changes to funding community pharmacy in 2016/17 and...

06/12/2016

1

Community pharmacy in 2016/17 and

beyond – final package

psnc.org.uk/pharmacychanges #pharmacychanges

Overview

• Changes to funding

• Pharmacy Access Scheme

• Quality Payment scheme

• Pharmacy Integration Fund

• NUMSAS

• Other contract changes

• Judicial Review

• Questions

Funding imposition

• 2016/17

– £2.687 billion (£113 million reduction)

– 4% reduction in funding (cf. 2015/16)

– 12% reduction from Dec 2016 - Mar 2017 cf. Nov 2016 levels

– Original plan was for £170 million reduction

– So eventual imposition was £57 million less than originally planned

Funding imposition

• 2017/18

– £2.592 billion

• £95 million reduction cf. 2016/17

• £208 million reduction = a further 3.4% reduction cf. 2015/16

– 7.4% reduction cf. Nov 2016 levels

• Beyond 2018 – Subject to future consultation

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Fees and services

• From 1st December 2016:

– Consolidation of a range of fees into a Single Activity Fee

– Phasing out Establishment Payments

– Quality Payments scheme

– Pharmacy Access Scheme (PhAS)

• Pharmacy Integration Fund (PhIF)

• NHS Urgent Medicine Supply Advanced Service pilot (NUMSAS)

Single Activity Fee

• Incorporates the:– professional fee

– Practice Payment

– Repeat Dispensing payment and

– monthly EPS payment

• Other fees (unlicensed medicines, appliances, CDs, etc) are not included

• One-off set up payment for EPS release 2 will cease at end of March

• £1.13/item

• Expected to rise in 2017/18 to £1.24/item

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Establishment Payments

• Will be phased out over a number of years

• 1st December 2016 – reduced by 20% compared to 2015/16

(equivalent to 6.7% reduction overall in 2016/17)

• 1st April 2017 – further reduced by 40% compared to 2015/16

levels

• Proposed to cease by end of 2019/20

PSNC website: indicative income calculator

Quality Payment

Indicative Income

Changes to reimbursement

• Changes previously agreed by PSNC

– non Part VIII products

– Cat M changes

– Changes to the margin survey to account for multiple suppliers of

non-Part VIII and Cat C products

– Splitting the discount scale

– Changes to the way Cat A prices are set

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Pharmacy Access Scheme (PhAS)

• Aim – ensure that a baseline level of patient access to NHS community pharmacy services is protected

• Funded from overall CPCF funding

• PhAS pharmacies will receive an additional payment – will be protected from full effect of the reduction in funding

• The payment takes into account the funding reduction and in addition another 1% efficiency saving for 2016/17 and 3% in 2017/18

• Payment will be based on the funding the pharmacy received in 2015/16

Pharmacy Access Scheme (PhAS)

• Cannot apply to ‘join’ the scheme

• A pharmacy is eligible if it meets three criteria:

