1. Pharmacy funding cuts for Halton, St Helens and Knowsley LPCBy
Suraj Shah MPharm
Pharmacy Operations Manager
National Pharmacy Association

2. Community pharmacy funding
Two-year funding package imposed on community pharmacy
2015/16 funding was set at £2.8bn
£2.687 billion for 2016/17
4% reduction for 2016/17
Average 12% fall for December 2016 – March 2017
£2.592 billion for 2017/18
Further cut of 3.4% (in addition to the 4% cut in 2016/17)
Around 7.4% less than 2015/16 funding levels
There is a 4% reduction based on 2015/16 funding from £2.8bn to £2.687bn for 2016/17. As the 1st year cuts are being taken between December 2016 and March 2017, it will be the equivalent of a 12% reduction for the remainder of the year.
In December 2015, the Department of Health announced its proposals to cut community pharmacy funding in England in 2016/2017.
In September 2016, the Pharmacy Minister announced that the cuts and efficiency measures would not take place from October and that he would “take time to make the correct decision”
In October 2016, PSNC announced that it had rejected the DH’s proposed funding package for 2016/17, which would reduce funding from December 2016 to March 2017 by 12% on current levels. Furthermore, funding for 2017/18 would be reduced by 7.4% on current levels.

3. How much will your income fall?
PSNC’s Indicative Income Tables:
Items dispensed per month
Indicative income
November 2016
Indicative income December 2016
Indicative income April 2017
1,000
£2,010
£1,865
£2,096
2,000
£4,219
£3,730
£4,193
4,000
£11,045
£9,134
£9,640
6,000
£15,359
£12,864
£13,833
8,000
£19,673
£16,594
£18,025
10,000
£23,987
£20,324
£22,218
 These tables are intended to illustrate indicative income levels that could be expected by an average pharmacy for Essential Services.
They do not include Advanced Services income. They assume an estimated average buying profit. Special fees and allowances have been distributed in proportion to monthly items – individual pharmacy income will vary depending on mix of products dispensed.
ESPLPS arrangements not included.
NB – indicative income for December and April may be lower if there are further Category M reductions.
Full payment for December will be made in early March 2017.
Your March 2017 Schedule of Payment will reflect the changes to funding for December prescriptions (submitted in January).

4. Monthly Repeat dispensing payment
Fees and allowances
Four fees consolidated into one:
Professional fee
£0.90 per item
Single activity fee
£1.13 per item
Practice payment
52.2p per item (2,500 items+)
Monthly Repeat dispensing payment
£125
The four fees and allowances listed will be consolidated into one single activity fee. This is one of the ways in which the Government will reduce pharmacy funding from £2.8bn to 2.592bn in 2017/18
Additional fees paid for dispensing prescriptions for specific types of product such as
unlicensed medicines, appliances, controlled drugs etc., will remain as separate fees.
Practice payment for contractors that dispense less than items a month are:
Up to 1,099 - £300
1, ,599 - £2,673
1, ,499 - £3,742
All contractors dispensing items a month are currently entitled to 52.2p per item only.
One-off set-up payment for EPS release 2 is not consolidated into the single activity fee. The one-off payment will cease from April 2017.
PSNC has stated that for December 2016 to March 2017, the single activity fee is set to £1.13 per item. It is then expected to rise in 2017/18 to a level of £1.24 per item however have not had confirmation of this from the DoH.
Monthly EPS payment
£200

5. Establishment Payment
Prior to 1 December 2016:
Number of items per month for 1 April 2015 to 31 March 2016
Establishment Payment for 1 April 2015 to 31 March 2016
2, ,829
£23,278
2,830 – 3,149
£24,190
3,150+
£25,100
This is the previous establishment payment that contractors were able to claim dependent on the number of items they dispensed

6. Establishment payment
November 2016
£2,092
Based on 2015/16 funding
December 2016
£1,673
20% less than 2015/16 payment
April 2017
£1,255
40% less than 2015/16 payment
2019/20 £0
Reduction of £419
Average pharmacy dispensing 3,150+ items per month
Reduction of £418
From November 2016 – December 2016 the establishment payment will be reduced from 20% compared to 2015/16 figures.
From December April 2017 the establishment payment will reduce by a further 20% compared to 2015/16 levels.
The establishment payment is expected to cease completely by 2019/20
Payment ceases

7. Projection: 2,000 items per month
November December 2016 April 2017
Professional fee £1,800
Single activity fee £2,260
Single activity fee £2,480
Practice payment £624
Repeat dispensing £125
EPS £200
Establishment payment £0
Establishment payment £0
Establishment payment £0
Based on PSNC’s Indicative Income Tables and an estimated single activity fee of £1.13 per item for December. Note - single activity fee expected to increase in April to £1.24
This is lower than indicative income (slide 4) because indicative income includes an estimate for buying profit. This projection is just for the income from fees and allowances for Essential Services. Quality payments are not included.
Special fees & allowances £200
Special fees & allowances £200
Special fees and allowances £195
Total £2,949
£1.47 per item
Total £2,460
-£489 vs. November 2016
£1.23 per item
Total £2,675
-£274 vs. November 2016
£1.34 per item

