Transfer of Care (ToC) service Frequently asked questions

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1 Transfer of Care (ToC) service Frequently asked questions 1) What is the Transfer of Care Service? The Transfer of Care service is a new service which aims to ensure patients receive appropriate support from their community pharmacist soon after leaving hospital. Correct completion of the PharmOutcomes template will allow accurate data to be analysed by the Academic Health Science Network (AHSN) which is likely to demonstrate the significant impact community pharmacists can have to the care of this group of patients. 2) How do I complete the PharmOutcomes template? If you have a management address set up on PharmOutcomes you will receive an each time a referral is received. If a management address is not set up, you will need to log into PharmOutcomes and click the services tab on a regular basis to check for referrals. They will appear at the top of the screen. On receipt of a referral, you should click the accept button. You can then view the patient s details and make contact with them to arrange their follow-up appointment with you. Once you have completed this review / counselling with the patient or their carer, go back to the referral on PharmOutcomes and click the Complete now button. This will allow you to input the details of your follow-up with the patient. This information will be analysed by the AHSN to demonstrate the impact community pharmacists can have so please provide sufficient details. If your follow-up met the criteria for a MUR or NMS consultation, then claim payment for this service via the FP34 form at the end of the month as normal. Only click the Reject referral button if you have been unable to contact the patient or their carer, they have failed to attend their appointment (after contacting them three times), they are housebound and you are unable to complete a domiciliary or telephone consultation, etc. You must record the reason for the referral not being followed up, using one of the drop down reasons. 3) How do I set up a management address? If no management address is set up, you will be prompted to set this up when you log in. If you do not receive this prompt but are not receiving s, you probably have an out of date set up. In order to update the management address, after logging in, stay on the home page. On the left hand side of the screen, under My account there is a link called Update my organisation details. Click this and on the next screen change the address which is set up to the correct and click save. You will now receive an to this address whenever you receive a referral from the hospital. 4) I haven t attended a launch event, can I still take part in the service? Yes. The launch events merely aim to raise awareness of the new service being offered to patients. They are not training events. The service builds upon the MUR and NMS services and basic patient counselling, there is no accreditation required to take part in this service.

2 5) How will the hospital pharmacy team know which pharmacy to refer to? When patients are asked to consent to the referral being made, the hospital pharmacy team will ask the name of their regular pharmacy. They will also seek consent to refer to an alternative local pharmacy, if the referral is rejected by the patient s usual pharmacy. The patient s safety following transfer of care is of paramount importance so overrides the usual choice of pharmacy if that pharmacy is unable to accept the referral. Given the long list of Boots and Lloyds pharmacies across the area or the patient not knowing exactly which pharmacy they use, it is possible that the hospital pharmacy team will occasionally choose the incorrect pharmacy. At the moment, you have to reject this referral with wrong pharmacy as the reason from the drop down list. Please state the correct pharmacy in the notes box, so the hospital team can re-refer to the correct pharmacy. Pinnacle are looking into developing the facility for pharmacy to pharmacy referral for onward referral to the correct pharmacy in the future. 6) How will the hospital pharmacy team know my pharmacy is taking part and willing to accept referrals? Pharmacies which are taking part in the service will appear in the drop down list of pharmacies which are shown when the hospital pharmacy team start to type into the Name of Pharmacy box on their referral form. We are presuming that all pharmacies will be taking part in the service, since patients have been identified as requiring support with their medicines. Even if you cannot provide a MUR or NMS consultation, you can still contact the patient (or their carer) to discuss their medicine and ensure they know how to use it safely and effectively. An informal discussion with the patient or carer should still be recorded on PharmOutcomes as a completed referral even if it is not claimable for payment as an advanced service. 7) How will I receive notification that a referral has been sent? You will receive an notification if you have a management address set up on PharmOutcomes. If this is not set up, you will need to log in to PharmOutcomes every day to check whether you have received a referral. You must contact the patient within three working days of receiving a referral, so you must log in regularly to PharmOutcomes to check for referrals. 8) I have contacted the number provided but couldn t contact the patient. What do I do? Try to contact the patient on three occasions before going back into PharmOutcomes and rejecting the referral. 9) When should I reject a referral? Only reject the referral if you have had no contact with the patient or carer. If you manage to contact the patient or carer to discuss their medication and offered any support via informal counselling then this counts as a completed referral and the outcome of your intervention should be recorded on PharmOutcomes. For example, do not automatically reject a housebound patient because you cannot conduct a domiciliary or telephone MUR. If you are able to speak to the patient or their carer informally (traditional medicine counselling) you can record this intervention on PharmOutcomes. You have provided support to the patient following the transfer of their care back into the community and should record the outcome on PharmOutcomes. 10) When contacted the patient said they didn t want the service or when I book appointments, they do not attend. How can I improve patient engagement?

