Minister for Health Mary Harney wrote to the Medical Council earlier this year expressing concern that some GPs in new multi-purpose medical centres may be "directing" patients towards pharmacies operating from the same building.
The Minister's concerns led directly to the Medical Council issuing a statement to doctors warning about possible conflicts of interests regarding surgeries co-located with pharmacies.
The Irish Times has learned that last February Ms Harney wrote to the Medical Council expressing concern at representations she had received suggesting that the relationship between doctors and pharmacies was being misused in some cases. These representations had been made to Ms Harney by the Irish Pharmaceutical Union, which represents community pharmacists.
Ms Harney said there were concerns that the development of pharmacies as part of medical centres could lead to conflicts of interest. She indicated that she intended to take steps in forthcoming pharmacy legislation to prevent overlapping beneficial interest between those who prescribed and those who dispensed medicines for patients.
The Minister also suggested that the Medical Council could consider strengthening its ethical guidelines. These maintain that any financial interest which a doctor had in the pharmaceutical or any allied industry must not influence a recommendation for a particular therapy.
"The main concerns relate to the possible unfair cornering of the retail market by such pharmacies, possible reduction in patient choice and the issue of conflict of interests between prescribing and dispensing," she said.
Ms Harney told the council that she was "strongly supportive" of medical centres supplying an integrated primary care service. She also said she did not believe the State could dictate where pharmacies were located.
"However, I am concerned at recent representations suggesting that patients are being in some way 'directed' by physicians towards onsite pharmacies and that this is being facilitated by physicians organising the delivery of medicines, having prominent inter-connections between the pharmacy and the rest of the centre and locating repeat prescription desks near those inter-connections.
"Circumstances such as these could give rise to public concern in relation to prescribing practices," Ms Harney said.
She said the Pharmacy Review Group maintained that in such group centres, the general practice and contracted pharmacy should occupy discrete premises with separate entrances.
In early March, Medical Council president Dr John Hillery replied and said any possible conflicts of interest were of great concern. He said that under the council's ethical guidelines, doctors had a duty to declare to patients any financial interests in pharmacies or centres to which they were making referrals.
At the end of March, the council issued a revised position statement on the co-location of pharmacies and general practices. It reminded doctors of the position with regard to financial interests as set out in its ethical guidelines and warned about conflicts of interests.
The Irish Pharmaceutical Union said it was not against the development of multi-purpose health centres but it did not believe pharmacies should be included in them.
