A message from NPA chief executive Mark Lyonette - you are heroes in this dark hour

As the impact of coronavirus continues to spread in our communities, pharmacies are coming under intense, almost unbearable pressure. At the NPA, we know this very well - and we are doing all that we can to help you...

We are taking hundreds of telephone calls daily from members needing the latest advice. And don’t forget we also open on Saturday mornings as well as during the week.

• As NPA members you have access to free of charge employment law advice.

• NPA Insurance is going out of its way to accommodate your needs in this rapidly evolving situation.

• We are also in constant dialogue with government, NHS and regulators, as well as telling your story in the media.

Our main message to the public right now is that you are serving the country with great courage and professionalism, but that your stamina and resources are not inexhaustible.

You need customers and patients to be considerate to you and to each other which, of course, includes not entering a pharmacy if you have coronavirus.

You need help from government too – urgent help that will enable you to continue to help others. This has started, but much more needs to happen to keep the show on the road.

Please keep an eye out for our emails with all the latest information about coronavirus, community pharmacy and the wider picture. We also maintain a website information hub which you can find from our homepage.

Now, more than ever in our 100 years history as the NPA, we are proud to represent and support you – heroes in this dark hour.

The NPA is here for you.

These are exceptional times. We have moved our resources and priorities to be able to best support members in every way possible as you face these daily challenges.

From resources and guidance, advice through our Pharmacy Services, Claims, and Employment and HR Teams, we’re here for you. We have plans in place to continue our service to you if we suffer further restrictions to staff movement, or reduced staffing, as our support to our members is paramount.

There may be some delays to non-emergency support and routine tasks, as we move staff to more critical tasks, so please bear with us.

Pharmacy in the media

The NPA press office is working hard to respond to the many requests from the media, and to show the daily challenges independent community pharmacies are facing as this crisis deepens. Most of the major media outlets have by now carried our key messages, but we continue to seek opportunities to tell the pharmacy story, as do other pharmacy bodies.

If you want to get your own story out there (for example via local newspapers or local radio/TV), we can help. Simply email press@npa.co.uk.

Here are some key messages you might wish to get across in your own words:

1. Pharmacies are on the frontline of the national effort to limit the impact of coronavirus and to keep people well.

2. Pharmacy teams are there for you in this crisis. But while pharmacists may be acting heroically, they are not invincible, so please remember to respect their safety and do not to go to the pharmacy if you are, or might be, infected with coronavirus!

3. Please be patient with pharmacy staff, who are doing their utmost, under extreme pressure, to support you at this time. Treat them with courtesy, as you yourself would wish to be treated.

4. Please only buy the medicines you need now for you and your family. This will help to avoid creating difficulties for others, so that everyone in your community gets the medicines they need.

Key considerations for delivering medicines

Identify the risks

• Check to see if your delivery drivers are in the ‘at-risk’ group or aged 70 years old or over – follow the latest Government advice for these groups of individuals which recommends social distancing

• Ensure that your delivery drivers have access to, and understand, the latest advice from the government on coronavirus (Covid-19) • Ensure delivery drivers are equipped with hand hygiene products and antiseptic wipes

• Carry out risk assessment of patients who require a delivery on a case-by-case basis – decide the best way to make the delivery safe • Review the requirement for collecting signatures from patients (see further details below)

• Update your Business Continuity Plan in line with any amendments made to your standard operating procedures (SOPs)

• Any new process must be communicated to pharmacy staff and drivers as well as locums.

Doorstep deliveries

When making a delivery, it may be left on the patient’s doorstep. The delivery driver can wait at a safe distance (>2m) until it has been collected from the doorstep by the patient/carer, and then make a note in the delivery record to confirm that it has been delivered.

Confirming who has accepted the medicine (patient, carer or family member) is also a good idea and an additional safeguard in case of future queries.

Requirement to obtain a signature

It is good practice but not a legal requirement for a patient/representative to sign for the medicines (and/or devices) at the point that it is handed to them as confirmation of receipt. You can temporarily relax this requirement in your SOP and look at different ways of making and confirming delivery to the patient. A review date for this temporary relaxation should be included in your revised SOP. Following the end of the current pandemic situation, the SOP should revert to your usual processes during the recovery phase of your business continuity plan.

