December 2020 CPN

CPN

Community Pharmacy News – December 2020

Financial pressures warning

As MPs warn of the COVID-19 impact on the pharmacy sector, PSNC provides some updates on negotiations.

Pharmacy and C-19 vaccination | Call for better access to SCR | Is it allowed factsheet

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Chief Executive’s blog PSNC Chief Executive Simon Dukes reflects on community pharmacy’s phenomenal work during 2020. teams implemented social distancing and other protective measures so the public still had somewhere to go for face-to-face healthcare advice and to receive their medicines.

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Simon Dukes

PSNC Chief Executive As we approach the end of a very long and difficult year for all of us, I am yet again tempted to comment on the now appallingly unacceptable delay in Government decision-making for two crucial funding bids for our sector; the apparent unconcern about the effect of this uncertainty on the financial and mental wellbeing of contractors; and the lack of understanding amongst officialdom of what community pharmacy does (and can do). However, I am not going to do so. Whilst not diminishing the importance of these issues, instead I want to say something about the incredible way that community pharmacy has risen to the unprecedented health challenge we have faced (and still face) - despite the very patchy nature of Government support and what message our ‘customers’ should read from it.

If there is any doubt lingering within DHSC as to whether community pharmacy is ‘healthcare’ or ‘retail’, the selfless manner in which the sector has served its patients has answered this question: maintaining dispensing services in the face of many operational challenges; reassuring anxious and at times abusive patients; and delivering a (non-funded) walk-in minor ailment service desperately needed by our citizens. Whilst other healthcare providers focussed their attentions on patients with COVID-19 or moved to remote services, community pharmacy

2 Community Pharmacy News – December 2020

You have made sure the public still had somewhere to go for face-to-face healthcare advice

If there is any confusion remaining within NHSE&I as to whether community pharmacy is innovative, look no further than the resilience shown by the sector: managing an immense workload with limited staff; sourcing its own PPE; modifying working practices to keep staff and patients safe while delivering services for which there was an increasing demand; and grappling with the shambles of Test and Trace and social distancing measures.

Doing all of this while not being granted in a timely fashion simple measures which would help pharmacies cope with these operational pressures like closed-door working. Despite everything that was thrown at the sector, you have all carried on serving the patients and communities who need you.

If there are any concerns enduring within HM Treasury as to whether community pharmacy is a good return on investment, look at the dispensing data and the fact that England has the lowest drug prices in the world thanks to community pharmacy; listen to local NHS professionals talking about how much the new Discharge Medicines Service will save Hospital Trusts; and read the PSNC pharmacy audit: 500,000 patients every week, who would have gone to see their GPs, are walking into their local pharmacy for (non-funded) health advice, guidance and signposting on to other primary care services – saving the NHS significant sums every year. More investment into the sector will enable

community pharmacy to do even more – at a fraction of the cost of alternative solutions.

I sincerely hope 2021 will have some positive movement on all three of these areas with colleagues from NHSE&I, DHSC and HM Treasury. The patient voice is very clear as recent NPA surveys have shown.

But those of you who have worked within our sector for much longer than me will rightly be cynical, and I can’t blame you for it.

For the vast majority of sectors in this country, end of year messages are along the lines of: “ … thank you for your endeavours and hope you all get a wellearned rest over the Christmas break etc etc … “ However, for community pharmacy, your graft continues throughout the end of December – in some cases heightened – as we enter into a worrying phase of the pandemic and the uncertainty surrounding our departure from the EU: frightened patients; staff concerned about their own well-being and that of their families; demand for pharmacy services soaring; and potential supply issues needing to be managed – all with a continued backdrop of financial uncertainty.

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Pharmacy has risen to the challenge despite the very patchy nature of Government support

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So my end of year message is simply this.

I and my team at PSNC and the entire Committee are immensely proud to serve our extraordinary community pharmacy sector. As we have done in 2020, we will do everything we can to support you in the year ahead. Thank you for everything you have done this year and continue to do on behalf of all of us.

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

APPG warns of pressures on pharmacies A group of cross-party MPs issues report warning of the extreme financial pressures that community pharmacies are currently experiencing.

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A survey, interviews and written evidence all helped inform the report

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The All-Party Pharmacy Group (APPG) has published a report following its inquiry into the pressures of COVID-19 on the pharmacy sector, which has warned that some pharmacies could be forced to close unless further Government support is pledged.

The aim of the inquiry was to examine the impact of the pandemic on the pharmacy sector, understanding some of the pressures and challenges facing frontline pharmacy teams and contractors, to produce a set of policy recommendations on what support the sector needs to remain sustainable.

According to a survey undertaken as part of the inquiry, nearly 8 out of 10 pharmacy contractors felt the financial support offered so far (the £370m advanced payments) has not been enough to mitigate financial pressures, and almost half believed their pharmacy could be forced to close within a year.

