NPA Essential: May 2022

This month’s key notes...

Extension of the Covid-19 vaccination service – urgent action required

Due to the Covid-19 pandemic, The Human Medicines Regulations 2012 were amended allowing flexibility to the legislation governing vaccines and their supply to patients. The statutory instrument, The Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2022, extends these provisions to 1 April 2024. As the Covid-19 vaccination programme continues to benefit public health and the legislation has been extended, the legal mechanisms have also been extended.

Urgent action required

The PGDs and National Protocols for Covid-19 vaccination had an expiry date of 31 March 2022. All relevant members of the Covid-19 vaccination team are now required to read and sign the updated legal mechanisms before operating a vaccination clinic.

Key points for pharmacy teams

• NHSE&I has published the updated legal mechanisms, which can be accessed here: bit.ly/3LJCBxY

• All relevant members of the vaccination team must now read and sign the updated PGDs/ National Protocols prior to any clinics.

• Professional indemnity policies are provided for Covid-19 vaccinations by NPA Insurance. Please refer to the NPA FAQs for further information: bit.ly/3uaguuC

Covid-19 costs claims: Independent internal review and appeal update (England)

NHSBSA has been undertaking pre- and post-payment verificatio (PPV) exercises of Covid-19 costs claims. The process for pharmacy contactors to challenge any NHSBSA decisions for any unpaid amounts, if required, has now been clarified Contractors must read and understand the full details of the independent internal review and appeals process found in the Drug Tariff and the PSNC guidance described below:

• Section 12.10 of the April 2022 Drug Tariff contains details of the internal review and appeals process to be followed by community pharmacy contractors who want to dispute the amount to be paid or to be recovered after PPV
• Part XVIIID of the April 2022 Drug Tariff sets out the appeals process which is a matter for NHS Resolution and follows the National Health Service Litigation Authority (Pharmaceutical Remuneration – Payment Disputes) (England) Directions 2022.
• The PSNC has produced a guidance document on the internal review and appeals process. Please ensure that you read the full information in this document to be fully informed of what you need to do. For further details go to: https://bit.ly/3DFPnuR

ALSO THIS MONTH

Calling all trainee pharmacists: practise for your summer assessment

The NPA’s eLearning mock exam is now open for any external trainee pharmacists wishing to practise for their assessment this summer. It is suitable for trainees sitting the GPhC and PSNI assessments. The price including a free handbook is £60 (inc. VAT). Find out more here: bit.ly/3DGjfqI

Evolution of community pharmacy vaccination services – international survey

The World Pharmacy Council is a leading international organisation dedicated to representing community pharmacy. As part of a collaborative project with Pfizer WPC is asking community pharmacists from around the world to contribute to the future direction of the sector. The aim is to collect information on community pharmacists’ attitudes, experiences and support requirements in relation to the provision of vaccination services. The responses will help inform the future direction of pharmacy vaccination services. Go to bit.ly/3KdigRv to take part.

Fuller takes stock of community pharmacy in primary care review

Members of the NHS team running a ‘stocktake’ of how primary care is currently engaged in local systems met with pharmacy representatives last month at a roundtable organised by the National Pharmacy Association.

The discussion ranged across prevention, urgent and complex care and will feed into the ‘Fuller Stocktake’ of how primary care - including community pharmacies - can best be supported within emerging integrated care systems (ICS) to meet the health needs of people in their local areas. Dr Claire Fuller, who is in overall charge of the stocktake which bears her name, said: “This roundtable brought together pharmacy leaders and other experts to inform the stocktake – focusing on practical next steps ICSs can take as they assume a statutory footing from July. We’re delighted that the National Pharmacy Association is helping to engage its members and the wider sector in this process.” NHS England & Improvement director Gina Naguib-Roberts, who took part in the roundtable, said: “There was real power in what people said at this event. We covered an enormous amount of ground and heard some incredible case studies which help to lift people’s eyes and show what is possible. “We don’t want to leave it to chance that community pharmacy is in the right conversations within ICSs.” The NPA’s Local Integration Lead, Michael Lennox, said: “The Fuller team wanted to know what is needed from system leaders to fully engage community pharmacy in planning and delivery at a local level.

“Just as importantly, they need to know what pharmacy representatives can contribute to this objective. We went into detail about enablers such as data, leadership development, training opportunities, and IT interoperability.

“This whole process is about finding solutions together and effecting change – not only visioning the future but also making it happen in a very practical sense.” Go to https://fullerstocktake. crowdicity.com/ for more information on how to get involved with the stocktake.

