October 2014 CPN

CPNCommunity Pharmacy News – October 2014

Community pharmacy funding 2014/15Reactions and background to the funding settlement

Your EPS Checklist | Seasonal flu reminder | Is it allowed? pull-out factsheet

2 Community Pharmacy News – October 2014

Pharmacy contractors will by now have

heard that PSNC has reached agreement

with the NHS on a community pharmacy

funding settlement worth £2.8bn and a

number of changes to Advanced Services

and to the Community Pharmacy

Contractual Framework (CPCF) for the

2014/15 financial year.

The New Medicine Service (NMS) will be

continued, with funding for it to come from

the overall settlement; and there are some

changes to targeted MURs with the

introduction of a new target group and a

move for contractors to provide 70% of their

MURs to patients within the target groups.

Contractors will also be required to include

pharmacy names in reports of patient safety

incidents; to give patients appropriate advice

about the benefits of the Repeat Dispensing

service; and to take part in a national audit

on the emergency supply of medicines by

pharmacies next year (in place of an area

team specified clinical audit).

The £2.8bn funding will comprise £2bn to be

delivered in fees and allowances, with the

remaining £800m to be delivered through

agreed purchase margins.

The increase to £800m reflects the fact that

to date, pharmacies have been able to retain

purchase margin earned above the agreed

£500m each year, and this provided, almost

every year, substantial additional income.

As part of the settlement PSNC has agreed

to work with the Department of Health (DH)

to reform the systems for managing margin

delivery and to make changes to

reimbursement.

In order to deliver the allowed purchase

margins, Category M prices will be increased

by £10m per month from October. This

equates to an increase in average item value

of around 12 pence (across all items). But

from November there will be a reduction in

the Practice Payment of around 17 pence per

item in order to ensure that the £2bn in fees

and allowances is delivered, accommodating

volume increases and the inclusion of

funding for the New Medicine Service. Using

current predictions of prescription volumes

this is expected to apply until the end of

March 2015. The impact of these

adjustments will be to reduce income

available to the average contractor by £870

in the second half of 2014/15.

PSNC was unanimous in accepting the

settlement as the best possible outcome for

community pharmacy contractors and a

sound basis for continuing to develop the

community pharmacy service.

Some of the details of the changes, including

the dates from which they must be

implemented, are yet to be agreed and

updates and full guidance will be published

as soon as they are available on PSNC’s

website at psnc.org.uk.

Funding Settlement 2014/15Following the funding settlement announcement contractors should be aware

of the key changes and are advised to read the PSNC Briefings on this topic.

funding and statistics contract and it dispensing and supply ser

FurtherInformation forContractors

PSNC Briefings

To help contractors to

understand the settlement and

the changes to Advanced Services

and the Contractual Framework,

we have published a number of

PSNC Briefings which you can

download from

psnc.org.uk/briefings

They cover:

• Changes to Contractual

Requirements 2014/15

(Briefing 015/14)

• Advanced Services (MURs and

the NMS) (Briefing 016/14)

• Purchase Margin and Margin

Reforms (Briefing 017/14)

• The Settlement Negotiations

and the Negotiating Process

(Briefing 018/14)

• The Cost of Service Inquiry

(COSI) (Briefing 019/14)

• Frequently Asked Question

(Briefing 020/14)

Community Pharmacy Funding

The Funding and Statistics

section of the PSNC website has

been re-arranged to be more

user-friendly and is now split into

six areas:

1. Current arrangements

2. Historical arrangements

3. Ongoing funding work of

PSNC

4. Funding distribution

5. A-Z of funding topics

6. Statistics

Reminder: Don’t miss our settlement updatesContractors are advised to check the PSNC website regularly as further information about the agreed changes, including

implementation dates, will be published there as soon as it becomes available. To ensure that you do not miss this please sign

up for PSNC’s email newsletters at psnc.org.uk/emails

psnc.org.uk 3

the healthcare landscape lpcs psnc’s work

Reaction to the Settlement: PSNC Members Comment

Following the announcement of the funding settlement for 2014/15 a

number of PSNC members have made statements. Some of these are

summarised below and they can be read in full at psnc.org.uk.

rvices and commissioning

The inclusion of funding for the New Medicine Service (NMS)

within the overall settlement means we now have two key

medicines optimisation services at the heart of our contractual

framework; and the development of the MUR service shows a

clear commitment from the NHS to it. The

refocus on Repeat Dispensing and the

decision to have a national audit on

emergency supply also show just how

interested the health service is in what we

can do beyond our core dispensing role.

I know that some contractors are still doubtful about the

benefits of moving towards a contractual framework that

rewards the delivery of services as well as dispensing; but I am

convinced this is something we must do – it helps to cement our

role at the heart of the NHS; it means that as health professionals

we have more to offer our patients; and it helps to secure the

future of our businesses, putting our destinies in our own hands,

rather than us relying solely on the prescriptions issued locally

for our success.

Gary Warner, Chair of PSNC’s Service Development Subcommittee, a PSNC NegotiatingTeam member, and an independent community pharmacy contractor

Although this settlement doesn’t mean lots more money;

what it does mean is that the excess margins that we have

been earning in recent years are now recognised by the NHS

and brought on the table; embedded within our core contract.

Protecting that income is good news for contractors now and

it’s good news for our futures because it shows us that the

NHS does value the supply function that we are doing.

We also need to understand just how

difficult a position the NHS is in at the

moment. The health service must find £20

billion in efficiencies and to do that every

healthcare professional has got to

contribute. Given that we are working in

that environment I do think that this settlement treats us fairly

– it protects our income levels in exchange for some

manageable changes and for a commitment to some reforms to

the systems for managing margin. Over the second six months

of the year contractors will earn around £870 less than they did

in the first half; but that is entirely manageable for a pharmacy

business, and it reflects a smoother delivery of funding over the

year than we have seen in some previous years.

