Prescribers obtaining Covid19 medicines for symptom control and treatment: guidance and templates

In April 2020, the NW Region Medicines and Pharmacy cell agreed a set of principles to ensure patients with Covid19 symptoms have fast access (i.e. within 1hr) to medicines1, when clinically necessary.

The principles are: - Patients can rapidly access clinical assessment, treatment of symptoms and

medicines, including at end of life. - The medicines supply chain is preserved, so all patients can get medicines

when needed (i.e. no stockpiles/excess stock)- Health and social care professionals know how to obtain these medicines - Health and social care workers can administer safely and keep accurate records - Commissioners do not start afresh but consider tweaking their existing

commissioned services (e.g. primary care in care homes, community pharmacy holding end of life medicines, OOH)

This pack was developed by cross-sector Pharmacy Leaders and other health and social care disciplines in the Northwest Region of England and focusses on: - Facilitating patients’ rapid access to medicines- Supporting prescribers in obtaining medicines - Guiding Covid19 primary care and prescribing hub commissioners during the

pandemic

It contains guidance, templates, and flowcharts for: 1. Screen shots for EMIS C19 symptom management plan 2. COVID19 EMIS prescribing protocols (incorporating end of life) 3. COVID-19 Primary Care Symptom Management Drug Therapy Options 4. Service level agreement for community pharmacies to dispense and deliver

within 1 hour for patients at end of life with Covid19 symptoms 5. Risk Assessment and Considerations for setting up COVID-19 prescriber hubs 6. COVID-19 Supporting Guidance for prescribers working within COVID hubs and

Medicine Conveyance with GP bags7. Organisation Prescriber Code and EPS Guide for Primary Care Provider Contract

1 Halsall, D on behalf of NW Medicines and Pharmacy Cell. Covid 19 hubs in the community and primary care – What “good looks like”. England. April 2020

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Documents can be accessed by either clicking on the icons for word versions, or the hyperlinked titles for pdfs.

Organisations are welcome to use and adapt the materials, and references to acknowledge authors and sources are included below.

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1. Screen shots for EMIS C19 symptom management plan

- Audience: EMIS GP practices and medicines optimisation/management teams supporting these practices

- Aim: to illustrate the prescribing protocols designed by South Sefton, Southport Formby CCG to support safe prescribing for those presenting with common COVID-19 related symptoms including those at end of life. EMIS protocols can be found in 2 below.

- Contents include screen shots of prescribing protocols for common Covid19 symptoms including:

- Fever

- Cough

- Constipation due to opioids

- Bacterial pneumonia including differential diagnosis

- Anxiety and agitation

- Delirium

- Breathlessness at end of life

- Respiratory tract secretions

- Reference: South Sefton, Southport and Formby CCG Medicines Optimisation Team. Screen shots for EMIS Covid19 symptom management plan; Northwest Region, England. May 2020.

2. COVID19 EMIS prescribing protocols (incorporating end of life)

- Audience: EMIS GP practices and medicines optimisation/management teams supporting these practices

- Aim: to support safe prescribing for those presenting with common COVID-19 related symptoms including those at end of life.

- Contents include:

- EMIS protocols for Covid19 symptom management

- Reference: South Sefton, Southport and Formby CCG Medicines Optimisation Team. Covid19 EMIS prescribing protocols including end of life. Northwest Region, England. May 2020.

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3. COVID-19 Primary Care Symptom Management Drug Therapy Options

- Audience: prescribers and medicines optimisation/management teams to adapt for their localities

- Aim: to support prescriber decision-making when some drugs are difficult to obtain when prescribing for Covid19 related symptoms including end of life.

- Contents include: - Summary of recommended drugs for 1st line, 2nd line and other alternatives

for: cough breathlessness/pain anxiety and agitation delirium nausea and vomiting respiratory secretions

- Suggested quantities in anticipatory care packs to treat patients with COVID-19 symptoms, including:

Drug therapy Dose Quantity per patient

- Reference: Midland and Lancashire Commissioning Support Unit Medicines Optimisation Team. COVID-19 Primary Care Symptom Management Drug Therapy Options Northwest Region, England. May 2020.

