Community Pharmacy Assurance Framework 2007/08 by 4Kgvgtn

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									                                                          ASHTON, LEIGH & WIGAN PCT
                                                     Community Pharmacy Assurance Framework
                                                              Pre-Visit Questionnaire

This document outlines the data collection requirements and lines of enquiry to support the implementation of the National Community Pharmacy Assurance Framework at Ashton,
Leigh & Wigan PCT. The national framework has been localized to meet specific monitoring requirements at ALW PCT. This data specification should be read alongside the ALW PCT
Protocol for Community Pharmacy Contract Monitoring which has been issued by the PCT in parallel with this data specification.


COMPONENTS OF THE FRAMEWORK

1.     Principles underpinning the development of this resource
2.     Use of the framework
3.     Pre-visit questionnaire declaration template
4.     Contractor feedback - pre and post visit feedback on PCT approach
5.     Essential Service 1 - Dispensing
       Essential Service 2 – Repeat dispensing (to be included from 2009/10)
       Essential Service 3 – Disposal of unwanted medicines
       Essential Service 4 – Promotion of healthy lifestyles
       Essential Service 5 - Signposting
       Essential Service 6 – Support for self care (to be included from 2009/10)
       Essential Service 8 – Clinical governance
6.     Advanced Services – Medicines Use Review
7.     Monitoring of hours and Directed Services
8.     Guidance on non-compliance
9.     Top Ten Tips for using the Community Pharmacy Assurance Framework
10.    Community Pharmacy Strategic Commissioning Tests – realising the benefits of the contractual framework – PCT performance against the Strategic Tests




                                                                                                                                                                   Page 1 of 32
PRINCIPLES UNDERPINNING THE DEVELOPMENT OF THIS RESOURCE

Key Principles For Monitoring Community Pharmacy Contractors’ Compliance With The Contractual Framework

1. Consistency                                                   National policy, e.g. Standards for Better Health
Monitoring the contractual framework for community               Primary care agendas
pharmacy should be in line with other key workstreams
and principles adopted across NHS organisations/staff
                                                                 Reflect monitoring arrangements for the Quality and Outcomes Framework
groups and providers locally and nationally, and be              Consistency across SHA and PCT boundaries
generally the same wherever it is applied in terms of            Consistency between types of pharmacy (e.g. independent, multiple, internet)
location or type of provider. This should not detract from
allowing some local flexibility, this is helpful and
constructive to the monitoring process for both PCTs and
providers.

2. Collaborative/Supportive                                      Transparency of requirements and clarity of purpose – there should be no surprises
Full engagement of potential stakeholders in the                 Collaboration locally with contractors, other health care/pharmacy providers, patient groups, LPC
development of and implementation of the monitoring tool
will be crucial to maximising the opportunities for quality
                                                                 Team approach – PCTs may consider using one team to monitor all primary care contractors
improvements in pharmaceutical services.                         Collaboration with other agencies including for example, Healthcare Commission, Audit Commission,
                                                                  RPSGB, Patient Forums, Overview and Scrutiny Committees etc., to promote sharing of resources,
                                                                  surveys, reports, audit, avoid duplication of effort and limit burden on contractors
                                                                 Compromise between ‘light touch’ and over-regulation

3. Clarity Of Purpose                                            Do they measure what they are intended to measure – how far should the evidence demonstrate quality
Each element of the monitoring should have a clear                of service and improvements in patient care versus a ‘tick-box’ exercise?
purpose and be legally robust in order to justify PCT            Measure of strict compliance with requirements of regulations (e.g. YES/NO)
decisions on performance.
                                                                 What are the limits of PCT authority to require ‘extra’ evidence?
                                                                 Measure of degree of compliance with regulations (e.g. how far has compliance been achieved)?
                                                                 How will the results be used (e.g. lead to action plan by contractor for improvement, lead to action by
                                                                  PCT for development/support, inform future monitoring)?

4. Ease Of Use                                                   The evidence required should be reasonably straightforward to collect and not too time consuming
                                                                 An initial self-assessment by contractors may help reduce time and breadth of inspection and allow
                                                                  PCTs and contractors to focus on areas for development and support



ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                               Page 2 of 32
USE OF THE FRAMEWORK

The format of the Community Pharmacy Assurance Framework documentation includes pre-visit questionnaire questions. Within each of the services, the first section consists of the
pre-visit questionnaire – the information requested should be produced in advance of a visit, and it is suitable for self declaration (subject to appropriate levels of PCT verification).

The second section contains the matters for which assessment by the PCT monitoring team is more appropriate.

In both sections, paragraph numbers of the Chemists’ Terms of Service and the Core and Developmental Standards of S4BH are included, so that PCTs and pharmacy contractors can
quickly access the relevant provision.

In a number of instances in the frameworks there is reference to pharmacies demonstrating their processes and staff understanding of them, via the existence of a SOP. Where it is not
a requirement to have a SOP, this has been made clear, but rather a suggested good practice route for pharmacies to evidence their compliance.

Pre-Visit Questionnaire

The questionnaire will be sent to Pharmacies in advance of the scheduled visit. If the contractor does not return a pre-visit questionnaire, then the monitoring visit may be lengthened,
so that those points can be assessed during the visit. The pre-visit questionnaire contains notes which are intended to inform the contractor why the information is sought, and the
checks that may be carried out during the monitoring visit, and therefore may be reassuring to the contractor and encourage completion and return.

