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

Flu: NPA SOPs and resources

The NHS Community Pharmacy Influenza Vaccination Advanced Service in England started on 1 September. The NPA has updated the flu vaccinations service support pack for members which details the flu service, including a summary of the key changes and timelines, actions for pharmacy contractors, training, funding, and professional indemnity insurance.

Access the NPA flu hub here: www.npa.co.uk/nhs-flu-service/

Funding for CPCS IT systems now available until the end of March 2022

NHS England and NHS Improvement (NHSE&I) previously announced the extension to the funding for the Community Pharmacist Consultation Service (CPCS) IT systems until 30 September 2021. However, the national procurement model has been extended until the end of March 2022.

It is a mandatory requirement for all pharmacy contractors providing the CPCS to have a CPCS IT system in place in order to receive referrals from NHS 111 and GPs (where the GP CPCS is being provided).

The IT systems can also, in some cases, be utilised for:

• Creation of clinical records pertaining to the service

• Communicating with GP practices

• Submitting payment claims to the NHS Business Services Authority (NHSBSA)

For more information go to https://bit.ly/3hgrsrE

Pharmacy Quality Scheme 2021/2022
The Department of Health and Social Care (DHSC), NHS England and NHS Improvement (NHSE&I) and the Pharmaceutical Services Negotiating Committee (PSNC) have agreed the arrangements for the 2021/22 scheme with a focus on priorities supporting recovery from the Covid-19 pandemic.

Initial details have been published on behalf of the DHSC on the NHSBSA website, with further details anticipated to be published in September.

Key points for PQS 2021/22

• The scheme began on 1 September 2021 with the declaration period in February 2022

• Pharmacy contractors will be required to meet all six gateway criteria on the day of the declaration

• There are seven quality domains in which all the quality criteria in each domain must be met to be eligible for a PQS payment for that domain

• The total available funding for PQS 2021/22 is £75m

• Further details will be published within the September 2021 Drug

Tariff which include details of:

o How contractors will be able to claim an aspirational payment in advance of the full declaration
o Points allocation to each quality domain

• NHSE&I will be publishing full guidance in September For further information go to bit.ly/3A4Jbdj

ALSO THIS MONTH

Resources to support the delivery of Pharmacy Collect in Northern Ireland

The NPA has prepared resources to support pharmacy teams in the delivery of the Community Pharmacy Covid-19 Lateral Flow Device Distribution Service ‘Pharmacy Collect NI’

The new optional pharmacy service requires pharmacy contractors to order free lateral flow device test kits from the current wholesaler, Alliance Healthcare, for supply on request to the public in boxes of seven tests.

Record of the delivery date and the batch number of tests must be retained. The Covid -19 Pharmacy Collect NI Lateral Flow Test eForm will be used to collate data on supply and is submitted for payments. Specific Covid-19 self-testing advice must be provided to people collecting the tests, including the purpose of the tests and how to use and report results.

Moving forward with the consent of independents

The Pharmacy Representation Review (of the role of Local Pharmaceutical Committees and PSNC) has been underway since 2019, but little has been said yet about how contractors will approve change.

The NPA has proposed a ‘triple unlock’, which would set three requirements that must be met to approve a new structure. An absolute majority of all eligible independent voters must approve it. An absolute majority of all eligible multiple voters must approve it. And two-thirds of all those casting a vote across the entire sector must approve it.

Pharmacy owners in England fund local representation via LPCs, and national negotiations via PSNC. This costs them on average £1,000 a year per pharmacy in levy deduction payments. So the NPA believes members have a right to understand - and influence - what is going to happen next. The views of independents (well over half of all owners-contractors) must be clearly heard in this process.

Go to www.npa.co.uk/representing-you/ wright-review/ for more information.

You’ll be our anchor, First Minister of Wales tells NPA members

The First Minister of Wales Mark Drakeford and Wales’ Chief Pharmaceutical Officer Andrew Evans were among the guests who gathered at Cardiff Castle to celebrate the centenary of the National Pharmacy Association.