Contractors will no doubt say that we haven’t done enough,

and of course our eye is always on what comes next and what

more we can do, but I do think that this settlement is an

important one for us, and I believe it represents a good and a

fair result for both our businesses and the NHS.

Kirit Patel, Vice-Chair of PSNC and Founder and Chief Executive of the Day Lewis Group

This settlement has been a long time coming; but I hope that

it brings some relief for pharmacy contractors. From this

October we will see additional money being put into Category

M – this is unusual and I hope it will be welcome news. But

contractors must also recognise that from November it will be

balanced by a reduction in fees to ensure that we are on

target to deliver the agreed £2billion in fees and allowances.

The agreement by the NHS to allow us

£800m in purchase margins is a win for us.

Although the money is not new for us

because it reflects the benefits of excess

margins that we have had in previous years;

the increase to £800m is a step forwards and shows how much

the health service does value the supply function we provide.

In exchange for this we have agreed to work with the NHS on

some changes and reforms to reimbursement. This will be

complex and time-consuming work but PSNC’s Funding and

Contract Subcommittee includes representatives from

pharmacy businesses of all types and contractors can be

assured that our priorities will be to ensure stability and

fairness in reimbursement. We hope the work to stabilise the

delivery of margin will help to reduce some of the cash flow

problems we have seen in recent years.

Peter Cattee, Chair of PSNC’s Funding and Contract Subcommittee, a PSNC NegotiatingTeam member, and CEO of PCT Healthcare


As part of PSNC’s ongoing work to

promote pharmacy and to engage with

politicians and policy makers, we

organised fringe events at both the Labour

and Conservative party conferences this

year in partnership with the British

Association of Pharmaceutical Wholesalers

(BAPW) and the Dispensing Doctors’

Association (DDA).

The events were entitled Getting

medicines to patients: could the wheels

come off the wagon? and they

highlighted the difficulties being faced by

pharmacies trying to obtain the medicines

their patients need in a timely manner.

We know that medicines supply continues

to be a significant problem for pharmacies,

and our intention with this work was to

ensure that policy makers are aware of the

impact that the problems are having on

the sector; and to gather support for our

work to find solutions. At the events we

heard from MPs including Sir Kevin Barron,

as well as patient groups and other

interested parties.

Alongside the events we have created an

information website for politicians,

healthcare bodies and members of the

public which explains how the medicines

supply chain operates and encourages

them to report any problems they have

experienced getting hold of prescription

medicines and to register their interest in

our work on this matter.

The website includes:

• A video called Getting Medicines to

Patients explaining how medicines get

to patients;

• A flyer explaining the issues faced by

the UK medicines supply chain;

• An email sign-up form to collect details

of those people who are interested in

this topic so we can build a group of key

allies;

• A reporting form for patients to tell us

about any problems they have had

getting medicines so that we can use

the data anonymously to work to

protect the supply chain.

The key aims for our campaign are as

follows:

Recognition: the medicines supply

chain must be as highly valued as any

other NHS service.

24-hour deliveries: pharmacies and

dispensing doctors must be able to

receive all medicines within 24 hours

of ordering them.

Protection: local authorities,

commissioners and policy makers

must understand the complexity and

importance of this under-appreciated

core of our NHS, and take it into

account as they assess care needs

and plan future services.

Find out more about our work on this topic

at patientsneedtheirmedicines.co.uk

Patients Need Their Medicines CampaignAt the party conferences, PSNC highlighted supply problems to politicians

and patient groups and we have launched a website to collate patient views.

psnc’s work funding and statistics contract and it

�

Conservatives

The party had a clear focus on health with

the Prime Minister announcing that they

would protect the NHS budget and

continue to invest more in the next

parliament. Plans to make it easier for

people to get GP appointments between

8am and 8pm and at weekends were also

announced.

Health Secretary Jeremy Hunt indicated

that the Government could not afford

greater than inflation spending increases

on the NHS, but he said they would have no

greater priority than to “protect, support

and invest in our NHS”. He stressed the

need for a focus on providing personal care.

Labour

Party leader Ed Miliband promised an

annual additional £2.5bn investment in the

NHS – a ‘Time to Care’ fund – if the party is

elected. This would fund an extra 8,000

GPs, 20,000 nurses, 5,000 care workers

and 3,000 midwives and come from taxes

including a ‘mansion tax’ and a tax

avoidance clampdown. Shadow health

secretary Andy Burnham led calls for

better integration of health and social care

and for the coordination of care to meet

all of people’s needs: physical, mental and

social; and the party promised “to repeal

the NHS Bill and stop the creeping

privatisation of the NHS”.

Liberal Democrats

Liberal Democrats leader and Deputy

Prime Minister Nick Clegg promised to

protect the NHS budget in real terms;

raising an extra £1bn for it every year, by

“ending three different tax breaks which

benefit the highest earners”. The party

was also committed to increasing

spending in the future too.

Mental health is a key focus for the party,

and Care Secretary Norman Lamb restated

their commitment to ensuring faster and

more consistent access to help and

treatment. He also called for an NHS

focusing more on prevention than repair;

and stressed the need to focus on

personal care.

Politicians focus on healthHealth and the NHS were high on the agenda at the Party Conferences; with politicians promising

a range of reforms and improvements. Here’s a summary of some of the key pledges made.

psnc.org.uk 5

services and commissioning the healthcare landscape lpcsdispensing and supply

The Essential EPSR2 checklistAs GPs gear up to increase the extent to which they use the Electronic

Prescription Service (EPS), this quick reference guide will help pharmacy

teams to ensure they are getting the most out of the system.

