january 2015 cpn

CPNCommunity Pharmacy News – January 2015

Lost in the Drug Tariff?Find your way around with our factsheet

EPS Troubleshooting | Focus on patient safety | PSNC Resources Roundup

Pharmacies taking part in an audit of

patients prescribed non-steroidal anti-

inflammatory drugs (NSAIDs) have

identified more than 2,800 patients at risk

of potentially serious complications.

The NSAID audit is available on the

PharmOutcomes electronic recording

system and was developed by the NHS

Specialist Pharmacy Services (SPS)

Medicines Use and Safety Team, and PSNC.

Last year it was used by 1,278 community

pharmacies who between them audited

16,366 patients prescribed NSAIDs, looking

to see whether they had also been

prescribed gastro-protection in line with

NICE standards.

In an analysis of the audit results the SPS

found that:

• 6,475 (40%) of patients prescribed

NSAIDs had not been co-prescribed

gastro-protection;

• 1,669 (10%) were aged over 65,

meaning they were at particular risk of

gastro-intestinal damage, and had not

been prescribed gastro-protection and

• 2,838 (27.5%) of patients who had used

NSAIDs regularly for more than two

months had no gastro-intestinal

protection.

This means 27.5% of prescriptions for

NSAIDs may not be meeting clinical

guidelines which state that patients

regularly prescribed an oral NSAID or COX2

inhibitor on a long-term basis should be co-

prescribed gastro-protection; putting

some patients at risk of complications.

Pharmacies offered 65% of the patients

they audited advice on their medicines and

2,138 patients not prescribed gastro-

protection were referred to their GPs.

The audit is the first of its kind to be

carried out on a national scale and is still

available for pharmacies to use via

PharmOutcomes.

2 Community Pharmacy News – January 2015

psnc’s work funDing anD statistics contract anD it

PharmOutcomes NSAID audit highlights extentof patient safety issuesAudit confirms role pharmacies can play in improving safety and adds to

weight of evidence for the application of dispensing checks.

This audit is the first of its kind to be

carried out all over the country and the

collation and analysis of the data that

PharmOutcomes has made possible gives

us some good evidence for the difference

that pharmacies can make. In particular

the evidence supports our belief, as set

out in our vision last year, that the

introduction of dispensing point checks

could make a significant difference to the

NHS, helping patients and saving other

services time and money. We continue to

make the case for these and other

developments to the pharmacy service.

Gary Warner is an independent

community pharmacy contractor and

Chair of PSNC’s Service Development

Subcommittee

NSAID audit: PSNC comment

NSAID audit Q&AQ. What is the NSAID audit?

The NSAID audit is a readymade audit

available on PharmOutcomes for all

pharmacy contractors (or NHS England

Area Teams) to use. It can be used as

pharmacies’ annual clinical audit and

has been designed to be as

straightforward as possible to help

busy pharmacies.

Q. How much time will the audit take?

To collect a useful sample for this audit

it is suggested that data is collected

over approximately two weeks or until

you have seen at least 10 patients.

Q. How can I use it in my pharmacy?

You can record the details of each

patient that presents a prescription for

an NSAID or COX2 inhibitor straight

onto PharmOutcomes, to save time and

effort. Alternatively you can use the

audit data collection sheet and then

enter the data on PharmOutcomes at a

later time. If you need to refer a patient

back to their GP, PharmOutcomes will

create a referral letter for you to use.

Q.Where do I go for more information?

More information about the audit can

be found at psnc.org.uk/nsaidaudit.

The NSAID audit in figures

1,669 high-riskolder patientsidentified

40% of patients notco-prescribed gastro-protection

14% ofpatientsreferredfor review

£6,825cost of admission for agastro-intestinal bleed

10,467patientsgiven advice

16,366patients audited

psnc.org.uk 3

services anD commissioning the healthcare lanDscape lpcsDispensing anD supply

The deadline for pharmacy contractors to submit their

completed Information Governance (IG) Toolkit for 2014/15 is

31st March 2015.

In particular contractors are reminded that this year no exemption

has been granted for the business continuity requirements and

pharmacies will need to have these plans in place.

Detailed guidance on the requirements including templates to

support meeting each requirement can be found in our dedicated

website section: psnc.org.uk/ig.

Also look out for further guidance due to be published on the

PSNC website towards the end of January/ beginning of

February.

Important Reminder: IG deadline approachingContractors are reminded that no exemption has been granted this year.

Changes to the way in which community

pharmacies report patient safety incidents

to the National Reporting and Learning

System (NRLS) will now not be brought in

until dispensing errors have been

decriminalised, NHS England has

confirmed.

Pharmacies have been required since 2005

to report patient safety incidents to the

NRLS and contractors may recall that as

part of the 2014/15 funding settlement it

was agreed that these reports would no

longer be anonymous and would have to

identify the pharmacy making the report.

A key concern for many pharmacists in

reporting errors has always been the laws

surrounding dispensing errors and the fact

that the errors remain a criminal offence.

Work is currently being carried out (by the

Rebalancing Medicines Legislation and

Pharmacy Regulation Programme Board)

to change medicines legislation, with a key

aim being to decriminalise dispensing

errors. But this work is taking some time

and is now not expected to be completed

before early 2016.

