NHS Pharmacy First Scotland Info Hub

Welcome to the Pharmacy First Info Hub your home to find any and all information regarding the changes happening to the current Minor Ailment Services. On the 29th July 2020, the Minor Ailment Service which has been delivered by community pharmacies since 2006 was replaced with the new NHS Pharmacy First Scotland service. This is the biggest change to the community pharmacy contractual framework in recent years.

The Pharmacy First Info Hub contains everything you need to know to stay up-to-date with these changes before they happen. From the NHS Pharmacy First Scotland Webinar to information on how NES will be supporting the delivery of the new NHS Pharmacy First Scotland service, including dates for all their upcoming events, please see below:

[Please note that updates to the Pharmacy First Info Hub will be added as and when new information is available]

Recording Consultations

  • Each claim can have one outcome – consultation only, treatment on NHS, or referral.
  • If there are two separate conditions during the consultation, this would go through as two claims e.g. athletes foot requiring terbinafine cream and rash on leg requiring further attention from GP would be submitted as “item supplied”  and “refer to GP”
  • If the result of the consultation is that patient is treated as an interim with advice to see further advice from GP practice, this would constitute one consultation submitted as “item supplied”
  • If treatment results in an OTC sale, as opposed to an NHS supply, a claim should be submitted for consultation only
  • As good practice, worsening statements should always be issued during every consultation i.e. if this doesn’t improve or gets worse in x time, take the following action
  • Where a patient is being referred on for further treatment the terminology “refer” is causing some confusion, as in some instances patients are expecting a formal referral to be made for them.  For clarity, the suggested wording is “I recommend you see practitioner x  for further assessment” or similar.
  • At all times, the best professional judgment should be used

 

War Pensioner

This category is no longer required for patients who previously paid a prescription levy, as they are now eligible for Pharmacy First. Please only use this category now for patients who are War Pensioners.

What Counts as a Consultation...

NHS Pharmacy First Scotland Consultations
At CPS, we have had an increasing number of enquiries around what can and cannot be recorded as a consultation under NHS Pharmacy First Scotland, As this is by far and away our number one FAQ, we thought it would be worthwhile getting in touch with contractors to provide a clear answer. This can be shared with your teams should they need further guidance. We will also be publishing short supportive messages in our newsletter over the coming months to continue this messaging.

What counts as a consultation under NHS PFS?

  • A consultation has to be in response to symptoms
  • The patient must discuss their symptoms with a member of the pharmacy team
  • The pharmacy team must assess these symptoms using their knowledge and skills, referring to the Pharmacist where necessary
  • The pharmacy team must make a recommendation on the most appropriate outcome, which can be: Advice on managing the condition only
  • Referral to another healthcare professional or team along with advice on managing the condition
  • Treatment and advice on managing the condition
  • This can be supplied for free on the NHS if it is on the approved list
  • A treatment can be purchased by the patient if it does not appear on the approved list (record as advice only)

What does not count as a consultation under NHS PFS?

  • A sale of a treatment should not be recorded if there is no conversation about symptoms, no assessment of symptoms or if the pharmacy team do not make a recommendation on the outcome of the consultation
  • For example - if someone purchases paracetamol tablets and the pharmacy team only provides advice about how to use them, this should not be recorded.
  • Similarly, general advice on medicines use as opposed to advice as a result of a person-centred consultation should not be recorded
  • For example, if someone asked how best to apply a steroid cream, this should not be recorded.
  • If a patient does not want to discuss their symptoms or take any advice, they cannot access the service.
  • For example, if someone does not engage in the pharmacy team’s questions about their hayfever following a direct product request, this interaction should not be recorded.
  • Or, if the patient clearly states that they do not want to access the service, then any consultation that takes place should not be recorded.

These examples are not exhaustive, and we will all learn as the service beds in across the country and we come across new scenarios. If you or your team need any advice or support around the recording of consultations, or any aspect of NHS PFS, please just get in touch at enquiries@cps.scot.

Guidance Sheet: NHS Pharmacy First Scotland in the Care Home Setting

On the 29th of July 2020, a new service which offers consultations and advice for minor illnesses will be launched in all community pharmacies across Scotland. For the first time, this will be open to those living in care homes and will require care home and pharmacy teams to work closely together in new ways to support residents. This guidance sheet gives a broad overview of how NHS Pharmacy First Scotland will work in the care home setting and what you will need to do to access the service. We would strongly advise that you also speak with your community pharmacy team(s) to agree further details on how you will work together.

