IPU Review AUGUST 2014 WEB

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IPU Review AUGUST 2014 WEB

Ireland’s Official Pharmacy PublicationIPUReviewAUGUST 2014IPU BusinessTrends Q2SurveyWhat are thetax advantagesof a limitedcompany?Franchising,Buying Groupsand SymbolGroupsChartingthe LocumexperienceOutlook forPharmacyUpcoming 2014 RAGMs | CPD: Female Urinary Incontinence | Prevention & Security

Time to Step UpImprove your knowledge and helpyour customers in just five weeksIPU Medicines Counter Assistant’s Course (MCA) – Face-to-FaceThis face-to-face course will increase your product knowledge and develop theskills needed to work in a pharmacy.The course, which runs one day a weekfor five consecutive weeks, will provideyou with the skills and knowledge todeal effectively and sensitively withcustomers. It covers the classificationof medicines, abuse and misuse ofmedicines, referral to the pharmacistand product knowledge and costs€550 to IPU Members, €750 tonon-members.Your employer can claim up to€1270 per pharmacy per year from thePCRS under the Pharmacy TrainingGrant Scheme.GalwayTullamoreWaterfordDublinAUTUMN DATES AND VENUESArdilaun HotelSeptember 22, 29, October 6, 13, 20Bridge House Hotel September 23, 30, October 7, 14, 21Woodlands Hotel November 3, 10, 17, 24, December 1Red Cow Moran Hotel November 4, 11, 18, 25, December 2ENROLNOW!IPUSERVICESLTDFor more information or to enrol contact Janice or Susan at01 493 6401 or go to www.ipu.ie

ContentsIPU REVIEWAUGUST 2014123249The IPU Review is publishedmonthly and circulated to Irishpharmacists. The views expressedby contributors are not thoseof the IPU nor is responsibilityaccepted for claims in articles oradvertisements.Subscription:€85 (Ireland North & South) and€130 (including postage overseas).Publisher:Irish Pharmacy Union(IPU Services Ltd),Butterfield House,Butterfield Avenue,Rathfarnham, Dublin 14Tel: (01) 493 6401Fax: (01) 493 6626Email: ipureview@ipu.ieWebsite: www.ipu.ieEditor: Jack Shanahan MPSIEditorial Associates:Jim Curran, Wendy McGlashanand Aoibheann Ní ShúilleabháinAdvertising: Wendy McGlashanEmail: ipureview@ipu.ieTel: (01) 493 6401©2014Copyright: All Rights Reserved,Irish Pharmacy Union.Printed by Ryson Colour Printers Ltd.IPU Review is a Registered Trademarkof the Irish Pharmacy Union.IPUSERVICESLTD05 A Note from the EditorIPU News The latest news and events from Butterfield House06 RAGMs take place in September and October06 IPU Business Briefing Roadshows09 IPU Support in place for NRT switchFeatures2508 IPU Delegation meeting with Joint Committeeon Health & Children12 Q2 2014 Business Trends SurveyOverview of trading environmentfor community pharmacies16 CPD: Female Urinary Incontinence20 Locum experiencesAn insight into working as a locum25 Now & Next: Reviewing your business plans28 Tax advantages of a limited company32 Supply v demandPrevention and security measures36 Epos – trouble shooting tips for your hardware40 Political Report IPUAll the latest pharmacy news from the Houses of the Oireachtas44 Professional Studies46 Wines for the warmer weatherNews48 International Pharmacy News – What’s happening abroad?49 2014 Pfizer Health Index50 New PSI President and Vice-President50 Electronic prescribing and info flow improved51 Irish Chemists Golfing Society News52 Lady Pharmacists’ Golf Society News53 Product Information55 Classified Ads4628IPUREVIEW AUGUST 2014 3

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A NOTE FROM THE EDITOR Jack Shanahan, MPSIBureaucratic juggernautshave lost the ability toapply brakesThe collapse in the price of medicines in Ireland, while generally welcome, hashad a profound effect on the viability of many Irish pharmacy dispensaries. Mostpharmacies will have seen a substantial drop in turnover this year. As each round ofreference pricing hits, the profitability of pharmacies is affected disproportionately.While largerpharmaciesareinsulatedto a certainextent, all of us that dependpredominantly on dispensingare beginning to look verynervously at the monthlyprofit and loss accounts.There is a continuous searchfor generating turnover fromother activities. One of thegreat hopes has been theanticipation of extended roles.Yet these, while desirable,are frequently beset by bothbureaucratic and practicalissues. Influenza vaccinationis a case in point. Whilethe growth of numbersvaccinated in pharmacieshas been encouraging, thereare still major barriers tothe efficient rollout of thisservice. One major thornis the requirement of theRegulator for annual training.It would be fair to state thatthe majority of pharmaciststhat have provided thisservice are affronted by theinsinuation that they areincapable of continuing toprovide the service withoutmore repetitious training.Indeed, many are so proficientthat they could be givingtraining courses themselves.It is not clear why such pettyconstraints are put in theway of providing an effectivevaccination service, other thana regulatory body strugglingto define an efficient role.Neither doctors nor nursesare required to retrainannually for vaccinationadministration. Pharmacistsare still being held to suchstringent standards thatthe majority of pharmaciesfind the provision of a lowvolume vaccination serviceuneconomic. To add insult toinjury, there have been almostcontinuous issues over the lastfew years with the availabilityof adrenalin injector pens.As this column goes to press,there is only one brand of penavailable. It has an expiry ofOctober this year. It is surelytime to allow pharmacists thechoice of using the same formof adrenalin that all otherprofessions use, the ampoule.While this would requirelegislative change, it wouldbe very minor. While we canhope and lobby for changes,it is clear that bureaucraticjuggernauts seem to havecurrently lost the ability toapply brakes.Whatever about extendedroles, part of our basic roleis the safe provision of OTCmedicines to the public. Thus,it was with considerableanticipation that attendees atthe last IPU Conference heardthe IMB, now HPRA, tell usthat they were being proactivein deregulating medicines.They were proposing to asklicence holders of certainmedicines to apply for nonprescriptionstatus for theirproducts. It is not clear whatthe status of this requestis. Is it a polite observationor a Marlon Brando makingan offer you can’t refuse?The more cynical in theprofession were in full selfcongratulatorymode when thefirst major announcement wasthe movement of NRT intosupermarkets. Yet, in recenttimes, we have seen a list ofproposed medicines releasedwith much fanfare. It is safeto say that the list did notinspire any great excitement.Indeed, it was probablythe least inspiring list thatwas possible to produce. Itbeggars belief that low doseaspirin was not on the list. Itis deeply disappointing thatoral fluconazole and topicalantibiotics for eye infectionswere not included. Indeed,the lack of these type ofproducts raises questionsabout the mechanics of sucha process. It is not clear howthis list was formulated,given the information theHPRA would have receivedfrom many sources, includingthe IPU. Many of the listedproducts are already on theOTC market in some form.Some are not. For instance,the inclusion of penciclovir, aproduct that is not currentlymarketed in Ireland, raisedmore than a few eyebrows.It is currently an S1A drugunder the Medicinal Products(Prescription and Controlof Supply) Regulations2003. It is not clear thatthere is an overwhelmingneed for another OTC coldsore treatment. There is anecessity for the internalprocedures that can lead toitems appearing on these liststo be more transparent. Yet,these observations should betaken as constructive. Themove to make more medicinesavailable to pharmacists, toprescribe for the public, is apositive move and must bewelcomed.IPUREVIEW AUGUST 2014 5

IPU NEWSSeptemberand Octoberare RAGMmonthsThe Regional Annual General Meetings (RAGMs) of theIPU will take place during September and October (seebelow for dates and venues). These meetings providemembers with an ideal opportunity for discussion, toair their views and to be briefed on all current issuessince the last AGM.Members can attend any of the Regional AGMs and itis in your interest to make a special effort to attend.Pharmacy inthe mediaThere was media coverage at the beginning of Julyon the IPU’s presentation to the Joint OireachtasCommittee on Health and Children. Interviews wereheld on regional radio stations, with IPU spokespersonscalling for an expanded role for pharmacists. The itemwas also included on Irishhealth.com.The cabinet reshuffle led to some media coveragealso, with IPU President Kathy Maher quoted onIrishExaminer.com and Irishhealth.com.Kathy was also quoted in national newspapersand interviewed on regional radio stations followingthe HPRA’s announcement that up to 34 medicinespreviously available on prescription only could nowbe available from a pharmacist without prescription.Media coverage also included the Irish Times and IrishIndependent.Date Region Venue29 September South Castle Hotel, Macroom30 September Mid-West The Strand Hotel,Ennis Road, Limerick01 October South East Newpark Hotel,Kilkenny02 October Dublin Clarion Hotel, LiffeyValley, Dublin 2206 October Midland Tullamore Court Hotel07 October North East Conyngham ArmsHotel, Slane, Co. Meath08 October North West Mill Park Hotel, Donegal09 October West McWilliam Park Hotel,ClaremorrisCongratulationsIPU BusinessBriefing RoadshowsIn July, the IPU held a number of roadshows promoting thenew state-of-the-art business intelligence service beingintroduced by the IPU in association with the PortugueseNational Pharmacy Association (ANF). The service, whichwill be delivered by Health Market Research (hmR) Ireland,will allow participating members to see trends or changes inproduct mix as well as transaction values across the sector,and within their own businesses. The service was very wellreceived by members present (see advert on page 7) who alsoheard from Economist Jim Power who gave a presentation onthe “Economic Context for Pharmacists”. See www.ipu.ie forfurther dates, venues and times.Congratulations toJanice Burke, TrainingAdministrator (top left);Susan MacManus, Training& HR Manager (top right);and Wendy McGlashan,Publications & CorporateAffairs Manager (bottomleft) who are all celebrating30 years working with theIPU this year.6IPUREVIEW AUGUST 2014

THE IPU IS ON YOUR SIDEAND BY YOUR SIDEThe IPU will shortly be launching a new Business Intelligenceservice in partnership with the Portuguese National PharmacyAssociation which will be delivered by Health Market ResearchIreland (hmR).MAXIMISE YOUR BUSINESS POTENTIALThis free service will provide participating members with accessto accurate, up-to-date information to assist them in running theirbusiness more efficiently. You will have information at your fingertipswhich will allow you to benchmark your performance against yourlocal and national markets.The data will be completely anonymised and aggregated. Noindividual pharmacist’s information will be shared with any otherperson or organisation and the reports will not allow individualpharmacies to be identified.We are now looking for you to supporthmR Ireland to ensure that your datais in safe hands. The IPU gives you acommitment to always be in control ofthis data. This is your new business, bepart of it.Register your interest todayby contacting John Donnelly at:john.donnelly@hmr.ie

Take the stepBecome a qualifiedPharmacy TechnicianIPU Pharmacy Technician’s Course NVQ Level 3 Pharmacy ServicesThis two-year programme is designed for pharmacy staff working at least20 hours per week in the dispensary of an IPU registered pharmacy.As a Pharmacy Technician you will be a keymember of the pharmacy staff, assisting thepharmacist in the preparation, checking, storageand the dispensing of medicines. This courseprepares you to support pharmacists in ensuringthe delivery of a high-quality and professionalpharmacy service.The IPU Pharmacy Technician’s Course isdistance learning, in modular format withcontinual assessment over two years.On successful completion you will receive theNVQ Level 3 Pharmacy Services Certificate fromthe awarding body (City and Guilds). Year 1commences September.Cost for Year 1€1650 to IPU members€2050 to non-membersEmployers can claim up to €1270 per pharmacyper year from the PCRS under the PharmacyTraining Grant Scheme.ENROLNOW!Applications Close15 August** All completed application forms must be received by fax,post or email to the IPU by the Friday, 15 August 2014.For more information contact Janice or Susan at01 493 6401 or go to www.ipu.ie

IPU NEWSIPU Supportin place forNRT switchThe HPRA (Health ProductsRegulatory Authority) isauthorising some NicotineReplacement Therapy (NRT)products to be sold in generalretail and grocery outlets.The IPU had anticipatedthis move and had ensuredthat pharmacists would beprepared by introducinga pharmacy-led smokingcessation service in March. Tosupport you in providing theservice, we also developed aSmoking Cessation eLearningmodule on www.ipuacademy.ie and a Smoking Cessationmodule on www.ipunet.ie.We encourage you to avail ofthese resources so that youcan continue to provide thisvaluable pharmacy serviceto your patients as it isrecognised that the chancesof quitting successfully areincreased by engagement witha healthcare professional.It is very disappointingthat the first switch to beannounced by the HPRA istaking a key product categoryout of pharmacy, ratherthan a POM to P switch.The HPRA has emphasisedthat this move was in linewith Department of Healthand HSE policy to push fora tobacco-free Ireland andto make these products asaccessible as cigarettes andother tobacco products.We understand thatthe products affected areNicorette ® Gum (2mg & 4mg,pack of 30); Lozenges (2mgx 20); Inhaler (15mg x 4);QuickMist Spray (1mg x 1)and Patches. It is expectedthat these Nicorette productswill be launched into generalretail at the end of August/early September. Althoughpatches are included in theswitch, we have been toldthey will not be launched intogeneral retail at that time.Thinning Hair?FOR YOUNGER LOOKING HAIRWomen & MenScientifically proven to reduce hairloss and increase hair growth*TVAdvertisingStarting inAugustRTE & TV3Bioxsine is available from Ocean Healthcare,United Drug & Uniphar. For more informationcontact Ocean Healthcare 01 2968080FarewellJill Lyons, who has worked with the IPUfor over 11 years, left the IPU at theend of July for a new role based inCork. Jill began working in the IPUProduct File Department in 2003before moving to the ContractDepartment and eventuallytaking over the managementof the Contract Departmentseven years ago. Everyone atthe IPU would like to take thisopportunity to thank Jill forher support and contributionto the organisation over thepast 11 years and wish herthe best of luck in her newrole.IPUREVIEW AUGUST 2014Unique BiocomplexB11 formula: Betacytosterol Zinc &Vitamins (includingA, B1, B2, B5 and B9)Scientifically provento improve hairstrength and reducehair lossSCIENTIFICALLYPROVEN*Test results are basedon 20 volunteers whotrialed Bioxsine Shampooregularly during 8 months

