CommunityPharmacy News

PharmaBaseNMS modulelaunched –now live on allPharmaBase sites

OCTOBER 2011

Inside this issue• Specials in Drug Tariff from November• PSNC events for contractors• Quit Kit 3 2012 campaign• Inducements FAQs

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� NMS module launched in PharmaBase

Capturing the evidence base for NMSThe PharmaBase module to supportthe New Medicine Service (NMS)was launched at the end ofSeptember. The module is live on allPharmaBase sites, so all pharmaciesshould be able to access it.

The use of the module will createa large dataset on the NMSwhich will support the academicevaluation of the service;national collation of this data isessential if communitypharmacy is to be able to makethe case for the ongoingcommissioning of the service.

The module has been designed withinput from practising communitypharmacists to be quick and easy to usein a busy pharmacy. The module will helpyou to efficiently provide the NMs andincludes the following functionality:– patient registration (including postcode

lookup functionality and a central list ofall GP practices)

– printing consent forms– scheduling interventions and follow ups

using a pharmacy calendar– printing a patient information leaflet

and appointment reminder– a task list of patient reminders to be

provided prior to appointments– recording the mandatory dataset for the

intervention and follow up– creating NMs Feedback forms to refer

patients back to their GP practice– an ‘NMs dashboard’ to allow the

pharmacy team to keep track of theirNMs activity during the month

– creating the quarterly reports for PCTs

A Quick start guide for the module canbe downloaded from www.psnc.org.uk/pharmabase. You will also find aPowerPoint presentation which has screenshots from the module, to help you withstaff training. A copy of the Quick startguide will be mailed out to pharmacies inearly October.

NMs worksheets for the Interventionand Follow up stages of the service canbe downloaded from www.psnc.org.uk/nms. These worksheets can be used if youdo not have access to a computer in yourconsultation area or do not wish to usethis during the consultation with thepatient. The worksheets allow you toquickly record the NMs data followingyour discussions with the patient; thisinformation can then be rapidly added tothe patient’s record on PharmaBase. Theworksheet data capture section is laid outto match the PharmaBase NMs module,so it is easy for pharmacy support staff totransfer data from the paper worksheet toPharmaBase.

Pharmacy contractors who areexperiencing technical difficultieswith PharmaBase can contact theCrimson systems helpdesk on:

01675 436572

Not got your PharmaBaselogon details?Independent communitypharmacies and most smallgroups were sent theirPharmaBase logon details in aletter earlier this year. If you havemislaid your logon details, contactthe Crimson systems helpdesk onthe above number.

If your pharmacy is part of alarge group (Company Chemists’Association and some AIMpmembers) your head office will bemanaging the distribution ofPharmaBase logon details; if youhave not yet received logondetails, please contact your headoffice in the first instance.

ENHANCED SERVICESThe most popular services searchedfor on the PSNC website during themonth of September were:

• Minor ailments• eHC• COPD• Gluten free food supply• Anti-coagulant serviceEnhanced services are negotiated locallyand commissioned mainly by PCTs.PSNC has collated details of over750 Enhanced Services on theCommunity Pharmacy Services databasewhich is available on the PSNC website at:

www.psnc.org.uk/database

Want to find information ona particular service?On the service database page on the PSNCwebsite click on the search button to finddetails of local services across the country.

Want to share details of aservice?PSNC is collating as much evidence aspossible on community pharmacy services.

If you have developed or implemented aservice in your area and would like to sharethe details including any documentationwith PSNC and LPCs then you can uploadthe information for any new service to theonline service database by clicking ‘Submitinformation on a Local Service’.

For any existing services already on thedatabase which need updating, MelindaMabbutt, a member of the PSNCInformation Team, will be inputting anyupdated information that you provide.Please submit any changes to existingservices to Melinda by email viadatabase@psnc.org.uk

Focus on OutcomesAs there is an increased need for anevidence base for service proposals, thereis a greater focus on outcomes so pleasesend any reports, audits, evaluations ofservices or summaries of outcomes toMelinda so that they can be added to thedatabase to provide further support.

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snc.org.ukMUR data capture requirements �

In order to demonstrate the value of theMUR service it is essential that data arecollected to show the benefits to patients.There are a number of changes that willbe required to MUR systems andpaperwork to facilitate the data collectionand NHs employers and PsNC havetherefore agreed a two-phased approach,with some changes being introduced inOctober 2011 and the remainder beingintroduced in April 2012.

This two-phased process will allow theopportunity to review the MUR recordingand reporting requirements prior to thesecond phase. An expert group will beestablished which will include a range ofstakeholders and academic input toreview the data requirement. In orderfor the necessary arrangements andprocesses to be put in place, the reviewwill take place by the end of 2011.

Changes from October 2011The MUR form will continue to be useduntil April 2012.

each participating pharmacy mustcomplete a reporting template (the MURreporting template agreed by NHsemployers and PsNC) by collating thenecessary data from pharmacy records forthe MURs conducted in that quarter andensuring that it is available to berequested after the end of 10 workingdays from the last day of that quarter (lastday of June, september, December andMarch). Completed templates must beprovided to the PCT or successororganisation on request (which may bean ongoing request).

Quarterly data to be enteredinto the reporting template:1. Total number of MURs delivered to

patients in each group:Respiratory / High risk medicine /Post-discharge / Non target group

For MURs that fall into more than onetarget group, the pharmacist shouldmake a determination as to whichgroup the MUR should be allocated.

