City & Hackney CCG & Homerton University Hospital NHS ... · City & Hackney CCG & Homerton...

Interface Prescribing Framework.

Version 6.0 Page 1 of 20 .

City & Hackney CCG & Homerton University Hospital NHS Foundation Trust

Interface Prescribing Framework

Author Developed by the Joint Prescribing & Medicines Management Group

Version 6.0 March 2017

Version Date

March 2015 V5 February 2013 V4 June 2009 V3

November 2007 V2 September 2007 V1

Implementation Date 11th March 2013

Review Date

February 2019

File Reference



City & Hackney CCG & Homerton University Hospital NHS Foundation Trust – Interface Prescribing Framework

Developed by the Joint Prescribing & Medicines Management Group

CONTENTS PAGE

1.0 Quick reference guides 3/4

2.0 Introduction 5

3.0 General Principles 5 4.0 In-patients 5

5.0 A&E 7

6.0 Outpatients 7

7.0 Day Cases 8

8.0 Homecare 8

9.0 Clinical Trials 8

10.0 Transfer of Prescribing from 8 Secondary to Primary Care

11.0 Tertiary Care Referrals 11

12.0 Clinical Governance / Performance 11 Outcomes

13.0 Review 13

14.0 Monitoring/ Audit 13

Appendix 1 Consultation Appendix 2 Equality Impact Assessment Appendix 3 Contract terms and conditions related to discharge documentation Appendix 4 Inappropriate Prescribing Request Communication Form Appendix 5 Letter to Patient (outpatients) Document Control Summary - Signatures



No FP10 - Patient told to

arrange to see or contact GP in 2 weeks’ time or after

they receive a copy of the clinic letter addressed to

their GP

Typed letter sent

within 5 working days to GP making a

recommendation regarding medication

to be prescribed.

Letter should arrive at GP surgery within 10

working days

A copy of the GP letter

should be sent to the patient

1.0 Summary /Quick Reference Guide - OUTPATIENTS

Following Outpatient Appointment -

is immediate or urgent treatment required?

YES NO

Patient takes FP10 to community chemist

to be dispensed

Typed letter is sent to

GP describing the medication prescribed.

GP provides repeat

prescriptions if required Patient contacts GP 2

weeks after OPD

appointment to arrange to collect a prescription

* OPD = Out Patient Department. ** HUHFT= Homerton Hospital NHS Foundation Trust *** OP = Outpatient

Provide FP10 –

available from OPD* lead nurse

(28 days supply) or patient pack.

Hospital only drugs will be supplied by

hospital pharmacy on HUHFT** OP***

prescription.



1.1 Summary /Quick Reference Guide – DAYCASES, INPATIENTS and A&E

Day Case

Patient Inpatient A&E Patient

Provide 14 days

medication (or less if

appropriate) in form of a pre pack or dispensed

from hospital pharmacy

Provide 14 days (or less if required by

the course of medication) in pre

pack form – or dispensed from

hospital pharmacy, or using patients own medicines if

deemed fit.

Provide 5 days of

medication in pre pack form, or

provide FP10 if pre pack unavailable

Provide at least 48 hours analgesia in pre pack form if required

DISCHARGE SUMMARY TO BE SENT TO GP WITHIN 24 hours OF DISCHARGE).

Patient to leave hospital with copy of preliminary summary



2.0 Introduction

This policy has been developed by the City and Hackney Clinical Commissioning Group and Homerton University Hospital Foundation Trust (HUHFT) Joint Prescribing and Medicines Management Group (JPG) and has been agreed by the members of the JPG and by the Clinical Board of HUHFT.

3.0 General Principles

3.1 The JPG should develop and maintain an up-to-date formulary, or prescribing guidelines with the involvement of hospital specialists, GPs and NHS prescribing advisers. The JPG will consider the clinical and cost-effectiveness of new medicines, the impact on primary care as well as secondary care and all related issues (eg. delivery of care and commissioning arrangements)

3.2 All patients should receive safe and effective drug therapy in the most appropriate healthcare

setting.

