July 2019 CPN

CPN

Community Pharmacy News – July 2019

Five-year funding settlement

PSNC, DHSC and NHSE&I agree to secure funding levels and expand clinical service delivery PSNC reflects on negotiations | EPS Phase 4 update and tips | Number of items factsheet

FUNDING AND STATISTICS

CONTRACT AND IT

DISPENSING AND SUPPLY

Funding negotiations result in five-year CPCF deal • Following negotiations between PSNC, DHSC and NHSE&I, HM Government has agreed to make a five-year investment in community pharmacies • The deal secures funding of £2.592bn per year for pharmacies (almost £13bn over the five years) – significantly more than original Government plans • The agreement sets out a clear vision for the expansion of clinical service delivery through pharmacies over the next five years, in line with the NHS Long Term Plan PSNC, the Department of Health and Social Care (DHSC) and NHS England and NHS Improvement (NHSE&I) have reached agreement on a five-year deal for community pharmacy.

The deal sets out what pharmacies will be expected to deliver through the Community Pharmacy Contractual Framework (CPCF) from October 2019 through to 2023/24.

It includes a clear vision for the piloting and introduction of new pharmacy services – such as the NHS Community Pharmacist Consultation Service (CPCS), being introduced ahead of this winter – over the course of the five years. This will bring pharmacy into a more integrated central role within primary care and it enables the sector to help to deliver the ambitions set out within the NHS Long Term Plan.

“

New settlement provides funding stability during a period of change for community pharmacy

Crucially, following strong representations from PSNC about rising costs for pharmacies, the deal secures funding for five years over this period of change. The deal will be reviewed on an annual basis, with detailed discussions on implementation and funding of new services each autumn.

This funding – which amounts to almost £13bn over the five years – is a significant increase on the Government’s planned funding level.

PSNC agreed to the deal following lengthy and difficult negotiations, recognising that while many community pharmacies are facing severe financial pressures, the deal puts the sector on a clear future path.

The deal provides pharmacy with opportunities to transform and prove our value; protected funding despite

”

widespread Government austerity measures; opportunities to explore new funding models and to improve the delivery of funding to contractors; the chance to pilot and roll out new services; opportunities to look for new ways to make efficiencies and to further integrate within primary care; and, importantly, a new collaborative relationship with our key customers.

The proposals constitute a fundamental and challenging ‘change of ask’ for community pharmacy, but successful delivery will further benefit the NHS and the hundreds of thousands of people who visit and are helped by community pharmacies on a daily basis.

Discussions about services and funding for introduction from October 2019 are being accelerated and further information will be made available for contractors as soon as possible.

PSNC launches CPCF Roadshow event schedule PSNC will be holding a series of Sunday roadshow events for community pharmacists across England. The events will take place throughout the autumn, hosted by PSNC Chief Executive Simon Dukes and his team.

The events are being held to help community pharmacy contractors and anyone working in community pharmacies to understand the new five-year deal on the Community Pharmacy Contractual Framework (CPCF).

Members of PSNC’s Negotiating Team will explain the context of the deal and what it means for pharmacies, and there will be lots of opportunity to share views and ask questions of the team. The events are an opportunity to explore what the future holds for your pharmacy; to help prepare yourself and your team for that; and to hold PSNC to account for the decisions it has made.

The events will cover: • Understanding the five-year deal and what

it means for your pharmacy • Why PSNC agreed to the deal, with the chance to ask questions of the Negotiating Team • Preparations for the introduction of the new Community Pharmacist Consultation Service • The Pharmacy Quality Scheme • Understanding how pharmacies need to start preparing for the future • The wider NHS context and your new local health and care structures

Roadshow dates and locations 25th August AM – Darlington PM – Doncaster

1st September AM – Reigate PM – Bicester

8th September AM – Southampton PM – Bristol

15th September AM – Ipswich PM – Peterborough

22nd September London Euston

Although events are free to attend, we ask that you register in advance via ow.ly/5iKJ50vgURl

2 Community Pharmacy News – July 2019

29th September AM – Walsall PM – Worsley

SER

RVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCS

PSNC’S WORK

Category M prices to increase from August • Category M reimbursement prices to increase by £15m a month • This will help to ensure that the overall margin delivered in this financial year is £800m and should help to ease immediate contractor cashflow issues • Single Activity Fee to increase by 1p per item • PSNC continues to seek improvements to funding and margin distribution mechanisms After discussions with PSNC, Category M reimbursement prices will increase by £15 million a month from August 2019, the Department of Health and Social Care (DHSC) has confirmed.

This is to correct a predicted shortfall in the margin delivery rate for the current financial year and it will be reviewed in the autumn.

