October 2018 CPN

CPN

Community Pharmacy News – October 2018

Community pharmacy funding settlement • Funding levels to be maintained for 2018/19 • Single Activity Fee to be set at £1.26 • £10m reduction to Category M prices per month Quality Payments update | Adrenaline auto-injectors supply | Getting ready for FMD

FUNDING AND STATISTICS

CONTRACT AND IT

DISPENSING AND SUPPLY

Funding of £2.592bn agreed for 2018/19 • Community pharmacy funding levels will be maintained • This is an improvement on a previously planned funding cut of £33m for 2018/19 • The Single Activity Fee will be set at £1.26 to keep within the funding envelope • The recovery of excess margin will be continued following the pause over the summer, but at £5m per month lower

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After a lengthy and difficult debate, PSNC unanimously accepted this funding offer recognising the great difficulties faced by contractors but also the need to begin rebuilding constructive working relationships with HM Government after a two-year hiatus

Community pharmacy funding levels will be maintained for 2018/19, with total funding set to £2.592bn. This will be split, as previously, to deliver £1.792bn in fees and allowances and £800m in medicine margin.

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The price reductions follow the pause in margin recovery which PSNC agreed over the summer to help ease cash flow for contractors, and they reintroduce the recovery at a lower monthly rate (£10m monthly reductions, rather than £15m monthly) than it had been previously.

debate at the October PSNC meeting, PSNC unanimously agreed to accept the funding offer from the Department of Health and Social Care (DHSC) on the grounds that: • Community pharmacy is in the very early stages of rebuilding a constructive working relationship with HM Government, its only payer, and needs to demonstrate its desire to move away from the adversarial relationship that has halted progress for the past two years.

• Previous proposals revealed through the Judicial Review process had been to reduce community pharmacy funding by £33m this year.

• In the context of widespread austerity and immense financial pressures on the health service, and pending substantial discussions on the long term future of community pharmacy, maintaining funding levels was felt to be the priority and the best likely offer.

• The agreed levels of margin recovery have been set to repay a conservative estimate of excess margin and has been spread over the longest period possible to avoid greater shocks to the market.

After rigorous analysis of funding and margin delivery rates and a very difficult

In accepting the offer, PSNC expressed to HM Government its deep concerns about

In order to deliver the £1.792bn in fees and allowances, the Single Activity Fee will be set to £1.26 from the November Drug Tariff, but this will remain under review throughout the year.

Alongside this, Category M prices will reduce by £10m per month from November for the next five months (until March 2019). This to repay excess margin earned by pharmacies in previous years, in particular 2015/16 for which the results of the margin survey show that there was a significant over-delivery of margin.

Further Information and FAQs To help community pharmacy contractors and others to understand the impact that this funding settlement will have on their businesses and the background to its agreement we have produced a number of briefings and resources which are available to download from psnc.org.uk/briefings

2 Community Pharmacy News – October 2018

the financial pressures facing community pharmacy contractors and the fact that they would increasingly be unable to reinvest, given pressures from rising staff costs and business rates.

PSNC stressed the need for its goodwill in accepting this funding offer to be recognised in future negotiations, and also called for progress to be made in amending the current margin delivery system to smooth adjustments, and to remove the inequity in delivery caused by the proliferation of branded generics, as recognised by DHSC. PSNC has expressed its desire to begin negotiations on community pharmacy funding for 2019/20 and beyond as soon as possible, and our intention remains to work towards a multi-year settlement that will give more certainty for contractors about future funding. This will necessarily involve substantive discussions with HM Government about its ambitions for community pharmacy in the long term and PSNC is keen to explore ideas about the development of pharmacies’ role in line with the emerging NHS long term plan which we have sought to influence working together with the other pharmacy organisations.

SER

RVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCS

PSNC’S WORK

Statements from PSNC Members of the PSNC Committee comment on the 2018/19 funding settlement. £33m this year, and in that context, along with the backdrop of uncertainty in the wider economic climate, we knew that pharmacy was not going to get a better offer from HM Government.

Simon Dukes

PSNC Chief Executive “We know that many community pharmacy contractors will be disappointed to hear that there is no more money available for pharmacies this year, and accepting this funding offer was a difficult decision for PSNC to make. But we were very mindful of the proposals we had seen previously to reduce funding by

Since starting at PSNC in May, I have been struck by how hard community pharmacies are working on behalf of the NHS and patients, and we will continue to work with the other pharmacy organisations to ensure that HM Government sees the value that pharmacies are delivering. We must not underestimate the scale of the challenges ahead and we must make our case using evidence, through strategic influencing and by demonstrating that we are a sector innovating and embracing change and new technologies to deliver the outcomes that HM Government wants. If we can do all of this, then I do believe we will able to create positive opportunities for community pharmacies.

PSNC Vice Chair and Regional Representative Bharat Patel said: “PSNC agreed to this funding settlement in the one part with a heavy heart, because all our businesses are struggling at the moment, but in the other part with optimism, as although we are in the very early stages of rebuilding our relationship with HM Government, we hope we are starting to move towards more constructive dialogue.

I know that the contractors and LPCs who I represent will, rightly, ask me why we have not got any more money, particularly when community pharmacy collectively has made strong arguments and put forward a number of evidenced proposals for service development over the past two years. But the financial constraints on health and all public services are very severe indeed, and we are only just emerging from a period in which constructive dialogue about the future of community pharmacy had just not been possible.

Looking to the future, HM Government, as our payer, must have the final say in what it wants us to deliver, and our best strategy for success will be to work with Government, not to try to change what we cannot change, but to find ways to meet their objectives that are as beneficial for community pharmacies and their patients as possible. This is exactly what PSNC intends to do.”

