Minor Ailment Service

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What is the Minor Ailment Service (MAS)?

The Scottish Government strategy “The Right Medicine” made a commitment to introduce a scheme to allow patients to use the pharmacy of their choice as the first port of call for the treatment of common illnesses on the NHS. Following the completion of a service in two pilot areas the service was rolled out nationwide in July 2006.

In short, the service provides people registered with a pharmacy for the service with a free NHS consultation to assess their symptoms. Advice to support self-care will always be given, and the pharmacist also has the options of:

  • Providing a treatment on the NHS
  • Referral to another healthcare professional
  • Both of the above

By doing this, the service aims to:

  • Improve access for patients to medicines
  • Promote care through the community pharmacy setting
  • Transfer care from GPs and nurses to pharmacists where it is appropriate
  • Help address health inequalities
  • Utilise the skills and training of the whole pharmacy team

The service has been hugely successful against its aims and is popular with eligible people, as evidenced by an independent study commissioned by CPS.

In 2018, the Scottish Government committed to extending and expanding MAS so that it was available to everyone – this will launch in April 2020, and we will update this page with relevant details as they become available.

Minor Ailment Service (MAS) Leaflet and Patient

Who is eligible for MAS?

Patients who are registered with a Scottish GP and who fulfil one of the following criteria

  • under 16 years of age or under 19 years of age and in full-time education;
  • aged 60 years or over;
  • have a valid maternity exemption certificate, medical exemption certificate, or war pension exemption certificate;
  • get Income Support, Income-based Jobseeker’s Allowance, Income-related Employment and Support Allowance, or Pension Credit Guarantee Credit, and their family members
  • persons who receive Universal Credit, subject to certain income thresholds, and their family members
  • persons who receive support because they are asylum-seekers, and their family members; and
  • are named on, or are entitled to, an NHS tax credit exemption certificate or a valid HC2 certificate

with the exception of people who are resident in a care home or are registered with a Scottish GP only as a temporary resident.

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Supply of products under MAS 

When a pharmacist decides that it is necessary to provide treatment, s/he will use the Universal Claim Form (UCF) function on their PMR to generate a prescription electronically which will then be printed out on a CP4 form. Those pharmacies which do not yet have UCF functionality will continue to use CP2 forms and their existing PMR software. The paper form is necessary to capture the patient’s declaration that they remain exempt from prescription charges. 

The pharmacist may supply any Pharmacy (P) or General Sales List (GSL) medicines that are not blacklisted, dressings and appliances from Part 2 of the Drug Tariff, selected items from Part 3 of the Tariff, such as bug busting kits, and any Prescription Only Medicines (POMs) agreed suitable and which are underpinned by a series of core patient Group Direction (PGDs). 

Each Health Board produces a local MAS formulary to give guidance as to which items have the strongest evidence of cost-effectiveness for use on the NHS, which helps to inform product choice. Prescribing off-formulary is possible if deemed necessary according to the professional judgement of the pharmacist providing the service. The local formularies are available below. 

Some problems with payment for prescribed items have occurred due to the default settings within the PSD system. To overcome some of these Community Pharmacy Scotland has negotiated the creation of a Minor Ailments Service Part 7B of the drug tariff. Further guidance on MAS prescriptions can be found in the Contractor Services section of the website. 

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Service Description

MAS allows eligible individuals (see MAS overview) to register with and use their community pharmacy as the first port of call for the consultation and treatment of common illnesses. The pharmacist will always provide advice, and may choose to treat on the NHS or refer to another healthcare professional as necessary.

The consultation must be provided by the pharmacist in person, or by trained staff under the direct supervision of the pharmacist.

Service Outline

MAS Registration and Withdrawal

Individuals who are eligible for MAS can register with the community pharmacy of their choice to receive MAS.

The following persons are currently eligible to register for the service:

  • persons who are under 16 years of age or under 19 years of age and in full-time education;
  • persons who are aged 60 years or over;
  • persons who have a valid maternity exemption certificate, medical exemption certificate, or war pension exemption certificate;
  • persons who get Income Support, Income-based Jobseeker’s Allowance, Income-related Employment and Support Allowance, or Pension Credit Guarantee Credit, and their family members;
  • persons who receive Universal Credit, subject to certain income thresholds, and their family members;
  • persons who receive support because they are asylum-seekers, and their family members; and
  • persons who are named on, or are entitled to, an NHS tax credit exemption certificate or a valid HC2 certificate

The following persons are not eligible to register for the service:

  • persons who are not included in the list of eligible persons above;
  • persons not registered with a Scottish GP practice;
  • persons registered with a Scottish GP only as temporary residents; and
  • patients in Care Homes (Nursing and Residential Homes)

Individuals can only register with one pharmacy at a time but can move their registration at any point in time and as often as they need to.

Registration without direct contact from a patient or patient’s representative is not permitted.

