NPA Essential: May

Things to do and things to know in community pharmacy across the UK

NPA conference in Manchester – book now

A national conference organised by the NPA with the theme ‘Forwards in Partnership’ will take place on June 20 at the Pendulum Hotel & Manchester Conference Centre. The conference is a collaboration between the NPA and Pharmacy Magazine. Health Secretary Matt Hancock is among the line-up of high profile speakers. NPA members attending the conference are also invited to attend the association’s AGM, which will be held in Manchester on the same day.

Book now for the conference and make the most of this opportunity to learn about the latest policy developments, network with fellow NPA members, meet senior figures in healthcare and have your say on the things that matter most to you and your pharmacy. For more information, go to the event page on the NPA site or email events@npa.co.uk.

 

The national flu immunisation programme 2019/20

The Department of Health and Social Care, NHS England and Public Health England have published details of the national flu immunisation programme for 2019/20. This programme covers all national programmes – not just the community pharmacy flu vaccination advanced service (NHS flu advanced service).

The recommended composition of the quadrivalent vaccines for the northern hemisphere in 2019/20 is:

  • A/Brisbane/02/2018 (H1N1)pdm09-like virus
  • A/Kansas/14/2017 (H3N2)-like virus
  • B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)
  • B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage)

The influenza B virus component for the trivalent vaccines for northern hemisphere in 2019/20 is to be a B/Colorado/06/2017- like virus of the B/Victoria/2/87 lineage.

Appendix E Table 2 lists the influenza vaccines available for the 2019/20 season, including details on manufacturers, age restrictions and ovalbumin content.

The patient group direction (PGD) and service specification for the NHS flu advanced service has not yet been published. However, it had been confirmed that the eligibility groups for the NHS flu advanced service 2019/20 will remain the same as in 2018/19. This will continue to include hospice and social care workers.

Table 1 – Flu vaccines considered equally suitable for use in eligible age groups.

Age Group New fee
18-64 years of age
  • Standard egg-cultured quadrivalent inactivated vaccine (QIVe)
  • Cell-based quadrivalent vaccine (QIVc)
65 years of age and over
  • Adjuvanted trivalent inactivated vaccine (aTIV)
  • Cell-grown quadrivalent vaccine (QIVc)
  • High dose trivalent influenza vaccine (TIV-HD) – not eligible for NHS reimbursement

 

For further information, the NPA member news item entitled ‘NHS flu service 2019/20 – recommended flu vaccines and ordering (England)’ on the NPA website details the currently licensed flu vaccines available in the UK.

 

FP34 schedule of payments – changes to codes

NHS Business Services Authority (NHSBSA) and NHS England have made some minor changes to the way payment descriptions for enhanced services are listed on the FP34 schedule of payments.

The change in coding was applied for enhanced services claim submissions for April 2019 enhanced services; services completed in March 2019 will appear on the FP34 “dispensing month: Feb 2019.” The change will not affect the way pharmacy contractors claim for payment.

The national menu of codes for enhanced services has been developed to ease data collection and reconciliation of payments. It will be easier for pharmacy contractors to identify the services they are being paid for and for NHS England to calculate total expenditure for individual locally commissioned services. This
is because the codes on the FP34 schedule of payments will be consistent across England; for example, locally commissioned screening services will always be coded as local scheme 4.

 

Pharmacy contractors should be aware of the following:


• Claims for enhanced services can continue being made using recommended local processes such as submitting paper claim forms to local NHS England teams or using online systems like PharmOutcomes.
• There may be a different local scheme number listed on the FP34 schedule of payments; other than this, the document will look the same as before.
• During payment reconciliation, they should check the national menu of services to identify the service they have been paid for.

 

For further information contact the NPA pharmacy services team on 01727 891 800 or email pharmacyservices@npa.co.uk

 

 

National Pharmacy Association welcomes start of contract negotiations in England

Negotiations on the community pharmacy contractual framework (CPCF) for 2019/20 have started.

According to the PSNC, the Department of Health and Social Care has initiated the negotiation process with a set of proposals that have been agreed with NHS England and shared with PSNC.

Negotiations between the three organisations will be confidential, but PSNC says it expects talks will cover urgent care, prevention and medicines safety.

In the statement, PSNC predicted challenging discussions on funding and reimbursement.

