October 2014 CPN

CPN

Community Pharmacy News – October 2014

Community pharmacy funding 2014/15 Reactions and background to the funding settlement Your EPS Checklist | Seasonal u reminder | Is it allowed? pull-out factsheet

funding and statistics

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Funding Settlement 2014/15 Following the funding settlement announcement contractors should be aware of the key changes and are advised to read the PSNC Briefings on this topic.

Pharmacy contractors will by now have heard that PSNC has reached agreement with the NHS on a community pharmacy funding settlement worth £2.8bn and a number of changes to Advanced Services and to the Community Pharmacy Contractual Framework (CPCF) for the 2014/15 financial year.

The New Medicine Service (NMS) will be continued, with funding for it to come from the overall settlement; and there are some changes to targeted MURs with the introduction of a new target group and a move for contractors to provide 70% of their MURs to patients within the target groups.

Contractors will also be required to include pharmacy names in reports of patient safety incidents; to give patients appropriate advice about the benefits of the Repeat Dispensing service; and to take part in a national audit on the emergency supply of medicines by pharmacies next year (in place of an area team specified clinical audit).

The £2.8bn funding will comprise £2bn to be delivered in fees and allowances, with the remaining £800m to be delivered through agreed purchase margins.

The increase to £800m reflects the fact that to date, pharmacies have been able to retain purchase margin earned above the agreed £500m each year, and this provided, almost every year, substantial additional income.

As part of the settlement PSNC has agreed to work with the Department of Health (DH) to reform the systems for managing margin delivery and to make changes to reimbursement.

Further Information for Contractors

In order to deliver the allowed purchase margins, Category M prices will be increased by £10m per month from October. This equates to an increase in average item value of around 12 pence (across all items). But from November there will be a reduction in the Practice Payment of around 17 pence per item in order to ensure that the £2bn in fees and allowances is delivered, accommodating volume increases and the inclusion of funding for the New Medicine Service. Using current predictions of prescription volumes this is expected to apply until the end of March 2015. The impact of these adjustments will be to reduce income available to the average contractor by £870 in the second half of 2014/15.

PSNC Briefings To help contractors to understand the settlement and the changes to Advanced Services and the Contractual Framework, we have published a number of PSNC Briefings which you can download from psnc.org.uk/briefings They cover: • Changes to Contractual Requirements 2014/15 (Briefing 015/14) • Advanced Services (MURs and the NMS) (Briefing 016/14) • Purchase Margin and Margin Reforms (Briefing 017/14) • The Settlement Negotiations and the Negotiating Process (Briefing 018/14) • The Cost of Service Inquiry (COSI) (Briefing 019/14) • Frequently Asked Question (Briefing 020/14)

PSNC was unanimous in accepting the settlement as the best possible outcome for community pharmacy contractors and a sound basis for continuing to develop the community pharmacy service.

Some of the details of the changes, including the dates from which they must be implemented, are yet to be agreed and updates and full guidance will be published as soon as they are available on PSNC’s website at psnc.org.uk.

Community Pharmacy Funding The Funding and Statistics section of the PSNC website has been re-arranged to be more user-friendly and is now split into six areas: 1. Current arrangements 2. Historical arrangements 3. Ongoing funding work of PSNC 4. Funding distribution 5. A-Z of funding topics 6. Statistics

Reminder: Don’t miss our settlement updates Contractors are advised to check the PSNC website regularly as further information about the agreed changes, including implementation dates, will be published there as soon as it becomes available. To ensure that you do not miss this please sign up for PSNC’s email newsletters at psnc.org.uk/emails

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Reaction to the Settlement: PSNC Members Comment Following the announcement of the funding settlement for 2014/15 a number of PSNC members have made statements. Some of these are summarised below and they can be read in full at psnc.org.uk.

This settlement has been a long time coming; but I hope that it brings some relief for pharmacy contractors. From this October we will see additional money being put into Category M – this is unusual and I hope it will be welcome news. But contractors must also recognise that from November it will be balanced by a reduction in fees to ensure that we are on target to deliver the agreed £2billion in fees and allowances.

The agreement by the NHS to allow us £800m in purchase margins is a win for us.

Although the money is not new for us because it reflects the benefits of excess margins that we have had in previous years;

the increase to £800m is a step forwards and shows how much the health service does value the supply function we provide.

In exchange for this we have agreed to work with the NHS on some changes and reforms to reimbursement. This will be complex and time-consuming work but PSNC’s Funding and Contract Subcommittee includes representatives from pharmacy businesses of all types and contractors can be assured that our priorities will be to ensure stability and fairness in reimbursement. We hope the work to stabilise the delivery of margin will help to reduce some of the cash flow problems we have seen in recent years.

Peter Cattee, Chair of PSNC’s Funding and Contract Subcommittee, a PSNC Negotiating Team member, and CEO of PCT Healthcare

The inclusion of funding for the New Medicine Service (NMS) within the overall settlement means we now have two key medicines optimisation services at the heart of our contractual framework; and the development of the MUR service shows a clear commitment from the NHS to it. The refocus on Repeat Dispensing and the decision to have a national audit on emergency supply also show just how interested the health service is in what we can do beyond our core dispensing role.

