February 2018 CPN

CPN

Community Pharmacy News – February 2018

Reducing NHS pressures

pharmacy flu service recommissioned · CNommunity · UMSAS helps patients avoid urgent care visits Price concessions update | Discount deduction factsheet | PSNC elections

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCs

Flu Vaccination Advanced Service in 2018/19 Pharmacy minister confirms recommissioning of Community Pharmacy Flu Vaccination Advanced Service for 2018/19 and that it will include the adjuvanted trivalent flu vaccine.

• the service will be re-commissioned in 2018/19; and • the community pharmacy service will include adjuvanted trivalent flu vaccine, for use within the relevant patient cohort.

Although the Department of Health and Social Care (DHSC) and NHS England have not initiated substantive negotiations for 2018/19, PSNC has received correspondence from DHSC on some interim measures, which were considered at its Committee meeting in January. These included a paper from DHSC, marked confidential, on the commissioning of the 2018/19 Community Pharmacy Seasonal Influenza Vaccination Advanced Service.

On 22nd December 2017, NHS England wrote to general practices and its local teams to provide guidance on the use of adjuvanted trivalent flu vaccine for the 2018/19 season. This document summarised the recent advice from the Joint Committee on Vaccination and Immunisation (JCVI) and the latest update in the Green Book on adjuvanted trivalent flu vaccine, in order to support decisions on optimal choice of influenza vaccine for the 2018/19 season.

We will provide further information on the proposals for the service as soon as possible, however, in an answer to a Parliamentary Question to the Secretary of State for Health and Social Care, asked by Sir Kevin Barron MP (Chair of the All Party Pharmacy Group), Steve Brine MP, the pharmacy minister, has confirmed that:

However, final advice on ordering flu vaccine has now been issued by NHS England; see below for details.

Guidance on flu vaccine ordering for 2018/19 NHS England has issued a letter to all community pharmacies and general practices giving advice on ordering flu vaccine for the 2018/19 season.

The guidance, set out in a letter from NHS England’s National Medical Director and Director of Primary Care, and Public Health England’s Medical Director, asks GPs and community pharmacy contractors to ensure their influenza vaccine orders for the 2018/19 season use the most effective vaccines for the population.

The letter says the clinical evidence is clear that for the 2018-19 winter season, GP practices and pharmacy contractors should offer: • The adjuvanted trivalent vaccine (aTIV) for all 65s and over; and • The quadrivalent vaccine (QIV) for people in the 18 to under 65s at risk group.

The letter also states that: • GPs and pharmacy contractors should review all orders (provisional and firm) for the 2018/19 season and ensure these are in line with

the evidence-based clinical view; • Vaccine suppliers have confirmed that there will be enough adjuvanted trivalent vaccine and quadrivalent influenza vaccine to meet demand; • Orders for these vaccines will need to be placed by 29th March 2018; • There is no change to the way in which contractors will be reimbursed for vaccines administered – the system will be the same as for the current 2017/18 service; and • If pharmacy contractors encounter any difficulties from a manufacturer placing or amending an order, they should advise their local NHS England team.

The letter also contains the answers to a number of frequently asked questions, including on changing or switching vaccine orders.

Read the letter in full at: ow.ly/nCpC30iddjo

Are you checking your flu payments?

Last year, PSNC received a number of queries from community pharmacy contractors regarding their NHS Flu Vaccination Service claims from the 2016/17 flu season. Where their payment queries fell outside of the flu vaccination season for 2016/17 (after 31st March 2017), pharmacies had to make claims directly to NHS England instead of to the NHS Business Services Authority which can be time consuming to resolve and may result in non-payment.

To mitigate any flu payment issues during the 2017/18 season, PSNC has created a list of recommended actions for contractors to take: ow.ly/PrYi30i9ZUm

2 Community Pharmacy News – February 2018

PSNC’s WORK

FUNDING AND STATISTICS

CONTRACT AND IT

DISPENSING AND SUPPLY

Stay Well Pharmacy campaign launches NHS England launches promotional campaign encouraging the public to ask community pharmacy teams for advice on minor health concerns.

NHS England’s Stay Well Pharmacy campaign, which encourages the public to ask community pharmacy teams for advice on minor health concerns, launched on 12th February. The campaign makes use of posters, leaflets, social media activity and television advertising to raise awareness.

The Healthcare Distribution Association has kindly agreed to distribute a branded toolkit to all pharmacies in England (multiples, small chain and independents) as part of their daily prescription medication deliveries.

