence for their effectiveness, according to a new. The research shows 67% of people are vaccines ‘believers’ while just 3% are ‘non-believers’. But 30% are unsure about them. The figure for ‘believers’ was higher among women at 70%. For men, the figure is 65%. Uncertainty about vaccines was highest among the over-55s at 34%. Respondents said a lack of information is the biggest barrier

The 10 products were approved for reimbursement over the following months so it was July before some of them were available to Irish patients.

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Oliver O'Connor, Chief Executive, IPHA

Almost half of respondents have never heard of the term ‘herd immunity’ which arises when a high percentage of the population is protected through vaccination. But once explained, almost nine in ten accept that herd immunity is important, according to the survey.

Oliver O’Connor, IPHA Chief Executive describes the research as “an important signpost” on the path to increasing the uptake of vaccinations as a barrier to disease. “Vaccines work. They save lives and protect the wider community. Our industry, which develops vaccines, is keen to boost public awareness of the importance of vaccinations. That’s a goal with share with the Government and the health authorities. Together, we can help to stop the spread of vaccine-preventable diseases,” he says. Earlier this year, IPHA launched a social media campaign, #VaccinesWork, aimed at raising public awareness about the importance of vaccination. The WHO estimates that vaccines saves up to three million lives each year. With the exception of clean, safe drinking water,

vaccination is one of the most successful and cost-effective public health interventions ever. However, its success is increasingly under threat as vaccination rates continue to fall below the required 95% uptake rate to ensure ‘herd protection’. A direct result of that is an increase in the number of global outbreaks of serious diseases such as measles. The best way to protect populations against these diseases is to vaccinate directly. Innovating for Life Closing the year, more than 300 delegates gathered in Croke Park, Dublin, for ‘Innovate for Life’, the IPHA Annual Conference and Dinner which made a big statement about the future for medicines innovation. The event drew record numbers across industry, policy, patient advocacy, research and academia for lively discussions on the major themes shaping the biopharmaceutical industry in Ireland and globally.

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The line-up of keynoters and contributors is high-calibre - 24 cross-sector thoughtleaders, 46% of whom are women, will share their views on everything from the therapies of the future to value-based adoption of medicines, from industry-academic-Government partnerships to patients’ experience of managing illness, and from data in healthcare to best practice in self-care.

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HPRA End of Year Review Increasing Collaboration and Engagement Dr Lorraine Nolan, Chief Executive of the Health Products Regulatory Authority talks about strengthening core relationships and promoting engagement with the profession. Dr Lorraine Nolan, Chief Executive, HPRA

Reflecting on 2019, the Health Products Regulatory Authority (HPRA) has seen great progress in a number of key areas of focus. One of the key positives I take from the past year is the increased level of collaboration and engagement with our health sector colleagues nationally. This was particularly evident in our preparations for the UK’s departure from the EU. Our core remit of protecting publicand animal health remained the driver to ourapproach.I believe a very important outcome of this has been that existing relationships have been strengthened among health stakeholders nationally. We have enhanced communication channels, which will serve to future strengthen how we work together in the future. In terms of Brexit, negotiations and indeed uncertainty will continue into 2020. In managing this, it is vital that our focus both at home and within the regulatory network in Europe continues to prioritise public and animal health protection. For some time, the HPRA has reinforced to all stakeholders that the Irish market is unique in the context of Brexit and that as a result there are both strengths and vulnerabilities around the supply of medicines and medical devices to the Irish market. We have worked with all stakeholders to ensure that any vulnerabilities are managed and potential negative impacts on continuation of product supply minimised. While we cannot absolutely guarantee full control of all elements, protecting the supply chain in light of Brexit will remain our highest priority as we look towards 2020. Returning to the theme of collaboration, there are many other examples of where our

engagement with other health stakeholders has been very effectively enhanced. One of these is the framework for a multistakeholder approach to handling shortages of human medicines, which we established in 2018. This was a significant step change in the management of medicines shortages in Ireland. Under the framework, the HPRA has responsibility for co-ordinating the management of medicines shortages on our market, but this is done in conjunction with manufacturers, wholesale distributors, marketing authorisation holders, healthcare professionals, the Health Service Executive, patients and representative groups. Throughout 2019,the framework has been utilised effectivelyto provide for better management and reduction of the impact of shortages on patients by advance co-ordination of necessary actions across stakeholders and by ensuring timely communications to healthcare professionals and the public. In some situations, the framework has also assisted in preventing shortages from occurring. Pharmacists continue to play a critical role in managing medicines shortages on behalf of patients. We see this as a partnership approach and, on behalf of all stakeholders, I would like to thank you for your commitment to this area. The HPRA continues to focus on better-informed users. Our work as an educational partner

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in the Irish Platform for Patient Organisations Science and Industry’s (IPPOSI) second Patient Education Programme continued this year. The programme has been designed to enable and empower patients to work effectively with Irish and EU-level health research and technology partners, health agencies and authorities. The positive reaction received indicates that our involvement has brought benefit to the participants, but it has also providedus with an opportunity of using the feedback provided to develop future engagement approaches. Within the organisation, our medical devices department has continued to undergo significant restructure and change in 2019. This will support us to respond to developments in the external environment including new regulatory requirements while also ensuring appropriate regulation of innovative and emerging technologies. This desire to optimise our processes and capabilities is part of our culture as an organisation. We always strive to position the HPRA and our staff for the future through enhanced capabilities, expertise and systems in addition to the provision and maintenance of a fulfilling workplace. To set that future direction, and as we approach the end of our existing strategic plan in 2020, we will be reaching out to stakeholders to inform the development of the next iteration of the HPRA’s strategic plan. Please keep an eye on our website www.hpra.ie if you would be interested in contributing.

“Pharmacists continue to play a critical role in managing medicines shortages on behalf of patients. We see this as a partnership approach and, on behalf of all stakeholders, I would like to thank you for your commitment to this area”

Looking outwardly, we can see how the regulatory landscape is constantly changing to respond to the development of new products and technologies. As a consequence, production models are constantly challenging existing regulatory frameworks. Through collaboration with our European and global regulatory colleagues, we are working to achieve greater harmonisation and more adaptive regulatory approaches to facilitate safe and timelier approval of new medicines and technologies. This includes initiatives undertaken at a European level, via the Heads of Medicines Agency and the European Medicines Agency, and globally through the participation of regulatory leaders in the International Coalition of Medicines Regulatory Authorities (ICMRA). This work will continue into 2020 and beyond. While innovation, and indeed the pace of that innovation, is one of the most significant challenges facing all regulators, it is also one of our biggest opportunities in terms of delivering on our remit to enhance and protect public and animal health. I genuinely believe this is an exciting time for the HPRA and we will continue to adapt and evolve, as we always have to deliver on our public health commitment.


IPU End of Year Review Fighting to advance the Pharmacy position Darragh O’ Loughlin, Secretary General of the Irish Pharmacy Union takes a look at the difficulties faced by members in 2019, the work they have done in trying to support these and the focus when moving into 2020. Darragh O’ Loughlin, Secretary General of the Irish Pharmacy Union

“2019 was another extremely busy year for the Irish Pharmacy Union (IPU), with our core focus throughout having been on unwinding FEMPI; negotiating a new pharmacy contract; and securing increased investment in pharmacy services. In addition to this, we are working hard to ensure key stakeholders confront the severe difficulties in the recruitment and retention of community pharmacists and commit to addressing the problem. “Throughout the year we met with key health policy influencers, including politicians, the Department of Health and the HSE, to further advance our key objectives, including key meetings with Minister for Health Simon Harris TD and the new HSE CEO Paul Reid. We constantly raised the huge opportunities available by expanding the services pharmacies can provide, sought an increase in resources for pharmacies and fought to reduce the unacceptably heavy regulatory and administrative burden on pharmacists. A highlight of the campaign was when Minister Harris spoke at our 2019 Annual Conference and said, “My commitment to you today, my commitment to the IPU and to the members of the IPU, is that this year let’s start our discussions on a new pharmacy contract, let’s start a discussion on how we move beyond FEMPI and let’s start our discussion in relation to a programme of investment”. The IPU has been working to ensure he keeps that promise. “One of our key activities was a briefing event for politicians in Buswells Hotel opposite Leinster House. Approximately 40 Oireachtas members attended the event, which was held on 2 October, shortly before Budget 2020 was announced. As part of the campaign we also sent our pre-Budget submission to all Oireachtas Members, and met with

politicians individually, including key government and opposition deputies. This engagement was reflected in a distinct increase in parliamentary calls for unwinding FEMPI cuts to pharmacy fees and negotiation of a new pharmacy contract. “Recognising the severe difficulties in recruitment facing our members, we commissioned research by Behaviour and Attitudes to better understand the attitudes of pharmacists towards becoming and remaining a community pharmacist, and to identify what drives and deters the appeal of working in community pharmacy. On the back of that research, we met with a number of key stakeholders including the PSI, HSE, APPEL, IIoP, the Schools of Pharmacy, Department of Health, PSI and Locum Agencies to discuss the contents of the report and have set up a stakeholders working group with clear objectives: foster a professionally rewarding working environment in community pharmacy; make community pharmacy an attractive and sustainable career choice; and increase the number of graduates choosing community pharmacy as a career. “The Communications Department issued a considerable number of media releases and responded to many media queries throughout the year. Alongside this, the IPU advertising campaigns continue to highlight the important role and services provided by pharmacists, with a number of campaigns throughout the year on national radio and through social media and video on demand.

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“Our very high-profile partnership with RTE’s Operation Transformation continued at the beginning of the year when 430 pharmacies signed-up to participate in the Weigh Your Age campaign. Participating pharmacies provided a free service to members of the public, which allowed them to get their metabolic age, visceral fat, fat percentage and weight measured in the pharmacy. The campaign was highlighted on the programme and garnered significant media coverage. “In partnership with the Irish Pharmaceutical Healthcare Association (IPHA), we launched a self care awareness campaign. A Be Well This Summer – Think Pharmacy in-store poster and promotional videos were made available to all members on the IPU website at the time. The second instalment of the campaign, Be Well this Winter – Think Pharmacy, launched with a Cough video in November. These campaigns aim to drive additional footfall and OTC revenue into pharmacies. “The IPU 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 that pharmacists are not over-burdened by excessive or unnecessary administration. The IPU also supported a number of individual pharmacists in their dealings with the HSE PCRS and helped them to successfully resolve specific claim-related issues. “We continue to help members with PSI Inspections and other Fitness to Practise Issues, as well as producing and updating SOP templates, which members can download from the IPU website and personalise for their pharmacy. We advocate for additional paid services and in 2009 achieved the introduction of funded HSE services for Hepatitis

C, Pre-Exposure Prophylaxis and Pneumococcal Vaccination. We also presented to the Department of Health’s Working Group on Access to Contraception to advance our proposal that women be allowed access contraception directly from a pharmacist. The Minor Ailment Scheme also remains under discussion and has not yet been implemented, although we continue to meet with officials from both Sláintecare and the HRB to promote it. “We also made submissions on the Regulated Professions Bill, to streamline the Fitness to Practise regime; to the Department of Health regarding payment for PPV Vaccination; to the PSI on Temporary Absence Rules; and to the Revenue Commissioners on Flat Rate Expenses. “As we all continue to live in the shadow of Brexit, we have been working throughout the year with the Department of Health, HPRA, HSE and the wholesalers and manufacturers towards ensuring a continued supply of medicines both throughout the Brexit crisis and planning in the event of a no-deal Brexit. The IPU Guide to Brexit and Brexit Checklist is constantly updated. We are a member of the Department of Health Brexit Communications sub-group and have made sure that all stakeholders are aware of the concerns of pharmacists and patients regarding supplies of medicines and the ever-worsening problem of medicine shortages. As we draw closer to 2020, Brexit will continue to loom large and the IPU will work to minimise the impact on pharmacists to the extent possible. “The final months of 2019 have been very busy at the IPU, and we expect that to continue and intensify into 2020, as we fight to advance the position of community pharmacists and ensure our members get the respect they deserve as valued members of the healthcare community and the resources they need to continue providing an unparalleled service. This is often a difficult uphill battle, particularly In light of proposed cuts to pharmacy fees, but all resources in the IPU are focussed on this challenge and we are working tirelessly to keep issues affecting pharmacists at the top of the political and health policy agenda.”


PharmaConex, Celebrating 10 Years in Business It has been another action packed year here at PharmaConex, filled with workshops, webinars and much, much more. Most recently, The PharmaConex Team were happy to introduce our first (of many) Career Development Workshop’s. What a success! Attendees enjoyed a range of topics including Your Impact in Pharmacy, Code of Conduct, Introduction to Pharmacy Claims as well as Dispensing System Training. All followed by an exhibit from industry leaders and topped off with a Prosecco toast for all new graduates commencing their careers. The PharmaConex Team are looking forward to another exciting 10 years with Nicola Ryan, Operations Director and Ashling Quinlan, Client Services Director at the helm. We promise to deliver an exciting New Year full of permanent, locum and training opportunities. Pharmaconex would like to wish all their clients and pharmacists a very happy Christmas and best wishes for the year ahead. We look forward to working together again in 2020. The PharmaConex Team

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IIOP End of Year Review IIOP - Supporting CPD for Pharmacists Dr Catriona Bradley, Executive Director, Irish Institute of Pharmacy, looks back on the achievements of 2019 as the Institute continues to manage and support CPD for pharmacists.

The Irish Institute of Pharmacy (IIOP) was established by the Pharmaceutical Society of Ireland (PSI) to oversee the management and support mechanisms for CPD for pharmacists, and the commissioning of required education and training programmes in line with national policy and evolving healthcare needs. Following national procurement processes, RCSI (Royal College of Surgeons in Ireland) was appointed as the managing body of the IIOP in August 2013, and re-appointed in 2018 for a further five years.

Dr Catriona Bradley, Executive Director, Irish Institute of Pharmacy

ePortfolio The CPD system for Irish pharmacy is based on a model of self-directed learning and reflective practice. Each year approximately one fifth of the pharmacy register is selected to participate in an ePortfolio Review process. This process involves pharmacists submitting a selection of the CPD cycles which they have created to be reviewed against a set of peer-determined standards. In May 2019, the outcomes of the 2018/19 ePortfolio Review were published. Of the 1338 pharmacists included in the review, 97.6% participated in the process, of which 99.6% met the ePortfolio Review Standards, thus demonstrating systematic and ongoing engagement with CPD. In October 2019, the 2019/20 ePortfolio Review commenced. The IIOP communicated with over 1300 pharmacists selected for ePortfolio Review to outline what the process involved, to inform them of the 2019/20 ePortfolio Review Standards and to signpost the support information available. Practice Review The purpose of Practice Review is to ascertain if pharmacists

practising in patient-facing roles demonstrate an appropriate level of competence in dealing with patient care in four key areas: clinical knowledge; the ability to gather and interpret information from and about patients; patient management and education; and communication (including counselling) skills. In 2019, the coordination of practice review involved input from over 200 people including IIOP staff, volunteer pharmacists and expert input from RCSI Student, Academic & Regulatory Affairs and RCSI Quality Enhancement Office. Over 100 pharmacists participated in one of the four practice review events, which were held in the RCSI campus at 26 York Street in April 2019 and October 2019. To support pharmacists selected for Practice Review, the IIOP offered a combination of webinar and face-to-face supports. In October 2019, two practice review information and panel discussion events were held in Dublin and Athlone where pharmacists who had been involved in the development and roll out of Practice Review spoke about their experience of the process.

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In addition to these face-to-face events, webinars were held in the month before each Practice Review event, specifically for pharmacists selected for review. Programme of CPD Activities The IIOP delivers a range of online and face-to-face training programmes to support pharmacistsâ&#x20AC;&#x2122; development. In 2019, the IIOP launched the Management of Benzodiazepines and Z-drugs Training Programme which aims to educate healthcare professionals on the legislation pertaining to benzodiazepines and the implications for patient care in practice. The IIOP also launched Mentorship Skills Training for Pharmacists. These face-to-face training programmes aimed to introduce pharmacists to recognised principles of mentorship and assist them to engage with examples and scenarios that will help them to implement these principles into their own practice. Engagement activities The IIOP Peer Support Network plays an important role in providing support to the profession as it engages in the CPD System.

It was developed to offer informal peer-to-peer support to pharmacists. This group receives updates from the IIOP on the implementation of the CPD system to help and support their peers and colleagues. This form of support is recognised in feedback from the profession as being helpful in making the IIOP accessible. In September 2019, the IIOP held its annual Peer Support Pharmacist training and development event with 56 members of the Peer Support Network and other contributors to the IIOPâ&#x20AC;&#x2122;s work attending a two-day event held in Dublin. In October 2019, the IIOP in conjunction with the Northern Ireland Centre for Pharmacy Learning and Development held the biennial All Ireland Pharmacy Conference where over 100 pharmacists showcased their research interests in Poster and Oral Presentations. Dr Catherine Duggan (CEO, International Pharmaceutical Federation FIP) delivered the keynote address, entitled Delivering the WHO Primary Health Care agenda: strategies to meet national care needs through pharmaceutical workforce transformation.


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Corporate Profile

Talking Transformations with Teva’s Paul Neill Paul Neill is Director of Generics and OTC, for Teva Pharmaceuticals, Ireland. He spoke to Irish Pharmacy News about transformations within both the company, and the wider pharmaceutical arena. Paul Neill, Director of Generics and OTC, Teva Pharmaceuticals, Ireland

Paul is responsible for the sales and marketing for all Teva’s generic and OTC products in Ireland and is proud to manage a portfolio of over 350 products, including iconic household brands like Sudocrem and Infacol. The path to his current position wasn’t a straightforward one. “I came to this industry via a fairly circuitous route,” he says. “After completing a degree in hotel and business management, I spent 10 years working in the hospitality industry in the UK and Ireland. “However, I’d always been interested in medicine and so made the move into the pharmaceutical industry, my first role in 2002 was with Intrapharma

(subsequently acquired by United Drug) on their syndicated sales team. I then joined Teva for the first time in 2007 and helped to launch our hospital generics portfolio.

or more chronic conditions affects your life in so many different ways and the only people who really understand what it is like to live with a chronic condition are those living with it.”

“After leaving the business five years later to start another generics company in Ireland, I returned to Teva in January 2017 to take up my current role.”

A big ethos of thinking behind the company is one of innovation; an attribute Paul is keen they continue to deliver upon.

It’s been a really transformative year for Teva Ireland. “We are proud of our many achievements,” Paul continues. “This includes the launch of our Life Effects initiative, an online platform where people with chronic conditions share their insights, support and tips. Living with one

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“This year also saw us launch the new Teva brand in Ireland. We make a huge contribution to the Irish healthcare system and our new brand, which puts patients at the heart of everything we do, is providing us with a great platform to strengthen our relationships with patients and healthcare professionals.

“We aren’t just active commercially in Ireland either – we have a manufacturing site in Baldoyle, where we are proud to produce Sudocrem, a staple in almost every Irish home! In addition, our plant in Waterford is a major supplier of respiratory products to the US market, as well as other countries around the world. It all adds up to the major contribution we make to healthcare in Ireland.” We're constantly developing new medicines that patients need – adding to our range with generic and branded therapies. We recently launched AJOVY®, our ground-breaking new drug for chronic and episodic migraine. With one in seven people in Ireland suffering from migraine,


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“There have also been some challenges this year, not least Brexit. We’ve been working closely with our colleagues in the UK and Europe in order to be as well prepared as we can be for all eventualities, including contingency measures put into place for supply challenges” men and women. The entry of a generic into the Irish market lead to a more affordable price for PrEP, it also expanded patient access by making it available through community pharmacy for the first time, where it is available subject to a doctor’s prescription. The Department of Health recently announced the introduction of a new public access programme for Pre-exposure prophylaxis, better known as PrEP. The programme will take effect from 1st January 2020. The introduction of a publicly funded PrEP programme is a significant advancement in preventing HIV infection. Opening Access Paul continues, “Up to this point, access to PrEP for Irish patients has been restricted and based on their capacity to pay. This announcement will hopefully end that inequality. Access to PrEP will now be based on need rather than financial means. “The decision is also an important statement on the value of preventative healthcare versus after-the-fact treatment. At a time of stretched health budgets, when our health services have so many competing priorities, medicines such as PrEP can make a huge contribution to keeping people healthy and in reducing healthcare costs.” 2019 has not been without its challenges

we feel a big responsibility to bring greater awareness to this disabling condition. Feedback from prescribers has been really positive so far, and we’re looking forward to continuing to expand access to AJOVY next year.” In December 2017, Teva launched the first generic version of the medication (Emtricitabine/Tenofovir disoproxil Teva). Pre-exposure prophylaxis (PrEP), a HIV prevention medication has been shown, in conjunction with safe sex practices, to significantly reduce the risk of HIV infection through sex, particularly for those deemed at risk, such as gay and bisexual men, and transgender women, but also for heterosexual

“There have also been some challenges this year, not least Brexit. We’ve been working closely with our colleagues in the UK and Europe in order to be as well prepared as we can be for all eventualities, including contingency measures put into place for supply challenges,” he says. “The general healthcare landscape is also changing; consolidation in the market means it’s extremely competitive. And we’re beginning to see changes in customer and patient behaviour, with people looking for more control over their health and wellbeing. “At Teva, we really see our role as enabling that empowerment for patients – whether that’s through high quality and accessible medicines or other services such

as Life Effects, our innovative peer-led patient-to-patient online platform. “Another challenge has been the EU’s Falsified Medicines Directive (FMD), which was introduced in February and included new regulations such as products needing a two-dimensional bar code and tamperproof seal. We develop, produce and market affordable generic medicines as well as innovative and specialty pharmaceuticals and over-thecounter consumer healthcare products, along with supplying active pharmaceutical ingredients. “This legislation has added greater complexity and we’ve had to change our manufacturing processes. However, we feel that Teva’s in very good shape going forward.” The Future of Generics Generics is an ever changing market. We asked Paul what, in his opinion, could be the main opportunities moving forward. “Looking ahead to 2020, the future of the generics industry in Ireland is going to involve a complex supply chain. We need to be honest about shortages in the market; they’re here. It’s all part of a global supply chain issue and is due to multiple factors. The industry needs to cope with fluctuations due to products going out of stock and we all need to know how to adapt and manage patients’ expectations. “Added to this, we’re going to see more complex generic products and we’ll need a new approach in how to market them. The introduction of these products will provide both opportunities and challenges for the generics manufacturers, and for our customers. “Our R&D capabilities have expanded beyond tablets, capsules, liquids, ointments and creams to a broad range of effective dosage forms and delivery systems including biologics. We want to continue to leverage the global footprint and cutting-edge R&D facilities that we run across the world to bring the latest therapies to patients in Ireland.

