Monthly planner

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

 

 

Community pharmacy interim funding arrangements

Interim community pharmacy funding arrangements will take effect

from 1 April 2019. These will continue until negotiations on future

pharmacy funding are settled.

The interim funding arrangements are as follows:

• The Single Activity Fee (SAF) remains at £1.26 - the level may be

adjusted later in the year

• Prices of Category M medicines will increase by £10 million per

month. This is a return to the position prior to November 2018

• Pharmacy contractors will be reimbursed for up to a maximum

of 200 Medicines Use Reviews (MURs) between 1 April and 30

September 2019

• No more Quality Payments Scheme requirements or review points

have been set

• Commissioning for the NHS Urgent Medicines Supply Advanced

Service pilot will continue until 30 September pending further

discussions

• Pharmacy Access Scheme (PhAS) payments — pharmacies

already receiving PhAS payments will continue to receive them

on a monthly basis at the same rate as those received in the last

financial year

 

Negotiations on future community pharmacy funding are expected

to begin before Easter to enable implementation of any agreed

changes to the Community Pharmacy Contractual Framework from

October 2019.

The NPA welcomes anything that relieves our members’ perilous

fi nancial situation, so it is good that the recent period of reclaiming

excess margin has come to an end.

However this doesn’t change the fundamental position. We advise

our members to remain cautious about investment decisions, until

the longer term position is clearer.

A multi-year settlement, which incentivises quality and clinical

services over volume can’t come soon enough. This would give

pharmacies more confi dence to invest and take on the challenges

laid out for the sector in the NHS Long Term Plan. 

 

Freestyle Libre Sensors will be more widely available

to patients with Type 1 diabetes across England

from April 2019

Pharmacy contractors and their teams should note that NHS England

has increased the funding available for Freestyle Libre sensors to

allow access to flash glucose monitoring for more patients with

Type 1 diabetes. There has previously been variability in access to

flash glucose monitoring to patients in some parts of the country;

pharmacy teams may notice an increase in prescriptions received for

Freestyle Libre sensors from April 2019.

NHS England has published guidance on patient eligibility criteria

for flash glucose monitoring and the maximum amounts that clinical

commissioning groups will be reimbursed for continuing costs of

flash glucose sensors.

Freestyle Libre sensors are only available from Abbott Diabetes

Care direct and are not distributed through any wholesalers.

To obtain the Freestyle Libre sensor, community pharmacies are

required to set up an account via the Abbott Diabetes Care website.

This will take 24 hours to activate and then orders can be placed

and an invoice will be sent direct to the pharmacy.

 

GPhC registration renewal fees are set to rise from

1 July 2019

General Pharmaceutical Council (GPhC) registration renewal fees

for pharmacists, pharmacy technicians and pharmacy premises will

increase from 1 July 2019 for the fi rst time since 2015. The Council

at the GPhC decided that the fees should be raised to refl ect the

increase in the organisation’s costs and workload.

The registration renewal fees from 1 July 2019 will be as follows:

Register/registrant	New fee	Previous fee
Pharmacist	£257	£250
Pharmacy technician	£121	£118
Pharmacy premises	£262	£241

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

 

Ramping up local NHS engagement

The NPA Board has approved a business plan for 2019/20 committing the NPA to delivering member-centric services and securing community pharmacy’s position as the front door to the NHS.

One key work stream in the plan is to help independent pharmacists engage with their local NHS on the planning and delivery of health services.

The NHS long term plan signalled that most new investment in primary care (in England) will fl ow through local primary care networks (PCNs). It will be crucial for community pharmacies to work together to engage with the PCNs, and the NPA is working with the other national pharmacy

organisations to support this, as well as providing our own specific support for independent pharmacists.

Michael Lennox, chief officer of Somerset LPC, will be 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 local level. At the same time Michael will also take on 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 ICSs; work cooperatively 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.

“You hear a lot of platitudes about inclusion, but you have to turn those platitudes into action, and move from inclusion to influence,” Michael explained. “It’s through infl uencing the development of these [primary care] networks that we can achieve true integration, improving the operational interface between community pharmacy and general practice, as well as developing service innovations.

“You have to make sure you’re integrated in both the clinical services through the CCG and the public health interventions through the council.”

Michael added: “In Somerset, we’re working collaboratively on creating a system-wide commissioning plan that integrates community pharmacy into key service sectors, for instance urgent and emergency care. We’re also working with the local authority public health team on how we can be a co-ordinated and optimised contributor to the public health and prevention drive.”