– Is more than a mile away from its nearest pharmacy by road

– Is on the Pharmaceutical list as on 1st September 2016

– Not in top quartile by dispensing volume

• According to DH’s original list, 1,356 pharmacies will receive

funding based on criteria

LLOYDSPHARMACY 8 NORTH STREET ASHBURTON

BAMPTON PHARMACY 22 FORE STREET BAMPTON

BEER PHARMACY FORE STREET BEER

IR PEACOCK CHEMIST THE PHARMACY BERE ALSTON

ASDA STORES LTD CLOVELLY ROAD BIDEFORD

ROSS CHEMIST 7 FORE STREET BISHOPSTEIGNTON

YOUR LOCAL BOOTS PHARMACY 47-48 FORE STREET BUCKFASTLEIGH

CHAGFORD PHARMACY 5 THE SQUARE CHAGFORD

LLOYDSPHARMACY 27 OLD EXETER STREET CHUDLEIGH

YOUR LOCAL BOOTS PHARMACY CORNWALL HOUSE COMBE MARTIN

CRANBROOK PHARMACY 151 YOUNGHAYES ROAD CRANBROOK

NORSWORTHY LTD GLASSHOUSE MEDICAL, CENTRE EXETER

EXWICK PHARMACY NEW VALLEY ROAD EXETER

TESCO STORES LIMITED EXETER VALE, SHOPPING CTR EXETER

EXMINSTER PHARMACY THE LIMES SURGERY EXMINSTER

PINES PHARMACY 39 PINES RD EXMOUTH

TESCO STORES LIMITED BATTISHORNE WAY HONITON

LYNTON PHARMACY 17-18 LEE ROAD LYNTON

MODBURY PHARMACY 5 BROAD STREET MODBURY

MORETON PHARMACY LTD 14 NEW STREET MORETONHAMPSTEAD

TUBB DA LTD THE PHARMACY NEWTON FERRERS

NORTH TAWTON PHARMACY 1 EXETER STREET NORTH TAWTON

SAINSBURY'S SUPERMARKETS LTD BRIXHAM ROAD PAIGNTON

WELL WHITLEIGH 77 WHITLEIGH GREEN PLYMOUTH

YOUR LOCAL BOOTS PHARMACY 25-26 FORE STREET SALCOMBE

SHALDON PHARMACY 36 FORE STREET SHALDON

SOUTH BRENT PHARMACY 6 CHURCH STREET SOUTH BRENT

ALLIANCE PHARMACY THE STRAND STARCROSS

SHIPHAY PHARMACY 11 COLLATON ROAD TORQUAY

ARNOLDS PHARMACY 21 NELSON ROAD WESTWARD HO!

WILLAND PHARMACY LINACRE HOUSE WILLAND

Devon Pharmacies - Access Scheme (PhAS)Pharmacy Access Scheme (PhAS)

• Distance-selling pharmacies & LPS pharmacies are not included

• Eligibility is fixed to pharmacies that are deemed eligible in the published list

• However, review mechanism is in place

– Including near misses – pharmacies between 0.8 and 1 miles from the next pharmacy but are in the top 20% of areas when ranked by Index of Multiple Deprivation

• Will run from 1st December 2016 to 31st March 2018 –unknown what will happen after this time period

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beyond

The Quality Payments Scheme

Introduction

• DH is introducing the Quality Payments scheme as part of the CPCF imposition

• Voluntary engagement – contractors don’t have to participate

• Derived from a PSNC proposal

– but the PSNC proposal was with full funding to recognise costs

– to tackle their move to even greater Rx volume focussed funding

• Payments will be made to community pharmacy contractors who meet certain quality criteria

• Payments will be made in 2017/18

• Implementation from December 2016

Eligibility to participate

• All pharmacies on the pharmaceutical list in England

– including Distance Selling Pharmacies

– including pharmacies receiving a Pharmacy Access Scheme (PhAS)

payment

• Does not include Local Pharmaceutical Services (LPS) contracts

– but NHS England local teams and LPS contractors can theoretically

include a similar concept in LPS contracts when they are reviewed

Funding

• £75m value in 2017/18 (from the overall £2.592bn CPCF funding)

• 100 points maximum per contractor

• Value of each point set at £64 = ‘max’ of £6,400

• But potentially a reconciliation payment in final payment for

March 2018 to pharmacies that have participated in the scheme

• The reconciliation payment received will depend on the number

of points the contractor has achieved

• £128 cap on points value (£12,800)

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PhAS and Quality Payments

• Pharmacies eligible for the Pharmacy Access Scheme will qualify for Quality Payments

• When the ‘top-up funding’ that PhAS pharmacies receive is calculated, it is assumed that the contractor will achieve 100 points

• The value of those points is deducted before the final PhAS payment is set

Claiming payment

• 2 review points during the year at which contractors assess

which requirements they have met and how many points they

have achieved:

– 28th April 2017

– 24th November 2017

• Declarations will be made to the BSA in April and November –

form still to be published

– payments made with the final payment for those months

– i.e. April claim paid in end June/early July payment

Gateway criteria

Pharmacies must first meet four gateway criteria:

1. Provision of at least one specified advanced service

•MUR •NMS •NHS Urgent Medicine Supply Advanced Service (NUMSAS)