3.3 Legal responsibility for prescribing lies with the healthcare professional who signs the prescription and assumes full medico legal responsibility regardless of whether they have received advice from another practitioner (e.g. hospital specialist or in the case of prescribing continuing regular medication as in-patients,)

3.4 Clinicians and pharmacists must prescribe, recommend, dispense and label by generic name

except where it is clinically inappropriate.

3.5 The hospital will dispense medicines routinely as patient packs, in order to comply with European

Community directive 92/27/EEC on pharmaceutical labelling, and the provision of information to patients.

3.6 Clinical Commissioning Groups (CCGs) expect providers to adhere to the guidance contained

within the following circulars

EL(91)127 ’Responsibility for prescribing between hospitals and GPs’

EL(94)72 ‘Purchasing and Prescribing’

EL(95)5 ‘Purchasing high-tech health care for patients at home’

Commercial sponsorship in the NHS, Dept of Health Nov 2000.

Technical patient safety solutions for medicines reconciliation on admission of adults to hospital NICE/NPSA December 2007. This list is not exhaustive and compliance with all relevant circulars and guidance is required.

3.7 HUHFT should have a discharge policy in place that includes arrangements for the transfer of

prescribing information to GPs. 3.8 The majority of prescribing by hospital clinicians should be in line with the joint formulary, or

prescribing guidelines. Where, exceptionally, a patient’s treatment necessitates the prescribing of a non-formulary drug, the hospital clinician should discuss the choice of drugs and reasons for prescribing outside the formulary with the JPG chair(s) (using the ‘Information Required for Request of Non-Formulary Use of a Pharmaceutical Agent’ form) in the first instance or the hospital pharmacy department. If treatment is non-urgent a new drugs application form for formulary inclusion should be submitted to the JPG for consideration.

3.9 GP prescribing under a shared care arrangement should only be considered when the patient’s

condition is stable, prior agreement of the GP has been sought, and the GP has sufficient information to safely prescribe for the patient.

4.0 In-patients

(Person admitted to hospital for the purpose of observation, care, diagnosis & treatment)



4.1 On referral to a hospital consultant it is the responsibility of the GP to give comprehensive details of a patient’s medical history, drug treatment, previous adverse reactions, allergies and reason for referral.

4.2 Medicines management arrangements on admission should include:

- Provision of information to patients before planned admissions about the arrangements in the

hospital e.g. bringing in own medicines, use of patients own medicines, dispensing for discharge. - Arrangements for medicines history taking, pharmacist review of medication and medicines

reconciliation. 4.3 All drugs and dressings prescribed for administration while an in-patient are the responsibility of

the consultant concerned. All necessary drugs and dressings will be supplied by the HUHFT (subject to paragraph 4.2).

4.4 Patients should be encouraged to bring their medicines with them into hospital. This facilitates

medicines reconciliation on admission and reduces risk of medication errors. 4.5 Patients own drugs remain their own property and should be returned to them on discharge from

hospital, providing such therapy is still appropriate. Any medicines not used during the admission in accordance with the hospital’s patients own drugs policy must be returned to the patient on discharge from hospital unless the patient/ patient’s representative have agreed to have the medicines destroyed. If the patients drugs are not of a suitable quality to discharge with or they are no longer required, then the patient’s consent must be obtained for destruction (please refer to HUHFT Patients Own Drugs Policy)

4.6 Patients’ own drugs, with the agreement of the patient, may be used while the patient is in hospital

until a supply is made by the hospital pharmacy or where a policy exists regarding the use of patient’s own drugs. They may be used to fulfil discharge medicine requirements.

4.7 When a patient is discharged from hospital, a minimum of 14 days of drugs (supplied in the form

of a patient pack wherever possible), or sufficient dressings for 3 working days should be prescribed (subject to paragraph 4.2) unless the full course of treatment calls for a shorter supply. It should be noted that some dressings may be difficult to obtain in primary care – in such cases more than 3 days’ supply should be provided. Where a medicines compliance aid (MCA) is in use, the hospital team will aim to ensure appropriate medication continuity through the following approaches:

Communication with the patient’s community pharmacy including faxing a copy of the discharge summary prior to discharge.

Supply of a 14 day MCA.

Supply of a Medication Administration Record (MAR) sheet.