Monitoring Documentation

Primary Care Trusts have used the Community Pharmacy Assurance Framework and monitoring visits to highlight areas of good practice, or to remind contractors of legislative matters
for which the Primary Care Trust does not have a monitoring role. In order to continue these very beneficial reminders, without leading to concern by contractors that monitoring reports
contain ‘non enforceable ‘good practice’, these are included in the self assessment sections, some useful tips are set out under the heading ‘Don’t forget’




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                 Page 3 of 32
 ESSENTIAL SERVICE 1 – DISPENSING

Service Description

The supply of medicines and appliances (i) ordered on NHS prescriptions, together with information and advice, to enable safe and effective use by patients and carers, and
maintenance of appropriate records.

Aims And Intended Outcomes

To ensure patients receive ordered medicines and appliances safely and appropriately by:
     The pharmacy performing appropriate legal, clinical and accuracy checks
     The pharmacy having safe systems of operation, in line with clinical governance requirements
     The pharmacy having systems in place to guarantee the integrity of products supplied
     The pharmacy maintaining a record of all medicines and appliances supplied which can be used to assist future patient care
     The pharmacy maintaining a record of advice given, and interventions and referrals made, where the pharmacist judges it to be clinically appropriate

To ensure patients are able to use their medicines and appliances effectively by:
     Pharmacy staff providing information and advice to the patient or carer on the safe use of their medicine or appliance
     Pharmacy staff providing when appropriate broader advice to the patient on the medicine, for example its possible side effects and significant interactions with other substances




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                  Page 4 of 32
 Pre-visit questionnaire (ii) (Pharmacy to complete shaded boxes and return to PCT within 14 days please)
      Service Indicator and Terms of Service (ToS)                               Pre-visit questions                           PCT comment / explanation                  Pharmacy                  PCT
    Reference(iii) & Standards for Better Health (S4BH)                                                                                                                   response              verification
                         Reference(iv)
Orders for NHS medicines and such appliances, supplied in         Does the pharmacy have a Standard Operating           The PCT do not need or want to check              Yes
the normal course of the pharmacy business, are dispensed         Procedure for dispensing, which is signed by all      these in detail, as it is for the contractor to   No
for patients on demand, with reasonable promptness.               relevant staff to say they have read it, understand   ensure they are fit for purpose and provide
ToS - 5(2)                                                        it, and will follow it?                               adequate direction to staff to enable safe
                                                                  (See ToS - 26(2)(c)(iv))                              working practices. The PCT may ask to
S4BH - C4, D1
                                                                                                                        see the signature sheet during the visit.
                                                                                                                        Don’t forget, since 1 January 2007,
                                                                                                                        additional requirements for controlled
                                                                                                                        drugs prescriptions have been introduced,
                                                                                                                        including a requirement for a SOP for
                                                                                                                        handling CDs.
If asked to do so, the pharmacist shall give an estimate of the   Does the SOP cover the time estimates that            Patients might ask, when presenting a             Yes
time when the drugs or appliances will be ready; and if they      should be given if asked, and does this take into     prescription, how long it will take to            No
are not ready by then, the pharmacist shall give a revised        account workload, current stock levels,               dispense. It is important for realistic
estimate of the time when they will be ready.                     pharmacist availability (for example, over lunch      estimates to be given.
ToS - 7(1)                                                        breaks) etc.?
S4BH - C13, C16, D9
Before providing any drugs or appliances, the pharmacist          Does the SOP include the need to ask for proof of     The NHS relies on pharmacists and their           Yes
shall ask any person who makes a declaration that the             entitlement when checking exemption                   staff to request proof of entitlement as part     No
person named on the prescription form or the repeatable           declarations?                                         of the measures to reduce patient fraud.
prescription does not have to pay the prescription charges to                                                           PCTs may monitor exemption declarations
produce satisfactory evidence of such entitlement.                                                                      and the frequency of ‘evidence not seen’
ToS - 7(3) & (4)                                                                                                        endorsements.
S4BH - C7                                                                                                               The PCT may observe prescription
                                                                                                                        reception procedures during monitoring
                                                                                                                        visits.
                                                                  When was the dispensing SOP last reviewed?            This should be indicated on the SOP.                    (Date)

