April 2019 CPN

CPN

Community Pharmacy News – April 2019

Contract negotiations begin

DHSC and NHS England open dialogue with PSNC about funding and services for 2019/20 and beyond Preparing for Brexit | Domiciliary service integrates care | Multiple flavours factsheet

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Chief Executive’s blog PSNC Chief Executive Simon Dukes uses this section of CPN to provide an update on PSNC’s work. will be fighting as hard as possible on behalf of the sector that we all work in. We as much as anyone passionately want to secure a sustainable future for community pharmacy.

Simon Dukes

PSNC Chief Executive The good news is that negotiations have finally started for the 2019/20 Community Pharmacy Contractual Framework (CPCF).

The more difficult news is that everyone is anxious to hear how I think the discussions are going to go. While I am not going to talk about our negotiating positions in public, there are some things that we can share. As per the details set out in the NHS Long Term Plan and GP contract, the Government is looking to better use the clinical skillset and reach of community pharmacy, so you can expect discussions around urgent care, prevention and medicines safety.

Specifically, we will be considering: • The possible roll-out of a national minor illnesses referral service via NHS 111, and the piloting of referrals to community pharmacy from other settings such as GPs and NHS.UK; • The future of the Healthy Living Pharmacy (HLP) programme and effective use of the Pharmacy Integration Fund; and • Medicines safety interventions and the future of Medicines Use Reviews (MURs).

All of this is positive, and PSNC’s Negotiating Team, which comprises experienced members from both the multiple and independent sectors,

2 Community Pharmacy News – April 2019

Which is why as well as looking forward to some promising service development conversations, we are preparing for some challenging discussions on funding and reimbursement, and on how we can free up capacity within the sector. The Government is our only payer and so our leverage is often limited; but rest assured that we will use all that we have robustly.

Alongside our negotiations, the move towards yet more local planning and provision of services is also going to test the sector. The evolving Primary Care Networks (PCNs) which I talked about in this blog last month will be the foundation of primary care in the future, and pharmacy contractors must take the lead in engaging with them.

To do this we must first tackle the lack of unity among us head on, and I would

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Talk to the pharmacies around you – what proposals can you make to your local PCN together?

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While I am not going to talk about our negotiating positions in public, there are some things that we can share

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urge all contractors to take the first step by talking to the pharmacies around them – how can you collectively meet the needs of your local patients, and what proposals can you make to your local PCN together? I know the idea of collaborating with a competitor will be difficult for many, and we are not going to make all of this happen overnight – and indeed nor do we need to, because the GPs face as many challenges as us as they work out how to collaborate to make PCNs work from their side. But we must start somewhere.

A good first step will be to watch PSNC’s animation about the future (available from 30th April at psnc. org.uk/futureofpharmacy) which will give you an idea of where we think pharmacy is headed and how you can start to prepare. Of course, we will be helping you to do this over the coming weeks and months, providing support and resources to help with local conversations; encouraging and coordinating collaborative work between the national pharmacy organisations; and working closely with the LPCs. As we go into what will be a crucial period for community pharmacy, I cannot stress enough that we are on your side. But we will also need contractors to play their parts as we go along. The challenges for community pharmacy must be faced and addressed by everyone in the sector, working together, not against one another. I look forward to another big year for all of us.

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCS

Negotiations on funding and CPCF commence • Proposals for negotiation put forward by DHSC and NHS England • Elements from NHS Long Term Plan and GP Contract are likely points for discussion • PSNC acknowledges need for difficult conversations as it seeks a sustainable future for pharmacy

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PSNC CEO is ‘absolutely committed’ to getting the best possible deal

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Negotiations on the Community Pharmacy Contractual Framework (CPCF) for 2019/20 and beyond have commenced.

while they are ongoing PSNC, DHSC and NHS England have agreed that the negotiations will remain confidential to facilitate frank and open discussion.

The Department of Health and Social Care (DHSC) has initiated the negotiation process with a set of proposals which have been agreed with NHS England.

These have now been shared with PSNC.

PSNC Chief Executive Simon Dukes said: “PSNC is pleased to be able to begin these negotiations; the outcome of which will be absolutely critical for all pharmacy contractors in England. There are going to be some difficult conversations over the coming months but our Negotiating Team includes experienced PSNC members from both the independent and multiple sectors, so contractors can be assured that we will be well equipped and absolutely committed to getting the best possible deal for community pharmacy.

Our priority is to seek a sustainable future for community pharmacy to enable us to better utilise the skills and knowledge of pharmacy teams to help people stay well in the community.”

The negotiations will take the form of tripartite discussions between representatives from all three organisations.

For PSNC the representatives will include independent community pharmacy contractors, representatives of multiple pharmacy businesses, and the senior executive – all of whom sit on the PSNC Negotiating Team.

