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STANDARD OPERATING PROCEDUREFOR Community Pharmacist Consultation Service

(CPCS)Note: this is a template guidance SOP only. Pharmacies need to adapt this for use in their own practice. All liability for the production of all SOPs lies with the individual contractor. This SOP covers information in both the NHSE CPCS Service Specification & the NHSE CPCS ToolkitNAME OF PHARMACY

BACKGROUND See “CPCS One-page flow chart Service Summary” - a copy of which is is at the end of this SOP

From 29th October 2019 the CPCS service will launch & will replace NUMSAS & DMIRS

The NHS CPCS is an Advanced Service where patients contacting NHS 111 are referred to a community pharmacist for a consultation regarding either lower acuity conditions (ie patients who have a minor illness) or where there is a need for the urgent supply of a medicine the patient normally receives as an NHS prescription but has no supply left.

The CPCS service will release capacity in other areas of the NHS’s urgent care system, such as accident and emergency (A&E) and general practices. The service will also support the integration of community pharmacy into the urgent care system and improve access for patients.

For full details of the aims and intended outcomes see the NHS CPCS service specification - however, this SOP comprehensively covers the NHSE CPCS specification (as well as the other key NHS document (the NHS CPCS Toolkit) & other guidance documents including PSNC guidance).

Note is this document where the phrase “NHS CPCS IT system” is used this means Sonar (for London) or PharmacaOutcomes (outside of London). From 2021 other IT providers might be available

Key message to understand about CPCSCPCS is different from most other NHS Pharmacy services: The CPCS service is based on receiving a referral (not signposting) from non-clinicians (the NHS 111 Call Advisors) to the pharmacist (the clinician). With referral services (as opposed to signposting services) the clinician (the pharmacist) takes on responsibility for Clinically Managing Patients (ie Assessing, Red Flagging / Safety Netting / Escalating if necessary).

CPCS is different from most of the other “transactional” services the NHS usually commissions from pharmacy. The pharmacist doesn’t have to “fix” the patient then & there but they do need to “clinically manage” patients, (& it’s ok (indeed it is critical) to advise the patient to come back if they are not better, ie to say “If your symptoms do not improve or become worse, then either come back to see me or seek advice from your GP”)

“Clinically managing” a referred patient means: looking out for Red Flags (ie assessing the patient & using the NICE CSK & SCR one-click, both built into the CPCS IT system); safety netting (ie giving advice to the patient about what to do if they are not better/get worse); & escalating the patient if necessary.

Ensure all staff (Pharmacists & non-pharmacists) carry out the training described below so they can complete the NHS CPCS self-assessment framework, which is part of the NHS declaration & signing up process.

All staff to read Appendix 2: Key message (of this SOP) so as to have a general understanding about CPCS (at the end of this SOP)

Note in this SOP where it says “All Pharmacists” this includes LPs, regular pharmacists, weekend pharmacists, second pharmacists & regular locums

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SCOPE This SOP covers the NHS CPCS Advanced Service

Documents to be read to deliver the CPCS service To be read by which members of staff

“CPCS SOP” ie this document

We suggest all staff read Appendix 2: Key message (of the SOP) so as to have a general understanding about CPCS (at the end of this SOP)

All staff. NB pharmacists to read the whole SOP. Non-Pharmacists do not have to read the sections marked for the Pharmacist

RPS Emergency Supply guidancehttps://www.rpharms.com/resources/quick-reference-guides/emergency-supply

All dispensary staff

“CPCS info, guidance & checklist for Superintendent Pharmacists”

The Superintendent Pharmacists or other Lead Pharmacists

“CPCS Pharmacists learning and development requirements checklist”

All Pharmacists

“CPCS One-page flow chart Service Summary” All staff (including All Pharmacists)

“CPCS (Minor Illness) Patient Flow & CPCS (Urgent Medicines Supply) Patient Flow”

All staff (including All Pharmacists)

“NHSE CPCS advanced service specification vFinal Oct 19”

However, the CPCS SOP supplied in this document pack compressively covers the NHSE CPCS service specification so by implementing the SOP, the service specification will be comprehensively covered.

Please note that when registering to provide the CPCS service the contractor declares “I confirm that I have read the service specification and will be able to comply with its requirements and deal appropriately with any CPCS referrals from the service commencement date (29th October 2019).”

All Pharmacists

For contractors where their LPC has signed up to the on line Vir-tual Outcomes modules we suggest all staff complete the Vir-tual Outcomes on line course NHS Community Pharmacist Con-sultation Service https://www.virtualoutcomes.co.uk/pharmacy-training/

All staff (including All Pharmacists)

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PROCEDURE/PROCESS RESPONSIBILITY

What do I need to do to get ready to provide the NHS CPCS?Read the RPS’s Emergency Supply guidancehttps://www.rpharms.com/resources/quick-reference-guides/emergency-supply to ensure all dispensary staff understand the emergency supply regulations

All dispensary staff

Read ““CPCS info, guidance & checklist for Superintendent Pharmacists” This has information on registering for MYS, checking that your shared NHS mail account is in the pharmacy Directory of Service (DoS) & how to register your pharmacy to provide the CPCS service

The Superintendent Pharmacists (or other Lead Pharmacists)

Read “CPCS Pharmacists learning and development requirements checklist”

This has full information of the educational & training requirements to provide the CPCS service

All pharmacists providing the CPCS service (eg the regular Pharmacists, Support Pharmacists, Relief Pharmacists, Locum Pharmacists are each to complete a copy of “CPCS Pharmacists learning and development requirements checklist” & ensure it supplied to the Superintendent Pharmacist (or other appropriate lead pharmacist) & is available in the pharmacy

All Pharmacists(including locum pharmacists)

All Pharmacists(including locum pharmacists) – the Superintendent Pharmacist (or other Lead Pharmacist) should ensure this is actioned for all pharmacists that work at their branch

Read “CPCS One-page flow chart Service Summary” – this provides a 1-page flow chart summary of the CPCS service

All Pharmacy staff

Read “CPCS (Minor Illness) Patient Flow & CPCS (Urgent Medicines Supply) Patient Flow” This provides:

a 1-page detailed flow chart summary of the CPCS Urgent Medicines Supply Patient Flow

a 1-page detailed flow chart summary of the CPCS Minor Illness Patient Flow

All Pharmacy staff

Read “NHSE CPCS advanced service specification”However, the CPCS SOP supplied in this document pack compressively covers the NHSE CPCS service specification so by implementing the SOP, the service specification will be comprehensively covered. Please note that when registering to provide the CPCS service the contractor declares “I confirm that I have read the service specification and will be able to comply with its requirements and deal appropriately with any CPCS referrals from the service commencement date (29th

All Pharmacists(including locum pharmacists)

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https://www.rpharms.com/resources/quick-reference-guides/emergency-supply


October 2019).” Virtual Outcomes –For contractors where their LPC has signed up to the on line Virtual Outcomes modules we suggest all staff complete the Virtual Out-comes on line course NHS Community Pharmacist Consultation Ser-vice https://www.virtualoutcomes.co.uk/pharmacy-training/

All staff

All pharmacists providing the service must have access to: the NHS Summary Care Record (SCR) the pharmacy’s shared NHSmail mailbox (the email address

of which must be in the following format: nhspharmacy.location.pharmacynameODScode @nhs.net ). Note:

o It is suggested all regular pharmacists (eg regular weekend pharmacists) should link their personal NHS email to the pharmacy’s shared NHS email.

o For non-regular pharmacists – as long as another member of the pharmacy team you are working with has access to the pharmacy’s Shared NHS email that is sufficient.

The CPCS IT system (eg Sonar or PharmaOutcomes). This IT system will

o allow NHS 111 / the IUC CAS to send referrals to the pharmacy (via electronic messaging system, the “ITK message”

o allow the pharmacist to maintain records of service provision and to send post-event messages to patients’ general practices.

o NB - NHS e-mails to the pharmacy’s shared NHS email is the back up messaging system if the normal ITK messaging system fails – hence why being able to access the pharmacy’s shared NHS email box is critical for all pharmacists.

All Pharmacists

The pharmacy must have a consultation room, which complies with the following minimum requirements:

the consultation room must be clearly designated as an area for confidential consultations;

it must be distinct from the general public areas of the pharmacy premises;

it must be a room where both the person receiving services and the pharmacist providing those services are able to sit down together and talk at normal speaking volumes without being overheard by any other person (including pharmacy staff), other than a person whose presence the patient requests or consents to (such as a carer or chaperone); and

from 1 April 2020, it must have IT equipment accessible within the consultation room to allow contemporaneous records of the consultations provided as part of this service to be made within the CPCS IT system.


Business Continuity PlanPrior to providing the service, the pharmacy should review and make any necessary amendments to their business continuity plan in order to incorporate appropriate content on the service within the plan. Note: If the service has to be temporarily withdrawn by the pharmacy due to unforeseen circumstances, the Superintendent Pharmacists / other Lead Pharmacists) / other responsible pharmacist will need to ensure the elements of their business


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continuity plan related to the service are activated. The pharmacy must inform the local Directory of Services (DoS) Team of the temporary withdrawal directly in order to temporarily stop referrals on 0300 0200 363 (the 24-hour DoS enquiry line). The pharmacy must also inform the local NHS England team by email.

It is suggested the following is added to the pharmacy’s Business Continuity Plan from 29th October 2019:

Remove DMIRS & NUMSAS from the Business Continuity Plan Add CPCS to the list of Services in your Business Continuity

Plan as a “critical service” or “essential service” (the decision as to which to add it to is for the pharmacy to decide)

Add the following to the “critical service” or “essential service” options list

Service CPCSOptions Inform the local Directory of Services (DoS) Team

of the temporary withdrawal directly in order to temporarily stop referralsThe local NHS England team must also be informed by the pharmacy contractor.

Essential Information

The local DoS team contact details are: 0300 0200 363 (24-hour DoS enquiry line)The local NHS England team email is [Superintendent to add when supplied by NHSE]

All pharmacy team members, including locums and relief pharmacists, need to be aware of the procedures to be followed in the event of a temporary suspension of the service (ie if there is an emergency & the pharmacy cannot deliver the CPCS service temporarily) and have easy access to the key contact numbers for the service – ie are aware of the pharmacy’s Business Continuity Plan & the key contact numbers in CPCS Essential Information section of the Business Continuity Plan (see above)

All pharmacy staff

During the pharmacy’s opening hours, the CPCS IT system must be checked with appropriate regularity, to pick up referrals in a timely manner. This includes checking the pharmacy’s shared NHS mail mailbox

It is recommended the CPCS IT system & the pharmacy’s shared NHS email is checked (as a minimum) on opening the pharmacy, at approx. 12pm, at approx. 4pm & 1 hour before closing.