Unless an individual is transferring pharmacies or has previously withdrawn from the service, registration only needs to occur once.

The pharmacist registers a person via the Central Patient Registration System (CPRS) hosted at National Services Scotland using the Community Health Index (CHI) number. This, in turn, triggers the printing of a paper registration form in the pharmacy which the person signs, also indicating their eligibility for the service.

Registration is either done in advance of requiring to use the service or at the time when the service is required. A check is made, for example by asking for evidence, that the person is eligible for MAS. Where evidence is not seen the person can still be registered but the ‘evidence not seen’ box on the back of the registration form should be marked with as cross.

A check is also made at each consultation that the person is still eligible for MAS. Providing that this is the case, they may access the service at any time.

Individuals can choose to withdraw from MAS at any point. In addition, pharmacists can withdraw an individual; this might be due to, for example, a change in their eligibility or other exceptional circumstances. CPRS withdraws people automatically if they die or move into a care home. Registering at a pharmacy automatically withdraws the individual from a pharmacy where they have been previously registered.

After one year of inactivity (i.e. no consultations), a patient’s registration will lapse and will no longer count towards payment. Only when the patient subsequently presents with symptoms for a consultation will the registration become “active” again and count towards remuneration.

Only approved national and local publicity initiatives and information leaflets prepared by the Scottish Government can be used to raise public awareness of the service.

MAS Consultation

Care provided through MAS includes the presentation, assessment and treatment of symptoms. The pharmacist assesses the patient and considers the most appropriate course/s of action, the counselling and advice needs and any requirements for follow up or referral.

Individuals present with a symptom or symptoms themselves or, occasionally, someone may present on their behalf (for example a parent for a child or a carer).

The pharmacist assesses the symptoms in order to ascertain and consider information which helps them to determine the cause and severity of the presenting condition and determine the most appropriate course of action. This includes the differentiation between common illness and major disease. This helps the pharmacist to decide on the most appropriate form of action. This can be advice only, treatment or referral.

In some instances the only course of action required is to provide advice to a patient. This may also include aspects of healthy lifestyle advice.

When the pharmacist decides that the most appropriate action is to treat the presenting condition(s) then they will then decide on the course of treatment they wish to recommend for the patient. They should select this in line with national and local NHS prescribing policy and wherever possible on a generic basis.

The pharmacist will also establish the counselling and advice needs of the patient. This includes explaining what to expect from their condition, what treatment is being prescribed for them, how to use that treatment, any follow up and how to avoid future episodes. This process is underpinned by the CRAG Counselling and Advice Guidelines.

The requirement to refer a patient is, in most instances, obvious when assessing the condition. Pharmacists and GPs should agree locally the circumstances when and procedure by which a patient requiring to be seen quickly can be referred and this should be supported using either a verbal or written referral request. Patients may also self-refer to their GP.

The MAS consultation enables the pharmacist to identify and agree a shared outcome or a set of outcomes with the patient. This happens as a result of the systematic approach applied to MAS.

The pharmacist also considers the requirement or need for any further follow up. Follow up involves looking for signs that the condition is improving and that there is no deterioration. This is carried out by the patient with any necessary information or support provided by the pharmacist or a member of their support staff.

Formulary

There is one national formulary which is the reference point for reimbursement purposes for products provided under MAS.

The formulary available to the pharmacist includes all Pharmacy (P) and General Sales List (GSL) medicines that are not blacklisted, dressings and appliances from Part 2 of the Drug Tariff, selected items from Part 3 of the Tariff, such as bug busting kits, and any Prescription Only Medicines (POMs) agreed suitable and which are underpinned by a series of core patient Group Direction (PGDs).

Pharmacists should prescribe in line with national and local NHS prescribing policy and guidance, such as local joint formularies. This includes, wherever possible, prescribing on a generic basis.

MAS is subject to the same prescribing support as other clinical services.

Administration and Record Keeping

Please refer to the MAS Principles and Directions (2016) for the latest guidance on administration.

A CP4 form (or CP2 if not UCF-enabled) is used to register people eligible for MAS.

A CP4 form (or CP2 if not UCF-enabled) is also used for each patient contact, recording whether they received a consultation, advice, a treatment or were referred to another health care professional.

Where appropriate, this information is annotated into the patient’s medication record on the pharmacy patient medication record (PMR) system.

CP4 and CP2 forms must be submitted within two months of the date of registration, or the registration may be cancelled.

In the case of adverse reactions the pharmacist will consider whether there is a need to report any adverse drug reactions through the Yellow Card reporting mechanism.

Remuneration and Reimbursement

The pharmacy contractor is remunerated for providing the MAS using a banded capitation fee. There is no incentive to prescribe.

The pharmacy contractor is reimbursed for any product from the national formulary supplied. Part 7B of the Scottish Drug Tariff clarifies the pricing of certain items when prescribed generically.

