PQS Asp spir iratio ion Payments Claim in October 2019 Aspiration payment for the 2019/20 PQS. Confirm that will meet the gateway criteria, indicate which quality criteria intend to complete and so how many points they expect to achieve. Can claim an Aspiration payment only if received a QP for either the June 2018 or February 2019 QPS and have registered for the MYS application. The maximum number of points can be paid for Aspiration payment is 70% of average number of points achieved across the two declaration periods It will be paid on 30 th November and reconciled with payment for the 2019/20 PQS on 1 st April 2020
PQS Gateway Advanced NHS Services – NMS or FLU – with evidence of claims in run up to declaration plus entry on NHS website NHSmail shared – in use with two active NHS accounts linked NHS website updated during October / November 2019 – all 3 sections (opening & bank holidays hours, services, facilities) 80% GPhC registered staff must have completed Safeguarding level 2 training within last 2 years Passing the gateway criteria will only deliver a payment if meet one or more of the quality criteria bundles/standalone criteria.
The pharmacy must be able to demonstrate access to SCR between 1 st October and the day of declaration. You can view this on the spine portal, using smartcard. • PharmOutcomes allows SCR access via the SCR 1 click option • NHS Digital publishes details of the SCR accesses made each Thursday. You are advised to check this and keep a screenshot as evidence https://digital.nhs.uk/services/summary-care-records- scr/summary-care-record-scr-in-community-pharmacy/prove-scr-access-for-the-pharmacy- Dig igit ital l quality-scheme-2019-20 You must have updated the NHS 111 DoS profile via the DoS Bundle le (2 (2.5 .5) updater in October / November: • Including opening hours for Easter Sunday 2020, public and bank holidays and • Must promptly update profile as information changes, ensure accurate in real time for referrals e.g. from NHS111 for CPCS • You will be able to search and update using the DoS Profile Updater, by ODS (F) code or Postcode to make sure that ALL of your services are listed
As Asthma Bundle (5 (5) • Evidence that asthma patients, having more than 6 short-acting bronchodilator inhalers without any corticosteroid inhaler within a 6 months period, have since the last review point been referred to an appropriate HCP for an asthma review • Plus can evidence that have ensured that all children aged 5-15 prescribed an inhaled corticosteroid for asthma have a spacer device where appropriate in line with NICE TA38 and have a personalised asthma action plan. If not, you need to refer to an appropriate HCP
PCN Bundle le (2 (22.5 .5 or 12.5 .5) More this afternoon…….
What ar are Prim imary Car are Networks? • GP practices working together in groups with community service providers and other health and care organisations, including community pharmacies • NHS Long Term Plan - all GP practices to be in a PCN • PCNs have: • an average 30,000 to 50,000 patients • 5-6 general practices • 9-10 community pharmacies • They will have teams comprising of a range of staff, e.g. GPs, pharmacists and allied HCPs • 100-150 clinicians and wider staff • Small enough to give a sense of local ownership • Big enough to have an impact • Different names may be used to describe them locally, e.g. locality, hubs or clusters
Primary Care Networks Bundle • Demonstrate that your pharmacy, and all other pharmacies within the PCN ,who wish to engage with a PCN, have agreed a collaborative approach . • Agreement on a single channel of communication with the PCN by appointing a named lead representative for all of the engaged community pharmacies in the PCN. • The Pharmacy PCN Lead must have provided their name to the LPC and must have evidence that have started the engagement process with the PCN, i.e. they have made initial contact with the Clinical Director for the PCN either by contacting by (post/email) or a meeting • All pharmacies claiming for this domain must submit the name, pharmacy along with ODS (F) code of their appointed Pharmacy PCN Lead as described in the NHSEi PQS Guidance. • The Pharmacy PCN Lead must declare: • that they are the appointed Pharmacy Lead for that PCN; • the name of the PCN; • that they have notified this to the LPC in which the PCN lies; and • that they have evidence of having started the engagement process with the PCN • The LPC will be supporting the Leads and have link LPC Leads for each PCN and have developed some resources and training
LPC LPC Support for or PCNs • PCN Newsletters • Section on our websites under resources • Resources and handouts • Facilitate • mapping pharmacies to PCNs • appointing Leads
