Milton Keynes Community Pharmacist Minor Ailment Scheme Service Specification

Milton Keynes Community Pharmacist Minor Ailment Scheme Service Specification Version 11 April 2012 Page 1

With acknowledgement to Hartlepool Primary Care Trust & Sheffield Health Authority and Primary Care Trusts for permission to build on the packs produced by them following similar schemes across Hartlepool & Sheffield. Version 11 April 2012 Page 2

Contents SERVICE SPECIFICATION Page Service Description & Aims of Service 5 Introduction 5 Transfer of Care 5 Referring patients with minor ailments to 5 pharmacies Duties of Community Pharmacies 6 How the Service will be Funded 7 Managing Risks 7 Process of Scrutiny 7 Accreditation 7 Variations and Termination of Agreement 7 Contacts & Signatures 7 APPENDICES 1. FPPharm (Pharmacist Prescription) 8 2. Formulary With Costs 10 3. Standard Operating Procedure 11 4. Incident Reporting Form 12 5. Pharmacy Record Card 13 6. Monthly Cost calculator 14 PROTOCOLS (Available as separate document) Athletes Foot Constipation Cough Diarrhoea Fever Hay Fever & Minor Allergic Reactions Headache Insect Bites or Stings Mild to Moderate Pain Mouth Ulcers Nappy Rash Nasal Congestion Sore Throat Threadworm Vaginal Thrush Please note that this specification supercedes any previous versions which have now expired. Changes from the previous specification are marked in blue print. Version 11 April 2012 Page 3

MINOR AILMENTS Specification for a Local Enhanced Service Date: 1 st April 2012-31 st March 2013 All pharmacies are expected to provide essential and those advanced services they are contracted to provide to all their patients. This enhanced service specification outlines the more specialised service to be provided for NHS supply of treatment & enhanced advice for the minor ailments specified in the protocol. No part of the specification by commission, omission or implication defines or redefines essential or advanced services. This service is commissioned under paragraphs 4 and 5 of The Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2005. This document constitutes the agreement between the pharmacy and MK PCT in regard to this LES. Service description Service description Minor Ailments Provision of an NHS supply of medicines to patients presenting with symptoms for minor ailments included in the specified list. Pharmacists will also offer enhanced patient education on self-care of the condition and signpost to other services where required. The pharmacist will also support patient education on appropriate access to NHS services. Aims of service To reduce the inappropriate use of GP appointments, UCS attendance and A&E attendance for minor illness. To increase support to patients for self-care of minor illness To increase use of community pharmacy expertise in cost-effective NHS management of minor illness. To signpost customers to the most appropriate support service available, where not covered by the scheme. 1. Introduction 1.1 This service is available to all patients registered with any Milton Keynes practice. Patients are at liberty to refuse this service. 1.2 The service is only available for the minor ailments identified in this pack. 2. Transfer of Care 2.1 Patients presenting at the GP surgery, MK UCS, or A&E may be offered transfer into this service. 2.2 Patients presenting at the Community Pharmacy who are confirmed as being registered with an MK GP practice, may self-refer into the service & will receive the enhanced level of care laid out in this specification. 2.3 Evidence of registration with MK GP must be confirmed for all patients self-referring into this service. The Pharmacist will be required to be satisfied of the patient s registration with an MK surgery. 2.4 Practitioners will work to the suggested SOP (Appendix 3) 3 Referring Patients with Minor Ailments to pharmacies 3.1 GP surgeries, MK Urgent Care Services (UCS) & A&E are requested to display Minor Ailments Scheme posters and provide patient information leaflets promoting the service. Version 11 April 2012 Page 4