Training

The pharmacist providing the service must practise within their own competency.

The contractor providing MAS is responsible for ensuring that the service is available at all times of opening. They are also responsible for ensuring that all staff delivering the service have the required competencies.

The pharmacist providing the service must be aware of and operate within the national service specifications and local formulary guidelines.

Useful References

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1. Citation and Commencement

1.1 These Directions may be cited as the Health Board Additional Pharmaceutical Services (Minor Ailment Service) (Scotland) Directions 2016 and come into force on 1 August 2016.

2. Interpretation

2.1 In these directions, unless the context otherwise requires:

“the Act” means the National Health Service (Scotland) Act 1978

“the 2009 Regulations” means the National Health Service (Pharmaceutical Services) (Scotland) regulations 2009

“the 2011 Directions” means the Health Board Additional Pharmaceutical Services (Minor Ailment Service) (Scotland) Directions 2011;

“the 2011 Regulations” means the National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations 2011

“approved appliance” means an appliance which has been approved by the Practitioner Services Division of the Common Services Agency for provision under MAS;

“care home” means an establishment which provides a care home service as defined in paragraph 2 of schedule 12 to the Public Services Reform (Scotland) Act 2010

“consultation” means a consultation with a pharmacist under the Minor Ailment Service

“eligible person” means a person who at the time of initial registration, and at the time of any subsequent consultation falls within the following categories of person:

  1. a person who is under the age of 16 years

  2. a person who is under the age of 19 years and is receiving qualifying full time education within the meaning of paragraph 7 of Schedule 11 to the Act;

  3. a person who is 60 years of age or over;

  4. a woman to whom a Health Board has issued an exemption certificate on the ground that she is an expectant mother or has within the last 12 months given birth to a live child or a child registrable as still-born under the Registration of Births, Deaths and Marriages (Scotland) Act 1965;

  5. a person with a valid exemption certificate;

  6. a person to whom the Secretary of State has issued a valid exemption certificate in respect of the supply of drugs and appliances for the treatment of accepted disablement but only in respect of those supplies to which the certificate relates;

  7. a person who falls within the categories of person specified in regulation 4(2) of the National Health Service (Travelling Expenses and Remission of Charges) (Scotland) Regulations 2003 ;

  8. except that a person who would be eligible by virtue of (a) to (g) is not an eligible person if that person is:

    1. not registered on a permanent basis with a GP in Scotland; or

    2. persons whose main or usual residence is a care home,

and “eligible persons” shall be construed accordingly.

“exemption certificate” means a certificate issued by a Health Board to a named patient under Regulation 4 of the 2011 Regulations

“General Sales List (GSL) Medicine” has the meaning ascribed to “medicinal product subject to general sale” by regulation 5(1) of the Human Medicines Regulations 2012;

“MAS provider” means a person with whom a Health Board has made arrangements for the provision of a Minor Ailment Service as described in paragraph 5.1;

“Minor Ailment Service” or “MAS” has the meaning ascribed in paragraph 3.1

“Minor Ailment Service stationery” or “MAS stationery” means forms, approved by Scottish Ministers, on which -

  1. the details of a patient registered for MAS are recorded; and

  2. the details of a registered patient’s MAS transactions are recorded, including:

    1. any consultation undertaken

    2. any supply of medicine or appliance

    3. any referral to another healthcare practitioner

“patient record” means a record maintained for each recipient of MAS in accordance with paragraph 4 of Schedule 2

“patient group direction” or “PGD” has the meaning ascribed to it in regulation 213(1) of the Human Medicines Regulations 2012;

“pharmacist” means a person who is registered as a pharmacist in Part 1 or 4 of the register maintained under article 19 of the Pharmacy Order 20109 or the register maintained in pursuance of Articles 6 and 9 of the Pharmacy (Northern Ireland) Order 1976

“Pharmacy (P) medicine” has the meaning ascribed to “pharmacy medicine” in The Medicines (Pharmacy and General Sale-Exemption) Order 1980

“registration” means registration for the Minor Ailment Service in terms of paragraphs 3 to 5 of Schedule 2, and “registered” shall be construed accordingly

“Yellow Card reporting mechanism” means an arrangement set up for reporting adverse reactions to medicines to the Medicines and Healthcare products Regulatory Agency on pre-printed and postage paid yellow cards, or to www.yellowcard.gov.uk

2.2 Other words and phrases used in these Directions have the same meaning as they have in the Act and in the 2009 Regulations.

  1. a registered patient in terms of the National Health Service (General Medical Services Contracts) (Scotland) Regulations 200412;
  2. a registered patient in terms of the National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 200413; or
  3. otherwise registered (other than as a temporary resident) to receive primary medical services in terms of the Act.

2.3 Other words and phrases used in these Directions have the same meaning as they have in the Act and in the 2009 Regulations.