The report makes a series of policy recommendations on what support the sector needs to remain sustainable. Recommendations for the Government and NHS leaders include empowering pharmacists to do more by providing more resources for training and supercharge the workforce, and boosting overall funding in recognition of both the great financial pressures faced and the huge contribution made to frontline healthcare during the pandemic.

Read more about the APPG’s report at: ow.ly/5KN330rp47K

Pharmacy workforce survey As part of the data gathering process, a survey of the pharmacy workforce was carried out – which was completed by 1,604 respondents – to assess the range of pressures on pharmacy teams, of which key findings included: More than 9 in 10 respondents felt their place of work was under financial pressure.

Nearly 8 out of 10 pharmacy contractors felt the support offered so far has not been enough to mitigate financial pressures.

Almost half felt it was either very likely, likely or somewhat likely that their pharmacy could be forced to close within a year.

91% of respondents felt the Government does not appreciate the role of pharmacy in frontline healthcare.

LPCS

PSNC CEO Negotiations Update PSNC Chief Executive Simon Dukes has recorded a new video message for pharmacy teams explaining the current situation regarding community pharmacy funding negotiations.

In the video, Simon outlines PSNC’s twopronged approach to money – to cover all COVID-related costs and a bid for an uplift to the annual contract sum – both of which require urgent resolution.

Watch the video: ow.ly/WkVO30rp3WR

Update on C-19 PPE reimbursement PSNC and the Department of Health and Social Care (DHSC) are working together to finalise a mechanism by which pharmacy contractors will be able to claim reimbursement for their expenditure on personal protective equipment (PPE) during the COVID-19 pandemic in 2020. We hope to be able to make an announcement on the reimbursement mechanism in the near future.

However, contractors should be aware that any PPE purchased directly by them from 1st January 2021 will not be reimbursable via the mechanism under discussion. Contractors can continue to order free of charge PPE for use in their pharmacy via the DHSC’s PPE portal, for which they should ensure they have registered.

January Category M prices The Drug Tariff Category M pricelist for January 2021 reflects natural reductions to prices due to changes in the buying costs of medicines in the reference period, along with an uplift to ensure margin run rates proceed at the desired level.

However, PSNC also pressed DHSC to retain the previous £15m per quarter uplift included in October’s Drug Tariff.

The Committee felt that, given that this list would take effect in the immediate aftermath of the end of the Brexit Transition Period, it would be prudent to try and maintain some stability of medicine reimbursement prices.

Learn more at: ow.ly/GYTa30rp0eY

psnc.org.uk 3

PSNC’S WORK

Flu and the COVID-19 vaccine

Some patients may be asking community pharmacists and their teams about COVID-19 vaccination and whether flu vaccination is still required.

The message for patients, including social care workers, is that they still need to get the flu vaccine even if they will be getting the COVID-19 vaccine soon, as the COVID-19 vaccine will not protect them against the flu or stop them spreading the flu virus.

Ideally there should be a gap of at least seven days between a flu vaccination and either dose of the Pfizer/BioNTech COVID-19 vaccination. Learn more at: ow.ly/7FnI30rp1jz

Guidance on use of DHSC flu vac stock updated

The Department of Health and Social Care (DHSC) has updated its guidance on the use of DHSC procured flu vaccines by pharmacy contractors.

The change to the guidance now allows contractors to use the DHSC procured stock to vaccinate frontline health and social care workers through occupational health schemes or through private vaccination arrangements; previously, vaccination of such workers through private vaccination services, where the patient pays for the vaccination, was not allowed.

This change in the DHSC guidance does not allow more general use of the DHSC procured flu vaccines in private vaccination services. Read more at: ow.ly/guNa30rp1jp

New pharmacist education and training standards The General Pharmaceutical Council (GPhC) has approved new standards for the initial education and training of pharmacists, making prescribing skills an integral part of the training.

The new standards will bring significant reform, educating pharmacists to become independent prescribers at the point of registration and introducing a foundation training year. The changes are intended to enable pharmacists to provide more clinical care, thereby better preparing them for their future role.

Learn more about the new standards: ow.ly/Tn1c30rp1jl 4 Community Pharmacy News – December 2020

FUNDING AND STATISTICS

CONTRACT AND IT

Community pharmacy and C-19 vaccination Community pharmacists in Kent and Sheffield have already begun playing a part in the early stages of the COVID-19 vaccination programme.

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It was great to get going with administering COVID-19 vaccines

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Despite the practical challenges of providing a COVID-19 vaccination service using the Pfizer/BioNTech vaccine, many community pharmacy contractors have stepped forward to play their part in the NHS programme by submitting hundreds of expressions of interest to NHS England and NHS Improvement (NHSE&I) to run designated vaccination sites. NHSE&I regional teams are currently working with contractors that submitted proposals for areas where additional capacity is required, to assess whether the sites can be approved to participate in the vaccination programme.

