NHS Community Pharmacy Contract

Question 1

What is CPCF?

Answer 1

NHS community pharmacy contractual framework

governs how community pharmacy contractors are remunerated for the provision of NHS services
- how they are paid

5 year deal

Question 2

What are the benefits of the CPCF?

Answer 2

rewards high quality services rather than volume of service (number of prescriptions)

secures pharmacy funding and sets out a clear vision for the expansion of clinical service delivery over the next five years in line with the NHS Long Term Plan

Question 3

Who governs the CPCF?

Answer 3

PSNC - pharmaceutical services negotiating committee

NHS England and NHS Improvement

Question 4

What are the three levels of NHS community pharmacy contractual framework?

Answer 4

essential services
advanced services
locally commissioned services

Question 5

What are essential services? What are the essential services offered?

Answer 5

are offered by all pharmacy contractors
must be offered to be considered for funding

dispensing medicine 
dispensing appliances
repeat dispensing 
disposal of unwanted medicine 
promotion of healthy lifestyle - public health 
signposting patients to other healthcare providers 
support for self care
discharge medicine service 
clinical governance

Question 6

How is repeat dispensing carried out? What is eRD? What are the benefits of eRD?

Answer 6

carried out using electronic repeat dispensing - eRD (previously paper prescription)
- must stay in one pharmacy

electronic repeat dispensing
- no need for prescribers to hand sign authorised repeat prescriptions each time -
= only the first as it covers the authorisation of all batches

Question 7

What is the difference between private and NHS repeat dispensing?

Answer 7

private

• paid for
• can be repeated
• requires a new signed prescription each time

NHS
- single record on NHS spine
- cannot repeat prescription
= service allows for a batch of prescriptions to be repeated

Question 8

What must an eRD show?

Answer 8

intended interval - time between each batch/repeat

how many batch issues = repeat total

repeat authorisation
- signature

Question 9

What is the pharmacists responsibility with eRDs?

Answer 9

checking the patient’s medication regimen has not been altered
- may indicate a review and referral is needed

checking the patient’s manner of utilisation has not changed
- may indicate a review and referral is needed

Question 10

What is the process of disposal of unwanted medicines?

Answer 10

obligated to sort unwanted medicines into solids, liquids and aerosols

benefits public health
- prevents accidental poisoning and environmental hazards

Question 11

How is a healthy lifestyle promoted as an essential service?

Answer 11

opportunistic service
campaign service
- 6 required annually = request of NHS England and Improvement
- required to undertake prescription linked interventions on major areas of public health concern
= smoking, high blood pressure, etc

Question 12

What is the discharge medicine service in essential services?

Answer 12

NHS trusts transfers patients discharge from the hospital to the pharmacy

compare medicine they were previously taking with those they are currently taking - check PMR and SCR

• reduce hospital readmission
• reduce harm from transfer of care
• support the development of effective team working

Question 13

What is clinical governance?

Answer 13

framework in which the NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care

examples
- patient satisfaction survey, complaints procedure, clinical audits, SOPs - standard operating procedures, patient safety incident analysis and reporting

Question 14

What are advanced services? What are the advanced services offered?

Answer 14

optional services offered by contractors
requires accreditation

community pharmacy consultation service - CPCS
new medicine service - NMS
stoma appliance customisation - SAC
flu vaccination service - FUS
medicines use reviews - MURs
hepatits C service 
appliance use services - AUS

Question 15

What is MUR? What type of service is it a part of?

Answer 15

Medicine Use Review - MUR
similar to AUR - appliance use review

it is an advanced service

• aim to increase the patient’s knowledge of their medication and increase adherence
• can conduct adherence centred reviews on patients with multiple medications

Question 16

Which patients are targets for MUR? How is an adherence centred review conducted for MUR?

Answer 16

medicine use review
patients on multiple medications
- especially those with long term conditions

patients with high risk medications
- NSAIDs, anti-coagulants, anti-platelets, diuretic
patients recently discharged from hospitals with changes to medication

conducted in a private consultation room by a registered accredited pharmacist
needs verbal consent only
may be provided by phone or video consultation

Question 17

What is NMS? What type of service is it a part of?