A third (33%) of GPs have gone live with processing electronic prescriptions, and the figures are set to rise rapidly over the coming

months. To obtain the full benefit of the Electronic Prescription Service Release 2 (EPSR2), and minimise disruption to your business,

we’ve developed this quick reference guide to help pharmacies ensure that all the relevant bases are covered when it comes to

processing EPSR2 prescriptions. Whether you’re preparing for EPS because a local GP is going live or, you are already dispensing

electronic prescriptions, the checklist below has been created to help you and your pharmacy team with EPS.

Pharmacyactions

Explanation & guidanceKey informationlinks

Notes andcompletion date

Know when yourlocal GPs aregoing live There is an 8-weekprocess for GPs whowish to start using

Release 2

• GPs must give at least 8 weeks notice before they startusing Release 2 so that pharmacies and others have timeto prepare.

• Your LPC should inform you when local GPs are goinglive, and may delay the go-live date if pharmacies are notready.

• Local deployment: You can use the HSCIC site to learnwhich GPs have ordered an R2-system, and see theexpected dates they will go live; or you can see a mapdisplaying GPs who are (1) live, (2) going live, and (3) notlive yet.

lpc-online.org.uk/

tinyurl.com/epsdeployment

Meet and workwith GPs

• Take up opportunities to take part in business processchange sessions at the GP practice, or contact your GP toarrange a meeting which other local pharmacies may alsoattend.

• Use the engagement checklist to make sure that your GPand pharmacy staff know how they will work together, forexample where:• the pharmacy loses internet/EPS access• a patient needs a combination of paper and electronic

scripts• non-routine clinical information needs to be passed on

to the patient.

You can find theengagement checklistusing the followinglink: psnc.org.uk/epsmeetgp

Ensure allrelevant staff arefully trained onEPSR2 and yourPMR system

• Find out what type of PMR system training is offeredand take part: E.g. one-to-one staff training, webinars,training videos, user manuals, quick reference guidesand/or desk aids and help files on the system.

• Plan the training so all staff will be trained in time forGP go live. The most effective training will be that takenplace shortly before staff start to deal with electronicprescriptions. Training undertaken too early may beforgotten.

• Consider appointing an 'EPS champion' within thepharmacy who staff can go to for support andtroubleshooting.

• Make provision for the training of part-time staff andlocums.

psnc.org.uk/epstraining

tinyurl.com/epstrainingmatrix


dispensing and supply services and commissioning the healthcare landscape

Gathernominations

• During meetings with GPs you may wish to agree howyou will handle nominations.

• Patient communications: Consider your approach toexplaining EPS to patients. Will patient leaflets, signs orvideos be available to patients?

• Nomination guidance: Ensure staff gatheringnominations are familiar with the national guidance.

• Re-confirmations needed? Nominations collected onpaper but not adjusted on the EPS system for more than 6weeks may need re-confirmation before these areadjusted onto the national EPS/spine. This is in casepatients had switched their nomination to anotherpharmacy during the interim period.

tinyurl.com/nominationguidance

psnc.org.uk/nomination

Check yourSmartcards are allworking correctly

• Obtain Release 2 Smartcards with the appropriate rolesassigned for each member of staff dealing withprescriptions (dispensing technicians, pharmacists etc.)and test that these work okay.

• Passcodes: Are these known. Can all staff use theirsmartcards or are any locked?

• Local Registration Authority (RA): Do you know theirdetails? Your RA is responsible for providing cards anddealing with card issues. They are commissioned by thelocal Area Team. RA contact information may be availablefrom your AT or on your LPC site.

psnc.org.uk/smartcards

Relevantstationery

• Check you have dispensing tokens. You may need toorder them from your local NHS England Area Team.

psnc.org.uk/tokens

Check your NHSChoices profile

• Pharmacy details: Are yours correct on NHS Choices?Where patients ask the GP about live pharmacies, the GPmust provide a list of local R2-enabled pharmacies, basedon NHS Choices information.

psnc.org.uk/choices

Contingencyplanning

• Know who to contact in the event of a problem. Use the IT troubleshooting guide, and fill in contactinformation.

• Contingency plan in case there is loss ofinternet/power/EPS.

• Signup to receive Spine alerts so you know if there areissues with the national EPS system.

psnc.org.uk/contingency

tinyurl.com/spinealerts

Reporting systemissues andmaking yoursystem work foryou

• Report all system problems and issues, however minor,to your supplier who may resolve some over the phone,and add others to a work plan as a future development.

• Helpdesk reference number: Always obtain one whencontacting your supplier so the issue can be escalated viaother routes if needed.

psnc.org.uk/systems

PrescriptionpaymentErrors onprescriptionendorsement andclaiming couldcost you

• Ensure you will be properly reimbursed. For example,are all relevant staff familiar that:• Exemption status and endorsements need to be applied

correctly to each electronic prescription before claiming. • Expiry takes place for prescriptions which go unclaimed

for six months (180 days after the date of issue) andonce expired, prescriptions cannot be submitted to thePricing Authority (PA). Check that your system willensure that no prescriptions can expire without warning.

psnc.org.uk/epssubmission

psnc.org.uk/epsexemption

psnc.org.uk/epsexpiry

Understand howto submit yourelectronicprescriptions

• FP34C totals will include the total of paperprescriptions/items and electronically submittedprescriptions/items.