In the meantime, the first Primary Care Network (PCN)/general practice designated vaccination sites have started to vaccinate patients, with some pharmacy contractors playing their part in supporting the wider PCN endeavour to start vaccinating the most vulnerable patients. Garry Myers, a community pharmacist in Sheffield started vaccinating patients, alongside colleagues at his local PCN vaccination site.

Garry Myers, community pharmacy contractor and PSNC Regional Representative said: “It was great to get going with administering COVID-19 vaccines with my PCN and general practice colleagues, knowing that this will have a really positive impact for the most vulnerable patients in the community I serve.”

Alongside Garry, other community pharmacist independent prescribers have been supporting the early stages of the vaccination programme, by working with their local hospital in Kent.

In just a few hours, Shilpa Shah, Chief Officer of Kent Local Pharmaceutical Committee (LPC) mobilised five community pharmacist independent prescriber volunteers to work with and support East Kent Hospitals University NHS Foundation Trust to issue patient specific directions (PSDs) for the COVID vaccine.

The independent prescribers signing these PSDs allowed the first batch of COVID-19 vaccine to be administered to patients in Kent and Medway. Feedback from the Foundation Trust was very positive, saying this work really made a difference.

Sunil Kochhar, one of the independent prescribers, community pharmacy contractor and PSNC Regional Representative said: “This is an excellent example of community pharmacy supporting the wider NHS system to help patients. I had the pleasure of being the first community pharmacist independent prescriber to write a PSD for COVID-19 vaccine. Our team of prescribers helped the hospital vaccinate patients because they didn’t have a patient group direction to authorise administration at that time.”

The Kent community pharmacy independent prescribers: Atika Tailor, Jaimin Patel, Lodi Lama, Krunal Vyas and Sunil Kochhar.

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

Pharmaceutical suppliers discuss Brexit The Community Pharmacy Brexit Forum meets to discuss contingency preparations ahead of the end of the Brexit Transition Period.

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There should be no disruption to the flow of medicines from 1st January 2021

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This month PSNC hosted a Community Pharmacy Brexit Forum meeting, hearing updates from a number of organisations, including NHS England and NHS Improvement (NHSE&I) and the Department of Health and Social Care (DHSC).

The meeting followed the helpful update on EU exit – medicines supply continuity – to all GPs and community pharmacists from the Chief Pharmaceutical Officer for England (see opposite).

NHSE&I gave key updates on primary and community care including messages to: • Prescribe and dispense as normal: Doctors and pharmacists are encouraged to reassure patients that they do not need to order extra medication as this could contribute to or cause supply problems. Prescriptions covering longer durations than normally prescribed should be avoided. Prescription durations will be monitored and investigated where necessary.

• Ensure you are familiar with the latest information on supply disruption: Ensure CAS alerts and other communications are quickly and effectively shared with all team members who need this information.

• Encourage patients to take out travel insurance before travelling to the EU: After the UK leaves the EU, European Health Insurance Card (EHIC) cards may not be valid.

• Encourage staff who are EU citizens to register with the EU Settlement Scheme.

There was also an update on the work of the Medicines Shortages Response Group, which supports the DHSC’s work responding to medicines shortages and advises, for example, on whether the development of a Serious Shortage Protocol (SSP) would be beneficial to help mitigate a shortage.

DHSC provided a comprehensive update on its multi-layered approach to maintaining continuity of supply of medicines. The overall message is that there should be no disruption to the flow of medicines from 1st January 2021.

Additional information on the practical aspects of supply to community pharmacies in Northern Ireland was provided by Martin Sawer of the Healthcare Distribution Association who gave assurances around the wholesale supply of medicines to NI from GB, although added that some issues remain to be resolved. Additional information on DHSC’s contingency work around appliances was also provided.

New Brexit hub PSNC’s Brexit and Community Pharmacy pages bring together updates from the Government and contractor guidance alongside PSNC’s work leading the Community Pharmacy Brexit Forum. Visit the Brexit hub at: psnc.org.uk/Brexit

LPCS

EU Exit: Update from NHSE&I The Chief Pharmaceutical Officer at NHSE&I, Dr Keith Ridge, has written to primary care providers to update them on the continuity of supply of medicines as part of the Government’s contingency preparations for the end of the Brexit Transition Period.

He also advised that, due to the preparations being undertaken at a national level, “… it is not necessary for local providers, whether in hospitals or primary care, to stockpile medicines or for clinicians to write longer prescriptions for patients.”

