December 2014 CPN

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Community Pharmacy News – December 2014

New MUR target group goes live from January Directions signed for cardiovascular risk group

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Cardiovascular risk MUR target group to begin in January Secretary of State Directions amended with new requirements for the proportion of MURs falling in target groups to rise from April.

The new target group for MURs covering patients with cardiovascular risk factors is to be introduced from January, PSNC can now confirm. But contractors will not need to increase the proportion of MURs falling within target groups until April 2015.

Pharmacy teams may recall that as part of the 2014-15 community pharmacy funding settlement some changes to Advanced Services were agreed between PSNC, NHS Employers and NHS England.

These included the addition of a new target group for MURs and an increase in the proportion of MURs to be undertaken with patients in target groups from 50% to 70%.

The Department of Health signed amendments to the Secretary of State Directions on 4th December 2014 which implement these changes to the MUR service. The Directions will be published in the January 2015 Drug Tariff and will mean that the new cardiovascular risk MUR target group will commence from 1st January 2015.

However, the minimum percentage of MURs that must fall within the target groups will remain at 50% until 31st March 2015; increasing to 70% only for MURs carried out from 1st April 2015.

This should help pharmacies to manage the transition to the new groups and targets more easily.

A revised spreadsheet for pharmacies to use to report quarterly MUR data to their NHS England area team has been agreed and NHS England will publish this shortly. The first time this amended spreadsheet will have to be used will be for quarter 1 2015–16

data, i.e. the report that has to be sent to area teams following the end of June 2015. Prior to that point the existing spreadsheet that is available on the PSNC website should be used for all reports to area teams even though this will not allow data to be reported on the new cardiovascular risk group from 1st January 2015.

Full details of the new MUR target group and other changes to Advanced Services agreed as part of the 2014-15 contractual framework can be found in PSNC Briefing 016/14: Advanced Services (MURs and the NMS) which can be downloaded from psnc.org.uk/briefings.

Settlement 2014-15 update PSNC is continuing work to progress the other changes agreed as part of the 2014-15 funding settlement and to work towards agreeing a 2015-16 settlement as early as possible.

The audit which will be undertaken by all pharmacies on the emergency supply of medicines next year has been developed and is now being piloted in pharmacies to ensure that it is best designed to work in practice; and more details on this will follow next year.

We will advise on implementation dates for the requirements for pharmacies to give advice to appropriate patients about the benefits of the repeat dispensing service and to change the way in which they report patient safety incidents when the relevant changes to terms of service and Approved Particulars have been finalised.

Politicians urged to back pharmacy Community pharmacy representative organisations are urging politicians and policy makers to back community pharmacy and to do more to make the most of the sector in the reformed NHS. PSNC, Pharmacy Voice and the Independent Pharmacy Federation (IPF) last week launched a Community Pharmacy Manifesto at an event held in the Houses of Parliament and chaired by Sir Kevin Barron MP, who is also Chair of the All-Party Pharmacy Group.

The manifesto asks politicians from all parties to sign up to five key pledges for the future of community pharmacy; and it lists a series of actions that they could take 2 Community Pharmacy News – December 2014

to help to make that future a reality. The manifesto covers topics such as using pharmacy to relieve pressure on GPs and improve public health; getting pharmacies access to patient records; and ensuring that local commissioners are maximising their use of pharmacies.

Pharmacies will be asked to help engage with politicians and gain their support for the manifesto in the New Year when a toolkit will be released to support this activity.

More information as well as sign up forms for politicians and others to pledge their support for the manifesto can be found at: pharmacymanifesto.com

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New stop smoking campaign for January NHS Smokefree is launching a new stop smoking campaign in the New Year featuring improved NHS Quit Cards and resources for pharmacies.

Pharmacies across England have once more been invited to work in partnership with Public Health England (PHE) to distribute the NHS Quit Cards to smokers.

support the campaign, distributing over half a million Quit Cards. PHE hopes to secure the same level of support from the sector again.

In January PHE will be launching a new health harms campaign to drive motivation to quit smoking. Alongside this campaign, smokers will be advised that they can pick up the new and improved NHS Quit Cards from their local pharmacy to help them find the right support tool for them.

Gul Root, Principal Pharmaceutical Officer at the Department of Health and Lead Pharmacist for the Health and Wellbeing Directorate, PHE, said: “The new Quit Cards provide a huge opportunity for pharmacy teams to start a conversation with people about quitting smoking. We have worked with Pharmacy Voice, PSNC, RPS and AIMp to improve the Quit Cards, so pharmacy teams can use them more easily.”

The NHS Quit Cards are specially designed to help pharmacy teams engage their customers in conversation about stopping smoking. They take smokers through a step-by-step journey to help them: • Get to know their level of addiction; • Understand how their local pharmacy team can help support them on their quit journey and; • Find the right free Smokefree support tool for them.

Alongside the NHS Quit Cards is the newly developed Advisor Guide – an easy-to-use

reference tool which pharmacy staff can keep with them and use when engaging smokers. It includes information on how pharmacy staff can tailor their advice to the addiction test results and the key benefits of the Smokefree support tools.