Delivering Controlled Drugs, highrisk medicines and temperaturesensitive medicines

• For delivering CDs, especially Schedule 2 CDs, the delivery driver should note the name of the individual who collects the medicine from the doorstep and record it in their delivery record. This can be done instead of collecting the patient/carer signature for delivering Schedule 2 CDs

• A further safeguard could include the pharmacist contacting the patient before and after the delivery to ensure that the patient is aware of the impending delivery of their CD medication, as well as to confirm afterwards that the patient has received the CD items

• Similarly, the name of the person picking up the doorstep delivery should be recorded for deliveries of temperaturesensitive medicines such as insulins or other fridge lines

• This process could also apply to any ‘high-risk' medicines with potential for misuse.

Electronic delivery support devices such as the Pro Delivery Manager available via the NPA

NPA members using Pro Delivery Manager (PDM) can use the functionality to flag to delivery drivers if the patient they are delivering to is in isolation/self-isolating. PDM will also give the driver a default delivery note which will give instruction by the pharmacist on how to adhere to their SOP.

For further information please contact the NPA Pharmacy Services team on 01727 891800 or email pharmacyservices@npa.co.uk

Community Pharmacy Home Delivery Service during the Covid-19 outbreak

NHS England & NHS Improvement (NHSE&I) have commissioned a Community Pharmacy Home Delivery Service to operate during the COVID-19 outbreak. The service specifications and detailed guidance were published on 10 April 2020.

The service is designed to support shielded patients in England to access their prescribed medicines and appliances while they are self-isolating at home during the pandemic period. The service will run until 1 July 2020 initially, although it may be extended beyond this date following a review. Distance-selling pharmacies (DSPs) are excluded from the service.

Both the Essential Service and Advanced Service are not applicable to DSPs as they are already contractually required to delivery prescription items to patients. They are, however, able to deliver prescriptions on another pharmacy’s behalf where that pharmacy has exhausted all other options for delivering the prescription.

How will the service be delivered?

There are two aspects to the Community Pharmacy Home Delivery Service during the COVID-19 Outbreak:

• The Essential Service requires pharmacies to ensure that prescribed items are delivered to shielded patients via a duly authorised person. This can be the patient’s carer, relative, friend, neighbour, or a volunteer such as NHS volunteer responder where appropriate.

• The Advanced Service allows pharmacies to choose or opt-in to provide a ‘paid for’ delivery service if the pharmacy is not able to facilitate delivery of the prescribed items to shielded patients via the Essential Service route.

Who can access the service?

The Community Pharmacy Home Delivery Service is available to patients who are self-isolating at home, having been identified as being extremely vulnerable (shielding). Those who have received a letter from the NHS, their GP or hospital consultant identifying them of their vulnerable status are eligible for this service.

Note that:

• GPs are able to add or remove patients to the extremely vulnerable list as their clinical condition changes.

• A flag has been added to the NHS Summary Care Record (SCR) of these patients, to confirm that they are an eligible patient; this SCR flag went live on 3 April 2020.

Further guidance and a template SOP will be available from the NPA to support you in implementing this new service. Go to www.npa.co.uk/coronavirus-updates/ for further details

- We are constantly feeding ‘pharmacy heroes’ stories to national and local media – telling them how pharmacy teams are going above and beyond during the coronavirus pandemic. Please share your stories and photos with us. Email press@npa.co.uk

Financial measures available to community pharmacies during the Covid-19 crisis

Following the announcement by the Chancellor on 17 March, there are a number of financial measures available to help businesses, including community pharmacies, during the Covid-19 crisis. Outlined below are some of the support measures available.

1. Support for businesses which are paying sick pay to employees

Details: You will be able to reclaim Statutory Sick Pay (SSP) paid for sickness absence due to Covid-19. This refund will cover up to 2 weeks’ SSP per eligible employee who has been off work due to Covid-19. Eligibility: Companies with fewer than 250 employees as of 28 February 2020.