8. Projection: 6,000 items per month
November December 2016 April 2017
Professional fee £5,400
Single activity fee £6,780
Single activity fee £7,440
Practice payment £3,132
Repeat dispensing £125
EPS £200
Establishment payment £2,092
Establishment payment £1,673
Establishment payment £1,255
Based on PSNC’s Indicative Income Tables and an estimated single activity fee of £1.13 per item for December. Note - single activity fee expected to increase in April.
This is lower than indicative income (slide 4) because indicative income includes an estimate for buying profit. This projection is just for the income from fees and allowances for Essential Services. Quality payments are not included.
Special fees & allowances £599
Special fees & allowances £599
Special fees and allowances £586
Total £11,548
£1.92 per item
Total £9,052
-£2,496 vs. November 2016
£1.51 per item
Total £9,281
-£2,267 vs. November 2016
£1.55 per item

9. Pharmacy Access Scheme (PhAS)
What is it?
Scheme set up with the aim of supporting the most-needed pharmacies to ensure that a baseline level of patient access is protected
Eligible pharmacies will receive an additional monthly payment on top of their usual fees and allowances for providing NHS Essential Services
The scheme will run from 1 December 2016 to 31 March 2018
PhAS funding to help patients retain access to pharmacy
Beyond March 2018 there will be a review of the effectiveness of the PhAS
The first PhAS payment will be included in the pharmacy’s reconciliation payment that relates to prescriptions dispensed in December These payments will continue monthly until the payment for March 2018.

10. Pharmacy Access Scheme (PhAS)
Payments
Eligible pharmacies automatically receive fixed monthly payments
First payment included in reconciliation payment that relates to prescriptions dispensed in December 2016
Average payment per annum: £11,600 in 2016/17; £17,600 in 2017/18
Roughly £2,900 per month in 2016/17 and £1,500 per month in 2017/18
Efficiency saving of 1% in 2016/17 and 3% in 2017/18 is included as part of this payment
This saving is less than the 4.6% and 8.3% cuts that ineligible contractors will experience
Amount paid per month is higher in 2016/17 as the funding will be paid for December – March, rather than throughout the year.
See “Community Pharmacy in 2016/17 and Beyond: The Pharmacy Access Scheme (PhAS)” and the list of eligible pharmacies for more details.

11. Pharmacy Access Scheme
Exact amount paid depends on number of items pharmacy dispensed in 2015/16:
2016/17 PhAS payment = (2015/16 remuneration x 0.99) – (2016/17 estimated remuneration)
2017/18 PhAS payment = (2015/16 remuneration x 0.97) – (2017/18 estimated remuneration)
Calculation assumes that pharmacy will earn quality payments
“Community Pharmacy in 2016/17 and Beyond: The Pharmacy Access Scheme (PhAS)” :
On average, this will equate to about £11,600 per annum in 2016/17 and about £17,600
per annum in 2017/18 for each eligible pharmacy. This is about £2,900 per month in
2016/17 and about £1,500 per month in 2017/18. The monthly payment is higher in
2016/17 because the payment is being made for just 4 months (payments for December
2016 – March 2017) whereas the 2017/18 payment is made over 12 months.
“To calculate the payment for each pharmacy, we calculate what their remuneration
would have been in 2016/17 had NHS community pharmaceutical services funding
remained unchanged (whilst accounting for the small efficiency saving). We then
calculate what we expect each pharmacy to earn under the new fee structure, and we
then pay the difference. When we calculate this, we factor in what we expect
pharmacies to earn through the new quality payment. This calculation for each
pharmacy is set out below:
2016/17 PhAS payment = (2015/16 remuneration * 0.99) – (2016/17 estimated remuneration)
2017/18 PhAS payment = (2015/16 remuneration * 0.97) – (2017/18 estimated remuneration)
The actual number of items dispensed in 2015/16 is applied to the new funding structure
in 2016/17 to give an estimate of 2016/17 remuneration assuming prescription volume
remains constant. The PhAS pharmacy is then paid the difference between 2015/16
actual remuneration and 2016/17 estimated remuneration (less a 1% efficiency saving,
which is deducted from 2015/16 remuneration in the calculation). The same approach is
used for 2017/18 remuneration, using the 2017/18 funding structure and a 3% efficiency
saving.
“The scheme will run from 1 December 2016 to 31 March During this time, eligibility will be fixed to the pharmacies that are deemed eligible in the list published on 20 October This is in keeping with the two year settlement, which will provide greater certainty to NHS community pharmaceutical services than the usual one year deal. Fixing eligibility in this way means that if a new pharmacy opens very close to a
pharmacy receiving the PhAS, the PhAS pharmacy will not lose entitlement, nor will the new pharmacy be eligible for the PhAS.
2.9. NHS Community pharmaceutical services funding levels and the PhAS beyond March 2018 will be subject to further consultation, which will include reviewing the PhAS and its effectiveness”
See “Community Pharmacy in 2016/17 and Beyond: The Pharmacy Access Scheme (PhAS)” and the list of eligible pharmacies for more details.