In light of this delay and the consequences

of the current legislation, NHS England has

now decided not to implement the

requirement to report incidents on a non-

anonymised basis until the relevant

legislation is in place. NHS England said

this was because it was keen to avoid a

situation where the contractual

requirements are not fully supported by

legislative requirements.

NHS England has confirmed that it will

make the changes to the Approved

Particulars, which set out the requirements

on incident reporting, to require non-

anonymised reporting as soon as the new

legislative framework covering dispensing

errors is in place.

PSNC will issue full guidance on the

requirements and the changes to the

Approved Particulars in due course.

Improving patient safety

While the recording of dispensing and

prescribing errors is an everyday

occurrence in the majority of pharmacies,

the number of incidents reported to the

NRLS has historically been very low.

Contractors may recall that as well as the

changes to the nature of the reports as

outlined above, it was agreed as part of

the 2014/15 funding settlement that

there must be an increase in the number

of patient safety incidents reported by

community pharmacies to the NRLS. This

was to help to meet broader NHS

objectives to improve patient safety (see

FAQs in PSNC Briefing 015/14).

This requirement still stands, and PSNC

encourages all contractors to review their

current approach to reporting incidents to

ensure that they are meeting their

contractual requirements.

PSNC Guidance

More details on the changes to patient

safety incident reporting, including FAQs

explaining why the changes were agreed,

what changes will be made to the

Approved Particulars, and how PSNC

represented contractors’ interests in the

negotiations, can be found in PSNC

Briefing 015/14: Changes to Contractual

Requirements 2014/15

(psnc.org.uk/briefings)

Updated information, including PSNC

Briefing 034/14, which explains how to

report a patient safety incident to the

NRLS, is available on our patient safety

page (psnc.org.uk/patientsafety)

Settlement 2014/15 update: patient safetyincident reportingPatient safety incident reporting changes will not be brought in until

dispensing error legislation work is complete.

1 PSNC Briefings

Every month PSNC publishes briefings designed to help contractors

and LPCs to carry out their roles. This month topics have included:

Patient safety incident reports (Briefing 034/14): explaining how

to report incidents to the NRLS.

Increasing use of vitamin D supplements (Briefing 033/14):

giving background information on vitamin D and why it is important

for at-risk groups to take supplements. The Briefing summarises

recent NICE guidance and gives details of the UK-wide Healthy

Start initiative.

NHS action planning (Briefing 032/14): providing details of The

Forward View into action: Planning for 2015/16 – guidance

published by NHS leaders, which sets out the steps to be taken by

national and local organisations during 2015/16. The Briefing

highlights the points that are most relevant to community

pharmacy.

Funding settlement and your payments (Briefing 031/14):

guiding contractors through the changes that are occurring

following the 2014/15 funding settlement, and highlighting the

payment fluctuations they are likely to see as a result of these

changes.

You can download and read all the briefings from psnc.org.uk/briefings

2 Facts and figures for LPCsThe following data and guidance may be

of use to LPCs as supporting evidence in

their local discussions and service

negotiations.

Health Survey for England (HSE) 2013

(tinyurl.com/HSEsurvey2013)

Published by the Health & Social Care

Information Centre (HSCIC); the HSE is an

annual survey monitoring the health of

the population. It highlights trends in

health; estimates the proportion of

people in England who have specified

conditions; and estimates the occurrence

of certain risk factors.

Each year the survey covers a range of

topics. For 2013 these included smoking,

social care, eye care, end of life care, shift

work, medicines, obesity, and fruit and

vegetable consumption. Trend tables

include data on alcohol consumption,

general health, longstanding illness and

well-being.

Hospital referral to community

pharmacy: an innovator’s toolkit

(tinyurl.com/referraltoolkit)

Published by the Royal Pharmaceutical

Society (RPS), the hospital referral toolkit

is endorsed by the Royal College of

Physicians (RCP) and explores ways to set

up an electronic referral system to ensure

community pharmacists are provided with

information about a patient’s medicines

when they are discharged from hospital.

3 CPPE e-learning programmes

The Centre for Pharmacy Postgraduate

Education (CPPE) has launched two new e-

learning programmes covering repeat

dispensing and urgent care.

Repeat dispensing: suitable for all

pharmacists, pre-registration pharmacists

and pharmacy technicians, this course will

support users to provide a safe and

efficient repeat dispensing service; explain

the service and its benefits to patients and

prescribers; and use paper-based and

electronic repeat dispensing. This will

support community pharmacy teams in

fulfilling the planned requirements agreed

in the 2014/15 funding settlement.

See: dld.bz/d4Uaw

Urgent care: this provides information,

videos and signposts to useful links to

support community pharmacy teams in

understanding their role in urgent care; to

develop services that could help relieve

pressure on urgent care services; and to

integrate into local plans to improve

urgent and emergency care pathways. See:

cppe.ac.uk/programmes/l/urgent-e-01/



PSNC resources round upAs well as Drug Tariff support (CPN, page 8 onwards), PSNC publishes a range

of resources to help pharmacies and LPCs. Here are some recent highlights.

services anD commissioning the healthcare lanDscape lpcsDispensing anD supply

Alcohol intervention role for pharmaciesAs Public Health England (PHE) launches its Dry January campaign, MPs have been

considering the success of local pharmacy services on this important health issue.