2. NHS Choices entry up to date

3. Ability to send and receive email via NHSmail

4. Ongoing utilisation of EPS

There is no payment for passing the gateway criteria

Quality criteria

Domain Criteria

Number of

review

points at

which it can

be claimed

Points at

any one

review

point

Total points

over the

two review

points

Patient

Safety

Written safety report at premises level available for inspection at review

point, covering analysis of incidents and incident patterns (taken from an

ongoing log), evidence of sharing learning locally and nationally, and actions

taken in response to national patient safety alerts

One 20 20

Patient

Safety

On the day of the review 80% of registered pharmacy professionals working

at the pharmacy have achieved level 2 safeguarding status for children and

vulnerable adults in the last two years

Two 5 10

Patient

Experience

On the day of the review, the results of the Community Pharmacy Patient

Questionnaire from the last 12 months is publicly available on the

pharmacy’s NHS Choices page

One 5 5

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Quality criteria

Domain Criteria

Number of

review

points at

which it can

be claimed

Points at

any one

review

point

Total points

over the

two review

points

Public

Health

On the day of the review, the pharmacy is a Healthy Living Pharmacy level

1 (self-assessment)One 20 20

Digital

On the day of the first review, the pharmacy can demonstrate a total

increase in access to Summary Care Records between 1 December 2016

and 28 April 2017 in comparison to the previous 5 months; and on the day

of the second review, the pharmacy can demonstrate a total increase to

access to Summary Care Records between 1 May 2017 and 24 November

in comparison to the previous 7 months

Two 5 10

DigitalOn the day of the review, the pharmacy’s NHS 111 Directory of Services

entry is up to dateTwo 2.5 5

Quality criteria

Domain Criteria

Number of

review

points at

which it can

be claimed

Points at

any one

review

point

Total points

over the

two review

points

Clinical

Effectivenes

s

On the day of the review, the pharmacy can show evidence of asthma

patients, for whom more than 6 short acting bronchodilator inhalers were

dispensed without any corticosteroid inhaler within a 6 month period, are

referred to an appropriate health care professional for an asthma review.

Two 10 20

WorkforceOn the day of the review, 80% of all pharmacy staff working in patient

facing roles are trained ‘Dementia Friends’Two 5 10

Total number of points: 100

PSNC’s view on the scheme

• Direction of travel is right and some useful enablers for the future

• Lack of specific funding is an issue, particularly for HLP

• Advise contractors to carefully consider which elements of the scheme they engage with and the costs that they will incur in comparison to the funding available for each element

• But we expect that most contractors will want to participate

• Longevity of the scheme is unclear and will be influenced by the Murray Review

• We still need to do some work with NHS England to sort out some details related to implementation - this should have been finalised by DH/NHS England before imposition

How to get going with meeting the

requirements

• If you are going to participate, get going as soon as possible

• Decide which QP criteria you plan to meet and by which review point– consider the costs you are likely to incur to achieve each criterion

– some will take more time and staff resource to achieve (e.g. Healthy Living Pharmacy (HLP) level 1), and some are much more complex than others

• Develop a timed plan for achieving the gateway and quality criteria– timing of meeting the gateway criteria – not all can be achieved now

– start with the easy ‘quick wins’, particularly those that have two review points

– consider which gateway and quality criteria you will initially find easiest to achieve during late 2016 and early 2017

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Devon LPCs suggested plan for contractors

1. Provision of Advanced service (G)

2. Use of EPS (G)

3. NHS Choices entry (G)

4. NHSmail (G)

5. NHS 111 DoS

6. Use of SCR

7. Dementia Friends

8. Clin effectiveness – asthma

9. Safeguarding

10.CPPQ publication

11.Patient safety report

12.HLP

1. Provision of one specified Advanced Service

On the day of the review, the contractor must be offering at the pharmacy

Medicines Use Review (MUR) or New Medicine Service (NMS); or must be

registered for NHS Urgent Medicine Supply Advanced Service Pilot.

• Gateway criterion

• Consider provision of MUR or NMS if not doing so already, or

signing up for NUMSAS

2. Ongoing utilisation of the EPS

On the day of the review, the pharmacy contractor must be able to

demonstrate ongoing utilisation of the Electronic Prescription Service at

the pharmacy premises.


• If your pharmacy is not enabled to provide EPS, speak to your

PMR system supplier about how to get enabled as soon as

possible

3. NHS Choices entry

On the day of the review, the NHS Choices entry for the pharmacy must be up to date.