The discussions will be complex and

On the agenda From details in the NHS Long Term Plan and GP Contract, PSNC expects discussions on how to utilise better the skillset and reach of community pharmacy. For example: • The possible roll-out of a national minor illnesses referral service via NHS 111, and the piloting of referrals to community pharmacy from other settings such as GPs and NHS.UK; • The future of the Healthy Living Pharmacy (HLP) programme and effective use of the Pharmacy Integration Fund; and • Medicines safety interventions and the future of Medicines Use Reviews.

We can also expect some challenging discussions on funding and reimbursement.

Seema Kennedy MP becomes new Pharmacy Minister Seema Kennedy, the MP for South Ribble in Lancashire, has become the new minister with responsibility for pharmacy.

In his resignation letter, Mr Brine indicated that he had enjoyed his time as Public Health Minister and “will carry on some of that work from the backbenches”.

The ministerial brief includes primary care, the public health system, and prevention and early intervention.

PSNC Chief Executive Simon Dukes commented: “Over the past year we have made considerable progress in rebuilding a constructive working relationship with Government, and as Minister, Steve Brine had been central to that.

Ms Kennedy has previously indicated an interest in small business, has supported local women’s health campaigns and is an advocate of Dementia Friends.

The new Parliamentary Under Secretary of State for Health was appointed after Steve Brine stepped down to vote in favour of an amendment to allow MPs to vote on a series of motions on the UK’s departure from the EU.

PSNC would like to congratulate the new Minister on her role; we look forward to meeting her at the earliest opportunity and to building on the collaborative working relationship we have established with the Department. We will ensure that Ms Kennedy is briefed on the value of community pharmacy and we hope to work with her to ensure that the full potential of community pharmacies is realised.”

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THE HEALTHCARE LANDSCAPE

LPCS

PSNC’S WORK

Helping you to engage with PCNs The team at PSNC has been working hard to develop a range of materials to help LPCs and community pharmacies engage with Primary Care Networks.

Community pharmacy contractors and LPCs will need to be proactive in engaging with Primary Care Networks (PCNs), and PSNC will be supporting you on this journey.

We have created a section on the PSNC website dedicated to PCNs and a new webpage specifically on resources and guidance to support local engagement.

Whilst the main page explains how PCNs are being developed, the resources page contains:

PSNC Briefing 018/19: A summary of the Network Contract Directed Enhanced Service (DES) 2019/20

A briefing summarising the Network Contract DES specification which enables general practices to take a leading role in PCNs.

PSNC Briefing 013/19: An introduction to Primary Care Networks

A briefing explaining what PCNs are and their role in the NHS.

Community pharmacy and PCN presentation

A presentation on PCNs for LPCs to use at contractor meetings.

PSNC Briefing 015/19: Supporting community pharmacies to engage with PCNs

A list of suggested actions that LPCs can take to engage with PCNs and help contractors to do the same.

You can use the following shortlinks to get to these webpages quickly: psnc.org.uk/pcn and psnc.org.uk/pcnresources

Coming soon

PSNC is developing a video animation describing the changes that lie ahead for community pharmacies. This visual resource, alongside a series of action points to consider is due to launch on Tuesday 30th April and will be available to view at: psnc.org.uk/futureofpharmacy Other resources are also being developed and will be added to this webpage over the coming months.

PCN podcasts NHS England has launched a new monthly podcast focusing on PCNs. The first episode features Dr Canniff who talks about her passion for PCNs and how she is supporting the development of networks in her own area, as part of the work across Surrey Heartlands Integrated Care System.

Listen to the podcast: ow.ly/8oo730otdAs

4 Community Pharmacy News – April 2019

FUNDING AND STATISTICS

CONTRACT AND IT

DISPENSING AND SUPPLY

No-deal Brexit preparations • UK granted an extension to EU exit date, but no-deal preparations continue • NHS England issues additional guidance for primary care contractors • Health Secretary Matt Hancock provides an update

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Despite news of an extension, contractors are still advised to prepare for a possible no-deal Brexit

The European Union (EU) has granted Prime Minister Theresa May an extended timeframe for the UK to leave the EU. The deadline is now until 31st October 2019, as long as the UK holds EU Parliamentary elections. If the UK does not hold these elections, it will leave on 1st June 2019.

There is also flexibility for the UK to leave the EU sooner if a deal is ratified by Parliament before then.

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Despite this extension, community pharmacy contractors are still advised to review the latest Government guidance on preparing for the possibility of a no-deal Brexit.

This month NHS England has published a letter to support primary care contractors.

The letter is intended to be a companion to the Department of Health and Social Care’s (DHSC) Operational Readiness Guidance issued in December 2018.

