Care Home Support Service

Support and advice on storage, supply and administration of drugs and appliances

Locally Enhanced Service

Contents

Section / Page Number
Executive Summary / 3
1. Introduction / 5
2. Service description / 5
3. Aims and intended objectives of the Pilot / 5
4. Overview of the scheme / 6
5. Scheme details / 6
6. Role of the pharmacist / 6
7. Record Keeping / 6
8. Service Funding Mechanism / 7
9. Training / 7
10. Evaluation / 7
11. Termination of Service / 7
Locally Enhanced Service Agreement / 8
Schedule - The services
  1. Purpose of the Agreement
  2. Duration of Agreement
  3. The Services
  4. Payment
  5. Termination of Agreement
  6. Health and Safety
  7. Training and Development
  8. Core Competencies
  9. Professional responsibility
  10. Clinical Governance implications
  11. Confidentiality
  12. Indemnity
  13. Complaints
  14. Incidents and Near Misses
  15. Quality Markers
  16. PCT responsibilities
/ 14
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15
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22
Scheme Authorisation Form / 23
Appendices
1- Flow chart / 24
2- Intention to offer Care Home Support / 25
3- Consent form / 26
4-Safe and secure handling of medicines assessment / 27
5- Summary report and claim form / 40
6- Letter to Care Home / 43

Executive Summary

The value of medication is the benefit it provides children and adults in improving the quality of their everyday lives. Appropriate medication, taken as intended, has the capacity of sustaining and maximising people’s independence and personal dignity. The management of medication in care homes and children’s homes is therefore one of the most important aspects of care for some of the most vulnerable people in this country[1].

Residents of care homes and children’s homes register with an NHS doctor to access medical care. They obtain their medicines from a community pharmacist or dispensing GP. The prescribed medicines are usually supplied at no cost to the patient or home because these residents qualify for free prescriptions.

Where adults and children need medicines, they differ in the degree to which they are able to manage the administration of medicines themselves. Some may be fully self-sufficient, while others may be wholly reliant on the support of care workers in the home. In many cases they may be vulnerable to the risk of mistakes being made1.

In March 2004, the National Care Standards Commission (NCSC), a predecessor organisation to the Committee of Social Care Inspection (CSCI), reported on homes’ performance on managing medication[2]. The report identified significant deficiencies in homes’ performance with key areas of poor performance identified;

  • wrong medication being given to residents;
  • poor recording of medicines received and administered;
  • medicines being inappropriately handled by unqualified staff;
  • medicines being stored inappropriately.

In February 2006, the CSCI Handled with Care? 1 study followed up the NCSC report. Evidence from this report is that homes are still not placing enough importance on this critical area of care.

NHS primary care organisations have a responsibility to support health care provision within private and voluntary care homes and children’s homes. The Handled with Care? report has outlined that Primary Care Trusts need to take more active steps to ensure that monitoring the prescribing of medicines in homes is given a higher priority and that support is given to homes in developing safe working practices.

Within the boundaries of Calderdale PCT there are currently 61 care homes serving 1529 patients. The Care Home Support Service would be on offer to all registered care homes in the Calderdale area.

Under the scheme, a pharmacist will provide advice and support to the residents and staff within the care home, over and above the Dispensing Essential service, to ensure the proper and effective ordering of drugs and appliances, their safe storage, supply and administration and proper record keeping. This will be done by auditing the home against set criteria, discussing and agreeing points for action with the home and following up that these actions have been met. The home will receive a visit every six months and the pharmacist will produce a report back to the PCT, which over time should show continued improvements in the standards. If continued improvements are not shown, or action points are not met the pharmacist will highlight this to the PCT scheme co-ordinator so that an appropriate course of action can be agreed. If the pharmacist identifies other issues that are outside this scheme, for example patients are identified who require a clinical medication review, they will be referred to the relevant health-care professional.

Scheme Summary

1.Introduction

It is proposed to offer support to all registered care homes in Calderdale to ensure that medicines ordering, supply, administration and storage systems are within current guidance and good practices. Using a framework of quality improvement the scheme aims reduce the risk of errors in the administration of medicines, reduce wastage of medicines, identify and remedy problems with the safe storage & handling of medicines. Additionally residents identified as part of the scheme who might benefit from input from another health-care professional or other issues highlighted that are outside the remit of this scheme will be appropriately referred.

The Pharmacies for this scheme have been selected on the basis of:

  • Willingness to provide the service; and
  • Pharmacy currently supplies a dispensing service to the care home (although NOT supplying a dispensing service to a care home does not exclude a pharmacy from providing this service to the home); and
  • The pharmacist has successfully completed the CPPE pack- Supporting Care Homes with Medicines Management: and
  • The pharmacy is in a position to provide all essential services to a satisfactory level, as identified by the PCT contract-monitoring visit.

2.Service description

The pharmacy will provide advice and support to the residents and staff within the care home, over and above the Dispensing Essential service, to ensure the proper and effective ordering of drugs and appliances, their safe storage, supply and administration and proper record keeping. This will be achieved through audit against specified criteria, advice and support and establishing agreed action points with the care home.