These are suggested times – the superintendent pharmacist should identify what times are appropriate for their pharmacy & amend this SOP appropriately. The Service spec states “During the pharmacy’s opening hours, the CPCS IT system must be checked with appropriate regularity, to pick up referrals in a timely manner. This includes checking the pharmacy’s shared NHSmail mailbox when a pharmacy opens and before the pharmacy closes each day to ensure that no messages have been missed that may have been sent to the NHSmail mailbox during any period of ITK messaging outage within the CPCS IT system.”

Assign responsibility for checking for referrals to appropriate members of the pharmacy team.

Appropriate members of the pharmacy team to whom responsibly for checking for referrals is delegated to by the LP

All staff need to be aware that the CPCS service needs to be available to patients throughout all of the pharmacy’s full opening hours, so all pharmacists working in the pharmacy (including locums) need to be able to deliver the CPCS service

All pharmacy staff

Confirm all pharmacists (RPs, support pharmacists, regular pharmacists, weekend pharmacists, relief pharmacists, regular

The Superintendent

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locum pharmacists) have read & actioned this SOP & are able to deliver the CPCS service.

Pharmacists (or other Lead Pharmacists)

Confirm all external Locum pharmacists have read this SOP / CPCS SLA & are able to deliver the CPCS service.


In case of issues with the CPCS IT system contact details for the helpdesk are:

For Sonar (the CPCS IT provider in London)Support line:

o 020 8743 9440 (0830 – 1800 Monday to Friday & 1030 – 1500 Saturdays)

o Sundays and out of hours: 020 8811 2307o [email protected]

For PharmOutcomes (the CPCS IT provider outside of London)o Use the help messaging function at

https://pharmoutcomes.org/pharmoutcomes/help/home?sendMessage&contactus

Issue with the CPCS service provision by the pharmacy In the event of NHS 111 or IUC CAS not being able to make a referral through to the pharmacy or patients reporting that they have been unable to speak to the pharmacist on two consecutive patient referrals, NHS England will investigate this issue and action may be taken in line with the local dispute resolution policy.In the event of problems with service provision by a pharmacy contractor, the local NHS England team will assess the ongoing ability of the pharmacy to provide the service. In the intervening period, the NHS 111 Directory of Services (DoS) will be amended to stop referrals to the pharmacy until the issue is resolved.

NHSE

Process to stop providing the CPCS advanced serviceIf the pharmacy contractor wishes to stop providing the CPCS advanced service, they must notify NHS England that they are no longer going to provide the service via the MYS platform, giving at least one month’s notice prior to cessation of the service, to ensure that accurate payments can be made, and referrals closed.The pharmacist must in all cases contact the Superintendent Pharmacists (or other Lead Pharmacists) before stopping to provide the service


Service promotionPatient access to the CPCS is via NHS 111 / IUC CAS, they refer CPCS patient to a pharmacy on the bases of the pharmacy’s DoS entry. It is therefore important that the pharmacy ensures their data is up to date on the DoS, to ensure that patients receive accurate information as to which pharmacies are available to provide the service.


This service must not be actively promoted directly to the public by either the pharmacy contractor or the NHS to ensure that it is only used for cases which otherwise would have led to a referral to a less appropriate patient pathway and, in the case of Urgent Medicines supply CPCS referrals, is not used as a replacement for the normal repeat prescription ordering and repeat dispensing processes.However, this does not impact the ability of the pharmacy or the NHS to promote the use of pharmacy to the public with campaigns such as the NHS’s Winter Pressure Campaign or the Ask Your Pharmacist Campaign

All Pharmacy Staff

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mailto:[email protected]

When the patient calls NHS 111When a patient calls NHS 111 for advice about urgent medicines or for advice on the treatment of minor illnesses they have their call answered by a NHS 111 Call Advisor who asks them a series of questions.Note the NHS 111 Call Advisors are non-clinicians, so they do not give patients clinical advice, instead they use NHS 111 decision support IT (this IT is called “NHS Pathways”) to navigate the patient to the most appropriate clinicians. When the NHS 111 decision support IT system suggests to the NHS 111 Call Advisor that referral to a community pharmacist for a consultation is an appropriate outcome a NHS CPCS referral occurs.

It is important to note that because the NHS 111 Call Advisors are not clinicians, they do not make clinical decisions, so some referrals received in the pharmacy might not “seem” appropriate for the CPCS service, but it the responsibility of the pharmacist to the clinically “manage” these patients (this is part of the whole key clinical role of the pharmacist). Part of “clinically managing” the patient could be, if in the clinical opinion of the pharmacist, if necessary, to escalate the referral (see below for details of how to do this).

It is important for the pharmacist to understand CPCS is a referral to the pharmacy (not signposting), with referrals the clinician (ie the community pharmacist) takes clinical responsibility for managing the patient (ie Assessing, Risk Managing, Safety Netting, Escalating if necessary)

NHS 111 is provided across England by several organisations such as ambulance trusts, GP OOH providers and urgent care social enterprise organisations.The aim is to integrate urgent care across the health care system to ensure the patient is directed to the most appropriate service according to their clinical need.

The NHS 111 call advisors that initially take a call are not clinicians; in exceptional circumstances clinicians may be involved in initial triage of calls, but generally NHS CPCS calls will be referred by non-clinical staff.

The call advisors carry out an initial assessment using a clinical assessment tool (NHS Pathways), to identify the clinical needs of the patient and make appropriate referrals according to the clinical priority.

NHS Pathways is the clinical assessment system used by NHS 111 to triage and assess patients with urgent healthcare needs and enable signposting and referral to healthcare services where they can appropriately respond to a patient’s care needs.The NHS 111 Directory of Services (DoS) is a database that can be used as a standalone reference source or integrated with NHS Pathways. It has pharmacy service information, structured using templates of data, which are applied to pharmacy ‘profiles’ in such a way that it can present information to the call advisor, in a nationally consistent format.See infographic below

NHS 111 Call Advisor

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The patient is offered the service by the NHS 111 Call Advisor and provided with the details of two pharmacies closest to the patient’s location, from where they are calling, to provide the service. The patient selects which pharmacy they wish to attend. A referral will not be made within 30 minutes of the pharmacy’s closing time. Sometimes a referral may be made when a pharmacy is closed, if treatment the next day is suitable for the need of the individual patient, and the pharmacy opens within the following 12 hours.The patient chooses which pharmacy they wish to attend. It is standard practice that the 111 call advisors do not overrule the choice with a specific pharmacy request except in exceptional circumstances.


The call advisor sends a referral to the pharmacy of the patient’s choice using a secure electronic technical message (known as an “ITK message”). NHSmail will be used as a backup messaging process in case of issues with the ITK messaging system. This ITK message will be received by the NHS CPCS IT system in the community pharmacy (during 2019/20-2021, the IT system will be Sonar (for London) & PharmaOutcomes (for the rest of England), after 2021 other IT providers will be available). The referral contains the information about why the patient is being referred, for the pharmacist to review ahead of or during the patient’s consultation.

Note there are some differences between the two strands of the service:

Patients who are referred for an Urgent Medicine or appliance supply are asked to ring the pharmacy before attending (Note: in reality not all patients will do so). If a patient does


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call the pharmacy, it is worth checking which prescription item they require to ensure:

o you have the item in stock (you will still need to ascertain that it is appropriate to make a supply) or

o that the item is not a controlled drug. Patients who are referred for a Minor Illness consultation will

not be advised by the NHS 111 Call Advisors to contact the pharmacy before attending, but they will advise the patient to tell the pharmacy staff that they have been referred by NHS 111 when they arrive. This avoids asking patients to make an unnecessary phone call to the pharmacy (as most minor illness consultations should be face-to-face in the consultation room). However, please note that not all patient will remember to make the pharmacy staff aware they have been referred by NHS 111.

o Patient referred to the pharmacy for a CPCS Minor Illness will usually 1st be seen by the pharmacy’s Medicine Counter Assistants (MCAs), so if patients request advice on management of a minor condition, it is advised the team may first want to ask if they have been referred to the pharmacy by NHS 111

A patient being referred for a Minor Illness consultation can be offered advice, onward referral or escalation to alternative healthcare providers (such as A&E, Urgent Treatment Centre or their own GP) or sold an over the counter product, or supplied with a medicine via a local Minor Ailments Service (where one is commissioned). If the patient wishes to make a purchase, the pharmacy’s own normal charges for the item will apply (it is not charged to the NHS or provided free).

Receipt of referralAs stated above it is recommended the CPCS IT system & the pharmacy’s shared NHS email is checked (as a minimum) on opening the pharmacy, at approx. 12pm, at approx. 4pm & 1 hour before closing.These are suggested times – the superintendent pharmacist should identify what times are appropriate for their pharmacy & amend this SOP appropriately. The Service spec states “During the pharmacy’s opening hours, the CPCS IT system must be checked with appropriate regularity, to pick up referrals in a timely manner. This includes checking the pharmacy’s shared NHSmail mailbox when a pharmacy opens and before the pharmacy closes each day to ensure that no messages have been missed that may have been sent to the NHSmail mailbox during any period of ITK messaging outage within the CPCS IT system.”

Appropriate members of the pharmacy team to whom responsibly for checking for referrals is delegated to by the LP

What to do if a patient presents but you haven’t received a referral

Double check with the patient that they were actually referred by NHS 111 (eg ask them if the phoned NHS 111, used NHS on line etc)

Check with the patient the name of the pharmacy that they were referred to. In some cases (depending on local arrangements), they might have received a text message from NHS 111 with details of the pharmacy they were referred to (however this is very rare).

If the patient has been referred to the correct pharmacy, re-check the NHS CPCS IT system for a referral message and the pharmacy’s Shared NHS mail account (if the NHS CPCS IT system has had an outage).

If no referral message is found, then the pharmacist should

The Pharmacist

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contact the referring service and ask for the referral to be re-sent.

o This should be recorded in the pharmacy and reported to both the local NHS England pharmacy contracting team and the referring service provider as an incident (contact details for this are recorded above in the Business Continuity section of this SOP)

Additionally, if no referral message is found, the pharmacist will have a duty of care for that patient and should ensure they make an assessment to determine next steps looking for any red flags.

