1. North Lincolnshire CCG Community Pharmacy Minor Ailments Scheme 11 January 2018
Caroline Hayward
Professional Development Pharmacist
Community Pharmacy Humber LPC

2. Agenda NL MAS Service Specification PharmOutcomes Live demonstration
Questions

3. What is the Pharmacy Minor Ailment scheme?
Pharmacists should be first point of call for common ailments
Cost of OTC medication prohibits some people from using their pharmacy
Pharmacy Minor Ailment service - designed to give people easier access to advice and medicines free of charge without the need to see a GP
Reduce pressure on GPs - freeing up their time for people with more complex medical complaints.
Reduce pressure on A&E departments
Promote self-care
Community Pharmacies provide access to a qualified health professional:
Convenient and accessible location
Available in local community
Fast same-day access: No need to wait for an appointment
England - no national scheme - Services locally commissioned therefore vary across areas
28 Conditions covered in the NL CCG scheme
Not an opportunity to simply stock up on medicines free of charge
Treatments can be refused by the pharmacist if abuse of scheme suspected

4. Pharmacy Criteria for participating in the NL Minor Ailments Service
Must provide all Essential Services within the Community Pharmacy Contract.
Must have a pharmacist on the premises whilst participating within the scheme.
All consultations must take place on the pharmacy premises and any medication if supplied must occur at the completion of the consultation
Must have a private consultation area that meets the requirements in NHS Directions for Advanced Services.
Can be provided by a qualified medicines counter assistant or member of staff who is qualified to NVQ 2 in Pharmaceutical Services and keeps their CPD up to date with regard to minor ailments.
Participating Pharmacists should keep their CPD on minor ailments up to date
Must operate within the NL CCG minor ailment service specification guidance booklet (Booklet TBC)
All service delivery information must be recorded onto PharmOutcomes platform

5. Who can access the scheme?
Patients exempt from paying NHS prescription charges
children < 16 years of age who self refer, without parental
agreement must be Gillick competent to receive this service
(Form available to download from PharmOutcomes
platform if required)
Patients who pay for their prescriptions - referred to a pharmacy for advice and to purchase
over the counter medicines in the usual way.
Must be registered with a GP practice located within
the North Lincolnshire CCG area
Minor Ailments Service is a "stepping stone" towards
the "Self-Care" approach to healthcare
Emphasis on self care advice and education
Products provided to support self-care if appropriate
Patients can receive advice and/or treatment for the conditions included in the scheme

6. Conditions covered in the NL MAS
Acne
Athlete’s Foot
Cold Sores
Conjunctivitis
Constipation
Cough/Cold/Flu/ High temperature including Prevention of fever after vaccination
Cystitis in adult females
Dandruff
Diarrhoea
Dry Eyes
Ear Wax
Eczema, Dry or Itchy Skin
Haemorrhoids (Piles)
Hay Fever
Head lice
Indigestion/Heart Burn/Tummy upset/ Vomiting
Insect bites and stings
Mouth or Gum Swelling
Mouth Ulcers
Nasal Congestion
Nappy Rash
Pain
Sore Throat
Teething
Threadworms
Thrush
Warts & Verrucae

7. Where will I find details of the MAS scheme?
Minor Ailments guidance booklet: Details of scheme operation
Pharmacies signed up to MAS service: Receive booklet and must work within its specification.
Only the Clinical conditions included in the booklet can be treated through the MAS scheme
Each Clinical Condition has a separate monograph (based on CKS guidance)
Monograph includes:
Definition of condition
Criteria for inclusion (group you can treat)
Criteria for exclusion / referral (You cannot treat these clients)
Self-care advice
Action for excluded clients
Recommended Treatments: Route, Legal status. Frequency of admin & max dosage
Additional treatment advice
Conditional referral to GP
References :
Medical products provided : MUST be relevant to the condition you are treating and contained within the guidance booklet

8. Examples of monographs

9. Service criteria NHS Number Consent to access NHS spine
No NHS number /doubt eligibility: decline treatment, urge client to seek medical care via GP or OTC route.
Patients' must be present at the pharmacy to receive the service.
Encourage patient to use same pharmacy all the time – not essential
PMR entry: Pharmacies should keep a detailed record of ‘Minor ailment service’ treatments on their PMR system.
Pharmacies should not issue the same medication to a patient within a four week period
Patients must give their consent to share details of the consultation with their GP
Normal rules of patient confidentiality apply. 
May be occasions when a parent/ representative presents for a child/ relative / friend.. PHARMACIST must use their professional judgement as to whether to treat client (risk assess scenario). Use professional discretion, act in the best interest of the patient.

