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IN THIS EDITION:  VIEW FROM THE CHAIRGDPR UPDATEFALSIFIED MEDICINES DIRECTIVE; CPAF 2018-19; GPHC CONSULTATION ON REGULTING REGISTERED PHARMACIES; ONPOS & DRESSINGS ; FLU ONLINE-ONLY TRAINING;   SUBSIDISED ACT TRAINING; HLC TRAINING UPDATECPPE UPDATE. VIEW THIS EMAIL IN YOUR BROWSER
 A View from the Chair...
Our June meeting began with a presentation on behalf of GPhC by Vicky Harris about their current consultation on developing their approach to regulating registered pharmacies. The GPhC are consulting on further developing their approach to how they regulate pharmacies having already made significant changes over the last 5 years; they expect to have inspected all pharmacies under the most recent inspection model introduced 5 years ago by this summer.
The most significant change proposed is that (now they have the legislative powers) they plan to start publishing inspection reports so that they can provide greater assurance to patients and the public.
After Vicky’s presentation the committee was given the opportunity to provide feedback. One of our main areas of concern is lack of consistency in inspections. Also, the time taken to inspect could be really important if there is a move to unannounced inspections as mentioned in the consultation document.
The committee welcomed the plan to remove the current inspection outcomes of excellent, good, satisfactory and poor and replace them with standards met and standards not all met, as we felt this is much clearer.
I would encourage you all to read the consultation document and submit a response as any changes will affect us all.
Also during our June meeting we discussed how we can continue to support contractors with the ongoing cuts to our funding. I would urge you all to make sure that you are maximising every opportunity to deliver both advanced and enhanced/locally commissioned services.
If you are unsure about what services are commissioned in Staffordshire then please visit the LPC website where you can find a wealth of information on all local services.

Lucy Dean
 A remider from the LPC that we are subject to GDPR and prior to 25th May emailed our full contact list to seek new and updated consent from everyone in our database.We have had about a third of our existing list confirm their subscription, however that may leave a number of contractors, pharmacists and support staff who are no longer receiving our News Updates and other emails; please therefore forward this on to all of your contacts to ensure they both get to see the contents, and the opportunity to sign up themselves using the link below. Anyone can subscribe to our list at any time, and amend or delete your subscription by clicking the link at the foot of any email. Note that our original email list in use until 25th May 2018 has now been deleted.
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Info from Staffordshire Area Prescribing Group June 2018

Methylphenidate: the recommended brand for prescribing for new patients is Xaggitin prolonged release which is bio equivalent to Concerta XL.  There are currently no plans to change existing patients off Concerta, the LPC will let you know if we find out that this has changed.
 

Fiasp and Tresiba:  Fast-acting insulin aspart, brand - Fiasp is going onto the Staffordshire formulary so you may see prescriptions for it.  Please be aware that it is currently in a yellow box and apparently looks very similar to Tresiba -  please take care not to mix these two products up.  

The manufacturer is changing the Fiasp packaging to yellow and orange to try to reduce this risk but there may be a lag before this appears in the wholesalers.  In addition there may be a period with both old and new packaging in the supply chain.  Please take care when dispensing these insulins to minimise risk of dispensing errors occurring.

Braltus (tiotropium):  risk of inhalation of capsule if placed in the mouthpiece of the inhaler.  MHRA have received reports of patients who have inhaled a Braltus capsule from the mouthpiece into the back of the throat, resulting in coughing and risking aspiration or airway obstruction.   This was included in MHRA bulletin in May 2018. https://www.gov.uk/drug-safety-update 

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FALSIFIED MEDICINES DIRECTIVE (FMD)
Another deadline for contractors to remember is 9th February 2019, when the Falsified Medicines Directive comes into force. We have previously alerted contractors, however there has been so many other important issues that this may have slipped from your minds! The key resource for contractors to keep checking is the UK Community Pharmacy FMD Working Group's FMD Source website

The working group has recently published a list of Falsified Medicines Directive (FMD) IT system suppliers who will be offering an FMD IT solution. The list will be updated as additional suppliers are identified.

