NHS legislation and the pharmacy contract

Question 1

What does NHS legalisation determine?

Answer 1

• Products prescribable under NHS
• Patient charges for drugs dispensed under NHS, and grounds for exemption
• Does NOT determine right to practise of pharmacists, establishment of pharmacies or arrangements for dispensing private prescriptions

Question 2

What is the Pharmacy Contract?

Answer 2

• Determines contractual arrangements or Terms of Service for NHS community pharmaceutical services including:
o Award of NHS pharmaceutical contracts
o Supply of medicines
o Provision of services
• Contract negotiated between DHSC, NHS England and Improvement & PSNC
• A 5 year investment in community pharmacies.
• Secures almost £13bn over the five years
• Sets out a clear vision for the expansion of clinical service delivery in line with the NHS Long Term Plan
• Much of detail to be finalised and annual review will see gradual shift away from dispensing to delivery of services

Question 3

What is the Pharmacy Quality Scheme?

Answer 3

• Payments made to community pharmacy contractors meeting certain quality criteria
• To be eligible the contractor must meet four gateway criteria:
o Offer NHS community pharmacy seasonal influenza vaccination and/or New Medicine Service
o Pharmacy staff must be able to send and receive NHS mail
o Have up to date NHS website profile for opening hours
o 80% of pharmacy professionals achieved level 2 safeguarding status for children and vulnerable adults
• Will become Terms of Service requirements from April 2020

Question 4

What is a quality payment?

Answer 4

• If pass the gateway criteria will receive a quality payment if meet criteria related to different domains:
o Risk management and safety composite bundle
o Medicines safety audits
o Prevention composite bundle
o Primary Care Networks
o Asthma
o Digital enablers

Question 5

What is the Pharmacy Integration Fund? (PhIF)

Answer 5

• ‘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.’
• NHS England responsible for allocation of the PhIF.
• PhIF aims to:
o make better use of community pharmacy, pharmacists and pharmacy technicians
o improve access for patients
o relieve the pressure on GPs and A&E
o contribute to delivering a seven-day service

Question 6

What is the Market Entry: Award of NHS community pharmacy contracts in England?

Answer 6

• Pharmaceutical lists are maintained by NHS England
• Applications for new, additional or relocated premises made to the NHS England local offices
• Base approval decisions on “Pharmaceutical Needs Assessment” (PNA) produced by LA’s Health and Wellbeing Board
• PNA will identify the pharmaceutical services that are needed and those that are provided

Question 7

What is the structure of NHS community pharmaceutical contractual framework?

Answer 7

• Three tiers
o Essential services
o Advanced services
 Both essential services and advanced services are nationally agreed and commissioned by NHS England
 Funding derived from “Global Sum”
o Locally commissioned services (includes enhanced services)
 Commissioned by LAs, CCGs and NHS England local offices
 Reflecting local PNA

Question 8

What are the 7 essential services?

Answer 8

o Dispensing (medicines & appliances)
o Repeat dispensing (Sept 14- requirement to advise patient on benefits)
o Disposal of unwanted medicines
o Public health (Promotion of Healthy Lifestyles) : must take part in 6 campaigns a year
o Signposting
o Support for self-care (minor ailments and LTCs)
o Clinical governance
o Payment agreed nationally

Question 9

What is contract monitoring?

Answer 9

Each NHS pharmacy monitored by NHS England for compliance and quality against criteria in Community Pharmacy Assurance Framework (CPAF) (includes questionnaire completion +/- inspections)
o Covers Essential and Advanced Services

Question 10

What is Clinical Governance?

Answer 10

“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.”

Question 11

What is the patient/public involvement of clinical governance?

Answer 11

o Display practice leaflet
o Notify patients of NHS services provided by CP contractor
o Undertake annual Community pharmacy patient satisfaction questionnaire
 sample size depends on dispensing volume
 must reflect on results, take necessary action
o Monitor medicines owed and out of stock
o Establish complaints systems and review, and act on, complaints

Question 12

What is a clinical audit?

