Sheffield Primary Care Trust
A Community Pharmacist Service
to Treat Minor Ailments
(Enhanced Service)
Compiled by the Community Pharmacy Development Unit of NHS Sheffield
April 2012
Contents
PageEnhanced Service Specification
1 / Service Description / 3
2 / Aims and Intended Service Outcomes / 3
3 / Service Outline / 3
4 / Patient Registration and Service Provision / 3/4
5 / Duties of General Practices / 5
6 / Transfer of Care / 5
7 / Duties of Participating Community Pharmacists / 5/6
8 / Service Funding and Payment Mechanism / 6
9 / Quality Indicators / 6/7
10 / Role of the Pharmacy Development Manager / 7
Pharmacist Consultation Record – including Patient Declaration of Exemption - Appendix 1 / 8/9
Minor Illnesses Key - Appendix 2 / 10
Monographs / 11-34
Drug List / Formulary- Appendix 3 / 35/36
Referral Form from Community Pharmacy - Appendix 4 / 37
Flow Chart for Service provision – general / 38
Flow Chart – Pharmacist / 39
Patient Leaflet (front sheet) / 40
Patient Leaflet (inside sheet) / 41
Enhanced Service – Minor Ailment Service
1. Service description
1.1 The pharmacy will provide advice and support to people on the management of minor ailments, including where necessary, the supply of medicines for the treatment of the minor ailment, for those people who would have otherwise gone to their GP for a prescription.
1.2 Where appropriate the pharmacy may sell OTC medicines to the person to help manage the minor ailment.
1.3 The pharmacy will operate a triage system, including referral to other health and social care professionals, where appropriate.
2. Aims and Intended Service Outcomes
2.1 To improve access and choice for people with minor ailments by:
¨ Promoting self-care through the pharmacy, including provision of advice and where appropriate medicines and/or appliances without the need to visit the GP practice;
¨ Operating a referral system from local medical practices or other NHS healthcare providers;
¨ Supplying appropriate medicines at NHS expense.
2.2 To improve primary care capacity by reducing general practice workloads related to minor ailments and improve ease of access to advice and support for patients.
3. Service Outline
3.1 The part of the pharmacy used for provision of the service provides a sufficient level of privacy and safety and meets other locally agreed criteria.
3.2 The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service.
3.3 The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the provision of the service are aware of and operate within local protocols.
4. Patient Registration and Service Provision
4.1 All patients must be registered onto the NHS Sheffield Online Reporting System prior to receiving the service. In order to register patients the following information must be recorded on-line:
· First Initial of First Name
· Year of Birth
· Gender
· First part of Sheffield Postcode: S_ _
4.2 The entry of this data onto the NHS Sheffield Online Reporting System will generate a unique personal identification code number. This number must be entered onto a card (as supplied by NHS Sheffield) which must be given to the patient to confirm their registration onto the scheme. A pharmacy label should also be affixed to the back of the card to show the original issue.
4.3 Patients already registered will have a registration number/card and their registration number should be entered onto the NHS Sheffield Online Reporting System for each consultation undertaken in order to up-date their personal record, which will incorporate:
· The GP practice with which they are registered (from drop down box);
· The condition presenting (from drop down box);
· The medication provided (from drop down box);
· Date and time of consultation.
If a patient, claiming to be registered, presents without a card or record of their registration number their details (as set out in 4.1) should be taken and entered onto the system to access their service history and a replacement card issued.
NB Please note that through the On-line Reporting System you will be able to see where and what the person holding this unique code number has received in respect of advice/treatment under this scheme previously. The Patient Identifiable Data (PID) is secured via the unique identity code.
4.4 The pharmacy will maintain appropriate records of the consultation and any medicines supplied, to ensure effective ongoing service delivery and audit (see Appendix 1). NB Due to the new On-line Reporting System, entries onto the PMR are not required.
4.5 The local Minor Ailments Formulary as revised (Appendix 3) which has been agreed with local stakeholders will be used in conjunction with the monographs.
4.6 This Enhanced Service (the service) may be offered to all patients, who are exempt from prescription charges and are registered with a Sheffield GP (as entered onto the on-line reporting system via a drop down box).
4.7 The Pharmacist is responsible for the delivery of the service and must make the decision as to the provision of any medicines or advice provided under the scheme. The Pharmacist may be supported in the delivery of the service by appropriately trained and competent support staff, however advice or medicines provided under the scheme requires the exercise of professional judgement by the Pharmacist, incorporating:
- advice on the management of the ailment, or;
- advice and a medicine from the local formulary, supported by advice on its use, or;
- advice on the management of the ailment plus a referral to an appropriate health care professional.