2. Number of patients where amedication issue was identifiedby the pharmacist and actionwas taken.

3. Number of patients referred back tothe GP practice or another primaryhealth care provider.

4. Number of patients where as a resultof the MUR the pharmacist believesthere will be an improvement in thepatient’s adherence to the medicinesand type of benefit (more than onemay apply):� Better understanding of whythey are using the medicine/whatis it for� Better understanding of when/how to take the medicines� Better understanding of sideeffects and how to manage them� Better understanding of thecondition being treated

The MUR reporting template andassociated record keeping resources can bedownloaded from www.psnc.org.uk/mur.

April 2012 onwardsFrom April 2012, the requirements for allMURs are set out below. Theserequirements are a minimum and may besupplemented with additional itemsbased on the recommendations of theexpert group.

The expert group will:� consider the appropriateness of use of

an interview schedule in the MURservice; assuming this approach isagreed, develop an appropriate

interview schedule, building on thework already undertaken for the NewMedicine service (NMs)

� assess the appropriateness of the NMsdataset for application to MURs andadvise on additions, amendments anddeletions

� review the current MUR form recordkeeping arrangements in light of theabove and agree good practice guidanceon professional records which may needto be maintained by the pharmacy

� review the approach taken tocommunicating with GPs about issuesarising in an MUR, building on the workundertaken by the Professional Relationsworking Group on NMs feedback.

A dataset has been agreed betweenNHs employers and PsNC which will becaptured for every MUR (including non-targeted MURs) that takes place from April2012. This is to be retained by thepharmacy. The agreed dataset is availableat www.psnc.org.uk/mur. when thisdataset is introduced, the requirement tocomplete and retain the current MURform will be removed from the Directions.

each participating pharmacy mustcontinue to complete a reportingtemplate (the MUR reporting templateagreed by NHs employers and PsNC) asdescribed above. In addition to theoutcome measures set out in above, thefollowing measure will also be collectedand reported on the reporting template:

5. Total number of patients given briefadvice about a healthier lifestyleand type of advice:diet and nutrition / smoking /physical activity / alcohol / sexualhealth / weight management

From April 2012, each of the outcomemeasures must be reported by target group.

The expert group will review theapproach taken to communicating to GPs.As part of this work is it expected thatthey will develop a feedback form to besent to GPs (where appropriate). This willreplace the use of the current MUR formas a referral document.

PSNC E-NEWSTo receive a weekly summary of the latestnews and guidance featured on the PSNCwebsite including pharmacy contractnews, Drug Tariff News, NCSO updates,events information and much more, signup to receive PSNC’s weekly e-newsletter.Visit www.psnc.org.uk/enews to register

www.twitter.com/ psncnews

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� NMS FAQs

Can the NMS be provided in the patient’shome?No, the Directions only allow the NMs tobe provided in a consultation area in thepharmacy or over the phone. PsNCbelieve it should be possible to providethe NMs in patients’ homes and willcontinue to seek the inclusion of thiswithin the Directions.

Can the NMS be provided to a carer, ratherthan the patient?No. As the service will often supportpeople who are intentionally non-adherent, it needs a conversationbetween the pharmacist and patient toencourage a change in medicines takingbehaviour. A service to assist carers insupporting another person to use theirmedicines would need to use a differentapproach.

Can the NMS be provided to a patient in acare home?Yes. Patients in care homes have the sameentitlement to take responsibility for theirown treatment as they would in their ownhome, unless they do not have the mentalcapacity to do so. If a patient in a carehome is prescribed an NMs medicine forthe first time, then they are just as likely toface the issues that may lead to intentionalnon adherence as patients in their ownhomes, and so should be able to benefitfrom the NMs. There would need to bearrangements made for a signed consentto be obtained from the patient, and theIntervention and Follow-up would need tobe undertaken by phone, if the patientcould not get to the pharmacy.

Can a ‘Special’ medicine that contains oneof the active ingredients listed in the NMSmedicines list trigger the provision of theNMS?Yes, if an active ingredient is in a BNFcategory listed in the NMs medicine listand a special is prescribed containing thatactive ingredient, it can be a target for theNMs, as long as the pharmacist canascertain that the special is beingprescribed for one of the NMs targetconditions.

How long should the NMS records beretained by the pharmacy?The Directions require that NMs recordsare retained for two years following theconclusion of the individual instance ofthe service.

How long should patient consent forms forthe NMS and MUR be retained by thepharmacy?The Directions do not state how long theyshould be retained. we recommend thatthe consent forms should be retained fortwo years from the time of provision ofthe service, in line with the requirementfor retention of NMs records. Pharmaciescan retain electronic copies of the consentforms if they wish, i.e. scanning andstoring images of the completed forms.

What should I do if a carer or relative picksup a newmedicine for a patient who iseligible for the NMS?explain about the service to therepresentative so they can pass oninformation to the patient. You may wantto give the representative a leaflet on theservice and a consent form to take to thepatient. It may be necessary to speak tothe patient on the phone to provideessential information on their newmedicine; you may then be able toexplain about the NMs and get thepatient’s verbal consent to use the service.Confirmatory written consent could thenbe obtained prior to provision of theIntervention.