He added: “An idea doesn’t have to be earth-shattering. It might be a better way of working together to triage patients, or a better way of communicating. A lot of positive things happen because we change things by one per cent. Ultimately, we need to get PCNs absolutely right, but that will happen because of lots of little changes.”

Health Secretary to speak at NPA conference

The Secretary of State for Health and Social Care, Matt Hancock, has been confirmed as the headline speaker at the NPA conference, Forwards in Partnership.

Mr Hancock will outline developments in health policy and his hopes for community pharmacy at an event in Manchester on June 20. He is the first of a stellar cast of speakers to be unveiled, with other senior names from the NHS, government and pharmacy to be announced shortly.

The conference is a collaboration between the NPA and Communications International Group, publisher of Pharmacy Magazine, Independent Community Pharmacist, P3 and Training Matters.

NPA chief executive, Mark Lyonette, said: “The NPA is working in partnership with others in the sector and with the NHS, to find a positive way forward for community pharmacy.

“The road to success is not a journey that can be taken alone. That is why we have chosen Forwards in Partnership as our theme. We are delighted that the Secretary of State has agreed to take part. We believe it demonstrates an eagerness to engage with the sector, and an understanding on his part that pharmacies are essential to the health of the nation.”

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

 

BUSINESS PRACTICE

Are the cracks starting

to show?

With the continued prospect of a

changing climate, colder winters and

warmer summers, the risk to your

property from subsidence will become

more pronounced.

Last year’s prolonged warm summer,

whilst a welcome change, has seen a

substantial increase in subsidence claims

across the insurance industry.

The Association of British Insurers (ABI)

reports that the number of claims jumped

from 2,500 (April-Jun 2018) to 10,000 (July-

September).

Property is at an increased risk following

extended periods of dry and warm weather,

but there are many reasons why cracks

might appear so there is no need to panic.

The worst hit area was south-eastern

England, where buildings are well-known

for being constructed on subsidence-prone

clay soil.

Subsidence is the downward movement

of ground beneath a property which leads

to abnormal stress on the structure and

foundations, which can result in cracking

and property damage.

The fi rst sign of subsidence is the

appearance of cracks in a property’s brick

or plasterwork. In general, subsidence

cracks develop abruptly and exhibit different

characteristics to other cracks. They are

usually diagonal, tapered and present both

inside and outside a property.

To determine whether your property is

subsiding the ABI advises that cracks are

typically:

• Diagonal, and wider at the top than at

the bottom

• Thicker than a 10 pence coin

• Found around doors and windows.

Subsidence may also cause doors and

windows to stick as the buildings structure

becomes distorted.

Quickly identifying and arresting the

cause of subsidence movement is critical.

These steps are integral to an insurer’s

claims solution which enables quicker, more

efficient and effective resolution of claims

that are unique to each event.

Mike Prevot, Head of Insurance Services

for NPAI said: “If you believe that your

property has exhibited any of the above

signs and you are concerned that there may

be the possibility of subsidence starting to

occur, I would strongly recommend that you

contact your insurer’s claims department in

order for them to arrange for someone to

investigate and take the corrective measures

if required.”

 

Local primary care network and pharmacy integration events

Getting engaged with emerging local structures within

NHS England.

It’s now more important than ever for pharmacy owners to get to

grips with local networks in the NHS. Most of the new investment

provided for primary and community care, alongside the NHS Long

Term Plan, will be funnelled through local commissioning structures.

Primary care networks (PCNs) are at the heart of the NHS

Long Term Plan. The aim of these networks is to produce a more

personalised, co-ordinated and integrated model of health and

social care by bringing together a range of local providers, including

GP practices, mental health and social care services, pharmacies, and

some hospital and voluntary services.

They are based on GPs’ registered lists and each covers around

30,000 to 50,000 patients. PCNs are already up and running in

many areas of the country and the plan is for the networks to cover

the whole of England by the end of 2019.

To understand more about these local structures, NHS England has

organised various events for healthcare professionals to attend.

For more information on events in your local area go to the

NHS England events website: www.events.england.nhs.uk

 

Partnership with Qube Learning

The NPA can now help members deliver non-clinical

apprenticeships after signing up Qube Learning, an Ofsted

approved training provider, as a business partner.

