dispensing gps lose market share to...
TRANSCRIPT
TEL: 07889412690 4 January 2018
HEADLINES Dispensing GPs lose market share to pharmacies
Dispensing GPs in England dispensed 84.9 million items during 2016-17, a rise of 300,000 items (0.1 per cent) on the previous year, new NHS statistics reveal. However, this represents a marginal (0.05 percentage points) fall in market share while community pharmacies increased their share by 2 per cent over the same time period. Community pharmacies now dispense 1.02 billion items, over half (52.1 per cent) of which are dispensed via the Electronic Prescription Service. Furthermore, community pharmacy numbers are yet to reflect any impact of the £113 million reduction in community pharmacy funding in 2016-17. During 2016-17, there was a net rise of 11 pharmacies, increasing the size of the pharmacy network in England by 0.1 per cent to 11,699. However, during the year 47 pharmacies closed, which is the largest number of closures since 2013-14.
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LPC events are
planned to help you to further deliver on services and demonstrate our impact in 2018.
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The statistics also reveal that there were five applications granted in controlled areas of which two were for unforeseen benefits. During the year the NHS heard 32 appeals relating to applications made in controlled areas, of which 62.5 per cent (20) were lost on appeal.There were no applications for outline consent by dispensing GPs.Looking at the make-up of the pharmacy sector, independents continue to decline in market share and now account for 37.9 per cent of the total network (4,434 pharmacies). The average monthly item volume per pharmacy now stands at 7,218, up from 5,865 in 2007-08, explaining the rise in the proportion of pharmacies dispensing 6,001 items and over. One in five community pharmacies now dispenses 10,000+ items per month.Pharmacies are also maximising clinical services income: in 2016-17 96.1 per cent of pharmacies provided the pharmacy medicine use review service, and on average deliver 300 a year (75 per cent of the maximum). Some 85 per cent of pharmacies provide the New Medicine Service at an average rate of 87 a year.The percentage of pharmacies providing NHS flu jabs has also risen significantly compared to the previous year, up to 72.2 per cent from 61.6 per cent. In volume terms this equates to 950,765 vaccinations across the network, a 60 per cent increase in delivery compared to the previous year.The report also notes the trend over the last 10 years of declining average NIC per fee, due to factors including the following:
• The Medicines Margin Survey resulting in adjustments to Category M generic drug reimbursement prices as agreed under the Community Pharmacy Contractual Framework
• An increase in generic dispensing rates (due to patent expiry and loss of exclusivity for a number of leading branded drugs) and the continued efforts to promote generic prescribing• The Pharmaceutical Price Regulation Scheme (PPRS), which has resulted in a reduction in branded drug prices (with price cuts of 7.0 per cent in 2005, 3.9 per cent in 2009 and 1.9 per cent in 2010). There were automatic permitted price increases of 0.1 per cent from 1 January 2011, 0.2
per cent from 1 January 2012 and 0.2 per cent from 1 January 2013. The 2014 PPRS agreed that the drugs bill will stay flat over the first two years of the scheme and will grow slowly after that.
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Nationally, 96.1% of pharmacies provide Medicines Use Reviews. Sadly, in both Nene and MK we are falling short of maximising clinical services income. The figure for MUR’s conducted in Nene is 88.38% and in MK 89.05%. The figures for delivery of NMS’s is 60.7% and 66.79% for Nene and MK respectively.
In the current flu season the number of vaccines delivered is up by 60%
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OTC prescribing review consultation underway 33 items to go from routine prescribing
NHS England has launched the public consultation on proposals to end routine prescribing of 33 over the counter item considered to be for conditions that are either self-limiting or suitable for self-care. Vitamins/minerals and probiotics are also included as items of low clinical effectiveness.The consultation is now open and runs until Wednesday 14 March. This was first announced in early December.NHS England has proposed five exceptions to the proposed restrictions:
• Circumstances where the product licence doesn’t allow the product to be sold over the counter to certain groups of patients.
• Patients with a minor condition suitable for self-care that has not responded sufficiently to treatment with an over the counter product.
• Patients where the clinician considers that the presenting symptom is due to a condition that would not be considered a minor ailment
• Circumstances where the prescriber believes that in their clinical judgement exceptional circumstances exist that warrant deviation from the recommendation to self-care.
• Patients where the clinician considers that their ability to self-manage is compromised as a consequence of social, medical or mental health vulnerability to the extent that their health and/or wellbeing could be adversely affected if left to self-care.