What should I do if we deliver prescriptionsto a patient’s home and the patient maybe eligible for the NMS?It may be necessary to speak to thepatient on the phone to provide essentialinformation on their new medicine; youmay then be able to explain about theNMs and get the patient’s verbal consentto use the service. Confirmatory writtenconsent could then be obtained prior toprovision of the Intervention.

Can I provide the NMS to a child? (Is therea minimum age for provision of the NMS?)Yes. But, the patient must be competent

to give consent to receive the service andto share information as required by theconsent arrangements in order to beeligible to receive the service. There is nominimum age, but pharmacists will knowthat the younger the child, the greater thelikelihood is that they would not becompetent.

Can I provide the NMS to a non-competentchild or adult?No. The patient must be competent togive consent to receive the service and toshare information as required by theconsent arrangements in order to beeligible to receive the service.

Can a distance selling pharmacy providethe NMS?Yes. Distance selling pharmacies are ableto provide Advanced services at theirpremises. Regulation 13(4) of the 2005Regulations states that such pharmaciesmay not provide or offer to providepharmaceutical services from theirpremises. The definition of the termpharmaceutical services in thisregulation only includes the provision ofessential services. They may thereforeprovide Advanced services from theirpremises but must ensure that whendoing so they do not provide anyelement of essential services. However,this Advanced service begins with thepatient presenting a prescription for anew medicine for a long term condition;if that took place at the pharmacy, thatwould constitute an essential service,and be prohibited. It is thereforeanticipated that Distance sellingpharmacies will conduct the NMs bytelephone. Distance selling pharmacieswill still be required to have an‘acceptable location’ (consultation area)on their premises.

Can I develop my own patient leaflet onthe NMS?Yes, but any leaflet should ideally coverthe consent arrangements for the service.PsNC and NHs employers have publishedtext which can be used in patient leaflets,buts its use is voluntary.

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Can pharmacy logos, or other additions oralterations be made to the NMS FeedbackForm?No. The form is approved by the secretaryof state and must be used, wherenecessary, to communicate with GPs.

Can we use the NHS logo on our patientleaflet for NMS?No. The NHs logo is a trademark and mustonly be used in line with the guidelineson its use by community pharmacies.These guidelines (available atwww.nhsidentity.nhs.uk) do not permitthe use of the NHs logo on pharmacyadvertising, including leaflets (special rulesapply to the pharmacy practice leaflet).

By when do you have to claim the £750implementation payment?The payment is only available in 2011/12;NMs implementation payment claimforms are available via the PsNC websiteand must be received by the NHs BsA by5th April 2012.

The service specification says that theIntervention should take place ‘typically 7to 14 days after patient recruitment’ andthe Follow-up ‘typically between 14 and 21days after the Intervention’. How rigidlyshould these timings be applied?Pharmacists should exercise professionaljudgement in order to determine whetherit is appropriate for a patient to have theIntervention or Follow-up outside thetimings indicated above; the Directionsallow for flexibility in the timing, butpharmacists should be cognisant of theunderlying aim of the service which is toprovide support to patients in the first fewweeks after the prescribing of a newmedicine.

A patient has their newmedicine dispensedin hospital but is not referred to the NMS.They have subsequently been givenanother prescription for the same newmedicine by their GP; do they still qualify forNMS if it is the first time they present theprescription in a community pharmacy?No. The patient would be ineligible toreceive the NMs as their new medicine

has already been dispensed for the firsttime in hospital.

If a patient gets a newmedicine dispensedat a pharmacy that does not offer theNMS, but then requests the service fromanother pharmacy, can the secondpharmacy provide the service?No.

Can NMS only be offered on NHSprescriptions issued by GPs in England?No. The NMs can be offered to any patientpresenting a valid NHs prescription for amedicine on the approved list ofmedicines.

Could GPs use a stamp or stickeron a prescription to indicate thatthe medicine was new to thepatient?Anything stamped on aprescription has a risk of adverselyimpacting on the accuracy of theOCR prescription pricing systemused by the NHS BSA. As aconsequence of this risk, PSNC andNHS Employers recommend thatsuch an approach should not beused to highlight patients whomay benefit from the NMS. GPscould instead give the patient aleaflet about the service.

Can a different pharmacy complete theIntervention and / or Follow-up from theone which undertook the patientengagement?No.

The consent form for sharing informationwith the GP and PCT etc, does not includeconsent to store information about theNMS consultations. Do I need to obtainconsent to make a record of theconsultation?A pharmacist, like other professionalssuch as doctors, dentists and lawyers, isentitled to make records of the servicesprovided, indeed it would be expectedthat a professional should keep adequaterecords of the services provided, andthere is no requirement to obtain

consent. In maintaining such records, thepharmacist must comply with theobligations set out in the Data ProtectionAct (such as ensuring they are accurate,and are kept for no longer thannecessary) and should also comply withNHs Confidentiality: Code of Practice.Pharmacies should have informationavailable to patients, explaining thatpersonal information may be stored aspart of providing the professionalservices, and explaining the patient’srights under the Data Protection Act. Asthe NMs is a clinical service, and clinicalservices involve the recording of sensitivepersonal information, patient consentwould be needed to share those recordswith the GP and PCT (for audit purposes),hence the reason the consent form hasbeen developed.

Does a pharmacy contractor have to sendthe PCT a copy of the completedpharmacist self-assessment form for allthe pharmacists that will provide the NMSat the pharmacy?No. The pharmacy contractor just needsto keep a copy of the completed formson file.

