Things to do and things to know in community pharmacy across the UK
Serious Shortages Protocol following NHS Contract Amendment in England
The National Health Service (Amendments relating to Serious
Shortages Protocols) Regulations 2019 (the NHS SSP 2019) came
into force from Monday 1 July 2019.
These regulations amend aspects of the NHS terms of service for
community pharmacists, NHS dispensing appliance contractors,
dispensing doctors and mandatory terms for Local Pharmaceutical
Services schemes, in relation to SSPs. They also amend the NHS
(Charges for Drugs and Appliances) Regulations 2015 (known as
“the charges regulations”).
SSPs allow for alternative arrangements to be put into place
for supply of a drug or appliance ordered on a prescription where
there is, or may be, a serious shortage of that drug or appliance.
Legislation governing SSPs was introduced in early 2019 as part of
no-deal Brexit planning, but it is not dependent on it.
The Human Medicines Regulations 2012 (known as “the 2012
regulations”) have already been amended under The Human
Medicines (Amendment) Regulations 2019 to allow pharmacists
from a retail pharmacy business to supply a different Prescription-
Only Medicine (POM). The NHS SSP 2019 regulations laid before
parliament now extend the scope of SSPs to all drugs and appliances
that may be dispensed as part of providing pharmaceutical services
in England, not just POMs.
Early May bank holiday 2020 – change
The early May bank holiday is set to move to Friday 8 May 2020
from Monday 4 May 2020 to coincide with the 75th anniversary of
victory in Europe (VE) day on 8 May 2020. The movement of the
bank holiday will allow people to pay tribute to current and previous
members of the UK armed forces. The change in bank holiday is
only applicable to England, Wales and Northern Ireland.
Pharmacy contractors should be aware that the change in bank
holiday may impact normal service and in particular may affect
the dispensing of controlled drug (CD) instalment prescriptions
on days when the pharmacy is closed. The NPA Pharmacy Services
team has developed guidance on the dispensing of instalment CD
prescriptions over bank holidays.
Yellow Card Scheme
The Medicines and Healthcare products Regulatory Agency (MHRA)
is asking community pharmacy teams to share two videos it has
produced, which highlight the Yellow Card Scheme, with patients.
The Yellow Card Scheme is an essential tool that the MHRA uses
to monitor the safety of medicines, medical devices and herbal
NHSmail password validity – extended to 365 days
NHS Digital has reduced the frequency of NHSmail password
changes through a new password policy. The policy has been
changed in line with National Cyber Security Centre (NCSC)
guidance which states that frequent password changes can harm,
instead of improve security.
NHSmail users will receive email reminders to change their
password within 45 days of the policy coming into effect. New
passwords will expire after 365 days instead of the current 90 days.
In addition, they must meet the following requirements:
• Be a minimum length of 10 characters which do not require a mix
of character types
• Not match the previous four passwords
• Not be identifi ed as a common password, eg password123
• Not be identifi ed as a password that has been breached (a
password which was used for a previously compromised account).
NCSC suggests that a memorable and strong password can be
created using three random words which hold personal signifi cance
to the user so that others cannot guess the password.
Pharmacy teams should be aware that failure to change their
passwords following the reminder emails will result in an expired
password which will need to be changed at the next login attempt
For further information please contact the NPA Pharmacy
Services team on 01727 891 800 or email
What independents need from the pharmacy contract in England
The NPA is urging everyone involved in
negotiating the community pharmacy
contractual arrangements for England to:
Be ambitious and don’t accept that
decline is inevitable
This is a significant moment in the long
history of community pharmacy and we
hope all parties to the negotiation will be
ambitious about the future. Decline is not
inevitable. Instead, we want to see techenabled
community pharmacies, better
integrated with other health services,
operating effi ciently as neighbourhood
health and wellbeing centres, providing
excellent patient care and recognised as
the front door to the NHS. The contract
negotiations now underway are a chance to
make a decisive shift, incentivising clinical
services, integrated with safe access to
Be fair to independent pharmacies
The current system does not deliver the
margin element of funding equitably
across the sector. Most independents are
disadvantaged by averaging, because
smaller businesses cannot easily spread
risk or hope to have losses averaged out.
