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All the latest from your LPC...July 2019
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In this issue...click on the image or text link for more information!
Don't keep the information to yourself, please share the LPC newsletter with your whole pharmacy team (please remember your pharmacist locums too) - they can SIGN UP HERE so they their own copy in the future!
GP Extended Hours appointments - reminding patients to ask for availability
NHS England updateCPAF feedback; MUR & NMS reporting; Annual submissions; Health Promotion Campaigns; Common Ailments Service; Palliative Care Service
 
Click on this link to read about the NHS changes to OTC prescribing - this affects every Community Pharmacy 
Serious Shortage Protocols (SSPs) - what you need to know.
CPPE Update
 
Medicines Safety Newsletters added to the LPC website.
Pharmacy First is continuing
Virtual Outcomes - Dementia and NHS Flu Service Engagement
 CCG Update: Self Care support materials;  Setting nominations; Gluten free policy; generic contact email address
Infect Insect Bites - please update your knowledge

Community Pharmacy South Staffordshire News - 

Please find below our latest News Update - as usual all of our recent Newsletters can be accessed via our website...click here to view other recent issues!

A View from the Chair...

Hopefully you have all seen this week’s news of the small reprieve in the money department - £15m going back into category M and an extra 1p on the activity fee from August 1st.

As ever in pharmacy there is plenty to keep us entertained whilst we wait with bated breath for news of what our long-term funding settlement and contract will look like...

For the pharmacist and technicians amongst us who have a GPhC renewal deadline of 31st October peer discussions and reflective accounts may well be one of those things. Gill is organising an event in September that may well just help you with both!

Another of the ‘entertaining’ topics for this month is ‘Serious Shortage Protocols (SSPs)’. PSNC have issued some very detailed guidance on this and I would urge you all to read it.

After that there are Primary Care Networks (PCNs). We now know where all the PCNs are in Staffordshire and who the clinical directors are. We spent some time at this month’s LPC meeting discussing the next steps for the LPC. We would appreciate it if you all left the initial contact making with PCNs to us. Once this is done, we will plan the next course of action and will look to engage contractors on a local basis then. If you want to do something to prepare yourselves for the future with PCNs then I would recommend that you read the NHSE PCN document for pharmacy teams.

If you are looking for training for pharmacy staff, then don’t forget the VirtualOutcomes training platform that is fully funded by the LPC. We looked at the uptake of the training at our July meeting and it is still quite low. There are loads of different training modules on VirtualOutcomes so please make sure you and your staff are getting the full benefit.

Finally, a gentle reminder that there are only two- and a-bit months to complete the 200 MUR target…

With best wishes for an ‘enjoyable’ summer,

Lucy
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South Staffs LPC Annual Contractor Meeting - Wednesday 11th September 2019 
Please make a note of this date for your diary - although we have our usual "official" business, we are hoping to have a more in-depth look at Primary Care Networks locally, and how the relationship between PCNs and community pharmacies can develop.

We hope to see you there, full details to be announced soon!
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Primary Care Networks - what now?

As we previously described, Primary Care Networks (PCNs) are a key part of the NHS Long Term Plan, with all general practices being required to be in a network by June 2019, and Clinical Commissioning Groups (CCGs) being required to commit recurrent funding to develop and maintain them.
All of the GP practices in Staffordshire are now part of a PCN - and as of the 1st July, you can now find out which practices are part of your local network - CLICK HERE to read the update from Staffordshire CCGs, which includes details of all of the local PCNs.

Also, our LPC meeting heard last week that the best briefing for pharmacy teams about Primary Care Networks is available on the NHS England website - it's worth taking a few minutes to read this.

Finally, once you've seen which surgeries are part of your local network, you might  well already have a good working relationship with one or more of the GPs and/or practice teams. As the PCNs are still in a very early phase of their development we do not recommend having an in-depth conversation about what your pharmacy might be able to contribute; however, your LPC is preparing to engage with all of the PCN Clinical Directors, and will be leading the way in ensuring that the services we provide are effectively utilised. We would therefore welcome your input on these local relationships, and will be seeking to identify local community pharmacist "champions" to take relationships forward after this initial phase - watch this space for more information!