Preventio ion Bundle le (2 (25) HLP Dementia Friends & Friendly Diabetes Sugary Drinks
Preventio ion Bu Bundle le • HLP Level 1 (self-assessment) • ALL patient facing staff are Dementia Friends • Dementia friendly environment standards checklist • Discussions with all people with diabetes – eye and foot checks • Reduction in volume of Sugar Sweetened Beverages sold by the pharmacy (10% or less)
He Healt lthy Liv ivin ing Ph Pharmacy (HLP) • Most pharmacies already are HLP accredited • If > 3 years ago need to check still compliant and document this – using the checklist • If not been HLP before refer to the PSNC and LPC websites or call the office for support • Leadership Training is available through CPPE and other providers • RSPH Level 2 Health Champion training is available from many providers including VirtualOutcomes, CHS, Pharmacy Complete, Buttercups
1) mid-February to Help Us Help You Pharmacy campaign (formerly mid-March 2019 Stay Well Pharmacy) Children’s oral health/Smile Month (in line with the 2) mid-May to mid- training that was incentivised by the Quality Heal ealth June 2019 Payments Scheme) Prom omotio ion Campaig Ca igns Antimicrobial resistance 3) September 2019 Resources for this campaign and Stoptober will be delivered together in August 2019 • You need to be supporting these as part of terms of Stoptober service as well as HLP 4) October 2019 Resources for this campaign and AMR will be • NHSEi will be providing a delivered together in August 2019 mechanism to collate data at some point until then keep a 5) November/ Help Us Help You main Winter campaign (formerly record / photos of any December 2019 Stay Well this Winter) activities to support these campaigns 6) January 2020 Alcohol
Dementia Friends • All patient-facing staff to be Dementia Friends. https://www.dementiafriends.org.uk/ What is a Dementia Friend? • Somebody that learns about dementia so they can help their community. What does a Dementia Friend do? • Help people living with dementia by taking actions - both big and small: from visiting someone you know with dementia to being more patient in a shop queue, every action counts!
Dementia Friendly Environment • Complete a dementia-friendly environment checklist – NHSEi guide • Create an action plan which includes making some demonstrable recorded changes to the environment in line with the checklist
Quiet space Signage requirements Lighting Checkli list t in inclu ludes Flooring Information Facilities e.g. toilets
Diabetic Screening • ‘ You must confirm that the pharmacy checked that all patients with diabetes aged 12 years or over, who presented from 1st October 2019 to 31st January 2020, have had foot and eye checks (retinopathy) in the last 12 months. • You must have recorded the patient’s response on the PMR or appropriate form/patient record and signposted/referred patients as appropriate. • This record should set out the total number of patients who have had this intervention, the number that have not had one or either check in the last 12 months, and it should be recorded where they have been appropriately signposted/referred and reported as part of this criterion’.
Diabetic Screening, Eyes Screening for eye problems (retinopathy) Everyone with diabetes, who is 12 years old or over, should receive a retinal examination once a year as part of the NHS retinopathy screening programme. At the screening, they will have a photograph taken of their retina, to check how healthy it is. Screening can take place either at a hospital or invited to book an appointment with an optician. The screening is free regardless of where it takes place. National Register – check with local surgery their process to book annual checks
Diabetic Screening, Feet Screening for nerve damage and circulation People with diabetes should have a foot examination at least once a year. Foot complications are relatively common, with foot ulcers alone affecting up to 1 in 10 people with diabetes, and need to be treated quickly to prevent them becoming even more serious. Note that it is very important that patients check their own feet on a daily basis as well, as foot problems can quickly become serious. If they notice any changes or damage to their feet, notify their doctor or podiatrist. The foot examination may be carried out by a diabetic consultant, a GP, a podiatrist or a nurse
Sugar Sweetened Beverages (SSBs) The sales by the pharmacy of Sugar Sweetened Beverages (SSB) account for no more than 10% by volume in litres of all beverages sold. The pharmacy must have either achieved this by the review point or declare that they will be meeting this by 31 March 2020. For the definition of added sugar see Annex B in the following link: https://www.england.nhs.uk/wpcontent/uploads/2017 /04/sugar-action-doc.pdf .