• Dispensing tokens are submitted to the PA, but for auditpurposes only. The PA use the electronic exemptionstatus. Only those exempt for a reason other than age arerequired to be sent.

psnc.org.uk/epssubmission

Pat Hanlon, kidney cancer survivor

‘Blood in pee’: Briefing for pharmacy teams H

psnc.org.uk 7

psnc’s work funding and statistics contract and itlpcs

Factsheet courtesey of Public Health England

‘Blood in pee’: Briefing for pharmacy teamsHow you can help support the campaign13 October – 23 November 2014

Public Health England will be running a national campaignto raise awareness of blood in urine as a symptom ofbladder and kidney cancers. We need your continuedsupport to help improve early diagnosis of these diseases.

What is Be Clear on Cancer?Be Clear on Cancer aims to improve early diagnosis of cancer byraising awareness of the signs and symptoms, and encouragingpeople to see their GP without delay.

What is the main message of the campaign?If you notice blood in your pee, even if it’s ‘just theonce’, tell your doctor straight away

What activities will be taking place and when?Advertising will start on 13 October 2014, and will include TV,radio, digital (eg YouTube) and out of home (eg washroomposters). There will also be events in public places (eg shoppingcentres), a schedule for which will be made available on theNAEDI website once finalised. TV advertising will run until 9November, while all other communications will end between 9and 23 November 2014.

Why are you re-running the national ‘blood in pee’campaign?Early results from the first national ‘blood in pee’ campaign,which ran in autumn 2013, are promising. Despite this, we wantto keep the campaign message at the front of people’s mindsand there’s still a great deal of potential to improve bladderand kidney cancer survival in England.

This campaign will be slightly less intense than the first nationalcampaign. There’ll be no direct mail to individual householdsand the TV advertising will also be a little less intense this year.Check the NAEDI website regularly for further updates in therun-up to the campaign start date.

Who is the ‘blood in pee’ campaign aimed at?Men and women from lower socioeconomic groups over theage of 50, and the people who influence them, such as friendsand family.

Why focus on ‘blood in pee’?Blood in urine (haematuria) is the most common symptom ofbladder and kidney cancers. Yet, when asked to name cancersigns and symptoms, only a third of people mentionunexplained bleeding.

Other bladder cancer symptoms include:• Needing to pass urine very often or very suddenly• Pain when passing urine.

Other kidney cancer symptoms include:• A constant pain below the ribs• An abdominal mass• Other more vague symptoms include unexplained weight

loss, high temperature, night sweats, a general sense offeeling unwell, or tiredness.

Who is most at risk of bladder and kidney cancers?• Age – People aged 50+ account for around 97% (8,600 cases)

of those diagnosed with bladder cancer each year, and 90%of all kidney cancer cases (around 7,300 each year)

• Men – bladder and kidney cancers are more common in men,although women are affected too

• Smokers have a much higher risk of developing bladder orkidney cancer, with nearly 4 in 10 bladder cancers, and 1 in 4kidney cancers estimated to be caused by smoking

• Being overweight or obese accounts for 1 in 4 cases ofkidney cancer

• Exposure to certain industrial chemicals – around 7% ofbladder cancer cases in men and 2% in women in the UK areestimated to be linked to occupational exposures

• Some other medical conditions, such as kidney disease• Having a family history of bladder or kidney cancer.

naedi.org/beclearoncancer/bloodinpee Supportedby

Last updated: 15 September 2014

Pat Hanlon, kidney cancer survivor


the healthcare landscape lpcs psnc’s work

Factsheet courtesey of Public Health England

Is there any evidence the ‘blood in pee’ campaign will work?Results from previous ‘blood in pee’ campaigns to date indicatethat Be Clear on Cancer is successfully changing levels of publicawareness. There are also early indications that clinicaloutcomes are improving too. Initial evaluaton results followingthe first national campaign show:• Over 2 in 5 spontaneously mentioned blood in pee as a

symptom of bladder or kidney cancer (44% up from 27% pre-campaign)*

• After the campaign there was an increase in people sayingthey would see their GP if they noticed blood in their pee justonce, up from 49% to 55%*

• 26% increase in two-week wait (2WW) referrals for suspectedurological cancer*†.

The regional pilot campaign that ran from January to March2013 in the Tyne Tees and Border TV regions has also shownpositive results:• 48% increase in bladder cancer diagnoses in pilot areas

following a 2WW referral*, compared with a 12.3% decreasein control areas*

• 47% increase in kidney cancer diagnoses in pilot areasfollowing a 2WW referral*, compared with an 8.5% increasein control areas.

* Statistically significant

† Pathway covers several cancer types in addition to bladder and kidney cancers

‘When I told my wife I’d noticed blood in my pee, she said Ishould see my doctor as soon as possible. I wasn’t sure, as itwasn’t painful, but I’m glad I listened to her.’Pat Hanlon, aged 72, kidney cancer survivor

How can pharmacy teams support this national campaign?Since pharmacies are often the first port of call for thosesuffering with urinary symptoms, you have an opportunity to bevigilant for people who may be showing symptoms of bladderor kidney cancer. Many people find it easier to discuss theirworries in an informal pharmacy setting. GPs will be followingNICE guidelines, which recommend a referral if:• haematuria is painless• the patient is over 40 and has recurrent or persistent urinary

tract infections (UTIs) associated with blood in urine• the patient has blood in urine with no identifiable infection.

‘Lots of people don’t realise that blood in pee could be asymptom of cancer, even if it only happens once. Thecampaign has a really clear message, one which pharmacyteams are in an ideal position to actively reinforce. Weneed to reassure our customers and help them overcomeany fears or worries they might have. Whether findingblood in the urine is a one-off, or something that keepshappening, encourage people to get themselves checkedout.’Ann Gunning, MRPharmS

Conducting cancer conversations with customers can bedifficult. Do you have any tips?A Cancer Research UK nurse, who specialises in communicatingabout cancer, advises:‘It is important for pharmacists and their teams to feel confidentand to try and make cancer a normal part of conversation. Forexample, if you are worried about someone who has repeatedlybought an OTC medicine for a suspected cancer symptom, youcould ask: “What does your doctor say about that?”.’

