This month's news from the National Pharmacy Association...

This month’s key notes

Serious Shortage Protocols (SSPs) for Hormonal Replacement Therapy (HRT) medicines

The Department of Health and Social Care (DHSC) has issued a further 10 Serious Shortage Protocols (SSPs) following significant ongoing disruption of supply to five hormone replacement therapy (HRT) medicines. There are three types of SSPs for these medicines – either restricting supply to three months, or substituting to a specific alternative, or both (i.e. restricting and substituting).

Recommended actions when dispensing against an SSP are:

• Ensure the pharmacy has access to an NHSmail/ HSC secure mail account so that it can receive notification when an SSP is issued

• Ensure all staff, including locums, involved in the dispensing of a product subject to an SSP are trained and competent to do so.

• Access the relevant SSP and decide whether it is appropriate to dispense against it• Obtain patient consent to apply the relevant SSP product against their prescription• Counsel the patient in accordance to the SSP cautions and relevant actions

• Follow the SSP SOP (including other relevant SOPs). These should be up-to-date, read, understood and signed by all those involved in the service delivery

• Clearly endorse the prescription form, whether paper or electronic, with the SSP number

• Inform the prescriber if a therapeutic equivalent has been supplied as per NHS Pharmaceutical and Local Pharmaceutical Services Regulations

Go to https://bit.ly/3NTiHBG for further information.

HRT Hub

The NPA has created a resource library to support members with common queries relating to HRT such as product availability, alternatives and charges. The library provides the latest updates regarding the menopause and HRT, including clinical guidelines and alternative therapies, signposting, government consultations and Serious Shortage Protocols (SSP). Go to bit.ly/3xwB9tF for further information.

ALSO THIS MONTH

Vaccination training and PGDs: New Clinical Assessment course dates

A new blended Clinical Assessment course is available with four hours of face-to-face training plus online modules. It covers clinical skills such as medical history taking, urine analytics, blood glucose monitoring, throat and ear examinations and blood pressure measurement to support services.

This course is designed to give you the confidence to deliver services such as CPCS or ear/throat assessments. ECG Training dates for the face-to-face sessions, which are subject to change based on uptake include:

•Manchester - 3 July

•Birmingham - 24 July

•Edinburgh - 21 August

This course can be purchased from the NPA/ECG website along with other vaccination training and PGDs. Go to www.ecgtraining.co.uk/npa/

NPA’s weight management hub

The NPA and Novo Nordisk are working collaboratively to support independent community pharmacies in delivering services to assist their patients with weight management and obesity.The weight management hub contains the information, training materials and support you will need for setting up weight management and obesity services in your pharmacy.

For more information visit the NPA’s ‘Getting started’ page and the ‘Setting up your service’ page which sets out all the necessary steps to consider when setting up your service. If you set up a weight management service you will receive further support from a business development manager at Novo Nordisk.

Go to https://bit.ly/3O0exbi for further details.

NPA welcomes NHS England’s commitment to break through primary care silos and engage community pharmacy

The National Pharmacy Association has described the eagerly anticipated ‘Fuller Stocktake’ into primary care integration by NHS England and Improvement, as a “clear signal” that integrated care systems (ICS) must break through silos in primary care, and pointed to potential new opportunities for community pharmacies.

During the review, the NPA convened a sector-wide meeting with the team leading the stocktake to explore community pharmacy’s place in the landscape of integrated care systems. NPA representatives sat on each of the review’s working groups.

The Stocktake states that “at the heart of the new vision for integrating primary care is bringing together previously siloed teams and professionals to do things differently to improve patient care for whole populations”. It calls for integrated neighbourhood “teams of teams” to evolve from primary care networks.

To tackle gaps in provision, in particular for the least well-served communities, ICSs should consider commissioning new providers. The report highlights roles for community pharmacy in urgent care and prevention, including early diagnosis of cancers.ICSs are encouraged to develop a “single system-wide approach to managing integrated urgent care to guarantee same-day care for patients”.

They are also told to develop a primary care forum or network at system level, with a breadth of views including professional representation.According to the NPA, this adds up to a significant opportunity for pharmacies to engage with the NHS at a local level.

NPA chief executive, Mark Lyonette, said: “The NPA is pleased to have worked with the Fuller team to ensure that the voice of community pharmacy was heard within this review. So often in the past community pharmacy has been barely recognised in key reviews. This document is a clear signal to ICSs to break through silos in primary care and to engage community pharmacy in a multidisciplinary push on prevention, urgent care and long term conditions. This is an invitation to be active partners in integrated care and that means investing time and energy in building relationships to improve local services.”