A New Year brings resolutions and, for

many people, these are about improving

their health. PHE is supporting people in

their efforts by promoting Alcohol

Concern’s “Dry January”; a campaign which

sees people committing to an alcohol-free

month.

Following a period of indulgence, it is

hoped that Dry January can act as “a reset

button concerning alcohol use for months

afterwards, not only helping people to

drink less per drinking day but also to drink

less frequently”, says Professor Kevin

Fenton, Director of Health and Wellbeing

at PHE.

People who sign up for Dry January at

dryjanuary.org.uk can register for tips and

tools to help them stay alcohol-free for

the month.

Pharmacy teams can of course signpost

people to this support; but they may have

a bigger role to play as well. The All-Party

Pharmacy Group (APPG) met last month to

discuss the need to use community

pharmacies to tackle problem drinking.

They heard just how successful pharmacy

alcohol intervention and brief advice (IBA)

services can be.

For example, the ‘What’s In Your Glass?’

campaign in Berkshire launched in 2013

used a kit designed to help patients

reappraise their drinking and included an

alcohol unit measure cup, calorie and unit

wheel, and information booklet. Pharmacy

teams found these kits really helped start

conversations and inspired patients with

their practicality, and of those the service

reached, more than 60% reduced the

amount of alcohol they were drinking.

The campaign is being repeated again this

month.

If you would like to help get the ball rolling

for an alcohol IBA service in your area, your

LPC’s contact details can be found via the

LPC Portal: lpc-online.org.uk.

LPC members may be also interested to

know that PHE’s Healthier Lives website has

recently added an alcohol section. This

online tool shows the prevalence of alcohol

and drug use in your area compared to the

national average, which may then serve as

evidence to support the commissioning of

related pharmacy services in these areas.

Berkshire’s ‘What’s In YourGlass?’ campaign 2013

Upcoming campaign: drug driving legislation changePharmacy teams are being asked to help make patients aware of

new drug driving legislation coming into force on 2nd March 2015.

A government awareness campaign starts in February with

contractors being asked to display campaign materials both in

their pharmacies and online or via their social media accounts.

These materials will be made available via the PSNC website.

Contractors will also need to ensure their pharmacy team

understands the implications of the legislation change for

patients. The following guidance has been published to assist

healthcare professionals: tinyurl.com/drugdriveguide

Background information and details of the campaign itself can be

found in the following partner pack: tinyurl.com/drugdrivepack

52% said the kit

helped them reducethe number of days

they drank on

Four in five respondents

said that they had startedkeeping better track oftheir drinking after usingthe kit

1 2 3 45 6 7 8 9 10 1112 13 14 15 16 17 1819 20 21 22 23 24 2526 27 28 29 30 31

Over halfswitched to lower-strength drinks

Two-thirds cut down

on the calories theyconsumed through alcohol

More than of users cut back on

the number of alcoholunits they drank60%

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

PSNC Community Pharmacy News is published by:The Pharmaceutical Services Negotiating Committee, Times House, 5 Bravingtons Walk, London N1 9AWCommunity Pharmacy News is edited by:Zoe Smeaton who can be contacted at the above address or by email at: [email protected] © PSNCPSNC Office: 0844 381 4180 or 0203 122 0810


contract anD it Dispensing anD supply services anD commissioning th

1. Make a business continuity plan: this

should be accessible to staff, and cover a

wide range of possible scenarios and the

actions you would take to address them.

(More information about Business

Continuity is available at

psnc.org.uk/epscontingency).

2. Sign up for alerts: the national Spine

has recently been upgraded. It is highly

resilient, but it is still important that you

sign up to receive Higher Severity

Service Incident alerts from the Health

and Social Care Information Centre

(HSCIC). Download the signup form at

tinyurl.com/spinealerts

3. Back-up your data: Speak to your

system provider and make sure you

have a robust system for backing up and

restoring data. If you already do regular

back-ups, then consider doing a dry run

to check that the process you would

follow to reinstate data actually works

in practice.

See the adjacent page for a

troubleshooting plan.

As Electronic Prescription Service (EPS) usage continues to rapidly rise,

it’s critical that pharmacies plan ahead and are prepared to deal with

any problems which could arise and affect their ability to access or use

the system. Here is a three step guide to being prepared:

Reminder: EPS business continuity

PSNC highlights significant role pharmaciescan play in relieving pressure on urgent careAs pressure on hospitals increases, PSNC has written to the Times and the

Health Secretary calling for the NHS to make the most of community pharmacy.

With a number of hospitals declaring

‘major incidents’ in the last few weeks,

PSNC has once again stressed the need

for the NHS to ensure that it is making

the most out of community pharmacy.

In a letter, an extract of which was

published in the Times newspaper on

Saturday 10th January, PSNC Chief

Executive Sue Sharpe expressed concern

about the current situation and outlined

the role community pharmacy could play

in relieving the pressure on urgent care.

