march 2014 cpn
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CPNCommunity Pharmacy News – March 2014
CPN Your monthly round up of news andinformation for Community Pharmacy
Wakefield blood pressure | Smartcard special feature | Prescription Submissioncampaign Factsheet
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2 Community Pharmacy News – March 2014
PSNC’s work FuNDiNg aND StatiStiCS CoNtraCt aND it
Community PharmacyFuture Project
Community pharmacy teams may have
read about the results of the Community
Pharmacy Future project this month.
The project was run in Wigan and the
Wirral and saw community pharmacies
offering a COPD case finding service, a
COPD support service and special support
for all patients taking four or more
medicines.
The results were extremely encouraging,
with benefits shown including:
• A significant increase in medicines
adherence and in quality of life for
people taking four or more medicines
• 135 people at risk of developing COPD
identified
• A significant increase in medicines
adherence and in quality of life for
patients with COPD
The evaluation report estimated that if
rolled across all pharmacies in England the
services could save the NHS a significant
amount of money such as:
• £4.5m in societal costs;
• £86.3m disease-related cost savings
from supporting people to stop
smoking;
• £33.9m in reduced hospital costs due to
reduction in falls that result in fractures.
Commenting on the results, PSNC Chief
Executive Sue Sharpe said:
“The Community Pharmacy Future Project
was an excellent project that has shown
very clearly the difference that community
pharmacies can make to patients and the
savings those benefits could translate into
for the NHS.
PSNC was a member of the steering group
of the project, and although it was funded
by the four large multiples, we were able
to ensure the wider involvement of
community pharmacies in the area. The two
local LPCs were also very much involved in
the project and were able to help facilitate
its delivery across the region.”
Future of the New Medicine ServiceNHS England has been considering the short term future of the new
medicine service (NMS), in discussion with PSNC.
It has been agreed that the NMS will continue in 2014/15, subject to the
outcome of the evaluation. This decision was informed by initial findings
from the evaluation; the full evaluation findings will be subject to the usual
academic scrutiny, with the final report not expected to be published before
May 2014.
This means that pharmacy contractors can continue to provide the NMS to all
eligible patients.
PSNCElectionsVoting in the PSNC
elections in North
London, Yorkshire and
East Anglia close at 2pm
on 14th March and the
results will be posted on
the PSNC website later
that day.
For the latest PSNC newsand information visit
psnc.org.uk
PSNC: NHS must usepharmacy to avoid collapse The NHS needs to make radical changes to find
cheaper ways to deliver care to patients to
avoid financial collapse, PSNC Chief Executive
Sue Sharpe has said.
Addressing contractors at the Sigma Pharmaceuticals conference in February, Sue
warned that the same would be true for community pharmacy, as adding more
burden on the sector within traditional operations will not be sustainable.
Sue said pharmacies would not be immune to the pressure as the NHS needs all
the money it can get to make the £20bn savings it has been tasked with, but that
there were key opportunities coming up for community pharmacy and that
through its response to the Call to Action, it could shape its own future in the
health service.
PSNC will be continuing its work to create opportunities for pharmacy and to help
LPCs and contractors to make the most of those, but Sue also advised contractors
that they too could help by thinking about the future, having plans and
implementing them, getting involved in local LPC work and investing in pharmacy
teams.
psnc.org.uk 3
ServiCeS aND CommiSSioNiNg the healthCare laNDSCaPe lPCsDiSPeNSiNg aND SuPPly
PSNC Comments ReviewPSNC and its members regularly comment on
topical issues within community pharmacy and
the wider NHS in order to help promote
pharmacy and to ensure pharmacies and others
are aware of its views. These comments are often
posted on PSNC’s website or published in the
pharmacy press. This month we look at a SWOT
analysis of the community pharmacy sector.
A SWOT Analysis of Community Pharmacy
PSNC Regional Representative and
independent community pharmacy
contractor Mark Burdon contributed an
article to the Pharmaceutical Journal
considering the strengths and
weaknesses of community pharmacy and
the opportunities and threats facing the
sector.
Mark highlighted a host of successes that
community pharmacy has had in recent
years, including delivering ever-increasing
prescription volumes safely and
efficiently; saving the NHS some £7bn
through efficient procurement; the
positive contributions pharmacies make
to public health; and the difference
services such as the NMS and MURs
make, helping patients to take their
medicines correctly and so avoid
unnecessary and costly complications.
He also stressed though that pharmacy
would need to adapt if it is to survive in
an NHS looking to make £20bn worth of
savings. Dispensing will not be immune
from Government cost-cutting measures,
and unless pharmacies can demonstrate
the value they can bring to support the
medicines supply function, by coupling it
with services to improve patients’
adherence and health, there is a real risk
that income could drop to unsustainable
levels.
Some pharmacies were not adopting
services as enthusiastically as others and
the inconsistency across the sector left it
vulnerable, Mark argued. “The
inconsistency means the public are
confused about what we offer, other
professionals are not confident in us, and
commissioners are nervous about
investing in us.”
But Mark concluded that despite the
threats ahead, we have every reason to
be optimistic about the future. He
outlined how PSNC is gathering evidence
to convince commissioners, politicians
and other professions of the value that
pharmacy can offer and the need to make
pharmacies a “third pillar of care” within
the NHS, adding: “Keep trying with
services and gathering evidence for what
you do; keep going that extra mile for
patients; respond to and encourage
others to respond to the Call to Action;
and help your LPC keep your services
commissioned. If we can rely on everyone
to play their part, I believe we could have
some good years ahead of us, but if we
cannot, then pharmacy is likely to feel the
pain of our struggling health service as
acutely as everyone else.”
Royal Pharmaceutical Society members
and others can read the full article on the
Pharmaceutical Journal website via:
tinyurl.com/cpswotanalysis
PSNC takes to twitterPharmacists and pharmacy teams may
already be aware of PSNC’s presence
on twitter under the @PSNCNews
identity. We use this to highlight news
stories and updates as they are posted
on our website, and we hope this has
been useful to contractors and their
teams.
