LPC Newsletter 5 – Community Pharmacy Contractual Framework (CPCF) October 2019

This is the fifth in the series of Newsletters for Contractors and Pharmacy Teams on the New Contract. Multiples should refer to internal processes and advice from their area or central teams. Refer to previous Newsletters and the LPC Website for further support, checklists, slides and handouts from the Contractor Events – all available on the LPC website. We have also got a dedicated PCN page as well.

https://psnc.org.uk/walsall-lpc/moving-forward/community-pharmacy-contract-funding/

This Newsletter explores the remaining PQS bundles.1. Reminders & changes since Newsletter 4:

Pharmacy Quality Scheme Updates

PQS: Directory of Services (DoS) update

We have been made aware that, due to the NHS Urgent Medicine Supply Advanced Service (NUMSAS) and the Digital Minor Illness Referral Service (DMIRS) finishing on 28th October 2019 and the Community Pharmacist Consultation Service (CPCS) starting on 29th October 2019, that this has caused some confusion for community pharmacy contractors when updating their DoS profiles to meet the DoS quality criterion of the Pharmacy Quality Scheme (PQS). PSNC has provided an update to clarify the situation.

View the full PSNC article: https://psnc.org.uk/our-news/pqs-directory-of-services-dos-update/ and see below:

PQS: Support available for the dementia-friendly environment checklist and action plan

Community pharmacy contractors may now like to consider completing the dementia-friendly environment checklist and action plan to meet the quality criterion, if they have not already done so.

The checklist and  action plan to meet this quality criterion is available as Annex 11 in the NHS England and NHS Improvement Pharmacy Quality Scheme (PQS) guidance. PSNC has made available a standalone version of the checklist and action plan (available as a Word document or PDF):

Dementia-friendly environment checklist and action plan (Word)

Dementia-friendly environment checklist and action plan (PDF)

Further information on how to meet this quality criterion can be found at: psnc.org.uk/pqsdfchecklist

Guidance around PCNs and Leaders has been shared by PSNC and we have picked this up separately. Look out for the PCN information. The NHSEi guide and annexes have been published by NHSBSA – copies and links on the LPC website. PSNC and the NPA have also produced checklists with timelines.

It was good to see so many of you at the three events run over the last couple of weeks. We had great feedback and lots of good discussion. If you were not able to attend, Birmingham LPC have kindly extended their invitation to other LPCs for their event on Sunday 10th November 2019, 10.00am – 4.00 pm,  West Bromwich Albion Football Clubhttps://www.eventbrite.co.uk/e/cpcf-what-you-need-to-know-and-do-about-pqs-cpcs-pcns-and-more-tickets-76558844565 PASSWORD: CPCF1WBA      

REMINDER: Remember to sign up to MYS and claim your PQS Aspiration payments asap and before 1st November 2019

Community Pharmacist Consultation Service Update

Final CPCS service spec published

Following its passage through the NHS England and NHS Improvement (NHSE&I) internal governance process, the final version of the Community Pharmacist Consultation Service (CPCS) service specification has now been published. See the following link: CPCS service specification

Prior to this final version of the service specification being published, a draft version was published on the NHSBSA website. A small number of changes were made to the text during the NHSE&I internal governance process. The only substantive change from a community pharmacy perspective was for references to annual reviews of Standard Operating Procedures and Business Continuity Plans to be amended to regular reviews, providing greater flexibility for pharmacy contractors.

2. Pharmacy Quality Scheme (PQS) 

Some of the quality criteria are bound together in composite bundles; you will need to achieve all activities within a bundle to receive payment for the bundle. 

1. Risk management and safety composite bundle (30 points) in Newsletter 3

2. Medicines safety audits complementing QOF QI bundle (25 points) in Newsletter 4

3. Prevention composite bundle (25 points) in Newsletter 4

4. Primary Care Networks bundle (22.5 or 12.5 points)

5. Asthma bundle (5 points)

6. Digital enablers bundle (these will move to Terms of Service in April 2020) (2.5 points)

PCN Bundle 22.5 or 12.5 points

NHS England and NHS Improvement expect to see this collaboration reflected in the Network Agreement, which is agreed by all member general practices, with community pharmacy being a key partner in PCNs.