BUSINESS Jim Curran, Director of Communications & Strategy, IPUIPU Delegationmeets the JointCommittee onHealth and ChildrenA delegation from the IPU met the Joint Oireachtas Committeeon Health and Children on 1 July to discuss a number of issuesincluding an expanded role for pharmacists, the exorbitantfees paid to the PSI, enforcement procedures by the PSI andbankruptcy provisions of the Pharmacy ActIn his oral presentationto the Committee, IPUSecretary General,Darragh O’Loughlin,highlighted the roleof the pharmacist as ahealthcare professional andthe significant benefits thatcan accrue to both patientsand the State from expandingtheir role.Darragh told theCommittee members that asa result of increasing demandfor healthcare services andthe shrinking resources inthe sector, the health systemis near ‘breaking point’ withhospitals overstretchedand GPs, as confirmed bythemselves, struggling withtheir existing workloads,which will only increasedramatically with universalaccess to GP care.He also informed themthat the current shortage ofGPs is unlikely to be solvedin the short-term, given thatover 1,000 Irish-trained GPshave taken up work in theUK health service since 2009.With an ageing populationthere will be additionalpressure on an alreadyoverstretched healthcareservice.“Similar problems havebeen experienced in othercountries and solutions havebeen found. When demandfor GP services exceeded theavailable capacity in England,Scotland and Canada, theunique skills of pharmacistswere used to enhance accessto healthcare,” he said.He briefed the Committeeon two specific services thatpharmacists could initiallyprovide; Minor AilmentSchemes and Medicines UseReview Service.The implementation ofa pharmacy-based MinorAilments Scheme in Irelandcould ease the pressure on GPservices sufficiently to allowGPs to provide the additionalfour million consultationswhich they have estimatedwill result from the roll-outof free GP care.In highlighting the benefitsof a Medicines Use ReviewService, he told Committeemembers, “According to datafrom Scotland, in-depthMedicine Use Reviews (MURs)conducted by pharmacistswith patients sufferingfrom chronic illnesses whowere taking a multitudeof medications reducedhospital readmission ratesby one-third. Internationalevidence confirms thatthe introduction of MURsprovided by pharmacists hasimproved health outcomes,enhanced quality of life andreduced the requirement forhospital care.”The Committee wasinformed of other servicesthat pharmacists couldprovide including NewMedicine Services,Health Checks, HealthPromotions, ExtendedVaccinations, Chronic DiseaseManagement, AnticoagulationService, MDS (MonitoredDosage Systems) andDUMP (Disposal of UnusedMedicines Properly).“The extension ofpharmacist services in othercountries has resulted inbetter access to healthcareand substantial reductionsin morbidity and mortalityrates from illnesses such asheart disease and diabetes”,Darragh continued.“It is our intention, asa profession, to proposepositive solutions to some ofthe problems and deficienciesin the health system, with aview to providing accessible,convenient and cost-effectivehealthcare services forpatients and members of thepublic and, where possible,relieving pressure on otherparts of the healthcaresystem.”Darragh also raised anumber of regulatory issuesof concern to pharmacists.He highlighted, for instance,the exorbitant cost ofregistering with the PSI,whose fees are way out ofline with other countries. Thecurrent fitness to practiseprovisions enforced by the PSIwas discussed with the IPUcalling for the system to befair, equitable, transparent,efficient and cost-effective.Finally, the IPU’s concernsabout the bankruptcyprovisions under thePharmacy Act were outlined.The Committee respondedvery positively to thepresentation. Senator JohnCrown acknowledged thecritical role that pharmacistshave played in keeping a‘limping’ health servicealive for so long. “We areall grateful to them forperforming that function.In addition, every doctorwill have had occasion tobe grateful to a pharmacistfor spotting a mistake in aprescription and therebyavoiding something badhappening. Pharmacyprovides a tremendous backstopservice”, he said.Senator Colm Burke wasparticularly interested in themerits of introducing NewMedicine Services, whichhe felt should have been10IPUREVIEW AUGUST 2014

introduced years ago and “is avery important proposal andshould be followed through”.Deputy Regina Dohertyexpressed frustration thatthe HSE has not engagedconstructively with theIPU in introducing newpharmacy services. She alsoquestioned why the high costof pharmacy registration feesand the bankruptcy issuehave not been addressed yet.The flu vaccination andmethadone treatmentservice being provided bypharmacists was welcomedby Deputy Catherine Conwaywho also explained, “Oneof the greatest assets anycommunity can have is apharmacist who knows thepeople on a first name basis.That is important because, asthe deputation has explained,pharmacists are able to relateto people better.”Deputy Ciara Conway wasof the view that both theMedicines Use Review Serviceand the Minor AilmentsScheme should be promoted.The Chairman of theCommittee, Deputy JerryButtimer, praised the‘tremendous’ serviceprovided by pharmacists tothe community. “Those ofus who actively engage withconsituents recognise thatpharmacists are a very goodresource in the community.They are very accessible andwhen the generic substitutionand reference pricing startedthey helped in many ways tocalm the waters and providegood information to people,particularly elderly peoplewho were concerned aboutthe different colour boxes.”He concluded byannouncing that theCommittee would followup with the IPU proposalson Minor Ailments Scheme,the Medicine Use ReviewService and the NewMedicine Services with theHSE and would contact theDepartment of Health to seewhat stage the bankruptcyprovision is at.“ The implementation of a pharmacy-basedMinor Ailments Scheme in Ireland could easethe pressure on GP services sufficiently toallow GPs to provide the additional four millionconsultations which they have estimated willresult from the roll-out of free GP care.”Are there medicinescurrently unavailable toyour patient in Ireland?We can help...www.medisource.ie | Call 1-890 2866366 | Fax 01 2866288 | Email info@medisource.ie227548-DPS-MEDISOURCE-AMA-IHCA.indd Medisource Ad Sept 2013.indd 1 2 05/09/2013 06/09/2013 10:06:11 12:17:14IPUREVIEW AUGUST 2014 11

BUSINESS Jim Curran, Director of Communications & Strategy, IPUIPU QuarterlyBusiness TrendsSurvey Q2 2014Jim Curran, IPU Director of Communications and Strategy,outlines the results from the IPU’s Pharmacy Business TrendsSurvey Q2 2014, which provides an overview of the current tradingenvironment for community pharmacies throughout the country.The secondquarterlypharmacy businesstrends survey,covering theperiod March to June, confirmsthat while there are signsof improvement in businessconfidence and less pessimismamong pharmacists thanpreviously reported, the resultsindicate that the tradingenvironment remains difficultfor the community pharmacysector. This is reflected indeteriorating levels of footfalland the consequent impacton sales and turnover, whichcontinue to decline.Business costs remain aconcern with one in threerespondents reporting anincrease in the last quarter.While pharmacies continueto shed employment, thelevel of job losses in Q2 hasreduced significantly incomparison to the first threemonths of the year.Reference pricing continuesto have a major impact withalmost half of respondentsreporting this as their numberone business concern.The survey was conductedin the first two weeks of July.Business EnvironmentFigure 1 / Are you more or less optimistic about businessprospects now compared to three months ago?As can be seen in Table1, while the majorityof pharmacists remainpessimistic about theirbusiness prospects, there hasbeen an improvement on theprevious quarter with 55% lessoptimistic compared to 67%in Q1, resulting in an overallreduction in the net figure.It is also noticeable thatthere has been a discernableimprovement on the sameperiod last year, when themood was particularly gloomy.Table 1BusinessprospectsQ22013Q32013Q42013Q12014Q22014More Optimistic 4% 6% 10% 13% 9%Less Optimistic 87% 82% 57% 67% 55%Same 9% 12% 32% 18% 35%No Opinion 0% 0% 1% 2% 1%Net* (83%) (76%) (47%) (54%) (46%)* Net highlights the overall position. In the above table subtract more optimistic (9%)from less optimistic (55%) to provide the net figure (46%).12IPUREVIEW AUGUST 2014

Table 2Rate businessenvironmentQ22013Q32013Q42013Q12014Q22014Improving 3% 5% 14% 10% 11%Getting Worse 78% 70% 53% 61% 49%No Change 17% 24% 31% 27% 38%No Opinion 2% 1% 2% 2% 3%Net (75%) (65%) (39%) (51%) (38%)The trends with regardto business confidence aregenerally reflected in howpharmacists rate the businessenvironment and these resultsare no different. As we can seefrom Table 2, there has beenan increase in the numberwho feel that the businessenvironment is improvingand not getting worse, similarto the trend idendified bypharmacists who wereasked to rate their businessprospects.“ 73% ofpharmaciesreport thatsales/turnoveris down.”FootfallFigure 2 / Have you seen your footfall increase or reduce in the last three months?The level of footfall continuesto reduce, but only veryslightly in comparison toQ1; the fact that there isno improvement remainsworrying. The situation,however, is not as bleak as atthis time last year.The indications are thatthere will be a slight recoveryin net terms over the nextnumber of months with 36% ofrespondents expecting footfallto reduce over the next threemonths and 15% reporting ananticipated increase.Table 3Footfall in thelast three monthsQ22013Q32013Q42013Q12014Q22014Increase 9% 9% 21% 15% 16%Reduce 57% 46% 39% 41% 43%Same 30% 45% 40% 40% 39%Don’t Know 4% 0% 0% 4% 3%Net (48%) (37%) (18%) (26%) (27%)IPUREVIEW AUGUST 2014 13

Sales/turnoverThe improvements reportedin business confidence and inthe business environment arenot reflected in sales/turnover,with 73% of pharmaciesreporting that sales/turnoveris down, and 6% reporting anincrease.When we examine thebreakdown we can see fromFigure 3 (right) that thedispensary is particularlyimpacted, with 73% reportinga reduction. No doubt theimpact of reference pricingis reflected here. Front ofPharmacy, while not as badlyhit, still shows that one outof two (51%) has experienceda reduction in sales with 16%reporting an increase.There is no significantimprovement envisaged overthe next quarter, with 68% ofrespondents expecting sales/turnover to reduce and only8% seeing an improvement.Figure 3 / How did sales/turnover perform in the last three months?Table 4Sales/turnover inlast three monthsQ22013Q32013Q42013Q12014Q22014Increased 8% 8% 17% 8% 6%Reduced 63% 83% 62% 74% 73%Remained the same 25% 8% 15% 10% 19%Don’t know 3% 1% 6% 8% 1%Net (55%) (75%) (43%) (66%) (67%)EmploymentTable 5Levels ofemploymentQ22013Q32013Q42013Q12014Q22014Increased 10% 4% 11% 7% 9%Decreased 15% 30% 19% 23% 17%Remained the same 75% 66% 70% 70% 74%Net (5%) (26%) (8%) (16%) (8%)Employment figures continuedto bounce up and down overthe last 12 months, withthe number of pharmaciesreducing employmentpeaking in Q3 2013. Overthe last three months therehas been an improvement,with a net 8% reducingtheir employee numbers incomparison to a net 16% inthe previous quarter. Thereis no obvious explanation forthis, particularly as sales andfootfall figures remain weak.Worryingly, a quarter ofpharmacies (net 25%) expectto lay staff off over thenext three months, whichwould confirm the level ofuncertainty that still exists.Business costs36% of pharmacies (38% inQ1) reported an increasein business costs in thelast three months, withenergy costs, waste chargesand wages the areas mostimpacted. 9% experienced areduction, up from 5% in theprevious quarter.“ Worryingly, a quarterof pharmacies (net25%) expect to laystaff off over the nextthree months.”14IPUREVIEW AUGUST 2014

“ With falling medicine prices,increasing business and regulatorycosts and reduced consumerdemand, the prospects remainrelatively bleak, with no indicationsyet of any discernable improvement.”Business concernsTable 6Main businessconcernsQ22013Q32013Q42013Q12014Q22014As Table 6 (left) confirms,‘Reference Pricing’ is far andaway the major businessconcern for pharmacies,which has consistentlybeen the case for the last12 months. Interestingly,there has been a fairlylarge increase in those whoidentified ‘Reduced ConsumerSpending’ as their majorconcern, which is reflectedin disappointing footfall andsales figures.Reference Pricing 39% 68% 56% 57% 49%FEMPI Cuts 50% 19% 22% 19% 16%Reduction inHealth BudgetReduced ConsumerSpendingEconomicUncertaintyN/A N/A N/A 10% 11%4% 7% 6% 7% 11%7% 7% 6% 5% 7%Business Costs 0% 0% 1% 1% 1%Regulatory Burdens 0% 0% 9% 1% 4%Losing Key Staff 0% 0% 0% 0% 0%ConclusionWhile there has been a slightimprovement in pharmacies’perceptions of the businessenvironment, the reality isthat the trading environmentcontinues to be tough, whichis reflected in the downwardtrend in sales and footfall andthe negative influence thatreference pricing continuesto have.With falling medicine prices,increasing business andregulatory costs and reducedconsumer demand, theprospects remain relativelybleak, with no indicationsyet of any discernableimprovement as has beenwitnessed in other sectors ofthe economy.It remains to be seen ifthe improvements beingreported in other sectors ofthe economy will be reflectedin the pharmacy sector, butbased on the indicators forthe next three months, wecan only conclude that this isunlikely.AmazingBags forAmazinggiftsContact Eileen BrowneE: eileen@barrypackaging.comT: 087 6869132www.barrypackaging.comCallNowfor aQuoteOrder your Christmas Bags TodayFree Artwork • Free DeliveryIPUREVIEW AUGUST 2014 15

CPD Breda Heneghan MPSIReflection andself-assessmentEvaluationRECORD(e.g. portfolio)Learning planAction(e.g. CE)CPD: Female UrinaryIncontinence from apharmacy perspectiveUrinary incontinence is defined as any involuntary leakage of urine. Femaleurinary incontinence is a common, debilitating and economically significantcondition, which many patients are too embarrassed to discuss.Prevalence anddemographicsThe reported prevalence ofurinary incontinence varieswidely (5-69%) becauseof differences amongthe populations studied,definitions and measurementsused. The prevalence increasesup to middle age, plateausbetween 50 and 70 years ofage, and increases again withadvanced age.Women experienceurinary incontinence morethan men. Contributoryfactors include pregnancy,childbirth, menopause, aging,neurological damage, stroke,birth defects and multiplesclerosis.Urinary incontinencecan be caused by bladderdysfunction, urethralsphincter dysfunction orsome of both. It is importantto diagnose the correct typeof urinary incontinence toensure appropriate treatment.The main types of urinaryincontinence are outlined inTable 1 (below).Table 1: The different types of urinary incontinenceTypeStress UrinaryIncontinence (SUI)Overactive bladdersyndrome (OAB)Mixed UrinaryIncontinence (MUI)Chronic urinaryretention (OverflowIncontinence)Nocturnal EnuresisFunctionalIncontinenceStress urinary incontinence(SUI) and overactive bladder(OAB) are the cause of over90% of cases of urinaryincontinence.When the bladder is full,nerve impulses pass to thepontine micturition centre,triggering urination. Thedetrusor muscle contracts asDefinitionInvoluntary leakage on effort or exertion,or on sneezing or coughingDefined as urgency, usually with increasedfrequency and nocturia, which may occurwith or without urgency incontinenceInvoluntary leakage associated with bothurgency and also physical stress (exertion,effort, sneezing or coughing)Occurs when the bladder cannot emptycompletely and becomes overdistendedInvoluntary leakage of urine during sleepIncontinence where no organic cause isfounda result of acetylcholine actingon muscarinic receptors.Anticholinergic drugs blockthe action of acetylcholine ondetrusor receptors. Duloxetinemediated stimulation ofalpha-1 adrenergic receptorstreats SUI.AssessmentIt is important that allpatients presenting withurinary incontinence have acomplete assessment to allowfor a differential diagnosis.This should include:n Taking a full history withregard to pattern andtype of incontinence,medical, gynaecological,surgical and neurologicalhistories.n If necessary, anabdominal, vaginaland rectal examinationshould be completed.n A three-day bladderdiary – document fluidintake, how often urineis passed plus volumemeasured, episodes ofincontinence and pador clothing changes.The normal volume ofurine passed per voidis 200-400ml and thegenerally quoted averagefrequency is 4-8 timesdaily including once pernight.16IPUREVIEW AUGUST 2014