Guidance for CCGs will not remove prescriber’s clinical discretion, according to NHS England. For more information please refer to https://www.england.nhs.uk/medicines/items-which-should-not-be-routinely-prescribed/
Milton Keynes CCG have already implemented some changes, I spoke of these and the consultation process involved in the July 2017 LPC Newsletter. If you would like to read the article please follow this link http://psnc.org.uk/northamptonshire-and-milton-keynes-lpc/wp-content/uploads/sites/102/2016/12/July-2017-LPC-Newsletter.pdf
This is not a case of refusing treatment, as some may argue, but redirecting people to a more appropriate place of care, particularly for simple conditions where OTC medications are identical. I think we all want to see good value for money from our tax pound, particularly when it comes to the NHS.
The CCG’s can only make suggestions and it is for GP’s to decide what to prescribe and to adhere to their contractual obligations.David Reissner, senior healthcare partner at law firm Charles Russell Speechlys LLP, stresses that CCGs “do not have the power to say what GPs can or cannot prescribe”.“CCGs are legally entitled to try to influence prescribing, but they cannot insist that GPs cease prescribing medicines that can be bought over the counter.”“GPs must make their decisions on the basis of their contracts, which require them to prescribe treatment if this is clinically appropriate.”
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Healthy Living Pharmacy in January Christmas and New Year is over and we are all slowly getting back to reality.But there are millions of people that decide to take a break from drinking alcohol for a month in a bid to shake off the excesses of the break, and to give themselves a health boost, known as Dry January.The concept is now backed by the charity Alcohol Concern who say that it “enables you to take control of your relationship with alcohol” and “drive a conversation” about drinking.They expect 3.1 million people to take part in Dry January this year.It’s common knowledge that drinking alcohol excessively is bad for you, making you more susceptible to heart disease, stroke, liver disease, depression, dementia and cancer.But will laying off the booze for one month really make a difference?
As it’s still a relatively recent phenomenon, there’s not a huge amount of research to draw on. But in 2013, an experiment conducted by New Scientist staff with the Institute for Liver and Digestive Health at University College London Medical School (UCLMS) showed marked differences in the condition of those who abstained from alcohol for five weeks.
The best advice is to drink in moderation throughout the year. Taking January off does not enable a binge in February! It would be better to have two alcohol free days each week all year rather than a one-month abstinence according to experts.
Some other reasons to give up alcohol for January include:• Weight loss• Better quality of sleep• Increased energy and better performance• Skin appearance will appear clearer as alcohol
dehydrates the body• No more hangovers• It’s likely to lead to healthier drinking habits and reduced
consumption of alcohol in the future• A great sense of achievement from completing a whole
month without any alcohol• A big cash saving – much needed after Christmas!
For #HealthyMK 2018 campaign ideas please see HEREInformation to support your patients in Northants can be
accessed here http://www3.northamptonshire.gov.uk/councilservices/health/healthy-workplaces/Pages/alcohol-reduction-healthy-workplaces.aspx
Men and women are advised not to drink more than 14 units of alcohol a week. This is the same as 6 pints of average strength beer a week. Regularly drinking more than this can increase the risk to your health
Read more at https://www.nhs.uk/oneyou/drinking#2QQzpCGbgcAKPz81.99
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This one page advert was published by Community Pharmacy Cheshire & Wirral.The points made in the article will be very useful to share with the whole team to answer patients
questions and concerns about some of their medicines being currently unavailable.Please feel free to share the poster. if you do so it may be useful to add your contact details as a footer. Thanks to Mo Kolia of Knights Pharmacy for drawing my attention to this helpful resource.I also have access to a GP version. If you would like a copy please let me know and I can forward it to you.
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There’s never been a better time to quit (smoking) We know that community pharmacies are often embedded in some of the most deprived and challenging communities, providing daily contact for individuals seeking ad hoc and unplanned health advice alongside picking up prescribed medicines or purchasing over the counter health related products. With 1.2 million visits to a pharmacy every day for health related reasons, this presents a huge opportunity to support behaviour change through making every one of those contacts count.
The challenge begins now that you are HLPs - embracing the culture and ethos of the HLP concept, so pharmacy staff, especially health champions, reach out to their communities pro-actively to promote health and well-being messages. Many of you come from the communities that you serve, making it much easier for you to help people change their lifestyles.
