September 2015 CPN

CPN

Community Pharmacy News – September 2015

Setting out community pharmacy’s future PSNC highlights vital role for sector in reducing NHS pressures, and urges caution over funding change suggestions

Flu resources library | Medicines database guide | Contract monitoring update

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PSNC warns future care development plans must work for patients and pharmacies As the Royal Pharmaceutical Society consults on future integration of community pharmacy and general practice, PSNC urges caution and stresses need for protection for community pharmacy owners.

PSNC has commented on the Royal Pharmaceutical Society (RPS) and National Association of Primary Care (NAPC) consultation on future primary care models, stressing the need for any future arrangements to adequately protect community pharmacies.

The consultation considers the integration of community pharmacy and general practice in the future. It sets out a range of proposals for the extension of community pharmacy services, but also supports the removal of a ‘one size fits all’ central core contract and funding for pharmacies.

PSNC supports many of the suggestions for service development and for better integration between pharmacy and general practice outlined in the consultation. However, we believe that a national core contract allows this and also offers protection for community pharmacy owners, allowing them to invest in their businesses to offer other services and care. We also believe it is vital for all patients to be able to access a reliable core service including the dispensing of medicines from any pharmacy, anywhere in the country.

Commenting on the consultation, Sue Sharpe, PSNC Chief Executive, said: We agree with the RPS and NAPC on the need for community pharmacists to be a first port of call for people with symptoms and as we confirmed earlier this summer we had been seeking a community pharmacy minor ailments advisory service as part of the 2015/16 funding negotiations.

Where we part company with the RPS and NAPC is their apparent suggestion that we can abandon national provider-based commissioning. We are very concerned by the comments from

the RPS President stating that community pharmacy has been straightjacketed by a ‘top down’ national contract. Far from being a straightjacket, for pharmacy owners the core contractual framework and its funding has been and remains a vital protection and PSNC will battle to protect this principle.

None of the service and role developments the RPS and NAPC want to see for community pharmacists are in any way hampered by having a strong, core national contract. We have seen countless examples of innovative local services but these developments have taken time, effort, investment and risk, none of which would have been possible for businesses without the support of the national core funding.

We are also cautious about suggestions to transfer the community pharmacy network into multi-disciplinary care settings. While community pharmacy can clearly have a role in some if not all of these settings, a core benefit of community pharmacy is its accessibility particularly in some of the most deprived communities.

We are therefore urging the RPS to carefully consider the consequences of its suggestions and we will be responding to the consultation in due course.

Sue Sharpe’s full comment is available to read on the PSNC website.

NHS needs pharmacy to survive current pressures, PSNC tells MPs The NHS needs to make better use of community pharmacies as a matter of urgency if it is to meet the demand and financial challenges it faces, PSNC has told an influential committee of MPs. Responding to the Health Select Committee’s inquiry into primary care, PSNC set out the ways in which community pharmacy services could improve the quality of care for patients and help the NHS. “With the right enablers community pharmacies could offer major changes to

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the provision of primary healthcare quickly and relatively easily,” PSNC stressed.

Local services currently offered value for commissioners and could reduce pressure on GP and urgent care services, but “their impact is stifled by patchy and low quality local commissioning”, the response read.

PSNC also highlighted where decisions by national commissioners had prevented pharmacy services with clear benefits from being implemented.

In particular PSNC pointed to the five services outlined in its recently published Pharmacy 5 Point Forward Plan, calling on NHS England to commission these nationally. “A national decision would support rapid implementation and uptake and so bring most benefits to patients and the NHS,” the response read.

Find out more and read the full Pharmacy 5 Point Forward Plan at psnc.org.uk/5pointplan

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PSNC defends Summary Care Record access PSNC, the Royal Pharmaceutical Society and Pharmacy Voice publish joint response addressing concerns raised in the national media about community pharmacy access to the Summary Care Record.

Last month, the Daily Telegraph featured an article raising concerns over plans for community pharmacy to be given access to the Summary Care Record (SCR). The article contained concerns that pharmacists, particular those in larger multiples, would use their new access rights to target patients with particular products.

PSNC, the Royal Pharmaceutical Society (RPS) and Pharmacy Voice have worked together to address the concerns raised within the story and to highlight the safeguards that will be put in place to prevent unauthorised access to the SCR. The joint response, which was published in the Daily Telegraph, is shown above and the original letter can be viewed in its entirety on the PSNC website.