What do I need to do to access the service?

If a resident is showing symptoms of a minor illness (headache, indigestion, cold sores, sore throat etc.), gather the following information before contacting the pharmacy:

  • Who it is that needs a consultation – name, date of birth, the address of the care home (including postcode) and their sex as assigned at birth (unless it is known that their CHI number has been changed). You will also need to give your name and position as the resident’s representative.
  • What the symptoms are – be as specific as possible
  • How long the resident has had these symptoms for
  • Action taken – what has been done so far?
  • Medication/Medical conditions – what other current health issues does the resident have?

What will the pharmacy team do?

On contacting the pharmacy, you will speak with the Pharmacist or a trained member of the pharmacy team. They will ask for the information you have gathered, and may look for further details if necessary – this may involve referring to any records they hold for the resident or asking you to investigate further if possible.

All of this information will be used by the pharmacy team to decide upon the course of action which is in the best interests of the resident.

What will happen next?

After discussing the information you provide about the resident, one or more of the following will happen:

  • You will be given advice on the management of the minor illness that the consultation was about. This may include advice on what homely remedy products you should use to manage/treat the condition.
  • If absolutely necessary (and using homely remedy stock is not appropriate), an NHS supply of medication may be made by the pharmacy for that individual person.
  • The Pharmacist may decide that it would be more appropriate that the resident is referred their GP or another healthcare professional – you would use your normal process to arrange this onward care as appropriate.

How can I prepare for this service launching?

We would strongly advise you to contact your community pharmacy team(s) to discuss the finer details of how this will work locally. You may wish to discuss practical aspects including but not limited to:

  • The types of condition that can and cannot be dealt with under the service
  • How to access consultations (in person, telephone, NHS Near Me etc)
  • How to capture the details and outcome of an NHS Pharmacy First consultation in the care home records
  • How to obtain any medication supplied and reasonable expectations on timescales – deliveries are not a funded part of this service, but you may wish to discuss whether this could be accommodated alongside existing arrangements
  • Best practice re: MAR sheets and labelling (if appropriate)

A service information leaflet is available to view and print here.

GP Team Guidance

This week, the Scottish Government have sent all GP practice teams a short guidance leaflet on NHS Pharmacy First Scotland, which can be found here. It may be useful to read and use the document to plan, open and aid any further local discussions on how the service might develop, particularly with respect to referral pathways.

We also hope to have the Scottish Government’s NHS PFS guidance for care homes for you over the next few days – keep an eye on your inbox and the NHS PFS hub.

As always, if you have any questions please submit these to enquiries@cps.scot

NHS Pharmacy first Scotland Service

PCA2020(P)13, first published in June 2020, details the launch of NHS Pharmacy First Scotland. The circular encloses the legal Directions, service specification and operational support documents which together outline how the service should operate.

This approved list of products has been developed by representatives of all 14 NHS Health Boards with input from Community Pharmacy Scotland and other key stakeholders.  It details the limited list of items which may be supplied to eligible patients following a consultation in response to presenting symptoms. Wherever possible, providing lifestyle advice and support to manage minor conditions should be the preferred course of action, with treatment supplied and referrals made only where necessary. With the exception of sections 10.1 (Skin: Eczema and allergy) and 6.1 (Cystitis), the items detailed in the Approved List can be supplied across all NHS Boards. In sections 10.1 and 6.1, each NHS Board has indicated the approved items which may be supplied by community pharmacy teams in their area.

As you may be aware, the Scottish Government’s Programme for Government 2018/19 committed to increase access to community pharmacy services by developing and implementing a redesigned minor ailment and common conditions service available to all. Our focus is on increasing access to community pharmacy as the first port of call for managing self-limiting illnesses and supporting self-management of stable long term conditions in and out of hours and to improve pharmaceutical care and contribute to the multi-disciplinary team.

It is intended that the redesigned service will replace the current Minor Ailment Service and current Pharmacy First services and will commence in all community pharmacies from the 29th July 2020.  Implementation of the service will be supported by a range of materials and approaches to raise awareness amongst members of the public, pharmacy staff and other healthcare professionals.

A new remuneration model will be introduced from April 2020.  This will replace the existing capitation model and will move to an activity based model, where the pharmacy team will be remunerated for the activity undertaken and reimbursed for dispensed items.  The activity will be based on Advice: Referral: Supply.

