This month's news from the National Pharmacy Association...
NHS CPCS goes live across England
The NHS Community Pharmacist Consultation Service (CPCS)
launched on October 29 placing community pharmacy formally in
the NHS pathway for urgent care.
The NPA urges independent community pharmacies to engage
with the service, whilst recognising the many challenges they already
face and the pressures on their time.
The NPA has produced resources to support our members
to deliver CPCS effectively. Go to www.npa.co.uk/communitypharmacist-
NPA publishes flu information chart for 2019/20 flu season
The NPA has published the Flu information pack 2019/20: vaccine
information to be used alongside previously published fl u resources,
to support you in delivering fl u vaccination services either under the
NHS or against a private Patient Group Direction (PGD). It provides
details on excipient content of vaccines and their suitability in
specifi c patient groups.
The fl u vaccine information chart includes the following details:
• Age suitability of vaccines
• Ovalbumin content – Flucelvax Tetra (Seqirus UK) is egg-free.
Patients with an egg allergy require an egg-free vaccine or
inactivated fl u vaccine with an ovalbumin content of less than
0.12μg/ml (0.06μg/0.5ml dose)
• Antibiotics, gluten, human blood products, lactose, latex, nut and
• Suitability for vegetarians and halal/kosher certifi cation.
Further information for the 2019/20 fl u season, including
adrenaline auto-injectors availability, standard operating procedures
and promotional materials can be found on the dedicated NPA
webpage for the fl u service (NHS and private).
NHS ‘Check before you tick’ campaign returns
NHS England and NHS Improvement is re-running its ‘Check
before you tick’ campaign and sending pharmacies updated
materials to help people understand their eligibility to receive
free prescriptions and how to claim correctly. A national burst of
promotional activity started in October and will continue until
CPCF-related changes in October Drug Tariff (DT)
The NPA advises you and your pharmacy teams to be aware of
important information in the October 2019 tariff about changes
to reimbursement and remuneration as follows (DT page numbers
Serious Shortage Protocols (SSP) – the inclusion of new
wording detailing endorsement requirements, reimbursement and
remuneration for supplies made according to an SSP.
• Reimbursement (page 11) – reimbursement is based on the
appliance/medicine that is dispensed, not the appliance/medicine
which was originally prescribed
o Contractors will be paid on the basis that the exact quantity
prescribed has been dispensed, except in cases where a SSP
specifi es that an alternative quantity is supplied
o Reimbursement price will account for VAT payment
• Remuneration (page 28) – contractors will receive an SSP fee
of £5.35 per prescription item, in addition to usual dispensing
allowances and fees
• Further information on SSPs is available in the Pharmaceutical
Services Negotiating Committee Briefi ng.
Establishment payment changes (page 35) – the monthly
Establishment Payments levels have been amended refl ecting
the ongoing phasing out of this payment. The funding will be
redistributed to keep the overall funding sum at £2.592bn.
Transitional payments – from October 2019,
all pharmacy contractors will automatically receive monthly
To view the rest of the information sheet go to
NPA calls for nationally commissioned health checks
Responding to a government consultation on preventing ill health, the NPA is
calling for additional public health services such as nationally commissioned
health checks where community pharmacists can screen for common long-term
conditions such as hypertension, diabetes and asthma.
The NPA’s formal submission to the Department of Health and Social Care (DHSC)
consultation on Advancing our health: prevention in the 2020s also calls for an Englandwide
service involving the provision of oral contraception and advice which includes
monitoring blood pressure and weight.
Helga Mangion, policy manager at the NPA, said: “The trusted position community
pharmacies occupy at the heart of communities, including many deprived communities,
means they have an important role in preventative healthcare. We want more people to
benefi t across the whole country.”
The Green Paper proposes that people should not be “passive recipients of care” but
rather “co-creators of their own health.”
“The challenge is to equip people with the skills, knowledge and confi dence they need to
help themselves,” it states, adding: “We are committed to delivering an expanded role for
community pharmacies and want to see them become the fi rst port of call for minor illness
and health advice in England.”
