February 2015 CPN

CPN

Community Pharmacy News – February 2015

Audit head start Get ready for the national audit kicking off next month

EPS Quick Tips | New contractual requirement | Dispensing FAQs | Flu service success

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Get ready for the national audit An English national audit of emergency supplies was agreed as part of the 2014/15 funding settlement and will take place over two periods in March and April. Pharmacies should ensure they are ready and look out for the full guidance.

Background Since the introduction of the Community Pharmacy Contractual Framework (CPCF) in 2005 community pharmacies in England have been required to carry out an annual audit where the topic of the audit was determined locally by the PCT or latterly by the NHS England Area Team (now sub region). As part of the 2014/15 funding settlement it was agreed that this would be replaced by a national audit. This allows focus on a priority issue for the NHS, in this case the provision of urgent and emergency care, and it is hoped that positive data from it will help make the case for the commissioning of community pharmacy emergency supply services at NHS expense.

Note: undertaking the audit is a contractual requirement. If a pharmacy does not undertake the audit it is a breach of their contractual responsibilities.

Aims of the Audit The aims of the audit are to understand: • the reasons behind patients requesting/requiring an emergency supply; • the reasons why an emergency supply was not provided (where that was the case); and • the patient's subsequent course of action had an emergency supply not been provided.

Timing Pharmacy contractors must undertake the audit in one of two defined two week periods: Period 1 - Monday 9th March to Sunday 22nd March 2015 (inclusive) or Period 2 - Monday 23rd March to Sunday 5th April 2015 (inclusive)

In order to get a good range of results from pharmacies across the country, it is very important that there is a good spread of pharmacies undertaking the audit across the two periods. Your Local Pharmaceutical Committee (LPC) is likely to issue guidance on this so please seek advice from them before selecting your audit period.

Guidance Following piloting late last year, PSNC has agreed the final paperwork for the substantive audit with NHS Employers and NHS England. The paperwork will be published by NHS England shortly, once it has been approved by their internal governance process.

The guidance will explain all that pharmacies need to do during the audit period. Once the audit data period is over, pharmacies should collate their results and then submit these to NHS England’s online reporting system; details of how to do this will also be contained in the final audit paperwork.

What to do next 1) Decide which audit period you are going to undertake the audit within. Seek advice from your LPC or head office before doing so.

2) Obtain copies of the audit paperwork. This may be emailed to you by your NHS England Area Team (now sub region) or you will be able to download it from psnc.org.uk/nationalaudit.

Please keep an eye on the PSNC website as we will highlight the publication of the audit paperwork there as soon as it happens.

3) Contractors are also advised to sign up to PSNC’s email newsletters to ensure that they do not miss out on updates.

Sign up at psnc.org.uk/email.

4) Follow the instructions in the audit paperwork to complete the audit.

5) Submit your collated audit data to NHS England online.

The Latest from PSNC committee members PSNC regularly appears in the pharmacy press and this month several committee members have appeared in Pharmacy Magazine, Pharmacy Business and C+D. The following are extracts from their comments.

Time to do our homework In busy community pharmacies it’s easy to feel like making it through the day is our key priority; but in a patient-centred NHS is it really enough? Focusing on patient safety is not always easy, but as healthcare professionals it is our duty and should be our first priority. It is also essential for the security of our future – supplying medicines remains our core role, but as the NHS comes under increasing pressure to cut costs we must

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keep showing the value of that service, making sure every patient gets the most benefit from the medicines we give them.

But what, I hear you ask, can we actually do? Well we could start by reflecting on our clinical audits; reviewing our patient safety incident reporting; and prioritising our MURs and NMS. If we can manage these, we’ll make this a great year for community pharmacy.

Gary Warner, independent community pharmacy contractor and Chair of PSNC’s Service Development Subcommittee

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Success as 90% of LPCs win flu service More than half of pharmacies sign up to offer vaccinations in 2014/15 flu season Almost 90% of Local Pharmaceutical Committees (LPCs) have reported having a local pharmacy flu vaccination scheme commissioned during the 2014/15 season.

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The services were commissioned by 21 of the 25 NHS England Area Teams (now sub region), across 69 LPCs. More than 5,000 contractors signed up to the services, and in some areas 84% of those signed up were active vaccination providers.

pharmacies signed up Area Teams 21 commissioned

The findings, which came from a PSNC email survey of LPCs, show that NHS teams are beginning to understand the value that community pharmacy flu vaccination services can offer. PSNC and LPCs have been working hard to make this case, highlighting the strong evidence we have for the positive impact that community pharmacies can have on vaccination rates.

In many areas the promising activity levels are an improvement on last year’s. Jeff Forster, Chief Officer of Cumbria LPC, explains: “Over the region, we saw each of our LPC areas delivering big increases over last year – with North of Tyne tripling their figures, South of Tyne doubling theirs, and Cumbria increasing from 9,000 to nearly 16,000 vaccinations (about 13% of the total given in the county).”

PSNC Head of NHS Services Alastair Buxton said he was delighted to see so many areas making use of community pharmacies to offer flu vaccinations. “This success is a testament to all the hard

69 LPCs involved of pharmacies took up service offer

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Chief Executive of Kensington, Chelsea & Westminster LPC and Pharmacy London, Rekha Shah, explains: “There is a real need to complement the traditional model through general practice for delivery of the annual seasonal flu immunisation programme in most parts of the country. This is apparent from the fact that in the vast majority of areas, all the ‘at-risk’ groups are not reached and vaccinated to the levels set.”

