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part 3d > nhs community pharmacy services > Flashcards

nhs community pharmacy services Flashcards

1
Q

NHS Community Pharmacy Contractual Framework (CPCF) 2019-24

A 
Essential services- mandatory-paid for
- As a whole NHS service (finishes 2021)
- Each dispensed item
Advanced services- optional
- Paid for each patient interaction
Enhanced/ locally commissioned services- optional
- Paid for each patient interaction
Pharmacy Quality Scheme (PQS)-optional 
- Self-declaration or provide evidence of quality service
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2
Q

what is the payment like for essential services

A

Establishment payment
up to Dec 16 £25,100 per year (most pharmacies)
£ zero 2021 onwards

PLUS Pharmacy Access Scheme (PhAS) for small volume rural/isolated pharmacies
(approx. £17,000)

PLUS:SINGLE ACTIVITY FEE (SAF) introduced 2017 for dispensing service

£1.27 per item Jan 2021

PLUS reimbursement for drugs/items purchased
PLUS endorsement fees (MF, BB, XP, SP, ED, CD fees etc)

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3
Q

what are the 9 essential services of a pharmacy?

A 
Dispensing (medication and appliances)
Repeat Dispensing
Disposal of unwanted medicines
Promotion of healthy lifestyles (public   health)
Sign-posting patients to other healthcare providers
Support for self-care
Clinical governance 
NEW-Discharge Medicines Service
Pandemic delivery service (temporary)

NHSE&I monitor these services via the Community Pharmacy Assurance Framework (CPAF)

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4
Q

what does the essential service - dispensing consists of?

A

Supply of a medicine, appliance, chemical reagent or other allowable substance against an NHS prescription written by an authorised prescriber.

Supply within a reasonable time

Check clinical safety (legal/ clinical/ contractual/accuracy checks) and provide advice

Record supply, clinical interventions, owings, referrals on a patient medication record (PMR).

Standard Operating Procedures (SOPs) in place for safety/ governance

Collection of correct dispensing charge/check exemption /inform patient if likely to receive a fine-now Real Time Exemption Checking (RTEC)

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5
Q

explain repeat dispensing (essential services)

A

Uptake depends on GPs

Prescriber signs the repeat authorising prescription (RA) which has identical unsigned batch prescriptions (RDs) associated with it

Up to 12 months of prescriptions are issued at once- usually 28 day batches (up to 12 prescriptions (RD)) or 56 days (up to 6 prescriptions (RD)) without the need to return to GP

Only for patients on stable medication, pharmacist to ensure suitability of repeat supply

Store in a lockable cabinet (keep RA and RD together for each patient)

  • for regular medications you don’t need to see GP every month
  • patients can use the repeat form to reorder prescription
  • or online - surgery website
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6
Q

what is RA? - repeat authorisation

A
  • only one
    -prescriber needs to sign
    -number of repeats
    authorising form not to be dispensed
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7
Q

what is RD - repeat dispensing batch prescription

A
  • many copies
  • unsigned
  • specifies which repeat
  • number of prescriptions can be dispensed
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8
Q

why is RA and RD benfited?

A

Good for:
Patients who are working people
Workflow in the pharmacy
Retention of patients

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9
Q

Essential Services 2-Repeat Dispensing RA/RD

A

Formatted for EPS (electronic prescribing) (eRD)

RA can be printed by GP and given to patient as a record.

Some pharmacies track dispensing through printing off RA

For 28 day batches, dispense one batch (RD) and another automatically downloads from the NHS Spine 21 days later

Can dispense routinely or wait for patient to request batches

Some PMR computer systems allow easy tracking

All electronic batches are signed electronically

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10
Q

Essential Services 3- Disposal of Waste Medication

A

Unwanted or out of date patient’s medication can be returned to pharmacies

Can also accept waste from care homes without nursing

NHSE&I arranges and pays for a specialist waste contractor e.g. SRCL/ Initial

Need SOPs and safety equipment for patient returns

No sharps/ chemicals/ vet products/ dialysis equipment/batteries/ paint

Special requirements for recording and denaturing returned CDs

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11
Q

CD Waste (Schedules 2-4)

A

If a patient returns a CD it must be ‘rendered irretrievable’:

Document returned medicine in a separate register for patient returns (Schedule 2 only)