2.4 any reference in these Directions

  1. to a numbered paragraph, is a reference to a paragraph bearing that number in these Directions

  2. to a numbered Schedule, is a reference to the Schedule to these Directions bearing that number; and

  3. to a numbered paragraph of a numbered Schedule, is a reference to a paragraph bearing that number in the Schedule bearing that number

3. Description of the Minor Ailment Service

3.1 The Minor Ailment Service is a service for the provision of pharmaceutical care to persons who are registered to receive MAS by a person who is authorised to provide MAS in terms of paragraph 5 and, where appropriate, advice, treatment or onward referral by that person to another NHS healthcare practitioner.

3.2 The services which are comprised in MAS are specified in Schedule 1 and schedule 4.

4. Health Board duty to arrange for a Minor Ailment Service

4.1 Until otherwise directed, Health Boards have a duty to arrange for the provision of Minor Ailment Services (MAS) for persons in their area as additional pharmaceutical services.

4.2 Health Boards must inform MAS providers of the formulary or prescribing guidelines that apply to the provision of MAS in their area. The products that a Health Board may include on their formulary are:

(i) (Pharmacy (P) and General Sales List (GSL) medicines that are not listed in directions given by Scottish Ministers under section 17N(6) of the Act as to drugs, medicines or other substances which may or may not be ordered for a patient in the provision of primary medical services14 (the “black list”);

(ii) dressings and appliances from Part 2 of the Drug Tariff; (iii) approved appliances from Part 3 of the Tariff; and

(iv) any Prescription Only Medicines (POMs) that are detailed in a Patient Group Direction in relation to MAS.

5. Persons authorised to provide the Minor Ailment Service

5.1 Health Boards may only enter into arrangements for the provision of MAS with:

    1. a person who is a registered pharmacist; or

    2. a person other than a registered pharmacist who, by virtue of section 69 of the Medicines Act 1968 , is taken to be a person lawfully conducting a retail pharmacy business in accordance with that section;

and, in the case of both (a) and (b) who

    1. is on the pharmaceutical list maintained by the Health Board in terms of regulation 5 of the 2009 Regulations ; and

    2. undertakes that all MAS shall be provided either by or under the direct supervision of a registered pharmacist.

6. Compliance and Conditions

6.1 The arrangements made by a Health Board in accordance with paragraphs 4 and 5 shall include the imposition of the terms and conditions specified in Schedule 2, with which the provider of MAS must comply.

6.2 Where a MAS provider requires a pharmacist to provide MAS, the MAS provider has ultimate responsibility for ensuring that the MAS service is provided in accordance with these Directions.

7. Payment for the provision of a Minor Ailment Service

7.1 Remuneration for the provision of MAS will be paid at nationally negotiated rates as set out in the Drug Tariff and in accordance with Schedule 3 of these Directions.

7.2 The prices and methodology for calculating reimbursements to a MAS provider for any preparations or appliances that he or she may supply to patients registered for MAS in connection with providing MAS will be in accordance with the provisions set out in Part 1 of the Drug Tariff.

8. The Health Board Additional Pharmaceutical Services (Minor Ailment Service) (Scotland) Directions 2011

8.1 These Directions revoke and supersede the 2011 Directions.

8.2 Notwithstanding paragraph 8.1, the 2011 Directions shall continue to apply in respect of any MAS provided on or before 31 July 2016.

Schedule 1 - Services to be provided as a Minor Ailment Service

1. The service comprises a consultation with a pharmacist and advice on the condition(s) that the patient presents and, where the pharmacist considers it appropriate, the supply of preparations or appliances for its treatment. Where the pharmacist considers the condition is one that requires to be considered by another member of the primary care team (e.g. a GP), he or she will refer the patient to that person.

2. The products that can be supplied by the pharmacist are listed in a nationally set formulary, which includes:

  1. Pharmacy (P) and General Sales List (GSL) medicines that are not listed in directions given by Scottish Ministers under section 17N(6) of the Primary Medical Services (Scotland) Act 2004

  2. dressings and appliances from Part 2 of the Drug Tariff

  3. selected items from Part 3 of the Tariff; and

  4. any Prescription Only Medicines (POMs) that are detailed in a Patient Group Direction (PGD) in relation to MAS.

Schedule 2 - Terms and Conditions of the provision of a Minor Ailment Service

1. A MAS provider must not advertise or offer incentives to the public to register for MAS, or set targets for employee pharmacists or staff to recruit people for MAS or for any other aspects of MAS.

2. A MAS provider may only issue or display the publicity material and patient information leaflet made available by Scottish Ministers in respect of MAS and the provision of MAS to promote and raise public awareness of the service.

3. Where a person is an eligible person and wishes to register for the service, a MAS provider must ensure that the registration process is undertaken in accordance the procedures set out in Schedule 4, and in particular that:

  1. evidence is seen to confirm the person’s eligibility;

  2. only MAS stationery approved by Scottish Ministers is used for the registration process;

  3. the patient’s, or their representative’s agreement to register has been obtained and recorded; and

  4. a patient record is established.