• Changes needed to NHS Choices to allow a record to be made of when a contractor updates / verifies their details

• Register for self-management rights and check content, but a ‘formal’ review will need to be undertaken once the changes to NHS Choices have been made

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4. NHSmail

On the day of the review, Pharmacy staff at the pharmacy must be able to send and receive NHS mail (Note: For the April 2017 Review, evidence of application for an NHS Mail account by 1 February 2017 will be acceptable).


• NHS England and NHS Digital are considering how NHSmail accounts for pharmacies could be set up via a centralised process, rather than via local NHSmail administrators

• Likely to be a rollout on an area by area basis

• NHS England currently advise contractors without an NHSmail address to await further information on the rollout process

5. NHS 111 Directory of Services

On the day of the review, the pharmacy’s NHS 111 Directory of

Services entry is up to date.

• Claim at BOTH review points - 5 points (£320)

• Pharmacy access to DoS information

• Currently no action can be taken by contractors to comply with

this QP criterion

• DLPC Return On Investment: Review time 15 minutes per

pharmacy cost £12.00 NET RETURN = £308.00

6. Use of the NHS Summary Care Record (SCR)

On the day of the first review, the pharmacy can demonstrate a total increase in access to Summary Care Records between 1 December 2016 and 28 April 2017 in comparison to the previous 5 months; and on the day of the second review, the pharmacy can demonstrate a total increase to access to Summary Care Records between 1 May 2017 and 24 November in comparison to the previous 7 months.


• PSNC will publish details of SCR access for each pharmacy or ‘Privacy Officer’ should be able to obtain the number of records accessed

• DLPC Return On Investment: SCR use average in HSCIC pilot 2.9p/m, if 7 SCR uses per month, time 1hr 45 minutes cost £78.75 NET RETURN = £561.25

3. Use of the NHS Summary Care Record (SCR)

• Consider how to make use of SCR part of ‘business as usual’

• Lots of resources available via psnc.org.uk/scr

• If you haven’t got SCR access yet – start that process ASAP

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7. Dementia Friends

On the day of the review, 80% of all pharmacy staff working in patient facing roles are

trained ‘Dementia Friends’


• Two routes by which people can become a Dementia Friend:

– attending a face-to-face Dementia Friends Information Session

– watching a short online video

• www.dementiafriends.org.uk or local Dementia Action Alliance

• All staff – including locums

• Record sheet on the PSNC website / keep copies of certificate/webpage print out

• DLPC Return On Investment: Dementia Friends video and training for 8 staff

members, time 2hr 40 minutes cost £65.50 NET RETURN = £574.50

8. Clinical effectiveness - over use of asthma

treatments

On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, are referred to an appropriate health care professional for an asthma review.

• NRAD 2014 - 165 people who died, 40% had been prescribed more than 12 reliever inhalers in the year before they died. Incredibly, 4% had been prescribed more than 50

• Claim at BOTH review points - 20 points (£1,280)

• PSNC Briefing on this subject – record sheet/referral form & PharmOutcomes module (to be developed)

• Talk to local GP practices about this

• DLPC Return On Investment: Circa 400 asthma/COPD patients per average pharmacy, review time (3mins per patient) 20hrs 0 minutes cost £400.00 NET RETURN = £880.00 (8-10 consultations paid by MUR/NMS)

9. Safeguarding

On the day of the review 80% of registered pharmacy professionals working at the pharmacy have achieved level 2 safeguarding status for children and vulnerable adults in the last two years


• Pharmacy professionals = Pharmacists and pharmacy technicians

• Local face-to-face training or CPPE e-learning and assessment

• https://www.cppe.ac.uk/services/safeguarding

• All pharmacy registered professionals – including locums

• Record sheet on the PSNC website / keep copies of certificate/webpage print out

• DLPC Return On Investment: CPPE training for 5 staff members, time 7hr 30 minutes cost £195.00 NET RETURN = £445.00

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10. Community Pharmacy Patient

Questionnaire (CPPQ) results

On the day of the review, the results of the Community Pharmacy Patient Questionnaire from the last 12 months is publicly available on the pharmacy’s NHS Choices page.

