Pharmacist not-dispensed, dose rationalisation anddischarge support scheme

  1. Parties to the Agreement

This agreement is between: «Pharmacy_Name» «Address_1» «Address_2» «Address_3» «Postcode» (“The Pharmacy”) and Newcastle Primary Care Trust (“The Trust”).

  1. Agreement Period and Notice
  • This agreement comes into effect from 1st June2010 and will continue on a rolling basis if agreed in writing by all parties, with subsequent termination by either the Provider or Purchaser giving the other party one month’s notice in writing.
  • It will be subject to annual review by all parties.
  1. Termination
  • The agreement may be terminated, without penalty, if the Pharmacy or NHS North of Tyne gives the other party one-month notice in writing.
  • NHS North of Tyne may terminate or suspend this agreement forthwith if there are reasonable grounds for concern including, but not limited to, malpractice, negligence or fraud on the part of the pharmacy.
  • If events occur which could not have been reasonably foreseen and are of such substance to affect the ability of either party to meet their obligations, then joint negotiations will be undertaken to consider the future provision of services or to terminate this agreement without prejudice.
  • The agreement will terminate immediately if the pharmacy ceases to trade.
  1. Aim and Intended Service Outcome
  • To incentivise pharmacists to support patients to take their medication appropriately, as prescribed, and to intervene where problems are identified.
  • To reduce unnecessary repeat admissions[1] secondary to medication related issues.
  • To undertake an intervention medication use review[2] (iMUR) with patients who have recently been discharged from secondary care[3] and have been specifically selected[4] and have consented to the review[5].
  • To require a positive obligation to appropriately advise patients on the importance of only requesting prescription items they actually need[6].
  • To reduce the number of unwanted medicines dispensed[7].
  • To reduce stock piling of medication by the patient.
  • To notify the prescriber when an item prescribed has not been dispensed.
  • To promote, support and encourage good prescribing practice.
  • To highlight over usage of medicines to GPs.
  • To reduce unnecessary prescribing costsof unneeded or unused medication through ‘not-dispensing’and rationalising prescribed dose forms, see section 7.
  • To improve dialogue with patients[8], GP practices and secondary care.
  • To promote the value of community pharmacy as an essential part in supporting the patient moving across care interfaces.
  1. Inclusion Criteria
  • The ‘not-dispensed’ service may be carried out on all prescriptions from a Newcastle PCT GP practice presented for dispensing at the pharmacy, except where patients’ repeat medicines are already being managed by the pharmacy or they are receiving their medication through the NHS repeat dispensing service[9].
  • Targeted patients1 recently discharge from secondary care who consent to an iMUR.
  • Dose rationalisation can take place irrespective of whether the patient is using Repeat Dispensing or any managed repeat service.
  • The pharmacist complies with national requirements stipulated as part of the National Contract for advanced services.
  1. Exclusions
  • Prescriptions dispensed as part of the NHS Repeat Dispensing service or a managed repeat scheme[10].
  • Where patients pay for their prescriptions, items not-dispensed because the patient is advised to purchase the medication as the purchase price is less than that of a prescription levy.
  • Where the following requirements can not be satisfied, a targeted iMUR can not be undertaken:

-Pharmacists must have a certificate accrediting them to undertake NHS advanced services[11].

  • Where the following requirement can not be satisfied, a targeted iMUR can only be undertaken in a suitable[12] location other than the pharmacy:

-The Pharmacyhas a consultation area that meets stipulatedrequirements[13] to undertake MURs and is accredited by NHS North of Tyne.

