NHS Legislation Flashcards
What replaced the NHS Act 1946 in 1977?
And act which gave the secretary of state for health powers to negotiate with the body of pharmacy. Can negotiate the terms of service under which community pharmacies supply services
terms of service became a legal framework under which community pharmacist contractors provide services - across England, Wales, Scotland and NI
What does NHS Legislation determine?
- products prescribable under the NHS
- patient charges for drugs dispensed under the NHS, and the grounds for exemption
What does NHS legislation not determine?
right to practice of pharmacists, the establishment of pharmacies or arrangements for dispensing private prescriptions
What is the Pharmacy Contract?
Determines the contractual arrangements for NHS community pharmacy services, including:
- award of NHS pharmaceutical contracts
- supply of medicines
- provision of services
Who negotiates the Pharmacy Contract?
NHS England and the PSNC
What is the CPCF?
Community pharmacy contractual framework
What are the recent changes to the CPCF?
- consolidation of a range of fees into a single activity fee
- phasing out establishment payments
- quality payments
- Pharmacy access scheme
What is the quality payment scheme?
Payments introduced as part of the CPCF in 2017/18
Payments made to community pharmacy contractors meeting certain quality criteria
What are the gateway criteria to be eligible to get quality payments?
- provision of at least one advanced service
- NHS.uk entry up to date (opening hours, patient questionnaire results)
- ability for staff to send and receive nhs email
- can link to NHS digital systems e.g. electronic prescribing service, SCR
What are the domains where you are scored to receive a quality payment?
Patient safety Public Health Digital/urgent care Clinical effectiveness Workforce
What is the PhIF?
Pharmacy Integration Fund
The aim of the PhIF is to support the development of clinical pharmacy practice in a wider range of primary care settings, resulting in a more integrated and effective NHS primary care patient pathway
What are the aims of the PhIF?
- make better use of community pharamcy, pharmacists and pharmacy technicians
- improve access for patients
- relieve pressures on GPs and A&E
- contribute to delivering a 7 day service
Market entry: who holds a list of registered pharmacies?
NHS England
Market entry: for what do you need to apply to NHS England for?
New, additional or relocated pharmacies
Market entry: what are approval decisions based on?
The PNA produced by local authorities, as these determine the services that are needed
What are the three teirs of community pharmacy services
Essential services
Advanced Services
Locally Commission Services (incl. enhanced services)
Who funds/commissions each of the three tiers of pharmacy services?
Essential - NHS England
Advanced - NHS England
Enhanced - local authorities, CCGs and local NHS England offices to reflect PNA
NHS England’s role in commissioning of services?
Accountable for direct commissioning on “core” NHS pharmaceutical services (essential and advanced)
Local offices also responsible for locally commissioned services
Role of CCGs and LAs in commissioning of services?
Responsible for locally commissioned (but not enhanced) services
Assess pharmacies applying to them to provide services using ‘Any Qualified Provider’ route or after Tender process outside the Community Pharmacy Contract
Role of Health and Wellbeing Boards and Local Pharmaceutical Networks?
HWB develop and publish pharmaceutical needs assessments (PNAs) used by commissioners to make decisions on funding
LPNs may negotiate with CCG’s to win contracts on behalf of their members
What are the 7 essential services
- Dispensing (medicines and appliances)
- Repeat dispensing (is now a requirement to advise the patient on benefits of this)
- Disposal of unwanted medicines
- Public health (promotion of healthy lifestyles): must participate in at least 6 campaigns a year
- Signposting
- Support for self care (minor ailments and LTCs)
- Clinical governance
How are contracts monitored in community pharmacies?
Each NHS pharmacy monitored by NHS England for compliance and quality against criteria in Community Pharmacy Assurance Framework (CPAF) (includes questionnaire completion +/- inspections)
What is clinical governance?
Clinical governance is a system through which healthcare providers are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish
Terms of service of clinical governance?
- display the practice leaflet
- notify patients of the services provided
- undertake an annual patient satisfaction questionnaire (sample size depends on dispensing volume, must reflect on the results and take action)
- monitor medicines owed and out of stock
- establish a complaints system (review and act on all complaints)
- clinical audit (one decided by pharmacy and nationally agreed audit)
- risk management programme (incidents, near misses etc)
- staffing and staff management programme - training, qualifications etc
- whistle blowing policy
- good standards of premises
- use of information e.g data protection
What are the six advanced services?
- MUR and prescription intervention service
- NMS
- NHS Urgent Medicine Supply Advanced Service
- Flu vaccination
- Appliance use review service
- Stoma application customisation service
How do pharmacies go about providing advanced services?