Store in CD cabinet until denaturation/ destruction can take place

Document the denaturation process

Store denatured CDs in the CD cabinet for 24/72 hours

Dispose of denaturation kits via pharmaceutical waste

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12
Q

Essential Services 4- Promotion of Healthy Lifestyles

A

Provision of opportunistic advice to patients with prescriptions indicating need, e.g.
diabetes
smokers
hypertensive/ high cardiovascular risk
Promotion of healthy lifestyle to all
Take part in local and national health campaigns
Document actions –for NMS, each patient interaction
Healthy Living Pharmacies (HLP) (part of Pharmacy Quality Scheme (PQS))

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13
Q

what are the 3 different levels of Promotion of Healthy Lifestyles

A

Level 1: Promotion-Promoting health, wellbeing and self-care

Level 2: Prevention-providing services (commissioner-led

Level 3: Protection-Providing treatment (commissioner-led)

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14
Q

Essential Services 5- Signposting

A

Pharmacists may not be able to fully support a patient’s needs - refer to further sources of help

information service

local support groups

other healthcare professionals e.g. GP

charity websites/support

local NHS or other service e.g. NHS 111

Also take part in local and national health campaigns

Document actions
e.g. ‘Blood in pee’ campaign-refer people affected to GP

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15
Q

Essential Services 6- Support for Self Care

A

Provision of advice (and treatments) for:

Long term conditions

Self limiting illness (responding to symptoms RTS)

Part of the advanced service Community Pharmacist Consultation Service (CPCS)

Document interventions

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16
Q

NEW Feb 2021 Discharge Medicines Service (DMS)

A

Based on Transfer of Care Around Medicines (TCAM) pilot programme

To ensure better communication of changes made to a patient’s medicines in hospital

Optimise the use of medicines, with shared decision making

Reduce harm from medicines at transfers of care

Improve patients’ understanding of their medicines and how to take them following discharge from hospital

Reduce hospital readmissions

Support the development of effective team-working across hospital, community and primary care networks pharmacy teams and GP teams and provide clarity about respective roles

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17
Q

what are the different stages of DMS

A

Hospitals digitally refer patients for DMS at their community pharmacy.

Stage 1:
Community pharmacists compare medicines at discharge to those patients were taking before admission, clinically check the discharge meds and ensure prescriptions in pharmacy match discharge

Stage 2:
Check the first new prescription from GP reflects discharge

Stage 3:
Discuss with patient/carer to ensure patients understand which medicines they should now be using.

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18
Q

which patients are referred into the DMS

A
  • high risk patient - more than 5. drugs, mi , new med, confused about med

high risk medication - anticoagulant, cd, new inhaler, opioids (dependence) etc

19
Q

What factors are common to the services of signposting, support for self care and promotion of healthy lifestyles?

A

They are all essential services

Each service must be documented to prove you are doing it (NHSE inspections)

Pharmacies do all these services routinely as part of the working day

They are opportunistic and form part of ‘Making Every Contact Count’ (MECC)

20
Q

what is advanced nhs services?

A

Nationally commissioned NHS pharmacy services

Optional

Paid for by NHS BSA via end of month declaration

21
Q

what services are involved in advanced nhs services

A

New Medicines Service (NMS)

Flu vaccination service

Community Pharmacist Consultation Service (CPCS) and GPCPCS

Appliance Use Review (AUR) Service

Stoma Appliance Customisation (SAC) Service

Pandemic Delivery Service (shielded patients-temporary)

COVID vaccination service…………?

22
Q

Advanced Services- New Medicines Service (NMS)

A 
Eligibility: patients starting a new medication being used to treat:
Asthma or COPD
Diabetes (Type 2)
Hypertension
Antiplatelet/ Anticoagulation therapy

These patients are selected because they:
have the greatest degree of non-adherence
will benefit the most

23
Q

NMS Aim-Adherence - 3 stage process

A

Provides support to people prescribed a new medicine to manage a long term condition

Helps patients to improve medication adherence.