Patients can be assured that their information will only be accessed by a registered pharmacist or pharmacy technician using

an NHS Smartcard and PIN, and then only after the patient has given consent. The registered professional’s access is subject to secure approval and will be monitored by the NHS. Enabling community pharmacy access to the SCR will allow patients to be better supported as the pharmacist will be able to provide better informed and tailored care, as was shown in a pilot carried out in 140 community pharmacies last year. The evaluation of that pilot showed pharmacists were able to help people who needed access to essential medicines by using the SCR, avoiding unnecessary visits to GPs, and they were also able to provide safer care with a reduction in the number of avoidable medicine errors.

Additionally, PSNC has put together PSNC Briefing 042/15: SCR access in the media: Responsive lines for LPCs and pharmacy teams to help address any media queries or concerns from members of the public. This briefing is available from psnc.org.uk/briefings Alastair Buxton, PSNC’s Director of NHS Services, said: “Community pharmacists are regularly identified as the most trusted healthcare professionals and they are already well informed about patients’ medicines and in some cases the conditions they are treating. This sensitive information is already handled properly and confidentially in pharmacies and similar practices will be adopted to secure the data in the SCR. Pharmacists are regulated healthcare professionals and all use of the SCR can be accessed and monitored by the NHS.”

Practice Payment change in September 2015 Community pharmacy contractors should be aware of changes to the levels of Practice Payment that have been made in the September 2015 Drug Tariff. The increase is related to delivering the agreed funding of £2bn through fees and allowances in 2015/16.

PSNC will continue to monitor funding delivery during 2015/16 to determine if further changes are required to meet the target.

The table opposite outlines the Practice Payments effective from 1st September 2015 in England:

Number of items per month Up to 1,099

Practice Payments for 1st September 2015 to 31st March 2016 £350

Monthly Practice Payment (as it will appear in your FP34 Schedule of Payment) £50

1,100 – 1,599

£3,268

£466.86

1,600 – 2,499

£4,575

£653.57

2,500+

54.7p per item

54.7p per item

Missed our Endorsing and Submission Good Practice Workshop?

Or found it so useful you want another look?

You can now find the webinar prescription quiz, listen to an on-demand recording, or view the slides without commentary on the PSNC website.

Just visit psnc.org.uk/webinar

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Flu vaccination service: the resource library Many community pharmacy teams are preparing to offer their patients flu vaccinations this winter. PSNC has a whole range of resources available to help, so make sure you don’t miss out.

Key facts and latest information:

Keeping up-to-date Our national flu vaccination service information, guidance and resources will be updated on an ongoing basis. You can stay up-to-date: Online — check psnc.org.uk/flu regularly By email — sign up for PSNC’s email newsletters at psnc.org.uk/email On Twitter — follow @PSNCNews and look at #getreadyforflu Dedicated webpage The new PSNC webpage on the Flu Vaccination Advanced service is the hub for all the resources linked to the service.

It includes a wealth of information and support tools for contractors, pharmacy teams and LPCs including the poster opposite, which pharmacy teams may like to put up in the dispensary, and a template anaphylaxis telephone card to guide staff on calling an ambulance if a patient has an anaphylactic reaction to a vaccination. Why not take a look now?

Visit psnc.org.uk/flu FAQ directory Our flu FAQs page contains answers to queries on topics ranging from training requirements and data recording, to the practicalities of service provision and the timing of the service launch. Check for regular updates at psnc.org.uk/flufaqs Process poster A PSNC Briefing has been published

setting out the steps involved in offering and giving a flu vaccination. The briefing has been designed as a poster which could be displayed in your consultation room as a reminder to pharmacy staff. It may also help pharmacy teams to think about the processes they will need to put in place to deliver the service smoothly and efficiently.

Why not take a look now?

Visit our Briefings Database (psnc.org.uk/briefings) Promoting the service On this section of the flu webpage you can download a range of resources including posters, letters and flyers to help you recruit patients to the service.

We also have translated versions of some of the resources coming soon, and a patient leaflet designed to tackle common issues and misconceptions about pharmacy flu vaccination resources. Download the resources now from psnc.org.uk/flupatientcomms

Key facts reminder • Your pharmacy must have a consultation room to provide the flu vaccination service.

• Eligible patients are those aged 18 years and over in the at-risk groups defined in the Annual Flu Letter.

• Only the pharmacist can administer the vaccine and they must be trained to do so.

• There is no limit on the number of vaccinations pharmacies can claim for as long as they are given to eligible patients.

Service timing As CPN went to press the wording of the service specification and the associated paperwork for the flu vaccination Advanced Service had been agreed between NHS England, NHS Employers and PSNC and was going through NHS England’s internal governance procedures.

It will be published once it has successfully passed through those procedures.

Alongside the service specification PSNC will publish full guidance on implementing the service for pharmacy contractors and their teams.

