On Friday evening (10 April 2020), NHS England and NHS Improvement published details of the first new services and corresponding funding for community pharmacies in England responding to the Covid-19 pandemic.
With effect from 8 April 2020 and until at least 1 July 2020, the Terms of Service for all pharmacy contractors (excluding distance selling pharmacies) have been amended to introduce a new Essential Service ("ES"). This ES requires contractors to assist shielded patients (1.28 million patients considered to be particularly vulnerable to Covid-19) to receive their prescription medicines without attending the pharmacy.
Under the new ES:
* Contractors must encourage shielded patients to arrange for their prescription medicines to be collected and delivered to them by a family member, friend, neighbour or carer.
* Where a patient does not self-identify as shielding, but the nature of their prescription causes the contractor to suspect the patient may fall within the shielding criteria, the contractor must enquire if the patient has been advised to self-isolate for 12 weeks. Where the patient has been so advised, again the contractor must encourage the patient to arrange for their prescription medicines to be collected and delivered to them by a family member, friend, neighbour or carer.
* Where no family member, friend, neighbour or carer is available to assist the patient, the contractor must advise the patient about volunteers able to assist, referring to both local provision of volunteers (such as those organised by local authorities) and the NHS Volunteer Responder Service.
* Where a volunteer is to be used, the contractor must be satisfied that they are an appropriate person to deliver medicines to the shielded patient. No guidance has been provided on how a contractor might be so satisfied, particularly in circumstances where NHS volunteer responders will not be DBS checked.
* Volunteers should not deliver Schedule 2 and 3 Controlled Drugs, but may deliver Schedule 4 and 5 Controlled Drugs if the contractor considers this to be appropriate.
* All pharmacies dispensing more than 100 scripts per month will receive a payment for the new ES, ranging from £34 to £563 per month depending on script volumes.
In cases where there is no family member, friend, neighbour, carer or volunteer available to assist the patient in the timescale within which their medicines are required, the contractor must ensure that the patient receives their medicines via either:
* Delivering the dispensed medicines themselves under the new Advanced Service ("AS");
* Arranging for another contractor to deliver the dispensed medicines under the AS;
* Arranging for another contractor to both dispense and deliver the medicines under the AS.
The key terms of the service specification for the new AS provide that:
* As a prerequisite, contractors must (a) already be complying with the Terms of Service in respect of both Essential Services and Clinical Governance, (b) be satisfied that all staff involved in provision of the AS are competent to do so, and (c) have established that no family member, friend, neighbour, carer or volunteer can assist the patient.
* The contractor must introduce a Standard Operating Procedure for the AS, which must include procedures covering health and safety and infection control.
* The contractor must ensure that the AS is accessible, appropriate and sensitive to the needs of all service users.
* The contractor must maintain appropriate records, in part to support post-payment verification. This must include at least the patient's details and date of delivery.
* Patient safety incidents must be reported under the Clinical Governance Approved Particulars For Pharmacies.
* Payment for the new AS (again excluding distance selling pharmacies) has been set at £5 & VAT per delivery.
Throughout the service specifications for both the ES and AS, NHS England and NHS Improvement have emphasised that volunteers must be used wherever possible and paid delivery under the AS is considered to be a remedy of last resort.
Although pharmacy contractors have no input to or control over the enrolment of volunteers, the burden of ensuring that a volunteer is an appropriate person to deliver medicines to a shielded patient has been placed squarely on contractors. A further blog on this issue will follow shortly. In the meantime, full details of the new ES and AS can be reviewed here.
Further details on how community pharmacies are now expected to ensure that very vulnerable patients can continue to receive their medicines safely during the COVID-19 pandemic