Led by Dr Claire Fuller, the ‘Fuller Stocktake’ considered six themes during the spring of this year, including: Creating the right environment (for working together), People (workforce), Access (physical and non-physical), Working with communities, Governance and Data (for improving population health). You can see the full report here: bit.ly/3NXPlCh

NPA achieves prime time TV celebration of community pharmacy

The One Show on BBC One showcased community pharmacy to a prime time TV audience on 10 May. The five minute segment told the story of community pharmacy’s role during the pandemic and contained footage of a speech by the Prince of Wales, praising the sector for its contribution to the nation’s healthcare.It featured several NPA members, including board member Reena Barai.

Reena said: “It was great to be part of such a positive story. It’s heartening that the national media are taking notice of the sector, because it’s too often overlooked. Coverage like this both reflects public opinion and shapes it. That’s why the NPA works so hard on keeping pharmacy in the public eye.”

NPA head of communications, Stephen Fishwick, said: “The NPA’s press office worked for weeks with the programme makers to achieve this extremely positive coverage for the sector. The One Show is a flagship BBC programme and the demographic of its millions of viewers closely matches that of pharmacy users. I hope lots of pharmacists and pharmacy staff watch the item back and share via social media, as this is a great advert for the sector.”

NPA meets with head of HRT Taskforce to address medicines shortages

NPA board members met with the head of the government’s HRT Taskforce, Madelaine McTernan, to explore solutions to the nationwide shortage of some hormone replacement therapies.

Olivier Picard said: “Madelaine is working hard to grip this complex issue. We welcome the 10 new SSPs which go some way to tackle the supply disruption, but we continue to press for longer term solutions that would empower pharmacists to use their professional judgement to provide alternative medicines.

“We also want to see progress in relation to pharmacies’ ability to share stock without a wholesaler dealer’s licence in the event of shortages.”

NPA’s 2022 Vaccination training and PGDs – supporting pharmacy services

The NPA continues its partnership with leading training provider ECG Training, to deliver its vaccination training and PGD packages. Patient group directions (PGDs) enable pharmacists to supply and administer specified medicines to pre-defined groups of patients without a prescription.

ECG delivers expert-led face-to-face training sessions and online learning across a wide range of locations in the UK for flu, travel, vaccination and non-vaccination PGDs. Louise Baglole, NPA’s director of professional services and development, said: “The pricing remains competitive, as the majority of our packages include the PGD as well as the training, with discounts available for members and associate pharmacists/technicians.

“ECG’s partnership with Pharmadoctor means you can be provided with all you require to maximise your clinical services, from training, e-tools and paper PGDs, to full marketing and advertising support. The NPA also has business partners who can help drive customers to your pharmacy."

She added: “ECG’s customer service support also helps with any query you may have and there are delegate resources on their website.”

In this year’s programme participants sign up for a blended Clinical Assessment course to support services the deliver. It covers skills such as medical history taking, BP measurement and ear/throat examinations. NPA members can also purchase a discounted ‘Unlimited Clinic PGD package’ which includes access to over 60 services (including the travel package) and any associated online training.

With travel now opening up, ECG is also offering two new Travel Health training options to support those who already have PGDs in place.Go to www.ecgtraining.co.uk/npa/ to purchase your training and PGDs. For more details of the NPA’s 2022 programme visit: https://www.npa.co.uk/pgd

Foundation pharmacist training programme 2022/23

The NPA’s integrated foundation pharmacist training programme for this year is now open for enrolments. The course focuses on the GPhC assessment syllabus and learning outcomes, and adopts a person-centred approach.

It is written and delivered by a team of experienced learning and development pharmacists who fully support and guide students to develop into confident and competent pharmacists. The programme provides students with an invaluable opportunity to interact, network and share experiences with other trainee pharmacists – all vital attributes for building a future multidisciplinary workforce.

The NPA’s pass rate for recent cohorts has exceeded that of the national pass rate published by the GPhC.Some of the key features in this year’s programme include:

•Four face-to-face study days delivered in three locations - London, Birmingham and Manchester - plus three virtual study days

•Opportunity to complete the NPA’s GPhC accredited Medicines Counter Assistant course, Flu/Covid practical vaccination and Clinical Skills training, as well as a Leadership webinar – all included within the member price

•Tutorials delivered via five webinars

•Comprehensive online training via the NPA Learning Academy, an intuitive e-learning platform•Emergency First Aid - practical training and certification

•Dedicated support teams - learning and development tutors and member services.

Heenal Malde, NPA’s learning and development manager, said: “The NPA’s Foundation Training programme delivers an industry leading blended learning experience for your trainee pharmacist that will not only equip them to pass their GPhC registration assessment, but also provide them with the practical skills and knowledge to become a valuable and professional member of your team.