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Serious Shortage Protocols - what you need to know
On 1st July 2019, Serious Shortage Protocols (SSPs) became part of the regulatory framework and are one of the diverse range of measures to prepare for a no-deal Brexit and the potential impact on medicines supplies.
The is a considerable amount of information and support for pharmacy contractors and their teams on the PSNC website, however there are a few points which our LPC members thought were worth sharing with you all:
  • All members of your teams, including locums, should be aware of SSPs, and be compliant with the guidance on the PSNC website on how to manage them
  • It is important to pay particular attention to the guidance on endorsing as this will impact on your reimbursement for the item(s) actually supplied
  • If you are part of a group, large or small, it is important to maintain a consistent approach to management of SSPs across all pharmacies in the group.
PSNC's guidance and information on SSPs including FAQs can be found at:
https://psnc.org.uk/contract-it/brexit-and-community-pharmacy/serious-shortage-protocols-ssps/

Finally, community pharmacy contractors can now access an online recording of PSNC's recent Serious Shortage Protocols (SSPs) webinar:

Click here to view an on-demand version of the webinar.*

You can also click here to view the slide pack used in the webinar.

*Please note, to watch the recording, you will need to register (or input the email address you registered with previously).

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Extended Hours Primary Care Services
GP Access (extended hours) appointments have been available now for just under a year, with each CCG area operating slightly different systems. Your LPC heard last week that there is a very variable picture as to if, and how, these appointments are being offered to patients; some practices seem to be offering them as a matter of course, others less so.
If patients are in your pharmacy complaining that they are unable to access appointments at their practice, and we cannot help them with one of our local services, we suggest advising them to ask reception staff if there any Extended Hours appointments available.
Further information for pharmacy teams and patients can be found at: 

https://www.cannockchaseccg.nhs.uk/images/180802_Extended_Access_FAQs_Public_.pdf
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KEY POINT: remember ALL communication from NHS England now goes by email to your NHS shared mailbox - check your mail regularly! 
NHS ENGLAND UPDATE
CPAF 2018-19 – All visits were competed by the end of March and reports issued to contractors. We have pulled together some of the common themes from the visits where evidence was lacking, and a letter has been sent to all contractors to highlight these areas. Examples include;
  • Practice leaflet not in accordance with Approved Particulars
  • Lack of T28 exemption for denaturing Controlled Drugs
  • Complaints procedures not clear for patients
CPAF 2019-20 – Three pharmacies in South Staffordshire failed to complete the short CPAF questionnaire. These pharmacies will automatically be put forward to complete the full CPAF questionnaire later in the year.

MUR/NMS submissions – Final figures from Q4 (Jan-Mar) identified that 40 contractors across Staffs and Shropshire did not submit MUR data via NHSBSA portal, and 27 did not submit NMS data. These contractors are likely to receive breach notices for non-compliance. Reminder that Q1 data needs to be submitted within 10 working days from the beginning of July.

Annual submissions – We are still awaiting for the annual complaints submission to be sent in from about a third of contractors. The initial deadline was 30th June, so these contractors will be contacted and asked to submit ASAP. We have also identified a small number of contractors that did not complete their Data Protection Toolkit submission by 31st March. These will receive breach notices but there are potentially wider implications for non-completion which we will highlight to these contractors such as access to NHSmail and SCR etc.