Medicines Safety Bundle – Audits – get started!
Medicines Safety Bundle (25) • Medicines Safety Audits complementing the GP QOF QI • Lithium • Complete a lithium audit, over three consecutive months, aligned with requirements of the NPSA alert on lithium (alternatives if not any Lithium patients: in order of priority - Methotrexate, Amiodarone, Phenobarbital) • Valproate • Complete a valproate safety audit, over three consecutive months for all girls and women of childbearing potential who have had valproate dispensed from the pharmacy • Repeat of the NSAIDs and gastro-protection audit • Implemented report from last audit and then repeat audit incorporating any learning into practice • Details in NHSEi guide along with the Annexes
Lithium Audit
Lithium
Valproate Audit
NSAID Audit it • Must have implemented, into practice, recommendations from the previous audit on NSAIDs for over 65 years without GI protection as part of the last QPS; the link for the report is in 4.2.4 . the NHSEi PQS 2019/20 Annexes to the guidance. • Repeat the updated audit, notifying the GP of any concerns, sharing anonymised data with NHSEi and incorporating any learning from the re-audit into future practice. • Note: Pharmacies that did not claim for the NSAID audit quality criterion previously, must complete the NSAID audit for the first time and complete the other elements. • Submission of information to NHS England & NHS Improvement should be reported on the Manage Your Service (MYS) application for all of the above audits.
Ph PharmOutcomes Su Support • Community pharmacy contractors can access support on PharmOutcomes for the Pharmacy Quality Scheme (PQS) 2019/20, and further support will be available soon. This support is available to all contractors free of charge. • Currently, support is available to assist contractors with meeting the asthma quality criterion . • Once a contractor has logged into PharmOutcomes, the tool can be accessed by clicking on ‘Services’; and then the two services are listed under the title ‘Pharmacy Quality Scheme – Quality criteria’. • The following audits/frameworks will also be available shortly; we will alert contractors through our normal communication channels when these become available: • PQS assessment framework; • Lithium audit; Methotrexate audit; Amiodarone audit; Phenobarbital audit; • Valproate safety audit; • NSAID audit; and • Dementia-friendly environment checklist.
Coffee Break 11:15
Risk Bundle (30) – with CPPE • CPPE Risk Management training and assessment • CPPE sepsis online training and assessment with risk mitigation and risk review entry • Update the previous risk review and record risk minimisation actions taken • CPPE online training and assessment on LASA errors • New safety report including a focus on LASA errors
CPPE Support Megan Harris, Hayley Berry, Mandip Rooprai 11.30 56
Overview Development of CPPE support for CPCF: Pharmacy quality scheme Development of CPPE support for CPCF: CPCS Future services- be service ready 57
Pharmacy Quality Scheme (PQS) Pharmacy Quality Scheme: CPPE have a bespoke Pharmacy Quality Scheme webpage which has launched in line with the NHS England PQS guidance document. There is some key learning and assessments which you can complete to help you in working towards meeting some of the elements of the PQS. This page tells provides more information about the learning. By logging into the CPPE website people can track their learning. https://www.cppe.ac.uk/services/pharmacy-quality-scheme 58
CPPE PQS webpage 59
CPCS highlighted on home page 60
Gateway criteria • Advanced services- Vaccination DoC available to help support provision of the Influenza vaccination advanced service ➢ The CPPE immunisation programme has been withdrawn and learning replaced with eLfH modules 1 and 2 • Safeguarding level 2- must achieve level 2 status within last 2 years of declaration ➢ Safeguarding – CPPE assessment updated o NHS website o NHS mail 61
PQS support Risk Management and safety domain • The CPPE risk management guide and associated assessment forms one quality criteria • Key message: if people have previously completed the learning and assessment they do not need to repeat it unless they wish to keep up-to-date 62
