March 2015 CPN

CPN

Community Pharmacy News – March 2015

Exemptions explained Check you’re not missing out with our EPS and exemption status checking factsheets

Resources round-up | ESPs in Parliament | Public health role backed | Ask PSNC

the healthcare landscape

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psnc’s work

MPs highlight importance of pharmacy in Westminster debates Over the past month MPs have discussed a variety of pharmacy issues including the future of the New Medicine Service; support for Essential Small Pharmacies; and the support the sector needs from any new government.

MPs have been discussing the value of community pharmacy in the past month, highlighting medicine review services, seasonal influenza vaccinations and healthy living advice in a debate in Westminster Hall.

support public health initiatives.

The debate was hosted by Caroline Nokes, MP for Romsey and Southampton North, who wanted to raise the uncertainty of funding for Essential Small Pharmacies (ESPs) going forward. As part of her opening statements, she told her fellow MPs how pharmacists “use their clinical expertise and practical knowledge to ensure that medicines are safely supplied to and used by the public”, as well as the work they do through local services such as smoking cessation.

One major contributor to the discussion was All-Party Pharmacy Group (APPG) Chair Kevin Barron who spoke at length about potential future development for community pharmacy services. Sir Kevin explained pharmacies are “the most accessible health care locations in the country” with many open outside of usual GP practice opening hours therefore having the capacity to reduce pressure on the rest of the NHS by being used as “the first port of call for health advice to help people to manage their health and wellbeing”. Sir Kevin also drew attention to the London flu vaccination scheme and called for other areas of the country to follow their example.

Alongside the ESP scheme debate, a wider discussion emerged on the pivotal role of pharmacies in their communities and the potential they have to do more. Whilst some MPs like Andrew Stephenson (MP for Pendle) suggested expanding their work in the field of supporting patients living with long-term conditions, others saw a larger role for pharmacy teams to

Also this month the APPG hosted a discussion on the future of the New Medicine Service (NMS), concluding that the service should be extended to include a wider range of conditions and patients; and it launched a plan of action for the next government to take to help community pharmacy to meet its full potential. In this the group gave five key

targets to be met by whoever forms the next UK government: 1. Consistent access to a wider range of health services from pharmacies; 2. Ensure local commissioners make best use of pharmacy in all communities; 3. Strengthen integration between pharmacy teams and other providers in primary and secondary care; 4. Decriminalise dispensing errors; and 5. Safeguard patient safety by making avoidable medicines shortages ‘never events’.

Essential Small Pharmacy (ESP) arrangements: FAQs Q. What is happening with ESPs? A. The essential small pharmacy (ESP) arrangements have existed for many years, providing modest financial support for small pharmacies in areas where they are needed for patients, but where the level of business is otherwise too low for a pharmacy to be viable. PSNC estimates that there are no more than 100 such pharmacies in England. The national contract for these pharmacies was first introduced in 2006, and has been extended following negotiations by PSNC a number of times since then.

However, following the NHS reforms NHS

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England confirmed last autumn that it would not be possible to continue national arrangements and that pharmacies must negotiate local arrangements with NHS England.

Q. So what is the situation now?

A. Many of these pharmacies have been in discussion with NHS England for some time now trying to negotiate alternative arrangements. This may involve agreeing to receive additional payments under LPS contracts or through payments for additional services commissioned from the pharmacy where they have chosen to

return to the pharmaceutical list. With just a few weeks until the nationally agreed financial support available for ESPs comes to an end on the 31st March 2015, PSNC is very concerned that in some areas NHS England teams have still not been able to provide clarity on this matter. We have recently, once again, escalated the issue within NHS England.

PSNC has been pleased to hear that some ESPs have received outline agreements to proceed with developing their LPS contracts, and we have issued advice to those contractors about the contracts and some of their implications.

funding and statistics

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dispensing and supply

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Important updates: IG business continuity and the clinical audit PSNC has issued a number of important updates in recent weeks. Here we summarise the announcements on business continuity requirements and the national audit.

Business continuity exemption granted NHS England has this month confirmed that community pharmacies will be granted an exemption from the business continuity requirements within the Information Governance (IG) Toolkit. The exemption will apply for 2014/15, but not for next year.

PSNC had been pressing for this exemption and hopes it will now be more straightforward for pharmacies to meet their IG requirements this year.

Contractors will recall that the deadline for completion of the IG Toolkit for 2014/15 is 31st March 2015. Contractors will still need to complete the rest of the Toolkit by this deadline. PSNC has produced guidance on completion of the Toolkit which is available at psnc.org.uk/ig. This includes frequently asked questions and a template business continuity plan which contractors may like to use in spite of the exemption in line with good business practice.

National clinical audit update As CPN went to press, NHS England had not published the paperwork for the national clinical audit on the emergency supply of medicines.