We recommend that pharmacy contractors that have not yet started to prepare for the introduction of FMD on 9th February 2019, should:

A range of options are expected to be available for use in pharmacies, including FMD solutions integrated within the PMR system and standalone systems. Contractors will need to consider the usability of the different options for each pharmacy, dependent on when and where the FMD scan will be undertaken in the dispensing process, and the impact on the workflow of their pharmacy team members.

NHS Guidance on OTC prescribing for self-limiting conditions
Please read - this will affect all community pharmacies

We previously highlighted the NHS guidance which advises that OTC medication for self limiting conditions should not be provided on prescription.  

NHSE have said that being eligible for free prescriptions does not automatically exempt patients from these guidelines so there is no automatic route to prescriptions.

Medication for long term conditions is not affected so for example the NHS does not want GPs to prescribe paracetamol for sprains and strains but they can prescribe these medications for long term conditions such as osteoarthritis.

Locally the CCGs are adopting the national guidelines and discussions are in place about communications to go to patients explaining this change.  

The Pharmacy First Common Ailments Service will be affected by the changes, GPs will not be referring into the service and the LPC will let you know as soon as a decision is reached on the future of the service in Staffordshire.  

NHSE have to give 28 days notice if it is to end, so the service is continuing for now,  As an alternative to decommissioning the service completely it may be re-developed into something that fits with the NHS guidance - you will be informed as soon as the decision is made.  

Actions needed by community pharmacy:
1. Be aware of the guidance - read it here if you have not already done so.
2. Watch out for LPC, NHSE and CCG comms about this so you know what is happening locally
3. Once the CCGs go live with this please do not advise patients to go to GP to ask for a prescription for self-limiting conditions covered by the guidance - they will be advised that they should purchase the medication.  You can save them a journey by explaining this and offering to sell a suitable OTC product.

Once the guidance is fully adopted and comms have gone out......
GPs do still have professional judgement about when to prescribe but the whole NHS is massively short of cash so we expect that most will follow the guidance for most patients.  We ask you not to undermine the guidance by giving patients unrealistic expectations about prescriptions.  It is important that we understand the local picture and help patients to understand how this has come about and that it is national NHS guidance.

PLEASE WATCH OUT FOR FURTHER INFORMATION.
 
Community Pharmacy Assurance Framework (CPAF) 2018-19

Just a reminder that the 2018/19 Community Pharmacy Assurance Framework (CPAF) screening questionnaire is now available for completion until Sunday 1st July 2018.

Now in its fourth year, the process asks all NHS community pharmacy contractors to complete a short screening questionnaire consisting of 10 questions; NHS England will then select a small number of pharmacies for a monitoring visit and/or to complete the full CPAF questionnaire.

At the request of NHS England, this year the screening questionnaire has been revised as follows:

  • Retire two questions – prescribed medicines advice (question 2) and owings (question 5);
  • Add two new questions – safeguarding (question 11) and pharmacy-based audit (question 12); and
  • Revise one question – repeat dispensing (question 4).

Like previous years, there remains 10 active questions. Further information and support on CPAF is available on the PSNC website.

Online No-Prescription Ordering Service (ONPOS)
The LPC have for some time been taking part in discussions over the supply of dressings to community (district) nursing teams; the outcome we have previously reported is that dressings will be procured under the ONPOS scheme through Coloplast. Despite our best efforts to come up with a solution that meets the needs of all stakeholders (GPs, providers, patients and pharmacies). This will not involve community pharmacies - and although this does not cover dressings for practices or care homes as yet, we are now advising ALL CONTRACTORS to consider reviewing and rationalizing stock levels of dressings prior to the switch being made.
As yet we don't have specific timetables, however we understand that the next pilot site is to be in Norton Canes - and once approved by the CCG is likely to be in early July.
Thereafter the localities are likely to go live with ONPOS in the following order:
  • Cannock/Colliery
  • Stafford and Seisdon
  • Tamworth, Lichfield and Burntwood
Again, we have no timescales as yet, but this is an advance warning to all.
 

Consultation on developing the approach to regulating registered pharmacies

As alluded to in Lucy's opening address, the LPC heard this month about the proposals to chenge the way the GPhC regulate and inspect registered pharmacy premises. Whilst we are not going to go over the whole document here (you can read through the full consultation HERE) there are a few clarifications that the LPC sought which you may find helpful in formulating a response, and planning for future inspections...