To read the full letter from Dr RoseMarie Parr click the image below.

Sg Letter

NES Education and Training Events

NES have also been asked by Scottish Government to provide education and training to support Pharmacy First delivery. This will include an online pack and the team at NES will also be delivering face-to-face events as part of their Spring agenda, which will delve into more detail about the actual day-to-day delivery of the Pharmacy First. These events are available to Pharmacists and Pharmacy Technicians, and can be booked onto via TURAS.

The NES roadshows in each Health Board will be delivered after the CPS Roadshow in that area and, again, a webinar will be made available by NES to support pharmacy teams.

NHS Education for Scotland Training Events

Webinar & Podcast

Checkout the latest webinar by CPS's Policy and Development Pharmacist Adam Osprey and former Board Member Kathleen Cowle who discuss everything regarding the new NHS Pharmacy First Scotland service:

Checkout the latest podcast by CPS's Policy and Development Pharmacist Adam Osprey and former Board Member Kathleen Cowle who discuss everything regarding the new NHS Pharmacy First Scotland service:

NHS Pharmacy First Leaflet

Click on the image below to download the leaflet...

Top Ten FAQ's

Top Ten PF

1. What qualifies as a consultation?

Our working definition is that a consultation occurs where the pharmacy team assesses a patient’s symptoms and recommends a course of action. This is subject to change based on the content of the legal directions and service specification for NHS Pharmacy First.

2. Does every consultation have to be recorded, e.g. counter staff, Saturday staff, telephone calls?

Need to use professional judgement and record if a consultation was provided, e.g. was advice given over the phone or was it just a request to order a prescription? Otherwise there is no recognition of the work carried out and no remuneration.

3. What do we need to record in referrals?

Referrals will look much the same as they do today – how you carry out a referral and what information you provide will depend on the patient, the condition and who you plan to refer onwards to. This could be anything from suggesting that the patient makes an appointment for a routine eye examination to calling an ambulance. You will have to make brief notes on your actions in the patient’s PMR – further detail will be provided in the NES NHS Pharmacy First resources. Many people find the PCR SBAR tool useful for clinical handover.

4. Does the patient have to physically attend the pharmacy for a consultation?

No. Just as has been the case for MAS, you should assess each case on its own merit, applying your professional judgement to make a decision on what is appropriate.

At the time of writing, NHS Near Me is in trial across some of our NHS Boards and it is anticipated that the service will roll out across Scotland from the middle of June onwards. This will provide the opportunity for remote consultations which could be appropriate for many Pharmacy First  consultations – more details to follow when available.

5. Will each activity be paid at the same rate?

Advice, referral and supply for a standard NHS Pharmacy First consultation will all carry the same weight for payment purposes. Advice, referral and supply as a result of a consultation where a PGD is involved will carry more weight than a standard consultation to reflect additional workload and Pharmacist involvement.

6. Will activity payments change month on month?

Yes. This has yet to be finalised, but as the service is recorded through UCF, we have been assured that contractors will be paid in line with their activity from month to month, 2 months in arrears.

7. If someone presents with more than one condition is that one consultation or more than one?

As each condition could have a separate outcome, these would be recorded separately. For example, during one episode of care you may prescribe something for head lice but also refer the patient for treatment of a skin infection.

8. Is this service decoupled from the CHI number?

Where a CHI number exists, it will be used. However, some people who are eligible will not have a CHI number. Your PMR system will perform an eligibility check based on patient name, address, date of birth and gender for standard consultations, and there will be separate UCF modules to be used for PGDs depending on whether the patient has a CHI or not.

9. Will there be a set payment for each pharmacy?

Each pharmacy will receive exactly the same base payment each month. Contractors who exceed a set number of consultations will receive a proportion of an activity pool of funding directly in proportion to their activity. As time progresses, the funding distribution will be reviewed and adjusted to more accurately reward contractors for their activity.

10. With respect to patients in care homes, will we need to treat them differently? For instance, you may be relying on care home staff to relay information about symptoms or a diagnosis so where would we stand?

This is no different from the present situation where a patient is not present in front of you. How would we deal with this situation now? We would have to use our professional judgement as to whether it was appropriate to supply or not. 

It may be the case that with the appropriate technology and information governance in place, you would be able to see care home patients remotely. If you think you might be able to do this, we would suggest having a discussion with your care homes and NHS Board representatives to set this up safely.