Primary care is and should be the central part of our national health service. This morning, 506 people are on trolleys across the country. The Sláintecare report, which was shared and signed up to by every party in this House, emphasises primary care and investing in community services so that people can be more engaged in their own health and well-being. Pharmacy is a key part of primary care and community pharmacists constitute a key part of that. They are essential if we are to address the crisis in hospitals and in so many other aspects of our health service.

The Minister for Health gave very solemn assurances at the conference of the Irish Pharmacy Union last May that he would address the FEMPI cuts, which took 30% out of the incomes of our community pharmacists around the country. He said that he wanted to move beyond FEMPI to a higher terrain and to move discussions on a new pharmacists' contract. He said "Let's get that done this year." It was the usual practice from the Minister - tell them what they want to hear, run away and have no follow up. The reality for community pharmacists is that after the cut in their income of 33% the Minister then came along and said that the HSE had instructed pharmacists that as of 1 January, there would be a range of cuts to their income, services and fees aside from the new contract. For many pharmacies, this range of cuts could take between €30,000 to €35,000 out of their income, which will lead to redundancies in pharmacies and to pharmacy closures in so many areas. Again, it will undermine primary care services. Not only will dispensing fees be reduced, the practice of phased dispensing, which is a safer and more efficient way of dispensing drugs, will be made unviable for many pharmacies putting patients in danger. There will be a reduction in the high-tech care patient care scheme. This is a system that pharmacies have embraced for three years that reduces pressure on GPs and emergency departments. They have done this at a very basic cost that will be reduced even further.

We had fine words from the Minister. He keeps patting community pharmacists on the head and telling them they are doing a great job. He spoke about going to a higher terrain in his usual language but the reality is that if these cuts proceed, this higher terrain will be a marsh in which pharmacies, including community pharmacies, will sink. Why is the Government doing an absolute U-turn on the very solemn commitments given by the Minister in May? Why is it proceeding to take €45 million out of community pharmacy? Why is it targeting community pharmacists for these cuts unlike any other part of primary care?

I thank the Deputy for raising this issue. The Minister has said many times that he recognises the role community pharmacists play in the delivery of patient care and the potential for this role to be developed further in the context of health service reform and modernisation. Recognising that critical role, the Minister is committed to root-and-branch review of the pharmacy contract in 2020. Notwithstanding this commitment, any publicly funded pharmacy service expansion should address unmet public health needs, improve access to existing public health services or provide better value for money in terms of patient outcomes. Accordingly, the decision to provide such services should be evidence-based and I hope Deputy Calleary would agree with that.

The regulation governing the current pharmacy fee structure was made under section 9 of the Financial Emergency Measures in the Public Interest Act 2009 and was set to expire at the end of this year. Under the Public Service Pay and Pensions Act 2017, these regulations must be replaced on 1 January 2020 to maintain the statutory basis for contractor payments and to prescribe the fees available from that date. The fees to be set are determined by the Minister for Health with the consent of the Minister for Public Expenditure and Reform. In keeping with obligations under section 43 of the 2017 Act, Department of Health officials have begun a process of consultation with the Irish Pharmacy Union as the representative body prior to the introduction of a new fee regulation. Department officials have met with the Irish Pharmacy Union delegation on two occasions and a detailed submission was received from the Irish Pharmacy Union on 8 November. This submission is being considered by the Department in the context of the statutory fee-setting process to which I have just referred. I have just been given a note to say that the Minister for Health is due to meet the Irish Pharmacy Union in the coming weeks to try to finalise those arrangements.

Two processes are under way. As late as 10 October, the Minister gave very solemn commitments about reversing FEMPI cuts. He told Deputy Brassil, who was a pharmacist in a previous life, that he would honour that, and that pharmacists are coming up with solutions and ideas. Why did the Minister give such a false impression on 10 October when he must have known that the HSE was planning on implementing €45 million worth of cuts to community pharmacies? The Tánaiste mentioned the regulations and the deadline of the end of December. Those same regulations apply to dentistry. The Minister has moved that on without any cuts ahead of 1 January yet the Government is piling €45 million worth of cuts on community pharmacies. The Tánaiste should go to his local pharmacy this weekend if he is looking for evidence. He should see how hard they are working, the hours they work and the extra services they provide that keep people away from GPs and emergency departments. I received an email from a pharmacist who stated that they feared for the profession of pharmacy and that all the good pharmacists would get tired of being the kicking boy of the PCRS and the HSE. That is how these professionals in primary care feel. I ask the Government not to introduce the cuts but to have the discussion around reversing FEMPI in a clear and honest manner and to respect community pharmacists.

I do not know whether the Deputy knows it or not but the Minister responded to a Topical Issue on this matter raised by Deputy Brassil yesterday. I would suggest that Deputy Calleary have a look at the detailed response given by the Minister. I know only too well how hard pharmacies work. My office on the main street in Carrigaline is within 20 yd. of two large pharmacies that I know well. As Deputy Calleary knows only too well, what is happening here is a process of negotiation to put a new contract in place, as has happened with other elements of the healthcare system, that must be led by the Minister for Health. He has to get value for money for the State and ensure that patient care is the first priority and that people are being reimbursed fairly for the work they do in terms of fee structure. That process is under way and as I have already said, the Minister will meet with the Irish Pharmacy Union in the coming weeks to try to progress that.