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work pharmacies have put in previously to make these services work; and I would like to encourage more to do so – it is important that as many people as possible take part in services like these so we can make a difference to patients and show our potential to the NHS. PSNC has repeatedly called for the national commissioning of a pharmacy flu vaccination service and we will continue to make that case.”

Facing up to the challenges The challenges that pharmacies face are very real at the moment and life can be difficult. At PSNC our challenges are also real as we negotiate with a cash-strapped NHS. PSNC is a committee of contractors though and we would not make decisions that are not in the best interests of pharmacy businesses; we do believe we are getting the best possible results.

Kirit Patel is Founder and Chief Executive of the Day Lewis Group and PSNC’s Vice Chair

But just as there are no excuses for those of us leading the profession – the contractors on PSNC, in particular the negotiating team, continue to spend long hours of their own time going through the arguments and evidence to ensure we make the best possible case, and we know

we must never stop working hard on this – so too contractors need to do all they can.

In particular this year I would suggest focusing on building patient loyalty by making the most of the services we already have, putting patient safety first, upskilling staff, and improving your communication with other health professionals. Difficult as those may seem, they can be achieved, including by independents; we need everyone to follow those leading the way. So rather than focusing on difficulties, let’s start getting around those, planning positively for the future, and ensuring that every pharmacy in England is as good as the best.

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Early success for carer-friendly pharmacy project Pilot finds pharmacies well placed to identify and offer support to carers, building evidence for commissioning case.

A community pharmacy project involving 44 pharmacies has helped to identify 128 carers in just the first nine weeks.

The Carer-Friendly Pharmacy initiative, organised by Carers Trust and PSNC, working with nine LPCs, aims to increase the support made available to unpaid carers within local communities. The project will be independently evaluated and, if successful, may pave the way for future commissioned pharmacy services in this area.

Carers make up one in eight adults in England, but many do not receive all the support that they could. In the Five Year Forward View NHS England set out plans to improve engagement with carers and community pharmacies are ideally placed to help with this due to their accessibility.

In this pilot project community pharmacies and carers support organisations are working together to identify carers, give them support and, where necessary, refer carers to other relevant resources within their local areas. Carers Trust worked with the Centre for Postgraduate Pharmacy Education (CPPE) to create a training programme to help pharmacy teams to identify carers and to engage with them.

The University of Leeds will be evaluating the work and it is hoped that this will demonstrate the key role that community pharmacies can play in helping carers. This

may then provide the stimulus for local or national commissioning of such a service.

The results so far are promising: • 81% of carers referred have requested an information pack; • 63% have requested a telephone call; and • 72% have asked to be referred to their GP practice.

Julia Ellis, who leads on primary care and community reach at Carers Trust, said: “We know from listening to carers how much they value the support their local pharmacy provides, from the ease with which they can ask for advice to the friendliness and approachability of the whole pharmacy team. The Carer-Friendly Pharmacy Pilot represents a unique opportunity to build on this key role and reach and support the many carers out there who are completely unaware that help is available to them.”

Resources and information More information on carer-friendly pharmacies can be found on our related webpage: psnc.org.uk/carerfriendly.

You can also find tips from pharmacies involved in the pilot in our story at psnc.org.uk/news.

PSNC has also published a briefing on how community pharmacy teams can help carers in their work, covering:

81% of carers requesting information

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• The commitments and strategies adopted by NHS England and the Department of Health; • The key organisations supporting carers; and • Examples of pharmacy projects to identify carers, such as the CarerFriendly Pharmacy Pilot.

See psnc.org.uk/briefings.

Related training is also available, such as the carer-awareness learning resources on the CPPE Learning Pharmacy website, a free online learning environment.

Additionally, the Carers UK website offers a ‘Carer Awareness: supporting frontline practice’ e-learning course.

Need to know if an item is a special container?

Try our new online tool!

Our new special container database contains all the products recognised by the Pricing Authority as special containers (or having sub-packs recognised as special containers).

With this regularly updated fully searchable database, you can quickly and conveniently find out if the item you are dispensing is a special container.

Where can I find it? psnc.org.uk/scdatabase – why not bookmark it now?

We are always trying to improve our website based on feedback from pharmacy teams and sometimes this means working with web developers to create new features such as this. We hope you’ll agree we have made our site even better. If you have any other suggestions, feel free to contact us (psnc.org.uk/feedback) and we’ll take them into consideration.

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New contractual requirement to commence from March PSNC guidance sets out steps pharmacy teams should take to promote repeat dispensing service as new requirement takes effect.

The new contractual requirement for community pharmacy contractors and their teams to advise appropriate patients about the benefits of the repeat dispensing service will commence from March.

Contractors will recall that this change was agreed as part of the 2014/15 funding settlement, and is intended to help significantly increase the proportion of patients using the service. This is because the service can free up time for practices; provide a more convenient service for patients; and help pharmacies to manage their repeat dispensing workload more efficiently.

As per the settlement agreement, the Department of Health has confirmed that from March 1st the community pharmacy Terms of Service will require that: Pharmacy contractors must ensure that appropriate advice about the benefits of repeat dispensing is given to any patient who: (i) has a long term, stable medical condition (that is, a medical condition that is unlikely to change in the short to medium term), and (ii) requires regular medicine in respect of that medical condition, including, where appropriate, advice that encourages the patient to discuss repeat dispensing of that medicine with a prescriber at the provider of primary medical services whose patient list the patient is on.

