September 2016 CPN

CPN

Community Pharmacy News – September 2016

In 2015, twelve services provided by community pharmacy contributed a net value of £3 billion On average, this is worth...

More than £250,000 per pharmacy

Nearly £3.00 per prescription

£54.61 for every resident of England

Quantifying the value of community pharmacy Evidence from PwC gives clear picture of the benefit pharmacies provide to their communities

Community Pharmacy Forward View | Flu Vaccination Service guidance | CheckRx launch

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PwC report quantifies value of community pharmacy PSNC commissioned research demonstrates that pharmacies provide significant value to the country, and could change to deliver even more in future.

Community pharmacies contributed a net value of £3 billion to the NHS, public sector, patients and wider society in England in 2015 through just 12 services, according to a PricewaterhouseCoopers (PwC) study released this month.

This means that community pharmacies deliver substantially more in benefits than they receive in compensation, providing excellent value to the Department of Health.

The study, which was commissioned by PSNC following the Government’s proposals to reduce community pharmacy funding, analysed the value to the NHS, public sector organisations, patients and wider society of 12 services across public health, self-care support and medicines support.

Services analysed included supervised consumption, emergency hormonal contraception provision, minor ailments, delivering prescriptions and managing drug shortages. Pharmacies made more than 150 million interventions through the services in 2015 and there was a benefit of more than £250,000 per pharmacy or £54.61 for every resident of England.

Breaking the combined contribution down into the areas which are benefitting, it was found that: • The NHS received a net value of £1,352

million, including cash savings as a result of cost efficiencies, and avoided NHS treatment costs; • Other public sector bodies (e.g. local authorities) and wider society together received over £1 billion through increased output, avoided deaths and reduced pressure on other services such as social care and justice; and • Patients received around £600 million, mainly in the form of reduced travel time to alternative NHS settings.

The report concludes that from these services alone, community pharmacy contributed an in-year benefit of £3 billion in 2015, with a further £1.9 billion expected to accrue over the next 20 years.

The expected amount of public sector spending saved directly as a result of the 12 services analysed in the report is enough, by itself, to offset the entire amount of public funding provided for community pharmacy in 2015. The benefits of all other pharmacy services not covered by the analysis, such as the NHS prescription service, can therefore be seen as additional net benefits of community pharmacy.

The report demonstrates the value of community pharmacy at a crucial time and PwC concludes that it is important to robustly assess the significance of any proposed changes to the support and delivery of these services.

In 2015, twelve services provided by community pharmacy contributed …

A net value of £1,352 million to the NHS Over £1 billion of benefits to other public sector bodies (e.g. local authorities) and wider society

Around £600 million of benefits to patients The PwC report, plus a two-page summary of key findings, are available to download and read at: psnc.org.uk/valueofpharmacy Sue Sharpe, Chief Executive of PSNC, said: “PwC’s research shows that community pharmacies punch above their weight in terms of economic value. This is the evidence ministers need to make the case for continued investment in community pharmacies, developing their services even further to bring additional benefits to the NHS and wider society. We look forward to working with ministers to help them consider the implications of the research.”

Minister confirms proposed funding cuts will not be implemented from October The proposed £170 million community pharmacy funding cut will not be implemented this October, pharmacy minister David Mowat has announced.

In a recorded statement to the Royal Pharmaceutical Society’s Annual Conference, Mr Mowat said: "I think it is right that we spend the time, particularly me as an incoming minister, to make sure that we are making the correct decision

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and that what we do is going to be right for you, is going to be right for the NHS and right for the public more generally."

The minister also commented on the Community Pharmacy Forward View (see opposite) and supported a greater role for community pharmacy, saying: "Your profession I think rightly recognises that it needs to go further, away from just doing dispensing and into the services area, and there is a big contribution that you can make, particularly in areas such as long-term conditions."

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Community pharmacy shares its Forward View The national pharmacy organisations outline their joint vision for the future of community pharmacy.

PSNC and Pharmacy Voice, with the support of the RPS English Pharmacy Board, have published their vision for the future of community pharmacy.

The Community Pharmacy Forward View sets out the sector’s ambitions to radically enhance and expand the personalised care, support and wellbeing services that community pharmacies provide. In the scenarios outlined in the document, pharmacy teams would be fully integrated with other local health and care services in order to improve quality and access for patients, increase NHS efficiency and produce better health outcomes for all.