CPD overviewReflect and Self-Assessmento What do I know about female urinary incontinence and itstreatment?o Can I provide advice about the treatment options for urinaryincontinence?o Can I identify those who may benefit from some extra adviceand care in a private consultation?Learning PlanIncluding a list of desired learning outcomes in a personallearning plan is a helpful self-analytical tool.o This article aims to provide an overview of female urinaryincontinence and current trends in the treatment andmanagement of this condition. It examines how pharmacistscan promote better outcomes for this patient group.Figure 1: Showing the nerve pathwaysassociated with incontinenceActionActivities chosen should be outcomes based to meetlearning objectives.o Read this article.o Consider current interactions with patients receivingmedication for urinary incontinence – could theseinteractions be improved?o Evaluate professional resource material in the pharmacy andsource additional material if necessary.o Identify the location of local continence clinic/physiotherapy department.EvaluateConsider outcomes of learning and impact of learning.o Do I now feel confident in my understanding of female urinaryincontinence and its treatment?o Do I now feel equipped to counsel patients and their carersaround concerns in relation to urinary incontinence?o Have I met my desired learning objective?Recordo Complete the short answer questions at the end of the article.o Create a record in a CPD portfolio.o Assess whether learning outcomes were achieved andidentify any future learning needs.n Urinalysis – to rule outinfection.n A residual urinemeasurement is neededto diagnose chronicurinary retention –overflow incontinence.n Consider other possiblecontributing factors:Obesity; smoking;high fluid, alcohol andcaffeine intake andconstipation.n It is very important todetermine the effectof the incontinence onthe woman’s qualityof life, her desire fortreatment, expectationsand motivation, as thiswill help predict heradherence to treatment.n Review the patient’scurrent medication assome drugs increaselower urinary tractsymptoms – see Table 2(next page).TreatmentTreatment varies dependingon the results of the initialassessment and which typeof urinary incontinence thewoman has.Stress UrinaryIncontinence (SUI)Stress incontinence isthe most common formof urinary incontinence.This is the complaint ofinvoluntary loss of urine oneffort or physical exertion,or on sneezing or coughing.It can be either due tohypermobility of the urethraand /or intrinsic sphincterdeficiency. Both occur more(but not exclusively) followingpregnancy with urethralhypermobility occurring dueto weakness of the pelvic floorsupport and damage to thepubourethral ligaments.There are numeroustreatment optionsavailable including pelvicfloor exercises, electricalstimulation, pharmacotherapyand surgery – surgery is themainstay of treatment formost women.n Pelvic Floor MuscleTraining (PFMT)Pelvic floor exercises havebeen the cornerstone ofconservative treatment forSUI (First line treatment –NICE guidelines). Successrates have been relativelymodest and depend onpatient adherence. Womenrequire an individualisedprogramme based onassessment by continenceadvisor/physiotherapist.The supervised programmeshould ideally last atleast three months. At aminimum, eight pelvic floormuscle contractions shouldbe performed at least threetimes per day. Review after12 weeks or as required toassess response. The use ofweighted vaginal cones andIPUREVIEW AUGUST 2014 17

ladder training in additionto PFMT may improvethe outcome but requirespecialist provision andhigh levels of motivation inthe woman.n Electrical stimulationBiofeedback to the patientmay assist motivation andelectrical stimulation maybe of help to women whocannot initiate a pelvic floormuscle contraction.n PharmacotherapyPharmacological treatmentis usually reserved forwomen unfit for surgery,awaiting surgery, do notwant surgery or who haveyet to complete theirfamily. NICE recommendsduloxetine as second lineto PFMT for this group ofwomen. It is a combinedserotonin and noradrenalinreuptake inhibitor and hasbeen shown to increasethe urethral sphinctermuscle activity during thestorage and filling phaseof micturition. There isgood evidence from RCTsthat short term use ofduloxetine in womenwith SUI can reduceincontinence, increase theintervals between voidsand improve quality of life.Adverse effects, particularlynausea, are common.Other side effects includevomiting, constipation, drymouth, dizzinessand insomnia. One studysuggested starting at alow dose of 20mg twicedaily for two weeks andthen increasing to therecommended dose of40mg twice daily to reducethe incidence of nausea.It may be more effectivewhen used as an adjunct toPFMT.n SurgerySurgery is an option ifconservative treatmentshave failed. Surgery hasmuch better success ratesbut it has been estimatedthat

PROFESSIONAL Ciara Ní Faoláin, MPSILocumexperiencesAs the sun makes brief appearances and employers plan holidaysand annual leave, the locum pharmacist prepares to fill up theirdiary. In this article, Ciara Ní Faoláin, a Cork-based locum, gives aninsight into the bumpy road that is locum pharmacist work.Locum work has certainlybeen an eye-openingexperience. For the past sixmonths I have been workingas a locum pharmacist inCork city and its surrounds.It’s been a bumpy road and asI’m sure many of my newlyqualified colleagues will befaced with similar difficulties,I thought that sharing myexperiences regarding thelocum struggle may help themand employers alike.I received my pharmacydegree from De MontfortUniversity in Leicester andcompleted my pre-registrationin University HospitalLeicester, a large, intensiveteaching hospital. After along difficult time away itwas fantastic to be back onIrish soil. However, after mytrip to Dublin to register, a 10minute lecture on pharmacyschemes in Ireland and abooklet regarding pharmacyregulations, I found myselfvery overwhelmed.The first difficulty wasgetting my name out there.I found that the IPU LocumList, going door-to-door withbusiness cards and settingup a comprehensive LinkedInprofile was the best wayto do this. Signing up withvarious locum agencies canalso be a good way of makingconnections.The second and mostdaunting difficulty was gettingto grips with the variousIrish schemes. It is onething reading about theschemes in theorybut another entirelywhen it comesto processingprescriptions.Which one tocode? Which oneto photocopy?How is it enteredin the software?Do you havethe HighTechSchemefax number? These are variousquestions that, if learnedthrough trial and error, couldcost your employer time,effort and money setting itright. I come from a hospitalpre-registration background,but anyone with an industrybackground or an Englishcommunity backgroundwill be faced with the sameproblems. I was lucky in thatI had a wonderful regularcommunity job whenI came homethroughout mydegree withfantastictraining buteven thenI found itdifficult to makethe transitionfrom UK to Irishschemes.My limited experiencehas taught me that being alocum can be an extremelystressful experience. Someareas that can prove to betricky include staff failingto turn up, being unfamiliarwith the software and gettingto grips with new processesin a busy environment. It’stough being the ‘new girl’and trying to get to grips withcertain pharmacies’ way ofdoing things. However, the flipside of the coin is that it canalso be a fantastic way to getinvaluable experience and, byseeing how each pharmacyoperates, you can use theknowledge gleaned to shapethe type of pharmacist youwould like to be.20IPUREVIEW AUGUST 2014

“ A clear set of locum-specific SOPs is notalways available but is extremely valuable toa locum pharmacist who is unfamiliar withthe pharmacy. It is not realistic to expecta locum to read the entire suite of SOPs inplace in any pharmacy in a single day.”In my six months as alocum I have worked in manydifferent pharmacies andno two pharmacies are thesame. This is not a problemif you have a very hands-onemployer who is willing totake some time to run throughthings with you, but I canunderstand how this wouldnot suit everyone. A clearset of locum-specific SOPs isnot always available but isextremely valuable to a locumpharmacist who is unfamiliarwith the pharmacy. It is notrealistic to expect a locum toread the entire suite of SOPsin place in any pharmacy in asingle day.I am very passionateabout making this processmore seamless and safer forlocums and employers alike.I attended the Seminar forPharmacy Interns in April,which was an invaluableresource and addressed somegreat issues such as dealingwith difficult customers andstaff. If offered again next year,I would highly recommend it.It’s not easy walking into anew job with new staff and wedo this regularly. I would liketo call on employers to take astronger hand in making thistransition easier for locumsand for locums to speak outwhen they feel they are inneed of more support.Get organisedTips for locumsGet yourself a diary, the IPU Yearbook & Diary is a good size and also contains veryuseful information regarding the Irish medicines schemes and useful contact numbers.Have a contactEvery pharmacist went through a tough time at the start of their employment so tryand have the number of an experienced colleague that you can contact for advice.Software trainingHone your skills by becoming familiar with the various software systems. Somesoftware companies even offer free software training.Personal checklistBefore accepting a job I always like to establish what support staff I will have andwhat the software is. Once in the door I have a checklist of things I’m quickly lookingto establish, such as the location of the duty register, the dispensary handover book,CD keys etc. The locum checklist located on the IPU website is a good checklistbase and a great template for employers in writing a locum SOP.Know your stuffWe can’t know everything, but to increase efficiency in your working environmentthere are some things that you should know at a first glance such as, maximumdoses for commonly prescribed painkillers and sleeping tablets, antibiotics andnotable interactions.MoneyMost of the employers I have dealt with are fantastic in terms of paying wages butto make this process easier for the employer have your payment details to hand.If you are working for an extended period in one place, or doing regular locumwork, ask for your employer’s registration number and contact Revenue to sort outassigning of credits. (See the Locum Issues folder in the Employee Pharmacistssection of www.ipu.ie for more information regarding payment).Helpful resourcesThe IPU website – www.ipu.ie – contains some great useful resources, such as agood recap of the Irish pharmacy schemes.22IPUREVIEW AUGUST 2014

PARALIEF DRIVING CASH SALESAND PROFIT IN YOUR PHARMACYProducts in units (000s)200015001000500Paralief the No.1 Paracetamol Brand in Pharmacy*1,943,176657,350517,351201,819110,098 104,404 74,039 16,233 7,391234,3040ParaliefPanadol ExtraPanadolPanadol ActifastPanadol Sol MaxPanadol NightAnadin ParacetamolHedexPanadol AdvancePara tabs*Volume Sales IMS MAT Mar 2012Paralief 500 mg Tablets. Clonmel Healthcare Ltd., Waterford Road, Clonmel, Co. Tipperary.A copy of the summary of product characteristics is available on request.Medicinal product available for retail sale through pharmacy only. Always read the label.2012/ADV/PAR/076

Get the retailfactor in yourpharmacyWith the latest set of cuts to your dispensaryincome, a bespoke retail review of yourfront-of-pharmacy will give your pharmacya facelift to boost your sales withoutoverstretching your budget.Our One-Day Review will include:■ Expert advice on your retail offering■ A complete review of the front-of-pharmacyincluding category management andpromotion planning■ Providing training in sales techniques■ Re-merchandising displays (interior andwindow) to enhance the retail experiencein your pharmacy■ Helping you and your sales team developnew sales ideas■ Using key performance indicators to helpyou increase front-of-pharmacy business■ Motivating your sales team to beinnovative, sales focused and up tospeed on product knowledgeDarren Kelly, IPU Business Development Manager,has almost 20 years of retail experience. If you would likefurther information on this service or would like to booka Retail Review, please contact Darren on (01) 493 6401 /086 028 9825 / email: Darren.kelly@ipu.ieHow we helped one pharmacistThe idea that the IPU could offer me a retail expert to come to mypharmacy and help me to get the “retail” factor into a pharmacy thathas massive competition from two retail multiples was a great idea.Oonagh O’Hagan, Meaghers Pharmacy Group

BUSINESS Brian Hyland and Edel Dempsey, Baker Tilly RyanNow & Next:Reviewingyour business plansIn this, the third article ina ‘Now & Next’ series, BrianHyland, Partner and EdelDempsey, Consultant, withBaker Tilly Ryan Glennon,looks at the changingoperating environmentof retail pharmacies now,with several pharmaciesbecoming involved inFranchising, Buying Groupsand Symbol Groups.Historically, retailpharmacies inIreland werepredominantlyoperatedby independent ownerpharmacists. While thisstill remains the case, thereis a current shift towardsaffiliation, both formaland informal, through theemergence of franchises,buying groups and symbolgroups in the market bylong established and nextgeneration pharmacies.Many are seeingthese affiliations as themodernisation of the retailpharmacy sector as theymake sense in a market thatis increasingly driven bybranding and margins, whilemaintaining and often timesincreasing, the level andquality of care and serviceprovided to the community.While there are clearadvantages to suchaffiliations, there is always aprice to be paid. The decisionfaced by many is whether thatprice is just too much to pay.The difficulty therein is thatthere is no black and whiteanswer to this question. It is aquestion for the individual toaddress; it is an answer thatis driven by personality, priorexperience and the vision ofthat individual.This decision should bemade during the developmentof a Business Plan – Where wewant to go next? and How arewe going to get there?Like all decisions, the devilis in the detail, an informeddecision will always be agood decision, based on theinformation that is availableat the time. But where tobegin? First we need tounderstand what is meant bya franchise, buying group andsymbol group within the retailpharmacy sector?Franchise“A franchise is the agreementor license between two legallyindependent parties which gives:n a person or group of people(franchisee) the right tomarket a product or serviceusing the trademark ortrade name of anotherbusiness (franchisor)n the franchisee the rightto market a product orservice using the operatingmethods of the franchisorn the franchisee the obligationto pay the franchisor feesfor these rightsn the franchisor the obligationto provide rights andsupport to franchisees”(Source: International FranchiseAssociation, 2014)For example, LloydsPharmacy and Life Pharmacyoffer franchise opportunitiesin the Irish retail pharmacysector.Buying GroupThe concept of a buying groupwas developed to open up theIPUREVIEW AUGUST 2014 25

enefits of group purchasingto local pharmacies while notimpacting on the integrityand service levels of thecommunity pharmacy.Examples of buying groupsin the Irish retail pharmacysector would includeHealthwise and Axium.Symbol GroupThese groups appear tohave stemmed from buyinggroups within the retailpharmacy sector. They retainall the characteristics of thebuying group, with the addedfeature of operating througha recognisable brand thatfurther strengthens the ethosand vision established by theoriginal buying group.This structure appears tobe gaining strength within theIrish retail pharmacy sectoras not only are more andmore buying groups movinginto this arena, the brandingnow offered by these groupsis becoming very visibleand recognisable across thecountry. Examples of thesewould include Totalhealth andHaven.Now that the meaning ofthese structures has beenestablished, one must thenuse that knowledge to addressthe following personalquestions;n Where do you see thebusiness in the next fiveyears?n What is important to youand the care and serviceyou want to provide tothe community?n What is currentlyoperating in yourlocality?n What options areavailable to you, givenyour location and themarket therein?The answers to these initialquestions will determinethe decision to be made, butsometimes they may notbe immediately apparentand some knowledge of thesector and the market maybe required. This is an areathat should be addressedduring the initial stages of thedevelopment of a BusinessPlan, when it is established‘Where we are Now and Howwe got here?Once the options have beenidentified, each scenario mustbe adequately assessed todetermine the most suitablestructure for the individualpharmacist, their location,the market therein and thecare and service they wish todeliver.The real difficulty is that,as it currently stands, thelines have become blurredas to where many of thesegroups, currently operatingin the retail pharmacy sectorsit. Are they franchises,buying groups or symbolgroups and what are the reallife implications of thesestructures? How does theoperation of these structuresinfluence the options availableto other pharmacists from ageographical and competitivestandpoint? For example, withmost franchise agreementsthere is a guarantee that noother franchised outlet will beestablished within a specificgeographical radius; this initself may limit the optionsavailable to any perspectivefranchisee.A simple and effectiveprimary exercise may be to setout the perceived advantagesand disadvantages of thevarious options:Independent PharmacyFranchised PharmacyAdvantagesDisadvantagesAdvantagesDisadvantagesNotoriety – The outlet willoperate under the name chosenby the individual.Autonomy – You make your owndecisions as to the look, feel &operation of your outlet.There is the opportunity to carveout a niche in the market for youroutlet through the products andservices offered.Relatively easy and inexpensiveto set up either as a Sole Traderor Limited Company.Cannot order in large enoughquantities to avail of bulkdiscounts.Difficult to launch new productsand ranges in the absence oflarge bulk orders.Difficult to gain exclusivedistribution of products in theabsence of large bulk orders.Advertising is expensive, doesnot have the advantage ofnationalised add campaigns.Relatively easy to set up basedon a tried and tested formula,helps to avoid the errors andpitfalls often associated withstart-ups.Management training usuallyprovided to shorten the learningcurve and allow the outlet tooperate smoothly from thebeginning.Pre-established suppliers andordering channels for moreefficient purchasing.Loss of notoriety – outlet to beoperated under the branding ofthe franchise.Loss of autonomy – the look,feel and operation of the outlet isdetermined by the franchise.No opportunity to carve out aniche in the market that does notadhere to the vision and directionof the franchise.No buy-in fees or annualcontributions based on turnover tobe paid.Does not have the financialsupport and assistance of a groupin terms of IT systems & supportand training resources etc.Opportunities to stock exclusiveproduct lines within the franchisechain.Financial support and assistanceof a group in terms of IT systems &support and staff training etc.Can be very expensive to set upwith considerable buy-in money.Can be expensive to operate witha sizeable percentage of turnoverto be paid to the franchise.Benefit of nationalised/globalised ad campaigns.“ While there are clear advantages to suchaffiliations, there is always a price tobe paid. The decision faced by many iswhether that price is just too much to pay.”26IPUREVIEW AUGUST 2014