MAS commissioned

76 indications per service

77% of services commissioned by CCGs

29 services can be delivered by support staff

Please look out for further updates on the clinical audit at psnc.org.uk

Minor ailments services in England

62% of LPCs have a 16

The first audit period was due to begin on the morning of Monday 9th March but the delay in the publication of the paperwork made this impossible. PSNC advised the NHS that the audit due to begin on March 9th could not go ahead.

services in England

13 services with PGDs associated *all figures taken from PSNC survey of LPCs 2015

Q. What has PSNC done about it?

A. PSNC agrees with the principle of providing modest support to ESPs, many of which provide vital healthcare to the isolated communities they serve. PSNC first pressed for a new national arrangement to be found in spring 2014 and has remained in dialogue with NHS England since then. PSNC has also offered, and continues to offer, a range of support to the contractors affected to help them in their local negotiations.

PSNC recognises that this is a very worrying time for ESP contractors; we remain in regular contact with many of

Almost two thirds of LPCs have at least one Minor Ailments Service (MAS) commissioned in their region, a PSNC survey has found. The services are commissioned mostly by CCGs, with some NHS England teams also commissioning, and they cover a wide range of indications, with the top five being vaginal thrush, hay fever, sore throat, diarrhoea and threadworms.

PSNC has produced a briefing to help LPCs looking to get similar services commissioned or to review existing services (PSNC Briefing 006/15) and we continue to make the case for a national MAS.

Q. So what happens now?

A. PSNC will remain in close dialogue with ESP contractors throughout their negotiations.

We will help to share experiences about how other contractors have demonstrated value for money, and we will continue to discuss matters such as funding with NHS England as needed.

A. PSNC agrees with the principle of providing modest support to ESPs, many of which provide much needed access to health services in rural areas. There are now fewer than 100 of these pharmacies and most will eventually become self-supporting. However, the journey is taking time for some, and further support is needed. The LPS proposals being considered may buy enough time for them all to become self-supporting.

Q. Why does PSNC support the continued support of these pharmacies?

For a full version of these FAQs see psnc.org.uk

them as they go through the local negotiation process.

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psnc’s work

funding and statistics

contract and it

Pharmacy resources round-up As well as Drug Tariff support (such as CPN, page 8 onwards), PSNC publishes a range of resources to help pharmacy teams and LPCs. Here are some recent highlights along with a round-up of the past month’s NHS and healthcare news.

1. Repeat dispensing resources From this month it is a contractual requirement for pharmacy teams to explain the benefits of the repeat dispensing service to appropriate patients. This follows an amendment to the Terms of Service as agreed by PSNC and NHS England last year.

To help contractors and their teams to meet the requirement PSNC has produced a range of support materials. These include: • Updated guides to the service for GPs, pharmacy teams and patients; • A briefing including top tips for pharmacy teams (PSNC Briefing 004/15); and • Updated posters and patient leaflets for use in pharmacies.

Contractors are also advised to work with their Local Professional Network (LPN), Local Pharmaceutical Committee (LPC) and other local partners to increase uptake of repeat dispensing by prescribers in the area and work to help facilitate this is being undertaken nationally. Read more information and download the support materials at: psnc.org.uk/repeatdispensing 2. Drug driving legislation support

New drug driving legislation came into force on 2nd March 2015 and there is a government awareness campaign to promote the change to the public. To assist pharmacy teams in understanding the implications of the legislation change for patients, PSNC has produced a briefing (PSNC Briefing 005/15) which can be found at psnc.org.uk/briefings The Department of Transport has asked that healthcare professionals help raise awareness with their patients with contractors being asked to display campaign materials both in their

4 Community Pharmacy News – March 2015

pharmacies and online or via their social media accounts. The relevant campaign materials, with details of how to order them for free, can also be found on the PSNC website.

3. PSNC Briefings Every month PSNC publishes briefings designed to help contractors and LPCs to carry out their roles. Many of those published recently have been highlighted throughout CPN; but other topics have included: Promotion of Pharmacy Premises (Briefing 009/15): describing what a pharmacy promotional leaflet must and must not contain and also the steps that pharmacists should take if their patients are receiving promotional leaflets which are not in accordance with the rules.

Analysis of Seasonal Influenza Vaccination Services 2014/15 in England (Briefing 007/15): following an email survey and a review of seasonal influenza (flu) service specifications and other associated documents, PSNC has conducted an analysis on the different flu vaccination services commissioned across England during the 2014/15 flu season. This briefing provides a summary of this analysis which may be of particular interest to LPCs developing proposals for a seasonal flu vaccination service or those reviewing existing services.

Analysis of Minor Ailment Services in England (Briefing 006/15): this provides a summary of a similar analysis carried out for Minor Ailment Services (MAS). This may be of particular interest to LPCs developing proposals for MAS in their area or those who are reviewing existing MAS. 4. Prescription Charge Card Each year PSNC provides a Prescription Charge Card for pharmacies in England which is designed to be used as a poster. At the time when CPN went to press the NHS had not confirmed the charge from April 2015; we hope to have this finalised in time to include the poster with CPN, but look out for updates at psnc.org.uk

Looking for a PSNC Briefing?

PSNC Briefings are available to download from the PSNC website, and our new database means you can also now search for briefings by date or topic. You can still browse the full list of PSNC Briefings by year of course too.

To find, read, print and download all PSNC Briefings go to psnc.org.uk/briefings

Annual ‘Act FAST’ campaign launched NHS England have launched their annual ‘Act FAST’ campaign encouraging people to phone 999 if they experience key stroke symptoms themselves or notice them in others. Since 2009, the campaign has resulted in an additional 38,600 people getting to hospital within the vital 3-hour window of experiencing symptoms.