The campaign materials feature real community pharmacy team members along with prominent green cross imaging.

The campaign materials will explain to parents that they can speak to the community pharmacy team about a range of minor health concerns.

Community pharmacies should receive a briefing pack and resources including posters from NHS England w/c 12th February. Pharmacy teams are asked to watch out for it arriving and start to use it immediately.

Running until 31st March 2018, the campaign is aiming to increase the public’s trust and confidence in community pharmacy teams as the place to go for clinical advice for minor health concerns, and encouraging people to use pharmacies rather than visiting their GP as a first port of call.

The campaign is targeting parents of children aged five years or under, aiming to increase their confidence and

trust in the advice given by community pharmacy teams, and encourage them to use pharmacies rather than visiting their GP for minor health concerns. Three key symptoms will be the focus of the campaign: sore throats; coughs and colds; and tummy problems.

Resources hub PSNC, working in partnership with the other national pharmacy organisations, has worked to compile a one-stop resources hub, linking to all the most up-to-date clinical resources that can help community pharmacy teams to manage minor illnesses, and identify any red flag symptoms.

Visit the resources hub: psnc.org.uk/ staywellpharmacy

NUMSAS update: information for contractors Evaluation of NUMSAS shows value of the community pharmacy service as it prevented 20% of patients from visiting an urgent care centre.

NHS England has undertaken an initial evaluation of the NHS Urgent Medicine Supply Advanced Service (NUMSAS), which has identified some of the positive impact the service is having for patients.

As part of the evaluation, it has been found that only around 15% of patients who have received the service have completed a patient questionnaire, and that FP10DT EPS tokens are not being fully completed in scenarios when a supply was not made. Pharmacy teams are therefore reminded of the importance of completing these actions to assist with later evaluations of the service.

Headline data 3,710 pharmacies have registered to provide the service (up to 5th February 2018) 35,108 items were supplied by community pharmacies between December 2016 and November 2017

3% of 1,928 patients 9 completing a patient questionnaire were very satisfied with the service 20% of patients would have gone to an urgent care centre, such as A&E, if the pharmacist had not made a supply

Ventolin/Salbutamol inhalers were the top two medicines supplied

Find out more at: ow.ly/8Acm30i5Hm1

psnc.org.uk 3

CONTRACT AND IT

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

Updated pharmacy practice leaflet requirements published New wording required to be used in community pharmacy practice leaflets issued by NHS England.

Contractors must implement changes by 31st July 2018.

On 1st February 2018, NHS England published updated Approved Particulars relating to: • Information Governance; • the Medicines Use Review service; • the Patient Satisfaction Survey; • the Pharmacy Practice Leaflet; and • Premises.

no longer refer to Primary Care Trusts or NHS Direct instead referring to NHS England and NHS 111. They are also now in line with the revised NHS identity guidance published in 2017.

There are no significant changes compared to the previous Approved Particulars and no actions are required by community pharmacy contractors except for those relating to the Pharmacy Practice Leaflet.

The Pharmacy Practice Leaflet Approved Particulars will take effect on 31st July 2018, so contractors will need to update their leaflets over the next six months, so they have a revised leaflet available for patients by 31st July 2018.

The Pharmacy Practice Leaflet Approved Particulars have been updated to reflect changes to NHS structures and guidance on use of the NHS identity; the updated requirements for leaflets

To assist contractors in meeting the updated requirements, PSNC has updated its Pharmacy Practice Leaflet template, which can be downloaded from: psnc.org.uk/practiceleaflet

Applications open for post-registration community pharmacist training Health Education England (HEE) has announced that community pharmacists around the country can now enrol on new, innovative and engaging training at masters-level through the Pharmacy Integration Fund (PhIF).

Pharmacists can choose to take a single or range of modules, with different credit values, dependent on their development needs or interests, with a maximum 60 credits per learner per year (60 credits is equivalent to a post graduate certificate).

They can choose a virtually delivered or online module from a provider determined by content rather than geography. Provision runs from February 2018 to March 2019 and is for the equivalent of up to 2,000 postgraduate certificates.

The training will be delivered by De Montfort University, the University of Manchester, and the University of Bath (in some cases with consortium partners) and it will cover five strands: • service improvement; • extended skills; • patient activation; • delivering medicines optimisation; and • NHS England clinical priorities.