CPCS referrals for Urgent Medicines Supply

General InformationCPCS IT systemRemember from 29 Oct 2019 CPCS referrals for Urgent Medicines Supply will be via the CPCS IT system (Sonar for London, PharmOutcomes outside of London), it will not be via the NUMSAS IT supplier (which was Anenta)

However, the Anenta system will stay open for 3 months (it will close on 31 Dec) to allow pharmacies to claim for any old NUMSAS referrals. However, it is advised to ensure all old NUMSAS claims are submitted as soon as possible in early Nov 2019

Pharmacist

Read the RPS’s Emergency Supply guidancehttps://www.rpharms.com/resources/quick-reference-guides/emergency-supply to ensure all dispensary staff understand the emergency supply regulations

The Emergency Supply regulations apply to CPCS Urgent Medicines supplies, ie:

In an emergency and at the request of a patient, a pharmacist can supply a POM without a prescription to a patient who has previously been prescribed the requested POM;

these ‘emergency supplies’ are made under the provisions and requirements of Regulations 225, 253 and Schedules 18 and 23 of the Human Medicines Regulations (HMR) 20121.

They include a requirement that the pharmacist has interviewed (on the phone or face to face) the person requesting the POM and is satisfied that there is an immediate need for it to be supplied and that it is impracticable in the circumstances for the patient to obtain a prescription without undue delay.

For the purposes of this service, any medicine or appliance that has previously been prescribed to the patient on an NHS prescription can be supplied, if the requirements of the HMR are met. Requirements in the HMR referring to emergency supplies of POMs, also apply to other medicines and appliances that are supplied as part of this CPCS service.

Pharmacist

Patients who have called NHS 111 because they have insufficient NHS 111 Call

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prescription items, will be given the pharmacy’s telephone number by the NHS 111 Call Advisor and will be advised to call the pharmacy within 30 minutes.

Referrals from NHS 111 will not contain medication details, as the call advisors are not clinically trained, so they do not ask for that information. This means that call advisors will not identify if the request is for a Controlled Drug.

In some cases the referral may come from the Integrated Urgent Care Clinical Assessment Service (IUC CAS) that is integrated with NHS 111 as a clinical call centre service using the same technical messaging as NHS 111.However, even with referrals from the Care Clinical Assessment Service it is possible the referral will not identify if the request is for a Controlled Drug

Adviser

It is important the Pharmacist understands the CPCS service is a Clinical Service, where it is the clinical responsibility of the pharmacist to the clinically “manage” these patients (this is part of the whole key clinical role of the pharmacist).

Part of “clinically managing” the patient could be, if in the clinical opinion of the pharmacist it is necessary, to escalate the referral (see below for details of how to do this).

It is important for the pharmacist to understand the CPCS is a referral to the pharmacy (not just signposting), with referrals the clinician (ie the community pharmacist) takes clinical responsibility for managing the patient (ie Assessing, Risk Managing, Safety Netting, & Escalating if necessary)

Pharmacist

Receipt of an Urgent Medicines Supply CPCS referralWhen the NHS 111 Call Advisor is making the referral, the Directory of Services (DoS) will automatically identify when a pharmacy is due to close and will not select a pharmacy that is due to close within 30 minutes of sending a referral. However, if a patient can wait for their prescription until the pharmacy is open, the referral may be sent when your pharmacy is closed for you to process once the pharmacy is open.

NHS 111

The NHS 111 Call Advisor will send the referral to the pharmacy (as described above). This referral will include information about patient details & the patient’s phone number. The patient will be asked by the Call Advisor to ring the pharmacy before attending.


When the patient contacts the pharmacy, the pharmacist should check for a referral message within the NHS CPCS IT system. Note that patients sometimes call the pharmacy immediately or sometimes come directly to the pharmacy without calling; the pharmacist should adapt to the situation accordingly.

Pharmacist

What to do if a patient presents but there was not a CPCS referral from NHS 111As well as the general points in the section above, specifically for the Urgent Medicines Supply element of the CPCS service, an option for the pharmacist is to supply an emergency supply under the “normal” emergency supply regulations (ie as one would do for a non- CPCS referral), or contact the patient’s GP.

However, if a referral has not been made, ie the patient did not contacted NHS 111 or the IUC CAS, any emergency supply required by the patient is outside the scope of this service & will not be paid

Pharmacist


for as part of the CPCS serviceWhere a pharmacy has received a referral but has not been contacted by the patient within 30 minutes of the referral, the pharmacy must make a reasonable attempt to contact the patient using the phone number given in the referral message as soon as possible. If the patient has not made contact before the next working day, then the pharmacist can close the referral as ‘no supply made’. No payment will be paid under the CPCS service to the pharmacy where there is no consultation (telephone or face-to-face) with the patient

Pharmacist

Telephone call between the patient and pharmacistIntroduction & identification of the patientWhen the pharmacist speaks to the patient the pharmacist should start the conversation by:

introducing themselves checking they are speaking to the patient by asking them to

validate details contained in the referral, e.g. date of birth and full address, but ensure you do not proactively offer any confidential information about the patient, in case the person you are speaking to is not actually the patient (ie ask “can I please check your date of birth”, do not ask “is your date of birth…”

Pharmacist

Suitability of an emergency supplyInterview the patient to assess the suitability of an emergency supply (ie the “normal” emergency supply requirements) and their eligibility to use the service by ascertaining the following:

The nature of the emergency and the reason for the request. The name of GP practice the patient is registered with – this

information should be on the referral message. The medicines or appliances being requested - check that the

drug is not excluded under the requirements of the Emergency Supply Rules, e.g. Schedule 1, 2 or 3 controlled drugs (except phenobarbital or phenobarbital sodium for the purpose of treating epilepsy).

Whether there is an urgent need for the medicine or appliance and that it is impracticable in the circumstances to obtain a prescription without undue delay. The pharmacist should use their professional judgement to determine whether there is an urgent need for each medication or appliance requested.

Whether the medicine or appliance has been previously prescribed on an NHS prescription.

o Where consent to access the patient’s SCR is given, this should be used to check current medicines or appliances.

SCR must be checked by the pharmacist unless there is a good reason not to do so. In this circumstance, the reason for not checking the SCR should be recorded

Checking the SCR will help to confirm whether a prescription for the requested medicine or appliance has recently been issued by the patient’s general practice, if so the prescription may still be available via the Electronic

Pharmacist


Prescription Service (EPS)o Verification can also be through examining physical

evidence such as a repeat medication slip or current labelled medication or by other appropriate means

If the supply can be legally made within the provisions of the Emergency Supply Regulations. Consideration should also be given to whether the medicine is liable to abuse.

If there is an existing EPS prescription on the NHS Spine available to download, which may be used to make the provision.

o The pharmacist can use the EPS tracker to see if a prescription for the patient is available to dispense. If a prescription is available, then this should be downloaded and used to fulfil the urgent supply need and complete the consultation.

NB in this circumstance the pharmacy is still eligible for the consultation fee element of the Urgent Medicines Supply CPCS referral

Check whether the pharmacy has the medicine or appliance in stock – see below what to do if the pharmacy does not have the item in stock

Pharmacist

Check whether the patient (or their representative) will be able to visit the pharmacy in person to collect the medicine or appliance.

Pharmacist

When a patient unable to travel to the pharmacy

Patients without transport or who live some distance from the pharmacy may state they are unable to travel to the pharmacy; this is more likely to happen late at night or during a public holiday when fewer NHS CPCS pharmacies are open near to the patient’s location.

If the patient is unable to travel to the pharmacy, the patient should be asked if there is someone they can ask to collect the medicine or appliance on their behalf. Pharmacies are not expected to deliver medicines or appliances to patients as part of NHS CPCS.

If no-one can collect a medicine or appliance on behalf of the patient, the pharmacist will need to consider the impact of the patient missing doses or not using their appliance and the alternative options. Note - GP OOH services do not routinely stock medicines or appliances and they are not able to deliver medicines or appliances to patients. The pharmacist should explore all options with the patient to avoid any harm.

Where advice is given to miss doses, patients should be advised to contact NHS 111 should they become unwell or if their condition deteriorates. The National Patient Safety Agency guidance (http://www.nrls.npsa.nhs.uk/alerts/?entryid45=66720 ) on missed and delayed doses may assist pharmacists in determining critical medicines or conditions where delays or omissions are more likely to cause harm.

Pharmacist

At the end of this initial telephone consultation, the pharmacist should decide whether, based on the information they have obtained:

It appears appropriate for a supply to be made. In which case the patient or their representative should be asked to attend the pharmacy premises.

Pharmacist


http://www.nrls.npsa.nhs.uk/alerts/?entryid45=66720

They want to ask the patient further questions face-to-face before they can decide whether to make a supply. In which case the patient or their representative should be asked to attend the pharmacy premises.

That an emergency supply cannot be made -see belowConsider Medicines liable to misuse & medicines that cannot be supplied via CPCS

Patients occasionally request a medicine which is liable to misuse, such as a benzodiazepine, or a hypnotic. Some requests may genuinely be needed, whilst others may be from a patient using the NHS CPCS to inappropriately gain additional supplies.

Pharmacists are reminded that medicines such as benzodiazepines (apart from temazepam, which is Schedule 3), zopiclone, and zolpidem are Schedule 4 controlled drugs, and medicines such as dihydrocodeine and codeine containing products (including co-codamol 30mg/500mg) are Schedule 5 controlled drugs.

Schedule 1, 2 or 3 controlled drugs (except phenobarbital or phenobarbital sodium for the purpose of treating epilepsy) cannot be supplied via CPCS. Gabapentin and pregabalin were reclassified as Schedule 3 controlled drugs from 1st April 2019 and therefore cannot be supplied via the service.

Some CCGs have issued guidelines to local GP OOH services on the supply of medicines liable to misuse. While it is for the pharmacist to determine whether a supply is appropriate, they should check if any such local guidelines are in place. The pharmacist needs to balance the potential for misuse versus the need and the impact on the patient of not supplying a medicine or appliance.

In situations with a medicine which is liable to misuse then a limited supply of up to 5 days treatment, until the GP practice reopens, may be appropriate. It is particularly important to check the SCR for such requests, as part of the assurance that the patient has been prescribed it before and that there has not been a recent supply made.If the pharmacist decides not to make a supply for a medicine liable to misuse, they should consider advising the patient to wait until they can collect their usual prescription from their GP practice or usual pharmacy, rather than referring them to the GP OOH service, as it should be noted that a GP OOH service will only prescribe medicines liable to misuse in limited circumstances.