The campaign, which runs from 2nd February 2015, encourages people to act FAST if they notice any of the below symptoms: Face – has their face fallen on one side? Can they smile?

Arms – can they raise both their arms and keep them there?

Speech – is their speech slurred?

Time – time to call 999 if you see any single one of these signs.

dispensing and supply

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

Joint working fund top up An extra £37m in funding for local authorities has been released by the government to speed up getting people discharged from hospital and to stop them from being admitted in the first place.

The funding adds to the £700m the Department of Health has found for the NHS to help manage its winter pressures and it also comes ahead of the introduction in April 2015 of a £5.3bn Better Care Fund, which will start to transform the way the NHS and councils work together.

CQC inspection rating displays All hospitals, GP practices and care homes, both public and private, will need to display their Care Quality Commission (CQC) inspection rating following new rules introduced in Parliament. The law is expected to come into force on 1st April 2015, subject to Parliamentary approval.

New GP patient nationality checks Government pilots, due to launch later in 2015, will require GP practices with high populations of EU migrants to carry out eligibility checks to see if new patients who wish to register with the practice qualify for free NHS care. Ten areas are participating in the pilot, which will require GP practices to ask all new patients wishing to register with them if they have a current European Health Insurance Card (EHIC). Patients will not be charged for accessing primary care under the pilot even if they do not have a valid EHIC, as the aim is to test how feasible it is for GP practices to routinely ask for such documents to enable the NHS to recover the costs of primary care from the patient’s home country.

Lib Dems pledge £8bn for the NHS The Liberal Democrat party has committed to investing an extra £8bn in annual funding for the NHS by 2020 and has promised equal care for mental health if the party remain in power following the general election in May. Overseas visitor charges Visitors from overseas will be charged 150% of the tariff pricing for secondary care if they do not have a valid EHIC starting from April 2015. The Government has estimated it spends hundreds of millions every year on providing free care to ‘health tourists’ who visit the UK to access free healthcare on the NHS. All

patients will continue to be able to receive free emergency treatment in A&E departments and, for now, all patients will also be able to register and access GP services at no cost.

CCGs take on commissioning powers NHS England has announced the first cohort of Clinical Commissioning Groups (CCGs) that will take on greater ‘delegated’ commissioning for the majority of GP services. The group, which involves 64 CCGs, almost a third of CCGs in England, will take on the responsibility from April 2015. The CCGs will take on full control of GP contracts and will be responsible for performance management and budgets of the member GP practices, including managing complaints about practices and GPs. They will also have power over locally agreed and nationally set enhanced services and the design of Quality and Outcomes Framework (QOF) alternatives. £6bn Manchester devolution deal Senior government officials have announced plans to devolve control of the entire health and social care system in Greater Manchester to local leaders in a deal worth £6bn. The memorandum of understanding that will see joint decisionmaking on integrated care to support physical, mental and social wellbeing has now been signed by 12 CCGs, 15 NHS providers, 10 local authorities, NHS England, the chancellor George Osborne and health secretary Jeremy Hunt.

BSA survey results Results of the British Social Attitudes (BSA) survey have shown that the public support the continuation of a national health service that is free for people to use, but that they do not have a strong preference for whether this is provided by the NHS or another provider, such as a private company or a not-for-profit body.

Importance of early use of antivirals highlighted It has been widely reported by the media that the flu vaccine has provided low protection this winter due to a mismatch between the strain of flu the vaccine covers and the main strain which is currently circulating.

Following the publication of its annual mid-season flu vaccine effectiveness report, Public Health England has highlighted the importance of using antivirals early to treat vulnerable patients and prevent them from developing serious cases of flu.

Patients in at-risk groups are still encouraged to get vaccinated as this year’s vaccine protect against strains of flu which may yet circulate this season. As always, effective hand and respiratory hygiene remains important in reducing the spread of the virus.

For all the latest round-ups of health and care news, see psnc.org.uk

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Pharmacy role in reducing premature mortality Pharmacy services and advice must be more visible, with a greater role for the sector on Health and Wellbeing Boards, says Royal Society for Public Health.

Community pharmacies have a key role to play in helping to reduce premature mortality and more must be done to ensure that the public understand and use their services, the Royal Society for Public Health (RSPH) has concluded.

In its recently published report, Reducing Premature Mortality: the role of community pharmacies, the RSPH calls for four actions to be taken. These are: • a further expansion of healthy living pharmacies (HLPs); • greater visibility of pharmacies and the advice and services they offer within communities in order to encourage greater awareness and usage; • inclusion of pharmacy representatives on Health and Wellbeing Boards; and • more research examining the effectiveness and value for money of pharmacy-based initiatives.

The calls to action are supported by RSPH research demonstrating the widespread public support for public health programmes and services delivered by community pharmacy teams.

The research, which involved surveying over 2,100 adults across the country, showed that the public are comfortable receiving a wide range of services and advice from their local community pharmacy team. For example, over three quarters (78%) of those

surveyed were comfortable receiving a routine health check including having their blood pressure, cholesterol and blood glucose level measured in a community pharmacy. More results from the survey are shown below.

