The Pharmacy contract Essential, Advanced and Enhanced Services Flashcards
What services are commissioned in pharmacies?
Essential services
Locally Commissioned services
Advanced services
Community pharmacist consultation service
Essential facts, stats and quotes
Seasonal Flu vaccination Service
Commissioners portal
Services Database
New Medicine Service (NMS)
__________ services MUST be offered by every pharmacy.
Essential
Part of the NHS Community Pharmacy Contractual Framework (‘the pharmacy contract’)
What are locally commissioned services?
A service that is made for a specific problem in a specific area. NOT ESSENTIAL
e.g stop smoking
How are Locally commissioned services contacted?
Locally commissioned community pharmacy services can be contracted via a number of different routes and by different commissioners, including local authorities, Health Boards (Wales), Clinical Commissioning Groups (CCGs - England) and local NHS England teams.
Is Morrison’s an essential service?
No - they do not dispense the medicine
prescribing v dispensing
P - evaluating the history of the patient, symptoms, and writing the prescription with the correct drug and dosage
D - authorized or qualified to make up and give out medicine.
Types of Essential services:
- Dispensing medicines
- Distancing appliances
- Repeat dispensing
- Clinical governance
-Discharge medicines service - Signposting
- support for self care
- disposal of unwanted medicines
-public health (promotion of healthy lifestyles)
Examples of signposting
provision of information to people visiting the pharmacy, who require further support, advice or treatment which cannot be provided by the pharmacy, on other health and social care providers or support organisations who may be able to assist the person.
- refer to GP
- depression
- mental health related
What is dispencing
supply of medicines and appliances ordered on NHS prescriptions with info and advice > enable safe and effective use by patients & carers and maintenance of appropriate records
Electronic Prescription Service (EPS) is also being implemented as part of the dispensing service.
Pharmacists may regularly dispense appliances in the course of their business (see Drug Tariff).
What type of service is Repeat Dispensing/electronic Repeat Dispensing (eRD)?
Essential Service - within the Community Pharmacy Contractual Framework (CPCF)
Most prescriptions generated in primary care are for patients needing repeat supplies of regular medicines
Since the development of the Electronic Prescription Service (EPS), the majority of repeat dispensing is carried out via EPS and is termed electronic Repeat Dispensing (eRD).
Under the repeat dispensing service pharmacy teams will:
dispense repeat dispensing prescriptions issued by a GP;
ensure that each repeat supply is required; and
seek to ascertain that there is no reason why the patient should be referred back to their GP
Define clinical governance:
“a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish”
are clinical governance built into ALL professional services?
YES - Continuous Quality Improvement
example of Clinical Governance?
- standard operating procedures
- recording
- reporting
- learning from adverse incidents; participation in continuing professional development and clinical audit
- assessing patient satisfaction
DMS
Discharge Medicines Service
Explain what the Discharge medicine service is:
- patients recently have been discharged from hospital = greater support from local pharmacy teams to MANAGE their medicines
- hospitals REFER patients = benefit from extra guidance about new prescribed medicines to their community pharmacy
- patients can ask qs to to find any concerns EARLY on
How are patients discharged from hospital to their community pharmacy?
digitally
DMS - Part of the health Secretary’s ‘_________ _______’ approach to ease wider pressures on A&Es and GP
Pharmacy First
Public Health – Promotion of healthy lifestyles
advice about…
have diabetes;
be at risk of coronary heart disease (CHD), especially those with high BP;
who smoke;
are overweight.
Outline the services
1) Prescription linked intervention
2) Campaign based service
1) Pharmacists and their staff will give opportunistic advice to people presenting prescriptions.
The advice is given verbally, but may be backed up by written information.
A record of the advice given is made on the patient’s pharmacy record.
Pharmacy contractors have systems in place to ensure that appropriate advice is given to patients.
2) The pharmacy provides this service to its primary care organisations (PCO) for up to 6 campaigns per year.
What is Disposal of unwanted medicines?
Acceptance, by community pharmacies, of unwanted medicines from households and individuals which require safe disposal.
LEGAL requirement
1) collection point fro public
2) returned medication stored in UN type containers - provided by waste disposal contractor
3) Return solid/ ampoules/ liquids/ aerosols = separated!
4) pharmacy contractors ensure that their staff are made aware of the risk associated with the handling of waste medicines
5) Appropriate protective equipment = gloves, overalls and materials to deal with spillage, must be readily available close to the storage site
Support for self care - advice and support by pharmacy staff to enable to derive max benefit from caring for themselves or their families;
What is the service outline?
- help w minor illness
- how to manage illness
Pharmacy staff advise on the appropriate use of the wide range of non-prescription medicines which can (support for self care) be used in the self-care of minor illness and long-term conditions:
- Pharmacy staff make healthy lifestyle interventions opportunistically when appropriate
- Pharmacy staff receive self-care referrals from NHS Direct and HCPs
- Pharmacy staff signpost patients to other health and social care providers
- For patients known to the pharmacy staff, records of advice given, products purchased or referrals made are made on a patient’s pharmacy record when the pharmacist deems it to be of clinical significance.
Opportunistic healthy lifestyle advice?
The pharmacist will go out of their way to talk about another concern about the patients health and try to tackle it;
talk about high BP and find out they are a SMOKER
AUR
Appliance Use Review
Appliance Use Review to be introduced into the NHS Community Pharmacy Contractual Framework (CPCF)
Who can carry this review out and how?