The referring NHS 111 service is unable to include in the NHS CPCS referral how many times a patient has previously been referred to NHS CPCS. It is important that the pharmacy ensures that the GP is notified of any supplies using the NHS CPCS IT system – this is a requirement of the service.

NHS 111 and IUC CAS providers also undertake audits to identify frequent users and these are flagged to their clinical staff for further investigation. Pharmacists must be vigilant and bear in mind that some patients may try to use the NHS CPCS to gain inappropriate supplies. Although the number of frequent users, particularly those requesting controlled drugs, is very low - pharmacists must be

Pharmacist


aware that this occurs, and use their professional judgement to not supply an urgent request for medications if it is not clinically appropriate. The pharmacist must discuss the reasons for no supply with the patient, notify the appropriate providers connected with the patient’s care, and raise an issue with NHS England local pharmacy contracting team if required – to do this the pharmacist should consider sending an incident form using the template in the NHS CPCS IT system to the NHS 111 provider or IUC CAS if they feel the NHS CPCS request is inappropriate.

Remember the NHS CPCS is intended to be used as an emergency service, not as a regular method for obtaining repeat prescriptionsWhat to do if the pharmacy does not have the item in stock (but another pharmacy might)Where it is appropriate for an emergency supply to be made, but the medicine or appliance is not in stock at the pharmacy, with the agreement of the patient, the pharmacist will identify another pharmacy (Pharmacy 2) that provides the service, and which is convenient for the patient, by searching the DoS tool, which is used in the area (see the below escalation section for details of how to search the DoS tool)

Before the referral to Pharmacy 2 is made, the pharmacist should be confident that an emergency supply is both possible and in the best interest of the patient, bearing in mind the receiving pharmacist will have to use their own professional judgement as to whether the requirements of the Emergency Supply regulations are met.

The following should be explained to the patient: That the pharmacy does not have the medicine or appliance

in stock and that a referral to another pharmacy will be necessary.

That a pharmacy with the medicine or appliance in stock needs to be identified.

That consent is required from the patient for sharing their details with another pharmacy.

That the patient may need to travel to an alternative pharmacy, but bear in mind that it will depend on where the medicine or appliance is stocked, and which pharmacies are open.

The pharmacist (at Pharmacy 1) will contact the pharmacist at Pharmacy 2 to check whether they have the item in stock. If Pharmacy 2 confirms they have, then Pharmacy 1 will forward the electronic referral received from NHS 111 to Pharmacy 2 via Pharmacy 1’s NHS mail to Pharmacy 2’s NHS mail or the CPCS IT system (where this functionality exists), and the pharmacist at Pharmacy 2 should contact the patient and follow the process as above.

The pharmacist (at Pharmacy 1) should ensure they provide the patient with the details of the pharmacy (name, address, phone number etc) to which they have been referred.

In this instance, both pharmacies are eligible for the service Consultation Completion fee.

Pharmacist


If, however, the pharmacist at Pharmacy 2 advises that they do not have any stock, then the pharmacist at Pharmacy 1 should contact the GP OOH service to discuss a solution, and if necessary, arrange for the patient to be contacted by an appropriate healthcare professional. Only Pharmacy 1 is eligible for the service Consultation Completion fee in this instance, completing their records to confirm that no supply was made.

If Pharmacy 2 does not have the items in stock, then the pharmacist can try another NHS CPCS pharmacy. The pharmacist should use their own professional judgement as to the number of NHS CPCS pharmacies that should be tried before considering contacting the GP OOH service to discuss an alternative.When not supplying a medicine or appliance

There may be times when the pharmacist does not supply a medicine or appliance

Reasons for not supplying an item include: The required item is out of stock – in which case the

pharmacist should refer the patient to another NHS CPCS pharmacy.

The required item is available as an over the counter (OTC) product so can be sold (at a price cheaper than a NHS Prescription charge).

An urgent supply is not necessary or appropriate – in this case the pharmacist must give the patient an explanation and additional advice where appropriate, such as contacting their GP practice when next open.

o When considering not making a supply, the pharmacist must also consider the possible impact on the patient’s future adherence to their regimen and should advise the patient accordingly

The item is a Schedule 1, 2 or 3 Controlled Drug & so cannot be supplied under the Emergency Supply regulations – the pharmacist must contact an appropriate service to arrange further assistance for the patient.

In all these cases the pharmacy is eligible for the service Consultation Completion feeIf no items are supplied to the patient, it is important that the reasons are recorded within the NHS CPCS IT system

Pharmacist

Escalation Process when an emergency supply cannot be madeIf it is not possible to make an emergency supply due to prohibitions within the legislation or other factors, the pharmacist must ensure the patient is able to speak to another appropriate healthcare professional.

The pharmacist must either: refer the patient to their own general practice (this will be the

normal place to refer the patient if it’s during the working day & the surgery is open); or

contact the local GP OOH (GP Out of Hours) provider (esp if the surgery is closed) to discuss a solution, and if necessary, request that the patient be contacted by an appropriate healthcare professional via the GP OOH provider.

Pharmacist


Examples of when a referral to the GP or GO OOH service (when the patient’s surgery is closed) may be appropriate include:

The patient is unwell and needs medical assessment. Controlled Drugs are requested and cannot be supplied under

the Emergency Supply regulations. Out of stock items are required where other local NHS CPCS

pharmacies do not have the item in stock and an alternative medicine or appliance may be required until stocks are available.

o In this situation the “escalation” might simply involve phoning the patient’s GP & in consultation with the GP, agreeing an alternative item to be prescribed by the GP & an EPS prescription to be sent to the pharmacy

Local care pathways determine other referral routes, e.g. palliative care patients (check CCG prescribing guidelines where these have been made available to you).

See below for contact details for GP OOH services and the NHS 111 service in your area to help the patient to access the appropriate service.

If the pharmacist does not know where to refer the patient, then the pharmacist should phone the referring NHS 111 service and advise the call advisor they are a health professional and need to speak directly to another health professional regarding a referral that has already been received. In some areas the pharmacist will then be put through to a clinician; in other areas the call advisor will take relevant details and advise that a clinician will phone the pharmacy back.

NB - patient consent for receiving the service and for the pharmacy sharing information with the patient’s GP practice, NHS England and the NHSBSA will have already been obtained by NHS 111 or the IUC CAS before a referral is made.Pharmacists must not refer a patient back to NHS 111 or the IUC CAS by asking the patient to call back directly. Remember the patient was referred (not signposted) to the pharmacist by NHS 111, & a referral means the clinician (in this case the pharmacist) has clinical responsibility for “clinically managing” the patient (& this includes escalating the patient to another clinician where necessary)

Pharmacist

Option A) Phone the Patient’s GP & if necessary, refer the patient for an urgent in-hours appointment (Monday to Friday 8:00-18:30):

To escalate a patient during the day, the Pharmacists should discuss with the patient the options & if required support the patient to make an urgent in-hours appointment with their GP. After agreeing this with the patient, the pharmacist should telephone the patient’s GP to discuss the issue & if necessary, to secure this appointment.

For out of stock items the “escalation” might simply involve phoning the patient’s GP & in consultation with the GP, agreeing an alternative item to be prescribed by the GP & an EPS prescription to be sent to the pharmacy.

Where the patient is unwell and needs medical assessment or

Pharmacist


where Controlled Drugs are required, the pharmacist should discuss the situation with the GP & support the patient to make an urgent in-hours appointment with their GP.

The pharmacist may wish to print a copy of the consultation for the patient to take with them to the consultation with their GP.

Pharmacists in London can access MiDoS©, to support in contacting the patient's registered GP and searching for other services that might help the patient. MiDos is a NHS web portal that provides details of bypass phone numbers for GP practices, so as to facilitate the pharmacist referring the patent to their GP (these are phone numbers not used by the public, so get answered quicker by surgery staff, it’s not the phone number on the surgery’s website or on the bottom of a prescription)

MiDos can be accessed via a link in Sonar. Log in details are not needed

Below is an example of what a MiDos search screen looks like

Option B) Call the NHS111 service when the patient’s own GP is not available:

To escalate a patient when their own GP is not available, Pharmacists are able to call the NHS 111 service using the *8 facility for fast access to a clinician if this is required.

The infographic below provides as to how this process works:

Pharmacist


A copy of this is provided in Appendix 3 C Key Contacts

The Pharmacist should summarise the situation & request that the patient be contacted by an appropriate healthcare professional via the GP OOH provider.

Face to Face consultation between the Pharmacist & the patient (if needed)Where the pharmacist has undertaken a telephone consultation but is unable to collect all of the information they require from the patient to comply with the requirements of Emergency Supply Regulations, or they feel that it is clinically appropriate to see the patient before making a decision on making an emergency supply, the pharmacist shall conduct a face-to-face consultation. The pharmacy’s consultation room can be used for this discussion.

Pharmacist

If the pharmacist did not check the SCR during the telephone call with the patient during the initial phone call, it must be checked at this stage unless there is a good reason not to. In this circumstance, the reason for not checking the SCR should be recorded. Likewise, if the EPS tracker was not checked during the telephone call, the pharmacist can use it at this stage to see if a prescription for the patient is available to dispense.

Pharmacist

If at this stage it is identified that a supply cannot be made, then the procedure set out above should be followed. Documentation of any repeat medicines or appliances not supplied should be recorded on the CPCS IT system (or patient’s PMR if not able to record on the CPCS IT system ).

Pharmacist

Advice and information to be given to the patientThe pharmacist will provide advice to every patient about the importance of ordering prescriptions in a timely manner. It is important to reduce the future need for emergency supplies.

Pharmacist

The following information should be discussed: The importance of avoiding running out of their medicine or

appliance. Planning for weekends / public holidays. How the patient’s usual community pharmacy would be able

to support the patient, e.g. patient should ask their usual pharmacy about their repeat dispensing service.

Ordering medicines in a timely manner from the patient’s usual pharmacy.

The benefits of the eRD Service.

Pharmacist


The NHS CPCS must not be used to attempt to change the patient’s use of their usual pharmacy.

All Pharmacy Staff

Confirming if a Supply is to be madeFollowing the phone consultation and/or face to face consultation, the pharmacist should use their professional judgement to determine whether they may supply the requested items in accordance with the requirements of the Emergency Supply regulations.

Pharmacist

Quantity to supplyThe Emergency Supply regs sets out the maximum quantity of a POM that can be supplied as an emergency supply. The pharmacist’s Professional judgement should be used to supply a reasonable quantity that is clinically appropriate and that will last until the patient is able to see a prescriber to obtain a further supply.