Repeat dispensing has been an essential service since 2005; the new requirement means that pharmacy teams will now need to actively work to identify appropriate patients and provide them with information about it. They may also like to speak to local practices who should be more likely to want to make use of the service once they are EPS Release 2 enabled.

To help contractors and their teams to ensure they are meeting the new requirement PSNC has produced a guidance document, setting out a range of suggested actions such as: • ensuring pharmacy teams are aware of local agreements; • discussing the service with local GP surgeries and reminding them of the benefits of it; and • ensuring SOPs are updated.

Resources and information You can download PSNC Briefing 004/15: Increasing use of the NHS Repeat Dispensing service from psnc.org.uk/briefings.

Further resources to help pharmacy teams, including leaflets for patients and information to share with GPs, are also available to download at psnc.org.uk/repeatdispensing

Asthma UK: can you help patients worried by latest headlines?

In the past few weeks Asthma UK has reported an increase in enquiries to its helpline from people with asthma who have been worried by recent news headlines regarding misdiagnosis. Stories suggested that some people were being wrongly diagnosed with the condition.

The charity is concerned that these headlines may make people with asthma think twice about taking their medicines, especially if they don’t fully understand their complex and variable condition.

Even someone who is not experiencing symptoms one day can find that the next week seasonal triggers such as flu and cold weather could trigger a potentially life-threatening attack.

Pharmacies can help reassure people with asthma that they do need to continue taking their medications as prescribed, to reduce their risk of having an asthma attack, and Asthma UK is seeking their help to do so. The charity suggests that pharmacies can: • check to make sure people understand their medicines, and are getting the most from them, through a Medicines Use Review (MUR) or the New Medicine Service (NMS); • discuss their inhaler technique and check it;

• discuss whether they have trouble sticking to their medication routine and help find ways around it; and • remind them to book an annual review.

Asthma UK’s website offers advice and downloadable Asthma Action Plans as well as information that pharmacies could signpost to their patients. Visit asthma.org.uk

Asthma UK’s one thing to do this month Remind your customers with asthma about the signs that mean they should seek help: • You find your reliever isn't helping or isn’t lasting for at least four hours.

• You notice any of your usual symptoms coming back (wheeze, tightness in chest, feeling breathless, cough).

• You are waking up at night with your symptoms (wheezing or coughing).

• You notice symptoms are interfering with your usual dayto-day activities (e.g. work, exercising).

• You are using your reliever inhaler more than usual.

• You find your peak flow drops.

• Children may have tightness or discomfort in their chest, or complain of a tummy ache.

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Reminder: Opening Hours With Easter rapidly approaching PSNC has received a number of queries about holiday opening hours and here we answer some common questions.

Easter Openings Q. I have been asked to open my pharmacy on Easter Sunday 5th April 2015 between 12:30 – 14:30 and have been informed that I will be paid per hour. I have been told I can make representations within 30 days of the letter. I have 40 core hours per week and operate for a further 24 supplementary hours per week; will I have to open for these hours?

The regulations state that NHS England, after consultation with the Local Pharmaceutical Committee (LPC), must carry out an assessment as to whether to issue a direction requiring a pharmacy to open at set times and on set days (which may include Christmas Day, Good Friday and bank holidays). Therefore, the first point for the pharmacy contractor to establish is whether the LPC has been consulted by the NHS England Area Team (now sub regions). If it has not, the contractor can speak to their LPC about the matter. If it has, and if NHS England has given the pharmacy contractor notice of the proposed changes and allowed him/her 30 days to make written representations about them, then the contractor will need to make representations if they do not wish to open. Contractors should also discuss this with the LPC and try to contact other pharmacists whose premises are in the vicinity and who would be happy to open during the proposed hours.

If the pharmacy contractor makes written representations NHS England may still issue a direction requiring the pharmacy contractor to open for the proposed day and times and they will notify him/her when the direction is issued. Then, within 30 days of receiving notification, the pharmacy contractor has the right to appeal in writing to the Secretary of State against any direction issued. The letter issuing directions will identify how the pharmacy contractor can exercise their right of appeal. As this is a lengthy process it is possible that the appeal will not be decided before Easter Day, but if the pharmacy contractor was directed to open and appeals and the appeal is not heard in time, they would not be obliged to open.

Q. Is the Area Team (now sub region) required to give me 90 days notice to open on Easter Sunday (as I would have to give the Area Team 90 days notice for a change in opening hours)?

The 90 days’ notice concerns changes to the core contractual hours agreed on request. In particular, the Area Team (now sub region) should consider and determine applications within 60 days, and changes, where approved, can be implemented 30 days later (90 days after the application). Because requests to amend core contractual hours are ‘applications’ they could be refused, so an unsuccessful application may result in an appeal. NHS England is not required to give the pharmacist 90 days’ notice to open on Easter Sunday but they must follow the procedures set out above, which could take longer than 90 days.

Boxing Day Reminder In 2015 Boxing Day is on Saturday 26th December with Monday 28th December as a substitute bank holiday. As Saturday 26th December is not designated as a bank holiday (see the Government’s website www.gov.uk/bankholidays), pharmacies will normally have to open on that day. Pharmacies will be entitled to close on Monday 28th December which is the substitute bank holiday.

