Response to interpellation 2024/25:637 on a national reform for self-care and pharmaceutical services

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Ulrika Westerlund has asked me how I view the need for a national strategy to strengthen self-care and pharmaceutical services in order to relieve primary care.

Ulrika Westerlund has also asked me what measures I believe the government should take to reduce the number of unnecessary healthcare visits through increased self-care counseling and increased responsibility for pharmacies.

Ulrika Westerlund has further asked me how I view the pharmacies' role in providing self-care advice and improving patients' use of medicines as a way to reduce the burden on primary care.

In addition, Ulrika Westerlund has asked me if I and the government plan to proceed with the proposals from TLV regarding pharmaceutical services.

Finally, Ulrika Westerlund has asked me if there are other plans from me and the government to, after necessary investigations, expand the pharmacies' responsibilities and activities.

Madam Speaker! Efforts are being made on several fronts to both strengthen primary care and develop the role of pharmacies in the care chain. It is about ensuring that every measure is carried out at the location and by the healthcare professional who has the best conditions to do so, taking into account both patient safety and person-centered care as well as cost-effectiveness. Let me give some examples.

Regarding primary care, the new ordinance (2024:1253) on state grants to municipalities and regions for the development of good and close care entered into force in January 2025. Through this ordinance, the government intends to distribute just over 3.6 billion kronor to municipalities and regions for the purpose of developing good and close care, with a focus on primary care.

The regulation replaces the previous agreements that the government has entered into with Sveriges Kommuner och Regioner and will create increased clarity and predictability in the state's support for health and medical care. In this way, it contributes to good and close care compared to previous agreements.

An important part of the ordinance is that the primary care providers shall work with measures that promote continuity in primary care, including with a regular doctor contact. Through strengthened continuity, better conditions are also provided for a well-functioning self-care counseling.

Furthermore, I want to highlight the Act (2022:1250) on self-care, which entered into force in January 2023, which is also mentioned in the question from the member. An important purpose of the Act is to clarify the concept of self-care. Self-care refers to a health and medical care measure that treating staff have assessed that a patient can perform themselves or with the help of someone else. Since the Act was decided, the National Board of Health and Welfare has, among other things, produced an information leaflet as well as, following a government mandate from 2023, a specific knowledge support directed towards health and medical care, social services, and LSS activities. In the knowledge support, the health-promoting perspective is also highlighted as important.

When it comes to the role of pharmacies, I would particularly like to remind that their core mandate already includes working towards good and safe medicinal use by, among other things, providing expert and individually tailored information and advice.

To further support this perspective, the government tasked the Medical Products Agency in 2022 with regulating competence requirements for self-care advice at community pharmacies. The assignment was reported in December of the same year, and the final report showed that the agency saw a need to regulate the requirements for the education and experience to be held by staff who provide self-care advice at community pharmacies. The agency has since, during 2024, referred a proposal regarding specific requirements for staff who are to provide information and advice on self-care.

Regarding the Dental and Pharmaceutical Benefits Agency's proposal on pharmaceutical services, the agency submitted a final report on its assignment in December 2024. It appears from this, among other things, that the introduction of one or more such services presupposes that financing, legal regulation, and technical solutions are developed. The report is currently being prepared in the Government Offices.

In summary, I view the ongoing efforts by the mentioned authorities positively to strengthen the staff within healthcare and at pharmacies so that they, in turn, can provide effective and safe self-care advice. I continue to follow the work in this area.

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Ulrika Westerlund (MP)

Madam Speaker! Thank you, Minister, for the answer and the opportunity to have this conversation! This issue concerns me very much. That is why I have submitted the interpellation, even though I have now left the Committee on Social Affairs and moved to the Committee on Justice. Perhaps it is from home that I have received the interest, as both of my parents are pharmacists.

Pharmacies have a very important role in the work of promoting health and relieving the healthcare system. I think that this is generally not a question of partisan differences, because I am convinced that we all have a great interest in improving public health, that people should have access to the care and medicines they need, and that this should be organized as accessibly and cost-effectively as possible.

I believe that many people in Sweden want to take more responsibility for their own health, but that many need more knowledge. There are calculations that show that increased self-care can mean significant savings.

A national strategy for self-care and pharmaceutical services could improve the opportunities to take advantage of people's own engagement. It could include pharmacies more clearly in the transition to good and close care. The law that the Minister mentions in his answer only covers self-care within the framework of the health and medical care system and is not really about developing national guidelines or strategies for self-care counseling and pharmaceutical services.

I would like to begin by discussing the issue of expanding today's self-care counseling at pharmacies. Today, the counseling focuses on determining when consultation with another profession is needed, that is, whether one must seek a doctor, and on providing support to the patient to make decisions about their own care, for example with over-the-counter medicines. It can also involve other interventions such as exercise, better sleep, and diet. But this could be expanded in several ways.

