NPA Essential: September 2023
This month's news...
Mandatory IT system requirement for hypertension case-finding service
As of 1 September, it is now a mandatory requirement that community pharmacies use an NHS-approved clinical IT system to make clinical records and payment claims for the Hypertension case-finding service. The IT system will allow the transfer of data via a new API (application programming interface) to automate payment claims and reporting data to the NHSBSA’s Manage Your Service (MYS) platform. This previously had to be done manually.
Key actions for pharmacy teams:
• Read the letter issued by NHS England providing further communication relating to the IT system update with the service
• Pharmacies are required to consider which IT system supplier they want to use and enter into a contract with them
• Contact your IT supplier direct if you have any questions about the solutions it provides
• At the time of writing, the following four suppliers were on track to complete assurance for the consultation template and API:
• HxConsult (Positive Solutions)
• Pharmacy Manager (Cegedim)
• PharmOutcomes (Pinnacle Health)
• Sonar Health (Sonar informatics)
• Claims for June, July and August 2023 must be made via the manual MYS process by 5 September 2023 • In future, all claims must be made via the clinical IT system as manual MYS claims will not be possible after this date
• Claims for each month’s service provision will be available to view on the first of the following month. It is important to check that the claims match the record made on the IT system. For example, all service provision for September 2023 will be available to view in MYS on 1 October 2023
• Update the pharmacy’s NHS Profile Manager to indicate that you provide the hypertension case finding service. This can be done by selecting ‘NHS Blood Pressure Check Service’ and checking the box under the heading ‘NHS pharmacy services’
• Update the pharmacy NHS Profile Manager to indicate that you provide the hypertension case findin service. This can be done by selecting ‘NHS Blood Pressure Check Service’ and checking the box under the heading ‘NHS pharmacy services’
• Contact the NHSBSA MYS Helpdesk by email at email@example.com or call 0300 330 1368 if you require further help.
The development for other Advanced Services to be supported by an API to automate the claims process is currently being worked on. The timescales for this are New Medicine Service Q3 of 2023/24 and Smoking Cessation Service Q4 of 2023/24.
Further information: firstname.lastname@example.org, 01727891800 (Mon-Fri 9am to 6pm).
ALSO THIS MONTH
Independent Prescribing Pathfinder
In August, a letter was sent to all Integrated Care Boards outlining the next steps in the Independent Prescribing in Community Pharmacy Pathfinder Programme. It outlines NHS plans to include up to 210 community pharmacy sites across the 42 Integrated Care Boards (ICBs) in the Pathfinder programme so that each ICB can participate, following the outcome of an expression of interest process.
The pilots will test different prescribing models to help inform and develop the framework for the commissioning of independent prescribing in community pharmacy. This marks an important next step in the journey to make better use of the clinical skills in community pharmacy teams through the expansion of clinical services and better integration of community pharmacies into the NHS, making them the first port of call for a range of common conditions.
Making Changes, Meeting Needs
The NPA has published a medium-term prospectus for the development of pharmacy services, calling it ‘a challenge to old ways of thinking and an opportunity to redefine the sector’s role in the NHS’.
The publication follows months of dialogue with NPA members about what a clinical future could look like for the sector. The document – Making Changes, Meeting Needs – will be shared with the King’s Fund and Nuffield Trust, who are currently working on a new vision for the future on behalf of Community Pharmacy England.
Among the ambitions in the NPA’s prospectus are:
• Improve the management of long-term conditions such as asthma, hypertension, heart failure and diabetes
• Expand preventative interventions to help make the NHS a wellness, health inequality reversing service
• Shift focus from a downstream dispensing role to an end-to-end prescription management role, with a focus on good pharmaceutical outcomes
• Become the go-to professionals for optimising the use of medicines, including upgraded Structured Medication Reviews and post-discharge reconciliation
• Offer prompt and accurate diagnosis, risk stratificatio based upon genotype and the capacity for personalised treatments
• Increase medicines safety right across the care pathway
• Build on hospital touchpoints – preparing people going into hospital for elective care, give them a soft landing back into the community and reduce readmissions
• Dramatically improve access to primary care.
With informed policy-making and sufficient public investment, NHS community pharmacy could, during the remainder of the 2020s, develop much further as a clinical care and safe medicines supply service, in ways that will cost effectivel benefit patients, the public and the NHS, the document states.