That means they are at the mercy of
factors beyond their control, such as hikes
in medicines prices and branded generic
prescribing. A model in which a smaller
proportion of funding is derived from
margin should be explored.
Provide clarity and certainty
A successful outcome to the negotiations
would include a clear direction on clinical
service development, as well as a multi-year
funding settlement, to give pharmacy
owners the confidence to invest in services
that will meet the priorities described in the
NHS Long Term Plan.
Provide sufficient and sustained
funding for change
Funding has been declining for several
years, despite the increasing cost of doing
business, which has led many pharmacies
to reduce service levels and cut staff. The
current, dire financial situation is a powerful
disincentive to pharmacy owners to invest in
NHS services. More funds should be made
available to community pharmacy where we
can demonstrate that the sector is delivering
on NHS priorities. To make the necessary
investments in staff, services and tech,
pharmacy owners need to know there is a
realistic prospect of a return.
Act with urgency
Day by day, the gap is growing between
what pharmacies have the capacity and
impetus to achieve and what NHS England
wants them to deliver. An urgent response
is required to stop irreparable damage to
the network. One change that could make
a difference relatively quickly is reform of
the concessionary pricing system, to ensure
accurate and prompt payments and give
pharmacies more forward visibility, plus
assurances that they will not be working
at a loss.
The NPA has written to the PSNC with
a more detailed description of how we
view the contractual framework and the
future position of independent community
pharmacy in England.
The PSNC performs its very diffi cult
functions diligently, seeking to balance the
needs of all contractors, so we are confi dent
it will take our views into account as it
continues its negotiations with NHS England
and the Department of Health & Social Care.
NPA at the APPG
The NPA joined other pharmacy bodies
at a recent All Party Pharmacy Group
(APPG) event at the House of Commons
in Westminster to discuss the NHS longterm
The NHS is planning for the next decade but
many pharmacies are currently managing
only on a month-by-month basis because
of overwhelming pressures on their funding
and rising medicines costs.
Mark Lyonette, the NPA chief executive, told
MPs: “A new, multi-year, funding settlement
for community pharmacies in England
is needed, to give pharmacy owners the
confidence to invest in services that will
meet the priorities described in the plan.”
Community pharmacy sector
concerned about new tax proposals
The NPA, alongside the Company Chemists’
Association (CCA), the Association of
Independent Multiple Pharmacies (AIM), the
Royal Pharmaceutical Society (RPS), Team
Locum and Locate a Locum have issued a
joint response to an HMRC consultation
highlighting concerns about how proposed
changes to tax law might impact the sector.
HMRC consulted on its proposals for
implementing changes to tax law known
as IR35, or “off-payroll” working rules,
between 5 March to 28 May 2019.
From April 2020, medium and large
businesses (companies employing more
than 50 people) will become responsible
for assigning the tax status of locums
contracted through their own limited
company, to refl ect the correct employment
However, there are other changes taking
place with HMRC conducting a wider review
of the use of self-employed locums which
could affect a larger proportion of the sector
than the IR35 reforms.
Our response to the off-payroll
consultation identified that:
• HMRC needs to ensure that the Check
Employment Status for Tax tool (CEST),
which is being promoted as the means
of determining tax status, is fit for
purpose. We believe that this tool is not
refi ned enough to meet the needs of the
community pharmacy sector. Those using
the tool need to be confi dent that it’s
accurate and fair in all cases.
• We have signifi cant concerns that,
following these reforms, the flexibility of
the pharmacy workforce may be affected
to the extent that it disrupts the necessary
supply of medicines and services to
• The IR35 reforms are complex changes
which will be diffi cult to embed across the
diverse populations of workers that exist
in the private sector.
We need HMRC to provide a detailed
timetable for rolling out the reforms and
clear, ongoing, communications about
how to prepare.
What actions should locums and
‘engagers’ (or employers) take?
Don’t assume your tax status if you’re
self-employed or a locum. If you are an
employer, don’t assume the status of those
• Make yourself aware of what your
CEST determination is. Access it here:
• Visit the government’s website and read
about IR35: https://www.gov.uk/topic/
• Read the HMRC’s guide for organisations
that sets out what actions they should be
taking now to prepare for the changes
ahead of April 2020. You can fi nd this at
• Keep an eye out for further messaging
including the HMRC’s publication of draft
legislation and the summary of responses
to the consultation.
