Coventry Primary Care Trust
Christchurch House
Greyfriars Lane
Coventry
CV1 2GQ
Telephone: 024 7655 2225
Facsimile: 024 7622 6280
Community Pharmacy
eND Scheme
Electronic NOT DISPENSED
Service Level Agreement V3.0
November 2011
eND Scheme - Electronic NOT DISPENSED
1.Background
Coventry Teaching PCT developed and launched the original “Not Dispensed” scheme in December 2005 to help address the substantial problem of prescribing waste estimated to account for between £2-8 million in Coventry each year.
Despite a multidirectional PCT strategy to reduce waste, including a GP repeat prescribing incentive scheme, waste campaigns and a prescription intervention scheme there was evidence that a significant number of unwanted items were still being generated on prescription.
Coventry community pharmacies dispense approximately 5 million prescription items a year. If only 1% of these items are not required by the patient then this is a highly significant and unnecessary burden on the prescribing budget. Key to the success of eND is the fact that pharmacists are usually the last healthcare professional in the medicines supply chain. Thus they are well placed to intervene where such cost savings can be made.
As part of the programme of transferring the community pharmacy enhanced service portfolio from a paper driven model to a web based management system the embedded eND scheme transferred to an electronic service in February 2011.
- Purpose
The “Not Dispensed” scheme (ND scheme) allows the pharmacist to intervene and identify and thus prevent dispensing of those items included on repeat prescriptions which the patient does not actually require at that time.
- Time Period
This Service Level Agreement (SLA) will support a web based service via PharmPerformfrom November 2011. It will be reviewed on a regular basis.
- Pharmacy Recruitment and Access
All community pharmacy contractors in Coventry are invited to provide this service. Thus the scheme can support all GP practices in the PCT.
Claims can only be made for items that are not dispensed on NHS prescriptions generated by prescribers within NHS Coventry. Prescription items prescribed by prescribers outside of NHS Coventry CANNOT be claimed as part of the eND scheme.
- Eligibility Criteria
The scheme focuses on repeat items and applies to all items not dispensedexcept:
- Repeat dispensing items (pharmacists receive a payment under their contract which requires the pharmacist to check that all items are needed at each dispensing).
- Acute, one-off, prescriptions (i.e. not repeat items).
- The scheme also does not apply to prescriptions where the pharmacy orders prescriptions on behalf of the patient.
N.B. Where pharmacists keep repeat lists and re-order medicines on behalf of patients, they must ensure that they confirm with the patient (or their representative) the exact items that are required before the next prescription is ordered; this is a professional duty expected of a pharmacist and does not form part of the eND scheme. Pharmacists must not automatically re-order all the items and then mark unwanted ND on the prescription and claim the Not Dispensed fee.
By data inputting the ND item onto the PharmPerform website you are declaring that the item was not dispensed after consultation with the patient or carer and that it would not be included in the exceptions above.
- Service Outline
The pharmacist or an appropriately trained member of staff will engage with a patient presenting a prescription to determine whether they require all of the items on the prescription at that particular time.
Pharmacy staff will be aware that a degree of sensitivity is required when appearing to question what has been prescribed for a patient or requested for repeat by a patient and should have regard to this when discussing with patients whether all items prescribed are actually required.
Where such discussions highlight that a patient has excess stocks of medicines at home, the pharmacy should consider offering the patient an MUR.
If the patient has enough of a particular item, it is Not Dispensed.
To qualify for an eND claim the following stages must be completed by the pharmacist:
- The prescription item must be endorsed “ND” to advise the Prescription Pricing Division so that the pharmacist should not be reimbursed for the cost of supplying the item.
- The pharmacist must also draw a line in ink through the item to clearly identify that it has not been dispensed*. Audit mechanisms are in place to randomly verify this.
*The Alphabetical Guide to Prescription Endorsement prepared by PSNC & NHS Business services Authority advises the following: where an item has not been dispensed the prescribed product should be scored out and an ND endorsement made immediately adjacent to the prescribed product. This is now standard guidance for recording an ND endorsement.