A summary of the information relevant to pharmacy teams is provided below.

Medicine supply: • There is no need to change behaviour in terms of ordering stocks or engaging with suppliers.

• Do not stockpile medicines, medical devices or clinical consumables.

• Public Health England, DHSC and suppliers will ensure there are sufficient stockpiles of vaccines in place.

Raising concerns: • In the first instance, try to resolve issues through the usual channels: report medicine supply issues to PSNC (psnc.org.uk/feedback) and notify your local NHS England team if you experience significant service delivery problems.

• These ‘business as usual’ arrangements, alongside input from PSNC’s Community Pharmacy Brexit Forum, will be supplemented by Regional Medicines EU Exit Panels.

Serious Shortage Protocols: • SSPs will only be used when an expert led clinical decision is approved by the Minister.

• A protocol would only be put in place for a specific medicine.

• An SSP would only enable community pharmacists to dispense a medicine in very limited circumstances, with the patient’s consent and for a defined time period.

For all the latest EU exit updates and guidance, please visit our Brexit hub: psnc.org.uk/Brexit

Health Secretary update The Secretary of State for Health and Social Care, Matt Hancock, wrote to frontline health professionals in early April to provide an update on the Government’s Brexit preparations.

Mr Hancock’s letter reiterates that local stockpiling is unnecessary, confirms the continued recognition of EU professional qualifications in the UK, and highlights the EU Settlement Scheme. Find out more at: ow.ly/bExG30okejN

SERVICES AND COMMISSIONING

Change of circumstance guide PSNC has updated its guidance to support community pharmacies that are due to change location or ownership.

Changes of circumstance such as new owners, relocations and closures are subject to regulatory requirements, but our guide focuses on mitigating potential IT/Electronic Prescription Service (EPS) issues where such changes are planned.

PSNC recommends that contractors prepare for a change of circumstance – which may also require a change of the pharmacy’s ODS (F) code – by familiarising themselves with the guidance: ow.ly/qjOB30o9b3G

Market-entry applications to move online At present there are more than 30 pharmacy application forms available including change of ownership, consolidation, relocation and new pharmacies.

Primary Care Support England (PCSE) has confirmed that it will introduce a new approach with one single online application, accessible via the PCSE Online website. The new system aims to provide a straightforward process that automatically checks applications for completeness before they are submitted.

National roll-out of the new form is expected later in 2019.

GPhC publishes new enforcement policy The General Pharmaceutical Council (GPhC) has published a new enforcement policy for registered pharmacies, which intends to drive continuous improvement in the quality of care patients receive when using a pharmacy.

The policy is aimed at community pharmacy contractors, whether sole trader, a partnership of pharmacists or a body corporate such as a limited company. It also applies regardless of whether contractors provide the traditional face-to-face service or operate at a distance.

View the new policy at: ow.ly/mgZS30ooIkl

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SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCS

Supporting community pharmacists in challenging times Pharmacist Support is offering wellbeing workshops free of charge via Local Pharmaceutical Committees (LPCs).

The independent charity Pharmacist Support offers free and confidential support for pharmacists and their families, former pharmacists, trainees and MPharm students. This includes a suite of wellbeing resources aimed at helping individuals identify the signs and symptoms of stress and equipping them with tools and techniques to help deal with feelings of pressure.

Workshops are now being offered free of charge to LPCs and cover four main areas – an introduction to wellbeing, assertiveness, time management and building resilience. The workshops are between 60 and 120 minutes in length and can be tailored to attendees’ requirements.

The Introduction to Wellbeing workshop is a great starting point for first-timers as it provides a good overview of wellbeing and touches on elements of the material from the other three sessions. Those who have already attended this session or who are interested in exploring a specific topic in more detail, may find one or more of the other sessions appropriate.

These sessions will also signpost attendees to further

resources and can be counted towards Continuing Professional Development (CPD).

Pharmacist Support can deliver workshops free of charge across Great Britain. All LPCs need to do is gather a minimum of 20 attendees (pharmacists, trainees or MPharm students), arrange a suitable venue and any refreshments (if required).

LPCs are encouraged to call 0161 441 0811 or email wellbeing@pharmacistsupport.org for further information about arranging one of these workshops.

If you would like to find out more about the support offered by the charity, or you would like to find out how to support its work, please visit: www.pharmacistsupport.org

Local commissioning resources Public Health England (PHE) has recently published some resources that are likely to be of interest to Healthy Living Pharmacies as well as to LPCs who want to initiate ideas for local public health campaigns or service developments.

The first resource, aimed at commissioners and other health professionals, highlights community pharmacy’s offer for delivering sexual health, reproductive health and HIV services across England. It highlights various issues relating to sexual and reproductive health (such as chlamydia screening and treatment, unplanned pregnancies and HIV testing) and opportunities for commissioners.