4. For the purposes of MAS the ‘patient record’ is a pharmacy retained record (paper and/or electronic) that as a minimum must include:

  1. the name and address of the patient;

  2. where relevant, the name and address of the person who gave consent to, or applied for, the registration and that person’s relationship to the person who is registered;

  3. the grounds for the patient’s eligibility to register for MAS;

  4. the date of each MAS consultation; and

  5. the services provided to the registered patient as MAS, to include:

    1. information on whether advice, treatment or onward referral was provided;

    2. details of any treatment provided; and

    3. the name, quantity, form and strength of any product supplied

5. MAS can be provided to a patient only from the premises at which the patient is registered for MAS.

6. Subject to the provisions of any Regulations made under section 69 of the 1978 Act, all drugs, containers and appliances supplied for MAS shall be supplied free of charge.

7. A MAS provider is to use MAS stationery to record details where a patient registered for MAS

  1. receives advice;

  2. is supplied with medicines and appliances for treatment purposes;

  3. is referred to another healthcare practitioner; or

  4. is no longer eligible for MAS and registration must be withdrawn.

8. Where a MAS provider supplies medicines, dressings and appliances he or she must have regard to any local formulary that the Health Board applies.

9. The products that may be supplied under MAS are:

10. The supply of medicines, dressings or appliances is to be performed by or under the direct supervision of a pharmacist.

11. Where the pharmacist referred to at paragraph 9 is employed, the pharmacist must not be one:

  1. who, has been disqualified under section 29B(2) of the Act , or

  2. who is suspended by direction of the Tribunal, or

  3. who is the subject of a corresponding decision in England, Wales or Northern Ireland.

12. In providing MAS a MAS provider shall do so:

  1. in compliance with all procedures and processes described in the service specification included at Schedule 4 of these directions;

  2. having regard to and, where required, in compliance with, stated standards and administrative guidance that is from time to time produced by Scottish Ministers; and

  3. in conformity with the standards generally accepted in the pharmaceutical profession.

13. The provisions at paragraphs paragraph 12 of Schedule 1 of the 2009 Regulations with regard to and referred to as a “complaints procedure” shall apply to the provision of MAS

14. A MAS provider must ensure that –

  1. where that MAS provider is an individual, they provide MAS in accordance with these directions; and

  2. where a MAS provider requires a pharmacist to provide MAS, that the pharmacist provides the MAS service in accordance with these directions.

Schedule 3 - Payment for the Minor Ailment Service

1. Where a provider of MAS complies fully with these directions, payment for the provision of a Minor Ailment Service will be paid monthly in arrears at the rates set out in the Drug Tariff.

2. Capitation payments will be calculated on the number of patients registered with the MAS provider for MAS on the last day of each month.

3.

  1. Where a person registered to receive MAS is no longer an eligible person, the MAS provider with whom that person is so registered must terminate that registration as soon as that change in status is known by the provider. In the event that the provider fails to do so, the Agency shall be entitled to refuse to make any payment in respect of MAS to the provider in respect of that person

  2. Notwithstanding sub-paragraph (a) of this paragraph, in the event that the Agency is made aware that a person registered to receive MAS is no longer eligible, the Agency will terminate that registration as soon as that change in status is known, and notify the relevant provider accordingly.

4. A registered person who has not used a MAS provider for 12 months and whose registration for MAS is deemed lapsed shall not be included in the number of registered patients on which the capitation payment is calculated.

5. A person whose registration for MAS was deemed lapsed but whose registration is reactivated shall be included in the number of registered patients of that MAS provider on which the capitation payment is calculated with effect from the last day of the month in which reactivation occurs.

6. Confirmation of patient registration and withdrawal, and claims for reimbursement of any medicines or appliances supplied to a registered patient, are to be made on MAS stationery and submitted within every two months to Practitioner Services Division of the Common Services Agency (NHS National Services Scotland) by the dates it specifies.

7. Health Boards will be entitled to take such reasonable steps as are necessary to ensure that MAS providers are:

  1. providing MAS as specified in Schedule 1 and complying with the provisions of Schedules 2 and 4 ; and

  2. only displaying the agreed patient information leaflets and publicity materials made available by Scottish Ministers in respect of MAS.

8. Payments made to providers for providing MAS will be subject to post-payment verification checks and investigation by the Agency.