In order for pharmacies to begin offering the Advanced Service, Secretary of State Directions are needed to provide the legal basis for provision of the service. As CPN went to press the Department of Health were drafting amendments to The Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2013 to allow implementation of the service.

Contractors are advised to look out for the latest updates – see Keeping up-to-date opposite.

Pharmacists and pharmacy contractors practising in Wales should visit the Community Pharmacy Wales website (cpwales.org.uk) for information on flu vaccination services in Wales.

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Top tips for flu vaccination service Earlier this year PSNC spoke to a number of pharmacists, LPCs and pharmacy teams involved in successful flu vaccination schemes in 2014/15 to ask them what they had learnt. Here is a selection of their advice.

For pharmacy teams 1. Think about your pharmacy and your patients.

Would appointments work or would a ‘drop in’ service be better? We had a ‘drop in’ service and it worked well for our pharmacy, although appointments will work better for some.

2. Be organised.* This is with regard to stock, paperwork and the running of your service as a whole. Utilising the skills of your staff is pivotal. Try and instil them with enthusiasm.

3. Go for it.

If you’re going to do it, then go ‘all in’. There’s no point in being half hearted 4. Appoint a ‘flu helper’ This is someone on the team with a specific brief to discuss the betnefits of flu vaccination with eligible patients who come into the pharmacy.

5. Talk to local GP practices Consider whether you could speak to any local GP practices about the service to try to work together to ensure that patients are not confused and that vaccination targets are met.

6. Make the most of everyone on the team Although the pharmacist must carry out the vaccination process, other team members can help both before and after that for example asking patients to complete the postvaccination questionnaire.

The above infographic details the process involved in flu vaccinations to help deliver the service smoothly and efficiently. It could be stuck on a wall in your consultation room as a reminder to pharmacy staff. The routine is based on advice provided to pharmacy teams in Cumbria by John Urwin, owner of Seaton Pharmacy in Workington and a member of Cumbria LPC.

*Additional pointers

For LPCs

a) Put anaphylaxis procedures in place Remember to ensure staff know where the Anaphylaxis Pack/Adrenaline injection is kept; consider training members of the dispensary staff to draw up the Adrenaline; and have a card by the phone detailing what information to provide when calling an ambulance (a template card is available on the PSNC website). b) Think about stock management Consider multiple delivery drops and remember to bear in mind your fridge capacity. c) Plan your appointments or walk in system 10 minute appointments are probably the best to start with. Once the pharmacist’s skill and confidence has built up (after the first few patients) you will find there is plenty of time to perform other duties and maybe even squeeze in a walk-in between appointments.

1. Support local pharmacies.

It’s different from waiting for the green script to come to you so pharmacy teams will need support in delivering the service; they need to know how you might try and sell a flu vaccine.

2. Combat negativity from GPs. Have well-informed arguments about why the community pharmacy is different, why there is strength of multiplicity of providers.

3. Prove how the service is successful.

Emphasise the need for data collection as a way to “share the good story” and try to have sight of the data and do something with it.

4. Promote the service PSNC has a range of resources available to help LPCs to promote the service locally including template press releases and some possible radio advert scripts. Download these from psnc.org.uk/flu psnc.org.uk 5

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How to use the NHS medicines database (dm+d) This guide explains how the NHS medicines database impacts on reimbursement and how you can use it to find out what you will be paid. It also highlights how it is used in the Electronic Prescription Service.

The Dictionary of Medicines and Devices (dm+d) is the NHS standard database of medicinal items, and is used across the NHS, for example in the Electronic Prescription Service (EPS) and for prescription pricing purposes. Pharmacy and GP system suppliers adopt or map to the information included within it. Each medicinal item has an entry in the database in which information is stored in several interlocking levels; there is information relevant to pharmacy teams in each level (see diagram of the structure below).

Using the database for information You can view dm+d information online using

an internet browser. Datapharm (collaborating with the Pricing Authority) provide access at the website: dmd.medicines.org.uk and this can help support the dispensing process. The examples at the bottom of this page show dm+d information at generic (VMP), supplier level (AMP), and supplier pack level (AMPP).

Reimbursement/EPS issues Each medicinal item listed in dm+d has its own unique code and new products are added by the Pricing Authority. With EPS prescriptions, reimbursement will be based on the dm+d code attached to the EPS prescription.

Electronic endorsing: Additional information for pricing can be provided by endorsing the electronic prescription using your PMR system endorsement options.

Supplementary product information added by the prescriber in the dosage section of an EPS prescription: The Pricing Authority will not take into account supplementary product information included in the dosage area section, i.e. immediately after the dosage instructions (psnc.org.uk/dosageissue).