The report calls for commissioners to recognise the value of community pharmacy teams as a key asset for the provision of the above services, especially given their convenient position and value within the community.

View the sexual health resource at: ow.ly/AFd230of4Fe PHE has also, with support from the Pharmacy and Public Health Forum, published A Menu of Interventions for Productive Healthy Ageing, aimed at pharmacy teams working in different settings.

This guide details opportunistic, evidence-based interventions that can help provide benefits for healthy ageing. The interventions cover topics such as falls prevention, dementia, social isolation and loneliness, and malnutrition.

View the heathy ageing guide at: ow.ly/OQtU30o9bcj

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Share your views on patient safety Community pharmacy teams have two opportunities to help improve patient safety by sharing their opinions this month.

Firstly, the Community Pharmacy Patient Safety Group has launched a survey to capture honest opinions on current patient safety incident reporting and learning processes from all members of the pharmacy team.

The anonymous survey, open until Friday 10th May, also seeks to gather insight on barriers to reporting, learning from incidents and thoughts on safety culture. To take part, please visit: ow.ly/CmfH30ojXZn Secondly, NHS Improvement will soon be implementing a Medicines Safety Assurance Model that supports local systems in identifying best medicines safety practice.

A consultation has been launched to help inform the development of the model and community pharmacy teams are invited to share their valuable insight: ow.ly/vzvY30opip7

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

DISPENSING AND SUPPLY

Pharmacy domiciliary service helps integrate care London pharmacy service shows how community pharmacists can help to integrate the diverse care needs of housebound patients.

A research paper about a community pharmacist-led holistic domiciliary Medicines Use Review (MUR) service has been published in the Research in Social and Administrative Pharmacy journal.

Research findings 133 patients were visited by community pharmacists Over a third of patients had unwanted medicines for disposal

The study concluded that community pharmacists may be a link in the care pathway to help integrate many aspects of care for older, isolated, housebound patients with multiple-morbidities. This may consist of understanding the patient’s medicines and care needs in the context of their home environment, providing missing medicine support to carers and family members, helping to optimise patients’ medicines and making referrals as appropriate.

interviews as part of a structured holistic domiciliary MUR.

What did the service involve?

Patients were identified in the London Borough of Richmond who were predominantly housebound and taking multiple medicines. Twelve community pharmacists visited patients and carried out

Pharmacists identified that a significant number of patients had physical difficulties taking their medicine, whilst some patients had stockpiled medicines and others were no longer taking a medicine but had not informed the pharmacy.

A total of 133 patients were visited by community pharmacists and 401 clinical, social or medicines-related issues were recorded.

Nearly 20% of patients had recently run out of a medicine More than a quarter of patients reported both preventable and potentially dangerous side effects It was discovered that patients with diabetes and those taking warfarin were not being regularly monitored and over a quarter of patients reported both preventable and potentially dangerous side effects.

Various social care issues were also identified by the pharmacists; this included damp and cluttered homes, the frequent presence of physical and gas hazards, and inadequate hydration, nutrition and lavatory facilities.

Learn more at: ow.ly/PgdT30opjSY

Emergency contraception workshops The Centre for Pharmacy Postgraduate Education (CPPE) is offering two-hour workshops on pharmacy emergency contraception services over the next few months.

Emma Anderson, Regional tutor, CPPE

We are running a number of Emergency “contraception workshops across the country

the efficacy of each method of contraception.

during the spring and summer months.

The workshop itself will run for two hours and will give you the chance to work through a PGD activity and role play some scenarios that address different aspects of emergency contraception. During the workshop you will also hear from a local expert in contraception and sexual health and be able to reflect on your current practice with your colleagues. You will also get to have a taster peer discussion which you could choose to continue after the event to support your GPhC revalidation.

Our Emergency contraception workshops aim to support you to provide highquality emergency contraception services as part of your pharmacy practice. The workshop will give you the opportunity to work through emergency contraception consultations and apply current clinical guidance to give safe and effective care.

The workshops will also help you to use patient group directions appropriately, while demonstrating a personcentred approach and considering the needs and preferences of the woman.

The workshop consists of pre-workshop learning activities that focus on consultation skills, safeguarding and thinking about

This workshop can also be used to support you in meeting specific competencies within the Declaration of Competence (DoC) self-assessment framework for this service.

This programme is open to all pharmacists, pharmacy technicians and pre-registration trainees. For more information about the workshop and to find an event near you, visit: www.cppe.ac.uk/programmes/l/ehc-w-16

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DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

Ask PSNC The PSNC Dispensing and Supply Team provides pharmacy teams with support and advice on a range of topics related to the Drug Tariff and reimbursement. Questions asked in recent months include: Q. How can I request copies of switched prescriptions for staff training purposes?

