NHS Blackburn with Darwen and NHS East Lancashire...

Pharmacy First Minor Ailment Scheme V_1 010411 1

NHS East Lancashire Community Pharmacy

Pharmacy First Minor Ailments Local Enhanced Service Introduction In 2005, the Primary Care Organisations (PCOs) across geographic East Lancashire introduced a “Pharmacy First” Pharmacy First minor ailments scheme based on a well documented Service called “Care at the Chemist”. This was to build capacity within primary care so GP practices could deal with the extra work especially around long term conditions dictated by the Quality and Outcome Framework of the new GP contract. The service was cash limited.

Since its inception the service has grown and developed. As a result of the current financial constraints, the service has been re-engineered to contain the spending without depriving needy people of the benefits that the service can bring. A summary of the main changes to the scheme can be found on Page 24

Brief service description

The Pharmacy will provide advice and support to people on the management of Minor Ailments, including the supply of medicines from a fixed formulary when appropriate. This service is targeted at people who would otherwise have gone to visit their GP for that ailment.

Where appropriate the Pharmacy may sell OTC medicines to the person to help manage the minor ailment.

The Pharmacy will operate a triage system including referral to the GP on a Rapid Referral process, or by usual appointment; or to other health and social care professionals as appropriate.

Intended service outcomes

To improve access and choice for people with minor ailments

• To free up GP appointments used by patients presenting with minor ailments • To provide free access to medicines for minor ailments for targeted populations • To provide pharmaceutical advice on self-management of current acute minor ailments • To provide pharmaceutical advice on the future management of minor ailments • To provide pharmaceutical advice on the expected duration and course of minor ailments and

as to when the patient may consider visiting the GP for management of that minor ailment • To refer or signpost people to other healthcare professionals as appropriate to their acute

clinical condition. • To ensure adequate primary care capacity for treating people with minor ailments

Service outline

This is a cash limited local enhanced service to be provided by accredited pharmacists under this local service level agreement commencing 1st April 2011

• Eligible patients from participating GP practices may be issued with a Minor Ailments patient held record card.


• The patient held record card may be presented by the patient at their community pharmacy or any other participating pharmacy on six occasions for a minor ailment covered by the service.

• The patient held record card, when full, must then be returned to the GP practice for review and issue of another patient held record card

• When the patient presents at the pharmacy with their patient held record card, the accredited pharmacist or a trained member of staff must assess the patient’s acute clinical condition.

• Patients may receive advice only, advice and medication from a set formulary, or referral to another healthcare professional including the GP if appropriate.

• The patient held record card must be updated at each consultation.

Responsibility for the service

• The named Minor Ailments accredited pharmacist is responsible for the provision of the service including assurance around current valid accreditation and the training and standard of work of the pharmacy staff.

• The Minor Ailments accredited pharmacist may delegate provision of this service to a non-pharmacist only in the presence of a Minor Ailments accredited pharmacist and only when the non-pharmacist member of staff has been trained and is abiding by the pharmacy Standard Operating Procedures covering the service (see “Postgraduate education and training”).

Obligations of the Pharmacy and of the PCO The PCO will manage this Pharmacy First minor ailments scheme according to the following criteria:

• The Pharmacy must meet all the criteria for Essential Services specified in the new Community Pharmacy Contractual Framework in order to provide this enhanced service.

• The Pharmacy must provide the service in accordance with this Community Pharmacy Minor Ailments Local Enhanced Service specification.

• The Pharmacy will provide the service at all times during contractual hours • A Minor Ailments accredited pharmacist must be present at all times. • The Pharmacist must inform the PCO if for any reason they are unable to deliver the service or

if supply is refused for a reason other than a GP referral.

Standards and guidelines

• Pharmacists must comply with the RPSGB Code of Ethics for pharmacists and pharmacy technicians and related professional standards and guidance.

• The pharmacy must have formal operating procedures for its Pharmacy First minor ailments scheme activities against which all staff are expected to perform. The procedures should include error and near miss reporting.

• All pharmacists involved in the scheme must be accredited - see Post-graduate education and training requirements below.

• The accredited pharmacist and the pharmacy staff must be clinically competent in the treatment of the minor ailments included in the scheme. Competency must be maintained

• All support staff, including part-time and locum pharmacists must be fully briefed on the service.

• Staff appraisals should be conducted regularly to ensure personal development for staff and adequate training is provided. An induction period for locum pharmacists would be advisable.

• Pharmacies must have relevant reference sources which Must be available to all appropriate staff.


• Records of interventions, conversations with prescribers, carers and patients should be kept on the PMR. All participating support staff should be trained on and be familiar with the PMR and associated programmes.

• The contracted pharmacist and support staff should reflect on their practice, and continually endeavour to improve. Regular audit cycles on procedures help ensure robustness and enable continuous improvement.

• The practice in the pharmacy should reflect the safety, confidentiality and views of patients.