I’m pleased to let you know free printed, digital and social resources are now on the Campaign Resource Centre to help you encourage smokers to quit this New Year. This will be useful for Healthy Living Pharmacy health zones.
Please read on for more detail about what's available..
Read the handy guide detailing available resources and the best way to use them.
Printed resources (available to download and/or order)
• A0 poster (download)• A3 'never been a better time to quit' poster
(order or download)• A4 'never been a better time to quit' poster
(order or download)• A4 'what will you start doing?' poster (download)• A5 leaflet (order or download)• A5 leaflet dispenser (order)• Activation guides (order or download)
There are specific resources for pharmacies, prisons and Ministry of Defence sites, so please make sure you order or download the right versions for pharmacies.
PHE are delighted to offer you more customisable digital and social resources than ever before. Please email [email protected] to access these files. You'll need to follow brand guidelines, and send any materials to [email protected] for approval before using.
There is huge potential for action to improve health through your everyday interactions – whether selling over the counter medicines, dispensing prescriptions, providing Medicines Use Reviews or the New Medicine Service. It is up to you now to demonstrate that you, as pharmacy teams, can do this, and demonstrate the impact.It is key to draw on the knowledge and skills of your qualified health champions to support the whole team to routinely make health promoting interventions and provide healthy lifestyle advice e.g. on stopping smoking, reducing alcohol intake, increasing physical activity etc.
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Important topics for pharmacy contractors in 2018 In 2018 and 2019 there are a number of big topics that are going to impact on community pharmacy that contractors will need to be aware of and be prepared for. These include:
General Data Protection Regulations (GDPR) – comes into force in May 2018 https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/ Falsified Medicines Directive (FMD) – early 2019 https://psnc.org.uk/contract-it/pharmacy-regulation/falsified-medicines-directive/ Revalidation (new CPD recording requirements) – 2018 https://www.rpharms.com/revalidation You will receive information from GPhC in February ahead of implementation from end of March. Some of these topics are complicated and require preparations in advance. Please look out for our communications regarding these changes.
Reminder about using NHS Mail user accounts NHS England has advised that following investigations by NHS Digital, it has been brought to their attention that a small number of pharmacies have set up a number of inappropriate NHS Mail user accounts (linked to their pharmacy’s shared account) that are not for actual people. Examples have been provided to them where the surname and forename fields have been deliberately completed to generate email addresses which are not for the use of a named person (so, for example, First name: Repeat, Last name: Prescriptions, to issue a user account named [email protected])
NHS England would like to remind all community pharmacies that user accounts should be set up for staff and are not intended to be used as generic or shared accounts for other purposes. Shared email accounts for each pharmacy are designed to allow access by multiple users accounts to ensure that Information Governance (IG) protocols are not breached. Sharing passwords is a clear breach IG, so setting up individual user accounts which are accessed by multiple people by sharing login details and passwords is not permitted. Users of the NHS Mail service should also bear in mind the restrictions on use for commercial advertising purposes and accounts set up should not, for example, be used to advertise job vacancies, offer commercial opportunities or advertise the services of a pharmacy. Any accounts that are found to have been set up inappropriately or which are operating in contravention of the Acceptable User Policy (AUP) declaration will be suspended and removed by NHS Digital as and when they are identified.
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Nene Repeat Prescribing Pilot Nene CCG intend to make a recommendation to CCG member practices which will change the way in which repeat medicines are ordered 'to improve repeat prescribing systems.’ This recommendation has recently been approved by the CCG Executive Team.
There was an inevitability about Nene adopting a new practice for managing repeats and the management of waste created thereof. Thus the LPC were keen to work with the CCG in order to get the correct messages to patients and to safeguard those most vulnerable patients against harm. We called upon the experience of one of our neighbouring LPC’s, Bedfordshire, our aim being to learn from the pitfalls they encountered during implementation.
Nene CCG do not anticipate that the Luton ‘model’ as it has been called, will impose restrictions on patient choice and access, but will enable the patient to be supported to order their repeat prescriptions in a way that best meets their needs. Patients and the wider community understand the urgent need for the NHS to make good use of the available resources in the current economic climate.
However, please do be mindful that the CCG cannot make the changes mandatory. They are reliant upon GP surgeries being willing to adopt the new way of working and also patients being accepting of the new method for reordering their repeats.