This would not always be supplying 28 days supply, as often the patient would be able to see a prescriber to obtain a further supply before this period of time

Where local clinical commissioning group (CCG) prescribing guidelines for the OOH period exist, these should be noted and should act as a guide.

Care should also be taken when deciding to supply any medicine that has a potential for misuse. In situations with a medicine which is liable to misuse then a limited supply of up to 5 days treatment, until the GP practice reopens, may be appropriate. It is particularly important to check the SCR for such requests, as part of the assurance that the patient has been prescribed it before and that there has not been a recent supply made.

The Emergency Supply regulations covers circumstances such as when it is not possible to split a pack (e.g. inhalers, creams etc.) as well as when there are additional limits to the quantity that can be supplied (e.g. the legislation limits the supply to 5 days for controlled drugs, such as phenobarbitone or phenobarbital sodium for the treatment of epilepsy, Schedule 4 and 5 controlled drugs).

Pharmacist

Medicines or appliances that are not POMsPrescription items that are not Prescription Only Medicines (POMs) can be supplied under this service if the criteria of the service are met (i.e. the supply is urgently needed, and it is an item previously provided on an NHS prescription to the patient). If a medicine or appliance which is not a POM is cheaper than a current NHS prescription charge and the patient is not exempt from prescription charges, the item can be purchased if the supply is within the product licence. The pharmacy would still be eligible to receive the CPCS Consultation Completion Service fee

Pharmacist

Once the pharmacist has counselled the patient the patient can be supplied with the non-POM items (this supply can be delegated by the pharmacist to appropriately trained members of the pharmacy team)

Pharmacist

Completing the consultation notes on the CPCS IT SystemOnce it has been confirmed that a supply is to be made & the quantity of the supply to be made is confirmed by the pharmacist, the pharmacist should complete the CPCS referral details on the CPCS IT System (Sonar for London, PharmOutomes outside of London).

Pharmacist

Records in the NHS CPCS IT system must be fully completed to Pharmacist


ensure an accurate clinical record is maintained of the consultation, correct payments for provision of the service are claimed and accurate information is available to support the management and evaluation of the service.The medicines or appliances supplied or not supplied must be documented on the FP10DT EPS dispensing token, via the CPCS IT system (Sonar or PharmOutcome) using the NHS dm+d dictionary naming convention (http://www.dmd.nhs.uk/index.html ). The CPCS IT systems have adopt the dm+d dictionary naming convention, so this naming convention should be picked up automatically

Pharmacist

The dm+d quantities are based upon the doses, for example, a salbutamol inhaler should be recorded on the FP10DT EPS dispensing token as 200 for 200 doses, not 1 for an original pack.

Pharmacist

Incorrect quantities recorded on the FP10DT EPS dispensing token will lead to incorrect payments – please be careful to enter the quantities correctly.

Pharmacist

When recording quantities for supplies made please note the guidance in the table below:

Pharmacist

Accurate documentation of the ‘no supply’ reason is an essential part of evaluating the pilot, which will inform decisions on commissioning the service in the future. The following is the list of options on the CPCS IT System for no supplies

Item not able to be supplied under emergency supply regulations (e.g. Schedule 1, 2 or 3 Controlled Drug)

EPS prescription dispensed for patient Pharmacist determined that supply not necessary (e.g. not

clinically appropriate; concern about abuse of service) Item not in stock Patient /Patient’s representative did not make contact and

pharmacy unable to make contact Patient bought the item Other

Pharmacist

The pharmacist must ensure that a notification (‘Post Event Message’) of any supply made as part of the service is sent to the patient’s GP practice on the same day the supply is made or as soon as possible after the pharmacy opens on the following working day.

This notification will normally be sent electronically via the CPCS IT system (which will send it via secure email or secure electronic data interchange). If the surgery’s email is not listed on the CPCS IT System, the pharmacist should contact the GP practice for details of their secure NHS email address. Where electronic notification is not possible, the pharmacy contractor should send the notification via

Pharmacist


http://www.dmd.nhs.uk/index.html

post or hand delivery.Printing of the Urgent Medicines Supply CPCS referral information onto a blank FP10DT EPS dispensing tokenOnce the consultation notes have been entered on the CPCS IT System by the pharmacist, the Urgent Medicines Supply CPCS referral information can to be printed onto a blank FP10DT EPS dispensing token. This is via the CPCS IT SystemThe pharmacist should carry out an accuracy check to confirm the information is correct & then print the Urgent Medicines Supply CPCS referral information onto a blank FP10DT EPS dispensing token

Pharmacist

The FP10DT EPS dispensing token must include the following information (this will be automatically pre-populated by the CPCS IT System):

Full name, address and date of birth of the patient (from the original

referral) Patient’s NHS Number (from the original referral or from

interview with patient) Name, strength and form of medicines requested (using

DM+D name or shortened DM+D name) or name of appliance requested (using DM+D name or shortened DM+D name)

The quantity supplied Date of supply Name and address of patient’s GP (from NHS 111 referral) NHS 111 referral ID number (from NHS 111 referral)

Pharmacist

The patient or their representative must complete the relevant sections of the reverse of the FP10DT EPS dispensing token to claim exemption from NHS prescription charge payment & the Pharmacist should check this is completed with the patient / their representative

Pharmacist

The now filled out FP10DT EPS dispensing token can then be passed to the dispensary team to label & assemble

Pharmacist

Labelling & AssemblingThe usual Emergency Supply labelling requirements apply, including the addition of the wording ‘Emergency Supply’ to the label.

In time PMR providers may produce an “Emergency supply CPCS” labelling option, in the meantime (for ProScript) use “Emergency Supply - Patient Request (Sale)”, & for reason for supply write “CPCS”. Note this will automatically record the CPCS emergency supply in the PMR’s Electronic Private Prescription Book (the POM Register) for ProScript (this is a legal requirement of the Emergency Supply regulations) & the patient’s PMR (a requirement of the SLA). For other PMR providers other requirements will apply – the Superintendent Pharmacist (or other Lead Pharmacist should edit this SOP appropriately)

The pharmacy’s normal Emergency Supply & Dispensing SOPs apply to the Labelling & Assembling of these items.

Dispensary staff

Record KeepingWhere a CPCS urgent supply is made this must be recorded in three places:

Private Prescription Book (the POM Register) o This will automatically be actioned if the labelling

instructions above are followed (unless the POM Register is not linked to the PMR)

Patient Medication Record (PMR)

Dispensary staff

Dispensary staff


o This will automatically be actioned if the labelling instructions above are followed

NHS CPCS IT systemo This is a requirement of the SLA & will automatically be

actioned if this SOP is followed & the consultation written up on the CPCS IT system

Pharmacist

Handing OutThe Pharmacy’s normal Handing Out SOPs applyOn handing out the medicine check the back of the FP10DT EPS dispensing token has been filled out & if appropriate take the appropriate number of prescription charge(s)

All Dispensary staff

The FP10DT EPS dispensing tokens must be filled for submission to the NHSBSA as part of the month end submission (see below)

Appropriately trained Dispensary staff

PaymentA Service Consultation Completion fee of £14 will be paid for each completed Urgent Medicines Supply CPCS referral

NHSE

For Urgent Medicines Supply CPCS, a referral is defined as being completed when the pharmacist has had a consultation with the patient (either via telephone or face-to-face) and

provides an emergency supply or confirms no supply is required or the patient is given advice or the patient purchases the required product OTC or the patient is referred on to another healthcare provider or an EPS prescription is downloaded and dispensed or an item is not available and the patient is referred to a

second pharmacy (both pharmacies can claim a Service Consultation Completion fee in this scenario).

Pharmacist

No Consultation fee can be claimed where the pharmacist cannot make any contact with the referred patient.

Pharmacist

In addition, the cost of medicines or appliances supplied under the CPCS Urgent Medicines provision will be reimbursed to the pharmacy using the basic price specified in Drug Tariff Part II Clause 8 – Basic Price. No other elements of the Drug Tariff in relation to reimbursement of medicines or appliances apply to this service. An allowance at the applicable VAT rate will be paid to cover the VAT incurred when purchasing the supplied medicine or appliance.

NHSE

Claims for payments for this service should be made monthly, via the MYS portal and/or the CPCS IT system (where this functionality is available).

Sonar & PharmOutcomes CPCS IT system will create a month end collated activity report/payment claim which will need the approval by the Pharmacy prior to it being submitted to the NHSBSA. The Pharmacy will then need to log onto the MYS portal where this data from the CPCS IT system will be available & need to be confirmed. Once CPCS is live it will be important for the Pharmacist to check the actual mechanism of payment process on the CPCS IT system & the MYS portal process.

Claims will be accepted by the NHSBSA within six months of completion of a referral, in accordance with the usual Drug Tariff claims process. Later claims will not be processed.



The NHSBSA will make appropriate payments claimed by the pharmacy contractor as described above, in the same payment month as other payments for NHS Pharmaceutical Services The payments will be separately itemised on the FP34 Schedule of Payments

NHSE

The FP10DT EPS dispensing tokens must be sent to the NHSBSA as part of the month end submission (clearly separated within the batch and marked ‘CPCS’). They will be retained by the NHSBSA to allow evaluation and verification of payments/ exemption claim accuracy.


CPCS referrals for low acuity / minor illness

General InformationThe pharmacy will provide patients with self-care advice and support, including access to printed information, on the management of low acuity / minor illness conditions (a sample list of conditions is provided in the box below).

Pharmacist

List of possible symptoms groups identified for referral to a community pharmacist wrt CPCS referrals for low acuity / minor illness

This list is not exhaustive but reflects the expected case mix based on current NHS 111 calls. A more detailed explanation of the referral coding used by NHS 111 is attached as Appendix 1 at the end of this document

Acne, Spots and PimplesAllergic ReactionAnkle or Foot Pain or SwellingAthlete's Foot PC assessment and management capability, minor conditionAthlete's Foot Bites or Stings, Insect or SpiderBlistersConstipationDiarrhoeaEar Discharge or Ear WaxEaracheEye, Red or IrritableEye, Sticky or WateryEyelid ProblemsHair loss PC assessment and management capability, minor conditionHeadacheHearing Problems or Blocked EarHip, Thigh or Buttock Pain or Swelling ItchKnee or Lower Leg PainLower Back PainLower Limb Pain or SwellingMouth Ulcers


Nasal CongestionRectal Pain,ScabiesShoulder PainSkin, RashSleep DifficultiesSore ThroatTirednessToe Pain or SwellingVaginal DischargeVaginal Itch or SorenessVomitingWound Problems - management of dressingsWrist, Hand or Finger Pain or Swelling

The outcome of referrals received in relation to low acuity / minor illness may include:

Self-care advice and support may be sufficient for the patient. The pharmacist may recommend the patient purchases an

OTC medicine (ie purchase OTC medicines privately, ie not on the NHS).