Pharmacists providing the Pharmacy First minor ailments scheme must ensure that the advice given is in accordance with:

• Current legislation. • Professional standards • This Service Level Agreement

Post-graduate education and training requirements

• This service will be HAG (Harmonisation of Accreditation) accredited. • The pharmacist present in the pharmacy must be accredited by completing the CPPE distance

learning package – Responding to Minor Ailments (38013) • A copy of the CPPE certificate from this package should be forwarded to Primary Care

Contracting (See Points of contact Page 13) when registering to provide the service or within 6 months of registration.

• The premises from which the service is offered must be registered with the PCO as complying with the specified requirements in this SLA and as having a Minor Ailments accredited pharmacist to deliver the service at all times

• The pharmacy will use Standard Operating Procedures (SOPs) to guide the operation of the service and the training of counter staff. Theses SOPs will concur with and support the requirements of the service

• Counter staff involved in delivery of this service must have received training to deliver the service as detailed in this specification and according to the pharmacy SOPs.

Process

• The contractor must agree a contract with the Primary Care Organisation for provision of the Pharmacy First minor ailments scheme. Page 25

• The contractor has a duty to ensure that pharmacists (including locums) are accredited and staff involved in the provision of the service has relevant knowledge and are appropriately trained in the operation of the service.

• The contractor has a duty to ensure that pharmacists and staff (including locums) involved in the provision of the service are aware of and operate within local protocols.

• The pharmacy must maintain appropriate records to ensure effective ongoing service delivery and audit.

Arrangements for payment

• A fee of £3.50 will be paid per consultation. • Payment will be made according to the online submission of consultation documentation. • A statement of amount paid will appear monthly on the PPD payment information sheet • The Pharmacy will be reimbursed for medicines supplied at the drug tariff, Chemist and

Druggist trade or wholesaler supplier cost price plus VAT.


• Payment will be made by LaSCA in arrears by BACS direct into the bank account of the pharmacy.

• This is a cash limited service The cost of the service and the fee structure will be reviewed regularly throughout the agreement period.

Termination of service

• Agreements between the pharmacy and the PCO once established, will run continuously until terminated or until 31st March 2012. Agreement may be terminated by either party giving 28 days notice. The PCO must be notified of any changes to an agreement and any termination of an agreement otherwise the contract will be considered to be continuous.

• The PCO should be notified, in writing, of any changes in pharmacist personnel in respect of provision of this service.

• If the service is provided by a pharmacist who is not accredited and not in the presence of an accredited pharmacist, payment will not be made.

• Although there is no obligation to provide the Pharmacy First minor ailments scheme, once a pharmacy has undertaken to provide this service, failure to comply with the arrangements made with the Primary Care Trust will constitute a breach of their Terms of Service.

• This agreement may be terminated by either party, provided always that the PCO may terminate or suspend this agreement immediately if there are reasonable grounds for concern, including but not limited to, o providing the service outside the terms of the Agreement o malpractice, o negligence o fraud on the part of the pharmacy

• If events occur that could not have been reasonably foreseen and are of such substance to affect the ability of either party to meet their obligations, then joint negotiations will be undertaken to consider the future provision of services or to terminate this Agreement without prejudice to the generality of the indemnity and termination aspects of this Agreement

Scope of service

Eligibility

This service is available to identified patient groups from GP practices signed up to the service and include

o Patients who currently qualify for free prescriptions from their GP except those patients with a pre-payment certificate.

o Children aged 16 years or under. Age restrictions apply to formulary items. Or by voucher arrangement

o Homeless people (MASH) o Asylum seekers (MASH)

• Only contracted Community Pharmacies with Minor Ailments accredited pharmacists will be included in this Pharmacy First minor ailments scheme.

• An accredited community pharmacist must be present in the pharmacy when a minor ailment consultation is being carried out

• Only minor ailments covered in this service specification and by this formulary are available • Patients may refuse this service


Formulary

• Each item included in the formulary has stated maximum amounts able to be supplied • A maximum supply per episode will apply • A maximum frequency of supply of each item per patient held record card will apply • If a patient returns within this time period, for a further supply, they may be referred back to

their GP or may purchase a suitable product; they must not be provided with a further supply under the Pharmacy First minor ailments scheme.

The Pharmacy First minor ailments scheme

• The constraints of this Pharmacy First minor ailments scheme take impact from the date specified above in “Service Outline”.

• Old blue Pharmacy First passbooks are obsolete and only Green Record Cards are acceptable. Similarly, patients may only be supplied with medication according to the new formulary issued 1st August 2010.

• Fees for minor ailments consultations not covered by the current Pharmacy First minor ailments scheme will not be paid.

For eligible patients wishing to use the service all the following MUST apply. The patient

• Must be registered with a participating GP surgery in NHS EL • Be presenting with current acute symptoms of a Minor Ailment listed • Must hold only 1 Minor Ailments patient held record card per person at any one time • Must attend a contracted pharmacy for the consultation preferably the pharmacy which

supplies their regular medication • Will receive the service level of care as laid out in this specification • Must expect to receive a professional consultation on their symptoms as they would at their GP

Practice • May receive treatment for that minor ailment with formulary items within the licensed

indications for that medicine if, in the professional opinion of the pharmacist, the medicine required is not contraindicated, and the treatment provided is in accordance with the Minor Ailment protocol.