An interim conventional supply as appropriate (i.e. if nothing changed in patient’s current MCA

but a short course of new treatment is required then supply of the new treatment will be given

only after discussion with the patient. 4.8 A hospital policy should be in place for use of patients’ own drugs, self-administration of

medication, dispensing medicines for discharge and the use of Compliance aids (such as monitored dosage systems) including making appropriate arrangements for continuity after discharge.

4.9 Patients will not be initiated on a MCA by the hospital, with the exception of selected patients e.g. requiring antiretrovirals for HIV. Where a patient is admitted into hospital with a MCA and where no changes to regular medications are made, the hospital will liaise with the patient’s GP and community pharmacist and arrange for further medicines to be prescribed and dispensed (either to be collected by the patient or delivered to the patient) on discharge. The prescriber and community pharmacist will subsequently review the patient for on-going need of a MCA.

4.10 Clinicians must provide the patients GP with:

information on diagnosis and reason for admission

a brief update from the inpatient stay



patient’s medication on discharge, including - whether to continue, titrate or stop, - any medication changes and reasons for the changes.

In addition, any relevant clinical or biochemical monitoring parameters should be communicated highlighting further monitoring to be undertaken by the GP. This information must be made available to the patient’s GP within 24 hours of discharge to allow ongoing treatment to be

maintained. If this cannot be guaranteed, then the hospital should prescribe for as long a period as necessary.

The definitions of a discharge letter and a discharge summary are set out in Appendix 3.

5.0 Accident and Emergency

5.1 A minimum 5 days’ supply of drugs and/or dressings needed should be given unless the full course of treatment requires for a shorter supply. A minimum of 48 hours of analgesia at recommended doses should be supplied.

5.2 Patients’ own drugs should remain with the patient during the time of their assessment and

transferred with them if they are admitted or sent home, unless clinically inappropriate. If it is clinically inappropriate to return a patient’s own medication, the patient should be made aware of the change and advised to dispose of similar medicines at home.

5.3 Where appropriate, patients with self-limiting conditions can be referred to the local Minor Ailments

scheme (Pharmacy First). This scheme is offered by community pharmacies.

5.4 Medicines supplied by A&E are subject to prescription charges. Therefore, arrangements will be in place where possible to collect prescription charges from patients who would normally pay and patients should be reminded it is a criminal offence to falsely declare exemption to charges.

6.0 Outpatients (A person who is attending a hospital outpatient clinic)

6.1 GPs should advise patients to take a list of all current medicines (including OTC) they are taking to all outpatient consultations and clarification of their allergy status to allow a comprehensive assessment by the hospital specialists. In most cases this can be obtained as an FP10 list from the GP practice.

6.2 Routine repeat medicines should not be supplied at outpatient consultations and patients

requesting these should be advised to contact their GP practice.

6.3 Drugs and dressings prescribed for administration during a hospital outpatient consultation should

be provided by the Trust. 6.4 If immediate treatment is required following an outpatient consultation, a minimum of 28 days of

drugs (supplied in the form of a pre-pack wherever possible or on FP10) and a minimum of 3 working days of dressings should be supplied, unless the full course of treatment requires a shorter supply. Examples of situations in which an immediate supply may be required include: antibiotics, corticosteroids or analgesics in some situations and some paediatric medicines.

6.5 If the medication is not available in primary care or the patient would experience difficulty in getting

an FP10 dispensed, a HUHFT outpatient prescription will be provided. This must be dispensed at HUHFT pharmacy. A minimum of 28 days’ supply (in the form of a patient pack wherever possible) should be made, unless the full course of treatment requires a shorter supply.

6.6 When any high risk drugs (which are exempt from ‘hospital only’ prescribing) are first initiated at

an outpatient consultation, the first supply should be provided, along with reference to any shared care arrangements for the GP if they exist or any other supporting information required by the GP in order to continue therapy where appropriate. A request should then be made to the GP to accept this shared care arrangement.

6.7 When the patient does not require an immediate supply, the patient should be informed that



their treatment is not urgent, and asked to contact their GP practice after 2 weeks, or after they receive a copy of the clinic letter addressed to their GP to arrange a supply. All relevant information enabling the GP to prescribe, should reach the practice within 10 working days or less.

6.8 Patients should be advised of the timescale that this information may take to reach the GP, and

should be advised to allow enough time for this information to reach their GP before contacting them for a prescription.