The Community Pharmacy Forward View sets out the organisations’ shared ambition for the sector, focused on three key roles for the community pharmacy of the future: 1. As the facilitator of personalised care for people with longterm conditions; 2. As the trusted, convenient first port of call for episodic healthcare advice and treatment; and 3. As the neighbourhood health and wellbeing hub.

The Forward View represents the sector’s vision for the future of community pharmacy but the views of key stakeholders are now invited – including patient groups, pharmacy contractors, community pharmacists and members of pharmacy teams, LPCs, local commissioners, other healthcare providers and the Government. This will help turn a shared vision for the sector into a reality that will be good for patients, the public, local communities and the NHS, as well as for the community pharmacy network and all those who work in it.

Learn more about the Community Pharmacy Forward View at: psnc.org.uk/forwardview Commenting on the launch, Alastair Buxton, Director of NHS Services at PSNC, said: “The Community Pharmacy Forward View describes how a thriving pharmacy network could effectively support the high performing, affordable healthcare system envisaged in the NHS Five Year Forward View.

The health and care system needs community pharmacy to play its part in improving the care of patients and helping people to stay healthy, so we hope that the Department of Health, NHS England and local service commissioners will positively engage with us to explore how this vision can inform the future commissioning of community pharmacy services.

Community pharmacy contractors need a clear framework for how they are to support patients and the NHS in the future, so they can have confidence in developing their teams, resources and services, and ensure that they are able to provide the most cost effective support to their local communities, using their unique relationships and skills. We hope the NHS and Government will respond positively and will work with us to develop a contractual framework that provides this.”

Guidance on pharmacy management of repeat medicines requests In recent months, some Clinical Commissioning Groups (CCGs) and general practices have raised concerns about medicines waste and the mismanagement of non-NHS repeat medication services such as "managed repeats"; some are considering the introduction of measures that restrict community pharmacies from supporting patients to request repeat prescriptions.

To help inform constructive local discussions, PSNC and Pharmacy Voice have published a joint briefing (presented as Frequently Asked Questions) about repeat medication services, where we outline common queries, shed some light on pharmacy processes and discuss a number of important considerations regarding the most talked about proposals that CCGs have put forward – the "Coventry model" and the "Luton model".

We hope this briefing will be informative and useful to pharmacy contractors, general practices, CCGs, Local Medical Committees (LMCs), Local Pharmaceutical Committees (LPCs), local patient groups and Healthwatch. The joint guidance can be read and downloaded from: ow.ly/A89p303BnV3

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Helping you prepare for the national Flu Vaccination Service For those community pharmacy contractors who have yet to begin administering NHS flu vaccinations as part of the national service, here are the key steps to get you started. A full guide can be found at: ow.ly/YeJX303KLC0 Make use of PSNC resources PSNC held a webinar on the Flu Vaccination Service 2016/17 on Wednesday 24th August. More than 650 people tuned in to the 60-minute webinar when Alastair Buxton, Director of NHS Services at PSNC, and Sunil Kochhar, PSNC Regional Representative and community pharmacist, explained how the Flu Vaccination Service works.

As well as advising viewers on how to ensure that their pharmacies were ready to make the most of the opportunity, Alastair and Sunil were joined by Lesley Grimes, Lead Pharmacist at the Centre for Pharmacy Postgraduate Education (CPPE) to talk about the Declaration of Competence (DoC) for the service. An on-demand recording of the webinar, recommended by 93% of attendees, is now available to watch at: psnc.org.uk/fluwebinar.

Lesley also explains the restructured DoC system on page 6.

PSNC has also developed a detailed guidance document to support the preparation process for the Flu Vaccination Service and it includes a checklist which contractors can print out and work through to ensure they have everything they need in place to successfully provide the service. PSNC Briefing 040/16: Guidance on the Seasonal Influenza Vaccination Advanced Service 2016/17 can be downloaded from: psnc.org.uk/flubriefing Lastly, an eligible groups factsheet can be found on page 9 of this month's edition of CPN and an A3 poster promoting the Flu Vaccination Service to carers is opposite. For more patient promotional materials, please visit: psnc.org.uk/flupatientcomms In addition to making use of PSNC’s guidance, contractors may want to check the latest information from their LPC as in many areas they have worked with the local NHS England team to put IT systems in place to support provision of the service. These may allow pharmacies to electronically inform GPs when they vaccinate patients, for example.

