November 2018 CPN

CPN

Community Pharmacy News – November 2018

NHS England determine clinical audit • Advising people with diabetes on value of flu jab • Contractually obliged to undertake • To complete by 16th December 2018 Health Secretary backs prevention | Digital exemption checking | Switching factsheet

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Chief Executive’s blog PSNC Chief Executive Simon Dukes uses this section of CPN to provide an update on PSNC’s work. about Brexit and the impact it will have on patients, communities and of course businesses. I share your concerns.

alternative equivalent medicine to patients in accordance with patient need.

From a medicine supply perspective, an agreed deal is essential if we are to reduce the negative impact of a chaotic exit from the European Union.

Simon Dukes

PSNC Chief Executive Despite dominating politics and the headlines now for years (literally), I am not going to apologise for adding to the tens of millions of words written about Britain’s exit from the EU. Although a draft Brexit Agreement is now on the table in London and Brussels, clearly we still have a long way to go until (if?) the deal is agreed by the EU27 and passed by the British Parliament.

Quite rightly a lot of Community Pharmacists and LPCs are concerned

PSNC will continue to work with officials at the Department of Health and Social Care to help minimise disruption from a no-deal Brexit. Stephen Barclay, from his time at DHSC, will be better briefed than most about Brexit-related medicine supply issues.

We wish him well in his new role as the third Brexit Secretary in under five months, and I look forward to meeting his successor at DHSC, Stephen Hammond, in due course.

We are doing our utmost to ensure that DHSC is fully aware of the potential ramifications of a no-deal, and moreover the impact that the stockpiling of medicines will have on supply and prices.

We have stated clearly to DHSC that Community Pharmacies need to have the ability to exercise appropriate professional discretion to ensure the continuity of an

Furthermore, we need to have expeditious reimbursement for additional costs and appropriate regulatory and practical support, to ensure medicine supplies to patients. You can see a full list of PSNC requirements of HM Government on our dedicated webpage: psnc.org.uk/brexit – where we will also be providing regular updates over the coming weeks.

As you would expect, PSNC is working collaboratively with other national pharmacy bodies (particularly the NPA, CCA, AIM, RPS and PDA) as well as organisations across the medicines supply chain to secure the best possible contingency plan for community pharmacies and their patients.

On other business, the PSNC Committee held its annual planning meeting last week in Birmingham. We will write-up the outcomes and fold these into our strategy for 2019 and beyond; I look forward to sharing the details with you in the next edition of my blog.

Funding 2018/19 webinar now on-demand answer contractors’ questions about the settlement, outlining what it means for your pharmacy and for the sector more broadly.

Almost 500 people registered for the webinar hosted by PSNC Chief Executive Simon Dukes and Director of Pharmacy Funding Mike Dent. Simon and Mike used the webinar to

If you weren’t able to join us, hopefully this recording of both the presentation and Q&A session will address some of your queries: psnc.org.uk/fundingwebinar

Feedback on the webinar

Community pharmacy contractors can now access an online recording of PSNC’s recent webinar on the 2018/19 funding settlement.

87% found it useful

2 Community Pharmacy News – November 2018

82% would recommend it to others

“ Having heard your webinar congrats on your openness and transparency. ”

Superintendent Pharmacist “ I think it was a great idea to reach out to

contractors in this way.

A perfect opportunity for timely two way communication.

LPC Chief Officer

”

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCS

National clinical audit 2018/19 • All community pharmacy contractors must complete the national clinical audit determined by NHS England • This year’s audit concerns advising people with diabetes on the importance of getting the flu jab • Data collection needs to be completed by 16th December 2018

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Steps for contractors to follow

The audit will generally need to be conducted over a week, with data collection complete by 16th December 2018

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NHS England has published the paperwork for the 2018/19 national community pharmacy clinical audit; this must be completed by all pharmacy contractors.

The focus of the audit is the provision of advice to people with diabetes on the importance of them receiving an annual seasonal influenza vaccination. The audit has been timed to take place during the flu vaccination season, so that people with diabetes can be encouraged to be vaccinated and where they have not yet been vaccinated and the pharmacy offers the NHS Flu Vaccination Service, they can be offered a vaccination at the pharmacy.

The aims of the audit are: a) To assess the frequency of provision of public health advice to people with diabetes on the importance of them receiving a flu vaccination; and b) To determine why some people with

diabetes are not vaccinated against flu, so that this insight can help inform future work by NHS England and individual community pharmacies to increase the vaccination coverage of this group in future years.

The audit standard is: 70% of people with diabetes identified by the pharmacy staff during the dispensing of a prescription or in another way, are offered public health advice on the importance of them receiving a flu vaccination.

The audit will generally need to be conducted over a one-week period, selected by the pharmacy contractor, but with data collection completed by 16th December 2018. The audit data then needs to be submitted to NHS England’s web-based portal by midnight on 30th December 2018.

NHS England will use the audit data to assess

1. Choose a week when you will commence the data collection (this must conclude by 16th December 2018); 2. Download copies of the audit paperwork*; 3. Follow the instructions in the audit guidance; and 4. Submit your collated audit data to NHS England using the webbased form at: https://pharmacyflu2018.nhsdatacollection.org/ (this must be submitted by midnight on 30th December 2018). *To find out more, download a copy of the audit documentation, and read the PSNC guide on how to submit your audit data, please visit: psnc.org.uk/fluaudit if there has been any change in vaccination uptake via community pharmacies and examine the reasons given for why patients did not get vaccinated in 2017/18 to identify any trends and potential actions for 2019/20. The findings will be communicated to contractors and will also be discussed with Public Health England to inform planning for the 2019/20 flu season.

Quality Payments resources now available DoS Profile Updater Community pharmacy contractors need to use the Directory of Services (DoS) Profile Updater to meet the DoS quality criterion of the Quality Payments Scheme.

Contractors must ensure their NHS 111 DoS entry is up-to-date, including bank holiday opening hours. In particular, please review: Good Friday, Easter Sunday, Easter Monday, Early May Bank Holiday and Spring Bank Holiday.

Asthma quality criterion PSNC has published a briefing which provides background information on the asthma quality criterion as well as template resources.

Contractors can also access support on PharmOutcomes. Two services are available, including one for children.

PharmOutcomes also enables contractors to record patient details and send referrals to the patient’s GP practice.

NSAID audit Specialist Pharmacy Service has published the non-steroidal anti-inflammatory drug (NSAID) audit, which contractors will need to complete to claim for the NSAID quality criterion.

Contractors must complete the audit, notify a patient’s GP where concerns are identified, share anonymised data with NHS England and incorporate their learnings into future practice to meet this criterion.

All these resources, plus more information, is available from psnc.org.uk/QP

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THE HEALTHCARE LANDSCAPE

2018 Budget announcement In his 2018 Budget statement Chancellor Philip Hammond pledged that funding for mental health services will grow to help take pressure off A&E departments and other public services.

Mr Hammond stated that HM Government will ensure that public health services will help people live longer, healthier lives but did not reveal any further details about the additional £20bn NHS funding as we await publication of the NHS Ten Year Plan.

He also announced a cut to business rates by a third for all retailers in England with a rateable value of £51,000 or less, and announced a ‘Future High Streets Fund’ worth £675m.

NHS workforce concerns Analysis by the Health Foundation, the King’s Fund and the Nuffield Trust – presented in The health care workforce in England: Make or break? – suggests that the health service could be short of more than 350,000 staff by 2030.

Alastair Buxton, PSNC Director of NHS Services, said: “We agree that HM Government and NHS leaders need to address the mounting challenges facing the NHS workforce, however the network of over 11,600 community pharmacies are ideally placed to assist. As pressure on the NHS workforce increases, it is more important than ever that we make best use of community pharmacies.”

MPs hear community pharmacy policy from devolved nations The All-Party Pharmacy Group (APPG) has heard about how community pharmacy is developing in Scotland, Wales and Northern Ireland and what learnings England could take from this.

Representatives from all three devolved nations addressed a desire to move away from a contract modelled on dispensing.

The MPs also heard about the challenge of moving services from pilot phases to national commissioning and why better IT integration is needed for pharmacy. The APPG is now working on a report based on the findings of this session.

4 Community Pharmacy News – November 2018

LPCS

PSNC’S WORK

Secretary of State advances the prevention agenda • Healthy Secretary announces plan to refocus healthcare on prevention rather than cure • The plan makes specific reference to the work of Health Living Pharmacies • PSNC’s work to inform NHS long-term plan outlined how pharmacies can help people stay healthy

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The Government wants to encourage more people to make the most of their local pharmacy

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The Secretary of State for Health and Social Care, Matt Hancock MP, has released a policy paper setting out the Government’s plan to put prevention at the centre of healthcare.

The paper, Prevention is better than cure, sets out plans to diagnose cancer earlier, tackle obesity and use technology to predict illness, in a drive to increase life expectancy by five years. It also stresses that individuals need to take extra responsibility for their wellbeing by adopting healthier lifestyles.

Mr Hancock announced that a Green Paper on Prevention will be published in the first half of 2019. This sits alongside his Department’s wider work in creating a long-term plan for the NHS. PSNC’s response to the long-term plan consultation called for further commissioning of services to enable community pharmacies to do more to help people to stay healthy and so we welcome a reference to this in the policy paper: ‘The Government wants to encourage more people to make the most of their local pharmacy, and for local pharmacies to play a stronger role in helping people stay healthy. There are almost 10,000 community pharmacies registered as Healthy Living Pharmacies in England. They deliver a wide range of lifestyle and health interventions, and promote wellbeing and self-care services.’

After Mr Hancock outlined his plans during a session at the House of Commons, Bim Afolami, MP for Hitchin and Harpenden, asked what his views are for community pharmacy as part of the strategy for prevention. Mr Hancock replied that community pharmacies have a “hugely important role to play in keeping people out of hospital and in supporting GP surgeries by doing more”.

PSNC Chief Executive Simon Dukes said: “We agree with the Secretary of State that we must do more to support preventative healthcare – this should help both people to live longer, healthier lives, and the health service to manage the increasing demands being placed on it. We were pleased to note the acknowledgement in this policy paper that local pharmacies can play a stronger role in helping people to stay well. We very much agree – community pharmacies are ideally placed to help people to stay healthy and avoid visits to hospital – and look forward to working with HM Government to make this shared vision a reality.”

FUNDING AND STATISTICS

CONTRACT AND IT

DISPENSING AND SUPPLY

FMD: three months to go With the implementation of FMD drawing ever closer, PSNC produces further guidance and resources for community pharmacy teams.

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Contractors are advised to visit the FMD Source website for guidance, resources and FAQs

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There are now fewer than 90 days to go until the Falsified Medicines Directive (FMD) comes into force on 9th February 2019.

In order to help community pharmacy contractors on the road to FMD implementation, PSNC has undertaken a full review of the content of the FMD Source website (fmdsource.co.uk), with updated information, resources and new FAQs being added.

Contractors that have not yet put in place plans to comply with the FMD requirements are advised to visit the How to get going with FMD page on the FMD Source website, for guidance from the UK FMD Working Group for Community Pharmacy.

SERVICES AND COMMISSIONING

Regulatory changes for EPS Amendments implemented by The National Health Service (Pharmaceutical Services, Charges and Prescribing) (Amendment) Regulations 2018 come into effect on 26th November 2018 and set out the legislative framework for EPS Phase 4. This phase will allow patients to have an EPS prescription dispensed by a pharmacy which is not their nominated pharmacy.

Following recommendations from PSNC, some other changes will be introduced in regards to breach notices, market entry applications and the General Data Protection Regulation (GDPR). Find out more at: ow.ly/YAcX30msnrQ

Brexit Forum update PSNC’s Brexit Forum has met with representatives from the Department of Health and Social Care (DHSC) to share thoughts and concerns about the UK’s exit from the European Union and hear more about plans to ensure that medicines supplies are maintained even in the event of a hard Brexit.

PSNC has also published a briefing which answers some common questions about the practicalities of complying with the FMD legislation. This is intended to provide community pharmacy contractors with a succinct resource they can use to help prepare the whole pharmacy team.

The Forum encourages community pharmacy contractors to follow DHSC guidance, particularly the advice that pharmacies “do not need to take any steps to stockpile additional medicines, beyond their business as usual stock levels”.

As well as explaining what pharmacy staff will be required to do when dispensing a medicine, the briefing outlines how the verification system will work and what to do in certain situations, such as when faced with a potential counterfeit product.

Medicinal cannabis on prescription

Find PSNC Briefing 058/18: Getting ready for FMD – a quick guide for the pharmacy team in our briefings database: psnc.org.uk/briefings FAQ. Will the costs incurred implementing FMD be covered in future funding for the sector?

PSNC is working to ensure that contractors’ FMD-related costs are recognised in future NHS funding settlements and this will be discussed with the Department of Health and Social Care in the forthcoming negotiations for 2019/20. Some of the costs involved include initial set-up, software and hardware, plus ongoing operational costs.

Watch PSNC’s FMD webinar Earlier this month Alastair Buxton, PSNC’s Director of NHS Services, held a webinar to explain how the introduction of FMD will affect the day-to-day working of community pharmacy teams and what they need to do to prepare.

Please visit psnc.org.uk/FMDwebinar to watch an on-demand version.

Changes to the Misuse of Drugs Regulations 2001 reclassified cannabisbased medicines from Schedule 1 to a Schedule 2 Controlled Drug as of 1st November 2018.

The Home Office has announced that specialist doctors (not GPs) now have the authority to prescribe medicinal cannabis as appropriate and community pharmacy teams should be aware that NHS prescriptions for cannabisbased medicines may be presented at community pharmacies.

NHS England and the Medicines and Healthcare products Regulatory Agency (MHRA) have issued guidance documents for healthcare professionals. These can be found at: ow.ly/IGWC30mqRdX

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DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

All you need to know about: Real-time Exemption Checking PSNC Director of NHS Services, Alastair Buxton, addresses some misconceptions about a new digital method of checking prescription charge exemptions.

The Department of Health and Social Care has announced a series of measures to reduce fraud against the NHS; this includes digitising information on exemption from prescription charges, via a project being undertaken by NHS Digital and the NHS Business Services Authority (NHS BSA), in collaboration with pharmacy PMR system suppliers. This project is known as Realtime Exemption Checking (RTEC).

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

How will RTEC work?

The system uses data on people’s prescription charge exemption status, held by the NHS BSA. The check of the NHS BSA data will usually occur automatically at the time the prescription is being processed in the PMR system to produce dispensing labels, but PMR suppliers have some flexibility about the point that the data will be requested from the NHS BSA using an Application Programming Interface (API) built into the PMR system.

Pharmacy staff will not normally need to check the patient’s exemption status more than once, but a second check will be possible, if the patient queries the initial status returned by the NHS BSA system. If the patient believes they are exempt from prescription charges, but RTEC returns no exemption information, the patient will complete a declaration on an EPS token in the normal way.

If a prescription is confirmed by RTEC as exempt, it will be treated as such by the NHS BSA and no

6 Community Pharmacy News – November 2018

The benefits of RTEC It is expected that RTEC will: • reduce the risks of contractor loss caused by pharmacy staff inadvertently submitting EPS prescriptions with a paid status when the category should have been exempt; • enable a reduction in the number of EPS tokens which have to be printed, completed by patients and then be sent from pharmacies to the NHS BSA; • provide a more efficient digital process for pharmacy staff, reducing the time spent helping patients complete declarations, checking physical evidence of exemption status and sorting tokens for submission to the NHS BSA; • reduce the risk to the NHS of prescription fraud due to a decrease in false prescription exemption claims; and • increase convenience for patients, as there will be less need for them to provide physical proof of exemption from prescription charges.

further prescription exemption checks will be applied and the patient will not need to complete a declaration on an EPS token.

Roll-out plans The system will be rolled out in phases: • Phase One will comprise maternity, medical, pre-payment, low income scheme and HMRC exemptions; • Phase Two will include all Department for Work and Pensions exemptions, including Universal Credit when they become available; and • 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.

Testing NHS Digital and NHS BSA are working with several PMR suppliers to test this functionality; a pilot with one supplier scheduled for late 2018. PSNC will provide further information on progress with the testing and rollout of RTEC as it becomes available.

LPCS

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

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

U pdate to adrenaline auto-injectors validation protocol Following on from the validation protocol for dispensing adrenaline 150 microgram auto-injectors brought in last month, the Department of Health and Social Care (DHSC) has now issued a revised protocol which comes into effect immediately.

The latest information can be found on our dedicated adrenaline resource page: psnc.org.uk/a drenaline

Leadership training for community pharmacy

Changes to the way you access the Drug Tariff NHS England will stop automatically sending monthly hard copies of the Drug Tariff out to community pharmacies after the January 2019 edition. Pharmacy teams can instead view the Drug Tariff online.

However, you can request to continue receiving the monthly hard copy.

Find details here: ow.ly/d z2q30m GJmD

The Centre for Pharmacy Postgraduate Education (CPPE) and the NHS Leadership Academy are offering an interactive leadership course to pharmacists and pharmacy technicians working in community pharmacy.

The Mary Seacole Leadership programme is designe d to help you feel more confident in your leadership skills by helping you to identify your strengths and areas for improvement and finding the right style to suit you.

Find out more at: ow.ly/F LdR30 mCcQV

Obesity and cancer resource hed the latest Cancer Research UK has publis er Insight Canc macy phar their of n editio ity. resource, which focuses on obes

patient It contains answers to common to discuss how on tips tical prac , tions ques who are nts weight management with patie poster. aign camp a and e overweight or obes

r downloaded from: Free copies can be ordered and/o www .canc erre sear chuk .org

Gluten-free prescribing

As of 4th Decemb er 2018, gluten-free food s permitted on the NHS will be restricted to bread and mix es only.

PSNC has created a briefing to explain what thi s change means for comm unity pharmacy teams : ps nc .or g.u k/ GF br iefi ng

psnc.org.uk 7

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

End of month submission webinar: Your questions answered Following PSNC’s prescription submission webinar in September, our Dispensing and Supply Team is working to respond to the questions you posed on the night but they didn’t have time to answer.

Q. Do I need to submit EPS RA Tokens for electronic repeat dispensing at the end of each month?

Q. If a patient ticks the exemption for Income Support but does not complete their details, would this prescription be switched to chargeable by the Pricing Authority (NHS BSA)?

A. The NHS Business Services Authority (NHS BSA) advises that where a patient is exempt because they receive Income Support, income-related Employment and Support Allowance, receive income-based Jobseeker’s allowance, is entitled to or named on valid NHS Tax Credit Exemption Certificate or has a partner in receipt of Pension Credit guarantee credit, they should complete the details of the person receiving the benefit in Part 1 which includes name, National Insurance number and date of birth.

If these details were omitted but a tick was placed against the correct exemption category in part 1 and a signature was captured in Part 3, the prescription would still be processed for payment and would NOT be switched from exempt to chargeable and prescription charge(s) would not be deducted.

A. The NHS Business Services Authority (NHS BSA) advises that where a patient is exempt because they receive Income Support, income-related Employment and Support Allowance, receive income-based Jobseeker’s allowance, is entitled to or named on valid NHS Tax Credit Exemption Certificate or has a partner in receipt of Pension Credit guarantee credit, they should complete the details of the person receiving the benefit in Part 1 which includes name, National Insurance number and date of birth.

If these details were omitted but a tick was placed against the correct exemption category in part 1 and a signature was captured in Part 3, the prescription would still be processed for payment and would NOT be switched from exempt to chargeable and prescription charge(s) would not be deducted.

Q. I have items referred back repeatedly on a monthly basis, could something be done to let the prescriber know not to re-prescribe the item in future?

A. If a copy of a prescription has been returned to you as ‘disallowed’ then it would be advisable to make the prescriber aware that this product is not permitted on NHS prescriptions.

However, if the prescription was returned for clarification due to insufficient or unclear endorsements, this is down to the pharmacy team not endorsing the prescription appropriately. On a referred back prescription there should be a code with a specific reason listed underneath the image of the prescription which should explain what information the NHS BSA require to be able to process your prescription for payment.

If you are still unsure of why the item has been sent back or do not know what needs to be endorsed, please contact PSNC with details of the prescription (i.e. the product, quantity supplied, and the endorsements used) so that we can investigate this further for you.

For more information on prescription returns, disallowed prescriptions and return codes please see psnc.org.uk/returns

Look out for more of your questions next month…

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

8 Community Pharmacy News – November 2018

LPCS

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Dispensing Factsheet: Prescription Switching Here our Dispensing and Supply team will take you through the common reasons for prescription switching.

How to complete the reverse of a prescription correctly The reverse of the current paper FP10 form contains three parts: Part 1 (exemption), Part 2 (charges paid) and Part 3 (signature). it is important to ensure that relevant parts are correctly completed by the patient/representative as either exempt or paid. The table below shows parts to complete for each patient status.

Patient status

Parts of the form which MUST be completed

Exempt

Part 1 & Part 3

Paid (Chargeable)

Part 2 & Part 3

The declaration on the reverse of paper prescription forms must be completed on all occasions except where: • the patient is under 16 or 60 or over and a computergenerated date of birth is printed on the prescription • the patient is a prisoner on release who presents an FP10 or FP10(MDA) with the letters ‘HMP’ computer printed in the practice address box • the prescription is a ‘Bulk’ Prescription (i.e. for two or more patients, see Drug Tariff Part VIIIA, Note 9) What is switching?

Once the correct parts on the reverse of the prescription form have been completed by the patient/representative, pharmacy teams are required to sort paper prescriptions into the correct exempt or chargeable group bundles for their end of month submission. Switching occurs when a prescription is moved from the group it was submitted in to the other (for example, moved from exempt to chargeable or vice-versa). When your account is processed by the NHS Business Services Authority (NHS BSA), the reverse of each paper prescription is assessed to determine if it has been filed in the correct group and has been completed correctly by the patient/representative.

1. A prescription is switched from Exempt (Group One) to Chargeable (Group Two) when: a. Part 3 is unsigned - the most common reason for switching from exempt to chargeable group is where the patient has ticked an exemption but not signed Part 3 on the reverse of a prescription (excluding age exempt patients where the date of birth is computer generated). b. Part 2 contains a charge rate - when a paid prescription has been incorrectly filed with the exempt prescriptions bundle prior to submission.

To prevent exempt paper prescriptions being switched to chargeable, ensure that: Part 1 of the declaration has been clearly marked with a tick or a cross

Part 2 (the ‘amount paid’ box) has not been obscured/marked for, e.g. with a signature Part 3 (the ‘signature box’) has been signed; a pharmacy stamp is NOT acceptable as a signature When prescription forms are switched from Exempt to Chargeable, a prescription charge is deducted for each item dispensed on the prescription. This can have huge financial consequences for contractors, as money can be lost through not correctly checking and completing the reverse of an exempt prescription. For example, if an exempt prescription with three items is switched to chargeable, NHS BSA would deduct three patient charges from the pharmacy account costing the pharmacy £8.80 x 3 charges = £26.40.

2. A prescription is switched from Chargeable (Group Two) to Exempt (Group One) when: a. Part 1 and Part 3 have been completed - a prescription is switched from chargeable to exempt when a form with a completed exempt declaration has been incorrectly filed with the paid prescriptions bundle prior to submission, or where the patient is age exempt with a computer-generated data of birth or age on the prescription.

To prevent chargeable paper prescriptions being switched to exempt, ensure that: Part 2 (the ‘amount paid’ box) has been completed correctly and is clear and legible Part 3 (the ‘signature box’) has been signed; a pharmacy stamp is NOT acceptable as a signature The age or date of birth printed on the front of the prescription is not obscured by a pharmacy stamp or other markings

No charge deductions are made for items on a prescription that is switched from chargeable to exempt status. Do ensure the correct number and amount of prescription charge(s) are collected and declared. This should be noted particularly during months when there has been a change to the prescription charge rate.

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DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

Switching statistics • The average number of switched prescriptions per month where Part 3 was deemed incomplete, decreased from 102,771 (2014) prescriptions to 44,012 (up to July 2018).

• The total reduction of switching where Part 3 was deemed incomplete was 50.33%. In 2014 there was at total of 1,233,256 prescriptions switched and in 2017 there was a total of 612,568 prescriptions switched.

• The total charge deductions per year where Part 3 was deemed incomplete, went from £9.9m (2014) to £5.2m (2017). This is a 46.97% reduction.

The graph below shows information on prescriptions switched from exempt to chargeable where Part 3 is unsigned, and the corresponding increase in EPS utilisation between 2014 and July 2018.

Prescription switching statistics for your pharmacy can be found on page 2 of your FP34 Schedule of Payments. This details the number of prescriptions switched and reasons for the switches. It is important to monitor this closely as it can be useful in identifying why prescriptions are being switched in your pharmacy. This information can be used to ensure your pharmacy team are following your prescription receipt Standard Operating Procedures (SOPs), update SOPs if needed and to identify any staff training requirements.

EPS prescriptions and switching Prescriptions submitted electronically will be processed according to the exemption status within the electronic claim message and therefore cannot be switched. It is important to note that where an exempt or paid status has not been selected on an EPS claim message, this will automatically default to paid (some EPS systems may prompt users to confirm paid/exempt status before a claim is submitted for payment).

At the end of each month, contractors are required to submit all tokens where an exemption declaration (other than agerelated) is captured or where a patient charge is paid. Any EPS prescriptions for age exempt patients will be automatically switched to exempt status. EPS prescriptions will not be switched if EPS tokens (used to capture patient declarations) are incorrectly filled, incomplete or unsigned. All prescription and dispensing tokens submitted to the NHS BSA are used for audit purposes only as part of their prescription exemption checking service.

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PSNC TOP TIPS: How to prevent prescriptions from being switched • It is good practice to check that the reverse of the prescription/ token has been correctly completed at the point of handing the medication over to the patient/patient’s representative.

• Ensure that each prescription/token is signed – especially where multiple prescriptions are presented at one time and where the patient is age exempt but the date of birth on a paper prescription is handwritten.

• Ensure that all prescriptions are correctly filed in the appropriate group – you may find it useful to separate these at the end of each day to avoid a build up at the end of the month.

• Double check your exempt group for misfiled paid prescriptions before submitting your bundle at the end of the month – this is also a good opportunity to check for any incorrectly completed or unsigned prescriptions.

• EPS – Before submitting a claim to NHS BSA, ensure all information regarding patient exemption/ prescription charge status is correctly recorded from the patient declaration made on the token.

For more information, see our related webpages: psnc.org.uk/charges psnc.org.uk/exemptions psnc.org.uk/switching

LPCS

PSNC’S WORK

FUNDING AND STATISTICS

Drug Tariff Watch: December 2018 Part VIIIA additions • Tenofovir 245mg tablets (30) - Category A • Co-trimoxazole 80mg/400mg/5ml solution for infusion ampoules (10) – Aspen Pharma Trading Ltd • Dexamethasone 8mg tablets (30) – Teva UK Ltd • Dexibuprofen 300mg tablets (60) – Seractil • Fondaparinux sodium 1.5mg/0.3ml solution for injection pre-filled syringes (10) – Arixtra • Fondaparinux sodium 10mg/0.8ml solution for injection prefilled syringes (10) – Arixtra • Fondaparinux sodium 2.5mg/0.5ml solution for injection pre-filled syringes (10) – Arixtra • Fondaparinux sodium 5mg/0.4ml solution for injection prefilled syringes (10) – Arixtra • Fondaparinux sodium 7.5mg/0.6ml solution for injection pre-filled syringes (10) – Arixtra • Gentamicin 20mg/2ml solution for injection ampoules (5) – Wockhardt UK Ltd • Gentamicin 5mg/1ml solution for injection ampoules (5) – Gentamicin Intrathecal • Glycopyrronium bromide powder for solution for iontophoresis (3g) – AMCo • Heparin sodium 5,000units/1ml solution

for injection ampoules (10) – Wockhardt UK Ltd • Lidocaine 200mg/20ml (1%) solution for injection vials (10) – Hameln Pharmaceuticals Ltd • Lidocaine 400mg/20ml (2%) solution for injection vials (10) – Hameln Pharmaceuticals Ltd • Liquid paraffin liquid (150ml) – Bell,Sons & Co (Druggists) Ltd • Liquid paraffin liquid (2000ml) – J M Loveridge Ltd • Liquid paraffin liquid (5000ml) – J M Loveridge Ltd • Metronidazole 500mg/100ml infusion 100ml bags (20) – AAH Pharmaceuticals Ltd • Morphine sulfate 5mg/5ml solution for injection ampoules (10) – Torbay Pharmaceuticals • Octreotide 1mg/5ml solution for injection vials  (1) – Pfizer Ltd • Octreotide 50micrograms/1ml solution for injection ampoules (5) – Sandostatin • Paracetamol 1g/100ml solution for infusion vials (10) – Accord Healthcare Ltd • Phenobarbital 60mg/1ml solution for injection ampoules (10) – Martindale Pharmaceuticals Ltd • Sodium bicarbonate 8.4% (1mmol/ml) solution for injection 250ml bottles (10) – AAH Pharmaceuticals Ltd

CONTRACT AND IT

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

• Sodium chloride 30% solution for infusion 100ml vials (10) – Torbay Pharmaceuticals • Sodium chloride 30% solution for infusion 50ml vials (10) – Torbay Pharmaceuticals • Sodium valproate 300mg/3ml solution for injection ampoules (5) – Episenta • Sodium valproate 400mg/4ml solution for injection ampoules (5) – Wockhardt UK Ltd • Tenofovir 123mg tablets (30) – Viread • Tenofovir 163mg tablets (30) – Viread • Tenofovir 204mg tablets (30) – Viread • Tobramycin 240mg/6ml solution for injection vials  (1) – Pfizer Ltd • Tobramycin 80mg/2ml solution for injection vials  (1) – Nebcin • Tobramycin 80mg/2ml solution for injection vials (5) – Pfizer Ltd • Tranexamic acid 500mg/5ml solution for injection ampoules (10) – Cyklokapron • Triamcinolone hexacetonide 20mg/1ml suspension for injection ampoules (10) – Intrapharm Laboratories Ltd • Vancomycin 1g powder for solution for infusion vials (10) – Flynn Pharma Ltd • Vancomycin 500mg powder for solution for infusion vials (10) – Flynn Pharma Ltd For a full list of the upcoming Drug Tariff changes, please visit: ow.ly/kooP30mCPoj

