SOP prepared by (full name) Position in pharmacy Signature Date of SOP preparation PURPOSE To ensure that the NHS Urgent Medicine Supply Advanced Service (NUMSAS) is operated in a safe, effective, systematic and efficient way which complies with the minimum requirements contained in this standard operating procedure (SOP) and the NHS Urgent Medicine Supply Advanced Service Pilot: Community Pharmacy Service Specification ( Service Specification ) SCOPE This procedure covers the provision of the NUMSAS at the pharmacy premises in England GUIDANCE NOTES This SOP has been designed to be used within a community pharmacy premises o The SOP should be tailored, where appropriate, to reflect processes in individual pharmacies Changes to the SOP should be considered carefully as some processes are based on legislative requirements or good practice recommendations This SOP should be used in conjunction with the Service Specification This SOP is not designed to be used as a legal document; rather it is designed to help community pharmacists adopt best practices in the operation of the NUMSAS; relevant legislation should be referred to if necessary The SOP should be agreed with the superintendent pharmacist /pharmacy owner
Preparing for the service *KEY: P = Pharmacist / PT = Pharmacy Team / SP = Superintendent Pharmacist / PO = Pharmacy Owner Action / Procedure Who?* Explanation / Guidance / Support 1) Register for an NHSmail account P/SP/PO Participating pharmacies must have a shared NHSmail account for each premises 2) The pharmacy must be Electronic Prescription Service (EPS) enabled 3) The pharmacy must have a consultation room 4) Contractors wishing to provide the NUMSAS must register their intention to provide the service for each individual pharmacy by completing the registration form on the NHS Business Services Authority website (NHSBSA) 5) Pharmacies must be compliant with their obligations stated in the NHS Terms of Service 6) Pharmacists must have an understanding of the legislation around an emergency supply 7) Contractors have an obligation to ensure that all staff involved in the service are competent, understand the service and SOP, and are appropriately trained P/SP/PO Users providing the service must also have a personal NHSmail account that is linked to the shared NHSmail mailbox for the pharmacy Further information on how to register fro an NHSmail account can be found in the Community pharmacy funding cuts 2016/17: final package (quality payments scheme) factsheet P/SP/PO The consultation room must meet the requirements as stated in the Service Specification and the General Pharmaceutical Council Standards for registered pharmacies P/SP/PO The registration form is available from 1 December 2016 P/SP/PO Registration should only take place after an NHSmail account has been activated Payment cannot be claimed until the pharmacy has registered their intention The aim of the registration form is to inform NHS England of the contractors intention to provide this service There will be a four phase roll out of the service from December 2016 and March 2017 Further details are available via NHSBSA website P/SP/PO Emergency supply legislation is stipulated in Regulations 225, 253 and Schedules 18 and 23 of The Human Medicines Regulations (HMR) 2012 NPA resources on emergency supply are available to support members P/SP/PO This includes locums
8) Contractors must ensure that the service is available during both core and supplementary hours 9) The NUMSAS will be provided through NHS 111. Pharmacy contractors are not to actively promote the service Delivering the service PO/SP/P If contractors wish to stop providing the NUMSAS, NHS England should be informed at least one month before cessation by completing the form available on the NHSBSA website PO/P/SP/ PT The service is not to be used as a replacement for normal prescription ordering and is for urgent cases only *KEY: P = Pharmacist / PT = Pharmacy Team / SP = Superintendent Pharmacist / PO = Pharmacy Owner Action / Procedure Who?* Explanation / Guidance / Support 1) Referral received from NHS 111 Check the pharmacy NHSmail account for NHS 111 referrals at opening, closing and regularly during opening hours (particularly during evenings, weekends and bank holidays) The pharmacist should receive a call from the patient within 30 minutes P/PT P P P P Referral will be via email, however, local systems may vary but should be approved and accredited further information can be found in the Urgent Repeat Medication Requests Guide for NHS 111 Services Document Email confirmation from NHS 111 should be received by the pharmacist prior to the telephone consultation taking place If no referral is received then the local NHS 111 health professionals telephone line should be contacted to confirm that the referral has been made by NHS 111 and to request the referral to be resent. The patients NHS number and GP details can also be confirmed at this stage if needed If NHS111 has not made a referral, the pharmacy may still choose to provide an emergency supply at the request of the patient, however, this supply is not included in the Service Specification and thus cannot be claimed via the service If the patient does not call then the pharmacist must make every reasonable attempt to contact the patient using the contact details provided in the referral email this should be done before the next working day o Reasonable is considered to be at least three attempts to contact the patient, with at least 10 minutes between each attempt If the patient does not contact the pharmacy, the Consultation and Administration fee may still be claimed if at least three attempts are made to contact the patient