3.2 Reception staff may advertise the scheme to patients requesting appointments. They shall advise patients of the need to take evidence of GP registration to the pharmacy. In the absence of an NHS medical card, or prescription tear-off slip, explain that the pharmacy may confirm registration status by telephone, with patient s permission. 3.3 Professionals referring patients in other situations (e.g. by phone, or after discussion with other practitioners) shall also advise patients of the need to take evidence of GP registration to the pharmacy. In the absence of an NHS medical card, or prescription tear-off slip, explain that the pharmacy may confirm registration status by telephone, with patient s permission. 3.4 For patients under the age of 16 the parent/guardian can accept transfer into the Scheme on behalf of the patient. (Usual Fraser Competencies apply) 3.5 Unless contraindicated, the GPs will prescribe from the same agreed formulary for the given minor ailment to ensure equity of treatment for the patient. 4 Duties of Community Pharmacies 4.1 The pharmacy will identify patients who present with symptoms for illnesses included on the approved list and offer inclusion into the scheme where this will prevent unnecessary use of a GP appointment. The pharmacy will also accept appropriate self-referrals and referrals from other healthcare professionals. 4.2 Patients should only be accepted into the service if the Pharmacist is satisfied of the patient s registration with an MK surgery. This may be confirmed with the practice by phone with the patient s consent. 4.3 Patients may be accepted into the service only if presenting in person at the pharmacy. 4.4 The Pharmacist routinely provides a professional consultation service including patient assessment and advice in line with Essential Service 6 (Support for Self Care). Where a product is required an NHS treatment may be supplied under the scheme, within conditions of the product protocol. The pharmacist will then also offer enhanced patient education on selfcare and signpost to other services where required. Where no treatment is supplied it is assumed that the patient falls outside the protocols and is thus not within the LES. 4.5 If a product is required the pharmacist will : 4.5.1 Provide a single course of medication, only if necessary, from the agreed formulary appropriate to the patient s condition. 4.5.2 Ensure appropriate advice is given on using treatment effectively as specified in protocol. 4.5.3 Update the pharmacy record card (Appendix 5) or enter onto the PMR system. The pharmacist will retain these details for their own records. 4.5.4 Complete the FPPharm Pharmacist Prescription (Appendix 1). Records may be kept on the pharmacy PMR, provided that a report of activity for a specified period can be provided to the post-payment verification auditors. Pharmacies must be able to identify what product was supplied to each patient, for which condition and on what date. They must also demonstrate when a claim was submitted for that activity. N.B. The patient must still sign the declaration on FPPharm (see point 4.7 below). The pharmacist will retain signed pharmacist prescription forms and computer records in the pharmacy for 18 months after the end of the year to which they relate. 4.5.5 Claims cannot be submitted for payment more than 2 months after the consultation. 4.6 The lead pharmacist will advise all staff and colleagues of the requirements for working within the protocol. 4.7 Normal rules of patient confidentiality apply. 4.8 The Pharmacist should ensure that the patient has completed and signed the declaration of Exemption of Prescription charges (on reverse of FPPharm.) or has paid the prescription charge for each item and signed accordingly. 4.9 If, in the opinion of the pharmacist, the patient presents with symptoms outside the Scheme, they should be referred to their GP/ MK UCS or A&E according to normal practice. 4.10 Generally, if a patient presents more than twice within a month with the same symptoms, the patient should be referred to their surgery (or A&E if appropriate), and no further supply will be made. However this is dependent on professional judgement (e.g. hayfever may continue beyond a month). 4.11 If the patient presents with symptoms indicating the need for an immediate consultation with Version 11 April 2012 Page 5