As part of our ongoing work to
improve our communications and
engagement with pharmacies we are
this month expanding our offer on
twitter. Still using @PSNCNews, we
will be using our tweets to help
pharmacy teams to:
• Stay up to date with all the latest
community pharmacy news
• Ensure they are using the latest
endorsement guidance and not
missing out on payments
• Find guidance, briefings and
information that could help their
day to day practice
• Share tips on service delivery and
overcoming challenges in the
dispensary
• Find out news and facts from
elsewhere in the NHS that may help
them in their work
We hope the new approach will better
meet the needs of pharmacy teams
and help them to find relevant and
useful information more easily on our
website, but we will be interested in
your feedback as it evolves. Tweet
@PSNCNews or email
melinda.mabbutt@psnc.org.uk.
PSNC E-NEWSTo receive a weekly summary of the latest
news and guidance featured on the PSNC
website including pharmacy contract news,
Drug Tariff News, NCSO updates, events
information and much more, sign up to
receive PSNC’s weekly e-newsletter.
Visit www.psnc.org.uk/enews to register
www.twitter.com/psncnews
4 Community Pharmacy News – March 2014
PSNC’s work FuNDiNg aND StatiStiCS CoNtraCt aND it
What next for the Call to Action?Hopefully by now pharmacy teams will
have heard about the community
pharmacy Call to Action and you may even
have sent in a response to it or attended a
local event to contribute. Many have called
the Call to Action pharmacy’s biggest
opportunity yet to shape its future, but
what exactly will happen next, and what
outcomes can we expect to see?
In an article in Chemist +Druggist
magazine this month, PSNC Head of NHS
Services Alastair Buxton explained that the
timing of the Call to Action makes this
consultation more important than those
that have come before it.
The NHS is now at a crucial point – it is
facing huge financial challenges and is not
sustainable as it is. The so-called Nicholson
challenge set the NHS a target to make
£20 billion worth of efficiency savings by
2015 and that is going to bite across all
areas, Alastair explained. Meeting the
challenge is also going to need radical
changes in the health service and the way
in which it delivers care, and NHS
England’s Calls to Actions have been
exploring what those changes should be.
For pharmacy, there are risks as the NHS
could earmark the sector as an area in
which savings could be made.
But there is also the chance that, if we
have made our case successfully, NHS
England will see that community
pharmacies need to be at the heart of the
health service, helping to ensure the NHS
gets best value from its spend on
medicines, and providing accessible
services that help people to stay healthy
for longer and manage their long term
conditions more effectively so that they
can avoid complications and the need to
use more expensive health services as a
consequence of them.
As the commissioner of primary care
services, NHS England has the power to
commission some of these services at a
national level, and to align pharmacy
payments with those of other health
professionals so that everyone is
incentivised to work more closely together
to deliver seamless patient care, and these
are the changes that we hope to see
coming next.
You will be able read more about PSNC’s
response to the Call to Action on the PSNC
website at psnc.org.uk this month, and we
expect NHS England to publish a summary
of the responses it received, which may
give some clues as to the direction it is
likely to take, in the next few months. This
will again be highlighted on the PSNC
website.
You can also read Alastair’s full article at
www.chemistanddruggist.co.uk
LPCs skilled up on coaching and mentoring
LPCs sometimes need to provide one-to-
one support to contractors on issues
such as compliance with the contractual
framework, the delivery of local
services, adapting to change or more
personal matters where the LPC may be
able to help. LPCs as local leadership
bodies also may be involved in
identifying and developing future
leaders. Internally, following the
elections, experienced LPC members
will be working with new members to
help them get to grips with their new
role as quickly as possible.
To support this work PSNC has provided
training for LPCs on coaching and
mentoring, helping delegates
understand when coaching is needed,
how to get the best out of people using
coaching and mentoring, the essential
skills and qualities of an effective coach
and mentor, how to build coaching and
mentoring relationships, using
facilitation skills as part of mentoring
and coaching peers as well as groups.
The training, held in London and Leeds,
also gave delegates the opportunity to
practise their new skills on real issues
concerning delegates so there was the
extra bonus of being able to talk
through problems with colleagues.
With great feedback and calls from LPCs
for a repeat of the training, PSNC has
organised an extra date for LPCs in
June, details to follow soon. The
coaching and mentoring training is part
of PSNC’s LPC Support programme
which provides a wide range of support
to LPC members and officers.
Further training
Over the next few months PSNC is
providing a day for new LPC members
on NHS regulations, LPC constitution
and governance, LPC management and
finance and NHS policy. There is also a
workshop for LPC members and
officers on preparing bids and business
cases to support the negotiation and
successful commissioning of local
services on behalf of local pharmacy
contractors.
psnc.org.uk 5
ServiCeS aND CommiSSioNiNg the healthCare laNDSCaPe lPCs
Paving the way for pharmacy:Part 3: South Yorkshire’s Respiratory ServiceThe latest in our series featuring the winners of last year’s PSNC Evidence Awardssees Nick Hunter, Secretary of Doncaster and Rotherham LPCs, telling us about aRespiratory Service that was commissioned across South Yorkshire’s LPCs.
When money became available for
community pharmacy across five LPC
areas, South Yorkshire’s LPCs decided that
the most effective way of utilising this
money would be to work together to bid
for one service which would span the
entire region. “[South Yorkshire] already
had a forum [where we] share ideas and
ways of doing things… so we utilised that
to take the idea forward,” Nick Hunter,
Secretary of Doncaster and Rotherham
LPCs, explains; but this project took these
links a step further.
These strong ties across South Yorkshire
helped the LPCs to get the money for their
Respiratory Service in June 2012, but they
were put on a tight schedule as the South
Yorkshire Strategic Health Authority
wanted an evaluation completed by the
end of the following March.
So Nick and Matt Auckland (then Head of
Medicines Management at Barnsley PCT)
looked to other areas for help, in the end
being guided by a similar scheme that had
run on the Isle of Wight. Of course the
unique geography of the island was a
cause for concern, but in the end South
Yorkshire has proved that the success
could be replicated in other areas of the
country. Carried out in conjunction with an
MUR or NMS consultation, the Respiratory
Service, which saw pharmacies giving
advice on inhaler technique, was shown to
have helped 98% of asthma patients using
inhalers improve their Inspiration Rate
Change in just one session (see The
Respiratory Service in figures box).
