March 2014 CPN

CPNCommunity Pharmacy News – March 2014

CPN Your monthly round up of news andinformation for Community Pharmacy

Wakefield blood pressure | Smartcard special feature | Prescription Submissioncampaign Factsheet

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2 Community Pharmacy News – March 2014

PSNC’s work FuNDiNg aND StatiStiCS CoNtraCt aND it

Community PharmacyFuture Project

Community pharmacy teams may have

read about the results of the Community

Pharmacy Future project this month.

The project was run in Wigan and the

Wirral and saw community pharmacies

offering a COPD case finding service, a

COPD support service and special support

for all patients taking four or more

medicines.

The results were extremely encouraging,

with benefits shown including:

• A significant increase in medicines

adherence and in quality of life for

people taking four or more medicines

• 135 people at risk of developing COPD

identified

• A significant increase in medicines

adherence and in quality of life for

patients with COPD

The evaluation report estimated that if

rolled across all pharmacies in England the

services could save the NHS a significant

amount of money such as:

• £4.5m in societal costs;

• £86.3m disease-related cost savings

from supporting people to stop

smoking;

• £33.9m in reduced hospital costs due to

reduction in falls that result in fractures.

Commenting on the results, PSNC Chief

Executive Sue Sharpe said:

“The Community Pharmacy Future Project

was an excellent project that has shown

very clearly the difference that community

pharmacies can make to patients and the

savings those benefits could translate into

for the NHS.

PSNC was a member of the steering group

of the project, and although it was funded

by the four large multiples, we were able

to ensure the wider involvement of

community pharmacies in the area. The two

local LPCs were also very much involved in

the project and were able to help facilitate

its delivery across the region.”

Future of the New Medicine ServiceNHS England has been considering the short term future of the new

medicine service (NMS), in discussion with PSNC.

It has been agreed that the NMS will continue in 2014/15, subject to the

outcome of the evaluation. This decision was informed by initial findings

from the evaluation; the full evaluation findings will be subject to the usual

academic scrutiny, with the final report not expected to be published before

May 2014.

This means that pharmacy contractors can continue to provide the NMS to all

eligible patients.

PSNCElectionsVoting in the PSNC

elections in North

London, Yorkshire and

East Anglia close at 2pm

on 14th March and the

results will be posted on

the PSNC website later

that day.

For the latest PSNC newsand information visit

psnc.org.uk

PSNC: NHS must usepharmacy to avoid collapse The NHS needs to make radical changes to find

cheaper ways to deliver care to patients to

avoid financial collapse, PSNC Chief Executive

Sue Sharpe has said.

Addressing contractors at the Sigma Pharmaceuticals conference in February, Sue

warned that the same would be true for community pharmacy, as adding more

burden on the sector within traditional operations will not be sustainable.

Sue said pharmacies would not be immune to the pressure as the NHS needs all

the money it can get to make the £20bn savings it has been tasked with, but that

there were key opportunities coming up for community pharmacy and that

through its response to the Call to Action, it could shape its own future in the

health service.

PSNC will be continuing its work to create opportunities for pharmacy and to help

LPCs and contractors to make the most of those, but Sue also advised contractors

that they too could help by thinking about the future, having plans and

implementing them, getting involved in local LPC work and investing in pharmacy

teams.

psnc.org.uk 3

ServiCeS aND CommiSSioNiNg the healthCare laNDSCaPe lPCsDiSPeNSiNg aND SuPPly

PSNC Comments ReviewPSNC and its members regularly comment on

topical issues within community pharmacy and

the wider NHS in order to help promote

pharmacy and to ensure pharmacies and others

are aware of its views. These comments are often

posted on PSNC’s website or published in the

pharmacy press. This month we look at a SWOT

analysis of the community pharmacy sector.

A SWOT Analysis of Community Pharmacy

PSNC Regional Representative and

independent community pharmacy

contractor Mark Burdon contributed an

article to the Pharmaceutical Journal

considering the strengths and

weaknesses of community pharmacy and

the opportunities and threats facing the

sector.

Mark highlighted a host of successes that

community pharmacy has had in recent

years, including delivering ever-increasing

prescription volumes safely and

efficiently; saving the NHS some £7bn

through efficient procurement; the

positive contributions pharmacies make

to public health; and the difference

services such as the NMS and MURs

make, helping patients to take their

medicines correctly and so avoid

unnecessary and costly complications.

He also stressed though that pharmacy

would need to adapt if it is to survive in

an NHS looking to make £20bn worth of

savings. Dispensing will not be immune

from Government cost-cutting measures,

and unless pharmacies can demonstrate

the value they can bring to support the

medicines supply function, by coupling it

with services to improve patients’

adherence and health, there is a real risk

that income could drop to unsustainable

levels.

Some pharmacies were not adopting

services as enthusiastically as others and

the inconsistency across the sector left it

vulnerable, Mark argued. “The

inconsistency means the public are

confused about what we offer, other

professionals are not confident in us, and

commissioners are nervous about

investing in us.”

But Mark concluded that despite the

threats ahead, we have every reason to

be optimistic about the future. He

outlined how PSNC is gathering evidence

to convince commissioners, politicians

and other professions of the value that

pharmacy can offer and the need to make

pharmacies a “third pillar of care” within

the NHS, adding: “Keep trying with

services and gathering evidence for what

you do; keep going that extra mile for

patients; respond to and encourage

others to respond to the Call to Action;

and help your LPC keep your services

commissioned. If we can rely on everyone

to play their part, I believe we could have

some good years ahead of us, but if we

cannot, then pharmacy is likely to feel the

pain of our struggling health service as

acutely as everyone else.”

Royal Pharmaceutical Society members

and others can read the full article on the

Pharmaceutical Journal website via:

tinyurl.com/cpswotanalysis

PSNC takes to twitterPharmacists and pharmacy teams may

already be aware of PSNC’s presence

on twitter under the @PSNCNews

identity. We use this to highlight news

stories and updates as they are posted

on our website, and we hope this has

been useful to contractors and their

teams.