Non-dm+d items are outside the scope of EPS so may not be processed and

Information levels on dm+d ‘Generic’ perspective e.g. ‘Atenolol 100mg tablet’ This is the generic product title described as the virtual medicinal product (VMP).

Information in this part of the database determines things such as the drug form and whether the medicine is a Controlled Drug.

VMP describes the generic product

CD status of a product

Here there are links to the suppliers’ product (AMP level, see picture opposite).

Link to the relevant pack levels, or the virtual medicinal product pack (VMPP). Information here determines such things as Drug Tariff category and whether the item is a combi-pack.

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Supplier’s product perspective e.g. Tenormin 100mg tablets (Actavis UK Ltd)’ This is the product level which is usually linked to a particular supplier, or the ‘actual medicinal product’ (AMP).

The supplier can have information listed here relating to availability and licensing status.

Name of product

Licensing status of product

Manufacturer/Supplier

Link to the relevant pack levels

Link to patient information leaflet

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priced correctly: Most items which are prescribed are listed in dm+d, but if a prescriber wishes to prescribe a medication item which is not listed in the dm+d (e.g. a particular special formulation), an electronic prescription should not be issued by EPS and national paper prescription processes should be followed.

Differences between EPS dm+d prescriptions and paper ones Prescribers issue prescriptions for products via EPS using either a product’s VMP or AMP code from dm+d. There can therefore be differences between EPS prescriptions and paper ones, such as: • Changes to medicine descriptions compared with historical medicine descriptions: For example 'enteric coated' tablets are described in dm+d as 'gastro-resistant', and for inhalers, dm+d uses the term 'dose' as opposed to 'actuation', 'inhalation' or 'puff'. In dm+d, products are described in the

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order: product, strength, form.

• Quantities and units of measurement: In EPS R2, GPs cannot prescribe ‘packs’ but must instead prescribe using dm+d quantities. For example since inhalers are expressed within dm+d using ‘number of doses’ prescribers may select '200 dose' rather than '1 inhaler'.

PMR systems can support pharmacy teams by calculating the prescribed quantity as a number of packs for ease of dispensing.

• Terminology length and abbreviations: Many products have a full name and an abbreviated name so that the latter can assist with dispensing label space restrictions.

Mapping of system supplier drug databases to dm+d The mapping process: Prescribers can issue EPS prescriptions using either the generic VMP or the supplier-linked AMP code. Most GP and pharmacy system suppliers use drug databases in their

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systems, and have to ‘map’ the dm+d products to products listed in their databases so that EPS messages can be sent and received. EPS R2 system suppliers must use dm+d information no more than two months old.

Reporting medicine ‘mapping errors’ (EPS): Where a particular item held on the GP system’s drug database is not mapped with a dm+d code, or the mapping is inaccurate, there may be risk of medicolegal consequences. If pharmacy teams spot that information printed on the token is different from prescribing information shown on the screen, they should report it to their pharmacy system supplier immediately and also report it as a patient safety incident to the National Reporting and Learning System (NRLS) (npsa.nhs.uk/eform).

More information about dm+d can be found at: psnc.org.uk/dmd, dmd.medicines.org.uk, and dmd.nhs.uk

Supplier’s product pack perspective e.g. ‘Tenormin 100mg tablets (AstraZeneca) 28 tablet’ This describes the pack levels relating to the above, or the ‘actual medicinal product pack’ (AMPP).

The supplier can list the NHS-listed price, whether broken bulk can be claimed, and whether the product is a POM, a ‘special container’, ‘discounted’ etc.

Pack size/subpack size If a product is P, POM, or GSL

This section includes: • patient prescription charges; • professional dispensing fees; • broken bulk eligibility; • special container status; and • discount not deducted status.

Note: Indicative NHS price does not always apply to reimbursement e.g. where a Part VIII item has been prescribed generically, or if a product has recently changed in price (then the Drug Tariff's price change mechanism would apply, see psnc.org.uk/pricematch).

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Community Pharmacy Assurance Framework update A new shortened monitoring questionnaire has been created for contractors and will enable NHS England teams to more effectively prioritise their pharmacy visits.

PSNC’s Health Policy and Regulation subcommittee was asked to consider an abbreviated Community Pharmacy Assurance Framework (CPAF) questionnaire, which contains 10 questions, each covering parts of the terms of service set out in the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. The results of this together with additional information collated by the NHSBSA and NHS England will be used to prioritise monitoring visits to help ensure that patients and members of the public receive safe, effective and high quality pharmaceutical services. The full CPAF will then be sent to those pharmacy contractors that are being considered for a visit.