At the same time, the Single Activity Fee (SAF) will rise by 1p to £1.27 per item from August to ensure delivery of the correct amount of funding to contractors this year.

The Category M price increases will help to ensure that the overall amount of margin delivered in this financial year is the agreed annual sum of £800m.

For the past year the margin delivery rate

has had to be set lower than £800m as DHSC sought to recover sums owing from the over-delivery of margin in previous years.

Although Category M prices increased in April 2019, April reimbursement levels were lower than anticipated. This appears to have been driven by movement in the drug mix in April, which means that contractors have not seen the positive cash flow impact that would have been expected.

The margin recovery process has affected contractors’ cashflow and PSNC remains very concerned about the difficult financial position many contractors find themselves in. PSNC has highlighted this to DHSC and NHS England & Improvement and we will continue to work with them to try to smooth the delivery of margin to contractors going forwards.

Consultation on drug reimbursement reforms The Department of Health and Social Care (DHSC) has opened a public consultation seeking views on a series of reimbursement reforms for community pharmacy.

In line with the five-year deal on the Community Pharmacy Contractual Framework (CPCF), this consultation is the first step in improving reimbursement arrangements.

PSNC’s intention is to work on changes that will deliver smoother cash flow and fairer distribution of margin.

Proposed reforms include: • Changing how Drug Tariff Category A, C and M prices are set; • Including more products prescribed for medicinal purposes (such as food supplements) in Part VIIIA of the Drug Tariff; • Changing to the arrangements for reimbursing and procuring unlicensed medicines; • Using the manufacturer’s (rather than supplier’s) list price for reimbursing non-Part VIIIA products; and • Splitting the discount deduction scale into one for generics and one for brands.

View the consultation documents: ow.ly/2ws130pcs1Z The public consultation runs until 17th September 2019, after which DHSC and NHS England and Improvement will discuss the findings and next steps with PSNC. We will publish a draft response shortly to help inform LPC and contractor submissions.

The August price increases should bring at least some relief to contractors, but we will continue to monitor delivery of margin and to press for improvements to funding delivery to try to avoid similar cashflow issues recurring in the future.

Simon Dukes, PSNC Chief Executive, said: “Recent months have been incredibly difficult for contractors, and this has in part been caused by the need to keep Category M reimbursement prices low following excess margins earned in previous years. These August price increases are being made to try to correct margin delivery for this financial year and this should bring some relief for contractors. We are pressing for improvements to the funding and margin distribution systems to avoid this sort of scenario in the future.”

Prevention paper promotes pharmacy The government has published a consultation paper on prevention, ‘Advancing our health: prevention in the 2020s’, which outlines policy ideas to help prevent and detect ill-health at an earlier stage.

As well as proposing a series of measures to help tackle future health needs, the paper also highlights the opportunity for community pharmacy to deliver a wider range of prevention services through the five-year Community Pharmacy Contractual Framework (CPCF).

The consultation includes a question about community pharmacy, where it encourages respondents to offer examples for services or advice that could be delivered by community pharmacies to promote health. Find out more at: ow.ly/6eVv50vbt2b

psnc.org.uk 3

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Chief Executive’s blog This month PSNC Chief Executive Simon Dukes reflects on the Community Pharmacy Contractual Framework (CPCF) negotiations. have already entered); the possibility of retribution from DHSC and NHSE&I if we walked away which almost certainly would have been a cut to the overall sum; and the potential and opportunity for community pharmacy presented by some of the services in the NHS pipeline.

Simon Dukes

PSNC Chief Executive I always believed that a multi-year settlement was essential to provide a period of stability and certainty for community pharmacies and to allow the sector reform itself. This five-year deal delivers that, but make no mistake: neither I nor the PSNC Negotiating Team set-out for a flat cash settlement of £2.592bn.

Quite the opposite. We pushed very hard for an uplift in the overall sum to recognise the rising cost base contractors have experienced over the past two years.

We will continue to do this over the next four years, especially with the backdrop of ‘change’ and the range of new services that contractors will have to perform.

But negotiation is the art of the compromise and we had to weigh-up all the factors around us: the period of political and economic uncertainty we are about to enter (some might say we

What also became clear to us was the fact that NHS funding had been set by HM Treasury to deliver the Long Term Plan and there was no more money on offer for community pharmacy right now. A shorter deal (say, two years) would have served only to give contractors false hope that ‘Year Three’ would be better. This I believe would have been irresponsible: in all likelihood the DHSC and NHSE&I negotiating position for Year 3 would have started at below the £2.592bn, and we would have had to try to claw our way to where we currently are.