A. To request a copy of switched prescriptions, you must submit the recheck request form available on our website: psnc.org.uk/recheck. The NHS Business Services Authority (NHSBSA) will return copies of switched forms to a pharmacy contractor on a single occasion only for training purposes.

Any subsequent requests should be directed to your local NHS England team.

Q. Where can I find my pharmacy’s prescription switching figures on the Schedule of Payment?

A. The switching figures appear under the section titled ‘Items transferred between exempt and chargeable groups.’

The four key switching figures given in this section include the: • Number of items switched from Exempt to Chargeable group (this is split into subsections - where part 2 contains a charge rate and where part 3 is unsigned by patient/patient representative.

• Number of items switched from Exempt to Chargeable Old Rate – normally relevant during period when there is prescription charge rate change – usually in April.

• Number of items switched from Chargeable to Exempt group – where declaration shows a claim for exemption.

• Number of items switched from Chargeable Old Rate to Exempt.

For more information see our page Exemptions from the prescription charge: psnc.org.uk/exemptions

Look out for more frequently asked questions next month…

If you would like more information on any of the topics covered, the team at PSNC will be happy to help (0203 1220 810 or email info@psnc.org.uk).

8 Community Pharmacy News – April 2019

Q. Does an age-exempt declaration need to be completed by a patient if their date of birth on the prescription is handwritten?

A. Yes. If a prescription is handwritten, it must be signed and the relevant box on the back of the prescription should be ticked. However, if the prescription is computer generated and the age or date of birth is clearly visible, a signature is not required, and the patient does not need to tick the box on the back of the prescription as they are classed as automatically age exempt.

Q. Am I obliged to request evidence of prescription charge exemption?

A. As part of a pharmacy’s Terms of Service, pharmacy staff must ask any person who makes a declaration that the patient is exempt from paying a prescription charge to produce satisfactory evidence of such entitlement. The legislative requirement is set out in paragraph 7 of the Terms of Service.

Where appropriate, pharmacy staff should advise patients of the required certificates and how they might go about obtaining them (e.g. Medical Exemption Certificates required for patients with diabetes, epilepsy etc. as well as exemption certificates on maternity grounds, low income, or Prescription Prepayment Certificates (PPC)).

Where patients do not have evidence or where there is doubt over whether the evidence provided is appropriate, the “Evidence not Seen” box on the back of the prescription should be marked with an X by pharmacy staff. Pharmacy staff need not refuse to dispense items on the basis that the patient does not provide evidence of their entitlement to free prescriptions.

If a patient is unsure whether they are entitled to free prescriptions, pharmacy staff should advise the patient to pay for their prescription and provide them with an FP57 Refund form with information on how to claim a refund at a later date. Further information for patients can be found at: www.nhs.uk/healthcosts

LPCS

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Multiple flavours factsheet Here we explain how to endorse prescriptions requesting multiple flavours to ensure reimbursement for the correct number of fees.

The Single Activity Fee (SAF) is paid automatically for all eligible items and, where a prescription orders multiple, assorted, various or mixed flavours, one SAF can be claimed for each flavour supplied and endorsed. The table below describes how different information about flavours is treated by the NHS Business Services Authority (NHSBSA) for reimbursement purposes.

Prescribed field information

EPS

Paper

1

Flavour specified e.g. ‘Vanilla’ ‘Fortisip Bottle vanilla (Nutricia Ltd)’

Only one fee is paid per flavour specified.

Only one fee is paid per flavour specified.

2

‘Flavour Not Specified’ ‘Fortisip Bottle (Flavour Not Specified)’ Where flavoured products are prescribed, and the prescriber does not specify the flavour required to allow the patient or pharmacist to choose instead, the prescriber can select the ‘Flavour Not Specified’ option.

Unless ‘AF’ endorsement is selected by the prescriber, only one fee per item is paid regardless of how many flavours are endorsed.

Only one fee is paid regardless of how many flavours are endorsed. However, see point 4.

3

Mixed/assorted/various flavours ‘Fortisip Bottle (Nutricia Ltd) (Flavour Not Specified) Multiple Flavours’

The prescriber must add the ‘AF’ endorsement in the prescriber endorsement field if the patient requires multiple flavours.

A fee is paid for each flavour endorsed. For example, six different flavours endorsed would attract six fees.

4

Supplementary information in dosage/directions ‘Fortisip Bottle (Nutricia Ltd) (Flavour Not Specified) One to be taken twice daily (Strawberry and Banana)’

If the prescriber has added assorted, mixed or various flavours to the dosage instructions of an EPS prescription, this will not be seen by NHSBSA as they only extract prescriber endorsements (for example, ‘AF’) from the prescriber endorsement field of the EPS prescription message.