Pharmacy advice is crucial in helping smokers make a quit attempt, and in 2014, 75% of pharmacies across England helped

Be Clear on Cancer: latest campaign Pharmacy teams are advised that the latest national Be Clear on Cancer campaign will run from 26 January to 22 February 2014. The aim this time will be to raise awareness of persistent heartburn for 3 weeks or more as a symptom of stomach and oesophageal cancers.

The Department of Health and Public Health England have asked pharmacies for their continued support to help improve early diagnosis of these diseases, pointing out the great potential in the pharmacy environment to capture people who are asking for advice on how to treat their symptoms of persistent heartburn or who are regularly purchasing over-the-counter medicines for the treatment of heartburn.

A variety of materials will be available to support this campaign, including posters, leaflets, symptom cards and a pharmacy briefing sheet. To order free campaign materials (including accessible versions), visit https://www.orderline.dh.gov.uk or call 0300 123 1002.

Quit Cards will be provided to pharmacies free of charge. Pharmacies can place an order for 50 Quit Cards and a point-of-sale toolkit by calling 0300 123 1019 from 24th November 2014. The order line will be open Monday to Friday, from 8am to 6pm, until 26th March 2015 or whilst stocks last.

If you are a large multiple pharmacy or part of a small chain of pharmacies, please check with your head office as PHE may already be liaising with your organisation.

Reminder: reporting generic medicines shortages Pharmacy teams will be familiar with the price concession system for agreeing a reimbursement price in month for products unavailable at the Drug Tariff price.

PSNC has seen an increase in generic shortages over the past year. The graph (right) demonstrates just how many lines we have agreed concessionary prices for between October 2013 and October 2014.

To assist us with identifying products, we would be grateful if contractors could continue to report generic supply issues to us by completing our generic shortages form at psnc.org.uk/feedback or emailing us on info@psnc.org.uk

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Antibiotic Guardians campaign gathers pace Healthcare professionals and public asked to sign up to pledges to help reduce the spread of antibiotic resistance.

Pharmacy teams have been asked, along with all other health professionals and the public, to pledge their support to a campaign aiming to reduce the spread of resistance to antibiotics.

The campaign is part of a five-year UK strategy on antimicrobial resistance, and was once again centred on a European Antibiotic Awareness Day (EAAD) held on November 18th. The day saw healthcare professionals across England encouraged to think about the appropriate use of antibiotics and the need to prevent the spread of infections.

Posters, flyers and other resources highlighted key pieces of evidence and information such as those pictured (below).

And people were asked to sign up to the

Antibiotic Guardian Campaign at antibioticguardian.com.

• Undertaking CPD or e-challenges from the EAAD resources page.

The website features a number of simple pledges to help people make better use of antibiotics and help save this vital medicine. For example; patients could pledge to talk to their pharmacists about how to treat the symptoms of coughs and colds rather than visiting their GP.

The Antibiotic Guardian campaign has been developed by Public Health England in collaboration with the Department of Health’s Expert Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI); the Department for Environment Food and Rural Affairs (DEFRA), the Devolved Administrations and professional bodies/ organisations towards the ‘One Health’ initiative.

For pharmacy teams options include: • Checking that antibiotic prescriptions comply with local guidance and querying those that do not; • Using patient information leaflets to explain to patients presenting with selflimiting coughs/colds the potential duration of illness and how to treat symptoms; or

All pharmacy teams can start to take action quickly and easily by pledging to become Antibiotic Guardians on the Antibiotic Guardian website: antibioticguardian.com

Further Educational Support

The annual EU-wide cost of antibiotic resistance in healthcare expenses and loss of productivity The increase in likelihood of GPs prescribing antibiotics for coughs and colds between 1999 and 2011

25,000

The number of people who die in Europe each year from infections that are resistant to antibiotics

10%

€1.5bn

40%

In October the Centre for Pharmacy Postgraduate Education (CPPE) launched a new learning campaign, Use antibacterials wisely. The campaign aims to enable pharmacy professionals to update their knowledge about antimicrobial resistance and to raise awareness of the important role pharmacy teams can play in antimicrobial stewardship. A key initiative in the campaign was the mailing of CPPE’s updated distance learning programme Antibacterial resistance – a global threat to public health: the role of the pharmacy team to all 62,000 GPhC registered pharmacy professionals in England. Find details of the programme at www.cppe.ac.uk

The proportion of sore throats that evidence suggest would benefit from antibiotic treatment

Changes to list of Independent Prescribers The December 2014 Drug Tariff sees the inclusion of Physiotherapists and Chiropodists/Podiatrists to the list of Independent Prescribers allowed to issue prescriptions on the NHS. Part XVIIIB(ii) now outlines the prescribing rules for not only Nurses, Pharmacists and Optometrist Independent Prescribers but also Physiotherapist and Chiropodists/Podiatrist Independent Prescribers.