Read the service documentation The service specification and Patient Group Direction (PGD) for the Flu Vaccination Service 2016/17 explain what community

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Can you help beat last flu season?

The NHS Business Services Authority’s Advance Flu Report reveals community pharmacists in England provided 595,467 flu vaccinations to patients under the national NHS Flu Vaccination Service in 2015/16.

83

7,195

was the average number of flu vaccinations per participating pharmacy...

community pharmacies (60.9%) provided the Flu Vaccination Service in 2015/16.

A total of

595,467 vaccinations were carried out under the NHS pharmacy Flu Vaccination Service.

...but the most proficient pharmacy provided more than 2,000

1,500

1,600 flu vaccinations.

1000

500

0

pharmacy contractors need to do to offer the service, including how to confirm that their premises are appropriate, pharmacist training and Declaration of Competence requirements, data capture and sharing of information, vaccine storage, gaining patient consent, GP notification and claiming payments.

Also, the Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2013 have been amended to include the Community Pharmacy Seasonal Influenza Vaccination Advanced Service for 2016/17, providing the legal basis for provision of the service.

Contractors are advised to read all the above service documentation, which can be found at: psnc.org.uk/fludocs

Notify NHS England Contractors must notify NHS England of their intention to begin providing the Flu Vaccination Service by completing the notification form available on the NHS Business Services Authority (NHS BSA) website: ow.ly/tcZC303Jj2B This must be done annually and for each pharmacy from which the service will be offered; therefore, even if a contractor provided the service in 2015/16, they must complete this signup process again. If the form is not completed before provision of the service, claims for payment will not be accepted by the NHS BSA.

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New IT platform for Flu Vaccination Service feedback Data from patient questionnaire responses to the Flu Vaccination Service can now be collated electronically through an online IT platform.

NHS England has launched an IT platform to enable patient questionnaires from the Flu Vaccination Service to be completed electronically either by the patient themselves or with help from the pharmacy team.

The IT platform allows patient questionnaire details to be recorded in a number of ways including: • completing the questionnaire online – a tablet device could be used in the pharmacy (if available) and the patient could input their responses; • using a QR code to access the questionnaire if the patient has a smart phone with a QR code reader App installed on it; • providing the patient with a compliments slip detailing the website address and QR code for them to complete the questionnaire online at a convenient time; and • a downloadable copy of the patient questionnaire which the patient can complete in the pharmacy.

When patient questionnaires are completed on paper, community pharmacy contractors should utilise the functionality available on

the IT platform to submit patients’ responses to the questionnaire so that these responses can be collated and analysed along with those submitted electronically.

Contractors are reminded that it is a requirement of the service to ask all patients who have a flu vaccination to complete the patient questionnaire.

Find out more about the IT platform, including a guidance document on how to use it, at: ow.ly/lDKQ303xiz8

Commenting on the launch of the Flu Vaccination Service, Alastair Buxton, Director of NHS Services at PSNC, said: “Although this is the second year of the national Flu Vaccination Service, it is just as important as last year to make the most of this opportunity. Community pharmacy needs to show the difference the sector can make and we are looking forward to seeing if the sector can improve on the number of patients vaccinated under the service last year.

Throughout the flu season we will be keen to promote examples of best practice so please do let us and your LPC know how you are getting on with the service.”

Claiming payment for the national Flu Vaccination Service Community pharmacy contractors who have provided the national flu service during the month of September are reminded of the need to claim payment for the service and reimbursement of vaccine costs as part of the end of month prescription bundle submission process.

The claim is made by submitting a completed copy of the Community Pharmacy Seasonal Influenza Vaccination claim form (ow.ly/YaZQ303L0JV) to the

Pricing Authority with the pharmacy’s prescription bundle.

A number of local NHS England teams have provided IT support via PharmOutcomes or Sonar for recording flu vaccinations administered in pharmacies and for sending an automatic notification to the patient’s GP. However, please note that use of these systems does not automatically make a claim for payment; the systems may allow you to print off a

completed copy of the claim form to include in the prescription bundle sent to the Pricing Authority or they may provide the information to allow you to fill in a copy of the claim form.

To receive payment, the claim form must be submitted to the Pricing Authority with the pharmacy’s prescription bundle no later than the 5th day of the month following that in which the vaccination was administered.

LPCs arrange local Flu Vaccination Service training for non-pharmacists We’ve been made aware of three LPCs who arranged Flu Vaccination Service training aimed at non-pharmacists, to help ensure the whole pharmacy team can play a role in delivering the service.

