1. New Contract Quality Criteria January Session
Fiona Lowe
Chief Officer Coventry, Warwickshire, Herefordshire & Worcestershire LPCs
This meeting has been supported by the following Companies: Christie. Napp Pharmaceuticals, GSK, Pfizer, Teva, Boehringer-Ingelheim and Chiesi through the purchase of the Exhibition stand space. These Companies have had no involvement with the Speaker selection or content of this meeting

2. Registration & Stands (09:00 – 09:30)
Breakout Room – Basics & Gateway Practical Support 09:00 – 10:00

3. Introduction (09:30)
Fiona Lowe

4. Welcome & Introduction
Welcome & introducing the team
Domestics
Fire Alarms
Toilets
Phones
Sponsors
Pre-work and Handouts
How the day will work
Main Room & Breakout Room

5. Agenda
09:00 Registration, refreshments and view stands (Basics, Gateway and other QC practical support in breakout room until 10 am)
09:30 Introduction followed by Dementia Friends session with Hayley Berry
10:15 Patient Safety session with Surinderpal Virdee (refreshments available at 12:00)
12:15 Asthma – Clinical Effectiveness session with Fiona Lowe
12:45 Q&A
13:00 Lunch and stands (Christie’s session in breakout room 12:45-13:30)
13:30 Dementia Friends session if required (Basics, Gateway and other QC practical support sessions in breakout room)
14:00 Safeguarding Level 2 (CPPE) with Hayley Berry (refreshments available at 15:45)
16:00 Healthy Living Pharmacy Introduction with Fiona Lowe (Basics, Gateway and other QC practical support sessions in breakout room)
16:30 Wrap Up and any remaining Q&A (Basics, Gateway and other QC practical support sessions in breakout room)
How presentation will benefit audience: Adult learners are more interested in a subject if they know how or why it is important to them.
Presenter’s level of expertise in the subject: Briefly state your credentials in this area, or explain why participants should listen to you.

6. Quality Payments in 17/18 Total of 100 points £64 per point
= £6,400 per contract
Could increase as additional allocation if less than 100% uptake
To a max of £128 per point
Gateway
EPS is active and used
NHS Choices is up to date and maintained (7th Feb onwards)
Active NHS Mail address and active (apply during January for generic )
Delivery of at least ONE specified Advanced service

7. LPC Communications

10. Dementia Friends (9:45) Hayley Berry
A Dementia Friend learns a little bit more about what it's like to live with dementia and then turns that understanding into action - anyone of any age can be a Dementia Friend.
Dementia Friends (9:45)
Hayley Berry

11. Patient Safety & CPPQ (10:15)
Surinderpal Virdee MRPharmS MFRPSII

12. Objectives
To meet the following criteria that fall within the Quality Payments Scheme
Community Pharmacy Patient Questionnaire (CPPQ) results
Patient Safety Report

13. Analysis of incidents and incident patterns
Details
CPPQ
Results of the CPPQ from the last 12 months is publicly available on the pharmacy’s NHS Choices website
Patient Safety Report
A written safety report at premises level available for inspection at review point covering:-
Analysis of incidents and incident patterns
Evidence of sharing learning locally and nationally
Action taken in response to National Patient Safety Alerts

14. Community Pharmacy Patient Questionnaire (CPPQ) REPORT

15. The CPPQ survey must be done annually
Each site has a minimum number of responses required based on their average monthly items
Average monthly script volume (Items) Minimum number of returned surveys
8001-upwards
The questionnaire is available on the PSNC website and available in 3 formats (PDF, Word document and a Large print Word document)

16. The PSNC have also provided a worksheet tool to enable you to analyze the results
Section 1 - Data collation
Section 2 - Ranks each question
Section 3 - Action plan. This is the part that will need to be published on your NHS Choices profile (for each site)
The survey needs to be completed by End March
Need to get started as soon as possible, you do not want to be chasing surveys close to the completion date
Most actions will actually be very simple and only require simple changes

17. Some examples of questions and potential solutions include:-
Waiting area not of sufficient size and was left standing for prescription
Solution - Review seating arrangement and added 2 more chairs
Was not offered any lifestyle advice
Solution - Pharmacy leaflet now directs patients to pharmacist when seeking such advice
Not enough stock to fulfil my prescription
Solution - Now have in place recommended average stock levels on electronic stock file