Services the public are comfortable receiving in pharmacies 76% treatment of minor ailments including injuries, bugs and viruses 71% vaccinations 67%

63% pregnancy testing and support

stop smoking services

70% advice on

66% weight

managing long-term conditions such as diabetes

management services

LPC News: community pharmacy in the papers As part of their work to promote the contractors they represent, Local Pharmaceutical Committees (LPCs) often work with local media outlets to get coverage of community pharmacy to explain to the public what they can offer.

This month we highlight a number of successful media campaigns by LPCs across England.

Gloucestershire pharmacies on the BBC Twice in the last month Gloucestershire LPC’s Minor Ailments Service has been mentioned as a potential solution to busy GP practices in BBC’s Inside Out West programme. The programmes included stories focusing on the perceived NHS crisis and the pharmacy service was given as an example of where else people can go.

Devon’s hepatitis C pilot At the end of February, the Mid Devon Star reported on a pilot scheme to eliminate the hepatitis C virus (HCV).

Devon LPC Chief Officer Sue Taylor said: “In Plymouth, there is a public health funded pilot taking place among a small number of community pharmacists who have been offering oral fluid tests and have already identified 22 cases of HCV.” Local politicians backed the service with Cllr Percy Prowse saying: “I applaud what you are doing.”

Pharmacy Manifesto gathers pace A number of LPCs have now been able to discuss the Manifesto in pharmacy visits from local MPs. For example, Conservative MP Robert Jenrick MP visited Whistlers Pharmacy in Newark on Friday 6th February 2015. Nick Hunter, Secretary of Nottinghamshire LPC, said: “The pharmacy team and representatives of the LPC used this opportunity to give Mr Jenrick a flavour of all the other services pharmacy can offer, showing him the services in practice as well as discussing the Manifesto.” Find out more at pharmacymanifesto.com

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Nottinghamshire Pharmacy Ball Pharmacists in Nottinghamshire were treated to their first Pharmacy Ball in January. The Ball was held in aid of the Alzheimer’s Society with an aim to raise as much money as possible to help the 60,000 people in the East Midlands who are affected by dementia. Nick Hunter, Nottinghamshire LPC Chief Executive, said: “We want to encourage local people working in different parts of the NHS to get to know each other better.” The LPC is currently working to get media coverage of the Ball.

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Sending EPS prescriptions with the right exemption information Don’t lose out: pharmacy teams must check they have recorded all of the relevant exemption information onto each EPS prescription before it is submitted for pricing to ensure accuracy. This factsheet explains what to do.

For each Electronic Prescription Service (EPS) Release 2 prescription, pharmacy teams must mark whether a prescription charge was made or an exemption category applied, and whether evidence of any exemption was seen. See page 11 for more guidance on checking the exemption status. Pharmacy system suppliers have flexibility in the way they support pharmacy teams with entering the right exemption information. Learn how your system helps you set the exemption category to be recorded onto the prescription.

Frequently Asked Questions Q. Do the Pricing Authority use the EPS tokens I submit to determine exemption status for the purpose of pricing our pharmacy’s prescriptions?

A. No. Tokens are not used to price pharmacies’ prescriptions, they are used for audit purposes ie to check for patient charge exemption fraud. Exemption information recorded by the patient onto either dispensing tokens (pharmacy-issued) or prescribing tokens (GP-issued) is solely used to assist with this.

As part of your business continuity planning, it’s useful to know how you will manage (and reduce the risk of) issues such as a broken printer, lack of ink, or an absence of token stationery (see psnc.org.uk/epscontingency).

Q. I asked the patient to pay just after they had turned 60 years old. Is the patient exempt? Can my system help determine exemption category?

A. Yes* exemption can be determined at the point at which the patient is asked to pay. Your EPS system may auto-suggest an exemption category but you may need to override this e.g. systems might use the date the Dispense Notification (DN) was sent and compare this with the patient’s • date of birth; or • certificate validity period recorded into the PMR.

However the date the DN was sent may be different to the date the patient was asked to pay, causing the need to override the exemption category suggested by the system.

Note: The printed patient’s ‘age’ on a prescription token or dispensing token may show the age at the time of the printing. *subject to the prescription still being within the period of validity

For further information see psnc.org.uk/epsexemption System supplier discussion points about exemption Get more out of your system. Additional discussion points to raise with your team include: • Preventing prescriptions being accidentally sent with ‘paid’ status: Whilst the majority of prescriptions are expected to have the exempt status, pharmacy teams report that some systems allow prescriptions to be sent for pricing with the paid status by default without any warning messages suggesting this is double-checked. Other systems may already assist users by (1) preventing prescriptions from being sent unless a category option is selected; and/or (2) where needed, asking whether either, the ‘paid’ status is right, or, if instead, the category needs adjusting.

• Can it support easy recording at the right time? E.g. Will the system efficiently support accurate recording of exemption information where it is obtained at the point of hand-out or before?

• Can it allow the exemption category to be changed where needed after submission for pricing? Suppliers can introduce the ability for pharmacy teams to, as a last resort, change the exemption category even after having submitted the prescription (but before the prescription is ‘locked’ by the pricing authority for pricing).