Ask Your Pharmacist Week
campaign materials now available
Pharmacies and pharmacy stakeholders
can access a suite of campaign materials
via npa.co.uk/ayp2019, to prepare
for Ask Your Pharmacist Week (11-18
The Ask Your Pharmacist initiative is part
of ongoing efforts by the NPA, the NHS and
others to promote community pharmacy as
a provider of clinical care and the fi rst port
of call for help with minor illnesses.
Campaign materials include:
• Digital assets – imagery for Twitter and
Facebook and template social media posts
• Window posters (downloadable in various
sizes) and leaflets
• Web banner and suggested form of
words for websites
• Template local newspaper column
• PowerPoint presentations and talk notes
for community talks
• Pull up banners and leafl ets for public
The NPA’S head of communications
Stephen Fishwick said: “The focus will be
on the suitability of community pharmacy
as a place to get clinical advice, in particular
about common illnesses like coughs, colds
“Pharmacists in England will understand
the timeliness of this message for the
NHS Community Pharmacist Consultation
Service, which began at the end of October.
“However, the core theme resonates
in Scotland, Wales and Northern Ireland
too. A selection of resources is available so
that pharmacies anywhere in the UK can
NHS England and NHS Improvement has
supported the development of Ask Your
Pharmacist Week 2019 and the campaign
assets carry NHS branding.
NHS dental prescriptions
The NHS Business Services Authority
(NHSBSA) has provided updated
information regarding reimbursement
for handwritten information on NHS
dental prescription forms (FP10D).
Dentists often use a stamp for prescribing
items such as Colgate Duraphat (or
sodium fl uoride toothpaste). Sometimes,
in addition to the stamp, the dentist states
a handwritten quantity of the prescribed
medicine that is different from the stamped
quantity, with no date and prescriber
initials/signature marking the additional
Previously, the NHSBSA had informed
the NPA Pharmacy Services team that there
would be reimbursement implications
for prescriptions written in this way; the
NHSBSA provided advice on the quantity
pharmacy contractors should dispense,
based on whether or not the handwritten
information had been countersigned by
The NHSBSA has confi rmed that where
a NHS dental prescription states a stamped
quantity with additional handwritten
information from the prescriber stating a
different quantity, pharmacy contractors will
be paid based on the handwritten quantity,
as long as this has clearly been endorsed
on the prescription. The prescriber is not
required to countersign the additional
handwritten information because this is not
considered to be an amendment.
NHSBSA has further clarified that a
handwritten amendment is only when a
prescriber crosses out one quantity and adds
a new quantity; in this case, the prescriber is
required to countersign the amendment.
Every Mind Matters PHE
mental health campaign
Public Health England has created
resources for new mental health
campaign, Every Mind Matters.
The campaign aims to encourage people
in England to look after and improve their
own mental health and wellbeing as well as
Posters and digital resources are
available to download and order from PHE.
Pharmacies will not automatically be sent
resources so will need to order them directly
from the campaign resource centre. A
webinar is also available for contractors to
obtain more information on the campaign.
Every Mind Matters is not a mandatory
health campaign set out by NHS England,
however, it will help pharmacies maintain
and/or work towards their Healthy Living
Pharmacy (HLP) status. By April 1, 2020, all
NHS-contracted community pharmacies will
be required to be HLP Level 1 pharmacies
as stated in the new Community Pharmacy
For further information contact the NPA
Pharmacy Services team on 01727 891 800
or email email@example.com
Changes to the CPCF, the full details of which, at the time of
going to press, had not yet been released by NHS England
and NHS England Improvement (NHSE&I), include the
introduction of new arrangements for claiming payments and
providing services. To help our members meet the various
associated deadlines, the NPA has launched the following
• CPCF calendar overview – a Microsoft Excel document with a full
list of calendar dates including deadlines, audit start/end dates
and relevant dates for the Pharmacy Quality Scheme (PQS) and
the Community Pharmacy Consultation Service (CPCS)
• CPCF calendar checklist – a checklist document of calendar dates
in Microsoft Word format which facilitates allocation of tasks
to appropriate members of the pharmacy team and logging of
• CPCF working calendar with spaces for your own use to set
deadlines for your pharmacy team – a Microsoft Excel document
with prepopulated CPCF dates and also containing blank dates in
the month-by-month tabs to allow you to input dates and actions
specifi c to your pharmacy/organisation — this is designed to be
used in conjunction with the above two calendars.