The partnership with Qube Learning helps pharmacy owners

who are considering taking on a customer service apprentice or

upskilling an existing employee with a leadership or management

apprenticeship.

Meanwhile NPA’s own pharmacy apprenticeship offering is also

making progress – the new Level 2 Standard for Pharmacy Services

Assistant was approved by the Institute of Apprenticeships in late

2018. The NPA plans to run a pilot later this year for their Level 2

apprenticeship. The Level 3 Standard for Pharmacy Technician has

been submitted to the Institute of Apprenticeships for approval.

Organisations with an annual salary bill of less than £3 million and

more than 50 employees can have 95% of the training costs of an

apprentice funded by the government from April 2019 onwards –

currently the funding is 90%.

For more details on apprenticeship funding for organisations

paying into the Apprenticeship Levy and for firms with less than 50

employees, view the NPA’s apprenticeships page on www.npa.co.uk/apprenticeships

More information about the full range of apprenticeships

on offer by Qube Learning can be found on their Business

Partner page on www.npa.co.uk/servicesandsupport/businesssupport/

partner/qube-learning/

 

Three questions employers

often ask about shared

parental leave

Introduced in 2015, Shared Parental

Leave (SPL) allows new parents to

share time off work in the fi rst year

of their child’s life, or in the fi rst

year after adoption. It is intended

to give parents greater fl exibility in

their childcare arrangements, while

still maintaining their profession.

Importantly, SPL allows both parents

to play an active role in caring for new

arrivals, and is another step towards

helping employees achieve a better

work-life balance.

Managing SPL can be complex, but

it’s important for pharmacy owners to

understand good practice so that you can

support employees and minimise disruption

to your business.

We’ve compiled a list of three key

questions employers often ask.

 

1. How much leave are employees

entitled to, and how should they be

paid during this time?

By law, women must take a minimum of

two weeks’ maternity leave after giving

birth. After this, new parents can take a

maximum of 50 weeks’ SPL, of which 37

weeks is paid, known as Shared Parental

Pay (ShPP). The statutory pay for shared

parental leave is £145.18 or 90% of the

employee’s average weekly earnings,

whichever is lower. You may wish to

offer additional pay above the statutory

minimum, which should be set out in an

employee’s contract of employment.

 

2. How can employees choose to

take SPL?

Employees can take SPL in the way

that’s best for them. It can be taken at

the same time as their partner, or at a

different time, meaning a woman can

take maternity leave while her partner is

on SPL. SPL also doesn’t have to be taken

in one go; employees can book up to

three blocks of leave during their child’s

first year. However, they must give you at

least eight weeks’ notice. Employers must

accept requests for one continuous period

of leave, but for employees requesting

discontinuous blocks of leave, you have

14 days to accept, put forward other

suggestions or refuse. Keep in mind that

shorter blocks of time may be preferable,

as it means employees won’t be away from

work for an extended period, keeping

them in the loop with what’s going on.

 

3. What’s in it for me?

Rather than seeing SPL as an

inconvenience, remember that there

are benefi ts for employers too. Greater

fl exibility around childcare is proven to

create happier, more loyal and more

productive workforces, and will make it

easier to attract and retain staff. Gone

are the days where employees are solely

focused on money – work fl exibility is now

high on people’s list of priorities when job

hunting. Ultimately, by embracing SPL,

employees will feel valued, appreciated

and supported, which can only be good

for business.

 

For advice, contact the NPA employment

advisory service on 0330 123 0558 or

email employmentadvice@npa.co.uk

 

 

New style GPhC inspections

Two of the biggest changes in the new inspection regime

which started from April 2019 are undoubtedly the move

towards unannounced inspections and the publishing of

the reports.

The general rule is that all inspections will be unannounced so

that inspectors witness the level of service patients and the public

experience on a day-to-day basis. Pharmacies can expect the

subsequent reports, including improvement action plans and details

of any enforcement action, to be published on a new website. These

new measures bring pharmacy broadly in line with other healthcare

providers inspected by the Care Quality Commission (CQC), but one

notable difference is the outcomes.

The GPhC has chosen a binary outcome that requires all standards

to be met to receive an overall ‘standards met’ outcome. Naturally

that means if any standard is found not to be met, this will result

in a ‘standards not all met’ outcome overall. The NPA would have

preferred graded outcomes similar to those used by the CQC, such

as inadequate, requires improvement, good and outstanding. We

understand pharmacies must keep pace with the public’s rising

expectations around transparency and open access to information,

in order to maintain the public’s confi dence.