As part of our ongoing work to

improve our communications and

engagement with pharmacies we are

this month expanding our offer on

twitter. Still using @PSNCNews, we

will be using our tweets to help

pharmacy teams to:

• Stay up to date with all the latest

community pharmacy news

• Ensure they are using the latest

endorsement guidance and not

missing out on payments

• Find guidance, briefings and

information that could help their

day to day practice

• Share tips on service delivery and

overcoming challenges in the

dispensary

• Find out news and facts from

elsewhere in the NHS that may help

them in their work

We hope the new approach will better

meet the needs of pharmacy teams

and help them to find relevant and

useful information more easily on our

website, but we will be interested in

your feedback as it evolves. Tweet

@PSNCNews or email

[email protected].

PSNC E-NEWSTo receive a weekly summary of the latest

news and guidance featured on the PSNC

website including pharmacy contract news,

Drug Tariff News, NCSO updates, events

information and much more, sign up to

receive PSNC’s weekly e-newsletter.

Visit www.psnc.org.uk/enews to register

www.twitter.com/psncnews


PSNC’s work FuNDiNg aND StatiStiCS CoNtraCt aND it

What next for the Call to Action?Hopefully by now pharmacy teams will

have heard about the community

pharmacy Call to Action and you may even

have sent in a response to it or attended a

local event to contribute. Many have called

the Call to Action pharmacy’s biggest

opportunity yet to shape its future, but

what exactly will happen next, and what

outcomes can we expect to see?

In an article in Chemist +Druggist

magazine this month, PSNC Head of NHS

Services Alastair Buxton explained that the

timing of the Call to Action makes this

consultation more important than those

that have come before it.

The NHS is now at a crucial point – it is

facing huge financial challenges and is not

sustainable as it is. The so-called Nicholson

challenge set the NHS a target to make

£20 billion worth of efficiency savings by

2015 and that is going to bite across all

areas, Alastair explained. Meeting the

challenge is also going to need radical

changes in the health service and the way

in which it delivers care, and NHS

England’s Calls to Actions have been

exploring what those changes should be.

For pharmacy, there are risks as the NHS

could earmark the sector as an area in

which savings could be made.

But there is also the chance that, if we

have made our case successfully, NHS

England will see that community

pharmacies need to be at the heart of the

health service, helping to ensure the NHS

gets best value from its spend on

medicines, and providing accessible

services that help people to stay healthy

for longer and manage their long term

conditions more effectively so that they

can avoid complications and the need to

use more expensive health services as a

consequence of them.

As the commissioner of primary care

services, NHS England has the power to

commission some of these services at a

national level, and to align pharmacy

payments with those of other health

professionals so that everyone is

incentivised to work more closely together

to deliver seamless patient care, and these

are the changes that we hope to see

coming next.

You will be able read more about PSNC’s

response to the Call to Action on the PSNC

website at psnc.org.uk this month, and we

expect NHS England to publish a summary

of the responses it received, which may

give some clues as to the direction it is

likely to take, in the next few months. This

will again be highlighted on the PSNC

website.

You can also read Alastair’s full article at

www.chemistanddruggist.co.uk

LPCs skilled up on coaching and mentoring

LPCs sometimes need to provide one-to-

one support to contractors on issues

such as compliance with the contractual

framework, the delivery of local

services, adapting to change or more

personal matters where the LPC may be

able to help. LPCs as local leadership

bodies also may be involved in

identifying and developing future

leaders. Internally, following the

elections, experienced LPC members

will be working with new members to

help them get to grips with their new

role as quickly as possible.

To support this work PSNC has provided

training for LPCs on coaching and

mentoring, helping delegates

understand when coaching is needed,

how to get the best out of people using

coaching and mentoring, the essential

skills and qualities of an effective coach

and mentor, how to build coaching and

mentoring relationships, using

facilitation skills as part of mentoring

and coaching peers as well as groups.

The training, held in London and Leeds,

also gave delegates the opportunity to

practise their new skills on real issues

concerning delegates so there was the

extra bonus of being able to talk

through problems with colleagues.

With great feedback and calls from LPCs

for a repeat of the training, PSNC has

organised an extra date for LPCs in

June, details to follow soon. The

coaching and mentoring training is part

of PSNC’s LPC Support programme

which provides a wide range of support

to LPC members and officers.

Further training

Over the next few months PSNC is

providing a day for new LPC members

on NHS regulations, LPC constitution

and governance, LPC management and

finance and NHS policy. There is also a

workshop for LPC members and

officers on preparing bids and business

cases to support the negotiation and

successful commissioning of local

services on behalf of local pharmacy

contractors.

psnc.org.uk 5

ServiCeS aND CommiSSioNiNg the healthCare laNDSCaPe lPCs

Paving the way for pharmacy:Part 3: South Yorkshire’s Respiratory ServiceThe latest in our series featuring the winners of last year’s PSNC Evidence Awardssees Nick Hunter, Secretary of Doncaster and Rotherham LPCs, telling us about aRespiratory Service that was commissioned across South Yorkshire’s LPCs.

When money became available for

community pharmacy across five LPC

areas, South Yorkshire’s LPCs decided that

the most effective way of utilising this

money would be to work together to bid

for one service which would span the

entire region. “[South Yorkshire] already

had a forum [where we] share ideas and

ways of doing things… so we utilised that

to take the idea forward,” Nick Hunter,

Secretary of Doncaster and Rotherham

LPCs, explains; but this project took these

links a step further.

These strong ties across South Yorkshire

helped the LPCs to get the money for their

Respiratory Service in June 2012, but they

were put on a tight schedule as the South

Yorkshire Strategic Health Authority

wanted an evaluation completed by the

end of the following March.

So Nick and Matt Auckland (then Head of

Medicines Management at Barnsley PCT)

looked to other areas for help, in the end

being guided by a similar scheme that had

run on the Isle of Wight. Of course the

unique geography of the island was a

cause for concern, but in the end South

Yorkshire has proved that the success

could be replicated in other areas of the

country. Carried out in conjunction with an

MUR or NMS consultation, the Respiratory

Service, which saw pharmacies giving

advice on inhaler technique, was shown to

have helped 98% of asthma patients using

inhalers improve their Inspiration Rate

Change in just one session (see The

Respiratory Service in figures box).