The pharmacist has to have an MURcertificate in order to be able to providethe NMS; does a pharmacy contractorhave to send the PCT a copy of thepharmacist’s MUR certificate?No. The pharmacy contractor just needsto keep a copy of the certificate on file. If,however, the pharmacist might undertakeMUR consultations for the pharmacy, thenthe pharmacy contractor should send acopy of the MUR certificate to the PCT asrequired in the MUR service specification.

Does a new patient consent form need tobe completed every time a patient issigned up for the NMS?Yes.

Does the patient have to have been usingthe pharmacy for a certain period of timein order for them to be eligible to receivethe service?No.

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� NMS FAQs cont.

Can dispensing doctors refer their patientsto a pharmacy to receive the NMS?such a referral would only be valid if thenew medicine was prescribed on an FP10which was dispensed by the pharmacy.

If a patient hands in a prescription for anewmedicine and then doesn’t collect thedispensed script for a few days, whenshould the Intervention take place?The timing of the Intervention should beassessed based on the point at which thepatient receives their dispensed medicine.

If a patient is recruited in one month, butthe Intervention and / or Follow-up areprovided in the second month, whenshould the payment claim be made?An NMs episode can straddle two months,or in some exceptional cases, threemonths. The claim should be made in themonth than the episode is completed.

The NMS dataset includes the patient’sethnicity. What happens if the patientrefuses to state their ethnicity?The standard ‘16+1’ ethnicity codes mustbe used to capture the patient’s ethnicity.If the patient refuses to state theirethnicity, the ‘Not stated’ option should beselected.

Can I claim an NMS completion if thepatient was recruited to the service butcould not be contacted for provision of theIntervention?No.

Does the pharmacy that provides theNMS have to dispense the medicine?Yes. The only exception to this rule iswhere the new medicine has beendispensed by a hospital and a healthcareprofessional at the hospital has referredthe patient to a community pharmacy forprovision of the NMs.

Can a pharmacist provide NMS on anynewmedicine prescribed from the listregardless of who prescribes it?Yes, the NMs applies to all NHsprescriptions for items that are on theNMs medicines list.

What is to stop patients who use a rangeof different pharmacies from receiving theservice at a different pharmacy each timethey get a prescription for a medicine onthe NMSmedicines list?Patients presenting a prescription for amedicine on the NMs medicines list at thepharmacy will be asked whether this isthe first time they have been prescribedthe medicine. Those patients whorespond “yes” can be offered the service.while some patients may not answer thequestion accurately we expect that theoffer to participate in the NMs mayremind them that they have taken themedicine in the past.

Can pharmacy technicians provide theNMS Intervention and Follow-up?No. The NMs Intervention and Follow-upmust be delivered by a pharmacist whohas self-declared that they have the skillsand knowledge to do so. However, thepharmacy can make good use of skill mixby allowing support staff to bookappointments, prepare copies of forms,and transcribing details of theconsultations where these are laterentered into electronic records.

Is it true that pharmacists must be MURaccredited to provide the NMS?Yes.

If different pharmacists undertake theIntervention and Follow-up stages of theservice for the same patient, how will thepharmacist undertaking the Follow-upknow what has happened at theIntervention stage?Pharmacies are required to keep recordsabout the service each patient hasreceived. These include details of thediscussion at the Intervention phase aswell as the outcome of the Follow-up.

Must the pharmacy have a consultationarea to provide the NMS?Yes. In order to provide the service thepharmacy must have a consultation areawhich is at least at the level required forthe provision of the Medicines Use Reviewservice. There are no exceptions to this

requirement, other than the pharmacyitself can be used when the premises areclosed, as long as the consultation can becarried out in an area of the pharmacywhere the patient and pharmacist can sitdown together and the conversation isnot going to be overheard.

How do patients get referred to the NMS?Pharmacies should be able to identifypatients eligible for the NMs who present aprescription. However we recognise that itcould be helpful for pharmacies if patientswere also referred into the service. we hopethat local discussions between pharmacistsand GPs will encourage GPs to refer theirpatients to the service. In addition we haveagreed with NHs employers that patientscan be referred into the service by asecondary care provider that has alreadydispensed the new medicine as part of thedischarge process.

Are patients who are prescribed more thanone newmedicine at the same timeeligible for more than one NMS?No. The NMs should cover all newmedicines prescribed at the same time.

My patient started two newmedicines atthe same time. While I am able to continuethe NMS for one medicine until theFollow-up stage, I need to refer the patientback to the GP for the other medicine. Howdoes this work?There may be occasions in which a patientwho has been prescribed two newmedicines has trouble with one medicineand requires early referral back to their GPwhile they are able to continue to theFollow-up for the other new medicine. Inthis case the pharmacy will be able to claimfor one completed NMs once the patienthas completed the Follow-up appointment.

Howmuch will a pharmacy get paid if itcompletes a greater number of NMSinterventions than the 80% target figurefor its prescription volume band?There are four target payments for theNMs in year one (2011/12) and threetarget payments in year two (2012/13).Pharmacies will be paid each month for

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�

the highest target they achieve,irrespective of the actual number ofcompletions it may achieve.

One of the pharmacy records for the NMSis the ‘patient reports negative feelingabout the medicine’. What does this cover?This pharmacy record covers patientswho report feeling different since theystarted taking the new medicine but donot report it as a side effect. This couldcover a range of occurrences that thepharmacist may recognise as potentialside effects or may consider that they arenot related to the new medicine.