If pharmacy contractors would like to amend their supplementary hours on Saturday 26th December they have to notify their Area Team (now sub region) who must receive that notification at least 90 days before the intended change. If they have core hours that they would like to amend on this day they must apply (perhaps by redistributing to other times that week). Contractors are advised to start the process early, to ensure that the notification has been received by NHS England, and to note that NHS England may refuse an application to amend core hours (subject to a right of appeal).

Update: Business Continuity Requirement Exemption Contractors are reminded that the deadline for completion of the Information Governance (IG) Toolkit for 2014/15 is 31st March 2015. In previous years community pharmacies have been granted an exemption from the business continuity requirements within the Toolkit but as CPN went to press the NHS had still not confirmed whether or not such an exemption would be granted again this year.

PSNC is still pressing for an exemption and we believe that it would be unreasonable for the NHS to seek to enforce the business continuity requirement in 2014/15 at this late stage. However, guidance on completing the requirement, including a template business continuity plan, is available on PSNC’s website and we would encourage contractors to use this in line with good business practice. Given the short time frame we hope that this matter is now a priority for the NHS to resolve and contractors are encouraged to look out for updates on our website at psnc.org.uk.

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Are you missing out on local opportunities and information?

Pharmacy teams advised to check LPC websites for resources and updates Want to know what is happening locally in NHS community pharmacy, service development opportunities, local pharmacy news, resources and training?

Then take a look at your Local Pharmaceutical Committee (LPC) website.

free template website to all LPCs, for LPCs to populate and maintain. To find your LPC website go to lpc-online.org.uk and follow the links. The sites are open access so you can look at other LPC sites to see what is happening in other areas too.

As a pharmacy contractor the LPC is the local body to represent, promote and support you: providing local leadership, representing the views of its contractors, promoting the services that the local community pharmacies do or can provide and looking for new opportunities.

An organisation’s website is often seen as the “shop window”, a picture of what is inside and a good website provides the information visitors need, easy to find and up to date.

The LPC is also a local hub for information: offering help and resources to its contractors, information on local negotiations and plans for the future.

An important communication channel for LPCs is the LPC website. PSNC provides a

If you haven’t visited your LPC site recently take a look in the next few days – there may be things you are missing out on, information that could be useful to your business. If you have any comments on your LPC site contact the LPC Chief Officer or a member of the LPC – the feedback is always welcome and helps the LPC deliver the best possible service to its contactors.

Upcoming event reminder Patient-centred care delivered through pharmacy Implementing new models of care Tuesday 17th March 2015 | The King’s Fund The NHS five year forward view emphasises the importance of integrating services around the patient and sets out the actions needed to develop and deliver new models of care, local flexibility and more investment in technology and innovation.

Designed in partnership with the Royal Pharmaceutical Society, this conference shines a spotlight on how integrating the pharmacist into collaborative work across primary and secondary care can improve patient outcomes whilst reducing costs.

Conference sessions will explore: • best practice case studies where pharmacists are leading the way in working with local authorities, GPs, nurses, community

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.

services and hospitals to develop new models of care; • what actions need to be taken to encourage innovative models of care that maximise the potential of pharmacists in service redesign and delivery; • overcoming the barriers and managing the risks involved in future change; • technological advances that support pharmacy-led services; and • pharmacists as an enabler of increased patient empowerment and self-care.

Key speakers include: • Dr Bruce Warner, Deputy Chief Pharmaceutical Officer, NHS England; • Duncan Rudkin, Chief Executive and Registrar, General Pharmaceutical Council; and • Rob Darracott, Chief Executive, Pharmacy Voice. www.kingsfund.org.uk/pharmacists

Distributed for PSNC by:

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

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Resources and NHS Campaigns Round Up PSNC regularly highlights resources from the NHS and other organisations that may help pharmacy teams. This month we cover a number of campaigns that may be of interest.

Feeling Under the Weather Pharmacy teams may recall this NHS England campaign designed to highlight the role that pharmacies can play in helping people before they need more urgent care. Another wave of media activity is now taking place and will continue throughout February.

Resources are available to download from www.england.nhs.uk/earlyadvice.

Be Clear on Cancer Public Health England (PHE) has announced a national campaign to raise awareness of heartburn as a symptom of stomach and oesophageal cancers. A briefing has been created for pharmacy teams which gives advice on how to approach the topic with patients and gives details of where to order free materials for the campaign. This can be downloaded from psnc.org.uk.

Guide to Healthy Ageing NHS England, in partnership with Age UK, has published a new practical guide to Healthy Ageing to help people, especially those over 70 or people with ‘mild frailty’, improve their health and general fitness. Pharmacists can order free copies of the guide from Prolog on 0300 1231002, quoting reference HA1; from the Health and Social Care Publications Orderline; or a pdf version of the leaflet can be downloaded from the NHS England website (england.nhs.uk).

Quit Cards reminder Ahead of No Smoking Day on 11th March, many community pharmacies have already been working hard to distribute ‘Quit Cards’ to their patients. If you have not yet ordered your Quit Cards, you can order them now from the dedicated pharmacy order line: 0300 123 1019. 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.

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.

Emergency admissions peak Emergency admissions have hit the highest level in 10 years, resulting in hospitals recording their worst results against the four hour emergency department waiting time target, again in the last decade.