1. Hertfordshire LPC has been working with Public Health England Midlands and East (Central Midlands) local team, which resulted in Medicines Counter Assistants (MCAs) being invited to join GP practice receptionists in a flu vaccination workshop.

2. Camden and Islington LPC arranged a free event aimed at Health Champions, MCAs, dispensers or technicians.

3. Kensington, Chelsea and Westminster LPC arranged an event, primarily aimed at Health Champions, but it was later opened up to all contractors within the LPC area.

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Declaration of Competence restructure Simplified Declaration of Competence system launched in time for the start of the Flu Vaccination Advanced Service.

With the Flu Vaccination Service season approaching, we have been working hard to restructure our “Declaration of Competence (DoC) system to support you in being ‘flu-ready’.

We saw a surge in uptake of the DoC system in 2015 when NHS England approved DoC for selfdeclaration to provide the new NHS Flu Vaccination Service. However, user feedback suggested that some found it more complex than necessary. The Community Pharmacy Competence Group (CPCG) considered this the ideal time to simplify the documentation and put more emphasis on the key DoC principles of reflection and assuring competence. This has led to the relaunch of DoC in a new simplified framework.

Lesley Grimes

So, what’s different? We have developed A guide to using the Declaration of Competence (DoC) system – an ideal resource to take you through the revised structure, which now takes you straight into the selfassessment framework. Once you have reflected on the competencies required for the service, and identified any gaps in your competence, you can move on to the recommended learning and assessment to find out how you can fill those gaps. There is a new section, which signposts you to tools to support your professional development.

Lead Pharmacist, CPPE and Deputy Chair, CPCG

Latest support from CPPE

There are 14 services included in DoC. You can find out more about how DoC can support you in your continuing professional development by visiting the CPPE website: www.cppe.ac.uk/doc

“

Lesley Grimes presented a section on the DoC in PSNC’s recent Flu Vaccination Service Webinar. You can listen to a recording of the webinar at: psnc.org.uk/fluwebinar

CPPE’s e-learning programme, Influenza, aims to help community pharmacy teams deliver an integrated, person-centred Flu Vaccination Service. This e-learning is a recommended learning activity in CPPE’s Declaration of Competence for the service.

The programme features video activities to promote understanding of effective consultation skills, as well as describing the impact of flu on public health and the types of flu vaccinations available. Find out more at: ow.ly/DDig303BWIL

Free campaign toolkits distributed Community pharmacy teams should begin receiving toolkits for the Stoptober and Stay Well this Winter campaigns from the week beginning 19th September 2016. All small chain and independent pharmacies across England will receive them directly from the Healthcare Distribution Association whilst multiple chain pharmacy branches will get them from their central depots.

Stoptober campaign Stoptober, the 28-day national stop smoking challenge, will be running again for its fifth year.

The campaign launches on 20th September to enable smokers to prepare for the challenge that starts on 1st October.

By signing up to the challenge, patients can access a range of free support including packs, emails, texts and an app.

All details correct at time of printing.

No part of this publication may be reproduced without the written permission of PSNC. Produced for PSNC by Communications International Group.

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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Stay Well this Winter campaign Following the success of last year’s campaign, NHS England and Public Health England will again launch a joint national initiative in October to help at-risk groups prepare for the winter months.

The campaign will encourage those in at-risk groups to get the free NHS flu vaccination, and take simple, easy-to-achieve action that may avoid admission to hospital.

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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CheckRx helps contractors make sense of their Px report PSNC launches new service to help contractors better understand how they have been paid for dispensed items.

CheckRx, a new service for all community pharmacy contractors, has been launched by PSNC Data Systems at: www.checkrx.net CheckRx, a companion service to Check34, turns the complex data in the monthly prescription item (Px) report from the NHS Business Services Authority into business friendly information that can be used by subscribers to better understand how they have been paid for dispensed items.

For a chosen month CheckRx can provide detailed information on: • FP34 Schedule of Payment data (script type, basic prices, fees paid, expensive items, etc.); • Drug Tariff splits of items dispensed (Part VIII Category A/M/C split, Part VIIIB, appliances, ACBS, etc.); • Brand/generic analysis and product usage by volume, value or number of items; and • Clinical/therapy area split (by item/patient).

CheckRx also provides basic competitor analysis, allowing you to benchmark your performance for items dispensed, MURs and NMS against other pharmacies. It also shows which GP practices your scripts come from, and the total of your Electronic Prescription Service (EPS) nominations.