NPA chief executive, Mark Lyonette, said the NPA, PSNC and indeed all the national pharmacy bodies have been working hard to build trust with officials and elected politicians, providing a solid platform for the negotiations.

“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,” he said.

“Community pharmacies need to be recognised as the front door to health – an indispensable component of the urgent care pathway, vibrant health and wellbeing hubs and a mainstay of support for people with long term medical conditions.

“The current financial pressures are a powerful disincentive to pharmacy owners to invest in NHS services. The negotiations provide an opportunity to change that, so that pharmacies can step up to meet the challenges laid out in the NHS long term plan.

“A successful outcome would include a clear direction on service development and a multi-year settlement, giving pharmacy owners the confidence to modernise and invest in patient services.

“We do not need to stand still until the outcome of the negotiations is known. At a local level, there is an urgent need to engage with the emerging NHS commissioning infrastructure, so the NPA is pressing ahead with a programme of support for independent representatives on LPCs. We are also developing a digital strategy to help independent pharmacies become more efficient and better connected, whatever lies ahead.

“The fact that the start of negotiations has been publicly announced is a first for pharmacy in England in recent times. This is perhaps a sign of a maturing relationship between the sector and its biggest paymaster, the NHS.”

 

Moving forward together

For nearly 100 years, the NPA has brought community pharmacists together to pool resources, learn from each other and move forward together.

In tough times - as now - the sector needs to stick together to develop solutions that benefit everyone and underpin progress
at scale.

That’s why we’ve chosen Forwards in Partnership as the theme for our national conference in Manchester on June 20. The conference is a collaboration between the NPA and Pharmacy Magazine, so the idea of partnership is at the very heart of arrangements.

Partnership certainly must extend to working collaboratively with the NHS in pursuit of shared, patient-focused objectives. So we are delighted that
Ed Waller, NHS England’s director of primary care strategy and NHS contracts, has accepted the invitation to join us in Manchester. He will share with our members his perspective on community pharmacy now and in the future.

Health Secretary Matt Hancock and Scotland’s chief pharmaceutical officer Rose Marie Parr have also confirmed for the conference, as have leaders from other pharmacy bodies plus patient representatives. All share an interest in developing community pharmacy as the front door to health – an indispensable component of the urgent care pathway, as well as a health and wellbeing hub and mainstay of support for people with long term medical conditions.

For more information and to register, go to www.npa.co.uk/conference-2019 or email events@npa.co.uk

 

TRAINING AND GOOD PRACTICE

NPA PGD packages and training

The NPA is launching new PGD packages with associated training that suit your needs at a preferential member rate across the UK. All NPA PGD package prices include the training – online and full practical (face-to-face) training, if applicable, as well as the provision of the PGD and certificate on completion of your training.

Choose the PGD training that’s right for you

  • Three new vaccination packages – PGD flu, PGD travel and PGD vaccination bundles.
  • Plus the option to add extra vaccination PGDs including shingles, HPV and pneumococcal pneumonia.
  • Plus oral PGDs – choose from 11 conditions.

Choose the type of training that’s right for you

  • Full training (practical face-to-face and online) – required at least every three years.
  • Throughout the year at venues across the UK.
  • Refresher training (online only) – required every year that practical training is not undertaken.

The NPA can also help you promote your PGDs with

  • your pharmacy details featured on traveljab.co.uk, a patient-facing online search tool for flu and travel pharmacies.
  • access to the NPA/CB training PGD packages and training portal.
  • where you can enrol for training, access the online training portal and download PGDs, certificates and patient consent forms.
  • access to the NPA website for vaccination guidance.
  • documentation for NPA members.
  • a free promotional pack including leaflets/posters, window stickers and templates for letters, social media and web banners.
  • the NPA pharmacy services support and advice line for NPA members.

Go to www.npa.co.uk/pgd for more information.

 

Stickers on prescriptions – how this can affect prescription submission

The NHS Business Services Authority (NHSBSA) is reminding pharmacy teams to ensure any stickers attached to prescriptions are removed prior to submission.

It was concerned over the number of prescriptions being submitted with stickers attached, particularly where they cover prescriber details. The prescriber details must be clear so that the NHSBSA can allocate costs to the correct clinical commissioning group (CCG). When these details are not visible, the NHSBSA is not able to determine the relevant CCG to attach costs to and as a result, these prescriptions are attributed as ‘national unidentified.’