9. Where after suitable investigation a Health Board is satisfied that a MAS provider is not providing the services listed in Schedule 1 and/or complying with the provisions of Schedule 2 and 4, but is receiving payment in terms of this Schedule and the rates set out in the Drug Tariff, it may (without prejudice to any other action which may be open to it):

  1. write to the provider advising of the conclusion reached by the investigation;

  2. inform the provider that payments will be stopped with immediate effect;

  3. recover any payments made to the provider under this Schedule and the Drug Tariff in respect of any period(s) when the provider was not providing the services specified in Schedule 1 and/or complying with the provisions of Schedule 2 and 4; and

  4. in exceptional circumstances, such as deliberate or repeated non-compliance with the provisions of Schedules 2 and 4, withdraw the service from the MAS provider and notify the General Pharmaceutical Council.

Schedule 4 - MAS Specification

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Language Leaflet Poster
English Leaflet Poster
Polish Leaflet Poster
Punjabi Leaflet Poster
Urdu Leaflet Poster

MAS Patient Leaflets and Posters are also available from:

Email: stockorders.DPPAS@theapsgroup.co.uk
Fax: F.A.O Karen McCallum: 0131 629 9967
Tel: 0131 629 9938

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Key Principles for the Provision and Operation of the Minor Ailment Service (MAS)

1. Following a national exercise into MAS operational practices, 10 key principles are now being put in place. In conjunction with the 2016 Directions which encompass the service specification, all MAS providers (i.e. the community pharmacy contractor) and registered pharmacists providing MAS are expected to adhere to these principles.

The 2016 Directions

2. The MAS (Scotland) Directions 2016 (“the 2016 Directions”) provide the legal framework for MAS and include four Schedules as follows:

Schedule 1: Services to be provided as a Minor Ailment Service

Schedule 2: Terms and Conditions for the provision of a Minor Ailment Service

Schedule 3: Payment for the Minor Ailment Service; and

Schedule 4: Minor Ailment Service - Service Specification

The 10 Key Principles

3. The following 10 Key Principles are intended to support the application of the 2016 Directions. The principles are drawn from the content of the directions and, where this is the case, must be adhered to.

Principle 1:

Compliance at all times with the Directions and Service Specification for MAS is essential.

4. All MAS providers and pharmacists providing MAS must familiarise themselves with all of the requirements of the 2016 Directions. This is fundamental to the arrangements between the Health Board and the MAS provider for the provisions of MAS.

(Schedule 4, paragraph 1.1)

5. The MAS provider has ultimate responsibility for the appropriate provision of MAS in accordance with all the requirements of the 2016 Directions. These must be complied with at all times.

(Directions, Paragraph 6.2 ; Schedule 2, paragraph 13;
and Schedule 4, paragraphs 1.2)

6. The 2016 Directions and the four Schedules are intrinsically linked. This further emphasises the need for MAS providers and pharmacists providing MAS to familiarise themselves with all aspects of these Directions.

Patient Registration

Principle 2:

MAS providers must not offer incentives to the public or staff, set targets or undertake activity that amounts to a recruitment drive to register patients for MAS

7. A MAS provider must not offer any incentives or inducements to the public to register for MAS; offer any incentives or inducements or set targets for pharmacists or staff to recruit people to register for MAS or for any other aspects of MAS.

Principle 3:

MAS providers and pharmacist(s) must only use approved MAS Stationery and publicity materials

8. Registration must be undertaken using only MAS stationery approved by Scottish Ministers. Registration using any other form of document or stationery (e.g. materials produced locally by the MAS provider) is not permitted.

(Schedule 2, paragraphs 3(b) and 7; Schedule 4, paragraph 4.4.1)

9. In addition, they may only issue or display the publicity material and the patient information leaflet made available by Scottish Ministers in respect of MAS and the provision of MAS to promote and raise public awareness of the service. Also, if listing MAS on a services offered panel, pharmacy leaflet or website then the MAS provider must not suggest that the service is exclusive to that pharmacy

Principle 4:

MAS providers and pharmacist(s) must always obtain the patient’s or representative’s consent

10. Obtaining and documenting patient (or their representative’s) consent to register and receive the associated services is fundamental to the operation of MAS. A pharmacist carrying out a registration must therefore ensure, where applicable, that the patient records their consent by signing the approved MAS stationery.

(Schedule 2, paragraph 3(b))

11. Only under certain circumstances can someone else give consent to registration or treatment on the patient’s behalf, or sign the MAS stationary in place of the patient. These circumstances are where:

  • The patient is under the age of 16 in which case, the parent or guardian may sign the form.
  • Where the patient is the subject of a Power of Attorney or Guardianship Order which allows a named person to give consent.
  • The patient is housebound and a representative is attending on their behalf.

Housebound Patients

12. Good practice requires that particular care is taken when registering, or providing a MAS consultation to, a patient who is housebound and has arranged for a representative to attend the pharmacy. The MAS provider should ensure that any staff involved in registration of these patients are suitably trained and competent to undertake this process.

13. Registration, or a MAS consultation, for a housebound patient must be carried out in compliance with the directions (as described in paragraph 11 above). The detailed internal process for registration of a housebound patient should be included in a Standard Operating Procedure within the pharmacy (see also paragraph 43 of this Annex).

