Service Level Agreement:-Urgent Care-Pharmacy Urgent Repeat Medicines Service

Service Level Agreement:-Urgent Care-Pharmacy Urgent Repeat Medicines Service.

1. Purpose

The purpose of the Pharmacy Urgent Repeat Medicines (PURM) Service is to facilitate appropriate access to repeat medication -Out of Hours (OOH), enabling patients to access urgent supply of their regular prescription medicines when appropriate. The service may be needed because the patient has run out of a medicine, or because they have lost or damaged their medicines or their GP and usual pharmacy may be closed.Therefore, they are unable to obtain a prescription before they need to take their next dose. There may also be local emergencies such as floods, civil unrest, displacing patients who then need emergency supplies. In all cases, the decision to supply rests with the pharmacist.

The aim of this service is to relieve pressure on urgent and emergency care services and general practitioner appointments at times of high demand.

In an emergency, a pharmacist can supply prescription only medicines (POMs) to a patient (who has previously been prescribed the requested POM) without a prescription at the request of the patient. This emergency supply is not an NHS service and patients may therefore be asked to pay the cost of the medicine[1]. This can lead to some patients seeking supplies or emergency prescriptions from urgent or emergency care providers. This service will allow the supply of medicine(s) at NHS expense where the pharmacist deems that the patient has immediate need for the medicine and that it is impractical to obtain a prescription without undue delay (such as when demand for urgent appointments is very high).

1. Period

This agreement is for the period 1st August 2015 to 31st March 2016.

1. Termination

One months’ notice of termination must be given if the pharmacy wishes to terminate the agreement before the given end date.NHS England London Region may suspend or terminate 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.

The commissioner 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 the provider seriously breaches the terms of this agreement, including by any act or omission which prejudicially affects or is likely so to affect the interests of the commissioner.

1. Obligations

The Community Pharmacy will provide the service in accordance with the specification (Schedule 1).

NHS England London Region Primary Care Contracting Dentistry, Optometry and Pharmacy (DOP) team will manage the service in accordance with the specification (Schedule 1).

The service will be monitored and evaluated by NHS England London Region DOP team and London Winter Resilience Programme Team reporting to the London Urgent and Emergency Care Board. The Pharmacy Delivery Group reporting to the London Winter Resilience Programme Team will be responsible for designing the service and supporting implementation. Representatives from London LPCs and Pharmacy Local Professional Network will be part of the Pharmacy Delivery Group.

1. Payments

NHS England (London) will pay the following:

a)A professional consultation fee of £12.50 will be paid for each referral to a community pharmacy by NHS 111 which will cover emergency supply (if made) andassociated advice to a patient referred to a community pharmacy. There will be a payment of £2 per item dispensed over and above the first item dispensed in addition to the consultation fee.

b)The cost of the medicine supplied (guided by Drug Tariff prices) plus VAT (where applicable) will be reimbursed by the commissioner.

c)Charges equivalent to a prescription charge per item should be collected unless the patient is normally exempt in accordance with the NHS charges for Drugs and Appliances Regulations. Any prescription charges collected from patients will be deducted from the sum payable to the pharmacy.

d)The pharmacy will enter the service delivery information onto the bespoke Anentainvoice system by the 7th of each month and invoices will be generated automatically. The weblink for the Anenta system is below :-

e)Payments will be authorised by DOP team using the data entered on the system within one month of the data being entered via FHS services and paid under Local Scheme 2 on the Schedule of Payments from NHSBSA.

1. Standards

The service will be provided in accordance with the standards detailed in the specification (Schedule 1)

1. Confidentiality

Both parties shall adhere to the requirements of the Data Protection Act 1988 and the Freedom of Information Act 2000.

Any approaches by the media for comments or interviews must be referred to NHS England London DOP team.

1. Indemnity

The pharmacy shall maintain adequate insurance for public liability and professional indemnity against any claims which may arise out of the terms and conditions of this agreement.Any litigation resulting from an accident or negligence on behalf of the pharmacy is the responsibility of the pharmacy who will meet the costs and any claims for compensation, at no cost to NHS England (London).

Schedule 1Service Specification

Urgent Care -Pharmacy Urgent Repeat Medicines (PURM) Service

In an emergency, a pharmacist can supply prescription only medicines (POMs) to a patient (who has previously been prescribed the requested POM) without a prescription at the request of a patient. This emergency supply is not an NHS service and patients may therefore be asked to pay the cost of the medicine. This can lead to some patients seeking supplies or emergency prescriptions from urgent or emergency care providers or placing extra demand on GP appointments. When demand is high it may not be practical to obtain a prescription in a timely way to meet immediate need.