Sepsis and Reducing LASA errors Sepsis: learning and assessment This can be found on the CPPE Sepsis gateway page. Key message – all six cases to be completed Look-alike, sound-alike (LASA) errors: this is an e-learning programme with associated assessment 63
NEWS2 https://www.england.nhs.uk/ourwork/clinical- policy/sepsis/nationalearlywarningscore/ 64
LASA resources 65
MUR changes From 1 st October 70% fall in target groups of • patients taking high-risk medicines; or • patients recently discharged from hospital who had changes made to their medicines while they were in hospital. From 1st October 2019, patients with respiratory X disease and patients at risk of or diagnosed with cardiovascular disease and regularly being prescribed at least four medicines are no longer target groups for MURs. 67
MUR assessment Updated to reflect changes Remind pharmacy professionals to apply new targets and changes Changes to assessment live now 68
Next steps Consider your own learning needs and visit our website for further career development. Are you ready for the changes ahead, be service ready with CPPE support. ▪ Being aware of biochemistry and blood results: ▪ e-learning modules 1, 2 and 3 https://www.cppe.ac.uk/programmes/l/biochem1-e-01/ ▪ Epilepsy distance learning: https://www.cppe.ac.uk/programmes/l/epilepsy-p-01 ▪ theLearningpharmacy.com - Non-steroidal anti-inflammatory drugs (NSAIDs) ▪ https://www.cppe.ac.uk/programmes/l/tlp-e-05/ ▪ High risk medicines and MUR https://www.cppe.ac.uk/programmes/l/murrisk-p-01/ ▪ Pain management: https://www.cppe.ac.uk/programmes/l/pain-e-01/ 69
Primary care networks 70
NHS Community pharmacist consultation service • National curriculum – developed by HEE • Self-assessment framework Aim: to describe the knowledge skills and behaviours to enable pharmacists to deliver the service to the full scope of their professional capability This is not a DoC Divided into two sections: ➢ Knowing yourself, your team and the service ➢ Applying clinical knowledge and skills 71
Supporting resources 72
CPPE resources and face-to-face training The starting point……… 73
CPCS Changes Change for patients, Reduce demands on pharmacy teams, integrated urgent care other healthcare services professionals Increase patients awareness of the role of community pharmacy- first Linked to NHS 111- easy port of call for low acuity and convenient access for conditions, medicines and patients advice
Community pharmacy consultation service (CPCS) CPPE workshops • Across the country from October 2019 • Upskilling clinical history taking • Clinical examination skills • Red flags • Record keeping • Clinical transfer
Training details • GP medic trainer • Clinical demonstrator • Two CPPE facilitators • Full day events SOCRATES LICEF
New: Inhaler technique: improving outcomes Available from January 2020 across the country • On completion of all aspects of this learning programme you should be able to: • discuss the potential implications of poor inhaler technique • explain your role as a healthcare professional in optimizing inhaled medication • describe the different types of inhaler devices and their instructions for use • describe how the aerosol is made in each type of device • describe the breathing technique required to achieve the optimum inspiratory flow for each device
Dementia Gateway page: https://www.cppe.ac.uk/gateway/dementia Consulting with people with dementia Dementia distance learning Dementia e-learning
Audits • Valproate • Lithium • NSADIS
Other new clinical services in the contract • HLP status for all pharmacies • Phased role out of new services ➢ Improve access to palliative care medicines ➢ Hypertension and AF case finding ➢ Hepatitis C testing ➢ POCT for common ailments 80
New DoCs to support services • Commissioned by Blood Borne Birmingham Addiction Virus Testing services • Live on the website Atrial • New programme to fibrillation support service detection • Live in the next two weeks 81
A note about DoC • Please ask people to enable PharmOutcomes • Sonar : we may be linking DoC into Sonar in the same way in the near future • Please ask people to sign up for their six monthly DoC reminder
Future services • Be service ready • How can you prepare your teams for future services and changes? • What training would you like?