Some people may be reluctant to visit their GP. Remindcustomers that their symptom/s may not be anything to worryabout, and if they are worried it is cancer, reinforce that getting itdiagnosed and treated early can make a big difference.Pharmacy employees who feel uncomfortable talking aboutcancer should seek the advice of their pharmacist.

How are GPs and hospitals preparing for the national ‘bloodin pee’ campaign?NHS Improving Quality will work with Strategic Clinical Networksto help ensure the NHS is prepared for the campaign. There arealso additional briefing sheets to support GPs and to helphospital providers plan for anticipated increases in referrals anddiagnostic tests.

Three things you can doMake it part of your day. During your regularconsultations, such as medicine-use reviews or when selling

over-the-counter medicines, be mindful that the people you aretalking to may have seen the campaign. It may prompt peoplewho have previously ignored symptoms, or discounted them as aone-off, to ask you about it; they may come to your pharmacylooking for OTC medicines or advice.

Give people confidence. People can delay going to see their GPand often seek reassurance from other healthcareprofessionals about making a GP appointment for a sign or

symptom they are concerned about. If customers have noticedblood in their urine, whether it’s just the once or frequently,alongside a recurring UTI, urge them to visit their GP withoutdelay. If you feel comfortable doing so, tell them to mention thattheir pharmacist sent them. It may be the encouragement theyneed to get themselves checked out.

Promote the campaign. Talk to your friends, family, customersand colleagues about Be Clear on Cancer. By talking aboutthe campaign you will help people to feel more comfortable

about sharing details of a sign or symptom of cancer they mightbe experiencing. Put up posters in your pharmacy and have some‘blood in pee’ leaflets readily available for customers.

To order free campaign materials (including accessible versions),visit the Health and Social Care Publications Orderline or call0300 123 1002.

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Key facts about bladder and kidney cancer• If kidney and bladder cancers are diagnosed at the earliest

stage, one-year survival is as high as 91–96%.At a late stage, it drops to just 33–42%

• It has been estimated that around 1,000 deaths frombladder and kidney cancers could be avoided each year ifsurvival rates matched the best in Europe

Find out more• Visit naedi.org/beclearoncancer/bloodinpee• Familiarise yourself with the adverts at

nhs.uk/bloodinpee, the public-facing website• Visit the British Oncology Pharmacy Association’s

E-learning Centre which can help you raise the subjectof cancer with patients

psnc.org.uk 9

contract and it dispensing and supply services and commissioning

GP contract changes 2015/16

NHS Employers and the General

Practitioners Committee of the BMA have

announced changes to the GMS contract in

England for 2015/16. A final decision on

any uplift to the GMS Contract has yet to

be made. The changes include:

• A named, accountable GP for all patients

who will take lead responsibility for the

co-ordination of all appropriate services;

• Publication of GP net earnings;

• A further commitment to expand and

improve the provision of online services

for patients;

• The avoiding unplanned admissions

Enhanced Services will be extended for

a further year;

• There will be a 15% reduction in the

total seniority payments as agreed in

2014/15; and

• GPC, NHS Employers and NHS England

will have a broader strategic discussion

about the primary care estate, especially

to support the transfer of care into a

community setting.

Consultants for GP practices

Simon Stevens, Chief Executive of NHS

England, has suggested that GP practices

could form expanded group practices

which employ or take on as partners

hospital consultants, community nurses,

pharmacists, social workers and potentially

other clinicians. These group practices

could be delegated budgets on a whole

population basis.

NHS England’s new area team structure

The Health Service Journal has reported

that NHS England will move from its

current 24 area teams outside of London,

to a new structure with half that number.

NHS England announced it was reviewing

its area and regional structure earlier this

year and the merger of area teams was

widely anticipated. The regional offices are

expected to take on roles currently

performed by area teams, including

responsibility for specialised

commissioning.

Limited use of AQP by CCGs

Research undertaken by the Health Service

Journal suggests that a minority of CCGs

have used Any Qualified Provider (AQP)

during 2014/15 and interest in the

approach seems to be waning.

MyNHS transparency website launched

A new website – MyNHS

(www.nhs.uk/mynhs) – has been launched

which links existing data that has already

been published on patient safety,

efficiency, quality, public health and social

care commissioning.

Think-tank backs self management of

LTCs

Research by the Institute for Public Policy

Research (IPPR) has found that three

quarters of patients with long-term

conditions want more of their health

needs to be managed independently at

home, but a lack of information and

support prevents them from being able to

do so. Community pharmacies are well

placed to provide this support.

PSNC regularly receives questions from LPCs and

pharmacy contractors about what is going on in the

wider health and care landscape beyond community

pharmacy. In this round-up we cover the latest news

from the past month.

funding and statistics

Reminder: seasonalflu vaccinations

Pharmacists and other professionals have

been reminded of the importance of

vaccinating staff against flu.

In a letter to PSNC, the Department of Health

wrote: “As part of their duty of care to their

patients or residents, care professionals

should do everything in their power to protect them against

infection. This includes getting vaccinated against flu.”

The Department stressed that although there was an

improvement in vaccine uptake last year; levels were still below

the 75% target.

The Department said it was the responsibility of employers to

make the vaccination available to their employees free of charge.

Read the letter in full at tinyurl.com/2014fluletter

Q. Why is it recommended that pharmacy contractors offer flu

vaccinations to their staff?