Pharmacists interested in taking up the fully-funded training will need to contact the course provider directly, but more information is available at: ow.ly/PflO30i3PSa

4 Community Pharmacy News – February 2018

New guidance sets out way forward for FMD New guidance on the Falsified Medicines Directive (FMD) has been issued by the UK FMD Working Group for Community Pharmacy. The detailed guidance is intended to build understanding of the options open to community pharmacy contractors as the 12-month milestone for implementation approaches.

The Way Forward for FMD in community pharmacy covers key assumptions about FMD, high level processes for incorporating authentication in to existing dispensing workflows, handling stock transition after 2019, what IT systems will need to deliver and implications for patient safety.

The guidance has been published on the FMD Source website (www.fmdsource. co.uk) and will be updated by the Working Group as new information becomes available.

TH

HE HEALTHCARE LANDSCAPE

LPCs

PSNC’s WORK

FUNDING AND STATISTICS

PSNC elections 2018 Election proceedings for 13 Regional Representatives and three non-CCA Multiple Chemist Representatives to the PSNC Committee are underway.

Here is an update following the close of nominations.

Non-CCA Multiple Chemist Representatives Nominations for election to PSNC as a non-CCA Multiple Chemist Representative have now closed.

PSNC has received six valid candidate nominations for the three positions available; three from candidates nominated by a non-CCA Multiple Chemist with fewer than 30 premises on the pharmaceutical list in England.

Any non-CCA Multiple Chemist (which includes all contractors that are members of the Association of Multiple Chemists, regardless of the number of NHS pharmacies they own) can nominate a candidate, but this will be the first non-CCA Multiple Chemist Representatives election to guarantee smaller Multiple Chemists representation on PSNC, if a candidate from a smaller non-CCA Multiple Chemist stands.

In October 2017, an amendment to PSNC Rules ensured that one of the elected representatives must be a candidate nominated by a Multiple Chemist that has fewer than 30 premises on the pharmaceutical list in England, if one or more such candidates are nominated.

which was nominated by a ‘non-CCA Multiple Chemist with fewer than 30 premises on the pharmaceutical list in England’ will be elected, even if it is not in the top three. So, we may see only the top two candidates elected and the highest placed candidate from the smaller non-CCA Multiple Chemist.

Regional Representatives

The deadline for receipt of nominations has passed in the PSNC election for 13 Regional Representatives and completed nominations forms received by the deadline have been validated.

A total of 11 representatives were elected unopposed:

Region

Candidate name

Result

North East and Cumbria

Mark Burdon

Elected

Yorkshire and the Humber

David Broome

Elected

East Midlands and South Yorkshire

Garry Myers

Elected

East Anglia

Anil Sharma

Elected

East

Bharat Patel

Elected

London South Thames

Indrajit Patel

Elected

South East Coast

Sunil Kochhar

Elected

South Central

Gary Warner

Elected

West Midlands

Jas Heer

Elected

Mersey

Dr Ian Cubbin

Elected

North West

Fin McCaul

Elected

The voting process PSNC will now hold a ballot to determine the three candidates who will become representatives. Each non-CCA Multiple Chemist contractor has one vote for each of its NHS pharmacy premises in England; which may be allocated to any candidate standing in the election. The contractor is free to choose how to allocate its votes to any of the candidates – whether that be all to one candidate or splitting the votes between several candidates. A smaller non-CCA Multiple Chemist can vote for a larger non-CCA Multiple Chemist and vice versa. Those eligible to vote will receive their ballot papers shortly.

A ballot will take place in the South Western and the London North Thames regions. Those eligible to vote will receive their ballot papers shortly.

The candidates with the most votes will be elected, but, and this is the new provision in the rules, the highest placed candidate

Duly elected Regional Representatives will take office with effect from 1st April 2018.

Are your Easter opening hours on NHS Choices?

In preparation for the upcoming Easter holiday period, community pharmacy contractors are encouraged to update their public holiday opening times on their NHS Choices profiles.

The service search on NHS Choices has now changed so that the primary search result is the nearest open pharmacy. It is therefore important that there is up-to-date information on opening times during normal hours and bank holidays.

With 525 million visits to NHS Choices in 2017, contractors may wish to take advantage of this opportunity and ensure their service users are kept informed on service offerings and opening times.

Find out more at: ow.ly/pDeZ30hVwJK

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PSNC’s WORK

FUNDING AND STATISTICS

CONTRACT AND IT

PSNC seeks fairer price concession system PSNC in discussion with DHSC about systems to address the impact of high price rises on community pharmacy contractors.