The full letter pointed out that pharmacy

is an under-used resource despite well-

documented evidence showing the

effect that pharmacy services, if

commissioned, could have on health in

the community. A similar letter was sent

to the Secretary of State for Health.

PSNC hopes that local commissioners

will increasingly recognise the pivotal

role that community pharmacy can play

in supporting patients and meeting their

needs, preventing many from needing to

visit hospitals or GP practices. This could

result in cost savings for the NHS, as well

as offering patients more convenient

care, closer to their homes.

PSNC has worked on a number of

resources to help LPCs on this topic, and

these can be accessed at

psnc.org.uk/urgentcare.

PSNC is interested to hear from any LPCs

who have successfully introduced these

services in their local regions.

PSNC Chief Executive Sue Sharpe said:

“Community pharmacies are at the very

heart of the NHS and local communities

and, as we continue to stress to policy

makers and commissioners, we believe

that the NHS must make the most of

them if it is survive the ongoing demand

and financial pressures. As set out in our

Vision and response to last year’s Call to

Action, we have a wealth of evidence

showing just how much pharmacy could

do to help. We now need the NHS and

commissioners to put in place the

enablers that will allow us to do so.”

The PSNC website provides a wealthof resources and informationdesigned to help pharmacy teams andLPCs carry out their roles. Over thenext few weeks we will be making anumber of improvements to the siteso look out for our special containerand Is it allowed databases; newprintable pages; and a searchabledatabase of PSNC Briefings.

Visit psnc.org.uk for more.

psnc.org.uk 7

lpcs psnc’s work funDing anD statisticshe healthcare lanDscape

EPS RELEASE 2 TROUBLESHOOTING(Please check with pharmacy owner and system supplier before switching anything off)

Here the HSCIC, who are the organisation responsible for the implementation and

management of EPS, identify some of the common problems which can arise when

using EPS and the key steps that should be followed to resolve them.

Dispensing system not working 1. Check if other programmes work.2. Check internet/telephone connection. If mobile reception consider speaking to your

system supplier about a backup 3G connection to help mitigate broadband outages.3. Call the system supplier helpdesk.

Smartcard reader failure 1. Ask another person to try their Smartcard.2. Try your Smartcard in a different reader.3. Call your system supplier helpdesk.

Smartcards Unlocking SmartcardsIf you lock your Smartcard by accidentally entering an incorrect passcode three times, it canbe unlocked if two smartcard readers are present and there is a user who EITHER:• Has an RA role (i.e. Sponsor, Agent or Manager) on their card OR• Has been granted the activity B0263 ‘unlock smartcard’.Any user with the relevant access rights will be able to unlock any card except their own.

View the December CPN (psnc.org.uk/cpn) for full details of upcoming changes to thebackground IT system which checks and manages Smartcards in the next few months. Thiswill take place during an overnight transition, older background authentication andmanagement software will be replaced with the new Care Identity Service (CIS).

Barcode scanner 1. Check the cable.2. Try a different scanner.3. Type in prescription/token barcode (if available).4. Call the system supplier help desk.

Electronic prescriptions cannotbe retrieved (in no particular order– professional judgment required)

• Check the internet connection.• Can you send/receive emails?• Have you received any other electronic prescriptions today?• Have you done a manual download to request prescriptions from EPS?• Check with the GP practice that the prescription has been signed and sent• Call the system supplier help desk.

Dispensing token and labelprinter isn't working

1. Check toner, cables and power supply.2. Try a different printer.3. Call the system supplier help desk.

Options if unable to resolve anyof the above issues (in noparticular order – professionaljudgment required to ascertainurgency and best option for patient)

• Patient to return to the pharmacy at a later time (if script not required immediately).• Deliver prescriptions to patient when systems are resumed.• Emergency supply at the request of the prescriber.• Paper FP10 prescriptions printed by arrangement with the GP surgery. • Referral to another pharmacy (not suitable for some scenarios).

Contacting your system supplier 1. Register to receive text or email alerts when there are incidents affecting the NHScomponents that support EPS systems.hscic.gov.uk/eps/dispensing/help

2. Ensure you understand the escalation route.3. Have a lead at each site with responsibility for progressing issues.4. Obtain a reference number – allowing you to track the issue and get updates.

Record the name of the person dealing with your issue and the date and time when youspoke to them.

5. Ask for an estimated time to resolve it – to decide what action to take.6. Keep a specific log of issues raised.

For more about EPS, visit hscic.gov.uk/epspharm and psnc.org.uk/eps

Follow HSCIC EPS team @EPSnhs

Sign up to receive the EPS bulletin systems.hscic.gov.uk/eps/contacts/signupThis factsheet was produced by HSCIC

ElectronicPrescriptionService

All details correct at time of printing.

No part of this publication may be reproduced without the written permission of the PSNC.

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

Colour repro and printing by Truprint Media, Margate.

The publishers accept no responsibility for any statement made in signed contributions or

in those reproduced from any other source.

