Pharmacy 2016 and Beyond Pharmacy 2016 and Beyond

Pharmacy 2016 and Beyond

Pharmacy 2016 and Beyond On the 1 st December 2016 the government imposed a twoyear funding package for community pharmacy.

Pharmacy 2016 and Beyond Fees and services changed on 1 December 2016. • consolidating a range of fees into a single activity fee; • phasing out establishment payments; and • introduction of a Pharmacy Access Scheme.

Pharmacy 2016 and Beyond In addition the government introduced: • NHS Urgent Medicine Supply Advanced Service (NUMSAS) • A Quality Payments Scheme

Pharmacy 2016 and Beyond December 2016 to March 2017 = - £ 113 million April 2017 to March 2018 = - £ 208 million April 2018 ? ? ?

In Sheffield December 2016 to March 2017 = - £ 1, 700, 000 April 2017 to March 2018 = - £ 2, 600, 000* * Assuming no-one does the quality scheme

What does this mean for your pharmacy?

PSNC website: indicative income calculator Quality Payment Indicative Income http: //psnc. org. uk/funding-and-statistics/cpcf-fundingchanges-201617 -and-201718/

PSNC website: cashflow calculator

Worked Examples Assuming that no-one does the quality payments scheme

Items per month December 16 to March 17 Monthly Cut Annual Cut April 17 to March 18 Annual Cut 5000 -£ 8812 -17% -6% -£ 17592 -11% 8000 -£ 12316 -16% -5% -£ 19776 -8% 10000 -£ 14652 -15% -£ 21228 -7% 15000 -£ 20492 -15% -£ 24876 -6% 20000 -£ 26332 -14% -5% -£ 28524 -5% 25000 -£ 32172 -14% -5% -£ 32172 -5% 86000 -£ 100656 -14% -£ 76656 -3%

Quality Payments Scheme

Funding • • £ 75 m value in 2017/18 100 points maximum per contractor Value of each point set at £ 64 = ‘max’ of £ 6, 400 But potentially a reconciliation payment in final payment for March 2018 to pharmacies that have participated in the scheme • The reconciliation payment received will depend on the number of points the contractor has achieved • £ 128 cap on points value so potentially £ 12, 800

Funding In Sheffield Quality scheme is worth £ 800, 000 to £ 1, 600, 000

Claiming payment There will be two review points during the year, at which quality payments can be claimed: • Friday 28 th April 2017; and • Friday 24 th November 2017. • Declarations will be made to the BSA in April and November – form still to be published – payments made with the final payment for those months – i. e. April claim paid in end June/early July payment

Gateway criteria To qualify for payments, pharmacies will have to first meet four gateway criteria: • provision of at least one specified advanced service; and • ongoing utilisation of the Electronic Prescription Service; and • ability for staff to send and receive NHS mail; and • NHS Choices entry up to date. There is no payment for passing the gateway criteria

NHSmail On the day of the review, Pharmacy staff at the pharmacy must be able to send and receive NHS mail New centralised process – submit email request by 1 st February

Requesting an NHSmail account for your pharmacy • • Contractors that wish to apply for an NHSmail account for their pharmacy, can do so by emailing the following information to nhspharmacy. registration@nhs. net Trading name of pharmacy; Owner’s name; Address, including postcode (for the premises the NHSmail address will apply to); Pharmacy ODS code (F code); Pharmacy telephone number; and Current pharmacy email address.

• Contractors with multiple pharmacies may submit this information via one email, providing details for each pharmacy premises. For this reason, pharmacy teams working within multiple pharmacy groups may want to check with their head office before requesting an NHSmail address for their pharmacy.

Already have an NHSmail account for your pharmacy • NHS England NHS Digital want all pharmacies to have shared mailboxes which can only be accessed by authorised users who log in using their personal NHSmail account.

• If you already have a shared mailbox – NHS Digital will put in place a process in 2017 to ensure all such shared mailboxes are modified so that they conform to the approach now being taken to creating new pharmacy shared mailboxes. Further details on this process will be released in due course – no action needs to be taken by contractors with an existing shared mailbox at this time. • If you already have a pharmacy NHSmail account, but it is not a shared mailbox – follow the above process to request a shared mailbox. NHS Digital will publish guidance on what should be done with your existing NHSmail account in due course.