12. Pharmacy Access Scheme
Eligibility criteria
Pharmacies eligible if all of the following criteria apply:
More than a mile from nearest pharmacy by road
On pharmaceutical list on 1 September 2016
Not in top 25 per cent of pharmacies by dispensing volume (i.e. pharmacies dispensing 109,012+ prescription items per year)
1,356 pharmacies eligible
Does not include appliance contractors, dispensing doctors or internet pharmacies
Aim is to ensure that baseline level of patient access to NHS community pharmacy is protected. PhAS is intended to protect access in areas where there are fewer pharmacies with higher health needs.
Distances between pharmacies are measured by road distance, not as the crow flies. Based on Department for Transport’s road network data, and takes account of footpaths. Note: public transport travel distances have not been taken into account.
The top quartile means the top 25% largest pharmacies by dispensing volume – ie, pharmacies dispensing 109,012 prescription items per year or more (on average, more than 9,084 items per month)
The scheme does not include appliance contractors and dispensing doctors, because funding reductions do not apply to them.
Distance selling pharmacies (internet pharmacies) are not included because the scheme is to protect physical access to bricks and mortar pharmacies.
See “Community Pharmacy in 2016/17 and Beyond: The Pharmacy Access Scheme (PhAS)” and the list of eligible pharmacies for more details.
Explain top quartile, also NHS contracted pharmacies eligible – check distance-selling

13. Pharmacy Access Scheme
Review process
Pharmacies not on the PhAS list can use the review process, if one of the following applies:
Inaccuracies - for example, postcode, or distance to nearest pharmacy incorrect
Physical feature anomalies – for example, semi-permanent roadblock
‘Near miss’ pharmacy in area of high deprivation
Applications can be made from 1 November 2016 until 28 February 2017
Applications for reviews have to be made within 3 months from start date of scheme (1 December 2016). Applications will be accepted from 1 November 2016 – details of where to send requests to be released shortly.
See “Community Pharmacy in 2016/17 and Beyond: The Pharmacy Access Scheme (PhAS)” and the list of eligible pharmacies for more details.

14. PhAS ‘near miss’ criteria
To be eligible for PhAS under the ‘near miss’ criteria the pharmacy must be:
Located at least 0.8 miles from another pharmacy
In the top 20% most deprived areas in England as ranked by the Index of Multiple Deprivation (IMD)
If both of these conditions are met, the contractor will then need to demonstrate, on the balance of probabilities, that the pharmacy is critical for access, and, in particular, that “... a local population relies on that pharmacy and would be materially affected by its closing”

15. Quality payments scheme
For 2017/18, up to £75 million available for contractors to claim as quality payments
Part of the £2.592bn 2017/18 funding
Payments can be claimed at two review points:
28 April 2017
24 November 2017
Payments from April’s review point paid at end of June/start of July 2017
Payment depends on achieving specific quality criteria
The review points are dates at which pharmacies can claim quality payments. At each review point, if all the gateway criteria have been fulfilled and some or all of the quality criteria have been fulfilled, pharmacies can make a declaration to the NHSBSA on the approved form and claim payment.

16. Quality payments: gateway criteria
Four gateway criteria:
Provision of at least one specified advanced service:
Medicine Use Reviews
New Medicine Service
NHS Urgent Medicine Supply Advanced Service
NHS Choices information must be up to date:
Opening hours
Facilities provided by the pharmacy
Services provided by the pharmacy
If not yet registered, contact NHS Choices helpdesk -
3 applicable advanced services:
MUR (evidenced by claims for payment)
NMS (evidenced by claims for payment)
NHS Urgent Medicine Supply Advanced Service (evidenced by registering for the service)
According to DoH final package, “NHS England will be commissioning a new urgent medicines supply pilot as
an advanced service, which will require changes to Directions”.
NHS Choices – Each review the following information will need to be amended or validated:
Opening hours
The facilities the pharmacy provides e.g. consulting room, parking etc
The services the pharmacy provides
Will need to validate from 7 February 2017 for April review point and from 1 May 2017 for November review. There should be regularly reviewed. Further information on how to validate and amend pharmacy entries will be released in January.
This the contractors responsibility. Multiples can use an Application Programming Interface (API) to automate the process. Further information can be found by ing the NHS Choices Service Desk requesting a call back from the Syndication team. Please add ‘Pharmacy Organisation API’ in the subject field of the ; please include one contact per organisation
Further guidance will be provided regarding distance selling pharmacies in the near future (they have a different NHS Choices profile)
NHS Choices - If not yet registered, contact NHS Choices helpdesk -
In the , please quote your pharmacy’s name, address and ODS code (F code) and the name and address of the staff member(s) to be given web editor and/or comment administrator rights.

17. Quality payments: gateway criteria
Ability for staff to send and receive NHS mail
To register for an NHS mail account:
The following information is required:
Owner’s name
Trading name of the pharmacy and the full address
Pharmacy ODS code (F code)
Pharmacy telephone number
Current pharmacy address
This information must be sent by 1 February 2017 in order to meet April review criteria
Ongoing usage of EPS
NHS Mail – If already have access to address then fine. If not yet been set up then NHS England is looking to roll out a new process for registration. As long as there is an application received by 1 February 2017 to get an address you will pass that criteria in April.
Requesting an NHSmail account for your pharmacy (for the April 2017 Review)
If contractors do not have an NHSmail account for their pharmacy, they can apply for an NHSmail account by ing the following information 1st February 2017):
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 address.
EPS –
You need to be enabled
Nominating patients
Endorse and claim for EPS rxs each month
If GP’s don’t use EPS you would still qualify if other criteria met

