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In this issue...click on the image or text link for more information!
Don't forget, please don't keep the information to yourself - freely share the LPC newsletter with your whole pharmacy team (please remember your pharmacist locums too) - they can SIGN UP HERE so they get their own copy emailed in the future!
Changes to your LPC approved at Special Contractor Meeting
Melatonin - prescriptions for liquid prearations for children
Primary Care Networks - latest news
 
FP10 Update: Changes to NHS prescription forms and Tokens
NPA Forum webinar 28th January 2020
CPPE Update for January 2020
NHS Shared mailboxes - how often are you checking your emails?
Pharmacy Quality Scheme - declaration window opens 3rd February!
HLP Certification now lasts 3 years!!!!!
Community Pharmacist Consultation Service (CPCS)
Dispensing labels and Braille pack markings
Flu vaccination guidance letter 2020-21
 
NHS Service Finder 
Virtual Outcomes 
 
A View from the Chair...
Hi everyone and Happy New Year!.
The first LPC meeting of the year (and decade) took place on Wednesday 8th of January. Unfortunately, both Peter and Lucy were unable to attend due to unforeseen events so Gill and I were called in as last minute replacements! I want to thank Gill for her help and support on the day.
We welcomed a new independent member, Mohammed Eshak who owns Stafford Health and Wellbeing Pharmacy in Stafford. Mo also sits on Birmingham LPC so will no doubt bring his experience from that forum to our LPC.

As described below, we reviewed the structure and composition of the committee and contractors agreed to an amendment to reduce the number of committee members, and increase the value for money of the committee to the contractors; in the same vein, we will continue bi-monthly, all-day meetings for the coming year which has been found to increase productivity and efficiency.
 
We had a presentation from Dr Andrew Campbell regarding issues around
prescriptions from secondary care for unlicensed melatonin products – again, more of which to come. Our second visitor, Luke Bracegirdle from Virtual Health SHED Ltd included a demonstration of a virtual reality app to support patients with AF; this has the potential to be used independently but with support from a community pharmacy, and demonstrates the increasing role of assistive technology impacting on our sector.

We are aware that most of you are on target regarding PQS, but we must stress the importance of this issue to ensure all contractors benefit in these challenging times; whilst we would love to able to mention every aspect of PQS in our News Update, the PSNC’s comprehensive coverage on their website is the place to make sure you are fully prepared for your declaration – the window opens in a little over a week!

Best wishes
Martin
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Pharmacy Shared NHS Mailboxes
An email received from one of our PCN Leads suggested that a number of contractors were having problems accessing their NHS.net shared mailboxes - further evidence the LPC has suggests many contractors are not accessing their shared mailboxes with any regularity.
Whilst the LPC understands that the day-to-day pressures and staff churn are always factors in keeping up with emails, the harsh truth is that whilst NHS England use this as a sole method of communicating with contractors, and CPCS notifications use emails to shared mailbox as a backup to PharmOutcomes (well over 90% of our contractors are signed up to CPCS) it is not feasible simply to ignore your shared mailbox - or the issues preventing you from accessing it.
Check the mailbox regularly - at the very least daily - and ensure that you have enough members of your team able to access it.
Full details on shared NHS.net mailboxes and NHS mail in general can be found on the PSNC's website at:
https://psnc.org.uk/contract-it/pharmacy-it/nhs-mail/
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Community Pharmacist Consultation Service (CPCS)


The CPCS is an Advanced Service introduced to enable community pharmacy to play a greater role in urgent care provision. It is part of the Community Pharmacy Contractual Framework and replaces the NUMSAS service and also the local pilots of DMIRS.

It is part of the pharmacy contract and is expected to be commissioned long term with over 90% of our community pharmacies signed up to provide the service.  So far we have had some very positive feedback about the service but we are also receiving some questions from pharmacies.

I can highly recommend the PSNC website which has a wide range of Frequently Asked CPCS Questions

Examples of questions we have been asked include referrals for patients that are received outside the pharmacy's normal opening hours and referrals for minor illness that turned out to really be for urgent meds.  Also about referring the patient into a pharmacy service rather than sending them back to a GP or NHS111

These are covered by PSNC and I've included the answers below to show you how you can use the link above to the FAQ page and find out about the service.  