“Building out from the existing portfolio of services, there are some major opportunities within this decade, encompassing prevention, medicines optimisation, long-term medical conditions and urgent care,” NPA chair Nick Kaye said.
“We are seeking to challenge orthodoxies that have limited the sector’s scope for too long. At the same time, these ideas are firmly planted in reality because our start-point is what the commissioners in the NHS want – not what we can dream up.
“Some of this is about redrawing the borders of pharmacy practice – for example, applying pharmacogenomics to pharmacist prescribing.”
In the community, out of the box
“Other aspects are about re-imagining what our domain is as a sector,” said Kaye. “We are rightly based firmly in the community, but our impact ought to be felt and formalised across the entire system, including hospitals. We need to be ‘in the community but out of the box’.
“We are confident that the large majority of NPA members – by their nature innovators – are open to the idea of ambitious, transformative change.”
Whilst pushing the boundaries of clinical service development, the NPA says it is also clear that the safe supply of medicines should continue to be a foundation stone upon which other pharmacy-based support is built.
Making Changes, Meeting Needs lists the enablers that would need to be in place in order to turn these ambitions into reality. They include digital connectivity, a boost to workforce and a supportive national contractual framework (in May, the NPA published its New Deal for Community Pharmacy in England, which describes such a framework).
More information is available via www.npa.co.uk/meetingneeds
NPA reveals Ask Your Pharmacist Week theme
The theme of this year’s Ask Your Pharmacist Week, which will run from October 30-November 6, will be ‘Meet Your Local Pharmacy Team’.
Held annually across the UK, Ask Your Pharmacist Week aims to raise awareness of pharmacy services and prompt conversations with stakeholders at a local level about community pharmacy’s role and benefits Activities range from window posters and social media to projects with patient groups and visits to pharmacies from local dignitaries and politicians.
“AYP Week 2023 will familiarise people with the skills of the pharmacist and the wider community pharmacy workforce, and how the team works together to provide a safe and effective service, including NHS clinical care,”
NPA head of communications Stephen Fishwick explained. “As usual, the NPA will supply campaign materials for our members and others wanting to take part in this long running initiative.”
More details will be provided soon. Meanwhile, any NPA member or pharmacy stakeholders wishing to get involved should contact Stephen Fishwick at email@example.com
NPA Mock Exam
You can support your trainee pharmacist to help them pass their common registration assessment this Autumn. The NPA’s Mock Exam is available for any trainee in England, Wales, Scotland and Northern Ireland and is now open for enrolments.
How will it benefit my trainee?
By purchasing the NPA’s Mock Exam, your trainee will be able to:
• Familiarise themselves with the online assessment process under timed conditions prior to the actual assessment
• Apply their knowledge to a full-length assessment reflecting the GPhC structure – part 1 consists of 40 calculation questions, part 2 consists of 90 single best answer questions and 30 extended matching questions
• Understand how to work out the part 1 answers by accessing our webinar
• Identify any gaps in their knowledge, as answers are received immediately, and take steps to fill these gaps before the actual assessment.
You can find out what’s included in the Mock Exam and how it has helped former trainees by visiting www.npa.co.uk/mock-exam.
NPA warns of compensation claims for delayed flu programme in challenge to NHS England
The National Pharmacy Association has told NHS England that its members have a legal basis on which to seek compensation should they incur losses due to changes to the start date of the NHS flu vaccination service in England.
The move came after NHS England pushed back the start date for adults to receive their flu jabs until October, a month later than in recent years. NPA members have, at their own risk, procured stock with a legitimate expectation that the service would be commissioned as normal, the NPA said in a letter to NHS England chief executive Amanda Pritchard.
Having taken advice from lawyers, the NPA decided to escalate the matter, both to affect the current situation and to send a message about the need for due process in the future.
“NHS England should expect to be held responsible for financial losses incurred – including wasted stock, additional storage costs and additional staffing costs – resulting from the late announcement to delay the NHS flu service,” NPA chief executive Mark Lyonette said.
“The NPA will help our members determine whether they have suffered a loss and have a realistic prospect of a successful claim for compensation.
“Even at this late stage, NHS England could choose to revert to usual practice, in order to maximise the effectiveness of this year’s flu campaign. However, we think it is right to warn them of the possible consequences if they choose not to do so.
“Whilst welcoming the recent concession which allows pre-booked appointments to go ahead, the NPA still maintains that it is a mistake to throw a previously successful NHS scheme into confusion by delaying the start date.”