(Schedule 4, paragraph 4.4.2 and 4.9.2)

Principal 5:

MAS stationery should not be signed by MAS providers, pharmacists or support staff on behalf of the patient except in exceptional circumstances.

14. MAS stationery should not be signed by MAS providers, pharmacists or support staff on behalf of the patient except in exceptional circumstances.

(Schedule 4, paragraph 4.4.4)

15. In any exceptional cases where the patient is physically unable to sign, explicit permission must be obtained from the patient and the form should be annotated with name of the signatory (in capitals) and the reason for the proxy signature.

16. In the event where the pharmacy is experiencing IT problems, the pharmacist must complete the appropriate MAS stationery manually and obtain the patient’s or patient representative’s signature on the form. Once IT functionality is restored an electronic version should be completed and the signed manual form attached.

(Schedule 4, paragraph 4.7.2 - 3)

Patient Eligibility

Principle 6:

MAS providers and pharmacist(s) must always ascertain the patient’s eligibility for MAS

17. A patient must be eligible and wish to register for MAS before a MAS provider, pharmacist or member of pharmacy staff commences the registration process.

(Schedule 4, paragraph 4.2.1-2)

18. A MAS provider, pharmacist or member of pharmacy staff should ensure that the required check on a patient’s eligibility is made prior to beginning the registration process.

(Schedule 2, paragraph 3(a), Schedule 4 paragraph 4.3.3)

19. As well as checking eligibility at the point of registration, a check must be made at each time the service is accessed thereafter to confirm that there has been no change in circumstances and the person continues to be eligible for MAS.

(Schedule 4, paragraph 4.1.1 and paragraph 4.9.1)

20. If a patient can’t provide evidence of their eligibility then the pharmacist should use their professional judgement to determine whether it is appropriate to provide MAS.

21. Patients registering for MAS should mark their eligibility category and sign the back of the MAS stationery. The pharmacist should sign the front of the form.

(Schedule 4, paragraph 4.3)

The Electronic Recording of Registrations - eMAS

Principle 7:

MAS providers and pharmacist(s) should always record complete and accurate patient information

22. Only once a patient or patient representative has given their agreement to register for MAS, and appropriate eligibility checks have been carried out, can a MAS provider, pharmacist or member of pharmacy staff begin the registration process.

23. The following information is required to support the registration of a patient electronically using eMAS (PMR systems all support this through their eMAS programmes):

  • Full Name
  • Postcode
  • Date of birth
  • Gender
  • CHI Number

28. It is important that this information is complete and accurate, for example the postcode is correct and properly populated in the correct information field.

(Schedule 4, paragraph 6.7)

29. A patient’s exemption category should also be recorded and confirmed each time a consultation is carried out in order to ensure that they are still eligible for MAS.

30. A patient record must be established and retained as part of the registration process which includes as a minimum:

  • the patient’s name and address;
  • the name and address of the person who gave consent to, or applied for, the registration and their relationship to the patient who is registered, where appropriate;
  • the reason for the patient’s eligibility to register for MAS, i.e. their exemption status;
  • the services provided to the registered patient as MAS, to include:
    • details of the treatment provided;
    • a record that advice only or a referral has been provided as an alternative to treatment and the associated date;
    • the date on which each of the above was provided; and
    • with respect to treatments, the name, quantity, form and strength of any product supplied.

(Schedule 2, paragraph 3(d) and 4)

31. Pharmacists and their staff should ensure that the information printed on MAS stationery is in the correct position and that this information is readable. Forms should be reprinted prior to signing if this is not the case. Note that this is reprinting of the form and not re-registering the patient. All PMR systems have the facility to reprint forms.

Principle 8:

MAS providers and pharmacist(s) should not ‘batch’ register patients for MAS other than in exceptional circumstances

32. MAS providers should not ‘batch’ register patients for MAS. The exception to this is where there has been an IT problem meaning electronic data capture has not been possible and the forms have had to be completed manually. Where this is the case then the pharmacist must notify the ePharmacy Helpdesk before they start to enter registrations or activities by batch and provide an estimate of registrations and consultations which have been delayed.

(Schedule 4, paragraph 6.8)

33. If access to the PRS is not available, a blank MAS stationery form should be completed manually and signed by the patient. Manual registration for MAS using this method is regarded as the exception; the normal route for registration is using electronic data exchange (eMAS).

(Schedule 4, paragraph 4.7.2)

34. In cases where manual registration has been necessary, the data must be entered electronically and forms generated. The signed manual forms should be attached to the associated electronically generated forms and submitted to PSD.

(Schedule 4, paragraph 4.7.3)

35. MAS providers and pharmacist(s) requiring to complete the MAS registration form manually should first contact the ePharmacy Helpdesk (0131 275 6600) indicating the reason why and when this use is expected to start and also when electronic submission of registrations will start / resume.