2) Telephone call between the patient and pharmacist An interview with the patient should be conducted over the phone in order to assess their suitability for the service Stock availability should be confirmed before agreeing to make a supply to the patient P The pharmacist will interview the patient to assess the patients suitability for an emergency supply in accordance with HMR 2012 further information refer to the NPA Emergency supply of prescription-only medicines factsheets The pharmacist can also use this opportunity to check if the pharmacy has the required items in stock If the patient request does not meet the requirements of the HMR 2012 then they should be referred to their own GP or the local out-of-hours (OOHs) service; patients should not be referred back to NHS 111 Contact details of GP OOHs and NHS 111 health professionals line can be found in the NHS 111 Mobile Directory of Services (DoS) or MiDoS (pharmacies will be alerted to which contact method to use during the service set up) If a prescription has been recently issued it may be available on the NHS Spine if this is the case then it should be used to supply the patient with the required medication o The pharmacy will still be able to claim for the Consultation and Administration fees if the supply is made in this way. The Supply fee cannot be claimed as the EPS prescription will be used for the medication supply P If the supply cannot be made then the pharmacist should refer the patient to another participating pharmacy that has the requested medication in stock this should be agreed with the patient first NHS 111 Mobile DoS should be used to locate a participating pharmacy and the pharmacist should make contact with the other pharmacy to confirm that the stock is available The email referral received from NHS 111 should then be forwarded to the second pharmacy if the second pharmacy has the items in stock. The second pharmacy would then make contact with the patient and follow the process as set out in the Service Specification If this occurs, the contractor who originally received the referral can still claim for the Consultation and Administration fees
If available, the patients Summary Care Record (SCR) should be accessed to assess suitability for the service 3) Pharmacy consultation Following the telephone consultation, the pharmacist should advise the patient to attend for a face-to-face consultation this is important to collect any missing information that was not recorded in the referral and to also assess whether the supply meets the legal requirements of an emergency supply 4) Supply If the patient meets all the criteria for the service, a supply can be made the pharmacist should make a professional decision as to the quantity to supply to the patient NHS 111 must also be notified of this onward referral by the original pharmacy If the second pharmacy also do not have the items in stock then the original pharmacy who received the referral should contact the GP OOHs service to explore other options the patient may need to be referred to another healthcare professional P Although SCR is not mandatory to providing the service, it can be used to assess whether the supply of medicine is appropriate for the patient, for example, by having sight of the patients prescription history to see if the item has been prescribed previously Consent should be obtained before accessing the SCR Guidance on SCR is available from the NPA website P If the patient cannot attend, the pharmacist should use their professional judgement to decide if the supply can be made to the patients representative The EPS tracker should be checked to see if there is a prescription available for the requested medication o If there is a prescription available then it should be used to meet the patient supply o If an EPS prescription is used, then the Consultation and Administration fees associated with the service can still be claimed. The Supply fee cannot be claimed as the EPS prescription will be used for the medication supply If a supply cannot be made at this stage, then the patient should be referred to an appropriate healthcare professional P The quantity supplied should meet the criteria of the HMR 2012 the HMR 2012 refers to emergency requirements relating to prescription-only medicines (POMs), however, for the purposes of the NUMSAS service, this includes medicines and appliances that are not POMs The record of supply and labelling requirements as stipulated in the HMR 2012 must be maintained
Once the supply has been made, a prescription charge should be taken for each item supplied unless the patient is exempt from prescription charges If the patient/representative is unable to attend, the pharmacist must discuss all reasonable options with the patient in order for them to receive their medicines in a timely manner 5) Advice and information The patient/patients representative should be asked to complete a patient questionnaire following the consultation The pharmacist should emphasise the importance of ordering prescriptions on time and the benefits of electronic repeat dispensing 6) Records and documentation Document referral using blank FP10DT EPS dispensing token even if a supply has not been made P/PT P P The questionnaire can be either paper based or available using an IT platform (yet to be released) If paper based questionnaires are used, the information should be transferred to the IT platform to submit patient responses The patient questionnaire is available in Annex D of the Service Specification Guidance on how to submit patient questionnaires will be available shortly P Although this service is aimed at supporting patient who have run out of their medicines, it is also an opportune time to counsel patients on the importance of changing their prescription ordering habits to ensure they never run out of their medicines in the future The pharmacist may also use this opportunity to raise the patients awareness of the Medicines Use Review (MUR) and Appliance Use Review (AUR) services if appropriate P The following information should be recorded on each form (available from the NHS 111 referral or the Dictionary of Medicines and Devices: o Full name, address and date of birth of patient o Patient s NHS Number o Name, strength and form of medicines requested or name of appliance requested o Either the quantity supplied or the reason for not supplying (using the standard code set out in Annex E of the Service Specification)