Drakeford told the assembled NPA members: “The word ‘community’ in community pharmacy means something. As well as being an essential clinical resource, community pharmacy is an economic driver.

“As we rebuild after the pandemic, you will be one of the anchors that help maintain the vitality of local high streets.”

He praised the work of pharmacy teams during the pandemic, saying: “You have been on the frontline of the extraordinary experience we’ve all been through.

“Without you we wouldn’t have got through this together... that’s why there is support for community pharmacy across the
political spectrum in Wales.”

Making a formal toast, Evans said: “We have ambitions for a reinvented community pharmacy service – one that is thoroughly modern but built around the values and behaviours that are intrinsic to independent community pharmacy. The NPA and its members will have an invaluable role in that future.”

The health and social services minister Eluned Morgan told guests, via a recorded video message, that the lessons of the pandemic will “help us further develop the role of pharmacies” and promised ongoing support.

The centenary event, held last month, brought together NPA members, the NPA board and a range of stakeholders to recognise the contribution of independent pharmacies in Wales. It was hosted by the NPA’s board representative for Wales, Raj Aggarwal OBE.

Ask Your Pharmacist Week 2021

Ask Your Pharmacist (AYP) Week will take place from 1st – 8th November 2021. AYP Week provides a platform for pharmacy public awareness activities across the UK.

It also serves as a prompt for conversations with key stakeholders at a local level about community pharmacy services.

During previous AYP Weeks:

• Pharmacies and NHS bodies have used social media and newspapers to signpost people to community pharmacy as the first port of call for common ailments.

• Pharmacies have invited local dignitaries and politicians to visit for a health check and to learn more about the valuable services on offer

• NPA members have distributed leaflets about the range of services and skills in pharmacies and appeared on radio talk shows.

• Patient organisations and community groups have invited pharmacy staff to their meetings and webinars – to explain the evolving role of community pharmacy and how to make best use of local pharmacies.

The NPA’s head of communications Stephen Fishwick said: “The pandemic has given people a sense that pharmacies are capable of helping them in many ways that they, as patients, might not have previously imagined.

“Yet many people don’t know specifically what help is available in pharmacies, or how to access it. They may be missing out because they are unaware that their specific health concern can be addressed effectively, conveniently and close to home in their local pharmacy.”

Any NPA member or pharmacy stakeholders wishing to get involved should contact Fishwick on s.fishwick@npa.co.uk

Myth busting

GP referrals to the NHS Community Pharmacist Consultation Service (CPCS England) extended...

GPs have been able to make patient referrals to community pharmacies under the NHS Community Pharmacist Consultation Service (CPCS) for minor illnesses since November 2020.

All GP surgeries are encouraged to use this service to ensure patients are able to access the right care, in the right place, with the right person, at the right time. The NPA has produced a resource which aims to address some of the common misconceptions GPs may have about this referral pathway to CPCS.

Some of the misconceptions are listed here:

Myth: Only a GP can make a referral through the service.

Answer: Referrals can be made by anyone in the GP surgery team who has been appropriately trained. This can include receptionists, care navigators and clinicians (such as nurse practitioners, practice pharmacists and GPs).

This can help spread the workload within the team. Local commissioning groups and primary care networks are able to provide guidance and support the training involved.

Myth: Setting up, registering and training staff to provide the service can be time-consuming.

Answer: GP practice staff can be easily trained on how to implement this
service. Investing time in staff training and implementing this service will actually help to reduce GP practice workload and free up capacity to see patients with more complex clinical needs. Many procedures and systems are already in place at GP surgeries. For example, referrals can be made from GPs to community pharmacies via NHSmail or EMIS web.

The GP/PCN Toolkit Appendix C outlines the minimum dataset that needs to be included when referrals are sent. Surgeries may also have referral templates in place if they have previously signposted patients. Local health system support agencies (such as clinical commissioning groups and NHS England) are able to provide advice on set-up and support.