• Once registered the patient should be encouraged to use that same pharmacy for further consultations arising from symptoms associated with one of the Minor Ailments listed. However, presentation of the patient held record card in association with a Minor Ailment consultation at another participating pharmacy in NHS EL is acceptable.

• Please note that for the Pharmacy First minor ailments scheme, eligible patients will only be able to obtain their Pharmacy First patient held record cards from their GP practice.

Referral

• Referral into the service is through the patients’ GP surgery • Patients may decline to participate in the service.


Registration

For patients wishing to register for the service:- • The participating GP surgery will issue a Minor Ailments patient held record card completed

with the patient’s details and Read coded in the patient notes on the GP system. • Patients must take the patient held record card to a participating pharmacy in NHS EL • Minors accessing the service must have their own patient held record card. It is not acceptable

to use the parent / guardians patient held record card • If a patient held record card is not presented, the patient will not be eligible for the

service and they will be advised to access medical care through the normal procedures or buy a suitable product.

• As this service is for an acute minor ailment and instead of a GP appointment, the patient must present in person to the participating pharmacy.

• The parent or guardian must always bring the child with them to the pharmacy in order for a full assessment to be carried out by a pharmacist / pharmacy staff.

• The patient will be assessed by a pharmacist / appropriately trained member of the pharmacy staff and offered treatment from the formulary as appropriate. If the member of staff identifies that the patient is more complex than their competence, an immediate referral is made to the accredited pharmacist.

• If the patient does not present in person, the patient will not be eligible for the service and they will be advised to access medical care through the normal channels

• Patients must present the Minor Ailments patient held record card at all subsequent pharmacy consultations under the service

• The condition treated and medication supplied will be recorded in the patient held record card and on the PMR where applicable.

• The patient must sign the Minor Ailments exemption form following each pharmacy consultation.

• A copy of the patient consultation form will be sent to the GP via the LaSCA online pharmacy claims system

• A copy must also be retained by the pharmacy for a period of two years and may be required by the PCO for audit purposes.


Responsibilities of the GP practice

Eligible patients presenting in person to the GP practice requesting a GP consultation for symptoms of a Minor Ailment listed should be offered details of the service as an alternative to an appointment with a GP or practice nurse. Note for GPs and reception staff The minor ailments covered in this service, and the formulary has been updated. It is advisable therefore that GPs and reception staff familiarise themselves with the Minor Ailment Formulary, to ensure that patients are only referred to the pharmacy for a condition which is treatable under the service. If agreeable the patient should

• be issued with and sign while at the practice, a minor ailments patient held record card, with their name, address, GP, regular pharmacy and NHS number added, operative for 6 supplies; and a service leaflet

• have the Read code 8HHm with free text MA patient held record card issued added to their notes on the PMR

• be advised of participating pharmacies, and encouraged to use the pharmacy where they normally obtain their prescriptions, provided that the pharmacy is participating in the Pharmacy First minor ailments scheme.

• be advised to expect a professional consultation at the pharmacy as they would at the GP practice

• be advised to return the patient held record card to the GP practice when full and have the Read code 8HHm with free text MA patient held record card returned added to their notes. Qualification for the service should be reassessed and a further patient held record card issue made if appropriate. When this occurs, the Read code 8HHm and free text Old pass book returned, new patient held record card issued to be added to the patient notes.

• patients must have only one patient held record card to use at any time • The completed patient held record card should be viewed by the GP to assess patient’s

usage of the service (as a hospital discharge prescription would be) then scanned onto the patients notes on the GP system.

• If the patient loses the patient held record card, the Read code 8HHm should be added to their notes and free text “Lost patient held record card: new book issued

• Liaison between participating practices and participating pharmacists should take place to allow the rapid referral procedure from the pharmacy to the GP to operate effectively. GP practices should reserve one or two slots per day to accommodate rapid referrals from the community pharmacy. Emergency referrals will always be accompanied by the Pharmacist to GP Communication form to authenticate the need for urgency.

• All GP practices should co-operate and liaise with Community Pharmacists. On receipt of a communication form (Page 18), the recommendation of the pharmacist should be actioned.

• Practices should inform the referring pharmacy of the outcome of the referral to the GP for repeated requests (Page 17). This will then be recorded on the patient held record card and the pharmacy Patient Medication Record where applicable.