6.9 Patients should be copied into correspondence with the GP wherever possible. Trust clinicians should follow best practice national guidelines regarding the copying of correspondence to patients.

7.0 Day Case Patients (a person that requires an intervention to be performed in

hospital but does not need to stay overnight)

7.1 Drugs and dressings prescribed for administration during day case treatments are the responsibility of the consultant concerned (subject to paragraph 7.2). All necessary drugs and dressings for administration as a day case will be supplied by the HUHFT (subject to paragraph 7.2).

7.2 Discharge medication for day case patients are supplied as pre-packs. A minimum of 14 days of

drugs (supplied in the form of a patient pack wherever possible) and a minimum of 3 working days of dressings should be supplied, unless the full course of treatment requires a shorter supply.

7.3 Where medicines are given on discharge of day patients, arrangements will be in place where

possible to collect prescription charges from patients who would normally pay for their prescriptions or for patients who are exempt from prescription a declaration of exemption will be obtained.

8.0 Homecare

8.1 HUHFT may consider the delivery of treatment via home care services to patients when there are internal trust capacity issues and/or when the treatment is considered to add value to patient care. Homecare should be set up in accordance with the principles and recommendations set out in the DoH report “Homecare Medicines – towards a vision for the future”. This should be reflected in commissioning arrangements. If this is not the case, individual care packages will need to be agreed between commissioners and Trusts, when necessary.

9.0 Clinical Trials

9.1 All clinical trials must have been subject to Research and Ethics Committee approval. GP should be adequately informed if a patient is participating in a clinical trial.

9.2 Prescribing and supply of clinical trial material is the responsibility of the HUHFT.

9.3 Patients should be made aware that funding for clinical trial medication may not be available once

the trial comes to an end. Trusts must discuss the financial implications of on-going clinical trials with commissioners.

10.0 Transfer of Prescribing from Secondary to Primary Care

10.1 It is usually more convenient for patients to access ongoing repeat prescriptions from their GP however the safety issues and monitoring requirements relating to some drugs will require ongoing hospital prescribing.

10.2 The JPG as part of its decision making on drugs will advise on the appropriate setting (hospital or

primary care) for drugs to be initiated and continued. Joint prescribing arrangements will be considered as part of the application to include drugs in the joint formulary.



10.3 Responsibility for Prescribing

EL(91)127 states that a GP should not accept responsibility unless he or she feels confident in prescribing for that condition, but recognises that he or she may prescribe any drug that is not on the Blacklist - Part XVIIIA of the Drug Tariff

GPs are encouraged to accept responsibility for prescribing whenever it is appropriate. Refusal to prescribe should not be made on economic grounds. If the GP feels s/he has not been given sufficient information by the hospital to undertake prescribing, then the GP should contact the relevant hospital clinician for further information / guidance to enable them to prescribe. The GP may also contact the respective Medicines Management Teams for advice.

Legal responsibility for prescribing lies with the doctor issuing the prescription.

Hospital doctors should not ask GPs to prescribe new treatments that have not been approved by the

JPG. When prescribing responsibility is transferred from secondary to primary care post discharge, the

GP must have confidence in prescribing the necessary drugs. The GP should receive a full discharge summary, including detailed clinical information, within 10 days of discharge from the hospital.

If there is insufficient clinical information, the GP should defer prescribing and contact the consultant

for more information. The consultant will arrange for the patient to receive a prescription until such time as the GP has sufficient information to be satisfied to accept responsibility for prescribing.

If a GP decides not to prescribe, the reasons should be put in writing to the consultant. GPs may use the ‘Inappropriate Prescribing Request Form’ (available to download from the intranet) to indicate the reason they are unable to prescribe a drug.

Refusal should not be on grounds of cost. If necessary, in exceptional circumstances, the

prescribing adviser and the hospital specialist pharmacist will liaise with clinicians to determine ongoing arrangements for prescribing.