PSNC and the Department of Health and Social Care (DHSC) have been holding discussions on changing the system for setting price concessions.

PSNC is seeking a system that is more responsive to price rises and ensures community pharmacy contractors do not carry unreasonable costs on behalf of the NHS. Currently, we make claims for price concessions to DHSC, who then verify them using data they collect from manufacturers and wholesalers, and, if they believe it to be appropriate, set a concession price.

PSNC has agreed key principles for a fair system, recognising the need for the NHS to continue to meet affordability challenges for medicines. The principles include: • Community pharmacy contractors must not be the victims of adverse events or activity further up the supply chain; • Any pricing system must balance fairly contractors’ duty to supply with a reasonable purchase risk; • PSNC must be able to provide data about price rises, but accepts that DHSC will want to verify this and that this leads to some period of uncertainty over pricing; • Any data used to set prices must relate to the period for which a concession is given; and

• PSNC must be able to challenge proposed price concessions.

Whilst agreeing these principles, PSNC was mindful of the fact that although contractors should not face unfair risks, and costs of supply problems should not be passed on to them, purchasing medicines for the NHS is a huge part of what the sector offers for the NHS. Successful buying reduces costs for the NHS, and community pharmacies should continue to try to drive prices down.

PSNC will continue to press for immediate improvements to the price concessions system but believes that forthcoming regulation on the disclosure of information on healthcare products will have an impact on managing price concessions, when a refined system can be established which makes use of the increased data capture.

Receive price concessions updates directly in your inbox.

Sign up to PSNC’s emails at psnc.org.uk/email.

PSNC agrees 2018 work plan and service ambitions PSNC has met and agreed its work plan for 2018, as well as proposals that would develop community pharmacy services to allow pharmacy teams to better support people with long-term conditions. Key agenda items at PSNC’s January meeting were as follows.

Development of the Contractual Framework PSNC considered proposals to revise the Community Pharmacy Contractual Framework (CPCF) to include a care plan service which supports patients with longterm conditions to optimise their use of medicines and manage their conditions.

Fully implementing such a service would be a significant change for many community pharmacy teams, so PSNC considered options for staged changes to the CPCF which would support the transition. The final draft proposals that PSNC agreed should provide a starting point for discussions with Department of Health and Social Care (DHSC) and NHS England.

6 Community Pharmacy News – February 2018

2018/19 Funding, Quality Payments and EPS Although DHSC and NHS England have not begun formal negotiations for 2018/19, PSNC has received correspondence on some interim measures, and agreed its response. These included the future of the Pharmacy Access Scheme and the Quality Payments Scheme. We will provide further information on the proposals, the details of which DHSC has marked as confidential, as soon as possible.

OTC Medicines PSNC considered NHS England’s consultation on draft guidance for Clinical Commissioning Groups, which would stop

routine prescribing for a range of minor conditions. PSNC agreed the need to highlight implementation challenges with the proposals, and that it must be made clear to NHS England that any transfer of work from GPs would increase workload for community pharmacy. The Committee also recognised that the proposals to stop NHS treatment for self-limiting conditions are likely to lead to the de-commissioning of minor ailments schemes.

Price concessions Discussions were held on changing the system for setting price concessions – more information is given in the story above.

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCs

New Patient safety learning campaign Discover more about the spring learning campaign from the Centre for Pharmacy Postgraduate Education (CPPE).

Our Patient safety spring learning “campaign beings on Monday 26th February and runs for six weeks until 2nd April, with weekly challenges and new resources to support you to improve patient safety in your practice.

Annie Sellers Learning development pharmacist and campaign lead, CPPE

Patient safety is integral to the work that pharmacy professionals carry out, but there will be inherent risks in your practice. Our Patient safety campaign aims to help you identify these risks, reflect on processes and manage incidents when they do occur.

Last year the World Health Organisation (WHO) launched Medication without harm, their third global safety challenge.

This safety challenge recognises that unsafe practices and medicine errors pose avoidable risk and cause harm in healthcare systems across the world. At CPPE, we encourage you to take an active role in this WHO campaign by completing our Patient safety learning campaign.

This campaign will be supported by our Risk management guide,

which will be posted out to all CPPE registrants. This guide will give important background to the concepts that the campaign explores, as well as providing the basis of the third challenge.

The other challenges in the campaign will involve reflecting on your own practices and having discussions with colleagues, friends and relatives, as well as putting your learning into practice by carrying out a risk assessment and making a pledge to make positive changes in your place of work.

When you complete all six challenges not only will you receive a virtual badge to add to your collection on your CPPE learning record but you will receive a downloadable poster to display which shows your commitment to patient safety. This poster is endorsed by the National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre.

Throughout the campaign the hashtag #CPPEPS will be used to promote the importance of this learning. Get involved by sharing their successful completion of challenges and see what others have been doing throughout the campaign. Access the CPPE website for more information and regular updates on the campaign: www.cppe.ac.uk

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Gluten-free foods to be restricted on the NHS In March 2017, the Department of Health and Social Care (DHSC) launched a consultation to seek views on proposals on whether to make changes to the availability of gluten free (GF) foods that are prescribed on NHS prescriptions.

Following the consultation, DHSC have announced that the Minister’s preferred option is to retain a limited range of gluten-free bread and mix products on prescription.

This means that GF foods from the following categories will no longer be available for prescribing; biscuits, cereals, cooking aids, grains/flours and pasta. The majority of consultation responses were in favour of this.

DHSC has said that they will commence work on amending the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004, Schedule 1, and then removing these products from the Drug Tariff. PSNC will notify contractors when these changes are implemented. If contractors hold stocks of GF products, they may want to review their stock holding policy on products which will in future not be prescribable.

In PSNC’s response to the consultation, it recognised the financial challenge that the NHS is currently facing and it consequently suggested that gluten-free prescribing should be restricted to the prescribing of staple products for patients who cannot afford or cannot buy gluten-free products in the local food outlets they are able to access.

DHSC has published the formal response document, impact assessment and equalities impact assessment.

Find out more at: ow.ly/gNVV30ifHhR

psnc.org.uk 7

PSNC’s WORK

FUNDING AND STATISTICS

CONTRACT AND IT

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

Have you completed your annual clinical audit?

of the requirement to Community pharmacy contractors are reminded of the Community Pharmacy part as audit complete a pharmacy-based clinical 2018.

March 31st by work Contractual Frame d a Community Pharmacy The NHS Specialist Pharmacy Service has create to PharmOutcomes added been has which Oral Anticoagulant Safety Audit who wish to use it. ctors contra all to e availabl is and (pharm outcom es.org)

other audits which contractors may wish to More information and paperwork for this audit and udit rg.uk/a complete can be found at: psnc.o

Hints & Tips newsletter

The Pricing Authority produces a quarterly newsletter called Hints & Tips for dispensing contractors.

We would like to draw your atten tion to the latest edition (Issue 30) which contains some really useful information and advice regarding: National Influenza Adult Vaccinatio n Service: using the correct form; Changes to proof of exemption ; Products now available as licens ed medicines; and EPS end of month submission proc ess.

All published editions of the Hints & Tips newsletter can be found at: www .nhsb sa.nh s.uk/ 3191.a spx

Dental factsheets for pharmacy teams

teams across The Health Education England (HEE) orated collab have East h London and the Sout s sheet fact l denta of s serie a to produce teams. specifically for community pharmacy nt-facing They are intended to be used by patie common with deal them help team members to / toms symp oral dental and conditions and signpost patients where appropriate.

Download the resources from: ow.ly /5fm I30hJ DdQ

PHE publishes updated review of e-cigarettes

Public Health England (PHE) has publis hed a new independent expert evide nce review of e-cigarettes which provides an update on PHE’s 2015 review.

In light of the review, PHE is advis ing anyone who has struggled to quit smoking to try switching to an e-cigarette and get professional help. It also state s that the greatest quit success is amon g those who combine using an e-cig arett e with support from a local stop smoking service.

Read the findings from the revie w at: ow.ly /n1TW 30ifH 8c

8 Community Pharmacy News – February 2018

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCs

Ask PSNC The PSNC Dispensing and Supply Team can provide pharmacy teams with support and advice on a range of topics related to the Drug Tariff and reimbursement. Questions asked in recent months have included: Q. What should I do when faced with incomplete prescriptions for medicinal products?

If an NHS prescription is missing basic information, community pharmacy teams can follow the actions below to resolve the situation.

Missing

Action

Strength or pharmaceutical form for a medicinal product

• If this drug is only available in one strength or form, dispense it and endorse what was given.

• If more than one strength or form exists, contact prescriber to ascertain form and quantity required and endorse “PC” (initial and date).

Quantity for a medicinal • Contact prescriber, add quantity required and endorse “PC” (initial and date). product • If cannot contact prescriber, supply enough for 5 days of treatment only and endorse “PNC”.

Strength AND quantity for a medicinal product

• Contact prescriber, add strength and quantity required and endorse “PC” (initial and date).

• If cannot contact prescriber, supply enough for 5 days of treatment only and endorse “PNC”.

Strength which doesn’t exist for a medicinal product

• Use professional judgement and make up required dose using lower strengths, if possible (e.g. dispense 250mg tabs to give 500mg per day).

• If this cannot be done or if in any doubt, prescription should be returned to the prescriber for amendment.

For incomplete prescriptions for Schedule 2 and 3 Controlled Drugs, see the Controlled Drugs section of our website: psnc.org.uk/cd

Q. How do I order EPS dispensing tokens?

Primary Care Support England (PCSE) delivers various stationery for community pharmacies – including EPS dispensing tokens. Contractors are required to request tokens through PCSE’s online portal: pcse.england.nhs.uk/howtoorder

Q. I have used the PCSE portal to order EPS dispensing tokens, but still haven’t had confirmation of my order or an estimated delivery time. I am concerned the pharmacy is going to run out of tokens, what can I do?

First, check your junk mail folder to ensure that a response is not there; if you cannot find an email from PCSE, contact them on 0333 014 2884 to chase up the order.

Q. I have received a prescription for “30g Ibuprofen 10% gel” but only the 100g pack size of this product is listed in Part VIIIA. How much should I dispense and how much will I be reimbursed?

Part VIII of the Drug Tariff contains the basic NHS reimbursement prices for products prescribed generically. Where an item is in Part VIII, contractors are reimbursed based on the Part VIII price.

In this example, only one pack size is listed in the Tariff (100g pack). As this pack is classed as a special container, a pharmacy would be reimbursed, based on the Drug Tariff price, to the nearest number of 100g packs to the quantity ordered. For example, if 30g is ordered, the pharmacy will be reimbursed for a 100g pack, if 120g is ordered, the pharmacy will be reimbursed for a 100g pack.

From a legal perspective, contractors should “supply the special container or containers nearest to that ordered”. Ibuprofen 10% gel is available in a variety of pack sizes including 30g packs. Therefore, in this example, even though the contractor may be reimbursed for dispensing the 100g pack, the contractor should supply 30g as requested. To prevent any allegation of fraud, PSNC recommends that the prescription is clearly endorsed with the dispensed pack size.

Look out for more frequently asked questions next month…

If you would like more information on any of the topics covered, the team at PSNC will be happy to help (0203 1220 810 or e-mail info@psnc.org.uk). psnc.org.uk 9

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

All you need to know about: Discount deduction Our Dispensing and Supply Team explains how discount deduction is applied to NHS prescriptions and which products are eligible to be included in the ‘Discount Not Deducted’ list.

How does discount deduction work?

When community pharmacy contractors are reimbursed for the cost of medicines and appliances dispensed against NHS prescriptions, a deduction is made to their payments, known as ‘discount deduction’.

This is an assumed amount of discount received to avoid the additional workload of pharmacy teams being required to calculate and declare exact levels of discount received on each individual item dispensed.

The level of discount varies depending on the value of products dispensed by a pharmacy in a given month. Currently the average level of discount is around 8%.

It is possible to work out from the deduction scale in Part V of the Drug Tariff what the deduction rate will be for a given value of standard discount rate products dispensed (the value of zero discount rated products dispensed is not considered when calculating the discount rate).

Which products are eligible for DND list?

The ‘DND’ (‘Discount Not Deducted’) list, found in Part II of the Drug Tariff, contains products which are exempt from the discount deduction scale and is updated monthly by the Department of Health and Social Care (DHSC). To be included on the list a product must come under one of the following groups: Schedule 2 or 3 Controlled Drug*

The three criteria: products where all three of the following criteria apply • the manufacturer, AAH and Alliance do not offer a discount; and • fewer than 500,000 items per year are dispensed; and • average net ingredient cost (NIC) per item is more than £50.

The NIC per item is the average NIC per prescription dispensed and not the list price of the product. As the NIC is based on the quantity of the product dispensed, it is independent of product pack size. For new products, the DHSC will give consideration to whether the product may, in time, meet the criteria. *Please note items included under these group headings are not listed in the Drug Tariff individually.

How can I request that a product be added to the DND list?

To make a request for a product to be considered for the list, please contact the PSNC Dispensing and Supply Team via info@ psnc.org.uk. We will investigate whether the product meets the criteria and, if appropriate, make an application to the DHSC for the product to be listed.

HazChem*: Product covered by the Chemical (Hazard Information and Packaging for Supply) Regulations 2002. More information on the CHIP Regulations can be found on the Health and Safety Executive Website: www.hse.gov.uk/chemical-classification/ index.htm

Can I endorse ‘DND’ to claim exemption from discount deduction for unlicensed medicines?

Cytotoxic or cytostatic item*: Listed in section 8.2 of the British National Formulary (BNF).

Cold-chain storage item*: The products SPC (available at: emc. medicines.org.uk) must state that the product must be stored at 2 – 8°C prior to dispensing. Products which require cold-chain storage after reconstitution in the pharmacy are not eligible for the list.

All unlicensed medicines not listed in Part VIIIB where the product has been sourced from a supplier holding a MHRA specials or importers license are automatically eligible to be exempt from the discount deduction scale.

Please see the unlicensed specials and imports page for further information.

Unlicensed Specials*: which aren’t listed in Part VIIIB of the Drug Tariff.

Further information on discount deduction and the DND list is available from psnc.org.uk/dnd

10 Community Pharmacy News – February 2018

The DND endorsement is no longer in use as the exemption from discount deduction is now automatic. Any DND endorsement will be ignored upon processing.

LPCs

PSNC’s WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Drug Tariff Watch The Preface lists additions, deletions and alterations to the Drug Tariff. Below is a quick summary of the changes due to take place from 1st March 2018.

Part VIIIA additions Category A: • Fluoxetine 10mg tablets (30) • Nystatin 100,000units/g / Chlorhexidine acetate 1% / Hydrocortisone 1% ointment SC (30g) • Nystatin 100,000units/g / Chlorhexidine acetate 1% / Hydrocortisone 0.5% cream SC (30g) Category C: • Lanreotide 60mg/0.5ml solution for injection pre-filled syringes SC (1) – Somatuline Autogel • Lanreotide 90mg/0.5ml solution for injection pre-filled syringes SC (1) – Somatuline Autogel • Mesalazine 250mg gastro-resistant tablets (100) – Salofalk • Mesalazine 500mg gastro-resistant modified-release granules sachets sugar free (100) – Salofalk • Mesalazine 500mg gastro-resistant tablets (100) – Salofalk • Ranitidine 150mg/5ml oral solution sugar free (150ml) – Creo Pharma Ltd • Soya oil 84.75% bath oil (1000ml (2xSC500ml)) – Balneum • Soya oil 84.75% bath oil SC (500ml) – Balneum • *Tenoxicam 20mg tablets (30) – Mobiflex

• Terbutaline 2.5mg/5ml solution for injection ampoules (10) – Bricanyl • Terbutaline 500micrograms/1ml solution for injection ampoules (5) – Bricanyl Part VIIIA amendments Change of category/reference product: • Amiloride 5mg/5ml oral solution sugar free (150ml) – Amilamont is changing to Rosemont Pharmaceuticals Ltd • Colestyramine 4g oral powder sachets sugar free (50) is changing to Category C – Questran Light • Docusate 12.5mg/5ml oral solution sugar free (300ml) – Typharm Ltd is changing to Category A • Hydroxyzine 10mg tablets (84) – Atarax is changing to Category A • Hydroxyzine 25mg tablets (28) – Atarax is changing to Category A • Indometacin 100mg suppositories (10) is changing to Category C – Indocid • Liothyronine 20microgram tablets (28) AMCo is changing to Category A • Nystatin 100,000units/g / Chlorhexidine hydrochloride 1% cream SC (30g) Nystaform is changing Category A • Tamoxifen 10mg/5ml oral solution sugar free (150ml) – Soltamox is changing to Rosemont Pharmaceuticals Ltd

KEY: SC Special container R Item requiring reconstitution * This pack only (others already available)

