East Sussex LocalPharmaceutical Committee

Healthy Living Pharmacy: Quality Criteria

Introduction

This application form is designed to help you and the accrediting body understand whether you have met the Healthy Living Pharmacy (HLP) quality criteriafor the environment you have created. This, together with other service specific criteria will help commissioners decide whether your pharmacy can work towards/be accredited as a Healthy Living Pharmacy. The evidence you put together will help towards you receiving your Healthy Living Pharmacy ‘kite mark’.

These quality criteria cover the environment, staff attitudes and training, information provision and engagement with others through joined up working.

These are not listed in any priority order; all are equally important.

The General Pharmaceutical Council sets standards for the safe and effective practice of pharmacy from pharmacy premises. These are the core standardsthat all retail pharmacies must meet. These quality criteria support a pharmacy in meeting their professional requirements when delivering healthy livingservices.

The HLP quality criteria will, in time, incorporate additional criteria where it is relevant for HLP levels 2 and 3.

Application Form for Healthy Living Pharmacy

Please ensure that the application is fully completed before posting as failure to do so may result in your application being rejected. All applications will be reviewed on 14th November 2012 and decisions made by 16th November 2012.

1. Name and address of Pharmacy including post code
Name of Pharmacist / Manager
Telephone Number
E mail address of
Pharmacist/ Manager
2. Statement by the pharmacist indicating why the pharmacy (named above) should be included in the Healthy Living Pharmacy scheme.
This statement should be written by the pharmacist and should NOT be influenced by any external / head office personnel.

3. Essential Services

Do you have a copy of the PSNC workbook, if so please indicate the date of issue? Please note that new guidance was issued November 2011.
Please give brief details or evidence to demonstrate that the pharmacy is compliant with all aspects of the workbook / Please respond below for each service
Essential Service 1 Dispensing
Essential service 2 Repeat Dispensing
Essential Service 3 Patient returned waste
Essential Service 4 Health advice
Essential Service 5 Signposting
Essential Service 6 Self Care
Essential Service 8 Clinical Governance

4. Advanced Services

Does the pharmacy provide the MUR service? / Yes / No
If Yes how many MURs have been done in the last 12 months? / Number
How many of these MUR were targeted? / Number
Asthma plus
Dermatology
Anti cholinergic meds
Does the pharmacy provide the AUR service? / Yes / No
Does the pharmacy provide the NMS, if so how many cycles in the last quarter reported to the PCT / Number

5. Enhanced Services

Please indicate in the table below which services are provided in the pharmacy.

Service / Provided Y / N / Number of clients in the last 12 months
Emergency Hormonal Contraception
Stop Smoking
(indicate the number of 4 week quits)
C Card
Chlamydia Screening
Supervised Consumption of prescribed medicines level 1
Supervised Consumption of prescribed medicines level 2 (NHS East Sussex only)
Needle and Syringe exchange
Palliative Care Level 1
Palliative Care Level 2
Advice to Care Homes B&H
Asthma MUR + (B&H)
Anti Coagulation service
Please list any Non NHS enhanced services that the pharmacy provides
Does the pharmacy provide any NHS service via another service provider if so please list here?

Data collection

Is the pharmacy willing to report all service activity via a web based reporting system as required?
This will be a key requirement for evaluation purposes / Yes / No
Does the pharmacy submit local enhanced service activity electronically as specified by the PCT? / Yes / No

6. Staff – Training information for all staff employed at the pharmacy.

Please tick as applicable

Full Name / Full time or Part time (indicate hours if p/t) / Please only show fully completed and certificated individuals / Registered Pharm Tech / ACT / Other
Please state / Pharmacist
SOM / NVQ 2 / NVQ 3

SOM = sales of medicines trained or equivalent

ACT = accredited checking technician

NVQ 2 = dispensing assistant

NVQ 3 = dispenser

If there is insufficient spaces for your response for question 6 please use an additional sheet.

7. Leadership

Please identify who is the pharmacist or registered technician who will receive leadership skills training via CPPE
Please indicate why this person has been selected.
Can the person named above attend a full day CPPE training session on the 3rdFebruary 2013)? Y / N
Please list any previous leadership training undertaken.

8. Healthy Living Champion

Please identify a member of the team willing to become / be trained as Healthy Living Champion (HT level 1). The healthy living champion will coordinate health promotion campaigns (6 per year), will be aware of the health needs of the community and thus promote appropriate services and the benefits of the healthy living pharmacy concept. This will require two and a half days off site traininginitially and followed up with regular training courses provided by health improvement teams. The dates for the training are as follows:
Brighton Pharmacies 15th, 18th and 19th March 2013
East Sussex Pharmacies 4th, 11th and 12th March 2013

9. Health Advice Training

Please confirm that all staff are willing and able to complete an online Health Advice Training program and to commit to a maximum of one day per year for update training. / Yes / No
Please list the names of all staff who would be interested to undergo training to become a healthy living champion in the future

10. Privacy

How will you ensure that all staff will be sensitive to the needs of the public regarding privacy whilst providing health and wellbeing services?

11. Premises

Yes / No
Has the pharmacy a fit for purpose consulting room?
Does the consulting room have a computer?
Is the computer connected to the internet?
Is the computer connected / networked to the dispensary PMR system?
Does the consulting room have hand washing facilities?
Does the consulting room have near patient testing facilities?
Does the consulting room have a range / supply of health advice leaflets?
Is the consulting room clearly signposted to the general public?
Does the consulting room provide an adequate level of privacy, both visual and audible?
Is the consulting room appropriately stocked with consumables for the services provided at all times?
Is the consulting room clean and free from clutter?
Does the pharmacy have toilet facilities available for public use?
Does the pharmacy have an area which can be clearly identified by the general public as an area to obtain health advice?
Does the pharmacy appear clean and inviting?

12. Engagement

Can the pharmacy demonstrate primary care engagementwith at least one or more GP practice? / Yes / No / If Yes please indicate the practice below and key contact person.
Please indicate the nature and frequency of engagement (give 3 examples) / 1.
2.
3.
What other service providers does the pharmacy engage with either on an ad hoc or regular basis?
What do your staff understand by the term
“Healthy Living Pharmacy”
Does the pharmacy team fully co-operate when the PCT requests information to inform decision making?
Please give 3 examples / 1.
2.
3.
Please write any other information to support your application in the box below.

Please return the completed application form to:

Jan Thompson, Broadmark Way, Rustington, West Sussex BN16 2EY

or email to

Please return completed application forms as follows:

Attendance at the Lewes Celebration Event at PCT Office, Lewes on

26th September 2012 must be returned by 1st November 2012.

Signature of authorised person for the community pharmacy
Printed Name
(please ensure this is clear)
Signature of area manager to confirm full support and time commitment for the project
Multiples only need to complete this section
Printed Name
(please ensure this is clear)

If you have any enquiries please contact:

Amanda Marshall

Vanessa Taylor

Mike Hedley

Jan Thompson

To avoid your application being rejected please ensure that your writing is clear and legible

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