CheckRx is a subscription service. The cost per pharmacy for a year’s subscription is £144+VAT. The NPA has entered into an arrangement with PSNC which will enable NPA members to subscribe at a reduced price of £120. The NPA will also be handling subscriptions for non-NPA members.

Independent contractors can subscribe via the NPA website at: npa.co.uk/checkrx, or by emailing checkrx@npa.co.uk. Company Chemists’ Association (CCA) members can email CheckRxadmin@psnc.org.uk or contact PSNC Data Systems on 0203 1220 813 for more information. Find out more about CheckRx at: psnc.org.uk/checkrx

Don't miss October SCR webinars

EPS Tokens submission

Make sure you watch two related webinars next month to find out how to get the most out of Summary Care Record (SCR) access in your pharmacy.

From the September submission bundle, the Pricing Authority will scan EPS tokens submitted by pharmacies, to support the Prescription Exemption Checking Service.

Although EPS tokens will be scanned they will still not be used for reimbursement purposes so please do not endorse any information on the tokens.

The October webinars, presented by NHS Digital (formerly HSCIC), are equally suitable for community pharmacists and technicians considering using SCR or those about to go live, as well as those who have already begun using SCR. PSNC recommends attending both webinars which will last about an hour and give viewers the opportunity to ask questions. Make sure SCR access becomes a great tool for your pharmacy by signing up to both webinars at: psnc.org.uk/screvents Title

Date and time

Host

SCR Part 1: Getting started and efficient usage

Thursday 13th PSNC October, 7.30pm

SCR Part 2: Privacy and liability

Tuesday 18th National Pharmacy October, 7.30pm Association

The following checks may help when preparing your bundle: • Keep all EPS tokens separate from paper prescriptions; • Ensure all EPS tokens have been signed by the patient/representative to capture the payment/exemption declaration; • Remember you do not need to submit any age exempt EPS tokens; and • Tokens do not need to be sorted into prescriber order.

The Pricing Authority is sending out a factsheet to all pharmacies with their September submission documents to relay this message.

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

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Ask PSNC The PSNC Dispensing and Supply Team can provide pharmacy teams with support and advice on a range of topics related to the Drug Tariff and reimbursement. Questions asked in recent months have included: A. Yes. If an item found in the Borderline Substances list (Part XV of the Drug Tariff) has not been endorsed by the prescriber, this product can still be dispensed as it isn’t a compulsory requirement (but the prescriber may be questioned by their local NHS England team later).

Q. If a prescriber has not endorsed ‘ACBS’ on an item listed in Part XV of the Drug Tariff, can I dispense it?

Q. Which products do we receive payments for containers on?

Q. What is a ‘split pack’?

A. Payment for containers is paid at the rate of 10p for every prescription item (except special containers) where the quantity prescribed leads the pharmacy having to split a pack and is to account for additional containers used. No endorsement is required to claim the container allowance.

A. For a Drug Tariff listed line, a “split pack” quantity is where the quantity prescribed on a prescription is not equal to or a multiple of the pack sizes listed in Part VIIIA of the Drug Tariff.

For non-Drug Tariff listed lines, a “split pack” quantity is determined by the contractor’s endorsement.

Where the proprietary product is prescribed, the contractor is paid the NHS list price from the PPRS or statutory PPRS for the pack size endorsed. Where the prescription is written generically, the contractor will need to endorse the pack size and the brand name or the name of the manufacturer or wholesaler from whom the supply was purchased.

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).

Can it be dispensed on an FP10?

When pharmacy teams receive NHS prescriptions, they must check whether the items prescribed are allowed on the NHS before dispensing otherwise the community pharmacy contractor may not be paid for them. Pharmacy teams may wish to check PSNC’s ‘Dispensing on an FP10 database’ (available at: psnc.org.uk/FP10database) for more information on whether an item can be dispensed on an FP10. Below is a list of some products that we have recently received queries about.

Product

Is the item listed in the Drug Tariff?

Is it Does it in the have a ‘CE’ blacklist?* mark?

Can it be dispensed on an FP10?

Additional information

Futuro wrist splint

No

n/a

Yes

No

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

MooGoo Skin Milk Udder cream

No

No

No

Yes

This item is not a medical device (CE marked) and does not appear in Part XVIIIA (the ‘blacklist’) of the Drug Tariff.

