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NPA Essential: November

 

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-

consultation-service/.

 

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

sulfur content

• 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

December.

 

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

included):

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

transitional payments.

 

To view the rest of the information sheet go to

www.npa.co.uk/services/superintendent-updates/

 

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

November).

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

exhibitions.

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

and earache.

“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

participate.”

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

information (countersignature).

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 prescriber.

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

support others.

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

Contractual Framework.

For further information contact the NPA

Pharmacy Services team on 01727 891 800

or email pharmacyservices@npa.co.uk

 

CPCF calendars

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

calendars:

• 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

completion dates

• 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/

to access.

 

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

discrimination justified?

 

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

certain circumstances.

 

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

share it.

 

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

aim.

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

legitimate aims.

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

absence.

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

employmentadvice@npa.co.uk

 

 

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

local community.

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

business.

• 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

approach.

• 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

the role?

• 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

the team.

 

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

ranitidine

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

investigations.

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

products.

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

supply disruption.

 

 

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

demand

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

appropriate alternatives

o DHSC recommends that prescribers and pharmacists work

together closely to achieve a better understanding of treatment

options

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

affected patients.

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.

 

EpiPen

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 scriptvalidation@alliancehealthcare.co.uk

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

device(s).

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

adrenaline auto-injector.

 

Extended use beyond labelled

expiry date

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

prescription.

 

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

per order.

 

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.

 

Administering SOP

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

anaphylaxis situation.

 

For further information contact

the NPA Pharmacy Services

team on 01727 891 800 or email

pharmacyservices@npa.co.uk

 

 

 

Recommended

NPA Essential: October

NPA Essential: September