AVON LPC NEWSLETTER

ISSUE 17 DECEMBER 2013

KEEPING YOU INFORMED OFWHAT’S GOING ON IN YOUR AREA!

Avon LPC2 Farleigh Court, Flax Bourton

Bristol BS48 1URTel: 01275 464770

E:Mail: avonlpc@gmail.comWebsite: www.avonlpc.org.uk

Hello All

Welcome to the last newsletter of 2013! We’ve

had quite a year at Avon LPC with a change

of Chairperson, holding our first conference,

launch of an NHS Pharmacy Flu vaccination pilot and a grant won to run another pilot to

create Dementia Friendly Pharmacies.

We would like to thank all our contractors for

your hard work over the past year, and

encourage you to continue participating in all available pharmacy services in your areas

so we can continue to showcase community

pharmacy to the commissioners!

This edition of the newsletter has some

exciting information about the new style GPhC Inspector visits, a round-up of our

recent conference as well as our regular Chief

Officer’s Blog, and a flu vaccination poster

for your pharmacy.

The committee would like to wish you all a Very Merry Christmas and look forward to

seeing you all in the New Year.

Chief Officer’s BLOG2

Black Triangle Status2

Avon LPC Conference3

Dementia Pharmacy Pilot 4

An Inspector Calls!5

NHS 1116

Healthy Living Pharmacies 7

Pharmacy News8

MHRA Update8

@avonlpc

NEXT FULL LPC MEETING:Wednesday 15th January 2014By this time we are hoping to have

moved into our new offices with Avon Local Medical Committee (LMC) at Staple Hill in Bristol.

Please keep an eye on our website for up to date location details, and

contact us on avonlpc@gmail.com if you would like to attend our next

open session meeting.

As we draw to the end of 2013, I find myself reflecting on what a busy year it has been and would like to take stock and present to you some of our highlights.✤ We have ensured that all locally commissioned services

were maintained in pharmacy during the NHS restructure and the fee structure held. Although I know there have been problems with payments, we have worked closely with Councils and commissioners to iron out problems as they arise.

✤ We have delivered a structured bi-monthly training programme across the year to support the clinical growth of not only our pharmacists, but also the wider pharmacy teams.

✤ We have successfully launched PharmOutcomes into Bristol to support the delivery of Council services (Sexual Health / Supervised Consumption etc.). This has provided an improved payment system as well as delivering evidence of the impact that pharmacy can make through these services.

✤ We have launched the first pharmacy based flu vaccination pilot in Avon with the desire that this will provide the evidence for a more widespread service in 2014.

✤ We delivered the first ever Avon LPC Pharmacy Conference attended by over 130 pharmacy delegates, plus commissioners from all the areas we cover.

✤ And lastly, we won the PSNC Dementia Challenge Award which has provided a £5,000 grant to develop a pharmacy based dementia identification and referral service. More news will come out about this in the coming weeks.

As we look forward to 2014, I can see that our challenges will be ensuring continuation of existing services as well as the development of new ones. We hope to have more localities live with PharmOutcomes to enable the simplification of reporting and claiming of all pharmacy based services. PharmOutcomes also provides a platform for research based programmes in pharmacy which takes us in an entirely new direction.2013 has been busy, but it has only laid the foundations for 2014, imagine where we could be in a years time!Please enjoy this edition and I wish you all a Merry Christmas and a prosperous New Year.Regards, Richard

Chief Officer’s BLOG

Black Triangle Status to appear in PILFor the first time patients will start to see the black triangle in the PIL for relevant medicines. The leaflet will explain that the medicine is subject to additional monitoring to allow quick identification of new safety information and patients can help by reporting any side effects.We all need to be aware that patients or carers may ask you questions about the black triangle symbol or reporting of side effects, please encourage these enquirers to report any suspected side effects via the Yellow Card Scheme. It is important to explain that the symbol does not mean the medicine is unsafe, but that there is less information available

about it compared with other medicines as it is newer to the market and there is limited data about its long-term use.The MHRA urge us to remember that they would like information about any adverse drug reactions, but are particularly interested in those associated with the black triangle medicines. They are also not concerned about duplicate reporting, so even if you think a patient may have reported an adverse reaction you can still report it yourself as their healthcare professional.To report an adverse reaction use a Yellow Card provided in the BNF, or alternatively report online at http://yellowcard.mhra.gov.uk/

Avon LPC was very proud to hold its first conference on Thursday 10th October 2013. The conference was attended by over 130 of our contractors, a fantastic turnout and we would like to thank you all for being part of it!