The calendars have been published in the above three formats to
give members a choice of the format that best suits them and their
teams. You can use one or all of them as suitable. Go to www.npa.
co.uk/information-and-guidance/cpcf-calendars/ to access
SOP: diabetes foot and eye checks – PQS
As part of the prevention composite bundle for PQS, there is a
quality criterion for pharmacy teams to check, from 1 October
2019 to 31 January 2020, that all patients with diabetes, over
12 years of age have had an annual foot and eye check.
The NPA standard operating procedure (SOP) sets out the
process for meeting this quality criterion, including steps and
guidance for identifying suitable patients, data collection and
making a declaration. Go to www.npa.co.uk/pharmacy-qualityscheme/
PMR systems enhancements – share your views
The Community Pharmacy IT Group (CP ITG), has launched a
survey to gather the views of community pharmacy teams
about their PMR systems and which enhancements they
would like to see prioritised.
All pharmacy staff can now take part in this work by completing
the online community pharmacy patient medication record (PMR)
system survey; it should take around 5-10 minutes to complete
depending on your answers. CP ITG would like to hear the views
of all community pharmacy team members, therefore multiple
members of staff at each pharmacy can complete the survey if they
wish. Responses will be anonymous.
Why is this survey important?
This survey will help the CP ITG and PMR suppliers explore how best
to prioritise future enhancements, which should ultimately benefi t
pharmacy team members and patients, so CP ITG encourages all
pharmacy team members to take part and share their views. The
anonymous results will be shared with PMR suppliers.
Go to www.surveymonkey.co.uk/r/XWL5WRP to complete the survey.
Establishing a legal defence: when is employment
The Equality Act 2010 outlaws several
different forms of discrimination.
While some of these can never be
justified, others – namely indirect
discrimination, discrimination arising from
disability (section 15 discrimination) and
direct age discrimination – can be lawful in
Indirect discrimination occurs when a
company’s policies, procedures or rules
which apply to everyone have the effect
that people with a certain protected
characteristic are put at a disadvantage
when compared with those who do not
Section 15 discrimination occurs when a
person is treated unfavourably because of
something arising as a consequence of their
disability. No comparison with how others
are treated is required in these cases.
Direct age discrimination occurs when
an employer treats a person less favourably
because of their age than they would
treat others. It is the only form of direct
discrimination that can be justifi ed.
In each of the above cases, the employer will
have discriminated against the employee,
unless they are able to justify the treatment.
In all three cases, it is down to employers to
persuade a tribunal that:
1. The provision, criterion or practice
(PCP) or treatment was in pursuance of,
and capable of meeting, a legitimate
Whether an employer’s stated aim is indeed
legitimate will be for a tribunal to decide.
For example, in relation to disability-related
sickness absence, case law suggests that
ensuring adequate attendance levels
and seeking to improve attendance are
2. When balanced against the
discriminatory effect, the PCP or
treatment was a proportionate means
of meeting that aim.
This part of the justification defence can be
very diffi cult to predict, particularly when
dealing with disability-related sickness
When considering proportionality, a
tribunal will look at how many people
in a protected group are adversely
affected by the PCP or treatment and
how severe that is.
Speak to the experts
If you would like practical advice
on discrimination or any other
employee relations matter
from a qualifi ed employment
law specialist, contact the NPA
Employment Advisory Service
on 0330 123 0558 or email
Reviewing the skills of your pharmacy team
Every now and then it’s good practice to check the skill mix of
the pharmacy team and ensure your business objectives are
being met by having the appropriate staff.
