TeesLocal Pharmaceutical Committee Meeting
25th January 2017 09.30-17.00
Pharmacy 365
Minutes
Officers Present:
Jay Badenhorst (JB)
Pete Horrocks, Vice Chair (PH)
Brent Foster Treasurer (BF)
Members Present:
Elaine Ballantyne (EB), Ross Hepplewaite(RH), Andrea Wilde (AW),Michael Maguire (MM); Richard Lyness (RL),Tony Oneill (TO)
Apologies:
Emma Bowman (EB),Yasmeen Asfar (YA)
Employed Officers present:
Sandie Hall, Chief Officer and HLP Project Manager (SH)
Lindsay Clode (LC)
PSNC Regional Representative:
Mark Burdon
Visitors
1.Chair’s Introduction
Pete Horrocks introduced all to the event. Introductions to all.
2. Minutes of Meeting
Agreed as an accurate record.
Actions
Ann Joshua contacted with regards to community pharmacy.
Stewart Findlay lead for emergency vanguard care.
MPs and DPHs – JB has contacted and met with several. Ongoing work with regards to Community Pharmacy, minor ailments and other areas of work including HLP.
Medicines Team meeting JB/PH – points of view that were collated at previous meeting regarding considerations to repeat dispensing changes. County Durham, LPC have sent a memo of understanding to all pharmacies and will be monitoring closely those pharmacies that sign up. There are savings to be made by utilising repeat dispensing effectively. PH – there may be some scrutiny around LPN and LPC at that meeting – positions confirmed with the group.
CCA response on managed repeats -Pharmacy Voice statement is used, in essence CCA would not support a ban due to commercial aspects etc. NHS service would be promoted. Managed repeats would support the direct communication with patients to ensure all medicines are required ahead of requirements. EB – local surgeries are looking to put a protocol in place to streamline the system.
TO – South Tees prescribing leads are not looking at a complete ban but the process needs to be managed. NECS are auditing the process, there may be bans for particular pharmacies if this is the case via NHS England and contractual responsibilities. There is a training issue with GPs having and understanding of setting up the system.
Andrea Wilde is not a member of the whatsapp group. Lindsay and Jane to be added.
Areas of interest – SH will resend targeted email
Virgin payment issues – on agenda
Business plan – domicillary MURs – BF/TO – ongoing work from the Croydon model. £70 for a service with a full review of all information. LPN N Tyne are doing a piece of work around this. JB/PH could take this back to CCG when formulated. Sunderland LPC currently trying to put something in place.
BF projected budget for next 12 months. To be circulated
Richard Lyness joined the meeting.
HLP funding to be taken from account and returned to LPC. Public Health investment in HLP moving forward.
CHAMP one has been rubber stamp funded as a research project.
Dementia friends – watch video.
SH to circulate a list of HLP pharmacies and when accredited.
JB – overview of NHS England survey monkey with waste. This has been fed to national NHS England – the suppliers are currently being streamlined and new service to be sent out. Results have been shared on Pharmoutcomes also.
Zoe Smeaton – SH to contact regarding webinar facilities.
Guidance on NHS digital – nominations done without patient consent.
3. Finance Review
BF auto enrolment is done – pensions. Jane and Lindsay will be opted in automatically 3 months after they start. There will be an opt out options if need be. SH is now contracted in. Salary payments are now sorted.
4.Pharmacy Funding Cuts – update and levy decisions
Invoice has been received which is more than expected. Levy’s are volume based.
It has become apparent that there are issues with transparency of PSNC funding and use of those funds.
There has been a level of silence which is accompanying PSNC work.
There are two new roles within the LPC which have been employed to support contractors with quality payments and ongoing work.
The additional roles are aimed to become self funding.
85k in reserve. Payment
As an LPC we need to have around 3 months reserve.
What is the judicial review to achieve? - we need to be seen to take a stance as a profession. PSNC have challenged the process that was followed. If there is a judgement that the process was not effective then there will be a new process. This does not mean we will get money back. NPA review hinges on the consideration of impact on the most vulnerable. The decision could determine that the impact is neutral. 1.25 million is requested.
How much is in the reserve of PSNC? What happens if we don’t pay it?
EB - CCA – LPCs should use reserves. Do they have more information than LPCs? CCA can back it from a large multiple viewpoint who can afford to pay this. The review where we make a stand and investing in the future is valid but we need some transparency from PSNC. How are independent pharmacies coping with the issues?
RH – if the review is a combined delivery between NPA and PSNC. NPA – limited company can make its own choice on what it is doing. We are 3 months down the line with no guidance as to what is being discussed or what outcomes are expected.
