Background
Flu services are now being commissioned  by the area teams of NHS England.  There are 2 area teams covering our region.  One team covers  Cumbria, Northumberland  North Tyneside, Newcastle, Gateshead, South Tyneside and Sunderland  and the second team covers Durham, Darlington and Tees.

As each LPC has traditionally  negotiated flu services separately with their own  PCTs we thought it would make sense for us to form one regional group to negotiate for the service.   


This group has been working hard to get the service commisioned.

Flu Service 2013/14
We can now confirrm that the area team covering Gateshead & South Tynside is intending to commision the NHS flu service this year through pharmacy.   

The regional group have put a website together to act as a central portal of information for flu this season.  The site can be accessed at www.northernpharmacy.net   and will be updated as soon as information is available.  Details of SLAs,  PGDs, marketing and resources will all be held on there for easy access.

You will be able to access this site through our own website also. 

TRAINING
Whilst we are waiting for the specific detail of the service we understand that everyone will need to undertake training. (Either full training as in previous years or an update training)

North of Tyne LPC, Gateshead & South Tyneside LPC and Sunderland LPC have jointly  organised training for contractors and their pharmacists in the North and South of Tyne area.  The training will ensure you have the relevant competencies required to provide the NHS Seasonal Flu Vaccination Service.

We have arranged training with Novartis again.  This means that many of you will not need to attend a live session but will be ok to complete an online update.

Full details can be found on our Flu training page  http://www.northernpharmacy.net/nt-gst-s-lpc.html  

Please make sure you read this information and register for the training that is relevant to you.  The LPC would encourage you to act on this as soon as possible so you don't miss out on training and are in a position to roll out your flu service quickly. The LPC is again subsidising the cost of training and the cost to pharmacists is the most competitive price we have found.

Following a couple of separate incidents In the last two weeks in the Sunderland area where controlled drugs taken for delivery have been ‘lost’.  Ken Dale (Controlled Drug Liason Officer) has advised all pharmacists to review their delivery procedures with regards to controlled drugs.

After investigation of the incidents in Sunderland it appears that the drivers, on both occasions, removed the packaged CD’s from the pharmacy however they were not delivered and there is no credible explanation as to where they have gone.

The investigation has shown that the systems in place for such deliveries were not robust enough and have been changed as a result..

Ken is requesting that  individual pharmacists assess their Standard Operating Procedures particularly around the following points.
 
1. Timed and dated signatures provided by the delivery driver within a ‘CD delivery register’ kept at the pharmacy. This will assist in the auditing of delivery CD’s and aid any future criminal investigation. This could also be used for returned/undelivered CD’s.
2.Timed and dated patient signatures at the point of delivery.
3. Delivery vehicles being fit for purpose, medication out of public view, vehicles to be locked at all times whilst unattended.
4. Consider prioritising the delivery of CD’s. This will reduce the risk of loss by opportunist thieves.

Ken is happy to offer any assistance/advice on this subject and his details are below.
 
Ken Dale
Controlled Drugs Liaison Officer
North of England Commissioning Support (NECS)
Tel: 0191 5297254

Mobile: 07919071655
Email: ken.dale@sotw.nhs.uk

The NHS is 65 years old and in that time, the  health system has undergone profound change, with the recent Health and Social Care Act introducing the most wide-ranging reforms since the NHS was founded in 1948.  As many of you will know the significant changes are having an impact locally with changes happening on a large scale.   

Trying to understand the new NHS structure can seem  quite diificult.  The Kings fund (An independent charity working to improve health and health care in England) have put together the following animation to explain the new structure in a simple manner.  Its an interesting animation and worth a watch as it try to simplifiy the complexity of the new NHS structure.

The animation gives a whistle-stop tour of where the NHS is now – how the new organisations work and fit together – and explains that the  new system is as much a product of politics and circumstance as design.

For more details about the Kings fund and their activities visit their website.

You can view and download  a copy of the final NHS Structure image here.

Following changes to the processing of pharmacy payments from 1st April 2013, both the PSNC Information Team and the NHS Prescription Services Help Desk have received calls from pharmacy contractors requesting more information. 

In order to support contractors, details are summarised below:


100% advance payments

All pharmacy contractors will now receive a 100% advance payment meaning that they will be refunded for medicines dispensed more promptly. For the June schedule, contractors received a 100% advance payment for the month of April (calculated based upon the average item value from the March bundle and volume from April) plus the outstanding 20% for the March bundle.  This means that contractors will have seen a higher than normal payment made in June (when the 100% advance was first implemented), but this will be a one-off.