“Medicine shortages are happening more often worldwide, pharmacists will need to continue engaging with and reassuring patients who are forced to change their medicine during shortages in the market, as well as sourcing alternative medicines. To provide the most up to date information on our products Teva provides a weekly stock update email in which we outline all of our products that are experiencing shortages, pharmacists can sign up to this by contacting any Teva employee. “Finally, we’ll be engaging robustly in the upcoming medicines, pricing and supply agreement, scheduled for August 2020. In 2016, the agreement with the HSE didn’t reflect engagement with generic suppliers in Ireland. Medicines for Ireland supply almost 60% of medicines used in Ireland and we want to be integral in ensuring both sustainability of that supply and increasing accessibility to medicines for patients. As an active member of Medicines for Ireland, we’ll be communicating with the Department of Health and the HSE. We want to play a central role in crafting an agreement that both meets the challenges that our industry faces, and the value that we offer as the largest supplier of medicines to the State. “Over 40,000 employees around the world are dedicated to our mission – and being able to leverage this in Ireland is a real differentiator. We’re quite unique in the pharmaceutical industry; our integration of generics and specialty R&D enables us to generate a robust pipeline of high-value medicines, with an emphasis on complex and branded generics. Teva is the world's leading generic drug maker with a range of more than 16,000 products and a presence in around 60 countries. As the largest volume supplier of prescription medicines in Ireland, Teva plays a major role in the Irish healthcare environment. Date of Preparation December 2019. IE/GENER/19/0007

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News

Another year of continued pharmacy growth A packed agenda met the representatives of 80 totalhealth pharmacies at the group’s recent AGM at The Johnstown Estate, with news of exciting new launches, CPD training sessions and supplier showcases. Patients and customers around the country will soon be offered even more convenience with the launch of two new services. The totalhealth App will allow remote ordering of prescriptions, as well as facilitating the group’s loyalty programme, powered by Azpiral. Kevin Nolan, sales director with Azpiral, was glad to tell attendees that the totalhealth loyalty programme is one of the most successful of its kind in the country. Also being rolled out is a full suite of pharmacy services. totalhealth’s ‘take totalcontrol of your health’ campaign centres around preventative health and health promotion, offering a range of screening and health-check services designed to empower patients to reduce their risk of developing chronic illnesses. Marketing & Communications manager, Naomi O’Farrell, explains, “Pharmacy teams have a unique place in the community to make a real difference to health outcomes. Providing convenient access to services like cholesterol and haemoglobin checks, urinalysis, and blood pressure measuring is part of our effort to encourage people to take control over their health risks, such as heart-disease or diabetes. Preventing these conditions from developing, or from getting worse, would make a massive impact on the wellbeing of our patients, as well as on the health service.” The AGM was also a chance to welcome the newest members of the co-operative group. Six additional pharmacies will soon be refitted to operate under the totalhealth brand, giving customers and patients in Laois, Mayo,

Managing Director, John Arnold said,”It’s always a pleasure to welcome new members to the totalhealth family, not least because we’re always eager to learn from each other’s experience and generate new ideas for improving our efficiencies and our services. The AGM was a wonderful way to introduce our newest family members to their colleagues.”

Keith Sheridan, Fleming Medical, Teresa Burke, Fleming Medical and Rory O’Donnell, Chairperson, totalhealth Carlow and Cork the chance to avail of improved value and additional services, provided by the same great, local teams.

Chairperson, Rory O’Donnell, was delighted with the reaction “Attendees at this year’s event left with renewed confidence in totalhealth and excited about our strategy for ongoing growth. It’s always refreshing and revitalising to get to spend time with colleagues, sharing ideas, getting advice and support; it’s a real privilege to be able to facilitate this forum when you see how welcome it is,” he reflected.

Sheena Mitchell, Milltown totalhealth Pharmacy, Dublin, Niall Tully, Tully’s totalhealth Pharmacy, Castlerea and Siobhán Reilly, Baxter’s totalhealth Pharmacy, Longford

Adding three pharmacies to the group is Peter McElwee, who will soon be re-branding his stores in Mountmellick and Portlaoise. “We’re very excited to launch our brand-new stores. Teaming up with a symbol group makes perfect sense for us. It’s crucial that we protect our business from market threats and ever-increasing costs. But the appeal of totalhealth is that it’s a collaborative organisation, with an approachable team and fellowmembers who are committed to supporting their peers.” Also joining the organisation are Christy McLoughlin of McLoughlin’s Pharmacy, Ballina, Laura Phelan of Bagenalstown Pharmacy, and Lorna Mullins of Mullins’ Pharmacies in Charleville and Kanturk.

3, 2, 1 Go! totalhealth Pharmacy Group recently teamed up with iRadio Ireland to offer one lucky winner a fantastic trip for them and two friends. The recipient will set off on an all expenses, first class trip to three of the world’s top cities; Paris, London and New York. Pictured here celebrating the launch of the campaign are pharmacists Mark Feely of Feely’s totalhealth Pharmacy in Tuam and Peter McElwee of McElwee’s totalhealth Pharmacy in Mountmellick.

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Huge congratulations to Rose Finlay and her staff from totalhealth Pharmacy, Tullamore, who last month won the Pharmacy of the Year Award at the Midlands 103 Customer Service Awards.


Staying Ahead of the Vitamins & Supplements Category

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harmacists should query customers about their vitamin intake to help identify deficiencies, assess potential interactions, and avoid toxicity.

The popular media draws attention to the benefits of vitamins for consumers. Their grocery shopping only reinforces vitamins’ importance—many juices, cereals, and canned goods have labels prominently stating that their contents are fortified with any number of vitamins and minerals. Keeping up with consumers or even getting a bit ahead of their desires is the name of the game. In the ever-changing and extremely fickle vitamins, minerals and supplements (VMS) category, it is even more vital to stay on pace or ahead of the curve with those visiting their local pharmacy, many of whom are demanding the next greatest product from this category to allow them to maintain a healthy lifestyle. Consumer demands for the next best thing from the VMS category always has put a burden on manufacturers to keep the new product pipeline going, and for pharmacies to have a sizeable selection of products that meet as many needs as possible. Globally, the over the counter (OTC) drugs and dietary supplements market is driven by improvement in lifestyle and ageing of baby boomers, rise in consumer awareness related to preventative healthcare, and proliferation of distribution channels. In addition, increase in trend of self-directed consumers and self-medication

for the treatment of primary health conditions have fueled the market growth. Locally, according to Euromonitor International’s report, ‘Vitamins in Ireland’ published in November of this year, vitamins continued to record stable but undynamic growth rates in Ireland in 2019, a trend that is predicted to continue. Some consumers look towards preventative measures over cures by taking certain vitamins that they believe they are deficient in through diet or lifestyles. Vitamin D continued to record the strongest performance in both retail volume and current value terms in 2019. This is being driven by the increasing awareness amongst local consumers of the importance of maintaining certain levels of vitamin D, particularly during the winter period, when the country endures fewer hours of daylight. Emerging Trends Decisions in purchasing Consumers purchase VMS for reasons often driven by their age. The rise in health technology is starting to show effect as younger consumers are turning to VMS to self-treat symptoms or meet certain fitness requirements. Older generations are often using VMS to avoid sickness and the development of chronic health conditions.

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Demographic segmentation Whilst male VMS represents the smallest segment of the market, it has been experiencing the fastest growth. The majority of products targeted at men have a clear focus on sports nutrition, while products for the everyday male consumer are less represented, presenting an opportunity for businesses. Similarly, there is potential to capitalise on the growing demand for sports related supplements for older generations, targeting against muscle wastage and maintaining healthy joints and for active females. Fun and innovative formats New product development has led to an increase in innovative delivery formats, including powders, chews, transdermal creams and sprays, helping the brand stand out and broaden the category to include children and teenagers. Powder based VMS products, which consumers can add to their food or drink to improve its nutritional content, are often perceived to be more 'natural', and as such are a key focus area for many brands. Own label brands however remain heavily focused on launching conventional pill methods which are regularly seen to be the most convenient format. Powder based VMS products which consumers can add to

their food or drink to improve its nutritional content, are often perceived to be more 'natural', and as such are a key focus area for many brands. The Lifestyle Effect Increasingly hectic lifestyles and busy work schedules mean we are a current population who eats out more often, with this in turn often leading to over-indulgence in meals which are often unbalanced in terms of nutrition. Alternatively there are many who just don’t have the time to eat adequately. There is also an adverse effect on health and wellbeing with tiredness and stress being two of the more pressing concerns. Nutrients that are of concern include: Vitamin D: Studies by scientists at University College Cork report one in 8 Irish people have vitamin D deficiency. Bones can become frail and soft if they are lacking in vitamin D. Severe cases of vitamin D deficiency can cause rickets in children and osteomalacia in adults. Vitamin D deficiency has been linked to other health issues such as cancer, asthma, depression, Alzheimer’s, type-II diabetes, high blood pressure and such autoimmune diseases as multiple sclerosis, type-I diabetes and Crohn’s.


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From October to early March, people should rely on getting their vitamin D from certain foods and vitamin supplements.

regulation and may also help blood sugar balance which can help with mood issues such as depression and anxiety.

Iron: one in 10 women are anaemic, yet many have no idea, even though their iron levels might be so low that their body’s producing less red blood cells, meaning they have full-blown iron-deficiency anaemia.This can have a significant impact, as iron is essential in the production of red blood cells, which are responsible for carrying oxygen around the body, keeping various tissues and organs in working order.

Selenium: up to half of adults and teenagers do not meet the recommended intake. This nutrient doesn’t get the same ‘buzz’ as vitamins C and D or calcium. It is needed in much smaller quantities than many other nutrients, but there are many ways selenium benefits the body, playing a role in reproductive health, thyroid function, DNA synthesis, and it’s also an antioxidant. Women and men need 55 mcg per day of selenium, which is considered a trace element. (Women who are pregnant or breastfeeding need 60 and 70 mcg, respectively.) Most people do get adequate amounts in their diet, though those who smoke, drink alcohol, or take birth control pills may run low in the mineral.

But while the symptoms, including tiredness, shortness of breath, palpitations and a rapid heart rate, headaches, paleness, hair loss and brittle nails, can have a significant effect, they’re often ignored, or dismissed as an inevitable sideeffect to hectic, modern lifestyles. Haemochromatosis affects around one in 200 people across Europe, but it’s particularly prevalent in Ireland, affecting one in 83 people. Those with haemochromatosis take in too much iron, leading to an overload which can result in symptoms such as tiredness, depression, joint and abdominal pain and loss of sex drive. Haemochromatosis can only be developed if both parents are carriers of the gene. As part of its awareness drive the HSE has said that research indicates early diagnosis should see the manageable condition being no barrier to a normal life. The element iron is required for the body to produce hemoglobin in red blood cells to transport oxygen around the body. Those with haemochromatosis have a mutation in this function in that they keep taking in too much iron after this process.As public awareness of the condition is low, symptoms (which include fatigue, depression, joint and abdominal pain and loss of sex drive) are often confused with other health issues. Magnesium: The average healthy adult requires around 270-400mg of magnesium per day, but research has shown that three-quarters aren't getting a good enough fix. In fact, magnesium deficiency is one of the most common nutritional deficiencies in adults today, and this is associated with an increased risk of conditions such as diabetes, poor absorption, chronic diarrhoea, coeliac disease and 'hungry bone syndrome'. Experts have even dubbed it the 'invisible deficiency', because it is so often overlooked. Studies have shown that when magnesium levels are too low, it’s harder to stay asleep. Magnesium also has a role in hormonal

Folic acid: Current guidelines state that all women thinking of having a baby should have a folic acid supplement, as should any pregnant woman up to week 12 of her pregnancy. Folic acid can help to prevent neural tube defects. Pregnant and breastfeeding women are also at risk of vitamin D deficiency and should take a daily supplement containing 10 micrograms – a point pharmacy teams could raise with expectant mothers. Fish oil supplements should be pregnancy-specific to avoid high doses of vitamin A, and breastfeeding women should continue with vitamin D and fish oil supplementation. Ageing population Nutritional issues play a key role in a wide range of age-related diseases and debility. The potential for good nutrition and physical activity programmes to improve health outcomes in later years are so far under-exploited, yet are urgently called for, as the Irish population ages. Within the next 40 years, approximately one in four Irish people will be over 65 years of age compared with less than one in nine currently. Without the implementation of strategies to address nutritional issues affecting this age group, such a demographic shift will pose enormous challenges for Irish society and its healthcare system. Although still under-detected and undertreated, malnutrition has been recognised by Governments across Europe, including Ireland, as an urgent public health issue that needs to be addressed, although a national action plan Supplements, such as a daily multivitamin, can provide an effective strategy for maintaining

health, supporting nutrient intakes, plugging dietary gaps and helping to address the nutritional challenges associated with ageing. Due to weaker digestive systems in older age, it is difficult for the human body to absorb the required nutrients from food. Among the geriatric population, loss of appetite and the weakening of bones are common issues. In many cases, the diet does not contain sufficient calories or the essential nutrients that the body needs. With the growing interest in healthy ageing, B vitamins, fish oils and zinc have all been shown in randomised clinical trials to support cognitive function, while vitamin D is recommended across the board for the over-65s. Managing the Category There is a plethora of conflicting information about the advantages and benefits to be had of certain supplements over others, in addition to a variation in the quality of products with the same ingredients. Ultimately, the decision will come down to what is seen as convenient and best suited for the purchaser. What is deemed an important quality by one customer may be an entirely different issue for another. Pharmacists should highlight products that have some research behind them and are manufactured with high quality control. It may also be beneficial to purchase from companies that are investing in promotional campaigns that could draw more customers into pharmacy, as well as companies that offer in-store support material and training for pharmacy staff. It is always important that a customer walks away from their pharmacy feeling like all their specific health needs were met. More often than not they will come away from the experience with more knowledge through the education given to them during their visit. Therefore pharmacists and their staff should provide

customers with clear advice and guidance on the variety of products available. When it comes to stock, keep in mind that there will always be the need for the basic vitamin and mineral essentials such as calcium, vitamins B, C and D and magnesium.

Outrage at Tax Hike Food supplements used by slimmers, sportspeople and bodybuilders will be hit with VAT in the Finance Bill in a move that could raise close to €10 million for the exchequer. The Bill introduces a new VAT rate of 13.5% on food supplements for human oral consumption with effect from 1 January 2020. Revenue has confirmed that it will not, as previously announced, apply VAT at 23% from 1 November 2019. The zero rate continues until 31 December 2019. Earlier this year, there were scenes of outrage at a planned 23% consumer tax hike on vitamins, minerals and food supplements. Customers, especially elderly and those with long term chronic conditions, expressed frustration at a needless price hike on products that supports their attempts to take control of their health and wellbeing. These products are often recommended by GP’s and hard pressed consumers are finding the Revenue enforced escalating price as a misjudged barrier to health promotions and self care. Pharmacies and retail stores used the theme of “Black Friday” to highlight the impact of the VAT increase on customers who purchase supportive nutritional products like fish oils, glucosamine, probiotics and vitamins like folic acid and vitamin D.

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The Tobacco Trap The Pharmacy role in helping Smokers Fight Back

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moking is the leading cause of preventable death in Ireland. Each week, over 100 people die from diseases caused by tobacco use; this represents almost one in five of all deaths. In addition, many people live with conditions related to smoking, with people who smoke, on average, losing at least 10 quality years of life.

The Healthy Ireland Survey reports that one in five of the adult population continues to smoke on a daily basis; similar smoking prevalence is observed among older persons (aged 50+ years) as reported by the Irish Longitudinal Study on Ageing (TILDA). Ireland is committed to becoming tobacco free by 2025. A range of policy measures are being taken by the Department of Health and the Health Service Executive (HSE) to achieve this goal by strengthening the prevention of initiation and through further promoting smoking cessation. Pharmacists are ideally placed to advise people on how to stop smoking and to provide information on the supply of medication. Many will also be able to provide treatment for smokers who want to stop. The contribution pharmacists can make to improving the health of the population has been widely recognised. Pharmacists and their staff are at the front line to encourage customers to take a look at the reasons why they smoke and consider giving up. Combining behavioural advice with pharmacotherapy for smokers who visit the pharmacy with an ailment or long standing condition could increase their chances of stopping.

The suggestion that giving up smoking will improve a smoker’s overall health, speed up the healing process and help prevent against disease could help build their motivation to quit. With an appropriately trained pharmacy team pharmacies can offer services such as carbon monoxide testing and one-on-one advice on an ongoing basis, all year round.

centred advice or guidance, depending on where they are at. Whether it’s a patient who has the idea in mind but doesn’t know if they’re ready to quit just yet, or if it’s another who is having intense cravings and feels as though they might succumb or relapse, the community pharmacist has the information to deal with any query.

Pharmacists are in a pivotal position to help patients find the most effective methods to successfully quit smoking and choose from the many OTC smoking cessation products currently on the market.

“As community pharmacies are located in most urban and rural areas and have a wide range of opening hours which offers accessibility to the patient when they need support in their progression, relapse or precontemplative phase of their journey in smoking cessation. Furthermore, it provides the patient with the opportunity to engage with the pharmacist to look at their overall health and wellbeing.”

Knowing the health benefits associated with smoking cessation may help motivate many smokers to initiate a plan to successfully quit smoking (Table 1). Denis O’Driscoll is a Superintendent Pharmacist with LloydsPharmacy, Castletroy. He believes the role of the community pharmacist is essential. “Personally, I consider support is the main role provided by a community pharmacist to those seeking to quit,” he told Irish Pharmacy News. “Pharmacists can provide the most appropriate and patient

30 | PHARMACYNEWSIRELAND.COM

Identifying Support Whilst ideally placed, pharmacists can experience significant barriers to providing counselling and support, including limited time, reimbursement, and training. Mr O’Driscoll adds, “I believe the main barriers to offering smoking cessation advice/support/ treatments are:

• If the patient isn’t actually as ready to quit as they initially anticipated • If there is a lack of funding/ campaigns to support the initiative • Although NRT is cheaper and more beneficial in the long term, people may find it expensive/not worthwhile at face value. If it were also covered on the DPS, people may be more enticed. • Despite relapse being completely normal, some catchment areas may have a higher rate than others or some catchment areas may be less willing to quit compared to others. “Smoking cessation services/ campaigns across pharmacies can be strengthened with the philosophy of the right time, the right place and the right advice. When a patient requests advice or seeks help on quitting, this is the right time to engage in a professional and informed manner. This will engage the patient. It is important that we listen and reflect to the patient their requirements, what they see as their barrier and how they can be empowered to overcome them.


Contains nicotine

“I quit smoking for her” Fergus O’Shea

Help smokers quit with an

unbeatable

combination* from

Mini ON THE GO CRAVING RELIEF

*Provides significant improvements in quit rates vs patch alone. Stead LF et al. 2012 Nicotine replacement therapy for smoking cessation, Cochrane Library.

IRE/NIQ/2019-001

Patch FOR 24 HOUR CONTROL

+

NiQuitin CLEAR 24 hrs transdermal patches are indicated for the relief of nicotine withdrawal symptoms including cravings as an aid to smoking cessation. Indicated in adults and adolescents aged 12 years and over. NiQuitin patches should be applied once a day, at the same time each day and preferably soon after waking and worn continuously for 24 hours. Apply a patch to non-hairy clean dry skin surface, a new skin site should be used every day. Therapy should usually begin with NiQuitin 21 mg/24 hrs and reduced according to the following dosing schedule: Step 1 NiQuitin Clear 21 mg/24 hrs transdermal patches first 6 weeks. Step 2 NiQuitin Clear 14 mg/24 hrs transdermal patches next 2 weeks. Step 3 NiQuitin Clear 7 mg/24 hrs transdermal patches last 2 weeks. Light smokers (e.g. those who smoke less than 10 cigarettes per day) are recommended to start at Step 2 (14 mg) for 6 weeks and decrease the dose to NiQuitin 7 mg/24 hrs for the final 2 weeks. Contraindications: Non-smokers, hypersensitivity, children under 12 years and occasional smokers. Precaution: Supervise use if hospitalised for MI, severe dysrhythmia or CVA, if haemodynamically unstable. Use with caution in patients with active oesophagitis, oral and pharyngeal inflammation, gastritis, peptic ulcers, GI disturbances, susceptible to angioedema, urticaria, renal/hepatic impairment, hyperthyroidism, diabeties, phaeochromocytoma, seizures & epilepsy. Discontinue if severe persistent skin rash. Pregnancy and lactation: Oral formats preferable to patches unless nauseous. Remove patches at bedtime. Side effects: Transient rash, itching, burning, tingling, numbness, swelling, localised pain urticaria, hypersensitivity reactions. headache, dizziness, tremor, sleep disorders, nervousness, palpitations, tachycardia, dyspnoea, pharyngitis, cough, nausea, vomiting dyspepsia, upper abdominal pain, diarrhoea, constipation, dry mouth, sweating, dermatitis, photosensitivity, arthralgia, myalgia, asthenia, malaise, influenza-type illness, fatigue, seizures and anaphylaxis. Legal classification: GSL: PA 1186/18/4, PA 1186/18/5 & PA 1186/18/6. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland. http://www.medicines. ie/medicine/12136/SPC/NiQuitin+CLEAR+7+mg+24+hours++transdermal+patch/ http://www.medicines.ie/medicine/12137/SPC/NiQuitin+CLEAR+14+mg+24+hours+transdermal+patch/ http://www. medicines.ie/medicine/12138/SPC/NiQuitin+CLEAR+21+mg+24+hours+transdermal+patch/ NiQuitin Mini 1.5mg/4mg Mint Lozenges are used for the treatment of tobacco dependence by relief of nicotine withdrawal symptoms and cravings. Indicated in adults and adolescents aged 12 years and over. NiQuitin Mini 1.5 mg are suitable for those who smoke who smoke 20 cigarettes or less a day. NiQuitin Mini 4 mg are suitable for smokers who smoke more than 20 cigarettes a day. Place a lozenge in the mouth whenever there is an urge to smoke, allow to dissolve completely. Do not chew or swallow whole. Abrupt cessation: Use a lozenge whenever there is an urge to smoke, maximum of 15 lozenges a day. Continue for up to 6 weeks, then gradually reduce lozenge use. Gradual cessation: Use lozenges whenever there is an urge to smoke in order to reduce the number of cigarettes smoked for up to 6 weeks, followed by abrupt cessation. Adolescents (12-17 years): Only with advice from a healthcare professional. Contraindications: Hypersensitivity to nicotine or any of the excipients, children under the age of 12 years and non-smokers. Precaution: Supervised use in dependent smokers with a recent myocardial infarction, unstable or worsening angina pectoris including Prinzmetal’s angina, severe cardiac arrhythmias, uncontrolled hypertensions or recent cerebrovascular accident. Use with caution in those with; stable cardiovascular diseases, diabetes mellitus, susceptiblity to angioedema & urticaria renal/hepatic impairment, phaeochromocytoma & uncontrolled hyperthyroidism, GI disease & seizures. Side effects: Nausea, mouth/throat and tongue irritation, irritability, anxiety, sleep disorders, dizziness, headaches, cough, sore throat, dyspnoea, vomiting, diarrhoea, GI discomfort, flatulence, hiccups, heartburn, dyspepsia, nervousness, depression, palpitation, rash, angioedema, pruritus, erythema, hyperhidrosis, fatigue, malaise chest pain, anaphylactic reactions, hypersensitivity, tremor, dysgeusia, paresthesia mouth, seizures & epilepsy, dysphagia, eructation, salivary hypersecretion, pharyngitis. http://www.medicines.ie/medicine/14493/SPC/NiQuitin+Mini+1.5mg+mint+lozenges/#PRODUCTINFO http://www.medicines.ie/medicine/14492/SPC/NiQuitin+Mini+4mg+mint+lozenges/ Legal classification: GSL: PA 1186/18/11 & PA 1186/18/12. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland.


Community pharmacy teams play a vital role in offering advice and NRT solutions

irritate the mouth and stomach and cause hiccups as the nicotine is swallowed.