This can result in ePACT data, prescribing budgets and prescribing data being incorrect.

Pharmacy contractors and their teams should:

• Remove all stickers from prescriptions. - Stickers may leave a residue on the

prescription when removed which can affect prescription scanners, causing a potential delay to the processing of end- of-month submissions.

• Ensure prescriber and patient details are not covered.

• Remove all staples and pins which can also affect the scanning process.

 

The NPA has produced country-specific standard operating procedures for the sorting and submission of prescriptions for NPA members. Go to www.npa. co.uk/information-and-guidance/ sorting-and-submission-of-prescriptions- sops/ for more information.

 

Overview of NPA’s pre-registration training programme for 2019-2020

Over the years, our experienced learning and development pharmacists have empowered countless pre-registration students to develop into confident and competent pharmacists by delivering an excellent standard of theoretical training coupled with practical learning solutions.

Our approach to learning and development enables the students to pass the GPhC registration assessment and progress seamlessly into the workplace as dependable pharmacists – helping to meet the constantly evolving needs of the pharmacy sector.

The NPA’s dedicated tutors (learning and development pharmacists) draw on their own pre-registration experiences to passionately deliver the essential knowledge and skills, as well as providing an engaging and insightful learning experience for trainees.

 

Pre-registration training programme – at a glance

A comprehensive 10-month programme written and delivered by the NPA’s team of learning and development pharmacists that supports trainees from the minute you enrol them on to the course through to the GPhC registration assessment and beyond.

Main topics covered:

  • BNF chapters.
  • Law and ethics.
  • Pharmaceutical calculations.
  • Responding to symptoms and minor ailments.
  • Measuring and fitting hosiery.

Key features of the NPA’s programme:

  • Comprehensive online training via a new intuitive eLearning platform.
  • Tutorials delivered via interactive webinars.
  • Seven face-to-face study days delivered at five locations around the UK.
  • Emergency first aid - practical training and certification.
  • Mock exam covering calculations and clinical questions.
  • Revision planning and GPhC exam style questions.
  • Dedicated support teams - learning and development tutors and advisers.

 

Study days

Students find that the study days offer a stimulating form of learning and development that differs from university lectures. They get involved in group activities and workplace scenarios/case studies that aim to embed their theoretical learning and prepare them for real-life pharmacy situations.

Your student will be expected to attend seven study days during the 10 months, which take place from 9am till 5pm during the week. Our learning and development pharmacists, who tutor the study days, have experience of working in community pharmacy practice, enabling them to bring real insight and guidance to the students.

On the first study day in September, students will receive their own training manual folder to make notes and for the safe-keeping of materials for future reference.

At the study days, students will also have the opportunity to:

  • Receive guidance and feedback from the NPA’s dedicated tutors.
  • Participate in Q&A sessions.
  • Acquire practical skills/familiarise themselves with equipment – first aid and OSCEs.
  • Answer GPhC exam-style questions. • Share experiences and challenges.
  • Broaden their peer network.

Trainees leave each study day with handouts on the items covered and with instructions on what they need to prepare for the next month’s learning.

At the end of each study day, students are asked to complete a brief evaluation form. The NPA’s tutors review these forms to ensure that the content in forthcoming study days and webinars reflects the needs of the students and our members and make adjustments where necessary. Without this contact with the tutors, it is more difficult to address issues that might arise.

Schedule of learning

The schedule below sets out the study days and webinars that will take place in 2019-2020. In addition to these events, students will have a programme of eLearning modules which will be given to them at the first study day in September.

September

Study day 1 - Gastrointestinal tract system, contraception, calculations.

October

Study day 2 - Cardiovascular system, calculations. Webinar 1 - Blood and nutrition.

November
Study day 3 Endocrine system, calculations.

December

Webinar 2 - Minor ailments case studies.

January

Study day 4 - Emergency first aid at work.

February

Study day 5 Central nervous system, calculations.

March

Study day 6 Infections and respiratory system, calculations.

April

Webinar 3 - Clinical pharmacy - genito-urinary tract and malignant disease.
Webinar 4 - Application of law and ethics, controlled drugs, FP10MDAs.