• Claim at ONE review point - 5 points (£320)

• Discussing with NHS England and the NHS Choices team about how this is to be undertaken by contractors

• Upload a PDF – probably using a standard template

• DLPC Return On Investment: Time for standardising report and upload to NHS choices, time 1hrs cost £40 NET RETURN = £280

11. Patient safety report

• Written safety report at premises level available for inspection at review point, covering analysis of incidents and incident patterns (taken from an ongoing log), evidence of sharing learning locally and nationally, and actions taken in response to national patient safety alerts.

• Claim at ONE review point - 20 points (£1,280)

• Discussing with NHS England what needs to be included in the report

• Likely to be a template made available to assist completion

• DLPC Return On Investment: Time for standardising report and upload to NHS choices, time 16hrs cost £640 NET RETURN = £640

12. Health Living Pharmacy level 1

On the day of the review, the pharmacy is a Healthy Living Pharmacy level 1 (self-assessment).

• Claim at ONE review point - 20 points (£1,280)

• Self-assessment process and the RSPH

• Grandparenting of existing HLPs?

• Hardest to achieve if starting from scratch

• Links to resources at psnc.org.uk/hlp

• DLPC Return On Investment: CPPE training for 5 staff members, time 56hrs cost £1,200 NET RETURN = £80.00

PHE New Self Assessment Process for

Accreditation at Level 1• Public Health Needs - All pharmacy staff have an awareness of the local

health and pharmaceutical needs.

• Health and Well being Ethos – All pharmacy staff have an understanding of basic health and wellbeing and every interaction is used to promote.

• Team Leadership.- A member of the team has undergone leadership training.

• Communication- The pharmacy team members are welcoming friendly and aware of privacy for different individuals seeking advice.

• Community Engagement.- The pharmacy team works with other organisations and can locally signpost where needed.

• Commissioner Engagement. Is aware of local commissioners and who to contact where needed.

• Health Promoting Environment – Has a dedicated health promotion Zone.

• Data Collection – Procedures are in place for secure emails to be routinely accessed confidentially.

• Sustainability - Contributes to a sustainable environment.

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Devon LPC HLP Support What next ?

• Work through the sections of the PHE document in preparation for self assessment.

• Devon LPC website has materials available to support.

• PSNC has documents to support.

• LPC support events and Training courses.

Next steps

• Further guidance is due to be published by

NHS England by 1st December

• PSNC Briefings and associated resources

available at psnc.org.uk/quality

• PharmOutcomes support being discussed with

Pinnacle Health Partnership LLP

The Pharmacy Integration Fund

• 5 year fund – £300m???

• 2016/17 & 2017/18 value now £42m

• Urgent care workstream – emergency supply, DoS improvement work, NHS 111 integration, deploying pharmacists in urgent care settings (from April 2017)

• NHS Urgent Medicines Supply Advanced Service (NUMSAS) pilot

• Care home workstream – deployment of pharmacists from April 2017 and workforce development

• HEE workforce plan for pharmacy professionals in primary care


• Educational grants for community pharmacists to access

postgraduate clinical pharmacy education and training courses

up to diploma level (from April 2017)

• A programme of pharmacy technician clinical leadership

development (from April 2017)

• Medicines Digital Strategy work (Domain E) – NHS Digital

– Transfer of care data from NHS 111 and hospitals to community

pharmacies and post-event messaging

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– NHSmail 2 rollout to community pharmacy

• Murray Review will inform future decisions on how the fund is

deployed

• Stakeholder reference group to be established in 2017

Spreading MAS…

• ‘NHS England will test the technical integration and clinical governance framework for referral to community pharmacy from NHS 111 for people who need immediate help with urgent minor ailments’

• ‘Aim to develop an evidence-based, clinical and cost effective approach to how community pharmacists and their teams contribute to urgent care’

• NHS England will encourage all CCGs to adopt this ‘joined-up approach’ by April 2018

Changes to market entry – consolidation of

pharmacies

• PSNC proposed changes to prevent a new pharmacy stepping

in straight away if a chain closes a branch or two businesses

merge

• Propose to make regulations which provide some protection

for pharmacies that consolidate, where this does not create a

gap in provision

• Aim – come into force in December 2016

Devon LPC – Engaging MPs For Pharmacy

06/12/2016

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842.5

886

926.7

961.5

1000.5

1030.1

1064.61083.7

800

850

900

950

1000

1050

1100

2008 2009 2010 2011 2012 2013 2014 2015

Ite

ms

x M

illi

on

s

Annual Total Prescription Items (work/demand)

