Services eBook Flashcards
List 8 Essential Services available under the CPCF.
Dispensing of medicines • Dispensing of appliances • Repeat dispensing • Public health • Disposal of unwanted medicines • Signposting • Support for self-care • Clinical governance
List 6 Advanced Services available under the CPCF
- Medicines Use Review (MUR)
- Appliance Use Review (AUR)
- New Medicines Service (NMS)
- Flu vaccination
- Stoma Appliance Customisation (SAC)
- NHS Urgent Medicine Supply Advanced Service (NUMSAS)
Examples of locally commissioned services include:
- Substance misuse services – needle exchange and supervised consumption
- Smoking cessation
- Minor ailments schemes
- Palliative care services
- Head lice management
- Out of hours services
- Pandemic and seasonal flu services
Compare Essential, Advanced and Enhanced Services
Service Type
- Commissioned Locally or Nationally
- Pharmacist Accreditation Required
- Pharmacy Must Offer (Yes / No)
Essential
- Nationally
- No
- Yes
Advanced
- Nationally
- Generally yes but see individual service specifications
- No
Enhanced
- Locally
- Generally yes but see individual service specifications
- No
Market Entry and Pharmaceutical Needs Assessment
Since the Health Act 2009, Clinical Commissioning Groups (CCGs – formerly Primary Care Trusts (PCTs)) have been required to publish Pharmaceutical Needs Assessments to determine where pharmacies are needed in their area. This information then forms part of
the decision to award a contract to a company applying to open a pharmacy in the area.
Historically market entry was assessed by a ‘necessary or desirable’ test based on the adequacy of pharmaceutical services in the local area. Four exemptions from this test were introduced in 2005:
• Pharmacies in large out of town retail developments
• Pharmacies open for a minimum of 100 hours per week
• Pharmacies in ‘new’ one stop primary care centres
• Mail order or internet pharmacies
In December 2016 the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 were amended to prevent another pharmacy from stepping in straight away when two pharmacies merge together on one site provided this merger does not create a gap in
provision.
Review the PSNC guidance on NMS and MUR patient consent requirements. Use
this box to record any notes you’d like to make about this factsheet.
From 1st October 2011, where a patient agrees to participate in the New Medicine Service (NMS) or the Medicines Use Review (MUR) service they must sign a consent form which uses the following wording:
Consent to participate in the NHS New Medicine Service/NHS Medicines Use Review Service
I agree that the information obtained during the service can be shared with:
my doctor (GP) to help them provide care to me
the Primary Care Trust (PCT – the local health authority) or successor organisation to allow them to make sure the service is being provided properly by the pharmacy
the Primary Care Trust (PCT) or successor organisation, the NHS Business Services Authority (NHSBSA) and the Secretary of State for Health to make sure the pharmacy is being correctly paid by the NHS for the service they give me.
Following the changes to the contracting arrangements for the Community Pharmacy Contractual Framework in April 2013, the following revised wording must be used by pharmacy contractors as soon as practicable.
NHS England, NHS Employers and PSNC recognise that pharmacy contractors will wish to use up stock of consent forms using the original wording, but any reprints of consent forms should use the new wording set out below.
Consent to participate in the NHS New Medicine Service/NHS Medicines Use Review Service
(delete as applicable)
I agree that the information obtained during the service can be shared with:
my doctor (GP) to help them provide care to me
NHS England (the national NHS body that manages pharmacy and other health services) to allow them to make sure the service is being provided properly
by the pharmacy
NHS England, the NHS Business Services Authority (NHSBSA) and the Secretary of State for Health to make sure the pharmacy is being correctly paid by the NHS for the service they give me.
Confidentiality
The law surrounding confidentiality includes the Human Rights Act 1998, Data Protection Act 1998 and the common law duty of confidentiality. The GPhC has published guidance on patient confidentiality, which aligns with the Standards for Pharmacy Professionals.