May

Study day 7 - Mock registration assessment (exam).

June

Webinar 5 Calculations and exam preparation (tips). Registration assessment.

For more information go to www.npa.co.uk/training/Pre-reg

 

 

New payslip rules explained

New government legislation regarding payslips was introduced on April 6 2019, and it’s important to understand what this means for your pharmacy.

From this date, pharmacy owners are required by law to:


A) Provide itemised payslips to all workers – including permanent, casual and zero- hours staff.

At present, the statutory right to receive an itemised payslip only applies to employees.

B) Include hours on payslips (in cases where the worker’s pay varies by the amount of time they have worked).

From April 2019, workers whose pay varies depending on the number of hours they have worked have the right to receive additional information on their payslip detailing the number of hours they have been paid for and how their pay has been calculated.

For workers who receive a fixed salary each month, payslips don’t need to display the worker’s hours as their pay does not vary based on the amount of time they have worked.

Employers are not required to include an hourly figure to reflect unpaid leave or statutory sick pay. However, if employees work occasional overtime paid at an hourly rate, this would need to be shown.

Hours can be shown as the total number of hours worked – making clear what period they were worked in – or broken down further into different types of work or different rates of pay.

For example, you will need to provide itemised pay statements for workers who:

  • Are salaried but work occasional overtime.
  • Are paid by the hour.
  • Are paid by the hour with additional pay for unsociable hours.
  • Are paid by the hour and receiving statutory sick pay.
  • Are paid a daily rate.

However, you will not need to provide itemised pay statements for workers who:

  • Are salaried but do not work overtime.
  • Are term-time workers.
  • Are salaried workers and take unpaid leave.

 

What are the consequences for employers who don’t comply?


If you fail to amend your payslip format once the new legislation comes into force, and a worker believes they haven’t received a payslip, or that the payslip they have received doesn’t contain the required information, they will have the ability to enforce this right at an employment tribunal.

If this happens, you could be ordered to repay any undisclosed deductions made in the 13 weeks prior to the claim being brought, even if you were entitled to make such deductions.

In other words, time spent updating payroll processes now could save a lot of time and money later down the line.

Need support?
For advice on the new payslip legislation, contact the NPA employment advisory service on 0330 123 0558 or email employmentadvice@npa.co.uk.

 

 

Rollout of EPS enhancement allows controlled drugs to be sent via EPS

Earlier this year, NHS Digital enabled EPS controlled drugs (CD) enhancement on a national level, following a successful pilot period across a number of GP test sites. This means that pharmacy dispensaries across England are now likely to see EPS prescriptions for schedule 2 and 3 CDs.

The NPA has seen an increase in the number of queries as pharmacists are being presented with EPS prescriptions for schedule 2 and CDs for the first time.

The benefits of EPS CD enhancement, according to NHS Digital, will be a reduced administrative burden on both surgery and pharmacy teams, improved security (fewer ‘lost’ prescriptions), improved patient safety as pharmacists will see everything that has been prescribed to inform their clinical check and fewer patients needing to obtain some of their items on FP10s and the remainder via EPS.

It will take some time for all surgeries to make the required software adjustments to include this functionality, and the progress will depend on the software provider and the clinical commissioning group (CCG). NHS Digital has published a list of the anticipated timeframes for surgery system upgrades (by software provider and CCGs) on their website national rollout schedule for controlled drugs in EPS.

The NPA encourages members to review their pharmacy workflow when processing EPS CD prescriptions. NHS Digital has produced guidance about EPS CD enhancement on their website, including a poster for pharmacies to display and a checklist for the dispensary team.

Prescriptions received via EPS for CD items must still meet the legal requirements as stated in the Misuse of Drugs Regulations 2001.

 

New guidance for pharmacies with online services

The GPhC has issued new guidance that says pharmacies operating online or providing services at a distance must carry out identity checks on patients before prescribing a medicine.

Entitled ‘Guidance for registered pharmacies providing pharmacy services at a distance, including on the internet,’ it updates guidance from 2015 and is effective immediately.

However, the NPA understands inspectors will take a pragmatic approach and pharmacies that do not meet all standards must be able to demonstrate there is a plan in place to do so.

The guidance follows the GPhC’s discussion paper on the topic that was published in June 2018.