In earlier representations, the NPA pointed out that the eleventh hour change was highly demotivating for hard pressed pharmacy contractors, who have proven themselves to be effective at delivering health protecting services. Some of these contractors are already at a financial clif edge, the NPA points out.
The NPA is partnering with Skills 4 Pharmacy to offer Level 2 and Level 3 pharmacy apprenticeships to NPA members in England. The NPA will refer its members who are interested in an apprenticeship to Skills 4 Pharmacy, who will deliver the apprenticeships.
The apprenticeship package:
• Provides a dedicated point of contact at Skills 4 Pharmacy
• Supports the student throughout their whole journey, right up to qualification
• Is an excellent opportunity to enhance pharmacy teams with minimal cost
• Is designed to upskill existing teams and support them in their professional development
• Enables new members to join and strengthen teams.
Skills 4 Pharmacy is an experienced pharmacy apprenticeship training provider, dedicated to initiating and developing the careers of pharmacy support staff and pharmacy technicians. It manages the recruitment of apprentices, as well as their enrolment and training.
The company is owned and managed by pharmacists, ensuring its training courses are perfectly tailored to meet industry needs. It has a team of experienced tutors on hand, ready to guide and assist with any queries that may occur during the apprenticeship and to make the student’s learning journey a rewarding experience.
For full information on Level 2 and Level 3 pharmacy apprenticeships, including what each course will include, visit www.npa.co.uk/apprenticeships/pharmacy-levels-2-and-3
NHS-funded clinical skills training
Community pharmacists and pharmacy technicians are being offered a range of fully-funded flexible training to expand clinical their skills and improve patient care.
Courses currently include:
Community pharmacy technician: advancing your role New, flexible, fully-funded training to help registered community pharmacy technicians develop the knowledge and clinical skills to deliver more clinical services and take on more responsibility in managing dispensing activity. The programme launches on 28 September. Registration is open now and more information is available from the Centre for Pharmacy Postgraduate Education.
Clinical Examination Skills for community pharmacists: Flexible training tailored to your skills, experience and individual learning requirements. Complete the gateway module in approximately one hour online, followed by one of four specialist modules in either: Paediatrics, Ear, Nose and Throat (ENT), Dermatology two-part module: Wound Care, Skin Presentations and Changes (expected this month), Cardiology (expected this month). More information is available from CliniSkills.
Independent Prescribing: Training to support patients from diagnosis to prescribing, providing advice and follow-up, and preparing to provide clinical care. NHS funding will cover all course fees.
More information: www.hee.nhs.uk/our-work/pharmacy/community pharmacy-training.
Share and learn – prescribing errors
Correction notice: Please note, in the July issue of NPA Essential, this share and learn segment contained an error in the legal status and indication for the product mentioned. Forceval® Soluble is a food supplement and Forceval® Capsules is a P medicine which has differen constituents of vitamins and minerals. The prescription error in this case study relates to the food supplement, and the indication stated in the July edition does not apply to Forceval® Capsules but relates to Forceval® Soluble. The original article which was inaccurate has been corrected below.
Prescribing errors affect 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 real patient safety incident, reported to reinforce the importance of making appropriate clinical checks
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 was 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 brief around clinical/ dosing errors at its next practice meeting.
• Forceval® Soluble is a one-a-day, effervescent multivitamin and mineral food supplement and can be used to help supplement a healthy diet. It can be used in women, men, and children over the age of 12. There is also Forceval® Soluble Junior, a one-a-day effervescen multivitamin and mineral food supplement that can be used to help supplement a healthy diet for children aged six to 12
• The product intends to help reduce fatigue and contribute to normal bone/muscle function: folate, iron, vitamin B2, vitamin B12, vitamin B6 and vitamin C each help to reduce tiredness and fatigue
• Calcium, magnesium and vitamin D each help to maintain normal bone function • Forceval® Soluble can be used in women, men, and children over the age of 12
• The information from the manufacturer also highlights not to exceed the stated dose
• Although no cases of Forceval® overdosage have been reported, the product contains multiple vitamins, each carrying 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 iron content, products like this must be kept out of sight and reach of children as the outcome could be 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 the patient’s PMR to prevent further incidents
• The NPA has produced Dispensing SOPs to support you
• Refer to NHS Choices for more information on 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
Alliance Pharmaceuticals Ltd has reviewed the corrected article for technical accuracy and did not commission or fund this article.