The biggest challenge the LPCs came up
against was the re-organisation of the
NHS, because just at the time they were
trying to get the service up and running
and needed the PCTs to back it to ensure
other health professionals were confident
in it and could refer to it, the PCTs were
winding down their activities. But relying
on the strong links the LPCs already had
with PCT contacts and through other local
health networks, they were able to
manage this.
One of the key aims for the Respiratory
Service was to improve patients’
management of their own condition to
help reduce avoidable hospital admissions.
However, whilst teaching patients
effective inhaler technique and symptom
control can go a long way towards
achieving this aim, proving the link to
hospital admission reduction can be a
difficult process, and some are still yet to
be convinced about it.
This need for clear evidence that health
services are effective is particularly
important at the moment as savings need
to be made. Fortunately, South Yorkshire’s
LPCs did manage to produce a very
effective evidence case for their
Respiratory Service, meaning that they not
only won a PSNC Evidence Award but were
also asked to present their work at the
leading UK conference for pharmacy
practice researchers called “Health
Services Research in Pharmacy Practice”
(HSRPP).
They also won over at least some of the
doctors, as both Nick and Doncaster CCG
are keen to continue the Respiratory
Service. Again it comes down to money
though, as the CCG must find a budget for
it.
If you would like to help get the ball rolling
for this or any other services in your area,
your LPC’s contact details can be found via
the LPC Portal at: lpc-online.org.uk
The Respiratory Service in figures
1,616 consultations took place between September 2012 andMarch 2013.
83% of respiratory service consultations took place as part ofan MUR
Nearly 80% of service users were aged 45 or over
11% of people with inhalers were unsure of their diagnosis
98% of asthma patients using inhalers showed improvementin their Inspiration Rate Change after their consultation
More than 1,000 patients met their target Inspiration Rateduring one consultation
Over half of patients used reliever inhalers at least once a day
Almost 80% of patients were given at least one interventionby the pharmacist
Nick Hunter on…… the decision to base service payments on data collection“It’s human nature… if you’ve got no incentive to dosomething, then you get on with the things where you havegot an incentive to do them… [so] the fees were a ‘no data,no payment’ system.”
… the benefits of data collection“[The data] has been vital to bring to discussions with newcommissioners… there is a much bigger pot now availableto [the Respiratory Service]. Had we not got that report,then we wouldn’t have got the commissioners’ interest inre-commissioning the service.”
…the future of pharmacy services“See if you can take what we’ve done [in South Yorkshire]and make it fit in with other areas.”
DiSPeNSiNg aND SuPPly
PSNC’s worklPCsthe healthCare laNDSCaPe
6 Community Pharmacy News – March 2014
PSNC’s regular round
up of health & care
news and policy
Keeping up with all the latest
developments in health and care policy
could almost be a full time job and PSNC
regularly receives questions from LPCs and
pharmacy contractors about what is going
on in the wider health and care landscape
beyond community pharmacy.
To help answer some of these questions
and to help contractors and LPCs stay up
to date, PSNC provides this regular update
service outlining the latest information in
an easily digestible format. Weekly
updates are published on our website and
each month here in CPN we summarise the
news from the previous few weeks. More
detailed briefings are available at:
psnc.org.uk/thehealthcare-landscape
Changes planned for locally agreed GP
contracts
In early February NHS England announced
changes to the way Personal Medical
Services (PMS) contracts will be managed
to ensure the most effective use of
resources; PMS is a locally-agreed
alternative to the General Medical Services
(GMS) contract.
NHS England’s Area Teams will be
reviewing PMS contracts over the next
two years to ensure that additional
practice funding, over and above that
provided to GMS practices, must reflect
local strategic plans for primary care and
secure services or outcomes that go
beyond what is expected of core general
practice. The GP press have reported that
PMS practices could face losing up to
£260m as a result of the review.
PHE release local authority adult
obesity data
New local authority excess weight data,
published by Public Health England (PHE),
confirmed that 64% of adults are
overweight or obese. The new data also
shows for the first time the considerable
variation in the numbers of people who
are overweight or obese in different parts
of England, as well as the extent of the
challenge many local authorities and the
local NHS face.
The Francis Report: One Year On
The Nuffield Trust has published a report
which analyses the impact of the Francis
Report on the NHS. Alongside that
publication Jeremy Hunt, Secretary of
State for Health, highlighted figures that
suggest NHS care has changed for the
better one year on from the Francis
Inquiry. NHS England also highlighted a
range of changes it has led over the past
year including:
• Launching the Friends and Family Test;
• Rolling out a new plan for nursing,
midwifery and care staff – the
Compassion in Practice strategy;
• Reviewing the quality of care and
treatment provided by 14 hospital trusts
that are persistent outliers on mortality
indicators;
• Approving the development of a
network of Patient Safety
Collaboratives;
• Publishing data on never events that
occur in hospitals; and
• Putting in place Quality Surveillance
Groups across NHS England’s 27 area
teams and four regions.
Jeremy Hunt, Secretary of State for
Health, subsequently announced that the
Mid Staffordshire Foundation Trust, which
was the focus of the Francis Report, would
be dissolved and its constituent hospitals
would be taken over by nearby NHS Trusts.
The NHS is not meeting the “Nicholson
Challenge” says Health Committee
Parliament’s Health Committee has
published a report following its annual
inquiry into public expenditure on health
and social care. The MPs said the health
and care system needs fundamental
change if it is to meet the needs of
patients. They note that while many of the
straightforward savings have been made
by the health and care system, the
transformation of care on the scale which
is needed to meet demand and improve
care quality has not yet been seen.
The Committee also said that the
economic situation is not helped by the
current fragmented commissioning
structures. The Committee’s view is that,
as Health and Wellbeing Boards have been
established to allow commissioners to look
across a whole local health and care
economy, their role should be developed
to allow them to become effective
commissioners of joined-up health and
care services. The Committee also
recommends that the current level of real
terms funding for social care should be
ring-fenced.
Hospital centralisation and chains
The Health Service Journal has reported
that discussions have begun between NHS
England, DH, Monitor and the NHS Trust
Development Authority on a major
engagement programme to seek a longer
term vision for the hospital sector. This
could include secondary care providers
forming national chains of hospitals and
services in order to improve efficiency,
standards and leadership.