Upskilling staff may also help to meet the needs of the new
community pharmacy contract and the evolving requirements of the
Louise Baglole, head of learning and development at the NPA,
said understanding your team “as individuals,” exploring their
strengths and weaknesses and harnessing these, is important to
drive a more successful team.
“Team members are all different and defi ning their role within
the team will enhance their ways of working, leading to greater
collaboration and productivity,” Louise explains.
She adds: “Making time to review your team is essential to
business success. Assessing team roles and ensuring you have the
correct skill mix will ensure your team is performing at its best.”
When reviewing the skills mix of your staff, contractors may wish
to think about the following objectives:
• Identifying how to ensure your staff are skilled appropriately and
understanding how you can get the correct skill mix for your
• Understanding the roles different people have within your team
and how you can get the best out of them.
• Refl ecting on skills and roles within your business and
understanding their importance and how you can improve your
• Providing CPD opportunities based on your knowledge about skill
mix and team roles that can form part of your revalidation.
Getting the correct skill mix
Louise says skill mix is a “broad term” which can refer to the mix
of staff in the workforce or the demarcation of roles and activities.
“It relates to the knowledge and skills required to conduct dayto-
day work to maximise effi ciency and effectiveness. Skill mix will
contribute to customer satisfaction, quality of services and patient
outcomes, with different skill mixes required for different roles.”
It is good practice from time to time to review both staffing and
skill mix to ascertain the following:
• Type of work which needs to be carried out - has this changed
recently or workload increased or reduced?
• Number of staff required to conduct the tasks.
• Skills needed.
• Could another member of staff do the activity?
• Would quality of care be impacted if a less skilled member did
• What is the cost implication, if any?
There are many considerations contractors need to think about
when looking at staffi ng and performance. Upskilling the team
is often a solution so the team members can take on new and
different tasks. The new pharmacy contract provides you with an
opportunity to do this to ensure you have the capabilities within
For more information on training course which can
help upskill members of the pharmacy team go to
www.npa.co.uk/training or call 01727 800 402.
Supply disruption for all oral preparations of generic
A Supply Disruption Alert has been issued by the Department
of Health and Social Care (DHSC) stating that all oral
preparations of generic ranitidine are expected to be out of
stock with no date of anticipated availability.
The contaminant, N-nitrosodimethylamine (NDMA), has been
identifi ed in samples of ranitidine active substance. All UKmanufactured
stock has been quarantined whilst the Medicines
and Healthcare products Regulatory Agency (MHRA) conducts
A Class 2 medicines recall drug alert (Ref: EL(19)A/24) was also
recently issued by the MHRA for all unexpired stock of four Zantac
The following oral formulations of ranitidine are affected:
Oral formulation type Strengths
Effervescent tablets 150mg and 300mg
Tablets 75mg*, 150mg, 300mg
Oral solution 150mg/5ml, 75mg/5ml
*Over-the-counter generic ranitidine tablets are also affected by the
Pharmacists and pharmacy teams should be aware of the following:
• Remaining limited stock of unaffected oral ranitidine preparations
which are still in the supply chain should be reserved for patients
in whom specialists have considered that there are no clinically
suitable alternative treatment options
• Some IV ranitidine stock has been affected; however, there is
adequate stock of unaffected IV ranitidine to meet current UK
o IV ranitidine stock is under review and this situation may change
• Patients requesting repeat prescriptions of any oral ranitidine
preparation should be reviewed to assess whether ongoing
treatment is needed; prescribers should supply clinically
o DHSC recommends that prescribers and pharmacists work
together closely to achieve a better understanding of treatment
o Patients should be referred to a specialist where there is no
clinically appropriate alternative
• DHSC has produced a table of alternative products to consider
for patients requiring ongoing treatment (page 3 of the Supply
Disruption Alert); key points to consider include:
o Omeprazole is the first-line choice of proton pump inhibitor,
where clinically appropriate. There is currently suffi cient stock of
omeprazole to meet an increase in demand.
o Patients should not be switched to a different H2-receptor
antagonist (such as cimetidine) – this may reduce the availability
of these products which are sufficient to meet current demand.