• Using exemption certificate expiry dates: Can the system automatically treat as exempt prescriptions processed within a certificate validity period that has been entered into the PMR? Risk areas: what happens if no expiry date has been entered or the expiry date has passed?

• Audit reports: What audit reports will the system generate to support checking that staff have entered exemption information where required?

• Month-end reports to support submission: Does the system generate reports of prescriptions dispensed and exemption status to support a month-end audit to see whether staff have entered the information correctly?

For further information see: psnc.org.uk/systems

Electronic Prescription Service

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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 for some categories. For more information visit psnc.org.uk/oop Below is a quick summary of some of the changes due to take place from 1st April 2015 Part VIIIA Additions Category A Additions: Chlorambucil 2mg tablets (25) Melphalan 2mg tablets (25) Part VIIIA Amendments SC Special Container • Amantadine 50mg/5ml oral solution sugar free (150ml) Auden McKenzie is changing to Category A • Aripiprazole 5mg tablets (28) is changing to Category A • Aripiprazole 10mg tablets (28) is changing to Category A • Aripiprazole 15mg tablets (28) is changing to Category A • Aripiprazole 30mg tablets (28) is changing to Category A • Benzylpenicillin 1.2g powder for solution for injection vials (25) Thornton & Ross Ltd is changing to Category A • Celecoxib 100mg capsules (60) Celebrex is changing to Category A • Celecoxib 200mg capsules (30) Celebrex is changing to Category A

• Cyclizine 50mg/1ml solution for injection ampoules (5) AMCo is changing to Category C • Estriol 0.01% cream with applicator SC (1) Marlborough Pharmaceuticals Ltd is changing to Category A • Itraconazole 50mg/5ml oral solution sugar free (150ml) Sporanox is changing to Category A • Oxprenolol 40mg tablets (56) AMCo is changing to Category C • Peppermint oil liquid (100ml) J M Loveridge Ltd is changing to Category C • Prednisolone 5mg soluble tablets (30) AMCo is changing to Category C • Triamterene 50mg capsules (30) AMCo is changing to Category C • Trifluoperazine 1mg tablets (112) AMCo is changing to Category C • Trifluoperazine 1mg/5ml oral solution sugar free (200ml) AMCo is changing to Category C • Trifluoperazine 5mg tablets (112) AMCo is changing to Category C 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 from whom the product was purchased; the pack size from which the item was dispensed; and price paid) in future.

• Ammonia and Ipecacuanha mixture (200ml) Category C – Thornton & Ross Ltd • Beclometasone 250micrograms/dose dry powder inhaler (100 dose) Category C – Asmabec 250 Clickhaler • Carbamazepine 200mg chewable tablets sugar free (56) Category C – Tegretol Chewtabs 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.

• Lumecare Sodium Hyaluronate 0.15% - 10ml • B. Braun Medical Biotrol Preference bag with filter, skin protector adhesive, fabric backing – White 30mm 32-630 • B. Braun Medical Biotrol Elite bag with skin protector adhesive and fabric backing - White 35mm 34-835

Have you seen?

Have you seen our page on Prescription Returns? Approximately 0.25-0.3% of prescriptions are returned to pharmacies each month for clarification. The majority of these are returned because of insufficient or unclear endorsements.

To try and help reduce the number of returned items, we have compiled a list of common issues for pharmacy staff to be aware of, information on resubmitting returned prescriptions, what the codes on returned prescriptions mean and a link to our Prescription Returns Factsheet.

Head over to psnc.org.uk/prescription-returns for more information.

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lpcs

psnc’s work

funding and statistics

contract and it

Ask PSNC The PSNC Dispensing and Supply Team can give pharmacy teams advice on a range of topics related to the Drug Tariff and reimbursement. Below are some questions the team have been asked in recent months.

1. I received an electronic prescription for a contraceptive. The prescription was incorrectly marked as ‘paid’ when the reimbursement claim was sent. Will a charge be deducted during prescription pricing?

Prescriptions for products listed in the ‘No Charge Contraceptives’ section of Part XVI of the Drug Tariff, along with prescriptions for contraceptive devices listed in Part IXA of the Drug Tariff and spermicidal gels, creams, films and aerosols, are automatically exempt from the prescription charge. As with paper prescriptions, even if the claim is marked as ‘paid’, no charge will be deducted for these items.

Electronic prescriptions for other drugs will also be exempt from the prescription charge if the prescriber has made the endorsement ‘CC’ in the prescriber endorsement field in the electronic message. Even if the prescription has been marked as ‘paid’ by the pharmacy team, no charge will be deducted if the ‘CC’ endorsement has been made in the prescriber endorsement field.

There is no exception from the requirement to obtain a completed exemption declaration on the grounds that the patient has been prescribed a contraceptive.

2. I have received an electronic prescription for four items but when I’ve sent the token to be printed, it has printed over two tokens. Do I need to get the patient to complete the exemption declaration on both tokens?