18. Quality payments: gateway criteria
You must meet all four criteria in order to be able to claim any quality payments

19. Quality points Points gained at either or both review dates
Value for each point initially set at £64
Based on £75 million total if all pharmacies achieve 100 points
Reconciliation process will divide any remaining funding between qualifying pharmacies, based on number of points, up to cap of £128 per point in total
Pharmacies claim by making declaration to NHSBSA at each review point, using approved form
Further guidance from the Department of Health is expected by 1 December 2016.
Approved form not yet available. Note, declarations will be subject to spot checks from NHS England as part of CPAF monitoring.
NPA will be producing resources to help members to meet the quality criteria.
Approved form yet to be released

20. Quality domains and criteria
Quality criteria
1) Patient safety
1) “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 points)
2) “80% of registered pharmacy professionals have achieved level 2 safeguarding status for children and vulnerable adults within the last two years” (10 points)
Written safety report
Template is being considered by NHS England. If one is not produced the NPA will produce one for members to use.
Level 2 Safeguarding
This refers to registered pharmacy professionals (i.e. Pharmacists, locums and technicians). There may be local events that will allow you to complete this training such as CCGs, LA etc. The CPPE also have an accredited course that can be completed in order to achieve this criteria.

21. Quality domains and criteria
Quality criteria
2) Patient experience
3) “Results of patient experience survey from the last 12 months published on the pharmacy’s NHS Choices page” (5 points)
3) Public
health
4) “Healthy Living Pharmacy level 1 (self-assessment)” (20 points)
4) Digital
5) “Demonstration of having accessed the summary care record and increase in access since the last review point” (10 points)
6) “NHS111 Directory of Services entry up to date at review point” (5 points)
Patient experience
Publish CPPQ on NHS Choices. There will be a template produced that will allow for contractors to upload on to the NHS Choices website. Again it is important to have web editor rights in order to amend the record. The template has yet to be released. This criteria involves very little extra work as the CPPQ is completed anyway.
Public Health
HLP 1. The NPA is currently updating the HLP resources on our website to help members with meeting this criteria. The Public Health England document gives all the components that need to be completed as part of achieving HLP. Once all of this has been completed then the contractor will need to register on the Royal Society of Public Health as level 1 HLP. They will conduct QA on a few pharmacies to make sure that the requirements are being met.
Digital
SCR. Increase in use over the two review points. Increase in the 5 months prior to dec and apr. And then increase in use for seven months from May to Nov.
NHS 111 DoS up to date at each review point. Some pharmacies already have access to DoS but the majority do not. NHS Digital is currently looking at how to roll this out to pharmacies. Will likely be a mobile platform that can be accessed using a web browser or mobile.

22. Quality domains and criteria
Quality criteria
5) Clinical effectiveness
7) “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” (20 points)
6) Workforce
8) “80% of all pharmacy staff working in patient facing roles are trained Dementia Friends” (10 points)
Clinical effectiveness
One of the more difficult ones to complete, particularly if GP prescribing is good. Discuss referral with GP surgery prior to initiating to arrange a suitable pathway.
Workforce
Dementia friends can be completed by attending a local session or can attend an online session. Once the session is completed a certificate will be sent out or a notification of completion will be available online. These should be kept in a file so that there is a record of completion if there is an inspection of the QP. Available to complete at each review point.

23. Quality points: weighting
Criteria
Number of review points at which it can be claimed
Points at any one review point
Total points over two review points
Quality payment (minimum)
1) Patient safety report
April OR November 20
£1,280
2) Safeguarding
Both 5 10
£640
3) Patient survey
£320
4) HLP
5) SCR
6) NHS 111 Directory
2.5
7) Asthma review
8) Dementia Friends
Weighting is judged on how important this criteria is for patients. Payment is linked to the number of points. Certain criteria are completed at both April and November reviews and others only need to be completed once.
In terms of how easy they are to complete:
Patient survey – Already completed as part of contract. Needs to be uploaded as well as putting up in the pharmacy
SCR – May already be up and running. If so, then you just need to increase use over time. If not then complete the training, update smartcards and start using
NHS 111 directory – Once mobile DoS is available will be simple to check records are up to date. If not, then depending on access may be able to amend or can contact local DoS manager
Dementia Friends – Can get members of staff to watch the video online, make a pledge and get registered. Of benefit to both staff and patients.
Safeguarding – May already be up to date with this if conducting emergency contraception for example. If not then can be completed online or by following local guidance on accreditation.
Asthma review -
Patient safety report – Form to be released. NPA is MSO for pharmacies with less than 50 branches. Can report dispensing incidents to us and we will pass on to NRLS. Also produce reports that show common dispensing incidents that can aid learning as part of this criteria.
HLP – The most time consuming of all the criteria. Can be completed. May already have local HLP. This may not meet the criteria. Waiting to see whether grandparenting will be accepted.