Communications International Group

Linen Hall, 162-168 Regent Street, London W1B 5TB

Tel: 020 7434 1530 Fax: 020 7437 0915

Distributedfor PSNC by:


Dispensing anD supply services anD commissioning the healthcare lanDscape

GSK supply webpage launched

When pharmacies receive NHS prescriptions they must check whether the items prescribed are allowed on the NHS before dispensing. If they are

not allowed, the pharmacy may not be paid for them.

Pharmacies can check whether medicinal products and medical devices are allowed using the Drug Tariff:

Medicinal products: assuming the prescriber has the appropriate prescribing rights, any food, drug, toiletry or cosmetic may be prescribed on an

NHS prescription unless the product is listed in Part XVIIIA of the Drug Tariff (the ‘blacklist’).

Medical devices: If a product has been registered as a medical device (also known as an appliance), it can only be prescribed on an NHS prescription

if it is listed in Part IX of the Drug Tariff. Registered medical devices can be identified by a ‘CE’ mark on the product’s packaging.

Dispensers may wish to check PSNC’s Disallowed Appliance List (psnc.org.uk/disallowedappliances) for medical devices they are unsure about, and

we have listed some products below that we have recently received queries about:

Product Is the item Does it Is it in Can it be Additional information listed in the have a ‘CE’ the dispensed Drug Tariff? mark? blacklist? on the NHS

Please note: If the prescription is one of the following form types, pharmacies will need to check the relevant sections of the Drug Tariff/PSNC website:

• FP10CN or FP10PN (community nurse prescriber) – Part XVIIB

• FP10D (dental prescriber) – Part XVIIA

• FP10MDA (instalment dispensing) – psnc.org.uk/mda

Is it allowed?

Jobst Bellavar class

2, thigh, open toe

with silicone band

ICaps One A Day

tablets

Nebuliser Mask

Gaviscon Cool

chewable tablets

Yes

No

No

No

n/a

No

No

No

Yes

No

Yes

No

Yes

Yes

No

Yes

Jobst Bellavar class 2, thigh, open toe with silicone band is a

registered medical device and appears in Part IXA of the Drug

Tariff so it is allowed on FP10.

Although ICaps One A Day tablets are not listed in the Drug Tariff

they are not CE marked therefore they are allowed on FP10.

Nebuliser Mask is CE marked and is not listed in Part IXA of the

Drug Tariff, so it is not allowed on FP10.

Although Gaviscon Cool chewable tablets are not listed in the

Drug Tariff they are not CE marked either, therefore they are

allowed on FP10.

Contractors have reported a number of

issues recently with some GSK lines,

including Betnovate Cream and

Bactroban Nasal Ointment. To assist

pharmacies GSK has set up a page on

their website with supply information

for medicines and vaccines. GSK advise

that the information will be updated

weekly and is designed to help provide

an up to date picture of the supply situation of their products. For the

latest information on real time availability of products, pharmacies should

continue to contact wholesalers Alliance and/or AAH.

To visit the new GSK supply page go to hcp.gsk.co.uk/supply.html

For further queries contact the GSK Customer Care Team on; freephone:

0800 221 441 or email [email protected]

Each week our Health and Care Review

summarises key news from across health and

social care to help pharmacies and LPCs to stay

on top of current trends and developments.

This month we cover the A&E crisis and how

pharmacies might help, as well as access to

medical records and funding backlogs.

Read the latest at psnc.org.uk.

psnc.org.uk 9

psnc’s work funDing anD statistics contract anD itlpcs

The first section of the Drug Tariff is the Preface. This contains

valuable information relevant for both the current edition and

the next. It lists additions, deletions and any other alterations to

the Drug Tariff. The Preface should ideally be checked each

month to identify products which are entering or being removed

from the Tariff as well as those products changing between

categories or in the case of Category C items, changes to the

brand used for pricing.

It is especially important to note which are Drug Tariff listed

products as well as which category products are entering and the

pack sizes being included in these entries, as reimbursement will

be based on this classification and its endorsement requirements.

Incorrect endorsement can lead to incorrect payment for items.

It is also important to know the category of an item when

claiming certain payments (e.g. OOP expenses) as these are not

allowed in particular categories. See psnc.org.uk/oop

Below is a quick summary of the changes due to take place from

February 2015.

Part VIIIA Additions

Category C Additions:

• Colecalciferol 800unit tablets (30) – Desunin

• Colecalciferol 880unit/Calcium carbonate 2.5g chewable

tablets (30) – TheiCal-D3

Part VIIIA Deletions

If a medicinal product has been removed from Part VIIIA and has

no other pack sizes listed, it can continue to be dispensed, but it

will need to be endorsed fully (i.e. brand/manufacturer or

supplier name, pack size and price per pack) in future.

• Calcium glubionate 1.09g/5ml / Calcium lactobionate

727mg/5ml oral solution (300ml) Category C – Calcium-Sandoz

• Emulsifying wax (500g) Category C – Alliance Healthcare

(Distribution) Ltd

• Salicylic acid 2% solution (177ml) Category C – Acnisal

Part VIIIB Deletions

• Sodium Chloride 5% eye drops preservative free – 10ml (refer

to page 187 in the January 2015 Drug Tariff)

Note: Prescriptions will only be passed for payment when

endorsed with one of the products listed in Part IXA.