Meanwhile, in an article in the Daily
Telegraph, Sir David Nicholson, Chief
Executive of NHS England, has said that
hospitals will have to close and services
will need to be centralised in order to
improve patient care. He called for a
radical reorganisation of health services so
a smaller number of larger hospitals offer
most major surgery while smaller hospitals
scale back the care they provide. Sir David
also called on politicians from all parties to
back these proposals and to avoid the
issue being used to score party political
points in the run up to the general
election.
Former M&S boss to advise on NHS
leadership
Jeremy Hunt, Secretary of State for Health
has appointed Sir Stuart Rose, former CEO
of Marks and Spencer to advise on how the
NHS can attract and retain the very best
leaders to help transform the culture in
under-performing hospitals. Sir Stuart will
also advise on how NHS trusts can improve
organisational culture, through leaders
being more visible and in touch with
frontline patients, services and staff.
ServiCeS aND CommiSSioNiNgDiSPeNSiNg aND SuPPlyCoNtraCt aND it
psnc.org.uk 7
Ongoing Branded Medicine Supply problemsAt present, the supply arrangements for some products are having an adverse impact on workload in pharmacies and can lead to
delays in patient care. PSNC continues to work constructively with manufacturers, wholesalers, the Department of Health and
regulators to find solutions to the current problems that could be introduced to help meet the needs of UK patients more efficiently.
List of Medicines Impacted by Branded Medicine Supply Problems
Pharmacies have reported problems obtaining the following medicines through wholesalers. This list is not exhaustive. If a
product cannot be obtained through the normal channels, emergency stock can be obtained directly from the manufacturer:
Azilect 1mg tablets (Lundbeck Ltd)
Azopt 10mg/ml eye drops (Alcon Laboratories (UK) Ltd)
Cialis 20mg tablets (Eli Lilly and Company Ltd)
Cipralex 10mg tablets (Lundbeck Ltd)
Cipralex 20mg tablets(Lundbeck Ltd)
Cymbalta 30mg gastro-resistant capsules (Eli Lilly and Company Ltd)
Cymbalta 60mg gastro-resistant capsules (Eli Lilly and Company Ltd)
DuoTrav eye drops (Alcon Laboratories (UK) Ltd)
Emselex 7.5mg modified-release tablets (Novartis Pharmaceuticals UK Ltd)
Emselex 15mg modified-release tablets (Novartis Pharmaceuticals UK Ltd)
Eucreas 50mg/1000mg tablets (Novartis Pharmaceuticals UK Ltd)
Exforge 10mg/160mg tablets (Novartis Pharmaceuticals UK Ltd)
Exforge 5mg/160mg tablets (Novartis Pharmaceuticals UK Ltd)
Exforge 5mg/80mg tablets (Novartis Pharmaceuticals UK Ltd)
Ezetrol 10mg tablets (MSD-SP Ltd)
Micardis 40mg tablets (Boehringer Ingelheim Ltd)
Micardis 80mg tablets (Boehringer Ingelheim Ltd)
MicardisPlus 40mg/12.5mg tablets (Boehringer Ingelheim Ltd)
MicardisPlus 80mg/12.5mg tablets (Boehringer Ingelheim Ltd)
Spiriva 18microgram inhalation powder capsules (Combopack and Refill Pack) (Boehringer Ingelheim Ltd)
Spiriva Respimat 2.5micrograms/dose solution for inhalation cartridge with device (Boehringer Ingelheim Ltd)
Symbicort Turbohaler (AstraZeneca UK Ltd)
Travatan 40micrograms/ml eye drops (Alcon Laboratories (UK) Ltd)
Yentreve 20mg gastro-resistant capsules (Eli Lilly and Company Ltd)
Deletions:
Aprovel 300mg tablets (Sanofi)
CoAprovel 150mg/12.5mg tablets (Sanofi)
CoAprovel 300mg/12.5mg tablets (Sanofi)
CoAprovel 300mg/25mg tablets (Sanofi)
Please note: If a wholesaler chose to trade medicines for export and as a consequence the needs of patients in the UK were not met,
the holder of the wholesale dealer’s licence could be in breach of the Regulations, and could face regulatory action against his licence,
and/or criminal prosecution. This also applies to products that have not been reported as having supply problems and are therefore not
listed above. There is no obstacle to exporting medicines in a way that does not impact on availability of the product to UK patients.
Feedback to PSNC: Contractors who have experienced problems in obtaining medicines because of quota arrangements are
encouraged to feed this into the PSNC Information Team to support PSNC’s ongoing monitoring of the situation. PSNC will work to
ensure this information is fed into the Department of Health as evidence of the problems that are arising. An online feedback form for
this purpose can be found on the PSNC website (www.psnc.org.uk/brandedshortages). For support on this issue, please contact the
PSNC Information Team (0203 1220 810).
Manufacturer Contingency Arrangements
Detailed guidance on individual manufacturers’ contingency supply arrangements can be found on the PSNC website
(www.psnc.org.uk/brandedshortages). Other resources on the site include guidance on legal and professional obligations in relationto trading medicines in short supply and supply chain best practice guidance.
FuNDiNg aND StatiStiCS
8 Community Pharmacy News – March 2014
DiSPeNSiNg aND SuPPly ServiCeS aND CommiSSioNiNg the healthCare laNDSCaPe
Ask PSNC – Smartcards SpecialThe PSNC Information Team can give pharmacies support and advice on a range of
topics related to the Drug Tariff and reimbursement. Questions the team have been
asked by pharmacies in recent months have included:
1. Where can I obtain a certain smartcard?
Please contact your Registration Authority (RA) to obtain a
smartcard. If you don’t know who your RA is, speak to your local
NHS England Area Team (contact details for local Area Teams can
be found at tinyurl.com/areateam or speak to your LPC).
2. What arrangements are in place to provide access to EPS
Release 2 for non-locum pharmacists who practice across RA
boundaries?
Prior to working at a pharmacy based in another area, the
pharmacist must contact the relevant RA for that area to organise
for the appropriate user profile to be added to their smartcard.