I know that some contractors are still doubtful about the benefits of moving towards a contractual framework that rewards the delivery of services as well as dispensing; but I am convinced this is something we must do – it helps to cement our role at the heart of the NHS; it means that as health professionals we have more to offer our patients; and it helps to secure the future of our businesses, putting our destinies in our own hands, rather than us relying solely on the prescriptions issued locally for our success.

Gary Warner, Chair of PSNC’s Service Development Subcommittee, a PSNC Negotiating Team member, and an independent community pharmacy contractor

Although this settlement doesn’t mean lots more money; what it does mean is that the excess margins that we have been earning in recent years are now recognised by the NHS and brought on the table; embedded within our core contract.

Protecting that income is good news for contractors now and it’s good news for our futures because it shows us that the NHS does value the supply function that we are doing.

We also need to understand just how difficult a position the NHS is in at the moment. The health service must find £20 billion in efficiencies and to do that every healthcare professional has got to contribute. Given that we are working in

that environment I do think that this settlement treats us fairly – it protects our income levels in exchange for some manageable changes and for a commitment to some reforms to the systems for managing margin. Over the second six months of the year contractors will earn around £870 less than they did in the first half; but that is entirely manageable for a pharmacy business, and it reflects a smoother delivery of funding over the year than we have seen in some previous years.

Contractors will no doubt say that we haven’t done enough, and of course our eye is always on what comes next and what more we can do, but I do think that this settlement is an important one for us, and I believe it represents a good and a fair result for both our businesses and the NHS.

Kirit Patel, Vice-Chair of PSNC and Founder and Chief Executive of the Day Lewis Group psnc.org.uk 3

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Patients Need Their Medicines Campaign At the party conferences, PSNC highlighted supply problems to politicians and patient groups and we have launched a website to collate patient views.

As part of PSNC’s ongoing work to promote pharmacy and to engage with politicians and policy makers, we organised fringe events at both the Labour and Conservative party conferences this year in partnership with the British Association of Pharmaceutical Wholesalers (BAPW) and the Dispensing Doctors’ Association (DDA).

Alongside the events we have created an information website for politicians, healthcare bodies and members of the public which explains how the medicines supply chain operates and encourages them to report any problems they have experienced getting hold of prescription medicines and to register their interest in our work on this matter.

The events were entitled Getting medicines to patients: could the wheels come off the wagon? and they highlighted the difficulties being faced by pharmacies trying to obtain the medicines their patients need in a timely manner.

The website includes: • A video called Getting Medicines to Patients explaining how medicines get to patients; • A flyer explaining the issues faced by the UK medicines supply chain; • An email sign-up form to collect details of those people who are interested in this topic so we can build a group of key allies; • A reporting form for patients to tell us about any problems they have had getting medicines so that we can use the data anonymously to work to protect the supply chain.

We know that medicines supply continues to be a significant problem for pharmacies, and our intention with this work was to ensure that policy makers are aware of the impact that the problems are having on the sector; and to gather support for our work to find solutions. At the events we heard from MPs including Sir Kevin Barron, as well as patient groups and other interested parties.

The key aims for our campaign are as follows: Recognition: the medicines supply chain must be as highly valued as any other NHS service.

24-hour deliveries: pharmacies and dispensing doctors must be able to receive all medicines within 24 hours of ordering them.

Protection: local authorities, commissioners and policy makers must understand the complexity and importance of this under-appreciated core of our NHS, and take it into account as they assess care needs and plan future services.

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Find out more about our work on this topic at patientsneedtheirmedicines.co.uk

Politicians focus on health Health and the NHS were high on the agenda at the Party Conferences; with politicians promising a range of reforms and improvements. Here’s a summary of some of the key pledges made.

Conservatives The party had a clear focus on health with the Prime Minister announcing that they would protect the NHS budget and continue to invest more in the next parliament. Plans to make it easier for people to get GP appointments between 8am and 8pm and at weekends were also announced.

Health Secretary Jeremy Hunt indicated that the Government could not afford greater than inflation spending increases on the NHS, but he said they would have no greater priority than to “protect, support and invest in our NHS”. He stressed the need for a focus on providing personal care.

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Labour Party leader Ed Miliband promised an annual additional £2.5bn investment in the NHS – a ‘Time to Care’ fund – if the party is elected. This would fund an extra 8,000 GPs, 20,000 nurses, 5,000 care workers and 3,000 midwives and come from taxes including a ‘mansion tax’ and a tax avoidance clampdown. Shadow health secretary Andy Burnham led calls for better integration of health and social care and for the coordination of care to meet all of people’s needs: physical, mental and social; and the party promised “to repeal the NHS Bill and stop the creeping privatisation of the NHS”.

Liberal Democrats Liberal Democrats leader and Deputy Prime Minister Nick Clegg promised to protect the NHS budget in real terms; raising an extra £1bn for it every year, by “ending three different tax breaks which benefit the highest earners”. The party was also committed to increasing spending in the future too.