The Pharmacy Urgent Repeat Medicines (PURM) Service allows the emergency supply of a patient’s medicine at NHS expense when referred by NHS 111 in order to reduce the number of patients contacting urgent and emergency care providers. This may include both prescription only medicines and other medicines usually obtained on prescription by the patient from their GP. The supply made is under the emergency supply provisions. Supplies will only be made when deemed necessary by the pharmacist. The consultation will also include a discussion with the patient/patient’s representative about the importance of ordering prescriptions in a timely manner.

1. Service description

1.1 NHS 111 will refer to pharmacies via NHS.net email. The NHS 111 provider will also provide the telephone number of the participating pharmacy to the patient advising them to call the pharmacy in the next 30 minutes so that the pharmacist can assess their need for an urgent medication supply. When the patient contacts the pharmacy the pharmacist should confirm an email has been received from NHS 111. If no email has been received the pharmacist will contact NHS 111 to confirm a referral has been made and confirm the patient’s NHS number and GP details via telephone. If a referral has not been made by NHS 111 the emergency supply is out of scope for this service

1.2 The pharmacist will at the request of a patient (or in pandemic situations where there has been a change in regulations, a representative of a patient), assess whether there is an urgent need for their medicine, in circumstances where it is impracticable for the patient to obtain a prescription before the next dose is due.

1.3 If an emergency supply is necessary, the pharmacist shall make a supply, in accordance with the Human Medicines Regulations 2012 maintaining a record of the supply and labelling the container appropriately.

1.4 A record of the supply will be made in the IT system for the purposes of audit and claiming payment. The required notification to the GP may be made within 48 hours via post, fax or NHS.net email (if email address is available) using the information supplied via the NHS 111 email. Activity and patient experience data collected as part of the service monitoring must be anonymised.

1.5 If it is not possible to make an emergency supply due to prohibitions within the legislation or other patient factors the pharmacist will contact the local GPOOHs provider to ensure the patient is contacted by another appropriate healthcare professional. Participating pharmacies will be provided with relevant contact details for GPOOHs services and the NHS 111 Health professional line.

1.6 This service only applies to patients referred by NHS 111 and does not apply to patients requesting emergency supplies from the pharmacy directly.

2. Aims and intended service outcomes

2.1 To facilitate appropriate access to medication OOH by ensuring timely access to medicines for patients in emergency situations, where it is not practicable to obtain a prescription.

2.2 To reduce pressures, demand and cost on other parts of the unscheduled care system, such as A&E, out of hours GP services, NHS 111 in the CCG area, many of who receive regular requests from patients for prescriptions for repeat medicines, especially at the weekend and bank holidays.

2.3 To ensure equity of access to the emergency supply provision irrespective of the patient’s ability to pay for the cost of the drugs supplied.

3. Service outline

3.1 The pharmacist will:

1. Receive an email from the NHS 111 service advising that a patient has been referred the pharmacy for an emergency supply of repeat medication from the PURM service at the pharmacy.
2. Routinely check the NHS.net email to pick up the notification of the referral in a timely manner.
3. Contact the patient by phone to interview the patient to assess suitability / eligibility to use the service, identify the medicines needed and to establish the nature of the emergency.
4. Arrange for the patient to come to the pharmacy for a face-to-face consultation.
5. If no supply is to be made the pharmacist to document any referrals and outcome of discussion. Documentation of any repeat medicines not supplied when requested is important evidence for the service demonstrating reduced medicines waste.
6. Complete the face-to-face consultation, where possible confirming the previous treatment ensuring that the emergency supply regulations and good practice guidance are met.
7. The pharmacist can use their professional judgment and where it is deemed appropriate interview the patient over the phone to ensure that the emergency supply regulations and good practice guidance are met. The patient’s representative can then collect the medication from the pharmacy on their behalf. It is expected that the majority of emergency supplies will be made to the patient, not their representative. Where a representative collects the medication the rationale for a telephone interview and the representative collecting the supply will be recorded.
8. The patient (or representative) must complete the relevant sections of the Patient Pharmacy Urgent Repeat Medicines Service Record Form to validate any exemptions from prescription payment and confirm supply.
9. The pharmacist will advise and educate the patient or their representative on the importance of ordering prescriptions in a timely manner from their usual pharmacy to support patients in understanding of the importance of not running out of medication

with the aim of changing behaviours where appropriate and preventing the future need for emergency supplies. The pharmacist will also use the opportunity to reinforce positive patient’s behaviours for achieving medicines optimisation. The PURM service must not be used to attempt to change the patient’s use of their usual pharmacy. If evidence of diverting or attempting to change patient’s use of pharmacy is found then a pharmacy will be removed from this service.

3.2 The pharmacist will at their discretion, make the supply in accordance with the requirements of the Medicines Act1968. The pharmacist will supply up to 28 day'ssupply of medication except where it is not possible to dispense this volume (e.g. inhalers, creams etc.); the smallest pack size should be dispensed in this instance.