• If the patient loses more than 3 books in 12 months, they must be excluded from the service

• Monitoring of use or abuse of the service will take place by the GP practice


• Inappropriate use or abuse of the service must be notified to reported immediately to NHS East Lancashire Medicines Management Team

[email protected] 01282 644807

• Adverse reports and complaints will be investigated and appropriate action taken • GP practices should display official posters and leaflets provided by the PCO. • GP practices will receive the pharmacy consultation logs from LaSCA . • Practices may find the model GP and Receptionist Protocols helpful in supporting the

service.

mailto:[email protected]


Responsibilities of the pharmacy a) Eligible patients can only access the service if they present their own patient held record card.

b) All participating pharmacies must provide the patient with the option of the Minor Ailments consultation being carried out in the PCO approved pharmacy private consultation area

c) All participating pharmacies must provide a professional consultation service for patients accessing the service.

d) The accredited Pharmacist or appropriately trained member of staff according to pharmacy SOPs will assess the patient’s acute clinical condition in a consultation. The consultation must consist of:

• Assessment of the patient’s acute clinical condition • Provision of advice • Agreement of course of action – referral back to GP, formulary medication provision. • Provision of medication from the agreed formulary appropriate to the patients condition if

required • Provision of any counselling required about the ailment or medication provided • Completion of the Minor Ailments online Consultation and patient held record card during

the consultation. • Recording the outcome or medication supplied on the PMR

* Please note where a formulary item supplied is not done so in accordance with the minor ailments protocols, no reimbursement for the formulary item supplied will occur and no consultation fee will be paid. Likewise no consultation fee will be paid for minor ailment consultations that results in no medication being supplied, this is an Essential Service under the pharmacy contract (Essential Service 5 Signposting and Essential Service 6 Support for Self-care), for which pharmacy contractors already receive payment.

e) All pharmacies must complete the online documentation via the LaSCA online pharmacy minor ailment claims system to take part in the service and hence claim for consultations provided.

f) If a patient presents more often than the specified formulary frequency, with the same symptoms, the patient may buy the medicine, or be referred to the GP for an appointment in the normal way unless the symptoms meet the criteria for a rapid referral.

g) All participating pharmacists will provide agreed medication in accordance with the Medicines Act 1968 and within the medications product licence.

h) All medication supplied should be in original packs and must contain a patient information leaflet. There is no need to label the medication, but pharmacists are advised to scribe in biro ‘NHS’ through the barcode of the product provided.

i) The Pharmacist must ensure that adequate levels of stock are maintained

j) If a product is unavailable, an alternative brand of the same drug may be supplied. The patient must be informed that the supply is in replacement to the normal product which is unavailable. The product will be reimbursed at the agreed product price only.

k) The Pharmacist should ensure that the patient has completed and signed the declaration of exemption form. The resulting documents must be kept for at least 2 years.

l) All completed documentation must be retained by the pharmacy for audit and monitoring purposes for at least 2 years.

Medicines Counter Assistant qualified staff may be delegated to undertake the minor ailment consultation provided they adhere to a Pharmacy First minor ailment scheme SOP and Sales of Medicines protocol. However the overall responsibility and accountability will remain with the accredited pharmacist.


Referrals to the GP m) The referral process should be implemented if:

• the criteria for referral or exclusion detailed in the protocols are met • The service is not suitable for the symptoms/request being made and the patient has chosen

not to purchase the medicine but to visit the GP. • The patient presents with more than 2 ailments (if considered necessary in the professional

opinion of the pharmacist) • The patient has made repeated requests beyond that specified in the formulary for the same

ailment. Pharmacies must complete the Repeated Request Referral Form (Page 17). Surgeries should inform the referring pharmacy of the outcome. This must then be noted on the patient held record card and on the pharmacy PMR if applicable.

A Pharmacy First online Minor Ailments Consultation Form should be completed via the LaSCA online reporting system and the referral box ticked.

The Pharmacist to GP Communication form (Page 18) must be completed. • One copy should be given to the patient to take with him to the practice. • One copy should be faxed to the surgery and then retained by the Pharmacy The reason for referral should be explained to the patient If the GP practice is closed and/or the symptoms are sufficiently severe the patient should be advised to contact the on-call doctors, the Out of Hours Service or attend A&E immediately. Urgent referrals Only the on duty accredited minor ailments pharmacist may make an urgent referral. The Pharmacist to GP Communication form MUST be used if an emergency appointment is required eg symptoms of meningitis. Failure to do this may result in the patient being denied an emergency appointment When NOT to supply treatment through the Pharmacy First Scheme NHS East Lancashire fully supports any pharmacist who refuses to supply a medicine through the Pharmacy First Minor Ailments Scheme, if the medicine requested is deemed to be clinically inappropriate.

Other circumstances in which a minor ailments formulary medicine should not be supplied include: • The patient has already received a recent supply of the same medicine within the exclusion time frame of the formulary • At the pharmacist’s discretion, if a patient presents on more occasions than specified in the formulary, treatment should normally be withheld and the patient should be referred to their GP for a routine appointment using the Repeated Requests Form see Page 17 . An entry should also be made in the patient’s hand held record card detailing that the patient has been referred to their GP. • The patient presents with more than 2 ailments (refer to GP if warranted)

• Patient presents with symptoms not indicative of any of the minor ailments included in the scheme.