the GP, the patient should be advised to telephone the surgery. If the pharmacist telephones the surgery on the patient s behalf the outcome should be documented on the form. If this situation is outside normal surgery hours the patient should be advised to contact the on-call doctor or to attend MK UCS or A&E as appropriate. 4.12 The Contractor will be required co-operate with any locally agreed PCT-led assessment of service user experience or survey to gain evidence of shift of workload. It is expected that this will take place over a one month period as directed by the PCT. 5. How the service will be funded Pharmacists will be paid 5.00 for each patient supplied with treatment under protocol. No fee will be paid where advice is given but no supply is made, as this falls under essential services. Costs of items supplied will be reimbursed according to current formulary price list (Appendix 2). These rates will be reviewed annually. At month end, the pharmacy will complete the summary claim form and submit this to Rosa Morris at NHS MK and NHS Northamptonshire Cluster 1 to be received by 4 th of the following month. The claim form may be submitted electronically to rosa.morris@northants.nhs.uk. The Pharmacy Team will process claims from approved service providers to PPD (Prescription Pricing Division) via SBS (NHS Shared Business Services). NHS Milton Keynes reserves the right to enter a practice and obtain access to relevant records to undertake an audit of the enhanced service at any time. The objective of the audit would be to ensure that this contract provides value for money to the PCT. The audit would check the adequacy of controls, the integrity and reliability of information for billing in the area under review. This is to ensure that payment is only made for valid work completed. The scope of the audit does not include checks on the quality of activity. Practices would be given one weeks notice of attendance and will be required to make the necessary records available. Each auditor would have appropriate authority from the PCT, treat any records viewed with confidentiality, and provide clear ID. 6. Managing Risks In order to understand, monitor and minimise any risks to patients and staff and to learn from mistakes, near miss and incident reporting systems must be utilised. In the event of any adverse incident or near miss the practitioner will complete the Incident Reporting Form (Appendix 4) and send a copy to the Pharmaceutical Advisers at the PCT. A copy of the completed form will remain at the Practice or Pharmacy. Any complaints about any aspect of the scheme should also be documented and sent via the same route. (Refer to NHS Milton Keynes & NHS Northamptonshire Complaints Procedure) 7. Process of Scrutiny The Pharmaceutical Adviser will be accountable for co-ordinating and managing the scheme at PCT level and will be responsible for: Production and revision of the protocol Provision of training around the referral, administration process and protocols An appropriate professional lead for each site will take responsibility for: Implementation of the service specification Updating all staff (including locum staff) with any amendments Assessing and providing where appropriate any training around the administration process. 8. Requirements for accreditation to provide this service All medicines currently included in the scheme are available for sale through pharmacies and hence required competence falls within essential service specifications. 1 Address: NHS Milton Keynes and NHS Northamptonshire, Francis Crick House, Summerhouse Rd, Moulton Park Northampton NN3 6BF Version 11 April 2012 Page 6

o A lead clinician in each site must attend PCT training on NHS supply of treatment using the scheme when this is offered. o The lead pharmacist for each site is responsible for ensuring his staff/colleagues/ locums are adequately trained to deliver the service at all times. o The lead pharmacist will be able to demonstrate a Continuing Professional Development portfolio which supports all aspects of this work and will submit evidence to demonstrate how this has been done over the past 12 months when returning the signed specification. o The Contractor must keep a copy of the Service Specification and the current protocols in the branch for reference. o The Contractor will participate in any audit of patient satisfaction or survey to demonstrate shift of workload as required by the PCT. 9. Variations to and termination of the agreement The PCT may vary the terms of this service specification or terminate this agreement with three months notice in writing to the contractor. The contractor may terminate this agreement with three months notice to the PCT. If the service provider is unable to meet all of the requirements of this specification the PCT reserves the right to terminate this agreement with immediate effect. 10. Contacts 1. If you have any queries about this specification please contact: Don Connolly don.connolly@northants.nhs.uk NHSMK & NHSN Francis Crick House Summerhouse Rd Moulton Park Northampton NN3 6BF Signatures: Before payment will be made each contractor must sign the contracts portfolio (separate document). Two signed copies of the contracts portfolio must then be returned to Anne-Marie Frost Associate Director Directly Commissioned Services at NHS MK & Northamptonshire. The relevant PCT Manager will then countersign the agreement & return your copy back to the pharmacy. Version 11 April 2012 Page 7