Why have you chosen the current fourlong term conditions for the NMS?we believe that the initial conditions(asthma and COPD, Type 2 diabetes,Antiplatelet /Anticoagulant therapy,hypertension) will help pharmacies tobest demonstrate the value of theservice. In selecting these conditions wealso considered the original proof ofconcept research.

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NMS Checklist� Visit www.psnc.org.uk/nms to download documents and resources on the NMs

and for links to other resources

� Read the service specification and the secretary of state Directions

� Read the PsNC/NHs employers guidance on the contract changes

� Read the CPPe NMs open learning programme

� Use the other CPPe and alternative learning resources as needed

� Attend a local workshop on NMs (where available)

� Complete the pharmacist self-assessment form and a CPD record

� Develop an sOP (template sOPs are available)

� Train your pharmacy team on the service

� with your support team, plan how the service will operate in your pharmacy

� Familiarise yourself with the data recording requirements and paperwork

� Discuss the service with your local GP practice teams (working with your LPCwhere appropriate)

� Familiarise yourself with the PharmaBase NMs module

� Notify your PCT when you are ready to start providing the NMs (a form to do thisis available from the PsNC website)

� Claim your £750 Implementation payment once you have completed 6 NMs (a formto send to NHs Prescription services can be accessed from the PsNC website)

NEWtelephone numberfor PSNC Aylesburyoffice switchboard:

08�� �81 �180

PSNC events for contractorsPsNC has completed a series of events for contractors giving theopportunity to find out more about NMs and pharmacy funding. Followingevents over the summer in Manchester, Leeds and London, members ofthe PsNC policy team led by PsNC CeO sue sharpe (pictured at theLondon event with PsNC Head of Finance Mike Dent (centre) and Head ofNHs services Alastair Buxton) held three sessions at the Pharmacy show inBirmingham earlier this month for contractors to put their questions andcomments on the contract changes, the recent funding settlement andthe cost of service inquiry. The feedback from the events has beenexcellent with contractors welcoming the chance to get practical adviceon getting started with NMs and to hear more about funding and thebackground to the recent settlement. For many the most valuable part of the events was to ask questions of PsNC and let us havetheir views. The PowerPoint presentation from the London event is on the PsNC website and keep an eye on PsNC CommunityPharmacy News and the PsNC website for more PsNC events for contractors in the future.

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8 General News

The Department of Health is launching anational Smokefree marketing campaignin January 2012 to capitalise on seasonalmotivation and is inviting pharmaciesacross England to participate in thecampaign by distributing Quit Kits tosmokers and displaying promotionalmaterial in store.

The campaign will aim to trigger massquit attempts and to help make quittingmore successful by encouraging smokersto get a Quit Kit. This activity is designedto support the national ambition toreduce adult smoking prevalence to18.5 percent or less by the end of 2015.

DH will be seeking to build on thesuccesses of Quit Kit campaigns in 2010and 2011 by distributing more Quit Kitsthrough a greater number of pharmaciesacross england. This year more than 3,700pharmacies across england took part andpatients who received the kits had a 70%success rate.

PsNC is supporting this campaign andhas briefed LPCs so that they can discusswith their PCTs the possibility of includingthe Quit Kits in their local healthpromotion campaigns available throughthe community pharmacy contractualframework.

Benefits to pharmacies:� The campaign will help drive footfall to

pharmacies between January to March

driven by anationaladvertisingcampaign whichwill encouragesmokers to pickup Quit Kits inlocalpharmacies.

� There will beincreasedopportunitiesto engagesmokers in adialogue aboutsmokingcessation andother health services.

� Pharmacies involvement will bepromoted via the NHs smokefreewebsite: customers will be able tolocate participating pharmacies via apostcode search tool

� DH will provide the kits, promotionalmaterial, briefing information to supportengagement with smokers and anational marketing campaign

DH will be conducting follow up researchwith smokers who have received Quit Kitsto measure quit attempts and success andalso seeking feedback from pharmacieswho have been involved in the campaign.

The 2012 kits will contain somepractical tools and advice which aredesigned to help people quit smoking,but will not include a voucher for a week’sfree trial of NRT. 400,000 kits will beavailable for distribution throughpharmacies and order lines are open fromOctober 3rd. with delivery from w/c 12thDecember. Contractors who decide toparticipate in the campaign can ordertheir Quit Kits by calling 0800 678 3173.Any pharmacy interested in supplyingthese kits and requiring furtherinformation can do so by contactingsmokefree@dh.gsi.gov.uk.

DH invites pharmacies to participate intheir Quit Kit 3 2012 campaign

Clinical Governance Framework

Pharmacy contractors are aware that changes came intoeffect on 1 October, refreshing the clinical governanceframework.PSNC has been working with NHS Employers and NHS

Primary Care Commissioning, to prepare guidance for PCTsand contractors, on the changes.PSNC has also been working with NHS Employers and the

Department of Health, to agree the ‘approved particulars’which will be set out by the Secretary of State (the approvedparticulars are where technical details are given).The approved particulars and guidance will be published as

soon as possible however priority has been given topublication of the guidance on the introduction of theNew Medicine Service and targeted Medicines Use Reviews.The clinical governance framework has a transitional period

until 31st March 2012, to allow existing pharmacy contractorsto implement any changes to their systems and proceduresthat are necessary. Whilst we know that pharmacists are keento get on and implement these changes, we can assurecontractors that they will not be in breach of the newrequirements, so long as they continue to comply with therequirements as they were in force prior to 1 October.