Between October and December 2014, emergency admissions were shown to have increased by 43.5% (1,013,307 admissions) compared to the same period of time 10 years ago. The admissions have also increased by 5.6% compared to last year. £8bn pledged by Clegg Deputy prime minister and Liberal Democrat leader Nick Clegg has committed to increasing NHS funding to the level recommended in the NHS Five Year Forward View (5YFV). However, this is dependent on eliminating the budget

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deficit and economic growth, the Health Service Journal has reported, and he has yet to explain where the majority of the funding will come from.

Treasury claims £1bn cost to Labour’s guaranteed 48-hour GP access plan The Treasury has claimed that Labour’s plans to guarantee all NHS patients access to a GP within 48 hours could cost £1bn, not the £100m that Labour has pledged to fund this. Analysis on the cost of Labour’s policy was conducted as part of the Government’s dossier on spending plans of other parties. £11.5m investment to eliminate TB in the UK NHS England, together with Public Health England, has announced a £11.5m plan to

decrease the number of tuberculosis (TB) cases with the ultimate aim of eliminating TB completely from the UK. New Models of Care Programme NHS England and its national partners have announced a New Models of Care Programme to focus and speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system as set out in the NHS 5YFV. The programme invites individual organisations and partnerships, including those with the voluntary sector, to apply to be ‘vanguard’ sites. These organisations will have the opportunity to work with national partners to co-design and establish new care models.

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Ask PSNC The PSNC Dispensing and Supply Team can give pharmacy teams support and advice on a range of topics related to the Drug Tariff and reimbursement. Questions the team have been asked by pharmacy teams in recent months have included: 1. Can zopiclone 7.5mg tablets be prescribed on an FP10MDA? Not in England, only Schedule 2 Controlled Drugs plus buprenorphine, buprenorphine/naloxone (Suboxone) and diazepam can be supplied in instalments against an FP10MDA form. In Wales, Schedule 2, 3, 4 and 5 Controlled Drugs can be supplied in instalments on a WP10MDA form.

2. What should I do if I can’t obtain a Part IXA appliance without extra charges?

As pharmacy contractors will not be reimbursed for out of pocket expenses incurred when items in Part IXA of the Drug Tariff are dispensed, manufacturers must ensure that their products are available to pharmacy teams either through the normal wholesale network as a standard line or on equivalent terms without extra charges. Where a Part IXA appliance is not available from wholesalers without additional charges, we recommend contacting the manufacturer directly to find out how you can obtain the product without extra charges. If a product appears to be unavailable without additional charges from either the manufacturer or the wholesale network, please report this to the PSNC Dispensing and Supply Team using our online form psnc.org.uk/?p=229, we will investigate the issue and then escalate to the Pricing Authority as necessary.

3. Are young people aged 16, 17 or 18 on apprenticeships automatically exempt from prescription charges?

No. Whilst there is an exemption for those who are 16, 17 or 18 in full-time education, NHS Help with Health Costs have confirmed that apprenticeships do not qualify for free prescriptions. Fulltime education means you must be receiving full-time instruction from a recognised educational establishment, such as a school,

college or university. However patients aged 16, 17 and 18 undertaking an apprenticeship are able to apply for help with their health costs using the HC1 form. If they are successful with their application, they will receive an HC2 certificate which would entitle the patient to receive free prescriptions.

More information on Help with Healthcare costs can be found at www.nhsbsa.nhs.uk/HealthCosts.

4. Can I endorse ‘NCSO’ for any item I am unable to purchase at the Drug Tariff Part VIII price?

The last No Cheaper Stock Obtainable (NCSO) concession was granted in April 2013. NCSO products are items for which in the opinion of the Secretary of State for Health and the Welsh Ministers there is no product available to contractors at the price in Part VIII of the Drug Tariff. In this scenario the Pricing Authority will only reimburse based on a full NCSO endorsement against those items which have been granted this status. Concessions only last for the month in which they are granted, therefore it is important to ensure that prescriptions dispensed for concessionary items are submitted with the bundle for the month in which the concession was granted. Contractors are reminded that the items which have been granted NCSO or price concession status are announced monthly on the PSNC and NHSBSA websites.

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).

Problems obtaining a medicine or appliance?

Pharmacy teams who experience problems in obtaining medicines (generic or branded) or appliances are reminded to feed this back to the PSNC Dispensing and Supply Team to support PSNC’s ongoing representation of issues in the supply chain.

PSNC passes a monthly summary of the feedback received to the Department of Health to support their monitoring of the situation. This information is also used as an evidence base in discussions with manufacturers on manufacturer-specific problems, for example, highlighting problems with contingency arrangements and promoting solutions.

Please make sure you let us know about any supply issues by using our online feedback forms at psnc.org.uk/feedback

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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Cavilon Durable Barrier Cream The manufacturer 3M has recently made some changes to its Cavilon Durable Barrier Cream range. As of January 2015 these changes are now reflected in the Drug Tariff. See below for the products and their corresponding codes now listed in the Drug Tariff.

Cavilon Durable Barrier Cream 3392GS (20 pack of 2g sachets) 3391G (28g) 3392G (92g) Note: prescriptions for items in the Cavilon Durable Barrier Cream range issued without a code will be reimbursed based on the items listed in Part IXA of the Drug Tariff.