AdvantagesNotoriety – The outlet willoperate under the name chosenby the individual.Autonomy – You make your owndecisions as to the look feel &operation of your outlet.Relatively easy and inexpensiveto set up either as a Sole Traderof Limited Company.Can avail of bulk discounts dueto the size of orders placed bythe group.BuyingGroupDisadvantagesDifficult to carve out a niche inthe market that does not adhereto the buying strategy of thegroup.Perceived loss of competitiveedge with direct competitorswithin the group.Risk of strong personalitiestaking the group in a directionthat is at odds with the initialethos of the group.Risk of overfamiliarity within thegroup, regarding the individualoutlets: their client base,successful product lines etc.Symbol Group– as distinct from Buying GroupsAdvantagesCan continue to trade under theirown name with the added benefitof the symbol associated with thegroup.Can take advantage of thegoodwill associated with thebrand of the symbol group.Benefit of nationalised/globalised ad campaigns.Relatively easy to leave thegroup with minimal disruption tooperations.DisadvantagesPartial loss of notoriety – outletto be operated under thebranding of the symbol group.Loss of autonomy – the look,feel and operation of the outlet isdetermined by the symbol group.Can often have the support of thegroup to assist with IT systems &support and staff training etc.Can build a support network offellow pharmacists.Relatively easy to leave the groupwith no disruption to patient careand service.This will help to focuson what is important tothe individual and theiroperations, particularly if theoptions available are rankedin order of preference. Withthis in mind, an in-depthanalysis of the preferredoption should be undertakento ensure it meets the criteriaset out at the initial planningstage. This can often becomequite technical and may oftenrequire the assistance of aconsultant with both technicaland sectorial knowledge, asthe true costs of the variousoptions are teased out toensure there are no surprisesonce an arrangement hasbeen agreed and is put inplace.The important factor to noteis that any structure adoptedby a pharmacist in theoperation of their outlet mustbe one that is in keeping withthem as an individual, theirmanagement style, vision andtheir ethos regarding the careand service provided to theircommunity.If you require further informationon any of the details containedin this article, please contactBrian Hyland or Edel Dempseyat Baker Tilly Ryan Glennon on01 496 5388 or email bhyland@bakertillyrg.ie or edempsey@bakertillyrg.ie.ABC Advert JULY2014.pdf 1 28/07/2014 14:41CABCSTOCKTAKING SERVICESMYCMMYPHARMACY SPECIALISTS | SAME DAY AUDITABLE REPORTSLIVE STOCK INTEGRATION WITH:CYCMYK44 Church Street, Tullamore, Co. Offaly Phone/Fax 057 93 20045Alan Daly – Director 087 2666431 Darren Donoghue – Manager 086 3809082IPUREVIEW AUGUST 2014 27

BUSINESS Stuart Fitzgerald, Business Advisory Director, Fitzgerald PowerThe taxadvantages of alimited companyIn this article, StuartFitzgerald, BusinessAdvisory Director ofFitzgerald Power, outlinesthe benefits of trading asa limited company.Incorporating a sole tradepharmacy can result insignificant tax savingsfor individuals whosedrawings are lower thantheir taxable profits.Corporation tax at 12.5%applies to trading profits in apharmacy company, comparedto the maximum marginalrate of 55% (Tax, PRSI andUSC) for profits in a pharmacysole trade.The following examplehighlights the tax savingsthat may be available fromincorporating a pharmacy soletrade:n Jack bought a pharmacyin 2007 for €2,500,000.He leases the businesspremises from theformer owner.n The former owneroperated as a sole traderand Jack has continuedwith this structure.n The pharmacy has aturnover of €1,750,000and a taxable profit of€385,000.n Jack is 50 years old. Hiswife Mary, who is also 50,is a qualified pharmacistand works in the shopfor an annual grosssalary of €25,000.n Jack’s annual drawings(to include income taxpayments and pensioncontributions) are€125,000 per annum.Under the current structure,Jack and Mary have thefollowing annual income taxliabilities (before credit forwithholding tax and for thepurposes of this exampleignoring tax relief on pensioncontributions):Jack Mary TotalTaxable Income €385,000 €25,000 €410,000Income Tax / PAYE €147,700 €3,350 €151,050Universal Social Charge €34,800 €1,070 €35,870PRSI €15,400 €1,000 €16,400Total €197,900 €5,420 €203,32028IPUREVIEW AUGUST 2014

ConvenienCe• The only once-monthly*contraceptive in Ireland 1,2• Unlike combined pillsNuvaRing does not requiredaily administration 121 28Pills1RING* In a given 1-month period, NuvaRing mustbe inserted, removed after 3 weeks, anda new ring must be inserted no more than7 days later. 1effiCaCyComparablewith that of theCombineD pill 1• 99% effectiveat preventingpregnancy when usedas directed 1ease of use 3• more than 95% of womenrarely or never had aproblem inserting orremoving NuvaRing 3Actual NuvaRing user.The unique delivery system of NuvaRing 1,2,†Nuvaring 0.120 mg/0.015mg per 24 hours vaginal delivery system® (See SPC before Prescribing) Etonogestrel andethinylestradiol • Presentation: Vaginal ring. Uses: Contraception. Dosage and Administration: A ring should be inserted into thevagina and left in for 3 weeks. Strictly follow insertion instructions. Contraindications: Presence/history of venous thrombosis,with/without the involvement of pulmonary embolism. Presence/history of arterial thrombosis or prodromi of a thrombosis.Known predisposition for venous/arterial thrombosis, with/without hereditary involvement or the presence of severe/multiplerisk factors. History of migraine with focal neurological symptoms. Diabetes mellitus with vascular involvement. Pancreatitisor history thereof if associated with severe hypertriglyceridemia. Presence/history of severe hepatic disease if liver functionvalues abnormal. Presence/history of liver tumors. Known/suspected sex-hormone dependent tumors. Undiagnosed vaginalbleeding. Hypersensitivity to any ingredients. Precautions and Warnings: No epidemiology data available on vaginaladministration but the warnings for combined OCs (COCs) are considered applicable. Risk of breast cancer possibly similarto that associated with COCs. This may be due to earlier diagnosis in COC users, the biological effects of the COC, or acombination of both.. Use of any combined hormonal contraceptive (CHC), including NuvaRing, carries an increased risk ofvenous thromboembolism (deep vein thrombosis and pulmonary embolism) compared with no use. The excess risk of VTE ishighest during the first year a woman initially starts using a CHC or when she restarts CHC use after an interval of no use of atleast one month. • Remove ring in event of a thrombosis and before long-term immobilisation. Council patients on symptomsof thrombosis. Increased risk of cervical cancer in long term COC users has been reported, but this may be confoundedby other factors. Abnormal liver function or liver tumors. Increased risk of pancreatitis in women with hypertriglyceridemiataking hormonal contraceptives. Hypertension. Diabetes. Crohn’s disease/ulcerative colitis. Chloasma. Sickle cell disease.History during pregnancy/previous use of sex steroids: jaundice and/or pruritis related to cholestasis, gallstone formation,porphyria, SLE, HUS, Sydenham’s chorea, herpes gestationis, otosclerosis. Remove ring if there is increased frequency/severity of migraine. Increased risk of thromboembolism in the puerperium. May not be suitable for women with a prolapse orsevere constipation. Consider incorrect positioning in case of cystitis. Occasional vaginitis. Very rarely it has been reportedthat the ring adhered to vaginal tissue, necessitating removal by a healthcare provider.If ring accidentally expelled followSPC instructions. Interactions: Possible interactions with phenytoin, phenobarbital, primidone, carbamazepine, rifampicin,oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin, penicillins, tetracyclines, ciclosporin, lamotrigine and St John’sWort. Use of antimycotic ovules may increase the chance of ring disconnection. Pregnancy and Lactation: Not recommended.Common Undesirable effects: Vaginal infection, depression, decreased libido, headache, migraine, abdominal pain, nausea,acne, pelvic pain, breast tenderness, genital pruritis, female dysmenorrhoea, vaginal discharge, weight increased, discomfort,device expulsion. See SPC for full details of other uncommon side effects. Overdose: No reports of serious effects fromoverdose. Legal Category: Prescription Medicine Product Authorisation Number: PA 61/29/1. Product Authorisation holder:Organon Ireland Limited, P.O. Box 2857, Drynam Road, Swords, Co. Dublin, Ireland. © Merck Sharp & Dohme Ireland (HumanHealth) Limited, 2013. All rights reserved. Date of review: July 2013 Further information is available on request from: MSD, RedOak North, South County Business Park, Leopardstown, Dublin 18 or from www.medicines.ie. Date of Preparation: May 2014.† The only vaginal contraceptive ring in IrelandReferences: 1. Nuvaring Summary of Product Characteristics August 2010 2. MIMS Ireland, Dec 2011 3. Novák A, de la Loge C,Abetz L, van der Meulen EA. The combined contraceptive vaginal ring, NuvaRing: an international study of user acceptability.Contraception. 2003;67(3):187-194.www.talkoptions.ieRed Oak North, South County Business Park, Leopardstown, Dublin 18, IrelandWOMN-1120830-0000

Jack and Mary have receivedprofessional advice whichindicates tax savings arepossible if they incorporatetheir business. The detailsof this incorporation are asfollows:n Jack sells the pharmacytrade to a newly formedlimited company, NewcoLimited.n As with manypharmacies, the valueof the trade has fallensince 2007 and, followinga valuation, the arm’slength value of thetrade is established at€1,750,000.n As the new companydoes not have funds, aloan account is createdon the balance sheetof Newco Limited for€1,750,000. It is agreedthat the company willmake annual paymentsof €100,000 to Jack for17.5 years until this loanis cleared.n Selling the trade to thenewly formed limitedcompany creates aCapital Gains Tax event.However, as this resultsin a loss, there is noliability to CGT (note asthis loss arose betweenconnected parties, thereare restrictions on howthis can be utilised):Sale price €1,750,000Purchase price (€2,500,000)Capital loss (€750,000)CGT @ 33%NilUnder these circumstances,each year Newco Limitedmakes the followingpayments:n €100,000 loan repaymentto Jack. The repaymentof this loan is not withinthe scope of incometax. This loan is createdby the Capital GainsTax event noted above,which does not attract aCGT liability.n €35,000 gross salaryto Jack, whichapproximates a netsalary of €25,000 perannum. Therefore, Jackstill draws €125,000annually from thebusiness.n €25,000 gross salary toMary, as before.The following tax liabilitieswill apply:By incorporating theirbusiness, Jack and Mary havereduced their overall annualtax bill (to include incometaxes and corporation tax)by €145,630 without reducingtheir annual drawings.In addition to this annualtax saving, Jack and Mary canavail of the following benefits:n Limited liability: Jackand Mary are no longerpersonally responsiblefor the liabilities of thebusiness.n Retirement relief: In 10years’ time, providingall conditions are met,Jack and Mary can availof retirement relief.Current retirementrelief exemptions meanthat Jack and Mary cansell their shares in thecompany in 10 years’time for up to €1,500,000without incurringa Capital Gains Taxliability.n Pension planning:A limited companystructure allows forgreater tax efficiencywhen Jack and Maryare providing for theirpensions.In the above example, theannual loan payments of€100,000 to Jack will ceaseafter 17.5 years as the loanwill be repaid. To maintainJack’s net income, the salarywill increase; when thisoccurs the overall annual taxliability would increase by€72,000 meaning the annualtax saving from incorporationwould reduce from €145,000per annum to €73,000 perannum.This example isstandardised and condensedand may over-simplify theissues involved but, in thecircumstances outlined, itclearly demonstrates thatincorporation can resultin significant income taxsavings. As incorporationwould impact on future plansfor retirement and successionplanning, care is needed toensure that tax reliefs arepreserved for future exitstrategies.If you would like to discuss thematters raised in this article,please contact Stuart Fitzgerald ofFitzgerald Power at 051-870152or sfitzgerald@fitzgeraldpower.ie.This article is general in natureand does not purport to be a legalguide or offer professional advice.If you wish to act or refrain fromacting on the basis of the aboveinformation, you should seekindependent professional advice.Jack Mary NewcoLimitedTotalTaxable Income €35,000 €25,000 €350,000 €410,000Income Tax / PAYE €5,350 €3,350 – €8,700Universal Social Charge €1,770 €1,070 – €2,840PRSI €1,400 €1,000 – €2,400Corporation Tax – – €43,750 €43,750Total €8,520 €5,420 €43,750 €57,690“ As incorporation would impact on futureplans for retirement and succession planning,care is needed to ensure that tax reliefs arepreserved for future exit strategies.”30IPUREVIEW AUGUST 2014

IRELAND’S N O 1**PHARMACY ONLYPAIN RELIEVERTHANPARACETAMOL ALONEAlways read the label. Can cause addiction. For three days use only. **IMS MAT Value June 2014SOL/IRE/14-002Solpadeine Soluble Tablets (P) contain Paracetamol, Codeine Phosphate Hemihydrate and Caffeine. For the treatment of acute moderate pain not relieved by other analgesicssuch as paracetamol or ibuprofen alone; for symptoms of headache, including migraine, toothache, backache, common cold, influenza, menstrual pain, muscoskeletal pain.Adults and children 12 years and over: 2 tablets in water three to four times in 24 hours as required; not more frequently than once every four hours. Maximum 8 tablets in24 hours. Children under 12 years: Not recommended. Do not take for more than 3 days without consulting a doctor. Do not take any other paracetamol or codeine containingproducts concurrently. Avoid excessive caffeine intake. Can cause addiction. Use for 3 days only. In case of overdose, seek immediate medical advice, even if the patient feels well.Contraindications: Lactation, acute asthma, known hypersensitivity to ingredients, known CYP2D6 ultra-rapid metabolisers, patients under 18 years who undergo tonsillectomyor adenoidectomy for obstructive sleep apnoea syndrome, rare hereditary fructose intolerance. Precautions: Caution in renal or hepatic impairment, non-cirrhotic alcoholicliver disease, obstructive bowel disorders, previous cholecystectomy, acute abdominal conditions, pregnancy, hypertension, oedema. Interaction with coumarins (includingwarfarin), domperidone, metoclopramide, colestyramine, monoamine-oxidase inhibitors. Side effects: anaphylaxis, bronchospasm, dependency or worsening of headachefollowing prolonged use, dizziness, GI disturbances, hepatic dysfunction, thrombocytopenia. PA 1186/11/1. MAH: Chefaro Ireland Limited, 1st Floor, Block A, The Crescent Building,Northwood Business Park, Dublin 9. RRP (excl. VAT): 12s €4.99, 24s €7.99, 60s (GMS) €12.15. SPC: www.medicines.ie/medicine/6826/SPC/Solpadeine+Soluble+Tablets.