The pharmacist’s sponsor should complete an RA02 form which is
sent to the RA Agent/Manager for the necessary amendments to
be actioned (please contact your sponsor or RA to obtain the
form(s) you require).
If the pharmacist has the locum profile on their card, they are able
to work at any EPS Release 2 enabled pharmacy in England and
are not required to go through this process.
3. My RA has told me that they will not be issuing smartcards at
present. Who should I contact to resolve this?
If an RA is refusing to issue cards or not issuing cards in a timely
manner, we would recommend contacting your LPC
(lpc-online.org.uk) in the first instance who will be able to take
this up with the NHS England Area Team.
4. I don’t have an NHSmail address or access to a mobile phone.
Is there any other way to remotely unlock my smartcard without
having to visit the RA Offices?
If an incorrect pin has been entered more than 3 times, the
smartcard is locked and needs to be ‘unlocked’ to be used.
Where a staff member has access to the online Smartcard Service
Centre (SCSC) and has either an @nhs.net email account or mobile
phone number listed in the Spine User Directory, the system can
be used to support unlocking an individual’s smartcard remotely,
without the need to visit the RA Office. If an individual does not
have either a mobile phone or an @nhs.net email account, it may
be possible to use the pharmacies landline if the following apply:
• The telephone line accepts text to voice conversations (this is
available through a number of telephone providers including
BT and Virgin and modern VOIP telephone systems)
• An auto-attendant is not in use (i.e. the message will go straight
through to a person, rather than a message.)
• The telephone number has previously been listed on the Spine
User Directory
To list a number in the Spine User Directory or to update a
telephone number, please contact the local RA.
A sponsor can also unlock smartcards if they have been given this
authority by the RA. They must also have access to a computer
with two smartcard readers attached and have access to the
online card management system. PSNC is recommending that to
ensure ready access to sponsors, a representative in each
pharmacy premises is given sponsorship responsibility, for
example the pharmacist-in-charge or branch manager.
5. How do I cancel a smartcard (e.g. when a member of the
dispensing staff is leaving)?
The pharmacist or pharmacy manager should advise the local RA
prior to a user leaving an organisation. The RA will then need to
follow the appropriate access removal process.
Where a smartcard is required to access NHS Care Records
Service (CRS) compliant applications, leavers with no intention of
returning to an organisation in the near future (for example users
having a change of career or those who are retiring), should have
their smartcard and its certificates revoked using an RA03 form
(please contact your sponsor or RA to obtain the form(s) you
require).
For more information please visit psnc.org.uk/smartcards
April 2014 Category Mprices published
The Department of Health has
announced the new Category M prices
which will apply to prescriptions from
April until June 2014. The April 2014
prices can be viewed on the NHS
Prescription Services website.
PSNC and the Department of Health (DH)
assess the medicine margin achieved by
pharmacy contractors and make
adjustments, as necessary. DH and PSNC
have agreed a reduction to generic
medicine reimbursement prices (Category
M) from April 2014 of £10 million per
month, equivalent to £120 million in a full
year. The Drug Tariff will be amended
from April 2014, to reflect this change.
The delivery of medicine margin will
continue to be assessed, with further
adjustments made, as necessary.
PSNC’s Head of Finance Mike Dent
commented: ‘Whilst we have agreed this
adjustment for April, it will be kept under
review as further data becomes available
on levels of margin being earned. Our
ambition is to move to a system that
offers greater consistency of margin
delivery for contractors, avoiding the
large cuts in reimbursement prices seen
in October for many years, and we are
working with DH to revise the systems for
adjusting Category M prices.’
psnc.org.uk 9
PSNC’s work FuNDiNg aND StatiStiCS CoNtraCt aND itlPCs
Are you being paid correctly?Check out the updated Prescription Payment
section of our website to make sure you are.
The Prescription Payment and Pricing Accuracy section of the PSNC website has
recently been updated to include much more detailed information than ever
before on things like making sure you have sorted your prescriptions correctly for
submission to the Pricing Authority, how to make sense of your FP34 Schedule of
Payments, and how to reduce the chance of errors in pricing. Below is a step-by-
step guide to where you will find the updated pages on our website.
This section of the website is split into three areas:
1. Prescription Submission: preparing, sorting and dispatching the prescription
bundle and completing your FP34c submission document
(psnc.org.uk/submission)
2. Monthly Payments: how to understand and make use of your FP34 Schedule of
Payment to monitor performance (psnc.org.uk/payments)
3. Prescription Pricing Accuracy: covering how your prescriptions are processed
by the Pricing Authority, prescription switching, PSNC prescription pricing
audits and pricing rechecks (psnc.org.uk/accuracy)
We hope that you will find our improved website better suited to your needs, but
please let us know if you experience any problems with the site. We would also
welcome any general feedback/ comments at: www.psnc.org.uk/report
Alongside our new webpages, we are also launching a new series of payments
factsheets so pharmacy teams have some short checklist style guidance that can
be used day to day in the pharmacy. The first of these factsheets can be found on
page 13.
All details correct at time of printing.
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Changes toSupplementaryOpening Hours
Pharmacies wishing to amend their
supplementary hours must notify their
Area Team, giving at least 90 days’ notice
of the intended change. The Area Team
may consent to a shorter period of notice –
but because that consent may not be
forthcoming, try to ensure that plans are
made sufficiently in advance.
NHS England has published a template
notification letter on its website
(www.england.nhs.uk/pharm-open-hrs).
There is no requirement for the Area Team
to grant applications for changes to
supplementary hours – the pharmacy has
the right to amend hours so long as 90
days’ notice is given. However, we have
been made aware that in some cases these
notifications may not have been seen by
the relevant person at the Area Team and
in light of this we are suggesting that
contractors ensure their notification
documents are correctly received. You can
do this in a number of ways by:
• Telephoning the Area Team before you
send the documents to obtain specific
contact details for the member of staff
you need to send it to, this can include
email address as well as postal address.
• If acceptable to make notification by
email, this could be an auditable way of
sending your notification and making
sure that the correct recipient has
received it.
• If you send your notification by post
then we also suggest doing so by
recorded delivery, so that you can then
be sure that the notification is received
by your Area Team.
