This month’s key notes

HMRC withdraws sector-specifi guidance on self-employed status and locum pharmacists

HMRC has given notice that the current guidance for locum pharmacists contained in ESM4270 and ESM2063 was withdrawn with effect from 30 June 2023. The employment status of engaging locum pharmacists will need to be considered in line with ESM0500 and the Check Employment Status for Tax (CEST) tool going forward. The withdrawal of the guidance does not in itself affect the tax status of self employed or locum pharmacists or their behaviour as locums; it means that, going forward, NPA members will no longer have a layer of comfort afforded through use of the NPA and PDA agreements that have been recognised by HMRC as an indication of locum status to date.

NPA members should, however, continue to ensure that locum pharmacists are engaged with a written agreement. Members will continue to have access to relevant advice and support on employment matters through WorkNest, including up to date information regarding the locum agreement templates. NPA members can access the NPA employment knowledge hub at tinyurl.com/3jafcu46 and contact WorkNest on 0330 123 0558 or employmentadvice@npa.co.uk to discuss individual enquiries.

ALSO THIS MONTH

NPA Weight Management and Obesity Hub

The Health Survey for England 2021 estimated that 25.9 per cent of adults in England are obese and a further 37.9 per cent are overweight, with similar figures seen across the rest of the UK. Obesity costs the NHS about £6.5 billion a year, and supporting patients to lose weight will help to tackle dangerous obesity-related health conditions such as hypertension and diabetes.

Community pharmacy can play a key role in supporting patients living with obesity. Therefore, the NPA has created a dedicated weight management and obesity hub page providing members with all the tools and resources they need to set up, launch and promote a successful weight management service for their patients.

The hub includes training, SOPs, resources for patients, step-by-step video guides and links to all relevant resources. There are also links to our trusted partners, with exclusive NPA member discounts and benefits to give you all you need to run a successful service.

For more information and to find out how you can launch your very own weight management service, visit: www.npa.co.uk/services/weight-management-and-obesity-awareness-hub/

NPA backs calls for new financial offer in Scotland

Patient services in Scotland could suffer unless there is increased funding for pharmacies, believes the National Pharmacy Association. This statement follows the rejection by Community Pharmacy Scotland (CPS) of the Scottish Government’s proposed funding package for 2023/24. CPS said the Government’s offer was not enough in light of rising costs, including higher medicines prices. It also described the Government’s interim cash injection of £20 million as insufficient.

NPA board member for Scotland, Phil Galt (pictured below), said: “The collaborative approach taken in Scotland for many years has resulted in world leading pharmacy services. The manner in which recent negotiations appear to have proceeded is out of character for the Scottish Government, which has until now worked in close partnership with the sector. “Other parts of the UK and the wider world see Scotland as a showcase for how to successfully expand access to NHS healthcare via pharmacies. It would be a great shame for Scotland’s international reputation to slip, but of course the main concern is the impact on patient services in Scotland.

“The £20 million cash injection announced as an interim measure, although welcome, doesn’t compensate for the vastly increased wholesale price of medicines being borne by our members in Scotland and across the UK.”

NPA at NHS ConfedExpo 2023

The NPA exhibited at the NHS ConfedExpo in Manchester in June. This is one of the biggest and most significant healthcare conferences in the UK. The event saw around 5,000 people attend over two days – the majority of whom were NHS leaders and managers.

NHS ConfedExpo aims to foster networking, spread learning and encourage innovation. The NPA was there to promote the benefits of engaging with community pharmacy to deliver NHS priorities, and to listen to what our partners across the NHS think of the sector.

MPs to look at the future of pharmacy

An inquiry has been launched by MPs to examine how pharmacy can help meet future demand for healthcare. The Health Select Committee will look at current challenges around funding, workforce and digital infrastructure. This is a significant opportunity for MPs to scrutinise the future of pharmacy and hold the current government to account, as well as guide policy beyond the next general election.

It puts pharmacy in the political spotlight just at the moment when fundamental questions are being asked about the sustainability of the NHS as a whole. Community pharmacy can help solve many of the long-term challenges faced by the health service and this must be the thrust of the inquiry, in the NPA’s view. Having had many discussions with the committee’s chair over the years, including during his time as Health Minister, we are confiden that he understands the sector’s potential, especially in the prevention sphere. The right questions seem to be within the scope of the inquiry, including key issues of capacity, workforce, commissioning and funding.

The committee’s conclusions and recommendations will be taken seriously by government, so it is vital that the community pharmacy sector engages fully. The NPA will, of course, be providing evidence to the committee on behalf of independents.

Leadership in your early career

Developing good leadership behaviours from the outset is crucial for pharmacists and other members of the pharmacy team, helping them contribute to the effective running of their pharmacy and its future development. Pharmacists also play a key role as leaders in making decisions that support patient safety, optimise the use of medicines and many other areas of pharmacy practice. Yet many pharmacists enter the profession after passing their foundation year with little or no formal training in leadership skills and behaviours.

They are then expected to lead pharmacy teams as they navigate new waters as newly qualified pharmacists. That’s why the NPA now includes leadership training in the NPA Foundation Training programme and we recommend leadership training to all foundation pharmacists, so they feel confident to lead from day one.

Clinical examination training

Community pharmacy staff are being offered a range of fully funded, flexible training to expand your clinical skills and improve patient care. Courses include Clinical Examination Skills and Independent Prescribing. Build your pharmacy future with specialist modules tailored to your skills, experience and individual learning requirements.

Complete the Clinical Examination Skills gateway module in approximately one hour online, followed by one of four specialist modules in cardiology, paediatrics, ENT or dermatology. Optional in-person practical training sessions are also available.