Krka’s Exclusive Generics,It’s time to take a closer lookIcorvida SR (Indapamide) 1.5mgCarvedilol Krka (Carvedilol) 3.125mg, 6.25mg, 12.5mg, 25mgValsartan HCTZ Krka (Valsartan HCTZ) 320/12.5mg, 320/25mgOprymea SR (Pramipexole SR) 0.26mg, 0.52mg, 1.05mg, 2.1mgDiacronal MR (Gliclazide SR) 60mgGalsya SR (Galantamine SR) 8mg, 16mg, 24mgRolpryna SR (Ropinirole SR) 2mg, 4mg, 8mgKRKA Pharma Dublin Ltd. Suite 6, The Mall, Beacon Court, Sandyford, Dublin 18Tel: 01 293 9180 Fax: 01 293 9185 E-mail: info.ie@krka.biz

n Targeting of prescriptionmedicines and, in mostcases, cash from tillstakes place, rarely isthe CD safe or cashsafe targeted, leadingus to deduce that thecraved medicines are theprimary target.n Most popular cravedmedicines targeted are:• Diazepam• Anxicalm• Zimovane• Valiumn All cases involved one ortwo offenders.n No or little ‘obvious’homework completed byoffenders and, in mostcases, offenders havetravelled outside of theirown living and operatingareas to commit theoffences.n Times of incidentswere, in the majorityof cases, late night orclose to closing times,usually in low footfallareas. Times of incidentstargeted quiet times,with minimal customersin the premises.n Successful offenceswhere the offenderswere not apprehendedhave led to repeatoffences in some cases.n High street locationpharmacies with nobarrier parking outsideor where ease of accessto motorway aretargeted.n Average time taken isone minute to completethe offence.n Mainly all female staffbase targeted.Unfortunately, these typesof crime cannot be 100%deterred as the offender typemay be driven by withdrawalsymptoms or desperation.Bearing this in mind,minimalising the negative riskto staff safety must have beenaddressed. The training ofstaff in management of armedrobbery, basics of conflictmanagement and seriouscriminal incidents will ensurethat their safety is maintainedduring possible incidents.Prevention andcontrol measuresRisk locations, which operatewith a number of the abovecontributing factors, can bemanaged by implementingcontrols such as SituationalCrime Prevention Techniques1.This entails reviewing andaddressing requirements in fivedifferent areas, which providesan overall security strategyspecific to that location.A decision on whichaction(s) is most suited tothe risk location is made andthe action applied. Finally,the risk locations shouldbe constantly monitored orevaluated to identify changes.Changes in risk locationscan then be addressedby completing the riskmanagement process again.The five areas to be reviewedto identify adequate controlmeasures.1. Reduce or control ofreward to offender.2. Increase the perceivedrisk to the offender.3. Increasing the perceivedeffort to the offender.4. Reducing provocation.5. Removing excuses.Reduce or controlof rewardThe target of these incidentsare specific medicines utilisedfor on-sale by criminaloffenders and cash fromtill points. Possible controlsmay include:n Education on minimalordering and carrying oftargeted medicines.n Removal of targetedrewards by placing inareas not visible to thepublic.n Education regardingimportance of cash liftsprior to high risk times.n Signage regarding timelocksafes and access tocash by staff.Increasing theperceived riskThe perceived risk to anoffender of being caught iscentred on being identified orcaught in the act of the crime.Possible controls used toincrease this perception mayinclude:n Increase of naturalsurveillance. Bothoutside the pharmacy inareas where an offendercan conceal themselvesand inside the pharmacy,so offenders can be“ By identifying thecontributing factorsof historic incidents,pharmacies canproduce controlsand processesto reduce thelikelihood of beingperceived as a softtarget for offenders.”viewed by footfalloutside the pharmacy.n External lightingincreases the possibilityof offenders being seenprior to entering thepharmacy by membersof the public.n Formal surveillancetechniques such asCCTV controls.n Immediate dispatch ofGarda through mobile RFPanic Alarms.n Immediate dispatchof Garda throughmonitored total securityRF systems linked toCCTV systems (signageis required for this toact as a deterrent asthis may not be obviousto an offender prior toentering the pharmacy).Increasing theperceived effortThis is location-specific andmust take into account how‘easy’ an offence is perceivedby the offender. Possiblecontrol measures include:n Access control systems.Controlled access tothe public during highrisk times, such as after6pm or minimal footfalltimes.n Restriction of access tothe dispensary areas. Useof counters and barriers.n Restricting access totargeted reward.n Manned guarding.Reducing provocationManaging an incident as ittakes place is vital to ensurethe safety of staff in thesesituations. As it cannot beguaranteed that adequatemeasures will eliminatethis type of crime, adequatetraining must be provided tostaff in high-risk locationsto ensure that their safety ismaintained and that they donot provoke violence duringthese incidents. Possiblemeasures include:n Training, such as threatrecognition, basic34IPUREVIEW AUGUST 2014

conflict managementand personal safetytechniques can aid staff.n SOPs and Policydocuments for alllocations covering thebasic security andsafety points.Removing excusesThis area covers themanagement of policies,procedures and controls bythe locations managementteam and staff. Ensuringsupport is provided to theteam to aid compliance ofthese measures increasesthe likelihood that they willbe adequately enforced andmaintained. Possible measuresmay include:n Allowing adequatestaffing levels to ensurekey security and safetytasks are completed.n Providing supportregarding training andadditional clarification.n Setting of clear rules,which are reviewedregularly andcommunicated to allstaff.n Providing clarityregarding benefitsof compliance andconsequences of noncompliance.Also important is followingup on suspicious behaviour,or offenders doing theirhomework. All suspiciousactivity must be reportedto the Garda as this couldsuccessfully deter an incident.In the event that yourpharmacy is victim of anarmed robbery, it is vital thatyour staff have been giventhe knowledge and skills todeal with such an incident.The objective of offendersis to get into the pharmacyunseen, get what they wantand get away as quickly aspossible. Ensuring that staffmembers do not impedethe offender’s objectiveswill ensure their safety ismaintained. As a minimum,staff members should bebriefed on the principlesof the Garda programmeof COOP:C-operate: Stay calmand do what theoffender wants.O-bey: Provide theoffender with whatthey want.O-bserve: Obtaindescription and listenfor names used.P-reserve: Securepremises, call Gardaíand never follow anoffender.Never forget that your staff isyour most valuable asset andshould be protected.1 Clarke, R.V. & Homel, R., (1997) A Revised Classification of Situational Crime Prevention Techniques in Lab, S. (ed), Crime Prevention at a Crossroads, Cincinnati, OH,Anderson Publishing Co.7th All Ireland Pharmacy Conference7th All Ireland Pharmacy ConferenceThe 7th All Ireland PharmacyConference is being held on26 and 27 January 2015 atBallymascanlon House Hotel,Dundalk. This Conference isheld biennially and is fundedby a number of pharmacyorganisations. Its focus isto share good practice inpharmaceutical care andpractice development acrossthe primary and secondarycare sectors. Pharmacists,technicians and qualifiedassistants will be encouragedto exchange ideas forpharmaceutical servicedevelopment in NorthernIreland and in the Republic ofIreland.Call for abstractsAbstracts that deal with abroad range of pharmacypractice are invited, including(but not limited to) thefollowing areas:n Collaborative initiativesn Leading innovationn Medicines managementn Medicines safetyn Service developmentAbstract formatConference abstracts shouldbe submitted via the IrishInstitute of Pharmacy website(www.iiop.ie) using the coursesand events link.Applicants should clearlyindicate the correspondingand presenting author(s)and whether they wish theirabstract to be considered forposter or oral presentation (10minutes plus 5 minutes forquestions).The closing date for receiptof abstracts is Friday 26September and authors will benotified regarding acceptanceby Friday 10 October.IPUREVIEW 7th AUGUST 2014 All Ireland Pharmacy Conference 35

BUSINESS Enda Harte, Sales & Marketing Manager, JustScan LtdTroubleshooting tipsfor your EposhardwareIn the July edition, Iwent through the variousconsiderations whendeciding on a websitefor your pharmacy. Thismonth, we are goingto focus on some basictrouble shooting tips foryour Epos hardware.While youfeel thatyou maybe too busyto troubleshoota problem or perhapsthat you do not have enoughtechnical knowledge,understanding the basicsabout your Epos hardwaremay save you time and moneywhen something goes wrong.Computer/integratedcomputerAll Epos solutions includesome form of computer – itcould be a tower unit similarto what you are using in yourdispensary or an all-in-one‘integrated’ unit. As you mayalready know, computers canslow down over time so it’s noharm to restart your unit(s)once a week. This refresheseverything on the computer.Be careful when restartingyour computers as they mayneed to be done in a certainsequence. For example, if themain unit (or server) has tobe restarted, you should exitout of the Epos software onall units to avoid potentialproblems.If the till is not working andthere is no power light, make36IPUREVIEW AUGUST 2014

Formerly known as:Services and ProductsPharmaSource is Ireland’s leadingsupplier of unlicensed medicines.PharmaSource can help reducethe valuable time our customersare spending searching formedicines that are currently inshort supply or discontinued in thenational market. We can sourcethese products for you.PharmaSource supply ourcustomers with an extensive rangeof manufactured specials includingliquids to meet the needs ofgeriatric and paediatric patientswith unique swallowingrequirements.PharmaSource supply a range ofcreams, ointments, gels, powders,suppositories, tablets and capsulestailored to the unique needs ofyour patients.PharmaSource have anunparalleled range of products instock including cold chain andcontrolled drugs. We haveimmediate access to a database ofmore than 1 million medicinesworldwide all of which can beeasily ordered via our website.PharmaSource have expertisein logistics, national andinternational regulatory affairs,HSE reimbursementpolicies and qualitycontrol.Why partner with PharmaSourceWe are an Irish company with acombined history of serving Irishpharmacies since 2006.We offer a tried and tested service youcan rely on. The Pharmasource team ismade up of qualified pharmacists andtechnicians who understand theimportance of delivering your order ontime every time to meet the needs ofyour valued patients.Market leading price structures.Multichannel ordering options: Via ourwebsite, fax or email makes placingyour order very easy.The majority of customer orders aredispatched with their next scheduleddelivery*.Contact details:4045 Kingswood Road,Citywest Business Park, Co. Dublin.Free Phone: 1800 440 440Free Fax: 1800 441 441Email: Pharmasource@uniphar.ieWeb: www.uniphar.iePharmasource is a division of the Uniphar Group.*In some cases products that are difficult to source may take longer, please call 1800 440 440 for more information.

sure to first check that nothinghas tripped on the fuse board.If it has, flick the trip switchand power on all units, againin the correct sequence. If yourtill system is connected to aUPS (backup power supply/surge protector), make surethat it is powered on. If there isstill no power, the final optionbefore calling your supplier isto use a different power cable.All computers use a similarpower cable (like a kettle lead).Keep IT cleanEpos hardware (because ofthe environment) can attracta lot of dust. It is importantthat you keep the hardwareitself clean, but also you mustkeep the area around the tillclean and free of clutter. Thisis especially important if youhave a PC under the counter.Sometimes it is quicker andeasier, to carefully vacuumthe dust rather than using acloth. Dust can clog up fans,which affect the performanceof the unit and may causeparts to blow. Make sure alsoto keep the area around thePC/till clear from obstructions.If there are items blocking thefans or vents on the PC, it maycause it to overheat.Blades are often used inpharmacies to open boxes ina delivery. These blades areusually left lying around ontop of keyboards and tills. Itis important to store these ina safe place away from thetills as they can fall down intothe units or under keyboardsand cause problems withperformance.Monitors/touchscreenmonitorsIf your screen is blank, thepower lead could be slightlyout of the socket at the back ofthe monitor, the plug may beloose or the VGA cable couldbe loose. Check both ends ofall cables coming out of theback of the monitor. If allseems ok, try a different powercable. Again, the power cablesfor all monitors are similar tothat of the PC (kettle lead).Over time, touch screens cango a little off centre. While yourfinger may be touching onepart of the screen, the softwaremay be pressing the buttonabove this. All touch screenmonitors have software thatlets it know what part of thescreen you are touching. Thereshould be a program calledELO at the bottom of yourscreen just beside the ‘Time’.If you open this program, youwill see a calibrate option.Select this option and followthe instructions to calibratethe screen. This will most likelyinclude pressing the centre of‘Target Icons’ as they appearon the screen. Once this isdone (usually four times),the screen is more accurate.I would highly recommendthat you do not use a pen orany other object, which coulddamage or mark the screen.Cash drawersNearly all cash drawers areplugged into the back of thereceipt printer. A loose cablemay cause a cash drawer notto open when it should. Thecash drawer connection lookslike an ordinary phone cable.If reconnecting this cable doesnot fix your problem, theremay be an issue with yourreceipt printer.Receipt printersMany receipt printer problemsare resolved by simplypowering the printer off andon again, a ‘re-set’ as such.The power button is usually atthe front or side of the printer.There are usually three cablesgoing into the rear of yourreceipt printer; one is for thecash drawer, the next is forpower and the last one is adata cable which allows thecomputer to talk to the receiptprinter. If the ‘re-set’ has notresolved your issue, ensurethat all cables are pluggedsecurely and restart the printeragain. Check to see that thereis paper in the receipt printerand that the door is closedfirmly on it. (There may be ared light flashing to indicate‘Paper Out’). Most receiptpaper has a pink/red back on itas it nears the end. When younotice this, have a new till rollready to drop in. Most receiptprinters use 80 x 80 thermaltill rolls and are available fromstationery supply companies.Barcode scannersIf the barcode scanner isnot working, the cable mayhave come loose. Pluggingthe cable out and in againusually resolves this problem.If the scanner has a roundedPS2 connection, this mustbe plugged into the roundpurple keyboard socket ofthe computer. If this does notwork, you may need to restartyour computer.BroadbandIf you are changing broadbandprovider or getting a newrouter, please make sure tocontact your Epos provider.A router change may affectinternet access on the tillsor may affect your supplier’sremote support access.BackupsIt is important to check yourbackups regularly as it is onlywhen something goes wrongthat you realise how importantyour data is.If a piece of equipmentstops working, check and seeif something changed. Didsomeone unplug somethingin the dispensary or movesomething which may haveloosened a cable? Theseare the basic questions toask when trouble shootinghardware problems. If youstill can’t resolve your issue,contact your Epos providerwho will be able to help youtroubleshoot the issue. If youare unsure about something,always contact your providerfirst. Most customers upgradetheir hardware every five toseven years to take advantageof newer technologies and tospeed up the transaction timesat the tills.Enda Harte is Sales & MarketingManager with JustScan Ltd whodevelop and sell their own Epossolution, PharmEpos. PharmEposhas been tailored for the specificneeds of the Irish pharmacist.For more information or a freeconsultation, contact Enda on 071-9130488 or visit www.justscan.ie.AmazingBags forAmazinggiftsContact Eileen BrowneE: eileen@barrypackaging.comT: 087 6869132www.barrypackaging.comCallNowfor aQuoteOrder your Christmas Bags TodayFree Artwork • Free Delivery38IPUREVIEW AUGUST 2014

POLITICS Stephen O’ByrnesCalls for introductionof maximum pricesfor emergencycontraception productsConcern about the price of emergency contraception products was raised in theDáil and Seanad recently and there were calls for the introduction of maximumprices. The role of pharmacists in reviewing patient medications was alsodiscussed in the context of according them a greater role in this area.Alex White, LabourBrendan Griffin, Fine GaelMichael Healy-Rae, IndependentColm Burke, Fine GaelContraceptiondrugs on IrishmarketThere are currently twolevonorgestrel emergencyhormonal contraceptionproducts licensed for sale onthe Irish market, Levonelleand NorLevo. Levonelle is aprescription-only product,which is currently includedon the list of reimbursableitems for the GMS and othercommunity drug schemes. Thisproduct is therefore availableto medical card holders underthe GMS Scheme, subject tothe prescription charge, oncethey have a prescription fromtheir GP.The other levonorgestrelemergency hormonalcontraception productlicensed for sale on the Irishmarket is NorLevo, whichthe Irish Medicines Boardapproved for sale withoutprescription in 2011. Therefore,this product may be suppliedfrom pharmacies without aprescription by or under thepersonal supervision of thepharmacist.This information wasoutlined in the Dáil recently bythe then Minister of State forHealth, Alex White (Labour,Dublin South) in response toDeputies Brendan Griffin (FineGael, Kerry South) and MichaelHealy-Rae (Independent, KerrySouth) who raised questionsabout the cost of emergencycontraceptive products.Deputy Healy-Rae hadasked the Minister to set amaximum price for NorLevoto be paid by patients and toconsider making emergencycontraception available freeto medical card holders,without prescription. DeputyGriffin called for regulationsto impose maximum price foremergency contraception.The Minister of State saidthat the HSE advises thepublic that if they are beingcharged prices which exceedthe reimbursement pricelisted on the HSE website, plusa dispensing fee of between€3.50 and €5, then they shoulddiscuss the differential withtheir pharmacist to ensurethat they get the best possibleprice for the medicineconcerned.“In addition, measures havebeen taken to increase pricetransparency among retailpharmacies. In March of thisyear the PharmaceuticalSociety of Ireland issuedguidelines to pharmacists onprocedures and minimumstandards of information tobe provided to customers,including a requirement toprovide an itemised receipt ofpurchase of medicines.”The subject was alsoraised in the Seanad recentlyby the Fine Gael HealthSpokesperson, Sen. ColmBurke, who said it had beenbrought to his attention by theUnion of Students in Ireland,which claimed that “the costof the relevant medication canvary quite substantially, from€9 to over €45”.Replying on behalf ofthe Department of Health,the Minister of State forHealth, Deputy KathleenLynch (Labour, Cork NorthCentral), said that thePharmaceutical Society ofIreland had issued guidelinesunder the PharmacyAct 2007 to pharmacistsrequiring that the emergencyhormonal contraceptivemay only be supplied to apatient by the pharmacistpersonally, following a privateconsultation between thepatient and pharmacist inorder that the pharmacist candetermine the appropriatenessof the supply and to providean opportunity to meetthe appropriate patientcounselling requirements. Thisconsultation is required totake place in the pharmacy’spatient consultation area.“However, as NorLevo is anover-the-counter product itno longer complies with the40IPUREVIEW AUGUST 2014