  • Patient does not consent.
  1. Duty of the Pharmacy
  • The pharmacist and support staff must ensure they are familiar with all aspects of the scheme before commencing the service.
  • The pharmacy staff must ensure the service is explained to the patient at the outset when they present their prescription. This explanation must include what the service is about and they must re-assure patient that having an item not-dispensed does not mean it has been removed from the repeat prescription[14].
  • The prescription should only be reviewed through the service if the pharmacist is satisfied of its suitability for inclusion.
  • As part of an iMUR the pharmacist should sensitively ask patients about all the medication they use, be it prescribed, borrowed or bought in a non-challenging, non-judgemental and supportive manner. This discussion should include asking about patterns and motivation for use as well as the amount of medication the patient has at home.
  • Where it is ascertained a patient has sufficient existing stock of a given medication the pharmacist must make every effort to ensure the stock is used before any new stock is dispensed.[15]
  • All participating pharmacies musteither provide a professional consultation service (MUR) for patients or if by virtue of not being able to satisfy either or both of the necessary basic requirements to undertake an MUR or prescription intervention they contact the GP recommending an MUR is undertaken and the reasons for the review to take place.
  • All interventions and targeted iMURs shall be recorded on the nationally approved form. In addition there may be a requirement to capture additional information on specific documentation[16]that must be completed to secure the additional fee for a targeted iMUR.
  • Pharmacists should ensure full patient confidentiality and compliance with data protection requirements.
  • If a medication isn’t required, the item will not be dispensed. The prescription must be endorsed ‘ND’ in a manner that has been agreed with the NHS Business Services Authority (see Appendix 1).
  • To act on any feedback received in relation to the quality of MURs undertaken[17].
  • Any item ‘not-dispensed’must be reported to the prescriber within two working days(see Appendix 2), with any additional comments added, and an anonymisedcopy must be sent to NHS North of Tyne to request payment.
  • As part of their professional obligations the pharmacist should seek to ensure appropriate use is made of NHS resources.
  • Where a patient is prescribed a dose of medication that could be supplied in a more rational dosage form a dose rationalisation scheme form (appendix 3) should be completed and sent to the GP practice. On return of the form from the GP Practice advising the proposed change has been agreed an anonymised copy of the form should be sent to NHS North of Tyne for payment.

NB.Any item not-dispensed as part of the rationalisation process must not be forwarded for payment under the not-dispensed element of this scheme.

  1. Training
  • There are no specific training requirements for pharmacists to ‘not-dispense’ item or a dose rationalisation not required by the patient, however pharmacists should ensure that they are familiar with the scheme and any support staff be made aware of the scheme and signed off as competent to participate in the scheme.
  • Where it is apparent the patient either does not take or is not using their medication correctly the pharmacist may only undertake formal action through the prescription intervention scheme if they are accredited, see exclusion criteria.
  1. Monitoring and Evaluation
  • The scheme shall be subject to ongoing evaluation conducted by NHS North of Tyne.
  1. Service Funding and Payment Mechanism
  • The pharmacy will be paid according to the following schedule:

- Fee: £2.50 per ‘not-dispensed’ item.

- 15% of the acquisition cost[18] of any medicines ‘not-dispensed’.

- An additional £5.00 for undertaking a targeted iMUR[19].

- 25% of the annual savings for any medication whose dosage has been rationalised, subject to a £30 maximum[20].

  • A summary invoice (Appendix 2) and monthly sheet (Appendix 4) should be submitted to the key PCT contact

Ann Gunning

NHS North of Tyne

Bevan House

1 Esh Plaza

Sir Bobby Robson Way

GreatPark

Newcastle upon Tyne

NE13 8BA

by the 5th of the month to enable prompt payment. Payment will be made monthly,

  • A copy of all ‘Not-dispensed’ intervention form and dose rationalisation forms will be kept in a file by the pharmacy for a minimum period of two years.

Claim and forms for recording not-dispensing, dose rationalisation and targeted MUR interventions, plus associated claim forms and notes on completion are attached in appendices 2 to 8. Forms are also available on the North Tyne LPC and Northumberland LPC portal:

see

NB: this method of remuneration may alter if alternative arrangements for a new payment system are made available. Details of any change will be made in advance and forwarded as appropriate.

  1. Role of the Medicine Management(Commissioning) team
  • Overall responsibility for co-ordinating and managing the project
  • Ensuring all claim forms are dispatched to medicine management promptly.
  1. Clinical Governance

Pharmacies providing the service must comply with the national clinical governance requirements as described in the National Health Service (Pharmaceutical Regulations) 2005. This covers such areas as:

▬Patient, public involvement

▬Clinical audit; risk management

▬Staffing and staff management; education

▬Training and personal development

▬The use of information to support healthcare delivery

▬Critical incident reporting and risk reduction

▬SOPs will be put in place to support this service.

▬Any claims for compensation resultant from any acts or defaults of the staff employed in providing this service, or any litigation arising from the provision of this service will be the responsibility of the pharmacy providing the service.