10.4 When Responsibility for Prescribing Normally Remains with Hospital Trust Consultants 10.4.1 The hospital Trust is expected to retain prescribing responsibility for medicines where:

o Drugs are undergoing or included in a hospital based clinical trial o The consultant considers that only s/he is able to monitor the patient’s response to medication

because, for example, of the need for specialised investigations o A drug or appliance is not available on a FP10 or is only available through the hospital o Drugs subject to High-tech Hospital at Home guidance, EL(95)5 o No shared care agreement exists and the GP does not feel confident in taking on clinical

responsibility for the prescribing of a drug o Medicines and dressings which are intended to be used/administered in hospital out-patient clinics

or day-care surgery (e.g: intrauterine levonorgestrel implants). 10.4.2 Unlicensed drugs remain the responsibility of the hospital consultant

except where:

o a drug is included in the joint formulary o a substantial body of evidence exists to support the use of an unlicensed medicine or a licensed

medicine outside its licensed indications e.g. paediatrics (the current BNF for Children is considered a substantial body of evidence), in which case the GP may be asked to prescribe.

10.4.3 Where a treatment is not licensed for a particular indication, the GP must be informed and the

consultant should give full justification for the use of the drug to the GP. 10.4.4 Informed consent for the use of unlicensed medicines or the use of licensed medicines outside

their licensed indications should be obtained from patients before the prescription is written.



10.5 Transfer of Prescribing Medicines Requiring Specialist Monitoring – Joint Prescribing

Arrangements 10.5.1 Therapy initiated in hospital which requires specialist knowledge, training and/or has complex

monitoring schedules would not normally be prescribed in primary care. However it is possible that the GP and hospital clinician can agree shared care for a named patient with a named drug once the patient’s condition is stable. This section relates to those drugs classified as Amber (Shared Care Guidance) in the City & Hackney CCG / HUHFT Joint Formulary, where shared prescribing /monitoring arrangements are available.

10.5.2 The most appropriate method of ensuring adequate exchange of information is by development of local Shared Care Guidelines. Shared Care Guidelines should be developed collaboratively between secondary and primary care clinicians within a locally agreed process that involves the JPG.

10.5.3 The following conditions should be met before the shared care takes place:

o The patient’s condition is stable o Treatment is in accordance with a shared care guideline, which clearly defines the

responsibilities of all parties, and which has been approved by the JPG o The written agreement of the patient’s GP is obtained, using an agreed form,

prior to the transfer of prescribing o The GP is sufficiently informed and able to monitor treatment, identify medicine

interactions and adjust the dose of any medicines as necessary.

10.5.4 The provision of joint prescribing arrangements does not automatically mean the GP prescribes the medication.

10.5.6 If the GP is unable to accept clinical responsibility, s/he should contact, in writing, the consultant

concerned stating the reasons. GPs cannot be forced to prescribe and the decision about whether to take on responsibility for prescribing will ultimately lie with the individual GP.

10.5.7 If a GP has accepted a joint prescribing arrangement for a patient and the patient does not attend

the hospital for monitoring, the GP must be informed. They will then have to exercise clinical judgement as to whether it is in the best interest of the patient to continue to prescribe until suitable monitoring can be commenced.

10.5.8 The GP should contact the prescriber as appropriate, within 14 days, as a minimum

if they are not able to accept shared care for the patient.

Joint Formulary Amber Drugs (Shared Care Guidelines) These drugs should only be prescribed by a GP if approved joint prescribing arrangements have been agreed between GP and consultant. Where a GP disagrees to shared care arrangements or needs further clarification the GP should contact the Hospital Specialist directly (using the ‘inappropriate prescribing request communication form’ appendix 4)

The JPG will update this list of drugs regularly. This list is not intended to restrict a GP’s freedom to prescribe.

There may be other drugs not included on this list for which a GP has concerns about accepting prescribing responsibility. GPs are advised to contact their medicines management team in the first instance to discuss how these concerns may be addressed.



11.0 Tertiary Care Referrals

11.1

It is expected that the care and treatment of patients referred to tertiary care will remain the responsibility of the tertiary centre while they continue to require specialist care.

11.2

In some cases it may be appropriate to transfer prescribing to a more local hospital Trust

or

more rarely to a GP. In all situations there should be robust processes in place between tertiary centre, hospital trust and GP to ensure timely and accurate transfer of a patient’s medication details to appropriate professionals responsible for his/her care. Where GPs are not required to prescribe (eg. hospital only drugs), discharge and outpatient letters should clearly state that the affected drugs are to be supplied by the hospital only.

