2. Pharmacy and Beyond

3. Pharmacy 2016 and Beyond
On the 1st December 2016 the government imposed a two-year funding package for community pharmacy.

4. 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.

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

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

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

8. What does this mean for your pharmacy?

9. PSNC website: indicative income calculator
Quality Payment
Indicative Income

10. PSNC website: cashflow calculator

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

12. Monthly Cut Annual Cut April 17 to March 18
Items per month
December 16 to March 17
Monthly Cut
Annual Cut
April 17 to March 18
5000
-£8812
-17%
-6%
-£17592
-11%
8000
-£12316
-16%
-5%
-£19776
-8%
10000
-£14652
-15%
-£21228
-7%
15000
-£20492
-£24876
20000
-£26332
-14%
-£28524
25000
-£32172
86000
-£100656
-4%
-£76656
-3%

13. Quality Payments Scheme

14. Funding £75m 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

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

16. Claiming payment
There will be two review points during the year, at which quality payments can be claimed:
Friday 28th April 2017; and
Friday 24th 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

17. 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

18. 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 request by 1st February

19. Requesting an NHSmail account for your pharmacy
Contractors that wish to apply for an NHSmail account for their pharmacy, can do so by ing the following information to
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.

20. Contractors with multiple pharmacies may submit this information via one , 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.

21. Already have an NHSmail account for your pharmacy
NHS England and 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.

22. 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.

23. 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

24. From 7th 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.

25. NHS Choices will maintain a record of when each contractor last updated its NHS Choices profile from 7th February 2017 until the first review date; and then again from 1st May 2017 until the second review date in November 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 7th February 2017 for the first review period and after 1st May 2017 for the second review period.

26. 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.

27. Registering for NHS Choices management rights
If you have not already been fully set up on NHS Choices:
the 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.
Any 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 confirmation.

28. 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/

29. Quality Criteria

30. Quality criteria

31. 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

32. 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

33. 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:

34. 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
or local Dementia Action Alliance
All staff – including locums
Record sheet on the PSNC website / keep copies of webpage

35. For organisations: Steps to becoming a Dementia Friend
Register your pharmacy on the Dementia Friends website

36. 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,
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.

37. 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 sent to could be retained to show to NHS England, if required.
The record sheet is available on the PSNC website.

38. Route 2
If you would prefer for your pharmacy team to attend a face-to-face Dementia Friends Information Session, please

39. Safeguarding Claim at both review points - 10 points (£640)
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
All pharmacy professionals – including locums
Record sheet on the PSNC website / keep copies of certificate/webpage print out

40. 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 & PharmOutcomes module
Talk to local GP practices about this
Inhaler technique checks and MURs…

43. 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.

44. 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.

45. PharmOutcomes: Asthma Quality Criterion referral tool
Contractors will find the Asthma Quality Criterion reporting tool under the “Services” tab of PharmOutcomes under the orange heading “Provide Services”
The tool operates in the same way as any PharmOutcomes 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.

47. 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 and NHS Digital are considering how pharmacies will be able to access their DoS entry and the process by which errors can be notified to NHS 111 DoS leads. 
Currently no action can be taken by contractors to comply with this Quality Payment criterion.

48. 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 and the NHS Choices team about how this is to be undertaken by contractors
Upload a PDF – probably using a standard template

49. Patient safety report Claim at ONE review point - 20 points (£1,280)
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

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

51. 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.

52. 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.

55. 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
PharmOutcomes modules available to help track progress and make referrals/records for the asthma criterion

57. 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

58. Our suggested plan for contractors
Provision of Advanced service*
Clinical effectiveness – asthma
Use of EPS*
NHS11 DOS
NHS Mail*
CPPQ publication
NHS Choices entry*
Patient safety report
Use of SCR
HLP
Dementia Friends
Safeguarding
* = Gateway Criteria

59. Quality Payment Scheme
For 1st Review 28th 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)
NHS111 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

60. Quality Payment Scheme
For 2nd Review 24th November 2017
All of the above
Total points (27.5) worth £1760

61. 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

62. 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

63. Worked Examples
Assuming that everyone does the quality payments scheme

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

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

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

67. NUMSAS

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

69. 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)

70. 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

71. Fees that will be paid A Consultation fee of £10, and
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:
A Consultation fee of £10, and
An Administration fee of £2.50 per consultation to reflect the additional work/documentation required to support evaluation of the service
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

72. Key resources
NHS England - Service specification (published 29th 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 1st 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

73. 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

74. 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

75. Questions about NUMSAS
psnc.org.uk/pharmacychanges
psnc.org.uk/numsas
psnc.org.uk/numsasfaqs

76. Pharmacy 2016 and Beyond
What is the LPC doing to help contractors with the changes ?
Where can contractors get information about the changes?

77. Weekly Updates:

78. CPS Website

79. PSNC website psnc.org.uk/pharmacychanges
psnc.org.uk/funding-and-statistics/cpcf-funding-changes and /