- pharmacist
- specialist nurse
- at patients home
- telephone
- video consultation
AURs should improve the patient’s knowledge and use of any appliance by:
1) Establishing the way the patient uses the appliance;
2) Identifying, discussing and assisting in the resolution of poor or ineffective use of the appliance by the patient;
3) Advising the patient on the safe and appropriate storage of the appliance;
4) Advising the patient on the safe and proper disposal of the appliances that are used or unwanted
Why is it important to always REVIEW patients and their use of medicines and appliances?
If they don’t use the appliances, it will cost so much for the NHS
Collect and NOT use / Take advantage
What is the Community Pharmacist Consultation Service (CPCS)?
The service connects patients who have a minor illness or need an urgent supply of a medicine with a CP
As well as referrals from GPs, the service takes referrals to community pharmacy from NHS 111, Integrated Urgent Care Clinical Assessment Services and in some cases patients referred via the 999 service
The CPCS aims to relieve pressure on the wider NHS by connecting patients with CP, which should be their first port of call and can deliver a swift, convenient and effective service to meet their needs
CPCS - encompasses 4 priority services
List them:
- common ailments
- emergency contraception
- emergency medicine supply
- seasonal flu jabs
combined in a single, national Clinical Community Pharmacy Service (CCPS).
Since when has the flu vaccinations been nationally commissioned?
Sep 2015
You are advised to take the flu vaccine if…
( can receive this in GP surgery or SOME community pharmacies + if work in health or social care> ask employer where e.g. school)
You are pregnant
You are aged 50 or over
You have a long term health condition that puts You at increased risk from flu
You live in a care home
The following groups are advised to have a flu vaccine to protect them and the people around them:
Children aged two and three years old (age on 31 August 2021)
Children and young people in school years
Reception to Year 11
Carers
People working directly with patients/clients in health or social care
Those who live with someone who has a compromised immune system
C-19 Lateral Flow Device Distribution Service - discontinued service
- during pandemic = pharmacies where PAID to give out the tests out to public FOR FREE
- At the end of March 2021, a new Advanced service – the NHS community pharmacy COVID-19 lateral flow device distribution service (or ‘Pharmacy Collect’) – was added to the NHS Community Pharmacy Contractual Framework.
What framework was the Hepatitis C testing service added to?
the CP Contractual Framework (CPCF) in 2020
How does the Hepatitis C testing work?
provision of point of care testing (POCT) for Hepatitis C (Hep C) antibodies to people who inject drugs (PWIDs)
i.e. individuals who inject illicit drugs, e.g. steroids or heroin, but who haven’t yet moved to the point of accepting treatment for their substance use. Where people test positive for Hep C antibodies, they are referred for a confirmatory test and treatment (where appropriate)
What are the two staged of the hypertension case-finding service?
- identifying people at risk of hypertension - offering BP measurement
- clinically indicated - offering 24hr ambulatory BP monitoring (ABPM) = results shared with GP for potential diagnosis of hypertension
The service is only provided by pharmacists,
The service must be delivered under pharmacist supervision it is provided by other staff.
NMS
New Medicines Service
New Medicine Service
support to people who are newly prescribed a medicine to manage a long term condition, which will generally help them to appropriately improve their medication adherence and self-manage their condition
The conditions eligible for the New Medicine service are:
LEARN
- asthma and COPD
- diabetes (Type 2)
- hypertension
- hypercholesterolaemia
- osteoporosis
- gout
- glaucoma
- epilepsy
- Parkinson’s disease
- urinary incontinence/retention
- heart failure
- acute coronary syndromes
- atrial fibrillation
- long term risks of venous thromboembolism/embolism
- stroke / transient ischemic attack
- coronary heart disease
Stoma Appliance Customisation (SAC)
customisation of a quantity of more than one stoma appliance, based on the patient’s measurements
Theaim of the service is to ensure proper use and comfortable fitting of the stoma appliance and to improve the duration of usage, thereby reducing waste
The stoma appliances that can be customised are listed in Part IXC of the Drug Tariff
stop smoking services;
- refer patients discharged from hospital to community pharmacy
- choice to continue their smoking cessation care pathway - providing
- service ONLY provided by pharmacists
- provided by other staff MUST be under pharmacist supervision
What are examples of enhanced services?
-Pharmacy Contraception Service
Appliance Use Reviews
Flu Vaccination Service
Hepatitis C Testing Service
Hypertension Case-Finding
NMS
Smoking Cessation Service
Stoma Appliance Customisation
e.g. National stop smoking service. What is the aim?
Provide one to one behavioural support and advice to smokers who are motivated to give up smoking, taking advantage of the accessibility and convenience of community pharmacies
What are the service outcome of the stop smoking service?
Improved choice of NHS stop smoking services and increased access to appropriate pharmacotherapy to support quitting;
Reduction in the number of people smoking, through provision of successful smoking cessation support through community pharmacies
Define Essential services:
These are the nationally set
MANDATORY services that community pharmacies must provide as part of their contract with the NHS if they are to operate providing NHS services
- Incl. dispensing of medicines and medical appliances, the disposal of unwanted or spare medicines, advising patients on self-care, providing advice on healthy living and providing medicines support following a hospital discharge
Define Advanced services:
- These are OPTIONAL services that pharmacies can choose to provide
- They are nationally set and specified, and the option to provide them is open to all community pharmacies, provided they meet certain minimum requirements
- Commissioned through the contract framework include flu vaccination, theNew Medicine Service, and the recently developedCommunity Pharmacist Consultation Service
Define Enhanced services:
- OPTIONAL services such as anticoagulation services that used to be commissioned by primary care trusts
- Since the abolition of primary care trusts, only NHS England can commissionenhanced services
- At present this route is not often used as most areas use locally commissioned services to commission these types of optional services
For any of the counter medicines what document is essential to use?
All Wales Common Ailments Formulary