Part I, Clause 5C of the Drug Tariff explains by means of this table (which we have simplified slightly here):

*Due to the transition to the new payment system, in June 2013's payment only, contractors will receive circa 120% payment.

**The value of (-) could be a positive, negative or zero.

Health Solutions Wales has confirmed that Welsh contractors will remain with 80% advance payments for the time being. The change to 100% is currently under discussion by Community Pharmacy Wales and the Welsh Assembly.

The Pharmacy Earlier Payment Scheme (PEPS)

The Pharmacy Early Payment Scheme, operated by Citibank, is an opt-in scheme which allows contractors to receive advance funding on attractive interest terms. Only those contractors who register for the scheme and ensure their bundles are received by the NHS BSA by set dates will be able to access the early payments.

Part I, Clause 5C of the Drug Tariff explains by means of this table (which we have simplified slightly here):

*If days referred to above fall on a weekend or bank holiday, the next available working day will be applied.

Further support

To assist pharmacy contractors in understanding the new details on their Schedule of Payment (FP34), the NHS Business Services Authority have now compiled a help guide for contractors. This can be found on their website.

The MHRA has issued class 2 drug alerts for Wockhardt and Pinewood Laboratories following manufacturing site inspections.

Pharmacies will need to take action within the next 48 hours and should note the large number of products  affected this time. 

16 different prescription only medicines in a variety of strengths made by Wockhardt Ltd  are affected following manufacturing deficiencies identified by the MHRA at Wockhardt’s Waluj site in India.

The medicines affected by the precautionary recall include those used for the treatment of infections, high blood pressure, diabetes, epilepsy, depression, schizophrenia, Parkinson’s disease, dementia in Alzheimer’s patients and thyroid conditions.

Full Details of the recalls 

1. Class 2 Drug Alert (Action within 48 Hours): Multiple products - Wockhardt UK Limited (EL (13)A/19) - This includes a list of all the medicines that are affected by the precautionary recall.

2. Class 2 Medicines recall (Action within 48 Hours): Erythromycin Oral Suspension - Pinewood Laboratories Limited (EL (13)A/20)

Patients do not need to return their medicines because there is no evidence that the medicines affected by the precautionary recall in the UK are defective. Therefore, it’s important that people continue to take their medicines as prescribed.

This is not a patient level recall because although the medicines that are affected have not been manufactured to Good Manufacturing Practice (GMP) standards, there is no evidence of a patient safety risk from medicines that have been sold in the UK. However, the MHRA has to act in the interests of public health as poor manufacturing standards cannot be allowed to continue.

The deficiencies identified by the MHRA during a routine inspection in March included a low risk of cross-contamination because of poor cleaning practices and defects in building fabric and the ventilation systems at the site. There was also evidence of forged documents relating to staff training records that had been rewritten. The MHRA is working with Wockhardt and other international regulators to resolve these issues.

Gerald Heddell, the MHRA’s Director of Inspection, Enforcement and Standards, said:

“This is a precautionary recall. People can be reassured that there is no evidence that medicines made by Wockhardt are defective so it’s important people continue to take their medicines as prescribed.  

“All batches of medicines manufactured outside the European Union are tested on importation to the UK before they reach patients. However, we have taken this precautionary action because the medicines have not been manufactured to the right regulatory standards.

“We are working with the Department of Health to ensure that people have access to the medicines they need. Anyone who has questions should speak to their pharmacist or GP.”

The medicines that are involved in the recall are available for patients from alternative manufacturers in most cases, either in equivalent strengths or varying strengths. Where there are no alternative manufacturers of the same medicines, substitutes are available and these should be selected by a healthcare professional.

The Department of Health is working closely with the companies concerned to help ensure that patients are able to get their medicines when they need them.

Pinnacle Health Partnership and PSNC are have jointly announced that the nationally specified Community Pharmacy Assurance Framework (CPAF) 2013/14 self-assessment is now available online at www.pharmoutcomes.org for community pharmacy teams in England to access.

Historiaclly our local area has used its own system of self monitoring forms to be filled in hower the we are still wating to hear if the Area team will use the same system again or if they will use pharmoutcomes to monitor the pharmacy contract.

Once we hear from our Area team we will inform you.  In the meantime the CPAF module in pharmabse may be a good option to help you prepare for contract monitoring anyway. 

Pharmacies can complete a paper copy of CPAF, but it is easier to use the PharmOutcomes online CPAF. The system will save your answers and allow you to download the completed CPAF to either print or email to your Area Team.