Confidential information includes:
- Electronic and hard copy data
- Personal details
- Information about a person’s medication – this includes non-prescribed medicines
- Other information about a person’s medical history, treatment or care that could identify them
- Information that patients or the public share that is not strictly medical in nature
Information is not considered ‘confidential’ if..
it is anonymous, coded so that it is not possible to identify the person from it, or if the information is already legitimately in the public domain
Safe Custody of Patient Information
You must take appropriate steps to ensure that all confidential information you hold is
protected. This includes
- Taking reasonable steps to protect the confidentiality of information received, stored, sent or destroyed
- Securely storing hard copy and electronic documents, including records, registers, prescriptions and other sources of confidential information
- Taking steps to prevent accidental disclosure of info
- Not discussing confidential information in an area where others can overhear
- Not disclosing information on websites, internet forums or social media
- Ensuring all members of the pharmacy team understand their duty of confidentiality
- Raise concerns about data control with the appropriate person where you suspect the security of personal information is not appropriate
- Continue to protect a person’s confidentiality after they have died
Disclosure Required by Law. There are circumstances where
There are circumstances where you may be legally required to disclose confidential information about a patient. Bodies with legal authority to request disclosure include:
• The police or other enforcement, prosecuting or regulatory authority
• A healthcare regulator e.g. GPhC or GMC
• An NHS counter-fraud investigation officer
• A coroner or procurator fiscal, judge or relevant court which order that the information should be disclosed
None of these individuals or organisations have an automatic right to access all confidential patient information, therefore you must be satisfied there is a legitimate reason for the request.
In the case of any disclosure without consent, you should be satisfied that the law requires you to disclose the information, ask for clarification from the person making the request if you are unsure about the reasons for the request, and ask for the request in writing.
Disclosing the Information
If you decide to disclose confidential information, the GPhC recommend that you:
- Code the information or make it anonymous unless necessary to identify the patient
- Obtain consent unless disclosure is required by law or in the public interest
- Disclose only the information needed for the particular purpose
- Ensure the person receiving the information knows that it is confidential
- Make records to show who the request came from, whether you obtained patient consent, whether consent was given or refused and what you disclosed
- Release the information promptly
Medicines Use Review and Prescription Intervention Service
Medicines Use Reviews (MUR) are an advanced service provided by community pharmacists under the Community Pharmacy Contractual Framework. MURs differ from full clinical medication reviews as MURs do not require a full medical history to be obtained. MURs
focus on a patient’s medicines use, their understanding and experience of taking these medicines, as well as any side effects, drug interactions or other factors that may be affecting adherence.
Accreditation
Pharmacists and the pharmacy both need to be accredited for an MUR to be performed; the
NHS England Local Area Team accredits the pharmacy, whereas pharmacists are required to
complete an approved training course to become accredited to provide the service.
Providers of MUR courses include the Centre for Pharmacy Postgraduate Education (CPPE),
Welsh School of Pharmacy (WCPPE), Keele University and Medway School of Pharmacy.
Location
MURs must be provided from an ‘acceptable location’. The latest service specification
(PSNC, 2013) identifies an acceptable location as an area for confidential consultations at
the pharmacy premises, which is:
(i) Clearly designated as an area for confidential consultations,
(ii) Distinct from the general public areas of the pharmacy premises, and
(iii) An area where both the person receiving MUR services and the registered pharmacist providing those services are able to sit down together and talk at normal
speaking volumes without being overheard by any other person (including pharmacy staff)
Paragraphs (i) and (ii) shall not apply in circumstances where the pharmacy premises are closed to other members of the public.
MURs can be performed outside of the pharmacy, but only with prior approval from the local authority – applications to perform an MUR outside of the pharmacy or over the phone need to be made to the local NHS England team using the PREM2 form.
MUR Eligibility
Patients are eligible for one annual MUR and as many intervention MURs as needed in any 12 month period. For an annual MUR a patient must be a regular patient with 3 months history with the pharmacy however intervention MURs can be performed on patients without any history with the pharmacy if necessary.
At least 70% of MUR consultations should be carried out on patients who are in one or more of the national target groups, which are:
• Patient taking high risk medicines – NSAIDs, antiplatelets, diuretics or anticoagulants
• Patients with cardiovascular disease – must be on at least one medicine to manage
cardiovascular risk and on a total of 4 or more medicines
• Patients with respiratory disease
• Patient recently discharged from hospital who had changes made to their medicines whilst they were in hospital – ‘recently discharged’ is usually within 4 weeks from discharge but can be up to 8 weeks after
Any patient who has participated in NMS would not be eligible for an annual MUR for 6 months, however an intervention MUR could be performed if necessary. For any intervention MUR it is appropriate to conduct a full review of all of the patient’s medication, not just the medication you have made an intervention for.