18. Patient Safety Report

19. GPhC Standards for registered premises: Principle 1
Before a patient safety report can be written, a number of other forms require completion. These forms will enable you to be more thorough in your analysis and review.
However…..before we look at those forms….let’s understand some key reasons why patient safety is important:-
Firstly and most importantly, none of us want to harm a patient and therefore want to constantly improve our standards to avoid patient harm
GPhC Standards for registered premises: Principle 1
‘The governance arrangements safeguard the health, safety and wellbeing of patients and the public’
In particular, it focuses on identifying and managing risk i.e. ‘what happened, why did it happen and what do we now need to do to make sure it doesn't happen again
Finally, the RPS released a new document in November 2016 titled ‘Professional Standards for the reporting, learning sharing, taking action and review of incidents’
(Please note: further details of the GPhC Principles and Standards can be found on the GPhC website)

21. Forms* that will help you complete a patient safety report include:-
Near miss log
Near Miss Error Improvement Tool (RPS)
Community pharmacy medication safety incident (Pharmacy error) report form
Controlled Drug incident report form
* There may be other forms that also require completion. The above list is an example

22. Templates available e.g. RPS website
Near miss log
Templates available e.g. RPS website
Log must be readily available to all staff
Need to have an open culture of reporting
Have a no blame culture
Before we look at a good example of a completed near miss log…I have some questions for you……….
Explain red/green cards on the tables
Each person to have a set each
Q1 Who should fill out the near miss log?
-Pharmacist (Green)
-Member of staff (Red)
Ask people to share why they gave their answer
Q2 How often should the new miss log be reviewed?
-Weekly (Green)
-Monthly (Red)
Q3 What types of near misses should be recorded on the log?
-All near misses (Green)
-Only clinically significant ones (Red)
Got on to define PSNC definition of a near miss
‘A near miss is defined a s a dispensing error that is detected before the patient or patient’s representative is handed the dispensed prescription’

23. Points to share:-
All of the boxes are completed (except the last column as the conversations have not taken place yet)
Writing is legible
Action taken column is completed (Actions are simple and realistic)
Only difference on this form v one in your dispensary is that this contains only one persons writing (mine!!!) when in reality it should be a combination of all of the staff’s writing

24. Near miss log Improvement Tool
Templates available from RPS website
To be used when reviewing the near miss log
Tool allows you to work out your near miss error percentage (calculated using your total items dispensed)
Review lets you understand
What type of near misses occurred
Why did they happen
What needs to happen to minimise the risk of it happening again
Review the actions within an agreed timescale to ensure action has been met
Complete as a team…not the pharmacist stuck in an office!!!
Does not have to be a drawn out process. If done weekly/monthly should not take > mins
The more reviews you do…the easier they become….and if the actions you put in place are correct, the error percentage will start to reduce
Question to the delegates at the end of the slide ‘we know that near misses occur due to incorrect strength…form…quantity etc…but can you name at least two real causes why they actually happen?’
1)Not looking properly at the shelves i.e. complacency (i.e. assuming you have picked the right thing)
2)TALKING/CHATTING to each other (normally about what you watched last night on the TV!!!!) therefore distracted and not concentrating on the task

25. Before we carry on discussing the remaining forms……………….
…..using your own near miss logs you have bought with you today……spend 10 minutes to start to complete the improvement tool (at this stage only need to compete boxes 1, 2 and 3)
We will walk around and field any queries or questions

26. Community Pharmacy Medication Safety Incident report form
Templates available from various sites e.g. PSNC (or if you have company specific version…use them)
NPA’s Chief Pharmacist Leyla Hannbeck is acting as the Medication Safety Officer (MSO) for all independent pharmacies in England with fewer than 50 branches
All incidents should be reported to the NPA via their website (you do not have to be a member of the NPA to do this)
Completed forms can be printed off and kept in the pharmacy
When reporting using the NPA website, you will not need to also report to the National Reporting and Learning System (NRLS) as the NPA will do this for you (Please note: these incidents will be anonymised prior to sending)
Where you have a Superintendent Pharmacist, please ensure they are notified of the incident and that you follow the approved SOP process for incident management for your business
Printing and keeping forms will also help meet the GPhC governance standards