Among other things, we can raise the question of a so-called pharmacist assortment. Certain medicines that are currently prescription-only could be sold directly at pharmacies after consultation by a pharmacist. This concerns medicines that cannot be completely prescription-free because there is a risk of misuse or poor interaction with other medicines, but which could be sold directly after consultation. One example is Respinal, i.e., naloxone in the form of a nasal spray, which can reverse opioid overdoses. It is now sold directly at pharmacies. This was perceived by parts of the industry and perhaps also the Medical Products Agency as some kind of pilot project for a pharmacist assortment. The regulatory framework would need to follow suit to provide good accessibility to naloxone and potentially also other medicines.

Another element that could be included in a national strategy or guideline is pharmacist prescribing, which in some countries is called pharmacy first. It is to go a bit further than what I spoke about earlier. Here, the pharmacist also makes a diagnosis. It could involve simpler ailments such as, for example, eczema, allergy, and urinary tract infection. If we introduce an expanded possibility for testing, it can also be introduced in Sweden.

The pharmacy's support to patients in managing self-care with prescription medicines can also be expanded. We were earlier discussing that TLV, The Dental and Pharmaceutical Benefits Agency, in December last year reported on the assignment concerning so-called pharmaceutical services, specifically two of them. Here, there were ready-made proposals for introduction.

The Minister mentioned that the pharmacies already have a certain such role. But as I understood it, part of the point with the report from TLV was also the question of how this should be compensated. When we have a system where time at the pharmacies is money, they must receive compensation for certain forms of counseling.

I would like to know a bit more about what plans exist. I understand that things are being prepared in the Government Offices, but are there plans to develop a national strategy or some other appropriate regulatory framework that addresses several of the aspects I have now mentioned?

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you, Member, for the question! It is extremely interesting and touches upon very many areas. I hope that we have time to address all those who are affected by this.

The role of pharmacies needs to be clarified; they are part of the healthcare system. One might think it is important to be able to get hold of perfumed skin lotion or makeup, but the more we treat pharmacies as a place that sells things that are not necessary, the less important they become for healthcare. We must fill them with as much healthcare as possible so that we use the staff's competence in the best way.

This is authorized personnel with solid education, and this applies to both pharmacists and dispensers. It is extremely important that we see them as a part of the health and medical care. I mean that far too few do so, not least when we talk about the pharmacies and the deregulation as if they were institutions that are not important for health and medical care. I am therefore very pleased with the interpellation and the opportunity to bring up these issues.

This is also the government's view, and that is why this is included in the Tidö Agreement. We will return with proposals. A tedious experience, which I believe the member has, is that when the government is not finished with a proposal, one also receives no information in the chamber until the proposal finally arrives. There is nothing that I will hint at today, but I will only speak about the issues concerned and how important they are.

First and foremost, the pharmacies must become an important part of the healthcare system. Knowledgeable, experienced, and licensed staff shall be utilized in the best possible way. 1177 is today a channel that I want us to develop. It has developed slowly and organically, and there have been discussions over the years about whether it is the best channel. But I assess that everyone today knows what 1177 is. One finds it quite easily. There are many self-care instructions there, not least those that triage for me and say: Here you can manage on your own, or here you need to seek care at a health center or hospital, if it is urgent.

I think it is very good that the regions are developing 1177 and that it can become a broad channel for many things, not just for my records and contacts with healthcare but also for obtaining reliable answers. I want to emphasize this: Many want to contribute with answers within the health and medical care system. Many are private providers who want to sell some product, but then one does not know if it is an evidence-based answer.

I believe that the member, just like me, took part in news today that addressed how it does not turn out well when someone wants to sell products that I actually do not need. It is extremely important that I receive information that is evidence-based. If I go to 1177, I get it. In addition to all the efforts already being made, 1177 is therefore an important channel in terms of self-care.

The next point I want to highlight is getting the right to a fixed doctor contact but also a care contact in general. A district nurse or a district doctor can be very important for me to receive the right care but also for me to have compliance with prescriptions. If I do not have a fixed doctor contact – let me start there – but meet different ones and none who know me, it can pose a risk that I do not take the medications prescribed to me. If I did not really feel that the doctor even understood my need, I might refrain from taking the medication or take it in the wrong way. It can also happen that I burden the healthcare system several times when I do not get continuity and a relationship with the person who is my contact.

To promote self-care and good advice, I believe that a fixed doctor contact and a fixed care contact, for example a district nurse and many others, is extremely essential. Furthermore, the person who prescribes is also responsible for the prescription, which I will return to in my next post. This means that we need to reflect a bit further when we talk about the pharmacies' role.