Femmeze Pelvic Trainer

No

n/a

Yes

No

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

Proshield Foam & Spray skin cleanser

Yes

n/a

Yes

Yes

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

*n/a is because medical devices are not listed in the blacklist.

Please note: If the prescription is an FP10CN or FP10PN (community nurse prescriber), an FP10D (dental prescriber) or an FP10MDA (instalment dispensing), please visit psnc.org.uk/prescriptionforms for more information.

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Factsheet: Eligible groups for the flu vaccination The national NHS Flu Vaccination Service covers those patients most at risk from influenza aged 18 years and older, as listed below. This list is taken from PSNC Briefing 040/16: Guidance on the Seasonal Influenza Vaccination Advanced Service 2016/17, which includes comprehensive guidance on preparing to start the service. Download the briefing from psnc.org.uk/flubriefing Eligible groups

Further details

All people aged 65 years or over

Including those becoming age 65 years by 31 March 2017.

All pregnant women (including those women Pregnant women aged 18 or over at any stage of pregnancy (first, second or third who become pregnant during the flu season) trimesters).

People living in long-stay residential care homes or other long-stay care facilities

Vaccination is recommended for people aged 18 or over living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality. This does not include, for instance, prisons, young offender institutions, or university halls of residence.

Carers

People aged 18 or over who are in receipt of a carer’s allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill.

Household contacts of immunocompromised individuals

People who are household contacts, aged 18 and over, of immunocompromised individuals, specifically individuals who expect to share living accommodation on most days over the winter and, therefore, for whom continuing close contact is unavoidable.

People aged from 18 years to less than 65 years of age with one or more serious medical condition(s) outlined below: Chronic (long-term) respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis

Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission.

Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema, bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).

Chronic heart disease, such as heart failure

Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease.

Chronic kidney disease at stage three, four or five

Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation.

Chronic liver disease

Cirrhosis, biliary atresia, chronic hepatitis.

Chronic neurological disease, such as Parkinson’s disease or motor neurone disease, or learning disability

Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers).

Clinicians should offer immunisation, based on individual assessment, to clinically vulnerable individuals including those with cerebral palsy, learning disability, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.

Diabetes

Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes.

A weakened immune system due to disease Immunosuppression due to disease or treatment, including patients undergoing (such as HIV/AIDS) or treatment (such as chemotherapy leading to immunosuppression, bone marrow transplant, HIV infection at cancer treatment) all stages, multiple myeloma or genetic disorders affecting the immune system (e.g.

IRAK-4, NEMO, complement deficiency).

Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day.

It is difficult to define at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of influenza and should be offered seasonal influenza vaccination. This decision is best made on an individual basis and left to the patient’s clinician.

Some immune-compromised patients may have a suboptimal immunological response to the vaccine.

Splenic dysfunction

This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction. psnc.org.uk 9

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Drug Tariff Watch Below is a quick summary of the changes due to take place from 1st October 2016.

Part VIIIA additions Category A Additions: • Atropine 3mg/10ml solution for injection pre-filled syringes SC (1) • Calcium gluconate 10% solution for injection 10ml ampoules (10) • Linezolid 600mg tablets (10) Category C Additions: • *Benzoyl peroxide 5% gel SC (50g) – Acnecide Wash • *Benzoyl peroxide 5% gel SC (60g) – Acnecide • Calcium folinate 15mg/2ml solution for injection ampoules (5) – Hospira UK Ltd • Colistimethate 1million unit powder for nebuliser solution unit dose vials SC (30) – Promixin • Co-magaldrox 195mg/220mg/5ml oral suspension sugar free (500ml) – Mucogel • Deferiprone 100mg/ml oral solution sugar free (500ml) – Ferriprox • Deferiprone 500mg tablets (100) – Ferriprox • Deferiprone 1g tablets (50) – Ferriprox • Dexamethasone 6.6mg/2ml solution for injection vials (5) – Hospira UK Ltd • Fluoxetine 20mg/5ml oral solution sugar free SC (70ml) – Prozep