Myth: This service leads to health inequalities as low income patients are having to pay for over-the-counter (OTC) medicines.

Answer: Many NHS CPCS consultations for minor illnesses undertaken by pharmacists often result in advice and self-care for the patient. The majority of OTC items are relatively inexpensive and are often cheaper than prescriptions costs (where the patient is not exempt from prescription charges).

There are also many OTC items that GPs no longer prescribe on the NHS in line with national NHS policy in order to reduce financial burden on the NHS. Some pharmacies provide additional NHS services to eligible patients, such as locally commissioned NHS minor ailment services or Patient Group Direction-based services, allowing pharmacists to supply certain OTC items and prescription-only medicines (under a PGD) free of charge to patients who are exempt from prescription charges.

Myth: Only a small number of patients are eligible for this service.

Answer: All patients are eligible to be referred into the service, including children over the age of one.

A list of possible minor illnesses for referral can be found in the NHS CPCS service specification. Around 90 per cent of patients who have been referred by their GP practice have been successfully helped by the pharmacist for minor illnesses.

Myth: This is the same as the patient calling NHS 111.

Answer: The NHS 111 referral pathways involve patients calling NHS 111 and being triaged via clinical assessment algorithms which in some cases may be time- consuming and stressful for patients.

The GP CPCS involves patients being referred to a community pharmacy for minor illnesses via the surgery. This provides a more immediate, local and accessible route for patients to receive the most appropriate care at the right time.

Learning and development updates

Introducing NPA eCertificates
Digital badges and certificates have now been introduced which means students who complete NPA training will have instant access to an e-certificate on completion of their course.

It also means students don’t have to be waiting for their paper certificate to arrive in the post and no
risk of it being lost en route. The NPA has selected Credly - one of the largest credentialing networks in the world - to provide the digital badges and certificates.

Emails have already been communicated to our active students and their supervisors to describe the simple and fast process to access their e-certificate via the Credly portal. Students will be able to share the link to their e-certificate with their supervisor who can also download it for their records.

There are sharing options within Credly that allow students to promote their achievement, share it with their colleagues and link the e-certificate to professional applications like LinkedIn if they wish.

Flu PGD/eTool and vaccination training

If NPA members have not yet purchased their vaccination training and PGDs for this season’s flu vaccines, the flu eTool service package is available for free to all pharmacists, as a gesture of goodwill from our partners ECG Training and Pharmadoctor, given the tough last 12 months.

To find out the selection of training and PGDs available or to check which training you are required to undertake this year, go to: https://www.npa.co.uk/pgd

To book your training and PGDs via our partners, ECG Training and Pharmadoctor, visit https://ecgtraining.co.uk/npa/

Key features of the NPA’s Foundation programme

The NPA’s blended approach to learning includes 10 study days – a mix of face-to-face, virtual and webinar accommodates all styles of studying and provides an engaging learning experience.

Included within the programme fee, the whole day mock exam incorporates full online Part 1 and Part 2 exams with access to the answers and the rationale behind the answers, as well as support from the NPA’s L&D tutors. Read more on our Mock Exam page.

The 2020 pricing remains unchanged, even though new elements (as above) have been added. Where we save slightly on venue costs (due to less face-to-face study days), creating the virtual study day content on the NPA Learning Academy requires extra resource. The time involved in delivering a face-to-face study day compared with one virtually is the same - so we believe that the NPA’s 2021-22 programme is priced competitively in the market place.

The NPA’s course page provides more information about the programme or you can download our 2021/22 brochure which includes testimonials from students.

If you want to enrol a trainee on the programme go to www.npa.co.uk/ training/foundation. If you have any questions, please contact member services on training@ npa.co.uk or call 01727 800402.

NPA guide helps members get most out of pharmacy services team

The NPA has created a simple six-page guide to help its members get the best out of the NPA’s pharmacy services team.