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Ulrika Westerlund (MP)

Madam Speaker! Once again, I thank the Minister for the answer.

This is, as has been said, a broad subject. I am aware of that.

I truly agree that pharmacies are part of the health and medical care system. Unfortunately, this is not reflected in all strategies. Regarding the goal of good and close care, the role of pharmacies is not fully clarified. I also truly agree that it is important to see them in that way, so that the focus is not placed on selling products that do not really fall within the framework of health and medical care.

One should receive compensation for one's competence. That is what pharmaceutical services are about, that is to say, that one should receive compensation for the advice given so that one does not become dependent on selling makeup or chewing gum.

I also think that 1177 has a very important role, and it can advantageously be included in a national strategy or in guidelines for self-care. It is part of the same system, as I see it.

I want to bring up more examples of how the pharmacies' activities could be developed. One such thing is testing at pharmacies. This could also further improve the possibility for pharmacists to determine if continued contact with other healthcare is necessary. For example, one could take blood samples and throat samples. Blood pressure measurement has existed at pharmacies for a long time, but technological development would also enable other types of samples, after necessary competence enhancement and review of the regulatory framework.

Another proposal is extra expedition, meaning that a pharmacist can expedite a withdrawal on a prescription that has expired or has been fully expedited. This would provide expanded possibilities for substitution to equivalent medicines.

There is a mandate at the Medical Products Agency regarding this, and the final report is to be submitted in 2026. An interim report is already underway, but it is somewhat unclear whether it will contain proposals that take into account the full competence of pharmacists or if it will solely focus on situations with a confirmed medicine shortage. This is also something to look into.

Another topic that often comes up in the debate is the possibility of remote pharmacy services. Sometimes problems arise with staffing the pharmacies, especially in rural areas. Therefore, one could also review this within the framework of work with a strategy or with guidelines to strengthen self-care and the pharmacies' role.

Another possible development of the activities at pharmacies is the possibility of vaccinations performed by pharmacists at pharmacies. I understand that many of the proposals are not possible to implement if one does not review regulations, develop competence, and so on. But this is something that happens in several European countries. Among others, one can in Norway, Denmark, and Finland vaccinate against influenza, covid, and other things at pharmacies. This obviously increases the accessibility across the entire country.

Several of the actors involved in the area we are discussing today – strengthened self-care and an expanded responsibility for pharmacies – point, among other things, to the possibility of significant savings. That is, of course, of interest. I wanted to mention it, but the greatest interest is perhaps not the savings, but rather the accessibility for patients and equality across the country and ensuring that everyone gets the best possible chance to take responsibility for their own health.

Regarding savings, however, a sum of up to 1 billion is sometimes mentioned. I am curious about what the government intends regarding such an assumption. This would, among other things, be achieved through fewer unnecessary doctor visits and increased use of over-the-counter medicines. The increased self-care would also reduce the pressure on primary care by avoiding visits aimed at getting medication prescribed for simpler ailments.

Is there any area of those that we have now discussed that is more interesting than the others? Does the Minister have any thoughts on that?

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Let me first agree that the measures we take shall be made to use the pharmacies and their well-educated staff in a wise way in the health and medical care system, not to save money. That is something we completely agree on. But if one does things that lead to a cost reduction, it is always positive. They are, however, rarely unambiguous, as there are costs elsewhere.

We have a strategy that we adhere to, namely the pharmaceutical strategy. It includes the pharmacies. To be crystal clear, I do not believe in a future with a mass of strategies. It solves very little. Someone has to be responsible for the strategy, and it will result in even more burdens on those who work.

No new strategy for this specific area will be created. We have the existing pharmaceutical strategy and other work. It is through these things that we intend to continue working. It states as said in the Tidö Agreement that we will carry this out.

The Chairman mentioned the importance of us having fewer unnecessary doctor visits. Let me truly agree with this. But the solution goes through fixed contacts, primarily to build continuity and relationship. It is the most important measure that the country's regions need to take so that we can reduce the number of unnecessary visits, regardless of whether it happens with a nurse, a physiotherapist, or a doctor. The more often I meet new people to whom I have to tell my story, the greater the risk that I will seek care once again. Patients rarely seek care unnecessarily. When we have rigged the system in a way that prevents me from building continuity and relationship, we risk many new visits.

For me, it is not measures of the kind that the member proposes that are prioritized to reduce the number of unnecessary doctor visits. Instead, it is about getting a fixed doctor contact – fixed care contacts are my priority task to reduce this. Then other things can contribute to this, but they do not constitute the main task.

