0113 2727560

Contact Us

Contact CPWY

Twitter Latest Tweets

Latest PSNC News

Quality Payments: New declaration process

Following the publication of NHS England's guidance for the Quality Payments Scheme February 2019 review point, NHS Business Services Authority (NHS BSA) will today distribute via email* further information on how contractors can claim for a quality payment when the declaration window opens on Monday 4th February 2019. Contractors will be able to claim for...

2 days ago

Quality Payments: Gateway criteria report now available on the NHS BSA website

Community pharmacy contractors are now able to view the first weekly gateway criteria report on the NHS Business Services Authority (NHS BSA) website, which details contractors who have been assessed, using national datasets, as meeting four of the five gateway criteria (Advanced Services, NHS website, Community Pharmacy Patient Questionnaire (CPPQ) and NHSmail). This weekly report,...

2 days ago

Brexit: Health Secretary letter to healthcare professionals

Health Secretary Matt Hancock has today (December 7th) written a series of letters, including one to healthcare professionals, to give an update on the Government's planning for a no-deal Brexit. In his letter to frontline healthcare providers Mr Hancock once again stressed that healthcare providers should not stockpile medicines. He said they should advise their...

2 days ago

Dispensing

This page contains resources to support pharmacies in delivering Essential Service 1 – Dispensing Medicines.


7 Day Prescription Guide

Antibiotic Awareness

Anticoagulation Clinics

British National Formulary

Local CCG Dispensing Policies

Dressings on FP10

Pharmaceutical Stationery Orders

New Rules for Instalment Prescription Endorsement (Methadone)

New Requirement for Prescriber Codes on NHS Prescriptions

Electronic Repeat Dispensing (eRD)

Use of Emergency Salbutamol Inhalers in Schools

 

  

7-Day Prescription Guide

The 7-Day Prescription Guide is to assist you in deciding which of your patients may require 7-day prescriptions and will help you in your discussions with GPs.

 

MDS Contractor Guide 

Following increased queries regarding MDS requests we have produced a MDS contractor guide which can be found below.  This guide summarises the key points regarding MDS and addresses the common queries that we receive relating to MDS. 

MDS Contractor Guide

MDS Notification Form


If you are unsure about what you should be taking in to account when deciding whether to supply medicines to a patient in MDS then the recently published briefing from PSNC will be very helpful. It gives you and overview of the background to where community pharmacy currently finds itself with regards to this issues and some practical points for you to consider. The briefing can be found below.

PSNC Briefing 001.16 - Equality Act 2010

The briefing also contains some excellent FAQs which many pharmacy teams will find it useful to read. These have been reproduced below.

FAQs

Q. Must I always carry out an assessment under the Equality Act 2010, if a patient asks me to make an adjustment to the way in which I normally dispense, because of a disability?

A No.  The legislation does not require a formal assessment to be carried out, only that a reasonable adjustment is made to help a disabled person overcome the obstacles to the use of the service.  A pharmacy could provide compliance aids (such as easy open containers, reminder charts/alarms, dexterity aids, winged or plain bottle caps) if they decide with the patient, that this will assist the patient to use the service.

HOWEVER – if an adjustment is made, the pharmacist is responsible for the decision.  If the adjustment causes harm, the pharmacist could be liable – for example, providing a reminder chart that the patient is not able to understand, or an MDS which results in incompatibilities or deterioration of the medicines.

 

Q. Where can I find an assessment toolkit?

A. The Department of Health commissioned a resource kit, which appears on the PCC website but is not “officially” a DH or PCC document. The use of this resource kit is not mandatory but might be useful to inform process stages of requests from patients/carers for auxiliary aids.

  

Q. A housebound patient’s care worker has asked me to dispense the patient’s medicines in a compliance aid i.e. MDS, because the care worker finds this easier and quicker to use than individual manufacturer’s containers.  Do I need to comply with that request?

A. It is the patient’s needs that must be addressed. The pharmacist will need to be satisfied that the request for a compliance aid would constitute a “reasonable adjustment” in terms of actually helping a disabled person to overcome the obstacles to the use of the pharmacy. If so, patient’s medicines are likely to be appropriately dispensed in an MDS.

However, it is not for the care worker to determine the appropriateness of whether to dispense patient medicines in a compliance aid. Care workers tend to be employed to provide care to people (for example in their own homes or in care homes) and are not directly regulated. Though as indicated above organisations employing the care worker are subject to CQC’s regulations and the outcomes which CQC expect people using a service will experience if the organisation is to be compliant with CQC regulations.