Many people today choose to work in a
more fl exible and diverse way. This can
mean that determining the employment
status of workers who are directly
contracted or engaged via third party
service providers has become more complex.
Employment status can have an impact on
the way in which tax and national insurance
is paid and, in some cases, the amount
paid. The IR35 regulations were introduced
in 2000 to address this variation and bring
equity between the amount of tax paid by
employed and off-payroll workers for doing
the same role, in the same conditions.
Employed pharmacists pay their tax through
salary deductions and the ‘pay as you earn’
(PAYE) system. Many pharmacy contractors
use locums to provide ad hoc cover for the
duties of employed pharmacists. Locums
may be working ‘off-payroll’, either as selfemployed
individuals or through personal
service companies they’ve set up and,
currently, they are responsible for determining
the employment status of their engagement.
Changes to the IR35 regulations
The Chancellor announced reforms to
the IR35 regulations in 2018 to increase
compliance and bring the private sector
into alignment with the public sector. From
April 2020, medium and large businesses
(companies employing more than 50 people)
will become responsible for assigning the tax
status of locums contracted through their
own limited company, to refl ect the correct
employment status position.
For more information, please
contact the NPA’s Employment
Advisory Service on 0330 123 0558 or
The NHS issued guidance for local pharmaceutical committees
on how to help contractors get involved with primary care
NHS England and NHS Improvement want LPCs to help
pharmacies “on a local footprint” to engage collectively with a
• Engaging with CCGs and local medical committees.
• Starting the conversation with local contractors.
• Understanding mutual benefi ts and local priorities.
• Agreeing ways of working between community pharmacies. There
are expected to be an average 10-11 pharmacies per PCN.
An NPA spokesperson said: “The fact that the NHS has issued
this guidance to LPCs shows that it sees community pharmacy as
a signifi cant player and wants community pharmacies to be fully
engaged with PCNs when the time is right. This guidance suggests
sensible preparatory steps for LPCs to take and we look forward
to further guidance in due course. We don’t yet have a complete
roadmap to PCN engagement, but in truth there is bound to be an
element of learning as we go. What’s important at this stage is to
make a start. This is a good start.”
According to the guidance, the opportunities for integrated
working with PCNs will include:
• Urgent care and minor illness
• Prevention and public health
• An increased clinical role
• Medicines safety and optimisation.
Collaboration with non-GP providers, such as community
pharmacies, will be a requirement for PCNs from April 2020.
A further briefing aimed at pharmacists and pharmacy technicians
across the NHS, including those working in community, general
practice, mental health, care homes, hospitals and commissioning
organisations, has also been published on the NHS England website.
It states: “As community pharmacy focuses more on its clinical role
of managing the minor illness aspects of urgent care; helping to
improve safety, outcomes and value from medicines; and supporting
patients to prevent ill health, it will need to have strong links with
PCN clinical pharmacists.”
NPA members may know that Michael Lennox, the chief officer of
Somerset LPC, is working with the NPA, on a part time basis, to help
independent community pharmacists get to grips with emerging
NHS structures such as PCNs and integrated care system (ICSs) at a
local level. At the same time Michael has a part time role at PSNC
where he will be helping to shape its PCN strategy and support for
LPCs. This should facilitate further close working between the NPA
and PSNC and ensure that our PCN support is all aligned. Michael
will help the NPA to:
- Support independent representatives on LPCs.
- Inform and educate NPA members about the opportunities and
threats that exist within the NHS long-term plan, the GP contract
and the development of integrated care systems.
- Work co-operatively with the National Association of Primary
Care and others on a joined up plan to help the sector make the
most of the long-term plan.
Go to www.npa.co.uk/news-and-events/past-events to see
the NPA’s lastest webinar on primary care integration.
How to have a stress-free summer
As an employer, you may be anxious
about the chaos that this time of year
Between weddings, barbeques and
trips abroad, work can often take a back
seat, leaving you to deal with a loss of
productivity and costly absences.
Here’s some advice on overcoming
summer HR challenges.