We wanted to hold the conference both to showcase the work we had undertaken on your behalf over that past year and to also seek your views on the strategic direction for 2014. The evening successfully

brought together the Area Teams, CCGs and Public Health Departments from each of the localities to give their views about the health care system across Avon.

Steve Davies (Member of Bristol CCG) described the conference for him as a commissioner as “an important strand in building relationship with pharmacy”

The conference began with an update of our achievements over the last year from our Chief Officer, Richard Brown who said “In these times of change the LPC has stepped forward to support all community pharmacies across Avon as well as promoting the great patient care provided day in day out across all our pharmacies.” Lydia Bartley (Chair of Avon LPC) spoke about our vision for the forthcoming year,

where we welcome all our contractors to have a greater input into our strategy. Please remember you are all welcome to attend the open part of our meetings every 2 months, details of which are posted on the calendar on our website homepage (www.avonlpc.org.uk).

A presentation then followed by Julia McCann (Director of Pharmacy for Glos, BANES, Swindon and Wiltshire Area Team) about NHS England, after which the delegates were split into the four CCG areas Avon LPC represents to hear from their local commissioners and get the chance to ask the questions most relevant to them. One pharmacist said “it was a great event to meet the commissioners and for me, to understand their issues and to seek common ground and solutions”.

AVON LPC CONFERENCE

Delegate signing in

Richard Brown addressing the conference

Presentation by Julia McCann

The evening was finished off by a Q&A session taken by a panel of experts including members of the LPC, CCGs,

Councils and NHS England.

Joel Hurst (Senior Commissioning Manager for Medicines Management & Primary Care – B&NES CCG) went on to say that he felt that “there is a void at present with the

LPN’s still forming, the LPC had an important role to play in supporting contractors”.

We hope you all enjoyed the evening and Avon LPC would once again like to thank all the speakers and contractors for attending, helping us make the evening a great success!

AVON LPC CONFERENCE

Dementia Friendly Pharmacy Pilot

We are pleased to announce that we have recently won funding to carry out a pilot for a pharmacy dementia intervention service, thanks to a proposal put forward by Avon LPC committee member David Tomlinson.

800,000 people currently live with Dementia in the UK, so how many more

are there who remain undiagnosed?

This is where YOU can make a difference

We will be funding 10 pharmacies to carry out a Dementia Friendly Pharmacy Pilot. The aims are to improve quality of life for both Dementia sufferers and their support

network.

Do you have a special interest in Dementia, or think this would work well in your locality? We invite you to express an interest in getting involved by contacting:

David TomlinsonDementia Friendly

Pharmacy Project Leader at Avon LPCdementia.avonlpc@gmail.com

01225 466454We have arranged Dementia Training sessions for all our contractors, which will include Dementia Friends awareness and CPPE Focal Point Dementia at:Engineers’ House, Clifton, Bristol. Thursday 9th January 2014 at 6.30pm.Fry’s Club, Keynsham. Thursday 16th January 2014 at 6.30pmOfficial invite to follow

Q&A Session

A full house!

PHARMACY

UPDATE by

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CAn Inspector Calls!

An Inspector Callswith the all new style GPhC Inspection

It may have passed you by, but the GPhC has now started a completely new style of inspector visit. Gone are the old style GPhC Inspections when the Inspector would spend half an hour examining your CD records and CD cabinet and then have a general chat about pharmacy standards and leave you in peace for three years.The new inspection visits will take up to three hours and you will be required to demonstrate your compliance with a variety of standards, your staff’s knowledge will be tested and post April next year the Inspector’s report on your pharmacy will be published online for the public to see!There are Five Principles of the new GPhC inspection are:

1. Governance Arrangements2. Empowered Competent Staff3. Managing Pharmacy Premises4. Delivering Pharmacy Services5. Equipment and Facilities