Read more about the letter at: ow.ly/jSRC30rp06O

Joint statement on medicines supply PSNC and the British Medical Association (BMA) have issued a statement on medicines supply ahead of the UK’s EU exit. The joint statement indicates the united position across primary care.

Both organisations highlight the significant amount of work undertaken

by DHSC and NHSE&I, and stress the importance of collaborative working to maintain patient care to their members.

Much of the statement reinforces Government messaging, particularly on the need to avoid local stockpiling of medicines and discouraging patients from over-ordering themselves. It also says that industry stakeholders will monitor the situation going forwards. Read the statement at: ow.ly/Dv6N50COuoV

Manufacturer & Wholesaler Christmas Opening Hours 2020 At this busy time of year manufacturers are working closely with wholesalers to ensure that sufficient stock is available at wholesalers for the Christmas period.

To help community pharmacy teams keep on top of customer service desk opening hours and wholesaler order cut off/delivery schedules (including information on operating hours and delivery schedules for Saturday 26th December and Saturday 2nd January), PSNC has been working with suppliers to collate this information together in one place for easy reference. See our summary: ow.ly/rQ7v30rp3TA psnc.org.uk 5

PSNC’S WORK

COVID-19 lateral flow testing NHS England and NHS Improvement (NHSE&I) have published a letter to all primary care contractors, announcing how they can order lateral flow tests.

The supply of these tests will allow all patient-facing staff to be able to test, twice-weekly, using self-administered nasal swabbing and report their results through an online platform.

Any positive lateral flow antigen tests will need to be followed up by a confirmatory PCR test.

The information from NHSE&I confirms arrangements for the roll-out, including further information on how to order and receive deliveries of lateral flow antigen testing kits for staff.

Learn more at: ow.ly/Mu9L50COux1

Christmas Bank Holidays NHSE&I have confirmed that there is no intention to issue a national direction for community pharmacies to open on Bank Holidays over the coming Christmas and New Year period, as happened at Easter this year.

However, many pharmacies will be open during the festive season, as this year Boxing Day (Saturday 26th December) is a normal working day for the purposes of community pharmacy opening hours.

In addition, NHSE&I Regional Teams may have agreed or directed Bank Holiday opening to cover estimated local demand for pharmacy services.

PPE Portal Christmas orders The Department of Health and Social Care (DHSC) has announced a 25% increase in order limits via the Personal Protective Equipment (PPE) Portal over the Christmas period.

Orders made during the Christmas period should still be delivered within five days, but the PPE Portal’s delivery partners will not be delivering on Christmas Day and Boxing Day. The increase in order limits until at least 4th January 2021 aims to make allowance for any potential disruptions.

Pharmacy contractors that have not yet registered to use the PPE Portal can find out how to do so at: psnc.org.uk/PPE

6 Community Pharmacy News – December 2020

FUNDING AND STATISTICS

CONTRACT AND IT

NHS Test and Trace update Government provides clarification on the guidance community pharmacy contractors should follow in regards to the NHS Test and Trace service.

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Advice on the application of Test and Trace to pharmacies

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Following a joint letter from PSNC, AIM, CCA and NPA to the Government to raise concerns about the impact of Test and Trace on the sector, the national community pharmacy bodies received a response from the Pharmacy Minister, Jo Churchill. PSNC recommends that pharmacy contractors and their teams follow the official documents for the healthcare sector referred to within that response.

The Pharmacy Minister’s letter confirms the Government understands the impact that Test and Trace is having on the sector, but states that maintaining a COVID-19 secure environment in the pharmacy is also important.

If pharmacy staff follow the Infection Prevention and Control (IPC) guidance and specifically the new recommendations for primary and community health care providers (including maintaining social distancing, working behind screens, regular handwashing and wearing appropriate PPE), they would not be considered to be exposed to infection and would not be asked to self-isolate.

Additionally, the Guidance on the management of staff and healthcare settings indicates that the effectiveness of the use of face masks, face coverings, or other PPE for prevention of transmission or acquisition of coronavirus infection cannot be guaranteed in settings other than the provision of direct care with patients or residents. Therefore, the use of PPE in other settings (such as a staff room or canteen) will not necessarily exclude an individual from being considered a close contact.

The Minister’s letter also confirms that pharmacy staff are eligible for priority coronavirus testing and, if a member of staff tests positive outside of work, they must follow the self-isolation guidance.

Public Health England (PHE) has also recently indicated that it recognises the need to balance the risks of transmission between requests for self-isolation and allowing the vital work of community pharmacies to continue. It made clear that in cases where continuity of service may be interrupted, the Local Health Protection Team should be asked to assess whether there are contacts that mean staff members should self-isolate.

This matches the advice in the NHSE&I COVID-19 SOP for community pharmacy.