applicable reimbursementcriteria for the GMS schemeand the community drugsschemes, as a prescriptionis not normally requiredfor its supply to a patient.Therefore, for all recipientsof this product, the supplyprocess is essentially a privatetransaction between thepatient and the pharmacy”,she added.Pharmacists’ role inreviewing patients’medicinesAlso in the Seanad, the FineGael Health Spokesperson,Sen. Burke, supported whathe said had been a proposalof the Irish Pharmacy Unionto operate a new medicineservice for people with a longtermillness who experiencedcomplications with newmedications, but werereluctant to go back to theirGPs.Sen. Burke said “pharmacistsare offering to provide afollow-up service where theperson could come back to thepharmacy within a three tofive day period, to ensure thatthe medication prescribed isworking and that they do nothave difficulties with it, and ifdifficulties arise they will bedealt with at an early stage”.Deputising for the thenMinister for Health, MinisterLeo Varadkar said thatunder the 2007 CommunityPharmacy ContractorAgreement and prior todispensing a prescription,“a community pharmacycontractor must ensurethat a pharmacist reviewsthe medicine therapy of theindividual for whom theprescription is issued. Thereview shall include screeningfor any potential drug therapyproblems which may arise outof the use of the medicinesprescribed, includingtherapeutic duplication; drugdruginteractions, includingserious interactions withnon-prescription or over-thecountermedicines or food;incorrect dosage or duration ofdrug treatment; drug allergyinteractions; and clinicalabuse and-or misuse.“The review shall alsoinclude an examinationof the rationale and costeffectiveuse of the medicineprescribed, including thechoice of the medicine andthe potential for wastage.Following the completion ofthe review the pharmacistshall offer to discuss withthe individual for whomthe prescription was issuedall such matters as thepharmacist, in the exerciseof his or her professionaljudgment deems significant,including any specialdirections and precautionsfor correct preparation,administration and use of themedicines; the importance ofcompliance and the directionsfor use; any common severeside-effects and adversereactions or interactions andtherapeutic contra-indicationsthat may be encountered,including their avoidance andthe action required shouldthey occur; techniques forself-monitoring during therapyand the need for patientcompliance; prescriptionrepeat information, asnecessary; and, as necessary,any other matters which maybe included or referred to inthe patient information leafletsupplied with the medicine”.He said that the existingagreement, therefore,“provides that pharmacistsdeliver a comprehensive,ongoing support serviceto their patients in termsof ensuring they are fullyinformed of all issuespertaining to their prescriptionmedicines”.Referring to thegovernment’s Future Healthstrategy document, MinisterVaradkar said that as partof its implementation,“pharmacists will be expectedto identify and contribute toimplementing evidence-basedand cost-effective solutionsto ensure the effectivenessand sustainability of thehealthcare system, byaddressing key medicationissues such as medicineswastage, inappropriate usageof medicines, supporting andimproving chronic diseasemanagement and patientadherence to medication.The Minister for Health looksforward to working closelywith pharmacists who willhave an important role to playin delivering on the goals ofFuture Health”.Drug would cost€437,247 perpatient per yearDeputy Sean Fleming (FiannaFáil, Laois-Offaly) asked theMinister for Health whenthe Health Service Executiveexpected to reach a decisionon the approval of eculizumabin the community drugsscheme.Minister of State Whitesaid the HSE had received anapplication for the inclusionof eculizumab (brand Soliris)in the community drugsschemes. The National Centrefor Pharmacoeconomics(NCPE) had conducted anevaluation of the drug, “andconcluded that, at a totalcost per patient per year of€437,247 and a cumulativegross budget impact overfive years estimated at €33million, the therapy did notrepresent value for moneyfor the treatment of patientsin the Irish healthcaresetting. In addition, themanufacturer did not includean economic model as part oftheir submission and failedto demonstrate the costeffectivenessof this therapy.“Consequently, the NCPEwas unable to recommendreimbursement of the productunder the community drugschemes”. The HSE wascarefully considering allthe issues in relation to theproposed benefits and costsof this medicine and expectedto reach a decision in the nearfuture, he added.Central purchasingof drugs notfeasibleThere is no scope forintroducing a centralprocurement arrangementfor the most expensive andthe most commonly useddrugs, Minister of StateWhite told the Sinn FéinHealth Spokesperson,Deputy Caoimhghín ÓCaoláin (Cavan-Monaghan),who called on the Ministerto quantify the full-yearsavings from sourcing the20 most expensive and 20most common on-patentpharmaceuticals from theKathleen Lynch, LabourLeo Varadkar, Fine GaelSean Fleming, Fianna FáilCaoimhghín Ó Caoláin, Sinn FéinIPUREVIEW AUGUST 2014 41

Gerry Adams, Sinn FéinThomas Pringle, IndependentCatherine Murphy, IndependentBernard Durkan, Fine GaelMichael Lowry, IndependentState where the cost of thedrug was the lowest in Europe.Minister of State Whitesaid that most drugs andmedicines which are paid forby the HSE were supplied topatients through over 1,800community pharmacies who,in turn, purchase them fromwholesalers or, to a lesserextent, directly from drugmanufacturers. “The currentpharmacy-based modelresults in over 70 million itemsbeing dispensed annuallythrough local pharmaciesacross the State, including lowpopulation centres in ruralareas.“It enables pharmacies toreceive deliveries each dayfrom multiple wholesalersensuring that all patients havecontinued access to essentialmedicines without delay.Under this model, as the drugsare purchased by individualpharmacies with no directinput by the HSE, there is noscope for the type of centralprocurement arrangementenvisaged by the Deputy”.127 pharmacies inneedle exchangeprogrammeThe Pharmacy NeedleExchange Programme (PNEP)has continued to expandneedle exchange servicesoutside the Dublin area,creating accessible harmreduction services within thecommunity pharmacy setting.By the end of 2013, there were97 pharmacies participatingin the PNEP and a further30 pharmacies have beenrecruited to the programmein 2014, bringing the totalparticipating to 127.This was stated in the Dáilrecently by Minister of StateWhite when responding toa question from Sinn FéinLeader, Deputy Gerry Adams(Louth), who asked theMinister to refocus spendingin the area of drug policy onpublic health interventions“in view of the need forcomprehensive needleand syringe programmecoverage, and the factthat the pharmacy needleexchange programme doesnot meet the needs of all thatrequire needle and syringeprogramme services”.Minister of State White saidthat the Department of Healthhas no plans to introducemedically supervised injectingcentres at present. “My focusis on ensuring that there isan increased emphasis onproviding the opportunitiesfor people to move on fromillicit drug use, through drugtreatment and rehabilitation,to a drug-free life where thatis achievable”. He said that theHSE had completed a reviewof needle exchange provisionin Ireland, which will bepublished shortly.People with LTIand GMS eligibilityto be reimbursedprescriptionchargesThe HSE is actively workingto identify people who hadeligibility under both the longtermillness (LTI) scheme andthe medical card scheme, butwho had to pay prescriptioncharges prior to 1 December2013 for drugs, medicines,medical and surgicalappliances related to theirqualifying long-term illness,or illnesses, with a view torefunding them the moneythey paid in prescriptioncharges.This was stated in the Dáilrecently by Minister of StateWhite, who confirmed thatarising from a policy changelast year, the HSE had decidedthat persons who had both amedical card and an LTI bookcould now access medicationfor their qualifying long-termillness condition or conditionsunder the LTI scheme.Up to that date, in thecase of persons who hadboth a medical card and anLTI book, it had been HSEpolicy that they should usetheir medical card to accessmedicines, thereby incurringprescription charges. “Themain reason for this was thatwhen a retail mark-up of 20%was payable to pharmacistsfor items supplied underthe LTI scheme, it cost theHSE considerably more tosupply medicines under thatscheme than under the GMSscheme”, the Minister of Stateexplained.The matter had been raisedby Deputy Thomas Pringle(Independent, Donegal South-West), who asked when “theHSE would reimburse patientson the LTI scheme, who arealso medical card holders, theprescription charges they werewrongly charged as a resultof having to use their medicalcards to obtain prescriptionitems, rather than their LTIcard”. He also complained thatthe HSE had not yet disclosedhow many people wereaffected.The Minister of State saidthat prescription charges hadbeen introduced in 2010 andthat the HSE was collatingdetails of the numbersaffected and how much theywill be refunded.Wider availability ofadrenaline pensThe Department of Healthwas currently examining thefeasibility, taking accountof policy and patient safetyconsiderations, of amendingthe Prescription Regulations tofacilitate wider availability ofadrenaline pens in emergencysituations, by persons trainedin the administration of thesepens, the Minister of State forHealth, Deputy White, toldthe Dáil.“This is a complex areaand includes considerationof a wide range of issuessuch as appropriate training,including in the identificationof anaphylaxis, conditionsattached to use of theadrenaline pen, productavailability and productshelf life. My Department isworking closely with the IrishMedicines Board (IMB) andthe Pharmaceutical Society ofIreland (PSI) on these issues”.The Minister of State wasresponding to a range ofquestions on the matter fromdeputies, including the SinnFéin Leader, Deputy Adams,and Deputies CatherineMurphy (Independent, KildareNorth), Bernard Durkan(Fine Gael, Kildare North) andMichael Lowry (Independent,Tipperary North).42IPUREVIEW AUGUST 2014

Systane Ultra Systane Gel Drops Systane Balance

STUDIESVfend ® (Voriconazole) new indication is approved for children aged 2 yearsand above and adults in oral and IV formulationsPfizer Healthcare Ireland recently announced that Vfend ® (voriconazole) received European Commission approval on 24 June 2014for a new indication in prophylaxis of invasive fungal infections (IFIs) in high-risk allogeneic hematopoietic stem cell transplant(alloHSCT) recipients.The European Commission’s decision to approve Vfend ® for prophylaxis of IFIs in high-risk alloHSCT recipients is based on phaseIII clinical trials (IMPROVIT and VOSIFI studies) showing the effectiveness of Vfend ® for primary and secondary prophylaxis of IFIs inalloHSCT recipients.Vfend ® is available in both oral and IV formulations, making it convenient for patients and clinicians, and the recommendeddosing for prophylaxis is the same as the well-established regimen for Vfend ® in the treatment of IFIs.In the prospective, randomised, open-label, multicentre IMPROVIT study of primary antifungal prophylaxis in alloHSCT recipients,success of prophylaxis in patients receiving Vfend ® was superior to itraconazole (48.7% vs 33.2%, p

STUDIESIPF Phase III trial results published in New England Journal of Medicine (NEJM) shownintedanib slows disease progression by approximately 50% compared with placeboResults from the Phase III INPULSIS trials, published online in the New England Journal of Medicine, show nintedanib significantlyslowed disease progression in patients with idiopathic pulmonary fibrosis (IPF). Nintedanib is the first targeted treatment for IPF toconsistently meet its primary endpoint in two international Phase III trials with identical design.Idiopathic pulmonary fibrosis (IPF) is a progressive and severely debilitating lung disease with a high mortality rate. It causesprogressive scarring of the lungs, resulting in continual and irreversible deterioration in lung function and difficulty breathing. Inpatients with IPF, lung function loss is measured by a decline in a patient’s forced vital capacity (FVC), the maximum volume ofbreath that can be exhaled. The average IPF patient has lung volume loss of between 150-200ml per year, compared to a normaladult lung volume decline of approximately 50ml per year.In the two, 52-week INPULSIS trials, involving 1,066 patients, nintedanib significantly reduced the annual decline in FVC byapproximately 50% compared to patients taking placebo. The annual rate of decline in each identical arm of the trial were:- INPULSIS-1: -114.7mL (nintedanib*) vs. -239.9mL (placebo)- INPULSIS-2: -113.6mL (nintedanib*) vs. -207.3mL (placebo)Both key secondary endpoints were met in the INPULSIS-2 trial. There was significantly less deterioration in quality of life(as measured by the St. George’s Respiratory Questionnaire) and a reduced risk of a first acute exacerbation in patients takingnintedanib, compared to placebo.In INPULSIS-1, there was no statistically significant difference between the nintedanib and placebo groups in the key secondaryendpoints.In both trials, the most common adverse events were gastrointestinal in nature, of mild to moderate intensity, generallymanageable and infrequently led to treatment discontinuation.The most frequent adverse event in the nintedanib groups was diarrhoea, reported in 62% of patients vs. 19% in the placeboarm (INPULSIS-1) and 63% vs. 18% (INPULSIS-2). Less than 5% of those who experienced diarrhoea in the nintedanib groups ofINPULSIS-1 and INPULSIS-2 discontinued treatment due to this event.The proportion of patients with serious adverse events was similar in all groups.Rheumatoid arthritis patients given more treatment choice with new self-injectionformulation of abataceptAbatacept solution for subcutaneous injection (SC Orencia ® ) is now available in Ireland, in combination with methotrexate (MTX),as a first-line biologic agent for adults with severe rheumatoid arthritis (RA), after failure with conventional disease modifyinganti-rheumatic drugs (DMARDs), including methotrexate (MTX) or a tumour necrosis factor (TNF)-alpha inhibitor. Abatacept is theonly biologic available for both the self-injectable SC and intravenous (IV) formulations, for the treatment of RA, therefore givingphysicians and RA patients in Ireland more choice in treating and managing their condition.Abatacept has a unique mode of action and combines sustained efficacy and a well-established safety profile to enable patientswith RA to reach their treatment goals. The new SC formulation gives patients the convenience and freedom to self-administer athome, removing the need to take time off work or travel to receive IV formulations that are usually administered in hospital.Around 40,000 people are affected by RA in Ireland with associated treatment costs estimated at around €544 million includingmedical costs, drug costs, non-medical costs, the costs of informal care and other indirect costs. The new SC formulation ofabatacept which will be available under the Hi-Tech scheme enables patient care to be transferred to the community, dispensedthrough local pharmacies rather than hospital pharmacies and it may offer an opportunity to reduce the burden on secondary careand improve patient experience.The European marketing authorisation approval of the SC formulation is based on the ACQUIRE study, the single largest phaseIII registrational trial of biologics in RA patients, as well as long-term efficacy and safety data from supporting phase II studies. InACQUIRE, the SC and IV formulations of abatacept were compared and shown to be similar in terms of efficacy and safety (noninferioritycomparison).Johanna Mercier, General Manager, Bristol-Myers Squibb, UK and Ireland, said, ‘This is an important milestone for clinicians and forpatients in Ireland as they now have an option to self-inject abatacept to treat this disabling chronic condition.’Abatacept, in combination with MTX, is indicated for the treatment of moderate to severe active RA in adult patients whoresponded inadequately to previous therapy with one or more DMARDs, including MTX or a tumour necrosis factor (TNF)-alphainhibitor.LINK-banner-ad.qxp_Layout 1 16/05/2014 16:57 Page 1Our new look Link guide is now available.Not a memberof Link?To join contact your Uniphar Representative.Details available on www.unipharcontact.ieOpen to ALL Community Pharmacies.IPUREVIEW AUGUST 2014 45