The biggest challenge the LPCs came up

against was the re-organisation of the

NHS, because just at the time they were

trying to get the service up and running

and needed the PCTs to back it to ensure

other health professionals were confident

in it and could refer to it, the PCTs were

winding down their activities. But relying

on the strong links the LPCs already had

with PCT contacts and through other local

health networks, they were able to

manage this.

One of the key aims for the Respiratory

Service was to improve patients’

management of their own condition to

help reduce avoidable hospital admissions.

However, whilst teaching patients

effective inhaler technique and symptom

control can go a long way towards

achieving this aim, proving the link to

hospital admission reduction can be a

difficult process, and some are still yet to

be convinced about it.

This need for clear evidence that health

services are effective is particularly

important at the moment as savings need

to be made. Fortunately, South Yorkshire’s

LPCs did manage to produce a very

effective evidence case for their

Respiratory Service, meaning that they not

only won a PSNC Evidence Award but were

also asked to present their work at the

leading UK conference for pharmacy

practice researchers called “Health

Services Research in Pharmacy Practice”

(HSRPP).

They also won over at least some of the

doctors, as both Nick and Doncaster CCG

are keen to continue the Respiratory

Service. Again it comes down to money

though, as the CCG must find a budget for

it.

If you would like to help get the ball rolling

for this or any other services in your area,

your LPC’s contact details can be found via

the LPC Portal at: lpc-online.org.uk

The Respiratory Service in figures

1,616 consultations took place between September 2012 andMarch 2013.

83% of respiratory service consultations took place as part ofan MUR

Nearly 80% of service users were aged 45 or over

11% of people with inhalers were unsure of their diagnosis

98% of asthma patients using inhalers showed improvementin their Inspiration Rate Change after their consultation

More than 1,000 patients met their target Inspiration Rateduring one consultation

Over half of patients used reliever inhalers at least once a day

Almost 80% of patients were given at least one interventionby the pharmacist

Nick Hunter on…… the decision to base service payments on data collection“It’s human nature… if you’ve got no incentive to dosomething, then you get on with the things where you havegot an incentive to do them… [so] the fees were a ‘no data,no payment’ system.”

… the benefits of data collection“[The data] has been vital to bring to discussions with newcommissioners… there is a much bigger pot now availableto [the Respiratory Service]. Had we not got that report,then we wouldn’t have got the commissioners’ interest inre-commissioning the service.”

…the future of pharmacy services“See if you can take what we’ve done [in South Yorkshire]and make it fit in with other areas.”

DiSPeNSiNg aND SuPPly

PSNC’s worklPCsthe healthCare laNDSCaPe


PSNC’s regular round

up of health & care

news and policy

Keeping up with all the latest

developments in health and care policy

could almost be a full time job and PSNC

regularly receives questions from LPCs and

pharmacy contractors about what is going

on in the wider health and care landscape

beyond community pharmacy.

To help answer some of these questions

and to help contractors and LPCs stay up

to date, PSNC provides this regular update

service outlining the latest information in

an easily digestible format. Weekly

updates are published on our website and

each month here in CPN we summarise the

news from the previous few weeks. More

detailed briefings are available at:

psnc.org.uk/thehealthcare-landscape

Changes planned for locally agreed GP

contracts

In early February NHS England announced

changes to the way Personal Medical

Services (PMS) contracts will be managed

to ensure the most effective use of

resources; PMS is a locally-agreed

alternative to the General Medical Services

(GMS) contract.

NHS England’s Area Teams will be

reviewing PMS contracts over the next

two years to ensure that additional

practice funding, over and above that

provided to GMS practices, must reflect

local strategic plans for primary care and

secure services or outcomes that go

beyond what is expected of core general

practice. The GP press have reported that

PMS practices could face losing up to

£260m as a result of the review.

PHE release local authority adult

obesity data

New local authority excess weight data,

published by Public Health England (PHE),

confirmed that 64% of adults are

overweight or obese. The new data also

shows for the first time the considerable

variation in the numbers of people who

are overweight or obese in different parts

of England, as well as the extent of the

challenge many local authorities and the

local NHS face.

The Francis Report: One Year On

The Nuffield Trust has published a report

which analyses the impact of the Francis

Report on the NHS. Alongside that

publication Jeremy Hunt, Secretary of

State for Health, highlighted figures that

suggest NHS care has changed for the

better one year on from the Francis

Inquiry. NHS England also highlighted a

range of changes it has led over the past

year including:

• Launching the Friends and Family Test;

• Rolling out a new plan for nursing,

midwifery and care staff – the

Compassion in Practice strategy;

• Reviewing the quality of care and

treatment provided by 14 hospital trusts

that are persistent outliers on mortality

indicators;

• Approving the development of a

network of Patient Safety

Collaboratives;

• Publishing data on never events that

occur in hospitals; and

• Putting in place Quality Surveillance

Groups across NHS England’s 27 area

teams and four regions.

Jeremy Hunt, Secretary of State for

Health, subsequently announced that the

Mid Staffordshire Foundation Trust, which

was the focus of the Francis Report, would

be dissolved and its constituent hospitals

would be taken over by nearby NHS Trusts.

The NHS is not meeting the “Nicholson

Challenge” says Health Committee

Parliament’s Health Committee has

published a report following its annual

inquiry into public expenditure on health

and social care. The MPs said the health

and care system needs fundamental

change if it is to meet the needs of

patients. They note that while many of the

straightforward savings have been made

by the health and care system, the

transformation of care on the scale which

is needed to meet demand and improve

care quality has not yet been seen.

The Committee also said that the

economic situation is not helped by the

current fragmented commissioning

structures. The Committee’s view is that,

as Health and Wellbeing Boards have been

established to allow commissioners to look

across a whole local health and care

economy, their role should be developed

to allow them to become effective

commissioners of joined-up health and

care services. The Committee also

recommends that the current level of real

terms funding for social care should be

ring-fenced.

Hospital centralisation and chains

The Health Service Journal has reported

that discussions have begun between NHS

England, DH, Monitor and the NHS Trust

Development Authority on a major

engagement programme to seek a longer

term vision for the hospital sector. This

could include secondary care providers

forming national chains of hospitals and

services in order to improve efficiency,

standards and leadership.