Answer 12

One audit decided by pharmacy & nationally agreed audit (2014/15 -emergency supply)
(part of clinical governance)

Question 13

What is the risk management programme?

Answer 13

o Pharmacies should keep a patient safety incident log and near-miss log
o Patient safety notices and alerts regarding patient safety should be acted upon within required timescales. Actions should be recorded
(clinical governance)

Question 14

What is the staffing and staff management programme?

Answer 14

Training, qualification and references, poor performance

clinial governance

Question 15

What policy must pharmacies have regarding raising concerns?

Answer 15

Pharmacies must have a whistle blowing policy

Question 16

What are advanced services?

Answer 16

• Six (currently!) advanced services within the NHS community pharmacy contract
• Can choose to provide any so long as meet requirements (no need to be commissioned)
o Medicines use Review (MUR) and Prescription intervention service
o New medicines service (NMS)
o NHS Urgent Medicine Supply Advanced Service (NUMSAS)
o Flu vaccination service
o Appliance-use review (AUR) service
o Stoma application customisation (SAC) service

Question 17

What is the new medicine service?

Answer 17

• Focuses on patients with long term conditions that have been prescribed new medicines
• Ambitions:
o improve medicines adherence
o increase patient engagement with their condition and medicines to support them in making decisions about treatment and self-management
o reduce medicines wastage
o reduce hospital admissions due to adverse events associated with medicines
o increase reporting of ADRs by pharmacists and patients
o positive patient assessments

Question 18

What is the evaluation of the NMS?

Answer 18

• DoH commissioned researchers to evaluate NMS to inform decision on future funding
• Methods included a RCT of the effectiveness of the service, along with an economic evaluation and qualitative work
• Results of evaluation demonstrated:
o NMS significantly increased patients’ adherence to new medicines (approx 10%)
o NMS saved money
o Patients were positive and supportive of the NMS
• Improvements identified:
o Need better integration of the service into care pathways
o Better GP and patient awareness of the service
o Access to patient medical records would be beneficial
o Inclusion of other patient groups (e.g. mental health)
• Over the settlement period, PSNC, DHSC and NHSE&I will look to include further conditions in the NMS

Question 19

What is the flu vaccination service?

Answer 19

• The 5th advanced service commenced in Sept 2015
• Community pharmacies can offer a seasonal influenza vaccination service for patients in at-risk groups
• ‘Can be provided by 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’
• Allowed under a ‘national patient group direction’
• CP to adapt to provide new services to help people to stay healthy and prevent illness; to support and provide urgent care services; to support patients leaving hospital; and to help patients avoid unnecessary visits to GPs and hospitals.

Question 20

What is the NHS community pharmacist consultation service?

Answer 20

• Aim to help people with minor illness
• Will integrate the CP better into primary care.
• In 2019/20 the CPCS will take referrals from NHS 111 then to expand to include referrals from GP practices, NHS 111 online & urgent treatment centres.
• CPCS brings together NHS Urgent Medicine Supply Advanced Service (NUMSAS) with local pilots of the Digital Minor Illness Referral Service (DMIRS).

Question 21

What are further service developments?

Answer 21

• Extension of the reach of the six mandated public health campaigns using digital resources
• Hepatitis C testing service
• A model for detecting undiagnosed CVD
• Stop smoking support referrals from secondary care
• Point of care testing around minor illness, to support efforts to tackle antimicrobial resistance
• The routine monitoring of patients
• Activity complementing the content of forthcoming PCN service specifications
• Service to improve access to palliative care medicines

Question 22

What are locally commissioned services?

Answer 22

• Allow for creativity and innovation to meet local needs
• Commissioned locally by Clinical Commissioning Groups (CCGs), NHS England local offices and Local Authorities (LAs)
• Commissioners must make sure that:
o Carried out on suitable premises
o By trained and qualified persons
o Appropriate equipment
o Aligned with national guidelines / local needs

Question 23

What are some locally commissioned services?

Answer 23

• Anticoagulant monitoring
• Vascular risk assessments
• Weight management schemes
• Sexual health
• Patient group direction service
• Needle and syringe exchange service
• Care home service
• Home delivery