TASK 6: For each of the patients below state whether the patient is eligible for MUR or the
Prescription Intervention Service, and whether this would be a targeted or non-targeted
MUR.
Mr Darvill participated in NMS 3 months ago for Aspirin 75mg Dispersible Tablets and has not reported any issues with his medication. He is also taking Simvastatin Tablets 40mg.
Mrs Tate, a regular patient of the pharmacy for the past 10 years who is taking Amlodipine
Tablets 10mg, Atorvastatin Tablets 20mg and using a Salbutamol Inhaler for asthma.
Miss Agyeman, who presents in the pharmacy saying she is having ‘problems’ using her Seretide 250 Evohaler. She has never visited your pharmacy previously.
Mr Capaldi who is taking Metformin 500mg Tablets for diabetes, Atenolol Tablets 50mg for hypertension and Sildenafil Tablets 50mg for erectile dysfunction. He has been regularly
visiting the pharmacy for the last 6 months and has not had an MUR previously
- No to MUR as patient has had NMS within last 6 months.
- Yes. It would be a targeted MUR as patient is on a respiratory medication for one of the target groups
- Yes if provided under Prescription Intervention Service as an intervention MUR
- Yes. It would be a generic MUR as although the patient is on one medicine for cardiovascular risk, he is only on a total of 3 medicines so doesn’t meet the requirement of 4 drugs for the cardiovascular disease target group.
MUR Payment
Pharmacies can claim payment for each MUR performed using the FP34C form at the end of each month. The 2017 rate is set at £28 per MUR, with a maximum of 400 MURs per financial year (1st April to 31st March). Pharmacies can exceed this number but will only be paid for 400.
New Medicines Service
The New Medicines Service (NMS) is an advanced service provided under the Community Pharmacy Contractual Framework which was designed to provide support to patients newly prescribed medicines for the treatment of selected long term conditions to help improve adherence. The service is expected to:
• Improve patient adherence
• Increase patient engagement with their condition and medicines
• Reduce hospital admissions due to adverse events from medicines
• Lead to increased Yellow Card reporting of adverse reactions to medicines, and consequently support improved pharmacovigilance
List the 4 conditions and therapies covered by NMS. Give one example of a drug
for each.
• Asthma and COPD
The patient’s newly prescribed medicine is listed in one of the following BNF chapters/sub-sections:
3.1.1 Adrenoceptor agonists
3.1.2 Antimuscarinic bronchodilators
3.1.3 Theophylline
3.1.4 Compound bronchodilator preparations
3.2 Corticosteroids
3.3 Cromoglicate and related therapy, leukotriene receptor antagonists and phosphodiesterase type-4 inhibitors
• Type II diabetes
The patient’s newly prescribed medicine is listed in one of the following BNF chapters/sub-sections:
6.1.1.1 Short acting insulins
6.1.1.2 Intermediate and long acting insulins
6.1.2 Antidiabetic drugs
• Antiplatelet or anticoagulant therapy
The patient’s newly prescribed medicine is listed in one of the following BNF chapters/sub-sections:
2.8.2 Oral anticoagulants
2.9 Antiplatelet drugs
• Hypertension
The patient’s newly prescribed medicine is listed in one of the following BNF chapters/sub-sections:
2.2.1 Thiazides and related diuretics
2.4 Beta-adrenoceptor blocking drugs
2.5.1 Vasodilator antihypertensive drugs
2.5.2 Centrally acting antihypertensive drugs
2.5.4 Alpha-adrenoceptor blocking drugs
2.5.5 Drugs affecting the renin-angiotensin system
2.6.2 Calcium-channel blockers
Any change of formulation is not classed as being appropriate for NMS e.g. a patient changing from Ramipril capsules to Ramipril tablets would not be eligible for NMS, whereas a change from one drug to another in the same class would be e.g. changing from Ramipril Tablets to Lisinopril Tablets.
NMS is split into three stages:
- Patient engagement
- Intervention
- Follow up
Patient Engagement
Patients are recruited into the service either by prescriber referral or by the pharmacy team when dispensing the prescription. Unlike MUR, a patient is not required to have visited the pharmacy previously. Once written consent has been obtained the patient should be given
initial advice about the medicine and how the NMS service works. Pharmacists are encouraged to use this discussion to provide opportunistic advice about healthy living and public health topics appropriate to the patient.