Meanwhile, in an article in the Daily

Telegraph, Sir David Nicholson, Chief

Executive of NHS England, has said that

hospitals will have to close and services

will need to be centralised in order to

improve patient care. He called for a

radical reorganisation of health services so

a smaller number of larger hospitals offer

most major surgery while smaller hospitals

scale back the care they provide. Sir David

also called on politicians from all parties to

back these proposals and to avoid the

issue being used to score party political

points in the run up to the general

election.

Former M&S boss to advise on NHS

leadership

Jeremy Hunt, Secretary of State for Health

has appointed Sir Stuart Rose, former CEO

of Marks and Spencer to advise on how the

NHS can attract and retain the very best

leaders to help transform the culture in

under-performing hospitals. Sir Stuart will

also advise on how NHS trusts can improve

organisational culture, through leaders

being more visible and in touch with

frontline patients, services and staff.

ServiCeS aND CommiSSioNiNgDiSPeNSiNg aND SuPPlyCoNtraCt aND it

psnc.org.uk 7

Ongoing Branded Medicine Supply problemsAt present, the supply arrangements for some products are having an adverse impact on workload in pharmacies and can lead to

delays in patient care. PSNC continues to work constructively with manufacturers, wholesalers, the Department of Health and

regulators to find solutions to the current problems that could be introduced to help meet the needs of UK patients more efficiently.

List of Medicines Impacted by Branded Medicine Supply Problems

Pharmacies have reported problems obtaining the following medicines through wholesalers. This list is not exhaustive. If a

product cannot be obtained through the normal channels, emergency stock can be obtained directly from the manufacturer:

Azilect 1mg tablets (Lundbeck Ltd)

Azopt 10mg/ml eye drops (Alcon Laboratories (UK) Ltd)

Cialis 20mg tablets (Eli Lilly and Company Ltd)

Cipralex 10mg tablets (Lundbeck Ltd)

Cipralex 20mg tablets(Lundbeck Ltd)

Cymbalta 30mg gastro-resistant capsules (Eli Lilly and Company Ltd)

Cymbalta 60mg gastro-resistant capsules (Eli Lilly and Company Ltd)

DuoTrav eye drops (Alcon Laboratories (UK) Ltd)

Emselex 7.5mg modified-release tablets (Novartis Pharmaceuticals UK Ltd)

Emselex 15mg modified-release tablets (Novartis Pharmaceuticals UK Ltd)

Eucreas 50mg/1000mg tablets (Novartis Pharmaceuticals UK Ltd)

Exforge 10mg/160mg tablets (Novartis Pharmaceuticals UK Ltd)



Ezetrol 10mg tablets (MSD-SP Ltd)

Micardis 40mg tablets (Boehringer Ingelheim Ltd)

Micardis 80mg tablets (Boehringer Ingelheim Ltd)

MicardisPlus 40mg/12.5mg tablets (Boehringer Ingelheim Ltd)

MicardisPlus 80mg/12.5mg tablets (Boehringer Ingelheim Ltd)

Spiriva 18microgram inhalation powder capsules (Combopack and Refill Pack) (Boehringer Ingelheim Ltd)

Spiriva Respimat 2.5micrograms/dose solution for inhalation cartridge with device (Boehringer Ingelheim Ltd)

Symbicort Turbohaler (AstraZeneca UK Ltd)

Travatan 40micrograms/ml eye drops (Alcon Laboratories (UK) Ltd)

Yentreve 20mg gastro-resistant capsules (Eli Lilly and Company Ltd)

Deletions:

Aprovel 300mg tablets (Sanofi)

CoAprovel 150mg/12.5mg tablets (Sanofi)

CoAprovel 300mg/12.5mg tablets (Sanofi)

CoAprovel 300mg/25mg tablets (Sanofi)

Please note: If a wholesaler chose to trade medicines for export and as a consequence the needs of patients in the UK were not met,

the holder of the wholesale dealer’s licence could be in breach of the Regulations, and could face regulatory action against his licence,

and/or criminal prosecution. This also applies to products that have not been reported as having supply problems and are therefore not

listed above. There is no obstacle to exporting medicines in a way that does not impact on availability of the product to UK patients.

Feedback to PSNC: Contractors who have experienced problems in obtaining medicines because of quota arrangements are

encouraged to feed this into the PSNC Information Team to support PSNC’s ongoing monitoring of the situation. PSNC will work to

ensure this information is fed into the Department of Health as evidence of the problems that are arising. An online feedback form for

this purpose can be found on the PSNC website (www.psnc.org.uk/brandedshortages). For support on this issue, please contact the

PSNC Information Team (0203 1220 810).

Manufacturer Contingency Arrangements

Detailed guidance on individual manufacturers’ contingency supply arrangements can be found on the PSNC website

(www.psnc.org.uk/brandedshortages). Other resources on the site include guidance on legal and professional obligations in relationto trading medicines in short supply and supply chain best practice guidance.

FuNDiNg aND StatiStiCS


DiSPeNSiNg aND SuPPly ServiCeS aND CommiSSioNiNg the healthCare laNDSCaPe

Ask PSNC – Smartcards SpecialThe PSNC Information Team can give pharmacies support and advice on a range of

topics related to the Drug Tariff and reimbursement. Questions the team have been

asked by pharmacies in recent months have included:

1. Where can I obtain a certain smartcard?

Please contact your Registration Authority (RA) to obtain a

smartcard. If you don’t know who your RA is, speak to your local

NHS England Area Team (contact details for local Area Teams can

be found at tinyurl.com/areateam or speak to your LPC).

2. What arrangements are in place to provide access to EPS

Release 2 for non-locum pharmacists who practice across RA

boundaries?

Prior to working at a pharmacy based in another area, the

pharmacist must contact the relevant RA for that area to organise

for the appropriate user profile to be added to their smartcard.

The pharmacist’s sponsor should complete an RA02 form which is

sent to the RA Agent/Manager for the necessary amendments to

be actioned (please contact your sponsor or RA to obtain the

form(s) you require).