  1. Aims and intended service outcomes of the Scheme

To improve patient safety within the care home with a particular focus on the following areas: ordering, storage, administration and disposal of medicines and appliances and use of residents’ own medicines (prescribed and purchased).

To ensure the safe storage, supply and administration of medicines by:

Providing an assessment of the systems for the management of, storage, supply and administration of medicines within the care home and making appropriate recommendations to the care home;

Ensuring appropriate systems are in place for the ordering, storage, administration and disposal of medicines and appliances;

Ensuring that appropriate recording systems are in place and are used to monitor the ordering, storage, administration and disposal of medicines; and

Ensuring appropriate systems are in place to facilitate the sharing of information about the person’s medicines when they move from one care environment to another.

  1. Overview of the Scheme

A pharmacist will provide advice and support to the residents and staff within the care home, over and above the Dispensing Essential service, to ensure the proper and effective ordering of drugs and appliances, their safe storage, supply and administration and proper record keeping.

This will be done by auditing the home against set criteria, discussing and agreeing points for action with the home and following up that these actions have been met.

The home will receive a visit every six months and the pharmacist will produce a report back to the PCT, which over time should show continued improvements in the standards. If continued improvements are not shown, or action points are not met the pharmacist will highlight this to the PCT scheme co-ordinator so that an appropriate course of action can be agreed.

If the pharmacist identifies other issues that are outside this scheme, for example patients are identified who require a clinical medication review, they will be referred to the relevant health-care professional.

5. Scheme Details

Details of the scheme will be a circulated to all GP practices, community pharmacists and practice pharmacists.

6. Role of the Pharmacist

The pharmacist will carry out the service as defined in ‘The Services’ as summarised in overview of the scheme.

The Pharmacist will attend any induction, and any ongoing training provided by the PCT (annually). The pharmacist will complete the CPPE distance learning pack Supporting care homes with medicines management.

7. Record Keeping

The pharmacist will keep the records of the care home visits, including records of the agreed actions. A copy of the visit will be provided to the care home.

A summary report of the visit will be completed and sent to the scheme co-ordinator at the PCT.

8.Service Funding Mechanism

Funding will be provided by the PCT as outlined in the Locally Enhanced Service Agreement (LES).

Remuneration will be made to the pharmacy according to the size of the Home.

Up to 20 registered places£100 per six monthly visit

21+ beds£130 per six monthly visit

  1. Training

Induction and any on-going training will be provided by the PCT or an established national provider e.g. CPPE (if a suitable pack is available).

10.Evaluation

The scheme will be reviewed every 12 months. The annual report will include impact of the scheme including service outcomes, any recommendations for amendments to the scheme, to the Pharmacy Development Group, Management Executive Committee and any other stakeholder PCT groups (e.g. Medicines Management Committee) using the following criteria: -

  • Number of care homes supported
  • Number of residents in those care homes that have been supported
  • Number of criteria fully, partially or not met.
  • Number of action points agreed
  • Number of action points completed
  • If carried out, assessment of usefulness of the scheme from the care homes and GP practices
  1. Termination of Service

Either party may terminate the agreement by providing written notice of their intention to do so. A period of 28 days should be given as notice.


Locally Enhanced Service Agreement

Agreement for services

Care Home Support

BetweenCalderdale Primary Care Trust (we/us/our/the commissioner)

AndThe Community Pharmacy (you/your/the provider)

Services covered:Care Home Support

INTERPRETATION

In this NHS Locally Enhanced Service Agreementfor the provision of services from The Provider the following definitions apply:

  • Calderdale PCT means Calderdale Primary Care Trust, Dean Clough Mill, 4th Floor, F Mill, Calderdale HX3 5AX and is inclusive of its employees, partners and voluntary workers.
  • The Providermeans the community pharmacy as named on the Authorisation and is inclusive of its employees, sub-contractors, associates, secondees, partners and voluntary workers.
  • Calderdale PCT is the commissioner of services.
  • The Provideris the provider of services
  • LES means Locally Enhanced Service Agreement including all written specifications and appendices.
  • The services mean the services and goods that The Provider is required to supply, as stated in the service specification of the LES.
  • In addition to the specific terms and conditions set out below, this LES is governed by the general terms and conditions, quality specifications, arrangements for contract management and monitoring procedures for pricing payment, which has been established by the Department of Health.
  • The headings to the conditions in this LES shall not affect their interpretation.

DURATION OF AGREEMENT

This agreement shall commence on XXX and shall continue until 31st March 2007.