A. All employers have an overarching health and safety duty of

care to their employees. The Department of Health have advised

employers of healthcare workers to offer flu vaccinations to

their staff to reduce the spread of infection and to aid staffing

resilience during the winter months.

Q. Do pharmacy contractors get any funding from the NHS to

cover the cost of vaccinating their staff?

A. Offering flu vaccinations to employees is not mandatory and as

an occupational health matter it falls outside the scope of NHS flu

vaccination services. As an example, GPs cannot immunise their

own staff as part of occupational health arrangements under the

NHS flu vaccination service that is commissioned by NHS England.

If employers decide to offer flu vaccination to their staff it is a

cost to them; all employers in health and care will incur this cost

where they choose to offer vaccination to their staff. We are not

aware of any NHS providers being given specific funding for

provision of vaccinations to staff; NHS commissioners view it as a

cost which has to be covered by the general funding they

provide to healthcare providers.



Where do I get the BNF from?

Pharmacies with one registered pharmacist will receive

a single copy of the BNF/BNFc, and pharmacies with

two or more registered pharmacists will receive 2

copies of the BNF/BNFc, once a year in September.

Any community pharmacists who have not received

copies should contact Binleys ([email protected] or

01268 495 609) to ensure they are registered to

receive copies in future.

Please also note that BNF and BNFc content can be

accessed online at www.bnf.org.

You can find information on where to get other

pharmacy resources, from FP57 Receipt and Refund

Forms to Prescription Recheck Request Forms, by

visiting psnc.org.uk/externalresources

When pharmacies receive NHS prescriptions they must check whether the items prescribed are allowed on the NHS before dispensing. If they are

not allowed, the pharmacy may not be paid for them.

Pharmacies can check whether medicinal products and medical devices are allowed using the Drug Tariff:

Medicinal products: assuming the prescriber has the appropriate prescribing rights, any food, drug, toiletry or cosmetic may be prescribed on an

NHS prescription unless the product is listed in Part XVIIIA of the Drug Tariff (the ‘blacklist’).

Medical devices: If a product has been registered as a medical device (also known as an appliance), it can only be prescribed on an NHS prescription

if it is listed in Part IX of the Drug Tariff. Registered medical devices can be identified by a ‘CE’ mark on the product’s packaging.

Dispensers may wish to check PSNC’s Disallowed Appliance List (psnc.org.uk/disallowedappliances) for medical devices they are unsure about, and

we have listed some products below that we have recently received queries about:

Product Is the item Does it Is it Can it be Additional information listed in the have a ‘CE’ in the dispensed Drug Tariff? mark? blacklist? on the NHS

Please note: If the prescription is one of the following, pharmacies will need to check the relevant sections of the Drug Tariff/PSNC website:

• FP10CN or FP10PN (community nurse prescriber) – Part XVIIB

• FP10D (dental prescriber) – Part XVIIA

• FP10MDA (instalment dispensing) – psnc.org.uk/mda

Is it allowed?

Ibuprofen lysine

400mg oral powder

sachets

Yes vaginal

lubricant 75 ml

Posey sheath

holder adult 90500

12 device

Ergocalciferol

3,000units/ml oral

solution

Tegaderm Film

dressing 20cm x 30cm

No

Yes

No

Yes

No

No

Yes

Yes

No

Yes

No

n/a

n/a

No

n/a

Yes

Yes

No

Yes

No

Ibuprofen lysine 400mg oral powder sachets are not CE marked

and they are not listed in Part XVIIIA (the ‘blacklist’) of the Drug

Tariff, therefore they are allowed on FP10

Yes vaginal lubricant is a registered medical device and appears in

Part IXA of the Drug Tariff so it is allowed on FP10

Posey sheath holder adult 90500 12 device was deleted from Part

IXA of the Drug Tariff in August 2014. As such, it’s no longer

allowed on FP10

Ergocalciferol 3,000units/ml oral solution is listed in Part VIIIB of

the Drug Tariff therefore it is allowed on FP10.

Tegaderm Film dressing 20cm x 30cm is CE marked and is not listed

in Part IXA of the Drug Tariff, so it’s not allowed on FP10

Drug Tariff Dual ListingsAppliances can appear in the Drug Tariff with a ‘dual listing’. This

occurs when the name of a Drug Tariff listed appliance changes, to

give prescribers time to change their prescribing habits from using the

old name to the new one. During this period of grace, which usually

lasts for 12 months, both the old and new name of a product are listed

in the Tariff and prescriptions for using either name will be passed for

payment by the Pricing Authority. When the dual listing is removed,

only prescriptions using the new name, as it appears in the Drug Tariff,

will be reimbursed.

By way of an example we’ve outlined the changes to Advasil Conform:

The September Drug Tariff had the following dual listing “ Advasil

Conform (including products formerly listed as Advasil)” so therefore

prescriptions dispensed for Advasil and submitted with September’s

bundle will be passed for payment. However as of October, this dual

listing has been removed and this product will only be reimbursed if

prescribed as Advasil Conform

psnc.org.uk 11


Drug Tariff WatchYour monthly summary of any additions, amendments and deletions being

made to the Drug Tariff to help with dispensing and endorsements.

The first section of the Drug Tariff is the Preface. This contains

valuable information relevant for both the current edition and

the next. It lists additions, deletions and any other alterations to

the Drug Tariff. The Preface should ideally be checked each

month to identify products which are entering or being removed

from the Tariff as well as those products changing between

categories or in the case of Category C items, changes to the

brand used for pricing.

It’s especially important to note Drug Tariff listed products as well

as changes to the category of a product along with the pack sizes

being included in these entries, as reimbursement will be based

on this classification and its endorsement requirements. Incorrect

endorsement can lead to incorrect payment for items.