1. Distracted employees
With better weather and a jam-packed
sporting calendar, employees may be
more tempted to pull out their phones to
check the latest score or make plans for
It’s important to have a clear policy on the
use of mobiles phones. You may wish to:
• Restrict the use of mobile phones to rest
breaks or emergencies.
• Require that phones are kept on silent or
switched off during working hours.
• Ask that employees leave their phones in
a locker or staff room.
Of course, you may want to take a more
generous approach by allowing employees
to watch an important match as a one-off
social event or permitting an extra-long
2. Employees pulling sickies
If you suspect that a ‘sick’ employee is, in
fact, making the most of the weather, avoid
making allegations without clear evidence.
By jumping to conclusions, the employee
may have grounds to suggest that such
allegations constitute a breach of trust and
confi dence, and could make a claim for
constructive dismissal if they have been
employed for more than two years.
If you do have clear evidence, such as
photographs on Facebook, this should be
dealt with as a disciplinary issue.
What can I do?
Taking proactive steps to discourage
absences will avoid having to resort to
sleuthing on social media. Consider:
• Improving visibility by ensuring line
managers log all absences, including
reason and duration.
• Measuring and reporting on absence
by calculating employees’ Bradford
Factor scores, which will highlight repeat
instances of short-term sick leave.
• Conducting return to work interviews
to show employees that their absences
have been monitored, that managers
are recognising specifi c trends and that
disciplinary action may be taken.
3. Hungover employees
What employees do in their own time is up
to them; however, if they turn up to work
hungover, it immediately becomes your
What can I do?
As summer approaches and there are more
occasions to drink, minimise disruption to
your pharmacy by:
• Reminding employees that alcohol can
stay in the bloodstream for up to 24 hours
and that drinking heavily may render them
unfit for work.
• Creating an alcohol policy that outlines
what constitutes a violation and clearly
explains the consequences.
• Keeping written records of incidents to
support disciplinary action if required.
For advice on overcoming summer
employment challenges, contact
the NPA Employment Advisory
Service on 0330 123 0558 or email
Sign up for the NPA’s pharmacy
undergraduate training programme
The NPA’s pharmacy undergraduate training programme is
open for enrolments.
The course has been created to enable pharmacy employers to
provide a structured training programme for undergraduates in
their fi rst, second or third year. This allows community pharmacy
employers to provide quality placements and attract the highest level
of candidates as future pre-registration students.
In addition, the NPA will also incorporate training material to help
these students better prepare for Oriel assessments, if they choose
to broaden their recruitment options for their future pre-registration
placements both within and outside of community pharmacy.
This course provides pharmacy undergraduate students
undertaking placements or employment in community pharmacies
with essential knowledge and skills in relation to:
• University exams
• Pre-registration training
• Obtaining a pre-registration placement (including Oriel).
After completing this course, students will be:
• More confident about working on the medicines counter and
within the dispensary, both as an undergraduate and preregistration
• More competent in working in the community pharmacy aiding
both safety and effectiveness.
• More prepared for applying for pre-registration placements and
undergoing university exams.
Pharmacy undergraduate students working in pharmacies, whether
this is during summer holidays or as a part time/weekend employee.
This modular learning programme is divided into three parts which
can either be completed in a single placement or spread over
multiple placements, dependent on the individual requirements of
the undergraduate student and the pharmacy.
The structure of this course is as follows:
• Module 1: Pharmacy practice skills.
• Module 2: Pharmacy practice knowledge.
• Module 3: Pharmacy job application skills.
At the end of modules 1 and 2 there will be a multiple choice
assessment to test a student’s knowledge on the content they have
covered. Module 3 also contains helpful information on multiple
mini interviews, situational judgement tests and numeracy tests.
The supervising pharmacist/tutor is expected to support the
student throughout the course, review their answers, mark their
assessments and provide constructive feedback.
The NPA serves to assist community pharmacy employers
recruiting both within and outside of the Oriel system. For those
employers that have opted out of Oriel, the NPA is offering
assistance to advertise independently via the website (www.npa.