Part IX Deletions

Make careful note of removals from Part IX because if you dispense

a deleted product, prescriptions will be returned as disallowed and

therefore payment will not be made for dispensing the item.

• Vaginal Contraceptive Diaphragm – Reflexions Flat Spring

Diaphragm

• Tracheostomy and Laryngectomy Appliances – Blom-Singer

HumidiFilter HME System – Adhesive Foam Discs Standard Thin

BE6047

• Tracheostomy and Laryngectomy Appliances – Blom-Singer

HumidiFilter HME System – Adhesive Foam Discs Large Thin

BE6049

• Tracheostomy and Laryngectomy Appliances – Prim-Air – Phon I

(Tinted, for normal breathing) 71-0952-29 H

• Tracheostomy and Laryngectomy Appliances – Prim-Air – Phon I

High Flow (Tinted, low breathing resistance, for sport and first

time users) 71-0952-29 HL

• Tracheostomy and Laryngectomy Appliances – Prim-Air Strip –

Firm Oval (Transparent with strong adhesive) 71-0974-00 R


Special Oval (Skin tone with shower resistant adhesive)

71-0978-00 O


Special Round (Skin tone with shower resistant adhesive)

71-0978-00 R

• Tracheostomy and Laryngectomy Appliances – Prima-Resist

hands free voice prosthesis valve 71-0952-18H

• Tracheostomy and Laryngectomy Appliances – Prima-Low-

Resist hands free voice prosthesis valve 71-0952-20H

• Leg Bags – Teleflex – Rusch Leg Bag 750ml, 10cm tubing slide

tap 850361-000750

• Leg Bags – Teleflex – Rusch Leg Bag 750ml, 30cm tubing slide

tap 850362-000750

Drug Tariff WatchYour monthly summary of any additions, amendments and deletions being

made to the Drug Tariff to help with dispensing and endorsements.

AMCo distribution changeAmdipharm, Mercury Pharma Ltd and Mercury Pharma Intl Ltd. (jointly known as

AMCo, Amdipharm Mercury Group) have confirmed that with effect from 1st

January 2015, Alliance Healthcare (Distribution) Limited became the sole

distributor of selected AMCo products to pharmacies, dispensing doctors and

hospitals in England, Scotland, Wales and Northern Ireland.

For more information on how this will affect your spend targets and other

information such as what the selected AMCo products are please visit the

medicines distribution page on our website: psnc.org.uk/distribution

Removal from Part VIIIBof Drug TariffSodium Chloride 5% eye drops preservative

free 10ml have been removed from Part

VIIIB of the January 2015 Drug Tariff without

notice. This product is now available as a

registered medical device and can be found

in Part IXA of the Drug Tariff. Prescriptions

need to be endorsed with one of the

products listed in Part IXA.


Ask PSNCThe PSNC Dispensing and Supply Team can give pharmacies support and advice on a range of

topics related to the Drug Tariff and reimbursement. Questions the team have been asked by

pharmacies in recent months have included:

1. I have a prescription for “4 Voltarol Gel

Patch 1% medicated plasters”; how will I

be paid for this?

This product is available in a pack of 10

with 2 sub-packs of 5 patches. The sub-

pack of 5 patches has been granted special

container status. In the scenario described,

the contractor would be reimbursed for

dispensing one sub-pack of 5. This rule is

applied automatically but it is best practice

for contractors to endorse the prescription

form with the packs (or, as in this case,

sub-packs) used to dispense from.

2. I normally source my specials through a

wholesaler – how will I be paid for (and

how should I endorse) my specials?

Wholesalers typically categorise products as

being either a “standard line” or “special

obtain” item. Items classified by wholesalers

as “special obtains” are those which the

wholesaler may not have readily available in

stock and has to “obtain specially” on an ad-

hoc basis e.g. food products, stoma or

incontinence appliances, or vitamin

supplement products.

To identify an unlicensed special medicine,

pharmacy staff should look for the

wholesaler’s MHRA specials licence

number on the product’s packaging and

invoice. For unlicensed imports the invoice

will state the wholesaler’s MHRA

importer’s licence number.

Where the unlicensed special medicine is

listed in Part VIIIB, the contractor will be

paid this price regardless of how the

product was sourced. However, for those

unlicensed specials and imports not listed

in Part VIIIB, the contractor will be paid

according to how the product was

manufactured. Where the product is

manufactured under an MHRA specials

licence, pharmacy contractors need to

endorse:

• Amount dispensed over pack size used;

• Invoice price per pack size from which

the order was supplied less any discount

or rebate;

• Manufacturers’/importers’ MHRA

licence number;

• Batch number of the product supplied;

• SP

Where the product is manufactured under

the section 10 exemption of the Medicines

Act 1968 (when a product can be made on

a pharmacy premises without the need for

a licence), pharmacy contractors need to

endorse the names, quantities and cost of

the ingredients used in preparing the

product, ED.