During 2019/20, the expectation is for general practice to be increasingly working with other non- GP providers as part of collaborative PCNs. The details of how this will be demonstrated are still to be agreed. It is key that Community Pharmacies engage ahead of April 2020 and so the PCN bundle includes points for engaging and supporting the appointment of a local PCN Lead.

There must be a Lead appointed (this is being facilitated by the LPC) and every pharmacy within the PCN who wish to engage know who that person is and how to contact them.

The LPC website has copies of the guidance from PSNC and the NHSEi. More details are being provided by the LPC separately around PCNs and training and support will be provided through the LPCs.

https://psnc.org.uk/walsall-lpc/primary-care-networks/

To meet the requirement for the 12.5 points you need to collectively demonstrate that:

•Your pharmacy, and all other pharmacies within the PCN who wish to engage with a PCN, have agreed a collaborative approach.

•Agreed on a single channel of communication with the PCN by appointing a named lead representative for all of the engaged community pharmacies in the PCN.

•The Pharmacy PCN Lead must have provided their name to the LPC and must have evidence that they have started the engagement process with the PCN, i.e. they have made initial contact with the Clinical Director for the PCN either by contacting by (post/email) or a meeting

•All pharmacies claiming for this domain must submit the name, pharmacy along with ODS (F) code of their appointed Pharmacy PCN Lead as described in the NHSEi PQS Guidance.

The Pharmacy PCN Lead can also claim a further 10 points and must declare:

· that they are the appointed Pharmacy Lead for that PCN;

· the name of the PCN;

· that they have notified this to the LPC in which the PCN lies; and

· that they have evidence of having started the engagement process with the PCN

The LPC will be supporting the Leads and have link LPC Leads for each PCN – resources have been developed to support initial engagement, training will be provided and a mechanism for holding and sharing information. We will provide the final agreed lists of Pharmacies in each PCN, Clinical Director name, Appointed Pharmacy Lead details, LPC Lead details etc.

NOTE: Nobody will be able to claim points if a Lead is not appointed for each PCN and no engagement has happened. So, look out for the LPC messages about the process for confirming PCN in and appointing a Lead. This will all take place in October /November.

Asthma Bundle 5 points

To meet this bundle you must be able to:

· Evidence that asthma patients, having more than 6 short-acting bronchodilator inhalers without any corticosteroid inhaler within a 6-month period, have been referred to an appropriate HCP for an asthma review since the last review point ; and

· Evidence that have ensured that all children aged 5-15 prescribed an inhaled corticosteroid for asthma have a spacer device where appropriate in line with NICE TA38 and have a personalised asthma action plan. If not, you need to refer to an appropriate HCP.

New evidence since last Feb 2019 ongoing process when receive scripts with retrospective review of PMR, the surveillance could also include a combination of one or more of the following:

· monitoring the number of SABA inhalers dispensed in a rolling 6-month period through the pharmacy patient medication records (PMR)

· or through routine or opportunistic access to the Summary Care Record (SCR);

· monitoring patient emergency supply requests for SABA inhalers;

· monitoring out of hours or urgent prescriptions for SABA inhalers;

· monitoring emergency supply requests through the NHS Urgent Medicine Supply Advanced Service (NUMSAS), which will close on 28th October 2019 or the Community Pharmacist Consultation Service (CPCS), when this goes live on 29th October 2019;

· monitoring repeat prescription requests for SABA inhalers;

· monitoring the number of SABA inhaler dispensed as part of a Medicines Use Review or New Medicine Service; and monitoring non-collection of prescriptions for steroid inhalers.