• Patient or parent cannot demonstrate that the patient is registered with a participating GP practice.

• Patient or parent unwilling to complete/use Pharmacy First minor ailments documentation

• Recent supply of the Pharmacy First medicine

• Medicine requested due to lost medicine


• Medicine requested ‘just in case’

• Medicine requested to take abroad

• Medicine requested to stock up medicine cabinet

• Medicine requested is in lieu of repeat prescription e.g. paracetamol for chronic pain (chronic illness must remain to be managed by GPs)

n) If the pharmacist suspects the patient is abusing or inappropriately using the scheme, this should be reported immediately to NHS East Lancashire Medicines Management Team

[email protected] 01282 644807 Other obligations and responsibilities o) Participating accredited pharmacies must display the up to date posters provided by the PCO

about the scheme.

p) The Pharmacist must inform the PCO if for any reason they are unable to deliver the service or if supply is refused for a reason other than a GP referral.

q) The named accredited pharmacist has the responsibility to ensure the service is run according to the SLA and has SOPs in place.

r) Claims must only be made for patients who are eligible and request care under the Pharmacy First Minor Ailment service.

s) Monitoring of inappropriate use or abuse of the service by the patient must take place by the pharmacy.

mailto:[email protected]


Rights and Responsibilities of patients using the Pharmacy First minor ailments scheme

Eligible patients accessing the Pharmacy First minor ailments scheme with their personal Minor Ailments patient held record card for assessment of a current acute minor ailment can expect to receive: • a professional service • An assessment of their current acute clinical condition • A consultation with an agreed outcome. Patients may not request or demand treatments available in the formulary of this service. Supply of a formulary treatment is based only on assessment of the current acute minor ailment in the presenting patient, in the professional opinion of the pharmacist.

Possible outcomes of the consultation may be: Advice and treatment

• Pharmaceutical advice on management of a current acute minor ailment • Pharmaceutical advice on the future management of minor ailments • Pharmaceutical advice on the expected duration and course of the current acute minor ailment and

when the patient may consider visiting the GP for management of that minor ailment • Treatment for the current acute minor ailment if that is appropriate in the professional opinion of the

pharmacist. The treatment provided must be part of the Pharmacy First Minor Ailments formulary and in the amount and within the frequency specified in the formulary.

Referral

• Referral to their GP in the normal manner if their current acute minor ailment lies outside the remit of this Pharmacy First minor ailments scheme.

• Rapid referral to their GP if their acute condition deems this necessary in the professional opinion of the pharmacist eg symptoms of meningitis.

• Referral to NHS Direct or A&E as and when appropriate To receive these benefits, eligible patients will be expected to abide by the arrangements of the service. This will mean • To present at the pharmacy with their own current Minor Ailments patient held record card • To be asked questions relating to their current acute clinical condition • To be asked questions relating to their regular or over the counter medications • To be asked to sign documentation Any overuse or abuse of the service will be taken seriously and acted upon. NB 1. No prescription only medication is included in the scheme. 2. Patients should not use the scheme in lieu of regular repeat prescribed medication such as paracetamol for chronic pain. 3. The medication listed can only be used to treat the ailment listed in the formulary.


Points of contact

NHS East Lancashire Sharon Young – Head of Primary Care Contracting Primary Care Commissioning, NHS East Lancashire

Walshaw House, Nelson, Lancs. BB9 5AS Tel 01282 644916 Email [email protected]

Local Pharmaceutical Committee Mark Collins - Director of Operations PO Box 270, Prestwich, Manchester M25 0WQ Tel 0161 740 0438

Email [email protected]

Quality of the service

Confidentiality

The Pharmacists and their staff must not disclose to any other person, other than a person authorised by the PCO any information acquired by them in connection with this Service Level Agreement.

Without prejudice to the generality of the Obligation of the pharmacy above, the pharmacists and their staff must not disclose to any person other than a person authorised by the PCO, any information acquired by them in connection with the provision of the service specified in this agreement which concerns

The PCO, its staff or procedures The identity of any patients The medical condition of or the treatment received by any patient.

Indemnity

The Pharmacy shall be liable for, and indemnify the PCO, its officers, employees and agents against any liability, loss, claim or consequences of this agreement.

The Pharmacy shall maintain insurance in respect of public liability and personal indemnity against any claims, whatsoever that may arise out of the terms and conditions and obligations of this Agreement.

The Pharmacy will at all times be a member of a recognised professional organisation.

The PCO will have the right to see documentary evidence of these obligations including policy renewal receipts prior to the commencement of this Agreement.

If the pharmacy fails to maintain adequate insurance, or is no longer a member of an appropriate organisation (for whatever reason), this agreement may be terminated by the PCO without prejudice to any other rights and remedies available.

Post-payment verification

The PCO has the right to access information supporting claims made in respect of the Pharmacy First minor ailments scheme, for the purposes of verification of those claims.

If fraud is suspected or evident, action will be taken.