ACPT Train up the team to help support new contract and new services. Available to pharmacy technicians across England Fully funded by PhIF New cohorts every month- don’t wait join now
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Training and VirtualOutcomes - Sepsis Resources 12:10
CPCS 12:20 NHS Community Pharmacist Consultation Service
Com ommunity Ph Pharmacist Con onsultation Se Service (C (CPCS) • The NHS CPCS is the first clinical service of the new CPCF to be mobilised and starts on 29 th October • It brings together the learning from the NUMSAS and DMIRS pilots into one service • Referred from NHS 111 by the Advisor instead of being directed to a GP • Patients like the service and value the consultation in a confidential environment • Onward referrals may be necessary to other urgent care services or the GP • The face to face consultation of minor illness symptoms includes the recognition of any Red Flags • Over the course of the pharmacy contract the NHS CPCS will be monitored and evaluated • By 2020/21 the learning from the GP CPCS pilots will be evaluated and a decision taken about whether to include “streaming” from general practice into the service
CPCS • Follow up calls to no-show patients reduced to one (from three) • Transitional payment of: • £900 if signed up by 1st December 2019; or • £600 by 15th January 2020 • Fee of £14 per completed consultation • To pilot: expansion with referrals from GPs, NHS 111 online, Urgent Treatment Centres and possibly A&E
Result lts of of NHS111 DMIR IRS pilo ilots Phase 1: North East Phase 2: London, East Midlands, Devon • Estimated 6% of all GP consultations could be safely transferred to a community pharmacy • Equivalent to 20.4 million appointments per year. 90
Age e an and d Gen Gender Sp Split it
Top 10 referred symptoms (from DMIRS pilots) 1. Cough 2. Pain 3. High temperature 4. Allergic rash 5. Colds 6. Sore throat 7. ‘Flu’ 8. Headache/Migraine 9. Diarrhoea 10. Sprains & strains
How doe does CPCS CPCS in integrate with ith othe other ser services?
Patient calls NHS 111 or IUC CAS with a request for medicine or appliance The Call may be transferred to a clinician or handled by a call advisor. NHS CPCS ( N.B. Call advisors are non-clinical) Urgent medicines Patient triaged to Community Pharmacy Patient offered choice of 2 community pharmacies providing NHS CPCS. Ideally the patient must be able to attend in the pharmacy in person. patient flow Telephone number of the pharmacy given to the patient by NHS 111 or IUC CAS And advised to phone pharmacy within 30 minutes Message sent to Community Pharmacy electronically Sent via the CPCS IT system* (NHSmail to be used as a backup in case of system failure) Pharmacy hasn’t received Patient doesn’t contact Patient telephones the referral? The pharmacy? pharmacy Pharmacy checks IT system Pharmacy makes one attempt Assessment of request and ability to contact the patient as a Pharmacist phones NHS 111 to attend pharmacy minimum. (N.B . Patient not asked to contact 111) Emergency Supply No Supply to be made Pharmacist assessment Pharmacist assessment that that supply required and is legal Emergency supply not required/ allowed or not possible Emergency Supply Post Event Patient (or representative) Message to GP Attends pharmacy via CPCS IT to complete supply system* Another reason for Referral to Medicine/ appliance no supply GP OOH not stocked EPS Rx dispensed Emergency Supply Forwarded onto a Patient buys item required but not possible pharmacy Supply not necessary for legal reason With stock of item(s) Supply not clinically (e.g. controlled drugs) required * CPCS IT system – two providers at this time (PharmOutcomes appropriate and Sonar)
Patient calls NHS 111 or IUC CAS with a minor illness The call may be transferred to a clinician or handled by a call advisor. ( N.B. Call advisors are non-clinical) NHS CPCS Patient triaged to Community Pharmacy Minor illness Patient offered choice of 2 community pharmacies providing NHS CPCS. Ideally the patient must be able to attend in the pharmacy in person. Telephone number of the pharmacy given to the patient by NHS 111 or IUC CAS patient flow And advised to phone pharmacy Message sent to Community Pharmacy electronically Sent via the CPCS IT system* (NHSmail to be used as a backup in case of system failure) Pharmacy hasn’t received Patient doesn’t contact referral? Patient telephones the the pharmacy? Pharmacy checks IT system pharmacy or attends in