12.0 Clinical Governance / Performance Outcomes

12.1 Providers will ensure that appropriate arrangements are established to meet the requirements of clinical governance, as described in “A First Class Service, Quality in the New NHS” (HSC 1998/113), with respect to prescribing practice. This will include a comprehensive programme of quality improvement activity, such as clinical audit and evidence based practice, and ensuring that clinical standards of National Service Framework and NICE recommendations are implemented.

12.2 The pharmaceutical and prescribing services of the Provider will also be responsible for ensuring

that internal processes are in place to meet the compliance targets with the outcomes stated in the ‘Medicines Management Outcomes & Performance Framework 2014-15’. They must comply with the performance indicators outlined in the framework to demonstrate accuracy of information, medicines optimisation, adherence to local formularies and implementation of national and local guidance.

13.0 Review

Mandatory: This policy will be reviewed in 3 years’ time. Earlier review may be required in response to exceptional circumstances, organisational change or relevant changes in legislation or guidance.

14.1 Monitoring/Audit

Mandatory: detailed arrangements for the implementation and application of the policy. It should also include details on how compliance could be audited; how it will be monitored, who by and how frequently.

Measurable Policy Objective

Monitoring/Audit Frequency of monitoring

Responsibility for performing the monitoring

Monitoring reported to which groups/committees, inc responsibility for reviewing action plans

Full supply of TTA as per policy for medicines and dressings as stated in section 4.7

Monitoring and Audit

Once every 2 years

HUHFT and CCG

JPG

Completeness of discharge summaries as stated in section 4.10

Audit Once every 2 years

CCG and HUHFT

JPG



Appendix 1 List of all staff consulted as part of guideline development

First Consultation (June - September 2007)

Members of the Joint Prescribing & Medicines Management Group Members of Clinical Board – Executive Directors & Clinical Directors

Final Consultation

Clinical Audit & Effectiveness Lead Trust Clinical Audit & Effectiveness Lead CWSH Clinical Audit & Effectiveness Lead DSO Clinical Audit & Effectiveness Lead GEM Clinical Director CWSH Clinical Director GEM Clinical Director DSO Chief Executive, Chair of Clinical Board Medical Director All Executive Directors General Manager, GEM General Manager, DSO General Manager, CWSH

Consultation Version 3 (June 2009)

Joint Prescribing & Medicines Management Group

Consultation Version 4 (February 2013)


Consultation Version 5 (March 2015)


1. Inclusion of Inappropriate Prescribing Request Form (Appendix 4)

Consultation version 6 (March 2016) Joint Prescribing & Medicines Management Group



Appendix 2

Equalities Impact Assessment This checklist should be completed for all new Corporate Policies and procedures to understand their potential impact on equalities and assure equality in service delivery and employment.

Policy/Service Name:

Interface Prescribing Framework

Author: Joint Prescribing and Medicines Management Group

Role:

Directorate:

Date 11th March 2013 (reviewed March 2017)

Equalities Impact Assessment Question

Yes

No

Comment

1. How does the attached

policy/service fit into the trusts overall aims?

This policy is in line with the contract held with CCGs regarding interface prescribing and supports the productivity and efficiency programme aims

2. How will the policy/service be

implemented?

The policy will be re-launched with clinicians in the Trust. There are no significant changes to the previous 2009 version.

3. What outcomes are intended by implementing the policy/delivering the service?

To provide clear guidance for interface prescribing.

4. How will the above outcomes be

measured?

Any interface prescribing issues which arise will be raised and dealt with via JPG.

5. Who are they key stakeholders in respect of this policy/service and how have they been involved?

Hospital Consultants and GPs – representatives consulted via JPG.

6. Does this policy/service impact on other policies or services and is that impact understood?

No

7. Does this policy/service impact on other agencies and is that impact understood?

No

8. Is there any data on the policy or

service that will help inform the EqIA?

No

9. Are there are information gaps,

and how will they be addressed/what additional information is required?

No

Equalities Impact Assessment Question

Yes

No

Comment

10. Does the policy or service

development have an adverse impact on any particular group?