Comparison based on

2015 Real Costs (calculated by

ONS inflation release June 2016

£2,685.00

£2,592.00

£2,500

£2,520

£2,540

£2,560

£2,580

£2,600

£2,620

£2,640

£2,660

£2,680

£2,700

2008 2015

Real Total Cost to the NHS of

Community Pharmacy Contract

(£ x Million)Pharmacy Cost

Savings

Community Pharmacy

Vision1. Urgent & Acute Care

2. Long Term Conditions Support

3. Public Health

& Disease Management

Judicial Review

• PSNC is seeking a Judicial Review of the Secretary of State’s October decision

• Sought permission from the High Court to apply for the Judicial Review on the grounds that it believes the Secretary of State failed to carry out a lawful consultation

• PSNC’s application raises a number of concerns about the consultation, including:

– The DH’s failure to disclose the fact that it had carried out an analysis of pharmacies’ profitability based on Companies House data as part of its Impact Assessment

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Judicial Review

– The delay in providing this analysis to PSNC after the publication of the Impact Assessment

– The validity of the DH analysis including the sample size and the use of accounting returns, rather than economic returns, as the basis for the assessment of pharmacies’ economic viability and how they might be affected by the changes

– The DH’s failure to analyse what the levels of pharmacy closures may be

• The National Pharmacy Association is named as an interested party in PSNC’s application

Questions

psnc.org.uk/pharmacychanges


beyond

The NHS Urgent Medicine Supply

Advanced Service (NUMSAS) Pilot

Overview

• The service

– Service specification and requirements

– IT support

– Roll out of the service

– The practical process for provision of the service

– Fees and reimbursement

• Resources to support provision of the service

• PSNC’s advice to contractors

• Questions – type your questions into the box as you think of them

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Introduction

• Service announced as part of DH imposition of changes to the

CPCF (20th October 2016)

• National pilot service – commissioned as an Advanced Service

• Funded by the Pharmacy Integration Fund (PhIF) - £2m budget

• The service will

– start to roll out from 1st December 2016

– End on 31st March 2018

– with a review point to consider progress in September 2017

Background

• PSNC proposed an emergency supply service as part of its service

development and counter proposals to DH and NHS England

– Fully funded and with additional funding, not from within the CPCF funding

envelope

– Covering all patients – walk-ins, referrals from other HCPs and NHS 111

• NHS England proposed that the PhIF could fund a pilot scheme to test

and evaluate a service to inform possible future commissioning

• The national Emergency Supply Audit conducted by community

pharmacies in 2015 and existing locally commissioned services have

informed the development and design of the service

Aims and intended outcomes of the service

• To appropriately manage NHS 111 requests for urgent supply of medicines and appliances

• To reduce demand on the rest of the urgent care system, particularly GP Out of Hours (OOHs) providers

• To identify problems that lead to individual patients running out of their regular medicines or appliances and to recommend potential solutions that could prevent this happening in the future

• To increase patients’ awareness of the electronic Repeat Dispensing (eRD) Service

• To ensure equity of access to the emergency supply provision irrespective of the patient’s ability to pay for the cost of the medicines or appliances supplied

Training, premises and other requirements

• The service specification sets out the requirements for the

service (published on 29th November 2016)

• Pharmacies must have a consultation room that meets

minimum requirements

• The pharmacy contractor must have a Standard Operating

Procedure in place covering the provision of the service

• The pharmacy’s Business Continuity Plan should be updated to

cover the service

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Training, premises and other requirements

• Training requirements

– Pharmacists’ core knowledge includes making emergency supplies

– Urgent care: a focus for pharmacy (CPPE, September 2016) may

provide useful background knowledge

– Ensure other staff know how the service operates

– Make sure locums know how to operate the service

• Contractors must sign up to service delivery through the NHS

BSA website

Roll out of the service

• The service is a fully integrated service that requires a number of key elements to be in place before it can go live

• To support the efficient roll-out of the service, particularly putting in place mechanisms for referral from NHS 111 to community pharmacy, a phased introduction will take place:– Phase 1 – December 2016 – Brighton and Hove CCG; Guildford and Waverley