It is not essential. It is sufficient to ask the patient to complete one token in this scenario. When the volume of text in an electronic prescription is greater than can fit on one token, there is provision for the electronic prescription to be printed over two tokens, for example three items on one token and one item on a second token. Both tokens link to the same electronic message and contain the same barcode and prescription identifier number. The patient declaration on the token is used to support prescription charge exemption fraud checks – asking the patient to complete one rather than both tokens is sufficient for this purpose – but

both tokens should be submitted to the Pricing Authority.

The Pricing Authority base payment solely on information provided by the pharmacy team and contained in the electronic reimbursement claim message, therefore it is essential that prescription charge exemption information is recorded accurately in the electronic message to ensure correct payment.

3. I have dispensed an electronic prescription for a special. Does the token with the patient’s exemption declaration need to go in a red separator?

No. Tokens are not used to price prescriptions, they are used for audit purposes (patient prescription charge exemption fraud) therefore there is no need to place tokens in the red separators.

Tokens should be filed separately from prescriptions and do not need to be sorted in GP order.

4. I have received an FP10 prescription for 7ml of Zopiclone 75mg/5ml oral suspension. My specials manufacturer will only supply a minimum size of 10ml. Can I claim Broken Bulk on this?

Broken Bulk cannot be claimed on unlicensed specials manufactured or supplied by a company operating under an MHRA specials licence. It should be noted that in Part VIIIB of the Drug Tariff, there is a minimum reimbursement price set against a pack size of 100ml – so a contractor would be paid the list price for 100ml, even where less was prescribed.

However, if a product has been extemporaneously dispensed by the pharmacy team, Broken Bulk is allowed on the ingredients used to make it. This is to cover times when the contractor may not have the opportunity to use the remainder of the open container used in preparing the special.

Look out for more frequently asked questions next month…

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

Want to print out a PSNC webpage for later? We have the answer!

Our new button prints out a fuss-free version of the page on our website you have open.

If you want to read the page at a later date or keep it as a reference, this button will allow you to easily print out the webpage in a nice, clean style.

Where can I find it? On every page, news story and event post on our website – why not try 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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Are you checking prescription exemption status?

Pharmacy teams will be aware of recent news articles and media coverage of the NHS’ increased activity around the checking of prescription exemption claims. The Dispensing Factsheet: Checking Prescription Exemption Status (pg 11–14) contains relevant information to help pharmacy teams in checking claims.

Pharmacy staff may also consider holding application forms for some of the certificates such as those for patients who may be eligible for the NHS low income scheme or prescription prepayments. The table opposite outlines how to obtain some of the common forms and resources.

Additional references For further information visit the PSNC page on exemptions – psnc.org.uk/exemptions NHSBSA Help with Health Costs – ppa.org.uk/ppc See page 7 for our factsheet Sending EPS prescriptions with the right exemption information.

Form/leaflet

What it is used for

Where to obtain it from

FP57

NHS prescription receipt and Contact NHS England. refund form

FP95

Application form for a Prescription Pre-payment Certificate (PPC)

Contact NHS England.

Alternatively, patients can order a PPC over the telephone with a credit or debit card (0300 0330 1341) or from the NHSBSA website.

Pharmacies can also register to sell PPCs. For further information visit the NHSBSA website.

FP92A

Medical exemption certificate application form

Available from the patient’s GP practice.

FW8

Maternity exemption application form

Available from the patient’s GP practice.

HC1

Help with health costs claim for the NHS Low Income Scheme

Contact 3M Supplies on 0300 123 0849 Option 1.

Alternatively patients can contact their local Jobcentre Plus Office or call 0300 330 1343.

Can it be dispensed on an 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 may not be paid for them.

Pharmacy staff 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 dispensed 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.

Pharmacy staff 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

Renasys Go canister kit 300ml small

Yes

Yes

n/a

Yes

This item is a registered medical device (CE marked) and appears in Part IXA of the Drug Tariff.

ChloraPrep solution 3ml applicators

No

No

No

Yes

This item is not listed in Part XVIIIA (the ‘blacklist’) of the Drug Tariff and it is not a registered medical device.

Dilatan Plus

No

Yes

n/a

No

This item is a registered medical device (CE marked) and is not listed in Part IX of the Drug Tariff.

Squill oxymel

Yes

No

n/a

Yes

This item is listed as a Category C line in Part VIIIA of the Drug Tariff.

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

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Dispensing Factsheet: Checking Prescription Exemption Status What pharmacy staff must do Pharmacy staff are reminded that unless patients are exempt by age and the date of birth on the prescription is computer generated, the patient is required to complete the exemption declaration and pharmacies are required to check for proof of a patient’s exemption status at the point of dispensing.

At the point at which the patient is asked to declare their exemption and the patient makes a declaration on the back of the prescription form, the patient must hold the required proof of exemption, and this must be within its period of validity – pharmacy staff are expected to check evidence of entitlement.

If the patient is unsure of whether they are entitled to free prescriptions, pharmacy staff should ask them to pay for the prescription, and issue them with an FP57 prescription receipt and refund form and signpost them to information on how they can obtain the necessary certificate. This enables the patient to receive a refund of paid prescription charges once they have obtained the necessary certificate, assuming it covers the time period when the prescription was dispensed. This can be processed at any community pharmacy up to three after the prescription has been dispensed.

Where appropriate, pharmacy staff should advise patients of the required certificates and how they might go about obtaining them (e.g. Medical Exemption Certificates required for patients suffering from diabetes, epilepsy etc, as well as exemption certificates on maternity grounds, low income, or Prescription Prepayment Certificates (PPC)).

Where patients do not have evidence of their exemption or where there is doubt over whether the evidence provided is appropriate, the “Evidence not Seen” box on the back of the prescription should be marked with an X by pharmacy staff. Pharmacy staff need not refuse to dispense items on the basis that the patient does not provide evidence of their entitlement to free prescriptions.

Patient obligations The patient is responsible for the accuracy of the declaration they make. NHS Protect has a responsibility to check for prescription charge exemption fraud and patients found to have wrongly claimed for free prescriptions could face a penalty charge and in some cases prosecution. This applies even where the patient has a medical condition which qualifies for exemption if the patient does not have a valid exemption certificate on the date the patient is asked to pay or if they do not complete the exemption declaration.

The table below outlines: • exemption categories; • who is eligible for each category; • what proof of exemption they can present; and • how they can obtain the required proof.

Pharmacy staff may consider holding application forms for some of the certificates such as those for patients who may be eligible for the NHS low income scheme or prescription prepayments.

Exemption category Age exempt

Who is exempt?

Children under 16 years of age and men and women aged 60 years and over are entitled to free prescriptions.

Proof required

How to obtain the required proof

If the patient is age exempt and their date of birth N/A (d.o.b) is computer generated on the prescription or included in the electronic prescription message, the patient is not required to complete the exemption declaration and no evidence is required.

If the d.o.b is hand-written or not computer printed on the prescription, the patient must complete the exemption declaration. Evidence that could be shown includes a passport, birth certificate, or any other official papers showing the patient’s name and d.o.b. For children under 16, if the child is obviously under 16, no evidence is required. psnc.org.uk 11

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Exemption category

services and commissioning

the healthcare landscape

How to obtain the required proof

Who is exempt?

Proof required

Full-time students aged 16, 17 or 18

Must be aged 16, 17 or 18 and in full-time education.

Full-time education means you must be receiving fulltime instruction from a recognised educational establishment, such as a school, college or university; therefore those young adults who are undertaking apprenticeships are not eligible. (However patients may qualify for a HC2 certificate under the NHS Low Income Scheme)

Evidence that should be shown is proof of the patient’s date of birth (see above) and proof that the patient is a full-time student (e.g. Student Card or letter from school/college).

Proof can be obtained from the patient’s school, college, university or local education authority (LEA).

Patients who have a valid Maternity Exemption Certificate

Pregnant women and those who have had a baby in the past 12 months get free prescriptions if they have a valid Maternity Exemption Certificate.

If a pregnancy ends in a miscarriage before the 24th week of pregnancy, the Maternity Exemption Certificate ceases to be valid. If the miscarriage occurs after the 24th week of pregnancy, the Maternity Exemption Certificate remains valid until its expiry date. If a woman has had a stillbirth, she will still have entitlement to exemption from NHS prescription charges up to 12 months after the stillbirth. Generally, the patient will still hold an NHS Maternity Exemption Certificate; this is acceptable as evidence of exemption until the date of expiry. The patient should also have a certificate of stillbirth but is unlikely to carry it with her. If the patient is distressed or hesitant, remember that the patient is not obliged to produce evidence. Simply mark the “Evidence not seen” box.

Patients are required to complete a FW8 form available from GPs, midwives and health visitors. The GP, midwife or health professional is required to sign the form and send it off to the Pricing Authority who will issue the certificate. More information is available on their website tinyurl.com/bsafw8

Patients who have a valid Medical Exemption Certificate

To claim exemption under this category, it is necessary for the patient to have a valid Medical Exemption Certificate, not simply a medical condition.

The list of conditions which would entitle a patient to a Medical Exemption Certificate can be found in Part XVI of the Drug Tariff. Medical Exemption Certificates are typically, although not uniformly, valid for five years. Note: a Medical Exemption Certificate is always required – the fact that a patient has one of the qualifying conditions is not sufficient to claim entitlement to exemption from the charge.

Patients are required to complete a FP92A form which is available from GP practices. The GP is required to sign the form and send it off to the Pricing Authority who will issue the certificate. More information is available on their website tinyurl.com/bsacosts

Appropriate evidence of exemption would be the certificate itself. Note: Patients may backdate their PPC up to one month from the date that they apply. If the patient intends to buy a PPC, they should be asked to pay for their prescription, provided with the FP57 Receipt and advised on how to obtain a refund. (Pharmacies can obtain copies of Form FP95 PPC application leaflet from NHS England).

Patients can obtain a PPC by completing a FP95 form which is available from pharmacies and GP practices. Pharmacies can obtain copies of the FP95 form from NHS England tinyurl.com/nhsareateam Alternatively, patients can order a PPC over the telephone with a credit or debit card (0300 0330 1341) or from the NHSBSA website tinyurl.com/help-costs Pharmacies can also register to sell PPCs; for further information see tinyurl.com/help-costs The Pricing Authority is responsible for issuing PPCs. More information is available on their website tinyurl.com/nhsbsa-ppc

Patients who Anyone can purchase a have a valid PPC. Prescription Pre-payment Certificate (PPC)

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Exemption category

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Who is exempt?