The document has all the important contacts required for the day-to-day working of community pharmacy teams and brings together the “quick links” to key resources.

It also helps NPA members to navigate through everything that’s on offer in an efficient way and presents exactly what you need from NPA’s pharmacy services which is a key benefit of membership.

Jasmine Shah, head of advice and support services at the NPA, said: “By contacting the NPA pharmacy services team you save valuable time, enabling you to focus on providing high quality patient care and your pharmacy’s work streams and priorities. “Our team of registered and experienced pharmacists and pharmacy technicians are able to answer all types of queries relating to professional community pharmacy practice, and support patient and medication safety as part of our role as the Medication Safety Officer for independent community pharmacies in England.

“We hope this helpful guide makes it easier for members to access this vital member benefit.”

To view the guide go to www.npa.co.uk/information-and- guidance/the-new-pharmacy-services- guide/

Take hub and spoke to the competition watchdog, says NPA

The National Pharmacy Association (NPA) wants the competition watchdog to look into hub and spoke dispensing to ensure the system can operate without undermining choice in the medicines supply chain and disadvantaging independent pharmacies.

The NPA says that there needs to be a dynamic and competitive market in which hubs compete on the basis of quality
of service and price for the custom of pharmacies that want to operate this model.

Its board has suggested five tests for maintaining fair competition and choice within hub and spoke dispensing:

1.Hubs must be registered pharmacies and meet all GPhC/PSNI standards.

2.Hubs must be prevented from using their trusted position in the supply process to try to circumvent the relationship between the spoke and the patient, for example by using patient dispensing data for other commercial reasons or inserting branding or advertising material into packs to be supplied to a patient.

3.The current barriers to entry for a hub provider presented by the direct to pharmacy (DTP) and limited wholesaler schemes must be removed so that any registered provider meeting standards can operate and compete in this market.

4.A common set of standards should set out the duties and accountabilities of a dispensing hub and professional metrics which must be collected and published by the hub to assist the spoke in selecting a potential provider.

5.Any mechanism which is designed to prevent a pharmacy from easily switching hub provider should be prevented, thus ensuring that pharmacies can drive competitive pressures in this market.

To achieve the third test, the Human Medicines Regulations 2012 would need to be updated to put an obligation on all manufacturers to supply the reasonable needs of all registered holders of a wholesaler dealer’s licence or a registered pharmacy.

The NPA wants the Department of Health and Social Care (DHSC) to ask the Competition and Markets Authority (CMA) to look into the matter. The Association recommends that the DHSC seeks a market review both before and after implementation of ‘inter-company hub and spoke’, whereby a pharmacy can outsource elements of its dispensing to a third party (the hub).

NPA vice-chair Nick Kaye said: “If the government believes that hub-and-spoke dispensing is the future for pharmacy, it must do more to allow independents to engage with the model on a level playing field and to prevent unintended consequences. This includes ensuring that pharmacies that do not have access to hub services, or choose not to use hub services, are not disadvantaged.

“The government should also ensure that manufacturer-controlled supply restrictions, which stifle competition along the supply chain, are swept away.

“The CMA is an obvious place to start for scrutinising the matter and achieving a competitive environment that works for independents and the NHS.”

The Medicines and Medical Devices Act, which became law in February 2021, paved the way for regulations to legalise ‘inter- company’ hub and spoke dispensing.

Important update from NPA Insurance on indemnity cover for the flu national protocol

Following the publication of a national protocol for the NHS flu vaccination service, NPA Insurance has issued an FAQ on professional indemnity cover for administration of seasonal flu vaccinations by pharmacists and non-pharmacists under the flu national protocol. Some of the FAQs are listed here:

Q Will my professional indemnity insurance cover the administration of seasonal flu vaccinations by pharmacists and also non-pharmacists under the new National Protocol?

