U1 SOPs, Pharmacy Contract & Services, Clinical Governance, POMs prescribers Flashcards
When was the Pharmacy Contract first introduced?
2005
What Framework was introduced in England in 2016?
The Community Pharmacy Contractual Framework
Since 2005, funds rewarded to Pharmacies for dispensing are now more widely used for
Services
How did the way in which pharmacies are rewarded money change in 2016?
- reduction in money for dispensing
- increase in money for services
- money for quality improvement schemes within pharmacies
What is meant by the term ‘global sum’ ?
The total pot of money available for pharmacy funding
What was the total global sum in England before 2005?
£1.7 Billion
After the introduction of funding for services in 2005, what was the global sum in England for the next 10 years?
£1.7 billion - £2.8 billion
In 2016 there was an annual funding freeze for pharmacies in England, of how much?
The CPCF outlines that this funding freeze will be in place until what year?
£2.59 billion
2024
What three areas is funding for pharmacies now split between?
- Services
- Quality and Safety
- Dispensing
What were the four main parts of the Pharmacy Contract prior to 2005?
- Essential Services
- Advanced Services
- Quality Schemes
- Enhanced Services
What does PSNC stand for?
Pharmaceutical Services Negotiating Committee
What does PCS stand for?
The initial tier of the PCS was rolled out when?
Pharmaceutical Contraception Service
11th January 2023
When was the launch of the second tier of the PCS?
4th October 2023
What does NMS stand for?
New Medicine Service
When was the NMS expanded to include antidepressants?
19th April 2023
Who must offer Essential Services according to the pharmacy contract?
All pharmacy contractors as part of CPCF
What is the newest essential service in England?
when was it launched?
Discharge Medicines Service launched in England in February 2021
What is involved in the Discharge Medicines Service?
Where is this service available?
- medication reconciliation after hospital discharge
- medication optimisation to ensure patient understands new regimen
- solving any issues that arise
Available in England
What is the DMR?
What kind of service is the DMR?
Where is the DMR available?
DMR - Discharge Medicines Review
Advanced Service
Available in Wales
What are some other essential services of pharmacies in England and Wales?
- repeat dispensing
- signposting
- healthy living
- dispensing appliances
Under what essential service can patients give back unwanted medicines to pharmacies?
Disposal of Unwanted Medicines
Who provides Advanced services?
Community pharmacies can choose to provide these services as long as they meet the requirements set out in the Secretary of State Directions
What are some examples of Advanced Services?
- Pharmacy First Service
- Flu Vaccination Service
- PCS
- Smoking Cessation
When was the Pharmacy First Advanced Service launched?
January 2024
What is Pharmacy First?
Advise for the following conditions
- sinusitis
- earache
- sore throat
- infected insect bites
- UTIs in women
- shingles
- impetigo
What are the three components of Pharmacy First?
- Seven conditions
- Minor illnesses
- Referrals from 111
What are Enhanced Services?
Enhanced services that are nationally specified in England e.g. Covid 19 vaccination Service
What are Local Enhanced Services?
Locally developed and designed to meet local health needs
What is the Pharmacy Quality Scheme, PQS?
Forms part of CPCF
Scheme that supports and rewards pharmacies
The PQS rewards community pharmacy owners that achieve quality criteria in three domains of healthcare quality, what are these three domains?
- Clinical effectiveness
- Patient safety
- Patient experience
What gateway criteria must be met in order for a pharmacy to take part in the PQS? (England)
Pharmacy must have completed at least 15 NMS consultations within the previous April and December
Are there any Essential Services in Wales that differ from those in England?
- Pharmacy information management and technology
- clinical governance
- primary care escalation toolkit
What is the only advanced service available in Wales?
Discharge Medicines Review
What is the purpose of the DMR?
To ensure the patient understands any changes in their medication upon discharge in hospital
What fraction of patients are readmitted to hospital within 2 weeks after changes made to their medications during emergency admission?
1/3
When were DMRs made a permanent part of the contract in Wales?
Autumn 2014
How much are pharmacies paid per DMR?
£37
The DMR Service is usually split into two parts. What happens in Part 1?
When does Part 1 occur?
Medicines Reconciliation - do the meds on the 1st Rx after discharge match the hospital advice?
Takes place within 4 weeks of discharge
What happens in Part 2 of the DMR Service?
When does it occur?
Adherence Support - compliance check and problem support
Usually 4 weeks after week 1
For a patient to be considered eligible for a DMR they must have been discharged from a ‘care’ setting and meet ONE of which four circumstances?
- meds have been changed during their stay
- taking 4 or more medications
- needs medications dispensed into multi-compartment compliance aid
- pharmacist believes patient will benefit from the service (professional judgement)
What did the 2014 review of the DMR service show?
- approx £3 million saved from 14k DMRs from reduced read mission, drug wastage and A&E attendance
What does CCPS stand for?
Clinical Community Pharmacy Service
What is the Clinical Community Pharmacy Service?
What does it include?
Wales’ version of Enhanced Services
- Seasonal Flu Vaccination
- Contraception Services
- Common Ailments Service
- Emergency Medicines Supply
What is the Pharmacy Independent Prescribing Service? (Only available in Wales)
Pharmacists can prescribe a wider range of products under
- common ailments service
- contraception service
What are some available Additional Clinical Services available in some health boards in Wales?