Pharmacy makes one attempt Pharmacist phones NHS 111 person to contact the patient as a minimum . (N.B . Patient not asked to contact NHS 111) Pharmacist consults USE ESCALATION PATHWAY Pharmacist with the patient MUST check IF PATIENT NEEDS HIGHER NICE CKS to & gives appropriate advice ACUITY CARE identify any around self care and risk factors • prevention Pharmacist to call NHS 111 (Out of Hours service) OR The patient Patient requires Patient requires • Patient requires Support patient with urgent may often not referral to a higher acuity OTC medication appointment at own GP (In care – escalate require any locally support & self hours service) OR medication. commissioned care advice Self care advice service • Call 999 if more urgent is sufficient Patient is Patient can supplied on a purchase an local MAS OTC medicine The Pharmacist will complete the consultation on the CPCS IT system* Post Event Pharmacist will supply any relevant patient information leaflets from www.nhs.uk Message to GP Via CPCS IT Patient is always advised: system* “IF SYMPTOMS DO NOT IMPROVE OR BECOME WORSE, THEN EITHER COME BACK TO SEE ME OR SEEK ADVICE FROM YOUR GP” * CPCS IT system – two providers at this time (PharmOutcomes and Sonar)
In In th the Pharmacy • The patient has a structured consultation with the pharmacist in the consultation room. The pharmacist will use PharmOutcomes to collect information during the consultation • The pharmacist will use NICE clinical knowledge summaries and the patient’s SCR • The pharmacist will identify any red flags (e.g. sepsis/meningitis). If a condition is deemed as urgent the pharmacist will escalate back to NHS 111 or in a serious situation to A&E or 999)
In In th the Pharmacy Following the consultation the outcomes are: • Advice only (verbal, printed and self-care) • Advice and the pharmacist recommends the patient purchase an OTC product to help their symptoms • Advice and referral into another NHS service • Advice and signposting to another healthcare service • Advice and escalation as per the previous slide • In all cases the patient is advised what to do if their minor illness worsens and how long they should expect their symptoms to last The post event message will be sent to the GP practice
Im Imple lementatio ion • A national implementation group (including NHSE&I, PSNC, CCA) is leading the implementation • Roadshows led by the national Directory of Services (DoS) team are taking place with all 111 Providers • A NHSE&I roadshow is being held in each of the seven regions with CPCF in the morning and CPCS in the afternoon • Webinars from PSNC and NHSE&I for LPCs and contractors • LPCs are supporting contractors locally to get ready for the service • Additional training is not mandatory as the supply of urgent medicines and advice about minor illnesses is core work for community pharmacists. However, all pharmacy staff involved in provision of the service must be appropriately trained on the operation of the service
Preparation for delivering the CPCS Check that your pharmacy can provide the service ✓ Must be providing all Essential services and meeting clinical governance requirements ✓ Have a clearly-designated consultation room (equipment must be available to allow the pharmacist to record notes electronically during the consultation from 1 April 2020 ) ✓ Have access to Summary Care Record (SCR), the pharmacy’s shared NHSmail mailbox and the local secure electronic messaging system used by NHS 111 (the CPCS IT system) ✓ Ensure that all staff including locums who will be involved in providing the service are trained and competent to do so ✓ Must be able to provide the service throughout the pharmacy’s opening hours
Preparation for or delivering th the CPCS • Read the draft CPCS service specification & Toolkit – available via a link from the NHSBSA page • Sign up for the CPCS ̶ the MYS portal is the only way that you can register for the CPCS service provision • Confirm that the pharmacy’s DoS entry is up to date • Use the NHS CPCS self-assessment framework and other online resources on the CPPE website • Enroll for CPD sessions covering consultation and physical assessment skills (CPPE in October & January and more from April 2020) or LPC events where available • Have relevant and current SOPs in place which the pharmacy team have read, understood and signed • Review and update business continuity plan to include CPCS
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