CCG; Blackpool CCG and Fylde and Wyre CCG; Nottingham City CCG; Cambridgeshire and Peterborough CCG

– Phase 2 – January 2017 – East of England; North East; North West

– Phase 3 – February 2017 – South East Coast; West Midlands; East Midlands; South West

– Phase 4 – March 2017 – London; Yorkshire and Humber; South Central; Isle of Wight

IT requirements

• The pharmacy must be enabled to receive and dispense Electronic Prescription Service (EPS) Release 2 prescriptions

• Pharmacies must have a shared NHSmail inbox

• Access to the Directory of Services

• If available, pharmacists providing the service should have access to the NHS Summary Care Record (SCR)

• Locally commissioned IT support, e.g. PharmOutcomes, may be used to support referrals from NHS 111 and notifications to GPs

• This will not however be nationally commissioned by NHS England

How will the service

work?

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Referral of patients to the service

• Patients contact NHS 111 to request access to urgently needed

medicines or appliances (previously supplied on script)

• Referral to a pharmacy, chosen by the patient, that is providing

the service - referral via NHSmail or other electronic solution

• NHS 111 provide the phone number of the selected pharmacy

to the patient, advising them to call the pharmacy in the

following 30 minutes

• The pharmacist will assess the need of the patient for an

emergency supply


• NHS 111 call handlers will not be assessing patients’ suitability

for emergency supply

• If a patient calls the pharmacy but no referral has been

received from NHS 111, contact the NHS 111 professionals line

• If a referral is received and no contact is made by the patient,

the pharmacy should attempt to make contact; referrals can be

closed if no contact is made before the next working day


• This service will not be actively promoted directly to the public

by either the pharmacy contractor or the NHS

• Pharmacy teams should regularly check for an email or

electronic message throughout the day to pick up referrals

from NHS 111

Pharmacy consultation: Over the telephone

• An initial telephone consultation will normally take place to:

– determine further information about the patient

– assess the need for an emergency supply (suitability and legality)

– decide whether or not to invite the patient to the pharmacy for a

face-to-face consultation and/or supply

• If the patient indicates that they cannot visit the pharmacy, the

pharmacist should use their professional judgement as to

whether it is appropriate for a representative to collect the

medication or appliance

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Pharmacy consultation: face-to-face

• If appropriate, the pharmacist can invite the patient or their

representative to come into the pharmacy

• The pharmacist will then conduct a face-to-face consultation,

to collect any additional information that was not obtained

during the telephone conversation with the patient

Decision making aids

• If appropriate the patient’s SCR should be checked to confirm the previous prescription history and whether a prescription has recently been issued by the patient’s general practice

• Where the requested item has recently been issued by the patient’s general practice, the prescription may still be available on the NHS Spine

• The pharmacist can use the EPS tracker to see if a prescription is available; if so, this can be used to fulfil the patient’s need for urgent medicines

If a supply is not possible…

• If an emergency supply is not possible at any stage pharmacists

should refer the patient:

– to their own general practice; or

– contact the local GP Out of Hours (OOH) provider to discuss a solution

• Do not refer the patient back to NHS 111

If stock is not available…

• If the required medicine or appliance is not in stock, with the agreement of the patient, identify another convenient pharmacy (Pharmacy 2) that provides the service, call them to see if they have stock and if so, forward the electronic referral received from NHS 111 to them

• Pharmacy 2 will then contact the patient

• Inform NHS 111 of the onward referral to pharmacy 2

• If Pharmacy 2 does not hold the stock, contact the local GP OOH provider to discuss a solution

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Deciding whether to make a supply

• All supplies must be made in line with the provisions and requirements of Regulations 225, 253 and Schedules 18 and 23 of the Human Medicines Regulations (HMR) 2012

• The pharmacist should apply their professional judgement in order to determine the most appropriate quantity of medicine or appliance to supply, in line with the provisions of the HMR

• If the patient (or representative) is not on the premises, then the pharmacist must ensure the patient is able to obtain the supply in a timely manner by discussing with the patient (or representative) all reasonable options for accessing their medicines

Provision of advice and information

• The pharmacist must advise the patient or their representative on the importance of ordering prescriptions in a timely manner from their GP practice and the benefits of the NHS eRepeat Dispensing Service