If the pharmacist has the locum profile on their card, they are able

to work at any EPS Release 2 enabled pharmacy in England and

are not required to go through this process.

3. My RA has told me that they will not be issuing smartcards at

present. Who should I contact to resolve this?

If an RA is refusing to issue cards or not issuing cards in a timely

manner, we would recommend contacting your LPC

(lpc-online.org.uk) in the first instance who will be able to take

this up with the NHS England Area Team.

4. I don’t have an NHSmail address or access to a mobile phone.

Is there any other way to remotely unlock my smartcard without

having to visit the RA Offices?

If an incorrect pin has been entered more than 3 times, the

smartcard is locked and needs to be ‘unlocked’ to be used.

Where a staff member has access to the online Smartcard Service

Centre (SCSC) and has either an @nhs.net email account or mobile

phone number listed in the Spine User Directory, the system can

be used to support unlocking an individual’s smartcard remotely,

without the need to visit the RA Office. If an individual does not

have either a mobile phone or an @nhs.net email account, it may

be possible to use the pharmacies landline if the following apply:

• The telephone line accepts text to voice conversations (this is

available through a number of telephone providers including

BT and Virgin and modern VOIP telephone systems)

• An auto-attendant is not in use (i.e. the message will go straight

through to a person, rather than a message.)

• The telephone number has previously been listed on the Spine

User Directory

To list a number in the Spine User Directory or to update a

telephone number, please contact the local RA.

A sponsor can also unlock smartcards if they have been given this

authority by the RA. They must also have access to a computer

with two smartcard readers attached and have access to the

online card management system. PSNC is recommending that to

ensure ready access to sponsors, a representative in each

pharmacy premises is given sponsorship responsibility, for

example the pharmacist-in-charge or branch manager.

5. How do I cancel a smartcard (e.g. when a member of the

dispensing staff is leaving)?

The pharmacist or pharmacy manager should advise the local RA

prior to a user leaving an organisation. The RA will then need to

follow the appropriate access removal process.

Where a smartcard is required to access NHS Care Records

Service (CRS) compliant applications, leavers with no intention of

returning to an organisation in the near future (for example users

having a change of career or those who are retiring), should have

their smartcard and its certificates revoked using an RA03 form

(please contact your sponsor or RA to obtain the form(s) you

require).

For more information please visit psnc.org.uk/smartcards

April 2014 Category Mprices published

The Department of Health has

announced the new Category M prices

which will apply to prescriptions from

April until June 2014. The April 2014

prices can be viewed on the NHS

Prescription Services website.

PSNC and the Department of Health (DH)

assess the medicine margin achieved by

pharmacy contractors and make

adjustments, as necessary. DH and PSNC

have agreed a reduction to generic

medicine reimbursement prices (Category

M) from April 2014 of £10 million per

month, equivalent to £120 million in a full

year. The Drug Tariff will be amended

from April 2014, to reflect this change.

The delivery of medicine margin will

continue to be assessed, with further

adjustments made, as necessary.

PSNC’s Head of Finance Mike Dent

commented: ‘Whilst we have agreed this

adjustment for April, it will be kept under

review as further data becomes available

on levels of margin being earned. Our

ambition is to move to a system that

offers greater consistency of margin

delivery for contractors, avoiding the

large cuts in reimbursement prices seen

in October for many years, and we are

working with DH to revise the systems for

adjusting Category M prices.’

psnc.org.uk 9

PSNC’s work FuNDiNg aND StatiStiCS CoNtraCt aND itlPCs

Are you being paid correctly?Check out the updated Prescription Payment

section of our website to make sure you are.

The Prescription Payment and Pricing Accuracy section of the PSNC website has

recently been updated to include much more detailed information than ever

before on things like making sure you have sorted your prescriptions correctly for

submission to the Pricing Authority, how to make sense of your FP34 Schedule of

Payments, and how to reduce the chance of errors in pricing. Below is a step-by-

step guide to where you will find the updated pages on our website.

This section of the website is split into three areas:

1. Prescription Submission: preparing, sorting and dispatching the prescription

bundle and completing your FP34c submission document

(psnc.org.uk/submission)

2. Monthly Payments: how to understand and make use of your FP34 Schedule of

Payment to monitor performance (psnc.org.uk/payments)

3. Prescription Pricing Accuracy: covering how your prescriptions are processed

by the Pricing Authority, prescription switching, PSNC prescription pricing

audits and pricing rechecks (psnc.org.uk/accuracy)

We hope that you will find our improved website better suited to your needs, but

please let us know if you experience any problems with the site. We would also

welcome any general feedback/ comments at: www.psnc.org.uk/report

Alongside our new webpages, we are also launching a new series of payments

factsheets so pharmacy teams have some short checklist style guidance that can

be used day to day in the pharmacy. The first of these factsheets can be found on

page 13.

All details correct at time of printing.

No part of this publication may be reproduced without the written permission of the PSNC.

Produced for the PSNC by Communications International Group. ©. PSNC.

Colour repro and printing by Truprint Media, Margate.

The publishers accept no responsibility for any statement made in signed contributions or

in those reproduced from any other source.

Communications International Group

Linen Hall, 162-168 Regent Street, London W1B 5TB

Tel: 020 7434 1530 Fax: 020 7437 0915

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Changes toSupplementaryOpening Hours

Pharmacies wishing to amend their

supplementary hours must notify their

Area Team, giving at least 90 days’ notice

of the intended change. The Area Team

may consent to a shorter period of notice –

but because that consent may not be

forthcoming, try to ensure that plans are

made sufficiently in advance.

NHS England has published a template

notification letter on its website

(www.england.nhs.uk/pharm-open-hrs).

There is no requirement for the Area Team

to grant applications for changes to

supplementary hours – the pharmacy has

the right to amend hours so long as 90

days’ notice is given. However, we have

been made aware that in some cases these

notifications may not have been seen by

the relevant person at the Area Team and

in light of this we are suggesting that

contractors ensure their notification

documents are correctly received. You can

do this in a number of ways by:

• Telephoning the Area Team before you

send the documents to obtain specific

contact details for the member of staff

you need to send it to, this can include

email address as well as postal address.