The patient/representative must complete the sections on the back of the form, including the exemption (if applicable) and signature Once the supply has been completed, a record of the emergency supply should be made in accordance with the HMR A notification ( Post Event Message ) should be sent to the patients GP on the same day as the supply if this is not possible, then it should be completed as soon as possible on the next working day after the pharmacy opens 7) Payment arrangements Payments are to be claimed using the NHS Urgent Medicines Supply Advanced Service Pilot claim form o Date and time of supply o Name and address of patient s GP NHS 111 referral ID number The information recorded should be collected from the NHS 111 referral and/or from the interview with patient It is important that the information is written in a clear way without ambiguity otherwise payment will be delayed P/PT If the patient cannot provide evidence of their exemption, the pharmacy should annotate this on the FP10DT EPS dispensing token it is important to explain to the patient that checks are made and charges may be recovered from the patient As the FP10DT EPS dispensing token is handwritten, all forms must be signed by the patient/representative P For further information refer to the NPA Emergency supply of prescription-only medicines legal and practical guidance factsheets P Notification should be via NHSmail if possible, or another secure electronic data interchange and should include the minimum data requirements as stated on page 10 of the Service Specification If electronic notification is not possible, notification should be sent either via post, by hand or safe haven fax where the contractor has confirmed the fax number with the GP surgery and that it is a safe haven ; the national GP Patient Notification Form should be used this can be found in Annex B of the Service Specification Any records made as part of the NUMSAS must be managed in line with the Records Management Code of Practice for Health and Social Care 2016 P/PT The NUMAS claim form and FP10DT EPS dispensing tokens should be sent to the NHSBSA before the 5 th day of the following month in which the supply was made This process is separate to the end of month submission Completed forms should be sent to: Prescription Services, Bridge House, 152 Pilgrim Street, Newcastle upon Tyne, NE1 6SN
If requested to do so, a local audit should be completed P/PT The submission process will be confirmed with the pharmacy during the registration process Information on the fee s payable for the service can be found on page 13 of the Service Specification
Annex A Key contact details NHS 111 Provider Name of Organisation Health Professional s telephone number (Note this number must NOT be shared with the public) Key Contact Local GP Out of Hours Provider Name of Organisation Address of Organisation Postcode Public Telephone Number Non-Public Telephone Phone Number (Note this number must NOT be shared with the public) Key Contact Mobile Directory of Service Which Mobile DoS is used in the area? Log-in details (Note these details are specific to this pharmacy and should not be shared) Username Password Local Directory of Service Lead Name Telephone Number Email address NHS 111 DoS Emergency Number: (to notify NHS 111 of temporary withdrawal of service) Key NHS England contacts: NHS Mobile Directory of Services (www.pathwaysdos.nhs.uk) or MiDoS (delete as appropriate) 0300
Staff declaration IMPORTANT: The following declaration must be made by all members of the pharmacy team involved in delivering the NUMSAS service. Declaration: I have read and understood this SOP and agree to implement the procedures set out in it when required. Date Full name Qualification GPhC number Signature
References and further reading emc Dictionary of Medicines and Devices Browser o http://dmd.medicines.org.uk/ General Pharmaceutical Council (GPhC) o Standards for registered premises: https://www.pharmacyregulation.org/standards/standards-registered-pharmacies Information Governance Alliance o Records Management Code of Practice for Health and Social Care 2016: https://digital.nhs.uk/information-governance-alliance National Health Service Business Services Authority (NHS BSA) o NHS Urgent Medicines Supply Advanced Service Pilot: http://www.nhsbsa.nhs.uk/prescriptionservices/ums.aspx National Pharmacy Association (NPA) o Community pharmacy funding cuts 2016/17: final package (quality payments scheme) factsheet: https://www.npa.co.uk/services/thepharmacy-imposition/quality-payment-scheme/ o Emergency Supply of POMs: https://www.npa.co.uk/information-and-guidance/emergency-supply-of-poms/ o Summary Care Record Resources: https://www.npa.co.uk/information-and-guidance/summary-care-record/ NHS England o NHS Urgent Medicine Supply Advanced Service Pilot: Community Pharmacy Service specification: http://www.nhsbsa.nhs.uk/prescriptionservices/ums.aspx Pharmaceutical Services Negotiating Committee(PSNC): o NHS Urgent Medicine Supply Advanced Service (NUMSAS): http://psnc.org.uk/services-commissioning/urgent-medicine-supply-service/ The Humans Medicines Regulations 2012 o http://www.legislation.gov.uk/uksi/2012/1916/contents/made Disclaimer: The information published is, to the best of our knowledge, correct at the time of publication. However, no responsibility will be accepted for any consequences of decisions made using this information.