Monitoring Monitoring of the service will

• Include regular review of LaSCA data of the service. Where the LaSCA data raises specific queries, ad hoc Practice visits will be undertaken, which may be in addition to the routine PCO visits.

• Be included within the PCO visit • Include any complaints received by the PCO • Include annual GP practice system searches • Take account of patient views


PHARMACY FIRST REVISED FORMULARY Condition Medicine AGE Frequency

Allergies and Bites Chlorphenamine 4mg tablets (30)

Chlorphenamine 2mg/5ml syrup (150ml)

Loratadine 10mg tablets (7)*

Loratadine 5mg/5ml syrup (100ml)

12 years+

1 year+

12 years+

2 years+

Supply once only per card

Hayfever

(for the seasonal period only & with the proviso of

1 issue only per patient. not to be repeated )

Chlorphenamine 4mg tablets (30)

Chlorphenamine 2mg/5ml syrup (150ml)

Loratadine 10mg tablets (7)

Loratadine 10mg tablets (30)*

Loratadine 5mg/5ml syrup (100ml)

Sodium Cromoglycate 2% eye drops (10ml)

12 years+

1 year+

12 years+

12 years+

2 years+

16 years+

Redirect to GP after 1 supply per hayfever season

(March to Sept)

Colds & Flu

Paracetamol 500mg tablets (32)

Paracetamol 120mg/5ml SF suspension (100ml)


Ibuprofen 200mg tablets (24)

Ibuprofen 100mg/5ml SF suspension (100ml)

12 years+

3 months+

6 years +

12 years+

6 months+

Twice only in 3 months

Nasal Congestion

(for babies under 1 year)

Sodium chloride 0.9% nasal drops (10ml) Under 1 year only

Once only per card

Conjunctivitis Chloramphenicol eye drops 0.5% (10ml) 2 years+ Once only then refer

Constipation Senna tablets (20) 6 years+ Once only per card

Cystitis Sodium citrate sachets (6)

Potassium citrate sachets (6)

16 years+

16 years+

Once only per card

Diarrhoea Loperamide 2mg capsules (8) 12 years+ Once only within 2 months

Fever (Temperature)

(Children only)




3 months+

6 years+

6 months+

Twice only within 3 months


Indigestion / Heartburn

Gaviscon® liquid (300ml)

Gaviscon® 250 tablets (16)

Ranitidine 75mg tablets (6)

16 years+

16 years+

16 years+


Pain Relief Paracetamol 500mg tablets(32)





12 years+

3 months+

6 years+

12 years+

6 months+


Toothache

(1 issue only)

Paracetamol 500mg (32)


12 years+

12 years+

Once only per card then refer to dentist

Vaginal Thrush

Clotrimazole cream 2% (20g)

Clotrimazole 500mg pessary (1)

Fluconazole 150mg capsule (1)

16-60 years

16-60 years

16-60 years

Once only within 2 months then refer to GP


Repeated Request Referral Form F.A.O. Pharmacist: Please Fax this form to the patients GP practice and give to the patient to take to their GP at their next routine appointment To be completed by the pharmacist Patient Name............................................................................................. GP Name………………………..………………………………………………. Patient’s D.O.B........................................................................................... Patient Address………………………………………………………………… …………………………………………………………………………………… GP Address …………………………………………………………………….. …………………………............................................................................... Date ……………………………………………………………………………... Pharmacy Tel Number …………………… Pharmacy Fax …….…………….. Pharmacy Address …………………………………………………………….. ……………………………………………………………………………………. ……………………………………………………………………………………. Pharmacist’s Name…………………………… Pharmacist’s signature………………………

Dear Doctor, This patient has presented at the pharmacy on……..occasions in the past …………. months for

the treatment of …………………………and received the following treatment:

1. …………………………………………….. 2. ……………………………………………..

As a requirement of the Pharmacy First Minor Ailment scheme, if a patient presents more frequently than the formulary allows for the treatment of the same ailment, treatment must be withheld by the pharmacy until that time interval expires and the patient referred to their GP for a routine appointment. (The patient could also choose to purchase appropriate medication)

I am therefore referring this patient back to you for your kind consideration.

To be completed by the patient’s GP. Please circle response as appropriate Please advise how you wish this patient’s specific ailment to be managed.

1. I will manage this specific ailment. Please refrain from treating this ailment for this patient through the Pharmacy First Minor Ailment Scheme

2. Please continue to treat this patient for this ailment within the confines of the Pharmacy First Minor Ailment Scheme formulary

3. Other…………………………………………………………………………………………

GP Signature …………………………………………………Date………………………………………

F.A.O GP: Please fax this form back to the pharmacy and give a copy to the patient for future reference when accessing the scheme.


The updated Minor Ailments scheme only covers certain ailments. Patients will be referred back to the surgery if their ailment is not covered. For patients requesting to use the “Pharmacy First” Minor Ailment Scheme;

check their registration with the practice check that a patient held record card has not already been issued previously.