• Fusidic acid 250mg/5ml oral suspension SC (50ml) – Fucidin • Insulin glulisine 100units/ml solution for injection 3ml prefilled disposable devices (5) – Apidra SoloStar • Isosorbide mononitrate 40mg modifiedrelease tablets (28) – Isotard 40XL • Losartan 2.5mg/ml oral suspension sugar free SC (200ml) – Cozaar • Macrogol compound oral liquid NPF sugar free (500ml) – Movicol Liquid • Mesalazine 2g/59ml enema (7) – Salofalk • Metronidazole 0.75% gel SC (15g) – Anabact • Mycophenolate mofetil 1g/5ml oral suspension sugar free SC (175ml) – CellCept • Octreotide 100micrograms/1ml solution for injection Ampoules (5) – Sandostatin • Octreotide 50micrograms/1ml solution for injection pre-filled Syringes (5) – Kent Pharmaceuticals Ltd • Octreotide 50micrograms/1ml solution for injection vials (5) – Hospira UK Ltd • Oxcarbazepine 60mg/ml oral suspension sugar free (250ml) – Trileptal • Safinamide 100mg tablets (30) – Xadago • Safinamide 50mg tablets (30) – Xadago

• Tolterodine 2mg modified-release capsules (28) – Neditol XL

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

Part VIIIA Amendments • Ampicillin 500mg capsules (28) is changing to Category C Essential Generics Ltd • Cefalexin 125mg/5ml oral suspension R (100ml) is changing to Category C Keflex • Diclofenac sodium 75mg modifiedrelease tablets (56) is changing to Category C Volsaid Retard 75 • Diclofenac sodium 100mg modifiedrelease tablets (28) is changing to Category C Volsaid Retard 100 Part VIIIA Deletions • Benzoyl peroxide 10% wash (150ml) Category C – PanOxyl 10 • *Benzoyl peroxide 5% gel (40g) Category C – PanOxyl 5 Aquagel • Diclofenac 50mg dispersible tablets sugar free (21) Category C – Voltarol • Sulfuric acid dilute liquid (500ml) Category C – J M Loveridge Ltd

Part IX deletions Product Self-Cath catheter (Coloplast Ltd) Male Continence Sheath (Salts Healthcare) OstoMart Cool Comfort Unisex Light Control Support Garment HiLINE Activ Medium Level Hernia Support Belt HiLINE Activ Medium Level Hernia Support Belt with lace front HiLINE Breathable Stretch Unisex Ostomy Belt 13.5cm, 18cm and 21cm deep HiLINE EZ-Wrap Unisex Hernia Support Belt HiLINE Lightweight Support Belt 13cm wide HiLINE Lightweight Support Belt (long) 21cm wide HiLINE Seamless Two Way Stretch Unisex Colostomy Belt 26cm deep HiLINE Seamless Two Way Stretch Unisex Colostomy Belt 27cm and above Single Elastic Belt with suspender ends (Salts Healthcare) Confidence Comfort colostomy bag with filter and overlap Confidence Comfort colostomy bag with filter and overlap, Transparent Confidence Gold colostomy bag, Transparent OstoMart OstoMist odour neutralising spray mint Latex Foam Diaphragm with Rigid Face Piece Flanges (Salts Healthcare) Confidence Comfort ileostomy bag with filer, Opaque Confidence Gold Convex Soft and Secure ileostomy bag with filer Confidence Gold Soft and Secure ileostomy bag with filter Koenig Rutzen MB ileostomy bag with screw outlet Koenig Rutzen WP reinforced rubber ileostomy bag with spout outlet Second Nature convex insert Confidence stoma cap with filter Black Rubber Bag (for use with flange) (Salt Healthcare) Confidence urostomy bag, Transparent Koenig Rutzen rubber urostomy bag, Black

Product code Female, 8Ch gauge and Paediatric, 10Ch gauge All sizes Packs of 3 for Belts, Briefs and Boxers (all sizes and colours) X Small and XXX Large sizes only All sizes X Small and XXX Large sizes only X Small and XXX Large sizes only X Small and XXX Large sizes only X Small and XXX Large sizes only X Small and XXX Large sizes only X Small and XXX Large sizes only 25mm (product code: 877007) Large, starter hole 13mm (product code: CFLO13) Standard, starter hole 41mm (product code: CF41) Standard, pre-cut 25mm (product code: CTNW25) 25ml and 50ml 38mm (product code: 811002) Standard, pre-cut (25mm – 38mm) All sizes All sizes Large, 32mm and 44mm (product codes: 165132 and 165144) Large 32mm and Small 32mm (product codes: 173132 and 173232) 45mm (35mm internal dia) (product code: CI4535) Starter hole 13mm (product code: SC13) Screw outlet, small (product code: 362229) All sizes Medium, 38mm (product code: 181338)