TO – The judicial review is a preventative measure for the next round of potential changes to the pharmacy contract. This is the first time pharmacy have stood up to government. CCA position is that payment is supported for special levy, firstly from LPC reserves. If reserves are not sufficient review current spending. If too low then supportive of a one off request from pharmacies as a last resort.
MM – Agree with all that has been said but from a transparency point of view there are issues before court regarding keeping confidential information. LPCs are part of PSNC and if funding is requested then there must be some transparency within LPCs as part of the same organisation. Before any money there is a due diligence viewpoint. If 1/3 of LPCs say yes we will give the money but others do not what is the consequences of this. As a contractor I would pay an additional £20 on the levy but as an LPC then we need clarity on how the money will be spent.
JB – has tried to get an understanding of where the existing levy money is being utilised. How sure are PSNC of winning the case? PSNC could come up with a plan of impact in order to gain additional support from members of the public. The only thing that is currently being used is Judicial Review.
AW – can PSNC make any cuts. What are similarities with junior doctors? There is not a high level of media coverage. Strong message from Sue Sharp regarding going against strikes.
RL – don’t think we should pay, we are not going to achieve what we need. There needs to be confidence in an organisation that is fighting on your behalf. What would benefit pharmacies, is investment in training to develop business. The special levy money would be better spent on pharmacies. ACT training etc would be beneficial.
PH – PSNC know what cash is available as all LPCs keep a reserve. It is important that we do not roll over to the government therefore support of some action. There needs to be some transparency from PSNC. We should not be approaching contractors at the current time for additional money. Levy money increase would have to be done over a period of time. This could raise local criticism around our issues.
BF – Its about time we stood up and challenged the government on the issues. We should back the process. We will eat into reserves which we will have to work hard to recoup and build up again. It might be worthwhile adjourning the decision.
LC – we have not got the backing of the people. They know there may be some that close due to the cuts but don’t know what is going on with pharmacy and the financial implications of the imposition.
JB -some pharmacies will have a different model of working but commercial challenges and market forces will create issues if deliveries etc are restricted.
AW – patients think that all we do is free to them but funded by the NHS.
There needs to be some myth buster work carried out.
Options –
no we don’t give a special levy,
yes we do give a special levy,
yes we pay a proportion when we have evidence of the cost of the Judicial Review
CCA / Ind / Aimp / TotalNo payment / 0 / 0 / 0 / 0
Full payment / 0 / 0 / 0 / 0
Partial payment pending further information / 3 / 5 / 1 / 9
Cost of Juditial review.
PSNC representation will be in attendance after lunch.
5.Emergency Supply Service
Previous services delivered. This has been implemented on an as required basis over holiday periods on several occasions.
NUMSAS is the new national service. Significant barrier is the NHS mail service. NHS England locally determined that PERMSS would be useful as previous via pharmoutcomes. This again was implemented at a very short timescale. Agreement that vanguard would fund drug costs and consultation fee to be paid to pharmacy to be funded via NHS England. 511 out of pharmacies in north of England signed up. There were some issues but the problems were minimal. Service was due to be turned off on January 11th, this would leave a gap in service, therefore, MM negotiated an extension in service until NUMSAS was ready to be implemented. The next question was how do we maintain momentum. Nationally NHS England would pay for the pharmacy service, drug costs were met locally via NHS England. The extension was only 111 and walk in was reduced. NUMSAS was a service that PSNC did not influence. Current situation is that sign up for NUMSAS will mean that NHS mail will be prioritised in those pharmacies. Contractors receive NHS Mail then have to sign up on BSA website. One aspect which has been supported by using pharmoutcomes, they are going to use this medium from 1st February. If NUMSAS is not up and running there will be a gap in service. Multiples are acting centrally. Nationally the plan is potentially 1st April for purpose of national implementation.
PSNC missed an opportunity to influence NUMSAS.
By keeping NHS England close to the LPC we have a good relationship with them which is giving us good standing for services moving forward.
RL – couple of recent problems with NHS 111. Walk in side has been smooth at the point of contact. Last 2 Saturdays issues with referrals from 111, no evidence provided and currently not up and running with Summary Care Records. These issues have been fed back to NHS England – Linda Bosher. This has been fed back to NEAS 111 service, they do not know how pharmacy works and training was minimal. Terminology was inappropriate ie sending prescription to the pharmacy.
There will be discussions around remote supervision – fight to keep community pharmacy in the pharmacy.
BF – also has issues – all to be fed back to MM for sending through to the NHS England 111 team.
Mark Burdon joined the meeting
6.Pharmacy Referral Service
MM gave an overview of the new potential service. Follow on from emergency supply to include those with a low acuity condition.
Currently A and E, Out of Hours or Walk in centre are on the dos for referral for low acuity conditions.