Being able to reach a negotiated settlement for 2018/19 moves us forward in this process and away from the adversarial position that has halted progress over the past two years. We hope that HM Government will see this agreement as a signal of our willingness to work with them in the future, and we have stressed our desire to start negotiations on 2019/20 with them as early as possible.”

PSNC Funding Webinar PSNC is keen to share as much information about the funding settlement as we can and, to give community pharmacy contractors the opportunity to ask questions about it, we will be holding a funding webinar on Tuesday 30th October at 7pm.

Visit psnc.org.uk/webinar to register.

PSNC Funding and Contract Subcommittee Chair Peter Cattee said: “PSNC’s Funding and Contract Subcommittee considered the available analysis on margins and funding delivery rates very carefully ahead of the wider PSNC discussion on the funding offer. We know the impact that flat funding has on businesses, and we are particularly concerned that the reductions to Category M prices will once again hit cash flow hard, so only very reluctantly accepted that part of the funding package.

We felt that spreading the margin recovery over five months would minimise the impact on cash flow as much as possible, and we were also only prepared to agree to the recovery of £50m of historical excess margin, pending agreement on the final results of the latest margin surveys.

I believe the retained margin system no longer works in the way that we want it to, and this is something PSNC is exploring in great detail as part of work to explore alternative funding models. Solutions are difficult, but although any new models will bring change and challenge for contractors, they should also bring opportunities for those willing to embrace new ways of working and delivering services.”

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SERVICES AND COMMISSIONING

Watch our Quality Payments webinar Earlier this month the PSNC Services Team held a Quality Payments webinar to talk community pharmacy contractors through the updated gateway and quality criteria for the Quality Payments Scheme.

With the next review point just four months away (February 2019), the webinar gave an important Quality Payments update for those contractors planning to take part. And time was devoted to answering questions live.

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

Quality Payments learning packages The Centre for Pharmacy Postgraduate Education (CPPE) has published two learning packages relating to the revised quality criteria of the Quality Payments Scheme.

The packages are the CPPE Risk management guide and e-assessment and the CPPE Children’s oral health e-learning (in the form of a video) and e-assessment. PSNC has produced record sheets which contractors can use to record details of the members of staff who have successfully completed this training.

Links to the learning packages, e-assessments and further guidance is available on the CPPE website: www.cppe.ac.uk/services/qualitypayments

NUMSAS pilot extension Steve Brine MP, the Parliamentary Under-Secretary for Health and Social Care, announced that the NHS Urgent Medicine Supply Advanced Service (NUMSAS) pilot had been extended until the end of March 2019.

This followed the amendment of the Directions and the publication of updated guidance by NHS England which also contain some changes to incorporate the use of Summary Care Records (SCR).

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THE HEALTHCARE LANDSCAPE

LPCS

Second Quality Payments Scheme for 2018/19 announced • Updated gateway and quality criteria agreed by PSNC, NHS England and DHSC • PSNC negotiates correction period for contractors found not to be meeting gateway criteria • Changes signal sector’s willingness to contribute to key Government priorities

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The agreement to give pharmacies time to correct any gateway criteria that they are found not to have met is an important improvement

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PSNC, NHS England and the Department of Health and Social Care (DHSC) have agreed to update both the gateway and quality criteria for a revised Quality Payments Scheme for the remaining months of 2018/19.

The revised scheme will have a review point on 15th February 2019, with contractors having a four-week window throughout February in which to make their declarations.

PSNC has negotiated a correction period, so that any contractors who are found by NHS England not to have met the gateway criteria will be given time to correct this so that they can receive any Quality Payments for which they have met the requirements.

The negotiations on the scheme have taken place independently of any discussions on wider community pharmacy funding for 2018/19 because PSNC and NHS England wanted to give contractors as much time to prepare for the upcoming February review point as possible.

PSNC’s objectives were to ensure that all the available funding for Quality Payments would be accessible to contractors, and that any changes to the criteria would be manageable for them.

The changes went through several rounds of negotiations in which they were subject to adjustments proposed by PSNC, before they were agreed.

The changes to the Quality Payments Scheme criteria all help community pharmacy to move in the direction that the sector wants to – contributing to patient safety, clinical effectiveness and public health.

PSNC felt that it was important to signal to HM Government the sector’s ongoing willingness to work in these priority areas at this early stage in rebuilding constructive working relationships with them.

Full details on the changes are contained within PSNC Briefing 051/18: A summary of the second Quality Payments Scheme 2018/19 (see ow.ly/6P3q30m9YZg).

Simon Dukes, PSNC Chief Executive, said: “PSNC is pleased to have agreed these changes to the Quality Payments Scheme so that pharmacies can have the opportunity to earn all of the available funds for the scheme this year. The agreement to give pharmacies time to correct any gateway criteria that they are found not to have met, rather than simply losing out on all Quality Payments, is an important improvement.”

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

DISPENSING AND SUPPLY

Adrenaline 150 microgram auto-injectors supply Urgent actions required by community pharmacy teams following warnings of reduced availability of EpiPen and EpiPen Junior.

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Steps for pharmacies to take

New protocol introduced to ensure those with the greatest need have access to limited stock of adrenaline auto-injectors

The Department of Health and Social Care (DHSC) and NHS England asked all community pharmacies to implement additional validation processes from Wednesday 17th October.

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This has been put in place following critical supply issues to ensure that the limited stock of adrenaline 150 microgram autoinjectors reaches those most in need.