(Patients may only have one patient held record card to use at once),If not, issue a patient held record card, complete the details on the front and ask the patient to sign it; and give a service leaflet.

On the clinical system patients notes, Read code 8HHm +free text “Minor Ailments Patient held record card issued”.

Direct the patient to their regular pharmacy or a pharmacy participating in the scheme

Patients who have lost or damaged their patient held record cards Supply a replacement. In the clinical system patients’ notes, Read code 8HHm + freetext “Replacement

patient held record card issued”. * Advise patients not to lose or damage their patient held record card. Patients should

have only one record card in operation at any one time.

Patients who lose more than 3 record cards in 12 months must be excluded from the scheme

The “Pharmacist to GP Communication form” (Page 18) indicates that the patient needs to see the GP.

Highlight that patient to the GP, in line with the recommendations made by the pharmacist.

Read code the consultation 8B3L on the patients notes and free text the details on the practice system *

Scan the “Minor Ailments” referral form into the patient’s record.

Patients presenting with their completed patient held record card Supply a new one. On the clinical system patients’ notes Read code patients notes 8HHm + free text

“Full Patient held record card returned: new patient held record card issued”. *

Monitor the Patient’s records for inappropriate use or abuse of the scheme including attempts to have multiple patient held record cards

Any inappropriate use or abuse of the service must be notified to the Practice Manager who will inform the PCT contact.

* Mandatory Re

Reception Guidelines


Gen

Minor ailment not covered or Patient does not wish to use the scheme

Eligible patient requesting to use the scheme?

Book a GP/Nurse

appointment

Provide patient with a service leaflet

Recommend patient uses regular pharmacy if possible Advise patients of participating community pharmacies

Minor ailment covered by the scheme and patient wishes to use the scheme

Issue a patient held record card and add details Read code 8HHm on practice system. Free text Minor Ailments Patient held

record card issued”. Ask patient to sign the record card

Offer patient the opportunity to use the scheme if presenting for a Minor Ailment covered by the scheme.

Patient has a patient held record card

Reception Flowchart

On receipt of the Pharmacist to GP referral form into practice.

Highlight the patient to the GP in a timely manner in line with the pharmacist recommendations

Read code ‘8B3L.’ on patients notes Scan the consultation form into the patient’s record.

Monitor patient record for evidence of abuse of the system and multiple patient held record cards in use. END

On receipt of completed patient held record card Read code 8HHm on practice system. Free text Full Patient held record card returned: new patient held record card issued”. Issue a new Minor Ailments patient held record card

Eligible patients are: People who do not

pay for prescriptions except those with prepayment certificates Age under 16 Homeless and Asylum

seekers by a voucher


Direct patient to the reception desk for

more information on how the scheme works minor ailments included in the scheme Issue of Pharmacy First patient held record card Documenting issue of patient held record card Responsibilities of the patient

GP may explain that a Pharmacy First minor ailments scheme for some ailments is available from local

pharmacies for eligible patients.

END

On this occasion, patient to be treated by the GP as an appointment has already been taken up

NB

Patients abusing / overusing the Pharmacy First minor ailments scheme will not be eligible to continue in the scheme.

Patients may only have one patient held record card at any one time Each patient must have their own patient held record card Documenting of patient held record card issue and receipt, pharmacy consultation forms and referral requests

by reception staff will help to ensure the good governance and smooth running of the scheme.

Minor ailments in the scheme

Hayfever > 1yr Colds & flu > 3 months Nasal congestion <1yr Conjunctivitis >2yr Constipation >12yr Cystitis >16yr Diarrhoea >12 yr Fever>3 months Indigestion >16 yr Heartburn >16 yr Pain relief > 3months Toothache > 12 yr Vaginal thrush 16-60 yr

There are limits set on how soon a patient may return for the same medicine for the same minor ailment. For some medicines this is once per month. For others it is longer .

Patient consults GP with minor ailment.

General Practitioner Guidelines

Consultations for patients of the practice carried out under the Pharmacy First Minor Ailments scheme will be fed back to the practice via Lancashire and South Cumbria Agency (LaSCA)

Eligible patients are: People who do not pay for

prescriptions (except those with prepayment certificates) Age under 16 Homeless and Asylum

seekers by a voucher


The Pharmacy First minor ailment scheme is only available to eligible patients with an acute minor ailment, registered with participating practices.

If a patient is not eligible, they should access medical care as normal.

Patient referrals from GP practice asking to use the scheme. Check patient- is eligible is registered on the scheme has received a Pharmacy First minor ailments patient held record card. has an acute minor ailment covered by the scheme

If the patient is eligible and not registered on the scheme- refer the patient back to their GP practice for a patient held record card.

Patient presenting with a patient held record card for the first time- explain to the patient how the scheme works citing:-

o ailments covered o possible courses of action following assessment o agreeing responsibilities of the patient in the scheme.

An accredited Pharmacy First minor ailments pharmacist must be available and supervise all consultations at the time they take place.