If supplementary information requesting various flavours is added to the dosage/directions area, the prescription will need to be placed in a red separator to be seen by an operator if multiple flavours are endorsed.

Below are some illustrations of tokens and paper prescriptions for a product available in multiple flavours with an indication of the expected number of fees payable depending on the dispenser endorsement.

EPS prescriptions

1. Single flavour specified by the prescriber DISPENSING TOKEN Fortisip Bottle vanilla 24 x 200ml As directed

Prescribed Medication

‘AF’ Box ticked?

No. of fees

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1

Note: Please contact your pharmacy system supplier If you are unsure of how and where the prescriber ‘AF’ endorsement will appear on the EPS message displayed on your system.

3. Flavour Not Specified – where the ‘AF’ endorsement has been selected by the prescriber DISPENSING TOKEN Fortisip Bottle (Flavour Not Specified) 24 x 200ml As directed

Prescribed Medication

‘AF’ Box ticked?

3

No. of fees Multiple fees based on number of flavours endorsed by dispenser

Note: Contractors should return the actual medicinal product pack (AMPP) for each specific flavour dispensed along with the quantity dispensed for that flavour.

2. Flavour Not Specified – where the ‘AF’ endorsement has not been selected by the prescriber DISPENSING TOKEN Fortisip Bottle (Flavour Not Specified) 24 x 200ml As directed

Prescribed Medication

‘AF’ Box ticked?

No. of fees

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1

Note: If the prescriber does not endorse ‘AF’, you can still dispense different flavours but will only receive one fee.

4. Supplementary information included in dosage instructions DISPENSING TOKEN Fortisip Bottle (Flavour Not Specified) 24 x 200ml As directed (Mixed flavours)

Prescribed Medication

‘AF’ Box ticked?

No. of fees

7

1

Note: There are no dm+d listings for prescribers to select ‘assorted’, ‘multiple’ or ‘various’ flavours, for example a listing for ‘Fortisip Bottle (Multiple flavours)’ does not exist. Any free-typed information into the main body of the prescription message will not be seen by NHSBSA. In EPS, the prescriber needs to select the ‘AF’ endorsement in the prescriber endorsement field if the patient requires multiple flavours.

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DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

Paper prescriptions

1. Single flavour specified by the prescriber Endorsements

24 x 200ml Fortisip Bottle vanilla

2. ‘Flavour Not Specified’ in main body of the prescription No. of fees

Fortisip Bottle vanilla 24 x 200ml As directed

1

3. Assorted, mixed or various flavours Endorsements

6 x 200ml Fortisip Bottle strawberry 6 x 200ml Fortisip Bottle vanilla 12 x 200ml Fortisip Bottle Banana

No. of fees

Fortisip Bottle (Mixed Flavours) 24 x 200ml As directed

THE HEALTHCARE LANDSCAPE

Endorsements

12 x 200ml Fortisip Bottle Strawberry 12 x 200ml Fortisip Bottle Vanilla

No. of fees

Fortisip Bottle (Flavour Not Specified) 24 x 200ml As directed

1

Note: ‘Flavour not specified’ is classed as a single item attracting only one fee. Only one fee would be paid regardless of how many flavours are endorsed.

3 4. Supplementary information in dosage instructions Endorsements

6 x 200ml Fortisip Bottle Strawberry 6 x 200ml Fortisip Bottle Vanilla

Note: Where multiple flavours are dispensed, it is good practice to endorse each flavour supplied as above, rather than just endorsing as ‘3 flavours’.

No. of fees

Fortisip Bottle (Flavour Not Specified) 12 x 200ml As directed. Please supply Mixed flavours

*2

*As multiple flavours are endorsed, this prescription must be placed in a red separator as there are additional instructions (i.e. ‘Mixed flavours’) included in the dosage line.

Prescription charges and fees If a patient is not exempt from prescription charges, and multiple flavours of the same product are prescribed as separate items, only one prescription charge would apply.

2. Starter or commencement pack

1. Multiple flavours of the same product Endorsements

6 x 200ml Fortisip Bottle strawberry 6 x 200ml Fortisip Bottle vanilla 6 x 200ml Fortisip Bottle banana

No. of fees

Fortisip Bottle strawberry 6 x 200ml As directed.

Fortisip Bottle vanilla 6 x 200ml As directed.

Fortisip Bottle banana 6 x 200ml As directed.

Note: If the patient pays for their prescriptions, they would only pay a single prescription charge as the prescription calls for multiple flavours of the same preparation.

3 No. of prescription charges

Endorsements

750ml Fortisip Compact Starter Pack liquid

No. of fees

Fortisip Compact Starter Pack liquid (Nutricia Ltd) 750ml (6 x 125ml) As directed.