Mental health is a key focus for the party, and Care Secretary Norman Lamb restated their commitment to ensuring faster and more consistent access to help and treatment. He also called for an NHS focusing more on prevention than repair; and stressed the need to focus on personal care.

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The Essential EPSR2 checklist As GPs gear up to increase the extent to which they use the Electronic Prescription Service (EPS), this quick reference guide will help pharmacy teams to ensure they are getting the most out of the system.

A third (33%) of GPs have gone live with processing electronic prescriptions, and the figures are set to rise rapidly over the coming months. To obtain the full benefit of the Electronic Prescription Service Release 2 (EPSR2), and minimise disruption to your business, we’ve developed this quick reference guide to help pharmacies ensure that all the relevant bases are covered when it comes to processing EPSR2 prescriptions. Whether you’re preparing for EPS because a local GP is going live or, you are already dispensing electronic prescriptions, the checklist below has been created to help you and your pharmacy team with EPS.

Pharmacy actions Know when your local GPs are going live

Explanation & guidance

Key information links

• GPs must give at least 8 weeks notice before they start using Release 2 so that pharmacies and others have time to prepare.

• Your LPC should inform you when local GPs are going live, and may delay the go-live date if pharmacies are not ready.

• Local deployment: You can use the HSCIC site to learn which GPs have ordered an R2-system, and see the expected dates they will go live; or you can see a map displaying GPs who are (1) live, (2) going live, and (3) not live yet.

lpc-online.org.uk/

Meet and work with GPs

• Take up opportunities to take part in business process change sessions at the GP practice, or contact your GP to arrange a meeting which other local pharmacies may also attend.

• Use the engagement checklist to make sure that your GP and pharmacy staff know how they will work together, for example where: • the pharmacy loses internet/EPS access • a patient needs a combination of paper and electronic scripts • non-routine clinical information needs to be passed on to the patient.

You can find the engagement checklist using the following link: psnc.org.uk/ epsmeetgp

Ensure all relevant staff are fully trained on EPSR2 and your PMR system

• Find out what type of PMR system training is offered and take part: E.g. one-to-one staff training, webinars, training videos, user manuals, quick reference guides and/or desk aids and help files on the system.

• Plan the training so all staff will be trained in time for GP go live. The most effective training will be that taken place shortly before staff start to deal with electronic prescriptions. Training undertaken too early may be forgotten.

• Consider appointing an 'EPS champion' within the pharmacy who staff can go to for support and troubleshooting.

• Make provision for the training of part-time staff and locums.

psnc.org.uk/ epstraining

There is an 8-week process for GPs who wish to start using Release 2

Notes and completion date

tinyurl.com/ epsdeployment

tinyurl.com/ epstrainingmatrix

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Gather nominations

services and commissioning

• During meetings with GPs you may wish to agree how you will handle nominations.

• Patient communications: Consider your approach to explaining EPS to patients. Will patient leaflets, signs or videos be available to patients?

• Nomination guidance: Ensure staff gathering nominations are familiar with the national guidance.

• Re-confirmations needed? Nominations collected on paper but not adjusted on the EPS system for more than 6 weeks may need re-confirmation before these are adjusted onto the national EPS/spine. This is in case patients had switched their nomination to another pharmacy during the interim period.

the healthcare landscape

tinyurl.com/ nominationguidance psnc.org.uk/ nomination

Check your Smartcards are all working correctly

• Obtain Release 2 Smartcards with the appropriate roles assigned for each member of staff dealing with prescriptions (dispensing technicians, pharmacists etc.) and test that these work okay.

• Passcodes: Are these known. Can all staff use their smartcards or are any locked?

• Local Registration Authority (RA): Do you know their details? Your RA is responsible for providing cards and dealing with card issues. They are commissioned by the local Area Team. RA contact information may be available from your AT or on your LPC site.

psnc.org.uk/ smartcards

Relevant stationery

• Check you have dispensing tokens. You may need to order them from your local NHS England Area Team.

psnc.org.uk/tokens

Check your NHS Choices profile

• Pharmacy details: Are yours correct on NHS Choices?

Where patients ask the GP about live pharmacies, the GP must provide a list of local R2-enabled pharmacies, based on NHS Choices information.

psnc.org.uk/choices

Contingency planning

• Know who to contact in the event of a problem.

Use the IT troubleshooting guide, and fill in contact information.

• Contingency plan in case there is loss of internet/power/EPS. • Signup to receive Spine alerts so you know if there are issues with the national EPS system.

psnc.org.uk/ contingency

Reporting system issues and making your system work for you

• Report all system problems and issues, however minor, to your supplier who may resolve some over the phone, and add others to a work plan as a future development.

• Helpdesk reference number: Always obtain one when contacting your supplier so the issue can be escalated via other routes if needed.

psnc.org.uk/systems

Prescription payment Errors on prescription endorsement and claiming could cost you

• Ensure you will be properly reimbursed. For example, are all relevant staff familiar that: • Exemption status and endorsements need to be applied correctly to each electronic prescription before claiming.