Health promotion campaign (Oral Health) – Review of PharmOutcomes data indicates that 132 contractors have not uploaded data for this campaign. Deadline was originally 20th June. I will send a reminder letter to those pharmacies this week giving an extension until Friday 19th July, but would appreciate LPC support with this aswell. The next two campaigns will be an antimicrobial resistance (AMR) campaign in September 2019, followed by Stoptober in October 2019. Public Health England (PHE) have agreed to provide and distribute the resources for these campaigns. Because the campaigns are taking place in consecutive months, PHE will deliver resources for both campaigns in one delivery. The packs will include briefing sheets tailored to community pharmacies, A4 posters for display in the pharmacy, and A5 leaflets and a dispenser for distribution to visitors to the pharmacy. The posters and leaflets will include messaging relevant to the campaigns in community pharmacy. The materials will be delivered in August 2019. (that’s the official line anyway!!)

Common Ailments Service – Confirmation that letter notifying contractors that the service will be decommissioned on 1st September has been sent. Contractors should also have started to receive the self-care promotional materials which are being distributed by CCG colleagues (see below).

Palliative Care Service 2019
The latest list of pharmacies has been finalised and can be found by clicking the link below:

Palliative Care Pharmacies 2019

If you do signpost someone to one of these pharmacies, please call them first to confirm stocks are available. The supply of palliative care medicines is not limited to these pharmacies however they are commissioned to keep a minimum stock of the medicines concerned; the list of medicines covered appears on page 8 of the SLA and can be downloaded by using the link below.

Staffordshire Stock List Palliative Care June 2019

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Changes to prescribing of OTC products for self-limiting conditions.  This affects ALL Community Pharmacies and their patients and customers.


You may recall that NHSE published guidance about moving treatment of minor, self-limiting conditions with OTC products away from prescription and encouraging the public to purchase these remedies. CCGs around the country are being asked to implement this policy.

https://www.england.nhs.uk/wp-content/uploads/2018/03/otc-guidance-for- ccgs.pdf

This change is linked to the NHS needing to save money and is seen as a way in which the public can be encouraged to purchase simple medicines and money saved by the NHS could be used to treat more serious conditions. The guidance considered those who are entitled to free prescriptions, but it was decided that being in receipt of free prescriptions (even on income grounds) was not considered a barrier to asking people to purchase simple, usually quite cheap medication.

It is recognised that this policy will require a change in patient behaviour and the CCGs across Staffordshire are raising public awareness and encouraging purchasing over the counter medicines by running an information campaign (starting in July 2019).

The campaign aim is to raise public awareness of the benefits of using their local pharmacy. This promotes the role of the local pharmacy as the first port of call to treat their minor ailments and purchase first aid medicines to treat their family. 

The focus of the public campaign is that patients can see a pharmacist without an appointment so they can get the help they need for self-limiting conditions much more quickly than if they try to see the GP.

Pharmacies are asked to support this NHS initiative by:

Encouraging the public to purchase OTC medicines to treat their minor ailments

• Reinforcing the message - GPs will not be prescribing OTC medicines for minor ailments

• Not referring “levy-exempt” patients to GPs for “free” prescription

• Displaying the Self-Care 2019/20 poster in a prominent area of the Pharmacy.

• Actioning any referrals from GP practices regarding the treatment of common ailments. Please help the patient to purchase an appropriate product (GPs have a supply of referral pads so they can give the patient some information to take to the pharmacy).

• Using the Pharmacy referrals pad to signpost patients back to their GP for a prescription ONLY where appropriate (eg if the product license for an OTC product would not cover the patient’s condition)

The CCGs will be providing every Community Pharmacy in Staffordshire with a sample section of the materials however if you would like more information or materials please contact Claire Dearden on 01785 854116 or claire.dearden@northstaffs.nhs.uk

What does this mean for Pharmacy First Common Ailments Service?

NHSE locally commission the Common Ailments Service, however, in light of the national guidance they feel they are no longer able to continue this service. In Staffordshire the Common Ailments Service will continue until 31.8.2019

You are still able to supply under this Common Ailments service until the end of August but you will need to be having conversations with patients explaining the NHS drive towards patients purchasing their OTC medication. You can explain that you can help them today, but that this service is ending so you will not be able to supply items free of charge going forward.