No



11. Could the way the policy is carried out have an adverse impact on equality of opportunity or good relations between different groups?

No

12. Where an adverse impact has

been identified can changes be made to minimise it?

NA

13. Is the policy directly or indirectly

discriminatory, and can the latter be justified?

No

14. Is the policy intended to increase equality of opportunity by

permitting Positive Action or Reasonable Adjustment? If so is this lawful?

No

EQUALITIES IMPACT ASSESSMENT FOR POLICIES AND PROCEDURES

2. If any of the questions are answered ‘yes’, then the proposed policy is likely to be relevant to the

Trust’s responsibilities under the equalities duties. Please provide the ratifying committee with information on why ‘yes’ answers were given and whether or not this is justifiable for clinical reasons. The author should consult with the Director of HR & Environment to develop a more detailed assessment of the Policy’s impact and, where appropriate, design monitoring and reporting systems if there is any uncertainty.

3. A copy of the completed form should be submitted to the ratifying committee when submitting the

document for ratification. The Committee will inform you if they perceive the Impact to be sufficient that a more detailed assessment is required. In this instance, the result of this impact assessment and any further work should be summarised in the body of the Policy and support will be given to ensure that the policy promotes equality.



Appendix 3 Terms and conditions in NHS acute services contract related to discharge obligations: refer to page 11 of link:

http://www.commissioningboard.nhs.uk/files/2013/02/contract-service.pdf

http://www.commissioningboard.nhs.uk/files/2013/02/contract-service.pdf



Appendix 4

Inappropriate Prescribing Request Communication Form

PRESCRIBING OF MEDICINES RECOMMENDED BY ACUTE TRUST CLINICIANS Primary care clinicians – complete this form if you are unwilling to take responsibility for prescribing medicines recommended by a hospital clinician. To prevent unintended breaks in the patient’s treatment, please call the City and Hackney Medicines Management Team on 020 3688 1424 to discuss interim medicine supply.

Please post /fax copy of this form to: the initiating hospital consultant and the hospital chief pharmacist.

Patient name Consultant name Patient date of birth Name of prescriber

(if different from above)

NHS number

Hospital number if known

Hospital / Trust

Name of drug Please fill in a separate form for each drug.

Dose & frequency

Indication

Duration of treatment

I have been asked to take over the responsibility of prescribing the above drug for this patient. However I feel I am not in a position to do this for the following reasons:

Please

mark A. Prescribing responsibility should stay with the hospital

Drug is included in the list of products approved by the local acute/mental health trust for hospital only prescribing

Drug requires regular specialist monitoring AND/ OR the majority of care and monitoring is supplied by the hospital (delete as appropriate)

Drug is included in the list of products approved by the local acute / mental health trust for shared care prescribing but no shared care guidance or clinical information has been provided

Drug is included in the list of products approved by the local acute / mental health trust for shared care prescribing however patient is not yet stabilised on the drug

Unlicensed drug / dose / indication where the primary care clinician is unwilling to take clinical responsibility

Hospital clinical trial drug

Please

mark B. Lack of experience / information

Drug is not on the ‘hospital only prescribing’ list but the primary care clinician feels unable to accept clinical responsibility because:

Drug is not in the local formulary / not approved by the local Joint Prescribing Group(JPG) / Mental Health Medicines Committee.

Hospital clinicians should not request primary care clinicians to initiate treatment with drugs that have not been approved, unless previously agreed between the hospital clinician and primary care

Newly licensed drug where place in therapy and / or risks due to the drug, are unknown by the primary care clinician.

C. General comments / other reasons

NB: Responsibility for prescribing should not be refused on the grounds of drug cost. If this is an issue please contact the Medicines Management Team for guidance

GP name: Date: Practice Address:



Information

It is essential that the primary care clinician must be completely satisfied that all the relevant clinical information related to a drug being recommended for prescribing in primary care is available and responsibilities are clear from the outset, in terms of who would be monitoring the patient, frequency of monitoring and follow up blood results and under which circumstance the patient should be referred back to the secondary care clinician.

If a primary care clinician does not feel that they have received sufficient information OR the recommended drug is outside of their competence and experience, it is recommended that the secondary care clinician is informed directly of this decision and alternative arrangements discussed.