The pharmacist may, where available, signpost the patient into another NHS pharmacy service, e.g. a Minor Ailments Service (if one is commissioned locally & supply medicines to the patient via that Minor Ailments Service), a Patient Group Direction service, a flu immunisation service etc.

o In all these cases the procedures for those services must be completed & payments claims for those services are separate & in addition to claiming the CPCS fees

The pharmacist may suggest that the patient seeks non-urgent advice from another healthcare professional. This could include, if acceptable to the patient (as is in line with the self-care agenda) a private GP service, PGD service, private IP service. Note, this is fundamentally not different than a patient purchasing OTC medicines not on the NHS ie privately). In all cases the choice to take up such options is with the patient & a self-care choice.

The pharmacist may escalate the patient if they require urgent attention. This may be to the patient’s own GP, GP OOHs, IUC CAS contact centre to access GP advice or in urgent cases by ringing 999 or referring the patient to A&E.

o Where escalation is necessary, the pharmacist must organise the escalation, rather than expecting the patient to do this.

Pharmacist

Only patients who have called NHS 111 / IUC CAS and been referred to the pharmacy are eligible to receive advice and treatment under this service. Patients presenting in the pharmacy with a low acuity condition / minor illness cannot be diverted into the service. Those who usually manage their own conditions through self-care and the purchase of OTC medicines should continue to self-manage and treat their conditions.

Pharmacist

Receipt of a Minor Illness CPCS referralThe NHS 111 Call Advisor will send the referral to the pharmacy (as described above). This referral will include information about patient details & the patient’s phone number. For Minor Illness CPCS referrals the patient will not be asked by the Call Advisor to ring the



pharmacy before attending.If no electronic referral message has been received and the patient has made contact, the pharmacist must contact the local NHS 111 or IUC CAS health professionals telephone line to confirm whether a referral has been made and, where appropriate, to confirm the patient’s NHS number and GP details and to request that the electronic referral message is re-sent.

Pharmacist

What to do if a patient presents but there was not a CPCS referral from NHS 111As well as the general points in the section above, specifically for the Minor Illness element of the CPCS service an option for the pharmacist is to make an intervention via an alternative method, e.g. advice, education and then the supply of an OTC product (purchases privately) or via a locally commissioned minor ailments service, (ie as the pharmacist would for a “normal” walk-in OTC patient)

However, if a referral has not been made, ie the patient did not contacted NHS 111 or the IUC CAS, any request by the patient is outside the scope of this service & will not be paid for as part of the CPCS service

Pharmacist

Where a pharmacy has received a referral but has not been contacted by the patient within 12 hours of the referral, the pharmacy must make an attempt to contact the patient using the contact details set out in the referral message. The SLA requires the pharmacist to make 1 attempt to contact the patient.In most cases, this should be the same day as the referral is received before closing the pharmacy at the end of the day. If a referral is received overnight, then it would be appropriate for the pharmacist to telephone the patient the next day if they haven’t attended the pharmacyIf the patient has not made contact during the next working day, the pharmacist can close the referral, via the CPCS IT system, as ‘no intervention made’. No payment will be made to the pharmacy where there is no consultation (telephone or face-to-face) with the patient

Pharmacist

Patient Attends the PharmacyPatients who have called NHS 111 because they have a minor condition are referred to the pharmacy. When the patient arrives at the pharmacy, the patient should let the pharmacy team know they have been referred from NHS 111.

Ensure the whole pharmacy team are aware that CPCS patients will be presenting in the pharmacy. Ensure the whole pharmacy team are aware patients may not remember to say they have been referred by NHS 111 – please note that if these patients are process as a “normal” OTC patient with an OTC sale the pharmacy will not be able to claim payment for a Service Completed Consultation fee.

Ensure the whole pharmacy team are aware to listen out for patients using phrases like the ones below as a means of identifying CPCS patients:

“Someone told me to come to the pharmacy?” “I’ve been referred from the NHS” “I rang NHS 111 and they told me to come here” “I rang NHS 111 and they told me to come to a pharmacy”

The whole Pharmacy team


In (a very few) areas (depending on local arrangements) the patient might have received a text message from NHS 111 with the details if the pharmacy, the patient might show this to the pharmacy staff. However please note it is rare that such a text message will be sent.

If the patient refers to NHS or NHS 111 referral when they come into the pharmacy, an appropriate member of the pharmacy must check if a referral has been made on the NHS CPCS IT system. If it is unclear, ask the patient what led them to attend the pharmacy today & ultimately refer to the pharmacist.

Pharmacist consultationThe pharmacist will conduct the consultation.

This consultation will usually be face-to-face but may be over the telephone if appropriate. A telephone consultation could be if the patient calls the pharmacy or where a pharmacy has received a referral but has not been contacted by the patient within 12 hours of the referral, and the pharmacist makes an attempt to phone the patient using the contact details set out in the referral message. If, in the clinical opinion of the pharmacist, the telephone consultation is sufficient, then the pharmacist can close the case, the patient does not have to attend the pharmacy (& the pharmacy can complete the consultation notes on the CPCS IT System & claim the Service Consultation Completion fee)

Where the pharmacist undertakes a telephone consultation but is unable to collect all of the information they require from the patient or they feel that it is clinically appropriate to see the patient before making a decision on their condition, the pharmacist should ask the patient to attend the pharmacy & the pharmacist shall conduct a face-to-face consultation with the patient when they attend the pharmacy

Pharmacist

The pharmacist must, using the CPCS IT system, collect information on the patient’s condition and make appropriate records, during the consultation. The pharmacist will assess the patient’s condition using a structured approach to respond to symptoms.

Pharmacist

Contemporaneous notes must be taken during the consultation and recorded on the NHS CPCS IT system by the pharmacist.

Alternatively, handwritten notes may be used, but must be transcribed into the NHS CPCS IT system immediately after the consultation. NB From 1 April 2020, the consultation room must have IT equipment accessible within the consultation room to allow contemporaneous records of the consultations to be made within the NHS CPCS IT system.

It is very strongly recommended, for robust clinical governance & good practice for the pharmacist to make contemporaneous notes on the CPCS IT System (& not to make handwritten paper notes). This will allow access to the SCR & NICE CKSs (Clinical Knowledge Summaries). The Superintendent Pharmacist (or other Lead Pharmacist) should amend this section in line with their clinical opinion

Pharmacist

The pharmacist will ensure that any relevant ‘Red Flags’ are recognised and responded to as part of the consultation process. The Pharmacist will be supported in recognising “Red Flags” by using the NICE CKSs (Clinical Knowledge Summaries) which a are

Pharmacist


linked to by the CPCS IT System

NICE Clinical Knowledge Summary can also be accessed via https://cks.nice.org.uk/The pharmacist will identify any concurrent medication or medical conditions, which may affect the treatment of the patient. This should involve access to the patient’s SCR, where appropriate and with patient consent.

Pharmacist

The workflow within the CPCS IT Sytem has been designed to support the pharmacist’s clinical consultation. So, the work flow / process of the consultation would involve the flowing stages:

The pharmacist reviewing the ITK Referral from NHSE 111 The pharmacist reviewing the patient’s SCR (so as to be

aware of any relevant history) The pharmacist reviewing CKS (Clinical Knowledge

Summaries) for the patient’s conditions & guidance on potential Red Flags

Pharmacist

If at this stage, it is identified that the patient needs to be referred to access higher acuity services, the Escalation procedure set out in detail below. This may be to the patient’s own GP, GP OOHs, IUC CAS contact centre to access GP advice or in urgent cases by ringing 999 or referring the patient to A&E.

Where escalation is necessary, the pharmacist must organise the escalation, rather than expecting the patient to do this.

Pharmacist

The pharmacist must escalate any safeguarding risks that exceed their Level 2 safeguarding training (as per the pharmacies normal safeguarding processes).

Pharmacist

The pharmacist will provide self-care advice on the management of the low acuity condition.

Pharmacist

The focus of the service is the consultation and provision of key messages regarding self-care and patient education. For many patients Self-care advice and support may be sufficient.

Pharmacist

Should medication be required for the presenting condition, then options open to the pharmacist include the following:

The pharmacist may recommend the patient purchases an OTC medicine (ie purchase OTC medicines privately, ie not on the NHS).

The pharmacist may, where available, refer the patient into another NHS pharmacy service, e.g. a Minor Ailments Service (if one is commissioned locally & supply medicines to the patient via that Minor Ailments Service), a Patient Group Direction service, a flu immunisation service etc.

The pharmacist may suggest that the patient seeks non-urgent advice from another healthcare professional. This could include, if acceptable to the patient (as is in line with the self-care agenda) a private GP service, PGD service, private IP service

Pharmacist

As well as the provision of verbal advice, patients should, if required, be provided with printed information relevant to their condition, or where this consultation takes place over the telephone, the pharmacist should signpost to relevant online resources, if required. This should include self-care messages, expected symptoms, the probable duration of symptoms, and when and where to go for further advice or treatment if needed. Printed or online information can be sourced from www.nhs.uk

Pharmacist


http://www.nhs.uk/

https://cks.nice.org.uk/

Verbal and written advice can also be used to reinforce the message that community pharmacies are an ideal first port of call when seeking advice on the management of low acuity conditions.At the end of every consultation, the pharmacist should give a closing statement to the patient:

“If your symptoms do not improve or become worse, then either come back to see me or seek advice from your GP. You can call NHS 111 or 999 if the matter is urgent and a pharmacist or GP is not available.”

Pharmacist

Where it is considered clinically important to inform the patient’s own GP or to ensure the patient’s GP based record is updated (for example if the pharmacist has cause to escalate the patient to Accident and Emergency), the pharmacist should ensure that a notification of the service provision(ie a “post event message”) is sent to the patient’s general practice on the same day the consultation occurs or as soon as possible after the pharmacy opens on the following working day.

This notification should ideally be sent electronically, using the NHS CPCS IT system (if that functionality is available) or by NHS mail. If necessary, the pharmacy should contact the GP practice for details of their NHS mail address. Where electronic notification is not possible, the pharmacy contractor should send the notification via post or hand delivery.

Pharmacist

It is very important to close each consultation - the pharmacy will not be paid for any consultations that are not closed on the CPCS IT System.