Appendix 1 FPPharm (Pharmacists Prescription) Please ensure that patients have signed the declaration overleaf Patient s Name. DOB Address Telephone No.. GP Name GP Address.... Patient s Presenting Symptoms: (Please tick) Cough Allergies / Hay Fever Vaginal Thrush Sore Throat Insect Bites or Stings Threadworm Headache Diarrhoea Athlete s Foot Fever Constipation Nappy Rash Nasal Congestion Common Mouth Ulcers Pain Details of formulary items supplied: Aspirin Soluble Tabs 300mg (32) Beclometasone Nasal Spray (100) Menthol & Eucalyptus Inhalation (100 ml) Miconazole 2% Cream (30g) Bonjela Gel (15g) Paracetamol 500 mg Tablets (32) Cetirizine Tabs 10mg (30) Paracetamol Soluble 500mg Tablets (24) Chlorhexidine Mouthwash (300ml) Chlorphenamine Syrup (150 ml) Chlorphenamine Tablets 4 mg (30) Paracetamol Susp SF 120 mg / 5 ml (100 ml) Paracetamol Susp SF 250 mg / 5 ml (100 ml) Pholcodine Linctus SF5mg/5ml (200ml) Clotrimazole Cream 2% (20g) Rehydration Sachets (6) Clotrimazole Combi 2% 500mg Senna Tablets 7.5mg (20) Clotrimazole Pessary (500 mg) Guaphenesin Linctus 100mg/5ml (200ml) Ispaghula Husk Sachets (10) Hydrocortisone Cream 1% (15g) Ibuprofen Tablets 200 mg (24) Ibuprofen Susp 100 mg/5 ml (100 ml) Mebendazole 100mg Chewable Tablet (x 1) Simple Linctus SF (200 ml) Simple Linctus Paediatric SF (200 ml) Sodium Chloride Nasal Drops (OP) Sodium Cromoglicate Eye Drops (5 ml) Sudocrem (125g) Xylometazoline 0.05% Nasal Drops Xylometazoline 0.1% Nasal Spray Action taken tick tick Advice and Treatment GP Referral recommended Summary of self-care advice given (see protocol) Pharmacy Stamp Pharmacist s Signature: Pharmacy Code: Date: Retain this in the pharmacy as a clinical record & as evidence of activity. An electronic version is available at www.qualitymk.nhs.uk. Version 11 April 2012 Page 8

DECLARATION OF EXEMPTION The patient doesn t have to pay because he/she: A is under 16 years of age B is 16, 17 or 18 and in full-time education C is 60 years of age or over D has a valid maternity exemption certificate E has a valid medical exemption certificate F has a valid prescription prepayment certificate G has a valid war pension exemption certificate L is named on a current HC2 charges certificate H * gets Income Support or income-related Employment and Support Allowance K * gets income-based Jobseekers Allowance M * is entitled to, or named on, a valid NHS Tax Credit exemption certificate N * has a partner who gets Pension Credit guarantee credit (PCGC) * Name of person who gets benefit * DoB * NI no. To the Patient - Please complete either declaration (1) or (2) below:- 1. I have received the above medicine(s) and am exempt from charges for the reason specified above. Signed Date.. 2. I have received the above medicine(s) and have paid the following prescription charge. Signed... Charge paid Date I am the patient I am the patient s representative (Please tick one) IMPORTANT Your Pharmacist is providing treatment and/or advice under the Minor Ailments Scheme in line with the symptoms you have described. If your symptoms persist you should seek further advice from your doctor. Please advise the doctor which pharmacy you have attended and what advice and/or treatment you have already received from the Pharmacist. Evidence of Exemption Seen: YES NO CLAIMING Date submitted to PCT To assist calculation of monthly claim, complete this table at the time of issue. Then total the forms at month end. Alternatively the pharmacy may use the monthly calculator and keep a running tally. (Item 1 ) If you had not used this minor ailments scheme (Item 2 ) would you have? (Item 3 ) a) consulted the GP b) visited the Walk in Centre N.B. Only claim one fee per patient c) gone to A&E Total cost of items supplied d) bought the medicine from the pharmacy Professional fee e) managed without Total f) other (please specify). Version 11 April 2012 Page 9