Local Health Protection letters Some Local Health Protection Teams have been issuing standard letters where a staff member has tested positive for coronavirus, inviting the pharmacy contractor to make an assessment of any close contacts. Contractors can then consider the steps they have taken to implement COVID-19 secure practices when determining whether other staff members should self-isolate.

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

Pharmacy professionals need better access to SCR National representative bodies call for continued pharmacy access to Summary Care Records with Additional Information following the COVID-19 pandemic.

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Access to Additional Information in SCRs can optimise patient care

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PSNC and the Royal Pharmaceutical Society (RPS) are calling for continued pharmacy access to Summary Care Records with Additional Information (SCRs with AI) following the COVID-19 pandemic.

In a letter to NHS England and NHS Improvement (NHSE&I), NHS Digital and NHSX, it is argued that community pharmacists need comprehensive access to electronic health records to provide the person-centred services set out in the NHS Long Term Plan.

Additional Information in SCRs can assist with enhancing patient safety, because extra information is available relating to management of long-term conditions, immunisations and significant medical history. However, so far, this additional information has only been made available to pharmacists and pharmacy technicians when patients consent to additional information being included in their SCR and during the COVID-19 pandemic for all patients, as a result of pandemic legislation.

PSNC and RPS are recommending that new legislation is introduced to enable ongoing access to SCR with AI, helping pharmacy teams to fulfil their professional potential. The argument is augmented by growing public support for healthcare professional access to electronic health records, as a way to optimise patient care.

The letter also highlights that pharmacists should be able to access Local Health and Care Record (LHCR) systems wherever they are put in place and whichever pharmacy clinical system is being used. Read the letter at: ow.ly/JzYl30rox1Y Alastair Buxton, PSNC Director of NHS Services, said: “We need the NHS to do more to help us help patients. Access to this additional information during the pandemic has been crucial for pharmacy teams, and it would be a retrograde step if the amount of detail available to them reverts to its pre-pandemic level.”

Contacting us with further case studies If you have any examples of how SCR with AI has supported your ability to care for your patients, in comparison to the normal SCR access, please contact it@psnc.org.uk, as such examples could support our case for ongoing access to SCR with AI and other health records.

LPCS

Changes to EPS token submission PSNC has received confirmation from DHSC that it is no longer necessary for contractors to submit EPS tokens (other than those used for SSP claims) to the NHS Business Services Authority (NHSBSA) whilst the temporary suspension of signature requirements on prescriptions remains in place.

During the suspension, pharmacy teams should ensure the correct declaration is applied to the electronic message before it is submitted for payment to the NHSBSA. For paper prescriptions, contractors should ensure forms are sorted into the correct charge groups when preparing the monthly submission bundle.

View PSNC’s updated guidance at: ow.ly/onLF30rp4os

NHS Flu vaccine finder A new community pharmacy flu vaccine service finder will go live onto the NHS website service finder webpage this month. This NHS website tool will allow patients to find local pharmacies that provide the NHS commissioned service and check their eligibility.

Your pharmacy’s NHS website profile will display whether you can offer the flu vaccine. Contractors should therefore make sure to update their pharmacy’s profile if they can no longer offer the service, e.g. because stocks become exhausted. Learn more at: ow.ly/2ZsT30rovBC

Updating pharmacy IT standards The Professional Record Standards Body (PRSB) previously established Pharmacy information flows IT standards. PRSB are now working with RPS, PSNC, Community Pharmacy IT Group and other stakeholders to further update these standards.

The use of IT standards in the healthcare sector enables people, devices and systems to communicate in a more efficient and electronic manner.

Pharmacy contractors who would like to get involved with the update should email it@psnc.org.uk with ‘Pharmacy information flows’ in the subject line. psnc.org.uk 7

8 Community Pharmacy News – December 2020

GP

Paper forms: FP10SS, FP10HP FP10MDA-SS, FP10MDA-SP FP10PN, FP10SP

Non-medical Independent/Supplementary Prescriber

Drug can be ordered on an NHS prescription

Yes

Drug cannot be ordered on an NHS prescription by a community nurse

No

Dentist

Drug can be ordered on an NHS prescription

Yes

Drug cannot be ordered on an NHS prescription by a dentist

No

Is the drug listed in the Dental Practitioners' Formulary (DPF) in Part XVIIA of the Drug Tariff?

Paper form: FP10D

Different types of prescribers hold different prescribing rights. It is important for pharmacy staff to identify whether the prescriber holds the relevant registration(s) to issue a prescription for the requested item(s). See psnc.org.uk/prescribing for more information.

Drug can be ordered on an NHS prescription

No

Is the drug listed in the Nurse Prescribers' Formulary (NPF) in Part XVIIB of the Drug Tariff?

