PHARMACY FIRST
Top ten FAQs
1. What qualifies as a consultation? Community Pharmacy Scotland’s (CPS’) working definition is that a consultation occurs where the pharmacy team assesses a patient’s symptoms and recommends a course of action. This is subject to change based on the content of the legal directions and service specification for NHS Pharmacy First.
2. Does every consultation have to be recorded, eg, counter staff, Saturday staff, telephone calls? You need to use your professional judgement and record if a consultation was provided, eg, was advice given over the phone, or was it just a request to order a prescription? Otherwise, there is no recognition of the work carried out and no remuneration.
3. What do we need to record in referrals? Referrals will look much the same as they do today – how you carry out a referral and what information you provide will depend on the patient, the condition and who you plan to refer onwards to. This could be anything from suggesting that the patient makes an appointment for a routine eye examination to calling an ambulance. You will have to make
> available to everyone and will therefore remove the pharmacist’s task of assessing whether someone is actually eligible for the service!
The service, according to CPS policy and development pharmacist, Adam Osprey, is based on a ‘truly national PGD and service level agreement model’ - which includes UTIs and impetigo for the launch phase – but which will eventually cover other PGDs for conditions such as acne, back pain, constipation, skin and soft tissue infections, pain relief and sore throat.
Every patient currently registered with a Scottish GP practice or who is an ordinary resident in Scotland – including the homeless and care home patients – will be able to access the service.
10 - SCOTTISH PHARMACIST
brief notes on your actions in the patient’s PMR – further detail will be provided in the NES NHS Pharmacy First resources. Many people find the PCR SBAR tool useful for clinical handover.
4. Does the patient have to physically attend the pharmacy for a consultation? No. Just as has been the case for MAS, you should assess each case on its own merit, applying your professional judgement to make a decision on what is appropriate. For example, you would probably choose to approach a phone call from a patient looking for advice on head lice differently to one regarding a child with a rash and sensitivity to light. CPS would expect these types of consultation to make up only a minority of overall activity. CPS also do not intend for the service to be delivered online.
5. Will each activity be paid at the same rate? Advice, referral and supply for a standard NHS Pharmacy First consultation will all carry the same weight for payment purposes. Advice, referral and supply as a result of a consultation where a PGD is involved will carry more weight than a standard consultation to reflect additional workload and pharmacist involvement.
Remuneration Remuneration details regarding the new service are still in the negotiation stage apparently, but the current feedback is that pharmacists will receive a base payment at the beginning and then everything will go into a ‘pot’.
The remuneration for this service will, in part, be activity-based, rightly placing proper value on professional consultations with the patient, which means that pharmacists’ clinical expertise and the time that they spend looking after local communities will be recognised.
Every pharmacist will receive a percentage of the ‘pot’ depending on how much they do, so it’s vitally important therefore that a comprehensive record of all activity is kept up to date.
6. Will activity payments change month on month? Yes. This has yet to be finalised, but as the service is recorded through UCF, CPS has been assured that contractors will be paid in line with their activity from month to month, two months in arrears.
7. If someone presents with more than one condition is that one consultation or more than one? This would count as a single consultation. Remember – it is not the outcome that NHS Pharmacy First places the value on, it’s the consultation.
8. Is this service decoupled from the CHI number? Where a CHI number exists, it will be used. However, some people who are eligible will not have a CHI number. Your PMR system will perform an eligibility check based on patient name, address, date of birth and gender for standard consultations, and there will be separate UCF modules to be used for PGDs, depending on whether the patient has a CHI or not.
9. Will there be a set payment for each pharmacy? Each pharmacy will receive exactly the same base payment each month. Contractors, who exceed a set number of consultations, will receive
a proportion of an activity pool of funding directly in proportion to their activity. As time progresses, the funding distribution will be reviewed and adjusted to more accurately reward contractors for their activity.
10. With respect to patients in care homes, will we need to treat them differently? For instance, you may be relying on care home staff to relay information about symptoms or a diagnosis so where would we stand? This is no different from the present situation where a patient is not present in front of you. How would you deal with this situation now? You would have to use your professional judgement as to whether it was appropriate to supply or not.
It may be the case that, with the appropriate technology and information governance in place, you would be able to see care home patients remotely. If you think you might be able to do this, CPS would suggest having a discussion with your care homes and NHS Board representatives to set this up safely
(Reproduced with the kind permission of Community Pharmacy Scotland)
Pharmacy First training available NHS Education for Scotland (NES) are running a series of local courses during March for pharmacists and pharmacy technicians on the NHS Pharmacy First Scotland service. They are also running a webinar and are developing other resources to support the roll-out of the service. All the latest content is available on Turas Learn at
https://learn.nes.nhs.scot/
Bridget Lamb, Will Chemists, Inverurie I think that the premise behind Pharmacy First is excellent, but I definitely think that we haven’t been given enough information yet. We are still missing a lot of information on a service that is meant to be implemented in less than two months’ time! No one has told us exactly how it’s going to work. I wasn’t able to make it to the local roadshow, but I watched the webinar which, I believe is what is shown at the roadshows, so I haven’t missed out on anything. I’m very concerned about the workload because we’re already flat out as it is. I think it’s going to be very much a case of ‘watch this space’ as far as this new service is concerned.
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