The surgery at Brackley will be part of a 2 practice pilot and I have learned in Christmas week that the intention will be to go live on February 12th 2018. I have been told that Ruth Britton (prescribing adviser Nene CCG) intends to visit the four pharmacies in the surrounding area to announce the plans. Ruth or her colleague Jean Langham may have already started these visits to Middleton Cheney, Lowick, Brackley and Larkrise. Over 85’s will be excluded meantime and will not receive a letter from the surgery outlining the changes. The pharmacies listed above will be provided with a list of (vulnerable) patients excluded over and above this cohort (for example patients with trays) and you will be given the opportunity to add to this list in w/c 8th January 2018. You should receive a form from the prescribing advisors to enable you to do this. If you elect to return the form electronically you must use a secure NHS Mail connection.
The second pilot surgery is Queensview. Louise Willis, Prescribing Support Technician for Northampton West, has split the pharmacies identified as being affected into two lists according to the number of vulnerable patients already identified by her team. The pharmacies are listed below. If Louise does not visit your pharmacy in person, and you wish to add patients to the vulnerable list that she has supplied previously, please email her [email protected] .
Louise would like to make it known that from from 19th Feb 2018, pharmacies should no longer order prescriptions for patients at Queensview surgery (except the vulnerable patients or patients expressing a desire to order as before).
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These are the pharmacies with the larger vulnerable patient lists and the ones that Louise Willis will be visiting:
Balmoral Pharmacy Touchwood Pharmacy, Kingsthorpe Centre, Harborough Road, NN2 7BD Boots, 1-2 Alexandra Terrace, NN2 7SJ Boots, 30 Weston Favell Centre, Northampton Regent Pharmacy, 10-11 Regent Square, NN1 2NQ The pharmacies with smaller vulnerable list size are: Jhoots Pharmacy, 42 Semilong Road, NN2 6BU Touchwood Pharmacy, 4 Malvern Grove, Duston, NN5 6AY Allisons Pharmacy, 56 Kingsley Park Terrace, NN2 7HH Limehurst Square Pharmacy, 9 Limehurst Square, Duston, NN5 6LP Parklands Pharmacy, 1a Coppice Drive, Northampton, NN3 6ND Boots, The Parade, Grosvenor Centre Wests chemist, 4 Kingsley Park Terrace, NN2 7HG Morningside Pharmacy, The Pines Surgery, Harborough Road Touchwood Pharmacy, 32 Harlestone Road Abington Pharmacy, 51a Beech Avenue, NN3 2JG Boots, Sixfields Retail park, 37 Gambrel Rd, Westgate Industrial Est, NN5 5DG Delapre Pharmacy, 52 Gloucester Ave, NN4 8QF Lloyds Pharmacy, 170 Park Ave North Park Square Pharmacy, 10 Park Square, Kings Heath Superdrug Stores Plc, 9-11 Wood Street, Grosvenor Centre, Northampton The Co-Operative pharmacy, 3 Adelaide Street, Northampton, NN2 6AR
These pharmacies are encouraged to review the vulnerable patient list distributed by Louise and add to it if appropriate. Please email Louise if you have questions.
I do not have a go-live date for any surgeries not included in the pilot and Milton Keynes is unaffected.
I am aware of one surgery at Earls Barton that decided to implement the ordering changes despite not being included in the pilot. I am also aware of a surgery possibly scoping the opportunity to take part sooner rather than later despite not being EPS enabled.
Please do let me know if you have concerns in your area.
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MK Emergency contraception PGD and training requirements updated
The PGD for emergency contraception has been updated. The training requirements to provide this service have also been updated with a few changes. The information below highlights some of these changes. Under the section, Professional and other qualification required, the PGD states that each pharmacist would attend one face to face CPPE Emergency contraception workshop every 3 years. This will give the pharmacists an opportunity to refresh their knowledge, discuss any new guidance and meet with peers to share best practice and local issues and solutions. At the workshop as well as our expertly trained CPPE tutor there will be local sexual health clinician/experts and a representative from Brook to support with any questions. Under the section, requirement of education/training, the PGD has also states that providers of the emergency contraception service will complete a Declaration of competence (DoC) for emergency contraception and review and update it every 3 years. As a pharmacy professional you are responsible for keeping your knowledge and skills up to date. Completing the CPPE learning and assessments suggested in the DoC framework for this service, carrying out the pre-workshop reading and tasks and attending the workshop will support you in meeting specific competencies within the DoC self-assessment framework for this service. As part of the DoC and PGD you will be asked to complete the e-assessment on emergency contraceptionhttps://www.cppe.ac.uk/programmes/l/ehc-a-09 and safeguarding children and vulnerable adultshttps://www.cppe.ac.uk/programmes/l/safegrdingl2-a-01 . The e-learning programmes for these will help you prepare for the assessment, emergency contraception: https://www.cppe.ac.uk/programmes/l/ehc-e-03, safeguarding children and vulnerable adults:https://www.cppe.ac.uk/programmes/l/safegrding-e-02 Please ensure you have fully read the October 2017 PGD and understand the changes made. A copy of the PGD can be found here PGD October 2017 To help support you with these changes CPPE will be providing 2 fully funded workshops per year in Milton Keynes (dates tbc). This will provide an opportunity to not only attend a workshop, but the CPPE tutor and local clinician/experts will be there to support any questions you have regarding the service or training requirements.