DHSC has stated: “We have now reached a critical supply issue and need to implement controls on the supply of 150 microgram adrenaline auto-injectors. Children weighing 25kg or less with the greatest short term need must have access to these first, ensuring that every patient has at least one in date 150 microgram adrenaline auto-injector. This can only be achieved by restricting issue of new devices until further notice.”

Pharmacy contractors and their teams are asked to read the protocol and Q&As (see: psnc.org.uk/adrenaline) and to implement this new verification procedure with immediate effect.

Community pharmacies are being asked to play a role in prioritising the limited stock now available by asking all patients who present with prescriptions (both NHS and private) for adrenaline 150 microgram auto-injectors some brief validation questions to check whether they are most in need of a supply. A flowchart outlining the questions to be asked is included in the Protocol.

The Dispenser Validation Protocol DHSC is advising that all patients need

to have access to a minimum of two adrenaline 150 microgram auto-injectors, but that it is sufficient if just one of these is in-date (meaning at least one month left before expiry) provided the patient also carries an expired device as back-up which is not discoloured and contains no precipitate.

Note: DHSC is now advising that expired auto-injectors should not be used if they contain a precipitate or are discoloured.

This can be checked by viewing the contents of the glass cartridge in the autoinjector through the viewing window.

The dispenser validation protocol should allow pharmacies to deduce whether a prescription should be fulfilled, partially fulfilled, or supply should be delayed.

The process applies to EpiPen Junior 150 microgram, Jext 150 microgram and Emerade 150 microgram adrenaline autoinjectors. The dispenser validation process does not apply to 300 microgram or 500 microgram strengths of adrenaline autoinjectors.

Ordering and Dispensing Auto-Injectors Where patients meet the criteria and are eligible to receive supplies, pharmacies will then need to order the product from wholesalers who will carry out an additional prescription validation step.

Where a patient is prescribed a different brand to what they have previously received, pharmacies will need to ensure that patients, parents and carers know how to use the auto-injector being supplied.

NHS England has issued a letter (shared

1. Read the new protocol from DHSC, noting in particular: • The flow chart of questions to ask patients to ascertain those who are in most need of supply; • The extension to the usability of some batches of Jext 150 and 300, previously advised of 300 EpiPen expiry extension; and • The guidance that all expired pens with precipitate or discoloured should be discarded.

This can be checked by viewing the contents of the glass cartridge.

2. Read the FAQs prepared by DHSC 3. Implement the protocol with immediate effect (i.e. from 17th October)

through GPs) to all patients and users of EpiPen Junior with further advice.

The letter can be used by pharmacies to support patients and make them aware of the latest advice.

Further Information In addition to the validation processes, there have been some changes to the recommendations around use of the various auto-injectors in addition to the changes announced previously. Pharmacy teams should note: • During the period of reduced supply, the cut-off for switching from 150 microgram to 300 microgram dosage for all devices is now 25kg. This change will result in off-label use of Jext 150 microgram and Emerade 150 microgram; • The extension to the usability of some lots of Jext 150 microgram and 300 microgram, and the previously advised EpiPen 300 microgram expiry extension; and • The guidance that all expired autoinjectors with precipitate or discoloured should be discarded.

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SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCS

Flu vaccinations: PGD addendum and new patient resource As the flu season progresses, the recommendation for certain patients to receive aTIV has led PHE to update its guidance and PSNC to publish a patient leaflet.

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An addendum to the influenza PGD allows for re-vaccination if a patient aged 65 or over is inadvertently given QIV instead of aTIV

Public Health England (PHE) has published an addendum to the community pharmacy Flu Vaccination Service 2018/19 Patient Group Direction (PGD).

This addendum provides the legal basis for two activities to take place: • For pharmacists to administer the recommended vaccine to patients who have inadvertently received the non-recommended vaccine for their age group during the 2018/19 Flu Vaccination Service, for example, patients aged 65 years or over who have received a quadrivalent vaccine (QIV) instead of the recommended adjuvanted trivalent inactivated vaccine (aTIV); and

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• For pharmacists to re-vaccinate patients who have received an incomplete dose of vaccine, for example, if some of the vaccine was spilled in the process of administering the vaccine.

NHS England is not advocating active recall of patients who have been given the non-recommended vaccine, but where a patient requests re-vaccination the addendum allows for this to take place.

PHE has also updated its inactivated influenza vaccine guidance for healthcare practitioners to include the process to follow when individuals have inadvertently been given a flu vaccine type that is not recommend for their age group.

NHS winter campaign series A new ‘Help Us Help You’ campaign series from the NHS brings together a family of campaigns incorporating messages about flu, staying well in winter, NHS 111, pharmacy and extended GP hours.

The first two phases of the campaign series, NHS 111 and Stay Well This Winter, began this month.

The campaign series aims to help people understand how to navigate the NHS and get the right help and advice they need in the most timely and appropriate way. It encourages people to take appropriate actions – whether that’s getting the flu vaccination or accessing the most appropriate service – to better enable the NHS to help them.

Every community pharmacy in England will receive a free pharmacy pack delivered by the Healthcare Distribution Association UK between 10th – 26th October.

6 Community Pharmacy News – October 2018

Support for pharmacy teams PSNC has produced a new leaflet for pharmacy teams to give to patients when they are advising those aged 65 years or over on the need to come back for a flu vaccination at a later date if the pharmacy has temporarily run out of stock of the recommend vaccine for their age group (Fluad, aTIV).

The leaflet covers key messages which are important for patients to be aware of, for example, why they are not able to have their flu vaccination immediately and why it is important to return to the pharmacy to have a flu vaccination.