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Dispensing Emla 5% Creamwith DressingsThe requirements for prescriptionsordering the packs of emla 5% cream withocclusive dressings have changedrecently.

The term ‘pre-medication pack’ is nolonger recognised by NHs Prescriptionservices. To keep in line with dm+ddescriptions (which prescribers should bedoing) prescriptions should be written aseither:Emla 5% cream 25g + 12 dressingsOREmla 5% cream 5g + 2 dressings

However, if a prescription is written justrequesting "emla 5% cream", pharmacycontractors can still be reimbursed fordispensing any of the available pack sizes(including the dressings packs), as long asthey endorse the prescription accordingly(using the descriptions given above).

CIP Error Payment – moredetails released together withrecheck request formThe full details of the payment package,together with a ‘question & answer‘document and a form to be used forrequesting rechecks are now available onthe NHsBsA website via the following link:http://tinyurl.com/43vbrfc. This link willtake you straight to the recheck requestform: http://tinyurl.com/5tsnfy2.

Contractors now need to considerwhether they are going to requestrechecks of bundles of prescriptions in theperiod 1 April 2009 to 31 March 2011inclusive and need to study carefully thedetails regarding the implications of doingso. The deadline for making theserequests is 31 December 2011. However,PsNC would encourage contractors whodo decide to request checks to submittheir request forms as soon as possibleand not to wait until the deadlineapproaches.

Apidra Supply Issuessanofi (formerly sanofi-aventis) issued aletter to healthcare professionals onseptember 9th about the interruption ofsupply of Apidra Optiset and solostarpens and Clikstar cartidges. The letterexplains the stock position and that newsupplies of Apidra solostar and Clikstarwill not be available until December 2011.It is unlikely that the Optiset product willbe available again as it is due forwithdrawal at the end of the year.

Hospitals and GP surgeries are beinginformed and there is still limited stock atwholesalers, at some pharmacies and inpatients’ homes. If a prescription ispresented for Apidra and there is no stockavailable, pharmacies should in the first

instance contact sanofi as the followingoptions are available:� To confirm whether Apidra is available

for order: Sanofi Customer Services –0800 854 430, (9am–5:15pm Monday-Thursday, 9am–4pm Friday).

� For any other enquiry, including torequest access to Apidra for anindividual patient for whom noalternative exists: Sanofi MedicalInformation – 01483 505 515.

� In addition, individual patient enquiriescan be directed to the Sanofi InsulinSupport Line – 0845 606 6887 (open24 hours/day, 7 days/week).

� Pharmacies can also contact their localsanofi diabetes account manager forfurther information and support.

Leaflets to help patients understandthe situation will be available from sanofiin the next few days. If you would like toreceive a supply of leaflets, pleasecontact your sanofi diabetes accountmanager or sanofi Medical Information,as above.

The latest supply update from sanofican be found via a link from the relatednews article on the PsNC website:http://tinyurl.com/4yot2hq

Ongoing Branded MedicineSupply problemsAt present, the supply arrangements forsome products are having an adverseimpact on workload in pharmacies andcan lead to delays in patient care. PsNC isworking constructively withmanufacturers, wholesalers, theDepartment of Health and regulators tofind solutions to the current problemsthat could be introduced to help meetthe needs of UK patients more efficiently.

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snc.org.ukDrug Tariff News �

This month includes:News on:� specials in the Drug Tariff� Dispensing emla 5% Cream

with Dressings� CIP error Payment – more details

released� Apidra supply Issues

FAQs on:� Inducements

Drug TariffNewsat a glance

Address change?Please let us know if your mailing address used for CPN is incorrect –either return the wrapper with any amendments made to the address to:

Database Changes, PSNC, 59 Buckingham Street, Aylesbury HP20 2PJor email changes to cpn@psnc.org.uk or fax changes to 01296 438427.

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10 Specials List for November 2011 Drug Tariff

From 1st November a list of Specials will be included in the Drug Tariff. The list is below. More informationabout the Specials List including FAQs can be found on the PSNC website www.psnc.org.uk

KeySTD standard formulation SF sugar freeLF Lactose free CF Colour freeNSF Non standard flavours PF Preservative free