10. The consultation
Consultation by pharmacist or trained MCA to assess patients condition will consist of:
Patient assessment.
Provision of advice – encourage self-care / patient education
Provision of a medication (Only if necessary, from the agreed formulary and suitable
for age of client).
Clinical management advice: Clinical Knowledge Summaries
Entering details onto the PMR.
When advice and/or treatment given to a child; recommend
pharmacist makes an entry in the child's ‘red health book;
include the date, pharmacists name and GPhC number
Complete a FPPharm (Pharmacists Prescription) or the PharmOutcomes
equivalent. (Can be downloaded from PharmOutcomes, electronic copy
will be automatically sent to the GP Practice. if doesn’t auto-send will
receive notification to print out and send manually)
Patient to complete and sign exemption declaration on
FPPharm or basic provision record confirming receipt of meds
and exemption as per FP10 (next slide)
Reason for client signing sheet is to confirm that meds have been supplied. Therefore it verifies the pharmacies submission and payment claim

11. Pharmacist FPPharm / Downloadable basic provision report including Exemption declaration form
Reason for client signing sheet is to confirm that meds have been supplied. Therefore it verifies the pharmacies submission and payment claim

12. Pharmacist referral procedure to GP Practice
When to use General Referral Procedure
Patient presents more than twice in a month with same symptoms: refer if clinically appropriate.
If symptoms do not meet the criteria for a rapid referral advise patient to make appointment in normal manner.
Complete Pharmacy Referral Form, fax to the practice (downloadable form from PharmOutcomes platform)
Rapid Referral Procedure –
If symptoms indicate need for immediate consultation with GP: Contact surgery and make an appointment for the patient within an appropriate time frame.  
Fax a completed Referral Form to GP Practice immediately
If the surgery is closed and/or the symptoms are sufficiently severe the patient should be advised to contact NHS 111, the ‘Out of Hours Service’ or attend A & E.
Abuse of the scheme
Suspected abuse of the scheme by patient and/or carer alert the patient’s GP in the first instance. Continued abuse of the scheme should be escalated to NHS England

13. Minor Ailment GP referral Form

14. Service funding and payment mechanism
Every consultation must be recorded on the PharmOutcomes platform
A monthly summary claim sheet will be automatically transmitted via PharmOutcomes to NHSE Area Team Office on the 6th working day of each month for monthly reimbursement of drug costs, evaluation of the service and feedback to practices.
Fees:
£4.10 per MAS consultation
Drug costs reimbursed at drug tariff/agreed cost prices plus VAT monthly.
Drug costs based on Dm&D pricing, these will automatically update within the electronic PharmOutcomes platform. Accurate up to date claims every month.
All payments made monthly through the NHS business services authority
Claims that are not completed correctly on the appropriate forms will not be processed.
Sample sheet in pack.. Also available as excel document for submission via

15. Monitoring and Evaluation
Pharmacies and GP Practices will be expected to participate in monitoring and evaluation of the scheme to show:
Cost and volume of pharmacy interventions and indications treated. (data collected via PharmOutcomes)
The Pharmacy must participate in any CCG organised audit of service provision.

16. PharmOutcomes Live demo
Use of PharmOutcomes
PharmOutcomes Live demo

17. Any Questions? LPC Contact details
LPC Contact details:

18. Use of PharmOutcomes – Stage 1 Registration
Start by logging on to PharmOutcomes
Click on services tab at top of screen
Select the relevant platform on left of screen:
Stage 1- Minor ailments service registration
Stage 2- Minor ailments consultation
Please note clients must be registered on
platform 1 before medication can be provided
on platform 2
Enter client details on platform 1.
GP can be selected from drop down by
entering part of practice name
Confirm patients eligibility for the scheme
Drop down options to confirm registration with
a NL CCG GP

19. PO– Consultation Stage 2
Stage 2 Consultation platform
Type patients name in the field
If they are registered on platform 1 their name and
details will appear
Patient must consent to treatment and the sharing of
data with their GP
Select symptoms/ condition from drop down list
Indicate whether advice/advice and medication given
Enter details of medication provided in box (start typing)
Only meds from approved list will pop up
Refer to left hand side of screen for prompts
Enter quantity (i.e. pack size)
Repeat for a second condition if applicable OR leave
blank
Record any referrals
Conditional logic: if you choose headlice as the condition to treat, the option to record provision of a detector comb arises
If you chose a liquid prep then the option of an oral syringe appears.

20. PO– Consultation Stage 2
Record levy status
Record where client would have gone if MAS not available
Record Name of Pharmacist
Save
Print out basic provision report and ask client to complete exemption info and sign
Refer to left hand side of screen for prompts

21. Downloadable resources from PharmOutcomes
Left hand side of both MAS service platforms
has downloadable resources:
Draft North Lincolnshire MAS service
specification booklet (TBC:DO NOT PRINT)
Appendix 2 - Consultation record
Appendix 3 - GP referral form
Appendix 4 - Gillick competence
Click to download