NPA Chief Executive Mark Lyonette on the Spring Statement by the Chancellor

“In his Spring Statement, the Chancellor made a big play about addressing the cost of living crisis, but there is also a business costs crisis that is squeezing the life out of many independent community pharmacies. Utility bills, locum fees and business rates are all taking their toll, and NHS funding is nowhere near keeping up with the inflationar pressures in our sector.

“As the government’s recent hub-and-spoke impact assessment shows, further efficiencies will be hard for pharmacies to achieve. So the inevitable result of decreased funding and spiralling business costs will be a diminished service and permanent closures. “The NPA initially persuaded the Treasury to include community pharmacy in the Employment Allowance, and this is now worth £5k per business per year.”

Workforce pressures and pharmacist recruitment discussed at NPA’s Scottish Member Forum

NPA members from across Scotland came together for the recent Spring member forum which took place virtually. They discussed the current workforce situation, NPA advocacy, and identified independent community pharmacy business support needs. Over a hundred pharmacies in Scotland were represented. NPA members highlighted their growing concerns around the workforce, which included sustaining the current pharmacy network, recruitment of advanced community pharmacists into GP practices, and difficulties in findin locum cover in rural areas.

Phil Galt, NPA Board Member for Scotland, said: “The forum is a great way to meet with other pharmacy owners and superintendents to discuss what matters now in independent community pharmacy. There was a great deal of depth in the discussions that we had and I’m grateful to all the NPA members who contributed.

“Community pharmacy workforce pressures in Scotland are damaging the sector like never before. We are in a precarious situation where we may not have a viable community pharmacy network in the country which could impact patient care and the NHS.

“The NPA will be taking on board the feedback and comments from the discussion to see how we can alleviate the current pressures facing pharmacy teams.”

The NPA is collating responses from NPA members to support its conversations with Scottish and UK pharmacy organisations to highlight the current community pharmacy workforce situation. Follow this link to fill in a quick survey: www.surveymonkey. co.uk/r/2Y6CGJR

If you are an NPA member and would like to attend future Scottish Member Forums, contact NPA’s Scotland Representation Manager, Janice Oman (j.oman@ npa.co.uk), for further information.

NPA Insurance has been named Claims Team of the Year at the 2022 National Insurance Awards

The NPA Insurance team, which comprises lawyers with over 100 years of specialist pharmacy and clinical negligence experience, fought off stiff competition to win this prestigious award. The accolade is a reflectio on the way NPAI’s insurance business embraces the philosophy of putting claims as a product at the heart of its customer service proposition.

Alex Buchanan, NPAI’s General Counsel, who received the award on behalf of the team at an awards ceremony held at the London Marriott Hotel in Grosvenor Square in March, said: “The whole team at NPA Insurance is delighted to have been presented with this award in recognition of our efforts to provide our members and customers with the high level of personalised claims support that they deserve.

“We believe our holistic legal and claims led approach to risk management differentiates us from other claims teams. It is at the centre of all we do and we are passionate about going the extra mile for our customers, putting their needs at the heart of our business to safeguard their businesses and reputations.”

The last two years have been particularly challenging for the NPAI claims team, presenting unforeseen perils that tested everybody’s attitude to risk. Chief Operating Office Lisa Banks, said: “Winning this award is testament to the team’s ability to respond dynamically and empathetically to the rapidly evolving operating environment pharmacists have found themselves in. In addition to offering protection against the familiar risks faced during ‘business as usual’, the team adapted quickly to the pandemic, factoring in additional support and emergency responses to ensure our customers could remain open for business. I am extremely proud of the team and its desire to go above and beyond all expectations every day.”

NHS England Cancer – Early diagnosis campaign

NHS England and Improvement has launched a new cancer phase of the ‘Help Us, Help You’ campaign. The aim of the campaign is to encourage people who are experiencing potential signs of cancer to come forward to their GP practice to help increase earlier diagnosis and improve outcomes. The campaign is designed to address the key barriers to people seeking help, the fear around cancer diagnosis, and to increase awareness of the importance of body vigilance when it comes to bodily changes that could be a sign of cancer. The NHS Long Term Plan committed to increasing the number of cancers detected early at stage one or two from half to three quarters by 2028.

To download or order resources, such as leaflets or posters go to: bit.ly/38lVNU6

Patient satisfaction survey requirements 2022/23

Under the clinical governance requirements of the contractual framework in England, pharmacy contractors are required to undertake a patient satisfaction survey each financial year (1 April to 31 March), to obtain structured feedback on patients’ experience of their NHS services. On 26 November 2021, a number of changes were announced, notably concerning use of the Community Pharmacy Patient Questionnaire (CPPQ). Full details of the new requirements are set out in the Approved Particulars which can be accessed here: bit.ly/3v1D7AT

Key points for pharmacy teams:

• The new requirements still require pharmacy contractors to conduct a patient satisfaction survey to obtain structured feedback on their experience of using the pharmacy’s NHS services (as a minimum Essential and Advanced) each financial year.
• The pharmacy contractor now has the choice to adopt a variety of methods to collect feedback, instead of using the CPPQ.
• The method of collecting patient feedback should be accessible to all patient’s using the pharmacy and reflec the pharmacy’s business profile. Methods could include face-to-face, postal, email or web-based submissions.
• For 2022/23 the survey needs to cover the three topics agreed nationally by NHSE&I and PSNC, which are: 1. The ease of being able to speak to staff privately without being overhead 2. The provision of advice on health problems and healthy living 3. The timeliness of provision of NHS services.
• In addition to the mandated questions, the survey can include additional questions that may address local issues or concerns.
• The minimum number of feedback responses per pharmacy per year is proportional to dispensing volume – these can be found within the Approved Particulars.
• Once feedback is collected, pharmacy contractors should consider the feedback and make any adjustments if necessary.
• A summary of the feedback needs to be published via one or more of the following methods: 1. Displayed in the pharmacy (e.g. leaflets, posters or other) 2.
• On the pharmacy website.

For further assistance call the Pharmacy Advice and Support team on 01727 891800 or email pharmacyservices@npa.co.uk

Closure of NHSBSA Wakefiel Processing Centre

The NHS Business Services Authority (NHSBSA) Wakefield Processing Centre has been closed since 1 April. Pharmacy contractors who have been sending their end of month submission to the Wakefield Division are required to submit their prescriptions to the NHSBSA’s new Processing Centre which is located at: NHS Prescription Service Unit 5 Greenfinch Way Newburn Industrial Estate Newburn NE15 8NX.

Key points for pharmacy teams:

• The change of address only applies to pharmacy contractors previously using the Wakefield division

• All other contractors should continue to submit bundles to their usual division

• NHSBSA has sent reminder letters to all affected pharmacy contractors together with new address labels to use

• The Manage Your Service (MYS) portal will also be updated with information about the new Processing Centre to allow pharmacy contractors to print address labels themselves • Any pharmacy contractor that sends their prescription bundle to the Wakefield address in error will have their batch diverted to the correct address

• If pharmacy contractors have any queries or are unsure of which division to use, contact the NHSBSA prescription services help desk on 0300 330 1349, or email prescriptionservices@nhsbsa.nhs.uk

• NPA members affected by the closure of Wakefield Processing Centre and using the Royal Mail service, should pick NPA – Newburn as the retailer, in order to generate the correct address label to send the bundle of prescriptions to the new address.

More pharmacies should do NHS Health Checks to help tackle obesity, says new study

A new report looking at ways to improve the lives of people living with obesity recommends that more pharmacies should do NHS health checks to improve access. Pharma giant Novo Nordisk held a series of roundtables with patient advocates, healthcare professionals and academics to generate understanding on the future of obesity care in England, and to support preparation of the report Levelling Up Obesity Care. Among its recommendations, the report says that “to widen access and alleviate pressure on GP services, consideration should be given to expanding NHS Health Checks in community pharmacy”.

NHS Health Checks include a measurement of body mass index (BMI). Those most likely to benefit from a Health Check include people who live in more deprived areas, and are more likely to be living with obesity, says the report. Sanjeev Panesar, a National Pharmacy Association board member who advised the report’s authors, said: “The benefits of losing weight can be profound for mental and physical wellbeing.

“As pharmacists, we are frequently asked for advice about medicines to support weight loss, and we can also help people on their journey to a healthier lifestyle, which is vital for maintaining a healthy weight.

“This report is a reminder of the scale of the obesity challenge, which has become even more pressing due to the impact of the Covid-19 pandemic.

“Having participated in the development of this report, the NPA is pleased to see it recommend the expansion of NHS Health Checks in community pharmacies.”

To read the full report go to: bit.ly/3xgqFzI

NPA backs report on collaborative working of primary care providers

A report which examines how primary care providers could work together more productively to improve patient access and outcomes of care has been welcomed by the NPA. Stronger Together: Collaborative Primary Care at Scale was published by Public Policy Projects (PPP), a global public policy institute, in conjunction with Healthworks, a think tank which works with health and care systems to improve effectivenes and efficiency for the benefit of populations. The report was launched during a session in the ‘Leading transformational change in primary care’ webinar, hosted by PPP on 5 April. It featured representatives from four independent contractor services in the NHS including: 

• Professor Paul Batchelor, Faculty of Medicine, University of Central Lancashire
• Zoe Richmond, Clinical Director, local optometry support unit
• Farzana Hussain, Clinical Director of Newham Central PCN
• Michael Lennox, NPA’s Local Integration Lead and Chief Executive of Somerset LPC.

The report is made up of contributions from thought leaders within the health and care sectors and representatives of the wider communities of primary care providers and professions. Nick Kaye, NPA vice chair, who contributed to the paper, said: “This is a much needed, timely piece of work which highlights how we as primary care providers can collaborate together to create primary care at scale.

“At a time when the health service and health needs of the population are growing ever more complex, it is imperative we come together to support the improved outcome for patients.”

The authors’ recommendations are that the four primary care contractors and their commissioners should:

• Seek to develop a culture in which co-production of care between four primary care contractors is paramount, working towards helping ensure each sector knows and understands how best it can work to support improved outcomes for patients.
• Confront the challenges of addressing inequalities through the adoption of population health principles and techniques.
• Acknowledge that the mixed economy supports the NHS.
• Adopt a more meaningful mantra than “building back better” – perhaps “achieving fair and sustainable health improvements”.
• Note the importance of the principle of national consistency in design and delivery of some services, but that contractors and commissioners work to “acceptable variability” tailored at local level.

To read the full report go to: https://publicpolicyprojects.com/ policy

Bank holiday reminder

Community pharmacies are not required to remain open during named bank holidays, as set out in the The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. Community pharmacies can remain closed without the need of notice, unless directed by NHS England and Improvement (NHSE&I) to open their pharmacies. The table below indicates when a pharmacy can close without being directed to remain open by NHSE&I:

Key points for pharmacy teams:

• Review your NHS 111 Directory of Services (DoS) profile and NHS website profile (step-by step guide) ahead of the bank holidays to ensure your pharmacy’s opening hours are accurate.
• Check, in advance, any controlled drug (CD) prescriptions received to ensure they are clinically suitable and legally valid to dispense: o The item (in the case of instalment prescriptions for CDs, this would be the first instalment) needs to be supplied within 28 days of the appropriate date on the prescription as stated in The Misuse of Drugs (Amendment No. 2) Regulations 2006. For instalment prescriptions, the remainder of the instalments are required to be dispensed in accordance with the prescriber’s instructions. o The appropriate date is the later of the date on which the prescription was signed (issue date) or the date indicated on the prescription as to when it should be dispensed, as stated in the Human Medicines Regulations 2012. o Ensure instalment prescriptions includes the approved Home Office (HO) wording to take into account of when the pharmacy may be closed, for example, over weekends/bank holidays to prevent any disruption to patients’ treatment.
• When presented with an instalment prescription with this wording, it may be advisable to clarify with the prescriber and document details of the discussion where necessary, when the instalment is to be dispensed on a day other than the day immediately prior to closure to ensure that patient care is not compromised.
• If a pharmacist decides to supply against a prescription that uses unapproved wording, the HO will not safeguard the pharmacist from legal ramifications when making the supply – the pharmacist should attempt to get the prescription amended so that it states the HO approved wording. The Drug misuse and dependence: UK guidelines on clinical management state: “If the issue date is before the treatment start date and the appropriate Home Offi wording is included regarding pharmacy closed days, the pharmacist can exercise professional judgement on the appropriate supply date to ensure there is no disruption to treatment”.

For example, if on a CD prescription:

• The issue date is 11/04/22
• The date when the prescriber wants the patient to have the methadone is 15/04/22, and the prescription contains HO approved wording for pharmacy closed days
• Pharmacy is closed on 15/04/22
• In this case, the issue date is before the treatment start date and it contains HO approved wording, it would not be unreasonable for the pharmacist to exercise their professional judgement and supply the methadone on a prior suitable day.

To read the full guidance go to bit.ly/3E90XyC