For patients aged 5-15

· checking the pharmacy PMR

· or through routine or opportunistic access to the SCR for spacer devices

· or asking the patient or parent/guardian whether they have purchased a spacer device without a prescription;

· Plus asking patients aged 5-15 or their parents/guardians whether they have been given a PAAP;

There are useful flow charts on PSNC website to support this and PharmOutcomes has a recording mechanism which you can use.

Digital Bundle 2.5 points

The pharmacy must be able to demonstrate access to SCR between 1st October and the day of declaration. You can view this on the spine portal, using your smartcard.

· PharmOutcomes allows SCR access via the SCR 1 click option

· NHS Digital publishes details of the SCR accesses made each Thursday. You are advised to check this and keep a screenshot as evidence https://digital.nhs.uk/services/summary-care-records-scr/summary-care-record-scr-in-community-pharmacy/prove-scr-access-for-the-pharmacy-quality-scheme-2019-20

· If a contractor believes that they have accessed the SCR and it is not included in the 

published data, they should contact scrpharmacy@nhs.net.  

You must have updated the NHS 111 DoS profile via the DoS updater in October / November:  

•Including opening hours for Easter Sunday 2020, public and bank holidays; and

•Must promptly update profile as information changes, ensure accurate in real time for referrals e.g. from NHS111 for CPCS

•You will be able to search and update using the DoS Profile Updater, by ODS (F) code or Postcode to make sure that ALL of your services are listed

If a contractor believes that they have accessed the SCR and it is not included in the published data, they should contact scrpharmacy@nhs.net.

Once the details on the DoS Profile Updater have been submitted, the contractor will receive an email confirming submission. If profiles for more than one pharmacy are reviewed on behalf of a multiple pharmacy group, an email should be received for each pharmacy. This should be instantaneous, however, please allow up to two hours for the emails to be delivered.

If the emails are not received, contractors are advised to check their junk mail folder first before emailing exeter.helpdesk@nhs.net with ‘Profile Updater Email Access’ in the subject line.

You are advised to retain these confirmation emails as evidence of meeting this quality criterion. These confirmation emails will be sent to the NHSmail address that the contractor provided. To help ensure contractors receive their confirmation emails, contractors are advised to add noreply@dos-profile.service.nhs.uk to their safe senders list before they update their profile.

Following on from the recent confusion, please note the advice below:

If you have already updated your DoS profile to meet the DoS quality criterion

If you have already updated your DoS profile to meet the DoS quality criterion (and therefore updated all the DoS services for your profile) within the required time period (from 1st October 2019) and have received an email confirming this, you do not need to take any further action.

If you have not yet updated your DoS profile to meet the DoS quality criterion

· Ignore the NUMSAS and DMIRS DoS services (if visible on your DoS profile)

· Ignore the ‘Other dates’ section on all the DoS services if it lists a long list of closed dates from 29th October 2019

· Update the CPCS DoS services (Pharm+, CPCS and CPCS+) if visible on your DoS profile

· Update your DoS profile by 30th November 2019

Contractors are required to review all the DoS services by 30th November 2019 for the pharmacy to meet the DoS quality criterion. (A single pharmacy may have multiple DoS services listed on the DoS Profile Updater.) However, following discussions with the national DoS team, NHS England and NHS Improvement have advised that if contractors have not already updated their DoS profile to meet the quality criterion, they should ignore the NUMSAS and DMIRS DoS services (if displayed when they log into the DoS Profile Updater) and NOT make any changes to these.

Please be aware that some DoS services, for example, the ‘Pharmacist’ DoS service may contain a long list of closed dates in the ‘Other dates’ section (which follows the Bank Holiday dates), showing the service to be closed from 29th October-20th December 2019. Contractors should not modify the dates contained within the ‘Other dates’ section. 

Community Pharmacist Consultation Service (CPCS)

If you have signed up to deliver CPCS on MYS from 29th October 2019, you may be able to see DoS services that relate to CPCS on the DoS Profile Updater. These are:

· Pharm+

· CPCS

· CPCS+

You should check the information is correct for all the CPCS DoS services (Pharm+, CPCS and CPCS+) as usual. When checking ‘holiday dates’ please proceed to add ‘Bank holidays’ as usual. Please be aware that CPCS DoS services will contain a long list of closed dates in the ‘Other dates’ section (which follows the bank holiday dates section), showing the service to be closed until 29th October 2019, which is when the CPCS service is launched. Contractors should not modify the dates contained within the ‘Other dates’ section.