For further information on 3M’s new product range see below and tinyurl.com/qeya6ol

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NHSBSA’s Hints & Tips NHS Prescription Services produces a quarterly newsletter called Hints & Tips for dispensing contractors.

We would like to draw your attention to the latest edition (Issue 18) as it contains some really useful information and advice regarding: • Prescription exemption claims – checking at the point of dispensing • The new refreshed electronic Drug Tariff • The Electronic Prescription Service in your pharmacy • Prescription endorsements All published editions of the Hints & Tips newsletter can be found on the Prescription Services website: nhsbsa.nhs.uk/3191.aspx

Dispensing items on FP10 When pharmacy teams receive NHS prescriptions they must check whether the items prescribed are allowed on the NHS before dispensing. If they are not allowed, the pharmacy contractor may not be paid for them.

Pharmacy teams 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

Flutter mucus clearance device

Yes

Yes

n/a

Yes

Flutter mucus clearance device is a registered medical device (CE marked) and appears in Part IXA of the Drug Tariff under the description of Oscillating positive expiratory pressure device therefore it is allowed on an FP10.

Cavilon Durable Barrier Cream 3392E (92g)

No

Yes

n/a

No

Cavilon Durable Barrier Cream 3392E (92g) has been discontinued by the manufacturers and is no longer listed in Part IXA of the Drug Tariff therefore it is not allowed on an FP10.

Cavilon Durable Barrier Cream + Honey 3391H (28g)

No

Yes

n/a

No

Cavilon Durable Barrier Cream + Honey 3391H (28g) has been discontinued by the manufacturers and is no longer listed in Part IXA of the Drug Tariff therefore it is not allowed on an FP10.

Cavilon Durable Barrier Cream 3392G (92g)

Yes

Yes

n/a

Yes

Cavilon Durable Barrier Cream 3392G (92g) is a registered medical device (CE marked) and appears in Part IXA of the Drug Tariff therefore it is allowed on an FP10.

Additional information on appliance prescribing on various prescription forms: • FP10CN or FP10PN (community nurse prescriber) – Nurses can prescribe all appliances that are listed in Part IX of the Drug Tariff as outlined in the Nurse Prescribers Formulary (Part XVIIB of the Drug Tariff).

• FP10D (dental prescriber) - Dentists can only prescribe appliances listed in the Dental Formulary (Part XVIIA of the Drug Tariff).

• FP10MDA (instalment dispensing) – Appliances cannot be prescribed on an FP10MDA form, for more information on items which can be prescribed visit psnc.org.uk/mda

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Dispensing Factsheet: Where to Obtain External Resources Below is a table outlining how to source commonly required resources for community pharmacies.

Resource

Where to obtain the resource from

Drug Tariff

Copies of the Drug Tariff are sent out every month to all pharmacy contractors in England. Area Teams* are responsible for arranging delivery of the Drug Tariff and should be contacted directly if a copy is not received. Contractors in Wales should contact their LHB for hard copies of the Drug Tariff. Some pharmacies find it useful to use the online version which can be accessed at www.ppa.org.uk/ppa/edt_intro.htm

BNF

Pharmacies with one registered pharmacist will receive a single copy of BNF/BNFc, and pharmacies with two or more registered pharmacists will receive 2 copies of BNF/BNFc once a year in September. Any community pharmacists who have not received copies should contact Binleys (BNF@Binleys.com or 01268 495 609) to ensure they are registered to receive copies in future. Please also note that BNF and BNFc content can be accessed online at tinyurl.com/nvklvz6 For further information, please visit the medicines complete website www.medicinescomplete.com From September 2013 community pharmacies only receive hard copy versions of the BNF once a year (in September). Those pharmacies wishing to have the March print edition, can purchase a copy and should contact Jo Cook on 020 7572 2223 or email jo.cook@rpharms.com for a quote.

Smartcards

Area Teams* are responsible for local Registration Authorities (RA) managing the issue of smartcards to access the Electronic Prescription Service (EPS). Your RA contact information may be available from your Area Team*, or might be listed on your LPC site (lpc-online.org.uk).

Equality Act Toolkit (Formerly DDA Toolkit)

NHS Primary Care Commissioning have published an Equality Act Toolkit 2010 (formerly known as Disability Discrimination Act) Resource Toolkit which can be used to assess patients for auxiliary aids. It is available on the PCC Website tinyurl.com/mvgrlan.

FP57 (Receipt and Refund Forms)

Area Teams* are responsible for issuing the FP57 (Receipt and Refund Forms) to pharmacies, on request.

FP95 Application for a Prescription Pre-payment Certificate

Copies of this form are available on request from Area Teams*.

Patient Safety Incident Reporting

Contractors can report patient safety incidents to the National Reporting and Learning System (NRLS) at https://www.eforms.nrls.nhs.uk/staffreport. PSNC guidance on patient safety incident reporting and template forms to use in the pharmacy are available at psnc.org.uk/patientsafety.

Controlled Drug Requisition Forms (FP10CDF)

In England, Area Teams* are responsible for providing FP10CDF forms to pharmacy teams, on request.

FP34C Submission Document

Copies of Form FP34C which is used when submitting NHS prescription forms for pricing are sent out monthly by the Pricing Authority. If the form hasn’t arrived by the end of the month, contact the NHS Prescription Services Help Desk on 0300 330 1349.