Pharmacist

As part of the pharmacy's end of month procedure it is advised to have a member of staff trained to check all consultations are closed. This person does not necessarily have to be the pharmacist, but should be a suitably trained member of the dispensary team. This member of staff should discuss with the pharmacist any consultations which are not closed for the pharmacist to action & close

Suitably trained member of the dispensary team

Escalation ProcessThere will be times when the pharmacist will need additional advice or will need to escalate the patient to a higher acuity care location (e.g. an OOHs GP or Urgent Treatment Centre or A&E).

There are three options in this circumstance & these are set out below. The pharmacist should use their clinical judgement to decide the urgency, route and need for referral

Pharmacist

Option A) Refer the patient for an urgent in-hours appointment (Monday to Friday 8:00-18:30):

To escalate a patient during the day, Pharmacists should support a patient to make an urgent in-hours appointment with their GP. After agreeing this course of action with the patient, the pharmacist should telephone the patient’s GP to secure this appointment. The pharmacist may wish to print a copy of the consultation for the patient to take with them to the consultation with their GP.

Pharmacists can access MiDoS©, to support in contacting the patient's registered GP and searching for other services that might help the patient. MiDos is a NHS web portal that provides details of

Pharmacist


bypass phone numbers for GP practices, so as to facilitate the pharmacist referring the patent to their GP (these are phone numbers not used by the public, so get answered quicker by surgery staff, it’s not the phone number on the surgery’s website or on the bottom of a prescription)

When referring patients to their GP practice, pharmacists should not give patients the expectation of any specific treatment e.g. antibiotics, or length of time until patients can expect a GP appointment

MiDos can be accessed via a link in Sonar. Log in details are not needed


Option B) Call the NHS111 service when the patient’s own GP is not available:

To escalate a patient when their own GP is not available, Pharmacists are able to call the NHS 111 service using the *8 facility for fast access to a clinician if this is required.

The infographic below provides as to how this process works:

Pharmacist


A copy of this is provided in Appendix 3 Key Contacts

After agreeing this course of action with the patient, the pharmacist should call NHS 111 using the healthcare professionals’ line, as described above, for fast access to a clinician

The clinical service will provide advice which may result in onward referral of the patient, or support to resolve the issue so that the episode of care can be completed.Option C) Refer patient to A&E or call 999: If the patient presents after referral from NHS 111 with severe symptoms indicating the need for an immediate consultation, the pharmacist should refer the patient to attend A & E immediately or if needed call an ambulance.

The pharmacist must report any such cases to the local NHS England team [Superintendent Pharmacist to add email address when supplied by NHSE] on the same day as they occur or as soon as possible after the pharmacy opens on the following working day.

Pharmacist

Where it is considered clinically important to inform the patient’s own GP or to ensure the patient’s GP based record is updated (for example if the pharmacist has cause to escalate the patient to Accident and Emergency), the pharmacist should ensure that a notification of the service provision(ie a “post event message”) is sent to the patient’s general practice on the same day the consultation occurs or as soon as possible after the pharmacy opens on the following working day.

This notification should ideally be sent electronically, using the NHS CPCS IT system (if that functionality is available) or by NHS mail. If necessary, the pharmacy should contact the GP practice for details of their NHS mail address. Where electronic notification is not possible, the pharmacy contractor should send the notification via post or hand delivery.

Pharmacist

If it is known that a patient has used the service more than twice within a month, with the same symptoms and there is no indication for urgent referral, the pharmacist should consider referring the patient to their general practice.

In addition, ensure that a notification of the service provision (ie a “post event message”) is sent to the patient’s general practice to allow the GP to understand your concerns

Examples of when you should consider such a referral to the GP: Persistent cough or hoarseness (esp for more than 3 weeks) Persistent indigestion or difficulty in swallowing A sore that does not heal Change in bowel or bladder habits

o blood in faeceso diarrhoea or constipation for no obvious reasono if the patient has a feeling of not having fully emptied

their bowels after going to the toileto unexplained / severe pain in abdomen or anuso persistent bloating

Unusual bleeding or dischargeo blood in urine

Pharmacist


o bleeding between periodso anal bleeding o blood when coughingo blood in vomit

Thickening or lump in the breast or elsewhere Obvious change in a wart or mole Unexplained weight loss

In all circumstances, if the patient presents with symptoms outside the scope of the service, the patient should be managed in line with the pharmacist’s best clinical judgement

Pharmacist

Records and DocumentationDetails of the CPCS referral, the consultation and the outcomes must be recorded on the CPCS IT system. This information will be used to generate the month end payment claim for each pharmacy.

Pharmacist

The pharmacist must maintain a record of the consultation on the CPCS IT system.

This will include a record of any medicine that is supplied (whether as an OTC purchase or as part of a locally commissioned MAS).

Pharmacist

Where it is considered clinically important to inform the patient’s own GP or to ensure the patient’s GP based record is updated the pharmacist should ensure that a notification of the service provision(ie a “post event message”) is sent to the patient’s general practice on the same day the consultation occurs or as soon as possible after the pharmacy opens on the following working day.

This notification should ideally be sent electronically, using the NHS CPCS IT system (if that functionality is available) or by NHS mail. Where electronic notification is not possible, the pharmacy contractor should send the notification via post or hand delivery.

Pharmacist

GovernanceThe pharmacy will report any incidents related to patient safety, the referral process or operational issues to the NHS 111 provider and any local IUC CAS via the local health professionals’ line. This feedback may be shared via the local Integrated Urgent Care governance group as part of an overview of the service and its performance and managing its integration with other local urgent care services (including handling patients who use the service inappropriately and dealing with them on a system wide basis).

Pharmacist

The pharmacist should consider if any patient safety incidents also need to be reported to National Reporting and Learning System (NRLS).

Payment for Minor Illness CPCS referralA Consultation fee of £14 will be paid for each completed Minor Illness CPCS referral

NHSE

For Minor Illness CPCS, a referral is completed when the pharmacist has had a consultation with the patient (either via telephone or face-to-face) and has provided advice to the patient (as described above)

Pharmacist

No Consultation fee can be claimed where the pharmacist cannot make any contact with the referred patient.

Pharmacist

No costs of products supplied in relation to referrals for the Minor NHSE


Illness CPCS will be reimbursed; as in this element of CPCS the patient purchases the medication privately OTC, or a supply is made (& funded for) by a local Minor Ailments Service (where one is commissioned)Claims for payments for this service should be made monthly, via the MYS portal and/or the CPCS IT system (where this functionality is available).

Sonar & PharmOutcomes CPCS IT system will create a month end collated activity report/payment claim which will need the approval by the Pharmacy prior to it being submitted to the NHSBSA. The Pharmacy will then need to log onto the MYS portal where this data from the CPCS IT system will be available & need to be confirmed. Once CPCS is live it will be important for the Pharmacist to check the actual mechanism of payment process on the CPCS IT system & the MYS portal processClaims will be accepted by the NHSBSA within six months of completion of a referral, in accordance with the usual Drug Tariff claims process. Later claims will not be processed.


The NHSBSA will make appropriate payments claimed by the pharmacy contractor as described above, in the same payment month as other payments for NHS Pharmaceutical Services The payments will be separately itemised on the FP34 Schedule of Payments

NHSE

Reporting and MonitoringPharmacies may be required to provide reports for service evaluation and monitoring purposes. These criteria and evaluation periods will be agreed nationally with the Pharmaceutical Services Negotiating Committee (PSNC) and communicated to contractors when any submission is required.

Pharmacist

How do I withdraw from providing the service?If the pharmacy contractor wishes to stop providing the service, they must notify NHS England that they are no longer going to provide the service via the MYS portal, giving at least one month’s notice prior to cessation of the service, to ensure that accurate payments can be made and all referrals are closed.

In all cases this must be done with the agreement of the Superintendent Pharmacist (or other Lead Pharmacist)

Superintendent Pharmacist (or other Lead Pharmacst)

REVIEW PROCEDUREThis procedure will be reviewed when there are any major changes in the law affecting this process or changes to the Service Specification or following any significant incident.In the absence of any of these events, it will be reviewed on or before the date shown below.

PREPARED BYSIGNATUREDATE OF PREPARATIONVERSION NUMBER V1DATE OF REVIEW Annually or by regular reviews to be

decided by the Superintendent Pharmacist (or other appropriate Lead Pharmacist)

I have signed to say that I have read the procedure overleaf & understand its implicationsNAME SIGNATURE DATE


Appendix 1 Summary of DX & Symptom codes for CPCS The following Dispositions, Symptom Groups & codes are used by NHS 111 on CPCS referrals & these sometimes cause confusion with Pharmacists. Below is a brief definition of what these mean


1. An NHS 111 disposition is a first assessment of the care the patient needs, based on the information the patient provides to the NHS 111 Call Adviser. Typically, these dispositions range from advice on self-care to calling an am-bulance. They often (but not always) comprise a broad service type with a time frame and most (but not all) can be mapped to appropriate care set-tings in the Directory of Services.

An NHS 111 disposition has both a code (known as a Dx code) and a description, e.g. Dx08 'To contact a Primary Care Ser-vice within 24 hours'.

It’s important not to confuse disposition with diagnosis, which is the clinical identification of what is wrong with a patient. NHS 111 does not diagnose, it directs callers to 'right care, first time' using algorithms to assess acuity/urgency.

2. Symptom Group (SG) and Symptom Discriminator (SD): For searching the DoS, an NHS 111 assessment using NHS Pathways generates a Symptom Group (SG) and Symptom Discriminator (SD) as well as a Dx code.

The SG is derived from the NHS Pathways body map (literally a picture of a human body) used by the call handler to pinpoint the pa-tient's symptoms, e.g. 'Abdominal pain' or 'headache'.