To reiterate, GPs are also being asked not to prescribe OTC medicines so please DO NOT refer patients to the GP to ask for a prescription just because they are exempt from prescription charges – this is not helpful to patients as they are very likely to be refused a prescription (it is also not good for your relationship with your GP practice as inappropriate referrals will waste everyone’s time!).

Once the Common Ailments service has ended, please only refer patients to their GP for one of the self-limiting conditions if the product licence of the OTC product does not allow it to be used for that patient. Otherwise explain to the patient that their GP is very unlikely to write a prescription for the condition.

Conditions not Medicines: be aware of the list of conditions, the guidance is a list of conditions suitable for self-care, it is not a black list of medication, so for example the patient would be asked to purchase paracetamol for short term pain or fever but can still have it prescribed for long term conditions such as osteoarthritis.

Does this affect other Pharmacy First Services?

The UTI, Impetigo and Emergency Supply Services will continue in their current form.

Those pharmacies offering the ENT, Eye and Skin service will no longer be able to supply OTC products under the common ailments service, the patients will need to purchase OTC items which are not covered by the service PGDs.

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Important Message from NHSE

Pharmacy First is Continuing
…..

 
Please print this message and share with your whole pharmacy team, it is really important because some of our pharmacy teams have been confused by recent notifications.
 
What is the Pharmacy First Service?
 
Pharmacy First is actually a family of locally commissioned Community Pharmacy Services in Staffordshire and Shropshire.
 
Is Pharmacy First Ending?
 
No!  Only one service within the Pharmacy First family is ending!
 
Which services make up the Pharmacy First Services?
 
Pharmacy First UTI CONTINUING
Pharmacy First Impetigo CONTINUING
Pharmacy First Extended Care (ENT, Eye + Skin) CONTINUING
Pharmacy First Emergency Supply CONTINUING
Pharmacy First Common Ailments – supply of OTC products Ending 31.8.2019
 
 
So, what is coming to an end?
 
Only the common ailments service is ending, and this is because NHS England produced a guidance document advising that OTC products should not be prescribed on the NHS for acute, self-limiting conditions.  This meant that the common ailments service no longer fits with NHS guidance.
Common ailments ends 31.8.2019 in Staffordshire and was discontinued in Shropshire from August 2018.
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CCG Update - Emma Bryan, CCG Medicines Optimisation Team
  • As previously mentioned the Common Ailments Service will be ending on 31st August 2019. The CCGs have been working with LPCs and other stakeholders to ensure that this change is managed as smoothly as possible, and the CCG Medicines Optimisation teams are in the process of delivering a package of Self-Care support materials to pharmacies and practices - a copy of the letter detailing the campaign can be found HERE. A full range of the materials are also available to download from the South Staffordshire formulary website. Should you require additional copies of any of the materials, please email claire.dearden@northstaffs.nhs.uk
  • The CCGs received a complaint from a patient who had a nomination set by a pharmacy without their consent - please ensure that you keep a record of any consent, ideally this should be written however at the very least a record in the patient's PMR of any verbal consent given, including the date and time of the consent, and if made by a patient representative or carer their details too.
  • We've had queries on the gluten-free products that remain available on prescription - the list can be downloaded from this page on the South Staffs Formulary website.
  • Finally, if you have any general enquiries, comments or need to get in touch with the Medicines Optimisation team within the CCGs for any reason, please us the following email address: southstaffs.medsoptimisation@nhs.net 
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Reporting issues arising on transfer of care
The LPC has become over a number of months of issues where information relating to a patient during transfer of care (mainly discharge from hospital) is incomplete, inaccurate or missing. This can result in discontinued items being supplied, duplication of treatments or no medication being supplied - all with the risk of the patient being re-admitted to hospital. 

The LPC are collecting information on any such issues via PharmOutcomes for a limited time, in order to get a fuller picture as to how often the issues are occuring, and what the impact is on both patients and pharmacies.