FP34PCD Submission Document

Private prescription forms for controlled drugs (FP10PCD) must be submitted to the Pricing Authority monthly along with a special FP34PCD submission document*. The submission document can be downloaded from the NHS Prescription Services website at tinyurl.com/fp34pcd6 *Please note that it is the originals of these forms which must be submitted.

Prescription Recheck Request Form

If a contractor requires a prescription bundle to be rechecked from the preceding 18 months, they must request so using the appropriate form. The Pricing Authority’s recheck request form can be downloaded from the NHS Prescription Services website at tinyurl.com/PPArecheck.

Hints & Tips Newsletter

The Pricing Authority produces a quarterly newsletter which is published on the NHS Prescription Services website (at www.nhsbsa.nhs.uk/3191.aspx). You can sign up for emails alerting you when a new edition comes out from that page.

Department of Health Publications

A number of publications are available from the Department of Health Publications Order line. They can be contacted by calling 0300 123 1002 or you can search and download from their website at tinyurl.com/DHpubsorder.

Dispensing Tokens (FP10DT)

NHS England through its Area Teams* is responsible for issue of tokens.

* You can find details of your local Area Team on NHS Choices tinyurl.com/mk2pv6m.

Please note that Area Teams are being reorganised by NHS England into sub regions. psnc.org.uk 11

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Understanding the EPS payment schedule This guide has been produced to help pharmacy contractors understand the Electronic Prescription Service (EPS) payment schedule.

General advice for pharmacy contractors on making claims for EPS items: • Pharmacy contractors can claim at any time after the final dispense notification has been sent, but this must be before the 180th day (around six months).

• Some pharmacy systems have developed reports and facilities to identify those prescriptions marked dispensed but still to be claimed; please speak to your system supplier about how you can be made aware of such prescriptions .

• Claim on time, by sending claims throughout the month.

• Claim as soon as practical where there are owings.

• Check you know how to filter and display prescriptions so you can see if there are any prescriptions that need dispense notifications or claims to be sent.

• Learn how to identify messages which have not been submitted using the new prescription tracker hscic.gov.uk/eps/tracker. Where needed, the new version of the

tracker allows users to enter a prescription ID and find out where your patient’s prescription is in the process. It is now also possible to search by NHS number and date range. The tracker will confirm if the prescription has left the prescribing site, if it has reached the Spine or if it has been delivered to an alternative dispensing site.

When should you claim?

Claims should be sent to the Pricing Authority no later than the 5th day in the month following the month supply was made (Drug Tariff Part I, Clause 5A). EPS claims can only be submitted after all items in the EPS Release 2 prescription message have been fully dispensed (or not dispensed), so occasionally a pharmacy may not be able to submit the claim due to an owing item.

Further information on this is provided in the Pricing Authority's Hints and Tips publication [tinyurl.com/nhsbsadc18], which is reproduced below:

Understand the payment schedule for EPS to ensure you get paid in the right month When a dispense notification has been sent in a given month the electronic claim message must be received by NHS Prescription Services before midnight on the 5th of the following month to secure payment with that month’s submission.

Remember you can send the claim message just after you have sent your dispense notification, at the end of each day, in batches or weekly; you do not need to wait until the end of the month. See example payment schedule below: August 28

29

September 30

31

Dispense notification sent on 29th August

August 28

29

30

31

August 29

2

3

4

5

6

1

2

3

4

5

6

31

= September Payment

Electronic claim message received after midnight on 5th September

September 30

= August Payment

Electronic claim message received before midnight on 5th September

September

Dispense notification sent on 29th August

28

1

1

2

3

4

5

6

= September Payment

Frequently Asked Questions 1. Is claiming possible at any point during the month?

Yes. See opposite. However, please leave two minutes between sending the final dispense notification and the reimbursement endorsement claim message, as the dispense notification MUST reach the Spine before the claim, or the claim will be rejected.

2. Is claiming impossible when any particular programme/update is running?

Pharmacy staff would need to check with system suppliers whether system updates etc. may affect the ability to claim. Staff should be aware that if a message is unsuccessful, they will receive a rejection message, so they will know that it has been unsuccessful.

3. Can payment be claimed from the Pricing Authority more than 180 days after an item has been dispensed?

No. All electronic claim messages must be sent within 180 days of the dispense notification message being sent (the ‘claim reconciliation period’). At this point, the Pricing Authority receives a no-claim message, which means it has been removed from the Spine and can no longer be priced by the Pricing Authority.

4. What if not all of the medicine on a prescription has been dispensed?

All items must either be marked as fully dispensed or not dispensed before you can claim.

Where you have dispensed one item but only part of a second item, and the patient has confirmed that they do not wish the remainder to be dispensed, you may choose to mark this item as fully dispensed with the actual quantity supplied. If none of the second item has been dispensed then this should be marked as not dispensed. Remember not to let the prescription reach its expiry.