A contractor may have registered to provide CPCS, but the corresponding CPCS DoS records (Pharm+, CPCS, CPCS+) may not be visible. This is because CPCS DoS records will be activated at different times in each region. Further information on meeting the DoS quality criterion can be found at: psnc.org.uk/pqsdos

3. PharmOutcomes Support for PQS

· Community pharmacy contractors can access support on PharmOutcomes for the Pharmacy Quality Scheme (PQS) 2019/20, and further support will be available soon. This support is available to all contractors free of charge.

· Currently, support is available to assist contractors with meeting the asthma quality criterion.

· Once a contractor has logged into PharmOutcomes, the tool can be accessed by clicking on ‘Services’; and then the two services are listed under the title ‘Pharmacy Quality Scheme – Quality criteria’.

· The following audits/frameworks will also be available shortly; we will alert contractors through our normal communication channels when these become available:

PQS assessment framework;

Lithium audit; Methotrexate audit; Amiodarone audit; Phenobarbital audit;

Valproate safety audit;

NSAID audit; and

Dementia-friendly environment checklist.

4. Community Pharmacy Consultation Service

The NHS CPCS is the first clinical service of the new CPCF to be mobilised and starts on 29th October. A great deal of importance has been placed on this and we have to deliver. CPPE is providing training to support this service and the LPC is providing additional options. Refer to the LPC website for more details of training events. Places are limited.

We have lots of information on our LPC website as well as on the PSNC website. The service will utilise PharmOutcomes service and you need to register with NHSBSA through MYS to provide it.

The service brings together the learning from the NUMSAS and DMIRS pilots into one service and is referred from NHS 111 by the Advisor instead of being directed to a GP. Patients like the service and value the consultation in a confidential environment although onward referrals may be necessary to other urgent care services or the GP. The face to face consultation of minor illness symptoms includes the recognition of any Red Flags. Over the course of the pharmacy contract the NHS CPCS will be monitored and evaluated. It is expected that by 2020/21 the learning from the GP CPCS pilots will be evaluated and a decision taken about whether to include “streaming” from general practice into the service.

Key elements of the minor illness part of the consultation service:

· The patient has a structured consultation with the pharmacist in the consultation room. The pharmacist will use PharmOutcomes to collect information during the consultation

· The pharmacist will use NICE clinical knowledge summaries and the patient’s SCR

· The pharmacist will identify any red flags (e.g. sepsis/meningitis). If a condition is deemed as urgent the pharmacist will escalate back to NHS 111 or in a serious situation to A&E or 999)

Key points to note

· Follow up calls to no-show patients reduced to one (from three)

· Transitional payment of:

£900 if signed up by 1st December 2019; or

£600 by 15th January 2020

· Fee of £14 per completed consultation

· To pilot: expansion with referrals from GPs, NHS 111 online, Urgent Treatment Centres and possibly A&E

How to sign up:

Pharmacy contractors can now register to provide the service via the NHSBSA Manage Your Service (MYS) portal. This includes claiming the Transition payment supplement, which will be £900 for those who register by 1st December 2019.

Pharmacy contractors that have not previously registered for access to MYS should follow PSNC’s guidance on registering.

Check that your pharmacy can provide the service

Before registering to provide the CPCS, pharmacy contractors should read the service specification to ensure they will be able to meet all the service requirements from 29th October 2019.