Q. I have received a CPCS referral from NHS 111 for an urgent supply while my pharmacy was closed. In what instances can such referrals be sent?
CPCS referrals for urgent medicines supplies may be made to a pharmacy when the pharmacy is closed if the patient declares that their next dose is due within the next 2, 6, 12 or 24 hours. In such instances, the patient will be advised that they need to call the pharmacy when it is next open.

Q. I received a minor illness referral, but the patient needed an urgent medicine supply. Why did this happen and what should I do about it?
In some circumstances, where the patient is exhibiting symptoms, potentially due to not having taken their regular medicine, this may be referred by NHS 111 as a minor illness referral, even though the patient’s eventual need is an urgent supply. This is the correct protocol within NHS 111, due to the patient being symptomatic and it can be managed by the pharmacist as an urgent supply referral; there is no need to ask NHS 111 to send another referral through. Your CPCS IT system supplier will be able to advise you how to make an urgent supply record, when the referral has originally been sent through as a minor illness case; generally this will involve using the manual/back-up templates within the system, making sure the NHS 111 case ID is added to the new record. Visit https://pharmoutcomes.org/pharmoutcomes/help/home?cpcs

Q. Can I refer the patient into another NHS pharmacy service?
Yes. Pharmacy services such as a Patient Group Direction or a Minor Illness Service can be used where they are appropriate to meet a patient’s needs.

Please remember our local Pharmacy First Services to treat UTI, Impetigo and the Extended Care Service that allows treatment of ear, nose, throat, eye and infected insect bites and infected eczema via PGD.  
More information on these services can be found on the LPC website along with a list of pharmacies signed up to provide the services.  


So in summary, you are able to advise your CPCS minor ailment patient about the Pharmacy First services, refer them in to the appropriate pharmacy service and you can then claim the CPCS fee.  
Be Aware: You can refer them into the service in your own pharmacy or if you do not offer the service yourself please refer them to a pharmacy which does provide the service.  The whole point of CPCS is to manage patients within community pharmacies wherever we can and not simply point them back into NHS111 or a GP service.

Changes to LPC Stucture approved by contractors

At a Special Meeting of contractors on Wednesday 8th January, the LPC's proposal to reduce in size from 14 to 11 members was approved by contractors.

The change will apply from 1st April 2020, and the committee will from this date consist of the following members:
Company Chemists' Association (CCA) - five members
Independent Pharmacies - four members
Association of Independent Multiple Pharmacies (AIMp) - two members.
At the January LPC meeting, members agreed to to continue meeting bi-monthly for full days, and will return to a former venue at Dean & Smedley's training room in Burton-upon-Trent.
As always, any contractor is welcome to attend any LPC meeting, please let us know beforehand however to ensure that we can make the relevant preparations.

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Primary Care Networks 
With a Community Pharmacy Primary Care Network (PCN) Lead in each of our 13 PCNs, we are starting to get some engagement from a number of the PCN Clinical Directors, around half of them having responded in one way or another.
One of the main topics of conversation is around service provision, particularly about information for the PCN's constituent practices about where patients can access services. Some of the PCN leads have started to check with their pharmacies on this, so expect to be contacted!
The Pharmacy Quality Scheme declaration window is now almost upon us, and you will need to have evidence that you have engaged with your PCN Lead and support them being the single point of contact with the PCN. Most leads have now emailed their PCN colleagues and have had some resonses - if you haven't seen an email yet, please check your NHS.net shared mailbox! The remaining PCN leads will be emailing out in the next few days.
If you haven't yet checked out who your local PCN Lead is, you can find this information on the LPC website at:
https://www.southstaffslpc.co.uk/our-news/primary-care-networks-community-pharmacy-lead-update-16th-december-2019/
Finally - don't forget to save a copy of your response to the PCN Lead ensure you evidence to support your PQS PCN Domain claim.
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Prescriptions for liquid melatonin preparations

At its January meeting, the LPC welcomed Dr Andrew Campbell, Director of Pharmacy and Medicines Optimisation for the Midlands Partnership Foundation Trust (MPFT) which is responsible for the provision of mental health services to children and adolescents across the county.
The LPC heard of issues around the dispensing of licensed and unlicensed liquid preparations of melatonin, and particularly that the licensed product contains alcohol and is therefore unsuitable for the young people they see. Contractors, however should always use a licensed preparation when available - and this is leading to some confusion as to their position in these circumstances. Dr Campbell also shared a leaflet about prescribing products "off-licence" which is given to patients, in the hope this would clarify the need for an unlicensed product in the circumstances, however this falls short of the information needed to satisfy MHRA requirements.
The LPC is gathering information and advice to support contractors in this and will update you via the usual channels when we have an effective solution.