• If acceptable to make notification by

email, this could be an auditable way of

sending your notification and making

sure that the correct recipient has

received it.

• If you send your notification by post

then we also suggest doing so by

recorded delivery, so that you can then

be sure that the notification is received

by your Area Team.

• After you have sent the notification,

telephoning the relevant contact at the

Area Team to confirm receipt. Be sure to

make a record of the name and details of

the person who confirms this.



Reminder: Changes to BNF distribution

Pharmacy staff are reminded that, from 2014, paper copies

of the British National Formulary (BNF) will be distributed

annually by NICE instead of six-monthly.

This means that the next hard copy versions for pharmacies

will be made available in September 2014 only.

Full details of distribution arrangements can be found at

psnc.org.uk/externalresources

The Royal Pharmaceutical Society (RPS) has released this

statement:

“The publishers of the BNF - the Royal Pharmaceutical

Society and BMJ - are committed to providing the formulary

in the formats our customers find most useful and

convenient.

For this reason we will be continuing to publish the BNF in

updated book form twice a year, in March and September.

NICE will not be purchasing the March 2014 edition for

nationwide distribution to NHS health professionals in

England. It is moving to one annual print distribution per

year, in addition to the availability via its website and app.

Those organisations that wish to have the next updated

print edition, therefore, should contact Jim Benham on 020

7572 2251 or email [email protected] for a quote –

as ever, prices flex with quantities ordered. Individual

clinicians wishing to purchase a copy should call 01256-

302699 or email [email protected].”

For more information on the BNF and its distribution, please

visit www.nice.org.uk/bnf

Drug Tariff Watch

The first section of the Drug Tariff is the Preface section. This

contains valuable information relevant for both the current

edition and the next. It lists additions, deletions and any other

alterations to the Drug Tariff. The Preface should ideally be

checked each month to identify products which are entering or

being removed from the Tariff as well as those products changing

between categories or in the case of category C items, changes to

the brand used for pricing.

It is especially important to note which are Drug Tariff listed

products as well as which category products are entering and the

pack sizes being included in these entries, as reimbursement will

be based on this classification and its endorsement requirements.

Incorrect endorsement can lead to incorrect payment for items.

It is also important to know the category of an item when

claiming certain payments (e.g. OOP expenses) as these are not

allowed in particular categories.

Below is a quick summary of the changes due to take place from

1st April 2014

Part VIIIA Additions

Category A Additions:

• Phenoxybenzamine 10mg capsules (30)

Part VIIIA Amendments

• Disopyramide 150mg capsules (84) is chaning to Category C –

A A H Pharmaceuticals Ltd

Part VIIIA Deletions

If a medicinal product has been removed from Part VIIIA and has

no other pack sizes listed, it can continue to be dispensed, but it

will need to be endorsed fully (i.e. brand/ manufacturer nameand pack size) in future.

• Beeswax yellow solid (500g) – J M Loveridge Ltd

• Camphor racemic powder (100g) – J M Loveridge Ltd

• Coal tar solution strong (500ml) – J M Loveridge Ltd

• Copper sulfate pentahydrate powder (500g) – J M Loveridge Ltd

• Hydrotalcite 500mg/5ml oral suspension sugar free (500ml) –

Peckforton Pharmaceuticals Ltd

• Kaolin light powder (1000g) – J M Loveridge Ltd

• Magnesium trisilicate powder (500g) – J M Loveridge Ltd

• Pentazocine 30mg/1ml solution for injection ampoules (10) –

Zentiva

• Peppermint emulsion concentrated (250ml) – J M Loveridge Ltd

• Potassium bromide powder (500g) – J M Loveridge Ltd

• Proflavine 0.1% cream (100ml) – J M Loveridge Ltd

• Sodium metabisulfite powder (500g) – J M Loveridge Ltd

• Sodium picosulfate 2.5mg capsules (50) – Dulcolax Pico Perles

• Sulfur 5% / Salicylic acid 3% shampoo (120ml) – Meted

• Valsartan 160mg tablets (28) – Aspire Pharma Ltd

• Valsartan 80mg tablets (28) – Aspire Pharma Ltd

Part IX Deletions

It is important to take careful note of removals from Part IX

because if you dispense a deleted product, prescriptions will be

returned as disallowed and therefore payment will not be made

for dispensing the item.

• BANDAGES – Short Stretch Compression bandage – Silkolan (all

sizes)

• VAGINAL PH CORRECTION PRODUCTS – Lactic Acid Vaginal

Tablets – LadyBalance

• INCONTIENCNE APPLIANCES – Urinal Systems – Manfred Sauer

UK Ltd – URIfem female reusable bottle urinal

psnc.org.uk 11

PSNC’s work FuNDiNg aND StatiStiCS CoNtraCt aND itlPCs

Wakefield urged to drop in for blood pressure testWith an estimated 30,000 people in Wakefield having undiagnosed high

blood pressure, Public Health England (PHE) has launched a pilot campaign

in the town to identify those people.

High blood pressure is estimated to cause over 20% of heart

attacks and 50% of strokes. Last year in Wakefield, there were

over 1,000 emergency admissions to hospital for a heart attack or

stroke.

PHE’s 4-week campaign aims to encourage people aged 40 or

over to visit one of over 50 blood pressure drop-ins set up across

the area from 10th March, that make it convenient for people to

get a quick, free test. Healthcare workers will also be on hand to

offer information and lifestyle advice, to help people achieve or

maintain a healthy blood pressure, without the need for an

appointment.

Everyone from community pharmacies, Wakefield Council and

West Yorkshire Police, to local businesses, are playing a part in

raising awareness of the campaign and encouraging their

employees and customers to have the quick test.

Dr Stephen Morton, PHE’s Centre Director for Yorkshire and

the Humber, said:

“Your chance of having high blood pressure increases as you get

older however the condition is often symptomless and is

impossible to spot without a test. This is why a number of drop-

ins have been set up across Wakefield – to make it as easy as

possible for people to find out if they are one of the 30,000

people currently undiagnosed with high blood pressure in the

area.

By working closely with community groups and organisations we

hope to reduce premature deaths by raising detection of high

blood pressure and educating everyone on the steps they can

take to control their blood pressure.