To view the leaflet, please visit: psnc.org.uk/patient-leaflet

Flu vaccination claims guidance This year community pharmacy contractors have the option of claiming payment for the Flu Vaccination Service either via the paper claim form or via a new digital service.

All contractors should have received an introductory email from the NHS Business Services Authority (NHS BSA) to their premises-shared NHSmail account to explain how the online claiming process works.

The flu vaccination claim form (for paper submission) and guidance on the new digital submission process are both available via: ow.ly/wBhI30m06M2

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

DISPENSING AND SUPPLY

Replacement IG toolkit launched

National clinical audit for 2018/19

• New toolkit introduced for the 2018/19 community pharmacy IG return

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

• Fewer questions for those who have completed the PSNC GDPR Workbook for Community Pharmacy • Deadline for submitting this year’s IG return is 31st March 2019

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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.

PSNC has been working with NHS Digital to ensure the Toolkit is optimised for completion

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The Data Security and Protection (DSP) Toolkit for 2018/19 is now available for completion; this replaces the Information Governance (IG) toolkit that contractors have completed in previous years. As before, the deadline for submitting this year’s IG return is 31st March 2019.

Over the last few months, PSNC has been working with NHS Digital to ensure that the Toolkit is optimised for completion by pharmacy contractors and that appropriate support vmaterials will be available to help contractors to complete it. One PSNC proposal to make completion as straightforward as possible, which NHS Digital have agreed to implement, is that where a contractor declares that they have completed the PSNC General Data Protection Regulation (GDPR) Workbook for Community Pharmacy, the number of questions they will be asked to respond to in the Toolkit will be significantly reduced.

Contractors should register to access the new Toolkit at: www.dsptoolkit.nhs.uk/ Account/Register (a pharmacy ODS code is required) New technical questions The new DSP toolkit will include some technical questions which need to be

The audit will generally need to be conducted over a week, with data collection to be completed by 16th December 2018. Full details available at: psnc.org.uk/audit

completed, but on which contractors are likely to need to get the answers from their PMR supplier. PSNC has agreed with NHS Digital and PMR suppliers that they will work together to pre-populate the answers to the technical questions based on information provided by individual PMR system suppliers.

Cegedim, EMIS, Positive Solutions and RxWeb have confirmed they will support this approach and they have started to prepare text for inclusion in the DSP Toolkit during October and November 2018.

Further support PSNC will be developing further guidance to support toolkit completion and once this is available it will be highlighted on this website and in our email newsletters.

Requests for support can also be made by email to exeter.helpdesk@nhs.net or telephone 0300 3034034.

Pharmacy multiples that want to use the batch submission feature in the Toolkit are advised to register and begin completion of a ‘master’ Head Office submission. The ability to apply this as a ‘batch’ assessment to all your pharmacies will be made available in time for the March 2019 deadline.

Find out more Community pharmacy contractors can read more on this topic on the following webpages: psnc.org.uk/ig and www.dsptoolkit.nhs.uk/Help

EPS Controlled Drugs pilot begins NHS Digital has begun to pilot the prescribing and dispensing of EPS Schedule 2 and 3 Controlled Drugs (CDs) in the North and London.

Initially up to ten GP practices using the Vision and EMIS systems will have the ability to prescribe CDs, with the project aiming to demonstrate that EPS CD prescribing capability is safe and appropriate to be rolled out more widely.

Feedback from GP practices, community pharmacies, PSNC and other stakeholders will be used to refine the process prior before further roll-out.

Transfer of information survey The Professional Records Standards Body (PRSB) has published a survey to support standardising information transfer from pharmacies to GP practices regarding New Medicine Services (NMS), Medicines Use Reviews (MUR) and Appliance Use Reviews (AURs).

The purpose of the survey is to ensure that the right information is being shared in clinical systems in the right way, to benefit patients and clinicians.

Community pharmacy teams are invited to share their views by completing the online survey: www.surveymonkey. co.uk/r/JK7NTLR (closes on 5th November 2018) psnc.org.uk 7

PSNC’S WORK

FUNDING AND STATISTICS

CONTRACT AND IT

Representing community pharmacy In the past month PSNC represented community pharmacy at the annual political party conferences and in its response to the NHS long term plan consultation.

Hosting the 2018 LPC Conference

Birmingham, At the end of September PSNC held its annual LPC Conference in to discuss country the across from tatives represen LPC 135 together bringing current challenges and plans for the future. forefront of With financial pressures and upcoming funding negotiations at the the conference everyone’s minds, PSNC Chief Executive Simon Dukes’ address to been doing to have teams y pharmac ity commun that work the ing included recognis LPCs that assuring and sector the protect patients from the funding pressures on of the NHS. future the on ent Governm with debate the of part be to PSNC is pushing ts Paymen Quality the of version The conference was also informed that a revised 3). page CPN (see 2018/19 of half second the for agreed been Scheme had and support A key feature of the day was for LPCs to contribute to PSNC’s work ten NHS the on session a including ns, discussio table each other through ity consider year plan consultation where LPCs were then given the opportun int the questions in groups to help develop their responses. The full PowerPo presentation from the day is available at: psnc.org.uk/LPCconf18

FEEDING INTO NHS LONG TERM PLAN

Launching a blog A new section has been launched on the PSNC website to host a series of blogs written by PSNC representatives.

The PSNC Blog will enable community pharmacy teams to hear directly from PSNC members.