• Expiry takes place for prescriptions which go unclaimed for six months (180 days after the date of issue) and once expired, prescriptions cannot be submitted to the Pricing Authority (PA). Check that your system will ensure that no prescriptions can expire without warning.

psnc.org.uk/ epssubmission

Understand how to submit your electronic prescriptions

• FP34C totals will include the total of paper prescriptions/items and electronically submitted prescriptions/items.

• Dispensing tokens are submitted to the PA, but for audit purposes only. The PA use the electronic exemption status. Only those exempt for a reason other than age are required to be sent.

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tinyurl.com/ spinealerts

psnc.org.uk/ epsexemption psnc.org.uk/ epsexpiry psnc.org.uk/ epssubmission

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Pat survivor PatHanlon, Hanlon, kidney kidney cancer cancer survivor

‘Blood forpharmacy pharmacyteams teams ‘Bloodin inpee’: pee’:Briefing Briefing for H you can help support the campaign How 13 October – 23 November 2014 Last updated: 15 September 2014

Public Health England will be running a national campaign to raise awareness of blood in urine as a symptom of bladder and kidney cancers. We need your continued support to help improve early diagnosis of these diseases.

Who is the ‘blood in pee’ campaign aimed at?

Men and women from lower socioeconomic groups over the age of 50, and the people who influence them, such as friends and family.

What is Be Clear on Cancer?

Be Clear on Cancer aims to improve early diagnosis of cancer by raising awareness of the signs and symptoms, and encouraging people to see their GP without delay.

Why focus on ‘blood in pee’?

Blood in urine (haematuria) is the most common symptom of bladder and kidney cancers. Yet, when asked to name cancer signs and symptoms, only a third of people mention unexplained bleeding.

What is the main message of the campaign?

If you notice blood in your pee, even if it’s ‘just the once’, tell your doctor straight away What activities will be taking place and when?

Advertising will start on 13 October 2014, and will include TV, radio, digital (eg YouTube) and out of home (eg washroom posters). There will also be events in public places (eg shopping centres), a schedule for which will be made available on the NAEDI website once finalised. TV advertising will run until 9 November, while all other communications will end between 9 and 23 November 2014.

Why are you re-running the national ‘blood in pee’ campaign?

Early results from the first national ‘blood in pee’ campaign, which ran in autumn 2013, are promising. Despite this, we want to keep the campaign message at the front of people’s minds and there’s still a great deal of potential to improve bladder and kidney cancer survival in England.

This campaign will be slightly less intense than the first national campaign. There’ll be no direct mail to individual households and the TV advertising will also be a little less intense this year.

Check the NAEDI website regularly for further updates in the run-up to the campaign start date.

Other bladder cancer symptoms include: • Needing to pass urine very often or very suddenly • Pain when passing urine.

Other kidney cancer symptoms include: • A constant pain below the ribs • An abdominal mass • Other more vague symptoms include unexplained weight loss, high temperature, night sweats, a general sense of feeling unwell, or tiredness.

Who is most at risk of bladder and kidney cancers?

• Age – People aged 50+ account for around 97% (8,600 cases) of those diagnosed with bladder cancer each year, and 90% of all kidney cancer cases (around 7,300 each year) • Men – bladder and kidney cancers are more common in men, although women are affected too • Smokers have a much higher risk of developing bladder or kidney cancer, with nearly 4 in 10 bladder cancers, and 1 in 4 kidney cancers estimated to be caused by smoking • Being overweight or obese accounts for 1 in 4 cases of kidney cancer • Exposure to certain industrial chemicals – around 7% of bladder cancer cases in men and 2% in women in the UK are estimated to be linked to occupational exposures • Some other medical conditions, such as kidney disease • Having a family history of bladder or kidney cancer.

naedi.org/beclearoncancer/bloodinpee

Supported by

Factsheet courtesey of Public Health England psnc.org.uk 7

the healthcare landscape

Is there any evidence the ‘blood in pee’ campaign will work?

Results from previous ‘blood in pee’ campaigns to date indicate that Be Clear on Cancer is successfully changing levels of public awareness. There are also early indications that clinical outcomes are improving too. Initial evaluaton results following the first national campaign show: • Over 2 in 5 spontaneously mentioned blood in pee as a symptom of bladder or kidney cancer (44% up from 27% precampaign)* • After the campaign there was an increase in people saying they would see their GP if they noticed blood in their pee just once, up from 49% to 55%* • 26% increase in two-week wait (2WW) referrals for suspected urological cancer*†.

The regional pilot campaign that ran from January to March 2013 in the Tyne Tees and Border TV regions has also shown positive results: • 48% increase in bladder cancer diagnoses in pilot areas following a 2WW referral*, compared with a 12.3% decrease in control areas* • 47% increase in kidney cancer diagnoses in pilot areas following a 2WW referral*, compared with an 8.5% increase in control areas. * Statistically significant † Pathway covers several cancer types in addition to bladder and kidney cancers

‘When I told my wife I’d noticed blood in my pee, she said I should see my doctor as soon as possible. I wasn’t sure, as it wasn’t painful, but I’m glad I listened to her.’

Pat Hanlon, aged 72, kidney cancer survivor How can pharmacy teams support this national campaign?