Along with payment for the product, the

contractor will also be paid the

appropriate additional payment

depending on whether the product was

manufactured by an MHRA licensed

specials manufacturer under their licence

(they must endorse SP) or manufactured

under the section 10 exemption by the

contractor or by a 3rd party (they must

endorse ED).

Look out for more frequently asked

questions next month…

If you would like more information on any

of the topics covered, the PSNC

Dispensing & Supply Team will be happy to

help (0844 381 4180 or 0203 1220 810 or

e-mail [email protected]).

For the latest on endorsementsand prescription submissions, visit

psnc.org.uk/dispensing-supply

3M has made some changes to their

Cavilon Durable Barrier Cream range, to

reflect these changes a three month notice

of deletion was given to a number of

products in the October 2014 Drug Tariff.

As of 1st January 2015 the following codes

have been deleted from the Drug Tariff:

Cavilon Durable Barrier Cream

• 3392S (20 pack of 2g sachets)

• 3391E (28g)

• 3392E (92g)

Cavilon Durable Barrier Cream + Honey

• 3392HS (20 pack of 2g sachets)

• 3391H (28g) • 3392H (92g)

The manufacturer 3M, has replaced the two

old products with a single product Cavilon

Durable Barrier Cream. For further

information on this new product range refer

to the 3M letter at tinyurl.com/qeya6ol.

The January 2015 Drug Tariff lists the

following product:

Cavilon Durable Barrier Cream

• 3392GS (20 pack of 2g sachets)

• 3391G (28g)

• 3392G (92g)

Due to a delay in prescribing and

dispensing systems being updated with

this Drug Tariff change at the end ofDecember 2014, PSNC has discussed this

problem with the NHSBSA who has agreed

that prescriptions for Cavilon Durable

Barrier Cream with the old codes (3392S,

3391E, 3392E) dispensed in the month of

January 2015 will be passed for payment.

Contractors will need to ensure that

subsequent prescriptions are amended to

reflect these changes.

Note: prescriptions for Cavilon Durable

Barrier Cream issued without a code will

be reimbursed based on the items listed in

the Drug Tariff.

For tables to help you understand the

status for each code see the PSNC

website: psnc.org.uk/cavilon-durable-barrier-cream/

Drug Tariff changes to Cavilon Durable Barrier Cream range


psnc.org.uk 11


The Drug Tariff provides information on what pharmacies will be paid for NHS Services including both reimbursement (i.e. the cost of

drugs and appliances) and remuneration (i.e. professional fees/allowances). Each section is described briefly below to help you

identify where to find relevant information (please note sections unrelated to pharmacy contractors have been omitted).

lpcs

Dispensing Factsheet: using the Drug Tariff

Part Name and Description of Part Find out more

PrefaceLists additions, deletions and any other alterations to the Drug Tariff for both the edition it is inand the next.Take note: Lists deletions to Parts IXA, IXB, IXC and IXR.

tinyurl.com/optruq5

I Requirements for the Supply of Drugs, Appliances & Chemical ReagentsOutlines general requirements for dispensing and claims for payment on the NHS.

psnc.org.uk/monthly-payments

II Requirements Enabling Payments to be madeExplains how payments made to pharmacy contractors are calculated. Includes guidance onendorsement requirements and quantity to be supplied.

psnc.org.uk/endorsement-guidance

IIIA Professional FeesSets out arrangements for the dispensing fee and additional fees contractors may claim.

psnc.org.uk/fees

IV Consumables & ContainersPharmacies must supply medicines in suitable containers and are required to provideconsumables for certain products. This Part sets out details of payments for these.

psnc.org.uk/consumables

V Deduction ScaleThe deduction (discount) scale shows the percentage deducted from a pharmacy contractor’smonthly payments according to the value of prescriptions dispensed.

psnc.org.uk/discount

VIA Payment for Essential ServicesProvides information on payments for Essential Services, including the Establishment Payment,Practice Payment, Repeat Dispensing Payment and the Transitional Payment. Also includesinformation on ETP/IT Allowances.

psnc.org.uk/pharmacy-funding &psnc.org.uk/it-and-eps-allowances

VIC Advanced Services (note: Part VID is for Wales only)Reproduces the Secretary of State Directions for Advanced Services for pharmacies.

psnc.org.uk/advanced

VIE Enhanced ServicesDetails arrangements for providing and determining payment for some local services.

psnc.org.uk/services-database

VIIIA Basic Prices of DrugsLists basic prices for generic drugs. This Part is divided into:• Category A includes popular generics, which are widely available. Price is based on a weighted

average of list prices from wholesalers and generic manufacturers.• Category C items based on a particular brand or manufacturer’s price.• Category M includes readily available drugs, where the Department of Health calculates the

price based on information submitted by manufacturers.Additional claims: Broken Bulk (BB) may be claimed on Category C items, or Category A or M itemsif the smallest listed pack size is equal to or greater than £50 (if not special containers). Out ofPocket (OOP) expenses may only be claimed on Category C items.

psnc.org.uk/medicines

VIIIB Arrangements for payment for Specials & Imported Unlicensed MedicinesLists basic prices for some unlicensed medicines. The pack size listed against a product will beused as the minimum amount for reimbursement. A prescription ordering any more than theminimum amount will be paid on the listed pack size plus the 1ml or 1g list price for everyadditional 1ml or 1g prescribed.Additional claims: ‘SP’ or ‘ED’ claims can be made instead of OOP expense claims. BB may onlybe claimed on ingredients used in extemporaneous dispensing.