· Must be providing all Essential services and meeting clinical governance requirements

· Have a clearly-designated consultation room (equipment must be available to allow the pharmacist to record notes electronically during the consultation from 1 April 2020 )

· Have access to Summary Care Record (SCR), the pharmacy’s shared NHSmail mailbox and the local secure electronic messaging system used by NHS 111 (the CPCS IT system)

· Ensure that all staff including locums who will be involved in providing the service are trained and competent to do so

· Must be able to provide the service throughout the pharmacy’s opening hours

· Read the draft CPCS service specification & Toolkit – available via a link from the NHSBSA page

· Sign up for the CPCS ̶ the MYS portal is the only way that you can register for the CPCS service provision

· Confirm that the pharmacy’s DoS entry is up to date

· Use the NHS CPCS self-assessment framework and other online resources on the CPPE website

· Enroll for CPD sessions covering consultation and physical assessment skills (CPPE in December & January and more from April 2020) or LPC events where available – November and January.

· Have relevant and current SOPs in place which the pharmacy team have read, understood and signed

Review and update business continuity plan to include CPCS

When registering to provide the service on the MYS portal, contractors will need to make the following declaration:

· I am registering to provide the Community Pharmacist Consultation Service from this pharmacy.

· 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).

· I am claiming the CPCS Transition payment and understand that I am committing to provide the CPCS until 31st March 2020, unless exceptional circumstances prevent the pharmacy from providing the service. Where I withdraw from service provision prior to 31st March 2020 and NHS England do not believe exceptional circumstances apply, they may reclaim all or part of the CPCS Transition payment.

Multiple pharmacy contractors that would like to register more than one pharmacy to provide the service can email the NHSBSA MYS team (mys@nhs.net) to discuss how to bulk register pharmacies.

Please see PSNC & LPC websites for details on the service and links to specifications and other information and links to training and webinars etc.

VirtualOutcomes have a very useful training presentation which you can access with your F-code and a checklist that you can download. https://www.virtualoutcomes.co.uk/pharmacy-training/ .

12 | Page

Activity

By when

How?

PQS & CPCS & Flu: Register for the Manage Your Service (MYS) Application (See Newsletter 1)

ASAP

https://psnc.org.uk/our-news/pqs-have-you-registered-for-the-manage-your-service-mys-application/

Business owner / authorised persons only can do this – multiples will be done centrally

Further information on the MYS registration and log-in process can be found on the NHSBSA website

Look at the LPC Website to see what information is available

September- February

https://psnc.org.uk/

https://psnc.org.uk/walsall-lpc/

Make sure that you meet your terms of service (essential services)

ASAP

Remember quarterly and annual submissions and mandated health promotion campaigns

https://psnc.org.uk/services-commissioning/essential-services/

Review training requirements for Gateway and PQS for February 2020 review point and plan them in for all required staff

By end of September

CPPE resources: https://psnc.org.uk/our-news/pqs-cppe-learning-and-e-assessments-now-available/

https://www.cppe.ac.uk/services/pqs

and VirtualOutcomes resources https://psnc.org.uk/walsall-lpc/our-news/sign-up-for-virtual-outcomes-training-packages/

Don’t forget the CPPE Safeguarding level 2 within two years of February 2020 review point - for 80% GPhC Registered staff to meet Gateway

Work on the FOUR Gateway Criteria for 19/20

ASAP but before end of October

See PSNC and LPC websites and Newsletter 2

Note includes Safeguarding level 2 and cannot use MURs as the Advanced Service

Update your NHS website profile (Gateway) and your Directory of Services

Between 00.00am on 1st October 2019 and 11.59pm 30th November 2019

You will need to update your NHS website profile (NHS Choices previously) and your Directory of Services profile – please note, this is ahead of the declaration period, which is different to previous schemes; if you miss this deadline you will not meet the gateway criteria and will therefore NOT be entitled to claim a PQS payment in February 2020;

Make sure that your NHSmail accounts are listed accurately in the NHSmail pharmacy directory

ASAP but before end October

Whilst most pharmacies will have their NHSmail set up correctly, contractors are advised to make sure that their pharmacy’s account follows the naming style: nhspharmacy.location.pharmacynameODScode@nhs.net. This naming style indicates your email address appears in the community pharmacy directory so that other NHS providers can find your email address more easily when they need it.

