community pharmacy services

Question 1

what is CPCS?

Answer 1

Community Pharmacist Consultation Service

- NHS 111 service referal to pharmacy for a consultation for a minor ailment or an emergency supply of regular medicines

Question 2

when did the CPCS start?

Answer 2

started in 2019

GP referals were meant to start in 2020 but were delayed

Question 3

what are the aims of CPCS?

Answer 3

Divert patients with lower acuity conditions

• Release capacity in other areas of urgent care
• Appropriately manage requests of urgent supply of medicines
• Identify ways patients can self manage their health

Question 4

what knowledge requirements should people have for CPCS?

Answer 4

• SOP in place
• pharmacist up to date with HMR
• pharmacist expected to assess patients and identify red flags as found in NICE CKS

Question 5

what IT requirements are required for CPCS?

Answer 5

reg for service of NHD business service authority
complete declaration of CPCS provision
be able to access :summary care records/ local electronic messaging system for 111 referrals/messaging system of alerts gp of consultation

Question 6

what are the requirments for CPCS premisis requirements?

Answer 6

Consultation area –confidential environment
•The patient and the pharmacist can sit down together;•They can talk at normal speaking volumes without being overheard by staff or customers; and
•The area is clearly signed as a private consultation area.

Question 7

what is urgent medicines supply?

Answer 7

Patients call 111 if they have run out of POM medicines

•NHS 111 refers patient to pharmacy using Directory of Services

Question 8

is there warning given to pharmacist about urgent medicine supply referal?

Answer 8

no
•Pharmacy team can check Pharmoutcomesfor notifications OR
•Patients can turn up for supply straight after calling 111

Question 9

does patient calling 111 for urgent medicatio supply generate their prescription?

Answer 9

no- need an interview

Question 10

what do you ask in the urgent medicine supply interview?

Answer 10

•Pharmacist needs to ensure they are speaking to the patient- confirm name , address and date of birth •Ascertain the followingReason for request and nature of emergencyName of GP (this is included in the pharmoutcomesmessage from NHS 111)The medicine or appliance requested( cannot be schedule 1,2 or 3 except phenobarbital for epilepsy)Urgent need or not? – use professional judgement
Has medicine/s been prescribed before

Question 11

what happens if the emergency medicine supply is out of stock?

Answer 11

If out of stock , use directory of services on pharmoutcomes to find pharmacies which might be able to supply medicines
.•Contact pharmacies to see which ones has medicines in stock and agree with patient which pharmacy they would like to attend.

Question 12

what are the quantity resrictions when supplying urgent medicine supplys?

Answer 12

HMR determines quantity to be supplied- full packs for creams, inhalers, liquid antibiotics , insulin and contraceptives
•5 days supply for schedule 4 and 5 drugs as well as phenobarbital for epilepsy.
•Up to 30 days supply for all other preparations- use professional judgement
- should say emergency supply

Question 13

what is used to record urgency medicine supply?

Answer 13

•Blank FP10 Electronic Prescription Service (EPS) token used to record medicines dispensed and details of who has collected the medication.

Question 14

do patients have to pat for urgent medicine supply?

Answer 14

•If patient is eligible to pay for prescriptions , this levy should be paid by the patient or their representative when medicine is collected.

Question 15

where do you record urgent medicines supplies?

Answer 15

•Record in three places- POM register, Pharmoutcomes and Patient Medication Record(PMR) which is on the regular dispensing and labelling system

Question 16

when do you refer a patient for urgent medicine supply?

Answer 16

• Made to another pharmacy if medicine is out of stock
• Made to another clinician ( patient’s own GP or out of hours service) if patient has requested schedule 1,2 or 3 drugs.
• Made to another service if pharmacist has any concerns about the patient’s welfare that arise during the consultation.

Question 17

when should a patient be asked to call 111 when refered to a pharamcy for a urgeny medicine referal?

Answer 17

Patients should never be asked to call 111 themselves if a supply cannot be made.

Question 18

when supplying the urgent medicine supply what advice should be given?

Answer 18

Steps they can take to avoid running out of their medicine
Importance of ordering their medicine on time
The advantages of the electronic repeat dispensing service

Question 19

what is the minor ailment rederral?

Answer 19

•Patients can only be managed under this scheme if they have been referred through NHS 111
•Pharmacy team picks up notification of referral from pharmoutcomes
OR
•Patients walks in or phones to notify pharmacy team that they have been referred -consultation

Question 20

what takes place in the minor ailment scheme consultation?