Physiotherapist Independent Prescribers can prescribe any licensed medicine for any condition within their competence 4 Community Pharmacy News – December 2014

within the overarching framework of human movement, performance and function. Podiatrist Independent Prescribers can prescribe any licensed medicine within their competence and relevant to the treatment of disorders affecting the foot, ankle and associated structures.

Currently, both Physiotherapist and Chiropodist/Podiatrist Independent Prescribers cannot prescribe any Controlled Drug in schedules 1-5. For further information visit Part XVIIIB(ii): tinyurl.com/cnnrsm

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Sector renews focus on self care Enabling and supporting self care is an increasingly important part of pharmacies’ role and in the last month both a conference and campaign week have highlighted this.

Helping patients to treat themselves for minor and self-limiting conditions is a crucial role for all pharmacy teams and as well as helping patients, plays an important part in reducing pressure on other parts of the health system.

This year pharmacies may have been involved in the awareness week which ran in November and encouraged people to self care. The awareness week, Self Care Week, ran with the theme ‘Be Healthy this Winter’ and it aimed to help the public understand how to look after coughs and colds themselves, but also make sure they can recognise when they do need to seek NHS support.

The focus for the week followed a study carried out on behalf of the ‘Treat Yourself Better with Pharmacist Advice’ campaign, which estimated that 6 million UK adults would visit their GP and over 2 million would visit A&E as a first port of call for common winter ailments.

The campaign was backed by pharmacy minister Earl Howe, who said it could help reduce the current unprecedented demand on the health service: “Going further on self care is absolutely vital for the sustainability of the NHS and is better for patients. If people are more involved in their health and care they are in a much stronger position to manage

their own healthcare and we know that this results in improved patient outcomes, fewer unnecessary consultations, better patient experience and, of course, better use of resources.”

Also last month the minister attended North-East London (NEL) LPC’s SelfCare Pharmacy Conference which raised awareness of their newly commissioned SelfCare pharmacy service.

The SelfCare service, which has been commissioned by Newham CCG, allows pharmacists and patients to develop a joint care plan. GPs will refer patients to a participating pharmacy of their choice, where a self-care plan will be created.

Three follow up sessions will be arranged over a 12 week period to empower behaviour change in patients to improve their health and wellbeing outcomes.

Initially patients with diabetes, cardiovascular disease, respiratory and mental health issues will be invited to participate in the service.

Expressions of interest have been sought from pharmacy contractors who wish to participate in the service with the plan for the service to go live in April 2015. Further information on the SelfCare service can be found on NEL LPC’s website: nellpc.org.uk

Medicines Compliance Aid Database launched by UKMi UK Medicines Information (UKMi) has launched a Medicines Compliance Aid database (tinyurl.com/mcadatabase), which makes recommendations on the suitability of transferring solid dose formulations from the manufacturers’ original packaging into multi-compartment compliance aids (MCAs).

The database, which is open access, makes recommendations based on physico-chemical stability and characteristics of the medicine and formulation, information received from manufacturers, and data (where available) on the storage in MCAs.

The database can be searched by the brand or generic name of the medicine, although most entries will be based on the brand leader. Once searched, the product is given a traffic light colour-coded UKMi recommendation as to whether it is suitable or not to be placed in an MCA. UKMi recommend using the database alongside the Royal Pharmaceutical Society’s guidance Improving patient outcomes through the better use of multicompartment compliance aids available from tinyurl.com/mcaresource

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LPCs in the Spotlight Our new online series highlights best practice and new innovations from LPCs across the country to help inspire others.

LPCs and pharmacies may well have wondered in the past year if there could be an easier way to do some parts of their jobs; like reaching out to their local Clinical Commissioning Groups. Our new interview series may have some of the answers.

In the first interview Community Pharmacy West Yorkshire's (CPWY) Chief Executive Officer Robbie Turner tells us how invaluable involvement with the local Urgent Care Working Group has been in connecting with their CCG. This is a novel approach; and one that has proved very successful - the LPC has just secured significant funding for an emergency supply service in the area.

LPCs around the country operate in different ways according to what they have learnt works best in their locality. They have often reached this point by going through a process of trial and error which has taken time; but as the NHS continues to evolve many LPCs are looking for new strategies. Sometimes others have already found easy ways to do things and this insight can save valuable time and effort elsewhere.

Recognising that LPCs would benefit from discussing the ways that they work with one another to share tips and good practice,

the LPCs in the Spotlight series is published once a month in the LPC Members Area of the PSNC website to facilitate this sharing of ideas. Whenever a new one is published we will highlight it to LPC Members via the LPC Newsletter.

In the series so far, topics such as training, organisation, and contractor engagement have been covered with more due to be explored. For example, Avon LPC Chief Officer Richard Brown explained how his LPC has benefitted by sharing an office with the local LMC. This month’s edition focuses on Hampshire and Isle of Wight LPC and their new joint initiative with Dorset LPC, the Community Pharmacy Wessex Academy (CPWA). The CPWA is an information hub designed to support the skills and development of local community pharmacy staff and including resources; workshops; facilitated networking and social media.