NHS Choices entry On the day of the review, the NHS Choices entry for the pharmacy must be up to date. • • Changes needed to NHS Choices to allow a record to be made of when a contractor updates / verifies their details Register for self-management rights and check content, but a ‘formal’ review will need to be undertaken once the changes to NHS Choices have been made

• From 7 th February 2017, NHS Choices will provide each contractor with the option to either amend their NHS Choices entry profile, or to validate the entry as being as accurate and up to date, in a manner which will create a record which will act as evidence to NHS England that these actions have been undertaken. • By each review date, the contractor will need to amend or validate three parts of their profile: opening hours; the facilities the pharmacy provides e. g. consulting room, parking etc; and the services the pharmacy provides. • • All three parts will need to have been amended or validated for the contractor to have met the requirement to update their NHS Choices profile.

• NHS Choices will maintain a record of when each contractor last updated its NHS Choices profile from 7 th February 2017 until the first review date; and then again from 1 st May 2017 until the second review date in November 2017. This record will then be provided to NHS England regional teams to enable them to confirm which community pharmacies have achieved this gateway criteria for the Quality Payments Scheme when reviewing contractors’ declarations. • Any inaccuracies between a contractor’s NHS Choices profile and their contractual opening hours, facilities and the services provided is the responsibility of the contractor. As this is a gateway criterion, an inaccurate NHS Choices profile may then jeopardise the entire payment claimed for under the Quality Payments Scheme. • Contractors’ claiming a quality payment will need to ensure that before they make any declaration they have amended or validated the three parts of their NHS Choices profile after 7 th February 2017 for the first review period and after 1 st May 2017 for the second review period.

Registering for NHS Choices management rights • • • There are two types of management rights that pharmacies can register to obtain: Web Editor rights allow an individual to update the editable information on their pharmacy profile, e. g. service details or opening times. Comment Administrator rights alert an individual to the publication of moderated patient feedback (a rating and/or free text comment) on their profile, and allow the individual to publish (subject to a moderation process) a response to that feedback.

Registering for NHS Choices management rights • • If you have not already been fully set up on NHS Choices: Email the NHS Choices helpdesk thechoicesteam@nhschoices. nhs. uk In the email, please quote your pharmacy’s name, address and ODS code (F code) and the name and email address of the staff member(s) to be given web editor and/or comment administrator rights. Any email address can be used to register; this doesn’t need to be an NHSmail address. The activation of the account can take up to two weeks and you will receive an email confirmation.

• Service descriptions for pharmacy teams have been created to ensure that pharmacy teams use standard paragraphs to populate the service pages on their profile. This will help people when navigating services on NHS Choices. psnc. org. uk/contract-it/pharmacy-it/nhs-choices/

Quality Criteria

Quality criteria

Use of the NHS Summary Care Record (SCR) On the day of the first review, the pharmacy can demonstrate a total increase in access to Summary Care Records between 1 December 2016 and 28 April 2017 in comparison to the previous 5 months; and on the day of the second review, the pharmacy can demonstrate a total increase to access to Summary Care Records between 1 May 2017 and 24 November in comparison to the previous 7 months. • Claim at both review points - 10 points (£ 640) • PSNC is seeking to publish details of SCR access for each pharmacy or ‘Privacy Officer’ should be able to obtain the number of records accessed

Use of the NHS Summary Care Record (SCR) • If you haven’t got SCR access yet – start that process ASAP • Consider how to make use of SCR part of ‘business as usual’ • Resources available via psnc. org. uk/scr

Use of the NHS Summary Care Records • • The total payments available are £ 840: £ 200 activation fee before the end of March 2017 £ 320 SCR access by April 2017 £ 320 increased use of SCR by November 2017. • For those pharmacies that are yet to attend a mandatory face to face briefing session NHS Digital’s have scheduled some ‘mop-up’ events schedule for January and February. Links to Eventbrite booking forms are now live on the NHS Digital SCR Community Pharmacy webpages: https: //digital. nhs. uk/summary-care-records/news/book-now-final-pharmacy-briefingsessions • •