No need to be commissioned, can choose to provide any as long as meeting requirements
Aim of MURs?
to improve patients’ knowledge, concordance and use of their prescribed medicines
Who can provide MURs?
all contractors who:
- comply with requirements for Essential Services
- have met accreditation requirements for both premises and pharmacists
- Should retain MUR dataset for each MU
Who are MURs for?
patients who have been using the pharmacy for dispensing of their Rx for previous 3 months
What are the changes made that resulted in targeted MURs?
Service requires that 70% of MURs provided to patients within select groups - to ensure the service is provided where most needed
Target groups:
- high risk medicines (NSAIDs, antiplatelets/coags, diuretics)
- patients recently discharged from hospital with changes made whilst in hospital
- respiratory disease
- at risk of or diagnosed with cardiovascular disease and regularly being prescribed at least four medicines
Aims of the NMS?
- improve medicines adherence
- increase patient engagement with their condition and medicines to support them in making decisions about treatment and self management
- reduce medicines wastage
- reduce hospital admissions due to adverse events associated with medicines
- increase reporting of ADRs by pharmacists and patients
positive patient assessments
Who is the NMS for?
patients with long term conditions that have been prescribed new medicines
Who can provide the NMS?
any community pharmacy that fulfils criteria
How do pharmacies receive payment for the NMS?
One-off payment for implementation of the service & target payments for achieving certain number of interventions related to prescription volume of pharmacy
Which patients is NMS targeted at and how is it accessed?
Conditions: Asthma/ COPD; type 2 diabetes; antiplatelet/anticoagulant therapy; hypertension
can be referred by prescriber or offered the service when the present with the prescription
Requirements from the patient for carrying out the NMS?
- gain patient consent
- ensure information is secure
- liase with prescribers and other staff
What were the findings of the NMS evaluation?
- it significantly improved patient adherence
- saved money
- patients were positive and supportive of the NMS
areas for improvement:
- better integration of the service into care pathways
- better GP and patient awareness of the service
- access to medical records would be beneficial
- inclusion of other patient groups e.g. mental health
Current issues with adherence?
30-50% of patients do not take their medicines properly
results in poor control of condition, treatment failure, complications resulting in hospitalisation. adherence can be intentionl or unintentional
Possible reasons for intentional non-adherence?
Fear of side effects
Fear of dependence
Thinking medicine is not working
Cultural beliefs
Not taking as reinforces fact they are chronically ill
Feel better so don’t feel need for further medicine
Disagree with drs diagnosis
Experiencing adverse effects
Side effects interfere with patients usual activities
Possible solutions for intentional non-adherence?
Provide clear explanation of medication, what it is used for, how it works, side effects – allay any fears – provide written information, direct to patient groups- quality assured websites.
If disagree with drs opinion and your advice or explanations don’t help might encourage to see the GP – a lot patients don’t discuss with GP as feel rushed or nervous.
Side effects – could change time of day patient takes med – bp meds at night- mealtimes/ formulations Modified release
Recommend changes to another drug within the same class or drug with a different side effect profile.
Possible reasons for unintentional non-adherence and solutions?
Memory
Confusion – poor cognition – simplify dosage regime, use compliance aid
Difficulty opening containers- change to non child resistance tops
Visual impairment – print of bigger font instructions
Unsuitable formulation: ask prescriber to alter
Obtaining rx- repeats – offer rx ordering and collect service, realign rx if run out at different times
Don’t understand the instructions
Poor instructions given; clarify instructions
Carer doesn’t understand how to give- explain to career, write out instructions clearer
What is the NUMSAS?
NHS Urgent Medicines Supply Advanced Service
national urgent medicines supply service where people calling NHS 111 requiring urgent repeat medicines are referred directly to community pharmacies
Where does NUMSAS come into NHS England’s plans?
Integrates community pharmacy into the urgent care pathway - significant impact on OOH GP appointments
How can community pharmacies offer the flu vaccine?
Under a national PGD
- provide seasonally to at risk patient groups
Which pharmacies can offer the flu vaccine?
any community pharmacy in England that fully meets the requirements for provision of the service and has notified NHS England of their intention to begin
What are the aims of the flu vaccination advanced service?
protect those most at risk of serious illness or death should they develop influenza, by offering protection against the most prevalent strains of influenza virus.
- provide opportunities and improve convenience for eligible patients to access flu vaccinations
- reduce variation and provide consistent levels of community pharmacy flu vaccination across England by providing a national framework
Benefits of locally commissioned services?
allow for creativity and innovation to meet local needs
What must commissioners ensure when providing a locally commissioned service?
- Carried out on suitable premises
- By trained and qualified persons
- Appropriate equipment
- Aligned with national guidelines / local needs
Examples of locally commissioned services?
- Anticoagulant monitoring (enhanced)
- Vascular risk assessments
- Weight management schemes
- Sexual health
- Minor ailment scheme (enhanced)
- PGD service (enhanced)
- Needle exchange service (enhanced)
- Care home sergice (enhanced)
- Home delivery (enhanced)