During this stage the pharmacist and patient should agree a method (face-to-face or via telephone) and a time for the intervention discussion; the intervention should occur between 7 and 14 days after patient engagement.
Intervention
As identified above, the intervention discussion occurs 7 to 14 days after patient engagement. During this discussion the pharmacist should confirm that the patient
understands the information they were given in the engagement stage and that the patient is still willing for their information to be shared with the GP if necessary. If consent is withdrawn then the intervention should not be performed.
If the patient has attended the pharmacy for a face-to-face discussion, the intervention should take place in the consultation room. If a phone call is preferred then this should take place in an area where the conversation cannot be heard by other people in the pharmacy.
During the intervention the pharmacist assesses the patient’s adherence to the medication and identifies any problems the patient may be having. Where issues are identified the pharmacist can either provide advice to help the patient manage their medication or refer
to the GP – an example where the pharmacist could advise rather than referring to the GP would be where changing the timing of the dose might benefit the patient. As with engagement, the intervention can be used to provide healthy lifestyle advice to the patient.
Depending on the outcome of the intervention, the pharmacist will either:
• Agree time and location for the follow up – this is usually between 14 and 21 days after the initial intervention. This would be appropriate where the patient is adherent and no problems have been identified
• Agree time and location for the follow up and any remedial steps to be taken by the patient. This would be appropriate where the patient is experiencing an issue that could be resolved with advice from the pharmacist
• Refer the patient back to their GP. If this course of action is followed the pharmacist should complete the NMS feedback form and send this to the GP. If a patient is referred back to their GP at this stage the NMS is deemed complete.
Follow Up
The patient discussion for follow up is the same as for intervention, with the service deemed ‘complete’ where:
• The patient is adherent
• A problem has been identified and the pharmacist and patient agree a solution
• A problem has been identified and the patient referred to their GP
• The pharmacist has made two separate attempts to contact the patient but been unsuccessful on both occasions
Data Collection
As with MUR, a written consent form and data collection tool meeting the data collection requirements for the service should be completed and retained for 2 years following completion of the service. The data collection requirements are listed in the service specification detailed in the further reading section. As with MUR, pharmacies are required to submit their NMS data to their local NHS England team at the end of each quarter.
Payment NMS
The current remuneration for each completed NMS is £20 per new medicine
TASK 8: For each patient below, state whether the NMS is ‘complete’
Mr Smith was recruited to NMS 7 days ago but cannot be contacted on two occasions.
Miss Jones was recruited to NMS 12 days ago. You have contacted her and she is having no
issues with her new medicine.
Mrs Davies was recruited to NMS 23 days ago. You have spoken to her face-to-face at the
intervention stage however you have been unable to contact her on two occasions for
follow up.
You had advised Mr Green to take his Ramipril Capsules at night during the intervention stage as he was experiencing “light headedness” during the day when taking the medication. During follow up the patient explains that taking the capsules has “worked wonders” but he now has an occasional dry cough, which you decide to refer Mr Gall to his GP for.
- No
- No – 12 days is within intervention stage so need to progress to follow up first
- Yes – intervention stage completed and two attempts made to follow up
- Yes – intervention and follow up stages both completed. GP referral in follow up stage counts as completion
NHS Urgent Medicine Supply Advanced Service
The pilot of the NHS Urgent Medicine Supply Advanced Service (NUMSAS) was introduced in December 2016 as part of the 2016 review of the CPCF and runs until 21st March 2018.
Funding for NUMSAS comes from the Pharmacy Integration Fund (PhIF), which was created to provide funding to allow community pharmacy to develop the clinical services, working practices and digital platforms provided by the sector. It is important to note that NUMSAS is a separate service from standard emergency supplies and requires NHS 111 referral for this service to apply.
The four objectives of NUMSAS are:
- Manage appropriately NHS 111 requests for urgent medicine supply
- Reduce demand on the rest of the urgent care system
- Resolve problems leading to patients running out of their medicines
- Increase patients’ awareness of electronic repeat dispensing
Fees
Pharmacies receive a set of fees for provision of NUMSAS; these are:
Pharmacies receive a set of fees for provision of NUMSAS; these are:
• Consultation fee
• Administration fee
• Medicine supply fee – only if a medication or appliance has been supplied
• Additional medication supply fee – if additional medicines are supplied. This is at a lower rate than the medicine supply fee