The NPA has also sought assurances that the reports will not

contain any commercially sensitive information or information

that could present a security risk. In addition, while we agree that

patients should not be identifi able in the reports, neither should

pharmacy staff.

The GPhC has published the following principles that will

underpin the new regime:

• To be fl exible, agile and responsive to the information it holds,

intelligence it receives and issues it identifi es within pharmacies.

• Inspections should refl ect as closely as possible how patients and

the public experience pharmacy services day to day.

• The overall outcome of an inspection is clear and understandable

to members of the public and enables pharmacy owners to be

held to account against the standards.

• All standards for registered pharmacies need to be met every day.

 

Fluoroquinolone antibiotics: new restrictions

and precautions for use following rare

reports of serious side effects

The Medicines & Healthcare products Regulatory

Agency (MHRA) has published a drug safety update on

fluoroquinolone antibiotics highlighting rare reports of their

harmful and potentially irreversible or long-lasting adverse

effects on the musculoskeletal and nervous system.

The MHRA has issued advice for healthcare professionals,

including pharmacists as follows:

• Fluoroquinolones, when administered systemically (by inhalation,

injection or mouth), may rarely cause harmful, long-lasting (up to

months/years) and possibly irreversible side effects that may affect

numerous body systems, organ classes and systems.

• Patients should be advised to stop treatment at the fi rst sign of a

serious side effects, including muscle pain/weakness, joint pain/

swelling and tendonitis or tendon rupture, and immediately

contact their doctor for advice. An information sheet for patients

is included in the drug safety update.

• Unless other commonly recommended antibiotics are considered

unsuitable, fluoroquinolones should not be prescribed for mild/

moderate/non-severe or self-limiting infections – Summaries

of Product Characteristics will be updated following an EUwide

review of safety to show new restricted indications.

Ciprofl oxacin and levofl oxacin should no longer be prescribed for

uncomplicated cystitis.

• Avoid use of fluoroquinolones/quinolone antibiotics in patients

who have previously experienced severe side effects.

• Exercise particular caution in patients with renal impairment, solidorgan

transplants and those aged over 60 years.

• Concomitant use of a corticosteroid with a fluoroquinolone could

increase the risk of tendon rupture and should be avoided.

 

Reporting adverse reactions

The MHRA are reminding healthcare professionals to report all

suspected adverse drug interactions (ADRs) to the Yellow Card

Scheme – this is via the Yellow Card website or Yellow Card App

available on iOS devicesand Android devices

• The Yellow Card App has been updated with an easy login,

increased stability, new features, and questions on medicines in

pregnancy.

 

NPA advice for pharmacists

• Ensure any side effects experienced with fluoroquinolone

antibiotics are queried with the patient’s prescriber.

• Highlight potential serious side effects to patients so they know

what to look out for and what steps to take.

• Make necessary notes on the patient’s medication record.

• Report suspected ADRs to the Yellow Card Scheme.

For further information please contact the NPA on 01727 891

800 or email pharmacyservices@npa.co.uk

 

Your FMD questions answered

A selection of questions taken from the

UK FMD Working Group for Community

Pharmacy website. For more FMD

related guidance go to fmdsource.co.uk

and www.npa.co.uk/fmd 

 

How will FMD help identify dispensing errors? 

If an integrated PMR / FMD system is used, the

software will be able to check whether the products

scanned match the items on the prescription/dispensing

label. If there is a mismatch, the user will be alerted by

the software, thus reducing the likelihood of incorrectly

selected products being dispensed to patients.

 

What happens if a counterfeit is detected? 

You will get a message to say the medicine is

not in the UK hub (and therefore a suspected

counterfeit). The UK hub will automatically alert the

MHRA; however, you should also contact the MHRA by

completing a Yellow Card report. It is also good practice

to notify the wholesaler/supplier. Physically check

all stock (shelves, fridge, controlled drugs cupboard,

returns area, prescriptions waiting for collection) for

medicines with the same batch number and quarantine

them until further instructions are issued by the MHRA.

 

Are food supplements, such as Ensure, and

gluten-free foods covered by FMD? 

No. 

 

Will we need two types of scanners – one for

“normal” 1D barcodes and one for 2D barcodes? 

No. 2D barcode scanners will also scan normal

1D barcodes. 