24. Quality payment submission
April 2017 submission
80% of patient facing professionals have achieved level 2 safeguarding status (5 points)
Access summary care records (SCRs) (5 points)
NHS 111 Directory of Services entry up to date (2.5 points)
Asthma review (10 points)
80% of patient facing professionals trained as ‘Dementia Friends’ (5 points)
Example submission
£25m available for April 2017 submissions
Based on £64 per point, contractors will achieve £1,760 for this submission
Payment is dependent on achieving all of the gateway criteria first
Submissions
April £25m funding available
November £50m funding available
Complete all the criteria that are needed for both review points by April as a minimum. This will put you in a good position to get the most number of quality points by the end of the assessment peiri

25. Quality payment submission
November 2017 submission
80% of patient facing professionals have achieved level 2 safeguarding status (5 points)
Increased SCR access (5 points)
NHS 111 Directory of Services entry up to date (2.5 points)
Asthma review (10 points)
80% of patient facing professionals trained as ‘Dementia Friends’ (5 points)
Written patient safety report (20 points)
Patient experience survey for the last 12 months published on NHS Choices (5 points)
Healthy Living Pharmacy level 1 (self-assessment) (20 points)
£50 million available for November 2017 submission
Based on £64 per point, contractor will achieve £4,640 for this submission

26. Other changes to reimbursement
DH is also considering making changes to drug reimbursement in the following areas:
Non Part VIII products
Category M
Margin survey
‘Splitting the discount’ – to reflect increased margin for generics compared to brands
Category A
Non Part VIII and Category M expected to change first
Non Part VIII products are products for which no reimbursement price is listed in Part VIII of the Drug Tariff –we have no more information on the changes being considered
Category M – there have already been reductions to Category M prices, from June to September The Department of Health (DH) made these reductions in response to preliminary findings of the 2015/16 medicines margin survey, to reclaim excess margin they believe was delivered to contractors in 2015/16 over the agreed allowed £800m. The DH said that they would reconsider the position in October onwards, once the finalised 2015/16 survey results were available. We have no further information on what changes will be made to Category M at present
Margin survey – this is carried out every year, using invoices collected from sample independent pharmacies. The DH intends to make changes to the survey ‘to account for multiple suppliers for Non Part VIII products and Category C products’ – it is not clear what these changes will be or what effect they will have on pharmacy contractors
‘splitting the discount’ – changes are proposed to reflect that, in general, generic medicines have increased margin over brands – no further information currently available
The DH intends to make ‘changes to the way Category A prices are set’ – again, no further information yet on how or what effect this will have
We have no further details on this at the moment.

27. Pharmacy mergers
Amendment to the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013
Change will allow two pharmacies to merge and prevent a new pharmacy from opening in its place
Aim of the amendment is to provide some protection to pharmacies that choose to consolidate
Changes came into force on 5 December 2016
Currently there is not a lot of information available related to mergers. More information is expected prior to the changes coming into force.
PSNC has stated that two pharmacies from different pharmacies can merge either by merger or sale. The decision to merge will be down to contractors to make base on their local needs and business factors.
Community pharmacy in 2016/17 and beyond: Final package pg 13

28. Pharmacy mergers The new regulation will:
Allow pharmacies to merge using a simpler process
Applications will not be assessed against a pharmaceutical needs assessment
Assessment will be based on whether there will be a gap in pharmaceutical service provision if pharmacies were to merge
When NHS England receives an application they will request a comment from the local health and wellbeing board (HWB). If they believe that the merger will not cause a gap in pharmaceutical service they will amend the PNA for the area to reflect that. If the HWB believe that a gap will become apparent then NHS England will reject the application. The aim of this is to prevent another pharmacy from immediately taking over the site of the closed pharmacy.
Only valid as long as PNA is valid updated again in 2 year where there could be gap then.

29. NHS Urgent Medicine Supply Advanced Service (NUMSAS)
£2 million pilot scheme
Funding from the Pharmacy Integration Fund
Expected to run to March 2018
Referral from NHS 111 to local pharmacy for emergency supply
Contractors should use notification form on NHSBSA website to register
Contractors permitted to charge NHS prescription charge
Contractors permitted to charge NHS prescription charge – if patient is not exempt then they will need to pay NHS prescription charge

30. NUMSAS payment Consultation fee of £10 Administration fee of £2.50
Supply fee of £1.50 for the first item and an additional 50p for each additional item supplied
The cost of the medicine supplied based on the Drug Tariff price

31. Staff engagement Involve staff in decisions
Communicate clearly with staff
Maintain staff morale
Improve staff morale
Better patient outcomes
Better business outcomes
Getting staff engaged is crucial to the success of the business
NHS Employers website has plenty of resources on staff engagement, including briefings, newsletters and case studies.

32. People power Assign roles to individuals
Many of the gateway criteria and quality criteria can be delegated to members of the pharmacy team
Set clear objectives and expectations
Including non-negotiable targets for gateway criteria
Skills matrix
To assess the skills and knowledge of individual staff members
Staff appraisals
Performance management and learning and development
Assigning roles to employees
The business achievement plan should include details of what is required and by whom. All individuals need to be aware of their responsibilities as they will be working towards meeting the KPIs of the business. If the plan highlights further learning and development required by staff, their individual abilities will need to be assessed to establish whether they require short term or long term support. This can be done by completing a staff skills matrix.
Development needs should be prioritised according to the requirements of the business. For example, if a particular member of staff requires further training in order to carry out their role more effectively, this may need to be prioritised over any training required for planned future projects. A variety of development activities may be required, including on‐the‐job training, specific courses and mentoring by a senior member of the team.
Skills matrices can be used to assess the skills and knowledge of individuals working in your pharmacy. A skills matrix allows employers/managers to assess individuals’ learning deficiencies and gaps in knowledge and to highlight any further education and/or training required. Once the requirements are highlighted, development of a training plan for each individual can be carried out. A skills matrix should be carried out for each current employee in the company.
A template for a skills matrix with standardised competencies listed is available on the NPA website and as part of the NPA Business Efficiency Solutions pack.
Staff appraisals form an important part of the learning and development and performance management processes within a business. Please refer to the NPA resource “The Appraisal Process” available on the NPA website for more information on the appraisal process as well as a template appraisal form and template achievement plan for individual staff members.