“By demonstrating a genuine interest in their journey, they are more likely to return to the pharmacy for more information, support and advice. Most often than not, pharmacies have smoking cessation listed as one of their services offered, however it is very rarely promoted anywhere further throughout the patient journey in the pharmacy. “As mentioned previously, community pharmacies are in a unique position whereby they are at the forefront of primary care, with easily accessible locations and extended opening hours. It is reported that 70% of smokers want to quit, but not necessarily at a stage in the near future. Given this, I believe it’s imperative that smoking cessation is encouraged more throughout pharmacies. “Hosting designated events or a “smoking cessation week” throughout pharmacies could be a good incentive to even promote consideration of cessation amongst smokers. This ideally would be done in partnership with the HSE and other voluntary organisationcould support this by arranging speakers/experienced quitters/smoking-related cancer survivors to attend pharmacies to speak/provide support. I believe the main reason for success with cessation is support and encouragement.” Available OTC Treatments The key elements of brief smoking cessation advice are: 1. Ask the patient if they smoke;

periods. There is no difference in the effectiveness of 16 hour and 24 hour patches. They work by giving a steady dose of nicotine into the blood through the skin. The 24 hour patch keeps the nicotine levels constant and is for people who smoke as soon as they wake up and people who smoke during the night. Customers should be advised to put the patch on a different part of the body each day so it won’t irritate the skin. Some people may have high skin sensitivity or react badly to the adhesive or latex in the patches. If this happens, advise a switch to a different form of NRT. Nicotine gum: Nicotine gum relieves withdrawal symptoms and gives ‘something to do with the mouth’ in place of smoking. This can help change a habit of smoking. The gum is available in various strengths depending on how the level of addiction to nicotine. Nicotine inhaler: The inhaler (sometimes called an inhalator) is made up of a mouth piece and cartridges which contain nicotine. When it’s inhaled, the nicotine and menthol vapour is sucked into the body. This is absorbed into the blood through the lining of the mouth and throat. Nicotine lozenge: The lozenge comes in various strengths depending on the level of addiction. Some people prefer the taste of lozenges over other oral forms of NRT. Lozenges may

Because tobacco smoke interacts with various pharmacologic agents through pharmacokinetic or pharmacodynamic mechanisms that may result in decreased therapeutic efficacy or, less commonly, increased toxicity, pharmacists are key in identifying possible drug interactions and contraindications associated with tobacco use. Examples of drug interactions with tobacco smoke include hormonal contraceptives, beta-blockers, theophylline, and benzodiazepines Helping Kick the Habit There are a number of tips and techniques that can assist pharmacists in their quest to help smokers kick the habit. Advise a quit date. Deciding upon a specific date allows for adequate preparation including coming to terms with it mentally, which can have a huge impact on the outcome. “Follow ‘The 5 Rs’:  Relevance: patients should be encouraged to think about the reasons why quitting is important  Risks: patients should be asked to identify the negative health consequences of smoking  Rewards: patients should be asked to identify any potential benefits they anticipate from cessation  Roadblocks: help the patient identify barriers to quitting and assist in overcoming these. E.g. stressful periods, trigger factors such as always having one with a cup of tea, boredom, negative side effects of quitting  Repetition: repeat the message when possible

Always acknowledge and congratulate a patient’s efforts, this can promote a positive mental attitude. Remind patients that slip-ups are normal and that they shouldn’t punish themselves. Promoting patients to take their cessation journey one day at a time, often allows for more reasonable goals. In addition, for cravings, promoting “The 4 Ds” is a good way to overcome them:  Distract  Delay (until the urge passesusually within 3-5 minutes)  Deep breathe (about 20 times)  Drink (patients find water extremely beneficial) Healthy snacks are often a good deterrent and encourage patients to reward themselves when they have achieved a milestone. Regarding NRT, patients often find the chewing gum a good distraction or the inhaler as it allows them to keep their hands busy and replicates the movements, whilst many patients find the patch option more convenient. E-cigarette Dangers Highlighted E-cigarettes are so dangerous and addictive governments should consider banning vaping, cardiologists have warned. As vaping rates around the world rise, new research has suggested the habit could damage the brain, heart, blood vessels and lungs. Researchers said an entire generation risks becoming hooked on nicotine as e-cigarettes are so addictive. Their warning came after a British teenager urged people to not vape after he nearly died from "catastrophic" respiratory failure. E-cigarettes, which are batterypowered, work by heating a liquid - which typically contains nicotine, propylene glycol, glycerin and flavourings - into an aerosol that the user inhales and exhales. Professor Thomas Munzel, Lead Researcher from the Cardiology Department at the University Medical Centre in Mainz, Germany, said e-cigarettes are so dangerous and addictive countries should consider banning them.

2. Advise them to quit; 3. If they would like to quit smoking, provide assistance by referring them to the NHS stopsmoking service, or if they do not want to attend the service, provide an alternative.

Opportunities for Pharmacy Advice

In addition, there are numerous over-the-counter aids.

• Minor ailment service: pharmacies are often the first port of call for minor ailments, for example a person presenting with a cough can be asked whether they smoke.

Nicotine patches: This treatment reduces or removes withdrawals associated with giving up smoking. Patches suit the moderately addicted smoker. They can be used for 16 hour or 24 hour

• Purchase of over-the-counter medicines: it is appropriate to ask a customer purchasing, for example, a cold remedy whether they smoke. Smokers buying NRT over the counter can be informed about additional treatment options available locally.

• Prescription service: the dispensing of many types of medication can be linked with smoking cessation advice, for example medication for respiratory disease and cardiovascular disease, and women using oral contraceptives. There is also an opportunity to ask clients with a prescription for smoking cessation medication if they are receiving additional support.

• Involvement in local or national campaigns: No Smoking Day and Quit campaigns (eg at Ramadan) are examples where pharmacists can be involved.

32 | PHARMACYNEWSIRELAND.COM


The OTC & Pharmacy Retail Product Awards offer top brands and products the opportunity to showcase the extensive support that they offer in self-care and beauty to the general public and to the pharmacy sector. By consistently establishing themselves as reliable, effective and innovative we would welcome any brand that offers this, the opportunity to be part of The OTC Awards. Closing date 13th January 2020 - www.otcawards.ie For further details on categories and how to apply please contact amy@ipn.ie


34

Educational

Best practice for treating chronic pain September was Chronic Pain Awareness Month. Pain is something that many feel, but it cannot be seen and is quickly forgotten. For those living with persistent chronic pain conditions they often feel isolated as others cannot comprehend the impact pain has on every aspect of life. The management of pain places a huge burden on HSE resources, with the number of patients seeking help for chronic pain increasing due to Ireland’s ageing population. Chronic pain is thought to affect 1.65 million people in Ireland, with chronic back pain one of the more common diagnoses. It has been widely suggested that there is a strong case for community pharmacists and their teams to contribute more to cost-effective and timely pain management services for chronic pain. Pain assessment and management is a service that lends itself well to pharmacy. Patients increasingly have problems with pain management, especially with the growing elderly population. There is a plethora of products available in pharmacy, and they can help reduce the workload of GPs, leaving them to focus on more serious cases. Chronic pain, as the name implies, is pain that persists longer than usual tissue healing time, or in cases in which healing does not take place at all. The timeframe for a condition to be described as chronic is usually from three to six months. The pain can be consistent or intermittent, and can be classified as follows: • Neuropathic pain: burning, stabbing, tingling, insect crawling, shooting, associated with allodynia, hypersensitivity or other sensory changes. • Nociceptive pain: aching, worse on movement, anatomically defined, fluctuates in severity. • Mixed i.e. a combination of both neuropathic and nociceptive pain symptoms. • Visceral pain: dull, diffuse, ill-defined. • Autonomic symptoms: colour and temperature changes, sweating, trophic changes. While neuropathic pain is caused by damage to or dysfunction of the nerves, spinal cord, or brain, nociceptive pain is the type of pain which results from injury or damage to body tissues, such as an accident or trauma, injury or burn, post-operative or due to a break or fracture. Headache, in all its forms, is a

very common type of pain, while musculoskeletal problems, such as lower back pain and osteoarthritis, are also widespread.

stress related disorders. It affects approximately 2% of people by the age of 20, increasing to 8% of people by the age of 70.

For example, NSAIDs should be avoided in people with stomach ulcers, heart problems, and high blood pressure.

Neurological conditions, such as multiple sclerosis and thyroid disease, can also cause chronic forms of neuropathic pain.

Treatment

Addiction to codeine can occur by taking over the counter remedies containing codeine for longer than the recommended three days.

According to the International Association for the Study of Pain, chronic pain can be experienced by those who do not have evidence of tissue damage or biological reason for pain, which can often make diagnosis difficult.

Treatment for chronic pain depends on the type of pain the person is experiencing. For migraine, aspirin is the traditional first line of defence, and has antiinflammatory properties that can help alleviate many of the physical symptoms.

As the most accessible frontline medical professional, pharmacists are extremely well placed to identify patients suffering from chronic pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for more severe migraine attacks, with evidence showing ibuprofen to be highly effective. Triptans are highly effective, reducing the symptoms or aborting the attack within 30 to 90 minutes in 70 to 80 per cent of patients.

In terms of chronic pain, it is particularly important to take account of the type of pain the person is experiencing, how long they have been experiencing it, and if they are taking medication for relief.

Triptans target the neural serotonin receptors specifically involved in migraine attacks and can be used in the treatment of migraine whether the patient is suffering from focal neurological symptoms <aura> or not.

Practically speaking, the two most common types of chronic pain seen in pharmacies are the result of headaches and back pain.

Neuropathic pain remains among the most difficult to treat of all the chronic pain syndromes and often antidepressants are prescribed as an adjuvant therapy to alleviate the pain.

The role of the pharmacist

When it comes to patients complaining of headache, it is important to consider that migraine is the most common form of chronic headache and it is still under-recognised by many health professionals and patients. Back problems are also very common and have a variety of causes, from slipped disks to arthritis. Osteoarthritis, caused by ageing and long-term wear-and-tear in the joints, is by far the most common form of arthritis and should be considered particularly in patients over the age of 40. A much under-diagnosed chronic pain condition is fibromyalgia. The condition affects connective tissues which include the muscles, ligaments and tendons. Myalgia, which means muscle pain, is the main symptom while debilitating fatigue, sleep disturbances, joint stiffness, headaches and mood disturbances can also occur. Fibromyalgia commonly co-exists with psychiatric conditions such as depression, anxiety and other

PHARMACYNEWSIRELAND.COM

Antidepressants are also widely used to manage irritable bowel syndrome, temporomandibular joint dysfunction, atypical facial pain and fibromyalgia. Tricyclic Antidepressants (TCAs) were the first medication category proven effective for chronic neuropathic pain in double blind, placebo controlled trials. Contrary to the assumption of the initial trials, pain relief and relief of depression are independent effects. Other adjuvant therapies for pain may include anti-seizure medications (gabapentin, pregabalin, topiramate for example); muscle relaxants (baclofen, cyclobenzaprine, methocarbamol, and diazepam); sedatives/anti-anxiety medications, and spasm medication (botulinum toxin). A particular problem for people with chronic pain conditions is that the medication itself can cause problems as the person often needs to take it for a significant period of time.

With long-term use of opioids, people need to be screened and monitored because a fraction of those treated will develop an addiction disorder, abuse the medication, or give them to others. Patients suffering from chronic conditions are often also affected psychologically which also needs to be taken into account, whether in the form of medication or counselling. Pharmacists should pay particular attention to the length of time a person is taking a medication and whether they are suffering from addiction issues or any other side effects. Important questions to ask in relation to identifying chronic pain • When pain began? • Was the onset of pain gradual, sudden, result of event/, trauma, accident? • Description of pain • Region(s) of the body that is experiencing pain? • Does it radiate (e.g. starts and spreads to another location in the body)? • Description of how severe the pain can be on a daily, weekly basis, does it vary? • When the patient is most affected (is it worse in the morning / night)? • How often the pain occurs, is it constant, frequent, does it come and go? • How intense is the pain (on a rate between 1 – 10, with 10 being worst)? • If pain is affecting the ability to work, socialise or is it affecting the patient’s private / family life? • If pain is causing sleeplessness, poor concentration or low mood? Courtesy of Chronic Pain Ireland


DIFFERENT FROM CLASSICAL OPIOIDS*

PALEXIA® SR Tablets are indicated for the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics1 PALEXIA® Film Coated Tablets are indicated for the relief of moderate to severe acute pain in adults, which can be adequately managed only with opioid analgesics2

*Palexia has a unique mode of action. Palexia MOR-NRI.3

PALEXIA® and PALEXIA SR® Prescribing Information Refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: Palexia: 50 mg (white), 75 mg (pale yellow) and 100 mg (pale pink) film-coated tablets contain 50 mg, 75 mg and 100 mg of tapentadol (as hydrochloride) respectively. Palexia SR: 50 mg (white), 100 mg (pale yellow), 150 mg (pale pink), 200 mg (pale orange) and 250 mg (brownish red) prolonged-release tablets contain 50 mg, 100 mg, 150 mg, 200 mg and 250 mg of tapentadol (as hydrochloride) respectively. Indication: Palexia is indicated for the relief of moderate to severe acute pain in adults, which can be adequately managed only with opioid analgesics. Palexia SR is indicated for the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics. Dosage and method of administration: Individualise according to severity of pain, the previous treatment experience and the ability to monitor the patient. Swallowed whole with sufficient liquid, with or without food. Palexia SR: should not be divided or chewed. The tablet shell may not be completely digested and eliminated / seen in the patient’s stool which has no clinical significance as the active substance will have already been absorbed. Palexia dosage: Initial dose 50 mg every 4 to 6 hours. On the first day of dosing, an additional dose may be taken 1 hour after the initial dose, if no pain control. The first day’s dose should not exceed 700 mg. Maximum maintenance daily dose of up to 600 mg. Palexia SR dosage: Initial dose 50 mg twice a day. Switching from other opioids may require higher initial doses. Titrate in increments of 50 mg twice a day every 3 days for adequate pain control. Total daily doses greater than 500 mg not recommended. Duration of treatment: Palexia: The possibility of switching to Palexia SR should be considered if longer term treatment is required, and pain relief is achieved with Palexia in the absence of intolerable adverse events. Discontinuation of treatment: Taper dose gradually to prevent withdrawal symptoms. Renal/hepatic impairment: Not recommended in patients with severe cases. Caution and dose adjustments with moderate hepatic impairment. Elderly: May need dose adjustments. Children below 18 years: Not recommended. Contraindications: Hypersensitivity to ingredients, suspected or having paralytic ileus, acute intoxication with alcohol, hypnotics, centrally acting analgesics or psychotropics. Not for use when mu-opioid receptor agonists are contraindicated (e.g. significant respiratory depression, acute or severe bronchial asthma or hypercapnia). Special warnings and precautions: Abuse and addiction potential of Palexia should be considered where there is increased risk of misuse, abuse, addiction or diversion. All patients should be carefully monitored for signs of abuse and addiction. At high doses or in mu-opioid receptor agonist sensitive patients, dose-related respiratory depression may occur. Caution and monitoring required with impaired respiratory function. Should not use in patients susceptible to intracranial effects of carbon dioxide retention (e.g. increased intracranial pressure, impaired consciousness or coma). Use with caution with head injury, brain tumors, moderate hepatic impairment, biliary tract disease including acute pancreatitis. Not recommended if history of or at risk of seizures or with severe renal or hepatic impairment. Care should be taken when combining with mixed mu-opioid agonists/antagonists (e.g. pentazocine, nalbuphine) or partial mu-opioid agonists (e.g. buprenorphine). Should not use with hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Use with benzodiazepines, barbiturates and opioid analgesics, antitussive drugs and substitutive treatments may enhance the risk of respiratory depression. Central nervous system (CNS) depressants (e.g. benzodiazepines, antipsychotics, H1-antihistamines, opioids, alcohol) can enhance the sedative effect and impair vigilance. Consider dose reduction with respiratory or CNS depressant agents. In isolated cases, there have been reports of serotonin syndrome in a temporal connection with the therapeutic use of tapentadol in combination with serotoninergic medicinal products (e.g. serotonin re-uptake inhibitors). Use with strong inhibitors of uridine diphosphate transferase isoenzymes (involved in glucuronidation) may increase systemic exposure of Palexia/Palexia SR. Caution if concomitant administration of strong enzyme inducing drugs (e.g. rifampicin, phenobarbital, St John’s Wort) starts or stops as this may lead to decreased efficacy or risk for adverse events, respectively. Avoid use in patients who have taken monoamine oxidase inhibitors (MAOIs) within the last 14 days, due to cardiovascular events. Pregnancy and lactation: Use in pregnancy only if the potential benefit justifies the potential risk to the foetus. Not recommended during and immediately before labour and delivery. Do not use during breast feeding. Driving and using machines: May have major effect on ability to drive and use machines, especially at the beginning or change in dosage, in connection with alcohol or tranquilisers. Undesirable effects: Very common (≥1/10): dizziness, somnolence, headache, nausea. Palexia only: vomiting. Palexia SR only: constipation. Common (≥1/100, <1/10): decreased appetite, anxiety, sleep disorder, tremor, flushing, diarrhoea, dyspepsia, pruritus, hyperhidrosis, rash, asthenia, fatigue, feeling of body temperature change. Palexia only: confusional state, hallucination, dry mouth, muscle spasms, constipation, abnormal dreams. Palexia SR only: depressed mood, nervousness, restlessness, disturbance in attention, involuntary muscle contractions, dyspnoea, vomiting, mucosal dryness, oedema. Other important undesirable effects observed in clinical trials and/or postmarketing: convulsion, impaired gastric emptying (rare ≥1/10,000, <1/1000). Palexia only: respiratory depression (uncommon ≥1/1000, <1/100), drug hypersensitivity including angioedema, anaphylaxis and anaphylactic shock, depressed level of consciousness, (rare ≥1/10,000, <1/1000). Palexia SR only: drug hypersensitivity, depressed level of consciousness, mental impairment (uncommon ≥1/1000, <1/100), respiratory depression, angioedema, anaphylaxis and anaphylactic shock (rare ≥1/10,000, <1/1000). No evidence of increased risk of suicidal ideation or suicide with Palexia/Palexia SR. Additional information is available on request. Overdose: Seek specialist treatment (see SmPC). Legal classification: POM, CD (Schedule II). Marketing Authorisation numbers and pack sizes: Palexia: 50 mg: PA 2242/12/1, 28 and 56 packs; 75 mg: PA 2242/12/2, 28 and 56 packs; 100 mg: PA 2242/12/3, 28 packs. Palexia SR: 50 mg: PA 2242/12/4, 28 and 56 packs; 100 mg: PA 2242/12/5, 56 pack; 150 mg: PA 2242/12/6, 56 pack; 200 mg: PA 2242/12/7, 56 pack and 250 mg: PA 2242/12/8, 56 pack. Marketing Authorisation Holder: Grünenthal Pharma Ltd, 4045 Kingswood Road, Citywest Business Park, Citywest, Co. Dublin, Ireland. IRE/P18 0017. Date of Preparation: May 2018. Reference: 1. Palexia SR Summary of Product Characteristics. 2. Palexia Film Coated Tablets Summary of Product Characteristics. 3. Kress, et al. European Journal of Pain, 2010. Date of Preparation: July 2018. IRE/P18 0027


36

Report

Uptake of Flu Vaccine in Pharmacy Since community pharmacies started first vaccinating in 2011, flu vaccine deliveries have increased overall by 48%. Pharmacists now represent 15% of all flu vaccinations, with a 99% public satisfaction rate. These statistics bring added strength to the debate that community pharmacies should be playing a wider role in the greater healthcare arena and should be enabled to provide more services. This year’s winter season has been predicted to be worse than earlier years, and community pharmacies have a vital role to play in ensuring people avail of the flu vaccine. Here are some key points from the National Disease Surveillance Centre's November 2019 Report published a few weeks ago in Epi-insight.  For the 2018/2019 season influenza vaccine uptake in the the over 65s group was 68.5%. This is the best result for ten years.  There was geographical variation in uptake, with the highest uptake reported in Community Health Office (CHO) 6 area (Wicklow, Dun Laoghaire and Dublin SE) at 84.5% and lowest in CHO 1 (Donegal/Sligo/ Leitrim/West Cavan and Cavan/ Monaghan) at 59.5%.  At national level, those aged 75 years and older had highest uptake (73.1%) and those aged 65-69 years had lowest at 58.3%.  Based on PCRS data, GP practices administered 89% and pharmacies gave 11% of vaccines.

a very serious infection; tragically last year 74 people in Ireland died as the result of flu. In the Northern Hemisphere the flu season typically lasts from October to April. “The 2019/20 Seasonal Flu Vaccine is now available in pharmacies nationwide. This has been proven as the best protection against flu. It has also been shown that the most effective time to get the flu vaccine is before flu begins spreading in your community. Therefore early vaccination is highly recommended, particularly for those in at-risk groups.” He added that, “Pharmacists have been safely delivering flu vaccines since 2011, in other countries they routinely offer a wider vaccination service and this is something that should be introduced in Ireland. We have been calling for the introduction of vaccines for meningococcal disease, tetanus and hepatitis A and B, as well as travel vaccines.” More than Half won’t get Vaccinated Meanwhile, Boots Ireland has launched new research[ii] revealing 57% of people in Ireland have never been vaccinated against the flu and only 29% plan to get vaccinated for the 2019/2020 flu season. During the 2018/2019 flu season, 3,217 influenza hospitalised cases[iii] were reported in Ireland. While these were the most severe cases, getting a flu vaccination reduces the risk of getting the flu by up to 60%[iv] and helps prevent the spread of the virus.

 The proportion of vaccines administered in pharmacies is increasing year on year since this option was first offered during the 2012/2013 influenza season.

HSE national guidelines strongly urges those in the at-risk groups

 This season, 41,700 people over 65 were vaccinated in pharmacies, 41% up on last year, ten times more than in the first year of pharmacist involvement.

80000

According to the Irish Pharmacy Union (IPU) early vaccination will provide the best individual protection and can contribute to a nationwide reduction in flu levels. Speaking at the launch of the IPU’s annual campaign to encourage people to get an annual flu vaccine IPU Vice President Eoghan Hanly said, “Influenza (the flu) is a highlyinfectious illness that can result in

to get the flu vaccination[v] as they are particularly vulnerable and have a greater chance of developing complications from flu. At risk groups include those over the age of 65 years, pregnant women and people with long-term health conditions.[vi] While it is strongly recommended that people in these groups get the flu vaccination, Boots are supporting the HSE by encouraging the public to take preventative measures to stop the spread of flu by getting vaccinated. Of those who have previously availed of a flu vaccination, 66% go to their GP for the service, with one in five people (20%) availing of the service from a pharmacy. The vaccination is now available for those aged 10 years or older in selected Boots stores nationwide*, see Boots.ie for full list of stores. Staying Healthy Speaking on the importance of getting vaccinated, Dr Kim Roberts, Ussher Assistant Professor of Virology and leader of the Influenza research group at Trinity College Dublin, says, “Getting the flu vaccination is the best preventive measure against influenza and the spread of the virus. With the service available in Boots stores across the country, it’s now more accessible than ever to get the flu vaccine and should be a priority for everyone to help prevent the spread of the virus. I have been availing of the service in Boots for years – it couldn’t be easier. The flu vaccine usually takes about two weeks to take effect, so it’s better to get the vaccination as early in the season as possible.”

Caoimhe McCauley, Director of Pharmacy, Boots Ireland, adds, “Getting vaccinated against the flu each season is the first step in staying healthy during the winter months. Some patients may be eligible for a free vaccine depending on their HSE scheme eligibility and risk factors. The consultation appointment can be booked on-line with walk-ins also welcome. The vaccination can help to prevent the spread of the virus to both you and those around you, helping protect those who are vulnerable against flu this season. Our in-store pharmacists are available to answer any questions about the vaccination service and give advice on general winter wellness. More information on the service is also on Boots.ie.” Of those who haven’t had a flu vaccination in the past, 10% stated cost was a main factor in their decision, while 7% claimed it was a matter of how much time it took to organise. Many stores offer late night and weekend opening hours and the service can be booked online with walk-ins also welcome. The cost of the vaccination is ¤20** however is free of charge for those over 10 years old who are in the categories for whom vaccination is strongly recommended and have a Medical Card, Doctor Visit Card, HAA** Card or 2015A*** Card. When the cough, cold and flu season begins around October, pharmacists should be poised for the onset of repeated outbreaks and a surge in demand for products that can help ease the symptoms of winter ailments. In order for the flu vaccination programme to maintain its ongoing

Number of flu vaccines delivery by pharmacies in Ireland

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inthe theongoing ongoingbattle battleagainst against serious serious childhood childhood diseases. diseases. in

www.immunisation.ie www.immunisation.ie


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Report

success, there must be a high level of uptake among those aged sixty five years and older. At risk groups should also be targeted by pharmacy teams and the EU urges member countries to commit to vaccinating 75% of at risk groups each year. Those most at risk of developing serious complications from the flu virus include the youngest and the oldest, pregnant women, persons with a BMI over 40, patients with pre-existing long term conditions such as heart, kidney, liver, neurological disease or diabetes, smokers, and patients who are immunosuppressed or immunocompromised. It can also disproportionately affect people with Down syndrome and the virus is known to spread quickly in congregated settings, such as nursing homes or supported living environments. The HSE estimates that over one million people should be vaccinated in Ireland for the programme to be fully effective. The HSE's flu vaccine lead, Dr John Cuddihy, said, “Recent national uptake figures indicate that 68.5% of people aged 65 and over who had a medical card or GP visit card received the flu vaccine during the 2018-2019 flu season, a substantial increase on last year when the uptake rate was 57.6%.” While Ireland was the first country in the EU to receive the flu vaccine some pharmacies and health providers experienced a delay in supply. A spokesperson for the Irish Pharmacy Union said that while flu vaccines were available to order, restrictions were in place for the initial delivery due to reduced quantity in the first shipment to Ireland.