If your LPC would like to contribute to this feature, please contact Head of LPC and Contractor Support Mike King on mike.king@psnc.org.uk

PHE guidance on commissioning chlamydia screening Public Health England (PHE) has published guidance for local authority commissioners to support them with the commissioning of chlamydia screening services from community pharmacies and general practices as part of the National Chlamydia Screening Programme.

The document – Information to support the commissioning of chlamydia screening in general practice and community pharmacies – sets out some of the benefits of commissioning the service from primary care providers such as community pharmacies and general practices and it suggests elements that should be included in specifications for the service.

This guidance will be of interest to LPC members and officers who are involved in reviewing existing chlamydia screening services and developing new services with local commissioners.

The guidance can be downloaded from the National Chlamydia Screening Programme website: chlamydiascreening.nhs.uk/ps/ resources.asp

6 Community Pharmacy News – December 2014

have you seen our latest website section?

The ‘website tools/publications to support local service development’ page includes links to tools and publications to help lpcs to identify new commissioning or development opportunities for community pharmacy services; as well as statistics to use as evidence to support this.

visit psnc.org.uk/localservices

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Smartcard background software to be updated during overnight transition due in early 2015 Smartcard users are advised to reduce the impact by renewing Smartcard certificates in advance of the transition if system prompts them to do so.

Pharmacy staff need working Smartcards to access the Electronic Prescription Service (EPS), so it’s important you note that there are going to be some changes to the background IT system which checks and manages Smartcards early next year. Older background authentication and management software will be replaced with the new Care Identity Service (CIS), which is being developed and run by the Health and Social Care Information Centre (HSCIC), who also manage the EPS. HSCIC will be announcing the early 2015 date of the overnight transition closer to the time of the event, and both HSCIC and PSNC will publicise the date via websites and email lists.

The impact of this change could be more significant if your Smartcard certificates need to be renewed soon. The table below outlines the changes, and will help you to take the appropriate action.

Impact of Smartcard Changes Who’s affected?

What you need to know

Any users who try to log on during the transition night

There will be a few minutes when you will not be able to authenticate your Smartcards during the night of the switchover.

Users with Smartcard certificates due to expire during the switchover period

Smartcard certificates due to expire during the switchover period must be renewed in advance.

Users whose Smartcards are due to expire will be warned each time they authenticate for 30 days before their certificates expire. If the certificates are due to expire during the switchover weekend, users must renew their certificates before the switchover weekend or they will be unable to renew, and therefore unable to use their Smartcard until the switchover is complete.

Sites that use selfservice Fallback Smartcards or premises cards (tinyurl.com/ hscicSmartcards)

You will not be able to use selfservice Fallback Smartcards or premises cards after the switchover to CIS. Premises cards are used by sites that have not yet upgraded to EPS Release 2.

N.B. Short Term Access cards should continue to work.

Talk to your Registration Authority (RA) staff about having a Local Smartcard Administrator in your pharmacy (a person assigned with the role B0263 on their Smartcard) to assist with unlocking and certificate renewal. RA staff can also advise about Short Term Access Cards.

Unlocking Smartcards If you lock your Smartcard by accidentally entering an incorrect passcode three times, it can be unlocked if two smartcard readers are present and there is a user who: • Has an RA role (i.e. Sponsor, Agent or Manager) on their card or • Has been granted the activity B0263 ‘unlock smartcard’.

Any user with the relevant access rights will be able to unlock any card except their own.

Frequently asked questions: Renewal How do I know if my smartcard certificates need renewing? Users will receive automated ‘count-down’ messages on their system to prompt them to renew their certificates when they are within 30 days of expiry.

How can I renew? Users are able to self-renew their certificates 30 days before expiry. Before the switchover, this can usually be done via the Self Service Portal (talk to your supplier if you cannot access this). After switchover, the message prompting users to renew will include a link to the relevant CIS application page, where they can complete the certificate renewal process.

After a renewal, Smartcards will be valid for two years. Every third renewal (i.e. once every six years), users will need to visit an RA to re-verify their identity.

What if I do not renew my smartcard certificates causing them to pass their expiry date? It will no longer be possible to use the card to access the Electronic Prescription Service. In this situation, a face-to-face meeting with the RA is required to renew the expired certificates. Contact the local RA for more information.

Further information Local RA contact details: NHS England Area Teams (ATs) are responsible for commissioning local RAs to provide and oversee Smartcard issues. Your RA contact information may be available from your AT (tinyurl.com/areateam), or might be listed on your LPC site (lpc-online.org.uk).

Further information about Smartcards is available on the EPS website, tinyurl.com/hscicSmartcards or the PSNC website, psnc.org.uk/smartcards.

Electronic Prescription Service

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PSNC regularly receives questions from LPCs and pharmacy contractors about what is going on in the wider health and care landscape beyond community pharmacy. In this round-up we cover the latest news from the past month.

