private community services Flashcards
Enhancing NHS Provision (income)
what is it?
Pharmacies provide extra services to supplement the requirements of the NHS contract (no NHS payment and not part of the contract) :
Prescription ordering and/or collection service
Delivery Service
Compliance Aids (monitored dosage systems- MDS)
Care Home Services
MOSTLY, BUT NOT ALWAYS FREE OF CHARGE FOR PATIENTS
Additional Free Services to Facilitate Dispensing -Getting Repeat Medication-Prescription Ordering and Collection Services
Patient orders directly from GP surgery-pharmacy collects Rx (paper FP10s)
Patient brings repeat form to the pharmacy, who order medication from GP surgery and collect Rx (or electronic transfer)
Pharmacy keeps the repeat form or use the PMR as a record and patients phone, email or call in to order. Pharmacy orders medication from GP surgery and collects Rx (or electronic transfer)
Pharmacy Website or Phone App Ordering Service
Managed Repeat Service – pharmacy orders all items and collects Rx for the patient (or electronic transfer) (no patient input)
NHS funds the delivery of certain appliances e.g. catheters (see Drug Tariff) but not medication
Usually medication is driven to patient’s homes-also Royal Mail post
Can be couriers, self employed or employed delivery drivers
SOPs and training needed for drivers (e.g. NPA GPhC accredited course)
Additional free services to facilitate dispensing – Multi-compartment Compliance Aids / MDS
7 day packs, each day has time sections- usually morning, lunch, evening, bedtime or morning/bed and tabs/caps are put in appropriate blister
eg. Dossette boxes, Manrex, NOMAD, Medisure, Omnicell, Pivotell
Pharmacist must be satisfied patient can use device safely
Patient/carer can purchase or pharmacy fills packs
advantage and disadvantage to MDS
Advantages:
Patients and carers love them
Increases business, especially if you have 7 day prescriptions
Provides patient centred care
Works well for patients with disability such as dexterity problems-a ‘reasonable adjustment’ to comply with the Equality Act 2010
Allows patients to remain independent for as long as possible (avoiding care home /hospital admission)
You can charge patients
disadvantages:
No NHS funding and expensive- yet patients see it as an NHS service as it uses NHS prescriptions
Often pharmacies order medication without consulting the patient as they are often unable to order themselves e.g. patients with dementia -pharmacy earns money from dispensing and is ordering their own work from the NHS (allegations of NHS fraud)
De-skills patients
De-skills carers – care agencies prefer their carers to ‘prompt’ patients to take their medication using MDS
Need a lot of well trained staff
Time consuming
Expensive-have to pay for trays and extra staff time
Difficult to manage, especially for patients that are frequently admitted to hospital
High dispensing error rate
Not all medication can be placed in trays e.g. prn medicines, creams, unstable medication, antibiotics-can cause confusion with ordering prescriptions and use of medicines
Difficult to change medication regime once a set of trays has been supplied to patient
If patients have difficulty remembering to take medication, MDS may not help
Additional free services to facilitate dispensing – Compliance Aids / MDS-Automation (robotic)
Hub and Spoke Robotic Systems
Create MDS using robots in one location (‘hub’) delivered to ‘spoke’ pharmacies for transfer to patients
Robot - labels, dispenses and checks medication trays
Delivery of medication expensive (x2 deliveries-hub to spoke, spoke to patient)
Difficult logistically
Who is responsible?
Additional Free Services to Facilitate Dispensing- Care Home Services
Medicines for residents of care homes packed into individual blisters, colour
co-ordinated for different times of day
Easier for care home staff
Pharmacist may review drug arrangements /patient medication on-site\
Deskilled care home staff
Additional Free Services to Facilitate Dispensing Care Home Services - mar + emar
Medicines Administration Record (MAR) chart
Generated by pharmacy at time of dispensing prescription
Used by care home staff to record administration to patient
Responsibility for MAR chart accuracy lies with care home staff/ their procedures
Electronic MAR charts: eMAR
Electronic interface between pharmacy and care home
Original packs of medication labelled for patients with barcodes supplied
Care homes have electronic MAR charts and ‘zap’ medication barcode when administering to patient
pharmacy sales
Important part of some pharmacy businesses Healthcare products GSL medicines P medicines pharmacy only Behind counter On open display in closed cabinets Specialist healthcare related items Disability equipment Wound management products Travel medicines and associated products Specialist dietary products Veterinary medicine
private prescription
Important in some pharmacies-depends on:
Location of pharmacy
affluent areas
Location of other private healthcare providers
private hospitals and clinics (TTA’s, private prescriptions from outpatients, clinics on Harley Street London)
prisons (private medical centres operated by companies such as G4S/Bristol Community Health CIC/Spectrum Community Health CIC)
hospices
Stock Supplies to Prisons, Hospices, Drug Treatment Centres, Dentists, Ambulance Services, Oil Rigs etc
All drugs:
Wholesale Dealers Authorisation (WDA(H)) required
Regular inspection by MHRA as licensed company and site to wholesale pharmaceuticals
SOPs in place to comply with MHRA Good Distribution Practice (GDP) e.g. temperature control, pest control, documentation
CDs:
For CDs Schedules 2-5 need CD Home Office Licence (annual application and fee)
Home Office inspects the site every 3 years
Annual Drugs Returns required for international drugs laws (International Narcotics Control Board (INCB)
SOPs to comply with Home Office e.g. security, documentation
Online Medication and Pharmacy Stock Supplies-Internet Pharmacies
Unlicensed none-medicine items
GSL and P medicines- every sale must be approved by a pharmacist
POM supply: Online prescribers
separate medical companies linked to specific pharmacies, supplying private electronic prescriptions e.g. Push Doctor/ Doctor Care Anywhere (DCA)/ HIMS
or
In-house prescribers supplying private prescriptions to internet pharmacy dispensary e.g.Boots/Lloyds
Doctors or pharmacist prescribers approve
medication
MOD Contracts
FMed 296 forms (white)
Issued to service personnel (army).
Should be dispensed in a barracks pharmacy or by a contracted community pharmacy
If presented to a non contracted pharmacy, treat as a private prescription
Almost all computer generated (not handwritten)
CDs on FP10PCD
Rental of Healthcare Space to other HCPs and for health related services
Private Nurses/doctors to do:
Botox
Skin cancer checks
Private prescribing
Private Health Related Services Osteopaths Chiropractors Physiotherapists Podiatrists Acupuncturists Herbalists/homeopathy
Other providers to do NHS Contracted Services
NHS Health Checks
Blood borne virus testing (HIV/Hep B and C)
Stop smoking services
Private Clinical Services (non medication)
Services may also be provided by other HCPs
Often require extensive training, specialist equipment, SOPs
May not require the pharmacist for service provision
Usually pharmacist trains for the service to provide supervision/advice
Ear Wax Removal Service
Hearing Testing Service
Blood Pressure Monitoring Service
Weight Loss Service
Administration or Supply of POMs without a Prescription
Requires:
Patient Group Direction (PGD)
Verification of online and/ or face to face training
Standard Operating Procedures (SOPs)
Requires diagnostic questions/records for clinical effectiveness and patient safety
PGDs –patient records filled in online or as paper copy