WINE James Tobin, Wine Taster and Lecturer, O’Briens WinesHere in Ireland, with our gloriously unpredictableclimate, there is certainly no guarantee of warmsunny weather in the summer months. However,when the weather is good we need to be preparedto seize our opportunity for al-fresco dining. Withthis in mind, James Tobin has put together a fewtips and recommendations for Summer Sipping.In warmer weather, weare more likely to beeating lighter foods,cold dishes and salads.In a wine, this meanswe should be looking forrefreshment, crispness andjuiciness; also, because quiteoften these dishes will tendto be dressed with vinaigretterather than a sauce, we needto look at wines with fairlyhigh to high acidity.Texture and body-wise, Iwould lean toward somethingjuicy and not too heavy,viscous or full-bodied. Loweralcohol wines are often abetter choice as, for manypeople, the heat accentuatesthe influence of the alcohol.Taking all of this intoaccount, it should come asno surprise that I will berecommending a numberof white, rosé and sparklingwines as the idea of bigchunky reds in summerweather can be quitedaunting.For those who don’t wantto deny themselves theirred wine, don’t worry, I willbe suggesting some suitablealternatives.First off, Ithink we shouldlook at somefizz. RizzardiProseccoFrizzante(€14.99 or twofor €25 forthe month ofAugust) is agently sparkingwhite madefrom theGlera grapevariety grownin vineyardsnear Venice. It has flavours ofripe pear and white peach onthe palate and is not too dry,too fizzy or too acidic, so ittends to suit most tastes. It’sthe ideal aperitif to kick off asummer garden party, or evenjust to sip while watching thesun go down. Pop a raspberryinto the glass for a touch ofluxury.With the current craze forProsecco, it is easy to forgetjust how delicious a goodbottle of Cava can be. La RoscaCava (€14.99 down from €17.99for the month of August) ismade using grapes pickedfrom high altitude vineyardsin Penedèsand is bottledfermented(justlike Champagne).All in all, thisleads to a verymodern, fruitdriven Cava,which is zestyand lively andwith loads offresh apple andlemon fruit. Notin any way sharp,it is soft androunded, makingfor a very easy to drinksparkler.There are certain whitegrape varieties and wineregions that I always associatewith summer days, such asSauvignon Blanc from France’sLoire valley, Albariño fromGalicia in Northern Spain,dry Riesling from Germanyand the mineral-drivenwhites, which emanate fromCampania in southern Italy.Whilst I have enjoyedmany an oaked white wine insummer, my tendency is tobuy un-oaked, as they usuallytaste lighter and are easier todrink.Petit BourgeoisSauvignon Blanc2012 (€11.99down from €15.99for the month ofAugust) is made byrenowned Sancerreproducer, HenriBourgeois. This‘baby Sancerre’, asit is affectionatelydubbed, attractshuge plauditseach year for itsquality and value.It is beautifullyfragrant with ripe citrusfruit aromas and flavoursalong with mouth-wateringminerality, striking the perfectbalance between New Worldaromatic intensity and OldWorld restraint.Pazo Señorans 2012(€18.99 down from€20.49 for the monthof August) is a veryclassy wine fromarguably the finestestate in the RiasBaixas region. This isa perfect example ofpremium Albariño,delicately floral onthe nose with hints46IPUREVIEW AUGUST 2014

of lemon and pear. This opensup on the palate to reveal acomplex, mineral-driven whitewith an incredibly long finish.Above all else, the purity offruit is extraordinary!The comebackof Riesling is trulyunderway andwith excellent dryGerman Rieslingslike SchönbornRiesling Trocken2013 (€14.49 downfrom €16.49 for themonth of August)on the marketit’s no wonder.Medium bodied,with deliciously puregreen apple fruit andgreat minerality thisis a classic dry Riesling fromthe oldest estate in Germany,under continuous familyownership – 21 generationsspanning over 660 years. Noother estate in the Rheingaupossesses such a selectionof fine vineyards as thishighly traditional propertyin Hattenheim.From volcanicsoils in the hillsof Campania,TerredoraFalanghina IGT2011 (€15.49 downfrom €17.49 for themonth of August)justifiably takesits place amongthe greatest whitewines Italy makestoday. This haseverything a topquality whiteshould have; depth,richness, complexity andthrilling minerality. A ‘musttry’ wine.Rosé offers the perfect bridgebetween white and red winesand these wines really comeinto their own in the summermonths. For me, nothing sayssummer quite like a crisprefreshing glass of rosé.Now, there was a time notso long ago when rosé wineswere considered deeplyunfashionable, mainly dueto preponderance of overlysweet, pink lemonadestylerosé emanating fromCalifornia among otherplaces. Today, however, rosé isone of the most vibrant andinteresting wine categories,thanks mainly to the influenceof the many delicious dry roséwines produced in the southof France.Like all proper rosé wines,these wines are made usingthe saignée method, wherebythe freshly picked black grapesare left to stand in a vat andthe weight of the grapes doesthe crushing. This free-rungrape juice is only in contactwith the black grape skins fora very short period resultingin a very pale pink wine. Theserosés usually share some ofthe presence and structure ofred wines, only written witha lighter hand. To enjoy themat their best, chill them, butdon’t freeze them to deathand you have a great summerweightsubstitute for manyred wine situations.Where rosé’s star reallyshines though, is when itcomes to food-matching,probably because of the factthat it expresses some of thecharacter of both red andwhite wines. Whether you areserving Asian cuisine, tapasor a salad, hot or cold dishes,meat, fish, or vegetables, oreven with a BBQ, rosé willoffer a tasty match. In fact,very few other wine-styles arequite so versatile.It is no secretthat the mostprestigiousrosés come fromProvence andChâteau RiotorRosé 2013 (€16.49buy 1 get 2nd½ price), is asuperb example.Wonderfullypale in colourbut with superbdepth of fruit, thisstructured foodstyle is ideal forsummer lunches.Supremely elegant in style,Château De Sours 2013 (€16.99buy 1 get 2nd ½ price) is astunning BordeauxRosé, which hasa nose of redberries and rosepetal,leading tomouth-wateringstrawberries andcream on the palate.It is surprisinglyfull and rich yetbalanced by lovelyrefreshing acidityand a long dry finish.Now, I’m sure the thought ofdrinking Rosé will give somered fans the shudders, but it ispossible to enjoy full-flavouredreds without being weigheddown.Some red grape varietieslend themselves to the idea ofsummer drinking more thanothers. Pinot noir in particularprovides the sort of throttledbackred that suits summersituations. Now that his PinotNoir vines have reachedfull maturity,acclaimedwinemakerSimon Waghornis fashioningsuperb, almostBurgundianPinot Noir at hisMarlborough,New Zealandestate. Fragrant,complex and witha great purity ofripe wild berryfruit, AstrolabePinot Noir 2010(€22.49 down from €25.49 forthe month of August) is anutterly delicious summer red.We should also considerthat some red wines aredesigned to take a chill, It’samazing what a differencea light chill can make; butremember, cold is the enemyof aroma and flavour in wine,so be careful not to overdoit. These wines are usuallyfruity (but not sweet) redswith low levels of tannin, thebenchmark for this style is aBeaujolais Cru such as Fleurie,made using the carbonicmaceration method, whichdoesn’t extract much tanninfrom the Gamay grapes. Alsoworth trying chilled, are theCabernet Franc based wines ofthe Loire.Château de Fleurie 2012(€16.99 down from€19.49 for themonth of August)is made from asingle 13 hectareestate coveringsome of the bestterroir in Fleurie,this is one of thefinest Cru’s in theregion. A complex,Burgundian Fleurie,this is a serious cutabove just aboutevery other Fleurieon the market –quite simply, velvet in a glass.Quality is paramount atLanglois-Château – owned andrun by BollingerChampagne, thereis nothing spared inensuring this is oneof the region’s bestproducers. Their St.Nicolas de Bourgueil2012 (€14.99 downfrom €19.99 for themonth of August)is a classic LoireCabernet Franc,light in body butwith wonderfullyjuicy red berry fruit.All wines are available atO’Briens stores nationwideor online at www.wine.ie.IPUREVIEW AUGUST 2014 47

INTERNATIONAL NEWS Roisin Molloy, Membership & Secretary General’s Office Manager, IPUInternationalpharmacy newsUKReport oncontributioncommunitypharmacy canmake to care ofasthma sufferersThe Pharmaceutical ServicesNegotiating Committee(PSNC) has published a reportoutlining the significantcontribution that communitypharmacies could maketo the care of people withasthma to help improve theircare, manage their conditionand reduce avoidablecomplications.The report pulls togetherevidence from a numberof local pilots and servicesto show the impact thatcommunity pharmaciescan make in this area. Forexample, by helping peopleto understand and usetheir inhalers correctly,pharmacies can help peopleto better manage theirconditions, reducing hospitaladmissions and even deathscaused by asthma.Building on PSNC’s visionpublished last year, it alsooutlines how the gradualdevelopment of asthmaservices, building on MURsand the NMS, could enablepharmacies to providelongitudinal care for peoplewith asthma, taking overthe key role in leadingtheir management to freeup capacity in generalpractice.The report is focused inparticular on the recentlypublished National Reviewof Asthma Deaths (NRAD)which highlighted the needfor improvements in careto help avoid unnecessarycomplications and deaths dueto asthma. Key findings fromthe report included that:n nearly half of thoseincluded in the studyhad not received anymedical help duringtheir last attack;n the standard of carereceived was less thansatisfactory in a quarterof those who died; andn there was widespreadunder-use of preventerinhalers and excessiveover-reliance on relieverinhalers.PSNC’s report outlineshow community pharmacycould help with many of theNRAD’s recommendationsfor care, and it forms part oftheir ongoing work to developcommunity pharmacy servicesand the sector’s role in theNHS.Alastair Buxton, PSNC Headof NHS Services, said: “TheNRAD showed once again theneed to develop services tobetter support people withasthma to manage theirmedicines and conditions. Wealready have evidence to showthat community pharmacycan do exactly that in a waythat is convenient for patientsand affordable for the NHSand we hope that our reporton this topic will help toconvince policy-makers andcommissioners of that.“Of course, what wewould like to see is nationalaction to enable communitypharmacies across the countryto provide the care we describeto asthma patients and we willcontinue to make the valueof that clear in our ongoingdiscussions with the NHS andothers. However, we recognisethe current direction of traveltowards local commissioningwithin the NHS and so weare also looking to work withstakeholders to develop acommissioning frameworkthat could be adopted byCCGs (Clinical CommissioningGroups) to initiate these sortsof services at a local level.In the meantime, we hopethe report may be of use inhelping Local PharmaceuticalCommittees (LPCs) withany local discussions oncommunity pharmacy asthmacare that they have alreadybegun.”Source: www.psnc.org.ukHealthy LivingPharmacyProgramme asuccess, saysRSPH reportCommunity-based ‘healthchampions’, including thosein pharmacies, have a clearpotential to improve publichealth, according to a reportpublished last week by theRoyal Society for Public Health(RSPH).The report, ‘Tackling healthinequalities: the case forinvestment in the wider publichealth workforce’, highlightsthe success of the HealthyLiving Pharmacy (HLP) model,which employs a tieredframework for deliveringhigh-quality services throughcommunity pharmacies.The RSPH argues thatintroducing public healthtraining for the “wider publichealth workforce” – includingpolice officers, firefightersand housing officers – andmaking it a core aspect oftheir continuing professionaldevelopment, could helpaddress the financial burdenof health inequalities, which itputs at nearly £60bn.The RSPH is a multidisciplinarymembershiporganisation for professionalswho share an interest inpublic health. It has morethan 6,000 members.Source: PGEU Monthly ReportJune 2014EUEuropean HealthInsuranceCard: almost200 millionEuropeansalready carry oneAlmost 200 million Europeansalready have the EuropeanHealth Insurance Card (EHIC),according to the latest figuresavailable for 2013. Thisrepresents more than halfof the insured population inthe EU. The number of EHICholders is steadily increasing,with 8 million more citizenscarrying it in 2013 comparedto the previous year (+4%).László Andor, Commissionerfor Employment, SocialAffairs and Inclusion,commented: “Just as manypeople are planning to leaveon their summer holidays,it is encouraging to see thatmore and more people havea European Health InsuranceCard. This allows them toget necessary treatmentwhen travelling within theEuropean Union, Switzerland,Liechtenstein, Norway andIceland. The increasingnumber of citizens obtainingthe Card demonstrates theconfidence in the EHIC systemand the recognition of theprotection it provides.”Source: PGEU Monthly ReportJune 201448IPUREVIEW AUGUST 2014

NEWS2014 Pfizer HealthIndex finds morethan half (53%) thepopulation believehealth cutbacks havehad greatest impactCost H of livingappPensioninessBudgetsFuturLooking aheadHealthImpactDisposable incomeOlder peopleMedical CardSpending lessBehaviourJob security StressFamilieseWorkCutbacksEducationMental healthTHE 2014 PFIZER HEALTH INDEXAttitudesWelfarePrioritising spendUnemploymentAusterityPrivatSmokingEntitlementsExerciseHealth screening IllnessLuxuriesMedicineHealth insuranceFundingDisabilityPrescriptionsLooking forwardHospitalHospital bedsUniversal healthcareGPAccessDoctorePublicRecessionAt the launch of the 2014 Pfizer Health Index were (L-R):Paul Reid, Managing Director, Pfizer Healthcare Ireland, withspeakers at the event, Prof Charles Normand, Edward KennedyChair of Health Policy and Management at Trinity College Dublinand Dr Anne Nolan, Research Director, The Irish LongituDinalStudy on Ageing (TILDA), Trinity College Dublin.Results of this year’s PfizerHealth Index reveal theimpact that years of recessionand austerity budgets havehad on people and shows abroad consensus that cuts inhealth have had the greatestimpact when contrasted withother cuts in social welfare,education, state pension andtransport.More than half (53%) of the1,000 people in the surveynominated health as the areain which cutbacks have hadthe greatest impact, withhealth mentioned first, secondor third by more than 9 in10 (93%). This year the Indexlooked at the effect austeritymeasures have had on Irishpeople, their health and, withsigns of economic recovery,where people’s priorities lie.Almost three out of fouradults (72%) believe thatfamilies with young childrenhave been impacted byausterity budgets, with morethan a third (36%) suggestingthey have been the hardesthit. The impact on familieswith young children is sensedmore by those aged between35 and 49, essentially the corefamily life stage. Older adultswere nominated as the groupsecond most likely (47%)to have been impacted byausterity.Since 2010, the proportionof adults holding privatemedical insurance hasdeclined from 44% of thepopulation to 33% in 2014.The rate of decline was morepronounced between 2010and 2012, but has slowed inrecent years. Over the sametime period, the number ofpeople with medical cardshad climbed to a high of 44%in 2012, at just under 1.6million people, but has sinceretracted to 1.4 million or 39%of the population in 2014. Asnumbers with both privatecover and medical cards hasfallen, we see a growth in thenumber of people who haveneither private insurance nora medical card; this groupconstituted 23% of adultsin 2011 but has risen to 31%in 2014.When asked to assess theirown personal health out of 10,where 10 is excellent healthand one is very poor health,the average volunteered scoreis 7.9 out of 10. The numberof people smoking is at an alltimelow with 25% of adults(aged 16 years plus) currentlysmoking, down significantlyfrom 33% in 2012.Mr Paul Reid, ManagingDirector, Pfizer HealthcareIreland, said; “The Indexis now in its ninth yearand during these nineyears we have gone fromboom to bust, and are nowemerging from recessioninto economic recovery andhopefully sustained growth.This presents a new set ofchallenges for public policyand government strategies –what should be prioritised?Investment in healthcarehas delivered results for Irishpatients – in terms of health,life expectancy at birth inIreland is now 81 years – thishas increased a full four yearssince the year 2000 and ishigher than the EU averageand above the OECD average.As we move out of austerityin Ireland, we must start toshift the focus away from costcutting and on to investmentin healthcare to fuel sustainedrecovery.”The Pfizer Health Indexdetails the findings of anationally representativequantitative market researchsurvey of the health andwellbeing of the Irishpopulation.IPUREVIEW AUGUST 2014 49

