Suggested Learning

NPA Essential: July

This month's news

Serious Shortage Protocol (SSP) for fluoxetine tablets 10mg (SSP05) extension

The SSP for fluoxetine tablets 10mg, which was due to end on 12 June, has been extended with a revised termination date of Friday 11 September 2020.

Under the SSP, when presented with prescriptions for fluoxetine tablets 10mg, pharmacists can instead supply fluoxetine capsules 10mg.

Summary of recommended actions to prepare for dispensing in accordance with an SSP

• Ensure that all staff, including locums, who will be involved in dispensing an item in accordance with an SSP are trained and competent to do so.

• Ensure that an SSP SOP is in place and other relevant SOPs are updated, read, understood, signed and implemented by all members of the pharmacy team involved in service delivery.

• Ensure that the pharmacy team know where they can find new SSPs and/or changes to an existing SSP.

• Ensure that the pharmacy has access to an NHSmail account so that it can receive notification when an SSP is issued.

• Ensure the current version of an SSP is being used prior to supplying.

Launch of Covid-19 risk assessment and risk reduction templates

To support you in conducting risk assessments and implement appropriate risk reduction measures as relevant to their pharmacy business, the NPA has developed the Covid-19: risk assessment and risk reduction template, based on the UK government’s guidance on working safely during Covid-19. Contact the NPA’s Advice and Support team for further information via email pharmacyservices@ npa.co.uk or telephone 01727891800.

Smoking Cessation Service –new flexibility introduced due to Covid-19

An NHS Scotland circular has outlined some temporary flexibility in how the national service can be delivered and support that may be available from local specialist smoking cessation teams. The changes enable the national Scottish Community Pharmacy Smoking Cessation Service to take less pharmacy staff time and support more patients to stop smoking during the pandemic

Changes include:

• Week 1 of supply and behavioural support may commence on initial contact

• Weekly face-to-face support can now, if the responsible pharmacist considers, be less frequent and by phone or video if necessary.

• Carbon monoxide testing is be discontinued until social distancing measures enable this to be safe to do.

• More than one week of NRT or varenicline may be supplied at a time, if the RP considers appropriate, considering clinical and medicine waste risk. The recommendation is that the maximum supply is for four weeks unless exceptional circumstances.

The full data capture, at initial contact, 4 and 12 weeks maintains a requirement of the service and is crucial for recognition of community pharmacy’s contribution towards the priority public health target of reducing smoking rates in Scotland to below 5 per cent by 2034.

The circular also highlights that in some areas Health Board smoking cessation teams may be available to those pharmacies unable to support follow up data capture.


Pre-registration training programme 2020-21

The NPA’s programme is open for enrolments. We will be running study days in London, Birmingham and Manchester – where social distancing restrictions are in place, the face-to-face study days may be turned into virtual study days and delivered remotely.

London study days will take place on Sundays. Full details of the programme including venues for the study days can be viewed by going to www.npa.co.uk/training/Pre-reg

Our 2020 brochure that sets out the learning schedule and

programme delivery is available to download by going to www.npa. co.uk/wp-content/uploads/2020/05/Pre-Reg-2020-brochure-May-web.pdf

We look forward to supporting you and your student in the coming months, which due to Covid may be challenging. However, we are confident that we can deliver our training to meet your needs and have a flexible approach by using the NPA Learning Academy and webinars to support you every step of the way.

Covid-19 support

For all our Covid-19 resources, issued guidance, we recommend that you visit www.npa.co.uk/coronavirus-updates for the latest information.

We continue to tell stories from the pharmacy frontline in local and national media. Over the last few weeks NPA spokespeople have appeared on several broadcast channels and newspapers, taking coronavirus coverage by the NPA to well over a 100. If you want to tell your own pharmacy story, please contact the NPA’s press office for support press@npa.co.uk

Think “big and bold” about the post-crisis world, says NPA following consultation with independent pharmacies

The National Pharmacy Association wants pharmacies to become the starting point for most patient journeys, in the wake of Covid-19.

The call follows a number of virtual discussion forums with NPA members across the UK, ahead of talks with other pharmacy bodies, patient groups and the NHS about the future.

NPA vice chair, Nick Kaye, said: “Our discussions with members indicate a desire within the sector to go big and bold in our post-crisis offer to the nation, not just to go back to the way things were before.

“There will be a window of time to position community pharmacy decisively as the default starting point for most patient journeys, within integrated local care systems. This will help the NHS recover from the trauma of Covid-19 and bring lasting benefits.