• After you have sent the notification,
telephoning the relevant contact at the
Area Team to confirm receipt. Be sure to
make a record of the name and details of
the person who confirms this.
10 Community Pharmacy News – March 2014
DiSPeNSiNg aND SuPPly ServiCeS aND CommiSSioNiNg the healthCare laNDSCaPe
Reminder: Changes to BNF distribution
Pharmacy staff are reminded that, from 2014, paper copies
of the British National Formulary (BNF) will be distributed
annually by NICE instead of six-monthly.
This means that the next hard copy versions for pharmacies
will be made available in September 2014 only.
Full details of distribution arrangements can be found at
psnc.org.uk/externalresources
The Royal Pharmaceutical Society (RPS) has released this
statement:
“The publishers of the BNF - the Royal Pharmaceutical
Society and BMJ - are committed to providing the formulary
in the formats our customers find most useful and
convenient.
For this reason we will be continuing to publish the BNF in
updated book form twice a year, in March and September.
NICE will not be purchasing the March 2014 edition for
nationwide distribution to NHS health professionals in
England. It is moving to one annual print distribution per
year, in addition to the availability via its website and app.
Those organisations that wish to have the next updated
print edition, therefore, should contact Jim Benham on 020
7572 2251 or email jim.benham@rpharms.com for a quote –
as ever, prices flex with quantities ordered. Individual
clinicians wishing to purchase a copy should call 01256-
302699 or email direct@macmillan.co.uk.”
For more information on the BNF and its distribution, please
visit www.nice.org.uk/bnf
Drug Tariff Watch
The first section of the Drug Tariff is the Preface section. This
contains valuable information relevant for both the current
edition and the next. It lists additions, deletions and any other
alterations to the Drug Tariff. The Preface should ideally be
checked each month to identify products which are entering or
being removed from the Tariff as well as those products changing
between categories or in the case of category C items, changes to
the brand used for pricing.
It is especially important to note which are Drug Tariff listed
products as well as which category products are entering and the
pack sizes being included in these entries, as reimbursement will
be based on this classification and its endorsement requirements.
Incorrect endorsement can lead to incorrect payment for items.
It is also important to know the category of an item when
claiming certain payments (e.g. OOP expenses) as these are not
allowed in particular categories.
Below is a quick summary of the changes due to take place from
1st April 2014
Part VIIIA Additions
Category A Additions:
• Phenoxybenzamine 10mg capsules (30)
Part VIIIA Amendments
• Disopyramide 150mg capsules (84) is chaning to Category C –
A A H Pharmaceuticals Ltd
Part VIIIA Deletions
If a medicinal product has been removed from Part VIIIA and has
no other pack sizes listed, it can continue to be dispensed, but it
will need to be endorsed fully (i.e. brand/ manufacturer nameand pack size) in future.
• Beeswax yellow solid (500g) – J M Loveridge Ltd
• Camphor racemic powder (100g) – J M Loveridge Ltd
• Coal tar solution strong (500ml) – J M Loveridge Ltd
• Copper sulfate pentahydrate powder (500g) – J M Loveridge Ltd
• Hydrotalcite 500mg/5ml oral suspension sugar free (500ml) –
Peckforton Pharmaceuticals Ltd
• Kaolin light powder (1000g) – J M Loveridge Ltd
• Magnesium trisilicate powder (500g) – J M Loveridge Ltd
• Pentazocine 30mg/1ml solution for injection ampoules (10) –
Zentiva
• Peppermint emulsion concentrated (250ml) – J M Loveridge Ltd
• Potassium bromide powder (500g) – J M Loveridge Ltd
• Proflavine 0.1% cream (100ml) – J M Loveridge Ltd
• Sodium metabisulfite powder (500g) – J M Loveridge Ltd
• Sodium picosulfate 2.5mg capsules (50) – Dulcolax Pico Perles
• Sulfur 5% / Salicylic acid 3% shampoo (120ml) – Meted
• Valsartan 160mg tablets (28) – Aspire Pharma Ltd
• Valsartan 80mg tablets (28) – Aspire Pharma Ltd
Part IX Deletions
It is important to take careful note of removals from Part IX
because if you dispense a deleted product, prescriptions will be
returned as disallowed and therefore payment will not be made
for dispensing the item.
• BANDAGES – Short Stretch Compression bandage – Silkolan (all
sizes)
• VAGINAL PH CORRECTION PRODUCTS – Lactic Acid Vaginal
Tablets – LadyBalance
• INCONTIENCNE APPLIANCES – Urinal Systems – Manfred Sauer
UK Ltd – URIfem female reusable bottle urinal
psnc.org.uk 11
PSNC’s work FuNDiNg aND StatiStiCS CoNtraCt aND itlPCs
Wakefield urged to drop in for blood pressure testWith an estimated 30,000 people in Wakefield having undiagnosed high
blood pressure, Public Health England (PHE) has launched a pilot campaign
in the town to identify those people.
High blood pressure is estimated to cause over 20% of heart
attacks and 50% of strokes. Last year in Wakefield, there were
over 1,000 emergency admissions to hospital for a heart attack or
stroke.
PHE’s 4-week campaign aims to encourage people aged 40 or
over to visit one of over 50 blood pressure drop-ins set up across
the area from 10th March, that make it convenient for people to
get a quick, free test. Healthcare workers will also be on hand to
offer information and lifestyle advice, to help people achieve or
maintain a healthy blood pressure, without the need for an
appointment.
Everyone from community pharmacies, Wakefield Council and
West Yorkshire Police, to local businesses, are playing a part in
raising awareness of the campaign and encouraging their
employees and customers to have the quick test.
Dr Stephen Morton, PHE’s Centre Director for Yorkshire and
the Humber, said:
“Your chance of having high blood pressure increases as you get
older however the condition is often symptomless and is
impossible to spot without a test. This is why a number of drop-
ins have been set up across Wakefield – to make it as easy as
possible for people to find out if they are one of the 30,000
people currently undiagnosed with high blood pressure in the
area.
By working closely with community groups and organisations we
hope to reduce premature deaths by raising detection of high
blood pressure and educating everyone on the steps they can
take to control their blood pressure.