Q? Will published reports apply to new inspections only or be retrospective?
A: Publication will only apply to inspections carried out after implementation of these proposals.

Q? Will there be any differentiation available for public to identify pharmacies with very high numbers"standards not all met"?
A: Public can follow link to full report, although the main initial entry will only show "standards not all met".

Q? We have concern on the consistency of inspections carried out by different inspectors - how will this be addressed?
A: There will be a Quality Assurance process  on inspections, along with review and training if necessary. Also all reports will go to Superintnedent Pharmacists before publication, outcomes on whether standards have been met or not met can also be challenged at this stage.

Q? For inspections involving multi-agency & Intelligence led approaches, will these be done against identified thresholds or on a case by case basis?
A: Likely to be on a case-by-case basis.

Q? Will there be any tolerance on impact of circumstances affecting effective delivery of services or patient safety, for example with EPS failure?
A:Yes, such circumstances will be considered and inspection halted, with the isnpector returning at another time to complete the process.

Q? What will be the frequency of inspections under the new routine?
A:This is likely to be similar to that currently in force, ie every 4-5 years.

Q Will type of inspection be made clear at the time?
A: Yes, this will be made clear at the start of the inspection.

Q? What is the planned timeline for implementation beyond the consultation?
A: Implementation is likely to be early in 2019 for both inspections & publishing of outcomes.

Q? Has there been any consideration of use of window decals similar to those used for food hygeine inspections?
A: Yes, this came up in focus group discussions, and may be considered as optional, however the GPhC has no powers to compel their use.
The LPC also made the point that the uploading of inspection reports and updates to standards met needs to be frequent enough to ensure fairness for pharmacies, and clarity for patients and public. 
The LPC urges you to access and read the consultation, and respond as appropriate.
Two issues which have been raised by NHSE locally, requiring action by contractors...
  1. There have been a number of insidences of community pharmacy contractors trying to amend opening hours byusing the Directory of Services (DoS) updater. The NHS Pharmaceutical Serivices Regulations 2013 make it clear that amendments to opening hours can only be made by either  i) Application to amend Core Hours or ii) Notification to amend Supplementary Hours. These must be made on the specified forms - in the case of amendments to Core Hours these are NOT guaranteed to be agreed, and MUST  be made only to be consistent with a change to the need for Pharmaceutical Services at the premises. In the case of Supplementary Hours, contractors may give 90 days' notice of any change to NHS England; however, this notice may be waived in corcumstances where the change results in an increase in Supplementary Hours, for example to match increased opening hours of a local GP practice. ACTION POINT - check the PSNC WEBSITE for information about amendments to opening hours; if you are unsure about ANY aspect, CONTACT THE LPC for advice.
  2. We have had some intelligence from NHS England that community pharmacy contractors have been using the funded DOOP service to dispose of out-of-date or damaged OTC stock. We must remind contractors that the service specification only includes the service to be used for out-of-date DISPENSARY stock, and all medicines returned by patients (including OTC-purchased items). ACTION POINT - To dispose of out-of-date OTC items, contractors must have a separate contract with an appropriate pharmaceutical waste company.
 FLU VACCINATION ONLINE-ONLY TRAINING LAUNCHED
Central Health Solutions Ltd have just launched their Year 2 Flu Training (online only, ie not face to face) and Flu PGD - at a reduced cost of just £25 plus VAT. This offer is available to all, including locums - simply CLICK THE LINK BELOW and complete the form online.

Please ensure all pharmacists that work for you see this email, thanks.

CLICK HERE TO REGISTER FOR YEAR 2 (ONLINE ONLY) FLU TRAINING AND PGD

SUBSIDISED ACT TRAINING PACKAGE
Just a reminder that the LPCs locally have secured funding from Health Education England to enable subsidised ACT training packages for community pharmacy contractors - this reduces the cost of the training to JUST £50 PER CANDIDATE - full information can be found HERE. Don't delay - the cut-off for applications to join the the first cohort is Wednesday 27th June.