The system will remember the answers from one year to the next – if you used the PSNC provided Contract Workbook/CPAF module last year, those answers have been imported into the new PharmOutcomes and should be visible in the right-hand column of this year’s assessment as an aide-memoire for you.

How to access CPAF on PharmOutcomes

If you are already using the new PharmOutcomes system, or you can remember your PharmOutcomes login details for the previous platform, then these will work and you can go to the Assessments menu in the new PharmOutcomes straight away.

If you do not remember your PharmOutcomes login details, use the information in the letter being mailed to all community pharmacies in England in the first half of July 2013 (excluding CCA member pharmacies, who will in most circumstances receive information via their head office) to gain immediate access to the system.

If you have any problems accessing the new PharmOutcomes or have questions about how to use it, please contact the dedicated support service that can be accessed via the Help tab at www.pharmoutcomes.org.

All NHS providers, including community pharmacies need to provide information governance assurances to the NHS on an annual basis. These assurances are provided through completion of an online assessment tool, the NHS Information Governance Toolkit (IGT). Requirements for IG change annually, and Version 11 of the toolkit has now been released.

Based on user feedback, some changes have been made to the IGT functionality and some requirement guidance materials have had minor improvements to add clarity or to include up to date information. As there are no significant changes to the sixteen IG requirements for community pharmacy for 2013/14,  there is no additional impact or burden on the service in terms of conformance. Requirement 319 cannot yet be completed as PSNC and NHS England are still in discussion on business continuity planning. Pharmacies are expected to attain Level 2 against each of the pharmacy IG requirements and the deadline for submitting this year’s return is 31st March 2014.

Improvements made to the functionality of the IG Toolkit to improve usability and user experience are outlined below:

• Domain name changes

These reflect the transition of the IGT product to the Health and Social Care Information Centre (HSCIC), which now has the responsibility for the url and improved hosting arrangements.  The same team is in place to continue maintaining the IGT website and content development and further work will be required over the course of 2013 to 2014 to finish updating  branding, content and reference materials.

• Disclaimer for model/exemplar materials

A disclaimer statement displayed under the Knowledgebase section, within the individual requirement pages and the Knowledge Base search tool section will read:-

‘These exemplar materials have been provided over several years by various organisations or drafted by NHS colleagues. They are intended as general information which may assist.  However, the inclusion of this material should not be interpreted as an endorsement or approval’.

• External IG Delivery Team Review Section

An area for the External IG Delivery Team to keep a record of notes or actions when reviewing IGT assessments in support of various will only be visible to IGT users, whose IGT assessment has been reviewed by a member of the External IG Delivery Team, when they are logged in, and will not visible to the public even after publication of the assessment.

• Enhancement of improvement planning and evidence management facilities

Users wanted a more dynamic improvement plan tool and facility to manage their evidence more efficiently from a single location on the IGT. One consolidated report/plan is now available and is displayed in different formats to allow for more active online improvement planning, managing evidence and an option for offline working if necessary.  User guides on the new/enhanced improvement planning and evidence management tools are available from the ‘Help section of the IGT.

• IG Incident Reporting Tool

This has been developed to facilitate and enhance existing processes in relation to IG Serious Incidents Requiring Investigation (SIRI), and to ensure that DH is informed when necessary.

IGT Version 11 Change Release Note is available here.

Please find below the latest contacts we have at the NHS for registration of MUR services.

MUR Premises Registration
Should you need to register your premises for MUR's Applications should be sent to:-

Linda Bosher (linda.bosher@nhs.net)    will be dealing with MUR applications for County Durham , Darlington and Tees Area Claire McVay   (claire.mcvay@nhs.net)    will be dealing with these for Cumbria, Northumberland, Tyne & Wear Area.
 
Domiciliary MUR requests
Should you wish to provide domicilliary MUR's  these need to be sent to the contract managers for approval as follows:
 
Cumbria / Northumberland – Glyn Bosson     (Gbosson@nhs.net)
Tyne & Wear / Darlington – Helen Scott           (helen.scott6@nhs.net)
Tees / County Durham –  Ahcene Djabri          (ahcene.djabri@nhs.net)
 
All these personnel are now located at Rapier House in Sunderland and address and contact details are below.

County Durham, Darlington & Tees Area Team
Cumbria, Northumberland, Tyne & Wear Area Team
NHS England
Rapier House
Colima Avenue
Sunderland Enterprise Park
Sunderland
SR5 3XB

Switch Board:   0191 502 6542
Fax:   01325 553096