There are a number of steps people can take to help manage
their blood pressure, including losing weight, exercising regularly,
cutting down on salt and eating a healthy diet.”
Robbie Turner, Chief Executive Officer at Community
Pharmacy West Yorkshire, said:
“Community Pharmacy West Yorkshire is delighted to be a key
partner in the Wakefield blood pressure drop in. Community
pharmacies in Wakefield already offer many high quality and
accessible health and wellbeing services and this campaign to
encourage the public to know their blood pressure numbers is an
ideal way to see the range of services community pharmacy can
offer you in improving your health.
We encourage people over 40 to drop into their local community
pharmacy from 10 March 2014 and get a simple free blood
pressure check.”
Faisal Tuddy, Deputy-Superintendent Pharmacist at Asda, said:
“The health and wellbeing of our colleagues and customers is
hugely important to us so this is why we are backing this blood
pressure campaign. Too many people have undiagnosed high
blood pressure in Wakefield and we hope to play a part in
changing this alongside the rest of the local community.
We aim to spread the word amongst our hundreds of colleagues
in our stores and distribution centres in Wakefield, along with
thousands of local customers, some of whom could be affected
by undiagnosed high blood pressure. As well as running Blood
Pressure Clinics in our distribution centres, the drop-in clinic will
visit Asda stores across the area over the coming weeks – so we’ll
leave no stone unturned in our bid to ensure that our Wakefield
community takes advantage of the free, 5-minute test.”
RNIB supporters create top tips forhealthcare professionals
The Royal National Institute of Blind People (RNIB) have
published guidance documents to assist healthcare staff in
improving the accessibility of their services for blind and
partially sighted people.
The guidance is in the form of “top tips” and has been
created by RNIB with the help of their supporters.
To read and download the top tips, please visit
tinyurl.com/rnibtips
lPCsthe healthCare laNDSCaPeServiCeS aND CommiSSioNiNg
12 Community Pharmacy News – March 2014
Supporting PSNC
Declaration of Competence (DoC) frameworkfor locally commissioned servicesCommissioners, education providers and local pharmacy
representatives have worked together in the North West region
over a number of years to harmonise the accreditation
requirements for provision of locally commissioned services (the
Harmonisation of Accreditation Group – HAG). Over the last few
months this foundation has been built upon with the
development of the Declaration of Competence (DoC)
framework. The DoC framework has been designed to support
community pharmacy professionals (pharmacists and pharmacy
technicians) in assuring their competence in delivering consistent
and quality public health services.
Where a commissioner agrees to use of the DoC framework for
the provision of a specific community pharmacy service, the
framework will provide pharmacy professionals with the tools and
guidance to enable them to reflect on their current practice and
competence relating to the service; completing the self-
assessment tool will enable pharmacy professionals to identify
their own personal areas for development.
Pharmacists (and pharmacy technicians where appropriate) can
access the information they need on the CPPE website and
complete their self-declaration; there are 4 main steps for
pharmacy professionals once a commissioner allows this
approach:
1. Access the Declarations of Competence;
2. Review their competence against the self-assessment
framework;
3. Use the recommended learning, if needed, to fill any gaps in
competence;
4. Print-out, sign and date the declaration statement (the
declaration statement will include relevant CPPE packs that
have been completed). The declaration statement can be used
to demonstrate competence for the service to both the
commissioner and the employer.
The group behind this initiative (some of whom previously
worked on HAG) are accountable to Health Education North West
(the Local Education and Training Board) and the DoC framework
documents are hosted by and have been developed in
conjunction with CPPE.
PSNC, Pharmacy Voice and the Royal Pharmaceutical Society have
all confirmed their support for the initiative and the group has
also engaged extensively with commissioners, particularly in the
North West, who have expressed positivity for the approach.
The DoC framework has been piloted in Manchester and
commissioners involved in the pilot have reported that they are
satisfied with the approach and are comfortable with pharmacy
professionals declaring their competence. The group is hoping
that Health Education England will in due course adopt this
process as a national solution.
Further information on the DoC Framework is available on the
CPPE website www.cppe.ac.uk.
When LPCs are discussing commissioning or re-commissioning of
services with their local commissioners, they may want to suggest
use of the DoC framework.
The following services have had DoC frameworksprepared (available on the CPPE website):
• Emergency Contraception
• Alcohol Use Identification and Brief Advice
• Chlamydia Testing and Treatment
A second phase will see the release of thefollowing DoC frameworks:
• Supervised Consumption of Prescribed Medicines
• Stop Smoking
• Needle and Syringe Programmes
• Minor Ailments Schemes (levels 1 and 2)
A third phase will see the release of thefollowing DoC frameworks:
• NHS Health Checks
• Oral Contraception
• Cancer Awareness and Screening
• Weight Management
• Care Homes
Payment Factsheet 1: Prescription Submission1. Daily dispensing checks:Below is a checklist of actions recommended to take before submitting your account for payment and could help to improve theaccuracy of pricing.
*For instance, Drug Tariff listed lines only require endorsement if they are a Category C item that comes in more than one pack size. Please see endorsing
guidance for more information: psnc.org.uk/endorsing
2. Sorting your prescriptions prior to submission:
• Remove all pins, staples, paper clips, labels or invoices from prescriptions as these will have to be manually removed before pricing
and can delay processing.
• Ensure prescriptions are submitted in the correct patient charge group (i.e. exempt, paid, and paid at old charge rate), taking extra
care that no paid prescriptions are submitted within the exempt section as these will be switched. (Incorrectly filed prescriptions
are a major cause of overpayments so please ensure that all prescriptions are filed in the correct charge group).
• Each charge group should be secured with one or two elastic bands. Avoid using too many elastic
bands (see picture).
• Use the ‘red separator’ for separating:
• expensive items*
• specials and unlicensed products
• items with broken bulk or out of pocket expense claims
• items with hand written amendments
• where the prescribers’ signature encroaches over an item on the prescription
Full details on which items to include is set out on the red separator document sent to you from the Pricing Authority.
DO DO NOT
✓ Double-check all endorsements, particularly for expensive items and unlicensed
specials/imports.
✓ Stick to the required endorsements only*, don’t over endorse and keep all
endorsements within the left-hand side margin of the prescription form.