PSNC supports the completion of the abbreviated CPAF by all pharmacies.

However, the full CPAF will also be available in due course, and whether the pharmacy is asked to complete one or not as part of the pre-visit planning, we would recommend that pharmacy contractors complete the full version.

For the 2015/16 questionnaire NHS England has requested the NHSBSA to carry out the administration of CPAF at a national level on their behalf and this will be facilitated by a secure on-line mechanism for contractors to complete their returns.

Contractors will have four weeks to complete the abbreviated CPAF questionnaire which will be available from Monday 5th October 2015 until Sunday 1st November 2015. The questionnaire should only take around 20 - 30 minutes to

complete and you will receive information and instructions on how to access and complete the questionnaire in advance.

Once you have submitted the completed questionnaire, responses can be saved or printed for future reference.

The NHSBSA and or your local NHS England team will contact you to provide log-on details. If you have not heard from either by 5th October, contact nhsbsa.help@nhs.net

Free EPS masterclasses

Changes to the NHS Constitution

To help pharmacy teams get the most out of EPS, new systemspecific training will be available for all those working in community pharmacy. This training will be relevant for counter staff as well as dispensing technicians, pharmacists and locums.

In his inquiry into the failings at Mid-Staffordshire, Sir Robert Francis QC recommended amendments to the NHS Constitution based on prioritising patients, protecting patients from avoidable harm, providing assistance that patients need, and staff compliance with guidance.

Over 800 training events will be held throughout England with at least one event per PMR system in each LPC area during the next year. The events are being organised by the EPS Team at the Health and Social Care Information Centre (HSCIC), in conjunction with LPCs, dispensing system suppliers and the Pricing Authority.

The free training will focus on: 1. dispensing system training, tailored specifically to your PMR system, covering how to use EPS Release 2; 2. business process change and how to get the best out of EPS, including business continuity; and 3. a claiming and endorsing masterclass by the Pricing Authority.

PSNC encourages all community pharmacy teams to attend at least one event, to ensure they can get the most out of EPS, understand their PMR capability, and are prepared for the future of EPS. Sign up for events in your area at tinyurl.com/traineps or read more at psnc.org.uk/epstraining 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.

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Each of these recommendations were implemented within the new NHS Constitution on 27th July 2015.

Additionally, the Department of Health has introduced a new duty of candour. There had previously been a requirement to be honest with patients, when things go wrong, but NHS providers are now required to be both honest and open.

Section 2(4)(a) and 2(6)(g) of the Health Act require providers of pharmaceutical services to have regard to the NHS Constitution, so this amendment is effective without the need for a change to the pharmacy Terms of Service.

The NHS Constitution and associated guidance can be found at: tinyurl.com/d7sa3wq

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

Stoptober returns

The Stoptober campaign, a 28-day national stop smoking challenge running in October, will return again this year.

The Public Health England campaign, helping encourage England’s smokers to quit, launches on 3rd September whilst Stoptober itself starts on 1st October.

Stoptober gives pharmacy teams a way to discuss products, tailor advice and introduce smoking cessation services to smokers who may already be thinking of quitting.

Pharmacy teams can get involved by ordering the Stoptober toolkit free of charge from 0300 123 1019. The order line is open Monday to Friday, from 8am to 6pm, until 28th October 2015 or whilst stocks last.

Antepsin supply

The manufacturer Chugai has k advised that there is no stoc of Antepsin 1g/5ml Oral Suspension and Antepsin 1g Tablets for community pharmacies.

supply will be Chugai said: "It is unlikely that ."

2015 of resumed until the end unlicensed Remember: when obtaining an

need to be product, the prescriber will ate, amend a opri appr contacted and, where Sucralfate for tion crip pres d generically issue ial'. spec d ense 'unlic ify to spec unlicensed For more guidance on endorsing als peci .uk/s .org psnc specials, see:

Have you seen PSNC’s factsheet “Sending EPS presriptions with the right exemption information”?

Recently PSNC’s Dispensing and Supply Team have had an increased number of calls relating to the wrong exemption information being populated on EPS resulting in the incorrect claim being sent.

A factsheet has been created to help ensure pharmacy teams send the right exemption information with EPS claims.

Head over to psnc.org.uk/espexemption to find out more.

Updated New Medicine Service e-course

The Centre for Pharmacy Postgraduate Education (CPPE) will be running an updated live e-course on the New Medicine Service (NMS).

The live course entitled ‘New Medicine Service: improving quality and getting it right’ will give participants an understanding of the purpose and scope of NMS; as well as looking at the practicalities of running the service.