In March 2015, the Care Certificate was introduced and is an identified set of standards that health and social care workers must adhere to in their daily working life.  The aim of the Care Certificate is to provide everyone the confidence that care workers have the same introductory skills, knowledge and behaviours to provide compassionate, safe and high quality care and support.  Any person (individual, partnership or organisation) who provides a “regulated activity” in England must be registered with CQC.  As part of registration, CQC expects that those who employ care workers should be able to demonstrate that staff have, or are working towards, the skills set out in the Care Certificate, as a benchmark for staff induction. 

One of the key standards which care workers must adhere to is to understand medication and healthcare tasks (see Care Certificate Standards).  Therefore, if the care worker is engaged to administer medicines, then they must have sufficient knowledge, experience, qualifications and skills to be able to undertake that activity.  The convenience of the care worker could be a valid practical consideration, but this would not be funded under existing NHS arrangements.  If care workers make repeated requests for MDS, try to ascertain why, and if appropriate, consider contacting the care worker’s employer or CQC if you believe that the level of experience, knowledge, qualifications and skills appear inadequate.

Ultimately, it is the pharmacist’s decision as to what is the appropriate “reasonable” adjustment/s for the individual patient, not a care worker or other healthcare professional. 

 

Q. I have decided to dispense a patient’s medicines in an MDS because the patient has a disability, and between us we have determined that the MDS provides the best way of allow the patient to access their medicines.  Unfortunately, due to intolerance of one of the medicines, the GP has prescribed an alternative and has asked that I replace this in the previously dispensed medicines.  Can I do this?

A. Once a medicine has been dispensed, the NHS pharmacy terms of service do not require any further adjustments.  Therefore, unless the GP has instructed the patient to ignore any of the discontinued medicines from the MDS, and is confident that the patient will do this and be able to take the separately dispensed replacements, the whole MDS container should be discarded, and a new one produced.  As the decision to dispense in an MDS was on disability grounds, it is possible that the patient will not be able to handle a separately dispensed item, and if this is the case, there is no alternative but for the GP to issue a new prescription for all current medicines, so that they can be dispensed together in a replacement MDS.

This is wasteful of the medicines already dispensed, and is the reason why GPs may prefer to prescribe on a weekly basis if the patient is likely to have changes made to the medication.

Indeed, pharmacists can charge patients for repackaging (if they are not entitled under the Equality Act) but many pharmacists and GPs have come to a pragmatic solution using seven day prescriptions.  This does not provide any additional funding to the pharmacy – he/she still carries out one dispensing activity per prescription, but now does so four times more often than once a month.  Pharmacies with under-utilised staff may have the capacity to handle seven day prescriptions, but a pharmacy at or near capacity may not be able to safely dispense these additional prescriptions (i.e. these more frequent prescriptions) without engaging more staff.

   

Q. Can the GP insist that I dispense a medicine in an MDS?

A. No.  It is the responsibility of the pharmacist to comply with their obligations under the Equality Act and, ultimately, the courts will definitively determine whether the pharmacist has complied with their duty to make “reasonable adjustments”, if challenged.  The final decision whether or not to use MDS for a patient with a disability rests with the pharmacist.

Nevertheless, if a GP is supportive of MDS to provide greater convenience for the patient, or to improve concordance, then the GP could ask if the pharmacist is willing to dispense in an MDS.  Because of the additional costs of equipment and time dispensing in an MDS, particularly on a monthly basis, and the risks of wastage (if medicines are changed), the agreement of the pharmacist may be dependent on the GP prescribing on a weekly basis.

 

Q. The GP has agreed to provide prescriptions on a weekly basis so that I can supply MDS.  He has provided four weekly prescriptions at once – can I dispense all four weekly MDS together?

A. No.  The purpose of weekly prescriptions is to support the supply of MDS containers on a weekly basis, and to minimise waste i.e. if there were to be a change to the patient’s treatment.  Dispensing all four MDS containers at once would defeat the purpose, and likely create unnecessary waste.

 

Medicines Compliance Aid Database launched by UKMi

UK Medicines Information (UKMi) has launched a Medicines Compliance Aid database, which makes recommendations on the suitability of transferring solid dose formulations from the manufacturers’ original packaging into multi-compartment compliance aids (MCAs).

The database, which is open access, makes recommendations based on physico-chemical stability and characteristics of the medicine and formulation, information received from manufacturers, and data (where available) on the storage in MCAs.

The database can be searched by the brand or generic name of the medicine, although most entries will be based on the brand leader.  Once searched, the product is given a traffic light colour-coded UKMi recommendation as to whether it is suitable or not to be placed in a MCA.

UKMi recommend using the database alongside the Royal Pharmaceutical Society’s Guidance Improving patient outcomes through the better use of multi-compartment compliance aids.