  • Pharmacies providing the service must maintain appropriate insurance as necessary. NHS North of Tyne will have the right to see documentary evidence of the appropriate insurance including policy renewal receipts prior to commencement of this agreement. If the pharmacy fails to maintain adequate insurance, or is no longer a member of an appropriate professional organisation (for whatever reason), this agreement may be terminated by the PCT without prejudice to any other rights and remedies available.
  • Pharmacies must have Standard Operating Procedures to record near misses and adverse incidents. Near misses and adverse incidents concerning the ‘not dispensing’ schememustbe made available to NHS North of TyneMedicines Management (Commissioning).
  1. Confidentiality
  • Clients are entitled to expect that the information about themselves, which a pharmacist learns during the course of a consultation and treatment, will remain confidential, except where communication between healthcare professionals is in the patient’s best interests.
  • Pharmacists and their staff must respect this duty of confidentiality and information must not be disclosed to a third party without client’s consent.

Signed for and on behalf of the Pharmacy

Name of Pharmacy: «Pharmacy_Name» «Address_1» «Address_2»

Signature: ……………………………………………………………………………….

Date: …………………......

Designation: …………………………………………………………………………….

Signed for and on behalf of Newcastle Primary Care Trust

Signature:

Date: 12th October 2010

Designation: Community Pharmacy Contracts Manager

Bank details

Bank: ………………………………………………………

Address: ….………………………………………………..

………………………………………………………………

………………………………………………………………

Sort Code: …………………………………………………

Account Number: …………………………………………

Appendix 1

Please put a line through the item not-dispensed.

Appendix 2

REPORT FORM
Newcastle PCT ‘non-dispensing’ scheme
Pharmacy Stamp: / Date: / DD/MM/201Y / GP Practice Stamp:
Patient details / Prescription Number
Name:
Address: / For payment to be passed each entry MUST be accompanied by the unique prescription number found at the bottom of each FP10 and the appropriate pink form. Failure to provide this will invalidate that claim
Prescriber's Name
DOB:
Targeted iMUR requested
(Delete as applicable) / Yes / No / Targeted iMUR requested by / Date requested:
DD/MM/201Y
Non dispensing intervention report
Items not-dispensed(drug/form/dose/quantity) / Comments from Community pharmacist:
Reason/ suggestions for any items not dispensed e.g. consider taking off repeat list. / Actioned by GP practice
(Delete as applicable) / Actioned by
(initial)
Y / N
Y / N
Y / N
Y / N
Y / N
The following prescriptions can not be included:
▬Prescriptions for repeat dispensing items
▬Items not-dispensed as they have been bought by the patient
▬Prescriptions that have been raised by the community pharmacy as part of a managed repeat service
I declare that the above items were presented on FP10 prescriptions and were not-dispensed after consultation with the patient or carer. In each case the prescription form was annotated with the words "Not-dispensed" or "ND" against each item not-dispensed.
Pharmacist Signature: / Date requested:
DD/MM/201Y
PatientSignature
(or their representative): / Date requested:
DD/MM/201Y
Send ONE copy to GP ONE copy to be retained by pharmacy

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/ Payment for Newcastle PCTDose rationalisation scheme
Patient’s name / DoB / Drug / Current dose / New dose / Pharmacist's comments / Actioned* Please delete as applicable / GP practice's comments / Annual saving** to be made by rationalising dosage forms
Y / N
Y / N
Y / N
Y / N
Y / N
Pharmacy / Surgery
Stamp / Stamp
*Practice pharmacist or designated member of GP Practice staff please:
  • Action recommendation by amending clinical system and issuing replacement prescription, or
  • advise why change can not be made and add brief comment for feedback to Community Pharmacist on return of form.

Retain form for 2 years
** Calculate the annual savings for the rationalised dose based on Drug Tariff/Chemists & Druggist/ Wholesaler Invoice prices to demonstrate savings to the GP practice.
NB. The maximum payment for any item rationalised is £30.00
Practice signature: / Pharmacist Name:

Appendix 3

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Appendix 4

Invoice for Not-dispensed, dose rationalisation & iMUR scheme /
Claim for (month) / Year
Name of pharmacy
Payment to be made payable to
Name of Bank
Address
Sort code
Account number
Total number of items Not-dispensed / @ £2.50/item =
Total number of iMURs undertaken / £5.00/iMUR
Total value of savings made by dose rationalisation / X 25%
Total value of items Not-dispensed / X 15% =
(Based on C&D list price or drug Tariff) / Total claimed
Name of pharmacist making claim
GPhC Registration Number
Date Claimed
Form to be returned to : /
or post to
Medicines Management, NHS North of Tyne, Bevan House, 1 Esh Plaza, Sir Bobby Robson Way, Great Park, Newcastle upon Tyne, NE13 9BA. Fax: 0191 217 2506
To arrive no later than the 5th of the month.
FOR OFFICE USE ONLY
Payment due_ / £
Budget Code / 5D7P / 643474 / 691300 / 0000
Authorised Signatory: / Date