27. Community Pharmacy Medication Safety Incident report form
Key points to note on the incident form
Date of incident - where possible include date of dispensing and date notified of incident
Time
Degree of harm - don’t forget to update if the patients condition worsens
Patient details - Try and capture as much information as possible. It will make contacting the patient much easier especially to help resolve any issues
Contributing factors - just be honest !!!
Planned actions to prevent reoccurrence - The most important box !!!!
Contacting the patient - where a representative wishes to be the point of contact….don’t forget that patient consent must be received before you can discuss with anybody else

28. Controlled Drug (CD) incident report form
All healthcare professionals have a statutory duty to report all complaints, concerns or untoward incidents involving controlled drugs to the Controlled Drug Accountable Officer (CDAO)
All CD incidents need to be reported to the CDAO using the secure account provided
Upon discovering the incident, report as soon as possible and definitely by close of the play of the following day. At this stage you may only have partial information, however, further details can be submitted as they come to light
CD incident report should include:
Name, Role and Professional registration number (if applicable)
Date and location and telephone number where incident occurred
Drug name, form, strength and quantity
Details of actual incident, action taken, action planned and measures to prevent recurrence
(information below taken from Arden and GEM CD bulletin Issue 1 Dec 2016) tails of any internal investigation and learnings identified
Mention that some AO’s produce a CD bulletin with the latest information and up to date contact details

29. Controlled Drug (CD) incident report form
Examples of what to report: to CDAO-
Stolen/missing/lost CD prescriptions
Fraud involving CD’s Supplying CD’s without a valid prescription
Incorrect item/quantity dispensed
Dispensing out of date CD items
Spillages and missing CD’s
Prescribing errors involving CD’s
Incorrect labelling of CD’s
Incidents involving CD instalment prescriptions (FP10MDA)
CD balance discrepancies
Issues with CD requisitions
Incidents involving CD deliveries
CD’s handed out to incorrect person
Mention that some AO’s produce a CD bulletin with the latest information and up to date contact details

30. Patient Safety Alerts
NRLS (NRLS) leads and contributes to improved, safe patient care by informing, supporting and influencing the health sector
Types of alerts from the NRLS include:-
Rapid Response Reports
Patient Safety Alerts
Safer Practice Notices
Other places you can receive alerts from include:-
MHRA
GOV.UK
RPS (if registered with them, they can send you drug and device recalls, patient safety notices etc)
NHS England
Local teams

31. Things to think about:-
Patient Safety Alerts
Things to think about:-
How do you get your alerts?
How do you know you are receiving all of them?
What do you do when you get the alerts?
What do you do with the alerts that are not applicable to you?
Keep all alerts
Stamp, date and sign and include action taken
If not applicable, still do as above but state no action applicable
Set up a folder to show evidence (in date order preferably). No requirement to do so but good practice
As an add on…..Do the same for CoC (certificates of conformity)…keep on a file

32. Case study
The month has ended and you are required to complete a Patient Safety Report
Using the information below….start to complete the report
Total items dispensed for the month 9,642
Total number of near misses for the month 86
Total incidents reported to NPA 2
Incident 1 - Azithromycin dispensed instead of Azathioprine. No incorrect medication taken by patient. Contributing factor - messy shelves
Incident 2 - Patient given Insulin Humalog Mix 25 instead of Mix 50. Patient has used three doses and suffered mild side effects however patient is now OK. Contributing factors - disorganised fridge and dispenser who lacks knowledge of insulins
1 CD discrepancy - 1 Concerta XL 18mg tablet missing. Reported to CDAO
Zero patient safety alerts received
15 CPPQ responses
Zero pharmacy complaints
Time for case study dependant on session time remaining
Use template patient safety report - share this is a mock template and not official as no official report released yet !!!!
Ask everyone to share any key insights
Walk the room and input on tables
If not raised…question zero patient safety alerts???????

