To:Heads of Public Health Commissioning

Screening and Immunisation Leads

Heads of Primary Care Commissioning

Pharmacy Contracts Managers

NHS England Internal Communication FAQs

Updated 19 Aug 2015

Changes to the Community Pharmacy Contractual Framework for 2015/16

GENERAL

  1. What do the changes to the community pharmacy contractual framework mean forflu?

NHS England and the Pharmaceutical Services Negotiating Committee (PSNC) have agreed a number of changes to the Community Pharmacy Contractual Framework (CPCF) for 2015/16 to include a national flu vaccination advanced service offered to all eligible adult patients (aged 18 and over at the time of vaccination) as defined in the annual flu letter.

2Why are we doing this?

  • To increase the uptake of flu vaccine by giving more opportunities for eligible patients to access flu vaccinations and making it more convenient.
  • To build on community pharmacy flu services that we already commission, providing a national framework that will enable us to reduce variation across England,improve quality and offer the population consistent levels of cover
  • To play a part in our NHS England strategy of reducing the burden on general practice, in this case by commissioning the service from a wider range of healthcare professionals
  1. Why has it taken so long to announce the advanced service?

The negotiations for the flu advanced scheme were part of the national pharmacy contract negotiations which have only recently concluded.

  1. Have GPC been consulted and what are they advising their members

Yes GPC were advised of this contract in advance of the public announcement. As this is a nationally commissioned service they have no influence over whether the scheme goes ahead or not.

  1. We’ve had the pharmacy flu announcement, what next?

The conclusion of the contract negotiations and confirmation that the national flu vaccination advanced service has been agreed means we can begin implementation. The service will not replace current general practice provision of the flu programme but is intended to complement it. At a national level, we will be developing a PGD, a single specification and confirming the payment and data sharing arrangements.

Locally Public Health and Primary Care Commissioning teams will need to work together to develop implementation plans for the area. This will need to include understanding current service provision from pharmacies, considering how the scheme will be implemented in the area, what steps will need to be taken to do this and associated risk mitigation. Clear timed actions for implementation with confirmation of lead individuals for implementation will be important as the programme will need to move at speed to have greatest impact this winter for patients.

A webinar was heldfor public health and primary care commissioners to come together to work through the implications and requirements for implementation. [Presentation circulated].

  1. How do we integrate the delivery of the national flu vaccination advance service into the national flu programme?

Public Health and Primary Care commissioners will need to work together to ensure the service delivery is aligned and integrated. This will be particularly important in the management and handling of the data flows from Pharmacy to General Practice, ensuring that all data is accurately recorded and uptake rates are maintained and improved on. Moving forward we need to ensure that any communications that are sent out to GPs about the flu programme are also received by community pharmacies.

  1. Is the new service being evaluated?

We are looking at ways in which the service could be evaluated andthis is under discussion. Once we are clear about what the method of data collection will be we will be able to make a decision on what level of evaluation can be conducted.

  1. How will patients know which pharmacists are offering a flu vaccination service?

The service is integrated into the Winter Campaign. It will be down to individual pharmacies to ensure that they let their patients know that they are taking part.

  1. Any feel as to what the uptake from pharmacies will be?

Not at the moment but one of the requirements will be that the pharmacies have a consultation room and in the order of 7% of pharmacies don’t currently have that facility.

  1. Have the risks being added to the NHS England national risk register? Do we need to add to regional risk registers?

The national PH risk register is under regular review by the central support team and any risks relating to this programme will also be discussed at Public Health Oversight Group (PHOG) 23 September 2015. Local teams should continue to record and escalate risks in accordance with agreed governance processes, which should include this programme if the programme is determined to be of sufficient risk locally.

CONTRACTS

  1. What are the implications for local pharmacy schemes/ contracts?

There are already a number of local pharmacy schemes in place as ‘enhanced services’ and the national advanced service framework will provide consistency across England by having a single approach. We anticipate that – in most cases – the new national advanced service will replace local ‘enhanced’ service arrangements. If local schemes do not confer any advantage over and above the national scheme they should be decommissioned.

The exception to this will be where the local ‘enhanced’ service offer goes beyond the provisions in the annual flu letter (for example a local service may offer vaccination of healthcare workers). Those additional elements should continue to be commissioned as an enhanced service. Together we will need to consider the elements of such local schemes and how we might most effectively move to the new scheme.

  1. Our local service was scheduled to begin in September. The delay will create concerns now as local schemes have been retracted. Will the national team deal with these issues?

The national team will help wherever we can and where it is appropriate for us to do so.

  1. Where can I get the service specification for the advance service?

The service specification will be available as soon as it has been fully agreed with PSNC. NHS England is also working to ensure that all the documentation (PGD, Service Specification and Declaration of Competency) are in alignment before any one document is published. The service specification in particular is being aligned with the PGD (see later FAQ on PGD) and NHS England won’t have a copy of the PGD until late August.

The specification has been based on a number of existing local specifications, and is subject to ongoing negotiations. Details of where to access the service spec will be made available as soon asit is ready for release.

  1. How will this affect GP QOF payments?

This scheme will enhance the GPs ability to attain QOF payments as patients vaccinated by community pharmacists will count towards their targets.

  1. Are GPs still expected to call and recall all adultseligible for flu?

Yes, the national flu programme remains in place, with all associated requirements for call & recall.