POINTS OF CONTACT

The following are nominated leads who will act as key managers and will be the initial point of contact on any aspect of this agreement:

For the commissioner
For queries on the content of this LES / Name: Julie Landale
Position: Head of Medicines Management
Address: Calderdale Primary Care Trust,
4th Floor, F Mill, Dean Clough
Tel: 01422 281300
For the commissioner
For general and operational queries regarding the scheme / Name: Ruth Buchan
Position: Community Pharmacy Facilitator
Address: Calderdale Primary Care Trust,
4th Floor, F Mill, Dean Clough
Direct line: 01422 281474
Email:
For the provider / As stated in the Authorisation

Commissioner: Calderdale Primary Care Trust

4th Floor, F Mill,

Dean Clough

POSTCODE

Tel: 01422 281300

It is agreed as follows

1. Pharmacy Services
1.1 You are engaged by us to provide services as described in the schedule hereto (the services see schedule 1 and associated appendices) and you agree to provide such services upon the terms and conditions set out below.
1.2 For the purposes of this agreement and in the provision of these servicesyou will be responsible to the Head of Medicines Management of Calderdale Primary Care Trust

1.3 We undertake to provide such training to staff provided by you to undertake this service, as we deem appropriate.

2. Duration

2.1 This agreement shall commence on [1.11.06] and shall continue except as provided for below

2.2The agreement is subject to review by the Head of Medicines Management

2.3The agreement will be re-authorised every financial year.

3. Pharmaceutical services

3.1 You are retained on a non-exclusive basis to provide the services as reasonably required by us

3.2 Throughout the termyou shall perform the services to the best of your knowledge power and ability and shall act in and use all reasonable endeavours to promote our interests and shall give us all information and assistance as we may reasonably require in connection with the provision of the services

3.3 No party shall assign transfer charge or deal in any other similar manner with this agreement or its rights or any part of them under this agreement, nor subcontract any or all of its obligations under this agreement without the prior written consent of the other party

3.4Nothing in this agreement shall be construed as or having effect as constituting the relationship of employer and employee between us and you or staff provided by you.

4. Fees and expenses
4.1We shall pay to you a fee per 6 monthly visit to a care home of £100 for Care Homes with up to 20 registered places and £130 per home with 21 or over registered places.
4.2We will make payment to you [retrospectively on receipt of a claim form to Calderdale PCT. Payment will normally be made, through WYCSA, within two weeks of receipt of the claim form]. Claims for payments MUST be received within 2 months of the care home visits. Forms received after this time period may not be paid.
4.3Any subsequent payments to employee pharmacists are a matter for agreement between the contractor and the employee
5Termination
5.1 Notwithstanding the provisions of clause 2 of this agreement, either party may terminate the agreement subject to providing one month’s notice in writing
5.2 Notwithstanding the provisions of clause 2 or sub clause 5.1 of this agreement, we shall be entitled (without prejudice to our rights and remedies for any breach of this agreement and without prejudice to any continuing obligations you have under this agreement) to terminate this agreement immediately if you seriously breach the terms of this agreement including by any act or omission which prejudicially affects or is likely so to affect our interests.
5.3 For the avoidance of doubt and without prejudice to any other reason for invoking sub clause 5.2 any breach of sub clause 6.1 would constitute a serious breach of the terms of this agreement and constitute grounds for immediate termination of the agreement.
5.4 Upon termination of this agreement for whatever reason you shall deliver to us all books documents papers memoranda notes records (including any contained in magnetic media or other forms of computer storage) and any other property and materials relating to our business which may be in your power or control. The ownership of all such property shall at all times be vested in us.
6Confidential information

6.1 You agree to treat as secret and confidential and not at any time for any reason disclose or permit to be disclosed to any person or otherwise make use of or permit to be made use of the following information gained as result of providing this service,

6.1.1 Any information relating to the health records of any client

6.1.2Any information relating to the prescribing practice habits or activities of any GP practice unless paragraph 7.4 applies

6.1.3Any information relating to the activities of the care home unless paragraph 7.4 applies

6.2This restriction shall continue to apply after the termination of this agreement without limit in time but will cease to apply to information which may come into the public domain otherwise than through unauthorised disclosure by you.

6.3 You shall not be prevented by clause 6 and its sub clauses from using any general knowledge experience or skill gained through the provision of these services.

6.4The restrictions of this agreement shall not apply to any disclosure or use authorised by us in writing or required by law or by this agreement.

7Restrictive covenants

7.1 You agree that throughout the term of this agreement services will only be provided by a registered pharmaceutical chemist, and following the Royal Pharmaceutical Society of Great Britain’s Code of Ethics and Professional Standards as published in the current edition of Medicines, Ethics & Practice or as amended provided such amendments have been published or notified in the Pharmaceutical Journal.

7.2 You agree to provide evidence to us that the services provided by you under this agreement are covered by adequate professional indemnity arrangements.

7.3 You agree that in providing the services you will operate to Standard Operating Procedures written by you that correspond the procedures authorised by us and not deviate from them and use only the documentation provided by us

7.4 You agree that in the event that through providing these services you become aware of any possible fraudulent activity, poor practice or professional misconduct on the part of an independent contractor their employees or agents or any employee of Calderdale Primary Care Trust you will communicate your concerns within one working day to the Head of Medicines Management or, as needs be, the Head of Clinical Governance and Clinical Risk.