Medical record access The National Information Board and the Department of Health have published Personalised health and care 2020: a framework for action (tinyurl.com/puznhsd), a vision for using data and technology more effectively to improve health, transform the quality and reduce the cost of health and care services by 2020.

The plan commits to giving all patients access to their GP records by next year using approved apps and digital platforms, and by 2018 patients should be able to access their full health record detailing every visit to the GP and hospital, every prescription, test results, and adverse reactions and allergies to drugs. Patients will also be able to comment on their records, which will be accessible through multiple routes including NHS Choices.

Extra £1.5bn for Better Care Fund The NHS should help local authorities deal with the tough financial settlement that they are facing, Health Secretary Jeremy Hunt has said. Hunt said that the NHS, which has been prioritised and has received a protected budget, has a responsibility to help local authorities (LAs) due to the interconnected relationship between the services that the NHS and local government offer.

In an apparent demonstration of both sectors’ willingness to collaborate, it has been revealed that the Better Care Fund has had an additional £1.5bn added to it by clinical commissioning groups (CCGs) and LAs from their local health funding, taking the original funding of £3.8bn to £5.3bn.

Proposals to save £10bn The Health Services Journal (HSJ) has reported that Health Secretary Jeremy Hunt has identified areas where the health service could potentially save £10bn to help reduce the NHS financial crisis. The areas include improving use of technology, releasing money from unused NHS land and estates, and reducing dependence on management consultants.

The £10bn would make a significant contribution to the £22bn in efficiency savings that the NHS Five Year Forward View (tinyurl.com/lylnesq) said is required by 2020 to close the gap in funding caused by rising patient demand.

A&E fund increased to £700m The HSJ has reported that an additional £300m funding is to be allocated to A&E departments to try to prevent further decline in performance over the winter months. This is on top of the £400m funding that was revealed in June 2014.

The demand is reflected in the number of major A&E departments failing to meet the four hour target; most have failed for the last 68 weeks.

The majority of the additional funding will be used to provide more bed space and pay for additional clinical staff in hospitals.

However, £25m will be used to increase access to GPs and £50m will be allocated to ambulance services to help meet additional demand and to help them to return to meeting standards as soon as possible.

All details correct at time of printing.

No part of this publication may be reproduced without the written permission of the PSNC. Produced for the PSNC by Communications International Group. ©. PSNC. Colour repro and printing by Truprint Media, Margate.

The publishers accept no responsibility for any statement made in signed contributions or in those reproduced from any other source.

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Distributed for PSNC by:

MyNHS launched on NHS Choices website MyNHS (tinyurl.com/lwfofkr), a site where people can compare the performance of their local NHS hospital, their care services and their LA with up-to-date information, has gone live from 19 November. The site, which is available on the NHS Choices website, is the first of its kind allowing such a wide range of performance indicators to be freely available to the public. People can search for data on many areas of care including food quality, staffing, patient safety and mental health.

NHS funding boost of £2bn in 2015–16 The Government has announced that an extra £1.95bn funding will be allocated to the health service in 2015–16 and that this will become a recurring allocation in the baseline funding for the NHS. This injection of funding follows a briefing published last week by the King’s Fund, which said that an additional £2bn funding was needed to prevent an NHS crisis that would see staff numbers cut, waiting times rise and a reduction in the quality of care.

Friends and Family test update All GP practices in England have to carry out the Friends and Family Test (FFT) (tinyurl.com/cxb2uoc) from 1 December 2014 as part of their contract. The FFT is a continuous survey rather than a one-off traditional style survey, which allows patients the option of giving anonymous feedback after every interaction with their GP practice. Anyone on the practice list should be able to complete the test at any time.

Communications International Group Linen Hall, 162-168 Regent Street, London W1B 5TB Tel: 020 7434 1530 Fax: 020 7437 0915

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Universal Credit is being extended In April 2013 as part of the government’s changes to the benefit system, Universal Credit was piloted. Following a review, the scheme has now been extended, rolling out to cover more areas. People receiving the Universal Credit benefit are eligible for free prescriptions.

Areas covered by the Universal Credit arrangements include: • Bath • Hammersmith, London • Harrogate • Inverness • North-west England • Shotton, Wales • Sutton

As Universal Credit is being introduced in stages, the NHS prescription form will not change for now. Patients who are able to produce a valid Universal Credit award letter bearing their name (either as the recipient or because they are a partner or child of the recipient), should sign to declare their exemption and will need to tick the box for “income-based Jobseeker’s Allowance” As patients can get their prescriptions dispensed from any NHS community pharmacy in the country, pharmacies outside of the areas listed should also be aware of these arrangements.

Further information can be found on the Gov.uk website at: tinyurl.com/blhhvrj

Is it allowed?

When pharmacies receive NHS prescriptions they must check whether the items prescribed are allowed on the NHS before dispensing. If they are not allowed, the pharmacy may not be paid for them.