                                                                  Is the pharmacy claiming the on-going allowance       The pharmacy is entitled to payment if it         Yes
                                                                  for the Electronic Prescription Service?              has a compliant system, is connected to           No
                                                                  (see Drug Tariff Part VIA, paragraph 6.5).            the Electronic Prescription Service, and the
                                                                                                                        regular pharmacist has a smart card and
                                                                                                                        can access the system.
                                                                                                                        The PCT may ask the pharmacist to
                                                                                                                        demonstrate the system during the visit.
ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                                       Page 5 of 32
In connection with the services provided … a pharmacist shall   Does the pharmacy maintain records of all NHS            Maintaining comprehensive records and               Yes
… keep and maintain records … of drugs and appliances           prescriptions dispensed?                                 referring to them when dispensing is                No
provided, in order to facilitate the continued care of the                                                               essential for the safe treatment of patients.
patient;                                                                                                                 The PCT will not ask to see individual
ToS - 10(e)(i),                                                                                                          records unless they are investigating a
                                                                                                                         specific complaint. They may observe the
S4BH - C4, D1
                                                                                                                         dispensing process during the visit (without
                                                                                                                         intruding on patient confidentiality) in order
                                                                                                                         to see that records are being made.
Where deemed clinically appropriate by the pharmacist           How many anonymised records of significant               The pharmacy is required to maintain
records will be made of advice given and any interventions or   interventions does the pharmacy have available           records of interventions that are deemed to
                                                                                                                                                                          (Number)
referrals made.                                                 for monitoring purposes?                                 be clinically significant. As such records
ToS - 10(e)(ii)                                                                                                          have been required since April 2005, it is
                                                                                                                         expected that most pharmacies have a
S4BH - C4, C22, D1
                                                                                                                         number that have been anonymised for
                                                                                                                         monitoring purposes. If you do not yet
                                                                                                                         have any records, consider the
                                                                                                                         circumstances when records might be
                                                                                                                         appropriate, for example where medicines
                                                                                                                         are ordered but a discussion with the
                                                                                                                         patient determines that they are not
                                                                                                                         needed. The PCT may ask to see records
                                                                                                                         or discuss with you the circumstances
                                                                                                                         when records might be appropriate.
In connection with the services provided … a pharmacist shall   Does the pharmacy provide an owing note to               The PCT will not be asking to see                   Yes
… provide a patient with a written note of any drug or          patients if a prescription cannot be fulfilled when it   individual owing notes, but may ask to see          No
appliance which is owed, and inform the patient when it is      is first presented and keep records of owings?           how records of owings are maintained.
expected that the drug or appliance will become available,                                                               Don’t forget, analysis of owings can help
and keep and maintain records … of notes provided.                                                                       identify common problems with stock
ToS - 10 (d) & 10(e)(iii)                                                                                                holding and improve the service provided.
S4BH - D1
Patients are advised on the safe storage and keeping of         Do you remind people orally and / or on                  When handing out medicines especially to                 (Orally /
medicines or appliances and returning unwanted medicines        dispensing bags and / or labels to store their           patients who might have young children,
                                                                                                                                                                          bags / labels)
or appliances to the pharmacy for safe destruction.             medicines safely?                                        do you give an oral reminder to store them
ToS - 10(b)                                                                                                              out of children’s reach? These important
                                                                                                                         safety messages can often be reinforced
S4BH - C4, C16, C22, D1, D2
                                                                                                                         with written messages.




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                                        Page 6 of 32
                                                  Do you remind people orally and / or on       Don’t forget – as returned controlled drugs           (Orally /
                                                  dispensing bags and / or labels to return     now require additional procedures for safe
                                                                                                                                              bags / labels)
                                                  unwanted medicines to the pharmacy for safe   disposal, and hazardous medicines may
                                                  destruction?                                  be segregated, it may be useful to ask
                                                                                                patients to return those separately or to
                                                                                                keep them separate from any bags of
                                                                                                assorted returns.




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                            Page 7 of 32
 ESSENTIAL SERVICE 2 – REPEAT DISPENSING

Service Description

The management and dispensing of repeatable NHS prescriptions for medicines and appliances (v), in partnership with the patient and the prescriber.
This service specification covers the requirements additional to those for dispensing, such that the pharmacist ascertains the patient’s need for a repeat supply and communicates
any clinically significant issues to the prescriber.

Aims And Intended Outcomes


     To increase patient choice and convenience, by allowing them to obtain their regular prescribed medicines and appliances directly from a community pharmacy for a period
      agreed by the prescriber.
     To minimise wastage by reducing the number of medicines and appliances dispensed which are not required by the patient.
     To reduce the workload of General Medical Practices, by lowering the burden of managing repeat prescriptions

 This element of the review will be initiated from 2009/10.




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                               Page 8 of 32
ESSENTIAL SERVICE 3 – DISPOSAL OF UNWANTED MEDICINES

Service Description

Acceptance, by community pharmacies, of unwanted medicines which require safe disposal from households and individuals. PCTs will need to have in place suitable arrangements for
the collection and disposal of waste medicines from pharmacies.

Aims And Intended Outcomes

      To ensure the public has an easy method of safely disposing of unwanted medicines
      To reduce the volume of stored unwanted medicines in people’s homes by providing a route for disposal thus reducing the risk of accidental poisonings in the home and
       diversion of medicines to other people not authorised to possess them.
      To reduce the risk of exposing the public to unwanted medicines which have been disposed of by non secure methods.
      To reduce environmental damage caused by the inappropriate disposal methods for unwanted medicines.