Further information is available at: tinyurl.com/hscicepsdispensing tinyurl.com/hscicepsreimbursement tinyurl.com/hscicepstracker psnc.org.uk/epssubmission

Dispense notification Electronic claim message received sent on 1st September before midnight on 5th September

Factsheet produced in association with the Health and Social Care Information Centre (HSCIC) 12 Community Pharmacy News – February 2015

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EPS Quick Tips

1 Preparing for EPS Release 2 Key information: a) Know when your local GPs are going live, and attend changeover sessions with them b) Work with GPs using the engagement checklist on our website (see link below) c) Ensure all relevant staff are fully trained in how to use your supplier’s EPS system d) Check your NHS Choices profile e) Know how to report issues and request improvements Guidance: psnc.org.uk/preparingr2

2 Funding & payment Key information: a) Once your pharmacy has gone live, your system supplier will give you a ‘Golden Ticket’ (i.e. a test prescription triggering your one-off £1000 EPS Release 2 payment) b) To begin ongoing payments, email the monthly allowance claim form to your Area Team (now sub region) c) Check your prescription totals match up on your Schedules of Payment with those you believe were submitted in that month Guidance: psnc.org.uk/nomination

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Business continuity

Key information: a) Know who to contact in the event of a problem. Use the IT troubleshooting guide, and fill in contact information b) Create a contingency plan in case there is loss of internet/power/EPS c) Sign up to receive Spine alerts so you know if there are issues with the national EPS system

3 Patient nomination The Electronic Prescription Service (EPS)

Guidance: psnc.org.uk/nomination

Guidance: psnc.org.uk/epscontingency

5 Smartcards

Key information: a) Explain the service fully to patients b) Do not influence patient choice c) Add nominations promptly d) Develop a Standard Operating Procedure (SOP)

4 Endorsing & submission

Key information: a) Check all Smartcards are working correctly prior to going live with EPS Release 2 b) Know how to unlock your Smartcard c) Keep a record of your local Registration Authority’s contact details

Key information: a) Check the exemption category is correct and all necessary endorsements have been made b) Remember prescriptions dispensed in Month A have until the 5th of Month B to be submitted c) For any outstanding prescriptions, remember you have up to 180 days to dispense and submit them d) All tokens containing a patient signature must be put in the prescription bundle for audit purposes e) FP34C totals should include the total number of paper prescriptions/items plus any electronically submitted prescriptions/items

Guidance: psnc.org.uk/smartcards

Guidance: psnc.org.uk/epssubmission

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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.

See more at: psnc.org.uk/oop Below is a quick summary of the changes due to take place from 1st March 2015 Part VIIIA Additions Category C Additions: * This pack only (others already available) SC Special Container • Canagliflozin 50mg / Metformin 850mg tablets (60) – Vokanamet • Canagliflozin 50mg / Metformin 1g tablets (60) – Vokanamet • Co-amoxiclav 875mg/125mg tablets (14) - Creo Pharma Ltd • Colecalciferol 800unit / Calcium carbonate 2.5g chewable tablets (30) Calcichew D3 Once Daily • * Haloperidol 5mg/1ml solution for injection ampoules (10) – AMCo • Umeclidinium bromide 65micrograms/dose dry powder Inhaler SC (30 dose) - Incruse Ellipta

Category C - J M Loveridge Ltd • Liquid paraffin / Magnesium hydroxide oral emulsion sugar free (150ml) will be: Category C - J M Loveridge 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 or supplier name and pack size) in future. * This pack only (others still available) • Haloperidol 5mg/1ml solution for injection ampoules 5 Category C Haldol Part IX Deletions It is important to take 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.

• Coloplast Ltd Simpla 2 litre S4 Urine drainage bag – Short Tube 340801

Part VIIIA Amendments • Arachis oil liquid (200ml) will be:

Dispensing of pregabalin/Lyrica FAQs At present the generic pregabalin is listed in Part VIIIA of the tariff as a Category C line with reimbursement currently based on the brand Lyrica. Contractors should be aware that Pfizer still retains the patent for Lyrica for one indication (peripheral and central neuropathic pain). This is a complex area of patent law. PSNC is unable to give legal advice, but the below FAQs may help contractors on this matter.

Q. I have been presented with a prescription for generic pregabalin specifically for the patented indication; what should I do?

A. If the medicines is being provided for the patented indication, the pharmacy should dispense Lyrica and may wish to advise the prescriber.

Q.Is there any requirement in the terms of service to make inquiries of the patient (or GP) about the medical condition being treated?

A. No. 14 Community Pharmacy News – February 2015

Q.If I receive a generic prescription for pregabalin for the treatment of neuropathic pain and I choose to dispense the generic, would it be fraudulent if there was a lower price in the Drug Tariff for the generic product?

A. If you know the product is being used for the patented indication, you must supply the brand.

Q. Is there any further information that could help pharmacies when dispensing?

A. Advice will be issued when it is available but, as above, PSNC cannot offer legal advice and this is a specialised area in patent law.

Q. PSNC’s news item states that the price payable for generic pregabalin is currently based on the price of the brand.

Is this likely to change when there are generics in the market?

A. The prices in the Drug Tariff are set each month by the Department of Health, and PSNC will be consulted before any change.

Q. How would Pfizer know that I am dispensing generic products for the patented indications?

A. Pfizer know what proportion of patients are being treated for the patented indication. In light of Pfizer's DTP distribution model, they will be able to identify outliers in purchasing behaviour.

Q. CCG has recommend prescribers to always prescribe the generic, irrespective of clinical indication. Where does that leave pharmacy?

A. Pfizer took their case to the High Court because of the risk that the generic would be prescribed and dispensed for the patented indication. Although it was unsuccessful in securing an injunction, it was agreed by all parties that the generic producers would write to CCGs to ensure they were aware that the generic could not be supplied for the patented indication. A CCG or other party that promotes the supply of generic pregabalin for the patented indication risks facing legal action by Pfizer.