Find the PSNC Blog at: psnc.org.uk/blog

online consultation PSNC has published its response to the the valuable g ightin highl plan, on the NHS long term can make in many es maci phar unity comm that ns contributio key areas of healthcare.

studies and The response includes a number of case ces, and calls for servi macy phar of ss succe evidence of the services. It macy phar further commissioning of community the NPA and PSNC by made s ission subm builds on the joint ps, grou ing work plan to three of NHS England’s long term plan. term long NHS the nd arou work nt and other engageme /ykLC30m8NfG Read PSNC’s response in full at: ow.ly

PARTIC IPATIN G IN CON FER ENC E SEA SON PSNC attended a number of conferences recently to exhibit (at the Royal College of GPs’ conference), contribute to panel discussions (at the Pharmacy Show) and engage with stakeholders (at the political party conferences).

8 Community Pharmacy News – October 2018

PSNC CEO Simon Dukes tells Pharmacy Show attendees about negotiating for the sector.

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

LPCS

Getting ready for FMD PSNC answers common questions about the practicalities of complying with the FMD legislation.

The Falsified Medicines Directive (FMD) aims to prevent the entry of ‘fake’ medicines into the legal supply chain. From 9th February 2019, market authorisation holders must place two safety features on all prescription medicines distributed in Europe: • a unique identifier (UI) in the form of a 2D data matrix (barcode) which contains the batch number, expiry date, product identifier and a unique serial number for the pack; and • an anti-tampering device (ATD).

What will community pharmacy’s role be?

Community pharmacy teams will be required as part of the dispensing process to: • check the anti-tampering device to ensure it is intact prior to dispensing; and • change the status of the pack in the UK’s National Medicines Verification System (the UK hub) and change it from “active” to “inactive—supplied”. This involves scanning the 2D barcode on each pack.

Which medicines will we need to authenticate?

Almost all prescription-only medicines, including generics, have to be authenticated; the exceptions include specials and several products which community pharmacies are unlikely to dispense. Non-prescription medicines do not need to be authenticated unless specified; the only OTC product currently specified is omeprazole.

What happens when we scan a medicine?

When the barcode is scanned, the unique identifier is checked in the UK hub to see if it is a valid serial number and if it is marked as previously dispensed, recalled or expired; this is known as verifying the pack.

If the medicine is to be supplied to the patient, the system will then send another message to the UK hub to change the status of the product to “Inactive – decommissioned”. This process is known as decommissioning and it prevents any other

pack with the same unique identifier from being authenticated – duplication of packs being a sign that falsification might have occurred.

During dispensing, there will also be a check that the pack still has an intact antitampering device.

What if we dispense and decommission a medicine, but the patient doesn’t return to collect it?

Once you have decommissioned a medicine, you can change its status in the UK hub back to active within ten days of decommissioning it; this is called recommissioning.

After that time, the product cannot be recommissioned, and the legislation requires that any medicines which are not collected by the patient must be disposed of; they cannot be supplied to another patient. Note – this does not apply to split packs which have been decommissioned, but which the pharmacy has not yet dispensed.

Due to this “ten-day rule” most pharmacies will want to use a system which allows the product to be decommissioned at the point it is handed out to the patient. Many system suppliers have developed FMD software products which allow scanning of the unique identifier at the time of dispensing, but the products are not decommissioned until the medicines are collected by the patient.

When do we scan a medicine?

This will vary from pharmacy to pharmacy, depending on what best suits the workflow of the pharmacy and how the FMD software system has been designed; it can be when preparing a prescription or at handover to the patient, but the decommissioning of the product should normally occur at the time of handing the product to the patient, as this avoids problems related to the ten-day rule.

What do we do about split packs?

a pack, you should decommission the pack when part of it is first supplied to a patient.

The next time you dispense from this partpack, you do not need to authenticate it again. However, since you are not scanning the pack on subsequent dispensings, you will not be alerted to recalls or expired medicines, so this will need to be checked manually.

What happens if a potential counterfeit is detected?

You will get a message to say the medicine has already been marked as “inactive – supplied” and it is therefore a suspected counterfeit. If this happens, you will need to contact the MHRA and the supplier of the product. You may also want to verify any other packs of the same product which you have in stock.

What happens if a product does not have a 2D barcode?

In the first couple of years following implementation of FMD, there will be many medicines in the supply chain, in both wholesale and pharmacies, that are not FMD-compliant and do not have a 2D barcode. These medicines can continue to be dispensed until such supplies are exhausted or the items reach their expiry date. Some products may have a 2D barcode, but their details are not contained within the UK hub, as they were released into the market before the start of FMD.

Learn more about FMD You can find out more about the detail of FMD, guidance on implementation and a list of system suppliers at: fmdsource.co.uk FMD webinar: PSNC will be holding a webinar about FMD on Wednesday 7th November at 7.00pm. Book your place now: psnc.org.uk/webinar

When you part-dispense a medicine from

psnc.org.uk 9

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

End of month submission webinar: Your questions answered • In September over 300 people tuned in to PSNC’s webinar on end of month submission • Feedback shows 95% found the webinar useful and 83% would recommend it to others • PSNC’s Dispensing and Supply Team answers some of the submission-related questions asked by webinar viewers

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Q. What is the 5-day window for EPS?

A. The 5-day window allows electronic prescriptions dispensed in one month to be claimed up until midnight on the 5th of the following month so long as the dispensing notification message has been sent to the Spine prior to midnight on the last day of the dispensing month.

The 5-day window was implemented so that the submission of electronic prescriptions would be aligned with that of paper prescriptions, i.e. contractors are given the first 5 days of the following month to submit both their paper prescription bundle and any electronic prescriptions. It was envisaged that these 5 days would be used by contractors for administration purposes, to ensure that all prescriptions dispensed within the dispensing month are counted and submitted correctly.