Answer 17

new medicine service

it is an advanced service

aim is to improve understanding of newly prescribed medicine for long term conditions

• reduces risk of hospitalisation
• reduce side effects

Question 18

What are the 5 conditions that NMS can be used with? What are the 3 stages of NMS?

Answer 18

new medicine service

long term conditions

• asthma
• COPD = chronic obstructive pulmonary disease
• type 2 diabetes
• anti-platelet/anti-coagulant
• hypertension

stages
1 = day 1 - patient engagement
2 = day 7-14 - initial intervention
3 = day 21-28 - follow up

Question 19

What is the FVS?

Answer 19

flu vaccine service

aim is to sustain and maximise uptake of flu vaccine in at risk groups

builds up the capacity of community pharmacies as an alternative to general practice

Question 20

What is the CPCS? What is the purpose of CPCS? What did it replace?

Answer 20

community pharmacist consultation service
- replaced NHS Urgent Medicine Supply Advanced Service (NUMSAS) and Digital Minor Illness Referral Service (DMIRS)
aim is to connect patients with minor ailments or need an urgent supply of medicine with a community pharmacy

takes referral from the NHS 111 - relieves pressure on wider NHS

replaced
NUMSAS - NHS urgent medicine supply advanced service
DMIRS - digital minor illness referral service

Question 21

What are locally commissioned services?

Answer 21

only some pharmacies provide them

in line with the needs of the local population

funded and commissioned by local authorisation, clinical commissioning groups (CCGs) and local NHS England teams

Question 22

What is the Pharmacy Quality Scheme? What is the pharmacy quality scheme made up of?

Answer 22

formerly known as quality payment scheme
quality criteria must be met in order to be eligible for funding

4 gateways - all must be met and new ones are made every year

domains fall into criteria which must be met

• all of the criteria of a single domain must be met to secure funding
• the more domains are met, the more PQS payments gained

Question 23

What is the process of CPCS urgent medicine supply?

Answer 23

1 - patient calls NHS 111
2 - patient is triaged to community pharmacy
3 - message sent to a community pharmacy
4 - patient telephones pharmacy
a - pharmacy does not receive referral = check NHS system
b - patient does not call = pharmacy makes one attempt to call
5 - emergency supply made
a - emergency supply
b - message sent to the GP
or
6 - supply not made = not required or allowed/possible
a - medicine is not stocked
b - referral to GP
c - another reason to not supply

Question 24

How is CPCS recorded?

Answer 24

recorded on CPCS IT system
FP10DT token used

only print the EPS token for those who are exempt
information printed on token in legible writing

token sent to NGSBSA as part of the month submission

Question 25

What is the process of CPCS minor ailment/low acuity?

Answer 25

patient may not require any medication
patient may be referred to locally commissioned service
patient requires OTC medication support and self care advice
patient requires higher acuity care = use escalation pathway

escalation pathway

• pharmacist calls NHS 111
• support patient with urgent appointment at their own GP
• call 999 if needed

Question 26

What type of service are the following? What is the procedure for each one?

dispensing medicine
dispensing appliances
signposting patients to other healthcare providers
support for self care

Answer 26

essential services - offered by all pharmacist

dispensing medicine 
dispensing appliances
- supplying medicines or appliances 
- legal, clinical and accuracy checks 
- give information and advice 

signposting patients to other healthcare providers
- referring patients who need further support to the correct healthcare provider

support for self care

• provision of advice for management of minor ailments and common conditions
• provide medication where appropriate
• patients with long term conditions/complex needs

Question 27

What type of service are the following? What is the procedure for each one?

stoma appliance customisation - SAC
hepatits C service
appliance use services - AUS

Answer 27

advanced services - require accreditation, are optional

stoma appliance customisation - SAC

• aim is to ensure the proper use and comfortable fitting of the stoma appliance
• aim to improve duration of usage and reduce waste

hepatits C service

• service is based on point of care testing (POCT) for hepatitis C
• if people test positive they will be referred for confirmatory tests and treatment where appropriate

appliance use services - AUS

• aims to help patients understand and use their prescribed appliances
• carried out by a pharmacist or specialised nurse