An accredited pharmacist or other appropriately trained members of the pharmacy staff can then assess the patient’s acute clinical condition in a consultation.

The consultation must consist of: Assessment of the patient’s acute clinical condition Provision of advice about the acute clinical condition and care. Agreement of course of action – formulary medication provision, referral to GP Provision of medication from the agreed formulary within the specified frequencies

appropriate to the patients acute clinical condition if required Provision of any counselling required about the ailment or medication provided Completion of Minor Ailments online Consultation Form and patient record card. Concurrent signing of patient held record card, exemption form, referral form used by

patient and pharmacist supervising/conducting the consultation Recording outcome/medication supplied on PMR as Minor Ailments–ailment treated

If the patient needs to be referred to a GP, Explain to the patient why this is Complete the “Pharmacist to GP Communication Form” (Page18). Ask the patient to return to the Practice and present the form to reception staff. Tick the appropriate “GP Referral” recommendation box. Ask the patient to sign the declaration of exemption form and store this in pharmacy.

Signed copies of the Pharmacist to GP Communication forms and patient exemption forms must be retained in the pharmacy for 2 years for audit and monitoring purposes.

Encourage patients to keep their patient held record cards in their own possession access the service at the same pharmacy. Keep their patient held record cards safe and not lose or damage them.

Online consultation documentation should be completed as the consultation takes place and submitted to LaSCA immediately.

Pharmacy Guidelines


Pharmacy Service Flowchart

Non-eligible patient requests treatment for one of the ailments under the scheme

Eligible patient requests treatment for one of the

ailments under the scheme

Does the patient have a Pharmacy First patient held record card?

Patient may purchase suitable medication

Refer patient back to surgery for GP/nurse

appointment Refer patient back to surgery to obtain a

Pharmacy First patient held record card

Eligible patient returns with repeated request sooner than the formulary allows for the same ailment

Begin Consultation

• Assess the patient’s acute clinical condition • Provide advice • Agree course of action – formulary medication

provision, referral to GP

Does the patient require referral to G.P?

Provide formulary medication

• Provide medication from the agreed formulary within the specified frequencies appropriate to the patients acute clinical condition if required

• Provide counselling about the ailment or medication provided

Complete documentation to refer to GP

1. Complete online consultation form and Pharmacist to GP communication form including signatures OR 2. Complete Repeated requests form including signatures. 3. Direct patient to their GP with form

Complete documentation

• Complete online Pharmacy First Consultation Form • Ensure exemption declaration is signed and

completed by patient • Complete and sign appropriate section of patient held

record card • File exemption form in pharmacy and keep for 2 years

END

Yes

No

Yes

No

Patient requests treatment for an ailment not covered under the scheme


Summary of main changes to the Pharmacy First minor ailments scheme

The main changes to the scheme are as follows: - A reduction in the minor ailments covered in the scheme A reduction in formulary items Stipulated maximum frequency of supply of formulary items Changes to eligibility of patients More explicit guidance on operation of the scheme Specified Rights and Responsibilities of patients using the scheme

Tightened governance arrangements for both GP and Community pharmacy practices Including:- Accreditation requirements for pharmacists Online consultation form Completion of patient details on the front of the patient held record card Documentation of activity on GP and Pharmacy practice systems A Referral to GP for repeated request form More in depth monitoring arrangements


Pharmacy:NHS East Lancashire Application to provide the

Pharmacy First Minor Ailments Local Enhanced Service All sections must be completed Section 1 Pharmacy Details: _____________________________________________________

Full Name: ___________________________________________________________

Postal Address: ________________________________________________________

_________________________________________________________

PPA Account No: ______________________________________________________

Host Primary Care Organisation:__________________________________________

Section 2 CPPE Certificate attached Named Accredited Pharmacist contracted for service ________________________ Y / N

Accredited pharmacist(s) name(s) who will ________________________________ Y / N

provide the Service. _________________________________ Y / N

_________________________________ Y / N

Section 3 The pharmacy has online facilities in the PCO approved consultation area Y / N

Section4 Purpose of the agreement This agreement relates to the Community Pharmacy, Pharmacy First minor ailments scheme

• The PCO will manage the service according to “Obligations of the pharmacy and the PCO” above.

• The pharmacy will meet every aspect of the service as described in the Community Pharmacy Minor Ailment Local Enhanced Service specification.

• The Pharmacy MUST inform the PCO immediately if their circumstances change and the pharmacy can no longer deliver the service

The agreement period • The agreement will commence as from 1st April 2011 or as from the date of the

confirmation of acceptance onto the service • The agreement may be terminated, without penalty, if the Pharmacy or the PCO give

the other party 28 days notice in writing.

Contracting Pharmacist Signature.................................... Contracting Pharmacist Name........................................ Date.............................

Return this form to:- Primary Care Contracting NHS East Lancashire, Walshaw House, Regent St., Nelson BB9 8AS

NHS Blackburn with Darwen and NHS East Lancashire...

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