Deadline for Submission of MAS Stationery used for registration

36. MAS stationery used for MAS registration must be submitted within two months of the date of registration. The electronic message will be matched to the associated form and registrations may be cancelled if no form has been submitted within two months of registration.

(Schedule 4, paragraph 6.6)

37. The blank right hand side of the MAS stationery form should be torn off and discarded prior to submission to PSD.

38. Incomplete registration forms should not be submitted to PSD.

(Schedule 4, paragraph 6.7)

Principle 9:

“Lapsed registrations” can only be reactivated if the patient uses the service

39. If a MAS registered patient has not accessed the service for 12 months, their registration will lapse and will not count towards the monthly total for that MAS provider.

(Schedule 4, paragraphs 4.6.1)

40. These “lapsed” registrations can only be reactivated if the patient accesses and uses the service at that pharmacy at a later date for a MAS consultation. MAS providers, pharmacists and members of pharmacy staff must not attempt to reactivate registrations if patients have not used MAS.

(Schedule 4, paragraphs 4.1.17 to 19)

41. All registration activity, including re-activation of a lapsed registration, must be based on direct contact with the patient or patient’s representative by either the pharmacist, or by a member of pharmacy staff under the direct supervision of the pharmacist.

(Schedule 4, paragraph 4.2.2)

42. If a patient registration has lapsed and they subsequently wish to access the service, the patient is required to confirm that they remain eligible for MAS and sign the appropriate MAS stationery form.

(Schedule 4, paragraph 4.6.3)

Principle 10:

MAS providers and pharmacist(s) must at all times operate MAS professionally and ethically and in the best interest of the patient

43. MAS providers should ensure that there is a comprehensive Standard Operating Procedure (SOP) for MAS which covers all aspects of service provision including registration, registration of housebound patients, withdrawal, consultation and treatment.

44. All providers of NHS services have a duty to use NHS resources responsibly and these should be only used in the best interest of the patient. In the case of MAS, this includes registration and treatment, covering remuneration for the provision of the service as well as reimbursement of the items dispensed and provided through the service.

45. MAS providers are obliged to provide the right environment to allow pharmacists to provide professional clinical care as they consider appropriate to the patient.

46. The supply of a medicine should be in response to a patient consultation and only when it is the most clinically appropriate intervention.

(Schedule 4, paragraph 4.9.6)

Post Payment Verification

47. As with all pharmacy payments, MAS claims will be subject to scrutiny by Practitioner Services’ Payment Verification (PV) team. Any anomalies or outliers will be investigated by PV and, where appropriate, will be referred to the relevant NHS Board, and to NHSScotland Counter Fraud Services (CFS).

48. MAS providers who submit an unsatisfactory response or fail to respond to payment verification enquiries may be considered for onward referral and/or financial recovery.

49. Where after suitable investigation an NHS Board is satisfied that a MAS provider has not provided the services in accordance with the 2016 MAS Directions it can suspend payments for MAS and recover those made in respect of any appropriate period(s).

(Schedule 4, paragraphs 7.3-7.5)

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Payment for the Minor Ailment Service is made on a capitation basis calculated on the number of registrations held within the Central Patient Registration System the calculation is carried out on the last day of each month.

Band Number of Registrations Annual Payment Monthly Payment
1 1-250 £7,300.92 £608.41
2 251-500 £9,253.92 £771.16
3 501-750 £11,208 £934.00
4 751-1000 £13,218 £1,101.50
5 1001-1250 £15,228 £1,269.00
6 >1250 £15,228 +£8.04 per patient above the threshold £1,269.00 + £0.67 per patient above the threshold
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So what is this report?

This report is both the largest and first nation-wide study, with respondents from every Health Board, of the Minor Ailment Service (MAS). This study was designed to capture the impressions and perceived efficacy of MAS by those who use it, so that the benefits of this service could be easily demonstrated.

What does the report conclude?

The report demonstrates just how popular MAS is with those who rely on it – 87% of those surveyed rated their satisfaction as 10/10 and their consultation experiences were consistently rated as ‘Excellent’ when using the CARE criteria. This report also shows that this service is an efficient use of NHS resources as 60% of users said they would have gone to their GP if the MAS service was unavailable to them.

Here at CPS we are delighted with this report and think that it highlights just how important and useful the Minor Ailment Service is.

Please see our press release for more analysis.

Extension of the Minor Ailment Service

CPS has been working with the Scottish Government to design an extend MAS which would be a service accessible to anyone registered with a GP in Scotland. The First Minister announced the extension of this service in September 2018 and although the fine details are still being worked out, we expect to see this updated service in 2019.

Further Information

Full Report

Interactive Press Release

PDF Press Release

If you have any comments or queries on the report, please get in touch with Caroline Rooks, Public Affairs Officer, at caroline.rooks@cps.scot or 0131 467 7766.

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