Q. How should I count up my EPS totals?

Q. Regarding the 5-day window, is this always 5th of month or is it the 5th working day?

A. This is always the 5th of the month and not the 5th working day. It is important to bear this in mind particularly during months where the first 5 days spread over a weekend or Bank holiday.

This may give pharmacies limited time to submit electronic claims before midnight of the 5th of the following month in order to secure payment for that monthly submission.

We recommend submitting claims regularly throughout the month to prevent issues that may arise (e.g. loss of connectivity) if claims are submitted all at once.

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A. We recommend using your PMR systems report to provide a breakdown of monthly EPS totals which can be used to complete your FP34C submission document. Counting EPS tokens for purposes of completing your declaration is not recommended as this can often lead to errors resulting in incorrect Advance payment calculation.

The image below outlines the different scenarios showing how the 5-day window can impact the timing of payment for a claim.

Looking at the image above, the first row shows that a dispense notification was sent

on 28th September and an electronic claim message received by the NHS BSA on 4th October (before midnight on 5th October).

This claim would be reimbursed along with the prescription bundle submitted for the month of September.

If a dispense notification is sent in September but claim message is received after midnight on 5th October (please see 2nd row), this claim will be counted towards the total for October prescriptions and reimbursed accordingly.

It will not be included in your payment for prescriptions dispensed in September even if it has been declared in your September end of month submission document.

The third row in the image shows a dispense notification message sent on 1st October with a claim message received before midnight on 5th October – reimbursement for this claim will be included with October’s submission and not September’s.

LPCS

PSNC’S WORK

FUNDING AND STATISTICS

Q. Do EPS tokens for expensive items need to be included with my end-of-month bundle?

CONTRACT AND IT

Q. How do you submit an EPS prescription where one item is covered by a war pension certificate and the other is a paid item?

A. There is no virtual red separator for EPS Release 2 prescriptions and EPS tokens should not be placed in the red separator in the end-of-month prescription bundle. This is because these tokens are not used for payment of electronic prescriptions (payment is solely based on the information contained in the electronic claim message).

EPS tokens need to be filed separately and only included with your bundle if it has been used to capture a patient signature for purposes of exemption (except age exemption) or charge declaration.

PSNC does advise, however, that as part of the pharmacy’s reconciliation process, contractors should keep a log or generate report(s) from their PMR system for the following types of items: • Expensive items (items with a net ingredient cost of £100 or over); • Specials and unlicensed products; and • Items with broken bulk or out of pocket expense claims.

This report or log should then be used to reconcile items/values on the pharmacy’s FP34 Schedule of Payment which is sent by the Pricing Authority after the bundle has been priced. If you are unable or unsure as to how to generate a report which incorporates the above, contact your PMR system supplier for further information.

Remember: EPS tokens with any captured exemption (except age exemption) or charge declarations should be filed separately from prescriptions. The tokens do not need to be sorted in GP order, or by exempt or charge status.

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

Look out for more webinar questions next month…

A. The NHS BSA has confirmed that the only way to process prescriptions (both paper and EPS) containing item(s) covered by a war pension certificate correctly is to request that the prescriber write two separate prescriptions; one prescription for the item which the patient is going to claim on the war pension exemption certificate and one prescription for the chargeable item. The contractor will then be able to submit these prescriptions separately in the relevant exemption groups.

Please note: NHS BSA has no way of identifying which item(s) on a prescription are covered by a war pension exemption (either during any audit work or exemption checks) so always ensure that items covered by a war pension exemption are on a prescription of their own.

Useful links A recording of the end of month submission webinar – psnc.org.uk/submissionwebinar Understanding the EPS payment schedule – psnc.org.uk/EPSfactsheet Exemptions from the prescription charge – psnc.org.uk/exemptions

MPs publish report on generic medicine price increases The Public Accounts Committee (PAC) has called on the Department of Health and Social Care (DHSC) to make plans to help address the impact of generic medicine price rises on the NHS by the end of the year.

The PAC’s report on its inquiry into price increases for generic medicines states that the NHS had to spend additional time, money and effort to source medicines affected by price rises in 2017, noting “the extra efforts that pharmacies had to make to get medicines that were in short supply”.

The MPs have asked DHSC to set out what actions it will be able to take to address future price rises and to set out its plans for maintaining the supply of medicines both before and after Brexit. The inquiry report recommends that DHSC and NHS England should establish clear and timely information flows about generics price or supply issues, including with local commissioners and clinicians.

PSNC gave both written and oral evidence to the PAC inquiry to highlight the impact that the generic shortages are having on community pharmacies, and remains in close contact with DHSC to monitor the generics pricing situation.

psnc.org.uk 11

DISPENSING AND SUPPLY

SERVICES AND COMMISSIONING

THE HEALTHCARE LANDSCAPE

NHS stationery for community pharmacy This guide highlights the NHS stationery that community pharmacy contractors can obtain from the PCSE portal.

Primary Care Support England (PCSE) provides administrative and support services to community pharmacies and other primary care providers on behalf of NHS England, including the distribution of NHS stationery. Community pharmacy contractors can order the majority of their NHS stationery, e.g. pre-printed FP10DT dispensing tokens or FP57 refund forms, using the PCSE Online portal. A full list of items available from PCSE is shown below.