Louise Baglole, head of learning and development, said: “The
NPA’s pharmacy undergraduate training programme is a great way
for community pharmacies to support students on placements. Over
the last few years, some community pharmacies were disappointed
not to be allocated a pre-registration student via the Oriel process
– supporting a student with a quality placement earlier on in their
studies may help them to secure that student as a pre-registration
trainee in the future.”
Veterinary CD prescriptions (UK)
In recent weeks, there has been a significant increase in
requests from pharmacists for information relating to legal
requirements for veterinary prescriptions, particularly those
involving Controlled Drugs (CDs). This has been more apparent
since the reclassifi cation of pregabalin and gabapentin.
Furthermore, the Veterinary Medicines Directorate (VMD) has
recently released a summary of responses to a survey conducted on
the disposal and use of CDs.
The legal requirements for a veterinary prescription are stated in
Schedule 3 Part 1 of The Veterinary Medicines Regulations 2013. In
addition, the Royal College of Veterinary surgeons (RCVS) guidance
states veterinary prescriptions for Schedule 2 or 3 CDs must also
• The Royal College of Veterinary Surgeons (RCVS) registration
• A declaration that the product has been prescribed for treatment
of an animal or herd under the care of the prescriber.
• Details of the prescribed CD(s).
o Strength must be stated where more than one exists.
o The quantity – this must be written in words and figures.
• The dose to be administered (must state an amount and a
frequency- ‘take as directed’ would not be acceptable).
*Currently this is not a legal requirement in Northern Ireland.
One of the most common queries with regard to the use of a
standardised CD prescription forms for veterinary use.
There is no requirement for a standardised form to be used for
veterinary purposes as there is for human use (eg FP10PCD,
Some of the other common queries received by the NPA are
Can I dispense CDs from a faxed, electronic or A
emailed veterinary prescription?
No. A faxed, electronic or emailed prescription is not a
legally valid prescription, therefore a supply of Schedule
2 and 3 CDs against a faxed, electronic or emailed prescription
is not permitted. The original prescription must be obtained
before dispensing the medicine.
How long are veterinary prescriptions for CDs valid
Veterinary prescriptions for Schedule 2, 3 and 4 CDs are
valid for 28 days from the appropriate date; Schedule
5 CDs are valid for six months from the appropriate date.
Schedule 1 CDs are not used in veterinary medicines.
Are repeatable veterinary prescriptions allowed
Repeatable prescriptions (single prescriptions with
multiple dispensing) for Schedule 2 and 3 CDs are not
allowed. Veterinary repeatable prescriptions for Schedule 4 CDs
are only valid for 28 days. All repeats must also be dispensed
within 28 days of the appropriate date. This only applies to
veterinary repeat prescriptions and is different from repeat
prescriptions for Schedule 4 CDs for humans.
Can instalments be prescribed on a veterinary CD
Yes. Schedule 2, 3, 4 and 5 CDs are permitted
to be prescribed as instalments on veterinary
prescriptions as long as:
• The instalment quantity to be supplied is stated
alongside the dispensing interval and dose.
• The first instalment must be dispensed within the
prescription validity period of 28 days for Schedule
2, 3 and 4 CDs – further instalments can be dispensed
outside this period.
How long do we need to retain veterinary CD
All veterinary prescriptions (including those for CDs)
must be retained on the premises from which it was
dispensed for at least five years from the date of supply.
Is there a maximum quantity that can be prescribed
on a veterinary CD prescription?
The VMD recommends prescribing CDs for a maximum
period of 28 days treatment unless it is for the treatment
of a long-term condition (for example, epilepsy in dogs). Where
more than 28 days treatment is prescribed, the prescriber must
be satisfi ed that the owner is able to use the medicine safely.
Can I supply a CD to veterinary surgeon on a signed
It is a legal requirement* for veterinary practitioners
to use the relevant mandatory requisition form when
requisitioning Schedule 2and 3 CDs from pharmacies as follows:
• England – FP10CDF.
o This can be downloaded from the NHS Business Services
Authority (NHSBSA) website.
o The FP10CDF is not required to be sent to the NHSBSA; it
should be retained on the pharmacy premises for 5 years.