Principally PSNC agreed this deal because of the need to secure for contractors a baseline sum for as long as possible and to protect that from the grasping hands of the Exchequer. We insisted on an in-built annual review of costs and capacity, service volumes, pharmacy income and sector stress which will allow us every year to provide evidence and a business case for further investment. This is not the deal we wanted – but I truly believe it is the best we could have got in the circumstances.

Some people have contacted me to say

Information and resources for contractors PSNC Briefing 026/19 – a briefing summarising the deal for the future of the CPCF. CPCF service development grid – a matrix document setting out when each of the agreed CPCF service development pilots may be implemented during the five-year deal.

PSNC Briefing 027/19 – a briefing that answers key questions about the future of the CPCF and the negotiations for contractors.

PSNC Briefing 028/19 – a briefing on the deal and pharmacy funding.

PSNC Briefing 029/19 – a briefing that summarises key information on the Pharmacy Quality Scheme (formerly QPS) for 2019/20.

Five-Year Deal on CPCF webinar – an on-demand recording of our contractor webinar.

All of the above, plus much more, can be found at: psnc.org.uk/5yearCPCF

4 Community Pharmacy News – July 2019

that they have been surprised about the speed at which negotiations concluded and expressed frustration at the lack of detail currently available on crucial topics such as the Pharmacy Quality Scheme (PQS). One of the political ‘uncertainties’ I referred to was an incoming Brexit-focused new Prime Minister who would (and indeed did) have a significant reshuffle of Ministers. We had already suffered from Brexit-related delays in our negotiations in the lead-up to the then Brexit deadline of 29th March. Had we failed to make this agreement when we did, we faced the likelihood of a further delay and the possibility of new Ministers being even less sympathetic to the sector.

The deal we have announced does lack some detail, but it gives those working in community pharmacy a clear sense of the direction of travel; something that we have not always been privy to in the past. But please be assured that we are working flat-out to finalise details on those elements due to be introduced from October 2019 and we will share that information as soon as possible.

This deal and the services outlined within it will enable the sector to transform its offer to the NHS. Importantly, the deal will better integrate the sector at the heart of primary care: giving community pharmacy a growing and indispensable part to play in delivering the NHS Long Term Plan, and with it, the leverage we need for future negotiations.

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCS

PSNC Statements Members of the PSNC Committee comment on the five-year deal on the Community Pharmacy Contractual Framework (CPCF).

Gary Warner, Chair of PSNC’s Service Development Subcommittee and independent community pharmacy contractor, said: “The introduction of the new NHS Community Pharmacist Consultation Service (CPCS) should be an exciting development for community pharmacies across England. Although delivery will bring big challenges – not least from the unpredictability of the workload, and the increasingly important role we will be taking on in managing patients and triaging for more serious conditions – the service is a positive development in our journey towards becoming providers of more clinical services.

PSNC is already consulting with colleagues from across the community pharmacy sector to try to ensure that the right support is in place for contractors.

Further details and guidance are rapidly being worked out and will be shared with contractors as soon as possible.

Recognising the challenge in preparing for the new service in the already short and busy autumn period, the funding structure agreed offers a significant incentive for those pharmacies who are able to be ready to offer it.

Over time, and particularly when referrals from GP practices are introduced in April 2020, the service will enable us to take the lead role in managing people with minor conditions on behalf of the NHS. Crucially, this will give us a core clinical role at the heart of primary care, with GPs and other services relying on pharmacies and sending their patients directly to us.

As we prove our abilities, we will become more vital than ever to the success of the health service and to patients, and PSNC will be using our success to make a business case for further investment in the service and the sector in future years.”

Bharat Patel, PSNC Vice-Chair and independent community pharmacy contractor, said: “Our priority in negotiating this settlement has been, as it always is, to get the best possible financial outcome for all community pharmacy contractors while also meeting the needs of patients and our customers, the NHS and HM Government. This will be an ongoing job as we work through the detail of some of the later service developments and monitor the delivery of funding; and we must also continue to look outside of the CPCF to ensure that community pharmacy is making the most of local opportunities and that the Pharmacy Integration Fund is used to its maximum potential.

As a pharmacy owner and Regional Representative on PSNC, I am very concerned about the precarious situation that many independent contractors now find themselves in. For some, this pressure is unlikely to go away as we work to take on new services and challenges, and as is inevitable with any national contract of this scale, significant changes can mean that some contractors stand to benefit more than others. Our priority through our work on legislative change will be to ensure that all pharmacies, whatever part of the sector they fall into, will be able to take advantage of changes that help to make them more efficient, and to consider new ways forward such as local consolidations and partnerships to work within Primary Care Networks.

I hope that this deal will give all pharmacy owners certainty about what the future holds for our sector so that they can start to plan and to make more informed business choices. I am also hopeful about the Government’s commitment to work with us to try to smooth the delivery of funding.”