  1. How will pharmacists check whether a patient is in an at risk group eligible on the NHS?

Community pharmacies already have an existing clinical relationship with their patients. As a consequence there are likely to be many ways that a pharmacist will know if a patient is eligible for flu vaccination. The obvious ones being that the pharmacy will know what long term medications the patient takes and therefore the condition for which they are being treated. NHS England has also recently announced that community pharmacy access to the Summary Care Record will be rolled out to the whole of the community pharmacy estate in England (planned for 2016/17), providing a further mechanism to establish whether a particular patient is in an at-risk group.

  1. How will the administration of payment be handled?

The Business Services Authority (BSA) will manage the process of payments to pharmacies as they do for other services that community pharmacy provides.

  1. Who will manage "sign up" local teams or nationally?

This will be captured nationally and information cascaded to local teams on a monthly basis (in line with existing data reports that the BSA produce in relation to community pharmacy). Specifically, Pharmacists will also need to declare, through the BSA portal, that their premises meet the requirements set out in the service specification and that each pharmacist that provides services under this specification are competent to do so (this is being assessed by a declaration of competence which will be hosted on the Centre for Pharmacy Postgraduate Education [CPPE] website).

DATA

  1. How much information will pharmacies need to provide in order to be paid?

A specific form is being developed by the Business Services Authority

  1. Will BSA be able to provide a breakdown of activity by geographical area?

Yes. This will be added to existing reports on a monthly basis by geographical area and individual pharmacy.

  1. Can local teams continue with existing data sharing solutions between pharmacy and GP practice?

Yes where local offices already have solutions in place with commercial providers, they can continue with these plans to support communication of vaccinations administered under the terms of the advanced service. This may be in addition to arrangements they have made with these providers to support commissioning of Local Enhanced Services such as those for ‘flu vaccinations for groups not covered by the advanced service or for other vaccination such as pneumococcal vaccine.

  1. Can any patient access this service anywhere e.g. how would a patient in London have their records updated in Cornwall?

The pharmacist will need to inform the patient’s GP irrespective of whether they are vaccinated in an area outside of where the GP practices and/or the patient lives.

PGD

  1. Can pharmacists use a local PGD where this has been developed and authorised?

No. Pharmacies delivering the national service must use the national PGD that we will supply when it is ready.

  1. Do we know what date the PGD will be available?

August 2015.

funding

  1. How will the advanced service be funded?

The advanced service is funded as part of the Public Health Section 7a Agreementand should be covered by existing public health allocations. Further guidance will be made available about how costs are to be recorded in the financial ledgers.

  1. I was told by the LMC that there is no personal administration fee

GPs do get paid a personal administration fee when administering the flu vaccination. There is no provision in the Drug Tariff for community pharmacies to be paid a personal administration fee and so the £1.50 paid to pharmacies enables NHS England to make a payment akin to a personal administration fee.

  1. Funding - what about paying for the vaccine costs - where will this land? In many areas this has been recharged to CCGs who have the budget following the 2013 reorganisation.

Guidance was sent out in 2014 asking for all costs relating to adult flu, including vaccine costs, to be charged to NHS England public health budgets. We know that in some cases this did not happen and some costs are being borne by CCGs. Where this is the case vaccines prescribed by GPs are charged to CCGs and these costs are not being charged to NHS England. Under the pharmacy contract, vaccine costs will be charged directly to NHS England. This means that some local teams may need to agree to charge the pharmacy vaccine costs onto CCGs or agree an allocation transfer to avoid a cost pressure. An allocation transfer would be the preferred approach.

  1. What about the risk of double-charging? If pharmacists inform GP of vaccination given and GPs upload this information, unless GPs note that the vaccine was given by somebody else, is there a risk that NHS England will pay twice for the same vaccination?

Pharmacies will inform a patients practice when they have been vaccinated, using the relevant READ/SnoMed codes, and the GP will update their records to reflect the vaccination has been provided.

VACCINE

  1. Will this affect the GP stocks of vaccines and how will this be paid for?

GPs ordered their vaccines in February. Those pharmacies who expected to be recommissioned this year will have done the same. Inability to access vaccines by those pharmacies who have not delivered a flu service before will be a factor which contributes towards their ability to do so this year.

  1. Practices are concerned about having vaccine left over because of increased activity in pharmacies. They only have limited sale or return agreements

This will be monitored.

  1. Will we have to report on pharmacy flu activity as part of the annual assurance process for the national flu programme?

Yes, a question is being included. The Flu assurance report request will be sent week beginning 16 August with responses due 31 August 2015.

  1. How will this affect PPV and shingles vaccine that are given alongside flu?

We know that in some instances GPs give PPV and shingles vaccines alongside the flu. As part of implementation plans, we will need to put processes in place to ensure Pharmacists remind patients about the need to have their PPV and shingles vaccine with the GP if they are eligible, when they present at the pharmacy for the flu vaccine. We will also look at the impact of this programme on shingles, PPV and pertussis uptake rates as part of the evaluation of the programme. Evidence to date shows that the uptake of flu is better than that of PPV and shingles.

  1. Will pharmacies call and recall patients in the future?

No, this is not part of the service requirement for pharmacies as they do not hold the registered list of patients which highlights eligibility to receive the vaccination It was suggested on the call that pharmacies know patients with LTCs because of prescriptions and that EPS2 could be used to call and recall but this functionality does not currently exist.

TRAINING

  1. Will they be required to do the 2 day training that we expect everyone else to do, plus an annual 1 day update?

Yes

  1. Are the pharmacists expected to be trained according to the existing standards for other immunisers

Yes Pharmacists will work to a PHE PGD which will include everything that other healthcare professionals providing flu vaccinations have to demonstrate they can do. The service will also be underpinned by a Declaration of Competency. A false declaration would be a Fitness to Practise issue.

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