Within these five principles there are 38 different standards for you to comply with. I strongly suggest that you look at the GPhC website and read further about these 38 standards. http://www.pharmacyregulation.org/pharmacystandardsguideThe Inspector will grade you and your pharmacy against these five principles and mark you as either “Poor”, “Satisfactory”, “Good” or “Excellent”. The GPhC has already made it clear that they expect the majority of pharmacies will be graded as “Satisfactory” with the aspiration that we all will aim to become “Good” or “Excellent” in the future.That said, all pharmacies that are graded as “poor” and some that are graded as “satisfactory” have action points identified by the inspector and will have a defined time scale to submit an plan to rectify these issues.Furthermore the GPhC Inspector visits will continue to be unplanned and hence they may visit when you have a locum pharmacist on duty. The Inspector will still grade the pharmacy on that day and will make a judgement based on the knowledge of the staff they meet.I recently had one of these new inspections and can confirm that we were graded as “satisfactory” with no action points. Rather than detail the 38 standards I will share some of our experiences from our visit.

The Inspector was with us for about two hours. She was friendly and appreciated that this Is a new style of visit for both her and us. During the visit the Inspector went through all the standards and expected to see evidence for each. For example we had to produce our expiry date checking forms, cleaning logs and fridge temperature forms. She reviewed our near miss log and questioned whether we ever reviewed the near misses to look for patterns of behaviour. We were required to explain the qualifications of all the staff that work at the pharmacy and to show the inspector the training logs for all staff not registered with the GPhC. The inspector was keen to know the suppliers the pharmacy used and our shelves were checked for unlicensed medication which has licensed alternatives.A number of the pharmacy’s staff were questioned. The counter assistant was asked about her knowledge of Child Protection and what she would do if she feared a child was being abused. One of the pharmacy technicians was questioned on a number of the pharmacy’s dispensary procedures.The pharmacy premises were scrutinised; our consultation room check for sound proofing and the Inspector toured the store reviewing the quality of the fixtures and fittings. Even our measuring cylinders were checked to ensure they had a British Kite mark.Overall the inspection went well, with the Inspector extremely helpful and informative. The visit was very similar to the NHS contract compliance visits the PCTs use to run and will require a significant amount of your time. After the visit you will be provided with a report, split in to the five principles. The report will detail the evidence and findings of the inspector and any action points that you are required to complete, this report will then (post-April 2014) be published on the internet.

The LPC are planning to run a training event on this new style inspection in the February 2014 to help you prepare for this new system, keep an eye on our website for more details.

Bristol Emergency Supply Service to be utilised by NHS 111!

The Avon LPC is encouraged to learn that pharmacists at Bristol CCG are working closely with their colleagues at South West Commissioning Support to ensure that NHS111 call handlers can refer patients directly to community pharmacies for emergency supplies of prescription-only medication.Bristol PCT commissioned a service from local community pharmacies that has been in place for a number of years (now commissioned by Bristol CCG) that allows patients to obtain emergency supplies of POMs for the price of a standard NHS prescription charge, or free-of-charge for those that are normally exempt. This removes the deterrent for patients that cannot afford a supply and would therefore normally seek a prescription.The local GP OOH service (provided by Brisdoc) receives a large number of calls via NHS 111 from patients that have run out of their regular medication; this results in reduced capacity for patients with more urgent and complex health needs.The Emergency Supply Service does not change the way that a pharmacist would respond to a request for an emergency supply in any way – it merely replaces the step in which they would ask the patient for the fee at the end of the consultation with a requirement to fill in a form (called an ES1). This form collects similar information to that which would be recorded in the POM register, meaning the service can therefore be provided with the minimum of training.The service is currently promoted to any pharmacy in Bristol that is open 6 days a week or more. If you are not currently providing it and would like to do so, please visit our website for more details:

http://psnc.org.uk/avon-lpc/our-area/bristol/ccg/emergency-supply-service/In the coming weeks NHS111 will update their database using a list of those pharmacies that currently provide the service. This means that callers to NHS111 will be referred directly to pharmacies without having to be first passed to OOH GP services before referral, as currently is the case in Bristol.NHS Bristol CCG are keen to see this move succeed, and if it does go smoothly their colleagues at SWCSU are keen to see it rolled out to other areas locally. It is therefore important that pharmacies that provide the service take these steps:

✤ Ensure they have formally signed up to the scheme with Bristol CCG

✤ Ensure that all their regular staff (and espec ia l l y those tha t work a t weekends) are familiar with the service and ready to support locum or relief staff when they make emergency supplies

✤ Ensure that patients are not turned away – patients that cannot receive an emergency supply (e.g. in the case of controlled drugs) can be referred back t o N H S 111 f o r a n O O H G P consultation

✤ Pharmacy staff should re-assure relief or locum pharmacists providing the service that the contractor is happy for them to not take a charge from the patient.