• Wales – WP10CDF should be used.
o This can be obtained from the local Business Service Centre
• Scotland – CDRF.
o All private prescribers (including veterinary practitioners)
are required to join the Prescriber List for CDs. When
approval has been granted by the local health board, a
‘unique prescriber code’ is generated and the veterinary
practitioner can then purchase CDRF forms.
*Northern Ireland – In Northern Ireland there is currently no
standardised requisition form available.
The veterinary prescriber must include the following particulars
on a CD requisition:
• Name, address and profession of the recipient.
• Purpose for which the drug is to be supplied.
• Name, form, strength and total quantity to be supplied.
• Signature of the prescriber.
These FAQs were correct at the time of publishing. To read more visit www.npa.co.uk
Serious shortages protocol
following NHS contract amendment
From a community pharmacy
perspective, a number of key changes
are introduced under the NHS SSP
2019 regulations. Please note that
these changes relate specifi cally to the
provision of NHS services and dispensing
of NHS prescriptions in England only.
• NHS pharmacists “must consider whether
it is reasonable and appropriate to supply
in accordance with the SSP instead of in
accordance with the prescription form
or repeatable prescription.” A different
product or quantity or both may be
provided if in the professional judgement
of the pharmacist it is appropriate and
reasonable to do so with reasonable
promptness and in accordance with the SSP.
• Pharmacists must notify the patient’s GP
if the product provided in accordance
with the SSP is a POM that is different
to but has a similar therapeutic effect
to the product originally prescribed.
Furthermore, in other cases of supplies
made under SSPs, the patient’s NHS GP
practice must also be notifi ed if such a
requirement is implemented for clinical
reasons (further clarifi cation will be
provided on this in due course).
• When a SSP is in effect for a drug or
appliance prescribed on a prescription
form, but in the opinion of the registered
pharmacist, supplying a different product
or quantity would be inappropriate or
unreasonable, the pharmacist is able
to supply the product ordered on the
original prescription — even if the
pharmacist is able to supply this within
a reasonable timescale, but not with
reasonable promptness; their terms of
service will not be breached by doing
so. These amendments have removed
the need for supply to be made with
reasonable promptness where an SSP is in
place; instead, the supply should be made
within a reasonable timescale (this has not
been defi ned in measurable terms).
• Furthermore, where the requested drug
or appliance is covered under a SSP,
but in the pharmacist’s professional
judgement it is not appropriate or
reasonable to provide an alternative
product or quantity to that ordered,
and the pharmacist is unable to provide
the product ordered on the original
prescription within a reasonable
timescale – the pharmacist may simply
refuse to provide the drug or appliance
ordered. In such cases, the NHS
pharmacist must provide the patient (or
representative) with appropriate advice
about returning to the prescriber to
review the patient’s treatment.
• When a product is supplied under the
SSP, a notifi cation to this effect must
be included in the dispensing label on
the packaging of the product supplied,
including identifi cation of the particular
• Where a different drug or appliance has
been provided under the SSP covering
the drug or appliance requested on
the original prescription form, the NHS
pharmacist cannot make the supply under
the original prescription form in addition
to that made under the SSP.
• In parallel to the NHS SSP 2019
regulations, amendments have been
made to the Charges Regulations when
a product is supplied in accordance with
a SSP. The original prescription form,
when endorsed, will be repurposed for
recording the SSP supply for prescription
charge exemption and remission of
charges. Furthermore, for patients who
would normally pay a prescription charge,
no prescription charge will be payable
when a supply is made in accordance with
a SSP for a smaller quantity of a drug or
fewer appliances supplied.
• Under transitional arrangements, a
separate token (“a dispensing token”)
is to be used to record supplies made
under SSP. This is for the purposes of
prescription charge exemptions, remission
of charges and reimbursement. Further
guidance and clarifi cation on a number of
operational and legislative aspects related
to SSP will be available in due course.
From an indemnity perspective, NPA
professional indemnity insurance will
cover NPA members, customers (and
the pharmacists they employ/engage)
when supplying medicines/appliances
under the relevant enabling legislation
and the serious shortages protocols
(SSPs) which apply. It is acknowledged
pharmacists will be expected to exercise
professional judgement to determine the
appropriateness of making each supply.
For further information please
contact the NPA pharmacy services
team on 01727 891800 or email at: