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NPA Essential: October

NPA Essential

NPA Essential: October

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



Community Pharmacist Consultation Service – toolkit


The new national NHS Advanced Service, the Community

Pharmacist Consultation Service (CPCS) will go live from 29

October 2019. The NPA encourages members to engage with,

register, and deliver the CPCS.

A new toolkit is now available on the NHS Business Services

Authority (NHSBSA) website:



The toolkit includes appendices which contain the patient fl ow

pathways for minor illness and urgent medicines supply.

Part A of the toolkit is intended to be read by the whole pharmacy

team and covers:

• An overview of CPCS

• How to get started

• How to provide the service

• How to claim payment

Part B of the toolkit is intended to be read and understood by

pharmacists providing the service as well as people who require

detailed information about the service. ENGLAND ONLY


Changes to MUR target groups from 1 October 2019

The target patient groups for Medicines Use Reviews (MURs)

changed from 1 October 2019.

Seventy per cent of all MURs carried out from 1 October 2019 to 31

March 2020 must be within two target groups:

• Patients taking at least one high risk medicine

• Patients who have been discharged from hospital who had

changes made to their medicines whilst they were in hospital.

From 1 October 2019, the following are no longer target groups

for MURs:

• Patients with respiratory disease

• Patients at risk of/diagnosed with cardiovascular disease who are

regularly being prescribed at least four medicines. ENGLAND ONLY


Public health campaigns

Pharmacy contractors are required to participate in the Stoptober

campaign in October as part of the Community Pharmacy

Contractual Framework.

Pharmacy contractors should have received Public Health England

(PHE) resources by courier from 14 August 2019. Social media and

digital resources are available to download from the PHE’s Campaign

Resource Centre. Community pharmacy teams can also order

materials from this website free of charge.

Pharmacy contractors that have not received their packs should

email stating the pharmacy name, address

and name of the campaign(s) they have not received materials for.



Living Well

A new scheme in Northern Ireland called ‘Living Well’ promotes

Public Health Agency initiatives. Funding has been provided by

Health & Social Care Board (HSCB) to those who have opted in to


Campaign runs every two months. The Stay Well/fl u this winter

campaign will run from October-November. NI ONLY


For further information or support please contact the NPA on

01727 891 800 or email



NPA flying flag for

community pharmacy at

party conferences

The NPA attended the three UK-wide

political party conferences in a bid to

remind activists and MPs that pharmacy

offers solutions to many of the big

challenges facing the health service.

For the Labour and Conservative

party conferences in Brighton and in

Manchester, the NPA partnered with the

Company Chemists’ Association (CCA),

the Pharmaceutical Services Negotiating

Committee (PSNC) and the Association of

Independent Multiple Pharmacies (AIM)

to organise joint roundtable events. The

events focused on prevention, particularly

the government’s Green Paper for

prevention. They brought together patient

groups, other healthcare professions,

parliamentarians and other stakeholders to

consider community pharmacy’s role.

Neil Bhayani, NPA’s public affairs

manager, was at the Lib Dem party

conference which took place in


Neil spoke with Sarah Wollaston MP,

who is chair of the Health and Social Care

Select Committee, about how community

pharmacies could help to relieve pressure

on GPs. He also spoke with Ed Davey MP,

deputy leader of the Lib Dems, about

medicines shortages and business rates.


AYP week to raise

awareness of community

pharmacists’ clinical skills

Right professional, right place –

that will be the theme for Ask Your

Pharmacist Week, the NPA’s annual

fl agship public awareness initiative

which this year runs from November


The overall message will be that

pharmacists are highly qualifi ed health

care professionals who can provide clinical

advice conveniently in a community

pharmacy setting as part of an integrated

local NHS team.

This is in line with the ambition outlined

in the NHS Long Term Plan to make greater

use of the skills of community pharmacists

and the clinical focus of the new

contractual arrangements in England.

Window posters and social media will be

available free of charge from the NPA. To

order the materials and view all campaign

assets go to

Any NPA member or pharmacy

stakeholders wishing to get involved can

contact NPA head of communications,

Stephen Fishwick, at


NPA response: GPhC

takes action against

unsafe supply of high risk

medicines online

The General Pharmaceutical Council

(GPhC) is taking action against online

pharmacies who have been identifi ed as

supplying high-risk medicines without

proper checks.

Recent pharmacy inspections by the

regulator found some online pharmacies

have supplied high-risk medicines to

patients without appropriate steps being

taken by the pharmacy owner, prescriber,

responsible pharmacist or other members of

the team.

Jasmine Shah, the NPA’s head of advice &

support services, said: “We strongly support

the safeguards introduced for online

pharmacies by the pharmacy regulator in

April and the proactive steps GPhC is taking

to check compliance, especially around

supply of high risk medicines.

“There were recently alarming reports in

the national media about a rise in addiction

to prescription medicines, and it is quite

right that opiates and sedatives are among

the medicines singled out for special

attention by the GPhC.

“This is in the interests of patient safety,

which must be the fi rst concern of every

pharmacist and every pharmacy owner.

“The GPhC points to the advantages of

having a face-to-face consultation with

the patient, which can reduce the risk of

making an inappropriate supply. Face-toface

interactions between pharmacists and

patients can make a big difference to the

quality of care given.

“Online pharmacies are convenient for

some people, but for this supply route to

gain wide acceptance, the public will need

to feel certain that their safety is assured.

Therefore we strongly support the action

the GPhC is taking. We urge all online

pharmacies to put proper governance

in place, assess risk in the context of

the particular service model and for

pharmacy owners and pharmacists to apply

professional judgement at all times.”


Green paper: community

pharmacy can play key

role in prevention

The government is “committed” to

expanding the role of community

pharmacists to support more people in

improving their health and wellbeing,

according to an offi cial policy paper

which proposes steps tackle the causes

of preventable illnesses.

The Department of Health and Social

Care is holding a consultation on its

‘Advancing our health: prevention in the


It proposes that people should not be

“passive recipients of care”.

“They will be co-creators of their own

health. The challenge is to equip them with

the skills, knowledge and confi dence they

need to help themselves.”

In addition the green paper states: “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


The consultation document explains that

to help achieve scale and pace to make the

2020s a decade of prevention, the following

should be considered:

• Expanding the role of community

pharmacists to support more people in

the community to manage and improve

their health and wellbeing

• Improving support options for people

living with musculoskeletal conditions,

and increasing the join-up across mental

and physical health services

• Strengthening links with councils,

charities and other local players,

otherwise the NHS will continue to be

treating the symptoms of problems

without influencing their causes.

Helga Mangion, policy manager at the

NPA, said: “The trusted position that

community pharmacists occupy in the heart

of their community means they can play a

central role in the management of various

conditions and their complications.

“The frequency at which people visit

pharmacies compared to other healthcare

settings makes it a good location for

monitoring the patient and any changes in

their condition.

“Prevention and early detection of

conditions such as diabetes for example is

a key part of the NHS Long Term Plan and

this is something community pharmacists

are well placed to support. We hope the

government continues to invest in the

pharmacy network which can help take

pressures of GPs and A&Es.”


For more information go to www.







Pharmacy Quality Scheme (PQS) action

plan and checklist published – are you

preparing for the PQS?

The NPA has produced an action plan and checklist to support

members to achieve the requirements of the Pharmacy

Quality Scheme (PQS). We will continue to update and/or add

to our resources as more information becomes available from

the PSNC and NHS England and NHS Improvement (NHSE&I).

The document is set out into two sections as follows:

• Key dates and deadlines table – this shows the deadlines as set

out by NHS England that pharmacy contractors must adhere to in

order to claim payments under the PQS

• Task list table – this indicates key actions for pharmacists and their

teams to complete over the next weeks in order to better prepare

them to be in a position to claim PQS payments when further

information is released by NHS England – the task list is intended

as a guide only and is not an indication of deadlines set out by

NHS England.

You are strongly recommended to read the detailed briefings from

the PSNC.


Other NPA support related to the CPCF

The following support is available to NPA members as part of our

ongoing guidance through the contractual changes:

• Go to the NPA website to watch the NPA CPCF webinar. It is a

practical session which will cover how the contract changes will

affect your business, what you can do to prepare; in addition a

panel of speakers aim to answer specifi c questions on CPCF from

individual pharmacy contractors

• The Community Pharmacy Contract Framework: What you need

to do webpage on the NPA website will continually be updated

with NPA resources and guidance to provide an understanding of

what you need to do and how to deliver the new agenda.


For further information please contact the NPA Pharmacy

Services team on 01727 891800 or email at pharmacyservices@


Support for Windows 7 operating system

will soon end

NPA members who are using Windows 7 on their IT systems

should start transitioning to Windows 10, as Microsoft has

announced the end of free support for the operating system.

After 14th January 2020 Microsoft will no longer provide free

security updates for Windows 7 which could place some systems at

higher risk from viruses and other running problems.

With the help of their IT or PMR helpdesks pharmacy contractors

should start planning to move away from the operating system.


The Community Pharmacy IT Group (CP ITG) has prepared

a briefing on the topic for pharmacy system suppliers

and IT helpdesks. Go to





Holiday pay - court bans

pro-rating entitlement for

zero-hour and casual workers

Following a recent landmark decision

by the Court of Appeal, employers

must now abandon generally accepted

methods for calculating holiday pay for

part-year workers.

In Great Britain, the Working Time

Regulations (WTR) 1998 entitle workers to a

minimum of 5.6 weeks’ paid annual leave. If

a worker doesn’t have normal working hours,

a week’s pay is taken to be their average

weekly pay over the previous 12 weeks.

Calculating entitlement for workers with

no set hours is more diffi cult. A common

approach is to say that workers accrue

annual leave at the rate of 12.07 per cent

of hours worked (as 5.6 weeks is equal to

12.07 per cent of the total hours worked in

a year).


The Harpur Trust v Brazel & Unison

Mrs Brazel was a visiting music teacher

employed on a permanent, zero-hour

contract. She worked when required at an

hourly rate and didn’t work during school

holidays, when it was agreed that she would

take her statutory and contractual annual

leave of 5.6 weeks.

When calculating holiday pay, the Trust

took Mrs Brazel’s earnings at the end of

each term and paid her 12.07 per cent of

that amount divided by three (to refl ect the

three school terms).

However, Mrs Brazel complained to an

Employment Tribunal that there is nothing

in the WTR to say that holidays for part-year

workers should be subject to a pro-rata


She contended that her holiday pay

should be calculated by:

• Working out her average weekly pay over

the 12 weeks prior;

• Multiplying this by 5.6; and

• Paying one third of this amount each term.

After a lengthy legal battle, the case

eventually ended up before the Court

of Appeal. Here, the Trust argued that

adopting Mrs Brazel’s method would mean

would mean she was paid proportionally

more in annual leave than full-time

employees (receiving 17.5 per cent of her

annual earnings in holiday pay compared

to the usual 12.07 per cent). They argued

that as Mrs Brazel worked fewer weeks than

the standard working year, her entitlement

should be pro-rated accordingly.

Despite this, the court held that the WTR

make no provision for pro-rating. They

simply require, as Mrs Brazel maintained,

the straightforward exercise of identifying a

week’s pay and multiplying that fi gure by 5.6.

NB: Pro-rating holiday entitlement is

permitted for employees who are on a parttime

contract but who have normal working

hours (e.g. Monday to Wednesday each

week for a full year).

The verdict confirms that staff

employed on a zero-hour contract, who

may not work or be paid for certain

parts of the year, are still entitled

to receive a minimum of 5.6 weeks

annual leave – and this should be paid

at the rate of a week’s pay (or based on

the average payment for the preceding

12 weeks, if work is irregular).


Contact the NPA employment

advisory service on 0330 123 0558

or email



NPA response: GPhC launches inspection

publication site

The public can now see pharmacy inspection reports online

after the General Pharmaceutical Council (GPhC) launched

its publication site in a bid to improve standards of safe and

effective care.

Jasmine Shah, head of advice and support services at the NPA,

said: “This brings pharmacy into line with most other public

services and public expectations. Patients now have access to

more information to help them make informed choices about their

pharmaceutical care.

“It’s encouraging that nearly nine in ten pharmacies met all

the standards set by the regulator. Most of the pharmacies rated

excellent since 2013 are independent pharmacies, which indicates

that independents are prepared to go the extra mile to provide great

service to their patients. What we would like to see is consistently

high quality care in all pharmacies.

“The GPhC analysis shows that investing in staff is a key driver of

performance against the standards. The NPA offers fl exible learning

options to suit training needs. Go to

for more information.”

More information about the GPhC’s approach to inspecting

registered pharmacies can be found here: www.pharmacyregulation.



Joint statement on medicine supply co-signed


We recognise that some patients and members of the public

are concerned about the potential impact that Brexit could

have on their ability to access the medicines they need.

Over the past year we have been working closely with colleagues

from across the pharmacy sector, the Department of Health and

Social Care (DHSC), the NHS and other stakeholders to seek to

ensure the continued supply of medicines and healthcare services in

community pharmacies as the UK leaves the European Union.

DHSC began to release details of its plans for ensuring medicines

supply in the event of a no-deal Brexit, along with supportive

guidance, back in August 2018.

Since then these plans have been

under regular review and the current plans are multi-layered.

Medicines will be given priority at ports and alternative routes for

bringing supplies into the country have been identifi ed. Medicines

manufacturers have been encouraged to build up buffer stock in

the UK and DHSC has procured a new freight service which will

be available to transport urgently needed medicines and medicinal

products into the UK quickly.

This additional supply route is intended to provide an extra level of protection

in the event that manufacturers’ contingency arrangements are not sufficient.

Whilst prescribers, pharmacists and the public have been asked

not to stockpile medicines, patients are advised to continue to

keep ordering prescriptions and taking their medicines as

normal. Guidance has been made available for patients on

the NHS.UK website.

Towards the end of 2018 we collectively worked with DHSC

as they reviewed legislation to enable pharmacists to support the wider NHS

in the event of serious shortages of medicines.

This new legislation is now in place so that, if the Secretary

of State believes there to be a serious shortage, pharmacists

will be enabled to provide continued access to medicines

and patients will continue to receive the best possible care.

The Serious Shortage Protocols are intended to prevent

unnecessary additional burden being placed upon general

practice during what would be an already challenging


In the weeks leading up to the end of October, and

beyond, we will continue to monitor the situation and do

all we can to help community pharmacy teams provide their

patients with the support and care that they need.


Your questions answered

Pharmacists Andre Yeung and Mike Maguire, who

developed and delivered the original NHS 111 referral

service in the North East of England, answer questions

from NPA members after a webinar on the NHS

Community Pharmacist Consultation Service (CPCS) –

which will replace the local pilots of the Digital Minor

Illness Referral Service (DMIRS). Go to

news-and-events/past-events/ to watch the webinar.



Q. If CPCS is supposed to save time/capacity for GPs,

aren’t we just transferring the problem to community

pharmacies and then reducing their time/capacity?

A. We know that general practice is very diffi cult to

access for patients right now. This service is about

seeing the patients with minor ailments and acute selflimiting

conditions on behalf of our GP colleagues, thereby

creating additional capacity for general practice to see the

many patients that truly need help from a GP. Community

pharmacies already see many patients every day for minor

ailments without extra remuneration. Additional revenue

generated from services like the CPCS could potentially be

used to fund extra staff or additional staff training in order

to help mitigate any time/capacity issues.


Q. How did the engagement process between general

practice and community pharmacies develop in the


A. As part of the NHS 111 referral service pilot in the

North East, there was no formal engagement of GPs.

It relied upon local relationships between pharmacies and

general practices. It is important to build and maintain great

relationships with your local GP practices. If you currently do

not have good relationships, then the CPCS is a good reason

and great opportunity to start having conversations and to

build relationships as the service develops.


Q. Use of community pharmacist prescribers will be a

game changer if community pharmacies had access

to a drugs budget and Rx pad - any thoughts?

A. Yes, this is something that would be extremely useful

and would be a signifi cant development not only

for this service but for the community pharmacy sector.

