Tech module- Wider Pharmacy Services

Wider Pharmacy Services

The Community Pharmacy Contractual Framework

  • Wales

    • 3 different levels of pharmacy services:

    • Essential Services

      • Dispensing medicines and appliances

      • Repeat dispensing

      • Clinical governance

      • Public health and promotion of Healthy Lifestyles

      • Disposal of waste medicines and patient returned medicines

      • Signposting

      • Support for Self Care

    • Advanced Services

      • DMR (Discharge Medicines Review) – this Advanced Service is only available in Wales. The aim of DMR is to reduce medication errors when patients are discharged from hospital, where their medicines may have changed

      • AUR (Appliance Use Review) – specialist service for patients using appliances such as catheters

      • Stoma Customisation Service – specialised service for patients with stoma

    • Enhanced Services

      • Anticoagulation monitoring

      • EHC (Emergency Hormonal Contraception)

      • Gluten-free food supply service

      • Minor Ailment Scheme

      • Out of Hours Services

      • Smoking Cessation

      • Seasonal Flu Vaccination

  • Local Services for Local People

    • These are locally commissioned services to suit local needs, examples include:

      • Blood pressure and cholesterol monitoring

      • Seasonal flu vaccination

      • Diabetes testing and monitoring

Patient Consent for Services

  • Consent

    • Most clinical services such as NMS and flu vaccinations require written consent from the patient prior to providing the service

    • you should provide all the necessary information to help them make an informed decision about whether to use the service

    • You should always explain how the service works, what is the scope of the service and how the service can help the patient.

    • You must also give the patient an opportunity to ask questions and confirm their understanding before giving consent.

    • Giving patients printed information about the service, such as leaflets, will help to summarise the information and allow them to decide in their own time.

Dispensing Services

  • Services related to dispensing include:

    • NHS Repeat Dispensing Service

    • Repeatable Prescriptions in community pharmacy

    • Chronic Medication Service (Scotland)

    • Emergency Supplies

  • NHS Repeat Dispensing Service / electronic Repeat Dispensing (eRD)

    • community pharmacies must take part in the Repeat Dispensing Service.

    • patients who take regular medication for a condition that is stable can get their repeat medication from the pharmacy without a new prescription being printed each time

    • The scheme starts with the GP reviewing the patient's medication and if the patient agrees, they authorise a set number of prescriptions in advance, usually 6 or 12 months' worth.

    • Under this scheme, the pharmacist must review the patient each time the medication is dispensed to ensure it is still appropriate for the patient.

    • Repeat Dispensing used to be done on paper prescriptions, but as the Electronic Prescription Service (EPS) becomes increasingly common, the majority is now sent electronically using EPS

    • After the GP decides how many times the prescription can be repeated and how often to repeat it (the interval, usually 28 days), the repeat prescription is sent to the nominated pharmacy via EPS at the specified intervals

    • service is not to be confused with a Repeat Prescription Collection service where patients authorise the pharmacy to collect their prescriptions from the doctor’s surgery on their behalf to be dispensed at the pharmacy.

  • Repeatable Prescriptions - Community only

    • Occasionally a repeatable prescription will be presented for dispensing. These prescriptions can be dispensed more than once if this is what the prescriber has requested.

    • Repeatable prescriptions will be private prescriptions. They are different to the NHS Repeat Dispensing Service.

    • instruction to repeat the dispensing will be written within the main body of the prescription underneath the drug.

    • If the instruction is "repeat" this means the items can be dispensed twice; once initially and one repeat dispensing.

    • If the prescriber has written "repeat four times" this means the prescription can be dispensed a total of five times, once initially and then on four other occasions.

    • If the medicine is an oral contraceptive, "repeat" means it can be repeated five times (so it can be dispensed for six times in total).

    • Patients can take the repeatable prescription away with them (provided it has not been dispensed for the last time, in which case the pharmacy will keep it)

      • so it is extremely important to keep a record of the dispensing in the prescription-only register as well as within your patient medication records on the dispensary computer.

    • first dispensing must be within six months of the date on the prescription or four weeks for Schedule 4 Controlled Drugs. Prescriptions for Controlled Drugs in Schedules 2 and 3 cannot be repeated.

Clinical Services

  • Include:

    • Patient Group Directions (PGDs)

    • Emergency Hormonal Contraception (EHC)

    • Pharmacy First service

    • Direct Referral Scheme and the National PGD (Scotland)

    • Appliance Use Reviews (England and Wales)

    • New Medicines Service (England) and Discharge Medication Review Service (Wales)

    • Signposting

  • Supply of Medicines against Patient Group Directions (PGDs)

    • Patient Group Directions (PGDs) are an arrangement that allow certain medicines to be supplied by healthcare professionals on behalf of a prescriber such as a doctor or dentist.

    • has to be a written instruction for the supply or administration of the medicine to a particular group of patients.

    • normally locally commissioned services set up in a specific area and pharmacies within the area choose if they wish to participate

    • usually receive additional payments from local authorities or from the NHS for taking part

    • There are also private PGDs which means that patients have to pay the full costs of any medicines supplied.

    • example you might be aware of is a flu vaccination which is offered by many pharmacies to the general public via this route.

    • supply of Emergency Hormonal Contraception (EHC) is a common PGD which many pharmacies offer on the NHS.

      • Patients meeting the criteria for supply will usually not have to pay for the medication.

      • Depending on the PGD, there may be age restrictions for patients who can have EHC supplied free of charge