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Proof required Appropriate evidence of exemption would be the certificate itself. Patients who are not entitled to help with health costs under any other category may apply for help under the NHS Low Income Scheme.

contract and it

How to obtain the required proof

The patient is named on a current HC2 Charges Certificate

Anyone on a low income can apply to get this certificate.

Patients may claim for help with health costs under the NHS Low Income Scheme using the HC1 form, obtainable from Jobcentre Plus Office or by calling 0300 330 1343. HC1 forms may also be available from the local hospital, dentist, optician or GP practice.

Pharmacies can obtain copies of Form HC1 by calling 3M Supplies on 0300 123 0849 Option 1.

The Pricing Authority administer the NHS Low Income Scheme; more information is available on their website tinyurl.com/nhshc1

The patient or his/her partner is entitled to, or named on, a valid NHS Tax Credit (TC) Exemption Certificate

Not all patients receiving tax Appropriate proof of exemption would be credits are entitled to free the NHS TC Exemption Certificate. prescriptions – those patients that are entitled are automatically sent an ‘NHS Tax Credit Exemption Certificate’ by the Pricing Authority.

The patient or his/her partner is receiving Income Support (IS)

Exemption certificates are sent automatically to eligible patients.

Note some letters and documents issued Patients can speak to their by the Department of Work and Pensions Jobcentre Plus Office.

(DWP) about income support, while relating to the patient (or their partner), do not show dates of entitlement therefore these are not acceptable evidence. An entitlement letter from the Jobcentre Plus Office would be appropriate evidence of exemption.

People receiving income based Jobseekers Allowance (JSA)

Note there are two types of JSA, income based and contribution based. Only receipt of income based JSA entitles patients to free prescriptions.

JSA is paid by giro cheque or BACs two weeks in arrears so patients may not have evidence. A letter from the Department of Social Security (DSS)/patient’s local Job Centre Plus Office that states their entitlement would be appropriate evidence. The letter must confirm that the patient was entitled to free prescriptions on the date the patient completed the exemption declaration.

Patients can speak to their Jobcentre Plus Office.

Universal Credit (UC)

As part of the government’s changes to the benefit system, UC is a new benefit introduced from April 2013. Those receiving this benefit are eligible for free prescriptions.

A valid UC award letter bearing their name (either as the recipient or because they are a partner or child of the recipient) is appropriate proof; they should sign to declare their exemption and will need to tick the box for “income based Jobseeker’s Allowance”.

For further information tinyurl.com/costsuni

The patient or his/her partner is getting Pension Credit Guarantee Credit (PCGC)

Those in receipt of PCGC.

A letter from the DSS/patient’s local Job Centre Plus Office would be appropriate proof. The letter must confirm that the patient was entitled to free prescriptions on the date the patient completed the exemption declaration.

Patients can speak to their Jobcentre Plus Office.

Exemption certificates are sent automatically to eligible patients.

Patients who are unsure as to whether they are entitled to help with health costs via tax credits can contact HM Revenue and Customs for support: 0845 300 3900.

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Exemption category

Who is exempt?

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How to obtain the required proof

Proof required

The patient is a Those holding a War Pension war pensioner Exemption Certificate. holding a War Pension Exemption Certificate and the prescription is for the accepted disablement

Appropriate proof of exemption would Patients can apply for a War Pension be a War Pension Exemption Exemption Certificate by writing to Certificate.

The Veterans Agency, Norcross, Blackpool FY5 3WP or by telephoning 0800 169 2277.

Employment and Support Allowance (ESA)

Only patients receiving the The patient should be able to provide income related strand of ESA will evidence in the form of a DWP award be entitled to free prescriptions. notice.

Prisoners on release

Prisoners on release and those released from secure accommodation (secure accommodation is defined as a court, a secure training centre or a secure children’s home) who present an FP10 or FP10 (MDA).

Patients can speak to their Jobcentre Plus Office.

The letters ‘HMP’, and the prison or N/A secure accommodation address and telephone number must be printed in the box provided for the practice address on the front of the form, along with the prescribing code and the cost centre code for the organisation.

Other Useful Resources Form/leaflet

What it is used for

How to obtain it

HC12

Quick guide to how patients can receive help with the cost of NHS services including prescription charges.

Contact 3M Supplies on 0300 123 0849 Option 1.

HC10

Help with health costs poster.

Contact 3M Supplies on 0300 123 0849 Option 1.

Claiming free prescriptions?

Booklet and poster

Display in the pharmacy to alert patients to when they are entitled to free NHS prescriptions.

These were sent out to all community pharmacies by the NHSBSA. To obtain further copies visit the NHSBSA website (tiny.url/claimingbooklet).

Some useful links For further information visit the PSNC page on exemptions – psnc.org.uk/exemptions NHSBSA Help with Health Costs – ppa.org.uk/ppc

have you seen all the latest psnc Briefings and factsheets? keep up to date at psnc.org.uk All details correct at time of printing.

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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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