Healthy Living Champion training update
All Healthy Living Pharmacies will at some time need to train new Healthy Living Champions, either to develop existing staff or to replace HLCs leaving the role. The LPC will no longer be providing face-to-face HLC training due to the likely low numbers, however there are a number of distance learning packages which meet the criteria - for example those provided by the NPA or Buttercups.
Public Health Campaigns 2018-19
 
You will be aware that the Public Health England directed campaigns  for 2018-19 are shown below and all pharmacies will be getting a letter from the local NHS Team reminding them of this very shortly.
  • Quarter 1 (April to June)
Cardiovascular (Diabetes, Stroke, Hypertension) No specific guidance or show material came out about what to focus on.  National Diabetes Week was  w/c 11th June, so you might have made use of Diabetes. Org.uk who had plenty of good, free material on their website. You might still be able to find some materials on there if you want to run the campaign for the end of June although stocks were limited.  Search for either Healthcare Professional or Booklets.
  • Quarter 2 (July to September) Mental Health.  
Again, there is no specific  guidance on which aspect of mental health we will be asked to focus on, but the websites below can provide free leaflets and booklets  on Dementia. As most of our staff are Dementia Friends, it makes sense to reinforce that with a focus on Dementia.  World Dementia Awareness month is September so you may want to plan activity for this, or late August for 4 weeks to avoid the start of the flu season.
https://www.alzheimers.org.uk/form/order-free-publications
https://www.dementiauk.org/understanding-dementia/advice-and-information/
https://www.dementiauk.org/information-leaflet-order-form/
  • Quarter 3 (October to December) Respiratory with World  COPD Day.
  • Quarter 4 (January to March) Alcohol Awareness - Dry January
  • 2 National Campaigns - which we are still waiting details on.

As always you will need to provide feedback through the Public Health module on PharmOutcomes.
A paper record chart for use on the Chemist Counter is also available to download from the LPC website
One of the key abilities for our team to support Public Health Campaigns, and is a requirement for HLP accredited pharmacies,  is to be able to start off conversations with patients. Many of you will have attended Making Every Contact Count training. This is now also available online at
https://www.e-lfh.org.uk/programmes/making-every-contact-count/
You need to register first before you can access any course content.
As more information on the 6 campaigns  becomes available, we will update you.
DISCLOSURE AND BARRING SERVICE (DBS) CHECKS
For a number of years, the LPC has been able to process applications for DBS (previosuly CRB) checks on behalf of pharmacy contractors' pharmacists and staff. Latterly, the number of applications coming through the LPC have dwindled and to ensure LPC resources are used effectively the committee has decided that we will no longer provide these locally. There are a number of companies that can provide these remotely using online application and confirming identity through web-based document verification services (typically the Government's Verify service) - for example, Disclosure Services who have been the LPC's service provider throughout our provision of the service.
Contractors now needing DBS checks for pharmacists and staff should now apply direct through Disclosure Services, or similar organisations; you can also get information about DBS checks from the Gov.uk website.

Here's the latest news on CPPE national programmes and local events...as usual, click on the link to see more information!

CPPE news

Events for next semester:  Please watch out for an email from CPPE when the events are open for booking and you can get information on the learning along with dates and venues.

We are arranging another series of full day primary care days to be held at MAC, Birmingham.


We are hoping to run a jont event in September with the RPS Local Professional Forum at Keele to support your revalidation.  The topic will focus on the learning in our patient safety campaign run earlier in 2017, this tutor led event will see Gill helping you to work through some case studies then considering how you can convert this into a CPD entry.  The date and booking details will be shared in the next LPC newsletter.

We will be running an event about falls in Lichfield, Keele and Tamworth, these events will be led by CPPE tutors Lisa and Geraldine and will run later in the Autumn.

For those of you who have not attended one of our inhaler technique events we are arranging two more, one in Shrewsbury on March 6th and one at Keele on March 13th 2019  - please encourage any colleague who hasn't been to one to come along - it will be great for your pre-reistration pharmacists too!  These events will be led by Gill and are a great way to make your practice more patient centred and are always lots of fun.


Food at each event is from 7pm and the learning starts at 7.30pm 

Revalidation- to help you find your way around the new revalidation process we have developed a gateway page on the CPPE website.  This will help explain the new system, has links to external websites and will also help you find CPPE events to support you in your revalidation journey.  Find the page at https://www.cppe.ac.uk/gateway/reval 

 

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