NHS Flashcards
CPCF, PGDs and NMS
Why is CPCF needed?
Tackle strain of staff and finance of NHS
GP overwhelmed
Development of IT
Introduction to SCR and IP clinics
Provision of CPCF
Pharmacists - upskilled
More resources provided -> more clinical service
Pharmacy technicians upskilled
CPCF is agreed between what bodies?
Government
NHS
Community Pharmacy England (CPE)
What are the four elements of CPCF?
Essential services
Advance services
National Enhanced Services and Locally Enhanced Services
Pharmacy Quality Payments
Name 9 current essential services
Dispensing medicines
Healthy living pharmacy
Discharge medicines service
Support for Self-care
Signposting
Disposal of unwanted med
Repeat medication
Dispensing appliances
Public Health
10 advance services of CPCF
Flu Vaccination Service
Hypertension Case-Finding Service
Pharmacy Contraception Service
Lateral flow device test Service
New Medicine Service
Appliance Use Reviews
Stoma Appliance customisation
Community Pharmacy Consultation Service
Hepatitis C Testing service
What service has been replaced?
Medicine Use Review (MUR) to Discharge Medicine Service (essential)
How can patients obtain community consultation service?
NHS 111
999 Service
GP referral for minor illness consultation
Primary care out-of-hour service
Referred by other urgent and emergency care provider
What are the 2 stages of hypertension case-finding services?
Identification of ppl at risk of hypertension -> offer BP measurement
If clinically indicated, offering 24 hours ABPM
What are the 3 stages of the Discharge Medicines Service?
Referral received to pharmacy
Medicines reconciliation process
Patient consultation on understanding
What are the two main dimensions in the pharmacy quality scheme?
Gateaway criteria: must be met on day of declaration to qualify for payment
Domains of the quality criteria: quality within a domain to be met for a payment for that domain
Differences between gateaway domains and domain of quality criteria
Gateaway domain must be met first to be able to qualify for a payment of domain of quality critera
The 6 current legislation of the CPCF?
Health and Social Care Act 2012
Equality Act 2010
Health Act 2009
NHS act 2006
NHS regulation 2019 - Serious Shortage Protocols (SSPs)
Human Medicines Regulations 2012
When is Serious Shortage Protocols (SSPs) used?
In the even of medicine being in a serious shortage
Considered by the Secretary of State for Health and Social Care
What should be stated in the SSPs?
Specify action to be taken for specific patient groups within a timeframe
Specificy alternative product or quantity may be supplied
What happened to the prescriptions after the medications are dispensed to the patients?
Seperated into specific sections
Include submission document FP34C which states quantity of items, prescription dispensed and services completed + code linked with pharmacy
Send to NHS Business Service Authority (NHSBSA)
What are the requirements of a PGD?
Name of business own direction
Start and end date
Description of med applied
Class of healthcare professional who can supply
Signature of a doctor/dentist AND a pharmacist
Authorisation by an appropriate organisation
Clinical condition or situation apploed
Description of exclusion
Description of when to get more advice + referrals
Details of drugs (dosage, quantity supploed, strength, route of administration,..)
Warnings, potential ADRs
Statement of records
What must be recorded when PGDs are applied?
Name of HCPs supplying or providing
Patient identifiers
Medicines providedW
What medicines can be supplied through PGDs?
All POM, P and GSL meds
Except: unlicensed meds, dressings, appliances and devices, radiopharmaceuticals, abortifacients, certain CDs.
Who cannot supply CDs under all five schedules under PGD?
Dieticians
Speech and language therapists
Dental therapists
Dental hygienist
What CDs can be listed in PGD legislation?
Schedule 2: morphine and diamorphine for treatment of conditions, NOT addiction. Only provided by nurses and pharmacists
Schedule 2: Ketamine
Schedule 3: Midazolam
Schedule 4: All drugs except anabolic steroids and injectables for addiction
Schedule 5: All drugs
Who contribute to the development of a PGD?
Doctor
Pharmacists
Representative of any professional group expected to supply
Authorisation from NHS trust, CCGs, LAs.
How and when should be the expiry date of the PGD decided?
Decided on a case-by-case basis
Should not be more than THREE years from authorisation
Two types of PGDs?
NHS PGDs - commissioning and authorisation and delivery from NHS body
Private PGDs - commissioned by NHS by delivered by public funded organisation
What should be considered when making decision to supply through PGDs?
Medicines
Patient group
Reasons why
Who will supply
Under Patient Specific Direction?
How can patients access PGDs in practice?
Engaged by advertising
Referred by satisfied customer
Engaged in-store by pharmacist or HCPs
Referred by HCPs
Returned after being given leaflet
Differences of EHC supply between from PGDs and as P pharmacy?
Free of charge
Given to clients aged more than 13
Taken immediately, before leaving
Specific verbal advice
Record-keeping requirements
What is the rationale of New medicines service (NMS)?
Support people with long-term conditions with newly prescribed medicines
Aim: improve adherence
What are the 6 conditions that the contractors of NMS need to achieve to provide the service?
- Satisfactorily complying with obligations under the terms of service
- SOPs present
- Have necessary knowledge and skill -> declared by NHS self-assess form
- Notify GP surgeries within locality of intention to provide service
- Consultation room complying with the requirements outlined
- Completed intention to provide surface through declaration form through NHSE&I team
Conditions that are included in the NMS.
Respiratory: Asthma and COPD
Neurology: PD, Epilepsy, use of antidepressants
Mucoskeletal: Osteoporosis
Cardiology: AF, HTN, VTE long-term risk, HF, Stroke/TIA, Hypercholesterolaemia, ACS, CHD
Endocrinology: T2DM, Gout
Urinary incontinence or retention
Eligible criteria of NMS?
Must be first prescription of that new medicines
Verbal consent obtained and recorded
Referral by a HCP at hospital responsible for that course of treatment
What do patients need to know while consenting for NMS?
Provision of service
Sharing of information between pharmacy and GP
Sharing of information with NHSE&I
Sharing of information with NHSE&I and NHSBSA
Structure of NMS service
Stage 1: engagement stage (day 1) - consultation about the new meds
Stage 2: 7 - 14 days after stage 1 - discussion about the ongoing of meds + advice
Stage 3: 14 - 21 days after stage 2 - discussion and resolve issues
Benefits of NMS for patients
Encourage shared decision making
Early identification of issues
Improve adherence -> improve quality of life
Increase patient engagement -> self-manage their long-term conditions
Range of healthcare providers
Lifestyle changes + interventions
Increase access to advice
Benefits of NMS for pharmacists and healthcare system.
Expanding roles of the pharmacist
Reduce medicine wastage
QIPP agenda contribution
Promote multidisciplinary working
Support integration of community pharmacy -> signposting and referral service
Improve pharmacovigilance
Reduce hospital-related admissions
Evidence-based effectiveness
NHS long-term plan
Is it possible to provide NMS service alongside the DMS service?
DMS - first-post discharge prescription is received
NMS can be offered if clinically appropriate (if patient would get additional benefits)