Minor Ailment Scheme Formulary N.B. Only 1 pack of quantity indicated should be supplied. Product Cost Price Inc. VAT Aspirin Soluble 300mg Tablets (32) 1.18 Beclomethasone Nasal Spray (100 sprays) 4.60 Bonjela Adult Gel (15g) 2.34 Cetirizine Tablets 10 mg (30) 1.13 Chlorhexidine mouthwash (300ml) 3.28 Chlorphenamine Syrup (150 ml) 2.99 Chlorphenamine Tablets 4 mg (1 pack of 28 or 30) 1.23 Clotrimazole Cream 2% (20g) * 4.78 Clotrimazole cream 2% + Pessary 500mg (Combi) 8.66 Clotrimazole Pessary (500 mg) * 3.75 Guaphenesin Linctus 100mg/5ml (100ml) 2.75 Hydrocortisone Cream 1% (15g) 1.71 Ibuprofen Tablets 200 mg (24) Ibuprofen Suspension 100 mg / 5 ml (100 ml) 1.82 Ispaghula Husk Sachets (10) 2.20 Mebendazole 100mg Chewable Tablet (1) 2.05 Menthol and Eucalyptus Inhalation (100 ml) 1.02 Miconazole 2% Cream (30g) 2.18 Paracetamol 500 mg Tablets (32) 1.22 Paracetamol Soluble 500mg Tablets (24) 2.66 Paracetamol Suspension SF 120 mg / 5 ml (100 ml) 1.88 Paracetamol Suspension SF 250 mg / 5 ml (100 ml) 2.25 Pholcodine Linctus SF5mg/5ml (200ml) 84p Rehydration Sachets (6) 2.70 Senna Tablets 7.5mg (20) 1.83 Simple Linctus SF (200 ml) Simple Linctus Paediatric SF (200 ml) 84p Sodium Chloride Nasal Drops (OP) 2.97 Sodium Cromoglicate Eye Drops (5 ml) 3.28 Sudocrem (125g) 2.20 Xylometazoline 0.05% Nasal Drops 1.90 Xylometazoline 0.1% Nasal Spray 2.29 The fee per patient will be paid in addition to drug re-imbursement costs. Do not supply together if both are needed use Combi-pack Prices reviewed by LPC April 2011 82p 70p Version 11 April 2012 Page 10

Appendix 3 Suggested Standard Operating Procedure This protocol is for use by all persons handling requests for GP appointments and/or prescriptions either by the patient in person or by telephone. For patients making a GP appointment by telephone or in person 1. Patients, where considered appropriate and practical, may be informed of the Minor Ailments Scheme which means patients can choose to self-transfer to a local pharmacist for advice and medicine rather than waiting for an appointment. Normal charges and exemptions from prescription charges will apply. 2. If the patient accepts self-transfer into the Scheme please advise him/her to take NHS registration card to the pharmacy or a prescription counterfoil, as evidence of registration with the practice. 3. If presenting in person, the patient should receive a patient information leaflet explaining the scheme. 4. If the patient does not wish to self-refer into the Scheme, an appointment should be made for them with the Doctor/ Nurse in the usual manner. For Patients Self-Referring at the Pharmacy Some patients will go straight to the Pharmacy to access the Scheme. The Pharmacist is required to be satisfied of the patient s registration with an MK surgery. If the patient does not have evidence with them the pharmacist may request permission from the patient to ring the surgery to check their registration. A current pharmacy medical record on the computer system is sufficient proof of patient registration. Where confirmation cannot be provided, the patient will not be entitled to use the Scheme. Referral from Pharmacy back to the GP On some occasions the Pharmacist may consider that the patient needs to be seen by a doctor. The urgency will depend on the symptoms. In most circumstances the Pharmacist will refer the patient back to the surgery and advise the patient to contact the surgery in the usual manner. The pharmacist may telephone the practice only with the patient s permission. If the pharmacist considers the referral to be urgent he/she should advise the patient to contact A&E or dial 999 as appropriate. If the surgery is closed the Pharmacist may advise the patient to call the surgery s emergency number to gain access to the out of hours service, or go straight to MK UCS or A&E as appropriate. Version 11 April 2012 Page 11