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                         Page 9 of 32
 Pre-visit questionnaire (vi) (Pharmacy to complete shaded boxes and return to PCT within 14 days please)
       Service Indicator and Terms of Service (ToS)                             Pre-visit questions                           PCT comment / explanation                 Pharmacy               PCT
     Reference(vii) & Standards for Better Health (S4BH)                                                                                                                response           verification
                         Reference(viii)
A pharmacist shall accept and dispose of unwanted drugs          Does the pharmacy have a Standard Operating           Note, a SOP is not required for this             Yes
presented to him for disposal from a private household or        Procedure which covers the receipt, storage,          service, but a written SOP would assist          No
residential care home where the PCT in whose list he is          handling (including segregating hazardous waste       you in meeting your obligations to operate
included has in place suitable arrangements for the collection   and incompatible products if appropriate), record     the service safely for staff, and to protect
and disposal of medicines from pharmacies.                       keeping and disposal of unwanted drugs,               the environment.
ToS - 13(1)                                                      including the denaturing of controlled drugs,         Don’t forget: The legislation dealing with
                                                                 which is signed by all relevant staff to say they     waste medicines in complex. Guidance
S4BH - C4, D1
                                                                 have read it, understand it, and will follow it?      has been issued by Pharmaceutical
                                                                                                                       Services Negotiating Committee.
Store the drugs in containers provided by the Primary Care       Does the pharmacy have a suitable bin or bins         During the monitoring visit, the PCT may         Yes
Trust, or by a waste disposal contractor retained by the         (where segregation is required) for unwanted          ask to see the storage (ix).                     No
Primary Care Trust, for the purpose of storing drugs of that     medicines, which is / are stored safely?              Don’t forget, medicines held in the
description.                                                                                                           pharmacy for dispensing purposes can be
ToS - 13(3)(b)                                                                                                         disposed of in the same bins, but they
S4BH - C4                                                                                                              must be properly described as originating
                                                                                                                       in the pharmacy on the waste disposal
                                                                                                                       consignment or transfer notes.
Comply with any other statutory requirements in respect of       Do you retain in the pharmacy the consignment         During the monitoring visit, the PCT may         Yes
storing or the disposal of drugs of that description             notes / waste transfer notes for at least three       ask to see the consignment notes / waste         No
ToS - 13(3)(c)                                                   years?                                                transfer notes.
                                                                 How frequently are unwanted medicines
                                                                 collected?
                                                                                                                                                                      (Frequency)
                                                                 Is the frequency of collection about right / too      This information is helpful to the PCT so
                                                                 frequent / not frequent enough?                       that they can arrange collection at
                                                                                                                       appropriate times so that you do not
                                                                                                                       accumulate excessive amounts of waste.
Ensure all staff are aware of the risks associated with the      Have members of staff been trained, in order to       During monitoring visits the PCT may ask         Yes
handling of waste drugs and the correct procedures to be         protect themselves and others from harm, and to       appropriate members of staff questions to        No
used to minimise those risks                                     protect the environment?                              assess their understanding of the
ToS - 14(a)                                                                                                            requirements.
S4BH - C11
Ensure that he and any staff he has, have readily available      Do you have protective equipment, including           The PCT may ask to see this protective           Yes
and close to any place where waste drugs are stored              gloves, overalls and materials to deal with spills?   equipment during our monitoring visit.           No
appropriate protective equipment, including gloves, overalls

ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                                  Page 10 of 32
and materials to deal with spillages.
ToS - 14(b)
S4BH - C21
                                                  Do you have a controlled drug denaturing kit   The use of a CD denaturing kit is not          Yes
                                                  available?                                     mandatory, but is recommended. If you do       No
                                                                                                 not use a CD denaturing kit, then the PCT
                                                                                                 may ask you, during the monitoring visit, to
                                                                                                 describe how you denature controlled
                                                                                                 drugs in a way that protects staff and the
                                                                                                 environment.
                                                                                                 Don’t forget: since 1 January 2007,
                                                                                                 additional requirements have been
                                                                                                 introduced for controlled drugs returned
                                                                                                 from patients – ensure SOP or procedures
                                                                                                 have been updated.




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                    Page 11 of 32
 ESSENTIAL SERVICE 4 – PROMOTION OF HEALTHY LIFESTYLES

Service Description

The provision of opportunistic healthy lifestyle and public health advice to patients receiving prescriptions who appear to:
     have diabetes; or
     be at risk of coronary heart disease, especially those with high blood pressure; or
     who smoke; or
     are overweight,
and pro-active participation in national/local campaigns, to promote public health messages to general pharmacy visitors during specific targeted campaign periods


Aims And Intended Outcomes


     To increase patient and public knowledge and understanding of key healthy lifestyle and public health messages so they are empowered to take actions which will improve their
      health
     To target the ‘hard to reach’ sectors of the population who are not frequently exposed to health promotion activities in other parts of the health or social care sector




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                              Page 12 of 32
 Pre-visit questionnaire (x) (Pharmacy to complete shaded boxes and return to PCT within 14 days please)
       Service Indicator and Terms of Service (ToS)                            Pre-visit questions                           PCT comment / explanation                   Pharmacy                  PCT
     Reference(xi) & Standards for Better Health (S4BH)                                                                                                                  response              verification
                         Reference(xii)
The pharmacist and their staff shall, as appropriate, provide   Does the pharmacy have a Standard Operating           Note, an SOP is not required for this              Yes
advice to people presenting prescriptions, who appear to        Procedure which covers the identification of          service, but a written SOP would assist you        No
have diabetes, be at risk of coronary heart disease,            appropriate patients, and the giving of               in providing guidance to members of staff
especially those with high blood pressure, smoke or are         opportunistic advice which is signed by all           and locums. When considering what is
overweight, with the aim of increasing the person’s             relevant staff to say they have read it, understand   appropriate for the prescription linked
knowledge and understanding of the health issues which are      it, and will follow it?                               intervention, it is expected that
relevant to that person’s personal circumstances.                                                                     pharmacists or their staff have a discussion
                                                                                                                      lasting up to about 3 minutes. Healthy
                                                                                                                      lifestyle advice should be provided when
ToS - 16(1)
                                                                                                                      patients first present a prescription and at
S4BH - C16, D2                                                                                                        regular intervals thereafter.
                                                                                                                      The health advice should include stopping
                                                                                                                      smoking, reduction of alcohol intake, diet
                                                                                                                      and nutrition, physical activity and weight
                                                                                                                      management, as appropriate
                                                                When was the SOP last reviewed?                       This should be indicated on the SOP.                     (Date)