“This delay in supply is not due to Brexit but due to the WHO not confirming the strains of virus for the flu vaccine until the end of March instead of February, thus delaying all flu vaccine production by all manufacturers by a month,” said the spokesperson. Planning for winter The changing season brings opportunities to re-organise your store, to rearrange fixtures and fittings and to develop a clear merchandising plan featuring beacon brands in both the P and GSL sections. Planograms are helpful guides that can be used to assist with arranging retail shelves to help maximise front-end sales. These visual plans, that are backed by research, show exactly where in the store certain products should be placed and they indicate the products that will increase profits and move quickly. Store plans also show how products should be arranged based on the general categories and subcategories with the most profitable products typically going onto the shelf at eye level, known as the ‘cone of vision’. Products that shoppers seek out no matter where they are, called destination items, can go on shelves outside of the cone of vision. Have a look at the shelves that are devoted to winter remedies, both on the shop floor and on the medicines counter, and ask yourself the following questions: • Is it clear to customers and staff which products are suitable for children and which are for adults only? • Are your staff up-to-date and clear on the risk of analgesic overdose due to combination products?

• Are staff aware of the sales restrictions for certain decongestants? • How could you make this fixture easier to understand and navigate? • Are all staff clear on the symptoms that should ring an alarm bell if mentioned by a patient with a cough, cold or flu? • Are details about your flu vaccination service clearly displayed? Cough & cold The term “common cold” is widely used to describe an upper respiratory tract infection of viral origin. Adults in general suffer from cold approximately two to four times annually while children can contract the virus three to eight times as their immune systems aren’t as developed. Distinctive symptoms means that people often diagnose and treat themselves through a combination of self-care and OTC products, without needing to go to the doctor. If there is no improvement then an appointment with a doctor should be arranged. A GP can do an investigation to rule out whether the symptoms are being caused by a more serious infection, such as pneumonia or glandular fever. [ii] Research commissioned by Boots Ireland, and carried out by iReach, on a nationally represantive sample of 1,001 adults aged 18+. Field work was conducted in September 2019 [iii] Influenza Surveillance in Ireland - Weekly Report, https://www.hpsc.ie/a-z/respiratory/ influenza/seasonalinfluenza/surveillance/ influenzasurveillancereports/20182019season/ Influenza_Surveillance_Report_Week%20 19&20%202019_20182019.pdf [iv] https://ecdc.europa.eu/sites/portal/files/ documents/influenza-why-do-I-need-flu-vaccine-every-year-infographic.pdf [v] https://www.hse.ie/eng/health/immunisation/pubinfo/flu-vaccination/about-the-flu/ [vi] https://www.hse.ie/eng/health/immunisation/pubinfo/flu-vaccination/about-the-flu/

At-risk patients include: • Persons aged 65 years and older; • Persons 10-64 with a chronic illness requiring regular follow up, e.g. chronic respiratory disease (including chronic obstructive pulmonary disease, cystic fibrosis, moderate or severe asthma and bronchopulmonary dysplasia), chronic heart disease (including acute coronary syndrome), chronic renal disease, diabetes mellitus, haemoglobinopathies, chronic liver disease, chronic neurological disease (including multiple sclerosis, hereditary and degenerative disorders of the central nervous system); • Those who are immunosuppressed due to disease or treatment including those with missing or nonfunctioning spleens; • All cancer patients; • Patients with any condition that can compromise respiratory function, e.g. spinal cord injury, seizure disorder or other neuromuscular disorder; • Persons with Down syndrome; • Those with morbid obesity, i.e. body mass index over 40; • all pregnant women (vaccine can be given at any stage of pregnancy); • Healthcare workers; • Household contacts of at-risk persons.

Hickey’s celebrate 50,000th flu vaccine Hickey’s Pharmacy Northside team recently celebrated their 50,000 flu vaccine milestone. Hickey’s Pharmacy Northside have been serving their local community for nearly 25 years. Nine years ago the team began vaccinating patients and in that time many thousands of patients have been vaccinated. Pharmacist Amy, vaccinated the 50,000th Hickey’s Pharmacy patient at the end of November.

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HSE guidelines recommend that:  Vaccines must be stored in pharmceutical fridges.  Temerature-controlled range is between a minimum of +2° Celcius and a maximum of +8° Celcius (+2°C to +8°C).  Data logger should be used in fridges where vaccines are stored.  Wireless data logger.  Set-up high and low alarms and receive instant email alerts when temperatures become too hot or cold in the fridge. Contact your account manager today on 1800 619 619 Web: www.promed.ie


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Training

Triaging Eye Health in Pharmacy Leading Ophthalmology company, TheaPamex recently hosted a very successful training event on the evening of the 7th of November in the Crowne Plaza Hotel in Blanchardstown. This educational evening was facilitated and Chaired by Jonathon Morrissey of Marron’s Pharmacy in Clane alongside two speakers; Jason Doherty, MSPI, of Haven Pharmacy Beaumont and Rush, and Dr Kevin Tempany MB,MSc.,D.Ophth.,F.R.C.S.I (Ophth) Vista Eye Clinic Ranelagh and Vista Eye Clinic Naas. The aim of the event was to provide an educational session to pharmacists, as the first point of care for patients within the community, by providing the necessary tools to assess and triage all eye conditions that present at pharmacy level. “The essence of the evening was about learning but also pushing the comfort zone and boundaries of pharmacy when it comes to eye trauma/health care. Pharmacists learned simple, practical things to do if an eye injury presents and learned that doing nothing might be more harmful than doing something as simple as applying an eye patch,” said Jonathon. Jason Doherty MPSI spoke

about, ‘Eye Health the Pharmacist Perspective’ with regard to both training and education within this important category. He looked at both how it benefits the pharmacist and the patient, as well as how to assess eye health conditions and what is treatable at community pharmacy level. Jason also gave attendees an overview as to his experience in dealing with patients in his community pharmacy presenting with minor eye health conditions. Dr Kevin Tempany looked at the different eye conditions which may present at community pharmacy level, how best to treat those conditions and when to refer patients to their GP, Medical Ophthalmologist or Eye Casualty Department within the hospital setting.

Jason Doherty, MSPI, of Haven Pharmacy Beaumont and Rush

Dr Tempany ran a practical session on the night showing those in attendance how to look for a foreign body in the eye and how to apply an eye patch correctly. He also spoke about minor conditions such as Dry Eye,

TheaPamex OTC Range

Dr Kevin Tempany MB,MSc.,D.Ophth.,F.R.C.S.I (Ophth) Vista Eye Clinic Ranelagh and Vista Eye Clinic Naas

“The essence of the evening was all about learning” – Jonathon Morrissey

Blepharitis and the importance in Eye Health Nutrition. Those who attended reflected afterwards on what an ‘excellent, practical and informative’ event it was. One of TheaPamex's core pillars is education, therefore the company is committed to providing continued educational sessions for pharmacists. Don’t miss out on the next Eye Health Training session in February 2020. Date and location to be confirmed. Spaces will be limited, to preregister contact; Orla Smith, Medical Sales Representative, on 087-6546556 or email orla.smith@theapamex.com Marron’s Pharmacy Superintendent Pharmacist, and Chair of the Educational Event Jonathon Morrissey

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JANUARY

FEBRUARY

 Pharmacists voice their concerns over the recently passed Abortion Bill, stating the Health Minister has not engaged with them on their rights to contentious objection

 It was announced that the Council of the Pharmaceutical Society of Ireland had approved a new Code of Conduct for Pharmacists. This would later come into effect in October

 GSK and Pfizer announce joint giant merger

 A report compiled by Fitzgerald Power and the Bank of Ireland took an in-depth look at the pharmacy transaction market. Pharmacy Watch showed sales of pharmacies in 2018 almost doubled those of 2014 with average deal values remaining steady

 IPN publishes a Special Report which questions the delay in introducing a Pharmacy Minor Ailment Scheme and looks at where it is operating successfully in other countries  The HSE published its National Service Plan following approval from Government and includes ¤70.3m in primary care scheme changes  Pharmacists Dermot Twomey, Jonathan Morrissey and Keith O’Hourihane gave their opinions on what the ‘pharmacy future looks like’ with an overarching emphasis was placed on the need to push the pharmacy profession forward and allow pharmacists to engage with patients in a new way

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 Pharmacy students who staged a rally owing to issues with the new integrated Pharmacy Programme, succeed in having a ban on unpaid placements lifted  We announced the finalists for the 2019 OTC & Retail Pharmacy Product Awards whilst submissions to the 2019 Irish Pharmacy Awards were opened for entry


YEAR END REVIEW MARCH  The Falsified Medicines Directive comes into force, giving patients further protection from the threat of counterfeit medicines  Behaviour & Attitudes published a new survey, ‘Perspectives of Community Pharmacy’ showing that the Government’s failure to deliver on promises made are seriously impacting and undermining the future of the profession  IPN publishes an exclusive interview with Chair of the Irish Medicines Verification Organisation, Professor Pat O’Mahony who answered questions on how FMD was going to embed and what community pharmacists needed to know  The news that a new rate of 23% VAT on certain vitamins and food supplements was to be delayed was welcomed by pharmacists  Life Pharmacy confirmed they have added 13 new stores to the Group in 2018

APRIL  Ryan’s Pharmacy in Kildare won the Services Category Awards at the SFA National Small Business Awards for their work and dedication in showing how the team respond to evolving trends and changing customer requirements  Figures released show that 10 innovative treatments – approved by the HSE – spent 890 days awaiting decisions, prompting calls for decision makers to take steps to end lengthy delays  Cara Pharmacy Group saw success at the Deloitte Best Managed Awards. They joined Meaghers Pharmacy Group and McCauley Health & Beauty Pharmacy as the 3 pharmacy businesses recognised  Winners of the 2019 OTC Product & Retail Pharmacy Awards are announced at the Radisson Blu in Dublin

MAY  The world of pharmacy bid a fond farewell to Rosemary McGrath, described as a visionary and a shining light within the industry  Government announced a commitment to reversing cuts to GP fees during the recession, leading to bodies to demand similar reversal of cuts in fees to pharmacists  Boots Pharmacy became the first in Ireland to offer a travel vaccination service to customers  Real World Retail held their annual gathering of owner and senior executives of leading pharmacy groups in Ireland  The Pharmaceutical Manager’s Institute celebrated 30 years in business  United Drug’s Pharmacy Show took place, celebrating its 13th year. The event saw registrations of over 600 guests

PHARMACYNEWSIRELAND.COM | 43


YEAR END REVIEW JUNE  Pharmacy shortages was on the agenda, as the Irish Pharmacy Union warned the problem was becoming ‘critical’ at their Annual Conference. Excessive bureaucracy, unnecessary regulation and too much red tape were deemed the biggest contributing factors  McCauley Health & Beauty Pharmacy opened their flagship store in Navan  A travel health service, meaning consumers can get their travel vaccinations in their community pharmacy, was launched  McCabes Pharmacy celebrated 60 years in Wexford  We announced all the winners from the 2019 Irish Pharmacy Awards

JULY  Adrian Dunne Pharmacy Group, with 12 stores across Ireland, marked 20 years of being in business  Fiona Roche re-opened the famous and well loved Fiona Roche Pharmacy in Blacklion after a 10year absence from the profession  Meaghers Pharmacy Group opened their ninth store in Churchtown  It was reported that levels of crime committed against community pharmacy was steadily rising  Minister for Health Simon Harris announced a commitment to implementing a PrEP HIV prevention programme

AUGUST  Uniphar announced its listing on the stock market, with some 1,100 pharmacist customers poised to gain a share  It was announced that community pharmacists in Ireland were able to dispense cannabis for medicinal use to patients for the first time  The Pharmacy Usage & Attitudes Survey shows that pharmacy usage is at an all time high and loyalty is continuing to grow  We publish our annual IQVIA Top 100 Pharmacy Products, offering readers the opportunity to compare key brands performance  The team from United Drug take time out of their day to support the worthwhile cause of Hugh’s House

44 | PHARMACYNEWSIRELAND.COM


YEAR END REVIEW SEPTEMBER  It was announced that the HPV vaccine is now available to all first year school students and pharmacists were urged to step-up and utilize their role in advising customers  Richard Woods, a Mullingar pharmacist, closed the doors of his pharmacy for the last time, having sold it to Robert and John Keane  O’Casey’s Pharmacy opened its door in Island Key  13 community pharmacies were shortlisted in the Retail Excellence Top 100 stores awards  IPN published an exclusive report looking at the opportunities for community pharmacists within the field of eMental health  The pharmacy team at LloydsPharmacy Castletroy celebrated winning in the Lotto

OCTOBER  CarePlus Pharmacy became Ireland’s first ‘autism friendly’ accredited pharmacy. The initiative was spearheaded by John Keane, owner of four CarePlus Pharmacies  17 former Bradley’s Pharmacy stores were re-branded by Allcare. The Bradley’s group of pharmacies were purchased by Uniphar at the start of the year  The delivery of crucial medicine by drone from Galway to the Aran Islands has been hailed by community pharmacists and allied professionals, as a first which could be lifesaving in an emergency. The drone delivered diabetes medications  It is announced that the ‘Towards Selfcare in Headache’ project is to receive funding under the Slaintecare Integration Fund in a move welcomed by community pharmacists. The programme includes educational sessions for pharmacy  Echoing the crisis in Northern Ireland, Irish pharmacists once again voice concerns that a shortage of pharmacists could reach ‘critical’ proportions

NOVEMBER  Health Minister Simon Harris was put to task on promises made at the IPU Conference in April and was asked about delivery of these promises during a Dail debate. He replied that he was working with the IPU on the matters at hand  Australian pharmacist Lucy Walker visited Ireland to gain first-hand insights into the workings of pharmacy practice here  Michael O’Connor of Pharmacy First Plus in Douglas started making personal deliveries of medicines to ensure patients were not affected by a fire at Douglas Village Shopping Centre which closed his store for a period of time  The All Ireland Pharmacy conference was held in the Ballymascanlon Hotel with a focus on sharing best practice across pharmaceutical care  Life Pharmacy Group held their inaugural Awards ceremony recognising the achievements of their pharmacy teams and individuals

PHARMACYNEWSIRELAND.COM | 45


Topic Team Training – Muscle and Joint Pain A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date. Hot and cold pain relief products in the form of gels, creams, roll-on lotions and patches, can provide targeted, relief and help to relax stiff and sore muscles and joints by boosting blood flow to the affected area.

The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Muscle and Joint Pain. Muscle and joint pain strikes people of all ages. Broadly defined as suffering from aches, pains, and swelling, it can be a debilitating condition that affects a person’s mobility and sleep. At its worst, it can negatively affect their quality of life. The good news is that community pharmacists offer patients a plethora of oral and topical medications, as well as various supports and aids, to treat the many conditions that cause muscle and joint pain. There are many causes for this type of pain, including injuries, poor posture, and disease. It can impact a particular area, or can also present as referred pain. Joint pain and stiffness is commonly caused by fractures, sprains and arthritis (such as rheumatoid or osteoarthritis), while muscle pain often results from impact injuries, overstretching, overuse, and strains. Injuries to the tendons that

join muscle to bone are another common source of pain, as are ligament sprains, which normally result from over-stretching or the twisting of a joint. No two patients will respond in the same way to one, or a combination of muscle and joint pain relief therapies. The Irish Society of Chartered Physiotherapists lists some of the most common therapies for alleviating muscle and joint pain as manual techniques (manipulation, traction or mobilisation), soft tissue techniques (massage, trigger point therapy, and acupressure), stretching and strengthening exercises, electrotherapy, hydrotherapy, and posture therapy. Patients who suffer from muscle and joint pain - whether it’s chronic or acute - are advised to treat it immediately. Various types of joint pain can be considered for management in the pharmacy setting. Over-the-counter medications may include: • painkillers, such as paracetamol

Consider:  Is the pharmacy team fully trained on the indications and benefits of all products for muscle and joint pain?  How are pain relief products (oral and topical) displayed in the pharmacy?  Do we make the most of the potential for linked sales (e.g. oral and topical analgesics, food supplements, complementary therapies, support bandages)  Am I up to date with the latest guidance on conditions causing pain such as osteoarthritis?  Are we clear on when to refer someone to the GP?

46 | PHARMACYNEWSIRELAND.COM

• non-steroidal anti-inflammatory drugs, such as aspirin or ibuprofen tablets • topical gels, creams, roll-ons, massage balms and patches that can be applied locally to the painful joint • heat pads, heated rice pads or hot-water bottles • various supports, braces, sleeves and walking aids.

Key Points: Check your pharmacy team are aware and understand the following key points:  The causes of joint pain, including the various types of injury and arthritis  What types of joint pain can be considered for management in the pharmacy  Which customers should be referred to the pharmacist  The appropriate use of hot and cold in cases of joint injury  The use of the PRICE method  The importance of not taking certain oral analgesics for longer than three days without referral  Questions to ask the customer  The role of dietary supplements (e.g. fish oils, glucosamine, chondroitin).

Pharmacies should stock a variety of topical products for local symptomatic pain relief, for example products containing diclofenac which can reduce inflammation and act as an analgesic. When diclofenac is applied to the skin as a gel, it is absorbed into the skin and then moves deeper into areas of the body where there is inflammation (for example, the muscle). The five-step process for treating a muscle or joint injury such as an ankle sprain is called "P.R.I.C.E." (which is short for Protection, Rest, Ice, Compression, and Elevation). It can be used even by someone without first-aid training, and should be used immediately when an injury occurs – the earlier, the better – while further medical attention is being sought. If the athlete experiences too much pain during the process, stop immediately.

Actions:  Include POS with associated conditions relating to this category  Ensure efficient sign posting and shop floor management with associated ailments linked for maximum cross aisle merchandising  Ensure there is a discreet area in which staff can assist with advice and product selection  Dedicated window displays will improve the shoppers experience and highlight the pharmacy  Ensure the team are able to communicate lifestyle advice  Train the team to meet all the above considerations


Voltarol gel with new No Mess applicator Voltarol Emulgel P 1% w/w Gel contains diclofenac diethylammonium. Always read the label/leaflet.

NEW

Applicator

No Mess applicator: An intuitive design for ease of use.

Easy to open in 4 steps

As the No Mess applicator introduces a fresh and innovative approach to gel application, the carton provides clear visual instructions to help with this relatively straightforward process. Once correctly opened and primed (Figs 1â&#x20AC;&#x201C;3), the patient simply lifts off the safety cap, and pulls the white section on the applicator to release the gel (Fig 4), and applies gel direct to the site of pain, using the carefully contoured applicator head to evenly and easily rub the gel into the affected area. In other words, targeted pain relief with clean hands.

Voltarol Emulgel P 1% w/w Gel (diclofenac). Indications: For the local symptomatic relief of pain and inflammation in trauma of tendons, ligaments, muscles, joints and localised forms of soft tissue rheumatism. Dosage: Adults and adolescents 14 years and over: 2g to 4g of gel, applied topically 3-4 times daily for up to a maximum of 7 days. Consult a doctor if the condition does not improve. Contraindications: Patients with or without chronic asthma in whom attacks of asthma, urticaria or acute rhinitis are precipitated by aspirin or other non-steroidal anti-inflammatory agents. Hypersensitivity to diclofenac, acetylsalicylic acid, non-steroidal anti-inflammatory drugs or any other ingredients. Use in third trimester of pregnancy, in children and adolescents aged less than 14 years. Warnings and Precautions: Caution with oral NSAIDs as may result in unwanted side effects. Avoid use with other products containing diclofenac. Apply only to intact, non-diseased skin and not to skin wounds or open injuries. It should not be used with occlusion. It should not be allowed to come into contact with the eyes or mucous membranes and should never be taken by mouth. Application over extensive areas for prolonged periods or application in excess of recommended dosage may give rise to systemic effects. These include gastrointestinal disturbances and bleeding, irritability, fluid retention, rash, hepatitis, renal dysfunction, anaphylaxis and rarely blood dyscrasias, bronchospasm and erythema multiforme. Discontinue if rash develops. Use with caution in patients with a history of peptic ulcers, gastrointestinal bleeding, hepatic or renal insufficiency, or bleeding diathesis, or intestinal inflammation. Pregnancy and Lactation: The systemic concentration of diclofenac is lower after topical administration, compared to oral formulations. During the first and second trimester of pregnancy, diclofenac should not be given unless clearly necessary. Only use during lactation on the advice of a health professional. Diclofenac is contraindicated during the third trimester of pregnancy. Should not be applied on the breasts of nursing mothers, nor elsewhere on large areas of skin or for a prolonged period of time. Side effects: Very rare: rash pustular, hypersensitivity (including urticaria), angioedema, asthma, photosensitivity reaction. Rare: Dermatitis bullous. Common: Dermatitis (including contact dermatitis), rash, erythema, eczema, pruritus. Overdose: The low systemic absorption of topical diclofenac renders overdosage extremely unlikely. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. MA Number: PA 678/140/2. Legal Category: Pharmacy only. Text revised: May 2019. Further information available on request. Trade marks are owned by or licensed to the GSK group of companies. CHGBI/CHVOLT/0275/17a(1)


48

News

Celebrating 75 years in Pharmacy Regular customers and Ferbane residents came out in force to support the local institution that is Aidan Walsh Allcare Pharmacy as it celebrated its 75th year in November. Aidan Walsh (left) celebrates 75 years with his regular customers and patients Started by Aidan’s father Thomas P. Walsh, the pharmacy has always sought to make time and space for its customers. This philosophy continues under Aidan and his team, with the success of the day underlining just how important this pharmacy is to the community of Ferbane. Thomas opened the pharmacy in 1944. Working with his fiancée

Eithne McKnight, a qualified pharmacy assistant, the store built up a loyal following in the town. This was matched by a dedicated staff who helped to place the pharmacy at the centre of the community. Aidan took the helm in 1992 following the passing of his father. To cater for the growing needs of the business, a new premises was found on the Main Street in Ferbane in 2005. In 2015, Aidan joined the largest Irish-owned network of pharmacies, Allcare Pharmacy.

Not enough for self-care of Diabetes The current cost of managing diabetes in Ireland is estimated to be approximately €2 billion (12-14%) of the annual health budget with very little of this spent on the prevention or effective self-management of diabetes. As a result many people with diabetes develop complications earlier and present to the health service with a range of complications varying from cardiovascular, stroke, renal, eye and foot complications. It is estimated that 65% of the annual diabetes health spend is on dealing with these complications with the remaining spend covering manpower, medication, blood glucose monitoring and ambulatory costs.

These were the startling statistics presented by Diabetes Ireland to TDs and Senators on World Diabetes Day (November 14th). The charity also called for a critical review of current diabetes care costs to be undertaken. The total number of people living with diabetes in Ireland is estimated to be 225,840 and the International Diabetes Federation estimates that by 2020 there would be 233,000 people with the condition

and by 2030 there would be 278,850 people with the condition. Because pharmacists are the most accessible healthcare providers, they are key players in the betterment of patients’ health, not just in terms of screening but in the lifelong management of diabetes. For those who are diagnosed, pharmacists are able to provide counselling about monitoring glucose levels and how to manage out-of-range

levels, including developing an action plan for what to do if sugar levels go too low. Pharmacist can help patients select the most appropriate hypoglycemic management strategy on an individual basis and can advise on an appropriate diet and exercise routine to compliment medication management in treating diabetes.

