Service Specification for the Provision of Monitored Dosage Systems As a Local Enhanced Service

BARNSLEY PRIMARY CARE TRUST

Service Specification for the Provision of Medication Management Systems as a Local Enhanced Service(Pilot Scheme)

Version 1.2

Service Description

1.1 This “Provision of Medication Management Systems Enhanced Service 2008/09”, herein known as “The Service”, is aimed at service users who are unable to self medicate largely as a result of cognitive decline, and/or frailty.

1.2Pharmacists participating in the scheme will undertake Medication Use Reviews (MUR’s), in advance of medication regimes being established through a Medication Management System. The aim is to implement a controlled safe environment where Home Carers are able to carry out the controlled administration of medication that meets the specific needs of each service user. The MUR will typically take place in the home of the service user or in the pharmacy where service users have the capacity to travel.

1.3 The core elements of the service will be the provision of appropriate compliance aids by participating pharmacists,this may include the provision of Monitored Dosage Systems (MDS) complimented by the use of Medication Administration Records (MAR) for recording purposes.

1.4 A network of pharmacy contractors will be identified to provide The Service to service users. Details of the service providers will be disseminated to GP’s, Community Nursing Staff, Community Care Teams and Hospital Pharmacists in order that they can direct service users to the most appropriate provider of The Service.

2.Service Objectives

2.1 To ensure that service users (older people, vulnerable adults, other identified groups e.g. learning disability, physical or sensory impaired or mental health patients who might benefit from the service) have a system in place to ensure medication compliance that meets their own personal needs

2.2 All service users must be registered with a Barnsley GP.

2.3 To improve patient care by ensuring medicines are taken correctly by service users reducing the risk of non compliance and medication errors

2.4To provide the necessary support to service users who are unable to self medicate to enable them to stay in the safety and security of their own homes and prevent unnecessary admissions into residential care.

2.5To reduce the admission rates into Hospital associated with poor medication regimes.

2.6To safeguard vulnerable service users from the risks associated with medication and comply with the legislation in respect of the Commission for Social Care Inspection

2.7To implement a system to ensure regular Medication Use Reviews (MUR)

2.8To reduce wastage of prescribed drugs by:

Providing feedback on the accuracy of repeat prescribing data
Encouraging patients to use the repeat prescribing system efficiently
Identifying excessive hoarding of medication
Ensuring safe disposal of medication

3.Service Outline

3.1 Following an initial assessment of the service user by either the GP, CommunityNursing Staff, Community Care Teams, Social Workers or Hospital Pharmacists which identifies that the service user is unable to self medicate, contact is madewith the service user’s current pharmacist. In the event that the current pharmacist is unable to provide the service then the nearest participating pharmacist to the service user should be contacted.

3.2 The pharmacist arranges to meet the service user and/or next of kin to initiate an assessment and undertake a MUR within 10 days of referral.The MUR will enable the pharmacist to establish a Medication Management System which can be implemented to meet the needs of the service user, within 15 days of referral. The Medication Management System will be implemented to meet the individual needs of each service user, this will also enable Home Carers to assist or administer controlled medication to service users in a safe environment.

3.3If the service user is being discharged from Mount Vernon hospital the MUR will be undertaken by Mount Vernon staff who will inform the service user’s current pharmacist of the Medication Management System to be implemented. Mount Vernon staff must provide the service users pharmacist withadequate notice, as agreed between Mount VernonHospital, LPC and PCT.

3.4All participating pharmacists providing this enhanced service need to be CRB checked if MUR’s are to be provided in the service users home. Proof of CRB checks and clearance need to be provided to the PCT before the contractor can commence the provision of The Service.Barnsley Primary Care Trust’s Personnel Department will manage the CRB process including refresher scheduling every 3 years.

3.5Following the MUR the pharmacist produces a Medication Plan for the service user, which includes details of medication and disposal arrangements along with the location and access method of secure storage boxes. The purchasing of the secure storage box will be the responsibility of the service user or their family.