6 No. of prescription charges

1

1 Note: Fortisip Compact Starter Pack liquid contains 6 different flavours. As this pack contains multiple flavours, you will receive a fee for each flavour included. If the patient pays for their prescriptions, they would only pay a single prescription charge.

PSNC Top Tips: • If the prescriber orders mixed or assorted flavours, endorse exactly which flavours you have given as opposed to the number of different flavours you have used, e.g. ‘6 x 250ml vanilla; 6 x 250ml coffee’ instead of ‘2 flavours’.

• Record the number of items dispensed in the box provided in the bottom left hand corner of the paper FP10 prescription. When totalling up your items figures and entering onto your FP34C ensure one item is claimed for each flavour dispensed and endorsed.

• When checking your Schedule of Payment for expensive flavoured products, remember that each flavour is paid separately so may not appear in the list of expensive items unless the cost per individual flavour exceeds £100.

• An EPS prescription for a flavoured product where the same flavour has been endorsed multiple times will only receive one fee regardless of how many times the same flavour is endorsed. The prescription should be endorsed as one entry of the required flavour with details of the appropriate total quantity dispensed.

PSNC’s webinar on endorsements which includes information on endorsing multiple flavours ordered on electronic and paper prescriptions can be viewed at: psnc.org.uk/endorsingwebinar

10 Community Pharmacy News – April 2019

LPCS

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Drug Tariff Watch: May 2019 Part VIIIA additions • Adalimumab 20mg/0.2ml solution for injection pre-filled syringes (2) – Humira • Ambrisentan 10mg tablets (30) and 5mg tablets (30) – Volibris • Belladonna medicated plaster ° 28cm x 17.5cm  (1) ° 9.5cm x 12.5cm (2) • Budesonide 2mf/100ml enema (7(7 x 1)) – Entocort • Capsaicin 179mg cutaneous patches  (1) – Qutenza • Cetrimide 0.2% / Benzalkonium chloride 0.01% cream  (100g), (200g) and (350g) – Drapolene • Chlorhexidine acetate 0.02% catheter maintenance solution  (100ml) – Urotainer • Dalteparin sodium solution for injection ° 10,000units/1ml ampoules (10) – Fragmin ° 10,000units/4ml ampoules (10) – Fragmin ° 10,000units/4ml vials  (1) – Fragmin • Dimeticone 10% / Cetrimide 0.3% cream  (50g) – Siopel • Econazole 150mg pessaries °  (1) – Gyno-Pevaryl Once °  (3) – Gyno-Pevaryl • Filgrastim solution for injection pre-filled syringes ° 30million units/0.5ml (5) – Zarzio ° 48million units/0.5ml (5) – Zarzio • Flecainide 200mg MR capsules (30) – Tambocor XL • Hydrocortisone sodium succinate 100mg powder for solution for injection vials  (10) – Solu-Cortef • Insulin protamine zinc bovine 100units/ml

suspension for injection 10ml vials  (1) – Hypurin BovineProtamine Zinc • Insulin zinc mixed bovine 100uniots/ml suspension for injection 10ml vials  (1) – Hypurin Bovine Lente • Iron dextran solution for injection ampoules ° 100mg/2ml (5) – CosmoFer ° 500mg/10ml (2) – CosmoFer • Ketamine 200mg/20ml solution for injection vials  (1) – Ketalar • Levocarnitine 1g/5ml solution for injection ampoules (5) – Carnitor • Lidocaine hydrochloride 0.5% / Cetylpyridinium chloride 0.025% oromucosal gel sugar free  (15g) – Bonjela Junior • Minoxidil 5% foam °  (60g) – Regaine for Men Extra Strength ° (120g (2 x  60g)) – Regaine for Women Once a Day ° (180g (3 x  60g)) – Regaine for Men Extra Strength • Nicotinamide 4% gel °  (10g) – Freederm °  (25g) – Freederm Treatment °  (60g) – Nicam • Nimodipine 30mg tablets (100) – Nimotop • Nonoxinol-9 2% gel  (81g) – Gygel • Omalizumab solution for injection prefilled syringes ° 150mg/1ml  (1) – Xolair ° 75mg/0.5ml  (1) – Xolair • Potassium citrate 3g granules sachets sugar free (6) – Cystopurin • Promethazine hydrochloride 20mg tablets (8) and (16) – Sominex