                                                                Do you and your staff have access to the              Note: The use of Pharmacy Meets Public             Yes
                                                                Pharmacy Meets Public Health brief advice and         Health is not a requirement of the Terms of        No
                                                                brief interventions resources, or other public        Service, but they are evidence based and
                                                                health resources?                                     consistent with government policy and will              Others
                                                                                                                      help you to deliver this element of the          (please list)
                                                                                                                      pharmaceutical services consistently and
                                                                                                                      effectively.
                                                                                                                      Further copies of these resources can be
                                                                                                                      downloaded from
                                                                                                                      www.pharmacymeetspublichealth.org
                                                                                                                      Additional Information leaflets to hand out
                                                                                                                      to patients can be obtained by contacting
                                                                                                                      Pharmacy HealthLink directly.
                                                                                                                      It would be helpful for you to refer to public
                                                                                                                      health resources in any SOP to remind
                                                                                                                      staff and locum pharmacists of their
                                                                                                                      availability.
                                                                                                                      The PCT may ask to see the public health
                                                                                                                      resources you use during monitoring visits
ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                                      Page 13 of 32
The advice may be backed up, as appropriate, by the                 Do you have leaflets available, for example, those   The PCT may ask to see leaflets during                (List)
provision of written information, e.g. leaflets, and by referring   distributed by the Department of Health, which       monitoring visits.
the person to other sources of information or advice.               can increase such patient’s knowledge and
ToS - 16(2)                                                         understanding of the health issues relevant to
S4BH - C16                                                          their personal circumstances? If so, please list
                                                                    those that you provide
                                                                    Do you have an up to date list of additional         The PCT may discuss other sources of            Yes
                                                                    sources of information or advice?                    advice or information during monitoring         No
                                                                                                                         visits.
A pharmacist shall, in appropriate cases, keep and maintain a       How many anonymised records of advice given          The pharmacy is required, in appropriate
record of advice, and that record shall be in a form that           does the pharmacy have available for monitoring      cases, to maintain records of advice given.
facilitates auditing of the provision of pharmaceutical services                                                                                                       (Number)
                                                                    purposes?                                            As such records have been required since
by the pharmacist; and follow-up care for the person who has                                                             April 2005, it is expected that most
been given the advice.                                                                                                   pharmacies will have a number that have
ToS - 16(3)                                                                                                              been anonymised for monitoring purposes.
S4BH - C22, D9, D13                                                                                                      If you do not yet have any records,
                                                                                                                         consider the circumstances when records
                                                                                                                         might be appropriate. The PCT may ask to
                                                                                                                         see records or discuss with you the
                                                                                                                         circumstances when records might be
                                                                                                                         appropriate.




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                                      Page 14 of 32
 ESSENTIAL SERVICE 5 – SIGNPOSTING

Service Description

The provision of information to people visiting the pharmacy, who require further support, advice or treatment which cannot be provided by the pharmacy, on other health and social
care providers or support organisations who may be able to assist the person. Where appropriate, this may take the form of a referral.

Aims And Intended Outcomes

     To inform or advise people who require assistance, which cannot be provided by the pharmacy, of other appropriate health and social care providers or support organisations.
     To enable people to contact and/or access further care and support appropriate to their needs.
     To minimise inappropriate use of health and social care services.