However for the moment the focus must be fi rmly set on

providing high quality clinical assessments and delivering a

successful CPCS.



Q. How long does it take pharmacists up north to

deliver the service and how does it affect their

work flow since patients walk in adhoc - we have no

appointment system. Should we have an appointment

system to aid workfl ow e.g. fiRst 15 mins per hour for

services so we can plan workload?

A. In the North East of England, without referrals from

general practice, the service operates successfully

without an appointment system being in place. One

of the unique attractive features of the community

pharmacy model is that patients can see a pharmacist

without an appointment. However, if the next phase of

this service (GP practices referring patients to community

pharmacies) becomes a reality across England, then

having an appointment system would need to be given

careful consideration.


Q. What’s the benefit for patients (over and above

them coming into the pharmacy for self-care

without a CPCS referral)?

A. As part of the service pilot, it is a requirement that

the pharmacist sees the patient in the consultation

room. The pharmacist uses the IT platform to standardise

their consultation which includes accessing the NICE

Clinical Knowledge Summaries (CKS), checking for red

flags and if necessary taking patients into escalation

pathways that link to NHS 111 and to general practice.

These elements cannot be guaranteed in most community

pharmacies if the patient walks in and asks for advice.

However, the fact that the patient has phoned NHS 111

for support with their symptoms/condition, shows that

they have not considered visiting a community pharmacy

in the first instance. These are the patients who really

benefit from this service.


Fire hazards with Diprosone

ointment and ondansetron

use in pregnancy – updates

from NICE

National Institute for Health and

Care Excellence (NICE) has provided

the following updated patient safety

information regarding fire hazards

with Diprosone ointment and use of

ondansetron in pregnancy as part of its

Medicines Awareness Daily updates:

  • Diprosone ointment – the Summary of

Product Characteristics (SPC) has been

updated to state:

- Patients using the product should not

smoke or go near naked fl ames due to

the risk of severe burns.

- Fabric that has been in contact with

the product (such as bedding, clothing,

dressings) burns more easily and is a

serious fire hazard; washing bedding

and clothing that has come into contact

with the product reduces product buildup

but may not completely remove it.

  • Ondansetron use in pregnancy – the

UK Teratology Information Service (UKTIS)

recommends that off-licence use of

ondansetron for hyperemesis gravidarum

and nausea and vomiting in pregnancy

should be reserved as a second-line

treatment due to a small increase in risk

of cleft lip and/or palate if the medicine

is taken in the fi rst trimester; patients

should be counselled on this risk

- UKTIS has updated its monograph for

healthcare professionals and patient



New NPA SOP for off-site

NHS flu vaccination

The NPA has launched a new standard

operating procedure (SOP) - ‘National

flu vaccination Advanced Service

(England) 2019-20 SOP for delivering

the service off-site’ - to support you in

delivering the flu vaccination service

under the NHS patient group direction


Available on the NPA website, the SOP

contains a comprehensive guide to support

NPA members to deliver the service offsite.

In addition, a checklist is included

that highlights key equipment/documents

required to provide the service safely and


Off-site administration of flu vaccinations

under the NHS flu PGD can only be

considered at either of the following two


• The patient’s own home, as long as there

is an existing clinical relationship with the

patient (the patient has used pharmacy

services in the past)

• Long-stay care home/residential facility for

a patient/resident who resides there.

NPA professional indemnity insurance

covers members to provide PGD services

(private and/or NHS) which may include

vaccination services, both from the

registered pharmacy premises as well as

from off-site locations, provided that all the

PGD and service requirements are fulfilled


It remains the personal and

professional responsibility of the pharmacist,

in all cases, to ensure that they are trained,

confi dent and competent to offer the

vaccination services (NHS and/or private)

including management of anaphylaxis and

resuscitation techniques.

A suite of resources and support for NPA

members providing the NHS Community

Pharmacy seasonal infl uenza vaccination

Advanced Service 2019/20 and private

vaccination services are available to

download from the dedicated fl u page on

the NPA website.


For further information on this or

any other query, please contact the

NPA Pharmacy Services team on

01727 891 800 or email





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