3.6Details of the proposed Medication Plan are dispatched to the referring professional and homecare provider where applicable and the pharmacist commences supply of the appropriate compliance aids.

3.7The pharmacist undertakes to evaluate the Medication Plan with the service user no later than 12/13 weeks after the commencement of the plan. This evaluation consists of a further MUR being undertaken with the service user, to ensure that the Medication Plan is meeting the needs of the service user. If changes are made to the Medication Plan these are communicated to the referring professional, Community Care Team and the service users GP.

3.8Further requests may be made at any time to the pharmacist by the referring professional or the Community Care Team for the pharmacist to reassess or review the service users Medication Plan.

3.9Not withstanding any reassessments or reviews of the Medication Plan the pharmacist will undertake an annual review with the service user in month 11 following the commencement of the Medication Plan. This annual review of the service user will consist of a further MUR, and feedback will be provided to the referring professional, Community Care Team and the service users GP.

3.10During the year there may be further changes to the service users medication by their GP; these will be picked up the pharmacist via prescriptions presented. Any new drugs supplied will be included in the service users MDS or MAR chart the week following receipt of the prescription. If medication changes happen frequently then the service user’s suitability for inclusion in the scheme should be re-assessed.

3.11The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service, and are aware of and operate within local protocols including the Barnsley Health and Social Care Medication Policy for Domiciliary Care to include Procedures and supporting Business Process. All staff providing The Service will be expected to attend an annual briefing training event to ensure they are up to date with the service provision.

3.12The pharmacy should maintain appropriate records of all service users being provided with a Medication Management System, this will include records on the Patients Medication Record (PMR) of MUR’s undertaken, details of the medication supplied as part of The Service, details of drug information provided on MAR charts, and details of any changes made to medication prescribed etc.

3.13The PCT will disseminate information on The Service to other pharmacy contractors and GP’s, Community Nursing Staff, Community Care Teams, Social Workers and Hospital Pharmacists, in order that they can direct service users to the most appropriate provider of MDS.

3.14The roles and responsibilities of the pharmacist in relation to the provision ofThe Service are included in Appendix 1.

3.15The pharmacist will ensure that they have a copy of the current operating guide available in the pharmacy at all times for reference.

Finance

4.1 Fees payable:

An annual fee of £500 paid in 2 equal instalments in April and Septemberto each contractor providing The Service

Fees of £10 per service user per month for all service users provided with The Service. Pharmacists should provide a spreadsheet to the PCT’s Commissioning Department (see Appendix 2) on a monthly basis which details all service users, payment will be one month in arrears. All spreadsheets must be sent by recorded delivery or faxed to a safe haven fax machine.

Fees for MUR’s undertaken as part of The Service will be funded centrally from dedicated resources to pay pharmacists for providing MUR’s to a maximum of 400 MUR’s per annum per pharmacy. Claims for MUR payments associated with The Service should be submitted by pharmacists in the usual manner i.e. as part of their normal claim procedure for MUR’s.

4.2 The level of payment will be reviewed annually taking into account the actual number of service users being provided with compliance aids by the pharmacy.

Quality Indicators

5.1 The contractor can demonstrate that it reviews its Standard Operating Procedures (SOP’s) and the referral pathways for The Service on an annual basis.

5.2 The pharmacy participates in an annual PCT organised audit of The Service – this is in addition to any audits required under the terms of the Essential Services of the Community Pharmacy Contract framework.

5.3 The pharmacy co-operates with any locally agreed PCT-led assessments of service user experience.

5.4 Quality indicators may be open to independent audit by a pharmacy advisor nominated by the PCT. This may take place at a time agreeable to both parties and/or as part of the PCT’s contract monitoring process of Community Pharmacies.

Terms and Duration

6.1 The contractor agrees to provide the service for a minimum period of one year from the date of “Agreement for Local Enhanced Services” (Appendix 3) or until they or the PCT gives 3 months notice of termination of the service.