4.8 The pharmacy has a system to check the person’s eligibility for receipt of the service.
4.9 The Community Pharmacy Development Unit (CPDU) will provide the On-line Reporting System for the recording of relevant service information for the purposes of audit and the claiming of payment, which must be used by all service providers.
4.10 The CPDU will be responsible for the promotion of the service locally, including the development of publicity materials, which pharmacies can use to promote the service to the public.
4.11 The CPDU will ensure the provision of details of relevant referral points that pharmacy staff can use to signpost service users who require further assistance (see Signposting Guide).
5. Transfer of Care
5.1 Patients presenting with identified symptoms at the GP surgery (before entering into a GP consultation) may be offered transfer into this service.
5.2 Patients presenting at the Community Pharmacy with a minor ailment who are confirmed as exempt from prescription charges, may receive the service as laid out in this Service Specification.
5.3 If the Pharmacist cannot confirm the patient’s registration with a Sheffield General Practice, the patient will not be eligible for this Scheme at that time and they will be advised to access medical care through the normal channels (eg Sheffield City GP Health Centre, Broad Lane).
6. Duties of General Practices
6.1 Sheffield registered patients requesting appointments (either immediately or on an appointment basis) for symptoms matching criteria identified in this service, may be offered transfer to this service (provided this is prior to the actual GP consultation taking place).
6.2 GP Surgeries are encouraged to co-operate and liaise with Community Pharmacists in the operation of the Minor Ailments Service.
6.3 On some occasions the Pharmacist may consider that the patient needs to be seen by a doctor. The urgency will depend on the symptoms. In these circumstances the Pharmacist will refer the patient back to the surgery. If the surgery is closed the Pharmacist may refer the patient to the Sheffield City GP Health Centre (Broad Lane), the Minor Injuries Unit (RHH), the Walk in Centre (NGH) or in extreme cases advise the patient to call the emergency number or go straight to A & E.
6.4 GP surgeries may display official posters and provide leaflets promoting the service.
6.5 For patients under the age of 16 the parent/guardian can accept transfer into the service on behalf of the patient.
7. Duties of Participating Community Pharmacies
7.1 Patients exempt from prescription charges should only be accepted into the service if the Pharmacist is satisfied of the patient’s registration with a Sheffield General Practice.
7.2 All participating Pharmacies will provide a professional consultation service for eligible patients, presenting with one of the specified conditions.
7.3 The patient’s condition will be assessed by the Pharmacist and may be supported by suitably trained and competent members of the pharmacy team – as detailed in section 4.7 (above). The consultation will consist of:
7.3.1 Patient assessment by Pharmacist (NB in the case of absence eg a sick child, clinical judgement should be used in deciding the appropriateness of supply);
7.3.2 Provision of advice;
7.3.3 Provision of a medication, only if necessary, from the agreed formulary appropriate to the patient’s condition;
7.3.4 A record of the consultation will be made on the On-line Reporting System. A Pharmacist Consultation Record (Appendix 1) should be completed, which must be signed by the Pharmacist to confirm service provision and signed by the patient to confirm eligibility and receipt of service. The Pharmacy will retain these details for their own records and audit purposes for two years.
· In the event of the consultation under the Scheme not leading to the supply of a product, the Pharmacist should indicate this on the Pharmacist Consultation Record and On-line Reporting System; the patient should sign the form to confirm validity.
· The information gained by NHS Sheffield from the on-line reporting system, will be used to calculate the monthly payment due, which will be generated automatically without a separate claim being required.
7.4 Normal rules of patient confidentiality apply.
7.5 The Pharmacist should ensure that the patient has completed and signed the declaration of exemption of Prescription charges (on the front of the Pharmacist Consultation Record).
7.6 If, in the opinion of the pharmacist, the patient presents with symptoms outside the service, they should be referred back to their GP or other relevant service (see Signposting Guide).
7.7 If a patient presents more than once within any 4 weeks with the same symptoms and there is no indication for urgent referral, the patient should be referred to their surgery. The referral form should be completed and given to the patient to take back to the surgery. (Appendix 4).