✓ Check your endorsements are legible. Are all prices endorsed clearly? Can they be read
easily by another person?
✓ Does your PMR system endorse automatically? Is your PMR making the endorsements
correctly? Are the printed endorsements readable or does your printer ink cartridgeneed replacing?
✓ Pharmacy stamp: Make sure the pharmacy stamp does not obscure the patient’s age or
date of birth, or any endorsements.
✓ Not dispensed items: Ensure ‘not dispensed’ items
are endorsed ‘ND’ in the endorsement column andthat the product name is clearly crossed out by ahorizontal line (see picture).
✓ Check exemption declarations on the backs of prescriptions (and in the electronic claim
message for EPS R2 prescriptions) are completed in full where necessary, and signed to avoidprescriptions being switched. Declarations are required unless the patient is age exempt andthe DOB/ age is computer-generated on the front of either the electronic or paper form.
✓ Occasionally, prescribers include supplementary product information, for example a brand
or manufacturer’s name or an indication that a sugar free or preservative free prescription isrequired, as part of the dosage instructions ratherthan as part of the name of the prescribed product(see picture). As reimbursement of electronicprescriptions is based on the product code of theprescribed product, supplementary product information included in the prescriber’s dosageinstructions will not be considered when calculating payment; therefore prescribers shouldbe encouraged to select the correct product to prescribe in the first place. (This is ofparticular importance when handling EPSR2 electronic prescriptions.)
✓ If possible, highlight and remove all red separator prescriptions during the day’s dispensing.
✗ Do not put labels or sticky notes on
prescriptions during the dispensingprocess. The residual glue canaffect the scanning process.
✗ Do not mark the prescribing area
of the prescription form with ticksor other marks during thedispensing/ checking process asthese could affect how theprescription is priced (see picture).
✗ Avoid putting any information
regarding quantities owing in theendorsement column as thesecould be interpreted as quantitydispensed. You could record owinginformation on your PMR system orattach a removable owings slipinstead.
✗ Do not make endorsements
(printed or handwritten) on anyother part of the prescription formother than the designated lefthand column only as there is achance that these may not be seenduring pricing. Also, ifendorsements encroach onto anitem on the prescription form, itcan affect pricing of that item.
Do NOT do this
DiSPeNSiNg aND SuPPlyCoNtraCt aND itFuNDiNg aND StatiStiCS
psnc.org.uk 13
PSNC’s work
Please note: prescription forms within each group should be sorted
into prescriber order. However, any prescribers with fewer than 20
forms can be placed into a ‘miscellaneous’ section at the end of
each group.
3. Completing your FP34c Submission Document:
4. Dispatching your prescription bundle:• Dispatch the bundle to your processing centre by a track and trace method no later than the
5th day of the month following that in which the supply was made.
• Send the prescription bundle in a secure package and in a manner that ensures prescriptions
don’t get mixed up in transit (see picture).
*PSNC recommends keeping a record of all expensive items
dispensed and submitted in the month as this will facilitate the
ability to perform reconciliation checks once you receive your
Schedule of Payment.
• Keep the following forms separate from main prescription
bundle but submit with your account:
• repeat authorising forms (RA forms)
• ETP tokens (note: these are not used for payment)
• FP57 forms (relating to refunds of prescription charges)
You may find this diagram useful to help you organise your
prescription bundle groups:
DO DO NOT
✓ Use the barcoded FP34c Submission Document for your pharmacy for that specific
dispensing month to declare the combined total of paper and electronic prescriptions(forms and items) being submitted to the Pricing Authority for reimbursement.
✓ Ensure accurate, complete and clearly written declarations are made in Sections 1 and 2
(check numbers of forms/items, staff hours, MURs, AURs and NMS declared).
✓ Declare the total number of staff hours spent in the dispensing process and not an average
as this can affect practice payment thresholds.
✓ For paper prescriptions, the figures should relate to the total number of forms and items
that are physically included in the prescription bundle (including returns). The number ofitems declared should be adjusted to take into consideration any additional fees due (e.g. ifan HRT product attracts 3 fees, it should be counted as 3 items).
✓ For electronic prescriptions, the figures should relate to the total number of electronic
forms and items that have been submitted to the Pricing Authority via an electronic claimmessage by midnight on the 5th of the following month but had been dispensed beforethe last day of the previous month.
✓ If you are submitting EPS Release 2 reimbursement claims, ensure that you tick the
relevant box and include the forms/items within the total numbers declared.
✓ When calculating the total forms/items to be submitted, double-check that your
cumulative item and form totals have been calculated correctly. It may help to calculate theforms/items ratio for each day.
✓ Carefully check the number of fees claimed on MDA instalment forms (see
psnc.org.uk/mda to find out more).
✓ PSNC also strongly recommends taking a photocopy of the completed FP34c form before
submission as a reference in the event of a suspected error.
✗ Do not borrow/ photocopy
anyone else’s as each barcodeis specific to one pharmacy forone month.
✗ Do not separate out EPS and
paper prescription figures, theseshould be totalled and includedin the total figures entry.
✗ Do not include the number of
ETP tokens or the number ofRA forms in your form/itemsdeclaration. These are not usedfor payment.
✗ Do not include items on re-
submitted forms which are notbeing queried. This is becausepayment will already have beenreceived for all other items onreturned copies ofprescriptions.
✗ Do not include electronic
prescriptions if the claimmessage was submitted aftermidnight on the 5th of thefollowing month.
A good example to follow
DiSPeNSiNg aND SuPPly ServiCeS aND CommiSSioNiNg the healthCare laNDSCaPe
PSNC websiteFor up to date information and news on community pharmacy issues, visit the PSNC website at psnc.org.uk
PSNC Community Pharmacy News is published by:The Pharmaceutical Services Negotiating Committee, Times House, 5 Bravingtons Walk, London N1 9AWCommunity Pharmacy News is edited by:Mike King LLB BSc MRPharmS who can be contacted at the above address or by email at: mike.king@psnc.org.uk © PSNCPSNC Office: 0844 381 4180 or 0203 1220 810
Correct as of March 2014. See psnc.org.uk/cip for the most up-to-date information.
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