The NPA was one of several pharmacy bodies that called for appropriate identity checks and other controls. The safeguards for patients and the public now focus on the following two key areas:

1) Making sure medicines are clinically appropriate for patients.

Online pharmacies will have to make sure:

  • there are robust processes in place to carry out identity checks on people obtaining medicines.
  • the pharmacy team can identify requests for medicines that are inappropriate, including by being able to identify multiple orders to the same address or orders using the same payment details.
  • pharmacy websites do not allow a patient to choose a prescription-only medicine and its quantity before there has been an appropriate consultation with a prescriber.

2) Further safeguards for certain categories of prescription-only medicines will have to be in place before supplying the following categories of medicines to make sure they are clinically appropriate:

  • Antimicrobials (antibiotics).
  • Medicines liable to abuse, overuse or misuse, or where there is a risk of addiction and ongoing monitoring is important. For example, opiates, sedatives, laxatives, pregabalin and gabapentin.
  • Medicines that require ongoing monitoring or management. For example, those used to treat diabetes, asthma, epilepsy and mental health conditions.

Responding to the new guidance, the NPA said:
- People seeking medicines online ought to be protected from harm to the same high standards they experience in their local community pharmacies. Medicines are not ordinary items of commerce and have the power to harm as well as to heal.

- We support the new safeguards introduced by the pharmacy regulator, including requirements for online pharmacies to carry out age identity checks and to track mailed packages to make sure they reach the right person.

- The guidance says that people should be able to choose where they get their medicines from on the basis of accurate information, so online pharmacies must not mislead service users about the identity or location of the pharmacy. We know that many patients have been confused by marketing materials that seem wrongly to suggest a connection to local GPs and pharmacies.

- It is now incumbent on the regulator to enforce the guidance robustly – in the interests of patient safety and levelling up standards such that all pharmacies can operate on a level playing field.

 

YOUR QUESTIONS ANSWERED

A selection of recent members’ questions that were answered by the NPA’s pharmacy services team.

Q. Which CDs can be prescribed via EPS?

A. All schedules 2, 3, 4 and 5 CDs can be prescribed via EPS except for instalment FP10MDA prescriptions.

Q. Do electronic prescriptions for schedule 2 and 3 CDs need to comply with prescription writing requirements?

A Yes. Electronic prescriptions for schedule 1, 2 and 3 CDs (including temazepam) must comply with all CD prescription writing requirements as stipulated in the Misuse of Drugs Regulations 2001. Further information on dispensing CD prescriptions can be found in the NPA ‘Controlled Drugs Guidance.’

Q. I have received an electronic prescription for schedule 2 and 3 CDs but the total quantity is written in figures but not words. Is this legally valid?

A. No. In order to meet legislative requirements, total quantities of schedule 2 and 3 CDs must be expressed in both words and figures.

Q. I have received an electronic prescription for a CD where the quantity in words is written in drug-specific additional instructions field of the prescription message and is prefixed ‘CD:’. Is this acceptable?

A. NHS Digital has advised that prescribing systems will automatically populate the total quantity in both words and figures and this will be included in the ‘message to pharmacy’ field of the prescription message in order to satisfy the legal requirements stated in the Misuse of Drugs Regulations 2001.

Q. A patient has an owing remainder to collect from a gabapentin prescription written before April 1 2019. Can I supply the remainder after April 1 2019?

A. From April 1 2019 gabapentin will be classified as a schedule 3 CD, so when considering making the balancing supply the pharmacist must ensure that both:

• the original prescription satisfies the legal requirements of a schedule 3 CD, and

• the remaining supply is not made to the patient more than 28 days after the appropriate date on the prescription.

 

Q. Do I need to submit all EPS tokens for CDs to the pricing authority at the end of the month?

A. Yes. All EPS tokens for schedule 2 and 3 CDs (age exempt, non-age exempt and charge paid) should be sent to NHS Prescription Services at the end of the month for audit purposes to demonstrate that the pharmacy is ensuring a signature from the people collecting the schedule 2 or 3 CD has been captured.