Part IX deletions Product

Size, Type, Product Code

Snap dressing kit - Gauze

All sizes

Reusable Pens - AllStar

All types and sizes

Vacuum Pumps - Owen Mumford Ltd - Rapport Premier

SM2200

Leg Bags - L.In.C Medical Systems - LINC-Flo sterile leg bag with lever tap, adjustable inlet tube

350ml bag (LM350AD-L)

Belts - AMI Medical Ltd - Suportx Ostomy/Hernia Support Belt

All except 15cm depth

Colostomy bags - ConvaTec Ltd - Colodress Plus (Stomahesive Wafer) Closed Pouches

Opaque and clear starter holes

Colostomy bags - ConvaTec Ltd - Esteem Closed Pouches with Integral filter

All types and sizes

Colostomy bags - ConvaTec Ltd - Esteem+ Closed Pouches with Integral filter X Small - opaque

All sizes

Ileostomy bags - ConvaTec Ltd - Esteem One-Piece Convex Drainable Pouch with InvisiClose Outlet

All types and sizes

Pressure plates/shields - Salts Healthcare - Convex Plate for Light White Bag

All sizes

Pressure plates/shields - Salts Healthcare - Plastic Retaining Shield Single

833008

Two piece ostomy systems - ConvaTec Ltd - Esteem Synergy ileostomy bag

S1007F, S1021F, S1212F, S1221F, S1222F and S1231F

Two piece ostomy systems - Oakmed Ltd - Option Connect 2 colostomy bag with filter, Clear

JH520

Two piece ostomy systems - Oakmed Ltd - Option Connect 2 ileostomy bag with filter, Clear

JH220 and JH120

psnc.org.uk 11

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

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

PSNC Briefings PSNC Briefing 055/18: How the 2018/19 funding settlement will affect your payments In this briefing, PSNC’s Funding Team explains the 2018/19 community pharmacy funding settlement and how it will affect your pharmacy business. It highlights the changes that have taken place and should help you to understand the timing of your payments.

Download from: ow.ly/oV7b30mwQWx PSNC Briefing 056/18: Background information on community pharmacy funding and the 2018/19 funding settlement This briefing sets out the community pharmacy funding settlement for 2018/19 and gives background information on what the announcement means and how community pharmacy funding works.

Download from: ow.ly/YwIi30mwQXh PSNC Briefing 057/18: Funding 2018/19 – Frequently Asked Questions To accompany the funding announcement for 2018/19, PSNC has set out responses to a number of questions to help to answer any queries that community pharmacy contractors may have.

Download from: ow.ly/rAGG30mwQYh See all our PSNC Briefings in our database at: psnc.org.uk/briefings

Other resources Cashflow Calculator This tool can help community pharmacy contractors to estimate the impact of the recent funding reductions (i.e. Category M and the Single Activity Fee) on their payments.

Visit now: psnc.org.uk/incometables Quality Payments Scheme webinar This on-demand webinar guides listeners through the updated gateway and quality criteria. As well as describing the new elements of the scheme, it also outlines the guidance and resources developed by PSNC.

Watch now: psnc.org.uk/qualitywebinar Look out for additional resources as you explore our website: psnc.org.uk

Email news alerts National pharmacy clinical audit for 2018/19 (24th October) This email announced the publication of paperwork for the 2018/19 national community pharmacy clinical audit by NHS England. The audit concerns advising people with diabetes on the importance of getting the annual NHS flu jab and data collection needs to be completed by 16th December 2018.

Read now: ow.ly/Cx9a30mwRos Update to adrenaline 150 microgram auto-injector validation protocol (6th November) Following the announcement of additional validation processes for the supply of adrenaline 150 microgram autoinjectors made in October, this email alerted community pharmacy teams of a revision to the protocol.

Read now: ow.ly/W3hr30mwRju Not receiving our emails? Sign up now at: psnc.org.uk/enews PSNC website For up to date information and news on community pharmacy issues, visit the PSNC website at psnc.org.uk PSNC Community Pharmacy News is published by: The Pharmaceutical Services Negotiating Committee, 14 Hosier Lane, London, EC1A 9LQ Community Pharmacy News is edited by: Melinda Mabbutt who can be contacted at the above address or by email at: mmabbutt@psnc.org.uk PSNC Office: 0203 122 0810

© PSNC