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Virtual Outcomes - January update

In addition to the Dry January public health campaign training, Virtual Outcomes also have a training package to support contractors in completing the Dementia Friendly Environment Checklist and improving the experience of those living with dementia when they visit your pharmacy. This supports contractors' Pharmacy Quality Scheme claims in the Prevention Domain.
We also still have available the FREE training and assessment for one Health Champion in each pharmacy, which includes:

  • Online training - 6 modules, covering all the necessary information you will need for the RSPH assessment
  • Access to the RSPH assement
  • There's no time limit on when you can access this, however if you're getting accredited as a Level 1 HLP for the first time, or need to re-accredit, then you need to act fast!
  • If you already have your Health Champion(s) in place, you're welcome to use your FREE course for another member of your team, at any time now or in the future
  • Want to train more than one member of your team? Further courses can be accessed via your LPC at a special discounted price - email us for details.

To register for this please email peter@southstaffslpc.co.uk and you'll receive your instructions.
Finally, Virtual outcomes also produce a staff training and development tracker which can support you demonstrate compliance with both GPhC standards and NHS England contractual requirements - click the link below to access a copy.

Download FREE Virtual Outcomes CPD Record Log
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The NHS Service Finder
A question from a locum pharmacist regarding how to complete registration for the NHS Service Finder prompted us to look into this tool, which enables healthcare professionals to be able to locate NHS services and provides information not available to the general public, for example contact telephone numbers for GP practices only to be used for healthcare professionals when dealing with a patient. The data comes from both NHS.uk website and the Directory of Services (DoS).
The registration form can be found at:
https://finder.directoryofservices.nhs.uk/#/register
You'll need an NHS.net email address and details of your pharmacy to register. PLEASE REMEMBER though - do not share any non-public information with patients!
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PQS Declaration Window opens 3rd February...
With the PQS Declaration window opening in a matter of days, we've had a query from a contractor about audit "nil returns" and how these are recorded.
Having checked the PSNC information on the relevant audits, there is an option in the declaration process via Manage Your Service (MYS) portal to state that there were no patients identified to audit during the relevant period. However, you still have to state the beginning and end date of the relevant audit period - and through information available via NHS BSA, NHS England & Improvement have the ability to use prescription data to verify a "nil return" declaration.  It is clear that contractors have to keep relevant records to support there declarations whatever the audit, and it would be prudent prior to making a "nil return" declaration that you confirm this via your PMR system.
One additional note on the Lithium audit - the guidance states that if you have no records of any patient taking lithium or any of the alternative drugs for audit on an "ongoing basis", then you may still provide a "nil return" - HOWEVER if you receive a prescription for any of these items during your audit period (which again, you will have to declare start & end dates) then you must complete the audit during the remainder of the audit period on that drug. Once again, worth a check through your PMR data to ensure compliance with this prior to making your declaration, bearing in mind the above comments on post-payment verification.
 
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NPA Forum Webinar - Tuesday 28th January 2020
7.30pm-8.30pm

The NPA's January forum webinar will cover CPCF, with an updated checklist for members of what should have been done and what still needs to be done, with impending deadlines.
Members who attended the NPA forum events earlier this month found them useful for information on PCNs, how to approach GPs with the importance of community pharmacy and the commissioning of new services. Click the button below to register...
Register for NPA Forum Webinar
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HLP Accreditation Changes


The Pharmacy and Public Health Forum (PPHF) has issued a statement (see below) recommending that the time period for a community pharmacy contractor to reassess their pharmacy against the Healthy Living Pharmacy (HLP) Level 1 quality criteria should be extended from every two years to every three years. The PPHF has also recommended that those who have been accredited locally, should also have their accreditation extended to three years.