2. Support for businesses through the Coronavirus Business Interruption Loan Scheme (BILS)

Details: The temporary BILS is availabe through 40 commercial lenders (and backed by the government-owned British Business Bank). It will support small/medium business owners with access to loans, overdrafts, invoice finance and asset finance of up to £5 million and for up to 6 years.

The government will also make a Business Interruption Payment to cover the first 12 months of interest payments and any lender-levied fees, so smaller businesses will benefit from no up-front costs and lower initial repayments. Finance terms are up to six years for term loans and asset finance facilities. For overdrafts and invoice finance facilities, terms will be up to three years.

Eligibility: Your business must be UK based, with a turnover of no more than £45 million per year. Additional British Business Bank criteria: You will need to have a borrowing proposal which, were it not for the current pandemic, would be considered viable by the lender, and for which the lender believes the provision of finance will enable the business to trade out of any short-to-medium term difficulty.

3.1: Support for businesses through deferring VAT payments

Details: VAT payments due between 20 March and 30 June 2020 may be deferred with no penalties or interest for late payment charged in the deferral period. Note this does not apply to import VAT. You must pay the deferred VAT due on or before 31 March 2021. You do not need to inform HMRC but if you normally pay by Direct Debit you will need to cancel the instruction, and you will still need to submit your VAT returns to HMRC on time. HMRC will continue to process VAT reclaims and refunds as normal during this time. Eligibility: UK VAT registered businesses

3.2. Support for businesses through deferring Income Tax payments Details: Payments due as part of Income Tax Self- Assessment on the 31 July 2020 can be deferred until 31 January 2021. Eligibility: All UK tax payers

4. Support for businesses paying tax: Time to Pay service

Details: Support is available for your tax affairs through the HMRC Time to Pay Service. This can include agreeing an instalment arrangement, suspending debt collection proceedings, and cancelling penalties and interest. The support is agreed on a case-by-case basis and are tailored to individual circumstances and liabilities. Eligibility: All businesses and self-employed people in financial distress, and with outstanding UK tax liabilities, may be eligible for support.tax liabilities, may be eligible for support.

5. Support for businesses through the Coronavirus Job Retention Scheme

Details: Support available to continue paying part of your employees’ salary for those employees that would otherwise have been laid off. HMRC will reimburse 80 per cent of the wage costs of furloughed workers, up to 2,500 per month. Eligibility: All UK employers

6. Small Business Grant Scheme

Details: There are two schemes available from your Local Authority:

a. The Small Business Grant Fund, with one-off grants of £10,000 to all eligible businesses.

b. The Retail, Hospitality and Leisure Grant Fund, with grants of £10,000 to businesses with a rateable value up to and including £15,000 and a grant of £25,000 to businesses with a rateable value over £15,000 and less than £51,000.

Eligibility: Small Businesses Grant – all businesses in England that occupy a property and who are in receipt of Small Business Rates Relief (SBRR) and/or Rural Rates Relief (RRR). In Scotland, all businesses that get Small Business Bonus Scheme relief and/or Rural Relief. Retail, Hospitality and Leisure Grant – all businesses in England that operate in retail, hospitality and/or leisure (including pharmacies). In Scotland pharmacies are not specifically listed in the eligibility/ineligibility criteria. Recipients eligible for the Small Business Grant Fund will not be eligible for the Retail, Hospitality and Leisure Grant.

7. Business Rates Holiday for Retail, Hospitality and Leisure (taken from gov.uk)

Details: Businesses in the retail, hospitality and leisure sectors in England will not have to pay business rates for the 2020-21 tax year. Businesses that received the retail discount in the 2019-20 tax year will be rebilled by their local authority as soon as possible.

Eligibility: You will be eligible if:

a. Your business is based in England AND

b. Your business is in the retail or hospitality sector. Properties that will benefit from the relief will be those that are wholly or mainly being used: i. As shops, restaurants, cafes, drinking establishments, cinemas and live music venues, ii. For assembly and leisure; or iii. As hotels, guest and boarding premises and self-catering accommodation.

For more information on how to apply for the various support measures available go to www.npa.co.uk/news-and-events/ news-item/financial-measures-availabletocommunity-pharmacy-during-covid-19/

For business support in Scotland, Wales and NI please also refer to our website.