33. SMART objective: example
‘Check and, where necessary, update the pharmacy’s NHS Choices profile in the first week of every month of 2017 so that the pharmacy meets this gateway criterion at both 2017 review points’
Specific – Check and update the pharmacy’s NHS Choices profile in the first week of every month
Measurable - pharmacy meets gateway criterion at both review points
Agreed – individual needs to agree to this objective and understand its importance
Realistic – this should be easily achievable
Timed - every month of 2017
This should be a non-negotiable objective
Example
Specific– Check and, where necessary, update the pharmacy’s NHS Choices profile in the first week of every month
Measurable - pharmacy meets this gateway criterion at both 2017 review points
Agreed – make sure staff allocated this objective agree to it and understand its importance
Realistic – this should be easily achievable
Timed - every month of 2017
This target should be non-negotiable

34. MURs 400 MURs per pharmacy @ £28 per MUR
In 2015/16 11,688 pharmacies on NHS list
11,029 pharmacies provided 3.3million MURs
Average number of MURs per pharmacy = 300
No MURs from 659 eligible pharmacies
Approx £38m in MUR fees unclaimed
Community pharmacies in England can carry out up to 400 MURs each financial year; however, in 2015/16:  * Of the 11,029 pharmacies that provided MURs, the average number of MURs delivered per pharmacy was 300 (total of 3,313,309 MURs) * 659 eligible pharmacies did not carry out any MURs at all * Approximately £38 million in MUR fees remained unclaimed by contractors  * The average unclaimed amount for each of the 11,029 pharmacies that did carry out MURs was over £2,800.

35. NMS No. of NMS depends on monthly items dispensed
In 2015/16 11,688 pharmacies on NHS list
9,439 (80%) pharmacies provided over 820k NMS
Total amount paid for NMS £20.2m
2,366 eligible pharmacies did not deliver NMS
Avg NMS per claiming pharmacy per year = 87
Avg NMS per claiming pharmacy per month = 10
The maximum number of NMS delivered that a pharmacy can claim for depends on the number of items dispensed each month. In 2015/16:  * The average number of items dispensed per month was 7,096 * Pharmacies dispensing this number of items per month would be able to claim for up to 35 NMS each month * Of the 9,439 pharmacies which did deliver the NMS, the average number claimed per pharmacy per month was seven * 2,366 eligible pharmacies did not deliver any NMS *

36. Maximising MUR/NMS delivery
Download NPA MUR and NMS resources
Promote - posters, patient leaflets, patient conversations
Utilise delivery drivers to supply leaflets to patients
Identify suitable patients using PMR
Highlight suitable prescriptions - stickers, stamps or notes
Get whole pharmacy team engaged with MURs and NMS and delegate tasks as appropriate
After NMS ‘engagement’, ensure intervention and follow-up stages take place – use diary or other reminder system
Have visible way of tracking weekly numbers of MURs and NMS completed – for example, a wall chart
Log on to the NPA website and download our MUR and NMS resources to support you in delivery of these
services
x Check the England and Wales Drug Tariff Part VIC to see which NMS target band your pharmacy falls
into – aim to complete enough NMS to at least meet the 20% target
x Promote the two services, using posters, patient leaflets and conversations with patients — support
materials for MUR and NMS are available from NPA Sales
x Speak to local GP surgeries and explain the benefits to them – they can signpost patients to pharmacies
x Ensure that suitable patients are being identified, using the PMR, and ensure that the pharmacy team knows
which medicines are eligible for NMS and targeted MURs
x Ensure that the whole pharmacy team engages with MURs and NMS and use the team’s skills to delegate
tasks as appropriate
x Use stickers, stamps or notes to identify suitable prescriptions and ensure that the pharmacy team know
how to engage patients in the services, including using consent forms and arranging appointments
x For NMS, ensure that after patients are ‘engaged’, the intervention and follow-up stages take place – use a
diary or other reminder system
x Ensure that all completed MURs and NMS are correctly recorded and claimed for promptly in the month
that they are completed
x Have a visible way of tracking the number of MURs and NMS completed each week in the pharmacy– for
example, a wall chart
x Use Check34 to monitor numbers of MURs and NMS completed and compare them with targets

37. Maximising MUR/NMS delivery
Use NPA tracker to record proportion of targeted MURs throughout each financial year
Check Drug Tariff to see how many NMS you need to do to meet the 20% target
Set weekly or monthly targets and review regularly
Break down 400 MURs target into manageable goals over 12 months – for example, per month
Record and claim for completed MURs and NMS promptly ‒ in the month that they are completed
Use Check34 to monitor numbers of completed MURs and NMS and compare them against targets