Since pharmacies are often the first port of call for those suffering with urinary symptoms, you have an opportunity to be vigilant for people who may be showing symptoms of bladder or kidney cancer. Many people find it easier to discuss their worries in an informal pharmacy setting. GPs will be following NICE guidelines, which recommend a referral if: • haematuria is painless • the patient is over 40 and has recurrent or persistent urinary tract infections (UTIs) associated with blood in urine • the patient has blood in urine with no identifiable infection.

‘Lots of people don’t realise that blood in pee could be a symptom of cancer, even if it only happens once. The campaign has a really clear message, one which pharmacy teams are in an ideal position to actively reinforce. We need to reassure our customers and help them overcome any fears or worries they might have. Whether finding blood in the urine is a one-off, or something that keeps happening, encourage people to get themselves checked out.’

Ann Gunning, MRPharmS Key facts about bladder and kidney cancer • If kidney and bladder cancers are diagnosed at the earliest stage, one-year survival is as high as 91–96%.

At a late stage, it drops to just 33–42% • It has been estimated that around 1,000 deaths from bladder and kidney cancers could be avoided each year if survival rates matched the best in Europe

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Conducting cancer conversations with customers can be difficult. Do you have any tips?

A Cancer Research UK nurse, who specialises in communicating about cancer, advises: ‘It is important for pharmacists and their teams to feel confident and to try and make cancer a normal part of conversation. For example, if you are worried about someone who has repeatedly bought an OTC medicine for a suspected cancer symptom, you could ask: “What does your doctor say about that?”.’

Some people may be reluctant to visit their GP. Remind customers that their symptom/s may not be anything to worry about, and if they are worried it is cancer, reinforce that getting it diagnosed and treated early can make a big difference.

Pharmacy employees who feel uncomfortable talking about cancer should seek the advice of their pharmacist.

How are GPs and hospitals preparing for the national ‘blood in pee’ campaign?

NHS Improving Quality will work with Strategic Clinical Networks to help ensure the NHS is prepared for the campaign. There are also additional briefing sheets to support GPs and to help hospital providers plan for anticipated increases in referrals and diagnostic tests.

Three things you can do Make it part of your day. During your regular consultations, such as medicine-use reviews or when selling over-the-counter medicines, be mindful that the people you are talking to may have seen the campaign. It may prompt people who have previously ignored symptoms, or discounted them as a one-off, to ask you about it; they may come to your pharmacy looking for OTC medicines or advice.

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Give people confidence. People can delay going to see their GP and often seek reassurance from other healthcare professionals about making a GP appointment for a sign or symptom they are concerned about. If customers have noticed blood in their urine, whether it’s just the once or frequently, alongside a recurring UTI, urge them to visit their GP without delay. If you feel comfortable doing so, tell them to mention that their pharmacist sent them. It may be the encouragement they need to get themselves checked out.

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Promote the campaign. Talk to your friends, family, customers and colleagues about Be Clear on Cancer. By talking about the campaign you will help people to feel more comfortable about sharing details of a sign or symptom of cancer they might be experiencing. Put up posters in your pharmacy and have some ‘blood in pee’ leaflets readily available for customers.

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To order free campaign materials (including accessible versions), visit the Health and Social Care Publications Orderline or call 0300 123 1002.

Find out more • Visit naedi.org/beclearoncancer/bloodinpee • Familiarise yourself with the adverts at nhs.uk/bloodinpee, the public-facing website • Visit the British Oncology Pharmacy Association’s E-learning Centre which can help you raise the subject of cancer with patients

Factsheet courtesey of Public Health England 8 Community Pharmacy News – October 2014

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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.

GP contract changes 2015/16 NHS Employers and the General Practitioners Committee of the BMA have announced changes to the GMS contract in England for 2015/16. A final decision on any uplift to the GMS Contract has yet to be made. The changes include: • A named, accountable GP for all patients who will take lead responsibility for the co-ordination of all appropriate services; • Publication of GP net earnings; • A further commitment to expand and improve the provision of online services for patients; • The avoiding unplanned admissions Enhanced Services will be extended for a further year; • There will be a 15% reduction in the total seniority payments as agreed in 2014/15; and • GPC, NHS Employers and NHS England will have a broader strategic discussion about the primary care estate, especially to support the transfer of care into a community setting.

Consultants for GP practices Simon Stevens, Chief Executive of NHS England, has suggested that GP practices could form expanded group practices which employ or take on as partners hospital consultants, community nurses, pharmacists, social workers and potentially other clinicians. These group practices could be delegated budgets on a whole population basis.

NHS England’s new area team structure The Health Service Journal has reported that NHS England will move from its current 24 area teams outside of London, to a new structure with half that number.

NHS England announced it was reviewing its area and regional structure earlier this year and the merger of area teams was widely anticipated. The regional offices are expected to take on roles currently performed by area teams, including responsibility for specialised commissioning.

Reminder: seasonal flu vaccinations Pharmacists and other professionals have been reminded of the importance of vaccinating staff against flu.

In a letter to PSNC, the Department of Health wrote: “As part of their duty of care to their patients or residents, care professionals should do everything in their power to protect them against infection. This includes getting vaccinated against flu.”