Algorithms will require altering. Workshop with Brent and Yasmeen, Out of Hours GPs and Dos lead for NHS 111, NHS England in attendance. 51000 patients could be referred to Community Pharmacy which is 15% of calls to 111. Relief of pressure on out of hours would be beneficial. Next stage could be with referrals from General Practice.
Andre Young and Michael Maguire are shaping the process and the service design. Costings have been laid out. NE steering group to be established, DOS lead, ambulance service, Ken Youngman and Helen Reynard involved, Ann Gunning and Sandie Hall are on this group. Engagement with CCGs and STPs is ongoing. Pharmacy integration fund stakeholders will be engaged. DOS accuracy will be carried out. Pharmacy escalation process will be set up for further clinical advice or support. Pharmoutcomes will be on board with the process. Patient experience needs to be paramount. Call handlers will also require training, to be carried out by SH.
Minor Ailments is a locally commissioned scheme. These patients are all referred in the same way that emergency supply of medicines. Its about channel shifting. How much will be put into a pilot from a funding point of view to implement this service? Money will be put in centrally for the consultation but drug cost will sit with CCG.
Evaluation – NHS body will be used for this process.
South Tees doing incentivising GPs to reduce referrals to A and E and Out of Hours – paid £2.50 per head.
ACTION: SH to look at accuracy of Tees information on the DOS.
Public Health agenda is around early identification of conditions.
ACTION: Health select committee – to be raised by JB, SH to raise with Peter Kelly at MECC group.
ACTION: Training of teams and call handlers to be sent to SH by All
Lorraine Crawford joined the meeting. Introduction of Lorraine for all.
7.PSNC Update
Gareth Jones will dial in from the NPA.
Sunderland LPC – Sue Sharpe will be in attendance – this is to be circulated to all.
PSNC is moving from Kings Cross.
Mark Burdon gave an overview of the current and budget situation with PSNC. Reserves currently sit at around 2 million on the balance sheet which is made up of levy’s collected. At least 6 months running costs plus battle fund. There is currently an overspend for last year’s media and support processes.
Special Levy. £100 on average is requested per contractor as this is based on volume. Contractors have been asked to contribute to the judicial review – Tees LPC will be £22 per contractor.
£800k budgeted for legal fees from our and their side if the judicial review is lost.
£300k PWC have been brought in to look at the economics and statistics provided by Department of Health of the review.
£1.2 million will be battle fund.
All work income and outgoings will be logged and some return of funds will be made.
LPC conference October
November-January is budget and planning for following year is set. There is a level of flex in there will replacement of some items
0 based budget is calculated
Resource development committee
A lot of the future of pharmacy hinges on the end of March Judicial Review. 75% of money on special levy has been received.
The plan is to have a dialogue with the other side. After a legal spat there will be a large process of rebuilding relationships.
JB – is there a possibility of additional funding being required as this process is extended.
Litigation has been the only option available. What would be in the best interests of contractors is the question that has been in the forefront?
Hearing is around the 20th March for 3 days. Following this time we will then have a decision. QC has determined PSNC have a good case.
PH – if PSNC lose and be liable for other costs how long would we have to pay that bill. The other side has to prove case costs but it does have a time limit to payment. Will there be a special levy plus an additional levy should PSNC lose the judicial review. All budgets were planned and reviewed significantly.
RH - Why were items used to determine the fee to each LPC area. MB - Levy collections are reviewed regularly but volume is the fairest way of doing this and it is historical.
EB – they take the money up front – will money come back to LPC? MB – Yes all money will be returned.
BF – we have been asked for 20% of our reserves but PSNC has reserves that have in place. If we have to provide 20% of reserves then 20% should be recouped from PSNC reserves.
Lorraine Crawford and Mark Burdon left the room.
JB gave an opportunity to change mind on the review.
Discussion – PH align with PSNC – we will not dip below our required reserves. The processes need to be more transparent. There should be a written agreement in place for us to recoup any money left.
We will pay and support the process without dropping our reserves below 6 months. In the event of a lost judicial review.
JB - Agree to a proportion of the levy to ensure we are not going below 6 month reserve. This will be communicated next week. If PSNC wins the case then we would expect review. If PSNC loses the case – Tees will commit to the remaining information. Commitment and PSNC to more transparency and open discussions rather than ‘drip feeding’ information. All LPC have confidentiality agreements.
MB – unable to respond to all requests for information as it is not in his gift to do so.
8.CPPE Update
LC has been a tutor for quite some time. CPPE has changed to way it works. LC has decided to step down as a local tutor but will still be an events tutor. Quality payments about how CCPE can support these is now available. Cath McLelland is now full time for CPPE.
Events:
Mental Capacity Act training x 2 coming up – driven by local commissioner’s 22nd March Tees, 27th April in Durham.
12th July CPPE in collaboration with Virgin EHC Event – 40 people.