There are a number of steps people can take to help manage

their blood pressure, including losing weight, exercising regularly,

cutting down on salt and eating a healthy diet.”

Robbie Turner, Chief Executive Officer at Community

Pharmacy West Yorkshire, said:

“Community Pharmacy West Yorkshire is delighted to be a key

partner in the Wakefield blood pressure drop in. Community

pharmacies in Wakefield already offer many high quality and

accessible health and wellbeing services and this campaign to

encourage the public to know their blood pressure numbers is an

ideal way to see the range of services community pharmacy can

offer you in improving your health.

We encourage people over 40 to drop into their local community

pharmacy from 10 March 2014 and get a simple free blood

pressure check.”

Faisal Tuddy, Deputy-Superintendent Pharmacist at Asda, said:

“The health and wellbeing of our colleagues and customers is

hugely important to us so this is why we are backing this blood

pressure campaign. Too many people have undiagnosed high

blood pressure in Wakefield and we hope to play a part in

changing this alongside the rest of the local community.

We aim to spread the word amongst our hundreds of colleagues

in our stores and distribution centres in Wakefield, along with

thousands of local customers, some of whom could be affected

by undiagnosed high blood pressure. As well as running Blood

Pressure Clinics in our distribution centres, the drop-in clinic will

visit Asda stores across the area over the coming weeks – so we’ll

leave no stone unturned in our bid to ensure that our Wakefield

community takes advantage of the free, 5-minute test.”

RNIB supporters create top tips forhealthcare professionals

The Royal National Institute of Blind People (RNIB) have

published guidance documents to assist healthcare staff in

improving the accessibility of their services for blind and

partially sighted people.

The guidance is in the form of “top tips” and has been

created by RNIB with the help of their supporters.

To read and download the top tips, please visit

tinyurl.com/rnibtips

lPCsthe healthCare laNDSCaPeServiCeS aND CommiSSioNiNg


Supporting PSNC

Declaration of Competence (DoC) frameworkfor locally commissioned servicesCommissioners, education providers and local pharmacy

representatives have worked together in the North West region

over a number of years to harmonise the accreditation

requirements for provision of locally commissioned services (the

Harmonisation of Accreditation Group – HAG). Over the last few

months this foundation has been built upon with the

development of the Declaration of Competence (DoC)

framework. The DoC framework has been designed to support

community pharmacy professionals (pharmacists and pharmacy

technicians) in assuring their competence in delivering consistent

and quality public health services.

Where a commissioner agrees to use of the DoC framework for

the provision of a specific community pharmacy service, the

framework will provide pharmacy professionals with the tools and

guidance to enable them to reflect on their current practice and

competence relating to the service; completing the self-

assessment tool will enable pharmacy professionals to identify

their own personal areas for development.

Pharmacists (and pharmacy technicians where appropriate) can

access the information they need on the CPPE website and

complete their self-declaration; there are 4 main steps for

pharmacy professionals once a commissioner allows this

approach:

1. Access the Declarations of Competence;

2. Review their competence against the self-assessment

framework;

3. Use the recommended learning, if needed, to fill any gaps in

competence;

4. Print-out, sign and date the declaration statement (the

declaration statement will include relevant CPPE packs that

have been completed). The declaration statement can be used

to demonstrate competence for the service to both the

commissioner and the employer.

The group behind this initiative (some of whom previously

worked on HAG) are accountable to Health Education North West

(the Local Education and Training Board) and the DoC framework

documents are hosted by and have been developed in

conjunction with CPPE.

PSNC, Pharmacy Voice and the Royal Pharmaceutical Society have

all confirmed their support for the initiative and the group has

also engaged extensively with commissioners, particularly in the

North West, who have expressed positivity for the approach.

The DoC framework has been piloted in Manchester and

commissioners involved in the pilot have reported that they are

satisfied with the approach and are comfortable with pharmacy

professionals declaring their competence. The group is hoping

that Health Education England will in due course adopt this

process as a national solution.

Further information on the DoC Framework is available on the

CPPE website www.cppe.ac.uk.

When LPCs are discussing commissioning or re-commissioning of

services with their local commissioners, they may want to suggest

use of the DoC framework.

The following services have had DoC frameworksprepared (available on the CPPE website):

• Emergency Contraception

• Alcohol Use Identification and Brief Advice

• Chlamydia Testing and Treatment

A second phase will see the release of thefollowing DoC frameworks:

• Supervised Consumption of Prescribed Medicines

• Stop Smoking

• Needle and Syringe Programmes

• Minor Ailments Schemes (levels 1 and 2)

A third phase will see the release of thefollowing DoC frameworks:

• NHS Health Checks

• Oral Contraception

• Cancer Awareness and Screening

• Weight Management

• Care Homes

Payment Factsheet 1: Prescription Submission1. Daily dispensing checks:Below is a checklist of actions recommended to take before submitting your account for payment and could help to improve theaccuracy of pricing.

*For instance, Drug Tariff listed lines only require endorsement if they are a Category C item that comes in more than one pack size. Please see endorsing

guidance for more information: psnc.org.uk/endorsing

2. Sorting your prescriptions prior to submission:

• Remove all pins, staples, paper clips, labels or invoices from prescriptions as these will have to be manually removed before pricing

and can delay processing.

• Ensure prescriptions are submitted in the correct patient charge group (i.e. exempt, paid, and paid at old charge rate), taking extra

care that no paid prescriptions are submitted within the exempt section as these will be switched. (Incorrectly filed prescriptions

are a major cause of overpayments so please ensure that all prescriptions are filed in the correct charge group).

• Each charge group should be secured with one or two elastic bands. Avoid using too many elastic

bands (see picture).

• Use the ‘red separator’ for separating:

• expensive items*

• specials and unlicensed products

• items with broken bulk or out of pocket expense claims

• items with hand written amendments

• where the prescribers’ signature encroaches over an item on the prescription

Full details on which items to include is set out on the red separator document sent to you from the Pricing Authority.

DO DO NOT

✓ Double-check all endorsements, particularly for expensive items and unlicensed

specials/imports.