Dementia Friends On the day of the review, 80% of all pharmacy staff working in patient facing roles are trained ‘Dementia Friends’ • Claim at both review points - 10 points (£ 640) • Two routes by which to become Dementia Friends: – attending a face-to-face Dementia Friends Information Session – watching a set of short online videos • www. dementiafriends. org. uk or local Dementia Action Alliance • All staff – including locums • Record sheet on the PSNC website / keep copies of webpage

For organisations: Steps to becoming a Dementia Friend • Register your pharmacy on the Dementia Friends website www. dementiafriends. org. uk.

Step 1: Once you have registered, you will be sent a unique code, which will allow you and your team access to access the online Dementia Friends videos. Step 2: To access the videos, click on ‘Watch our videos for organisations’ and enter: �your unique code; �the number of people who are going to watch the videos; and �the postcode of where you are watching the videos. Step 3: Pharmacy team members should watch the introductory video and at least one other video. Step 4: Once the pharmacy team members have watched the videos, email: DForgs@alzheimers. org. uk to let them know how many people in the pharmacy have become Dementia Friends so they can all be sent a Dementia Friends badge and action card.

• • Contractors will not be sent any certificates/letters for staff who become Dementia Friends through this route. We therefore suggest pharmacy team members also complete the record sheet that PSNC has created to keep a record of staff members and temporary staff, such as locums, that have become Dementia Friends. A copy of the email sent to DForgs@alzheimers. org. uk could be retained to show to NHS England, if required. The record sheet is available on the PSNC website.

• Route 2 If you would prefer for your pharmacy team to attend a face-to-face Dementia Friends Information Session, please email DFOrgs@alzheimers. org. uk

Safeguarding On the day of the review 80% of registered pharmacy professionals working at the pharmacy have achieved level 2 safeguarding status for children and vulnerable adults in the last two years • Claim at both review points - 10 points (£ 640) • Pharmacy professionals = Pharmacists and pharmacy technicians • The CPPE Safeguarding children and vulnerable adults e-learning and e-assessment meets the level 2 requirements • https: //www. cppe. ac. uk/services/safeguarding • All pharmacy professionals – including locums • Record sheet on the PSNC website / keep copies of certificate/webpage print out

Clinical effectiveness – over use of asthma treatments On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, are referred to an appropriate health care professional for an asthma review. • Claim at both review points - 20 points (£ 1, 280) • PSNC Briefing on this subject – record sheet/referral form & Pharm. Outcomes module • Talk to local GP practices about this • Inhaler technique checks and MURs…

Data collection • Contractors may be required to provide evidence to local NHS England teams to show that they have met the Quality Payment criterion. A data collection form is provided below which could be used to aid this process. Please note, if this form is used, the left-hand side of the form containing patient information, should be hidden if it is shown to NHS England representatives to prevent a breach of patient confidentiality.

Communicating with GP practices • Since contractors will be referring patients who meet the above requirements to their GP practice, it may be useful for contractors to speak to local GP practices to inform them of the referral requirement and to hear what feedback they would like to receive or how they would like patients to be referred. Where the notification to the GP practice is undertaken via hardcopy/fax the Community pharmacy referral form can be used.

Pharm. Outcomes: Asthma Quality Criterion referral tool • • Contractors will find the Asthma Quality Criterion reporting tool under the “Services” tab of Pharm. Outcomes under the orange heading “Provide Services” The tool operates in the same way as any Pharm. Outcomes referral service. Developed to support the “Clinical Effectiveness” quality criterion, this simple template supports the secure referral of appropriate patients to their GP when identified as using short acting bronchodilators long term without the benefit of an inhaled corticosteroid. Simply completing the template and saving the data will auto send a GP notification in the same way as flu notifications are generated. Contractors also benefit from an audit report summarising their activity in this clinical area and allowing them to evidence meeting the Quality Payment criterion.