NEWSNew President of thePharmaceutical Societyof IrelandThe Council of thePharmaceutical Society ofIreland (PSI), the pharmacyregulator, has elected a newPresident, Ms Leonie Clarkeand a new Vice-President, DrAnn Frankish.Leonie Clarke (pictured left)has served on the PSI Councilsince 2010, studied pharmacyin Trinity College Dublin andholds an MSc by research anddiplomas in legal studies andaccounting and finance. Sheruns her own pharmaceuticalconsultancy, focusingprimarily on compliancewith medicines legislation,corporate governance andquality management. Shestarted her career as AssistantRegistrar of the PSI in 1991,has several years’ experiencein the pharmaceuticalindustry and also spent timein academia. Leonie followsEoghan Hanly as President.Ann Frankish (picturedright) has also previouslybeen on the PSI Council andhas served as Vice-Presidentand President prior to theintroduction of the PharmacyAct of 2007, which establishedthe current regulatory system.She graduated from the UKand first registered with thePSI in 1982. For the past 26years she has served as ChiefPharmacist in the RotundaHospital, Dublin, a post fromwhich she has recently retired.Ann has had a long careerin pharmacy, in a variety ofsettings including community,hospital, and academia andhas recently taken up a rolein industry. Ann follows NoelStenson as Vice-President.Electronic prescribing and informationflow between GPs and other healthprofessionals improvedGeneral Practice MessagingStandard Version 3.0Outline Summary May 2014Electronic prescribing andthe safety of electroniccommunication between GPsand healthcare services hasbeen improved with thepublication of an update tothe Health Information andQuality Authority’s GeneralPractice MessagingStandard (GPMS).The GPMS specifies thestructure and contentof electronic messages.It aims to standardisethe transmissionof these electronicmessages betweengeneral practices,secondary care andout-of-hours care,leading to safer better healthinformation in Ireland.The GPMS outlines theway patient information,ranging from blood testresults, diagnosis information,referrals and X-rays canbe more accurately andsafely transferred betweenhealthcare services.This Standard was firstapproved by the thenMinister for Health andChildren in May 2010. Thisnew version, 3.0, has beendeveloped to include themessaging requirements forthe electronic transfer ofprescriptions between GPsand community pharmacy. Itis also relevant for prescribingin outpatient departments ofhospitals. This new versionof the Standard goes furtherto reduce medication errors,leading to safer, better care.This Standard forms partof HIQA’s work through itshealth information functionto ensure that high qualityhealth and social careinformation is available tosupport the delivery, planningand monitoring of servicesthroughout Ireland.An outline summary anda full copy of the Standard isavailable on www.hiqa.ie.50IPUREVIEW AUGUST 2014

Michael Foley (L) beingpresented with his prize byCaptain Michael Foley.Irish ChemistsGolfing SocietyNewsThe results of the ICGS golf outing at Carlow, which wassponsored by United Drug, were:Class 11st prize Robert Falconer2nd prize Pat Downey3rd prize Michael FoleyClass 21st prize Kevin O’Gorman2nd prize Pat McGee3rd prize Michael FogartyClass 31st prize Percy Delaney2nd prize David O’Farrell3rd prize Michael HennessyThe next outing is in Dun Laoghaire on Monday 11August, followed by the final two-day outing in Adare on14-15 September.Reminder – FunBridge WeekendSeptember 12-14If you intend participating in the Bridge Weekendand have not booked, please contact Ann Moynihan– annglennonmoynihan@eircom.net (087 7755128) orPaddy Colleran MPSI (086 0880513) before 1 Septemberto guarantee a place.The emphasis will continue to be in providing anopportunity to enjoy a game of bridge at your own levelbut the weekend also provides a Gala Dinner on theSaturday evening, with entertainment afterwards. Donot let the lack of a bridge partner put you off. Mentionit to Ann when booking and she will arrange one for you.Mary O’Rourke, pictured with Lisa McLaughlin and Ian Pitcher, Sanofi PasteurMSD, is calling on people over 50 to know their risk of developing shingles.New shingles and PostHerpetic Neuralgia (PHN)vaccination now availablein Ireland for patients over50 years of ageThe first vaccination for theprevention of shingles andpost herpetic neuralgia (PHN)is now available for privatepatients over the age of 50 inIreland. Zostavax, from SanofiPasteur MSD, is a one-dose,live attenuated vaccine for theprevention of shingles (herpeszoster) and herpes zosterrelatedPHN.This is the first vaccineavailable for the preventionof shingles in Ireland. 95% ofadults have had chickenpox,caused by the varicella-zostervirus (VZV), and thereforehave the potential to developshingles. If a person has nothad chickenpox they will notdevelop shingles. One in fourpeople will have shinglesduring their life-time and twoout of three cases occur inpeople over 50 years of agedue to the natural age-relatedweakening of the immunesystem.Sanofi Pasteur MSDhas launched a shinglespublic awareness campaignspecifically targeting peopleaged over 50 years andsupported by Age Action andChronic Pain Ireland. Thisat-risk population will beencouraged to become moreaware of shingles and itscomplications and urged togo to their GP or healthcareprofessional should theyrecognise the symptoms orrequire further informationabout the disease. A newwebsite developed by SanofiPasteur MSD, www.shingles.ie, is a useful resource formore detailed information onshingles.IPUREVIEW AUGUST 2014 51

NEWSActavis namedone of the world’sgreenest companiesActavis Ireland is pleased toreport that Actavis Ltd. havebeen named by Newsweekmagazine (American weeklynews magazine) as one of theWorld’s Greenest Companies.An annual list compiledand published by themagazine ranks the world’slargest companies on theircorporate sustainabilityand environmental impactinitiatives. A position onthis list is a true indicatorof Actavis’ commitment tosustainably performance.Speaking of the honour,Tony Hynds, ManagingDirector, Actavis Ireland,said: “Actavis prides itselfon leading in innovationand striving year on yearto better our company andthis award is a sign of thatcommitment paying off.We work hard every dayto create medicine for ahealthier world so it is onlynatural that sustainabilityand environmental impact ishigh on our agenda. We wouldlike to congratulate all of ourGlobal EH&S teams and ouremployees here in Ireland andaround the world whose hardwork and dedication madethis possible.”Actavis was ranked on thisyear’s list as the 44th greenestcompany in the UnitedStates and the 71st greenestcompany in the world,ahead of such leading globalcompanies as Apple, Toyotaand Microsoft, among others.The full results can be viewedonline at www.newsweek.com/green-2014.New RATE campaign designedto educate and inform peopleof the need to reduce heartrate and improve mortalityfor HF and CAD patientsServier Laboratories Irelandrecently launched “Know YourHeart RATE”, a campaign toempower and educate patientson Heart Rate managementso they can lead a longer andbetter life. The RATE campaignwas influenced by the resultsof recent research whichrevealed that heart rate incardiology patients is regularlymeasured by healthcareprofessionals (HCP) but is notactively treated.Study findings show thatwhile heart rate is measuredroutinely by GPs in patientswith heart failure (93%) andcoronary artery disease (86%),only about half of GPs aim toactively treat Heart Rate inthese patients. In secondarycare, 50% of cardiology doctorsconsider Heart Rate in HFpatients to be high at 70-75bpmand aim to treat these patientsto the target of 55-60bpm.As part of the “Know YourHeart RATE” campaign,Servier has invested in anew HCP education pack,which will be distributednationwide to provide HCPswith additional informationon Heart Rate managementand treatment. As HF patientsare a higher risk patientpopulation they will be theinitial focus of the campaign.The packs are designed tohelp HCPs quickly optimisetheir HF patient care and willinclude posters, heart failurepatient checklist, summarisedchecklist stickers to put oneach patient’s chart and anew HF information booklet.It will help patients play anactive role in their treatment;understanding their disease,knowing how to monitorHeart Rate, BP and weight,and making lifestyle choices.LadyPharmacists’Golf SocietyNewsPresident’s Prize outing, 24 May, Glasson GC1st prize Ciara Marmion (34)2nd prize Celeste O’Regan (33)3rd prize Jean O’Donnell (33)Category 1 Marie Donnellan (26)Category 2 Diana Hogan Murphy (31)Category 3 Marie Walsh (27)Front 9Back 9Nearest the pinPar 3sLongest driveNorma FerriterAnne MurphyMary MelletAnn Walsh RyanCeleste O’ReganCavan County GC, 19 July1st prize Majella Brady (35)2nd prize Ann Nolan (32)3rd prize Jean Brogan (32).Front 9 Anne Hillary (17)Back 9 Anne Murphy (15)LPGS President Ann O’Driscollpresenting the President’s Prize toCiara Marmion in Glasson on 24 May.Category 1 Marie Donnellan (28)Category 2 Mary Jordan (27)Category 3 Marie Walsh (30)The next outing is on 13 September inMount Wolseley, Tullow, Co Carlow.For further information, contact VeronicaTreacy, Competition Secretary,on 086 8099275.52IPUREVIEW AUGUST 2014

PRODUCT INFORMATIONClonmel Healthcarelaunch Aspirin 75mggastro-resistant tabletsOmegaPharmare-launchesZantac forlong-lastingrelief from H&IClonmel Healthcare is delighted to announce the launch ofAspirin 75mg gastro-resistant tablets x 28. The product issubject to medical prescription.Aspirin film-coated tablets are indicated for:n Secondary prevention of myocardial infarction.n Prevention of cardiovascular morbidity in patientssuffering from stable angina pectoris.n History of unstable angina pectoris, except during theacute phase.n Prevention of graft occlusion after Coronary ArteryBypass Grafting (CABG).n Coronary angioplasty, except during the acute phase.n Secondary prevention of transient ischaemic attacks (TIA)and ischaemic cerebrovascular accidents (CVA) providedintracerebral haemorrhages have been ruled out.Full prescribing information is available on request, or onwww.clonmel-health.ie. Please contact Clonmel Healthcare on01 620 4000 if you require any additional information.Omega Pharma is re-launchingH2 Antagonist, Zantac inIreland this month. Combiningheavyweight above and belowthe line activity with pharmacyeducation, the campaign willhighlight the number 1 H2Antagonist’s 30-year heritagein providing long-lasting relieffrom heartburn and acidindigestion (H&I).The re-launch will includea robust ATL campaignincluding TV advertising,Video On Demand and adigital presence along with PRsupport. Educational resourceswill also be made availableto pharmacies, which willinclude information andonline tools that help refreshpharmacy knowledge onthe Heartburn and AcidIndigestion category andensure pharmacists are ableto provide in-depth support tocustomers.H&I is one of the largestOTC categories in pharmacy.With 44% of the populationsuffering from H&I in Ireland,affecting both men andwomen, pharmacists areideally placed to offer bothlifestyle and treatment advice.Fiona Keenan, OmegaPharma said: “This significantinvestment in Zantacreflects our commitment tosupporting pharmacists indelivering effective solutionsfor their customer needs.We know heartburn andacid indigestion affects ahuge amount for people inIreland and Zantac is ideallypositioned to provide longlastingrelief through the dayor night.”Zantac is fast acting and hasthe power to relieve heartburnand indigestion for up to 12hours, thereby providing allday or all night relief. Zantac75 is available in pharmacy in12s and 24s.For all enquiries pleasecontact customer.service@omegapharma.co.uk or call01 879 0600.Solpadeine supports pharmacists in findingright pain relief solutions for customersOmega Pharma, thedistributors of Solpadeinein Ireland, is investing in anew educational campaignaimed at helping pharmacistsprovide the right pain reliefadvice to their customers.The campaign includes thedevelopment of new trainingbooklets and online toolsthat help refresh pharmacyknowledge on the painmanagement category andensure pharmacists are ableto provide in-depth supportto customers suffering from arange of different pain types.Supplementary resourcesalso provide advice on theSolpadeine range, helping tofacilitate recommendationsfor finding an appropriatepain relief option for eachcustomer.Pain management is oneof the most vital servicesprovided by pharmacies today.Pharmacists are ideally placedto offer lifestyle and treatmentadvice as well as tacklesome of the key pain reliefchallenges such as reluctanceto treat, choosing the wrongtreatments, subtherapeuticdosage and incorrect oroveruse of treatments. Poormanagement of pain can havea range of negative personaland societal effects, including€252 million lost to the Irisheconomy per year through lostwork days and productivitydue to migraine.Solpadeine includes a rangeof pain solutions to addressdifferent customer needs,including Solpadeine SolubleTablets, which contain a tripleacting set of ingredients,including codeine to blockpain messages, paracetamolto relieve pain symptomsand caffeine to help speed upabsorption of the paracetamol.For all enquiries, includingtrade and to request trainingor POS materials pleasecontact: customer.service@omegapharma.co.uk.IPUREVIEW AUGUST 2014 53

PRODUCT INFORMATIONRowexlaunchBruprofor ChildrenRowex Ltd has announced thelaunch of Brupro for Children100mg/5ml Oral Suspension(Ibuprofen).Brupro for Children isused for the short-termsymptomatic treatment of:n mild to moderate pain.n fever.The details are as follows:n Brupro for Children100mg/5ml OralSuspension x 100mln Brupro for Children100mg/5ml OralSuspension x 150mlThe presentations are OTCmedicines.For further informationcontact Rowex Ltd. onFreephone 1800 304 400 oremail rowex@rowa-pharma.ie.Bioxsine – MajorTV advertisingcampaign announcedBioxsine is scientificallyproven to reduce hair loss andincrease hair growth in menin women. Recently launched,Bioxsine Femina is a shampooand conditioner that hasbeen specifically developedto treat female hair loss. Theactive ingredients in Bioxsineshampoo encourage hairgrowth, strengthen and addvolume by thickening the hair,nourish the scalp, improveblood circulation to the scalpand reduce hair loss.In August and September,Bioxsine will be supported bya heavyweight TV advertisingcampaign on RTE & TV3.Window display and producttraining material is availablefrom Ocean Healthcare.Bioxsine is available fromOcean Healthcare, UnitedDrug & Uniphar. For furtherinformation and POS materialplease contact OceanHealthcare on 01 296 8080 orvisit www.bioxsine.ie.VichyintroduceAqualiaThermalThe Aqualia Thermal rangeis designed for women ofall ages with dehydratedand sensitive skin lookingto rediscover smoothedfeatures, re-plumpedskin and a fresh, radiantcomplexion. Dermatologicallytested and rich in VichyThermal Spa Water theproducts hydrate, sootheand care for up to 48 hours,leaving users with beautiful,healthy-looking skin.Aqualia Thermal Lightis suitable for normal tocombination skin andAqualia Thermal Rich is fordry to very dry skinContact your Vichyrepresentative for furtherdetails.Are there medicinescurrently unavailable toyour patient in Ireland?We can help...www.medisource.ie | Call 1-890 2866366 | Fax 01 2866288 | Email info@medisource.ie227548-DPS-MEDISOURCE-AMA-IHCA.indd Medisource Ad Sept 2013.indd 1 2 05/09/2013 06/09/2013 10:06:11 12:17:1454IPUREVIEW AUGUST 2014

Tailored to YouTake Controlwith ActavisSimplifying your business and maximisingprofitability is fundamental to Pharmacygrowth. That is why, at Actavis, we havelaunched a new innovative purchasing modelfor customers called the ‘Accumulator’.The ‘Accumulator’ is a simple pack replacementscheme offering transparency and consistencytogether with excellent customer service.The ‘Accumulator’ puts you in the drivingseat, offering the best margins and excellentvalue across our portfolio which will allow youto develop your business with confidence.THE ACTAVIS ‘ACCUMULATOR’ GIVES YOU MORE: Transparency – of Pricing, Margins and Invoicing. Consistency – of Supply, Purchasing and Customer Service. Value – across Generics, OTC and Branded Medicine. Control – over your Purchasing, your Profits and your Business.Actavis and You – The partnership that adds up.Contact us at 021 461 9040 or on www.actavis.ie to seehow the ‘Accumulator’ can be put to work for you.Date of Preparation: April 2014. NA-019-01.

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