It’s also important to know the category of an item when claiming

certain payments (e.g. OOP expenses) as these are not allowed

for some categories.

Below is a quick summary of the changes due to take place from

November

Part VIIIA Additions

Category A Additions:

• Glycopyrronium bromide 1mg tablets 30

• Glycopyrronium bromide 2mg tablets 30

• Perindopril erbumine 4mg / Amlodipine 10mg tablets 30




Category C Additions:

SC Special Container

• Brinzolamide 10mg/ml / Brimonide 2mg/ml eye drops SC 5ml -

Simbrinza

• Colecalciferol 25,000units/ml oral solution sugar free 3

ampoule - InVita D3

• Donepezil 1mg/ml oral solution sugar free 150ml Rosemont

Pharmaceuticals Ltd

• Empagliflozin 10mg tablets 28 - Jardiance

• Empagliflozin 25mg tablets 28 - Jardiance

• Olodaterol 2.5micrograms/dose solution for inhalation

cartridge with device CFC free

SC 60 dose - Striverdi Respimat

Part VIIIA Amendments

R Item requiring reconstitution

• Ampicillin 250mg/5ml oral suspension R (100ml) is changing to

Category C - Penbritin Forte

• Orphenadrine 50mg tablets (250) is changing to Category C -

Disipal

Part IX Deletions

Make careful note of removals from Part IX because, if you

dispense a deleted product, prescriptions will be returned as

disallowed and therefore payment will not be made for

dispensing the item.

• Interpose (all sizes)

• N Woundcare Sterile Pack.

• Extracellular Matrix Protein (0.5ml and 1ml) – Xelma

• WipeAway Adhesive Remover (50ml spray) - Salts Healthcare

All details correct at time of printing.

No part of this publication may be reproduced without the written permission of the PSNC.

Produced for the PSNC by Communications International Group. ©. PSNC.

Colour repro and printing by Truprint Media, Margate.

The publishers accept no responsibility for any statement made in signed contributions or

in those reproduced from any other source.

Communications International Group

Linen Hall, 162-168 Regent Street, London W1B 5TB

Tel: 020 7434 1530 Fax: 020 7437 0915

Distributedfor PSNC by:

Medicines Optimisation Scratch Card now availableCommunity pharmacy teams can now download a medicines optimisation scratch card designed to help them to have

conversations about medicines with patients and to potentially create opportunities to offer pharmacy services such as MURs

and NMS.

The postcard-sized cards, developed by Pfizer in consultation with the NPA and

supported by PSNC and others, contains five simple statements about medicines use

and patients can scratch a section of the card to indicate how strongly then agree or

disagree with each statement. A member of the pharmacy team will be able to

interpret the responses and provide appropriate advice.

View and download the Pfizer Scratch card from psnc.org.uk/murresources or order

additional resources to support the campaign from accesspfizer.co.uk



Dispensing Factsheet: Is This Item Allowed?The following factors can affect whether an item is

allowed to be prescribed on the NHS or not.

1. What prescribing rights does the prescriber have?

Different types of prescribers hold different prescribing rights. It is important for pharmacy staff to be

able to identify which products each prescriber type is entitled to prescribe.

Type of prescriber Licensed or unlicensed medicine, food, drug, toiletry or cosmetic

Appliances or chemical reagents

Doctors (GPs) Can prescribe any of these, except productslisted in Part XVIIIA of the Drug Tariff (theblacklist).

Can prescribe any that are listed inPart IX of the Drug Tariff.

Dentists(See Part XVIIA of theDrug Tariff)

Can only prescribe products included in theDental Prescribing Formulary on an FP10Dprescription. Can also prescribe by brand forgeneric items listed in their formularyprovided the brand is not listed in PartXVIIIA of the Drug Tariff (the blacklist).

Can only prescribe if the applianceis listed generically in theirformulary

Communitypractitioner nurseprescribers(See Part XVIIB(i) ofthe Drug Tariff)

Can only prescribe products included in theNurse Prescribers’ Formulary for CommunityPractitioners. They are allowed to prescribeby brand. Can also prescribe by brand forgeneric items listed in their formularyprovided the brand is not listed in PartXVIIIA of the Drug Tariff (the blacklist).

Can prescribe any appliance listedin Part IX of the Drug Tariff as theyare included in their formulary.

Optometristindependentprescribers(See Part XVIIB(ii) ofthe Drug Tariff)

Can prescribe any licensed medicine forocular conditions affecting the eye andsurrounding tissue, but are not authorisedto prescribe any Controlled Drugs.

Can only prescribe if the applianceis listed in Part IX of the Drug Tariffand is for ocular conditionsaffecting the eye and surroundingtissue.

Nurse and pharmacistindependentprescribers(See Part XVIIB(ii) ofthe Drug Tariff)

Can prescribe any medicine for any medicalcondition within their level of expertise andcompetence (except those in the blacklist).They can prescribe any Controlled Drug inSchedules 2 to 5 (except diamorphine,dipipanone or cocaine for addiction).

Can prescribe any listed in Part IXof the Drug Tariff.

Supplementaryprescribers Can prescribe any medicine (except those in

the blacklist) as agreed as part of a patient’sclinical management plan.

Can prescribe any listed in Part IXof the Drug Tariff.

More details on prescribing rights can be found at psnc.org.uk/prescribing

2. Is the item a medicine or a medical device (also known as appliances)?

The easiest way to tell the difference between medicinal products and medical devices is to look for a mark which signifies that

the item is a medical device. The CE mark can normally be found on the packaging of a device.