7.8 If the patient presents with symptoms indicating the need for an immediate consultation with the GP, they are outside the service and should be advised to refer back to their GP (within surgery hours) or to contact the on-call doctor, or to attend the Walk-in Centre, Minor Injuries Unit, Sheffield City GP Health Centre (Broad Lane) or A & E immediately (as appropriate, outside surgery hours). Utilise Signposting Guide for addresses and telephone numbers as required.
7.9 If the pharmacist suspects that the patient and/or parent is abusing the service they should contact the Pharmacy Development Manager to discuss options.
7.10 The Pharmacist will provide feedback to the patient’s GP where appropriate.
7.11 The Pharmacist will be reimbursed a fee per consultation. A consultation is the management of a patient’s minor ailment(s) through the provision of advice and treatment(s) as appropriate.
8. Service Funding and Payment Mechanism
8.1 The Pharmacy will be paid according to the following schedule:
Fee: £7.00 (per consultation)
The fee incorporates the provision of advice and the cost of all treatment(s) supplied to the patient per consultation.
Number of consultations: The number of consultations commissioned from each pharmacy is stated as a cap in the individual Service Level Agreement (SLA). The cap represents the maximum number of consultations that will be paid for in the period covered by the SLA.
8.2 The On-line Reporting System will generate the monthly payment at each month end.
9. Quality Indicators
9.1 The pharmacy is making full use of the promotional material made available for the service.
9.2 The pharmacy has appropriate health promotion and self-care material available for the user group and promotes its uptake.
9.3 The pharmacy reviews its standard operating procedures and the referral pathways for the service on an annual basis.
9.4 The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service.
9.5 The pharmacy participates in NHS audit of service provision.
9.6 The pharmacy co-operates with any locally agreed NHS led assessment of service user experience, which will include a questionnaire for patients over a two week period to collect data for the Commissioner.
10. Responsibility of the Pharmacy Development Manager
Overall responsibility for co-ordinating and managing the project
· Managerial leadership
· Co-ordinating evaluation
· Maintaining contact with the participating pharmacies
APPENDIX 1
Pharmacist Consultation Record (Sheffield Minor Ailments Scheme)
Date of Consultation: / Patient Registration Number (as obtained from NHS Sheffield On-line Reporting System):Time of Consultation: / ____ AM / ____ PM
Patient Details:
Name
Address
Date of Birth
Registered GP Practice
Medical Information:
Condition Treated:
Medication Given:
Exemption Information: / Evidence Seen? / YES / NO
I am exempt from paying prescription charges for the following reason:
A. is under 16 / G. has a valid War Pension Exemption Certificate
B. is 16, 17, 18 and in full time education / H. gets Income Support or income-related Employment and Support Allowance
C. is 60 or over / K. gets Income-Based Job Seeker’s Allowance
D. has a valid Maternity Exemption Certificate / L. is named on a current HC2 charges certificate
E. has a valid Medical Exemption Certificate / M. is entitled to, or named on, a valid NHS Tax Credit Exemption Certificate
F. has a valid Prescription Prepayment Certificate / S. has a partner who gets Pension Credit guarantee credit (PCGC)
X. was prescribed free-of-charge contraceptives / N/A
I am the patient / I am the patient’s representative
Patient Declaration (please tick which applies):
I have received the above medicine(s) and am exempt from charges for the reason specified above. I understand this is an NHS service and that NHS will retain data relating to my use of the service and may contact me for my views.
I have consulted the pharmacist under the Minor Ailments Scheme, am exempt from charges and confirm that no medicines have been issued to me on this occasion. I understand this is an NHS service and that the NHS will retain data relating to my use of the service and may contact me for my views.
Signature / Name
Date
I am the patient / I am the patient’s representative
Details of Consultation – FOR PHARMACY CLINICAL RECORDING PURPOSES ONLY:
Advice Given
Product(s) Supplied or Recommended (if any)
Dose Recommended
Was the patient signposted to another health care professional?
If yes, to who?
Medical Information:
Symptoms:
How long has the person had these symptoms?
Has the person tried taking any medication yet?
If so, what medication has been tried?
Does the person suffer from any existing medical conditions?
If so, what are they?
What medication is being prescribed by the doctor for these conditions?
Pharmacist Declaration:
I confirm that I have provided appropriate advice / treatment for the patient named overleaf under the Sheffield Minor Ailments Scheme in accordance with the Service Specification *
Name
Signature
Date
· NB: One form represents a consultation which may include advice and treatment for more than one condition as necessary.