38. GP awareness
Attend GP meetings/local practice forums to raise awareness
Provide GPs/practice staff with leaflets to give to patients
Ensure GPs understand potential benefits of the services:
Improved patient adherence
Improved patient safety through early identification of possible ADRs – reduced hospital admissions
Increased Yellow Card reporting
Less medicines wastage and unnecessary re-ordering
Reduced cost to NHS by making early interventions
Better patient engagement with their condition/medicines
Saving GPs’ time - fewer patient queries about medicines
GP awarenesss needs to improve so that more patients who are entitled to the service are able to access it.
The intention to notify GPs is to encourage effective partnership working between GP practices and pharmacy contractors to ensure the service delivers better outcomes for patients. The key messages that should be communicated as:
• the extent of non-adherence by patients and the consequences
• what the service is and how it will work
• why the service is being delivered
• how pharmacies will feedback information to the GP and other prescribers
• how the service helps to reinforce the messages prescribers already give to the patient
• the benefits the service will bring to patients and the NHS.
At initial meetings, pharmacy contractors may also like to discuss with their local GP practices the value of ongoing, regular meetings to discuss patients who have participated in the service. Contractors will need to be able to demonstrate that they, or their representatives, have been in touch with the local GP practices. This could include copies of letters and information exchanged with practices. Alternatively, where local meetings are held for GP practices and pharmacy contractors, copies of agendas, presentations and information circulated, along with copies of sign-in sheets could be kept on file.
There is no obligation on GP practices to meet with pharmacy contractors and consequently, there is no requirement to gain the support of GPs before the service is provided. However it is hoped that GPs will respond positively. If a GP practice declines
invitations to discuss the NMS, a record of that should be kept.
 reduction in the number of patients who do not take their medicines as intended (some estimates suggest that up to 50 per cent of prescribed medicines are not used as intended)
 reduction in patients returning to general practice due to problems related to poor adherence, exacerbations and side effects
 reduction of waste from unused medicines and unnecessary reordering and dispensing of medication
supporting initial and ongoing management of patients with long-term conditions identifying patients who are intentionally non-adherent but reluctant to inform their GP which could be resolved by the pharmacist
 Reduction in patients returning to general practice with questions about their medicines that could be answered by the pharmacist
 NMS Supplements and reinforces information provided by the prescriber and practice staff to help patients make informed choices about their care

39. NPA Support Business Efficiency Solutions Pack Check34 and CheckRx
NPA Business Partners
Business skills training for you and your team
Advice and support
Medication Safety Officer role
Resources and SOPs
Private PGD services and vaccination training
GPhC inspection support
Sales
Insurance
A few examples of how the NPA can and will continue to support members

40. The NPA’s Medication Safety Officer (MSO) role
NPA’s Chief Pharmacist – MSO for all independent community pharmacies in England with fewer than 50 branches
Role includes:
Acting as main point of contact for NHS England and the Medicines and Healthcare products Regulatory Agency (MHRA)
Cascading medicines safety information to pharmacies
Implementing local and national medication safety initiatives
Leyla Hannbeck, Chief Pharmacist at the National Pharmacy Association (NPA), is the Medication Safety Officer (MSO) for community pharmacies with fewer than 50 branches.
Responsibilities include:
acting as main point of contact between pharmacies with fewer than 50 branches and NHS England/the MHRA.
cascading medicines safety information to pharmacies - Patient Safety Alerts issued by NHS England and drug and device alerts issued by the MHRA which are relevant to community pharmacies
implementing/helping pharmacies to implement local and national medication safety initiatives

41. How the NPA enhances MSO role
Cascading drug alerts
Dedicated area on NPA website
Factsheets and guidance
MSO Quarterly updates
Patient Safety Incident report form
Patient safety news stories
Pharmacy Voice Patient Safety Group
Standard Operating Procedures (SOPs)
Superintendent updates
Cascading drug alerts and supporting material where appropriate – by and on NPA website
Dedicated area on website – a one-stop shop on patient safety matters
Factsheets and guidance – to support members in managing patient safety incidents
MSO Quarterly Updates – summarise key findings from patient safety report forms received, including common errors and learning points
Patient Safety Incident report form – to report incidents to the MSO; data is passed onto NHS England and NPA carries out analysis of trends/identifies learning points
Patient safety news stories – issued as member news stories on a day-to-day basis and highlighted in the weekly
Pharmacy Voice Patient Safety Group – Leyla is a member of this group, which meets bi-monthly to discuss patient safety issues, share learnings and identify improvements that can be made
SOPs – to support NHS England Patient Safety Alerts (for example, methotrexate dispensing)
Superintendent updates – highlight issues of key importance for superintendents that they may want to cascade to their staff

42. Business Efficiency Solutions Pack
Available to download for members via the NPA website
Offers resources to help ensure that all parts of your business are robust
Aids you in identifying opportunities and threats
Helps you to analyse your internal business processes