Three stage process:

Patient Engagement (Day 0) - advice + leaflet

Intervention (Day 7-14)- talk with patient, do they know why they are called, have consent, check adherence

Follow Up (Day 21-28) - further advice and support

Opportunity to provide healthy living advice at each stage

at-least have conversion with patient 2 times - engagement and intervention

  • get paid after intervention
  • all stages can be done via telephone
24
Q

what is the interview schedule for new medicine service

A
  1. have you had the chance to start the medication
  2. how is it going
  3. any problems with the new medicine
  4. do you think it is working
  5. any side effects
  6. have you missed any dose or changed when you take it
  7. anything else you want to know about the medicine
25
Q

benefits of NMS

A
  • improves adherence
  • reduced hospital admissions
  • increase patients engagement with medication/condition
  • reduces medicine wastage
  • increased yellow card reporting
  • patients like it
  • Supports the development of outcome and/or quality measures
26
Q

Seasonal Flu Vaccination NHS Advanced Service - what and why

A

Provision of seasonal flu vaccines (IM injection) free of charge to eligible adult patients

NHS advanced service for pharmacy 2015 onwards

WHY?
Improve patient choice
GP service: High level of uptake by over 65s but low uptake of flu vaccine to ‘at risk’ groups
Provide more consistent coverage and less local variation in flu vaccine uptake

27
Q

Administration or Supply of POMs without a prescription requires:

A

Patient Group Direction (PGD)

Verification of online and/ or face to face training

Standard Operating Procedures (SOPs)

Regular renewal and review of training/ contract

28
Q

what is pgd

A

Written instructions for the supply or administration of medicines to a group of patients who may not be individually identified before presentation for treatment

No prescription needed

Labelling requirements for POMs still apply/PIL provided/ records kept as stated in PGD documentation.

29
Q

PGD-document contents

A

Written and signed off by doctor (or dentist), pharmacist and an authorising body (with CQC registration)

Introduction

Clinical condition or situation to which this direction applies- Inclusions and exclusions

Designated staff authorised to supply medicines prescribed under the PGD

Description of treatment available under the PGD

Documentation

Facilities and supplies available at sites supplying PGD

Management and monitoring of PGD

30
Q

Pharmacist NHS flu service-Eligibility

A

Over 65s - in 2021, over 50s

Adults 18-65 in a clinical risk group such as:

chronic respiratory disease, e.g. severe asthma, COPD
chronic heart disease, e.g. heart failure
chronic kidney disease at stage 3-5
chronic liver disease
chronic neurological disease e.g. Parkinson’s disease, motor neurone disease, learning disability
diabetes
asplenia or splenic dysfunction
weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment)
splenic dysfunction, sickle cell disease
morbidly obese (BMI ≥40)

At risk groups-pregnant women, care home residents

Carers, household contacts of immunocompromised individuals

Care workers and workers in hospices and care homes

31
Q

when is training given for flu vaccine service ?

A 
Training
Face to face every 3 years: 
-anaphylaxis  
-basic life support (CPR) 
-injection technique IM/SC

e-learning and e-assessment (yearly)
Declaration of Competence (DoC)
NHS PGD and pharmacy SOP
Patient assessment and consent

32
Q

which vaccine do you administer - NHS flu service

A

65 years and older - with no egg allergy = adjuvanted trivalent vaccine
when they have a severe egg allergy = cell based quadrilevent influenza vaccine - flucelvax

when 18-65 years old
egg allergy = cell based quadrivalent influenza vaccine - flucelvax
or
egg grown quadrivalent influenza vaccine
severe egg allergy = cell based quadrivalent influenza vaccine - flucelvax

not eligible when younger than 18

33
Q

Community Pharmacist Consultation Service (CPCS) and GPCPCS

A

Referral to community pharmacy from NHS 111, A&E or GP surgeries for:
Minor ailments
Urgent medicine supply (not GPCPCS)

AIMS:

part of NHS urgent care system (NHS 111 referrals)

easy access for patients

reduce demand on NHS urgent care and GPs for minor ailments

promote pharmacy as the ‘first port of call’

cost effective for the NHS

34
Q

Referrals for Minor Ailments

A

Patient phones or calls into the pharmacy (referred from NHS 111 or GP surgery)

Assess the patient’s presenting symptoms and check SCR (consultation room or phone)

Check for ‘red flags’

Provide patients with self care advice and printed information

If needed:
Sell OTC treatments OR
Refer to PGD OR
Supply under Minor Ailments Service (locally commissioned)
Refer if needed
Document consultation
       Acne, Allergic Reaction   
Ankle or Foot Pain or Swelling 
  Athlete's Foot, Bites or Stings          
Blisters, Constipation, Diarrhoea 
    Ear Discharge, Wax, Earache 
Red or Irritable, Sticky or Watery Eye 
   Eyelid Problems, Hair loss 
Headache, Hearing Problems
  Limb Pain, Mouth Ulcers
Nasal Congestion……………………
35
Q

Referrals for Urgent Medicine Supply

A

In an emergency and at the request of a patient, a pharmacist can supply a POM without prescription to a patient who has previously been prescribed the requested POM (HMR 2012 Reg 225)

Pharmacist (Responsible Pharmacist) MUST interview the patient him/herself and be satisfied that:
Immediate need
Impracticable to obtain a prescription without undue delay
Treatment has previously been prescribed by a UK registered appropriate prescriber for the patient (or EEA or Swiss health professional)
It is an appropriate dose for that patient in the circumstances

CDs-
Schedule 2 and 3? - no
Schedule 4 and 5?- yes - limited amount
Quantity to supply?

