1. NHS Urgent Supply Advanced Service Pilot

2. Urgent Care Pressures will be familiar to all Five Year Forward View:
“need to redesign urgent and emergency care services in England for people of all ages with physical and mental health problems”
Urgent and Emergency Care Review:
“a fundamental shift in the way urgent and emergency care services are provided to all ages, improving out-of-hospital services so that we deliver more care closer to home and reduce hospital attendances and admissions”

3. Urgent and Emergency Care Review
The review proposes that five key changes need to take place in order for this to be achieved. These are:
Providing better support for people and their families to self-care or care for their dependents.
Helping people who need urgent care to get the right advice in the right place, first time.
Providing responsive, urgent physical and mental health services outside of hospital every day of the week, so people no longer choose to queue in hospital emergency departments.
Ensuring that adults and children with more serious or life threatening emergency needs receive treatment in centres with the right facilities, processes and expertise in order to maximise their chances of survival and a good recovery.
Connecting all urgent and emergency care services together so the overall physical and mental health and social care system becomes more than just the sum of its parts.

4. Urgent and Emergency Care Review
“Commissioners and providers should minimise the number of ‘hand-offs’ between different people to avoid unnecessary re-work"
“Community pharmacies can make valuable contributions to local health communities’ urgent care programmes. They can enhance patient safety and reduce pressure on other parts of the local health community, particularly general practice, thus creating headroom for the management of patients with more serious problems”

5. NUMSAS
The Service will allow community pharmacies to supply a repeat medicine at NHS expense, following a referral from NHS111 and where the pharmacist identifies that the patient has an immediate need for the medicine and that it is impractical to obtain a prescription without undue delay.

6. Legal basis
In an emergency, a pharmacist can supply prescription only medicines (POM) to a patient (who has previously been prescribed the requested POM) without a prescription at the request of the patient under the provisions and requirements of Regulations 225, 253 and Schedules 18 and 23 of the Human Medicines Regulations 2012 (HMR). The pilot is using these existing regulations to enable the supply to be made as an NHS transaction.
These regulations are set out in Annex A of the service specification.
The Royal Pharmaceutical Society has published guidance on making supplies under these regulations.

7. Why is the service needed?
Requests for medicines needed urgently account for about 2% of all completed NHS 111 calls
This can rise to 30% at peak times in some areas.
In the North West, NHS111 has taken calls in the last 6 months where the outcome was a need for a repeat prescription
In Blackpool or Fylde and Wyre CCG areas:
1503 calls for these reasons in the last 6 months
All but 24 were passed to a GP Out of Hours service
We have the potential to free up nearly 3000 OOH contacts per year on CCG area alone

8. Pilot Service
This service is not like other community pharmacy advanced services in that it requires a number of key stakeholders to collaborate to enable it.
Therefore although it is being commissioned as a national service it requires local implementation and management.
A key element of the pilot is to evaluate it to inform key elements that need to be developed to ensure integration of pharmacy into the wider NHS to support existing urgent care and general practice.

9. Key requirements to provide the service
Consultation room – not all consultations need to be held in it, but it must be available for when it is appropriate to do so.
A Standard Operating Procedure for the service.
EPS enabled.
Have a premises specific shared NHSmail box and linked personal NHSmail addresses.
Successfully registered on NHSBSA website to provide the service.
Read the service specification (
As with all advanced services, must be satisfactorily providing essential services and have an acceptable system of clinical governance in place.

10. NHSmail – interim process for obtaining
NHS Digital setting up a national process, but until it is in place there is an interim process.
In December all pharmacies in Phase 1 (including Blackpool & Fylde and Wyre CCG areas) were sent information by the NHS England team.
Those that wanted to provide NUMSAS were able to apply.
Most of those pharmacies have now been sent details of new NHSmail addresses and log-ins – some were missing information so are outstanding.
Additional pharmacies that want to provide can still request these through the NHS England team – updated forms now available.
Crucial that information is accurate – have had instances of incorrect or missing ODS codes, incorrect addresses (required to notify log-in details).
Restriction of 3 individual NHSmail addresses per pharmacy except in exceptional circumstances – there is a cost for each address and a logistical challenge in issuing large numbers of s at one time.

11. Registration on NHSBSA website
Register at
Uses the same tool as that used for Seasonal Flu Vaccination Service and CPCF Assurance
Requires NHSmail address
Automatically generates a confirmation within 2 hours – if not received, contact NHSBSA (after checking junk box!)
NHSBSA staff will telephone the pharmacy to explain the claims process.
Information from the website is then sent to NHS 111 Directory of Services leads to add the pharmacy details to the DoS as a provider of NUMSAS, so important that the information - especially – is correct.
Information is also sent to NHS England local teams.

12. NUMSAS Process

13. NUMSAS Process

14. NUMSAS Process

15. NUMSAS Process

16. NUMSAS Process

17. Payment structure
Pharmacy will be able to claim payment for ANY referral received from NHS 111 whether or not there is a supply as long as FP10 DT dispensing token filled in with all information.
This payment will be £10 consultation fee and £2.50 administration fee
A supply fee of £1.50 for initial item
An additional supply fee of £0.50 per item for subsequent items supplied to the same patient
Cost of medicines in normal way

18. Payment structure
If pharmacy A refers to pharmacy B (e.g. as out of stock) BOTH will be able to claim consultation and administration fees (but only the pharmacy making the supply will be able to claim the other fees)
Where a pharmacy receives a referral but can meet the patient’s need by using an EPS prescription downloaded via the EPS Tracker, they will still be able to claim the consultation and administration fees
Where the pharmacy cannot contact the patient after three attempts they will still be able to claim the consultation and administration fees

19. Pharmacy to manage on-going referrals
Expectation is that the pharmacy manages all referrals.
Where a supply cannot be made because of legal reasons – e.g. a CD – the pharmacy must contact the GPOOH (will have the private health professional phone number) and discuss next steps and if appropriate send on the referral.
Note that the NHS 111 call handler is not a clinician and is not able to identify if a patient is requesting a CD.
No patient should be referred back to NHS 111.
Part of the evaluation will be to identify how successfully pharmacies can manage all referrals.

20. Information to patient’s GP
Suggested content:
Patient name, date of birth, NHS number, address and postcode
Pharmacy name, address and telephone number
Name and GPhC number of pharmacist
GP practice name and address
Date and time of episode
Outcome of assessment
Whether EPS Tracker and/or Summary Care Record accessed
Details of each item supplied (drug/appliance name, form, strength, dose, quantity)
Free text space for comments
Pre-populated statements describing core aspects of the service and intervention
A template is to be developed that will enable this
Working across North West to use PharmOutcomes to support.

21. Only for patients via NHS 111 referral
The service is being added as an additional option in the existing NHS 111 pathway.
Pharmacies must not advertise the service to the public.
Pharmacies should continue to manage requests for urgent supplies from patients as they currently do.
Calls for urgent medication to NHS 111 will be monitored. In areas which have commissioned similar services locally there has not been an increase in calls.

22. Phased Implementation
NUMSAS is being commissioned as a fully integrated service and therefore requires a number of key elements to be in place before it can go live.
To support efficient roll-out for the referral from NHS 111 to community pharmacy a phased introduction is taking place. The NHS 111 provider – NWAS – covers the whole of North West England.
Aim to go live by end of March The pilot running until March 2018.