Pharmacies can check whether medicinal products and medical devices are allowed using the Drug Tariff: Medicinal products: assuming the prescriber has the appropriate prescribing rights, any food, drug, toiletry or cosmetic may be prescribed on an NHS prescription unless the product is listed in Part XVIIIA of the Drug Tariff (the ‘blacklist’).

Medical devices: If a product has been registered as a medical device (also known as an appliance), it can only be prescribed on an NHS prescription if it is listed in Part IX of the Drug Tariff. Registered medical devices can be identified by a ‘CE’ mark on the product’s packaging.

Dispensers may wish to check PSNC’s Disallowed Appliance List (psnc.org.uk/disallowedappliances) for medical devices they are unsure about, and we have listed some products below that we have recently received queries about: Product

Is the item listed in the Drug Tariff?

Does it have a ‘CE’ mark?

If no, is it in the blacklist?

Can it be dispensed on the NHS

Additional information

K-Y Jelly (sterile until opened)

Yes

Yes

n/a

Yes

K-Y Jelly is a registered medical device and appears in Part IXA of the Drug Tariff so it is allowed on FP10.

Bexsero vaccine suspension for injection 0.5ml pre-filled syringes

No

No

No

Yes

Bexsero vaccine suspension for injection is not listed in the Drug Tariff and is not CE marked so it is allowed on an FP10.

Spare Suspender for thigh stockings

Yes

Yes

n/a

Yes

Spare Suspender for thigh stockings kit is a registered medical device and appears in Part IXA of the Drug Tariff so it is allowed on FP10.

Otrivine adult metered dose

No

No

No

Yes

Otrivine adult appears in Part IXA of the Drug Tariff so it is allowed on an FP10.

Bladder Infusion Kit

Yes

Yes

n/a

Yes

Bladder Infusion Kit is a registered medical device and appears in Part IXA of the Drug Tariff so it is allowed on FP10.

Please note: If the prescription is one of the following, pharmacies will need to check the relevant sections of the Drug Tariff/PSNC website: • FP10CN or FP10PN (community nurse prescriber) – Part XVIIB • FP10D (dental prescriber) – Part XVIIA • FP10MDA (instalment dispensing) – psnc.org.uk/mda

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Ask PSNC The PSNC Dispensing and Supply Team can give pharmacies support and advice on a range of topics related to the Drug Tariff and reimbursement. Questions the team have been asked by pharmacies in recent months have included: 1. I have received an FP10D prescription for Colgate Duraphat Toothpaste, is this allowed?

Yes. Duraphat contains Sodium Fluoride 0.619%. Sodium Fluoride Toothpaste 0.619% DPF is listed in Part XVIIA of the Drug Tariff (the Dental Prescribing Formulary) therefore this prescription would be passed for payment by the Pricing Authority.

Dentists can prescribe products by their generic name or the proprietary equivalent (providing that the equivalent is not listed in Part XVIIIA of the Drug Tariff, the blacklist).

2. I’ve received a lilac FP10P prescription asking for 150 paracetamol tablets, is this allowed?

It depends on the type of nurse prescriber.

The Drug Tariff only permits a community practitioner nurse prescriber to prescribe paracetamol in quantities of up to 100 (see Part XVIIB(i) of the Drug Tariff) so they cannot prescribe this amount.

However, nurse independent prescribers are not limited in the quantity of paracetamol that they can prescribe. This type of prescriber would have the words “nurse independent/ supplementary

prescriber” printed onto the prescription forms they use. For more information see psnc.org.uk/who-can-prescribe-what 3. Where in the prescription bundle should I put a paid prescription which includes a free of charge contraceptive medicine?

In this scenario the prescription should be placed in the ‘chargeable’ group.

The item itself will be switched to give it an ‘exempt’ status, but it will not be shown on the Schedule of Payments as a switch as the Pricing Authority does not deduct charges where the prescribed item is a contraceptive medicine or device included in Part XVI of the Drug Tariff ‘List of Contraceptive Drugs to be Dispensed Free of Charge’.

4. I have received an FP10 prescription for “140ml amoxicillin 125mg/5ml oral suspension”. What quantity will I be reimbursed for dispensing?

The pharmacy would be reimbursed for dispensing 2 x 100ml.

There is an antibiotic rule which means that where the quantity of a drug preparation reconstituted from granules or powder is unavoidably greater than the quantity ordered and it is not possible for

AS Saliva Orthana listings AS Saliva Orthana 50ml and 500ml sprays have become registered medical devices (CE marked) and are now listed in Part IXA of the Drug Tariff. As a consequence, the entry for AS Saliva Orthana in Part XV (Borderline Substances) has been removed from the Drug Tariff. However, this change does not affect AS Saliva Orthana Lozenges which will be reinstated in Part XV of the January Drug Tariff because they are an unlicensed product approved by the Advisory Committee on Borderline Substances (ACBS).

AS Saliva Orthana products listed in Part XVIIA Dental Prescribing of the Drug Tariff have now been annotated as medical devices listed in Part IXA of the Drug Tariff. This does not apply, however, to AS Orthana Lozenges and a separate entry will be reinstated under Artificial Saliva Substitutes in the Part XVIIA of the January Drug Tariff.