Patient phones or calls into the pharmacy (referred from NHS 111)

During the telephone call or consultation:

Access referral (if not already done)
Access SCR with patient’s consent
Check NHS Rx tracker for an EPS Rx
Give advice on ordering prescriptions in time, electronic repeat dispensing

If supplying, create and print Rx on FP10DT
Dispense as per emergency supply regs
Supply (immediately or when patient arrives) and collect NHS charge (unless exempt)
If emergency supply not possible:
refer the patient to their GP or
Contact GP out of hours provider
If no stock:
Forward referral to another pharmacy doing CPCS or
Contact GP OOH service

36
Q

funding for consultations

A

Registration with NHSE:
Transition payment of £900 per pharmacy

Payment for service:
£14 fee per completed consultation

Medicines/appliances supplied under CPCS urgent medicines are reimbursed using Drug Tariff prices

No reimbursement for medication supplied under CPCS minor ailments

37
Q

what are the Locally Enhanced (LES) or Locally Commissioned Services

A

Paid for by:
Public Health England (PHE) via local authorities (LA/Councils)
Clinical Commissioning Groups (CCGs)
NHS England (NHSE)

Local NHSE area teams can commission locally enhanced services listed in part 4

CCGs or PHE can also commission these but they are then termed ‘locally commissioned’

Sometimes services are commissioned from pharmacies via a formal tendering process for NHS standard contracts (or similar)

Services local, often for a small area (Town, City, County Councils)

Local Pharmaceutical Committees (LPCs) instrumental in keeping local pharmacies involved and informed.

38
Q

what does Locally Enhanced (LES) or Locally Commissioned Services startup depend on

A

pharmacies may or may not do enhanced/locally commissioned services depending on:

Which services are on offer from the commissioners in that area

Whether all pharmacies in the area are being offered the service (Any Qualified Person (AQP))

Whether it is only for those that bid for the service through a formal tendering process and win

Choice

39
Q

who funds Locally Commissioned Services

A 
CCG funded
INR clinics and warfarin supply
Tailored dispensing service
Latent TB service
Palliative care service

NHS England funded
Minor ailments scheme
Out of hours service

PHE funded (via local councils)
EHC to young people
Chlamydia testing/treatment
Free condoms
Stop smoking 
Supervised consumption of methadone/ buprenorphine
Needle exchange
NHS Health Checks
40
Q

what are the services which are offered : Locally Commissioned Services

A

Services:
often very localised
or offered countrywide but with different service specifications in different areas.
- can involve supplying / administering POMs

41
Q

Locally Commissioned Services-Sexual Health Services

A

Chlamydia testing kits supply to young people
Azithromycin provision for positive test results
Condom supply

42
Q

Pharmacy Quality Scheme (PQS)

A

AIM: To improve the quality and safety of community pharmacy and other linked primary care services

Payments are made to community pharmacies if they meet certain quality criteria

Up to 100 Quality Points to achieve (£6,400 (possibly more) per pharmacy per year)

Changes every year

43
Q

what is PQS part 1 and 2 (5 domains)

A

Part 1 £18.75 million
14 actions relating to the pandemic-all must be actioned for payment e.g.
Individual COVID risk assessment for all staff
All staff wearing NHS approved PPE (National Pharmacy COVID SOP)
Update business continuity plan and SOPs
Review examples of good practice during the pandemic and adopt them as considered appropriate for the individual pharmacy (GPhC website)
Every registered staff member to read/ record they have read relevant COVID-19 guidance on the GPhC website

Part 2 £56.25 million
5 domains-have to complete all actions in each one to claim:
Domain 1 - Infection Prevention & Control and Antimicrobial Stewardship
Domain 2 - Prevention
Domain 3 - Risk management
Domain 4 - Primary Care Network - Prevention
Domain 5 - Primary Care Network - Business continuity

part 3d (21 decks)

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