Psoriasis onset and Psoriatic Arthritis Up to 140,000 people in Ireland have Psoriasis and many of these develop Psoriatic Arthritis, which affects the back and joints causing severe pain and immobility. Much research is being carried out into Psoriatic Arthritis (PsA) and its cause, and a new study has determined that the age of psoriasis onset determines whether arthritis or psoriasis starts first in people with psoriatic arthritis. The prevalence of PsA is estimated to be between 0.3 – 1% of the general population. However, studies have indicated that up to 42% of psoriasis patients can have accompanying PsA. The incidence of PsA is slightly higher in women, with peak onset occurring between 35-45 years of age. Onset may be gradual with mild symptoms developing slowly over a period of years, or progress more rapidly to become severe and destructive. The study was presented at the

2019 ACR/ARP Annual Meeting, and researchers found that pustular psoriasis is associated with arthritis onset two years earlier than the intercept interval; and there is an increased delay for nail involvement, plaque psoriasis or family history of psoriasis from psoriasis to arthritis by approximately two years for each characteristic. This study explored the relationships between the characteristics of skin psoriasis, arthritis and the timing of arthritis onset using PsART-International, which is a web-based registry of PsA patients under routine care in Turkey, Italy and Canada. PsARTInternational includes detailed disease history about the type and onset of skin and joint disease. “The PsART-International cohort focuses on PsA patients in whom

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musculoskeletal symptoms start before skin lesions, which is approximately five to 10% of all PsA patients. We need more patients to determine related factors,” says Umut Kalyoncu, MD, professor, Internal Medicine and Rheumatology, at Hacettepe University in Turkey, and the study's lead author. “PsA is a heterogeneous disease for clinical presentation and treatment response. If patients with arthritis first are really a different subgroup, it means that treatment response and prognosis could be different from others. Indeed, in our cohort, achieving minimal disease activity is statistically less frequent in patients with arthritis first.” The researchers extracted data on demographic characteristics, family history of psoriatic disease regardless of skin or arthritis, types of skin psoriasis, site of skin

psoriasis onset and components of PsA ever observed. They tabulated patient characteristics in three groups: arthritis-first, psoriasis-first and synchronous, or onset of skin and joint disease within 12 months. The study's primary outcome was the absolute time elapsed in months after skin disease to arthritis, with negative values indicating arthritis onset before psoriasis. They included 1,631 patients in the study, including 71 who had arthritis first, 309 with synchronous onset, and 1,251 who had psoriasis first. According to their findings, the age of psoriasis onset, not arthritis, determined if arthritis or psoriasis would appear first. Their analysis also shows a 65-month delay of arthritis onset after psoriasis when other independent variables are set to their baseline values.


Superior results for your patients with moderate to severe plaque psoriasis1,2* 5 years of sustained efficacy and a consistent safety profile3

Complete Treatment† Complete Confidence‡ ▼

ABBREVIATED PRESCRIBING INFORMATION ▼ COSENTYX 150 mg solution for injection in pre-filled pen. 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. Please refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: COSENTYX 150 mg solution for injection in pre-filled pen. Therapeutic Indications: The treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy; the treatment of active ankylosing spondylitis in adults who have responded inadequately to conventional therapy; the treatment, alone or in combination with methotrexate (MTX), of active psoriatic arthritis in adult patients when the response to previous disease modifying anti rheumatic drug (DMARD) therapy has been inadequate. Dosage & Method of Administration: Plaque Psoriasis: Recommended dose in adults is 300 mg given as two subcutaneous injections of 150 mg. Dosing at Weeks 0, 1, 2 3 and 4, followed by monthly maintenance dosing. Ankylosing Spondylitis: The recommended dose is 150 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2 3 and 4, followed by monthly maintenance dosing. Psoriatic Arthritis: For patients with concomitant moderate to severe plaque psoriasis or who are anti TNFα inadequate responders, the recommended dose is 300 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2 3 and 4, followed by monthly maintenance dosing. Each 300 mg dose is given as two subcutaneous injections of 150 mg. For all other patients, the recommended dose is 150 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. Based on clinical response, the dose can be increased to 300 mg. For all of the above indications, available data suggest that a clinical response is usually achieved within 16 weeks of treatment. Consideration should be given to discontinuing treatment in patients who have shown no response up to 16 weeks of treatment. Some patients with initially partial response may subsequently improve with continued treatment beyond 16 weeks. The safety and efficacy in children below the age of 18 years have not yet been established. Contraindications: Severe hypersensitivity reactions to the active substance or to any of the excipients. Clinically important, active infection (e.g. active tuberculosis). Warnings/Precautions: Infections: Cosentyx has the potential to increase the risk of infections. Serious infections have been observed in patients receiving Cosentyx in the post-marketing setting. Infections observed in clinical studies are mainly mild or moderate upper respiratory tract infections such as nasopharyngitis not requiring treatment discontinuation. Non serious mucocutaneous candida infections more frequently reported for secukinumab than placebo in psoriasis clinical studies. Caution in patients with a chronic infection or a history of recurrent infection. Instruct patients to seek medical advice if signs or symptoms suggestive of an infection occur. If a patient develops a serious infection, close monitoring and discontinue treatment until the infection resolves. Should not be given to patients with active tuberculosis. Anti tuberculosis therapy should be considered prior to initiation in patients with latent tuberculosis. Inflammatory bowel disease: Cases of new or exacerbations of Crohn’s disease and ulcerative colitis have been reported. Caution should be exercised when prescribing to patients with inflammatory bowel disease including Crohn’s disease and

ulcerative colitis. Patients should be closely monitored. Hypersensitivity reactions: In clinical studies, rare cases of anaphylactic reactions have been observed in patients receiving Cosentyx. If an anaphylactic or other serious allergic reactions occur, administration should be discontinued immediately and appropriate therapy initiated. Latex-sensitive individuals: The removable cap of the Cosentyx pre filled pen contains a derivative of natural rubber latex. Vaccinations: Live vaccines should not be given concurrently with Cosentyx. Patients may receive concurrent inactivated or non live vaccinations. Concomitant immunosuppressive therapy: Use in combination with immunosuppressants, including biologics, or phototherapy have not been evaluated. Interactions: Live vaccines should not be given concurrently with Cosentyx. In a study in subjects with plaque psoriasis, no interaction was observed between secukinumab and midazolam (CYP 3A4 substrate. No interaction seen when administered concomitantly with methotrexate (MTX) and/or corticosteroids. Fertility, Pregnancy and Lactation: Women of childbearing potential should use an effective method of contraception during treatment and for at least 20 weeks after treatment. It is preferable to avoid the use of Cosentyx in pregnancy as there are no adequate data from the use of secukinumab in pregnant women. It is not known whether secukinumab is excreted in human milk. A decision on whether to discontinue breast feeding during treatment and up to 20 weeks after treatment or to discontinue therapy with Cosentyx must be made taking into account the benefit of breast feeding to the child and the benefit of Cosentyx therapy to the woman. The effect of secukinumab on human fertility has not been evaluated. Undesirable Effects: Very common (≥1/10); Upper respiratory tract infections. Common (≥1/100 to <1/10); Oral herpes, rhinorrhoea, diarrhoea, urticaria Uncommon (≥1/1,000 to <1/100); Oral candidiasis, tinea pedis, otitis externa, neutropenia, conjunctivitis. Rare (≥1/10,000 to <1/1,000) Anaphylactic reactions. Please see Summary of Product Characteristics for further information on undesirable effects. Legal Category: POM. Marketing Authorisation Holder: Novartis Europharm Ltd, Vista Building, Elm Park, Merrion Road, Dublin 4, Ireland. Marketing Authorisation Numbers: EU/1/14/980/004-005. Date of Revision of Abbreviated Prescribing Information: October 2018. Full prescribing information is available upon request from: Novartis Ireland Limited, Vista Building, Elm Park Business Park, Elm Park, Dublin 4. Tel: 01-2204100 or at www.medicines.ie. Detailed information on this product is also available on the website of the European Medicines Agency http://www.ema.europa.eu ▼ This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Adverse events should be reported. 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. Adverse events should also be reported to Novartis Ireland by calling 01-2080 612 or by email to: drugsafety.dublin@novartis.com

* Secukinumab was shown to be superior to ustekinumab in clearing skin of subjects with moderate to severe plaque psoriasis in 52-week, double-blind study, in which subjects were randomized 1:1 to subcutaneous injection of secukinumab 300 mg or ustekinumab per label. Primary end point was 90% or more improvement from baseline Psoriasis Area and Severity Index score (PASI 90) at week 16.1 Secukinumab was shown to be superior to ustekinumab in clearing skin of subjects with moderate to severe plaque psoriasis in a 52-week, double-blind study, in which subjects were randomized 1:1 to subcutaneous injection of secukinumab 300 mg or ustekinumab per label. Co-primary endpoints were 90% or more improvement from Baseline Psoriasis Area and Severity Index (PASI 90) and Investigator’s Global Assessment (IGA) mod 2011 0/1 (clear or almost clear) response rates at Week 12.2 † Complete refers to the fact that Cosentyx has demonstrated efficacy in various manifestations of psoriasis (psoriatic arthritis, nail, scalp and palmoplantar)4-6 ‡ Used in over 150,000 patients and no new safety signals seen in clinical studies up to 5 years3,7 References: 1. Thaçi D et al. J Am Acad Dermatol 2015; 73(3): 400-409. 2. Bagel J et al. Dermatol Ther 2018 ;8(4):571-579. doi: 10.1007/s13555-018-0265-y. 3. Bissonnette et al. J Eur Acad Dermatol Venereol 2018: doi: 10.1111/jdv.14878. 4. Kavanaugh A et al. Arthritis Care Res 2017; 69; 347-355. 5. Reich et al. Poster 7382 presented at AAD 2018. 6. Cosentyx SPC, Novartis Ireland. 7. Novartis (15 May 2018). Novartis ARROW trial to assess mechanistic superiority of direct IL-17A inhibition (Cosentyx) over IL-23 inhibition (Tremfya) [press release]. https://www.novartis.com/news/media-releases/novartis-arrow-trial-assess-mechanisticsuperiority-direct-il-17a-inhibition-cosentyxr-over-il-23-inhibition-tremfyar Accessed 10 January 2019. Date of Preparation: January 2019 IE02/COS18-CNF043a


1. Recent Picture of Rose at the counter i

top


in Castletymon

Welcoming your older customers: Some free & low-cost tips

Older customers locally not only spend and have a lot of er, but purchasing pow also have the time to shop.

Your older customers are a diverse group. They might be still raising teenagers, or they might be pushing their first great-grandchild in a buggy. They may have travelled the world or they may find it difficult to leave the house.

people wear glasses or lenses. Significant numbers have some physical restriction caused by conditions like arthritis or diabetes or perhaps a bad hip or a knee that is giving them trouble.

While they are a varied group, many share certain physical restrictions. One in three older people is affected by hearing loss. Almost two-thirds of older

Knowing this, and making small changes in the areas of sound, sight and mobility, can give your business the edge it needs.

The following pages are a checklist of Age Friendly practices. Go through each guide and see what simple actions would make a difference in your business.

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52

Top 100 - Ones2Watch

The Ones2Watch section acts as a source of discovery for the pharmacy profession, showcasing those up-and-coming contributors already making a difference to the profession across Ireland. The Top 5 here are amongst those not only poised to change the face of community pharmacy but who are already doing so in profound ways. The Ones2Watch are, redefining the future of pharmacy. With this in mind, Irish Pharmacy News is proud to recognise the Top5 unique movers and shakers and rising stars of pharmacy.

David Collins, Pharmacy Technician, Marron’s Pharmacy, Clane David displays excellence in an expanded technician’s role, assisting and driving Marron’s Pharmacy’s value-added service offering. He was the force behind introducing a first aid fee, which has strengthened the overall pharmacy service model. This has demonstrated that there is another branch of care pharmacies can pursue going forward that is independent of the State as a patient. He is very competent in taking blood pressure, assisting in running the weight management clinic if a pharmacist is not available, demonstrating inhaler technique or talking about a patient’s complex prescription. David’s main areas of interest are First Aid, Hypertension, Medication Adherence and advancing the role of the Pharmacy Technician.

Ciarán Fitzgerald, Royal College of Surgeons, Ireland A 4th year pharmacy student, Ciarán who worked tirelessly as an APPEL rep, campaigning for paid Pharmacy placements and for a reduction in the final year fees. The efforts of his hard labour came to fruition this year when the ban on paid pharmacy placements was uplifted. This year he also undertook an RCSI summer research project focused on children with ADHD and the impact of their diagnosis on their family. This work shows that Ciarán is always focusing not only on the patient and their family but their relationship with their healthcare provider. A talented sportsman and musician, Ciarán was appointed Captain of the RCSI Men’s GAA team for 2017. He proved to be one of the most successful captains in RCSI leading the team to their first All Ireland Title in the history of the college.

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Laura Gilmartin, Commons Road Pharmacy, Navan Any new business is not without its challenges, and Laura has risen to the occasion. Commons Road Pharmacy has only been opened for three years and during that time, Laura has had to think outside the box with new and innovative ways to increase business. She has established and built upon relationships with local nursing homes, GAA teams, increased social media activity and sourced new products to benefit patients and customers. The team were also involved in a couple of incidents of armed robbery, one in which a staff member was injured. As a pharmacist/manager it was a difficult time to help the staff recover from the emotional trauma it caused but again Laura quickly helped her staff recover and the team, she says, are now stronger than ever.

Niamh Loughlin, Past President, Irish Pharmacy Students Association, Trinity College Dublin Niamh has been a passionate driver of student rights in Pharmacy since her freshman year. She has constantly challenged every barrier placed upon her in several leadership roles and was successful as president of IPSA this year in revoking the decision to not pay students on placement in pharmacy. In March of this year a large number of pharmacy students held a protest outside Leinster House and following this and a meeting Niamh held with the Health Minister on behalf of IPSA, the ban on pharmacy students receiving payments for internship placements required for their courses was reversed.

Glenn Ryan, Pharmacy Student, McCabes Pharmacy & Pharmacy Intern, Perrigo Glenn was named IPN’s Pharmacy Student of the Year in 2019 and has enjoyed a busy end to a great year. He continues to work as a pharmacy technician in McCabes Pharmacy while juggling a placement in Perrigo with his academic modules at Trinity College. Glenn has recently been working closely with the owner and supervising pharmacist of Peter Street Pharmacy in Drogheda to create SOPs and policies for the newly-opened independent community pharmacy. From November 2019 to February 2020, Glenn will be a participant of 100 Minds. This charity project challenges 100 of Ireland’s top college students to raise ¤1,000 each in 100 days for Temple Street Children’s University Hospital. Glenn is currently completing a four-month placement within an industry practice setting at Perrigo. “Working for a major global pharmaceutical company alongside incredible people who are passionate about self-care has been an amazing experience,” he says.

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Top 100 - Influencers2Pharmacy

This section shines a spotlight on the Influencers2Pharmacy within Irish pharmacy at present based on reach, engagement and impact. These individuals have established, and built, a strong reputation for their knowledge and expertise. Their evident credibility, authenticity and audience, make them hugely effective within their respective arenas.

Rachel Dungan, 4Front Pharmacy Co-Founder, The Pharmacist Coach Educational partner to IPN, 4Front Pharmacy.ie scooped the prestigious 'Educational Project of the Year in General Practice / Pharmacy at the Irish Healthcare Awards this year. www.4Front Pharmacy.ie is a leading edge online training platform for community pharmacy teams, proven to drive patient safety, staff engagement and increased sales through raising the quality of pharmacy / patient interactions. In addition to hosting the Online MCQ Assessments for IPN Clinical CPD articles, and contributing pharmacy business CPD articles, in its inaugural year, 4Front Pharmacy has created 62 audio visual, assessed and verified learning modules for community pharmacy teams. They have done the work, so you don't have to, saving pharmacists valuable time.

Jack Kavanagh, B.Sc. (2017) Pharmacy Jack was awarded as one of ‘Ten Outstanding Young People of the Year’ in 2019 as someone who is doing inspirational work. A spinal cord injury in 2012 aged just 20 left Jack Kavanagh paralysed from the armpits down with limited use of his arms and hands, 15% muscle function in all. Defying the odds Jack returned to TCD only thirteen months post injury to continue his Pharmacy studies. Having completed a BSc in Pharmacy in May 2017 he completed the Masters of Pharmacy in RCSI in 2018 and joined the professional register in December 2018. At the same time through talks and workshops Jack continues to deliver to audiences on the concepts of resilience, personal leadership, the power of choice and personal development.

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Gerard McCormack, Magees Pharmacy, Letterkenny Magees Pharmacy in Letterkenny have their own blog, informing customers about all the latest updates and news on makeup, skincare and health. The pharmacy opened its doors ninety years ago, and over the years, it has grown to become a central part of the community and has continued to play a crucial role in the everyday lives of the locals ever since. Gerard McCormick now runs the business, having taken over from his late father in 2006. In recent months he has overseen a total refurbishment of the shop to suit the needs of a modern day pharmacy. The outcome of the latest transformation is encouraging news for smaller retailers and retail service outlets facing increased competition from the chain stores. Not only has the pharmacy’s turnover increased, the redesigned store has attracted top pharmaceutical company executives to Letterkenny to see the results of the revamp.

Leonora O’Brien, Founder & CEO, Pharmapod During 2019, Pharmapod were listed in Top 10 Medical Practice Management Solution Providers in Europe. Leonora has more than 20 years’ experience working in the pharmacy sector. She is the first Irish woman to be selected for EY’s year-long Entrepreneurial Winning Women leadership programme and has previously won the Cartier Women’s Initiative Award for Europe. “We have become a go-to place for data. Prior to our platform being developed, a lot of knowledge gained about errors would often stay locked within individual pharmacies. A doctor might learn from a mistake, as might a pharmacist, but it normally wouldn’t go beyond this. Now, though, healthcare professionals have a way to share information and better monitor risks in a way that also greatly improves transparency,” she says.

Neil Sokay, Lynch’s totalhealth Pharmacy, Kells Neil is renowned for his levels of engagement with patients and customers, which has been prevalent during 2019. “Like all relationships we have with one another, engagement is what brings us back to a service provider and encourages repeated views and participation. “In today's mobile society we are bombarded with generic product-only pitches which rarely leave a lasting impression. “As we developed our social media strategies across Facebook and Instagram, we decided to focus on 1 product only - the Pharmacy team and the expertise and advice we offer to our friends, families and patients across the week. By embracing what our pharmacists, techs and counter assistants provide, we have become a go to pharmacy for general health and lifestyle advice. When analysing data from each platform, which I highly recommend you do, we see massive responses from the public when we use our knowledge and life experiences as our primary pitch - people buy people first,” he says.

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Top 100 - Retail60Leaders

The Retail60Leaders reflects on those professionals within the retail pharmacy arena who have been, and who continue to be, empowering others moving into the future. The 60 listed on the following pages features those who act as ambassadors and role models for their peers and colleagues; redrawing the landscape of the future, with the patient at the heart of everything they do. Those who have made this list have displayed motivating behaviour and inspirational leadership affecting the development of retail pharmacy across Ireland. John Arnold, Managing Director, totalhealth Pharmacy Group During 2019, John Arnold has overseen continued growth of the group to 80 pharmacies in 2019, the launch of a new company PAPS, the launch of a new website and customer app and a host of services to the membership. John has led the way in the formation of the new company, “Pharmacy Assistance Purchase Scheme” or “PAPS” to provide and manage the purchase and sale of pharmacies. He also recently announced the launch of the new totalhealth App, which will allow remote ordering of prescriptions, as well as facilitating the group’s loyalty programme. Proud to work for a committed group of independent pharmacists who support each other on an equal basis within totalhealth. He believes that independent pharmacists are one of the most important health resources in Ireland, who have patients at the heart of everything they do. Highlights of 2019 include the multiple industry award nominations for the group and its members and the group’s sponsorship of the Connacht Rugby Junior camps.

Cormac Black, McCabes Pharmacy Cormac has been described as a young pharmacist that has brought a wealth of knowledge, enthusiasm and a dedication and commitment to improving both the role of the pharmacist and the services and level of care giving in McCabes Pharmacy. He has adapted exceptionally well to a busy pharmacy that can be a highly pressurised environment at times with its high volume of dispensing and high footfall. Cormac won the JPA Brenson Lawlor Young Community Pharmacist of the Year Award for 2019.

Norman Brookes, Pharmacist/Owner, Brookes Pharmacy Bandon When Norman Brookes opened the Brookes Pharmacy in 2001, he had one clear aim in mind: to offer fast and reliable pharmacy services tailored to the needs of the local community. The business has become the pharmacy of choice for many in Bandon, providing not just efficient prescription dispensing but also a complete range of enhanced services. “We are committed to keeping up with the latest healthcare techniques, which has led us to completely refurbish the pharmacy and provide a better service to our clients,” says Norman, who works alongside an experienced team of pharmacy professionals.

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John Carroll, Managing Director, Axium Buying Group Pharmacist John Carroll founded and established Axium Buying Group in 2009. Earlier this year, it was revealed that The Navi Group - the Irish-owned firm behind Axium and the CarePlus Pharmacy franchise - is in advanced negotiations with a number of European buying groups with a view to rolling out its software internationally. Axium is the largest independent community pharmacy buying group in Ireland, servicing over 490 independent pharmacies, delivering savings on products for members through daily supplier negotiations, ordering and advisory services. Axium has developed market leading technology platforms and has added new dynamic services for members.

Susan Concannon, Supervising Pharmacist, Adrian Dunne Pharmacy Ashbourne Susan Concannon is Supervising Pharmacist in Ashbourne since it opened in 2003. This branch is the only ‘Greenfield site’ within the group and in this time Susan implemented all of the pharmacy’s healthcare services. One of those services has seen exceptional growth in the past year. The Pharmacy’s 2018 Flu vaccination numbers grew by more than 75% year on year.

Tomás Conefrey, Pharmacist, Conefrey’s CarePlus Pharmacy, Dublin Tomás Conefrey has been running family business Conefrey's CarePlus Pharmacy since 1999 and has firmly established himself as the key community Pharmacist in the Pearse Street and surrounding Dublin 2 area. He has been at the forefront of many health initiatives during 2019, including the promotion of FMD and Men’s Health Week. Tomás has positioned Conefrey's as a hub for health services and has launched successful Health Services Programmes for local corporate companies in the area. As part of his corporate initiatives, Tomás also visits corporate offices to host health and wellness talks and clinics.

Áine Costello, Pharmacist, Boots Carrickmines Áine is dedicated to the pharmacy profession and has acted as tutor pharmacist to pre-registration and intern pharmacists. She has also supported undergraduate pharmacy students through summer placements and pharmacy visits, portraying a positive image of the profession to the next generation. Most recently she has a facilitated the induction of newly qualified and new to the business pharmacists, leading by example and supporting their entry to the role of the pharmacist. She also supports new managers to the business in understanding the different aspects of the pharmacy business and the role they play.

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Top 100 - Retail60Leaders

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Rose Cummins, Meaghers Pharmacy Castletymon Rose was recognised for her contribution to the profession and received the Avene Counter Assistant of the Year Award for 2019. Rose is one of the longest standing team members in Meagher’s Pharmacy Group, dedicating an overwhelming, twelve years of her to life to serving the community between two stores, Glenview and Castletymon in Tallaght. Rose has now been in Castletymon for seven years, a position she ‘thrives in’ within the store. Having grown up in the Tallaght area she has an excellent knowledge of her customers, to whom she greets by name and with a smile on a daily basis. Customers are the centre of everything Rose does in her job and without doubt her most loved part of working in community pharmacy.

Adrian Dunne, Pharmacist/Owner, Adrian Dunne Pharmacy Group The Adrian Dunne Pharmacy Group, which has 12 stores across Ireland, recently celebrated 20 years of being in business. Adrian graduated in 1997 as a qualified pharmacist and in 1999 bought his first pharmacy in Whitehall, Dublin 9. Over the following years Adrian acquired a further eleven pharmacies, the most recent of which is in Kilbarrack, Co. Dublin. The Group opened their first store in Whitehall in 1999. They marked the milestone with a birthday bash in House, Leeson Street on Saturday 15th June with staff from all branches, and head office, in attendance. “To every single Adrian Dunne Pharmacy employee, I can’t thank you enough on our 20th birthday for your endless compassion and dedication to our customers,” said Mr Dunne.

Audrey Dunne, Supervising Pharmacist, Stacks Pharmacy Castledermot Audrey has been the Supervising Pharmacist at Stacks Pharmacy Castledermot for the past eight years. She quickly became known locally for her excellence in customer care, trusted advice, hard work and dedication to the community, which has helped build a very loyal customer base for the pharmacy. Audrey is patient focussed and strongly believes in patient education as a means of empowering patients to take responsibility and control of their own conditions and medication- helping her patients help themselves. Audrey has developed a strong working relationship with local medical practitioners enhancing the role her pharmacy plays in the primary care of its patients. A previous finalist of Young Pharmacist of the Year, Audrey has, since qualifying, recognised the importance of CPD and has remained committed to her continuous education. She received a higher distinction in her Postgraduate Diploma in Community Pharmacy from Trinity College in 2017.