SmokeFree MK Julia Banham has now taken up a new role and is no longer our point of contact for this service. Rachael Holland and her team will be pleased to assist you. Rachael is the Principal Public Health Officer – Tobacco Control and Stop Smoking Services Public Health Central Bedfordshire, Bedford Borough and Milton Keynes Council Central Bedfordshire Council, Priory House, Monks Walk, Chicksands, Shefford, Bedfordshire, SG17 5TQ Direct Dial: 0300 300 5307 | Internal: 75307 | Email: [email protected]
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Northants and MK LPC, CPPE and Northants County Council invite you to attend the following learning event on Thursday 8th March 2018 19.00-21.30. The venue is the Holiday Inn Express Northampton , Loake Close, na, Northampton, na, UK, NN4 5EZ Falls prevention and bone health
To book please visit https://www.cppe.ac.uk/mycppe/login
This bespoke event has been put together primarily to address the specific priority area of Falls Prevention in Northamptonshire. It is a one-off opportunity. At the end of this workshop and associated learning you will be able to: • Describe the falls and bone health strategic framework for Northampton and the
pharmacist role in prevention • Demonstrate how to increase awareness of falls • Identify patients at risk of falls and provide solutions to reduce this risk though lifestyle
and medicine interventions • Provide educational advice on promoting good bone health and medicines for
osteoporosis (Open to Northants and MK).
CPPE Spring events in our area Please see all the Spring events from CPPE on our website http://psnc.org.uk/northamptonshire-and-milton-keynes-lpc/our-events/milton-keynes-cppe-events-autumn-2017-spring-2018/
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Jon Bell workshop coming soon
Electronic Lungs, Carbon Footprints and Inhaler Design presented by Jon Bell. At this workshop Jon Bell of Canday Medical ltd will provide an overview of the skills required to support respiratory patients to manage their condition and maximise the patient’s quality of life. This is a very “hands on” event where you will learn about the different mechanism of inhalers, better understand how inspiratory flow can affect drug delivery for different inhalers and apply that to practice. There will be an opportunity to practice your own technique using a variety of different devices including the Incheck device and an AIMs machine.
The date is yet to be confirmed so please keep an eye on the events section on the LPC website http://psnc.org.uk/northamptonshire-and-milton-keynes-lpc/our-events/
This event is brought to you by the LPC and GSK.
LPC Elections The term of office of the members of the Northamptonshire and Milton Keynes Local Pharmaceutical Committee expires on 31st March 2018 and I wrote* to you seeking nominations for the pharmacy contractor places on the committee. (*email 20th December)
There are five places available and a nomination form was attached to the email. Other places on the LPC are filled by nominations from the Company Chemists’ Association (CCA) and Association of Independent Multiple Pharmacies (AIMp) and consequently neither candidates nor nominators may be representatives of member companies of the CCA or AIMp. The same prohibition applies to non AIMp regional multiples with more than 8% of the total contracts in the LPC area who have accepted reserved places on the LPC.
If you would like to put forward a nomination please complete and return the nomination form to reach me (Anne-Marie) by 12 noon on 22nd January 2018.If there are more nominations than places available there will an election and voting papers will be distributed to eligible contractors. Accompanying the voting paper will be the information taken from the shaded boxes on the nomination paper to provide voters with information on each of the candidates.
Independents, if you require another nomination form please get in touch (details below).
THANK YOU FOR READING THE JANUARY NORTHANTS AND MK NEWSLETTER. PLEASE DON’T HESITATE TO GET IN TOUCH IF I CAN HELP IN ANY WAY.
ANNE-MARIE KING, CHIEF OFFICER, TEL: 07889412690
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