Answer 20

• Usually face to face but can be over the phone if pharmacist feels it is appropriate
• Pharmacist needs to ensure that all red flags as detailed in NICE clinical knowledge summaries are recognised and patient referred appropriately

Question 21

what advice should the pharmacist provide for the minorailment scheme?

Answer 21

• Pharmacist should provide written and verbal advice on managing the condition
• Written advice re-enforces verbal message•Source of written advice can be http://www.nhs.uk/

Question 22

at the end of a consultation what advise should you always give?

Answer 22

“If your symptoms do not improve or become worse, then either come back to see me or seek advice from your GP. You can call NHS 111 or 999 if the matter is urgent and a pharmacist or GP is not available.”

Question 23

what happens when you refer a patient out of hours

Answer 23

refer to A&E
must be agreed with patient first
needs to be done through 111- given a time frame
or call 999 if very unwell

Question 24

how do you refer during opening hours of GP?

Answer 24

•Pharmacist needs to contact GP surgery, requesting urgent appointment.•Can complete GP notification form and ask patient to take along to appointment.•Patients presenting twice a month or more with the same complaint should be referred to GP

Question 25

what reocrds should be kept for minor ailment scheme?

Answer 25

• Details of consultation and any referrals made kept on Pharmaoutcomes
• If necessary , a notification of the consultation can be sent to the patient’s surgery even if a referral was not made

Question 26

how much should you charge for CPCS referral?

Answer 26

£14
•Urgent supply is complete when pharmacist has had discussion with patient and determined if supply is or is not possible.•Minor ailments is complete when pharmacist has had discussion with patient and given advice on self-care or medication that can be used OR has escalated patient to another clinician

Question 27

what is new medicine service?

Answer 27

• Introduced October 1st2011
• Adherence to medication for chronic conditions is a major problem
• Targets 4 main areas:–Asthma/ COPD–Type 2 diabetes–Antiplatelet/ anticoagulant therapy–Hypertension

Question 28

what are the aims of NMS?

Answer 28

•Patient /carer to be able to manage new medicine for a chronic condition and make decisions about it•Increase adherence•Increase pharmacist’s role•Reduce medicine waste•Promote interprofessional working•Promote healthy lifestyles•Promote self-management of chronic conditions•Signposting to relevant services•Reduce hospital admissions

Question 29

what are the 3 step processess in NMS ?

Answer 29

1.Day 0 patient engagement–Patient is referred to the pharmacy or as part of the dispensing process–Give information leaflet–Get consent and arrange follow up

•Day 7-14(approx.) intervention–Can be done face to face or over the phone–Structured interview to check how the patient is ‘getting on’ and make any required intervention–Record the intervention–Arrange follow up

Day 21 (approx.) follow up–Two possible outcomes–Patient adherent (desired outcome)–Patient non-adherent–Refer to the GP–Give more advice/ support–Record the discussion

Question 30

what is the discharge medicine service?

Answer 30

it is an essential service
•Referral of selected discharged patients to community pharmacists for extra guidance .•Advice and support offered by community pharmacists around new medicines and other changes made in hospital.

Question 31

what are the DMS requirements?

Answer 31

•Registrants should complete any associated e-learning and assessments.•SOP should be available for all team members.•A robust communication network with local GP practices and pharmacists in the Primary Care Network (PCN)

Question 32

what is the first stage of DMS care?

Answer 32

•First stage- reception of referral by community pharmacy .•Pharmacist does a clinical check to reviewchanges to dose, formulation, quantity , administration and prescribing frequency.Changes to medication regimen that might result in interactions with other existing regimens.Newly prescribed and discontinued medicationAny contraindications.Any monitoring requirements.

Question 33

what is the second stage of the DMS?

Answer 33

•Second stage – reception of first prescription post discharge from GP surgery.•Pharmacist or pharmacy technician ensures that any changes that were in the original referral have been acted upon.•New prescription should reflect any changes that were done during the hospital admission and highlighted in the original referral.•Any discrepancies should be picked up with the GP practice or PCN pharmacist

Question 34

what is the 3rd stage of the DMS review?

Answer 34

•Third stage - patient involvement.•Pharmacist or pharmacy technician should discuss with the patient or their carer the changes to their regimen.•Establish that the patient/ carer is aware of what condition is being treated by which medicine.•Establish that patient/carer understands administration of their medicines , how they can get the best from their medicines and how they can minimise adverse effects.