Pharmacists requested by prescribers to provide advice on
clinically suitable alternatives should request a full medication
history for the patient from the prescriber, where appropriate,
before suggesting alternatives.
Adrenaline – patient safety
update from NPA
Following ongoing disruptions in
production of Emerade, EpiPen and Jext
adrenaline auto-injectors (AAI), the NPA
pharmacy services team has continued
to receive queries about suitable
alternatives and ways to support
To help community pharmacies, part
of the patient safety section of the NPA’s
website is dedicated to adrenaline. It
includes links to various adrenaline alerts,
the latest stock availability information for
AAIs/solution for injection ampoules and the
adrenaline Standard Operating Procedure
(SOP). This open-access resource can be
accessed by all community pharmacies.
The prescription validation process for
EpiPen 0.3mg remains in effect and has
now been extended to include EpiPen Jr
0.15mg. Pharmacies can supply patients
with a maximum of two AAIs per
prescription; this will continue until steady
supply is re-established.
Prescription validation process
Send the anonymised prescription to
Alliance Healthcare’s prescription validation
service by email at firstname.lastname@example.org
or by fax on 0330 332 8126. Please ensure the Alliance Healthcare
account number has been included.
Supply is limited to a maximum of two
EpiPen 0.15mg and two EpiPen 300mcg
AAIs per prescription.
Alliance Healthcare has advised that the
process will take up to 72 hours, followed
by a further 24 hours for delivery of the
Community pharmacy teams are
reminded to take the above timeframe into
consideration when placing orders and
advising patients ordering repeat prescriptions.
The Medicines and Healthcare products
Regulatory Agency (MHRA) has advised that
patients carry two adrenaline auto-injectors
at all times.
Patients should also be reassured that
there are other adrenaline auto-injectors
available which are not subject to the
prescription validation process and, with
their agreement, pharmacists can speak
with their GP and arrange for a new
prescription for two devices of an alternative
Extended use beyond labelled
To ensure patients have access to their AAI
during the ongoing supply shortage, the
MHRA has permitted the use of specific
lot numbers of EpiPen auto-injector 0.3mg
for four months beyond the labelled expiry
date. The MHRA has reviewed the stability
data for these lot numbers and agreed that
extension of use beyond the expiry date
will temporarily improve patient access
to the use of EpiPen auto injector 0.3mg.
Additional guidance for pharmacy teams
including information to support patients
can be found on the NPA website.
Supply to schools
Send the valid written requisition to Alliance
Healthcare using the contact details on this
page. Supply is limited to a maximum of
two EpiPen 0.15mg and 0.3mg AAIs per
Supply for use in GP practice
GP practices can email a request for EpiPen
0.15mg and 0.3mg AAI to the Mylan
customer service team at services@mylan.
co.uk; this will be forwarded to the relevant
department to be processed. Ideally requests
should be limited to a quantity of two AAIs
NHS Flu vaccination advanced
service 2019/20 (England only)
NHS England & Improvement (NHSE-I)
encourages pharmacy contractors to
consider using adrenaline solution for
injection ampoules instead of AAIs.
Pharmacists should be competent to
draw up and administer adrenaline from
ampoules with a normal syringe and needle.
This will conserve supplies of AAIs for
patients, carers, teachers, etc. who cannot
be expected to inject adrenaline using this
route of administration.
The NPA has published on its website a SOP
covering the administration of adrenaline
from an ampoule, and an auto-injector
device. This is intended to support pharmacy
teams in administering adrenaline if
required to do so, either as part of providing
vaccination services, or to manage any other
For further information contact
the NPA Pharmacy Services
team on 01727 891 800 or email