The Department stressed that although there was an improvement in vaccine uptake last year; levels were still below the 75% target.

The Department said it was the responsibility of employers to make the vaccination available to their employees free of charge.

Read the letter in full at tinyurl.com/2014fluletter

Limited use of AQP by CCGs Research undertaken by the Health Service Journal suggests that a minority of CCGs have used Any Qualified Provider (AQP) during 2014/15 and interest in the approach seems to be waning.

MyNHS transparency website launched A new website – MyNHS (www.nhs.uk/mynhs) – has been launched which links existing data that has already been published on patient safety, efficiency, quality, public health and social care commissioning.

Think-tank backs self management of LTCs Research by the Institute for Public Policy Research (IPPR) has found that three quarters of patients with long-term conditions want more of their health needs to be managed independently at home, but a lack of information and support prevents them from being able to do so. Community pharmacies are well placed to provide this support.

Q. Why is it recommended that pharmacy contractors offer flu vaccinations to their staff?

A. All employers have an overarching health and safety duty of care to their employees. The Department of Health have advised employers of healthcare workers to offer flu vaccinations to their staff to reduce the spread of infection and to aid staffing resilience during the winter months.

Q. Do pharmacy contractors get any funding from the NHS to cover the cost of vaccinating their staff?

A. Offering flu vaccinations to employees is not mandatory and as an occupational health matter it falls outside the scope of NHS flu vaccination services. As an example, GPs cannot immunise their own staff as part of occupational health arrangements under the NHS flu vaccination service that is commissioned by NHS England.

If employers decide to offer flu vaccination to their staff it is a cost to them; all employers in health and care will incur this cost where they choose to offer vaccination to their staff. We are not aware of any NHS providers being given specific funding for provision of vaccinations to staff; NHS commissioners view it as a cost which has to be covered by the general funding they provide to healthcare providers.

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Drug Tariff Dual Listings Appliances can appear in the Drug Tariff with a ‘dual listing’. This occurs when the name of a Drug Tariff listed appliance changes, to give prescribers time to change their prescribing habits from using the old name to the new one. During this period of grace, which usually lasts for 12 months, both the old and new name of a product are listed in the Tariff and prescriptions for using either name will be passed for payment by the Pricing Authority. When the dual listing is removed, only prescriptions using the new name, as it appears in the Drug Tariff, will be reimbursed.

By way of an example we’ve outlined the changes to Advasil Conform: The September Drug Tariff had the following dual listing “ Advasil Conform (including products formerly listed as Advasil)” so therefore prescriptions dispensed for Advasil and submitted with September’s bundle will be passed for payment. However as of October, this dual listing has been removed and this product will only be reimbursed if prescribed as Advasil Conform

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Where do I get the BNF from?

Pharmacies with one registered pharmacist will receive a single copy of the BNF/BNFc, and pharmacies with two or more registered pharmacists will receive 2 copies of the BNF/BNFc, once a year in September.

Any community pharmacists who have not received copies should contact Binleys (BNF@Binleys.com or 01268 495 609) to ensure they are registered to receive copies in future.

Please also note that BNF and BNFc content can be accessed online at www.bnf.org.

You can find information on where to get other pharmacy resources, from FP57 Receipt and Refund Forms to Prescription Recheck Request Forms, by visiting psnc.org.uk/externalresources

Is it allowed?

When pharmacies 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.

Pharmacies can check whether medicinal products and medical devices are allowed using the Drug Tariff: Medicinal products: assuming the prescriber has the appropriate prescribing rights, any food, drug, toiletry or cosmetic may be prescribed on an NHS prescription unless the product is listed in Part XVIIIA of the Drug Tariff (the ‘blacklist’).

Medical devices: If a product has been registered as a medical device (also known as an appliance), it can only be prescribed on an NHS prescription if it is listed in Part IX of the Drug Tariff. Registered medical devices can be identified by a ‘CE’ mark on the product’s packaging.

Dispensers may wish to check PSNC’s Disallowed Appliance List (psnc.org.uk/disallowedappliances) for medical devices they are unsure about, and we have listed some products below that we have recently received queries about: Product

Is the item listed in the Drug Tariff?

Does it have a ‘CE’ mark?

Is it in the blacklist?

Can it be dispensed on the NHS

Additional information

Ibuprofen lysine 400mg oral powder sachets

No

No

No

Yes

Ibuprofen lysine 400mg oral powder sachets are not CE marked and they are not listed in Part XVIIIA (the ‘blacklist’) of the Drug Tariff, therefore they are allowed on FP10

Yes vaginal lubricant 75 ml

Yes

Yes

n/a

Yes

Yes vaginal lubricant is a registered medical device and appears in Part IXA of the Drug Tariff so it is allowed on FP10

Posey sheath holder adult 90500 12 device

No

Yes

n/a

No

Posey sheath holder adult 90500 12 device was deleted from Part IXA of the Drug Tariff in August 2014. As such, it’s no longer allowed on FP10

Ergocalciferol 3,000units/ml oral solution

Yes

No

No

Yes

Ergocalciferol 3,000units/ml oral solution is listed in Part VIIIB of the Drug Tariff therefore it is allowed on FP10.