Paper forms: FP10SS, FP10PN, FP10SP

Community Practitioner Nurse Prescriber

FUNDING AND STATISTICS

Drug cannot be ordered on an NHS prescription

Yes

Is the drug included in the Drug Tariff (Part XVIIIA) list of drugs, medicines and other substances not allowed on the NHS?

Paper forms: FP10SS, FP10NC, FP10HP, FP10MDA-SS, FP10MDA-S

COSMETICS)

IS THE ITEM ALLOWED ON AN NHS PRESCRIPTION? Drugs – Includes medicinal and non-medicinal substances (Food supplements and Cosmetics) DRUGS – INCLUDES MEDICINAL AND NON-MEDICINAL SUBSTANCES (FOOD SUPPLEMENTS AND

Is the item allowed on an NHS Prescription?

Drugs refers to medical products and non-medical substances such as food supplements and cosmetics. Subject to prescribing rights, any drug or non-medicinal substance such as food supplements or cosmetics may be prescribed on an NHS prescription form if the product(s) do not appear in Part XVIIIA (drugs, medicines and other substances that may not be ordered under the NHS) of the Drug Tariff.

Drugs

PSNC’s Dispensing & Supply team are regularly asked by pharmacy staff if specific products are allowed on NHS prescriptions. This factsheet outlines the checks required by dispensing staff to establish whether a product is allowed on the NHS.

Dispensing factsheet: Is this item allowed?

PSNC’S WORK CONTRACT AND IT

GP

Paper forms: FP10SS, FP10HP, FP10PN, FP10SP

Non-medical Independent/Supplementary Prescriber Paper forms: FP10SS, FP10PN, FP10SP

Community Practitioner Nurse Prescriber

Appliance cannot be ordered on an NHS prescription

No

Appliance can be ordered on an NHS prescription

Yes

For more information and additional guidance on identifying whether an item is allowed see our Is It Allowed page.

Appliance cannot be ordered on an NHS prescription by a dentist

No

THE HEALTHCARE LANDSCAPE

If you are unsure whether a product is allowed, you can contact the PSNC Dispensing and Supply Team 0203 1220 810 or info@psnc.org.uk.

For information on prescriber type EPS codes see our factsheet on page 10.

Appliance can be ordered on an NHS prescription

Yes

Is the appliance listed in the Dental Practitioners' Formulary (DPF) in Part XVIIA of the Drug Tariff?

Paper form: FP10D

Dentist

SERVICES AND COMMISSIONING

Is the appliance included in Part IX of the Drug Tariff (Part IXA, IXB, IXC and IXR) approved list of appliances?

Paper forms: FP10SS, FP10NC, FP10HP

IS THE ITEM ALLOWEDAppliances ON NHS PRESCRIPTION? APPLIANCES

Is the item allowed on an NHS Prescription?

Appliances can only be prescribed on NHS prescriptions if the product is listed in Part IX (the Appliances section) of the Drug Tariff. Prescribed appliances must be an exact match for the listing in the Drug Tariff; for example, the specific type and pack size must correspond with a Drug Tariff listed product. Appliances can be identified by a CE mark which indicates that the product is an appliance/medical device. The CE mark can normally be found on the packaging of a device, on the instruction leaflet and on the device itself (where practical). See psnc.org.uk/appliances for more information.

Appliances

DISPENSING AND SUPPLY LPCS

psnc.org.uk 9

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Prescriber type EPS codes This factsheet provides information for pharmacy teams about prescriber type EPS codes.

Prescriptions have indicators about the type of prescriber that issued the prescription e.g. a General Practitioner (GP) or a Community Practitioner Nurse. Different prescriber types have different prescribing rights.

With paper prescriptions the type of paper prescription form stationery, the colour of the form and the description on the form indicate the prescriber type. EPS electronic prescription messages do not need to make use of the stationery form reference (e.g.

‘FP10SS’) because prescriber type EPS codes are used instead within EPS messages.

Prescriber type: EPS vs paper The table below compares how EPS prescriptions and paper stationery forms indicate prescriber type.

Use of paper stationery form reference codes

EPS prescriptions and processing

Paper prescription form stationery

EPS electronic prescriptions do not use of the stationery form reference (e.g.

‘FP10SS’) because prescriber type EPS codes are used instead.

Paper prescription form stationery include stationery reference codes e.g. ‘FP10SS’ or ‘FP10HNC’ printed onto the prescription form for use by a prescriber.

EPS tokens can still be printed onto relevant paper forms e.g. ‘FP10SS’. NHS Business Services Authority (NHSBSA) scan EPS tokens for audit purposes only, pricing is based solely on the electronic message submitted not the scanned token (other than those used for SSP claims submitted in your red separator).