The SD usually indicates the skill set required, e.g. 'full Primary Care assessment and prescribing capability', or adds further symptom details, e.g. 'urinary catheter problem AND fever'

DispositionsPlease note - just because it says "GP" in a disposition, this does not mean the pa-tient needs to see a GP, this is a “leftover” of old wording, so please note these are definitely appropriate CPCS referrals to Pharmacy. In the next iteration when the DX codes are next updated will probably be changed to “primary care” (for eg Dx 08 used to say “DX 08 to contact GP Practice service within 24 hours”). Likewise, “prescribing capability” actually means ability to supply meds (eg OTC meds)

The following 10 Dx codes covers the Dx codes linked with the CPCS Ur-gent Medicines Supply (all age groups):

DX28:Contact Pharmacist within 24 hoursDX29:Contact Pharmacist next working dayDX45:Service Location InformationDX80:Repeat prescription required within 6 hoursDX82:Medication EnquiryDX85:Repeat prescription required within 2 hoursDX86:Repeat prescription required within 12 hoursDX87:Repeat prescription required within 24 hoursDX97:Emergency Contraception within 2 hoursDX98:Emergency Contraception within 12 hours

The following 7 Dx codes covers the Dx codes linked with the CPCS refer-rals for low acuity / minor illness CPCS (age 1 and above):


DX08:To contact a Primary Care Service within 24 hoursDX09:For persistent or recurrent symptoms: get in touch with the GP Practice for a non-urgent appointmentDX10:MUST contact own GP Practice for a non-urgent appointmentDX15:Speak to a Primary Care Service within 24 hoursDX16:For persistent or recurrent symptoms: get in touch with the GP Practice within 3 working daysDX75:MUST contact own GP Practice within 3 working daysDX115:Contact Own GP Practice next working day for appointment

The following 35 SG/SD combinations covering the current minor illness case mix are how the referrals might be shown on the ITK message on the CPCS IT system

Acne, Spots and Pimples->PC full Primary Care assessment and prescribing capabilityAllergic Reaction->PC full Primary Care assessment and prescribing capabilityAnkle or Foot Pain or Swelling->PC full Primary Care assessment and prescribing capabilityArm, Pain or Swelling->PC full Primary Care assessment and prescribing capabilityAthlete's Foot->PC full Primary Care assessment and prescribing capabilityBlisters->PC full Primary Care assessment and prescribing capabilityCold or Flu->PC full Primary Care assessment and prescribing capabilityConstipation->PC full Primary Care assessment and prescribing capabilityCough->PC full Primary Care assessment and prescribing capabilityDiarrhoea->PC full Primary Care assessment and prescribing capabilityEar Discharge or Ear Wax->PC full Primary Care assessment and prescribing capabilityEye, Red or Irritable->PC full Primary Care assessment and prescribing capabilityEye, Sticky or Watery->PC full Primary Care assessment and prescribing capabilityHair loss->PC full Primary Care assessment and prescribing capabilityHeadache->PC full Primary Care assessment and prescribing capabilityHip, Thigh or Buttock Pain or Swelling->PC full Primary Care assessment and prescribing capabilityKnee or Lower Leg Pain or Swelling->PC full Primary Care assessment and prescribing capability

Appendix 2: Key message to understand about CPCS


CPCS is different from most other NHS Pharmacy services: The CPCS service is based on receiving a referral (not signposting) from non-clinicians (the NHS 111 Call Advisors) to the pharmacist (the clinician). With referral services (as opposed to signposting services) the clinician (the pharmacist) takes on responsibility for Clinically Managing Patients (ie Assessing, Red Flagging / Safety Netting / Escalating if necessary).

CPCS is different from most of the other “transactional” services the NHS usually commis-sions from pharmacy. The pharmacist doesn’t have to “fix” the patient then & there but they do need to “clinically manage” patients, (& it’s ok (indeed it is critical) to advise the patient to come back if they are not better, ie to say “If your symptoms do not improve or become worse, then either come back to see me or seek advice from your GP”)

“Clinically managing” a referred patient means: looking out for Red Flags (ie assessing the patient & using the NICE CSK & SCR one-click both built into the CPCS IT system); safety netting (ie giving advice to the patient about what to do if they are not better/get worse); & escalating the patient if necessary.

FAQ regarding use of equipment. This is for consideration only in response to a FAQ. Using equipment that most pharmacies sell & probably already use in their consult-ing rooms (eg digital otic thermometers, BP machines) to gather data significantly helps the assessment (& it doesn’t have to be the pharmacist that takes the readings, just like in a hospital / surgery where a trained HCA usually takes these readings before the patient sees the clinician – it is worth considering if this could be part of a pre-screen carried out by a member of the pharmacy team. If clinically indicated the pharmacist should be con-sidering gathering key data eg like a patient’s temperate if the patient seems to have an infection or it is otherwise indicated). However please note that use of equipment is not a specific requirement in the CPCS service Specification.

Ensure all staff (Pharmacists & non-pharmacists) carry out the training described in the SOP so they can complete the NHS CPCS self-assessment framework, which is part of the NHS declaration & signing up process.

Basic background understanding about the CPCS service & referrals: NHS 111 acts as a triage service, ie it sends people that phone NHS 111 on to other

places The NHS 111 call advisors are non-clinicians, they use NHS software algorithms to

work out what the best place to send the patient is (eg A&E, GP, Community Phar-macy ect etc) based on what the patient says on the phone

If NHS software algorithms says a referral to pharmacy via CPCS is appropriate, the NHS111 algorithm shows the NHS 111 Call Advisor the 2 nearest pharmacies to where the patient is, which have the appropriate NHS DOS profile (there is no “dir-ection” to specific pharmacies)

Remember the Call Advisors at NHS 111 are not clinical, so they are NOT diagnos-ing, just using algorithms to work out what the best place to send the patient is (based on what the patient says on the phone). Whatever clinical place the patient gets sent to (eg A&E, Community Pharmacy, GP, Out of Hours, etc) that’s where the diagnosis & managing the patient happens.

Pharmacists should bear in mind that sometimes what patients say on the phone to the NHS 111 Call Advisor doesn’t match to what the patient presents with when they walk through the door.

o For eg there have been 3 cases (in the original pilot areas during 2017-19), when the patient attended the pharmacy & the pharmacist saw the patient it was clear they were in a really bad way & the pharmacist needed to call 999 for an ambulance. This was totally correct escalation by the pharmacist. It


wasn’t that the referral was wrong, it’s just what happens in Urgent Care (CPCS is part of the NHS Urgent Care offer) & in these cases it was shown the pharmacist “managed” the patient totally appropriately.

This is no different than if a patient walked into a pharmacy off the street, we’d still “manage” the patient (eg we are aware of a case where a patient walk into a London pharmacy a couple of years ago complaining of indigestion & wanting to buy some Rennies, as the pharmacist came over to serve the patient & looked at the patient it was clear it wasn’t indigestion & actually the patient then collapsed on the floor & had a heart attack & the pharmacist performed CPR & got the MCA to call an ambulance, this saved the patient’s life).

o The point is, we should think of CPCS referrals in the same way we treat an OTC consultation (ie a patient walking into the pharmacy off the street) & we “manage” the patient in the appropriate way (anything from calling an ambu-lance (for a patient having a heart attack -ie in CPCS language this would be called “appropriate escalation”) to giving verbal advise & assurance or saying to a patient with a very minor issue “take these paracetamol, 2QDS for a couple of days & pop in & see me if you’re not better tomorrow”

o Another example was a patient that was referred via CPCS with a sore eye. The pharmacist wrote on the CPCS IT System “it was a totally inappropriate referral & the patient should have been sent to an optician or eye hospital, the pharmacy does not have equipment like an ophthalmoscope to look into the eye”. What the pharmacist actually did with the patient was to provide really good care – they looked at the patient’s eye (with a pen torch) & talked to the patient, was happy it was nothing serious & advised the patient to pop into the optician across the road (whom the pharmacist knew well) or at least come back & see them if it wasn’t better. Apart from writing on CPCS IT Sys-tem the referral was inappropriate, what the pharmacist actually did was to perfectly handle the referral, ie the pharmacist “managed” the patient (ie as-sessed the patient, checked for Red Flags & Safety Netted), realised there was nothing serious & signposted appropriately to the optician (ie a perfectly dealt with case). That’s exactly what the pharmacist would have done if the patient walked into the pharmacy off the street. CPCS is about the clinician (the pharmacist) “managing” the patient. It shows that in this example, actu-ally the referral was appropriate, perhaps in this case the pharmacist didn’t fully understand how CPCS referrals works, but did manage the patient per-fectly.


Appendix 3 – Key Contacts

In addition, these key contacts will be available on the CPCS IT Systems (both PharmOutcomes & Sonar)

NHS 111 Provider

Your local NHS 111/Integrated Urgent Care provider varies depending on the CCG where you are lo-cated:

NHS 111 Provider London Boroughs

Care UK Outer NWL (Brent, Ealing, Harrow, Hillingdon, Hounslow)

LCWNCL (Barnet, Camden, Enfield, Haringey, Islington)

Inner NWL (Central London, Hammersmith & Fulham, West London)

LAS NEL (Barking & Dagenham, City & Hackney, Havering, Newham, Redbridge, Tower Hamlets, Waltham Forest)


Vocare SWL (Croydon, Kingston, Merton, Richmond, Sutton, Wandsworth)

LAS SEL (Bexley, Bromley, Greenwich, Lambeth, Lewisham, Southwark)

CPCS - Key Contact Details [Superintendent Pharmacist / other lead Pharmacist to complete when information supplied by NHSE]

NHS 111 providerName of organisation

Health professionals’ telephone number (Note – this number must NOT be shared with the public) Key contact

Integrated Urgent Care Clinical Assessment Service (IUC CAS)Name of organisation

Health professionals’ telephone number (Note – this number must NOT be shared with the public) Key contact

Local GP Out of Hours providerName of organisation

Address

Postcode

Public telephone number

Health professionals’ telephone number (Note – this number must NOT be shared with the

public) Key contact

Directory of Services (DoS) search toolLocal DoS search tool NHS Service Finder (www.pathwaysdos.nhs.uk)

MiDoS Direct access via pharmacy clinical system

Login details(These details are specific to this pharmacy and should not be shared)

Username:Password:

Local DoS leadName

Telephone

Email address

NHS DoS provider and commissioner helpline0300 0200 363Call this number to notify NHS 111 or IUC CAS of temporary withdrawal of the service


Local NHS England team contactKey contact

Telephone

Email address

Mobile Directory of Services To support pharmacies in contacting the patient's registered GP and searching for other services that might help the patient pharmacists can access MiDoS©.

MiDos is a NHS web portal that provides details of bypass phone numbers for GP practices, so as to facilitate the pharmacist referring the patent to their GP (these are phone numbers not used by the public, so get answered quicker by surgery staff)

When referring patients to their GP practice, pharmacists should not give patients the expectation of any specific treatment e.g. antibiotics or length of time until patients can expect a GP appointment

MiDos can be accessed via a link in Sonar


*8 facility To escalate a patient when their own GP is not available, Pharmacists are able to call the NHS 111 service using the *8 facility for fast access to a clinician if this is required. The infographic below provides as to how this process works:


Appendix 4 Overview




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