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                              Page 15 of 32
 Pre-visit questionnaire (xiii) (Pharmacy to complete shaded boxes and return to PCT within 14 days please)
      Service Indicator and Terms of Service (ToS)                                Pre-visit questions                          PCT comment / explanation                 Pharmacy              PCT
    Reference(xiv) & Standards for Better Health (S4BH)                                                                                                                  response          verification
                        Reference(xv)
 Having regard to the need to minimise inappropriate use of        Does the pharmacy have a Standard Operating          Note, a SOP is not required for this             Yes
 health and social care services and support organisations,        Procedure which covers the provision of sign-        service, but a written SOP would assist you      No
 when appropriate, where it appears to a pharmacist or the         posting to alternative sources of advice which is    in providing guidance to members of staff
 pharmacy staff that a person using the pharmacy requires          signed by all relevant staff to say they have read   and locums, as well as supporting
 advice, treatment, or support that the pharmacy cannot            it, understand it, and will follow it?               evidence to demonstrate compliance with
 provide, but another health and social care or support                                                                 this element of the contract.
 service provider, of which the pharmacist is aware, is likely
 to be able to provide that advice, treatment, or support, the
 pharmacist should provide contact details of that
 provider.(xvi)
ToS - 19(1)
S4BH - C6, D2, D13
                                                                   Does the pharmacy have a list of other health and    Note: having a list of providers is not a        Yes
                                                                   social care providers to whom you may sign-post      specific requirement, but it may help you        No
                                                                   patients?                                            meet to this requirement.
                                                                                                                         The PCT may ask members of staff about
                                                                                                                        sign-posting to other providers of health or
                                                                                                                        social care, during monitoring visits.
Where appropriate, a referral may be made by means of a            Does the pharmacy use written referral forms, in     The PCT may ask to see blank referral            Yes
written referral note.                                             appropriate cases?                                   forms during monitoring visits.                  No
ToS - 19(2)
S4BH - C22, D9
A pharmacist shall, in appropriate cases, keep and maintain a      How many anonymised records of information           The pharmacy is required, in appropriate
record of information given or referral made, and that record      given or referrals made does the pharmacy have       cases, to maintain records of information
shall be in a form that facilitates auditing of the provision of                                                                                                       (Number)
                                                                   available for monitoring purposes?                   given or referrals made. As such records
pharmaceutical services by the pharmacist; and follow-up                                                                have been required since April 2005, it is
care for the person who has been given the information or in                                                            expected that most pharmacies will have a
respect of whom the referral has been made.                                                                             number that have been anonymised for
ToS - 19(3)                                                                                                             monitoring purposes. If you do not yet
S4BH C22, D9                                                                                                            have any records, consider the
                                                                                                                        circumstances when records might be
                                                                                                                        appropriate. The PCT may ask to see
                                                                                                                        records or discuss with you the
                                                                                                                        circumstances when records might be
                                                                                                                        appropriate.
ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                                  Page 16 of 32
 ESSENTIAL SERVICE 6 – SUPPORT FOR SELF-CARE

Service Description

The provision of advice and support by pharmacy staff to enable people to derive maximum benefit from caring for themselves or their families.

Aims And Intended Outcomes

     To enhance access and choice for people who wish to care for themselves or their families.
     People, including carers, are provided with appropriate advice to help them self manage a self-limiting or long-term condition, including advice on the selection and use of any
      appropriate medicines.
     People, including carers, are opportunistically provided with health promotion advice when appropriate, in line with the advice provided in ES4 – Promotion of healthy lifestyles
      service.
     People, including carers, are better able to care for themselves or manage a condition both immediately and in the future, by being more knowledgeable about the treatment
      options they have, including non-pharmacological ones.
     To minimise inappropriate use of health and social care services.

 To be implemented from 2009/10




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                 Page 17 of 32
 ESSENTIAL SERVICE 8 – CLINICAL GOVERNANCE

 Service Description

 Pharmacies have an identifiable clinical governance lead and apply clinical governance principles to the delivery of services. This will include use of standard operating procedures;
 recording, reporting and learning from adverse incidents; participation in continuing professional development and clinical audit; and assessing patient satisfaction.


 Definition Of Clinical Governance:
 Clinical governance is a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards
 of care by creating an environment in which excellence in clinical care will flourish. There are seven key components: Patient and public involvement; clinical audit; risk
 management; clinical effectiveness programmes; staffing and staff management; education, training and continuing professional and personal development; and use of
 information to support clinical governance and health care delivery.




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                  Page 18 of 32
  Pre-visit questionnaire (xvii) (Pharmacy to complete shaded boxes and return to PCT within 14 days please)
      Service Indicator and Terms of Service (ToS)                         Pre-visit questions                        PCT comment / explanation               Pharmacy                  PCT
   Reference(xviii) & Standards for Better Health (S4BH)                                                                                                      response              verification
                         Reference(xix)
There should be a clinical governance lead for each          Who is your clinical governance lead?                                                                  (Name)
pharmacy.
ToS - 26(2)(c)(vi)
The pharmacy should produce, in an approved manner, and      Do you have a pharmacy practice leaflet,          There is a statutory requirement to            Yes
make available in an appropriate manner a practice leaflet   containing the information required? (xx)         produce a practice leaflet as laid out in      No
ToS - 26(2)(a)(i)                                                                                              paragraph 26 (2)(a)(i). The SoS has not
                                                                                                               yet laid out what the required contents of
S4BH - C16, C18, D3
                                                                                                               the leaflet are, however, the PSNC has
                                                                                                               published, on their website, the contents
                                                                                                               that have been agreed with the DH so far.
                                                                                                               Further, formal details of this clinical
                                                                                                               governance requirement will be made
                                                                                                               available in due course, including by when
                                                                                                               all leaflets issued by contractors will need
                                                                                                               to contain this content.
The pharmacy should publicise the NHS services which are     How do you publish the availability of NHS        The PCT may ask to see publicity during        Practice
being provided at or from the pharmacy.                      services from your pharmacy?                      monitoring visits.                               leaflet
ToS - 26(2)(a)(ii)                                                                                                                                            Other leaflet
S4BH - C16                                                                                                                                                    Website
                                                                                                                                                              Other -