These changes will not affect reimbursement for pharmacy contractors. See: nhsbsa.nhs.uk/4782.aspx 10 Community Pharmacy News – December 2014

the contractor to use the remainder of the reconstituted product to fill another prescription, payment will be based on the nearest pack or number of packs necessary to cover the quantity ordered. This is outlined in full in the Drug Tariff, Part II, Clause 13B. Under this rule, in the situation described above where the quantity ordered falls between two packs (the Drug Tariff listing is for a 100ml pack size), the contractor can round up to dispense the nearest complete container as it is important for patients on antibiotics to cover the complete course of treatment prescribed.

Reimbursement for dispensing two packs will be automatic under these rules, but, as is usual with Part VIIIA products, it is good practice to endorse the prescription and declare the total amount dispensed over the pack size used.

Look out for more frequently asked questions next month…

If you would like more information on any of the topics covered, the PSNC Dispensing & Supply Team will be happy to help (0844 381 4180 or 0203 1220 810 or e-mail info@psnc.org.uk).

Hyoscine 1mg/72hours transdermal patches (Scopoderm) The pack of 2 Hyoscine 1mg/72hours transdermal patches has been added to the December Drug Tariff without notice in the Preface.

Clause 9 (Part II )of the Drug Tariff states that contractors are required to endorse a pack size for Category C products when there are more than one pack size listed. Both packs of hyoscine transdermal patches are in Category C. Therefore contractors who are dispensing Hyoscine 1mg/72hours transdermal patches should ensure that they endorse the prescription appropriately, with the pack size they have used.

The pack of 5 patches will be deleted in January 2015.

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Dispensing Factsheet: No Charge and Multi-Charge Items Pharmacy teams will often be presented with prescriptions for items which incur either no charge, or multiple charges. Here we summarise some of the most commonly encountered items in these groups.

No Prescription Charge No charge is payable for contraceptive substances and listed contraceptive appliances for women prescribed on FP10 or any of its variants.

Systemic drugs promoted as contraceptives which are listed below will not be specially marked and a prescription charge should not be levied.

If the prescription is for any other drug to be used for contraceptive purposes the prescriber should mark the item with the symbol ♀ (or endorse the item in another way which makes it clear that the prescription is for contraceptive purposes) and a prescription charge should not be levied for any items so marked.

In the absence of such an endorsement by the prescriber, the normal prescription charge will apply to that item.

The following is a list of commonly dispensed products which incur either no prescription charges or multiple prescription charges. The list is not intended to be exhaustive.

Aizea Binovum Brevinor Cerazette

Multiple Prescription Charges Multiple prescription charges are payable where: • Different drugs, types of dressings or appliances are supplied • Different formulations or presentations of the same drug or preparation are prescribed and supplied • Additional parts are supplied together with a complete set of apparatus or additional dressing(s) together with a dressing pack • More than one piece of elastic hosiery is prescribed and supplied (there is one charge for each anklet, knee cap, below knee, above knee or thigh stocking supplied).

Two Charge Items Actonel Combi Ametop 4% gel disp pack Canesten Combi pessary & cream

Norinyl-1

Canesten Oral & Cream Duo

Levonorgestrel 1.5mg tablet

Noristerat 200mg/1ml

Climagest 1mg or 2mg

NuvaRing

Levonelle One Step

Ecostatin Twin Pack Elleste Duet 1mg or 2mg Evorel Sequi patches Femoston 1/10mg FemSeven Sequi patches

Prempak-C 0.625mg Prempak-C 1.25mg

Ovysmen

Cyclo-progynova 2mg

Migraleve (combination pack)

Logynon ED

Qlaira

Logynon

Diocalm Complete

Napratec OP

Rigevidon

Desogestrel

Marvelon

Desomono

Mercilon

Elevin

Microgynon 30 ED

EllaOne

Microgynon 30

Evra

Micronor

Sayana Press 104mg/0.65 ml suspension for injection pre-filled disposable devices

Femodene ED

Millinette 20mcg/75mcg

Femodene Femodette Gedarel 20mcg/150mcg Gedarel 30mcg/150mcg Gygel 2% Katya Levest 150/30 Levonelle 1500

Sunya Synphase Trinovum

Mirena IUD

TriRegol

Nacrez 75mcg tablet

Upostelle 1500microgram tablets

Norgeston Noriday Norimin

Tridestra Trisequens

Three Charge items Fortisip Range Starter Pack liquid

Cyclo-progynova tabs 1mg and 2mg (prescribed together)

Heliclear Triple Pack

Triadene

Millinette 30mcg/75mcg

Nexplanon 68mg

Pabrinex I/M High Potency

Clinorette

Ovranette

Depo-Provera 150mg/ml

Paludrine/Avloclor travel pack

Pabrinex I/V High Potency

Loestrin 20

Cimizt

Nuvelle

Femoston 2/10mg

Loestrin 30

Cilest

Novofem

Yasmin Zelleta

Additional information can be found in Part XVI of the Drug Tariff.