33. ANALYSIS PATIENT SAFETY REPORT Pharmacy name Month / Year
Near miss error % for month
Total no of near misses for month
Total no of incidents for month
Total no of CD incidents for month
No of patient safety alerts received/ actioned for month
No of CPPQ responses received for month
No of pharmacy complaints for month
ANALYSIS
Complete the next section after your team has discussed and identified the key contributing factors and root causes for each of the following
Near Misses
Issue identified
Cause / contributing factor
Dispensing Incidents
Issue identified
Cause / contributing factor
Pharmacy Complaints
Issue identified
Cause / contributing factor
Other Issues e.g. CPPQ
Issue identified
Cause / contributing factor

34. KEY ACTIONS: PHARMACY Action 1 Reason Action 2 Action 3 Date Agreed
Description
Action Owner
To complete by
Outcome
Team briefed
Action 1
Reason
Action 2
Action 3
Date Agreed
Date Reviewed
Pharmacist Lead

35. Refreshments (12 noon)

36. Asthma – Clinical Effectiveness (12:15)
Fiona Lowe

37. Asthma – clinical effectiveness quality payment
Community pharmacy contractors passing the gateway criteria will receive a Quality Payment if they meet one or more of the Quality Payment criteria. One of these is:
‘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.’
Two opportunities to collect 10 points (each worth £64)

38. Asthma review
Requires pharmacists to refer asthma patients to an appropriate healthcare professional if they have been dispensed more than six short- acting bronchodilators without any corticosteroid inhaler within a six month period
Evidence required and if a minimum number of patients to be referred not yet clear
In the meantime, consider what changes may need to be made to, for example, standard operating procedures (SOPs), and Patient Medication Record (PMR) systems
Ensure pharmacy team can identify short-acting bronchodilator inhalers and corticosteroid inhalers

39. Asthma review Eligibility They have been diagnosed with asthma
They have been prescribed an inhaler containing one of the following short-acting bronchodilators:
Short-acting beta-2 agonist
Ipratropium bromide
They have been prescribed more than six inhalers containing a short acting bronchodilator in the last six months
Inhaled corticosteroid therapy has not been prescribed during this six month period

40. Asthma review Meeting the criterion
Identify potential patients that meet this criterion
E.g. Checking patient medication record (PMR) to see if the patient is eligible when presenting with a prescription
Speak with the patient to understand their inhaler use
Medicines Use Review (MUR) or their inhaler technique check may be undertaken
If an issue is identified:
Refer patient to their GP using the pre-determined referral system
All referrals should be documented on the patients PMR
It may also be appropriate to use a data collection form as evidence for the criterion being met
The NPA has produced a data collection form that can be used to collect the data.

41. How to achieve the quality payment
Further information on this Quality Payment criterion is available in PSNC Briefing 068/16: Quality Payments – referrals for asthma reviews (November 2016)
Process
A suggested process for pharmacy teams to follow to incorporate this Quality Payment criterion into their daily practice can be found below.
Asthma referrals – Suggested process for referring patients for an asthma review (Word)
Asthma referrals – Suggested process for referring patients for an asthma review (PDF)
This process looks to identify patients who have been diagnosed with asthma and have been prescribed more than 6 short-acting bronchodilators in the last 6 months as these patients are likely to require their asthma to be assessed urgently.

42. Referral Process

43. Tools available on PharmOutcomes

46. What added value is possible?
MUR
NMS
Inhaler technique checks
Differential diagnosis from COPD
Clinical audit
Evidence of supporting patients with LTC
Link to other services
Build relationships with GP Practice team
Future sessions – NMS/ MUR support and inhaler technique training

47. Q&A (12:45) (Christie’s in breakout room)

48. Lunch & stands (13:00) Christie Presentation in Breakout Room
Or in Breakout Room – Basics & Gateway Practical Support 13:30 – 14:00

49. Dementia Friends (13:30) Hayley Berry
A Dementia Friend learns a little bit more about what it's like to live with dementia and then turns that understanding into action - anyone of any age can be a Dementia Friend.
Dementia Friends (13:30)
Hayley Berry
Or in Breakout Room – Basics & Gateway Practical Support

50. Safeguarding (14:00)
Hayley Berry

51. Refreshments (15:45 – 16:00)

52. Healthy Living Pharmacy Introduction (16:00)
Fiona Lowe
Or in Breakout Room – Basics & Gateway Practical Support 16:00 – 17:00

