Community Pharmacy Services

Question 1

How many advanced services are there?

Answer 1

9

Question 2

True or False: Pharmacies must do all 9 advanced services.

Answer 2

False. They can choose what services to offer but cannot claim payment for services they don’t offer.
-> Have to follow the full criteria to provide the service

Question 3

What are the 9 advanced services?

Answer 3

1. Appliance Use Reviews
2. Influenza Vaccination
3. Hypertension Case Finding Service
4. LFD Distribution Service (Lateral Flow Test)
5. New Medicines Service
6. Pharmacy Contraception Service
7. Pharmacy First Service
8. Smoking Cessation Service
9. Stoma Appliance Customisation

Question 4

True or False: Advanced services can be based on the health conditions in the local area.

Answer 4

True.
-> May be an area where there is a high risk of HPT.

Question 5

How can we use community pharmacy to help in patient’s health?

Answer 5

Address conditions in primary care to reduce hospital administrations.

Question 6

The HCFS focuses on which age group?

Answer 6

Adults aged 40 and over.

Question 7

For the HCFS, what should we do if we have identified a patient with HPT?

Answer 7

Refer them to the GP for an appointment.
-> GP may ask patients to do clinic and ambulatory BP measurements

Question 8

Can patients be offered a BP test if they are under the age of 40?

Answer 8

Yes as they may:
- Have a family history of HPT/stroke etc.
- Be aged 35-39 for people who are more at risk (must be a justified reason).
- Request this.

Question 9

What is the first stage of the HCFS?

Answer 9

Clinic blood pressure check

Question 10

What is stage 2 of the HCFS?

Answer 10

Patient has a BP of > 140/90 and < 180/120mmHg
-> Ambulatory blood pressure measurement

Question 11

What is a low blood pressure reading?

Answer 11

< 90/60 mmHg

Question 12

What is a normal blood pressure reading?

Answer 12

> 90/60 mmHg and <140/90 mmHg

Question 13

What is a high blood pressure reading?

Answer 13

> 140/90 mmHg and <180/120 mmHg

Question 14

What is a very high blood pressure reading?

Answer 14

> 180/120

Question 15

True or False: If a patient has an irregular pulse, count for 60 seconds and continue to do the blood pressure measurement.

Answer 15

False. If a patient has an irregular pulse, then they should be referred to the GP.
-> will undergo further tests (ECG) to identify conditions such as AF and atrial flutter.

Question 16

What should be offered if a patient has a normal BP reading?

Answer 16

Lifestyle advice to continue to keep it within the normal range.
-> Come back after 5 years
-> Come back within 1 year if borderline or low

Question 17

What should you do if a patient has a low blood pressure?

Answer 17

Ask if the patient has any symptoms
- No - Take BP within 1 year
- Yes - Refer to GP within 3 weeks

Question 18

What should you do if a patient has a very high blood pressure reading?

Answer 18

Refer to GP within the same day.
-> no appointment -> urgent care

Question 19

What should you do if a patient has a high BP?

Answer 19

Offer ambulatory BP monitoring.
-> If patient declines, advise patient to see GP within 3 weeks

Question 20

What are the ambulatory blood pressure readings for each stages of BP?

Answer 20

Low blood pressure: <90/60 mmHg
Normal BP: > 90/60 and < 135/85 mmHg
Stage 1 hypertension: >135/85 and <150/95 mmHg
Stage 2 hypertension: > 150/95 mmHg

Question 21

What should you do if a patient’s ambulatory BP reading is normal?

Answer 21

Send a summary email to GP
-> they will add it to patient record

Question 22

What should you do if the patient’s ambulatory BP reading is Stage 1?

Answer 22

Refer to GP for appointment within 3 weeks.

Question 23

What should you do if a patient has Stage 2 ambulatory BP?

Answer 23

Registered patient -same day appointment or urgent care
Unregistered patient - give results to patient and refer to urgent care
-> also give information on how to register with GP

Question 24

What would be included when giving lifestyle advice?

Answer 24

• Exercise
• Diet
• Smoking
• Alcohol

Question 25

What are the three times when information will need to be shared with GPs from the HCFS?

Answer 25

1. Urgent same-day referrals 2. Appointments within 3 weeks 3. Weekly summary email

Question 26

What are the aims of the NMS?

Answer 26

- Increase adherence - Reduce waste - Promote self-management of long-term conditions - Promote healthy lifestyles - Reduce hospital admissions

Question 27

What are the three stages of a New Medicines Service?

Answer 27

1. Patient engagement 2. Intervention 3. Follow up

Question 28

What happens under the patient engagement for the NMS?

Answer 28

1. Patient recruited into service by prescriber referral or pharmacy staff 2. Medicine dispensed as usual and given advice on medication. Patient offered to use NMS. -> Pharmacist must obtain consent. Can withdraw from the service at any time.

Question 29

What happens during the intervention stage of the NMS?

Answer 29

- Pharmacist and patient have a discussion (face-to-face or telephone/video) - Assess patient adherence to new medicine - Any problems? Use clinical judgment to provide further support and information, or refer to GP - No problems? Agree a time to meet next time. (2-3 weeks later)

Question 30

What happens during the follow-up stage of the NMS?

Answer 30

- Pharmacist and patient have discussion - Assess adherence again - Identify any problems and refer back to GP if necessary

Question 31

What should be done if a patient needs to be referred to the GP in the NMS?

Answer 31

- Call GP surgery immediately if referral urgently required - Send an NHS GP feedback form to GP practice

Question 32

Can an NMS be completed at different stages or only at stage 3?

Answer 32

At different stages. Stage 2: If patient is referred to GP Stage 3: Patient is uncontactable, if medicine is discontinued by GP, patient is adherent with no issues, or problem identified and patient is referred to GP.

Question 33

What must NHS England do for National Enhanced Service?

Answer 33

Consult with Community Pharmacy England on: - How the service should work - How service is funded to community pharmacies

Question 34

How is advanced service different to enhanced services?

Answer 34

Advanced service: Any pharmacy can decide if they want to offer it or not. Enhanced service: If there is a need in the local area, the service can be done in that local area.