Many of the weekly learning activities from the e-course can be done at a time convenient to the participant, but the live aspect will allow participants to interact with colleagues in discussion forums and learn together in online webinar sessions.

28th September 2015 is the last date on which you can join the 8-week course.

Pharmacy teams’ work recognised The potential for community pharmacy post-discharge services to improve care for patients has been recognised in Healthwatch England's latest inquiry

report.

PSNC submitted evidence to HealthWatch England's special inquiry into people's experiences of leaving hospital, highlighting some of the great work already being carried out locally. Examples included the Isle of Wight's Reablement Project, which saw a 67.5% reduction in hospital bed days following discharge, and has been showcased in Healthwatch's final report.

Read the Healthwatch report, and PSNC's submission to the inquiry, at: dld.bz/dQxQK

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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 10% of primary care budget spent on diabetes The report Prescribing for diabetes in England (dld.bz/dRRj4) published by the Health & Social Care Information Centre (HSCIC) shows that in 2014/15: • the Net Ingredient Cost for managing diabetes was £868.6 million – this represents 10% of the total primary care prescribing spend in 2014/15 (£8,704.9 million); • 47.2 million items were prescribed for diabetes, a 4.6% increase (2.1 million) from 45.1 million items in 2013/14; and • diabetes medicines accounted for 4.5% (47.2 million) of all prescription items (1,059.8 million).

Antimicrobial stewardship programme NHS England, Health Education England and Public Health England (PHE) have issued a joint National Patient Safety Alert to all providers of NHS care in England to highlight the challenge of antimicrobial resistance and the need for antimicrobial stewardship.

The joint patient safety alert signposts NHS organisations to the TARGET (Treat Antibiotics Responsibly, Guidance, Education, Tools) (dld.bz/dRRjG) and Antimicrobial Stewardship: Start Smart then Focus (dld.bz/dRRjH) toolkits. These have been developed

by PHE in collaboration with several professional bodies to support the NHS in improving antimicrobial stewardship in both primary and secondary care.

Fire and Rescue Services Partnership NHS England and the Fire and Rescue Services have established a new partnership to use their collective capabilities and resources more effectively to enhance the lives of older people and those with complex conditions.

Working together with PHE, the Chief Fire Officers Association, the Local Government Association (LGA) and Age UK, the group has established a new working relationship aimed at improving the quality of life for people who would benefit from brief health and wellbeing interventions in their own homes.

Diabetes management accounted for 10% of the total 2014/15 primary care budget 2014/15 saw a 4.6% increase in items prescribed for diabetes One in 20 appointments at GP practices are missed More than 200,000 signed a petition calling for a vote of no confidence in the Health Secretary of the NHS by threatening to impose a harsh contract and conditions on first consultants and then other NHS staff.

Hospital-based GP practice A GP practice based within a hospital is looking to sign up just patients who have five or more serious long-term conditions to its list to help reduce pressure on the Emergency department. The scheme is run by GPs who have received funding from the Prime Minister’s Challenge Fund (dld.bz/dRRjw) to increase GP access, and it has been commissioned by NHS Barking & Dagenham Clinical Commissioning Group (CCG) and NHS Havering & Redbridge CCG. 5% of GP appointments are “no-shows” One in 20 appointments at GP practices are missed by patients, research by a Local Medical Committee (LMC) has shown. In 2014 68,000 appointments across 29 practices in the Leicester, Leicestershire and Rutland LMC area were missed by patients.

The findings suggest that across England, more than 16 million appointments are missed each year.

Primary Care Workforce Commission report The Primary Care Workforce Commission has published The future of primary care, Creating teams for tomorrow (dld.bz/dRRjb), which calls for wider use of community pharmacists and pharmacy support staff in managing minor illness and advising people about optimising their medicines. It also recognises that greater use of pharmacy services such as weight management and smoking cessation, could relieve some of the demand for care from general practices.

7-day NHS services The Department of Health has published a factsheet (dld.bz/dRRjk) describing why the NHS needs to offer a 7-day service and further action that the Government wants to take to make NHS services safer.

More than 200,000 sign Hunt no confidence petition More than 200,000 people have signed a petition calling for a vote of no confidence in Health Secretary Jeremy Hunt. The no confidence petition (dld.bz/dRRjn) was organised by NHS doctors who say the Health Secretary has alienated the entire workforce

E-cigarettes evidence review PHE has published an expert independent evidence review (dld.bz/dRRjE), which has concluded that e-cigarettes are significantly less harmful to health than tobacco and have the potential to help smokers quit smoking.

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

1. What is the NHS standard list of medicinal items?

The NHS Dictionary of Medicines and Devices (dm+d) is a database which contains information about medicines and devices used in the UK. The Pricing Authority maintains dm+d.