“They will partake in a dynamic and comprehensive programme that successfully supports trainees right from the start of the course, through the GPhC assessment and beyond.”

She added: “We understand that the foundation training year may be quite overwhelming for students, so your student will be supported every step of the way by the NPA’s dedicated teams – from enrolment through to the GPhC registration assessment.”

For further information on this year’s programme go to www.npa.co.uk/training/foundation

Health Education England elearning resources for pharmacy teams

Serious shortage protocols (SSPs) for hormonal replacement therapy (HRT) medicines

Health Education England e-learning for healthcare (HEE elfh) has worked with Health Innovation Manchester to develop a Breast Cancer Primary Prevention Education e-learning programme. The resource - aimed at primary care staff including GPs, nurses, pharmacists, and allied health professionals - outlines the lifestyle and pharmacological interventions that can be used in the primary prevention of breast cancer for pre and postmenopausal women.

It also covers the side effects of each drug and the guidelines to receive treatment.The programme consists of one module, which takes approximately 20 minutes to complete. At the end of the programme learners will be able to:

•list the strategies for lifestyle interventions for the prevention of breast cancer

•identify which drugs are used in the prevention of breast cancer for pre and post-menopausal women

•describe the potential side effects of each drug

Learners can access the session here: bit.ly/3O3Y7Pr

New learning path supports ambulatory teams treating people nearing the end of life

A new learning path for ambulatory care teams has been added to Health Education England e-learning for healthcare (HEE elfh)’s end-of life-care for all programme. Ambulatory teams consist of physicians, nurses, pharmacists and allied health professionals who offer same-day care to patients at the hospital.

This means that patients are assessed, diagnosed, treated, and can go home the same day, without being admitted into hospital overnight. This learning path was collated with the assistance of the Ambulatory Assessment Team at Oxford University Hospitals. It is designed to support ambulatory team members to be more confident in the assessment, diagnosis and treatment of patients nearing the end of life.

For more information and to access the learning path, please visit the end-of-life-care for all (e-ELCA) programme page here: bit.ly/3NrxSCv

Respiratory disease toolkit now available

Recognised as a new national clinical priority in the NHS Long Term Plan, the NHS is investing in improving treatment and support for those with respiratory disease.HEE has developed a new Respiratory Disease Toolkit to provide health and social care professionals and multi-disciplinary teams with a comprehensive list of resources that can be used to support respiratory workforce upskilling, training and development.

Available in the Respiratory Disease e-learning programme, the toolkit offers an extensive list of credible and helpful resources relating to the prevention and management of respiratory conditions, from symptom onset to ongoing care, including early detection and diagnosis, treatment and rehabilitation.

You can read more about the toolkit, including how to access it, by visiting the Respiratory Disease programme page here: bit.ly/3tlPcAG

Cardiovascular disease toolkit available for the health and care workforce

Cardiovascular disease (CVD) has been identified as the single biggest condition where lives can be saved by the NHS.The NHS Long Term Plan sets out ambitions for the next 10 years, highlighting CVD as a clinical priority. Health Education England has highlighted the need to enhance workforce understanding of CVD and create a holistic online repository of CVD resources, due to its multifaceted nature and complexity including multiple conditions, risk factors and high-risk conditions. The new Cardiovascular Disease Toolkit acts as a central portal for CVD resources and provides learners with the appropriate level of knowledge, skills and experience they need to deliver effective CVD prevention and care to people with CVD, and at risk of CVD.

You can read more about the background to the toolkit by visiting the programme page here: bit.ly/3GXKCOF

Review pharmacy funding in light of limited savings on hub-and-spoke, says NPA

The NPA has called for increased funding for community pharmacies in its response to a government consultation on hub-and-spoke.It also recommends that competition authorities intervene to avoid medicine price rises and poor service resulting from a lack of competition among hub providers.

The NPA accepts the proposed model in which supply is made from the spoke, but opposes one of the models described in the consultation, where the hub pharmacy supplies medicines directly to patients.Findings from an official impact assessment of hub-and-spoke dispensing, which revealed the limited extent of savings that may be possible, showed that an immediate re-think on pharmacy funding is required, the NPA response said.

The impact assessment suggests that the total savings to the sector’s operational costs will be £1m by 2024. This compares with well over £1 billion being withheld from community pharmacies in England from 2019 to 2024 due to flat funding – which was supposedly justified in part by efficiencies derived from hub-and-spoke.

The NPA also believes a fair and competitive market for hubs would be essential to avoid unintended consequences such as price rises and poor service by hubs. The NPA wants the Department of Health and Social Care (DHSC) to ask the Competition and Markets Authority to consider the matter, including a post-implementation market review. The DHSC consultation on hub-and-spoke, which closed on 8 June, included proposals for two models.