6.2 In the event of the ongoing agreement:

The pharmacy does not commence the service in the first 12 months
It can be proved that the pharmacy is no longer providing continued support to existing service users
It can be proved that the pharmacy is unwilling to consider new referrals into the scheme
It can be proved that the pharmacy is not providing sufficient capacity based on annual reviews with the pharmacy and BMBC
The pharmacy terminates the agreement

The contractor is liable to reimburse the annual fee paid for The Service.

In the event of such an occurrence the PCT may offer The Service to an alternative provider.

APPENDIX 1

Roles and Responsibilities of the Pharmacist

The pharmacist must be on the Pharmaceutical List for Barnsley PCT. The Service will only be reimbursed for patients from GP practices within Barnsley.

The pharmacist will be responsible for:

Ensuring that all referrals to the scheme are assessed by means of undertaking a MUR within 10 days of receipt of the referral, and that a Medication Management System can be implemented to meet the needs of the service user within 15 days of receipt of the referral

Ensuring that the Medication Plan is fully completed to include details of the agreed medication management system, delivery/collection and disposal arrangements prior to forwarding to the referring professional

Ensuring that CRB checks are maintained every 3 years with the appropriate agency

The selection and supply of an appropriate MDS for the service user – if secure storage boxes are required the pharmacist will recommend products for purchase by the service user or their family

A full explanation of the use of medication compliance aids e.g. MDS and MAR charts if provided to the service user

Satisfying themselves of the stability of the medication provided in the MDS

Liaison with the service users GP about the need for continued synchronisation of repeat prescriptions

Filling, sealing and labelling of MDS – ensuring there is adequate space in the pharmacy to make up MDS supplies

Supplying patient information leaflets where appropriate

Making up MDS following safe guidelines – an SOP for the service should exist which should cover the prescription request, ordering systems and medication delivery – the medication in the MDS is assembled after receipt of the prescription and checked against the original and most up to date prescription

Ensuring the service users PMR is updated and the MAR chart and labels are produced after receipt of the prescription

Timely liaison with relevant professionals, carers and service user in addressing any problems that arise

Advice and guidance to the relevant professionals on solutions available to overcome the barriers of self medication e.g. larger labels for the visually impaired

C:\Users\jmartin\AppData\Local\Microsoft\Windows\Temporary Internet Files\OLK7240\02 Service Specification for the Provision of Monitored Dosage Systems as a Local Enhanced Service (v1 2).doc 1 08 July 2010

BARNSLEY PRIMARY CARE TRUST

APPENDIX 2

Medication Management System Monthly Claim Sheet
Pharmacy Name and Address:
Name of Pharmacist providing support
PPA Code:
Month of Claim:
Service Users Name / D.O.B / Service Users Address / GP / Medication Compliance Aids supplied ( please provide details)
Total number of claims made/ no of claim sheets completed / /
Name and Signature of person completing form
Claims to be submitted by the 5th working day of every month.

Please return to: Rebecca Bailey , NHS Barnsley Longfield's House Longfield's Court, Middlewoods Way, Wharncliffe Business Park, Carlton, Barnsley, S71 3GN or fax 01226 327234

BARNSLEY PRIMARY CARE TRUST

APPENDIX 3

Agreement to provide a Medication Management System

I/We (please insert name of the pharmacist) ______agree to provide a Medication Management System to service users referred to us.

Of (please insert pharmacy address and telephone number):

______

Name(s) of Pharmacist(s) who will provide the service:

______

I confirm that all the pharmacists listed to provide the service have been CRB checked and attach copies of CRB checks/proof of CRB clearance with this signed agreement.

I agree to comply with the requirements outlined in Appendix 1 Roles and Responsibilities of the Pharmacist.

I agree to submit monthly claim forms to the PCT using the form in Appendix 2 to claim the fees for the service provided.

Pharmacist’s signature :______

Date:______