3.3 The pharmacy will maintain a record:

1. of the emergency supply, setting out the name and address of the patient, the prescription only medicine supplied, the date of the supply and the nature of the emergency in accordance with the Human Medicines Regulations 2012.
2. of the consultation and any medicine that is supplied or not supplied when requested on the Patient Pharmacy Urgent Repeat Medicines Service Record Form. This record form will be retained in the pharmacy for 3 months after the supply to allow for post verification checks.
3. of the consultation and any repeat medicine that is supplied and not supplied on the IT system which will generate a copy of the record to the patient’s general practitioner. The supply will be recorded onto the system as soon as possible after the supply and within 48 hours of the notification from NHS 111.
4. of activity and patient experience using the service monitoring including any medicines not supplied
5. of services delivered, ‘exemption status’’ and medicines supplied in the IT invoicing system by the 7th day of each month

3.4 Patient consent will need to be given to take part in the service, which includes consent to share information with the patient’s own general practitioner, where applicable the GP Out of Hours Service and NHS 111. This will be undertaken by NHS 111.

3.5. A fee equivalent to a prescription charge per item should be collected unless the patient is usually exempt from prescription charges in accordance with the NHS Charges for Drugs and Appliances Regulations. Any fees collected from patients will be deducted from the sum payable to the pharmacy.

3.6 If a patient is exempt from paying a prescription charge in accordance with the NHS Charges for Drugs and Appliances Regulations, evidence of entitlement to exemption should be provided by the patient for the pharmacy to check and the patient must make a declaration of entitlement. Where a patient is unable to provide evidence of exemption the pharmacist will record this on the Patient PURM medicines Service Record Form. The commissioner may make additional checks and where evidence of exemption is not substantiated charges may be recovered from the patient by the Commissioner.

3.7 The pharmacy contractor must have a standard operating procedure (SOP) in place for this service.

3.8 The pharmacy will refer patients requiring urgent supplies of medication not allowable under the emergency supply regulations into the designated direct referral route.E.g control drugs. Schedule 2 and 3.

4. Training and Premises Requirements

A locum pharmacist briefing pack must be available to ensure all pharmacists have access to the service information and FAQs when working in the pharmacy and take responsibility for the service. This must include local information about how to access NHS Mail, the service forms and local GPOOHs contact details.

5. Service availability

The pharmacy contractor should ensure that the service is available throughout the pharmacy’s opening hours.

If the service has to be withdrawn by the pharmacy due to unforeseen circumstances the pharmacist will ensure the business continuity plan is activated.

In the event of NHS 111 not getting through to the pharmacy by email or patients reporting that they have been unable to speak to the pharmacist on two consecutive patient referrals, action will be taken by NHS England London Region DOP to suspend the pharmacy from the service.

6. Quality Standards

6.1 The pharmacy reviews its standard operating procedures and the referral pathways for the service on an annual basis or when significant changes may affect business.

6.2 The pharmacy can demonstrate that pharmacists involved in the provision of the service have undertaken continuing professional development (CPD) relevant to this service.

6.3 The pharmacy participates in any audit of service provision.

6.4 The pharmacy co-operates with any assessment of service user experience.

7. Claiming payment

The commissioner will provide access to the pilot IT system, for the recording of relevant service information, for the purposes of audit,the claiming of payment and generating the GP notification.

1. Selection criteria

In determining which pharmacies are selected to provide the service NHS England (London) will apply the following criteria:

• Extended opening hours, including late openings, Saturdays and Sundays
• Service will be available for all the nationally contracted opening times of the pharmacy
• Ease of access to residents within the locality
• Location within the CCG area with respect to other pharmacy providers
• The pharmacy is open on bank holidays
• The pharmacy is willing to participate in evaluation of the service
• The Pharmacy in good standing with GPhC and NHS England Area Team
• The Pharmacy has no previous, ongoing or outstanding concerns from any professional body or CCG with regard to procuring, maintaining or supplying inappropriately high costs of non-Drug Tariff medicines and specials at the pharmacy

Due to the face-to-face element / collection of medications from the pharmacy, this service is not therefore available to distance-selling pharmacies.

9. Safeguarding

9.1 Pharmacies and their staff are reminded of their existing obligations to comply with local and national guidance relating to child protection procedures.

9.2 When dealing with all patients, pharmacy staff has a responsibility to consider if there is a potential safeguarding issue.

9.3 If the pharmacy becomes aware of a potential safeguarding or child protection issue this should be dealt with using the pharmacy’s Safeguarding Policy and discussed with the Duty Team at the relevant Safeguarding Children’s Board.

10. Governance

10.1 The Pharmacy will effectively manage any complaints using the pharmacy’s own internal complaints procedures which must be consistent with the NHS Local Authority Social Services and National Health Service Complaints (England) Regulations.

10.2 Additionally the pharmacies will notify NHS England London Region DOP team and record on the pilot IT system any complaint relating to the service.