“The health service will need to deal with the pent-up demand caused by coronavirus, including postponed elective surgery and delayed preventative interventions. Community pharmacy has a huge role to play in freeing up capacity to clear the backlog of care – especially if independent prescribing spreads its wings and better integration with other parts of primary care can be achieved.

“And with the Treasury needing to save money in the light of the massive public expenditure of the past few months, pharmacies can bring more care into the community and out of more expensive hospital-based care, if properly supported.

“Furthermore, the health system needs to be future-proofed against the inevitability of a future pandemic. This implies substantial investment in community pharmacies, which have proven themselves a key element of system resilience over the past few months.

“Some of this is about accelerating service innovations that are already underway in parts of the UK. Some of it is about thinking from first principles about the role of community pharmacy in a world that will be forever changed by the experience of this pandemic.

“Naturally, the NPA’s primary focus continues to be helping our members provide essential services in the here-and-now. However, it’s also necessary to think ahead about a long list of issues for the post crisis world.”

Resource hub

We have added two new assets to our media and advocacy resources hub www.nhsfrontline.com:

• An updated template newspaper template column, for you to personalise and send to your local press.

• An infographic summarising what pharmacies have been doing during lockdown, for you to share on social media.

The nhsfrontline website makes it easier for you, as pharmacy teams, to take part in media work and tell your own story about life on the NHS front line. It can also help you engage your local MP as an advocate for your vital work.

NPA Insurance: Helping you through the pandemic

Businesses across the UK are facing the toughest trading conditions on record as they navigate the Covid-19 pandemic - and community pharmacy has been at the epicentre of this maelstrom.

Within days of lockdown, pharmacies found themselves one of only a few essential businesses open to the public, rapidly becoming a lifeline to customers relying on them for the provision of vital medicines and clinical advice.

As a result, community pharmacy has found itself exposed to a myriad of emerging jeopardies. Over the last four months, NPA Insurance (NPAI) has acted as a sounding board and help line to policyholders concerned about the potential impact of Covid-19 on various aspects of their business.

The Professional Indemnity (PI) team has been offering guidance, reassurance and advice on Covid-related lability issues resulting from taking on additional responsibilities. These range from risks associated with the delivery of incorrect medicines and the use of non-validated testing kits through to the use of commercial cars to make urgent deliveries. The in-house claims team has also been dealing with claims as quickly as possible to minimise business interruption, facilitate cash flow and help pharmacies to remain open for business throughout the pandemic.

“Our PI team has been inundated with calls from anxious customers facing previously unforeseen liability,” explained Lisa Banks, chief operating officer at NPAI. “Pharmacies and pharmacists are taking on increasingly diverse roles to help the NHS combat the pandemic. They are understandably worried about the impact that this might have on their risk profile. We advise them that the unprecedented demands put on them by Covid do not overrule good practice and that they should take the same approach to risk as they would under ‘normal’ trading conditions.

"For example, only use validated testing kits to avoid unnecessary liability over inaccurate results. And our advice to anyone who has received a Covid-related liability claim is clear – contact us as soon as possible and do not admit liability. We will then look into the matter on their behalf.”

NPAI has also worked closely with customers to quickly resolve general insurance claims to minimise business interruption and facilitate cash flow. “When responding to breakages and break-ins, it is vital that premises are secured, made safe, re-glazed and pay-outs received as quickly as possible, so that our customers can focus on running their businesses,” explained claims manager Daryn Hughes.

NPAI has also been offering advice to property owners. It recommends that customers who own properties rented out to tenants who have not been trading during lockdown, make a visit to the premises to check that they are secure and have not experienced leakage or break-ins.

Covid-19 has had a monumental impact on community pharmacy. This invisible enemy has accelerated the rate of change the sector was already experiencing in the months leading up to the pandemic, as its integration into the overall provision of primary healthcare services gained momentum.

As community pharmacy moves on from these unprecedented times, the lessons it has learned about managing risk, while painful, will put it in good stead for the future.

Professional organisations collaborate to provide easier access to essential medicines information

Pharmaceutical Press from the Royal Pharmaceutical Society and the National Pharmacy Association are pleased to support independent community pharmacists with a special rate subscription to essential information resources through MedicinesComplete.