• If appropriate, the pharmacist can also raise the patient’s awareness of the Medicines Use Review or the Appliance Use Review services

• The patient or their representative should be asked to complete a patient questionnaire; an IT platform (like the flu vac platform) will be made available to record the results electronically

Records and documentation

• A blank FP10DT EPS dispensing token will be used to document

ALL referrals received from NHS 111, irrespective of whether or

not a supply has been made

• Information will need to be printed or recorded in legible

handwriting on the token – IT support may be available

• An NHS prescription charge per item should be collected, unless

the patient is exempt from prescription charges

Records and documentation

• The patient (or representative) must complete the relevant

sections of the reverse of the token to claim any exemptions

from NHS prescription charge payment and confirm supply

when they receive the medicine or appliance at the pharmacy

• Make your usual records of the emergency supply in

accordance with the HMR

• A Post Event Message notification to the patient’s general

practice must be sent either electronically, via hardcopy or fax

on the same day or the next working day

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Payments and how

to claim them

The claims and submissions process

• Contractors who fail to notify NHS England that they intend to provide the service by completion of the NHS BSA form will not be paid if they submit any claims

• To claim payment, the contractor must complete the NHS Urgent Medicines Supply Advanced Service Pilot claim form and submit it to the NHS BSA along with the completed FP10DT EPS dispensing tokens

• This process will be separate to the submission of other FP10 forms and NHS BSA will advise contractors on this process as part of the registration process

Fees that will be paid

a. For ANY referral received from NHS 111 for a request for an urgent

medicine or appliance supply, whether or not a supply is made and

irrespective of the reason for any non-supply:

I. A Consultation fee of £10, and

II. An Administration fee of £2.50 per consultation to reflect the

additional work/documentation required to support evaluation of

the service

b. Where a medicine or appliance has been supplied, a Supply fee of

£1.50 will be made for the first item and an additional £0.50 will be

paid for each additional item supplied


c. Where an item is out of stock and the pharmacy is able to refer a

patient to Pharmacy 2 which has the item in stock and accepts the

onward referral, both pharmacies will be eligible to claim the

Consultation and the Administration fees; only Pharmacy 2 can claim

the Supply fee

d. Where a pharmacy receives a referral from NHS 111 and subsequently

finds a prescription for the patient on the NHS Spine and downloads

and dispenses it, the pharmacy is eligible to claim only the

Consultation and Administration fees (as long as an FP10EDT EPS

token is completed)

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e) Where a pharmacy receives a referral from NHS 111 but the patient has

not made contact and the pharmacy has made at least 3 attempts to

contact the patient without success, the pharmacy will be eligible to

claim the Consultation and Administration fees (as long as an FP10DT

EPS token is completed)

• No payment will be made under this service, for patients outside of the

service specification requirements, for example, walk-in patients who

have not been referral by NHS 111

Reimbursement for items supplied

• The cost of medicines or appliances supplied under the service

will be reimbursed using the basic price

• An allowance at the applicable VAT rate will be paid to cover

the VAT incurred when purchasing the supplied medicine or

appliance

Key resources

• NHS England - Service specification (published 29th Nov 2016)

• NHS England - Service guidance (due in December 2016)

• NHS BSA web-based form for notification of intention to

provide the service (available from 1st December 2016)

• NHS BSA claims form (will be sent to contractors by the BSA)

• Further guidance and resources are available at

psnc.org.uk/numsas

PSNC’s advice to

pharmacy contractors

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PSNC’s general view on the service

• PSNC supports, in principle, the commissioning of emergency supply services, as they drive value for NHS commissioners, reduce the burden on general practice and GP out of hours services and provide a timely and convenient service for patients

• Pleased to see, in the commissioning of the service, recognition of how community pharmacies can help patients and the NHS

• Disappointed that the scheme has only been commissioned as a pilot

• Disappointed that the service will not cover patients who have been referred by other health professionals or come to pharmacies in the first instance themselves

PSNC’s advice to contractors

• The service is part of the DH imposition of changes to the CPCF

• As such the service, including the funding, has not been agreed

by PSNC

• We have however sought to work with NHS England to ensure

the service specification and requirements are, wherever

possible, as manageable as possible for contractors

changes to funding community pharmacy in 2016/17 and...

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