Further information

The EPS prescribing specification explains: “The EPS supports three prescribing models; acute; repeat; and eRD.” NHSBSA maintains the list of prescriber type EPS codes within the EPS endorsing guide specification: e.g. ‘EPS Prescription Type Code 0001’ indicates “General Practitioner (GP) Prescribing”

Paper prescription forms such as ‘FP10SS’ are used to enable printing of paper prescriptions or EPS tokens. See our page for more information on Paper prescription forms (PSNC).

System supplier development to support EPS Prescribing system suppliers may include or add logic to their prescribing systems to ensure that prescribers do not inadvertantly try to request an item that they should not e.g. Controlled Drugs prescribed by Community Practitioner Nurses are not allowed within NHS prescriptions. Prescribing system logic can prevent a Community Practitioner Nurse prescriber being able to request a Controlled Drug via EPS by providing suitable warnings or blocks.

Pharmacy system suppliers may also add logic to their pharmacy systems to prevent pharmacy teams inadvertently trying to process a prescription which is not allowed to be reimbursed by the NHS (if received) e.g. by preventing a prescription being processed for a Controlled Drug, if the prescriber type EPS code was for a Community Practitioner Nurse prescriber as Controlled Drugs are outside of the prescribing rights for this type of prescriber.

Some pharmacy patient medication record (PMR) systems suppliers can opt to adjust the colour on-screen when a different prescriber type is present, but this is not a pharmacy system requirement. See also: PMR wishlist items.

Further information EPS was originally rolled out to GP practices, but EPS continues to be expanded to urgent and other care settings and more types of prescribers. NHSBSA may further update the EPS prescriber type codes later.

More details can be found on the following PSNC webpages: psnc.org.uk/prescriptionforms psnc.org.uk/prescribing psnc.org.uk/epsdispense psnc.org.uk/systems Contact it@psnc.org.uk for IT queries or info@psnc.org.uk for dispensing and supply queries.

10 Community Pharmacy News – December 2020

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCS

Ask PSNC PSNC’s Dispensing and Supply Team answer your questions to help determine whether an item is allowed on an NHS prescription.

Q. I have received a yellow FP10D dental prescription for Colgate Duraphat 5000ppm fluoride toothpaste. Can a dentist prescribe by brand and will I be reimbursed for dispensing this prescription?

A. Yes. Dentists are encouraged to prescribe generically, but can prescribe by brand, any item listed in the Dental Prescribing Formulary (Part XVIIA of the Drug Tariff) on an FP10D prescription. Colgate Duraphat 5000ppm fluoride toothpaste is a brand of Sodium Fluoride Toothpaste 1.1% which is listed generically in the Dental Prescribing Formulary.

A prescription for this item written by its brand or generic name would be passed for payment by the NHS Business Services Authority (NHSBSA).

Q. I have received a lilac paper FP10P nurse’s prescription asking for Paracetamol tablets x 150, is this allowed?

A. It depends on the type of nurse prescriber that has issued the FP10P prescription. The Drug Tariff only permits a Community Practitioner Nurse Prescriber to prescribe any drug(s) listed in the Nurse Prescriber’s Formulary (see Part XVIIB(i) of the Drug Tariff) in quantities of up to 100.

However, Nurse Independent Prescribers are not limited in the quantities of paracetamol they can prescribe. Nurses holding this type of prescribing qualification would use prescriptions printed with the words “Nurse Independent/ Supplementary Prescriber”.

Q. I have received a prescription for Hycosan Plus eye drops, is this allowed?

A. No. Hycosan Plus eye drops is an appliance/medical device that is NOT listed in Part IX (the Appliances section) of the Drug Tariff.

Appliances can only be prescribed on an NHS prescription if the product is listed in Part IX of the Drug Tariff. Appliances can be identified by a CE mark which indicates that the product is a medical device. The CE mark can normally be found on the packaging of a device, on the instruction leaflet or on the device itself (where practical). See our Appliances webpage for more information.

Q. I have received a prescription for Aptamil Pepti 2 powder which appears in the Borderline Substances List (Part XV of the Drug Tariff) but the prescriber has not endorsed the prescription with the initials ‘ACBS’. Will I be reimbursed for dispensing this prescription?

Q. I have received a prescription for Uvistat sun cream SPF 30 x 125 ml, is this allowed?

A. Yes. Subject to prescribing rights (see our Who can prescribe what? webpage for further information of the prescribing rights for different types of prescribers), any drug or non-medicinal substance such as food supplements or cosmetics may be prescribed on an NHS prescription if the product does not appear in Part XVIIIA (drugs, medicines and other substances that may not be ordered under the NHS) of the Drug Tariff.

A. Yes. If an item included in the Borderline Substances list (Part XV of Drug Tariff) has not been endorsed by the prescriber with ‘ACBS’, the product can still be dispensed and will be passed for payment by the NHSBSA. Pharmacy staff are not required to endorse prescriptions with the initials ‘ACBS’.