7. Service Management
7.1Web Based Service Model
7.1.1Online filing is accessed via the PharmPerform portal at
7.1.2All Coventry online services are accessed via the same portal and via a single login / password.
7.1.3Login / passwords can be obtained by completing a faxback approval form from – logins will be provided within 24 hours of a request being received.
Please make a note of your pharmacy login (e.g. Cov086)
Please make a note of your pharmacy password (e.g. FP786CV2817)
7.1.4PharmPerform will upload all eND claims at the end of each calendar month and submit to the PCT for payment.
7.1.5Paperwork no longer needs to be submitted separately to the PCT. All scripts not dispensed should be stored safely in-pharmacy. Over time sample audits will be conducted by PCT staff that will validate samples of electronically filed service records.
7.2eND item entry
7.2.1Some explanatory notes, for first time users, are on the entry page via the “eND”. Screen shot instructions are also available.
7.2.2Data entry is possible at any time over the 24 hour period.
7.2.3Please review cost input data and ensure that all missing prices i.e. those not in the Drug Tariff, are entered manually before the end of each calendar month. Once uploaded incomplete data will incur payment delays.
7.2.4Please ensure that quantities are entered correctly e.g. in multiples of stated quantity unit. This may mean that some quantities are part units.
For example:
28 Tamoxifen 10mg tablets would be 0.93 of Tamoxifen 10mg tablets pk 30
100 Prednisolone ec 5mg tablets would be 3.33 of Prednisolone ec 5mg pk 30
7.2.5Please ensure that all quantities claimed are in line with the quantity ordered on the prescription. All claims should be based on the most appropriate larger pack size and not multiples of the smallestpacksize.
For example:
1 x 500g Aqueous cream should be costed as such and not as 5 x 100g.
Or
100 Paracetamol 500mg tablets should be 1 x 100 and not 3.13 x 32
Any claims not complying with this will be removed from the final payment.
8. Feedback to Prescriber
8.1Contractors are required to feedback details of eND interventions to the relevant prescribers. The form GP Feedback PDF form available on the PharmPerform website should be used.
8.2Pharmacists can play a valuable role in promoting the eND scheme and are encouraged to communicate with local GPs to make them aware of the eND scheme and how it might benefit the practice.
For example:
- Highlight some ND-examples to the local practice to get a feel for the sort of ND-intervention that they wish to be informed about.
- Prepare a running total of savings that have been achieved for each practice as a result of pharmacy eND interventions and highlight this with the practice.
8.3Pharmacies will need to post photocopies of ND-scripts or GPFeedback forms to Practices NOT receiving a Collection & Delivery service from the pharmacy.
8.4Pharmacies should ensure that any relevant service promotional material e.g. posters and leaflets are displayed appropriately in the pharmacy.
9.Training
An operational briefinghas been provided by the PCT to train staff and ensure they are familiar with the electronic service support processes. Providing a member of the pharmacy staff has attended this original training they will be authorised to cascade the training to other staff working in their pharmacy provided this is documented on the appropriate form.
Providers of the service will need to ensure that:
- Staff delivering the service are competent to do so
- The service is delivered strictly according to the SLA
- The pharmacy meets all Essential Service criteria.
If training is required please contact the PCT who will provide this.
10.Clinical Governance
There are no clinical risks associated with this scheme. In practice the interventions may help to improve patient understanding of compliance with medication, thus reducing risk. If a patient is suggesting that an item should be “not dispensed” where the pharmacist in his professional opinion believes that this is not in the patients best interests they should counsel the patient in the normal way and if necessary feedback to the GP.
11.Monitoring and Audit
Random checks will be carried out on pharmacy returns via the PPD to ensure that items have not been dispensed. In cases where there is evidence of suspected fraud, each case, without exception, will be referred to NHS Counterfraud Services.