Appendix 4 Pharmacy Code What Happened? Milton Keynes Primary Care Trust Incident Reporting Form Location Date & Time Equipment Involved Individuals/Agencies notified What harm / potential harm did it cause, e.g. pharmacy; patient; or staff? Record of Incident Why did it happen (contributory factors)? Key Lessons? Changes planned? Please post or email to: don.connolly@northants.nhs.uk or contact 01604 651224 Please retain a copy of this form in the Practice/Pharmacy Version 11 April 2012 Page 12

Appendix 5 Pharmacy Record Card Patient s Name Address....... Pharmacy Stamp Date of Birth. NHS number (if known).. Pharmacist Signature and Date Presenting Symptoms Medication Supplied / Action Taken 1.. 2........ 3........ 4........ 5........ 6 This is a voluntary form designed to support record-keeping in pharmacies. Some pharmacies keep records on their computer PMR. Version 11 April 2012 Page 13

Minor Ailment Scheme Monthly Reimbursement Cost Calculator Pharmacies are free to copy this form and use it each month if desired, to calculate the claim at month end. The form does not need to be submitted to the PCT at month end, but should be kept in the pharmacy. Month Cost Price inc VAT PRODUCT Aspirin Soluble 300mg Tablets 32 1.18 Beclometasone Nasal Spray (100 Sprays) 4.60 Bonjela Adult Gel (15g) 2.34 Cetirizine 10mg Tablets (30) 1.13 Chlorhexidine Mouthwash 300ml 3.28 Chlorphenamine Syrup 150ml 2.99 Chlorphenamine 4mg Tablets (30) 1.23 Clotrimazole 2% Cream 20g 4.78 Clotrimazole 2% Cream + 500mg Pessary (Combi) 8.66 Clotrimazole 500mg Pessary (1) 3.75 Guaphenesin 100mg/5ml 100ml 2.75 Hydrocortisone 1% Cream (15g) 1.71 Ibuprofen 200mg Tablets (24) 0.82 Ibuprofen 100mg/5ml Suspension 100ml 1.82 Ispaghula Husk Sachets (10) 2.20 Mebendazole 100mg Chewable Tablets (1) 2.05 Menthol and Eucalyptus Inhalation 100ml 1.02 Miconazole 2% Cream 30g 2.18 Paracetamol 500mg Tablets (32) 1.22 Paracetamol Soluble 500mg Tablets (24) 2.66 Paracetamol 120mg/5ml SF Suspension 100ml 1.88 Paracetamol 250mg/5ml SF Suspension 100ml 2.25 Pholcodine 5mg/5ml SF Linctus 200ml 0.84 Rehydration Sachets (6) 2.70 Senna 7,5mg Tablets (20) 1.83 Simple SF Linctus 200ml 0.70 Simple Peadiatric SF Linctus 200ml 0.84 Sodium Chloride Nasal Drops 10ml 2.97 Sodium Cromoglycate Eye Drops 5ml 3.28 Sudocrem 125g 2.20 Xylometazoline 0.05% Nasal Drops 10ml 1.90 Xylometazoline 0.1% Nasal Spray 10ml 2.29 Notes Only one professional fee may be claimed for each patient even if several conditions are treated at the same time. Total No Given Total Cost Total Fees Claimed @ Total Cost Claimed Prices reviewed by LPC April 2011 / October 2011 Final Total Version 11 April 2012 Page 14