If the primary care clinician has been asked to prescribe a drug which is non-formulary the request should be challenged.

To prevent unintended interruptions or delays in the patient’s treatment, an ‘inappropriate prescribing request communication form’ should be completed and faxed to:

1. The secondary care specialist initiating the prescription

2. The chief pharmacist at the Acute Trust

If an urgent prescription is needed, please contact:

The Chief Pharmacist at Homerton University Hospital NHS Foundation Trust on 020 8510 7028 or The Lead Pharmacist at East London Mental Health Foundation Trust on 020 8510 8401 or The Chief Pharmacist at Barts Health NHS Trust on 020 3246 0140 or The Chief Pharmacist at Moorefields Eye Hospital NHS Foundation Trust on 020 7566 2366

If the request originates from an acute or mental health trust not mentioned above, please contact the City and Hackney Medicines Management Team for advice on 020 3688 1424

Addresses:

Chief Pharmacist, Homerton University Hospital NHS Foundation Trust Pharmacy Department Homerton Row London E9 6SR

Fax: 020 8510 7428

Chief Pharmacist, East London Mental Health Foundation Trust Pharmacy Department Mile End Hospital Bancroft Road London E1 4DG

Fax: 020 8510 7251

Chief Pharmacist, Barts Health NHS Trust Pharmacy Department Pathology and Pharmacy Building 80 Newark Street Whitechapel London E1 2ES

Fax: 020 32460125

Chief Pharmacist Pharmacy Department Moorfields Eye Hospital NHS Foundation Trust City Road London EC1V 2PD

Fax: 020 7566 2360



Appendix 5

Date: ………………………………………….

Dear: ………………………………………….

Your GP has asked for advice about your health problem and that is why I saw you in my clinic today. I am pleased to inform you that I can see no need for urgent treatment. I will however be writing to your GP with my recommendations for your future care.

My formal letter will be with your GP within two weeks, as will the results of all routine tests you had done today. Please arrange to see your GP after two weeks to review my findings and discuss the next phase of your care. Results from the more specialist tests do occasionally take a little longer than two weeks but we will inform your GP of these.

.

Yours sincerely

Consultant Homerton Hospital



Policy Submission Form

Policy Submission Form To be completed and attached to any policy or procedure submitted to the Trust Policy Group

1 Details of policy 1.1 Title of Policy: Interface Prescribing Framework

1.2 Lead Executive Director Martin Kuper Medical Director

1.3 Author/Title JPG

1.4 Lead Sub Committee JPG

1.5 Reason for Policy To ensure appropriate interface prescribing

1.6 Who does policy affect? Hospital consultants, clinical nurse specialists and GPs

1.7 Are national guidelines/codes of practice incorporated?

Yes

1.8 Has an Equality Impact Assessment been carried out?

Yes

2 Information Collation 2.1 Where was Policy information

obtained from? From national guidance and national acute services contract + advice from clinicians at JPG and Clinical Board

3 Policy Management 3.1 Is there a requirement for a new or

revised management structure if the policy is implemented?

No

3.2 If YES attach a copy to this form

3.3 If NO explain why

4 Consultation Process 4.1 Was there internal/external

consultation? Internal

4.2 List groups/Persons involved JPG

4.3 Have internal/external comments been duly considered?

Yes – all comments have been incorporated

4.4 Date approved by relevant Sub- committee

4.5 Signature of Sub committee chair

5 Implementation



5.1 How and to whom will the policy be distributed?

To all clinical consultants and clinical nurse specialists, operational managers, clinical board.

5.2 If there are implementation requirements such as training please detail?

No

5.3 What is the cost of implementation and how will this be funded?

NA

6 Monitoring 6.1 List the key performance

indicators e.g. core standards FP10 expenditure at appropriate level expected for current outpatient activity

6.2 How will this be monitored and/or audited?

Monitoring will be via FP10 expenditure

6.3 Frequency of monitoring/audit Quarterly

Date policy approved by Trust Policy Group:

………………………………………………………………

………………… Signature of Trust Board Group

chair:

………………………………………………………………………………

Date post:	30-Jun-2020
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

City & Hackney CCG & Homerton University Hospital NHS ... · City & Hackney CCG & Homerton...

Documents