Pharmacy News

HEALTHY LIVING PHARMACY

“I’ve heard of those, but what are they?”The Healthy Living Pharmacy (HLP) concept came from work by Hampshire & Isle of Wight LPC and Portsmouth PCT in 2008. It was developed to recognise our role in public health, and to advertise that message to pa t ien ts and loca l commissioners.

“So what’s happening now?”HLPs are being rolled out in other a reas , suppor ted by pharmacy organisations and the Department of Health

“What constitutes a Healthy Living Pharmacy?”

An accredited HLP:✤ Consistently delivers broad range

of high quality services✤ Has achieved quality requirements

and met productivity targets linked to local health needs e.g. a number of stop smoking quits at 4 weeks

✤ Has a team that proactively promotes health and wellbeing and proactively offers brief advice on a range of health issues such as smoking, activity, sexual health, healthy eating and alcohol

✤ Has a Healthy Living Champion✤ Is recognisable by the public

“What has been achieved?”HLPs in 14 areas were evaluated in April this year and demonstrated the delivery of cost-effective services with high public approval.

“What does the NHS think?”The Chief Medical Officer (Dame Sally Davies) said “HLPs work. They improve choice and we must ensure they are embedded in the new NHS. An inspirational concept.”

“What’s in it for me?”Two thirds of HLPs reported an increase in demand for all services, and three quarters saw an average increase in income from services of 25%, and 80% said their staff members were more productive.

Overall, 70% of HLPs saw a worthwhile investment in their business, and over 90% saw it as a worthwhile investment in staff development.

“I want to be an HLP – what can I do?”Avon is not currently an HLP site, but there is plenty that you can do to move towards the standards by reading the information and standards pages on the NPA website:h t t p : / / w w w. n p a . c o . u k / b u s i n e s s -management/service-development-opportunities/healthy-living-pharmacy/

The first thing is to ensure that you are making the most of your public health services – check the LPC website (www.avonlpc.org.uk) for details of what is commissioned in you area and review your performance.

HEALTHY LIVING PHARMACIES PHARMACY

PRACTICE

by

Chris H

owland-H

arris

The MHRA had previously advised that the contraindications for Dabigatran had been clarified to

include a range of clinical conditions where the patient is at significant risk of major bleeding and because of the similar risks associated, the newer oral anticoagulants (Apixaban and Rivaroxaban) now also have the following contraindications included for all indications and doses following a recent European review:✤ A lesion or condition, if considered a

significant risk factor for major bleeding.This may include:✦ Current or recent GI ulceration✦ Presence of malignant neoplasm at

high risk of bleeding✦ Recent brain or spinal injury

✦ Recent brain, spinal or ophthalmic surgery

✦ Recent intracranial haemorrhage✦ Known or suspected oesophageal

varices✦ arteriovenous malformation✦ vascular aneurysms, or major

intraspinal or intracerebral vascular abnormalities.

✤ Concomitant treatment with any other anticoagulant agent e.g. unfractionated heparin, low molecular weight heparin (such enoxaparin or dalteparin), heparin derivatives (such as fondaparinux, or oral anticoagulants (such as warfarin).

For more detailed information see:http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON322347

Drug Safety Update - Anticoagulants

The Public Health pharmacy campaign Alcohol Awareness organised by Public Health in Bristol was taken up with gusto by Lloyds in Redfield.Pharmacist, Amy Rowe, at Lloyds said “My Pre-Registration Pharmacy student, Nighat, manned the stall for a morning, talking to customers and passers by on Church Road, Redfie ld , and o f f e r i n g a d v i c e a n d information about alcohol.We also ran a raffle of alcohol-free prizes and raised £62.50 for BHF.”Congratulations to the

team - excellent work!Please let us know of any campaigns you are supporting in the advancement of pharmacy.

Pharmacy News