KEY:  Special container  Item requiring reconstitution * This pack only (others already available) • Raltegravir 400mg tablets (60) and 600mg tablets (60) – Isentress • Rifabutin 150mg capsules (30) – Mycobutin • Riociguat 1.5mg tablets (42), 1mg tablets (42), 2.5mg tablets (42), 2mg tablets (42) and 500microgram tablets (42) – Adempas • Sodium chloride 0.9% infusion polyethylene bottles 1litre  (1) and 500ml  (1) – Polyfusor S • Sodium chloride 0.9% solution for injection 20ml ampoules (20) – Sodium chloride MiniPlasco • Sodium fusidate 500mg powder and solvent for solution for infusion vials  (1) • Tacalcitol 4micrograms/g lotion  (30ml) – Curatoderm • Valganciclovir 50mg/ml oral solution sugar free  (100ml) – Valcyte • Varicella vaccine (live) powder and solvent for solution for injection 0.5ml vials  (1) – Varilrix • Varicella vaccine (live) powder and solvent for suspension for injection 0.5ml vials  (10) – Varivax • Voriconazole 200mg/5ml oral suspension  (75ml) – VFEND • Water for infusion 1litre polyethylene bottles  (1) – Polyfusor W • Zinc acetate 25mg capsules (250) and 50mg capsules (250) – Wilzin For a full list of upcoming Drug Tariff changes, please visit: ow.ly/RHdT30oxkoE

Part IX deletions Product

Size, Type, Product Code

AUTO INFLATION DEVICE - Otovent WOUND MANAGEMENT DRESSINGS - Venturi MiNO Foam Weekly Therapy Wound Care Set WOUND MANAGEMENT DRESSINGS - Ultrasound Therapy System Accessories - MIST LUBRICANT GELS - K-Y Jelly (sterile until opened)

n/a Portal Drain, 10cm x 15cm x 3cm Single use applicator kit 82g tube

SPACER/HOLDING CHAMBER DEVICES - EasyChamber C-Flow SURGICAL SUTURES - Non-Absorbable Sutures - Ethicon - Sterile Polyamide Synthetic Suture SURGICAL SUTURES - Non-Absorbable Sutures - Ethicon - Sterile Polyamide 6 Suture, Monofilament COLOSTOMY BAGS - Hollister Ltd - Impression ‘C’ with filter ILEOSTOMY (DRAINABLE) BAGS - Hollister Ltd - Impression ‘C’

All W1618T W319, W320 and W1615T Beige, 44mm (3498) Transparent, 25mm (3282)

ILEOSTOMY (DRAINABLE) BAGS - Hollister Ltd - Karaya 5 seal with microporous adhesive TWO PIECE OSTOMY SYSTEMS - Hollister Ltd - Conform 2 with filter and Lock’n’Roll Closure CHEMICAL REAGENTS - OneTouch GM CHEMICAL REAGENTS - OneTouch Ultra CHEMICAL REAGENTS - OneTouch Vita

229mm Length, 51mm (3134) Midi, Beige, 35mm (23750) 50 strips 50 strips 50 strips

psnc.org.uk 11

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Pharmacy notice board In this section of Community Pharmacy News we have highlighted some key notices for you and your team to be aware of in the coming weeks and months.

Webinar date for your diary When? Tuesday 11th June at 7.30pm What? Helping community pharmacy contractors to better understand their FP34 Schedule of Payments.

Who? Hosted by PSNC and the NHS Business Services Authority (NHSBSA) Look out for more details at: psnc.org.uk/webinar

Flu Vaccination Service

that claims 2018/19: Contractors are reminded months of six within made be for payment must ils of how to Deta n. inatio vacc the of tion administra u uk/fl claim can be found at: psnc .org.

2019/20: The Department of Health and Social Care, Public Health England and NHS England have jointly published a letter outlining the eligibility criteria and the vaccines licensed to be used for the 2019/20 flu season. Find out more at: ow.ly /BM Na30 of4s Q

Stickers on prescriptions

NHSBSA has raised concerns over the increasing number of prescriptions they are receiving with stickers attached to them.

This can obscure patient or prescriber information.

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Find out more at: ow.ly /DdF 230o pjpN

Coding changes for locally authorised payments

changes to the way payments NHS England and NHSBSA are making some minor Schedule of Payments. monthly the on ed describ are s for Enhanced Service sioned services, which will This is to ensure consistent coding of locally commis ts. paymen of iliation reconc simplify data collection and ed Services claim The national menu will be applied to April 2019 Enhanc 2019 and paid to March in ted comple submissions, i.e. to Enhanced Services 2019. contractors on 1st May See the new codes at: ow.ly/T aQm30 opjzy

PSNC website For up to date information and news on community pharmacy issues, visit the PSNC website at psnc.org.uk PSNC Community Pharmacy News is published by: The Pharmaceutical Services Negotiating Committee, 14 Hosier Lane, London, EC1A 9LQ Community Pharmacy News is edited by: Melinda Mabbutt who can be contacted at the above address or by email at: mmabbutt@psnc.org.uk PSNC Office: 0203 122 0810

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