 The pharmacy should undertake an approved Community         When did you carry out, or when do you            You are required to carry out the survey on          (Date)
 Pharmacy Patient Questionnaire (formerly called a patient   anticipate carrying out the survey?               an annual basis. As the format was
 satisfaction survey) annually, in an approved manner.                                                         published in March 2007, the first survey
ToS - 26 (2)(a)(iii)                                                                                           must be completed no later than March
                                                                                                               2008..
S4BH - C7, C13, C14, C16, C17, C21, D1, D3, D8, D11




                                                             If you have carried out your survey, have you                                                    Yes
                                                             sent to the PCT a summary of the areas in which                                                  No
                                                             the pharmacy has performed strongly, and those

ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                           Page 19 of 32
                                                                where performance has greatest potential for                                                          N/A
                                                                improvement? (xxi)
                                                                Was any action taken as a result of the survey, to     See note above, about sharing information            (List any
                                                                improve the services provided? If so, what were        with PCTs.                                           action)
                                                                these?
Monitoring arrangements for medicines or appliances owed        Do you have arrangements in place to monitor           The PCT may want to discuss these              Yes
to patients, which are not in stock, should be in place.        medicines or appliances owed to patients?              arrangements during the visit.                 No
ToS - 26(2)(a)(iv)
S4BH - C4, C9
                                                                Do you take action as a result of monitoring out of    The PCT may discuss the procedures             Yes
                                                                stock items? For example, is it possible to identify   during monitoring visits.                      No
                                                                inconsistent prescribing patterns or failures in
                                                                stock replenishment?
An approved complaints system should be in place. The           Does the pharmacy have a Standard Operating            Note, a SOP is not required for this           Yes
complaints system will be ‘approved’ if it is essentially the   Procedure or Complaints Procedure which is             service, but a written SOP or complaints
                                                                                                                                                                      No
same as that set out in Part II of the NHS (Complaints)         signed by all relevant staff to say they have read     procedure would assist you in providing
Regulations 2004.                                               it, understand it, and will follow it?                 guidance to members of staff and locums,
                                                                                                                       particularly as there are time limits for
ToS - 26 (2)(a)(v)
                                                                                                                       written responses, etc.
S4BH - C1, C13a, C14, C17, D8, D11
                                                                                                                       The pharmacy must maintain a complaints
                                                                                                                       record, but this contains sensitive personal
                                                                                                                       information and should not be examined,
                                                                                                                       however the presence of a complaints
                                                                                                                       record may be verified by observation
                                                                                                                       during the monitoring visit.

                                                                                                                       The PCT may ask members of staff about
                                                                                                                       complaints, to assess understanding,
                                                                                                                       during monitoring visits and for example,
                                                                                                                       ask about changes made to procedures
                                                                                                                       arising from learning from complaints.
                                                                Do you have a leaflet outlining your complaints        The PCT may ask to see any information         Yes
                                                                procedure, which is available to patients or other     that is provided to patients or other
                                                                                                                                                                      No
                                                                members of the public?                                 members of the public, who want to know
                                                                                                                       about your complaints procedure, during
                                                                                                                       monitoring visits.
                                                                Do you maintain a record of complaints received        The PCT may discuss complaints in              Yes
                                                                (including the findings of any investigations and      general during monitoring visits. The PCT
                                                                                                                                                                      No
                                                                                                                       will not ask to see individual complaints
ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                                 Page 20 of 32
                                                                 actions you have taken as a result)?              records, but may wish to be satisfied that
                                                                                                                   you are keeping records, and are taking
                                                                                                                   appropriate action.
Monitoring arrangements in respect of compliance with the        When did you last review your arrangements for    There are two aspects to the DDA – the                (Date)
Disability Discrimination Act 1995 are in place.                 accessibility to your pharmacy by people with a   first is the arrangements made for access
                                                                 disability?                                       to your premises, by persons who have a
(It is important to note that ES7 was not carried forward into
                                                                                                                   disability.
the NHS (Pharmaceutical Services) Regulations 2005. The
pharmacist must, however, still comply with the Disability
Discrimination Act, but this no longer includes a requirement                                                      The PCT will be checking that you have
to provide information to the PCT on assessments carried                                                           arrangements in place in which
out, or of adjustments                                                                                             you monitor your compliance with the
ToS - 26 (2)(a)(viii)                                                                                              DDA.
S4BH - C18, C13, C18, C20, C21, D11, D12
                                                                                                                   For example, do you keep a log of
                                                                                                                   complaints about lack or access; do you
                                                                                                                   record and respond to comments made by
                                                                                                                   persons with a disability
                                                                                                                   about improvements that might be made?