Dispensing Factsheet:Unlicensed Specials andImportstinyurl.com/pokb84a

IXA AppliancesThese are permitted appliances and dressings set out in alphabetical order of category. Additional claims: BB and OOP expenses cannot be claimed.

psnc.org.uk/appliances

IXB Incontinence AppliancesDivided into sections for different item types (e.g. belts, sheaths, tubes). Each sub-section is analphabetical list of manufacturers with products, codes, pack sizes and prices. There is acomponents and accessories index at the beginning and a list of manufacturers’ contact details atthe end of this section of the tariff. Additional claims: BB and OOP expenses may be claimed.



Part Name and Description of Part Find out more

IXC Stoma AppliancesHas a similar layout to the Incontinence Appliances section. Also includes an index andmanufacturers’ contact details. Additional claims: BB and OOP may be claimed.


IXR Chemical ReagentsThese are the only chemical reagents allowed on an NHS prescription. Only the pack sizes statedwill be allowed. Additional claims: BB and OOP cannot be claimed.


X Home Oxygen Therapy ServiceDiscusses the Home Oxygen Therapy Service, including details of suppliers.

See Part X of the DrugTariff ppa.org.uk/ppa/edt_intro.htm

XII Essential Small Pharmacies Local Pharmaceutical Services (ESPLPS)Provides information on the Essential Small Pharmacies Scheme. Although the scheme continuesin Wales, it ceased in England on 31st March 2006 and was replaced by a standard LPS Contract.

psnc.org.uk/esplps

XIII Payments in respect of Pre-Registration TraineesOutlines the grant payable to contractors training pharmacy graduates.

psnc.org.uk/prereg

XIVA Reward Scheme – Fraudulent Prescription formsDetails the reward paid when a pharmacy correctly identifies a fraudulent prescription.

nhsbsa.nhs.uk/protect

XIVB Arrangements for Contractors Concerning Prescription Pricing ErrorsExplains how pharmacy contractors can request a pricing recheck for one or more of theirprescription bundles.

psnc.org.uk/recheck

XIVC Devolving the Global Sum – Temporary Safeguarding PaymentsProvides information on temporary safeguarding of payments made to protect pharmacycontractors from prescription volume changes beyond their control.

psnc.org.uk/temporary-safeguarding-payments/

XV Borderline SubstancesSets out the foods and toiletry preparations which may be regarded as drugs. List A is analphabetical index of accepted products and List B is an alphabetical index of conditions andthose products suitable for the conditions.


XVI Notes on ChargesCovers prescription charges, exemptions and examples of the application of charges. Alsoincludes instructions on the Prescription Charge Refund Procedure.

psnc.org.uk/charges

XVIIA Dental PrescribingThe Dental Prescribing Formulary is the list of substances permitted on Form FP10D. Althoughproducts are listed generically, a product may be ordered by brand name providing that thebrand is not listed in Part XVIIIA of the Drug Tariff (the ‘blacklist’).

psnc.org.uk/prescribing

XVIIB (i) Nurse Prescribers’ Formulary for Community PractitionersCommunity Practitioner Nurse Prescribers are only entitled to prescribe medicines from this listor appliances from Part IX of the Drug Tariff.(ii) Nurse, Pharmacist, Optometrists, Physiotherapists and Chiropodists IndependentPrescribingDetails on what each Independent Prescriber is able to prescribe.

psnc.org.uk/prescribing

XVIIC National out-of-hours formularySets out the minimum list of drugs that patients should be able to access; exact mechanisms forthe provision of these drugs are decided locally.

Speak to your LPCpsnc.org.uk/lpcs

XVIIIA Drugs not to be ordered under a GMS ContractCommonly known as the ‘blacklist’. Items listed are not permitted on NHS prescription.


XVIIIB Drugs that may be ordered only in certain circumstancesThe Selected List Scheme lists items that may only be prescribed under certain conditions.Prescriptions must be marked ‘SLS’ by the prescriber. Please note there are separate lists forEnglish and Welsh prescribers to follow.

Dispensing and SupplyFactsheet: Is This Item Allowed?tinyurl.com/o6y7ag6

XVIIIC Criteria notified under the Transparency DirectiveOutlines criteria originally used in selecting products for inclusion in the Blacklist/ Selected List.


XIX Payments to Chemists Suspended by the NHS Commissioning BoardDetails payments to chemists suspended by NHS England or under the direction of the NHS First-Tier Tribunal.

See Part X ElectronicDrug Tariffppa.org.uk/ppa/edt_intro.htm

XX Requisitions and Private Prescriptions for Controlled DrugsOutlines legal requirements for controlled drug requisitions and private prescriptions.

psnc.org.uk/cdforms

For the online version of the Drug Tariff, please visit: psnc.org.uk/dt

january 2015 cpn

Documents