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PSNC websiteFor up to date information and news on community pharmacy issues, visit the PSNC website at psnc.org.uk

PSNC Community Pharmacy News is published by:The Pharmaceutical Services Negotiating Committee, Times House, 5 Bravingtons Walk, London N1 9AWCommunity Pharmacy News is edited by:Zoe Smeaton who can be contacted at the above address or by email at: [email protected] © PSNCPSNC Office: 0844 381 4180 or 0203 122 0810

Supporting PSNC

Is the prescription item listed in the Drug Tariff?

NO, Check whether the item is CE marked.

(CE marks can be found on the packaging)

YES, the item will be allowed provided it's not listed

in the blacklist [Drug Tariff - Part XVIIIA]

YES, it's CE marked.The product will be disallowed.

Only products which are recognised as medical devices and listed in the

Drug Tariff are allowed.

NO, it's not CE marked.If the item is a medicinal product or a

borderline substance it will be allowed.

FP10, FP10SS, FP10SP*Prescriptions issued by a GP, supplementary

or independent prescriber

3. How to check the item is allowed on the NHS

This flowchart should help identify which items can be dispensed against an NHS prescription

4. In conclusion

Medicinal products: Subject to prescribing rights, any food, drug, toiletry or cosmetic may be prescribed on an NHS prescription

unless the item is listed in Part XVIIIA of the Drug Tariff (the ‘blacklist’).

Medical devices: If a product has been registered as a medical device (also known as an appliance), it can only be prescribed on an

NHS prescription if it is listed in Part IX of the Drug Tariff.

5. Common Disallowed Appliances List

If you are unsure of whether your prescription item is allowed, visit our Common Disallowed Appliance List

(psnc.org.uk/disallowedappliances).

6. Further support

If you are still unsure, the PSNC Information Team can help: call us on 0844 381 4180 or 0203 1220 810, alternatively email us at

[email protected]

For the most up to date information, please visit the PSNC website: psnc.org.uk/allowed

*Please note: For other NHS prescriptions,please check below:• FP10CN or FP10PN (nurse) – see Drug Tariff

Part XVIIB• FP10D (dentist) – see Drug Tariff Part XVIIA• FP10MDA (instalments) – visit our website

psnc.org.uk/mda



Ask PSNCThe PSNC Information Team can give pharmacies support and advice on a range of

topics related to the Drug Tariff and reimbursement. Questions the team have been

asked by pharmacies in recent months have included:

1. Is Kerraped All Purpose Boot medium prescribable by a

community practitioner nurse on an FP10?

Yes. Kerraped All Purpose Boot medium is prescribable on an

FP10 by a community practitioner nurse as it is listed in Part IXA

of the Drug Tariff and community practitioner nurses can

prescribe any appliance listed in Part IX of the Drug Tariff as they

are included in their formulary. For more information on which

prescribers hold what prescribing rights see attached Dispensing

Factsheet: Is This Item Allowed?

2. I have a prescription for a patient who was 59 when his

prescription was written, however the patient did not hand over

his prescription to be dispensed until he was 60. Is the patient

exempt from paying a prescription charge?

Yes, subject to the prescription still being within the period of

validity.

Entitlement to prescription exemption is based on the patient’s

circumstances at the point of dispensing rather than on the date

the prescription was written. In this case, as the patient was over

60 when they entered the pharmacy to have their prescription

dispensed, they would be exempt from paying a prescription

charge.

If the patient’s age is shown on the front of the prescription as

“59”, then the patient should sign the back of the prescription

form to declare that they are indeed over the age of 60 at the

point of dispensing.

3. I have dispensed the final batch from a patient’s repeat

prescription. How do I submit the authorising (RA) form to the

Pricing Authority?

Authorising (RA) forms should be submitted to the Pricing

Authority at the end of the month in which all batch issue forms

have either been dispensed or expired or the medication is no

longer required.

It is important that forms are sorted for submission in the correct

order as detailed on the reverse of Form FP34C. In months where

repeat authorisation forms are being submitted, tick the

appropriate box on the FP34C Submission Form to indicate this.

There is no need to declare the number of repeat authorisation

forms submitted.

4. I have tried to renew my registration of exemption for the

storage of waste, but the Environment Agency say this is not

required - is this correct?

Yes. Pharmacies are now automatically exempt from the need to

hold environmental permits (the successor to waste management

licences) where they are temporarily storing waste for the

purpose of transferring the waste elsewhere for disposal. The

conditions that apply include:

• The waste must be stored in secure containers;

• No more than 50 cubic metres of solid waste can be stored;

• The waste cannot be stored for longer than three months;

• The service is not provided as a waste management service

(e.g. you do not receive payment for the service);

• The waste must not have a flash point of less than 21ºC.

5. I have been told that I must register with the Environment

Agency if I denature controlled drugs. Is this correct?

Yes. This is known as a ‘T28’ exemption. Registration of this

exemption is straightforward, and can be completed online on

the Environment Agency’s website www.gov.uk/waste-

exemptions-treating-waste. If you have difficulty with

registration, contact your local Environment Agency.

Look out for more frequently asked questions next month…

If you would like more information on any of the topics covered,

the PSNC Information Team will be happy to help (0844 381 4180

or 0203 1220 810 or e-mail [email protected]).

Problems obtaining a medicine or appliance?Pharmacies who experience problems in obtaining medicines (generic or branded)

or appliances are reminded to feed this back to the PSNC Information Team to

support PSNC’s ongoing representation of issues in the supply chain.

PSNC passes a monthly summary of the feedback received to the Department of

Health to support their monitoring of the situation. This information is also used as

an evidence base in discussions with manufacturers on manufacturer-specific

problems, for example highlighting problems with contingency arrangements and

promoting solutions.

Please make sure you let us know about any supply issues using our online feedback forms at psnc.org.uk/feedback

Documents

October 2014 CPN