March 2014 CPN by Community Pharmacy England

CPN

Community Pharmacy News – March 2014

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CPN Your monthly round up of news and information for Community Pharmacy Wakeﬁeld blood pressure | Smartcard special feature | Prescription Submission campaign Factsheet

PSNC’s work

Community Pharmacy Future 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:

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PSNC: NHS must use pharmacy 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.

Future of the New Medicine Service NHS England has been considering the short term future of the new medicine service (NMS), in discussion with PSNC.

• £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.

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.

Commenting on the results, PSNC Chief Executive Sue Sharpe said:

This means that pharmacy contractors can continue to provide the NMS to all eligible patients.

“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.”

2 Community Pharmacy News – March 2014

PSNC Elections Voting 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 news and information visit

psnc.org.uk

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PSNC Comments Review PSNC 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.”

lPCs

PSNC takes to twitter Pharmacists 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-NEWS To 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

Royal Pharmaceutical Society members and others can read the full article on the Pharmaceutical Journal website via: tinyurl.com/cpswotanalysis www.twitter.com/psncnews

psnc.org.uk 3

PSNC’s work

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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-toone 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

4 Community Pharmacy News – March 2014

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.

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.

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.

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lPCs

Paving the way for pharmacy: Part 3: South Yorkshire’s Respiratory Service The latest in our series featuring the winners of last year’s PSNC Evidence Awards sees Nick Hunter, Secretary of Doncaster and Rotherham LPCs, telling us about a Respiratory 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

Nick Hunter on…

1,616 consultations took place between September 2012 and March 2013.

… the decision to base service payments on data collection “It’s human nature… if you’ve got no incentive to do something, then you get on with the things where you have got an incentive to do them… [so] the fees were a ‘no data, no payment’ system.”

83% of respiratory service consultations took place as part of an 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 improvement in their Inspiration Rate Change after their consultation More than 1,000 patients met their target Inspiration Rate during one consultation Over half of patients used reliever inhalers at least once a day Almost 80% of patients were given at least one intervention by the pharmacist

… the beneﬁts of data collection “[The data] has been vital to bring to discussions with new commissioners… there is a much bigger pot now available to [the Respiratory Service]. Had we not got that report, then we wouldn’t have got the commissioners’ interest in re-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.”

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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.

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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

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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.

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Ongoing Branded Medicine Supply problems At 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 relation to trading medicines in short supply and supply chain best practice guidance. psnc.org.uk 7

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Ask PSNC – Smartcards Special The 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

April 2014 Category M prices 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)

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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

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.’

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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-bystep guide to where you will ﬁnd the updated pages on our website.

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Changes to Supplementary Opening 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).

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. No part of this publication may be reproduced without the written permission of the PSNC. Produced for the PSNC by Communications International Group. ©. PSNC. Colour repro and printing by Truprint Media, Margate. The publishers accept no responsibility for any statement made in signed contributions or in those reproduced from any other source.

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.

Distributed for PSNC by:

Communications International Group Linen Hall, 162-168 Regent Street, London W1B 5TB Tel: 020 7434 1530 Fax: 020 7437 0915

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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.

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.

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

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 01256302699 or email direct@macmillan.co.uk.”

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 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 name and pack size) in future. 10 Community Pharmacy News – March 2014

• • • • • • • • • • • • • • • •

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

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Wakefield urged to drop in for blood pressure test With 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 dropins 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.

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.”

There are a number of steps people can take to help manage

RNIB supporters create top tips for healthcare 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

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.”

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Declaration of Competence (DoC) framework for locally commissioned services Commissioners, 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 selfassessment 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 frameworks prepared (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 the following 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 the following DoC frameworks: • • • • •

NHS Health Checks Oral Contraception Cancer Awareness and Screening Weight Management Care Homes

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Payment Factsheet 1: Prescription Submission 1. Daily dispensing checks: Below is a checklist of actions recommended to take before submitting your account for payment and could help to improve the accuracy of pricing.

DO ✓ ✓ ✓ ✓ ✓ ✓

✓

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 cartridge need 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 and that the product name is clearly crossed out by a horizontal 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 avoid prescriptions being switched. Declarations are required unless the patient is age exempt and the 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 is required, as part of the dosage instructions rather than as part of the name of the prescribed product (see picture). As reimbursement of electronic prescriptions is based on the product code of the prescribed product, supplementary product information included in the prescriber’s dosage instructions will not be considered when calculating payment; therefore prescribers should be encouraged to select the correct product to prescribe in the ﬁrst place. (This is of particular importance when handling EPSR2 electronic prescriptions.) If possible, highlight and remove all red separator prescriptions during the day’s dispensing.

DO NOT ✗

✗

Do not put labels or sticky notes on prescriptions during the dispensing process. The residual glue can aﬀect the scanning process. Do not mark the prescribing area of the prescription form with ticks or other marks during the dispensing/ checking process as these could aﬀect how the prescription is priced (see picture).

Avoid putting any information regarding quantities owing in the endorsement column as these could be interpreted as quantity dispensed. You could record owing information on your PMR system or attach a removable owings slip instead. Do not make endorsements (printed or handwritten) on any other part of the prescription form other than the designated left hand column only as there is a chance that these may not be seen during pricing. Also, if endorsements encroach onto an item on the prescription form, it can aﬀect pricing of that item.

*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 Do NOT do this 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. psnc.org.uk 13

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*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.

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You may ﬁnd this diagram useful to help you organise your prescription bundle groups:

• 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) 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: DO ✓ ✓ ✓ ✓

✓

✓ ✓ ✓ ✓

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 of items declared should be adjusted to take into consideration any additional fees due (e.g. if an 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 claim message by midnight on the 5th of the following month but had been dispensed before the 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 the forms/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.

4. Dispatching your prescription bundle:

DO NOT ✗

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Do not borrow/ photocopy anyone else’s as each barcode is specific to one pharmacy for one month. Do not separate out EPS and paper prescription figures, these should be totalled and included in the total figures entry. Do not include the number of ETP tokens or the number of RA forms in your form/items declaration. These are not used for payment. Do not include items on resubmitted forms which are not being queried. This is because payment will already have been received for all other items on returned copies of prescriptions. Do not include electronic prescriptions if the claim message was submitted after midnight on the 5th of the following month. A good example to follow

• 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). Correct as of March 2014. See psnc.org.uk/cip for the most up-to-date information. PSNC website For 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 9AW Community 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 PSNC Oﬃce: 0844 381 4180 or 0203 1220 810