DM+D name (for listing in the Tariff) Formulations covered by tariffAmisulpride 25mg/5ml oral solution sTD, sF, LFAmisulpride 25mg/5ml oral suspension sTD, sF, LF, CF, NsFAmitriptyline 10mg/5ml oral solution sTD, sF, LFAmitriptyline 10mg/5ml oral suspension sTD, sF, LF, CFAmlodipine 10mg/5ml oral suspension sTD, sF, LF, CF, NsFAmlodipine 5mg/5ml oral solution sTD, sF, LF, CFAmlodipine 5mg/5ml oral suspension sTD, sF, LF, CF, NsFAzathioprine 50mg/5ml oral suspension sTD, sF, LF, CF, NsFBendroflumethiazide 2.5mg/5ml oral suspension sTD, sF, LF, CF, NsFCaptopril 5mg/5ml oral solution sTD, sF, LF, CF, NsFCaptopril 5mg/5ml oral suspension sTD, sF, LF, CF, NsFChloral hydrate 500mg/5ml mixture BP2000 sTD, LFClobazam 10mg/5ml oral solution sTD, sF, LF, CF, NsFClobazam 10mg/5ml oral suspension sTD, sF, LF, CF, NsFClobazam 5mg/5ml oral solution sTD, sF, LF, CF, NsFClobazam 5mg/5ml oral suspension sTD, sF, LF, CF, NsFClonazepam 500microgram/5ml oral solution sTD, sF, LF, CFClonazepam 500microgram/5ml oral suspension sTD, sF, LF, CF, NsFCo-Dydramol 10mg/500mg/5ml oral suspension sTD, sF, LF, CF, NsFDipyridamole 100mg/5ml oral suspension sTD, sF, LF, CF, NsFFerrous sulphate 60mg/5ml oral solution sTD, sF, LFFerrous sulphate 60mg/5ml oral suspension sTD, sF, LF, NsFGabapentin 250mg/5ml oral solution sTD, sF, LF, CF, NsFGabapentin 250mg/5ml oral suspension sTD, sF, LF, CF, NsFGliclazide 80mg/5ml oral suspension sTD, sF, LF, CF, NsFGlycopyrronium Bromide 1mg/5ml oral suspension/solution sTD, sF, LF, CF, NsFHaloperidol 1mg/5ml oral solution sTD, sF, LF, CF, NsFHaloperidol 1mg/5ml oral suspension sTD, sF, LFLisinopril 5mg/5ml oral solution sTD, sF, LF, CFLisinopril 5mg/5ml oral suspension sTD, sF, LF, CF, NsFLorazepam 1mg/5ml oral solution sTD, sF, LF, CFLorazepam 1mg/5ml oral suspension sTD, sF, LF, CF, NsFLorazepam 500microgram/5ml oral solution sTD, sF, LF, CFLorazepam 500microgram/5ml oral suspension sTD, sF, LF, CF, NsFMelatonin 5mg/5ml oral solution sTD, sF, LF, CF, NsFMelatonin 5mg/5ml oral suspension sTD, sF, LF, CF, NsFMidazolam 10mg/1ml oral solution sTD, sF, LF, CF, OromucosalMidazolam 10mg/1ml oral suspension sTD, sF, LF, CF, OromucosalOmeprazole 10mg/5ml oral suspension sTD, sF, LF, CF, NsFOmeprazole 20mg/5ml oral suspension sTD, sF, LF, CF, NsFOmeprazole 5mg/5ml oral suspension sTD, sF, LF, CF, NsFParacetamol 500mg/5ml oral solution sTD, sF, LF, CF, NsFParacetamol 500mg/5ml oral suspension sTD, sF, LF, CFPhenytoin sodium 90mg/5ml oral suspension sTD, sF, LFPrimidone 50mg/5ml oral suspension sTD, sF, LF, CF, NsFQuetiapine 12.5mg/5ml oral suspension sTD, sF, LF, CF, NsFRamipril 2.5mg/5ml oral solution sTD, sF, LF, CFRamipril 2.5mg/5ml oral suspension sTD, sF, LF, CF, NsFRamipril 5mg/5ml oral solution sTD, sF, LF, CFRamipril 5mg/5ml oral suspension sTD, sF, LF, CF, NsFsertraline 50mg/5ml oral suspension sTD, sF, LF, CF, NsFspironolactone 25mg/5ml oral suspension sTD, sF, LFspironolactone 50mg/5ml oral suspension sTD, sF, LF, CF, NsFTacrolimus 5mg/5ml oral suspension sTD, sF, LF, CF, NsFTopiramate 25mg/5ml oral suspension sTD, sF, LF, CF, NsFZopiclone 3.75mg/5ml oral solution sTD, sF, LF, CFZopiclone 3.75mg/5ml oral suspension sTD, sF, LF, CF, NsFGlyceryl trinitrate 0.2% ointment sTDHypromellose 0.25% eye drops sTDsodium Chloride 5% eye drops PF

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Subject to the prescriber having the appropriate prescribing rights, any food, drug, toiletry or cosmetic may be prescribed on an NHS prescriptionunless the product is listed in Part XVIIIA of the Drug Tariff (the ‘blacklist’) or the criteria set out in the Tariff for prescribing products listed in PartXVIIIB of the Drug Tariff (the ‘selected list’) is not met. As an exception to this rule, ‘blacklisted’ products can be dispensed where a product isprescribed generically and the generic product is not blacklisted and the name of the product has a recognised ‘official title’.

If a product has been registered as a medical device, it can only be prescribed on an NHS prescription if it is listed in Part IX of the Drug Tariff.Registered medical devices can be identified by a ‘CE’ mark on the product’s packaging.

Product Allowed on Product Commentan FP10 Type

Prescription

BD Plastipak No Device This medical device is not allowed as it is not listed in Part IX of the Drug Tariff. It also appears inPsNC’s Disallowed Appliances list (www.psnc.org.uk/disallowedappliances).

Coban 2 Yes Device This medical device is listed in Part IX of the Drug Tariff so is allowed.Compression N.B. Don’t forget to check that the size on the prescription matches one of the sizes listed in the Tariff.Layer bandage10cm x 4.5m

Colgate Duraphat Yes Toiletry Duraphat is allowed as it is a medicinal product which is not found in Part XVIIIA of the Drug Tariff2800ppm fluoride the ‘blacklist’).toothpaste This item also appears in the Dental Formulary as the generic Sodium fluoride toothpaste 0.619% DPF so

would be allowed on an FP10D.