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Summary record of iMUR /
Month
Year
Date iMUR undertaken (DD/MM/YY) / Pharmacist Name / GPhC number / iMUR reference number / Location iMUR took place / Other location / Name of GP Practice
Form to be returned to : /
or post to
Medicines Management, NHS North of Tyne, Bevan House, 1 Esh Plaza, Sir Bobby Robson Way, Great Park, Newcastle upon Tyne, NE13 9BA. Fax: 0191 217 2506
To arrive no later than the 5th of the month.

Appendix 5

Appendix 6

Summary record of actioned dose rationalisation interventions
NB. Do not submit claims until you have received written confirmation a proposed dose rationalisation has been actioned by the relevant GP practice /
Month
Year
Pharmacist Name / GPhC number
Date confirmation received from GP practice (DD/MM/YY) / Prescription number / Approved drug name / Strength / Form (e.g. tablet, capsule, MR tablet etc) / Dose / Frequency / Quantity / Brand as appropriate / Item cost (C&D list or Tariff price) / Name of GP Practice
Corresponding rationalised dose details / Total value / £
Prescription number / Approved drug name / Strength / Form (e.g. tablet, capsule, MR tablet etc) / Dose / Frequency / Quantity / Brand as appropriate / Item cost (C&D list or Tariff price)
Total value / £
Form to be returned to: / / NB. maximum claim of 25% of annual savings must not exceed £30.00. / Total saving / £
or post to Medicines Management, NHS North of Tyne, Bevan House, 1 EshPlaza, Sir Bobby Robson Way, GreatPark, Newcastle upon Tyne, NE13 9BA. Fax: 0191 217 2506
To arrive no later than the 5th of the month.

Appendix 7

Summary record of Not-dispensed items /
Month
Year
Pharmacist Name / GPhC number
Date (DD/MM/YY) / Prescription number / Approved drug name / Strength / Form (e.g. tablet, capsule, MR tablet etc) / Dose / Frequency / Quantity / Brand as appropriate / Item cost (C&D list or Tariff price) / Reason Not-dispensed / Did discussion result in a MUR with recommendations / Other reason, please state / Name of GP Practice / Comment
Date (DD/MM/YY) / Prescription number / Appliance details / Item cost (C&D list or Tariff price) / Reason Not-dispensed / Did discussion result in a MUR with recommendations / Other reason, please state / Name of GP Practice / Comment
Number of items ND / Total value / £0.00
Key to reasons for not-dispensing
1 / Patient has sufficient stock to continue treatment as prescribed until next prescription is due and does not need this supply.
2 / Patient does not take drug, stopped by hospital.
3 / Patient does not take drug, stopped by GP.
4 / Patient does not take dose prescribed, dose changed by hospital.
5 / Patient does not take dose prescribed, dose changed by GP.
6 / Patient does not take drug as prescribed. Consider need for MUR to discuss medication use with patient.
7 / Any other reason, please state. / or post to / Medicines Management, NHS North of Tyne, Bevan House, 1 Esh Plaza,Sir Bobby Robson Way, Great Park,Newcastle upon Tyne, NE13 9BA. Fax: 0191 217 2506
Form to be returned to : / / To arrive no later than the 5th of the month.

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1.Recording not-dispensed interventions

Whenever a prescription item is not-dispensed as part of this scheme a record must be made of the intervention and a copy forwarded to the patient’s GP practice.

The original copy of the intervention must be retained in the pharmacy for 2 years and must be made available to the Commissioners as required to support any claims for payment made.

Complete all relevant sections; ensure the narrative in the comments section has sufficient detail to allow the GP to make any recommended changes to the patient record.

One of the main objectives of this initiative is to begin to address habitually wasteful behaviour in relation to the acceptance of medication the patient does not use as prescribed. By engaging with the patient the benefits of adherence to prescribed regimens should be discussed and to confirm communication with the patient it is advised their signature should be collected.