Clare Kerr, PSNC Negotiating Team Member and Head of Healthcare Policy for McKesson UK, said: “As a member of PSNC’s Service Development Subcommittee, I was pleased that we have been able to agree with Government, a collective view for the development of community pharmacy services, noting how closely this matches the vision we had set out for ourselves as a sector in the Community Pharmacy Forward View.

Pharmacies becoming healthy living centres, as well as being the first port of call for people with minor illnesses, are changes that we have been calling for, for some years. It is clear that we and our customer now agree on our future and potential, and this should be celebrated: the move towards a more clinical service offering is one that I hope many contractors from independents and multiples alike will want to embrace.

The challenge of course will be how to operationalise all of this, and this will be particularly difficult within a fixed funding settlement and with so many other changes and unknowns – from the possibility of Serious Shortage Protocols to the likelihood of another difficult winter – going on. The decommissioning of MURs, and the predictability of the income that they brought, will of course be another challenge and disappointing to many, but the NHS was very clear on this matter: it will not fund services that it believes offer poor value for money.

Our collective job then must be to do all that we can to prove the value of the new services that we are being asked to offer. I would urge all contractors, large and small, to look to one another to start this important work so that we, as a sector, ensure that we are making all the progress we need to a local level.”

psnc.org.uk 5

PSNC’S WORK

PHE blog promotes pharmacy Gul Root, lead public health pharmacist at Public Health England (PHE), has written a blog outlining how community pharmacy teams are contributing to the public health agenda and how this could be further enhanced.

The blog explores community pharmacy’s role in prevention through opportunistic interventions and commissioned public health services, as well as highlighting pharmacy’s accessibility and the unique way in which community pharmacy is interwoven with people’s daily lives.

Read the blog at: ow.ly/NL3k30p6c4ht

Opportunity to join advisory committee The National Institute for Health and Care Excellence (NICE) is seeking a community pharmacist or a community pharmacy technician to join the quality standards advisory committee as a topic expert looking at community pharmacy: promoting health and wellbeing.

All specialist committee members need to attend two committee meetings, provide information on quality improvement areas at the topic engagement stage, undertake background reading and provide comment on draft versions of the quality standard during its development.

Find out more at: ow.ly/bUb850vgohv

2020 Early May Bank Holiday The Government announced last month that it is pushing back next year’s Early May Bank Holiday by a few days to Friday 8th May 2020.

In practice this means that next year community pharmacies must open on 4th May 2020 for their usual Monday opening hours, but are permitted to be closed on Friday 8th May without giving notice or applying to change their core hours.

PSNC’s annual opening hours factsheet provides contractors with a quick reference guide on which public and bank holidays pharmacies can close without giving notice. Our 2020 factsheet has just been published at: ow.ly/ht5J30pbVxC

6 Community Pharmacy News – July 2019

FUNDING AND STATISTICS

CONTRACT AND IT

PSNC appoints Sue Killen as new chair New chair for the PSNC Committee, with experience of healthcare whilst working in the civil service, to start in September 2019.

Sue Killen has been appointed as non-executive Chair of PSNC. Sue brings a wealth of experience from working in government and the third sector and will take up the post at PSNC on 1st September 2019. She replaces Sir Michael Pitt who will complete four years as Chair at the end of August.

Sue previously worked as Chief Executive of first-aid charity St John Ambulance for ten years and she is also a former interim Chief Executive and registrar of the Nursing and Midwifery Council. She is currently Vice Chair of the UK’s largest social housing association, Clarion; Chair of its charitable foundation and Chair of the Katie Piper Foundation.

Sue was formerly a Director General in the Civil Service. During a long Civil Service career she worked in a wide range of roles including leading an independent review of children’s palliative care and tackling the impact of drug misuse. She has held a range of Non-Executive Director and Trustee roles over the last 20 years.

Sue’s role at PSNC will include chairing all PSNC meetings; overseeing the governance of PSNC and championing and building strategic support for community pharmacy.

Sue Killen said: “I am delighted to take on this role at such an important time for the future of community pharmacy. I know from my previous roles what an essential role pharmacists play in community health. I believe strongly that the NHS Long Term Plan provides an opportunity to develop this further and to secure greater recognition for the vital role community pharmacists play.”

PSNC Chief Executive, Simon Dukes, said: “It is a pleasure to welcome Sue Killen to PSNC and we are looking forward to drawing on her wealth of experience and skills to help us in our work. Sue will undoubtedly prove a key asset as we work to promote community pharmacy to policy makers and to guide the sector through the potentially radical changes ahead. We would also like to thank Sir Mike Pitt for all his work on behalf of PSNC and community pharmacies over the past four years, helping to steer the Committee through some particularly challenging times.”