✓ Stick to the required endorsements only*, don’t over endorse and keep all

endorsements within the left-hand side margin of the prescription form.

✓ Check your endorsements are legible. Are all prices endorsed clearly? Can they be read

easily by another person?

✓ Does your PMR system endorse automatically? Is your PMR making the endorsements

correctly? Are the printed endorsements readable or does your printer ink cartridgeneed replacing?

✓ Pharmacy stamp: Make sure the pharmacy stamp does not obscure the patient’s age or

date of birth, or any endorsements.

✓ Not dispensed items: Ensure ‘not dispensed’ items

are endorsed ‘ND’ in the endorsement column andthat the product name is clearly crossed out by ahorizontal line (see picture).

✓ Check exemption declarations on the backs of prescriptions (and in the electronic claim

message for EPS R2 prescriptions) are completed in full where necessary, and signed to avoidprescriptions being switched. Declarations are required unless the patient is age exempt andthe DOB/ age is computer-generated on the front of either the electronic or paper form.

✓ Occasionally, prescribers include supplementary product information, for example a brand

or manufacturer’s name or an indication that a sugar free or preservative free prescription isrequired, as part of the dosage instructions ratherthan as part of the name of the prescribed product(see picture). As reimbursement of electronicprescriptions is based on the product code of theprescribed product, supplementary product information included in the prescriber’s dosageinstructions will not be considered when calculating payment; therefore prescribers shouldbe encouraged to select the correct product to prescribe in the first place. (This is ofparticular importance when handling EPSR2 electronic prescriptions.)

✓ If possible, highlight and remove all red separator prescriptions during the day’s dispensing.

✗ Do not put labels or sticky notes on

prescriptions during the dispensingprocess. The residual glue canaffect the scanning process.

✗ Do not mark the prescribing area

of the prescription form with ticksor other marks during thedispensing/ checking process asthese could affect how theprescription is priced (see picture).

✗ Avoid putting any information

regarding quantities owing in theendorsement column as thesecould be interpreted as quantitydispensed. You could record owinginformation on your PMR system orattach a removable owings slipinstead.

✗ Do not make endorsements

(printed or handwritten) on anyother part of the prescription formother than the designated lefthand column only as there is achance that these may not be seenduring pricing. Also, ifendorsements encroach onto anitem on the prescription form, itcan affect pricing of that item.

Do NOT do this

DiSPeNSiNg aND SuPPlyCoNtraCt aND itFuNDiNg aND StatiStiCS

psnc.org.uk 13

PSNC’s work

Please note: prescription forms within each group should be sorted

into prescriber order. However, any prescribers with fewer than 20

forms can be placed into a ‘miscellaneous’ section at the end of

each group.

3. Completing your FP34c Submission Document:

4. Dispatching your prescription bundle:• Dispatch the bundle to your processing centre by a track and trace method no later than the

5th day of the month following that in which the supply was made.

• Send the prescription bundle in a secure package and in a manner that ensures prescriptions

don’t get mixed up in transit (see picture).

*PSNC recommends keeping a record of all expensive items

dispensed and submitted in the month as this will facilitate the

ability to perform reconciliation checks once you receive your

Schedule of Payment.

• Keep the following forms separate from main prescription

bundle but submit with your account:

• repeat authorising forms (RA forms)

• ETP tokens (note: these are not used for payment)

• FP57 forms (relating to refunds of prescription charges)

You may find this diagram useful to help you organise your

prescription bundle groups:

DO DO NOT

✓ Use the barcoded FP34c Submission Document for your pharmacy for that specific

dispensing month to declare the combined total of paper and electronic prescriptions(forms and items) being submitted to the Pricing Authority for reimbursement.

✓ Ensure accurate, complete and clearly written declarations are made in Sections 1 and 2

(check numbers of forms/items, staff hours, MURs, AURs and NMS declared).

✓ Declare the total number of staff hours spent in the dispensing process and not an average

as this can affect practice payment thresholds.

✓ For paper prescriptions, the figures should relate to the total number of forms and items

that are physically included in the prescription bundle (including returns). The number ofitems declared should be adjusted to take into consideration any additional fees due (e.g. ifan HRT product attracts 3 fees, it should be counted as 3 items).

✓ For electronic prescriptions, the figures should relate to the total number of electronic

forms and items that have been submitted to the Pricing Authority via an electronic claimmessage by midnight on the 5th of the following month but had been dispensed beforethe last day of the previous month.

✓ If you are submitting EPS Release 2 reimbursement claims, ensure that you tick the

relevant box and include the forms/items within the total numbers declared.

✓ When calculating the total forms/items to be submitted, double-check that your

cumulative item and form totals have been calculated correctly. It may help to calculate theforms/items ratio for each day.

✓ Carefully check the number of fees claimed on MDA instalment forms (see

psnc.org.uk/mda to find out more).

✓ PSNC also strongly recommends taking a photocopy of the completed FP34c form before

submission as a reference in the event of a suspected error.

✗ Do not borrow/ photocopy

anyone else’s as each barcodeis specific to one pharmacy forone month.

✗ Do not separate out EPS and

paper prescription figures, theseshould be totalled and includedin the total figures entry.

✗ Do not include the number of

ETP tokens or the number ofRA forms in your form/itemsdeclaration. These are not usedfor payment.

✗ Do not include items on re-

submitted forms which are notbeing queried. This is becausepayment will already have beenreceived for all other items onreturned copies ofprescriptions.

✗ Do not include electronic

prescriptions if the claimmessage was submitted aftermidnight on the 5th of thefollowing month.

A good example to follow


PSNC websiteFor up to date information and news on community pharmacy issues, visit the PSNC website at psnc.org.uk

PSNC Community Pharmacy News is published by:The Pharmaceutical Services Negotiating Committee, Times House, 5 Bravingtons Walk, London N1 9AWCommunity Pharmacy News is edited by:Mike King LLB BSc MRPharmS who can be contacted at the above address or by email at: [email protected] © PSNCPSNC Office: 0844 381 4180 or 0203 1220 810

Correct as of March 2014. See psnc.org.uk/cip for the most up-to-date information.

March 2014 CPN

Documents