4. Service level agreement for community pharmacies to dispense and deliver within 1 hour for patients at end of life with Covid19 symptoms

- Audience: Covid19 hub commissioners, Local Pharmaceutical Committees (LPCs) and Medicines Optimisation/Management teams to adapt for their localities

- Aim: to support local commissioners and community pharmacies to agree the rights and duties of both parties aiming to:

- Maintain an agreed stock of medicines used in the treatment of patients during the COVID-19 pandemic at designated community pharmacies

- Provide a fast track delivery service (within one hour) during agreed times, when requested by a prescriber

- Supply care homes with medicines in line with the local CCG/PCN Homely Remedy policy for suspected COVID-19 infection.

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- Contents include:

- Aims and intended service outcomes

- Service duration

- Prerequisites for service provision

- Service description

- Payment

- Applicable service standards

- Governance

- Reference: South Sefton, Southport and Formby CCG Medicines Optimisation Team; Service level agreement for community pharmacies to dispense and deliver within 1 hour for patients at end of life with Covid19 symptoms. Northwest Region, England. May 2020.

5. Risk Assessment and Considerations for setting up COVID-19 prescriber hubs

- Audience: CCG commissioners and prescribers to adapt for their locality. It is strongly advised that commissioners seek advice from medicines optimisation/management teams (MOT/MMT) to ensure their plans are legal and safe.

- Aim: to support commissioners and prescribers in COVID-19 primary care hubs to identify, mitigate and record risks related to medicines and prescribing.

- Contents include:

- Twenty (20) risks tabled to include documentation of

- Mitigating actions

- Supportive guidance provided by MOT/MMT

Reference: Midland and Lancashire Commissioning Support Unit Medicines Optimisation Team. Risk Assessment and Considerations for setting up COVID-19 prescriber hubs. Northwest Region, England. May 2020.

6. COVID-19 Supporting Guidance for prescribers working within COVID hubs and Medicine Conveyance with GP bags

- Audience: Covid19 hub commissioners, prescribers and Medicines Optimisation/Medicines Management Teams to adapt for their locality

- Aim: to support prescribers working in COVID-19 primary care hubs to ensure safe storage and management of medicines. Various prescribers may be

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involved in the delivery of care; however GPs are likely to be responsible for the safe management and use of emergency GP bags.

- Contents include:

- Individuals who can possession and supply prescription only and Controlled Drugs (POMs and CDs) by individuals

- Organisations that can keep Schedule 2 and 3 CDs as stock

- Can CD stock be carried by GPs for administration to a patient?

- Security of the GP bags

- CD stock requisition used by a GP for administration to a patient

- Individuals allowed to make a requisition (for stock)

- Ongoing stock management

- Additional requirements

- Disposal of expired or unwanted controlled drug stock

- Other items for consideration for inclusion in a ‘GP bag’

- Flowcharts include:

- Flow for movement of CDs from GP Bag to GP Bag

- Example Supply Process Flows

Prescriber seeing patient at COVID Hub or via remote consultation with no medication stock: In hours

Note that the traditional prescription supply via community pharmacy remains the preferred and recommended route. GP bag / Hub stock is only to be used in exceptional circumstances when a delay would clinically compromise a patient

GP seeing patient at COVID Hub with medication stock: In hours

GP with GP bag visiting a patient in their own home, or in Care Home with or without nursing: In hours

GP without GP bag visiting a patient in their own home, or in Care Home with or without nursing: In hours

Reference: Midland and Lancashire Commissioning Support Unit Medicines Optimisation Team. COVID-19 Supporting Guidance for prescribers working within COVID hubs and Medicine Conveyance with GP bags. Northwest Region, England. May 2020.

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7. Organisational Prescribing Code and EPS Guide for Primary Care Provider Contract

- Audience: GP practices, Covid19 prescriber hubs, primary care commissioners, Covid19 hub commissioners, medicines optimisation/management teams

- Aim: to provide guidance and templates for obtaining prescriber codes against cost centres

- Contents include:

- Provider Contract

- Process for setting up a new cost centre for a new service such as a COVID 19 Hub

- Generating a Spurious GP Code

- How to request a spurious code

- Templates and leaflets

1. Spurious Code Request Form

2. Quick Guide: Emis Web Organisation Configuration

3. Emis Prescription Tracker: A Quick Guide (Leaflet)

4. MLCSU Quick Guide to EPSr2 (Leaflet)

- Reference: Midland and Lancashire Commissioning Support Unit Medicines Optimisation Team. Organisational Prescribing Code and EPS Guide for Primary Care Provider Contract. Northwest Region, England. May 2020.

Author – Devina Halsall – 22 May 2020 Approved by NW Medicines Cell – 6 May 2020

Approved by NW Clinical Cell – 22 May 2020

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