Please note: it is not possible for a prescriber to use EPS release 2 to request a bulk prescription (Drug Tariff Part VIII note 9) for a school or institution. Private prescriptions are also out of scope.

The database not only includes the vast majority of medicines or devices that are currently available, but also those that have been discontinued, used in clinical trials or imported. Each product or device is assigned a unique code, which is never deleted or reused.

There will be occasions where a product cannot be prescribed electronically for technical reasons. For example, this could occur if the product is not listed in dm+d or if the prescribing system is not able to issue a prescription for the item because the supplier hasn’t ‘mapped’ the appropriate codes.

The dm+d underpins many of the NHS IT initiatives including the Electronic Prescription Service (EPS) which currently only allows prescribing and dispensing of those items listed in dm+d.

The InDemand version of the dm+d database can be searched and viewed from: dmd.medicines.org.uk. A guide to dm+d can be found on pages 6 and 7.

2. What items can be issued on EPS? Prescribers are able to issue: • Acute prescriptions; • Repeat prescriptions (repeat prescribing); • Repeatable prescriptions (repeat dispensing); and • Schedule 2,3,4 and 5 Controlled Drugs.* * Although Schedule 2 and 3 Controlled Drugs can now legally be prescribed on EPS release 2, the date at which pharmacy teams will start to receive such prescriptions has yet to be confirmed.

3. Can EPS be used with items not included within the dm+d?

No, an EPS prescription cannot be issued where the product is not listed in dm+d or if the prescribing system is not able to issue a prescription for the item because the supplier hasn’t ‘mapped’ the appropriate codes. This is likely to affect less commonly prescribed items including products to be specially manufactured or extemporaneously dispensed products.

Please note: if information is included in the dosage area which indicates a non-dm+d item, this cannot be taken into account by the Pricing Authority for reimbursement.

Look out for more frequently asked questions next month…

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

News from the NHSBSA Have you registered for the Pricing Authority Information Services Portal?

As part of the programme to provide prescription pricing transparency, the Pricing Authority has made pharmacy contractor payment information (i.e. FP34 Schedule of Payments) available to view via the Information Services Portal (ISP).

To view your FP34 Schedule and gain access to the upcoming item level payment reports, register for the portal at: tinyurl.com/BSAportal

NHSBSA’s Hints & Tips NHS Prescription Services produces a quarterly newsletter called Hints & Tips for dispensing contractors. We would like to draw your attention to the latest edition (Issue 20) as it contains some really useful information and advice regarding: • Information on changes to the Misuse of Drugs Regulations; • News on the new live service reports for the Electronic Prescription Service (EPS);

• Information on incorrect patient declaration of exempt/paid status for EPS Release 2 messages; and • Referred back (returned) items.

NHSBSA have published a Special Edition of Hints & Tips on EPS which may also be of benefit to pharmacy teams.

All issues of Hints & Tips can be found at: www.nhsbsa.nhs.uk/3191.aspx

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: Melinda Mabbutt who can be contacted at the above address or by email at: mmabbutt@psnc.org.uk PSNC Office: 0844 381 4180 or 0203 122 0810

© PSNC

psnc.org.uk 11

Dispensing anD supply

services anD commissioning

the healthcare lanDscape

Drug Tariff Watch Below is a quick summary of some the changes due to take place from 1st October 2015 SC Special Container Part VIIIA Category C additions • Aluminium chloride 20% solution SC (20ml and 75ml) – Driclor and SC (60ml) – Anhydrol Forte • Azelastine 0.05% eye drops SC (8ml) – Optilast • Betamethasone 0.1% / Neomycin 0.5% ear/eye/nose drops SC (10ml) – Betnesol-N • Canagliflozin 100mg and 300mg tablets (30) – Invokana • Coal tar extract 2% shampoo SC (125ml and 250ml) – Neutrogena T/Gel Therapeutic Shampoo • Desmopressin 120microgram oral lyophilisates sugar free (30) – DesmoMelt and (100) – DDAVP Melt • Desmopressin 240microgram oral lyophilisates sugar free (30) – DesmoMelt • Desmopressin 60microgram oral lyophilisates sugar free (100) – DDAVP Melt