53. Healthy Living Pharmacy – getting started

54. Healthy Living Pharmacy (HLP)
Can be claimed for at one of the two review points and is worth 20 points
Requires pharmacy to achieve HLP level 1 status – this is self-assessed
HLP level 1 status includes having at least one member of the pharmacy staff being a Health Champion, and at least one member of the team undergoing leadership training

55. Key Criteria
Meet all essential Contract Criteria including governance and health promotion requirements
Meet Gateway Criteria
Consultation Room
Providing MURs and NMS
Provide or signpost to provider of NHS Flu and NUMSAS
Health Promotion Zone in place and updated regularly
Proactively engage local commissioners, charities and signpost to other local services
One Leader per pharmacy attended recent Leadership training from appropriate provider and has certificate
One FTE Health Champion per pharmacy completed RSPH Level 2 Understanding Health Improvement and passed exam with certificate
All pharmacy staff can provide brief health interventions (MECC)
Record evidence of activity including signposting and photos of health promotion events

56. Support available Health Champion and Leadership training
Face to face options near to you
On line options
Expert advice and support from Michelle Dyoss – part of the national group
Prospectus with all the information that you need to meet National Criteria
Reaccreditation for HLPs > 2 years old, where criteria still met.

57. Examples of evidence collection
Certificates – e.g. HLC, leadership training (required when claiming completion of training; certificates for assessment and/or training)
Minutes of pharmacy meeting notes showing HLC sharing learning with the pharmacy team
HLP action plan
Written feedback from pharmacy team members to their team leader
Photos of the pharmacy team engaging with the public (consent), consultation room, pharmacy, HLP logo location, recycling bins, paper disposal system, outreach work
This list is not exhaustive but offers some guidance on how to show that the requirements have been met

58. Examples of evidence collection
Case studies of local outreach programmes conducted by pharmacy
Health and wellbeing notice board – local public health services / initiatives information
Health and wellbeing information in a range of formats (e.g. DVDs, plasma screen, leaflets etc)
Signposting information folder
Lists of local public health commissioners and their contact details along with examples of correspondence with them (e.g. s, letters)

59. HLP action plan Area for improvement / Objective / Goal
Actions to be taken
When by
Who is responsible
Support / resources available
Outcome
HLC training and certification
Identify suitable member of pharmacy team to train, source training (NPA), book, payment, allocate time to undertake
30 April 2017
Joe Bloggs
e.g. Funding to undertake training, training time for individual, training provider identified - NPA
Training undertaken by [a] on [date], certificate available
Team leadership
Source training (NPA), book, allocate time to attend
31 May 2017
Pharmacist/Pharmacy owner
MUR
Continue to provide service
Ongoing
Pharmacist
Service provision maintained
NMS
Health promotion zone
Identify relevant local health topics to promote. Review and update at least every two months
Review every two months and update
HLC
Time to research local issues and update the information. Local health campaigns and resources can be used
HLC regularly updates content and patients are using the resources
Example of an action plan that contractors can set up to ensure standards are met

60. Community pharmacies in England are now able to register as a Level 1 Healthy Living Pharmacy (HLP) under the new self-assessment process. The Royal Society for Public Health (RSPH) is the quality assurance provider for the HLP self-assessment scheme, and contractors can register their pharmacy as a Level 1 HLP by completing the registration process on the RSPH website. Achieving HLP Level 1 status is one of the quality criteria under the new quality payments scheme for community pharmacies in England.  This criterion is worth 20 quality points, which amounts to a minimum payment of £1,280. The self-assessment process requires pharmacy teams to work through the HLP Level 1 quality criteria, provide appropriate evidence and complete an online assessment of compliance form. Once this is completed satisfactorily and submitted to the RSPH, pharmacies should receive confirmation of registration and an HLP certificate within ten working days. Currently, registration is free, as this pilot scheme is being funded by PHE.  HLPs will need to go through the self-assessment process and registration every two years. Pharmacies already accredited as HLPs by their Local Authority will not be able to complete the registration process with the RSPH, as this pilot scheme is for community pharmacies that are yet to achieve level 1 HLP status.  Information on the NPA training available to meet these criteria is on the NPA website.

61. Wrap Up (16:30) Thank You Feedback Forms Q&A Next Sessions
Safe Journey Home
Or in Breakout Room – Basics & Gateway Practical Support