Q. Will I need to re-nominate patients so electronic prescriptions for schedule 2 and 3 CDs can be sent via EPS?

A. Patients who are already nominated will not need to be re-nominated as prescriptions for schedule 2 and 3 CDs will be sent via EPS. However, patients who previously did not have a nomination may need to consider setting one so all their prescription items are dispensed by one pharmacy.

Q. When did the national rollout for EPS for schedule 2 and 3 CDs commence?

A. NHS Digital started the national rollout following a successful pilot that was running across several GP practices. Two GP system suppliers, TPP SystmOne and Vision, started from Thursday, February 28 2019. However, the majority of the sites went live from Tuesday, March 5 2019. EMIS Web has also announced that they will ‘go live’ from Monday, March 25 and April 8 2019.

Q. How can I record that prescriptions for CD items have been collected within 28 days?

A. It is a requirement that all CD prescriptions must be ‘marked’ with the date of supply ‘at the time the supply is made.’ One method of ‘marking’ EPS prescriptions would be to create a pharmacy workflow whereby the dispense notification for all tokens containing CDs is always sent close to the time the patient was given the medication. Other methods of ‘marking’ the prescription may be achieved depending on local system configuration or by making use of the PMR record to ensure a clear audit trail is placed. Physically making handwritten annotations on the EPS dispensing token (FP10DT) would not be suitable as this token is not a legal prescription.

Q. For monitored dosage system (MDS) patients, I use paper repeat dispensing prescriptions (RAs/RDs) for pregabalin. If I hold RDs written before April 1 2019, can I dispense against these if I ‘assemble’ the MDS before April 1?

A. From April 1 2019, pregabalin will become a schedule 3 CD. Schedule 2 and 3 CDs cannot be prescribed on repeat prescriptions (paper RA/RD or EPS RD) so any patient supply on, or after, April 1 2019 will not be legally valid. In this example, it is the date the MDS is handed out/delivered to the patient (date of dispensing) that is relevant, not the date of ‘assembly.’ Pharmacists should identify all affected patients and work with GP surgeries to re-issue valid prescriptions in advance of April 1 2019 to ensure that patient supply is not interrupted and made in accordance with legal requirements.

 

How are you dealing with requests for alternatives when there are medicines shortages?

Guidance to assist pharmacists when dealing with medicine shortages and requests from prescribers to suggest alternatives.

Recently the NPA has received a large number of queries from pharmacists about how to deal with requests from prescribers to suggest alternative medicines when the patient’s medicine is out of stock. These requests are often made without the clinically relevant information about the patient’s health or the condition being treated being available to the pharmacist.

Below are some key points on how pharmacists could approach discussions with prescribers when dealing with issues related to medicine shortages, and to aid discussions with prescribers about alternative treatment options.

  • Be very clear about what is being asked when dealing with requests for alternatives from prescribers before offering specific information about a potential alternative.
  • As a minimum requirement, determine the clinical indication – this is crucial to understanding the prescribing pathway and what alternatives may be considered and what the licensing implications are.
  • Consider the prescribing information available – the National Institute for Health and Care Excellence (NICE) guidelines and NICE Clinical Knowledge Summaries (CKS) are open access sources of prescribing information that can be used to support prescribing advice within the UK as relevant.
    - Remember: local and regional prescribing information may also be in effect and prescribers should consider this too.
  • Consider if there are any further clinical factors that may affect the decision.
    - This may include patient allergies, renal or hepatic impairment, monitoring requirements, specialist interventions, off-label use, previous treatments, etc.
  • Consider your professional competence – in Great Britain, the General Pharmaceutical Council Standards for pharmacy professionals states that pharmacy professionals should “recognise the limits of their competence.” The Pharmaceutical Society of NI’s professional standards
    of conduct, ethics and performance for pharmacists states that pharmacists should not “whether by actions or omissions, create a risk to patient care or public safety” and should “apply knowledge and experience appropriately to their scope of practice.”
  • You may wish to approach the discussion by saying to the doctor “if you give me some clinical alternatives you would like to prescribe, I can then provide you with availability information on these medicines.”

 

Professional indemnity

The responsibility for safe and appropriate prescribing always rests with the prescriber. NPA Insurance will indemnify members where thorough professional interventions are made in light of medicine shortages. Pharmacists who feel that prescribers are making unreasonable demands or are placing them in a difficult professional/ ethical position should contact NPA for further assistance.

 

 

 

 

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