Prescription Audit Centre Relocation PSNC’s Prescription Audit Centre (PAC) has moved offices. From now on the PAC team will be based in PSNC’s main office and all correspondence for them should be sent to: PSNC Prescription Audit Centre, 14 Hosier Lane, London, EC1A 9LQ. The PAC team conducts independent checks to verify the accuracy of the pricing of prescriptions by the NHS Business Services Authority (NHSBSA).

Given the growth and prevalence of electronic prescriptions in recent years, the team has been reorganised and this included relocating them from Enfield to the main PSNC site in central London.

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCS

EPS Phase 4 update

Improved access to shared NHSmail accounts

As more GP practices begin piloting EPS Phase 4, PSNC has compiled a set of top tips to support community pharmacy teams.

Pharmacy teams can now have up to 10 individual NHSmail accounts for staff members, which can then be used to access their pharmacy’s shared NHSmail address.

“

Top tips on dispensing EPS Phase 4 tokens when they come to your pharmacy

”

The NHS Digital pilot of EPS Phase 4 is continuing, and all pharmacy staff need to be aware that they could receive a paper EPS Phase 4 token from a patient to process.

Around 60 GP practices are now able to use EPS for patients without an EPS nomination: patients will be given a paper Phase 4 token with a scannable barcode instead of a signed paper prescription.

Although the GP pilot sites are in specific areas, patients can choose to take their token to any pharmacy in England. As with all EPS prescriptions, dispense notifications and endorsements need to be added to the electronic prescription using your pharmacy system. Endorsements written or printed onto any type of EPS token will not be processed by the NHS Business Services Authority (NHSBSA).

If the pilot is determined a success, EPS Phase 4 will be deployed to further sites – potentially during Autumn 2019. Further announcements about wider roll-out will be made in due course.

Phase 4 top tips for pharmacy teams • If you receive a Phase 4 token, you should scan the barcode and dispense it as you would any other electronic prescription.

• Use the green Phase 4 prescription tokens to capture any patient exemption-related or charge-related signatures.

• It may help to use a highlighter pen to pick out the ‘Prescriber signature not required’ wording on the token so that it is not confused with a barcoded paper prescription.

• Green Phase 4 tokens should be filed with the other white EPS tokens and not in the main bundle of paper prescriptions submitted to the NHS Business Services Authority (NHSBSA).

• Consider your system and print settings: many PMR systems have settings to customise which types of electronic prescription automatically print a white EPS dispensing token.

• If a patient fills in the back of the green Phase 4 token before they arrive at the pharmacy, it may be simpler to use the green Phase 4 token for patient declarations, rather than printing out a new white EPS dispensing token.

Providing feedback If you have an EPS Phase 4 issue that requires reporting, you can use the usual escalation routes (see psnc.org.uk/reportEPS) to do this. If you have any questions or comments on EPS Phase 4, please contact PSNC’s Community Pharmacy IT Lead, Daniel Ah-Thion: da@psnc.org.uk

Previously pharmacies were limited to just three individual staff accounts as standard, unless they specifically requested additional accounts from NHS England and NHS Improvement.

This change was included in a list of suggested NHSmail improvements compiled by the Community Pharmacy IT Group.

Find out more at: ow.ly/cexV50uTWuI

SCR 1-click feature Pharmacists and technicians can now access vital patient information quickly through a new Summary Care Record (SCR) 1-click feature that is available in the PharmOutcomes and Sonar systems.

The 1-click function allows pharmacy professionals logged in with their Smartcard to click straight through to a selected patient’s SCR whilst using PharmOutcomes or Sonar, without having to log in separately and complete a manual search by entering an NHS number.

Learn more at: ow.ly/OviQ50uTW2k

Pharmacy staff training survey The General Pharmaceutical Council (GPhC) is seeking views on its draft education and training requirements for pharmacy support staff, who are an integral part of the pharmacy team.

The GPhC has updated its requirements for the education and training of support staff to make sure they continue to have the necessary knowledge, attitudes and behaviours to provide safe and effective care to people using pharmacy services.

Find details of the survey, open until 20th August 2019, at: ow.ly/QbY930p6cb3

psnc.org.uk 7

DISPENSING AND SUPPLY

Retrospective price adjustment Retrospective Drug Tariff adjustments The Department of Health and Social Care (DHSC) has retrospectively determined the following adjustments to the Drug Tariff.

From 1st July, Melatonin 1mg/1ml oral solution sugar free (150ml) has been added to Part VIIIA of the Drug Tariff as a Category C line based on Colonis Pharma. It follows that Melatonin 5mg/5ml oral solution and Melatonin 5mg/5ml oral suspension have been deleted from Part VIIIB. For June 2019, Telmisartan 80mg/ Hydrochlorothiazide 12.5mg tablets (28 pack) will be reimbursed at £16.79 (instead of £16.72).

Between April and June 2019, Glyceryl trinitrate 400micrograms/dose aerosol sublingual spray (180 dose) will be reimbursed at £3.43 (instead of £3.37).

Serious Shortage Protocols webinar PSNC recently held a webinar about the new legislation for Serious Shortage Protocols (SSPs).

During the webinar, our presenters explained what an SSP is, clarified situations when they may be used, described what they may involve, and talked through the decisions you may need to make when one is in place. We also outlined the endorsement and claiming process.

View the webinar now at: psnc.org.uk/SSPwebinar

Flu vaccination supply update Public Health England, NHS England and NHS Improvement have issued a letter to general practices and community pharmacy contractors regarding a delay in the supply of quadrivalent flu vaccines (see ow.ly/crmm30pbX3B).

Contractors are therefore advised, if they have placed an order for quadrivalent influenza vaccines, to contact the relevant manufacturer or supplier to confirm delivery dates in order to plan effectively for the season.

8 Community Pharmacy News – July 2019

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

Real-time Exemption Checking pilot Digital system has enabled community pharmacy contractors to confirm the prescription charge exemption status for more than 3,700 patients so far.

“

New electronic method of checking prescription charge exemptions being trialled

”

Four community pharmacy contractors have been piloting Real-time Exemption Checking (RTEC) since February 2019.

Those teams can now digitally check whether patients are eligible for free prescriptions (because they hold specific exemptions) using the new RTEC system.

NHS Digital worked with the NHS Business Services Authority (NHSBSA) and Positive Solutions to develop the RTEC system.

More than 3,700 patients were confirmed as exempt during the opening stage of the pilot, meaning those patients did not have to be asked whether they pay for prescriptions or to sign a declaration.

PSNC believes there will be clear benefits to pharmacy teams and patients when RTEC is more widely rolled out, reducing the burden of the current prescription charge exemption system which pharmacy contractors are required to operate.

Initially, those pharmacy teams that use the Positive Solutions Analyst pharmacy system will be able to use RTEC. Other pharmacy system suppliers are working with NHS Digital to introduce the RTEC feature in their software.

Further announcements will be made in due course, once roll-out timings are confirmed for those pharmacy contractors using the Positive Solutions system.

Roll-out plans The RTEC system is being rolled out in phases: Phase One: Maternity, medical, pre-payment, low income scheme and HMRC exemptions.

Phase Two: All Department for Work and Pensions (DWP) exemptions, including Universal Credit.

Once the first two phases are complete, NHS Digital plans to conduct a prioritisation and costing exercise to explore the possibility of including the Education and Ministry of Defence exemptions in the system.

LPCS

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Number of items – getting your declaration right This factsheet outlines the importance of accurately counting up and declaring the correct number of items on your pharmacy’s FP34C submission document.

The declared item totals on your FP34C submission document are used to calculate your pharmacy’s Advance payment. Incorrect figures could therefore have an impact on cashflow. This makes completing the FP34C submission document accurately an important job.

The key point to be aware of is that:

Total number of items declared on FP34C* = total number of Single Activity Fees (SAF) calculated *Note, the total number of items declared is not the physical count of each individual item on a prescription, it is the total number of fees attracted by all items.

What is the box in the bottom left-hand corner of a paper prescription used for?

The box in the bottom left-hand corner of paper prescriptions is used for recording the total number of fees for all items supplied on the prescription. Using this box will make counting item totals for end of month submission easier and go some way to ensure the completion of the FP34C submission document is accurate. Please note this figure is for pharmacy use only and is not used by the NHS Business Service Authority (NHSBSA) for processing prescriptions.

Calculating your item totals for declaration 6 different flavours in the Fortisip Compact Starter Pack = 6 items 2 different types of patches in Evorel Sequi = 2 items 2 different types of tablets in Migraleve = 2 items

This prescription attracts a total of 10 fees (SAFs) although there are 3 separate products dispensed on this prescription, the total number of items to declare would be 10 (6+2+2)

PSNC’s Top Tips • Ensure FP34C declarations are accurate and clearly written.

• For both paper and electronic prescriptions, the number of items declared should take into consideration any additional fees due (e.g. if an HRT product attracts 3 fees, it should be counted as 3 items).

• Carefully endorse and count up the correct number of fees claimed on FP10MDA instalment forms (see psnc.org.uk/mda to find out more).

• Use your PMR system to generate a report showing the correct number of EPS and paper items to declare on your FP34C (do not use tokens to calculate EPS item totals).

• Remember to add your paper and EPS figures together and declare the combined total on your paper FP34C. • Manage Your Service (MYS) offers an online alternative to the paper-based process. Currently in the pilot phase, MYS enables pharmacy teams to submit their FP34C submission document digitally to NHSBSA. The digital monthly submission application asks for your paper, EPS, forms and item totals separately. Validation has been built into the entry fields to help improve the accuracy of your submission.

psnc.org.uk 9

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

EPS totals and submission When making your declaration it is important to consider your EPS submissions. The timing of the EPS five-day window will determine which dispensing month your EPS prescription is submitted in and counted for payment. This is based on the timing of the submission of your Dispense Notification (DN) message and your Claim Notification (CN) message.

When a DN is sent before midnight on the last day of the dispensing calendar month, the CN must be received by the NHSBSA before midnight on the 5th of the following month to be counted towards the total items for the actual dispensing month. However, if the CN is submitted later than the 5th of the following month, the item will NOT be counted towards the actual dispensing month.

Remember: Always use your PMR system report to get your EPS figures. Do not declare EPS item totals by counting dispensing tokens.

How to determine item numbers When totalling your prescription forms and items, there are a number of things to consider and helpful tools available to assist you in completing your declaration correctly: The Dictionary of Medicines and Devices (dm+d) – dm+d can be used to view the number of Dispensing Fees (items) that a product attracts. Access dm+d: https://apps.nhsbsa.nhs.uk/DMDBrowser/DMDBrowser.do Part XVI 12. Of the Drug Tariff – this section includes examples of items which attract multiple fees and prescription charges. Access the Drug Tariff online using psnc.org.uk/dt Your PMR system – your dispensing system should automatically calculate the total number of fees linked to each prescription.

This table contains items that attract multiple fees: Number of item fees

Item

Pack content

Nutricrem Starter Pack dessert ‘Starter pack’ could indicate the pack contains multiple flavours attracting multiple fees.

1xN utricrem dessert mint chocolate 125g 4 1xN utricrem dessert vanilla 125g 1xN utricrem dessert strawberry 125g 1xN utricrem dessert chocolate orange 125g 30 x T ritace 5mg tablets 3 10 x T ritace 2.5mg tablets 10 x T ritace 10mg tablets 6xF emSeven Sequi 50micrograms/24hours Phase 1 patches 2 6xF emSeven Sequi Phase 2 patches

Tritace titration pack tablets The presence of the word ‘titration’ may indicate the pack contains multiple strengths.

FemSeven Sequi patches ‘Sequi’ could indicate this pack is a continuous treatment pack and may contain more than one component.

Actonel Combi 35mg tablets and 1000mg/880unit effervescent granules sachets The word ‘Combi’ here indicates this is a combination pack which could attract multiple fees.

Sandostatin LAR 20mg powder and solvent for suspension for injection vials Products that contain two components (in this case the powder and solvent for injection) often attract multiple fees.

1xA ctonel 35mg tablet 6xC olecalciferol 880unit / Calcium carbonate 2.5g effervescent granules sachets

2

Powder and Solvent for suspension for injection vials

2

Useful PSNC Resources • See our Prescription Submission Factsheet for guidance on the endorsing and submission of prescriptions: psnc.org.uk/submissionfact • Refer to our factsheet Understanding the Single Activity Fee for information on what the Single Activity Fee is and for examples of items that are eligible for multiple fees: psnc.org.uk/SAFfactsheet • Read our factsheet Claiming for EPS prescriptions on time: psnc.org.uk/EPSclaimguide • See our Dispensing Factsheet: No Charge and Multi-Charge Items for information on items which incur either single multiple or no patient charges: psnc.org.uk/chargesfactsheet • See our page for guidance on using the NHS medicines database (dm+d) to view reimbursement information: psnc.org.uk/dmd

10 Community Pharmacy News – July 2019

LPCS

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Schedule of Payments webinar: Your questions answered Following PSNC’s Understanding your Schedule of Payments webinar in June, our Dispensing and Supply Team respond to some of the questions you posed.

Q. Why doesn’t the number of items on my PMR system report match the figure on my Schedule of Payments?

Q. How do I calculate VAT for the Flu Vaccination Advanced Service?

A. VAT is automatically added to the flu vaccines (reimbursement) and total drugs cost are claimed at the applicable rate.

A. This may be down to your EPS submission timing. Where a dispensed notification is sent before midnight on the last day of the dispensing calendar month, the claim notification must be received by the NHS Business Services Authority (NHSBSA) before midnight on the 5th of the following month to be counted towards the total items for the actual dispensing month.

It is important to note that where the claim notification is submitted later than the 5th of the following month, the item(s) will not be counted towards the actual dispensing month.

See our Claiming for EPS prescriptions on time factsheet: psnc.org.uk/EPSclaimguide

Q. Where can I find NUMSAS payment details on my Schedule of Payments?

A. Payments for pharmacies taking part in the NHS Urgent Medicines Supply Advanced Service (NUMSAS) appear on page 2 of the Schedule of Payments. Look under ‘Details of other amounts authorised’ and see the items listed as Urgent Medicine Reimbursement, Remuneration and Charges payments.

Q. Do I need to declare my staff hours on the FP34C submission document?

A. No. As of December 2016, pharmacy staff do not need to declare staff hours as this previously formed part of the practice payment which is no longer in effect for community pharmacies in England.

Q. How do pharmacies with LPS contracts differ in terms of what is displayed on the Schedule of Payments?

A. Fees for LPS pharmacies are omitted from the Schedule of Payments and paid by their local NHS England teams.

The payment will appear under details of local amounts authorised and is titled ‘Local Pharmaceutical Services’.

Useful links Watch the Understanding your Schedule of Payments webinar on-demand: psnc.org.uk/FP34webinar Read the factsheet: psnc.org.uk/FP34factsheet Visit the webpage: psnc.org.uk/FP34

If you would like more information on any of the topics covered, the PSNC Dispensing and Supply Team will be happy to help (0203 1220 810 or email info@psnc.org.uk). psnc.org.uk 11

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

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 August 2019.

Part VIIIA additions: Category A: • Pneumococcal polysaccharide vaccine solution for injection wv0.5ml vials (1) Category C: • Betamethasone valerate 2.25mg medicated plasters (4) – Betesil • Clozapine 100mg tablets (84) • Clozapine 200mg tablets (100) – Denzapine • Clozapine 25mg tablets (84) • Clozapine 50mg tablets (100) – Denzapine • Clozapine 50mg/ml oral suspension sugar free  (100ml) – Denzapine

• Etanercept 50mg/1ml solution for injection pre-filled disposable devices (4) • Guaifenesin 100mg/5ml / Pseudoephedrine 30mg/5ml oral solution (100ml) – Benylin Mucus Cough Plus Decongestant syrup • Hydrocortisone acetate 1% cream  (15g) – Hc45 Hydrocortisone • Levocarnitine 1g chewable tablets (10) – Carnitor • Lidocaine 200mg/10ml (2%) solution for injection ampoules (20) – Lidocaine MiniPlasco • Lidocaine 44mg/2.2ml (2%) / Adrenaline (base) 27.5micrograms/2.2ml (1 in 80,000)

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

solution for injection cartridges (50) – Lingospan Special • Mexiletine 167mg capsules (100) – Namuscla • Naphazoline 0.012% eye drops  (10ml) – Murine irritation & redness • Salicylic acid 40% medicated plasters  (8) – Scholl Corn Removal 40% plasters washproof • Salicylic acid 40% medicated plasters  (30) – Scholl Verucca Removal System For a full list of the upcoming Drug Tariff changes, including amendments, please visit: ow.ly/ePZN50vgViL

Part IX deletions Product

Size, product code

K Tech (layer #1) bandage K Tech Reduced (layer #1) bandage K Press (layer #2) bandage Askina Hydro dressing - Square

All sizes All sizes All sizes All sizes

Askina Biofilm Transparent dressing - Square Sutherland Lubricating Jelly (sterile until opened) Urinal Systems - Salts Healthcare OstoMart OstoFIX40 HydroAV Security Frames Dansac NovaLife TRE 1 colostomy bags

All sizes All sizes All products DWK40 3003-25, 3003-30, 3002-25, 3002-30, 3002-35, 3002-40, 300245, 3031-24, 3032-30, 3032-40, 3032-35 and 3031-40 3024-40, 3024-45, 3018-25, 3018-30, 3016-25, 3016-30, 302345 and 3042-40 All sizes All sizes X 70mm (27410) Pack of 50

Dansac NovaLife TRE 1 ileostomy bags Dansac NovaLife TRE 1 open convex ileostomy bag - Pre-cut Confidence Gold Convex ileostomy bag Conform 2 two piece ostomy system colostomy bag - Mini, Beige TrueTrack System testing strips

Notice of deletion BD Micro-Fine + Sterile, Single-Use lancets (Becton Dickinson) 0.20mm/33 gauge, 100 0.30mm/30 gauge, 200 have been flagged with a notice of deletion and are due to be deleted from Part IX of the October 2019 Drug Tariff.

To see the other appliances due to be deleted from the Drug Tariff in the coming months, please visit: psnc.org.uk/appliancedeletions

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

© PSNC