The NOT DISPENSED scheme applies to all items not dispensed except:
- Repeat dispensing items (pharmacists receive a payment under their contract which requires the pharmacist to check that all items are needed at each dispensing).
- Acute, one-off, prescriptions.
- The scheme also does not apply to prescriptions where the patient has given permission for that pharmacy to order on their behalf.
N.B. Where pharmacists keep repeat lists and re-order medicines on behalf of patients, they must ensure that they confirm with the patient (or their representative) the exact items that are required before the next prescription is ordered; this is normal ethical practice and does not form part of the Not Dispensed scheme. Pharmacists must not automatically re-order all the items and then mark unwanted ND on the prescription and claim the Not Dispensed fee.
12.Patient Complaints and Significant Events
- The pharmacy must record any significant events or patient complaints according to the NHS requirements. Any event relating to this service must be reported to the PCT lead.
13.Confidentiality and Record Keeping
- Individual patient data and information must remain confidential to the pharmacy, patient and patient’s GP (following informed signed consent).
- All patient data submitted to the PCT from pharmacies must be anonymised
- Patient records stored in the pharmacy must at all times remain secure
14.Volume of Activity
There is no limit on the volume of activity that a contractor can submit as part of the scheme.
15.Payment Details
Payments to pharmacy contractors (providers) for services are dependent on the provider delivering services according to this SLA, and utilising specified software.
Contractors must also submit a signed SLA before payment is authorised.
Payments will be received by contractors on a monthly basis (a month following the month of submission) detailed on the FP34 form as local payment 2.
16.Remuneration
Remuneration Arrangement1. / An initial flat rate of £3.00 per unit of service (item intervention) will be paid to cover data input and processing.
2. / A further 10% of the savings for each item will also be paid to the contractor.
3. / Payments will be received monthly by contractors as Local Payment 2 on FP34.
17.Termination of Service Level Agreement
Two months notice by either party in writing is required to terminate the SLA.
Where it has been demonstrated that either party is in breach of this specification, the agreement can be terminated immediately.
Where it is demonstrated that the provider is in breach of the specification, the commissioner has the right to suspend or terminate the agreement until such time the breach has been rectified.
18.Variation
The PCT reserves the right to alter the SLA should new developments become apparent. The pharmacy will be given one month’s notice of any contract variation.
eND – electronic Not Dispensed Scheme
Authorisation to the Agreement
I/we agree to the terms outlined in this specification.
Name of Pharmacy: …………………………………………………………..
Address of Pharmacy: ………………………………………………………………………
Prise no. : ………………………..
Telephone no.: …………………………………
Email address: ……………………………………………………
Signed on behalf of the Pharmacy Contractor
Signature ………………………………………………
Print Name ……………………………………………..
Position ………………………………………… Date ………………………………
Signed on behalf of NHS Coventry
Signature ………………………………………………
Print Name ……………………………………………
Position …...…………………………………… Date ………………………………
eND – electronic Not Dispensed Scheme
Name of pharmacy:
Name of contractor:
I have read and understood the contents of the appropriate ServiceLevel Agreement and agree to provide the service as described.
I attended the PCT service briefing session on …………………………………………..
and enclose*/ have already enclosed*a copy of the certificate for verification purposes.
Signed Dated
I did not attend the session but the followingmember of staff attended on my behalf
……………………………………. and a copy of the relevant attendance certificate is enclosed* / has already been enclosed*forverification purposes
* Please delete as appropriate
Signed
Following attendance at this briefing meeting the pharmacisthas cascaded the briefing to the following members of staff who have signed to say that they have received the cascaded information, read the SLA and understand how the service should operate.
Signature of trainer Name of recipient Signature of recipient
Please return completed form to:
Lisa Scullion
Senior Pharmacy Technician
Medicines Management
Coventry PCT
Christchurch House
Greyfriars lane
Coventry
CV1 2GQ