Simply log on to PharmOutcomes, click on the Services tab and look for the Service module called "Discharge Issues Questionnaire".
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INFECTED INSECT BITES

We have been asked by the Area Prescribing Group to pass on a message about pharmacists referring patients with "infected" insect bites.

Some patients have been referred to their GP by their local pharmacy and told their insect bite is infected and they NEED antibiotics. One GP estimated that of 10 patients referred to them from their local pharmacy, only one actually needed antibiotics.  The problem then became convincing the patient that they didn't need antibiotics as the pharmacist had told them they did.

Please consider the message that you give to a patient - it is OK to say you "don't like the look of a bite and want the GP to check it out" but please do not tell the patient they need to see the GP to get an antibiotic.

If you want more information on management of insect bites please check out the CKS guidance from NICE here 
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We have a new Medicines Safety Network page on the LPC website where we will upload the Medicines Safety Network newsletters, along with other useful resources produced by this really important Staffordshire network.

Your LPC has representatives at this group so we are involved in helping to identify safety issues, the group discusses how to improve safety and produces resources to help with this.
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Virtual Outcomes - Dementia and NHS Flu Service Engagement

Your LPC funds access to FREE ONLINE TRAINING for every pharmacy contractor across South Staffordshire through Virtual Outcomes – here’s their latest offering, essential learning for you and your colleagues!

Did you know that Dementia is NOT a normal part of ageing?

Dementia is an umbrella term used to describe a range of progressive neurological disorders which affect the
brain. Although no treatment can cure it, there are things people can do to lower their risk of the disease and
approximately a third of all cases of dementia are thought to be influenced by factors within our control.

NHS Flu Engagement Training

Would you recognise the symptoms of flu?
Do you know which vaccines are being used this year?
What plans do you have in place to target your at risk patients and pregnant women?
Our updated 2019 flu online training will answer all these questions.

To find out more about each of the above, you can access the FREE online training

Also available as a podcast from iTunes or download HERE

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 Your West Midlands CPPE tutors and education supervisors have been busy planning a great programme of revalidation learning opportunities for you. Take a look at the great choice of events and book your place soon at www.cppe.ac.uk or click on the titles of the events and login to the CPPE website to book your place. 
A light buffet will be served before the start of our evening workshops. 
Asthma Focal point - On completion of all aspects of this learning programme you should be able to: apply medicines optimisation principles in the context of asthma treatment, demonstrate how guidelines are used to provide optimum care for individual patients, examine whether a person’s asthma treatment is appropriate, recognise when treatment needs to be increased or decreased, implement a holistic approach to support people with asthma, consider all factors which influence their asthma control, enable people to self-manage their asthma with appropriate inhaler use and a personalised asthma action plan. #CPPEasthma

Local Asthma Focal Point events:
Lichfield Cathedral Visitor Centre 24th September 2019.


Full day events across the West Midlands
Confidence in consultation skills (full day event) - with medical actors to practice and develop your skills.
Pharmacy professionals are spending more time than ever consulting with patients and the public. This workshop will support you in developing the key consultation skills needed to ensure you are confident in delivering high-quality person-centred consultations. This full-day workshop has been developed to support pharmacy professionals working in all sectors. #CPPEconsultationskills
•    22/9/19 (all day) – Birmingham Hallmark hotel (Booking ref. 47994)

Clinical assessment skills and history-taking - This event will equip you with the knowledge, skills and confidence that you need to conduct effective clinical medication reviews. During the workshop you will apply evidence-based clinical medication review tools in a case study setting to make recommendations for optimising medicines use. #CPPEclinicalskills
•    8th September (all day) – Birmingham The Mac (Booking ref. 48579)
As ever, log in to CPPE to book these events; refreshments and lunch are provided for full-day workshops.

Possible Mental Health Events in Autumn.
We are hoping to offer a couple of events in the Autumn semester in Staffordshire and Shropshire, these would be on the topics of depression and dementia - more details to follow.
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