MedicinesComplete provides healthcare professionals access to essential medicines information online at the point of care. Easy-to-use trusted resources include: British National Formulary and BNF for Children, Stockley’s Interactions Checker and Stockley’s Drug Interactions, plus Martindale: The Complete Drug Reference and Martindale’s ADR Checker.

In response to requests, the two professional organisations have worked together to listen to independent pharmacists’ needs and create a tailored and affordable offer.

Nic Potter, sales and marketing director, Pharmaceutical Press, said: “We have been planning this release for a year, but with the current situation now is the right time to make it easier for community pharmacists to protect patient safety, by creating an enhanced offer that will allow access to our trusted evidence-based medicines information at a price that is affordable.”

Laura Sims, head of membership at the NPA, said: “We are delighted to collaborate with Pharmaceutical Press to support independent community pharmacists with a special rate subscription to selected resources online, especially during these challenging times when providing safe and effective patient care is vital.”

The special rate subscription is only available to independent community pharmacists located in England or Wales. Prices start at £275 for 1 site/premises and £455 for 2 sites/ premises. Eligibility criteria apply.

For more information about the independent community pharmacist special rate subscription and MedicinesComplete essential resources go to https://about.medicinescomplete.com/ communitypharmacyoffer

Medicines regulations need democratic oversight says NPA

In a formal submission to MPs, the National Pharmacy Association (NPA) argues that changes to regulations on medicines supply should be subject to parliamentary scrutiny, including rules about hub and spoke dispensing.

The Medicines and Medical Devices Bill, currently being examined by the Public Bill Committee, will confer power to ministers to amend or supplement medicines law, without the need for primary legislation.

A bill of this kind is seen as necessary to facilitate the uninterrupted business of government following the UK’s exit from the European Union.

However, it also opens up the possibility of important changes to the rules around medicines supply taking place without sufficient parliamentary scrutiny and democratic accountability.

This includes regulatory changes to allow inter-company hub-and-spoke dispensing, where a pharmacy outsources elements of its dispensing to a third party. The NPA has consistently warned that official claims about the benefits of inter-company hub-and-spoke are overblown and that it risks diminishing competition and choice in the pharmaceutical wholesale market without a level playing field. Other unintended consequences could be less resilience of the medicines supply system and rises in medicines prices.

NPA chief executive Mark Lyonette said: “The changes relating to the safe supply of medicines that could be implemented using secondary legislation empowered under this Bill are significant. Big changes to the way that medicines are supplied to the public could be enacted without the need for further primary legislation.

“What matters to the people of this country should matter to our politicians – and people do care about the safe supply of medicines. We want the provisions of this Bill to require both full consultation with stakeholders and sufficient parliamentary scrutiny.”

The Medicines and Medical Devices Bill will confer power to amend or supplement the law relating to human medicines, veterinary medicines and medical devices; and make provision about the enforcement of regulations. The Bill passed at second reading on 2 March and is now with the Public Bill Committee.

How the Job Retention Scheme is changing

As more businesses are unleashed from lockdown, Chancellor Rishi Sunak has laid out the government’s plans to gradually withdraw the Job Retention Scheme.

According to data, one million firms are currently utilising the scheme, which has now been extended until October. What does the future of furlough look like?

Employer contributions

With 8.4 million workers having been furloughed by their employer at a cost of around £14 billion per month, the Chancellor has announced that from August, employers will be asked to foot some of the bill.

While workers will continue to receive 80 per cent of their regular wages up to £2,500 for the remainder of the scheme, from 1 August, employers will be required to cover National Insurance and minimum pension contributions for employees who remain on furlough, in the way that they normally would before the scheme was introduced.

In addition, businesses still utilising the scheme in September will have to contribute 10 per cent towards the 80 per cent wage subsidy, rising to 20 per cent in October. In other words, in September, employers will have to contribute 10 per cent up to £315.50 and the government will cover 70 per cent up to £2,187.50. In October, employers will have to put in 20 per cent up to £625 and the government will fund the remaining 60 per cent up to £1,875. As usual, employers can choose to top-up their contributions so that the employee receives 100 per cent of their regular wage if they wish.

While many will have been relieved to see the scheme extended, a survey by the Institute of Directors has suggested that a quarter of members utilising the scheme will struggle to fund any percentage of payments, leading to difficult decisions for employers. Indeed, though the scheme’s fundamental aim was to prevent mass lay-offs, once employers’ costs start to increase, tough questions will need to be asked as to whether it is viable to keep an employee on, meaning more redundancies may be inevitable from as early as mid-June.