FORM

DESCRIPTION

Drug Tariff

Copies of the Drug Tariff are sent out every month to all pharmacy contractors in England. Some pharmacy teams find it useful to use the online version which can be accessed from the Pricing Authority’s website. (We have created a shortlink for quick access: psnc.org.uk/dt)

eRD

Electronic Repeat Dispensing promotional leaflets

FP57 Form

Receipt and Refund form for patients claiming reimbursement for prescription charges. Note: that 1 unit is 100 pads of 10

FP92A Pad

Application for prescription charge exemption (medical)

FP95 Form

Application for certificate of prepayment of prescription charges

FP1010 Book

Peak Flow Meter Charts

FP10DT Token

EPS Release 2 Dispensing Token

HC1 Application Form

Low Income Scheme application form /Claim for Help with Health Costs

HC1(LP) Application Form

Low Income Scheme Application Form (Large Print)

HC1(SC) Application Form

Low Income Scheme application form Special Circumstances

HC12 Guide

A quick guide to help with health costs (including dental, charges and optical voucher values)

HC12LP Guide

A quick guide to help with health costs including charges and optical voucher values - (Large Print)

HC20 Guide

Paying NHS Prescription Charges

IPD Pack

Insulin Passport for Diabetics information booklet

Lithium Alert Card Pack

Lithium Alert Card (Red) - In addition to those in the packs

Lithium Books Pack

Lithium Record Books - in addition to those in the packs

Lithium Info Book Pack

Lithium Info Book - In addition to those in packs

Lithium Pack

Collation of Info Book, Record Book and Alert Card

MTB

Methotrexate Treatment Booklets

OAT Alert Card

OAT Alert Card - card only

OAT Book

OAT Record Booklet- in addition to those in packs

OAT Info Book

Information Book for oral anticoagulant patients- In addition to those in packs

OAT PACK

OATPACK collation of all 5 OAT products

PPAEXENV (RE26) Envelope

PPA Return Exemption manila Envelope

STC Card

Steroid Treatment Card

Useful links: • The portal can be accessed via the PCSE website: http://pcse.england.nhs.uk/pharmacies/ • A step by step guide to ordering supplies can also be found on the PSCE website: http://pcse.england.nhs.uk/help/supplies/ ordering-supplies/ All supplies orders will be delivered by CitySprint, operating on planned daily routes on a weekly schedule.

• For queries regarding the delivery of Drug Tariff’s, please contact pcse.supplies-leeds@nhs.net • For further help or information, please visit their FAQ page: http://pcse.england.nhs.uk/help/ • You can contact PCSE by email at PCSE.enquiries@nhs.net or via their website: http://pcse.england.nhs.uk/contact/ • If your enquiry is urgent, you can telephone the PCSE customer service centre: 0333 014 2884

12 Community Pharmacy News – October 2018

LPCS

PSNC’S WORK

FUNDING AND STATISTICS

Drug Tariff Watch: November 2018 Part VIIIA additions Category A: • Dicobalt edetate 300mg/20ml solution for injection ampoules (6) • Ephedrine 30mg/1ml solution for injection ampoules (10) • Ivabradine 2.5mg tablets (56) • Nevirapine 400mg modified-release tablets (30) • Paroxetine 40mg tablets (28) Category C: • Alitretinoin 10mg capsules (30) – Toctino • Beclometasone 5mg gastro-resistant modified-release tablets (30) – Clipper • Bupivacaine 25mg/10ml (0.25%) solution for injection ampoules (5) – Marcain • Bupivacaine 25mg/10ml (0.25%) solution for injection ampoules (20) – Bupivacaine Sure-Amp • Bupivacaine 50mg/10ml (0.5%) solution for injection ampoules (5) – Marcain • Bupivacaine 50mg/10ml (0.5%) solution for injection ampoules (10) – AMCo • Bupivacaine 50mg/10ml (0.5%) solution for injection ampoules (20) – Bupivacaine Sure Amp • C1-esterase inhibitor 1,500unit powder and solvent for solution for injection vials  (1) – Berinert • C1-esterase inhibitor 500unit powder and solvent for solution for injection vials  (1) – Berinert • Chlorhexidine gluconate 1% solution  (150ml) – Cepton • Deferasirox 180mg tablets (30) – Exjade • Deferasirox 360mg tablets (30) – Exjade • Deferasirox 90mg tablets (30) – Exjade • Epoetin alfa 1,000units/0.5ml solution for injection pre-filled syringes (6) – Eprex • Epoetin alfa 10,000units/1ml solution for injection pre-filled syringes (6) – Eprex • Epoetin alfa 2,000units/0.5ml solution for injection pre-filled syringes (6) – Eprex • Epoetin alfa 20,000units/0.5ml solution for injection pre- filled syringes  (1) – Eprex • Epoetin alfa 3,000units/0.3ml solution for injection pre-filled syringes (6) – Eprex • Epoetin alfa 30,000units/0.75ml solution for injection pre- filled syringes  (1) – Eprex • Epoetin alfa 4,000units/0.4ml solution for injection pre-filled syringes (6) – Eprex • Epoetin alfa 40,000units/1ml solution for injection pre-filled syringes  (1) – Eprex