3 Think about how you approach the patient when you first contact them. A referral is a more compelling reason to engage with the service than asking them to come to your pharmacy for a medicines check. Think about using a phrase like I ve received your referral from the hospital following your stay. The fact that the hospital has contacted you with a referral for them will make your appointment with them more important. 11) If the regular pharmacist is on holiday and the locum is not MUR accredited, would it be ok to complete this when the regular pharmacist gets back from holiday? The patient must be contacted within three working days and the referral accepted. Having contacted the patient, the locum pharmacist must make a professional decision about whether patient safety will be compromised if the community pharmacy intervention does not take place until the regular pharmacist returns. If this is judged to be acceptable, an appointment can be made with the patient for when the regular pharmacist returns. If the patient s safety will be compromised by such a delay, the locum pharmacist should have an informal conversation with the patient to ensure safety concerns are addressed. PharmOutcomes can then be completed but no advanced service payment can be claimed. If on return, the regular pharmacist wants to follow-up with the patient, a professional decision must be made about whether a MUR consultation can be claimed. 12) How am I paid for providing this service? You claim via the standard routes used for any patient, i.e. via the FP34C form submitted to the NHS BSA each month. You will receive the usual MUR or NMS fee. If you also complete a public health intervention, for example, a stop smoking intervention or administer a flu vaccination, you claim via the normal method for providing these services. 13) I ve received a referral for the NMS but the medicine isn t covered by that service. What should I do? Provide the most appropriate service for the referred patient, either a MUR or a prescription intervention. The hospital pharmacy team do not have the same knowledge of these services as community pharmacists. Still contact the patient, as the hospital team obviously felt the patient needed support with their medicines but carry out a MUR or a prescription intervention. 14) How can I provide the service to a patient for whom I don t usually dispense? The prescription intervention service does not require you to have dispensed for the patient for a period of three months. This requirement only applies to MURs. The consultation you provide is identical, the difference is how the patient was identified for an intervention. A MUR is usually a routine appointment but a prescription intervention is when an issue is identified, for example, ToC from the hospital. 15) I ve completed all 400 MURs / prescription interventions for this year. How do I get paid for further interventions? You cannot claim for more than 400 MURs / prescription interventions in any financial year. Each contractor will be expected to monitor the number of referrals being made to their pharmacy by this service. As these patients are pre identified by hospital teams as being high risk we would anticipate that Transfer of Care (ToC) patients will form a baseline target group for the pharmacy's MUR / prescription interventions each week. Therefore this situation can be managed effectively. If you do reach 400 MURs / prescription interventions well before the end of year, then please contact the LPC and if appropriate, your line manager, for further advice. Please do not reject these patients. As these patients are identified as high risk, we would advise that the pharmacist still

4 performs a standard intervention outside of the Advanced Service framework to ensure patient safety. 16) What if I don't have the time to complete the interventions or the additional forms? The expectation is that a minimum of 90% of all referred patients are accepted and that a minimum of 80% of all referred patients receive an intervention in the pharmacy. Pharmacies are asked to manage this workload through the appointment system. As these patients have been pre identified as high risk by hospital colleagues, the interventions should be marked as high priority for all community pharmacy colleagues in order to provide safe and high quality patient care. This service is an opportunity for community pharmacy to demonstrate its ability to work collaboratively with secondary care for the benefit of patients in the North East and North Cumbria. If you have any concerns or queries then please contact the LPC and if appropriate, your line manager. 17) What comments are useful to the hospital pharmacy team when completing the PharmOutcomes module? Your judgement should guide you when completing the information on the PharmOutcomes Hospital ToC module. Any clinically significant interventions or adverse drug reactions (ADRs) should be noted within the form as well as remarks such as any dietary advice given, referrals to public health services, general concerns about the patient, adherence issues identified, communications sent to GP etc. The information will be similar/identical to the comments normally made on the standard form to the patient s GP so may be cut and pasted across from your standard MUR software. All comments made on every form will be sent directly and electronically to the hospital clinician who made the referral. The more information you provide will help to justify the RiO score you have given to the intervention when the score is reviewed by the project team. 18) What if the patient is a domiciliary patient? Within the North East and Cumbria area there is no formal domiciliary pharmacy team currently in operation. If a domiciliary patient is referred, then please follow your normal procedures for completing the intervention. This may involve asking the patient when they will next have transport available to visit the pharmacy. Permission to conduct domiciliary MURs is granted by NHS England. They will require a copy of your MUR certificate and current DBS clearance, if they do not have these on file. Applications for offsite and telephone MURs should be ed to england.pharmacyandoptometry@nhs.net with the subject line Application for offsite MUR. NHS England will prioritise applications for Transfer of Care patients and have confirmed these applications will be authorised. Ensure that within the you state this is a Transfer of Care patient. Please see the accompanying procedure document which details the information which must be supplied when applying to conduct a domiciliary MUR. 19) North East and Cumbria is a wide geographical area. Is this service available to all patients? Yes. Community pharmacies within a geographical area are switched on when their local hospital trust goes live and the launch events have taken place so staff in both hospital and community pharmacy are aware of the service. All community pharmacies have now been switched on, although one acute trust and the mental health trusts have still not gone live. Ultimately, the service will be available to all patients when all hospital trusts have gone live. 20) I don t have log-in details for PharmOutcomes. Where do I get them?

5 All pharmacies have been provided with log-in details for PharmOutcomes. If you have lost this information, contact the PharmOutcomes helpdesk on There must always be a minimum of two members of staff on duty at all times with a PharmOutcomes log-in, so referrals can be accessed and actioned when the regular pharmacist is not present, e.g. day off, on holiday. Referred patients must be contacted within three working days. 21) When I look on PharmOutcomes, there is a ToC patient survey service. What is this? We are evaluating the service with Durham University and are very keen to collect patient comments about the service. Please print a copy of the patient survey and ask all patients who have been referred to you to complete the survey. Please then enter their feedback onto the PharmOutcomes service. If you have any comments about the service generally or the PharmOutcomes module specifically, please get in touch. We need your feedback to continuously develop both the service and the tools to support you with service provision. Send comments to ann.gunning@northoftynelpc.com