There are technicalities surrounding making an employee redundant during furlough, so speak to an employment law specialist before taking this route. 

‘Flexible furlough’

Although certain businesses have been given the green light to re-open, in sectors such as retail it is likely to be some time before customer demand returns to pre-crisis levels. Because of this, plus the fact that some will be operating with a reduced workforce in order to meet social distancing guidelines, employers argued for the scheme to be more flexible.

In response to pressure from business groups now that more sectors are re-opening, the Chancellor has announced that furloughed staff will be allowed to return part-time from July – rather than August as initially suggested – without losing out financially.

In practical terms, furlough will only be payable for the hours that an employee is NOT working. Any part-time work undertaken by the employee while furloughed should be paid by the employer at their full rate of pay, and this amount should be deducted when claiming. This will allow employees to earn more than the 80 per cent furlough pay and allow businesses to bring staff back as they gradually restart their operations.

The minimum claim period for flexible furlough will be one week but longer claim periods are permitted.

For more information contact the NPA Employment Advisory Service on 0330 123 0558 or email employmentadvice@npa.co.uk

Heatwave Plan for England now includes new Covid-19- specific resources

The Heatwave Plan for England, remains the same as for previous years; however, new Covid-19-specific support resources have been added for summer 2020...

The Department of Health and Social Care (DHSC), Public Health England (PHE), and NHS England (NHSE) have published additional resources specific to Covid-19, to support the Heatwave Plan for England. The following are some of the new additions, which might be useful for pharmacy teams:

• “Heatwave Plan for England” guidance

• “Beating the heat: Coping with heat and Covid-19” poster and leaflet

• “Heat-health risks and Covid-19: action to prevent harm” guidance

• “Advice for health and social care professionals: supporting vulnerable people before and during a heatwave” guidance

Specific guidance on heatwaves in relation to Covid-19

Excessive heat can be harmful to people and medicines. Due to the government’s measures on social distancing, shielding and staying at home, the following additional considerations are advised on how to cope with a heatwave during these unprecedented times:

• Ensure pharmacy teams wearing any personal protective equipment (PPE) for a long time keep themselves hydrated – prolonged PPE wearing can lead to dehydration. If needed, consider whether it is possible for the staff to undertake activities where PPE may not be required so they can take a break from wearing it.

• Ensure appropriate procedures are in place, within the pharmacy’s business continuity plan, to minimise medicines exposure to excessive heat, and combat excessive heat.

• Ensure pharmacy stock is stored correctly and promptly after each wholesaler delivery.

• Ensure pharmacy fridges, and thermometers are working correctly. It is advisable to monitor ambient room temperature as well.

• Ensure air-conditioning systems work properly, and/or open doors and windows as much as possible – please read the latest NPA FAQs on fans and air-conditioning below.

• Ensure appropriately trained members of the pharmacy team can advise customers on preparing for and coping with a heatwave.

• Ensure pharmacy teams are aware of the steps to take following someone experiencing a heatstroke.

Heatwave FAQ:

Can we use portable fans in the pharmacy due to the hot weather?

Although there is no specific advice on the use of fans in community pharmacies, the following points may be considered as there is evidence that portable fans are linked to cross infection in health and social care settings:

• A Medicines and Healthcare products Regulatory Agency (MHRA) Central Alerting System (CAS) alert from January 2019 advises to clinically risk assess each use of all portable fans, including bladeless and electric motor/conventional bladed fan. Further action is detailed within the CAS alert, which includes, ensuring fans are maintained and decontaminated correctly.

• Public Health England (PHE) advises avoiding the use of fans that re-circulate air in hospital settings in order to reduce the risk of Covid-19 transmission.

• Good ventilation should be encouraged by opening windows and doors regularly if possible.

Can we use air-conditioning systems in the pharmacy?

The following guidance has been published for using air-conditioning systems in retail settings, including pharmacies:

• If you have a centralised ventilation system, it is recommended that the air-conditioner uses a fresh supply of air instead of recirculating it.

• Check whether your ventilation system requires a service or adjustment.

• The majority of air-conditioning systems will not require adjustments; however, if a system covers several buildings, or you want to double-check, contact the heating ventilation and air conditioning advisor/engineer.

• Good ventilation should be encouraged to minimise infection risk.

For further information on this or any other query, please contact the NPA Pharmacy Services team on 01727 891 800 or email pharmacyservices@npa.co.uk

Picture: FG Trade (iStock)

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