A The administration of flu/influenza vaccines by pharmacists (both within and outside of registered pharmacy premises) is covered under NPA members’ professional indemnity insurance policies and cover in this respect will extend to administration under the National Protocol. However, professional indemnity policies provided by NPA Insurance will not cover non-pharmacists to administer flu/influenza vaccines under the National Protocol or any other mechanism permitting administration by a non-pharmacist unless specifically endorsed. Further cover in this respect will need to be obtained at a cost of £244.90 (inclusive of insurance premium tax). This charge will cover all employed or engaged non-pharmacist vaccinators working both within and outside of registered pharmacy premises where permitted. Members can obtain this cover by emailing vaccineinsurance@npa.co.uk with details of their membership and/or policy number.

Q Will my professional indemnity insurance cover the administration of Covid-19 vaccinations and booster injections?

A Professional indemnity policies provided by NPA Insurance will not cover clinical negligence claims arising out of the Covid-19 vaccination service.
In England, the Department of Health has confirmed that cover in this respect, for existing vaccination schemes (phases 1 and 2) under a Local Enhanced Service, is provided under the Clinical Negligence Scheme for Coronavirus until 31st October 2021.

For phase 3 (booster vaccinations) from 6th September 2021, the Department of Health has agreed to a risk sharing agreement with pharmacy insurers for the period up to 31 March 2022, which restricts potential losses for pharmacy insurers and allows NPA Insurance Ltd to charge an affordable premium for these largely unknown and unquantifiable risks.

The premium now payable per pharmacy to cover clinical negligence risks for phase 3 booster vaccinations is £95 + IPT per branch/ vaccination site. Members and customers whose expressions of interest have been accepted to provide the phase 3 Covid-19 booster vaccination programme, must complete the document (found here: bit.ly/3hR1sDD) for every branch/site where vaccines are being administered and return this to vaccineinsurance@npa.co.uk

If the vaccination service takes place within the registered pharmacy premises, members of the NPA will be covered for other professional indemnity, public liability and legal expenses risks.

Members who are insured with NPA Insurance Ltd for their employers liability insurance are also covered for this service. Those who hold employers liability insurance with another provider are advised to check the position.

If not already obtained, further public liability cover will need to be arranged if vaccination services take place outside of the registered pharmacy premises, at a cost of £100 plus insurance premium tax per vaccination site. Members should email vaccineinsurance@npa. co.uk with their membership number, address of each vaccination site and start date so this cover can be arranged. Members should also check with their employer’s liability insurer that they have appropriate cover for the off-site service.

In Wales, the Welsh government has confirmed that clinical negligence cover is provided under the Primary Care (Oxford/AstraZeneca Covid-19 Immunisation Scheme) Directions 2020.

In Scotland it is understood that vaccination contracts have only been awarded to pharmacies in NHS Highland hotspots and state indemnity for clinical negligence is not being provided to those pharmacies.

We are able to provide an endorsement to member’s professional indemnity policies to provide cover against the risk of clinical negligence claims at a cost of £150 plus insurance premium tax per branch. Members in Scotland who have been contracted to provide Covid-19 vaccinations should email vaccineinsurance@npa.co.uk with their name, address details of the branches who have been contracted to provide the vaccination service and corresponding NPA membership numbers, start date and the number of vaccinations they have been contracted to carry out per week, so that cover can be arranged.

In Northern Ireland we have been informed that state indemnity for clinical negligence is not being provided to pharmacy contractors carrying out Covid-19 vaccinations.

If members have been contracted to provide Covid-19 vaccinations in Northern Ireland, we are able to provide an endorsement to professional indemnity policies to provide cover against the risk of clinical negligence claims at a cost of £150 plus insurance premium tax per branch.

Members in Northern Ireland who have been contracted to provide Covid-19 vaccinations should email vaccineinsurance@npa.co.uk with their name, address details of the branches who have been contracted to provide the vaccination service and corresponding NPA membership numbers, start date and the number of vaccinations they have been contracted to carry out per week, so that cover can be arranged.

Please email vaccineinsurance@npa.co.uk if you have any additional questions or want to check cover.