 

Do I have to verify and decommission medicines

I supply via a Patient Group Direction or as an

emergency supply?

Yes, supplies of any prescription medicines will

need to be verified and decommissioned before

they are supplied to the patient.

 

How does FMD work if stock is “loaned” to

another pharmacy to fulfill a prescription or stock

is transferred from one pharmacy to another (within the

same body corporate)?

If a full, active pack, ie. one which has not been

decommissioned, is to be loaned or transferred,

the pack should be decommissioned by the receiving

pharmacy when they supply the medicine to the patient.

The pharmacy that loans or transfers the item does not

need to use the FMD system in relation to the medicine

prior to the loan or transfer, but they could choose to

verify the product.

If a split pack of medicine, which has already been

decommissioned, is loaned or transferred, the receiving

pharmacy should be notified of this, so they do not

attempt to decommission the product.

 

Do I need a separate internet connection for FMD? 

FMD systems will not specifi cally need a separate

internet connection from the pharmacy’s main

connection (eg. HSCN or N3), but the systems could

operate on a separate connection if desired.

 

My internet/broadband is slow. Will that affect the

system? 

No. The system is designed to work on a very low

internet speed. 

 

Will FMD impact on the way pharmacies use the

English Electronic Prescription Service (EPS)? 

There will be no direct impact on the way EPS

operates, but PMR systems with integrated

FMD functionality may be configured to link the

decommissioning of products, as they are handed to

a patient, to also trigger the sending of the dispensed

message to the Spine.

 

 

Pre-registration Pharmacist Training Programme

The NPA’s Pre-registration Pharmacist

Training Programme focuses on

the GPhC assessment syllabus and

performance standards.

The course is written and delivered by a

team of experienced pharmacists who will

fully support and guide pre-registration

students to develop into confident and

competent pharmacists. This programme

provides students with an invaluable

opportunity to interact, network and share

experiences with other pre-registration

pharmacists – all vital attributes for building

a future multidisciplinary workforce.

 

Course suitability

Pharmacy graduates undertaking their

pre-registration training year.

 

Course delivery

This blended learning programme is

delivered primarily through monthly

face-to-face study days at venues across

the UK. Further learning is provided

through webinars. Additional resources

are available online, including interactive

modules. Newsletters incorporating

support tools are also provided. Students

benefit from regular practice of exam-style

questions throughout their training and

a mock assessment mapped to the GPhC

assessment framework towards the end of

the year. Course topics covered include:

• GPhC registration assessment syllabus.

• Clinical pharmacy topics.

• Objective Structured Clinical Examination.

• Responding to symptoms.

• Law and ethics.

• Pharmaceutical calculations.

• First Aid.

• Measuring and fitting compression

hosiery.

• Public health.

 

How the NPA delivers the course

The NPA’s pre-registration training

programme incorporates a variety of

learning formats, as we recognise that

people learn in different ways and at

different speeds. By delivering in this way,

theoretical learning can happen at a time

and place to suit the student, practical

training can be accommodated within the

workplace and your student will be inspired

and fulfi lled by the mix of studying. The

majority of the course content is delivered

across three formats – e-learning, webinars

and study days.

 

Webinars

Tutorials in the form of webinars are

offered to students on several occasions

throughout the course. If the trainee

is unable to attend during the live

presentation, they can view it at a time

that suits by logging on to the e-learning

platform and view the content ‘on

demand.’ With an average duration of one

hour, a webinar provides an interactive, fun

way of learning but without the need for

the trainee to be away from the pharmacy.

 

E-Learning

The NPA’s e-learning system provides

an engaging and intuitive platform for

students to get to grips with the theoretical

aspects of the course. Access is available

24/7, so study can take place at a time

that suits them. There is also an app

that trainees can download, if they wish

to study ‘on the go’ or at times when

computer access within the pharmacy

may be limited. The NPA’s dedicated tutors

will be able to communicate directly with

students via the platform, so reminders of

forthcoming study days and pre-work, for

example, will appear as a notifi cation when

students log onto the platform or they

can arrange to receive text notifi cations.

Their supervising pharmacist, will also be

able to log onto the system and review

the student’s progress, as well as accessing

the Tutor Training programme and online

resources – free to all NPA members who

enrol a student on our pre-registration

training programme.

 

Pharmacy owners and students can

download a brochure from the NPA

website which contains more information

about the course including the schedule

of learning and student testimonials.