Effective Intervention Scheme
Locally Enhanced Service
Contents
Executive Summary / 3
1. Introduction / 4
2. Service description / 4
3. Aims and intended objectives of the Pilot / 4
4. Overview of the scheme / 4
5. Scheme details / 5
6. Role of the pharmacist / 5
7. Delivery / 6
8. Record Keeping / 6
9. Service Funding Mechanism / 6
10. Training / 7
11. Evaluation / 7
12. Termination of Service / 7
Locally Enhanced Service Agreement / 8
Schedule - The services1. 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. Clinical Governance implications
10. Confidentiality
11. Indemnity
12. Complaints
13. Incidents and Near Misses
14. Quality Markers
15. PCT responsibilities / 13
14
14
14
16
16
16
17
17
18
18
18
19
19
19
19
Scheme Authorisation Form / 21
Appendices
1- Scheme details / 22
2- EIS form / 25
3- Monthly Claim Form / 26
4- Community Pharmacy details4- GP practice details
4- Practice Pharmacist details / 28
29
30
5- Monthly record sheet / 31
6- Key to intervention types / 32
7- Examples of Interventions / 38
With thanks to West Cumbria PCT for sharing their work and experience.
Executive Summary
Community pharmacists can play a greater role in medicine management through a Pharmacy Intervention Scheme. The scheme allows community pharmacists to assess and review prescribed medication, at the point of dispensing, and identify locally agreed interventions that will result in a financial and /or clinical benefit and to facilitate the implementation of any proposed change.
Additionally, an intervention scheme increases the use of the skills and expertise of pharmacists as indicated in Pharmacy in the Future- Implementing the NHS plan.
Pharmacy Intervention Schemes have been successful in PCTs all over the country in making substantial savings in the prescribing budget. Cost savings have been shown even from the early stages (around £2000 per practice per year[1],[2]). Feedback from GPs has been positive with over 80% of pharmacists’ recommendations accepted[3].
Scheme Summary
1. Introduction
The Effective Intervention Scheme (EIS) is an initiative developed following a scoping document put forward to the Directors by the Head of Medicines Management.
The scheme will commence in November 2006. By regularly updating the interventions that can occur the scheme can be adapted and continue to be effective into the future.
The Pharmacies for this scheme have been selected on the basis of:
· Willingness to provide the service; 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 Effective Intervention Scheme (EIS) is based on the opportunity to reduce unnecessary costs associated with the supply of medicines in the community, with the potential to support the recommendations made to practices by the Medicines Management Team.
Those pharmacists participating in the scheme will assess and review prescribed medication, at the point of dispensing, to identify locally agreed interventions and to facilitate the implementation of any proposed intervention.
3. Aims and intended service outcomes of the Scheme
By assisting GPs to rationalise patients’ medication community pharmacists will assist in meeting the objectives below
· Reduction medicines waste
· Increase cost-effective prescribing
· Financial savings for the PCT/GP practices
· Improve patient satisfaction with the medicines management services
· Increase use of the skills and expertise of community pharmacists as indicated in Pharmacy in the Future- Implementing the NHS plan
· Multidisciplinary working
4. Overview of the Scheme
- Community pharmacists will identify suitable interventions (from a list of PCT agreed interventions). These interventions will include current cost savings and the current work of the medicines management team.
Interventions can include:
· Dose optimisation e.g. Ramipril 2.5mg 2od switched to ramipril 5mg 1od
· Generic/ Brand substitution e.g. Losec switched to Omeprazole
· Synchronisation of medication quantities
· Patient safety issues e.g. where the prescriber has not given the patient adequate or clear directions
· Medicines management switches e.g. atorvastatin 10mg switched to simvastatin 40mg
· Identifying items that are not needed or are no longer required by the patient and non-dispensing the item.
The types of intervention may be tailored to the needs of the GP practice.
Interventions occur on repeat items only- i.e. non-acute items.
This scheme does not apply to repeatable scripts (i.e. a repeat dispensing script) as not dispensing the item is part of the service specification and changes to a prescription cannot easily be made.
- The community pharmacist will explain the proposed change to the patient, addressing any patient concerns. When the script can be immediately amended (for not dispensed, duplicated, inappropriate repeat items and computer inaccuracies) the pharmacist will explain the change to the patient and attach a copy of the endorsed script to the claim form. For changes that need amendment by the GP practice, the pharmacist will explain to the patient that any alteration will appear on the patients next prescription. The PCT will consider providing leaflets to support the verbal information given by pharmacists.
- The community pharmacist will notify the GP practice of the proposed intervention by sending the practice an EIS form.
- Community Pharmacists are paid for each intervention. To ensure full participation in the scheme a payment for the intervention will be made regardless of whether the intervention leads to a change or not. Payments will vary dependent on the potential cost savings of the intervention.
- The GP needs to assess and, if appropriate, authorise the proposed change. If the intervention is agreed, the GP clinical system will be altered. Practice pharmacists will work to the Standard Operating Procedure, agreed and signed by the GP, for any alterations made. The GP practice sends a copy of the intervention outcome to the community pharmacy. Practice pharmacists could be used to facilitate the implementation and recording of interventions.
- The PCT will pay the community pharmacists for the interventions and audit the scheme.
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 the induction, any ongoing training provided by the PCT (annually).
7. Record Keeping
The pharmacist will keep the records of the interventions, including records of the GP practice feedback.
Additionally the pharmacist will send details of the interventions to the PCT.
9. Service Funding Mechanism
Funding will be provided by the PCT as outlined in the Locally Enhanced Service Agreement (LES).
Pharmacists will be paid a fee of £2 per intervention for interventions saving less than £20 per year, and £5 per intervention for those that save more than £20 per year.
10. 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).
11. Evaluation
The scheme will be reviewed every 3 months. Feedback will be given with 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: -
§ Financial savings
§ Proportion of interventions that are not implemented
§ Use of the scheme by community pharmacists
Annually a full report of the scheme will be produced for the Pharmacy Development Group, MEG and if required any other stakeholder group (e.g. PEC).
12. 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
Effective Intervention Scheme
Between Calderdale Primary Care Trust (we/us/our/the commissioner)
And The Community Pharmacy (you/your/the provider)
Services covered: Effective Intervention Scheme
INTERPRETATION
In this NHS Locally Enhanced Service Agreement for 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 Provider means 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.
o The Provider is 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 1st November 2006 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 commissionerFor 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 services you 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
2.2 The agreement is subject to review by the Head of Medicines Management
2.3 The 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 term you 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
3.4 Nothing 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
4.1 We shall pay to you a fee of £2 per intervention for interventions that save less than £20 per year, and £5 per intervention that save more than £20 per year.
4.2 We will make payment to you [retrospectively on a monthly basis 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 intervention. Forms received after this time period may not be paid.
4.3 Any subsequent payments to employee pharmacists are a matter for agreement between the contractor and the employee.
5 Termination
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.
6 Confidential 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
6.1.2 Any information relating to the prescribing practice habits or activities of any GP practice unless paragraph 7.4 applies