For information on the prescription charges that should be levied for a particular product or combination of products, please contact the PSNC Dispensing and Supply Team on 0203 1220 810 or email info@psnc.org.uk

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Drug Tariff Watch Your monthly summary of any additions, amendments and deletions being made to the Drug Tariff to help with dispensing and endorsements.

The first section of the Drug Tariff is the Preface. This contains valuable information relevant for both the current edition and the next. It lists additions, deletions and any other alterations to the Drug Tariff. The Preface should ideally be checked each month to identify products which are entering or being removed from the Tariff as well as those products changing between categories or in the case of Category C items, changes to the brand used for pricing.

It is especially important to note which are Drug Tariff listed products as well as which category products are entering and the pack sizes being included in these entries, as reimbursement will be based on this classification and its endorsement requirements. Incorrect endorsement can lead to incorrect payment for items.

It is also important to know the category of an item when claiming certain payments (e.g. OOP expenses) as these are not allowed in particular categories.

Below is a quick summary of the changes due to take place from January 2015.

Part VIIIA Additions Category A Additions: • Furosemide 500mg tablets 28 • Lactulose 10g/15ml oral solution 15ml sachets sugar free 10 Category C Additions: * This pack only (others already available) SC Special Container • * Benzylpenicillin 600mg powder for solution for injection vials 2 - Thornton & Ross Ltd • Carmellose 0.5% eye drops 0.4ml unit dose preservative free 30 – Celluvisc • Colecalciferol 3,200unit capsules 30 Fultium-D3

• Colecalciferol 400unit / Calcium carbonate 1.5g effervescent tablets 56 (4xSC14) - Adcal-D3 Dissolve • Itraconazole 50mg/5ml oral solution sugar free 150ml – Sporanox • Methylphenidate 54mg modifiedrelease tablets 30 - Matoride XL • Nicotine 15mg inhalation cartridges with device SC 4 – Nicorette • Nicotine 15mg inhalation cartridges with device SC 20 (5x4) – Nicorette • Nicotine 15mg inhalation cartridges with device SC 36 (9x4) – Nicorette • Propiverine 45mg modified-release capsules 28 - Detrunorm XL • Rivaroxaban 2.5mg tablets 56 - Xarelto Part VIIIA Amendments SC Special Container • Amantadine 100mg capsules (56) is changing to Category C Auden McKenzie (Pharma Division) Ltd • Amantadine 50mg/5ml oral solution sugar free (150ml) is changing to Category C Auden McKenzie (Pharma Division) Ltd • Benzylpenicillin 1.2g powder for solution for injection vials (25) is changing to Category C Thornton & Ross Ltd • Coconut oil (500g) is changing to Category C J M Loveridge Ltd • Estriol 0.01% cream with applicator SC1 is changing to Category C Marlborough Pharmaceuticals Ltd Part VIIIA Deletions If a medicinal product has been removed from Part VIIIA and has no other pack sizes listed, it can continue to be dispensed, but it will need to be endorsed fully (i.e. brand/ manufacturer name and pack size) in future. *This pack only (others still available) • * Benzylpenicillin 600mg powder for solution for injection vials (25) – Crystapen

• Diclofenac 4% cutaneous spray (15ml) Voltarol Active • Hyoscine 1mg/72hours transdermal patches (5) - Scopoderm TTS • Metformin 1g oral powder sachets sugar free 60 - Glucophage Part IX Deletions Make careful note of removals from Part IX because if you dispense a deleted product, prescriptions will be returned as disallowed and therefore payment will not be made for dispensing the item.

• Contraceptive DevicesAncora 375 Ag Novaplus T 380 Ag (Maxi) • DressingsUrgotulDuo Border 8cm x 8cm • Lubricant GelsK-Y Jelly (sterile until opened) 42g tube • COLOSTOMY BAGSB. Braun Medical – Biotrol, Elite bag with filter, skin protector adhesive, fabric backing - Transparent 35mm 30835 B. Braun Medical – Biotrol, Elite bag with filter, skin protector adhesive, fabric backing - Transparent 40mm 30840 B. Braun Medical – Biotrol, Elite Petite bag with filter, skin protector adhesive, fabric backing - Beige 35mm 37-335 • ILEOSTOMY (DRAINABLE) BAGSB. Braun Medical – Biotrol, Elite bag with skin protector adhesive and fabric backing – Beige 40mm 38-840 • SKIN FILLERS AND PROTECTIVES3M Health Care Ltd - Cavilon Durable Barrier Cream 2g sachet 3M Health Care Ltd - Cavilon Durable Barrier Cream + Honey 2g sachet

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, Times House, 5 Bravingtons Walk, London N1 9AW Community Pharmacy News is edited by: Zoe Smeaton who can be contacted at the above address or by email at: zoe.smeaton@psnc.org.uk PSNC Office: 0844 381 4180 or 0203 122 0810

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