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Top 100 - Retail60Leaders

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Ola El-Garawany, Pharmacist/Owner, Lilly’s Pharmacy & Health Store, Ratoath Ola El-Garawany took the title of Teva Superintendent Pharmacist of the Year Award for 2019. Based in Ratoath, Ola was recognised for her work within the community, managing full responsibility for the pharmacy while also holding service clinics and assisting the rest of the pharmacy team. Ola El Garawany owns and runs the store with her daughter Sally El Banna, and has seen their business thrive on their holistic approach to health. Ola studied pharmacy in Egypt where she grew up. When she came to Ireland in the early 1990s, she did an internship in a community pharmacy.

Avril Farrell, OTC Medicines Buying Manager, Boots Pharmacy Ireland Boots Pharmacy Ireland won RB Nurofen Rapid Relief OTC Retailer of the Year Award for 2019. The Boots team believe in “customers first and colleague at the heart of what we do” as a vision for how they want to do things. This strapline helps them make sure that whatever they land in healthcare is done from the lens of the customers and ensures that they support colleagues to have great conversations in store. As a small, yet efficient team, Boots Ireland pride themselves on integrity in all of their endeavours. “Our category strategies are underpinned by quality assurance, innovation and breadth of range,” Avril says.

Pauline Forde, Superintendent Pharmacist, Staunton’s Allcare Pharmacy, Galway Pauline was one of the key players when, earlier this year, a delivery of crucial medicine was delivered by drone from Galway to the Aran Islands -hailed as a first which could be lifesaving in an emergency. The successful test delivery of diabetes prescription medication over some 18km of water between Connemara Airport and Inishmore is being seen as showing the possibilities for future emergency deliveries in planned drone corridors.

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Top 100 - Retail60Leaders David Gilsenan, Pharmacist, Hilton’s Pharmacy Corneslcourt Hilton’s Pharmacy recently integrated a self-service mobile app into the pharmacy’s workflow. This has reduced wait times in the pharmacy, made ordering prescriptions more convenient and helped patients improve their medication compliance. The app is very user friendly and is used by customers from 18 to over 80 years old. David and his team were recognised for their work when he picked up the McLernon Computers eHealth & Innovation Award 2019.

Paddy Hickey, Pharmacist/Owner, Hickey’s Pharmacy Group Hickey’s Pharmacy Group recently opened two new stores in Cork as part of an ambitious five-year growth plan. The family-owned company was founded by pharmacist Paddy Hickey in 1995 and are on target to hit their goal of 60 pharmacies in Ireland by 2022. Furthermore, Hickey’s Pharmacy Northside team recently celebrated their 50,000 flu vaccine milestone. Hickey’s Pharmacy opened its first pharmacy in Northside Shopping Centre, Dublin. Since that time, Hickey’s Pharmacy has grown and expanded its range of services in response to the changing needs of communities. The Pharmacy Group has a strong customer focus and now employ over 350 people in 37 stores throughout the country. Hickey’s Pharmacy plays an integral role in the communities we serve, working alongside GP’s and other healthcare professionals.

Anne Marie Horan, Pharmacist, Fortfield Pharmacy, Terenure As an IPU Executive Committee Member, Anne Marie has been at the forefront of offering consumers and patients healthcare advice and tips during 2019, on topics including holiday health, flu vaccinations and much more. She has also presented to the Joint Committee of Business, Enterprise and Innovation speaking out about crimes against pharmacies and pharmacy staff. Anne Marie runs Fortfield Pharmacy in Terenure, Dublin.

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Samantha Jones, Keane’s CarePlus Pharmacy, Enfield Pharmacy Technician Samantha hit the ground running when she joined Keane’s CarePlus Pharmacy in Enfield. Described by her team members as an integral part of the pharmacy, Samantha has brought much more to the Keane’s table than just serving customers. Pharmacist John O’Shaugnessy says, “Samantha has exceeded our expectations with what she has brought to the team. With the basics of being a diligent, hard-working team player covered in little time she reinvented our whole approach to improving our customer relations and providing great services to our clientele. She quickly came to grips with our working model and slowly started to introduce improvements to our dispensary which have greatly benefited the whole team.” Samantha won the Pure Pharmacy Recruitment Community Pharmacy Technician of the Year Award 2019.

John Keane, Pharmacist/Owner, Keane’s CarePlus Pharmacies In 2019, Keane’s CarePlus Pharmacy became the first pharmacy group in Ireland to be certified by Adam Harris and AsIAm as Autism Friendly. Keane's CarePlus Pharmacy was founded by John Keane in September 2008. Shortly afterwards Robert joined the team opening Green Road in 2010. They believe by having an excellent team, excellent customer service easily follows and have built and continue to grow their business based on this philosophy. Keane’s CarePlus Pharmacy in Mullingar also received the Sudocrem Children Baby Health Pharmacy of the Year Award 2019.

Brian Kearney, Supervising Pharmacist, McCauley Health & Beauty Pharmacy Tralee Brian has led the pharmacy team at McCauley Health & Beauty Tralee towards the promotion of healthcare during 2019, working tirelessly to grow the pharmacy business through initiatives targeted at educating and engaging with their customers on health issues. One of their most recent successful events was a healthcare seminar organised by the team entitled ‘Women’s Health and Well-being for All Ages’. They also actively embraced and utilised the new McCauley App and the McCauley group’s recently launched Smoking Cessation club which offers an incentive to those on NRT. Brian and the OTC pharmacy team won the IPN/4Front Pharmacy Community Pharmacy Team of the Year Award for 2019.

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Top 100 - Retail60Leaders

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Lauren Kelly, Pharmacy Technician, Haven Pharmacy Brennans Lauren has worked for Haven Pharmacy for over 10 years and during that time has become the number one go-to person within the dispensary. More recently, she has taken on board a range of additional roles, one of which was that of prescription verification, correctly monthly rejects and re-claiming. She has also been responsible for simplifying the processes associated with the management of phased dispensing of patient medications.

Joan Kilgallen, Pharmacist/Owner, Burkes Pharmacy Group Joan is the Managing Director of Burkes Pharmacy Group, which she established in 1993, to provide professional pharmacy services to the communities in which they are located. Joan and the eam strive to deliver quality dispensing services, in bright cheerful surrounding, through talented, educated and highly trained, friendly staff. In addition, they are committed to treating all their customers queries, professionally and confidentially. They opened their latest store just last year.

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Paul Knox, Pharmacist, Coffeys Allcare Pharmacy, Roscrea Paul Knox is the Pharmacist at Coffeys Allcare Pharmacy, who this year, as like in previous years, have gone above and beyond in raising vital funds for charity. Paul has also been advocating Continuing Professional Education within pharmacy and has had several articles published this year on various clinical and therapeutic areas for the benefit of his pharmacy colleagues. Paul and his pharmacy team also boast a range of pharmacy services such as Blood Glucose Screening, Diabetes 5 Point Health Check, Blood Pressure Check, Emergency Contraception, Smoking Cessation, Asthma Care, Winter Flu Vaccination, Health Checks, Weight Management / BMI, Prescription Texting.

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Top 100 - Retail60Leaders Enda Lannon, Pharmacist/Owner, Lannon Late Night Pharmacy In Enda Lannon Limited of three busy community pharmacies, Enda strives to ensure that all his Pharmacies are supporting the health and well being of each and every one in their care. The teamwork between the 3 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. Enda has continued to prove himself as a valuable asset to his community throughout his career because of his caring and compassionate nature. He has frequently gone above and beyond to help his customers, offering advice and reassurance through difficult times. Enda’s genuine concern for the welfare and care of his customers, staff and colleagues provides a welcome comfort as he always goes above and beyond. Enda’s personal touch goes far for any patient, sometimes it goes miles.

Bernadette Lavery, MPSNI, Managing Director, Boots Ireland In a career with Boots which has spanned 30 years, Bernadette has held a number of senior roles across Pharmacy, HR and Stores Leadership in both the UK and Ireland. Bernadette began her career as a pharmacist and in her current role as Managing Director of Boots Ireland, remains committed to delivering a pharmacy-led strategy which puts the wellbeing of colleagues, patients and customers to the fore. Passionate about the role of pharmacists within the wider business community, Bernadette sits on the boards of Business in the Community and Retail Ireland.

Cormac Loughnane, Group Superintendent Pharmacist, Allcare Pharmacy Cormac and his Allcare support team have had a busy 2019. Earlier in the year they secured a substantial investment which allowed them to expand Allcare’s health services offering. This facilitated greater access to cholesterol testing, diabetes screening and 24-hour blood pressure monitoring for patients in 18 pharmacies that recently joined the Allcare family. In December, he was invited to present at a national pharmacy conference in Katowice, Poland. “Farmaceuci Bez Granic” (Pharmacists Without Borders) aims to showcase innovation in pharmacy across Europe and Cormac was asked to share his experiences of how Irish pharmacists are continually evolving the profession in their efforts to improve primary healthcare in local communities.

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Conor Maloney, Pharmacist, Adrian Dunne Pharmacy Baldoyle Conor was shortlisted as a finalist in the People’s Pharmacist of the Year Award for 2019, He was shortlisted for his work in going above and beyond for the community within Baldoyle which he serves as a Superintendent Pharmacist with the Adrian Dunne Pharmacy Group. Conor has been a pharmacist in Baldoyle for the last 7 years and regularly support charity and fundraising events.

Caoimhe McAuley, MPSI, Director of Pharmacy and Superintendent Pharmacist, Boots Ireland Caoimhe McAuley is Director of Pharmacy & Superintendent Pharmacist for Boots in Ireland. She has been instrumental in setting and realising the strategy for the Boots Ireland pharmacy business. This includes ongoing provision and delivery of quality pharmacy services such as emergency contraception, winter flu vaccination as well as traditional prescription services. She has been a true innovator across 2019 in launching a new travel vaccination service and most recently a prescription ordering service via the Boots app. McAuley joined Boots 12 years ago and was appointed to the role of Director of Pharmacy for Boots Ireland in 2017 and also holds accountability as Superintendent pharmacist. McAuley remains committed to expanding the role of pharmacy professionals as a primary health provider, in line with national priorities.

Sharen McCabes, Pharmacist/Chairperson, McCabes Pharmacy Group McCabes Pharmacy Group are consistently acting with innovation. Earlier in 2019, they commissioned a research survey on the skin health. More than half of the Irish public confessed to not knowing that they should protect their skin from the harmful effects of pollution, according to the research. McCabes Pharmacy also marked a special anniversary recently with their store in Wexford town celebrating 60 years in business. Sherwoods Pharmacy opened on the 1st April 1959 and became McCabes Pharmacy in 2006.

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Top 100 - Retail60Leaders

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Eoin McCartan, Supervising Pharmacist, McCartan’s Pharmacy Northside Eoin has worked hard over the last 2 years to establish McCartans Pharmacy Northside as one of the most prominent in the area. He is continually striving to ensure his pharmacy team are kept updated with the latest training and educational, writing and compiling training guides and manuals on a variety of topics. He attends CPD courses and uses the information gained from these to implement service changes and enhancements.

Peter McElwee, Pharmacist/Owner, McElwee totalhealth Pharmacy The McElwee family have been operating pharmacies in Laois since 1975 when James A and Mary started their first store in O'Connell Square in Mountmellick. Their son, Peter joined the family business in 2001 and is now Managing Director of McElwee totalhealth Pharmacies three stores at O’Connell Square Mountmellick, Davitt Shopping Centre Mountmellick and at the Cedar Clinic Portlaoise. Peter moved the business forward in 2019 by joining the totalhealth Pharmacy Group. The focus for Peter and his team is the patient’s health and wellbeing.

Tony McEntee, Chief Operating Officer, McCauley Health & Beauty Pharmacy The McCauley Health & Beauty Pharmacy Group opened a flagship store earlier in 2019 and followed that up with investment in re-brand of many of their existing stores. As part of the re-brand, McCauley has evolved every aspect of the business - health, beauty and pharmacy - to meet the changing needs of its customers. Recognising such a market shift, McCauley is positioning itself as a leader in the self-healthcare space, empowering customers to make better lifestyle choices. Tony was appointed CEO of the Sam McCauley Chemist Group in 2017. He joined McCauleys following the completion of a majority investment in the group by the private equity fund established by The Carlyle Group and Cardinal Capital Group, Carlyle Cardinal Ireland (CCI).

Jennifer Mendes, Supervising Pharmacist, McCauley Health & Beauty Pharmacy Williamstown In Sam McCauley Williamstown, the team is happy to accommodate local students for work experience throughout all year. Jennifer teaches and coaches them on their learning journey whether in transition year or if they are completing the IPU OTC course in Waterford College. Jennifer has a strong belief that by educating our local community it will attract more professionals into a healthcare career but also increase health literacy amongst them. In addition, Jennifer organises sponsorship for local clubs, charities and businesses. Recently she sponsored Waterford Park RFC with a first-aid kit and offers gift hampers to many associations and companies in Waterford community, such as Farronshoneen Youth and Community Centre, Acquired Brain Injury Ireland (appreciation letter attached), Dunmore East Community First Responder, Gailltir Camogie Club, Solas Cancer Care Centre, Waterford Hospice, Pieta House, Waterford Intellectual Disability Association, amongst others.

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Jonathon Morrissey, Pharmacist/Owner, Marron’s Pharmacy, Clane Jonathon Morrissey, Community Pharmacist and owner of Marron’s Pharmacy in Clane, ws recognised with the prestigious MediMarshal Community Pharmacist of the Year Award 2019. The MediMarshal Community Pharmacist of the Year accolade recognises Jonathon as a pharmacy professional who is defining the future standard of pharmacy through his excellence in practice. Via his contribution and leadership to the profession, Jonathon has demonstrated enhanced patient care and displaying the core values of pharmacies at the heart of every community in Ireland.

Ronan Mulligan, Managing Director, Mulligans Pharmacy Group Ronan Mulligan is Managing Director of Mulligans Pharmacy Group, which has Ireland’s only Drive-through Pharmacy. Mulligans has a rich history, which began 61 years ago in 1957 when Jim and Sheila Mulligan established the first of many Mulligans Pharmacies at 25 Georges Street, Waterford. Fast forward to 2019 and Mulligans Pharmacy has seen tremendous expansion, renewal and innovation with the Mulligan family still at its helm, now operating 17 stores across the South East, offering pharmacy services, health & beauty clinics, and a host of premium brands and giftware.

Ramona Nicholas, Pharmacist/Director, Cara Pharmacy Group At the end of May this year, the Cara Pharmacy Group officially opened the door of its first Dublin store, located on Pottery Road, Dun Laoghaire. The premises, formerly Abbey Healthcare, were acquired by the group in 2017, and after months of preparation, hard work and remodelling Ramona and Canice along with the team invited customers to celebrate newest addition to the Cara family with them. It was the Group’s acquisition of Abbey Healthcare that brought them to Dublin, and which also saw them open stores in Cork. This was an exciting development for the Cara Brand, which will forecast employee numbers to increase from 160 to 245 and one that takes them nationwide.

Rory O’Donnell, O’Donnell’s totalhealth Pharmacy, Derrybeg Rory O’Donnell is the pharmacist owner of O’Donnell’s totalhealth Pharmacy Derrybeg, Co. Donegal. Rory is a huge industry contributor, serving as Chairman of the Board of the totalhealth Pharmacy Group, as Chairman of PAPS- the Pharmacy Assistance Purchase Scheme, as Chairman of HMR (Health Market Research) Ireland and has recently been re-elected to the IPU Executive. In the past Rory served as President of the PSI Council of Ireland, President of the IPU and President of the Pharmacy Benevolent Fund. Rory recently found time in his busy schedule to do some lecturing at the RCSI! In 2019, Rory was a key driver in the formation of a new company by totalhealth called “Pharmacy Assistance Purchase Scheme” or “PAPS”as it has become known. Recognising the difficulties for young pharmacist to get started in buying their first pharmacy and for owners wanting to retire to see their pharmacy, totalhealth launched PAPS as an investment opportunity for their own members as well as a secure avenue for growth. This new development is creating great interest from within the totalhealth network and from the industry at large.

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Top 100 - Retail60Leaders Brian O’Donoghue, Pharmacist/Owner, O’Donoghue’s totalhealth Pharmacy, Virginia Community Pharmacist Brian established his own company to manufacture and distrubute blister packs, making it easy for patients to take the right doses of the right medicines at the right time. In addition to blister packs, the company has also developed a cloud-based software platform which allows pharmacists and doctors as well as nursing home and hospital staff to engage more effectively in a patient's care. Located in Virginia O’Donoghue’s totalhealth Pharmacy has been in Virginia, County Cavan for over 100 years.

Laura Dowling, Supervising Pharmacist Manager, LloydsPharmacy, Dublin Pharmacists are the most easily accessible healthcare professional. So a few years ago Pharmacist Laura decided to make her knowledge even more accessible and go online under the alias Fabulous Pharmacist. It was an attempt to inspire people to lead balanced, healthier lives in a consistent and achievable way that avoided short-term fads. There is so much misinformation on the internet and social media that Laura believed she could bring some ‘sense to the nonsense.’

Niamh O’Dwyer, Pharmacist, Haven Pharmacy Butlers, Birr Niamh always aims for the highest professional standards while at work in the pharmacy and has fostered an environment of life-long learning and on the job training for all her colleagues. This consists of both structured and less formal opportunities but it manifests in a highly educated and informed workplace. During 2019 she has driven the flu vaccination and cholesterol testing aspects of Haven Pharmacy, developing them into busy commercial concerns. In addition Niamh regularly hosts inhaler technique workshops and is currently investigating the feasibility of a blood coagulation clinic in the pharmacy.

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Oonagh O’Hagan, Pharmacist/Owner/Managing Director, Meaghers Pharmacy Group With Oonagh at the helm, Meaghers Pharmacy Group continues to grow in strength, opening its ninth pharmacy store earlier this year. In 2019 Meaghers announced they are part of Ireland’s first pharmacy-led Diabetes Liver Screening which highlights the importance of screening for people with type 2 diabetes. They also picked up the Customer Experience Award in Pharmacy/Healthcare at the CX awards Ireland. This was for their outstanding team across all stores and online Meagher's Pharmacy Group. Oonagh and the team are also supporting the promotion of emptive use of antiretroviral medication for at-risk populations to combat new HIV infections across Ireland, with specialist training for its staff across its networks of pharmacies.

Paul O’Hea, Pharmacist/Director, Inish Pharmacy, Inishowen Paul O’Hea’s Inish Pharmacy is renowned for its excellent and innovative online offering in services and education. With a community pharmacy background Paul is passionate about excellent patient care and determined to make www.inishpharmacy.com the leading online pharmacy in Ireland. Inish Pharmacy Carndonagh moved to bigger premises in March of this year. Their new larger store is open 7 days a week. Inish Pharmacy is an independent pharmacy and healthcare formed in 2007.

Keith O’Hourihane, Director/Superintendent Pharmacist, Pharmacy First Plus, Cork When a fire damaged part of a shopping centre in Douglas earlier this year, which houses a Pharmacy First Plus store, Keith and his staff reacted immediately to ensure all patients were still able to receive their medication. Also this year, Keith took part in April’s Defeating Diabetes month for Pharmacy First Plus. He has extensive experience in community pharmacy and has sat on various committees in both the Irish Pharmacists’ Union and the Pharmaceutical Society of Ireland.

Roma O’Loughlin, Pharmacist/Owner, Haven Pharmacy Monkstown Roma O’Loughlin has been serving the community of Monkstown Farm and Monkstown for 30 years. Located in Dun Laoghaire, Co. Dublin, Haven Pharmacy is a family run pharmacy that prides itself on delivering a professional service with a friendly smile. Established over 60 years ago, Monkstown Pharmacy has been known for its welcoming staff and excellent health services and now has been rebranded as Haven Pharmacy. They recently introduced top of the range beauty products from the biggest brands onto our shelves.

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Top 100 - Retail60Leaders Conor Phelan, Pharmacist/Owner, Phelans Pharmacies Phelans Pharmacies are a family-owned group of pharmacies based in Cork city and county in the South of Ireland and one outlet in Stillorgan, Co. Dublin, run by Conor and his wife, Denise Phelan. Following Conor’s graduation from Trinity College Dublin, he and his wife Denise opened their first pharmacy in Carrigaline, Co. Cork, in 1988. In 1991 they introduced the late-night pharmacy concept to Cork and in the intervening years they have expanded and now operate pharmacies in Carrigaline, Glanmire, Cork city centre (Patrick St) and on the Kinsale Road roundabout. More recently they have introduced a complete mobility aids supply service in Phelans midnight pharmacy on the Kinsale Road with a wide range of products available to browse instore or online.

Ronan Quirke, Pharmacist/Owner, Quirke’s Pharmacy Clonmel When Clonmel Pharmacist Ronan Quirke decided to update the family pharmacy, the intention was a refurbishment project. What he ended up with, was Ireland’s only passive pharmacy, which heats itself. The super low energy project: a three-storey building in Tipperary became Ireland’s first certified passive house pharmacy. Quirke’s Pharmacy in Clonmel is only the third nonresidential building in Ireland to be independently certified as having achieved the benchmark passive standard in energy efficiency and it’s proving popular with owners and staff.

Mairead Reen, Pharmacist, Reen’s Life Pharmacy Millstreet Camogie Reen’s Life Pharmacy turned 80 this year and made sure their customers were on hand to celebrate the event with them. The Pharmacy has been in three generations of family since 1939. Mairead was nominated and shortlisted in 2019 for the Sanofi Pharmaton People’s Pharmacist of the Year Award. She was nominated for her work within the community in helping her customers and patients with issues including special needs, cancer and suicide. Mairead and her team also raise vital funds every year for worthwhile local charities.

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Fiona Roche, Pharmacist/Owner, Roche’s Pharmacy Blacklion Pharmacist Fiona Roche sold her pharmacy in 2005 but took the brave decision to step back into the profession when she took it back on again this year. Her passion for her profession, alongside historic family values, saw her re-open the much-loved Roche’s Pharmacy business in Blacklion, Greystones. Fiona got her old pharmacy team back together and within a very short period of time was back up and running, much to the huge delight of her customers and patients in Blacklion, Greystones.

Dr Paul Ryan, Pharmacist/Medical Director, Pharmabuddy In March of this year, Dr Paul Ryan and his team, worked with Accord Healthcare to provide pharmacists with a demo video on how to use the HSE Hi Tech Hub. The Hi Tech hub was introduced to all pharmacists by the HSE in March 2018 in an effort to streamline administration of the scheme for pharmacists and to provide enhanced visibility of stock management and spending on this scheme to the HSE. The video answers any queries pharmacists may have in relation to the Hi Tech Hub. They also launched a demo video on the use of Biosimilars later in 2019.

Shane Ryan, Pharmacist/Owner, Ryan’s Pharmacy Kildare Kildare-based pharmacy, Ryan's Pharmacy won the Services Category at the SFA National Small Business Awards 2019. Shane Ryan, who runs five pharmacies in Kildare and Offaly is thrilled with the award.The first pharmacy opened its doors in Rathangan, Co Kildare in 1996 and since then, through hard work and a genuine concern for the community he and the team have gone on to open four more Pharmacies in Edenderry, Derrinturn, Rhode and Daingean.

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Top 100 - Retail60Leaders

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Sinead Ryan, Pharmacist, Dublin Sinead Ryan has over a decade of practical experience working in community and hospital pharmacies in both the UK and Ireland. She is a part time lecturer in Therapeutics and Pharmacology in Technological University Dublin and Trinity College Dublin, and is about to graduate with an MBA in UCD Smurfit Business School with scholarships to Oxford and Yale Universities. She serves on the committees of the Irish Pharmacy Union, Pharmaceutical Society of Ireland, Health and Social Care Professionals (CORU), Irish National Accreditation Board and the Irish Medical Council. Sinead has also published a number of articles in industry magazines and national media, completes industry projects and is an IIOP Peer Support Pharmacist.