Tegaderm Film dressing 20cm x 30cm

No

Yes

n/a

No

Tegaderm Film dressing 20cm x 30cm is CE marked and is not listed in Part IXA of the Drug Tariff, so it’s not allowed on FP10

Please note: If the prescription is one of the following, pharmacies 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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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’s especially important to note Drug Tariff listed products as well as changes to the category of a product along with 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’s 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.

Below is a quick summary of the changes due to take place from November Part VIIIA Additions Category A Additions: • Glycopyrronium bromide 1mg tablets 30 • Glycopyrronium bromide 2mg tablets 30 • Perindopril erbumine 4mg / Amlodipine 10mg tablets 30 • Perindopril erbumine 4mg / Amlodipine 5mg tablets 30 • Perindopril erbumine 8mg / Amlodipine 10mg tablets 30 • Perindopril erbumine 8mg / Amlodipine 5mg tablets 30

Category C Additions: SC Special Container • Brinzolamide 10mg/ml / Brimonide 2mg/ml eye drops SC 5ml Simbrinza • Colecalciferol 25,000units/ml oral solution sugar free 3 ampoule - InVita D3 • Donepezil 1mg/ml oral solution sugar free 150ml Rosemont Pharmaceuticals Ltd • Empagliflozin 10mg tablets 28 - Jardiance • Empagliflozin 25mg tablets 28 - Jardiance • Olodaterol 2.5micrograms/dose solution for inhalation cartridge with device CFC free SC 60 dose - Striverdi Respimat Part VIIIA Amendments R Item requiring reconstitution • Ampicillin 250mg/5ml oral suspension R (100ml) is changing to Category C - Penbritin Forte • Orphenadrine 50mg tablets (250) is changing to Category C Disipal Part IX Deletions Make 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.

• Interpose (all sizes) • N Woundcare Sterile Pack.

• Extracellular Matrix Protein (0.5ml and 1ml) – Xelma • WipeAway Adhesive Remover (50ml spray) - Salts Healthcare

Medicines Optimisation Scratch Card now available Community pharmacy teams can now download a medicines optimisation scratch card designed to help them to have conversations about medicines with patients and to potentially create opportunities to offer pharmacy services such as MURs and NMS. The postcard-sized cards, developed by Pfizer in consultation with the NPA and supported by PSNC and others, contains five simple statements about medicines use and patients can scratch a section of the card to indicate how strongly then agree or disagree with each statement. A member of the pharmacy team will be able to interpret the responses and provide appropriate advice.

View and download the Pfizer Scratch card from psnc.org.uk/murresources or order additional resources to support the campaign from accesspfizer.co.uk

All details correct at time of printing.

No part of this publication may be reproduced without the written permission of the PSNC. Produced for the PSNC by Communications International Group. ©. PSNC. Colour repro and printing by Truprint Media, Margate.

The publishers accept no responsibility for any statement made in signed contributions or in those reproduced from any other source.

Distributed for PSNC by:

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

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Dispensing Factsheet: Is This Item Allowed?

The following factors can affect whether an item is allowed to be prescribed on the NHS or not.

1. What prescribing rights does the prescriber have?

Different types of prescribers hold different prescribing rights. It is important for pharmacy staff to be able to identify which products each prescriber type is entitled to prescribe.

Type of prescriber Doctors (GPs)

Dentists (See Part XVIIA of the Drug Tariff)

Community practitioner nurse prescribers (See Part XVIIB(i) of the Drug Tariff)

Optometrist independent prescribers (See Part XVIIB(ii) of the Drug Tariff)

Nurse and pharmacist independent prescribers (See Part XVIIB(ii) of the Drug Tariff)

Supplementary prescribers

Licensed or unlicensed medicine, food, drug, toiletry or cosmetic

Can prescribe any of these, except products listed in Part XVIIIA of the Drug Tariff (the blacklist).

!

Can only prescribe products included in the Dental Prescribing Formulary on an FP10D prescription. Can also prescribe by brand for generic items listed in their formulary provided the brand is not listed in Part XVIIIA of the Drug Tariff (the blacklist).

!

Can only prescribe products included in the Nurse Prescribers’ Formulary for Community Practitioners. They are allowed to prescribe by brand. Can also prescribe by brand for generic items listed in their formulary provided the brand is not listed in Part XVIIIA of the Drug Tariff (the blacklist).

Appliances or chemical reagents

Can prescribe any that are listed in Part IX of the Drug Tariff.

!

Can only prescribe if the appliance is listed generically in their formulary

Can prescribe any appliance listed in Part IX of the Drug Tariff as they are included in their formulary.

Can prescribe any licensed medicine for ocular conditions affecting the eye and surrounding tissue, but are not authorised to prescribe any Controlled Drugs.

!

Can only prescribe if the appliance is listed in Part IX of the Drug Tariff and is for ocular conditions affecting the eye and surrounding tissue.

Can prescribe any medicine for any medical condition within their level of expertise and competence (except those in the blacklist).

They can prescribe any Controlled Drug in Schedules 2 to 5 (except diamorphine, dipipanone or cocaine for addiction).