Pharmacy and Public Health Forum statement.... 

“The current HLP quality criteria for the profession-led self-assessment state ‘The pharmacy owner and Responsible Pharmacist in each HLP pharmacy are responsible for reassessing their pharmacy against the HLP Quality Criteria every two years by re-completing the assessment process/Declaration of Compliance’.

HLPs are going to be embedded within the essential services component of the CPCF as of April 2020. The Pharmacy and Public Health Forum has recommended that the re-assessment requirement by pharmacy owners and responsible pharmacists should be automatically extended from two to three years to enable easier transition to the new CPCF arrangements

Even if you are not claiming as an HLP as part of QPS, please be aware HLP is an Essential Requirement from April 2020.  What do you need to do to be sure you meet this requirement.

 
HLP status of pharmacy Action required
Contractors whose pharmacies have not been previously accredited as an HLP
  • Contractors will need to meet the requirements of an HLP Level 1 as defined by PHE.
  • Contractors will need to retain a portfolio of evidence together with the completed assessment of compliance signed by a pharmacist to demonstrate that they meet the HLP Level 1 quality criteria and retain this in the pharmacy.
  • An Evidence portfolio and the assessment of compliance is available in the ‘How to become an HLP Level 1 or maintain status as an HLP Level 1 (includes PSNC resources)’ section.
Contractors whose pharmacies became HLPs in the last three years* (accredited locally or via the profession-led self-assessment process)
  • Contractors will need to retain a copy of the signed and dated documentation that demonstrates that the pharmacy has been accredited as an HLP Level 1 in the last three years.
  • Contractors do not need to complete/re-complete the profession-led self-assessment process to meet the quality criterion at this stage.
Contractors whose pharmacies became HLPs more than three years* ago (accredited locally or via the profession-led self-assessment process)
  • Contractors will need to meet the requirements of an HLP Level 1 as defined by PHE (if accredited locally) or ensure they still meet the requirements if accredited via the profession-led self-assessment route.
  • Contractors will need to retain a portfolio of evidence together with the completed assessment of compliance signed by a pharmacist to demonstrate that they meet the HLP Level 1 quality criteria and retain this in the pharmacy.
  • An Evidence portfolio and the assessment of compliance is available in the ‘How to become an HLP Level 1 or maintain status as an HLP Level 1 (includes PSNC resources)’ section.

Help is available on the PSNC website in the form of a series of HLP FAQs
Dispensing labels and Braille markings on medicine containers
We have heard recently via a CCG Patient Congress about the problems some patients with sight loss are having when dispensing labels cover Braille markings on medicine packaging.
The advice from Andy Pickard,  Pharmacy Advisor for NHS England & NHS Improvement in Shropshire & Staffordshire, is as follows:
"There is clearly a legal obligation for pharmacies to apply dispensing labels to all medication, and contractors should wherever possible attach the dispensing label so as not to obscure any Braille markings. If they have to do so though, they should ensure that the patient and/or their representative has been given verbal instruction/support on how to take their medication in accordance with the Accessible Information Standards."
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NHS England and NHS Improvement has issued a Flu Guidance Letter for the 2020-21 Season

As in previous years, depending on the age of the patient, you are asked to use either adjuvanted trivalent inactivated influenza vaccine (aTIV) or a Quadrivalent vaccine (QIV).

Please note: There are two types of quadrivalent vaccine, cell-culture vaccine (QIVc) and egg-culture vaccine (QIVe).

Latest evidence suggests a slight advantage to the cell-culture vaccine (QIVc) compared to the egg-culture against H3N2 strains.  For 2020-21 NHSE&I are asking both pharmacists and doctors to consider using the cell grown quadrivalent vaccine (QIVc) for all at-risk patients who are under 65 years.

Please note - the following list shows what will be reimbursed by NHSE & I for 2020-21 (this can also be found in the summary on page 3 and the table on page 4 of the NHSE&I letter).
  • For those aged 65 and over - the adjuvanted trivalent inactivated influenza vaccine (aTIV) 
  • For those aged 65 and over where an aTIV is not available you may give Quadrivalent influenza cell-culture vaccine (QIVc)
  • At risk adults aged 18 to less than 65 you may give the QIVc vaccine or as an alternative you may use the QIVe vaccine 
Caution: You will NOT be reimbursed for High Dose Trivalent vaccine (TIV-HD) for any patients!
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FP10 Update: Changes to NHS prescription forms and Tokens

New NHS prescription forms and EPS Tokens are being introduced in England from January 2020.