• Febuxostat 120mg and 80mg tablets (28) – Adenuric • Ibuprofen 5% spray SC (35ml) – Ibuleve Speed Relief and SC (100ml) – Ibuspray • Isosorbide dinitrate 20mg and 40mg modified-release tablets (56) – Isoket Retard • Lidocaine 5% medicated plasters 30 (6x SC 5) – Versatis • Lidocaine 5% ointment SC (15g) – A A H Pharmaceuticals Ltd • Liraglutide 6mg/ml solution for injection 3ml pre-filled disposable devices (2) – Victoza • Miconazole 2% powder SC (20g) – Daktarin • Midodrine 2.5mg and 5mg tablets (100) – Bramox • Naproxen 500mg / Esomeprazole 20mg modified-release tablets (60) – Vimovo • Nifedipine 40mg modified-release tablets (30) – Fortipine LA 40 • Oxytetracycline 3% / Hydrocortisone 1% ointment SC (30g) – Terra-Cortril

• Prednisolone 5mg/5ml oral solution unit dose 10 (2x SC 5) – Logixx Pharma Solutions Ltd • Salicylic acid 16.7% / Lactic acid 16.7% paint SC (10ml) – Salactol • Valsartan 160mg and 80mg tablets (28) – Macleods Pharma Ltd Part VIIIA Category A additions • Alpha tocopheryl acetate 500mg/5ml oral suspension (100ml) • Dexamethasone 3.8mg/1ml solution for injection vials (10) • Hyoscine hydrobromide 600micrograms/1ml solution for injection ampoules (10) • Lidocaine 5% / Phenylephrine 0.5% nasal spray SC (2.5ml) Part VIIIA deletions • Aspirin 300mg suppositories (10) – Category A • Bimatoprost 300micrograms/ml eye drops (3ml) – Category C Lumigan

Part IX Deletions Brand

A H Shaw & Partners Ltd

Hollister Ltd

Salts Healthcare

Sigvaris Cotton

Sterifix

Product description Double Side plasters 128mm x 128mm hole cut to size Double Side plasters 102mm x 102mm hole cut to size Night Bag Cover, Cotton Night Bag Cover, Lycra Colostomy Belt 102mm wide elastic web made to measure Hainsworth bags with body mould adhesive hole size 25mm, 32mm, 38mm, and 51mm Hainsworth bags with Healwell adhesive hole size 25mm, 32mm, 38mm, and 51mm Stick on bags with plasters Shaw double seal 280mm x 154mm Colostomy bags 350mm x 204mm Complete Colostomy outfit comprising of a 102mm wide elastic web belt with groin-strap 660mm, 715mm etc. to 107cm, 1 Colostomy facepiece (flange), 100 Colostomy bags 280mm x 154mm Complete Colostomy outfit comprising of an adjustable 102mm wide elastic web belt with groin-strap 660mm, 715mm etc. to 107cm, 1 Colostomy facepiece, 100 Colostomy bags 280mm x 154mm Rubber Adhesive Flange Rubber Non-Stick Flange Black Rubber Day Bag (with screw cap) 22mm, 29mm and 38mm Shaw Healwell Squares hole sizes 25mm, 32mm and 38mm Body Mould Squares hole sizes 25mm, 32mm and 38mm Washers hole sizes 25mm, 32mm Rings hole sizes 25mm, 32mm and 38mm Impression “C” with convex wafer, Transparent front with filter and beige Comfort backing on body worn side 19mm Drainable Pouch, symmetrical shape, flexible barrier plus integral filter and Lock and Roll closure system Maxi - Beige with comfort backing on both sides 20mm Flex Wear Floating Flange pre-cut 55mm flange 35mm Flex Wear Floating Flange pre-cut 55mm flange 40mm Male Continence Sheath 17mm Standard Adjustable Ostomy Belt 25mm Button Belt Peri-Prep Wipes Foam Seals as in large twin pack Class 2 Below Knee Xtra Maxi Closed Toe Normal, Long XS, S, M, L, XL Class 2 Below Knee Xtra Maxi Closed Toe Plus Normal, Long XS, S, M, L, XL Class 3 Below Knee Xtra Maxi Closed Toe Normal, Long XS, S, M, L Class 3 Below Knee Xtra Maxi Closed Toe Plus Normal, Long XS, S, M, L Dressing (with two adhesive strips) 5cm x 7cm, 7cm x 10cm and 10cm x 14cm

Product code NSI 46 10 896 NSI 49 10 864 NSI 47 1 599 NSI 45 1 643 NSI 10 1 NSI 63 20 NSI 39 20 NSI 62 10 967 NSI 64 100 1163 NSI 65 100 NSI 6 1 NSI 8 1 NSI 1 1 NSI 2 NSI 66 1 NSI 53 12 NSI 56 5 NSI 59 10 NSI 55 5 3590 10 28320 30 35235 5 35240 5 ZL0028 10 877011 1 840001 50 833085 10 n/a n/a n/a n/a n/a