Product name change: • Dorzolamide 2% / Timolol 0.5% eye drops SC (5ml) Category M is changing to Dorzolamide 20mg/ml / Timolol 5mg/ ml eye drops SC (5ml) Category M • Dorzolamide 2% / Timolol 0.5% eye drops 0.2ml unit dose preservative free (60 (4xSC15)) Category C – Cosopt is changing to Dorzolamide 20mg/ml / Timolol 5mg/ ml eye drops 0.2ml unit dose preservative free (60 (4xSC15)) Category C – Cosopt • Dorzolamide 2% eye drops SC (5ml) Category M is changing to Dorzolamide 20mg/ml eye drops SC (5ml) Category M • Dorzolamide 2% eye drops 0.2ml unit dose preservative free (60 (4xSC15)) – Trusopt is changing to Dorzolamide 20mg/ml eye drops 0.2ml unit dose preservative free (60 (4xSC15)) – Trusopt Part VIIIA deletions • Alprostadil 5microgram powder and solvent for solution for injection vials (1) – Category C Caverject • Carteolol 1% eye drops(5ml) – Category C Teoptic • Co-danthrusate 50mg/60mg capsules (63) – Category C Alliance Healthcare (Distribution) Ltd • *Tenoxicam 20mg tablets (28) – Category A

Part IX deletions Take careful note of removals from Part IX because if you dispense a deleted product, prescriptions will be returned as disallowed.

Product

Type, Size and Product Code

Foley Catheter – 2 Way For Long Term Use – Adult: Rüsch Brillant SilFlate All-Silicone with glycerine filled syringe for balloon inflation and empty syringe for balloon deflation

Male, 10ml, 12-24Ch (DG310112 - DG310124) and Female, 10ml, 1224Ch (DG210112 - DG210124)

Hyabak UD eye drops

30 x 0.4ml preservative free single dose unit

SurePress Comfort Pro Graduated Compression System (ConvaTec Ltd) (pack contains 1 stocking and 1 liner)

Size B - Ankle 20cm-22.5cm, calf 30.5cm-38cm

Medicina Ltd, Ace Dressing

Standard (SD01)

Oakmed Ltd, Oakmed Option PEG dressing for washout set

PEG 50-3, PEG 50-7, PEG 75-10 and PEG 75-15

Dansac Ltd, Dansac TRE Seals

50mm (82.5mm diameter), 071-50

Oakmed Ltd, Option Urostomy Bag, Clear with soft covering to one side

Clear, pre-cut - 16mm (GC1600C), 19mm (GC1900C), 22mm (GC2200C), 25mm (GC2500C), 32mm (GC3200C) and 38mm (GC3800C)

psnc.org.uk 11

PSNC’s WORK

FUNDING AND STATISTICS

CONTRACT AND IT

PSNC resources library In this section of Community Pharmacy News we have provided details of some of the resources that PSNC has produced this month.

PSNC Briefings PSNC Briefing 001/18: Upcoming clinical governance deadlines – actions to be completed by 31st March 2018 PSNC’s Regulations and Support Team is often asked questions about key actions and submission deadlines for the clinical governance aspects of the terms of service. Therefore, we have produced this briefing as a quick reference guide identifying the actions to be completed by 31 March 2018 (Section A). The briefing also includes details of ongoing clinical governance requirements (Section B).

Download from: ow.ly/cFfH30iekr4 PSNC Briefing 004/18: Dispensing & Supply Factsheet – Information on medicines supply for patients When community pharmacy teams struggle to source medicines, this can lead to queries from patients as to why there are delays. PSNC has therefore created this factsheet which provides some lines that could be used to explain the situation to patients.

Download from: ow.ly/uw3I30iekiI PSNC Briefing 006/18: Better managing Smartcards Smartcards are used by community pharmacy team members to access NHS IT systems such as the Electronic Prescription Service (EPS) and the Summary Care Record (SCR). In this factsheet, learn how you and your team can better manage your team’s Smartcard setup with support and the Care Identity Service (CIS).

Download from: ow.ly/iLhB30iekTZ See all our PSNC Briefings in our database at: psnc.org.uk/briefings

Other resources NHS England Primary Care Prescribing Guidance NHS England is currently holding a consultation on proposals to “rein in prescriptions” for a number of products that are available ‘over-the-counter’ (OTC). The intention is to produce consistent national guidance for CCGs to refer prescribers to. A page has been created on the PSNC website which outlines the proposals and plans for their implementation.

Visit now: ow.ly/2IYz30iemUm Look out for additional resources as you explore our website: psnc.org.uk

Email news alerts Stay well Pharmacy campaign: Resources hub launched (5th February) Announcing the launch of a resources hub to support community pharmacy teams to participate in the Stay Well campaign which will promote use of community pharmacies.

Read now: ow.ly/vVAk30iemLm Not receiving our emails? Sign up now at: psnc.org.uk/enews

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

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