Under model 1, the prescription is sent from the spoke, then returned assembled from the hub back to the spoke pharmacy to be supplied to the patient. In model 2 the spoke sends the prescription to the hub, which then supplies the medicines directly to the patient.

The NPA is opposed to model 2 on the grounds that this could undermine the relationship between the pharmacy and the patient, creates uncertainty about accountability and potentially impacts patient safety. The NPA said that, in the end, the decision whether or not to engage with hub-and-spoke must remain with pharmacy owners and they should not be penalised if they don’t take part.

Helga Mangion, policy manager at the NPA, said: “The NPA has been leading the debate on hub-and-spoke since 2015. We have taken an evidence-based approach to our work in this area and convened an expert group, having published a review of research in 2016. In 2020 we published a review of international experience with hub-and-spoke.

“We need to have an honest conversation about efficiencies, a conversation that reflects the reality for independents struggling to survive. The government’s own official impact assessment, which accompanied the launch of the consultation, revealed the limited extent of savings that may be possible. Overestimating the likely benefits and using overblown cost-saving calculations is not a sound basis for funding decisions.”

NPA and Sigma discuss key issues on hub-and-spoke

The NPA joined Sigma Pharmaceuticals for a webinar about hub-and-spoke dispensing.

Patient safety, along with costs and competition issues were put under the microscope, as well as practicalities such as what to do with uncollected medicines.

NPA director of corporate affairs, Gareth Jones, chaired the event and was alongside NPA vice chair Nick Kaye and NPA head of advice and support services Jasmine Shah, as well as Sigma’s Hatul Shah and Raj Haria.

Nick said: “There are still many ‘unknown unknowns’ with hub-and-spoke and the jury’s still out on potential benefits. I have reservations about cost and it worries me how efficient this is for the business and the long term sustainability for the sector as a whole. Above all, we need to think about the patient at the centre of all this and the potential confusion for them.”

A Department of Health and Social Care consultation on hub and spoke closed on 8 June and the NPA has encouraged it’s members to respond. The consultation includes a model in which hubs supply medicines directly to patients, bypassing the pharmacy spokes.

Sigma’s CEO, Hatul Shah, dismissed the hub to patient model because it cannot match local pharmacies for “service, advice and care”.

The webinar is well worth a watch for any community pharmacy considering the potential impact of hub-and-spoke on their operations. You can view the webinar here: bit.ly/3Q8uUo0

Over £11,000 raised for mental health charity Mind as part of NPA’s centenary celebrations

As part of its centenary celebrations, the NPA has raised over £11,000 for the mental health charity, Mind. The NPA marked its 100th birthday in 2021 and partnered with Mind in England and Wales, and its equivalent charities in Scotland and Northern Ireland - SAMH (Scottish Association for Mental Health) and Inspire Wellbeing – to raise awareness of pharmacy services for people with mental health problems and to generate funds for the work of these charities.

The NPA held set-piece events, such as sponsored walks, and pharmacists, colleagues and their families and friends were encouraged to organise their own activities. Fundraising events included a sponsored walk by NPA Board member Raj Aggarwal and his pharmacy team, who visited pharmacies in Cardiff in July. In Scotland, a team from the NPA took part in the Kiltwalk in Glasgow in September.

Collection tins were placed in pharmacies in Northern Ireland.Money was also raised by the creators of the 2022 NPA calendar after they donated 5 per cent of orders during ‘Ask Your Pharmacist’ Week in November.NPA chief executive, Mark Lyonette, said: “I was delighted to be at our sponsored walk in St Albans, home of our head office, last year.

This and other fundraising events all underlined the message that community pharmacies are concerned with the wellbeing of the whole person – mind as well as body.”

Charlotte Porter, head of corporate partnerships at Mind, said: “We are so grateful to the National Pharmacy Association for supporting Mind as we help those affected by a mental health problem.

“The money raised will help support our services, like the Mind Infoline, and the campaigning we do to ensure that the one in four of us who experience a mental health problem each year do not face it alone.”

The NPA raised a total of £11,583 for Mind and continues to encourage members to support the charity.

Launch of the NPA Controlled Drugs SOP templates

The NPA’s suite of updated template Standard Operating Procedures (SOPs) will support pharmacy teams when encountering CDs.

Key points for pharmacy teams:

•Please note the SOPs are templates and should be adapted to individual pharmacy processes

•A declaration page has been added at the end of each SOP, which should be completed by each member of the pharmacy team involved in the process

•It is advisable for SOPs to be reviewed at regular intervals by the pharmacist and where appropriate after a dispensing incident.

For further information and to access the SOPs go to: www.npa.co.uk/services/sops