Can prescribe any listed in Part IX of the Drug Tariff.

Can prescribe any listed in Part IX of the Drug Tariff.

Can prescribe any medicine (except those in the blacklist) as agreed as part of a patient’s clinical management plan.

More details on prescribing rights can be found at psnc.org.uk/prescribing 2. Is the item a medicine or a medical device (also known as appliances)?

The easiest way to tell the difference between medicinal products and medical devices is to look for a the item is a medical device. The CE mark can normally be found on the packaging of a device.

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3. How to check the item is allowed on the NHS This flowchart should help identify which items can be dispensed against an NHS prescription

FP10, FP10SS, FP10SP* Prescriptions issued by a GP, supplementary or independent prescriber

Is the prescription item listed in the Drug Tariff?

YES, the item will be allowed provided it's not listed in the blacklist [Drug Tariff - Part XVIIIA]

*Please note: For other NHS prescriptions, please check below: • FP10CN or FP10PN (nurse) – see Drug Tariff Part XVIIB • FP10D (dentist) – see Drug Tariff Part XVIIA • FP10MDA (instalments) – visit our website psnc.org.uk/mda

NO, Check whether the item is CE marked.

(CE marks can be found on the packaging)

YES, it's CE marked.

The product will be disallowed.

Only products which are recognised as medical devices and listed in the Drug Tariff are allowed.

NO, it's not CE marked.

If the item is a medicinal product or a borderline substance it will be allowed.

4. In conclusion Medicinal products: Subject to prescribing rights, any food, drug, toiletry or cosmetic may be prescribed on an NHS prescription unless the item is listed in Part XVIIIA of the Drug Tariff (the ‘blacklist’).

Medical devices: If a product has been registered as a medical device (also known as an appliance), it can only be prescribed on an NHS prescription if it is listed in Part IX of the Drug Tariff.

5. Common Disallowed Appliances List If you are unsure of whether your prescription item is allowed, visit our Common Disallowed Appliance List (psnc.org.uk/disallowedappliances).

6. Further support If you are still unsure, the PSNC Information Team can help: call us on 0844 381 4180 or 0203 1220 810, alternatively email us at info@psnc.org.uk

For the most up to date information, please visit the PSNC website: psnc.org.uk/allowed

Supporting PSNC 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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Ask PSNC The PSNC Information Team can give pharmacies support and advice on a range of topics related to the Drug Tariff and reimbursement. Questions the team have been asked by pharmacies in recent months have included: 1. Is Kerraped All Purpose Boot medium prescribable by a community practitioner nurse on an FP10?

Yes. Kerraped All Purpose Boot medium is prescribable on an FP10 by a community practitioner nurse as it is listed in Part IXA of the Drug Tariff and community practitioner nurses can prescribe any appliance listed in Part IX of the Drug Tariff as they are included in their formulary. For more information on which prescribers hold what prescribing rights see attached Dispensing Factsheet: Is This Item Allowed?

2. I have a prescription for a patient who was 59 when his prescription was written, however the patient did not hand over his prescription to be dispensed until he was 60. Is the patient exempt from paying a prescription charge?

Yes, subject to the prescription still being within the period of validity.

Entitlement to prescription exemption is based on the patient’s circumstances at the point of dispensing rather than on the date the prescription was written. In this case, as the patient was over 60 when they entered the pharmacy to have their prescription dispensed, they would be exempt from paying a prescription charge.

If the patient’s age is shown on the front of the prescription as “59”, then the patient should sign the back of the prescription form to declare that they are indeed over the age of 60 at the point of dispensing.

3. I have dispensed the final batch from a patient’s repeat prescription. How do I submit the authorising (RA) form to the Pricing Authority?

Authorising (RA) forms should be submitted to the Pricing Authority at the end of the month in which all batch issue forms have either been dispensed or expired or the medication is no longer required.

It is important that forms are sorted for submission in the correct order as detailed on the reverse of Form FP34C. In months where repeat authorisation forms are being submitted, tick the appropriate box on the FP34C Submission Form to indicate this.

There is no need to declare the number of repeat authorisation forms submitted.

4. I have tried to renew my registration of exemption for the storage of waste, but the Environment Agency say this is not required - is this correct?

Yes. Pharmacies are now automatically exempt from the need to hold environmental permits (the successor to waste management licences) where they are temporarily storing waste for the purpose of transferring the waste elsewhere for disposal. The conditions that apply include: • The waste must be stored in secure containers; • No more than 50 cubic metres of solid waste can be stored; • The waste cannot be stored for longer than three months; • The service is not provided as a waste management service (e.g. you do not receive payment for the service); • The waste must not have a flash point of less than 21ºC. 5. I have been told that I must register with the Environment Agency if I denature controlled drugs. Is this correct?

Yes. This is known as a ‘T28’ exemption. Registration of this exemption is straightforward, and can be completed online on the Environment Agency’s website www.gov.uk/wasteexemptions-treating-waste. If you have difficulty with registration, contact your local Environment Agency.

Look out for more frequently asked questions next month…

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

Problems obtaining a medicine or appliance?

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

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

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

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