44. CheckRx Launched in 2016 as companion service to Check34
Converts raw data from your NHSBSA Prescription Item Report into information that can be viewed, analysed and interpreted easily
Provides essential business intelligence
Helps you to identify areas within the business that are not performing as well, so that you can improve and grow your business
Background
At the beginning of 2016, The NHS Business Services Authority (BSA) began to publish the Prescription Item Report via the Information Services Portal. The Prescription Item Report (Px report) is a breakdown of your item level payment paid for your monthly prescription bundle. The data contained within, provides a line-by-line breakdown of all items dispensed by a contractor in the stated month. The Schedule of Payments (FP34) is a summary of payments from NHSBSA which is sent to pharmacy contractors on a monthly basis.
What is CheckRx?
The monthly Px report produced by the NHSBSA for each pharmacy contractor is a large Excel spreadsheet containing 72 columns and as many rows as items submitted for that month. This spreadsheet is not particularly user friendly and requires contractors to understand and analyse the data themselves.
CheckRx uses the NHSBSA Px report data and converts it to information that can be viewed, analysed and interpreted easily, providing essential business intelligence for pharmacy contractors. It has been developed as a companion service to Check34; CheckRx can be used in tandem with Check34 to help pharmacy contractors view areas of the business that is not performing as well as it could and improve and grow their business.
Check34 provides an overview and trends of the prescription business. CheckRx allows pharmacy contractors to drill down into item level information for all prescriptions dispensed and provides a breakdown of the monthly prescription bundle (Px report) in an easy to use and clear format.

45. Dashboard
This is what the CheckRx dashboard looks like. The CheckRx dashboard which is a similar format to the Check34 dashboard, shows 6 info graphics displaying different information relating to your prescription business.
View the breakdown of fees, allowances and reimbursement information for each item dispensed
Improve pharmacy stock management and ordering processes
Identify and analyse items dispensed by Drug Tariff category to gain an understanding of product usage (generic/branded/branded generic)
View patient groups by BNF category to help tailor clinical pharmacy services locally
Identify the five GP practices that contractors receive most NHS prescriptions from  
Benchmark and analyse your pharmacy’s performance against the nearest ten competitors
In addition to this, CheckRx allows you to compare your monthly prescription data with the FP34 Schedule of Payment. This allows you to identify payment shortfalls and discrepancies, giving you the confidence you are being paid correctly.
By recreating your FP34 Schedule of Payment, CheckRx allows you to:
Compare reimbursement with your FP34 Schedule of Payment so that any discrepancies are highlighted and can be rectified
View line-by-line pricing for each prescription submitted
Establish whether prescriptions have been endorsed correctly
Identify if any pharmacy processes need to be reviewed – for example, a large number of prescription switches (from ‘exempt’ to ‘chargeable’ status) may indicate that improvements to exemption checking processes need to be implemented

46. Benefits of CheckRx
View the breakdown of fees, allowances and reimbursement information for each item dispensed
Improve pharmacy stock management and ordering processes
Identify and analyse items dispensed by Drug Tariff category to gain an understanding of product usage (generic/ branded/ branded generic)
View patient groups by BNF category to help tailor clinical pharmacy services locally
Identify the five GP practices that you receive most NHS prescriptions from  
Benchmark and analyse your pharmacy’s performance against the nearest ten competitors
In addition to this, CheckRx allows you to compare your monthly prescription data with the FP34 Schedule of Payment. This allows you to identify payment shortfalls and discrepancies, giving you the confidence you are being paid correctly.
By recreating your FP34 Schedule of Payment, CheckRx allows you to:
Compare reimbursement with your FP34 Schedule of Payment so that any discrepancies are highlighted and can be rectified
View line-by-line pricing for each prescription submitted
Establish whether prescriptions have been endorsed correctly
Identify if any pharmacy processes need to be reviewed – for example, a large number of prescription switches (from ‘exempt’ to ‘chargeable’ status) may indicate that improvements to exemption checking processes need to be implemented

47. NPA business partners Examples
Financial services (e.g. Accounting)
Pharmacy IT
Shop fitting and signage
And others
Directory of vetted suppliers – reputable, reliable, trusted
Preferential rates for NPA members, where possible
There are times when running your pharmacy you may benefit from some external help and/or advice. This may be because you’re looking to rebrand, need a new company car, want to improve your security or require help with your accounts. It’s important to make sure you find a supplier who will provide you with high quality work at a reasonable cost. With the wide choice of suppliers available this can be time consuming.
The NPA has a directory of carefully vetted suppliers who can support you with business functions. This directory is constantly being added to and should be your first point of call to see if there’s a supplier who can help you. Where possible the NPA will have negotiated preferential rates for NPA members.
By using one of these suppliers you can rest assured that you’ll be working with a reputable, reliable and trusted supplier who is experienced in working with independent pharmacies.
To find out more visit 09

48. Funding changes: what to do
Check if you qualify for the Pharmacy Access Scheme
If not, check if you are eligible to request a review - if so, submit your application by end of February 2017
Aim to claim your quality payments:
Ensure that you meet all the ‘gateway’ criteria
Aim to meet as many of the quality criteria as possible and start collecting the evidence
Look out for further details being published
The NPA will be producing resources to assist members to meet these criteria
Applications for reviews have to be made within 3 months from start date of scheme (1 December 2016). Applications will be accepted from 1 November 2016 – details of where to send requests to be released shortly.
See “Community Pharmacy in 2016/17 and Beyond: The Pharmacy Access Scheme (PhAS)” and the list of eligible pharmacies for more details.
Further details of the quality payments scheme are expected to be published by the Department of Health by 1 December 2016.

49. Questions?

50. Thank you