Find out more and register for Clinical Examination Skills training or Independent Prescribing courses at tinyurl.com/y75fw757

NPA medication safety update (MSO report) Quarter 1 2023 (England)

In the NPA Q1 2023 medication safety update:

• Analysis of patient safety incidents reported during Q1 2023

• Lookalike, soundalike (LASA) errors analysis

• Share and learn: prescribing errors

• Share and learn: near miss errors

• Share and learn: severe harm errors

• Medicine safety highlights

• Changes to the NPA Incident Reporting System.

Overall, there was a 3 per cent decrease in the number of incidents reported during Q1 2023, compared to Q4 2022.

Contact the NPA Medication Safety Officer (MSO)

NPA members

NPA members can contact the NPA MSO through the Pharmacy Services Team for further information, advice and/ or support on any patient safety or pharmacy topic by email at pharmacyservices@npa.co.uk Independent community pharmacies in England with fewer than 50 branches who are currently not members of the NPA can also contact the MSO by email at pharmacyservices@npa.co.uk

Include your pharmacy name, ODS code, name of the owner/ superintendent pharmacist and telephone/mobile number, and the pharmacy’s NHSmail email address. State ‘Non-member MSO query’ in the subject field

NPA patient safety resources

The full range of NPA patient safety resources can be accessed on the NPA website: www.npa.co.uk/services-and support/ patientsafety For further information, please call the NPA Pharmacy Services team on 01727 891800 or email at: pharmacyservices@npa.co.uk

National flu immunisation programme plan 2023-2024

The annual flu letter for 2023 to 2024 describes the national fl immunisation programme and outlines which groups are eligible for flu vaccination. Further details can be found at: tinyurl.com/ypcy57p6

Save on your utilities

Full Power Utilities

Full Power Utilities is an established, independent whole of market energy consultancy. It offers competitive procurement for any SME, mid-market or corporate business and is recognised in the industry as a ‘premier’ broker. Full Power Utilities can help members with the following:

• Energy procurement

• Energy audit service

• Water procurement

• Energy efficiency

• Net zero / carbon reduction service

• Telecoms

• Utility account management.

NPA member benefits:

• Your own dedicated account manager

• A free no-obligation audit on your energy requirements

• Free, independent advice on all energy matters you may have.

Find out more about Full Power Utilities at www.fullpowerutilities.com/partners/npa

Testimonial

“We have been working with Full Power Utilities and specifically our personal broker Juliette Stone since 2008. We started off with a portfolio of seven sites that were with various suppliers all ending at differen times, making things hard to manage ourselves. The benefit of using Full Power’s services was a no brainer to us. They help us with site additions, metering issues and billing discrepancies, and are always looking ahead of time for our renewal contracts. We now have all sites (over 20) with one supplier all ending in 2023. We would recommend anyone with a business to take up their service. They are paid by the supplier and have over 40 suppliers that they work with. They have saved us a huge amount of time and a lot of money over the years. Juliette and her team always respond to emails and queries very quickly and are a pleasure to deal with. We can’t recommend Full Power Utilities more highly.”

Gurdev Sehmi, director, Touchwood Pharmacy, Berkshire.

Share and learn – prescribing errors

Prescribing errors risk patient safety and pharmacists and pharmacy teams can play a huge role in reducing the risk of them occurring. In this share and learn segment, we would like to highlight a reported prescribing error to reinforce the importance of recording and learning from these types of errors.

A pharmacy received a prescription for a 25-year-old female patient requesting Forceval soluble tablets with a dose of 10 tablets to be taken daily. Immediately, the pharmacist queried the dose with the surgery and the pharmacist was informed that this was directly requested from the hospital and stated on the discharge letter. The pharmacist felt that this must be an error and requested this to be escalated. Upon further inspection, the discharge notes stated Forceval soluble tablets ‘1OD’. It was found that this was forwarded to the doctor by the prescriptions clerk, who did not recognise the clinical error, and further signed off by the doctor without appropriate checks.

The ‘1OD’ instruction should have been interpreted as 1 OD; translating to ‘One to be taken DAILY’. The GP was then informed and corrected the error and issued a new prescription with the correct dosage. The surgery recorded this error as a significant event and informed the pharmacy that it would conduct a briefing around clinical/dosing errors in the next practice meeting.

Learn:

• Forceval soluble tablets are a licensed medicine, indicated as a therapeutic nutritional adjunct where the intake of vitamins and minerals is suboptimal – e.g. in the presence of organic disease such as malignancy and immune deficiency syndromes, IBD and conditions that lead to malabsorption of vitamins

• The licensed dose is one capsule daily, preferably taken one hour after meals • It is also stated on the SPC to not exceed the stated dose

• Although no cases of Forceval overdosage have been reported, the product contains multiple vitamins, each carrying their own risks when large quantities are ingested

• If iron overdosage is suspected, symptoms may include nausea, vomiting, diarrhoea, abdominal pain, haematemesis, rectal bleeding, lethargy and circulatory collapse

• Hyperglycemia and metabolic acidosis could also occur

• Due to the product’s iron content, if this had been prescribed for a child under the age of 12, the outcome could have been fatal

• This highlights the importance of a clinical check as it could be argued that the doctor should have picked up on this when signing of

• As this was a female patient of childbearing age, the risk of Vitamin A toxicity could have been detrimental to the development of any unborn child

• Ensure follow-up with the patient and place a note on patient’s PMR to prevent further incidents

• The NPA has produced Dispensing SOPs to support you

• Refer to the NHS Choices website for more information on iron at www.nhs.uk/ conditions/vitamins-and-minerals/iron/

• See the NICE guidelines on nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition: www.nice.org.uk/guidance/cg32