- Needle and Syringe Service
- Inhaler Review Service
- Blood Borne Virus Testing
What are the three main elements of the Wales Quality and Safety Scheme 2024/2025?
- Wales National Workforce Reporting System
- Climate Change: Carbon Literacy Training
- AWPD (All Wales Pharmacy Database) Validation
What are Primary Care Clusters?
Multiple areas of Wales that are under one Health Board and work collaboratively
What is the CPCL?
Community Pharmacy Collaborative Lead
A pharmacy lead within a Primary Care Cluster
What is the role of a CPCL?
To bring together representatives of pharmacies within their cluster and discuss collaboration between themselves and other HC professionals e.g. optometry, dentistry
Where is the NMS available?
England
When can a pharmacy supply urgent meds?
- referral from 111
- self referral with interview
In Wales, as part of the quality and safety scheme, how many times a year must an audit be carried out on High Risk Medicines use?
zero
How do payments for the collaborative meeting attendance (in primary care clusters) work?
£277.10 per meeting per pharmacy
potential bonus after 5th or 6th meeting of another £277.10 if 3 meetings with pharmacy collab and 2 with other HC professionals
total 6 meetings plus bonus is £1939.70
The service specification for NMS categorises eligibility for the service depending on what?
Which condition a patient has
What is clinical governance?
Framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care
What sorts of activities form part of clinical governance?
- CPD - Continuing Professional Development
- Surveys (patient satisfaction)
- Risk Assessment of Workplace
What three tools within pharmacies can help to reduce risk to our patients via dispensing?
- Near Miss Logs
- Incident Management
- SOPs
What is considered a near miss?
error made but identified and corrected BEFORE final sign off to supply to the patient
What is considered a dispensing incident?
a mistake that has been signed off as patient ready
What should happen after recording an incident?
demonstration of change to prevent it from happening again
What should happen following the introduction of a new SOP into a pharmacy?
- should be signed by RP to acknowledge that this is the SOP that the team will work to
- all staff should read and understand the SOP and then be tested as competent and signed off by RP
The Pharmacy Quality Scheme is in place where?
England
The Quality and Safety Scheme is in place where?
Wales
What is PIPS?
Pharmacist Independent Prescribing Service
Since when have the availability of community pharmacy clinical services in Wales been increasing?
2011
In what ways do clinical services provided by pharmacies protect the NHS?
- advice and treatment for some urgent care needs (reduces pressure on NHS)
- increasing vaccination rates (protecting health of population)
- facilitating safe hospital discharge; reducing incidence of medicines related admissions
When did Pharmacist IPs begin to work in Welsh community pharmacies?
2019
What is ‘Pharmacy: Delivering a Healthier Wales’ ?
When was it published?
Document released by the Welsh Government outlining plans to incorporate pharmacy into long-term vision for healthcare
2019
What plan involving Pharmacy IPs does ‘Pharmacy: Delivering a Healthier Wales’ set out?
To have an Pharmacist IP (PIP) in every community pharmacy in Wales by 2030
What can an independent prescriber actually prescribe for?
any clinical condition but they must only prescribe within their professional and clinical competence
They may prescribe for one of the services listed within the specification where such conditions are in scope of a pharmacist
(other conditions may be added with prior agreement of the relevant Local Health Board)
What is an IP responsible for?
- clinical assessment of a patient’s condition
- formulating or reviewing diagnosis
- devising an appropriate treatment plan
How does a a pharmacist registration with the GPhC compare to the registration of an IP pharmacist?
PIPs have an annotation alongside their name on the register stating further accreditation
When was PIPS launched?
Why?
1st April 2022
It is a formal arrangement for PIPs to work within a Contractual Framework
When can a pharmacy provide PIPS?
- employment of an IP qualified pharmacist
- also providing ‘Clinical Community Pharmacy Service’
What are the main categories for which PIPs can prescribe?
- ears e.g. Otitis Externa, Media
- skin e.g. Acne, fungal and candida infections
- UTIs
- Upper respiratory tract e.g. sinusitis, rhinitis
- contraception e.g. UKMEC 1, UKMEC2
- other e.g. constipation, bacterial conjunctivitis etc
What does UKMEC stand for?
UK Medical Eligibility for Contraceptive Use
What does UKMEC 1 include?
- progesterone only pill
- implant
- progesterone only injectable
What does UKMEC 2 include?
- combined oral contraceptives
Through what process might a PIP prescribe for/treat a patient?
- Patient with condition in scope of PIP presents to pharmacist
- Pharmacist completes full assessment of patient including history taking, physical exams if needed
- PIP forms diagnosis and treatment plan
- If needed, W10IP Rx issued, advice and safety netting given or referral to GP
- Pharmacist may arrange follow-up for management
What is CAS?
Common Ailments Service
scheme offered by local pharmacies in Wales that provides patients with free NHS advice and treatment for a range of minor illnesses
How does CAS differ from PIPS?
- under CAS items can be provided by any pharmacist who is registered (no need for IP); under PIPS items can be prescribed by IP working in their scope of expertise
- patient must register for CAS; patient must have Welsh address for PIPs
In what ways are CAS and PIPS similar?
- both require patient to be registered to a GP in Wales
- both free
- both need face-to-face consultation with Pharmacist
What is a supplementary prescriber, SP?
practitioner who prescribes within agreed patient-specific written clinical management plan, agreed in partnership with doctor or dentist
What three services are included under the CCPS?
- CAS
- Emergency Med Supply
- Contraception Service