NHS 111 Directory of Services On the day of the review, the pharmacy’s NHS 111 Directory of Services entry is up to date. • Claim at both review points - 5 points (£ 320) • NHS England NHS Digital are considering how pharmacies will be able to access their Do. S entry and the process by which errors can be notified to NHS 111 Do. S leads. • Currently no action can be taken by contractors to comply with this Quality Payment criterion.

Community Pharmacy Patient Questionnaire (CPPQ) results On the day of the review, the results of the Community Pharmacy Patient Questionnaire from the last 12 months is publicly available on the pharmacy’s NHS Choices page. • Claim at ONE review point - 5 points (£ 320) • Discussions with NHS England the NHS Choices team about how this is to be undertaken by contractors • Upload a PDF – probably using a standard template

Patient safety report • Written safety report at premises level available for inspection at review point, covering analysis of incidents and incident patterns (taken from an ongoing log), evidence of sharing learning locally and nationally, and actions taken in response to national patient safety alerts. • Claim at ONE review point - 20 points (£ 1, 280) • Discussions with NHS England what needs to be included in the report • A template will be made available to assist completion

Health Living Pharmacy level 1 On the day of the review, the pharmacy is a Healthy Living Pharmacy level 1 (selfassessment). • Claim at ONE review point - 20 points (£ 1, 280) • Self-assessment process and the RSPH

How to achieve HLP Level 1 • In July 2016, the HLP Task Group of the Pharmacy and Public Health Forum developed a new process for the implementation of Level 1 HLPs. • Move from a totally commissioner-led HLP accreditation system to a profession-led self-assessment process for Level 1 HLPs, based on clear quality criteria and underpinned by a proportionate quality assurance (QA) process; • PHE published a letter (tinyurl. com/PHELetter) explaining this in more detail.

• PHE has published a self-assessment guide which sets out the quality criteria that pharmacies must achieve to gain HLP Level 1 status and lists suggested evidence which can be used to demonstrate that the pharmacy meets the criteria. • Pharmacy teams must be able to provide evidence of their behaviours and activities as well as the physical environment. A checklist of the 27 quality criteria which need to be met can be found on the PSNC website. • PSNC has published a HLP Level 1 Evidence Portfolio Workbook which pharmacy teams can use to guide them through the HLP quality criteria and assist them with recording their evidence to show they have reached HLP Level 1.

Next steps • Initial guidance on Gateway criteria was published by NHS England in December • Further guidance being developed by NHS England • PSNC Briefings and associated resources available at psnc. org. uk/quality • Pharm. Outcomes modules available to help track progress and make referrals/records for the asthma criterion

Our suggested plan for contractors • No ‘one size fits all’ approach • But the following approach is ordered based on the criteria on the previous slides • All the criteria are included – both gateway and quality criteria

Our suggested plan for contractors 1. Provision of Advanced service* 2. Use of EPS* 3. NHS Mail* 4. NHS Choices entry* 5. Use of SCR 6. Dementia Friends 7. Safeguarding 8. Clinical effectiveness – asthma 9. NHS 11 DOS 10. CPPQ publication 11. Patient safety report 12. HLP * = Gateway Criteria

Quality Payment Scheme For 1 st Review 28 th April 2017 • Satisfy the Gateway Criteria • 80% of registered pharmacy professionals have achieved level 2 safeguarding status for children and vulnerable adults (5) • Accessed the Summary Care Record (5) • NHS 111 Directory of Services entry up to date (2. 5) • Asthma patients dispensed more than 6 short acting bronchodilator inhalers without any corticosteroid inhaler within a 6 -month period are referred to an appropriate health care professional for an asthma review (10) • 80% of all pharmacy staff working in patient facing roles are trained ‘Dementia Friends’ (5) • Total points (27. 5) worth £ 1760

Quality Payment Scheme For 2 nd Review 24 th November 2017 • All of the above • Total points (27. 5) worth £ 1760

Quality Payment Scheme For either Review • Results of patient experience survey from the last 12 months published on the pharmacy’s NHS Choices page (5) • Production of a written report that demonstrates evidence of analysis, learning and action taken in response to near misses and patient safety incidents, including implementation of national patient safety alerts and having shared learning (20) • Healthy Living Pharmacy level 1 (self-assessment) (20) • Total points (45) worth £ 2880