 

↑ Back to top

   

The latest edition of the British National Formulary (BNF) is now available.

Pharmacies with one registered Pharmacist will receive a single copy of the BNF, and Pharmacies with two or more registered Pharmacists will receive 2 copies of the BNF. Any Community Pharmacists needing to register to receive copies should contact Binleys by email BNF@Binleys.com or by telephoning 01268 495 609.

Please note that BNF and BNFc content can also be accessed online here. For further information, please visit the NICE website.

↑ Back to top 

 

Local CCG Dispensing Policies

 

Dressings on FP10

We have become aware that some CCGs are implementing a change to the way that dressings are supplied by setting up schemes that allow direct supply of dressings to nursing teams.  These schemes circumvent the usual FP10 route.  This will obviously have an impact on community pharmacy by reducing the number of dressing items prescribed via FP10 route, essentially leaving non-GSL, expensive, infrequently used, part pack dressings on FP10.

Community Pharmacy West Yorkshire does not support the proposed changes but know that it is important that our contractors are informed enabling contractors to make adjustments to stocks held. 

Contractors are reminded that the NHS Pharmaceutical Regulations state that "P must, with reasonable promptness, provide the drugs so ordered, and such of the appliances so ordered as P supplies in the normal course of business". 

These CCG schemes will reduce the number of dressing items prescribed via FP10 route, mainly leaving non-GSL, expensive, infrequently used, part pack dressings on FP10. A community pharmacy contractor has no obligation to supply dressings if it is not part of normal business and is quite within the regulations to refuse to dispense a prescription for dressings where they determine this is the case

 

Calderdale

Gluten Free Formulary

Gluten Free Guidelines

Coeliac UK List with CCG Formulary Choices

Hayfever Guidance

Children's Pathway for Vitamin D

Key Prescribing Messages Letter

Key Prescribing Messages 2017/18

 

Greater Huddersfield and North Kirklees

Greater Huddersfield and North Kirklees CCGs have recently reviewed and updated their prescription lengths policy.  The policy is available below.

Prescription Lengths Policy - September 2018

The key principles for 7-day prescriptions within this policy is in-line with the Community Pharmacy West Yorkshire 7-day prescription guide and the MDS (monitored dosage system) guidance which can be found at the top of this page.  The policy is helpfully clear that it is the decision of the pharmacy whether MDS is an appropriate adjustment for a patient.  The policy includes a pro-forma for a pharmacy to use to request 7-day prescriptions.

We understand that this has led to some GP practices to review their provision of 7-day prescriptions.  The CCGs policy is clear that 7-day prescriptions are appropriate for some patients using MDS for example those requiring weekly supply, where less stable medication is prescribed and preventing waste where regular changes to medication are made.

 

Kirklees

Flyer for Patients to Outline CCG Prescribing Policies

Hard copies of this leaflet can be ordered from: Dawn.Toothill@greaterhuddersfieldccg.nhs.uk

 

North Kirklees

North Kirklees CCG has commissioned PriDerm to provide community dermatology services.  Community pharmacies may be asked to dispense prescriptions for Isotretinoin and the Pharmacist's Guide to Dispensing Isotretinoin provides information on dispensing Isotretinoin in accordance with the Pregnancy Prevention Programme (PPP).

 

Leeds

Leeds CCG have informed us that they are introducing a change in dressings supply.  We understand that each pharmacy has been sent a letter by post regarding this change.  The letter and dressing list can be found below for your information.

Leeds CCG Dressings Letter

Leeds Dressing List

Also, see Community Pharmacy West Yorkshire stance on dressings supply.

 

Wakefield

Wakefield CCG have informed us that they are introducing a change in dressings supply from 21st May 2018.  We understand that each pharmacy has been sent a letter regarding this change but a copy of the letter and list of dressings affected can be accessed below: 

Wound Care Products Letter 

Wound Product Stock List

Also, see Community Pharmacy West Yorkshire stance on dressings supply. 

↑ Back to top

  

Pharmaceutical Stationery Orders

EPS tokens and other NHS stationery can be ordered via the Primary Care Support England (PCSE) portal.  Click here for further details of how to register for the portal.

 

↑ Back to top

 

Use of Emergency Salbutamol Inhalers in Schools

From 1st October 2014 the Human Medicines (Amendment) (No. 2) Regulations will allow schools to keep a salbutamol inhaler for use in emergencies. 
 
The Department of Health has written guidance for schools which will be of interest as schools are advised to discuss the use of inhalers and spacers with their community pharmacist. 
 
The guidance can be found here.
 
School Inhaler Request Form

 ↑ Back to top