Dietary specials Yes Food This gluten free bread is allowed because it is not in Part XVIIIA of the Drug Tariff (the ‘blacklist’).gluten free It can be found in the ACBs list (Part XV of the Drug Tariff ).cracker bread

systane Balance No Device This medical device is not allowed as it is not listed in Part IX of the Drug Tariff. It also appears ineye drops PsNC’s Disallowed Appliances list.

Please note: Systane eye drops and Systane Ultra eye drops are listed in Part IX so would be allowed.

Vaseline Intensive No Toiletry This item is not allowed as it appears in Part XVIIIA of the Drug Tariff (the ‘blacklist’).Care Lotion

Is it allowed?

All details correct at time of printing.No part of this publication may be reproduced without the written permission of the PSNC.

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

Colour repro by TSS Digital, Margate. Printed by Truprint, Margate.

The publishers accept no responsibility for any statement made in signed contributions orin those reproduced from any other source.

Communications InternationalGroup

Linen Hall, 162-168 Regent Street, London W1B 5TBTel: 020 7434 1530 Fax: 020 7437 0915

Distributedfor PSNC by:

Pharmacies have reported problems obtainingthe following medicines through wholesalers.This list is not exhaustive. If a product cannotbe obtained through the normal channels,emergency stock can be obtained direct fromthe manufacturer.Changes to shortages list

ADDITIONSDuoTrav eye drops (Alcon Laboratories(UK) Ltd)

REMOVALSPentasa 500mg modified-release tablets(Ferring Pharmaceuticals Ltd)Zyprexa 2.5mg, 5mg, 10mg, 15mg, 20mgtablets (Eli Lilly and Company Ltd)

Zyprexa 5mg, 10mg, 15mg, 20mg velotabs(Eli Lilly and Company Ltd)

Feedback to PSNC: Contractors who haveexperienced problems in obtaining medicinesbecause of quota arrangements areencouraged to feed this into the PSNCInformation Team to support PSNC’s ongoingmonitoring of the situation. PSNC will work toensure this information is fed into theDepartment of Health as evidence of theproblems that are arising. An online feedbackform for this purpose can be foundon the PSNC website (www.psnc.org.uk/brandedshortages). For support on this issue,please contact the PSNC Information Team(please note the new number: 0844 381 4180).

List of Medicines Impacted by Branded Medicine Supply Problems

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1� FAQs – Inducements

Partners in the PSNC CommunityPharmacy Development Programme

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

PSNC Community Pharmacy News is published by:The Pharmaceutical Services Negotiating Committee, 59 Buckingham Street, Aylesbury, Bucks HP20 2PJ

Community Pharmacy News is edited by:Mike King LLB BSc MRPharmS who can be contacted at the above address or by email at: mike.king@psnc.org.uk © PSNC

The PSNC Information Team can providesupport on a broad range of topicsincluding whether an item is allowed onan NHS prescription and how muchreimbursement to expect for supplying anitem. Frequently asked questions include:

1. Can I offer a free gift such as a voucherfor new patients who bring in aprescription to be dispensed by thepharmacy for the first time?No. The Terms of service state that apharmacy must not offer any gift orreward to any person as an inducement to:a) present an order for drugs or appliances

on a prescription form or repeatableprescription;

b) nominate the pharmacy as theirdispensing contractor;

c) receive any Advanced or enhancedservices.

A ‘gift or reward’would include vouchers,money or reward points. Additionally, theterms of service state the pharmacy mustnot offer any gift or reward to any person forrecommending the pharmacy to others forprovision of the above mentioned services.

2. Would providing a home deliveryservice for patients who bringprescriptions to the pharmacy be aprohibited inducement?No. The Terms of service permit theprovision of a home delivery service, andthe provision of ‘auxiliary aids’ withoutthese being considered to be prohibitedinducements.

3. Can I offer a free gift such as a voucherto a patient for signing up to aprescription collection service?There have been many different schemesestablished, where pharmacies offer tocollect prescriptions from a surgery,where the patient has ordered theseand authorised the GP to hand theprescription to the pharmacy, or wherethe pharmacy is authorised to order andthen collect repeat prescriptions. It will befor the PCT in each case, to considerwhether the service being offeredcontravenes the prohibition on gifts orrewards, including considering whetherthe service is associated with thepresentation of an order for drugsor appliance.

4. Can I offer a free gift such as a voucherfor new patients who agree to an MUR orsign up for the NewMedicine Service?No. The regulations state that a pharmacymust not offer any gift or reward to anyperson as an inducement to:a) present an order for drugs or appliances

on a prescription form or repeatableprescription;

b) nominate the pharmacy as theirdispensing contractor;

c) receive any directed services.

A ‘gift or reward’ would include vouchers,money or reward points. Both the MURand NMs are Advanced services. In theTerms of service, ‘directed services’ meansAdvanced services or enhanced services.

Look out for more frequentlyasked questions next month…If you would like more information onwhether a particular product is allowed onan NHs prescription, the PsNCInformation Team will be happy to help(please note the new number: 0844381 4180 or e-mail info@psnc.org.uk).

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