One such example is that buses are set up at different locations from time to time, where different types of sampling are carried out. But as long as they are not part of the health and medical care system, it just becomes an extra sampling that we will collectively pay for. Then it must be done once more when I arrive at the health center.

All such exciting thoughts about how one can do it must also be part of the health and medical care system when it comes to being able to pass information forward. That cannot be done today between pharmacies and other health and medical care; there are clear boundaries.

I am not negative towards being able to do more of the things that the member is raising. But when I administer a vaccination, I take part of the patient's history. I know what kind of patient I have in front of me. Then I must have significant knowledge to be able to determine if it works. If something happens, there must be knowledgeable staff who can avert what could happen. That is not done just any way, according to the order for patient safety that we have in Sweden.

I am not going to compromise on patient safety, and everything we intend to do moving forward requires, just as the member points out, complementary training or competencies if we are to do it. The country's pharmacists point this out very clearly. They are, of course, positive about being able to do more things but point out that they must, of course, have training that corresponds to the new tasks. The member has also pointed this out several times.

Let me return to the question of what can be done. It is important that the person who prescribes has responsibility for the prescription and the risks for the patient. If someone else enters along the way, what responsibility and what role does that person have? Those questions may perhaps not be quite as simple as they may sound to the public when they are raised. It is important that, when looking at such things, one clarifies who has responsibility for the patient. We have a very strong accountability in Swedish health and medical care today, and I think that is a good thing.

But with that said, there may be things we can do, not least to facilitate cooperation between primary care and pharmacies. It is also one of the issues I discussed at the beginning of last week with representatives from primary care specifically. I hope to return to good examples.

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Ulrika Westerlund (MP)

Madam Speaker! I believe there is much that we are in complete agreement on, not entirely surprising. I also think that a fixed doctor contact is good, of course. I do not know for how many people this is a reality. If one does not seek care very often, doctors often manage to change workplaces and so on anyway. But it is of course something that it is good to strive for.

I also of course think that competence is important and that people who provide care have sufficient competence and education to be able to provide it. Several of the examples from other countries that I have given require rapid training and so on, and that one reviews regulations and systems. I think that this is included in the work with a possible strategy or other types of measures in the area.

I also think that the current regulatory framework, even if one has a fixed doctor contact, is such that one is still forced to seek care for things that one thinks could perhaps be solved in a simpler way, for example, recurring urinary tract infections or a skin disease that one knows one has and which requires a certain type of skin cream. Now it is required that one first goes to a doctor to get the prescription and then to the pharmacy to get the medicine. It could be investigated whether there are a limited number of ailments where it could be a question of first and only going to the pharmacy, in order to save resources so that care can devote itself to the more advanced cases and we take advantage of pharmacists' competence. This also applies to sampling, vaccination, and so on. It would of course require competence and that we follow up in a way that we do not quite do now because we have not introduced this.

I also think it is important that the person who prescribes takes responsibility. This requires, as mentioned, a certain review. I wonder if there is an ambition and an interest to conduct a larger such review in some form, which would lead to the pharmacies and 1177 being able to take a larger role and to us spreading out the resources and the possibility, for both patients and others, to have as great access as possible to our common resources in the area.

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! No legislative changes are required for 1177 to be developed. They have developed fantastically well over the recent years and continue to do so – no legislative changes are required there.

There we also have quality-assured advice – I want to emphasize that again. It is so important that the public receives evidence-based advice. There are many others who choose advice for various reasons. It is important to know that if you go to 1177 you get the right advice – you know how to behave.

The pharmaceutical strategy is what we adhere to. It has been adopted, and we are constantly implementing what is in it and following up on it, of course. We will return to it as much as is needed during the time, but above all when we renew it.

The one who prescribes is also the one who is responsible for what happens to the patient. One could ponder whether the one who prescribes could prescribe something for the patient in the meeting with the pharmacy that has been determined in advance, by the doctor in this case. Could there be a possibility for my patient to, as the member points out, have something prescribed one more time – perhaps a month's use or so – before the patient needs to visit a doctor, when the doctor himself prescribes that that possibility should exist for the patient in question?

I believe there is an interest in doing something there. That is to say: The responsibility remains with the one who prescribes, but it is also that person who decides which possibilities would be to the benefit of that specific patient, without risking patient safety. But again: This requires opening up between the different parts. Above all, we know that the doctors want to be able to have better contacts with the pharmacies. Pharmacists often tell about how difficult it is to get in contact with the health center when it is needed. They do not have phone numbers so that they can get through in the right way. I perceive, therefore, that both sides, if I may call them that, have an interest in coming closer to each other.

I hope to return in the near future with more proposals. We need to use the pharmacies and the trained staff better. That is the coalition parties' view, and we will return to this.

The interpellation debate was hereby concluded.

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