Each person listed within the registration portal will get their own new personal account (naming style: firstname.surname@nhs.net), personal inbox and personal login details – all connected to the shared pharmacy mailbox. Each staff member can regularly login to NHSmail to keep their account ‘active’. For help and advice:https://psnc.org.uk/walsall-lpc/about-us/contact-us/

Claim Aspiration Payment (See Newsletter 1)

By end of October

Pharmacies can claim for an Aspiration payment if you: received a Quality Payment for either the June 2018 or February 2019 Quality Payments Schemes (previous name for the PQS); and

have registered for the Manage Your Service (MYS) application

https://psnc.org.uk/services-commissioning/pharmacy-quality-scheme/pharmacy-quality-scheme-aspiration-payment/

Sign up for CPCS

Asap – service starts 29th October NOTE NUMSAS ends 28th October

Sign up through NHSBSA Manage Your Service (MYS) portal by 1st December to claim £900 transition payment or by 15th January 2020 for £600.

Look out for training through CPPE and LPC to support this service. Note it is not compulsory to undertake the training but it is recommended.

Information will be posted on LPC website.

PCN Leads appointment

October / November

LPCs will facilitate the process to appoint Leads – you will need to confirm to the LPC: the PCN that the pharmacy is belongs to, whether you want to put forward a Lead Pharmacist or Technician from within your pharmacy and vote for any candidates for Lead within your PCN. Leads will then be offered support and training by the LPC with some backfill support available for agreed training / meetings. An engagement pack will be provided to give to Clinical Director to support an initial meeting.

HLP Level 1 Accreditation (See Newsletter 1)

By November for PQS and by April 2020 to meet Terms of Service

Speak to the LPC if new to HLP and for re-accreditation support

https://psnc.org.uk/services-commissioning/locally-commissioned-services/healthy-living-pharmacies/

You need to ensure that the evidence of your self- accreditation is up to date which needs to be refreshed every three years. You do not need a new certificate, but we can arrange for one through the LPC if required -provided you can share a copy of the completed checklist, name of leader & names of health champions

Pharmacies becoming Healthy Living Pharmacies for the first time – Beware of time delays

Contractors should be aware that when members of staff complete the RSPH Level 2 Award in Understanding Health Improvement course, which is provided by several national and local organisations, it may take a few weeks after completion of the assessment before staff members receive their certificate from the course provider (RSPH return certificates to the course provider and aim to do that within 10 working days).

Contractors are therefore advised to consider this time frame when planning how long it will take to achieve HLP Level 1 to ensure this ‘processing time’ does not prevent contractors from achieving the HLP quality criterion.

Community Pharmacy Consultation Service (CPCS)

Two strands of new CPCS service will be rolled, with referrals to community pharmacies being made from NHS111 for minor illness and urgent medicines supply. Replacing NUMSAS and DMIRS

Pharmacy contractors can now register to provide the service via the NHSBSA Manage Your Service (MYS) portal. This includes claiming the Transition payment supplement, which will be £900 for those who register by 1st December 2019.

·

Sign Up by October 28th for roll out on 29th

Sign up and be ready to deliver by 1st December 2019 to claim maximum transitional payment

https://psnc.org.uk/services-commissioning/advanced-services/community-pharmacist-consultation-service/

Funding for the CPCS will include an initial transitional payment for Contractors. If you are ready to provide from December 2019 it will be £900, and those ready from January 15th 2020, will receive £600. This will be followed by £14 fee per consultation.

The NHS Community Pharmacist Consultation Service (CPCS) will launch on 29th October 2019 as an Advanced Service.

The service, which will replace the NUMSAS and DMIRS pilots, will connect patients who have a minor illness or need an urgent supply of a medicine with a community pharmacy.

As usual if you have any questions please contact us:

Email: https://psnc.org.uk/walsall-lpc/about-us/contact-us/

Website: https://psnc.org.uk/walsall-lpc/

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