Ade Stack, Pharmacist/Owner, Stacks Pharmacy Group Ade Stack represents an entrepreneur, a successful woman in business and someone within the community pharmacy arena as having a proven track record in driving business forward. As the Stacks Pharmacy Group continue to expand in 2019, opening their eighteenth pharmacy in April 2019, she is a leader to the 192 people she employs across 7 counties. Ade is a strategically focused and commercially aware leader capable of operating both at an advisory level to senior teams yet possessing a strong ability in driving the execution of key business programmes and initiatives.

Emma Storrie, Pharmacist, Fairgreen Pharmacy Naas Emma ran a heart health month in February within her pharmacy, in which the team provided a service of promoting blood pressure checks in store. Emma was on hand to provide advice and referral to GP's when necessary. In November she also ran a diabetes awareness month, training staff and educating customers, which was hugely well received by the community. Those who were newly diagnosed with diabetes benefited greatly and understood the disease a lot more. She worked at increasing the business and gaining new customers in the community and takes great care of the community patients.

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Top 100 - Retail60Leaders Tom Treacy, Pharmacist/Owner, Treacy’s Pharmacy Ballinrobe Tom Treacy is known, and has been widely recognised, for his commitment to pharmacy excellence. His exceptional efforts have enabled pharmacy services to be delivered in a manner more beneficial to the community he serves. Alongside his team, they were shortlisted for the 2019 IPN/4Front Pharmacy Community Pharmacy Team of the Year. Tom Treacy runs his pharmacy in Ballinrobe as a modern and unique concept consisting of a pharmacy, health food shop, photo centre and treatment rooms. Treacy’s Pharmacy/Picture of Health has the sole mission to offer customers a onestop solution for all their health, wellness and lifestyle needs.

Diana Truta, Pharmacist, Hickey’s Pharmacy, Cork Diana is a caring and principled young pharmacist and has been instrumental in the setting up and operating of the Hickey’s Pharmacy Group’s two newest locations in Cork. She also plays an instrumental role in staff training, role playing with OTC assistants or training the future of the profession. Diana was involved in an anaphylaxis incident while working in O’Connell Street in April of last year. The young man is alive today because of her quick actions.

Sophie Tummon, Pharmacist, O’Sullivans Pharmacy, Cork Sophie is the Managing Pharmacist at O’Sullivans Pharmacy in Douglas. During 2019, this well known pharmacy group have been actively engaging with their customers and patients through a range of self-care, wellness and health education campaigns and events. Across all the stores they offer a free delivery service for those in the vicinity of their stores, free blood pressure checks, food intolerance testing and much more.

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Emma Vaughan, Supervising Pharmacist, Allcare Pharmacy Perrystown Emma was on hand towards the end of this year offering her pharmacy customers the latest guidance on the flu vaccine. She spearheaded a Flu FAQ video with Allcare Pharmacy and was also available to answer customers questions. Allcare Perrystown Pharmacy continue to provide great value prescriptions teamed with expert healthcare advice and boast a range of services such as Blood Glucose Screening, Diabetes 5 Point Health Check, Blood Pressure Check, Emergency Contraception, Smoking Cessation and Asthma Care.

Aneta Walczynska, Pharmacist/Manager, Remedi IFSC Pharmacy Dublin Dublin-based Remedi IFSC Pharmacy were recognised for their work and dedication, receiving the GSK Self-Care Award, 2019. In the face of rising costs and ageing populations, many people are themselves seeking more control over every aspect of their lives, including their health. There is a growing awareness of the need for preventable health, and consumers are driving a move towards self-care. The pharmacy team at Remedi IFSC has built slowly over the last number years. As the team increased in size, they were able to undertake more ambitious projects, which had a positive impact on wellbeing of their community.

Denis Walsh, Pharmacist/Owner, Walsh’s Pharmacy Galway Denis Walsh is the founder and owner of Walsh’s Pharmacy and is originally from Cork. He studied to become a pharmacist in the United Kingdom and now holds a BSc Pharm from University of Brighton. Denis’ role in the business is the Group Superintendent Pharmacist, as well as Managing Director. His focus, within the group, is promoting high standards and consistent improvement. The company reflects his own personal values of customer satisfaction, service and value. Walsh’s Pharmacy has been synonymous with excellence in healthcare advice and services for over fifteen years.

Tina Walsh, Pharmacist, Haven Pharmacy Baldoyle Tina Walsh, Retail Manager at Adrian Dunne Pharmacy Baldoyle left no stone unturned when organising a fundraising event in-store for local boy, Jimmie. As soon as Tina heard that Jimmie, age 3, was diagnosed with Rhabdomyosarcoma, a rare cancer that forms in soft tissue, she wanted to do what she could to help and went above and beyond to raise as much money for Jimmie and his family as she could. To this end, Tina decided to organise a fundraising event “Standing with Jimmie” on 19th September in Adrian Dunne Pharmacy in Baldoyle. She organised a Bake Sale and hounded all the local businesses for prizes to raffle off for the big day. All the staff in the branch fully got behind the event and called in favours from everyone they could. In the end, Tina and the team raised ¤4,500 for little Jimmie – an amount the family were thrilled to receive. The whole community came together and we were definitely #StandingWithJimmie

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Top 100 - Industry30Innovators

In this section we highlight the Industry30Innovators within the pharmaceutical industry; those with the proven knowledge and expertise within their field who are ensuring that initiatives are borne to the betterment of the pharmacy profession. These individuals, and the professional bodies/companies they represent play a critical role in ensuring pharmacists and their teams are able to seize the opportunities and squarely meet the challenges. Bridget Barcoe, Nurofen Marketing Manager, RB It has been a strong year of growth for the Nurofen brand in pharmacy. The big news of 2019 was the launch of Nurofen Rapid Relief Liquid Capsules in February, which was supported by an extensive education program and backed by a highly effective above the line campaign. Bridget has been championing this as a great example of RB’s mission to empower patient self-care. RB’s purpose is to ensure people live healthier and happier lives. “It has been an exciting year for Nurofen, recognising a consumer need gap and using this to shape our innovation. I look forward to building on the success of Nurofen Rapid Relief with our trade partners in 2020,” she says. 125 million pain occasions were treated by Irish Pharmacy over 12 months and 40 million of these were treated with Nurofen. *Nurofen Rapid Relief Liquid Capsules were launched in February 2019 providing over the counter fast and effective pain relief to patients. ** Nurofen now accounts for 44% of the Mild Pain market. *** *IMS Data Aug 2018 **Nurofen Rapid Relief Maximum Strength 400mg Liquid Capsules contain Ibuprofen. For pain relief. Always Read the Label. ***IMS Data June 2019 ZINC No. IRL/CC/1219/0039. Date of preparation: Dec 2019

Dr Catriona Bradley, Executive Director, Irish Institute of Pharmacy 2019 continued to be a successful year for the IIOP which also saw the launch of several educational support tools. In May 2019, the outcomes of the 2018/19 ePortfolio Review were published. Of the 1338 pharmacists included in the review, 97.6% participated in the process, of which 99.6% met the ePortfolio Review Standards, thus demonstrating systematic and ongoing engagement with CPD. The IIOP also launched the Management of Benzodiazepines and Z-drugs Training Programme which aims to educate healthcare professionals on the legislation pertaining to benzodiazepines and the implications for patient care in practice and Mentorship Skills Training for Pharmacists. Dr Bradley has held various positions across the areas of pharmacy, education, research and HR. She has completed diplomas in Quality Improvement, Legal Studies and Coaching, and is a qualified executive and personal coach. She’s passionate about supporting and enabling pharmacists to realise their full potential.

Niall Byrne, Registrar and Chief Officer, Pharmaceutical Society Ireland A new Code of Conduct for pharmacists was published this year, representing a significant body of work for the PSI over the past two years. The new Code came into effect in October and during the autumn, the PSI held a series of information events around the country to provide pharmacists with the opportunity to discuss the key themes in the code. “I consider these events to be crucial opportunities for us and for registered pharmacists to come together and to consider issues of significance for pharmacists as healthcare professionals. I look forward to working with the pharmacy sector and to more of these beneficial engagement opportunities next year,” says Mr Byrne.

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Leonie Clarke, General Manager, Irish Medicines Verification Organisation The IMVO has, alongside other key stakeholder organisations, been instrumental in overseeing the successful embedding of the new Falsified Medicines Directive in Ireland at the start of 2019. Leonie Clarke has been with the Irish Medicines Verification Organisation (IMVO) since October 2015. She has run her own consultancy since 2006, advising clients in the pharmaceutical and healthcare sector on medicines legislation, industry codes of practice and corporate governance. She started her career with the Irish pharmacy regulator and also has extensive experience in the pharmaceutical industry, including a number of years as Scientific & Regulatory Affairs Manager with the international research-based industry trade association in Ireland, IPHA. Leonie is a former Chairperson of the European Pharmacy Students Association, and President and board member of the Irish pharmacy regulator.

Chris Coleman, Consumer Buyer, Uniphar Chris Coleman joined Uniphar in 2014 in a customer service supporting role and has rapidly developed within the business, now holding a role as senior buyer for the Uniphar LinkUp Consumer division. He has played a key role in Unipharâ&#x20AC;&#x2122;s consumer strategy over the last 18 months, diversifying and expanding the consumer offering and giving margin back to pharmacies through their enhanced front of counter. His skills also expand to the operations side where he has implemented processes to increase business efficiencies that have resulted in overall better service experienced by customers.

Elaine Enright, University College Cork, Fulbright Student Elaine was one of the 37 recipients of the Fulbright Irish Awardees for 2018-2019. Elaine is a pharmacist having completed a BPharm at University College Cork and an MPharm at Royal College of Surgeons in Ireland. Currently, Elaine is an Irish Research Council PhD Scholar based at the APC Microbiome Institute, UCC. Her PhD research investigates the influence of gut bacteria (the microbiota) upon oral drug delivery and efficacy. As a Fulbright Student Awardee to Purdue University, Indiana, Ms Enright will investigate the impact of gut microbial bile acid metabolites on the solubility and absorption of oral dosage formulations.

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Top 100 - Industry30Innovators Stuart Fitzgerald, Director, Fitzgerald Power Towards the start of 2019, Fitzgerald Power, along with the Bank of Ireland launched a report providing an overview of the pharmacy transactions market and analysing key trends over the last two years. The report revealed that 2018 was a busy year in the pharmacy transactions market with sales of pharmacies in 2018 (33) almost double those in 2014 (17). Average deal values remained steady year on year, ranging from between ¤1million to ¤1.5million, with the greatest demand for opportunities in Dublin reflected in the prices achieved. Stuart was the co-author of this report. During 2019 Stuart and the Fitzgerald Power team also published “Review of the Community Pharmacy Sector, 2018: The Professional Forces Shaping the Sector” and “The Irish Community Pharmacy Wages & Employment Report 2019” both on behalf of the Irish Pharmacy Union. Stuart continues to advise pharmacy owners across Ireland on all aspects of their businesses from acquisitions & disposals to performance appraisal & profit maximisation.”

Sandra Gannon, CEO, Azure Pharmaceuticals Following a career spanning almost 25 years with Teva Pharmaceuticals, ex-General Manager Sandra Gannon opted to redirect her entrepreneurial and commercial drive into a new dynamic venture in the Irish medicines market. She established Azure Pharmaceuticals in May 2018 and the company launched its first products in Ireland in November this year. Azure’s initial focus is on filling the gaps in the medicines market – those left when products become too old and low value to be of interest to multinational pharma companies. Azure’s arrival in the market is timely given the current extent of medicine shortages and the fact that they are likely to worsen after Brexit. As a new company, with an ability to be agile and innovative, Azure believes that it can make a significant contribution to the health and wellbeing of Irish patients.

Professor Anne Marie Healy, Head of School, School of Pharmacy, Trinity College Dublin Professor Healy recently secured funding for a UK-Ireland research and training partnership programme. She is a Professor in Pharmaceutics and Pharmaceutical Technology in the School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin (TCD) and is currently Head of School. She has a B.Sc. in Pharmacy and a Ph.D. in Pharmaceutics, both from the University of Dublin. SSPC, the Science Foundation Ireland (SFI) Pharmaceutical Research Centre, has won new funding under the EPSRC-SFI Centres for Doctoral Training (CDT) Partnership programme. The funding, secured from SFI, will enable the SSPC to engage with two of the world leading Schools of Pharmacy in the UK, at the University of Nottingham and University College London, in a new CDT in Transformative Pharmaceutical Technologies.

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Dr Paul Kavanagh, Director of Public Health Medicine, HSE Dr Kavanagh is the Director of Public Health Medicine, HSE North East and Public Health Adviser to the HSE Tobacco Free Ireland Programme. It is within this role that, during 2019, he has been actively working with organisations across the country to promote smokefree environments and de-normalise smoking among adults and young people. He has also co-authored a study with Dr Ian Quintyne which identified and evaluated the quality of methodological rigours and transparency used in guidelines for smoking cessation for specific groups including general adult population, persons with mental illness, and pregnant women.

Joanne Kissane, Director & National Co-ordinator, APPEL Joanne was appointed Director and National Co-ordinator for APPEL (Affiliation for Pharmacy Practice Experiential Learning) in 2019. APPEL manages the experiential learning placements of the integrated pharmacy programmes of the three Schools of Pharmacy in Ireland. Joanne worked as a community pharmacist with LloydsPharmacy until 2011 when she became Superintendent Pharmacist for the group, a role she held for seven years. While Head of Operational Excellence she was responsible for leading the implementation and management of a highly efficient, customer-centric store operating model. She is currently undertaking a Masters in Quality and Safety in Healthcare Management in the Royal College of Surgeons in Ireland.

Aidan Lynch, President, Irish Pharmaceutical Healthcare Association As President of IPHA, Mr Lynch represents the research-based pharmaceutical industry in Ireland whose companies are discovering and manufacturing innovative medicines that enhance and save lives. Vice President and General Manager of GSK (Ireland) Limited, he was elected as President in October of last year. “Our industry, made up of pharmaceutical innovators, has a major stake in Ireland’s future. Our medicines are helping people live longer, healthier lives; our scientists are discovering tomorrow’s cures; and we are creating high-value jobs in a fast-growing economy. But we face challenges. Among these is closing the gap between access and innovation,” he says.

Dr Frank Moriarty, Royal College of Surgeons in Ireland,· HRB Centre for Primary Care Research Dr Moriarty was involved in a study presented at the 2019 All Ireland Pharmacy Conference, which explored the enablers of pharmacy research. This highlighted the interests of members of the pharmacy profession in research and provides valuable stakeholder opinion. He completed his PhD in 2016 as part of the HRB Scholars Programme in Health Services Research (the SPHeRE programme), which was entitled "Pharmacoepidemiology and economic evaluation of measures potentially inappropriate prescribing". Frank also has experience practicing as a community pharmacist. He began working at the HRB Centre as a postdoctoral researcher in 2016, and took up the position of senior research fellow in April 2018.

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Top 100 - Industry30Innovators Gwynne Morley, General Manager, IQVIA

Gwynne recently presented as the IPHA 2019 Innovate for Life Conference, where she engaged with stakeholders on the future of medicines. Gwynne previously held the positions of Commercial Manager (IQVIA), Director of Heart & Vascular, Diabetes & Emergency Department at the Mater Private and Managing Director at Uniphar Retail Services division. She has extensive experience and knowledge of the pharmaceutical industry, from the manufacturer to the patient. Previously she worked for United Drug Group (UDG) Healthcare for 13 years where she was a member of the Senior Executive team. During her tenure with UDG, she held a number of senior roles namely in pre-wholesale, consumer, homecare and quality.

Eibhlin Mulroe, CEO, Cancer Trials Ireland In March of this year, Eibhlin and the Cancer Trial Ireland team presented to the Joint Oireachtas Committee for Health where they pressed the case to reverse the 20% cuts to cancer trials research. In May they launched the Cancer Trials Ireland’s Just Ask Your Team campaign and said that the ¤3 million cut in its grant is now having a direct impact on potentially breakthrough treatments being available for people in Ireland with cancer. Under her leadership, Cancer Trials Ireland rebranded, moved to a bespoke office space, commissioned an Economic Impact Report (DFK) on cancer trial activity in Ireland, worked with InterTrade Ireland in 2017/8 to revisit the all-Ireland cancer trials network and established a Patient Advocate Advisory Group.

Johnny Murphy, Head of Consumer Health, A.Menarini Pharmaceuticals Ireland Ltd Johnny launched the new RELIFE dermatology division in 2019. RELIFE products are now available in over 230 pharmacies nationwide. This success has meant that the RELIFE dermatology division has grown from a headcount of one full time equivalent (FTE) to six FTE's, including a dedicated Scientific Advisor & Training Specialist, a Sales and Product Manager, and three fully dedicated RELIFE Territory Leads. The RELIFE dermatology division has an exciting pipeline and an ambitious plan to develop and grow the business into the future. The Relizema range was the first of the RELIFE range of products to be launched onto the Irish market. Relizema, helps manage conditions like eczema, dermatitis and dry and sensitive skin.

Eimear (Nallen) Nee, MPSI, Pharmacy Trainer, Uniphar Retail Services & Supply Chain Eimear has more than 10 years’ experience as a community pharmacist and joined Uniphar as a Pharmacy Trainer in 2018. Eimear delivers regional and face-to-face training to pharmacies across the country and was responsible for the launch of Uniphar’s online training programme earlier this year. The programme aims to make training accessible to all regardless of location or time constraints, helping to raise standards across the profession in Ireland. With a projected 20% increase in pharmacy consultations by 2030, ongoing clinical and pharmacy practice training is vital to ensure continued excellence in the profession with the imminent increased pressures. Eimear also acts as a Peer Support Pharmacist with the IIOP.

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Top 100 - Industry30Innovators Dr Lorraine Nolan, Chief Executive, Healthcare Products Regulatory Authority During 2019, the HPRA under Dr Nolan’s leadership, has witnessed progress in areas such as increasing levels of collaboration and engagement, particularly with regards to preparations for Brexit. Dr Nolan joined the HPRA in 2001 and since that time has held a number of different roles at senior level within the organisation across a range of areas including inspection and authorisation of human medicines, medical devices, cosmetics and controlled substances. Prior to assuming the role of Chief Executive she was Director of Human Products Authorisation & Registration. Ms Nolan is a member of the Management Board of the European Medicines Agency.

David O’Brien, Commercial Director, Uniphar Retail Services & Supply Chain David joined the Uniphar team in December 2016, bringing with him more than 15 years’ of senior management commercial experience in FMCG. He previously worked with both Kerry Group and Coca-Cola Hellenic. As part of the Uniphar Retail Services and Supply Chain division, he is responsible for implementing a commercial and sales strategy that puts the success of Irish pharmacies at the forefront. Among his key focuses is unlocking category growth opportunity and increasing margins in retail pharmacy. David holds a master’s degree from UCD and previously graduated from NUI Galway with a Bachelor of Commerce (International).

Professor Moira O' Brien, Founder & President, Irish Osteoporosis Society Professor Moira O’Brien was involved with the IOS Dishes for Density initiative, which was shortlisted at the recent Health care awards. The initiative was to increase awareness about the importance of healthy bones. Baz and Nancy Ashmawy were involved with raising the importance of everyone checking to see if they have risk factors for bone loss and videos with Chef Eunice Power who showed the public how to make healthy meals, which included calcium and vitamin D, which are essential nutrients for bone health. 50% of women and 25% of men aged 50 will break a bone from Osteoporosis, it is not just an older women’s disease. The only cancer that supersedes Osteoporosis in death is lung cancer.

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Daithi O’Connor, CEO, Revive Active In April of this year, Revive Active opened a ¤1million production facility in Mullingar to Brexitproof the business that previously depended on a Welsh factory to manufacture its products. Mr O’Connor describes it as “the best thing we have ever done” as it allows more control over the product and its quality. It also means the company will bump its staff to 40 by the start of the new year. Last year that number stood at 22. It was 2011 when O’Connor set out to build Revive Active and he has since grown the business to provide a range that includes supplements to support energy levels, muscle recovery and healthy joints. O’Connor’s products are now in more than 1,000 pharmacies across Ireland and his company is also expanding internationally.

Professor Catriona O’Driscoll, APC Microbiome Ireland Critical Path Institute (C-Path) announced the launch of Critical Path Institute Ltd in Ireland at the start of this year. This will allow them to increase activity in the EU as it works to accelerate the development of therapies in a wide range of diseases and conditions. Professor O’Driscoll has joined the Board of Directors, bringing a wealth of experience in innovation. Professor O’Driscoll is a pharmacist and Professor and Chair of Pharmaceutics at the School of Pharmacy in UCC.

Professor Pat O’Mahony, Chair, Irish Medicines Verification Organisation As Chairperson of the IMVO, Professor O’Mahony has overseen the embedding of the Falsified Medicines Directive within Ireland. IMVO has worked extensively with the relevant State organisations to ensure a successful system is in place. Ireland is now in compliance with the EU Falsified Medicines Directive (FMD), which provides more safeguards and security to ensure Irish patients will continue to have absolute confidence in the medicines they receive from their pharmacy. Professor O’Mahony was appointed as independent chairperson of IMVO in June 2017. He has a long and varied experience in pharmaceutical regulation and public health through previous roles such as Chief Executive of the Health Products Regulatory Authority, Deputy Secretary General and Head of Governance and Performance at the Department of Health, and Chairman of the Management Board of the European Medicines Agency.

Paul O’Neill, Sales Director, Cosmetic Association As Sales Director of Cosmetic Alliance, this year Paul and his team have brought some exciting brands to market. Paul has been involved in the pharmacy industry for many years, particularly within teams launching dynamic brands. The main attraction this year was a brand by Formawell, an exciting hair tool range which has collaborated with Kendall Jenner. He believes that the beauty industry has changed and more so the way you market the products. He says relationships with key influencers and bringing product to market that excites them drives the end consumer to our community pharmacies. Paul has some very exciting brands for 2020 and specifically with in the colour cosmetic space. Paul is excited to launch this brand and is looking forward to the continued support from pharmacies around the country.

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Top 100 - Industry30Innovators

Averil Power, Chief Executive, Irish Cancer Society In November of this year, the Society released their second Real Cost of Cancer Report which found that cancer patients are also losing an average of ¤18,000 a year in income, or over ¤1,500 per month, as a result of their cancer diagnosis, making it even more difficult to pay for increased costs. They have also funded a plethora of research during 2019. Former President of Trinity College Dublin Students’ Union (TCDSU), Averil was appointed Chief Executive of the Irish Cancer Society in 2017. The appointment comes after her position as chief executive of the Asthma Society of Ireland in August 2016. The charity played an major role in the development of the government’s National Cancer Strategy 2017-2026.

Ger Rabbette, Chief Executive Officer, Uniphar Uniphar has diversified under Mr Rabbette, setting the foundations for a business that would ultimately raise ¤135m in an IPO. Pharmaceutical distribution industry veteran Ger was named The Irish Times Business Person of the Month for July 2019, an award run in association with KPMG. An industry veteran, Mr Rabbette joined Uniphar from Celesio, where he was Managing Director of Movianto and Head of Celesio Manufacturing Solutions. He is a Chartered Accountant by training and has held a range of senior positions in supply chain with Cahill May Roberts and the wider Celesio Group. He was appointed Chief Executive Officer in 2010.

Paul Reilly, Managing Director, United Drug Ireland In March of this year, United Drug announced an agreement with Mountpark Logistics to lease Unit A of the Mountpark Baldonnell Development. The long-term lease will see United Drug locate their main warehouse facility in the ¤40m purposebuilt logistics development in Mountpark. In April, United Drug held its 13th Pharmacy Show, with record registrations of over 600 guests for the two-day event, the biggest of its kind in Ireland. United Drug brought insights, knowledge and expertise to the Pharmacy sector through Ted Talk style sessions, called UD Talks, as well as offering attendees the opportunity to meet suppliers and broaden their knowledge to grow their business. United Drug is Ireland’s largest pharmaceutical distribution company and is part of McKesson Europe, a leading company in the healthcare sector, with strong brands across 13 European countries.