• Epoetin alfa 5,000units/0.5ml solution for injection pre-filled syringes (6) – Eprex • Epoetin alfa 6,000units/0.6ml solution for injection pre-filled syringes (6) – Eprex • Epoetin alfa 8,000units/0.8ml solution for injection pre-filled syringes (6) – Eprex • Etanercept 25mg/0.5ml solution for injection pre-filled syringes (4) – Enbrel • Etanercept 50mg/1ml solution for injection pre-filled syringes (4) – Enbrel • Golimumab 100mg/1ml solution for injection pre-filled disposable devices  (1) – Simponi • Golimumab 50mg/0.5ml solution for injection pre-filled disposable devices  (1) – Simponi • Golimumab 50mg/0.5ml solution for injection pre-filled syringes  (1) – Simponi • Hepatitis B (rDNA) 20micrograms/1ml vaccine suspension for injection vials  (1) – Engerix B • Hepatitis B (rDNA) 40micrograms/1ml vaccine suspension for injection vials  (1) – HBvaxPRO • Insulin isophane porcine 100units/ml suspension for injection 3ml cartridges (5) – Hypurin Porcine Isophane • Insulin soluble bovine 100units/ml solution for injection 10ml vials  (1) – Hypurin Bovine Neutral • Insulin soluble bovine 100units/ml solution for injection 3ml cartridges (5) – Hypurin Bovine Neutral • Levobunolol 0.5% eye drops 0.4ml unit dose preservative free (30) – Betagan Unit Dose • Mefloquine 250mg tablets (8) – Lariam • Methyl salicylate 30% / Menthol 8% cream  (35g) – Deep Heat Maximum Strength • Paliperidone 175mg/0.875ml prolongedrelease suspension for injection pre-filled syringes  (1) – Trevicta

CONTRACT AND IT

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

• Paliperidone 263mg/1.315ml prolonged-release suspension for injection pre-filled syringes  (1) – Trevicta • Paliperidone 350mg/1.75ml prolongedrelease suspension for injection pre-filled syringes  (1) – Trevicta • Paliperidone 525mg/2.625ml prolongedrelease suspension for injection pre-filled syringes  (1) – Trevicta • Posaconazole 100mg gastro-resistant tablets (24) – Noxafil • Prednisolone 30mg tablets (28) – Actavis UK Ltd • Sodium phenylbutyrate 500mg tablets  (250) – Ammonaps • Sodium valproate 50mg modified-release granules sachets sugar free (30) – Epilim Chronosphere • Tocofersolan 50mg/ml oral solution sugar free (20ml) – Vedrop • Tramadol 75mg / Dexketoprofen 25mg tablets (20) – Skudexa • Valproic acid 150mg gastro-resistant capsules (100) – Convulex • Valproic acid 300mg gastro-resistant capsules (100) – Convulex • Valproic acid 500mg gastro-resistant capsules (100) – Convulex Part VIIIA amendments • Aspirin 300mg suppositories (10) – Martindale Pharmaceuticals Ltd is changing to Category A • Macrogol compound oral powder sachets NPF sugar free (30) – Laxido Orange is changing to Category A • Terazosin 10mg tablets (28) – Hytrin is changing to Category A

Part IX deletions Product

Type, Size

LYMPHOEDEMA GARMENTS - Sigvaris Advance Arm Sleeves Advance 1, Low Compression (14-18mmHg) • with Seamless Hand Piece and Grip Top Plus Size • with Seamless Hand Piece and Grip Top • with Seamless Hand Piece without Grip Top

All sizes

LYMPHOEDEMA GARMENTS - Sigvaris Advance Arm Sleeves Advance 2, Medium Compression (20-25mmHg) • with Seamless Hand Piece and Grip Top • with Seamless Hand Piece and Grip Top Plus Size • with Seamless Hand Piece without Grip Top

All sizes

psnc.org.uk 13

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 050/18: Flu Vaccination Service 2018/19: Adjuvanted trivalent inactivated influenza vaccine (aTIV) PSNC has published a Briefing which summarises the different documents and news stories relating to the use of adjuvanted trivalent influenza vaccine (aTIV) for patients aged 65 and over, as well as clearly explaining what contractors should do if they have no aTIV available.

Download from: ow.ly/Od7S30lRD8Z PSNC Briefing 051/18: A summary of the Second Quality Payments Scheme 2018/19 In September 2018, a new Quality Payments Scheme was announced for the remainder of the 2018/19 financial year.

The new scheme has a review point in February 2019 and several revisions from previous scheme criteria. This PSNC Briefing provides a summary of key information on the Quality Payments Scheme for the second half of 2018/19.

Download from: ow.ly/6P3q30m9YZg PSNC Briefing 052/18: Quality Payments – How to achieve the Healthy Living Pharmacy quality criterion This PSNC Briefing provides an overview of how to achieve the Healthy Living Pharmacy (HLP) quality criterion of the Quality Payments Scheme for the February 2019 review point.

Download from: ow.ly/TVhS30maYCs See all our PSNC Briefings in our database at: psnc.org.uk/briefings

Other resources PSNC Blog A new section has been launched on the PSNC website to host a series of blogs written by PSNC representatives.

The PSNC Blog will enable community pharmacy teams to hear directly from PSNC members.

Visit now: psnc.org.uk/blog Watch the End of month submission webinar This joint webinar from PSNC and the NHS Business Services Authority (NHS BSA) guided viewers through the end of month submission processes and previewed NHS BSA’s digital submission application pilot.

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

Email news alerts EPS Controlled Drugs pilot to begin shortly (21st September) Detailing NHS Digital’s preparations for piloting the prescribing and dispensing of EPS Schedule 2 and 3 Controlled Drugs.

Read now: ow.ly/wo9O30mb0YN Second Quality Payments Scheme for 201/19 announced (26th September) Announcing the launch of a revised Quality Payments Scheme for the remaining six months of 2018/19 and providing key information about the updated criteria.

Read now: ow.ly/Xjmu30mb1aF Not receiving our emails? Sign up now at: psnc.org.uk/enews PSNC website For up to date information and news on community pharmacy issues, visit the PSNC website at psnc.org.uk PSNC Community Pharmacy News is published by: The Pharmaceutical Services Negotiating Committee, 14 Hosier Lane, London, EC1A 9LQ Community Pharmacy News is edited by: Melinda Mabbutt who can be contacted at the above address or by email at: mmabbutt@psnc.org.uk PSNC Office: 0203 122 0810

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