Changes have been made to the reverse of the new versions (1219) of all FP10 prescription types (FP10SS, FP10D, FP10PN, etc.), and Tokens (FP10DT), to make it easier for patients and pharmacy teams to determine whether the patient is eligible for exemption from the prescription charge, thereby avoiding the possibility of incurring a penalty charge.

One change which appears to have a very complex outcome is the rmeoval of box "X" for free-of-charge contraceptives, and the new endorsement that prescribers must make to ensure all treatments for sexual health are provided free of charge. Whilst prescribing and dispensing system suppliers make the necessary changes to minimise issues arising from this change, not understanding the exact implication of this could have the outcome that contractiors lose money from incorrect charging of patients.
ACTION: Make sure that you read and understand the PSNC's briefing on the change, available at:
https://psnc.org.uk/our-news/fp10-update-changes-to-nhs-prescription-forms-and-tokens/
A second key change is the inclusion of a new exemption box ‘U‘ for “Universal Credit and meet the criteria“. This change will help to provide more clarity to patients and their representatives when completing the declaration on the reverse of the new FP10 forms and Tokens.
You can find full details including an image of the revised declaration, guidance document and FAQs on the PSNC website above.

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The Centre for Pharmacy Postgraduate Education

Dementia Focal point:
This learning event will help you develop your role in the early identification of dementia and to recognise signs and symptoms of its different types, while helping you to deliver improved outcomes and signposting.
  • Birmingham 4th March 2020
  • Keele 25th March 2020
Depression Optimise
Reflect on your confidence to engage in discussion with people with depression and your ability to listen to their concerns and respond to their needs. Use this programme to improve your consultation skills, encourage people with depression to seek your support and achieve better health outcomes.
  • Lichfield 12th February 2020
As ever, booking is via the CPPE website.

New Events from April 2020: 

We have a newly developed focal point on COPD and we also have a new, updated inhaler event. There will also be the opportunity to book for some full day training events, these will include consultation skills for pharmacy practice; two primary care days for non-pathway pharmacists and technicians - one on urology + dementia, the other on care homes.

Mary Seacole Leadership next cohort for 2020 is open for booking: 

Mary Seacole Leadership programme for pharmacists and pharmacy technicians working in community pharmacy or the Health in Justice Workforce is running in Birmingham and is now open for booking. Find more details here https://www.cppe.ac.uk/services/leadership-community.

Cohort 91 – Birmingham:  Application closing date: 11 February 2020

Start date: 24 March 2020; Workshop 1: 21 April 2020; Workshop 2: 16 June 2020; Workshop 3: 11 August 2020
 

CPPE New Year New Contract Pharmacy Campaign January 2020: 

Please take a couple of minutes to have a look at the campaign page and make a pledge on how you are going to take to make the best use of the opportunities offered by the new community pharmacy contract.  Find the campaign at 
https://www.cppe.ac.uk/news/a/845/welcome-to-week-1-of-our-campaign


Community Pharmacy Consultation Service (CPCS) - Clinical Assessment Skills - YOU MIGHT JUST GET A LAST MINUTE PLACE!
CPPE have also been commissioned to deliver some learning events focusing on the Community Pharmacy Consultation Service.  These are not compulsory but may be of interest to contractors - planned dates locally are: Telford (Holiday Inn) Jan 25th; Newcastle-under-Lyme (Holiday Inn) 26th January 2020 
Stafford (Beacon Conference Centre) 29th February 2020. All of these events are showing as full or with very limited places, however it is worth checking the website in case there have been any cancellations and a place has become available.


Download the CPCS Workshop flyer HERE.

Pharmacy Quality Scheme (PQS): 

CPPE have a page dedicated to helping you with aspects of the PQS, follow this link for information on Risk Management, Sepsis Training, Look Alike Sound Alike (LASA) training and find out what your next steps should be.

Further information that might help as we approach the declaration window opening is also available on the FAQ page on the PSNC website here.


 
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