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Top 100 - Industry30Innovators

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Paul Reid, Director General, HSE The Government announced the appointment of Paul Reid as Director General of the Health Service Executive early in 2019. The post had been vacant since Tony O'Brien left the position last summer. He says his three priorities for healthcare are the delivery of quality and safe services, transitioning to a new model of integrated care and strengthening confidence and trust in the organisation. Mr Reid was Chief Executive of Fingal County Council, a role he occupied since 2014. He previously worked in the Department of Public Expenditure and Reform, as well as Eircom and Trócaire.

Dr Máirín Ryan, Director of Health Technology Assessment & Deputy Chief Executive, HIQA In April of this year, the Health Information and Quality Authority (HIQA) published a health technology assessment recommending the introduction of a pre-exposure prophylaxis (PrEP) programme for populations at substantial risk of sexual acquisition of HIV. HIQA advised the Minister for Health that the HTA found that the successful implementation of a national PrEP programme in Ireland would be safe, effective and cost-saving. Dr Ryan was appointed Deputy Chief Executive in September 2014. She joined HIQA as Director of Health Technology Assessment (HTA) in September 2007. Prior to this appointment, she was the Chief 1 Pharmacist at the National Centre for Pharmacoeconomics and previously a senior clinical pharmacist at St James’s Hospital in Dublin with responsibility for HIV clinical pharmacy services.

Mrs Wagner-Halswick, Managing Director, Rowa Pharmaceuticals Ltd In September 2019, Rowa Pharmaceuticals Ltd, reached a monumental milestone as the company celebrated 60 years in business. Ask anyone in Bantry and they will tell you that this achievement is due in part to the company’s dynamic managing director, Mrs. Wagner- Halswick. Rowa which is based in Bantry, West Cork, has grown to be a highly regarded and reliable supplier in both the Irish market and 80 countries worldwide. After decades of hard work and determination, Rowa can proudly say that they export to 80 countries. Mrs Wagner has kept the business in Bantry despite multiple offers and opportunities to move the business especially during the recession. Rowa is a remarkable success story driven by a dynamic and determined business woman, Mrs Wagner-Halswick.

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Haven Pharmacy Awards

Haven Pharmacy Celebrates Excellence at Awards Night 2019 Haven Pharmacy hosted their 6th Annual Awards night on Saturday 30th November in the Killashee Hotel, Kildare. The much-anticipated night welcomed over 260 guests from Haven Pharmacies across Ireland as well as many of Haven’s Commercial Partners. This very special event celebrated not only the dedication and commitment of individuals, but also the professional excellence, community care and customer focus demonstrated by independent Haven pharmacies. A total of nine awards were presented on the night: Haven Rising Star, Haven OTC Assistant, Haven Pharmacy Technician, Haven in the Community, Haven Community Pharmacist, Haven Ambassador of the Year, Haven Special Achievement, Haven Customer Service Team of the Year and Haven Pharmacy of the Year.

Mr. Connolly noted that the co-operative ethos of helping improve the health and well-being of patients & customers in local communities was part of the Haven DNA. He praised the teams on raising over ¤55,000 for charities including CRY Ireland, Beaumont Hospital, Pieta House, Childline, Temple Street Children’s Hospital, the Irish Cancer Society and Cystic Fibrosis Ireland to name just a few.

He concluded by extending his thanks to all the sponsors for the event - Clonmel Healthcare, KBC Bank, Perrigo, Accord Healthcare, Fitzgerald Power Accountants, GSK Ireland, Reckitt Benckiser Ireland Ltd., Uniphar Retail Services, United Drug, Fleming Medical, HMR Ireland, Parle & Hickey, iMed, Sam McLernons, Touchstore, Teva Pharmaceuticals and Azpiral – and said he looked forward to another successful year for Haven in 2020.

Jack Wise, MC for the night, wowed the audience with his winning combination of jaw-dropping magic tricks and razor-sharp wit ensuring the audience were thoroughly entertained all night. Over ¤2,000 was raised on the night for Bumbleance, the Childrens National Ambulance Service.

Indepharm Co-Op and Haven Pharmacy Chairman, Daragh Connolly, thanked everyone for their input into another successful year for the Group. He welcomed new Co-op members and new staff to the Haven family and congratulated the Pharmacy Interns who were placed on the PSI Register earlier this month and continue to practice as Pharmacists within the Haven group. Mr. Connolly said that the staff in Haven directly contributed to the success of Haven and he was delighted with the results of a recent Haven Staff Satisfaction Survey which confirmed that over 88% of staff are happy to work in Haven and 80% would recommend working in Haven to a friend. The results of the survey reinforced the positive impact of being in the Haven Pharmacy Group as well as the strong bonds of collegiality between the pharmacy teams.

Haven Pharmacy of the Year – Haven Pharmacy Butlers, Birr, Co. Offaly sponsored by Clonmel Healthcare Ltd and presented by Barry Fitzpatrick

Haven Pharmacy Technician of the Year (Joint Winner) – Lauren Kelly, Haven Pharmacy Brennans Barna and Helen Condon, Haven Pharmacy Dohertys Beaumont Dublin sponsored by Fitzgerald Power and presented by Noel Winters

PHARMACYNEWSIRELAND.COM

Haven Rising Star – Marie Kelly, Haven Pharmacy Hollys Liosban, Co. Galway sponsored by Accord Healthcare and presented by Gregg Farrell


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Haven Community Pharmacist of the Year – Aideen Delaney, Haven Pharmacy Raffertys Stillorgan, Dublin sponsored by KBC Bank and presented by Michael O’Grady

Haven Pharmacy OTC Assistant of the Year – Ciara Leavy, Haven Pharmacy Mullingar, Co. Westmeath sponsored by GSK and represented by Maria Kenyon, Indepharm Ltd pictured here with Kieran Brennan and Andre Barbosa, Haven Pharmacy Mullingar

Haven in the Community – Haven Pharmacy Kennys, Tramore sponsored by United Drug and presented by Veronica Carragher

Haven Ambassador of the Year – Michelle Melia, Haven Pharmacy Cavan sponsored by Reckitt Benckiser Ireland Ltd and presented by Ciaran Woods

Haven Customer Service Team of the Year – Haven Pharmacy Hickeys, Rush, Co Dublin sponsored by Uniphar Retail Services and presented by Adrian O’Sullivan

Haven Pharmacy Special Achievement of the Year – Karl Bingham, Haven Pharmacy Moloneys, Dublin sponsored by Perrigo and presented by Niall McMorrow

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Business CPD

Santa – The Pharmacy Business Mentor? How to turn your Christmas Wish List into Reality in 2020 IPN’s Pharmacy Business Excellence Series is for community pharmacists committed to growing their professional and business knowledge and skills to overcome challenges and thrive as a community pharmacist. Each month, Rachel Dungan poses strategic questions aligned with 4Front’s 6Ps of Pharmacy Excellence Framework. She shares best practice tips, insights from pharmacy leaders and showcase examples of pharmacy business excellence in action. This month Rachel and 4Front Pharmacy.ie co-founder David McLean, interview Santa. Each article in the series is accompanied by a sample CPD Cycle to use as inspiration to take action and record the impact in your own CPD Cycle in your ePortfolio. Share your successes and submit your questions for the IPN/4Front Pharmacy Business Excellence Series to Rachel.Dungan@4FrontPharmacy.ie LEARNING OUTCOMES At the end of article, you will be able to: • Recognise what is within your control • Create strategies to turn your vision into reality • Measure the impact of the actions you take as you implement your strategy • Reflect on what you are willing to do to turn your vision into reality in 2020

LESSON CONTENT Have YOU written YOUR letter to Santa yet? Read what happened last year when this pharmacist did. This time last year, I was hoping for a good Christmas. Well, I was hoping that I would be able to sell much (all) of the Christmas stock we had purchased. I was hoping that last minute presents would make it a bumper year and that online shopping and scares over delivery time would not leave us with shelves and boxes of ‘Frozen themed’ bubble bath and gift sets of ‘Blue Stratus’ shave kits. I was hoping for the usual last-minute panic of others to clear out my Christmas stock. (In fact, I don’t remember buying ‘Blue Stratus’ shaving sets this year, or indeed last year, but every Christmas we dust them down and put them out again.)

Yes, Christmas can make or break a year in Pharmacy. But hope is not a strategy and last year I wanted something different from Santa. I wanted to dream big and change the way my business operated. I wrote a letter to Santa, with a wish list. The letter is private, but the list is below: Dear Santa, I have been a very good Pharmacist this year. I have always had a desire to serve my community and to provide employment in the local area. I am asking for your help to support me to fulfil my mission. Please could I have • A consistent increase in sales throughout the year • Consistently high-quality customer service, that makes me proud • Less worry and fewer errors in the medicine supply chain • Help with regulatory compliance And if I promise to be good, could you

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also help me to improve team morale and reduce my staff turnover… So, what happened?? Santa wrote me this letter. To be honest, it was a bit of a kick in the pants. Despite being the epitome of magical thinking, it seems that Santa has a reality based business model. Dear Pharmacist, Ho! Ho! Ho! and Merry Christmas from the North Pole. Busy as I am preparing for my big Christmas trip around the world, I wanted to make time to personally write to you. Your letter intrigued me, because your age profile and wish list does not fit our typical customer demographic. Frankly, most pharmacists your age have forgotten the magic of Christmas. They have forgotten how to dream big. They have forgotten why they became pharmacists in the first place. They have forgotten how to ask for help from mentors and receive that help with gratitude. They have forgotten how much of a privilege it is to become prosperous by dispensing health and happiness and being of service to others. What inspires me about your letter is that you have a dream. You have a measurable goal. You know you don’t have to do this alone. You have asked for help from someone who is ready, willing and able to help you. It seems that we both face very similar challenges. Christmas season is the busiest time of the year both for you and for us at the North Pole. Therefore, before I deliver your Christmas present on Christmas night, I’d like to give you a behind the scenes glimpse of my business model. What’s worked? What hasn’t worked so well? What I now do differently and why. I invite you to decide which three priorities you choose to relentlessly apply next year. All I ask in return is that you USE the gift I give you in your Christmas stocking and in December 12 months, tell me what actions you took, what worked, what didn’t work and what you will do differently in 2020. After all, dispensing joy, health and happiness is the best job in the world.

Santa’s Top Tips 1. VISION: Great visions start by dreaming big and writing down everything that is on your wish-list, without any constraints. Start by defining a compelling future vision you are proud to be associated with. Then work with your team to create and implement a roadmap to achieve it. Questions: If money and time were no object, what would you WANT to have happen? WHY is that important to you? 2. ALIGNMENT: Even though I have the ability to do everything myself, I don’t. It creates dependency and is disempowering to my team. The ‘I’ll do everything myself’ motto is isolating and creates all round resentment – the antithesis of the Christmas Spirit. Instead create a clear vision that inspires others to follow. The magic of Christmas (or any business) is created through extra-ordinary teamwork, 100% aligned to a common purpose. A leader’s job is to manage the energy of yourself and those you lead. Do not tolerate or enable toxic behaviours. They do not create magic moments. Questions: What attitudes and behaviours are critical to my 2020 vision becoming reality? What attitudes and behaviours must I stop tolerating in myself and others? 3. EXECUTION: Empower your team to perform at their best, by clarifying expectations, setting goals, creating measures to benchmark progress and providing them with the tools and accountability to deliver excellence. For example, my elves all know exactly what their role is, how they contribute to the overall team goal (every child gets their gift delivered on Christmas Eve), what the measures of success are. They know the quality standards that must be met and are provided with on-going training and support to meet these standards. I meet with them weekly to reflect on wins and challenges and prioritise the highest value work for the next week. Questions: How do you define excellent performance for you, for your team, for each member of your team? How do you know that each of your team shares the same definition as you? How do you enable your team to execute at the highest standard? How do you address poor performance? How do you acknowledge and celebrate excellent performance?


95 Santa’s Business Model Personal - I have a non-negotiable deadline (December 25th), which keeps me focused. Failure is not an option. I NEVER make excuses for anything less than 100% satisfaction. Do you have the ‘what if you had to?’ mindset, with a sense of urgency? Professional - We have Santa’s Code and a competency framework for the elves at the North Pole. Our goal is 100% customer satisfaction and 100% delivery rate. These standards apply to everyone – 100% of our team. Our motto is ‘We deliver joy.’ We pay close attention to customer satisfaction feedback, to spot emerging trends, mitigate risk and respond proactively to market shifts. In April and October, we conduct an internal audit of our customer engagement strategy, premises, production and distribution processes to identify areas for improvement and reduce the risk of product or distribution errors during the business Christmas period. People (Staff) - To maintain our competitive edge in an increasingly competitive market, our elves engage in continual professional development. Like all agile businesses, we adopt a blended learning approach where all elves, (including the part time elves we recruit in for the Christmas rush), complete their online learning before demonstrating their skills in my workshop. Once I am happy with the standards being produced, I check in periodically. If the elf is struggling to meet the standard, additional supports are provided. Our philosophy is ‘No elf left behind.’ In a tight labour market, we still attract and hire elves with a growth mindset. The only fireable offences are nonengagement in the training and behaviours that are not aligned with the spirit of Christmas. Complacency has no place in creating the magic of Christmas. People (Customers) - Our customers are children, so our entire business is child-centred. As a result, we have very high customer retention rates, with the mean customer loyalty duration being 10 years. Even after our customers grow up, we maintain good relationships with them, and we have a 95% referral rate to our business. We are continually striving for 100% referrals. Product and Services - We have a diverse team and have crowd sourced production. While we produce products all year round, Christmas is our biggest time of year. Our product and service suite has changed dramatically over the years, with increasing

focus on technology and wellness related gifts. Our distribution strategy has had to cope with a doubling of the world population since 1970, without any extension of the delivery timeframe. Our product and service development department is continually innovating to meet unmet market needs. Promotion - As Santa, marketing and customer fulfilment is my job. From November onwards, I attend Santa grottos, schools and clubs. To ensure we keep our finger on the pulse of what our customers really want, we engage with parents and schoolteachers to make sure the children write us a letter, outlining their dreams and requests. We have exceptional market penetration, with Santa songs played throughout December and interviews on radio and TV. Given the level of media scrutiny, it is even more important that our workmanship and service is of the highest quality and I can confidently stand over this, because I know my team has the attitude, knowledge and skill to execute to the highest level, even under tight deadline pressure. Prosperity - One of the secrets of the success of the Santa Business Model is that I relentlessly focus on what matters most to our customers and society. I continually ask myself ‘How can my team and I create, sustain and grow the magic of Christmas?’ in this Volatile, Uncertain, Complex and Ambiguous (VUCA) world. Regulatory compliance and customer expectations have grown exponentially in recent times, so adapting and changing to the everevolving needs of our customers requires constant upgrades in our people, processes and business model. We have improved our margin by crowd sourcing production, increasing automation and freeing up my team, so we focus on creating connections and exceptional customer experiences. Every child wants personal attention from Santa, and this can only happen when the entire team is aligned, inspired and trained to working to the peak of their scope of practice. I believe that our turnover, profit and EBITDA continue to grow, because I have continually adapted our business so that I am increasingly child-facing and my team is empowered, enabled, equipped and engaged to deliver excellence behind the scenes, so that I can lead from the front. So, this is my model. It seems that we are in the same business – the business of dispensing health and happiness, by being of service to others. I can’t help but wonder

how much of our business model you could apply in your business? How aligned are your Elves to your business and your customers? How well are you prospering? Dear Pharmacist, As promised, here is your Christmas Gift. One of my biggest roles as a leader is building capacity within my team by empowering, enabling, equipping and engaging them to optimise their performance, which is why I enclose www.4FrontPharmacy.ie annual membership for you AND your team. Expires December 24th next year. Wishing you a healthy, prosperous year. Santa PS Remember: The more consistently you and your team use it, the more health and happiness you will dispense! Dear Santa, (12 months later) I wanted to write and thank you for your letter and for taking the time to show me how I can help myself. You didn’t just give me a tool; you renewed my purpose and most importantly gave me hope that I can make a difference again. These are the key changes I made in the past year.

Personal - Last January, I held a staff meeting, where I laid out my plans for 2020 and outlined what the team could expect from me as a leader. I asked them to help keep me honest and call me out if I ever make another excuse for anything less than business excellence. Every member of my staff deserves this, and every customer deserves this. I deserve this. Professional - We have a new Code of Conduct for pharmacists, a core competency framework and ePortfolio Review. I have developed a staff handbook which enables my entire team to uphold these professional standards. To keep us honest, we hired a peer pharmacist to conduct an external review of our professional practice, using the Pharmacy Assessment System Audit in January and again in September to benchmark performance. People - As promised, I enrolled myself and my entire team on the www.4frontpharmacy.ie platform you gave me for Christmas last year. All but one member of staff has completed one module (15-30 mins) per week for the past year and has now completed 50 modules each. This continuous improvement has shown dramatic results for the business and for the staff. (The member of staff who kept finding reasons for not completing their weekly training, has since found employment elsewhere. Excuses are no longer tolerated. Our customers deserve better.)

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Self-Appraisal WHAT I intend to learn and why As CEO, I am in the process of reviewing 4Front’s personal, professional and business performance in 2019, so that I can celebrate and acknowledge our successes and clearly see our 2020 vision. 4Front Pharmacy’s goal is to support community pharmacies to dispense health and happiness to 1,000,000 in Ireland in 2020. Through our leading edge online training platform for pharmacies, we will up-skill more community pharmacies to increase sales, staff engagement and the quality of the pharmacy/patient interaction.

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Personal Plan HOW I intend to learn it Customers - I always considered that I delivered patient-centred care. But when I read your letter last year, I realised that all my metrics were product based, not patient based. This year, we invited our customers to outline what they valued most, what cheesed them off and what ideas they had for additional services. In addition to our traditional metrics, we created customer-centred metrics, based on what matters most to their health and happiness, such as customer retention and medication adherence metrics. Product and Services - Based on our customer research, we discovered that our customers MOST appreciated a private consultation with the pharmacist. We used the www.4FrontPharmacy. ie staff training, created marketing and changed our operational structure to free up the pharmacist for their highest value work – consulting with patients at the pharmacy counter. We adopted 4Front Pharmacy’s STEPS™ Consultation Framework to structure these consultations, which initially revolved around prescription and OTC consultations. In 2020, we plan to expand into a paid service model. Prosperity - Prosperity is measured in multiple ways. Thanks to changing our mindset and investing in our staff, we have achieved our most prosperous year yet. In 2019, we • Increased OTC sales by 18% • Increased Prescription Understanding by 275% with our customers • Increased Error Interventions by 200% • Increased Staff Engagement by 88% • Increased Staff Knowledge by 82% •

Started to measure the number of Pharmacist Consultations and the use of the Consultation Room. Next year we will have a benchmark against which we can measure improvement.

have succeeded in changing the way I think and the way I manage my business. All my staff thank you. All my customers thank you also. You have given me hope to dream big again, feel valued as a healthcare provider and pharmacist and most importantly to make me feel like I can (and do) make a difference. The only thing I would ask for this Christmas, is that you might share your letter and vision with the many pharmacists in Ireland who may, like I had, have lost the true meaning of the privilege of being a pharmacist; the excitement of being at the very centre of healthcare and the opportunity to bring prosperity & health to their staff, customers and of course, themselves. Happy Christmas and a very prosperous New Year. AUTHORS: 4FrontPharmacy.ie Co-founders Rachel Dungan, MPSI, ACC and David McLean, BSc MBA www.4FrontPharmacy.ie, a leading-edge online training platform for pharmacies, proven to drive patient safety, staff engagement, and increased sales, through raising the quality of pharmacy / patient interactions. Known as ‘The Pharmacist Coach,’ Rachel worked for 20 years as a supervising and superintendent pharmacist. Rachel’s entire career has focused on developing and applying professional and business excellence to enable pharmacy teams to deliver exceptional results.

• Freed up a day per week to focus on building my team’s capacity and performance • Spend a fraction of the time I did this time last year entertaining excuses, intervening in unproductive conflict and acting like a busy fool. I have direction, purpose and focus, with far less drama! I have taken control of what is within my control (which is FAR more than I thought) and stopped wasting my energy on things I cannot change or influence. This alone has created so much freedom in my life. When I wrote to you last year, I was desperate. Now I am cautiously optimistic for 2020. While there are very real challenges to be overcome, dispensing joy, health and happiness is worth the effort. So, Santa, thanks to your kind letter and mentoring. By accepting your advice and Christmas present, I

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I plan to: • review the business performance in 2019, using 4Front’s Six Ps of Pharmacy Excellence Framework • identify what is working well, what is not working so well and what we could do differently in 2020, to ensure our business performance is aligned with our vision and goals. • focus on what is within our control or influence and to not waste my energy focusing on things over which we have no control or influence. By accepting the things I cannot change, I will free up more energy to focus on delivering what is truly most important.

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Action What I actually did • Personal: I reviewed my personal performance with my coach, reflecting on what has worked, what didn’t work and what we could do differently in 2020 • Professional: I created my personal and team development plan for 2020, aligned with who I need to become as a leader to guide 4Front Pharmacy to achieve its goals in 2020 and to build my team’s capacity to deliver. • People: I input into our 2020 calendar our strategic weekly accountability calls and our monthly strategic review meetings. • Product: We reviewed our 2019 platform and course enrolment, the grades achieved and the number of people who completed each course. We reviewed customer requests and outlined our 2020 training curriculum. • Promotion: We are nurturing and building partnerships with businesses (such as the IPN and Pharmaconex) who are dedicated to community pharmacy thriving and fulfilling its potential into the 21st century. We continue to explore new ways to build awareness and share our resources with pharmacies. • Prosperity: See ‘Evaluate’ Impact

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Document What I have learned specifically Our success and our ability to achieve our goal is determined by our client’s success and their success is determined by their • willingness to invest in themselves and their team • engagement with the learning tools provided • commitment to track and monitor progress towards their goals • leadership and role-modelling accountability to deliver results We continue to gather evidence of client success, to inspire other pharmacy owners to turn their wish-list into reality. Our focus is to demonstrate the business case for investing in whole team learning and development and supporting pharmacists to implement a strategy for success. A proactive business model is essential for pharmacies to survive and thrive.

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Evaluate ONE example of how I put my learning into practice This CPD cycle is not completed yet. On a monthly basis, I will track progress towards our goal of supporting community pharmacies to dispense health and happiness to 1,000,000 in Ireland in 2020 and evaluate the impact on pharmacy practice, pt safe and 4Front’s customer’s business growth.

CCF

Domains (and Competencies) The Pharmacist selected Competencies under the following domains for this CPD Cycle: 1. Professional Practice (Engages in appropriate CPD), 2. Personal Skills (Leadership Skills), 3. Organisation and Management Skills (Quality Assurance)


rs a ul ome f cust a peace r u all o as and g n i h m Wis Christ Year! py New Hap

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Minami MorEPA Rebranding In 2018, Nestlé Health Science acquired Atrium Innovations. One of the Atrium brands is Minami - an established ultra-pure, high quality Omega-3 fish oil brand that offers products tailored to different life stages and lifestyles. Minami, the omega-3 expert uses a unique, patented production method (Supercritical CO2 Extraction). This results in an extremely pure product and enables us to have some of the highest concentrations of EPA and DHA in one capsule. The Minami MorEPA brand is currently undergoing a complete rebrand; the new packaging and fresh new look will be coming to the market in 2020. The New Year also brings a very exciting, innovative and relevant new product launch and much more. Available in 800 pharmacies, 200 health food stores and some online retailers across the Republic of Ireland. Minami, the premium omega-3 brand has some great partnerships with the pharmacy community. Key benefits  High concentration of Pure Omega 3  Fewer capsules required vs other competitor offers for same Omega 3 dose, provides a competitive cost per day routine  Customised ratios of DHA/EPA that correspond to leading Omega 3 research  No Fishy Taste  Responsibly and sustainably sourced from unpolluted waters of the Pacific  Every single batch tested for its purity  Range of proven formulations tailored to lifestyle and life stage  EU Eco-Management and Audit Scheme (EMAS) certified.  Eco-friendly production operating primarily on hydroelectric power and using residual fish oil by-products as biofuel at the facility, resulting in virtually no material waste. The team look forward to updating the market with exciting launches in the New Year. Minami MorEPA is available to order from Uniphar and United Drug Wholesale.

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