If you are unsure whether a product is allowed, you can contact the PSNC Dispensing and Supply Team 0203 1220 810 or info@psnc.org.uk. psnc.org.uk 11

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Drug Tariff Watch The Preface lists additions, deletions and alterations to the Drug Tariff.

Below is a quick summary of the changes due to take place from 1st February 2021.

Part VIIIA additions • Allantoin 10.25mg / Lidocaine 10.25mg suppositories (12) Anodesyn • Chlorhexidine hydrochloride 0.5% cream ■ (30g) - Germolene Wound Care • Estradiol 1.53mg/dose transdermal spray ■ (56 dose) - Lenzetto • Granisetron 1mg/1ml solution for injection ampoules (10) hameln pharma Ltd • Guaifenesin 100mg/5ml oral solution sugar free (100ml) and (250ml) - Robitussin Chesty Cough • Methylprednisolone sodium succinate 125mg powder and solvent for solution for injection vials ■ (1) - Solu-Medrone • Methylprednisolone sodium succinate 1g powder and solvent for solution for injection vials ■ (1) - Solu-Medrone •M ethylprednisolone sodium succinate 40mg powder and solvent for solution for injection vials ■ (1) - Solu-Medrone • Methylprednisolone sodium succinate 500mg powder and solvent for solution for injection vials ■ (1) - Solu-Medrone • Paracetamol 120mg/5ml oral suspension 5ml sachets sugar free (12) and (20) - Calpol Infant

KEY: ■ Special container ● Item requiring reconstruction * This pack only (others already available)

• Trazodone 100mg tablets (56) and (84) - Accord Healthcare Ltd • Xylometazoline 70micrograms/dose / Ipratropium bromide 84micrograms/dose nasal spray ■ (70 dose) - Otrivine Extra Dual Relief Part VIIIA amendments • Caffeine citrate 50mg/5ml oral solution ■ (5ml) is moving to Category C - Martindale Pharmaceuticals Ltd • Ciprofloxacin 0.3% / Dexamethasone 0.1% ear drops ■ (5ml) Cilodex is changing to - Consilient Health Ltd • Codeine 60mg/1ml solution for injection ampoules (10) is moving to Category C - Torbay Pharmaceuticals Part VIIIA deletions • Pneumococcal polysaccharide vaccine solution for injection 0.5ml vials (1) - Category A • Hepatitis B (rDNA) 20micrograms/1ml vaccine suspension for injection vials (1) - Engerix B • Ranitidine 75mg tablets (48) - Zantac 75

Part IX deletions Product CATHETERS, URINARY, URETHRAL – Foley Catheter – 2 Way For Long Term Use – Adult – Covidien UK Commercial Ltd Dover All Silicone – (Male) CATHETERS, URINARY, URETHRAL – Foley Catheter – 2 Way For Long Term Use – Paediatric – Covidien UK Commercial Ltd Dover All Silicone WOUND MANAGEMENT DRESSINGS – Soft Polymer Wound Contact Dressing Impregnated with Silver – Physiotulle Ag TRACHEOSTOMY AND LARYNGECTOMY APPLIANCES – SpiroTect HME System – SpiroTect Hands Free Valve

Additional information (e.g. size, product code, etc.)

10ml, 12-20Ch (88878051288887805201) 5ml, 10Ch (8887803107) 10cm x 10cm All types and sizes

TRACHEOSTOMY AND LARYNGECTOMY APPLIANCES – SpiroTect Antibacterial Cassette

Hands Free (PTC1003) & Wear2Protect (PTC1006)

TRACHEOSTOMY AND LARYNGECTOMY APPLIANCES – SpiroTect Baseplate – Fabric with Tube Connectors

Oval (PTW102) & Round (PTW103)

TRACHEOSTOMY AND LARYNGECTOMY APPLIANCES – SpiroTect Laryngectomy Tube

All Perforated & Non-Perforated

TRACHEOSTOMY AND LARYNGECTOMY APPLIANCES – SpiroTect Premium Baseplate

All types and sizes

TRACHEOSTOMY AND LARYNGECTOMY APPLIANCES – Trachi-Naze Plus Nasal Restoration System – Orange (Active Filter) resistance level -1kPas 1-1

LATNP 1003

TRACHEOSTOMY AND LARYNGECTOMY APPLIANCES – SpiroTect Shower Protector

PTA100

VACUUM PUMPS AND CONSTRICTOR RINGS FOR ERECTILE DYSFUNCTION – Mediwatch UK Ltd S0001 – ErectEase INCONTINENCE APPLIANCES – TUBING AND ACCESSORIES – Bard Ltd – Leg bag straps

Latex (8440) & foam/Velcro (8441)

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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