Quality Payment Scheme • Decide which QP criteria you plan to meet and by which review point – consider the costs you are likely to incur to achieve each criterion – some will take more time and staff resource to achieve (e. g. Healthy Living Pharmacy (HLP) level 1), and some are much more complex than others • Develop a timed plan for achieving the gateway and quality criteria – timing of meeting the gateway criteria – not all can be achieved now – start with the easy ‘quick wins’, particularly those that have two review points – consider which gateway and quality criteria you will initially find easiest to achieve

Worked Examples Assuming that everyone does the quality payments scheme

Items per month December 16 to March 17 Monthly Cut Annual Cut April 17 to March 18 Annual Cut 5000 -£ 8812 -17% -6% -£ 11192 -7% 8000 -£ 12316 -16% -5% -£ 13376 -6% 10000 -£ 14652 -15% -£ 14828 -5% 15000 -£ 20492 -15% -£ 18476 -4% 20000 -£ 26332 -14% -5% -£ 22124 -4% 25000 -£ 32172 -14% -5% -£ 25772 -4% 86000 -£ 100656 -14% -£ 70256 -3%

Ph. AS and Quality Payments • Pharmacies eligible for the Pharmacy Access Scheme will qualify for Quality Payments • When the ‘top-up funding’ that Ph. AS pharmacies receive is calculated, it is assumed that the contractor will achieve 100 points • The value of those points is deducted before the final Ph. AS payment is set

Questions psnc. org. uk/pharmacychanges psnc. org. uk/quality

NUMSAS

NHS Urgent Medicine Supply Advanced Service (NUMSAS) • National pilot service – commissioned as an Advanced Service • Funded by the Pharmacy Integration Fund (Ph. IF) - £ 2 m budget – End on 31 st March 2018 – with a review point to consider progress in September 2017

IT requirements • The pharmacy must be enabled to receive and dispense Electronic Prescription Service (EPS) Release 2 prescriptions • Pharmacies must have a shared NHSmail inbox • Access to the Directory of Services • If available, pharmacists providing the service should have access to the NHS Summary Care Record (SCR)

Referral of patients to the service • Patients contact NHS 111 to request access to urgently needed medicines or appliances (previously supplied on script) • Referral to a pharmacy, chosen by the patient, that is providing the service - referral via NHSmail or other electronic solution • NHS 111 provide the phone number of the selected pharmacy to the patient, advising them to call the pharmacy in the following 30 minutes • The pharmacist will assess the need of the patient for an emergency supply

Fees that will be paid a. For ANY referral received from NHS 111 for a request for an urgent medicine or appliance supply, whether or not a supply is made and irrespective of the reason for any non-supply: I. A Consultation fee of £ 10, and II. An Administration fee of £ 2. 50 per consultation to reflect the additional work/documentation required to support evaluation of the service b. Where a medicine or appliance has been supplied, a Supply fee of £ 1. 50 will be made for the first item and an additional £ 0. 50 will be paid for each additional item supplied

Key resources • NHS England - Service specification (published 29 th Nov 2016) • NHS England - Service guidance (due in December 2016) • NHS BSA web-based form for notification of intention to provide the service (available from 1 st December 2016) • NHS BSA claims form (will be sent to contractors by the BSA) • Further guidance and resources are available at psnc. org. uk/numsas

PSNC’s advice to contractors • At PSNC’s November 2016 meeting, the Committee considered the costs of providing the service and they expressed concern that contractors would find that the likely costs of provision of the service would exceed the fees that NHS England will pay for its provision

PSNC’s advice to contractors • The volume of referrals from NHS 111 to contractors is likely to be relatively low • The maximum number of all such potential referrals is in the region of 200, 000 per annum • Based on the experience of similar locally commissioned services, it is unlikely that it will be possible to transfer all of these patient requests to community pharmacy, at least to begin with • The likely volume of transactions per pharmacy is a factor that should be considered when contractors make a decision on whether they wish to seek to provide the service