                                                                                                                   The PCT will not be carrying out any
                                                                                                                   assessment of whether persons with a
                                                                                                                   disability can access the premises, but
                                                                                                                   may discuss how you review your
                                                                                                                   compliance with the DDA.
                                                                 Do you carry out assessments of patients, and     This is the second aspect to the DDA – the      Yes
                                                                 keep these together with records of adjustments   assessment of disabilities and identification
                                                                                                                                                                   No
                                                                 made in the course of supplying medicines?        of adjustments necessary.
                                                                                                                   The enforcement of the DDA is for the
                                                                                                                   courts, not the PCT, so the monitoring will
                                                                                                                   only wish to ensure that you give due
                                                                                                                   consideration to your obligations. The PCT
                                                                                                                   may do this by discussing with you during
                                                                                                                   monitoring visits your process for the
                                                                                                                   assessment of patients, the adjustments
                                                                                                                   that might be appropriate and records that
                                                                                                                   are helpful. However, the PCT will not
                                                                                                                   attempt to suggest how you must act in
                                                                                                                   order to meet your obligations.
Clinical Audit                                           Which pharmacy based audit have you carried               The PCT may wish to discuss with you                  (Type)
                                                         out in the last 12 months?                                during monitoring visits the audit that you
A clinical audit programme (normally of five days) is in
ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                                Page 21 of 32
place, which includes at least one pharmacy based audit                                                               carried out, and if it is possible, to see the
and one multidisciplinary audit agreed by the Primary Care                                                            record of the audit, so long as there is no
Trust in each financial year.                                                                                         intrusion into confidential patient
ToS - 26 (2)(b)                                                                                                       information.
S4BH - C5d, D2
                                                              Have you carried out the multidisciplinary audit                                                           Yes
                                                              proposed by the PCT? If not, please provide an                                                             No
                                                              explanation.
                                                                                                                                                                       Explanation




Risk Management                                               Do you have a SOP which is signed by all                Note, a SOP is not required, but a written         Yes
                                                              relevant staff to say they have read it, understand     SOP would assist you in providing
Arrangements are in place to ensure that all stock is                                                                                                                    No
                                                              it, and follow it?                                      guidance to members of staff and locums.
procured and handled in an appropriate way.
                                                                                                                      The PCT may wish to discuss with all
ToS – 26(2)(c)(i)                                                                                                     relevant staff their understanding of and
S4BH – C4                                                                                                             compliance with a SOP.
All equipment used in the provision of pharmaceutical         Do you have service contracts for the regular           The PCT may ask to see documentation               Yes
services is maintained appropriately.                         maintenance of equipment used in the provision          relating to the regular maintenance or for
                                                                                                                                                                         No
                                                              of pharmaceutical services?                             example, wish to see monitoring records
ToS - 26(2)(c)(ii)
                                                                                                                      for fridge temperatures.
S4BH - C4
An approved incident reporting system is in place, together   Do you have internet access to allow on-line            Note, on-line reporting is not required, but       Yes
with arrangements for analysing and responding to critical    reporting to the NPSA?                                  is good practice. If you do not use on-line
                                                                                                                                                                         No
incidents.                                                                                                            reporting the PCT may wish to discuss
                                                                                                                      your arrangements for this to ensure you
ToS - 26(2)(c)(iii)
                                                                                                                      have appropriate systems in place.
S4BH – C1(a), D1
                                                              If not what local processes are in place to record      The PCT may wish to discuss these                Process
                                                              and consider critical incidents in the pharmacy?        processes with you during the visit.



                                                              Have you made any reports to the NPSA                   Sometimes there may be reluctance to               Yes
                                                              following critical incidents (this may be as a result   discuss with the PCT incidents that have
                                                                                                                                                                         No
                                                              of incidents arising in your pharmacy or                arisen in the pharmacy, The PCT
                                                              elsewhere)?                                             understands this and for the purpose of
                                                                                                                      this section are interested only in whether
                                                                                                                      you have experience of reporting –
                                                                                                                      whether that is of an incident in the
ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                                   Page 22 of 32
                                                                                                                            pharmacy or elsewhere.
                                                                   As a result of a critical incident / near miss, has it   The PCT may discuss with you the types           Yes
                                                                   been necessary to modify any of your                     of learning that arises from investigating
                                                                                                                                                                             No
                                                                   procedures?                                              critical incidents /near misses. If the
                                                                                                                            opportunity arises, the PCT may be able to
                                                                                                                            share with you learning from other
                                                                                                                            pharmacies, as well as taking away any
                                                                                                                            learning that you would be willing to share
                                                                                                                            with the PCT and other pharmacies.
Appropriate waste disposal arrangements for clinical and           Do you have an appropriate mechanism for the             The PCT may ask to see your shredder. If         Yes
confidential waste are in place.                                   disposal of confidential waste? This could be a          you do not have a shredder, then the
                                                                                                                                                                             No
                                                                   shredder for example.                                    arrangements you adopt for disposal of
ToS - 26(2)(c)(v)
                                                                                                                            confidential waste may be discussed at the
S4BH – C13                                                                                                                  monitoring visit.
The pharmacy should have appropriate child protection              Have relevant staff been trained on the RPSGB            The PCT may discuss with pharmacists             Yes
procedures in place, in line with national and local guidance      and / or PCT guidance on child protection?               during monitoring visits, the local
                                                                                                                                                                             No
                                                                                                                            arrangements for child protection to assess
ToS - 26(2)(c)(vii)
                                                                                                                            understanding and compliance.
S4BH – C2
                                                                   Do you have contact details of local child               The PCT may ask for confirmation during          Yes
                                                                   protection officers?                                     monitoring visits
                                                                                                                                                                             No
Monitoring arrangements in respect of compliance with the          When did you last carry out a Health and Safety          The enforcement of HASAWA is the                       (Date)
Health & Safety at Work etc. Act 1974 are in place                 risk assessment and Fire Risk Assessment?                responsibility of the Health and Safety
                                                                                                                            Executive / Local Authority, and therefore
ToS - 26(2)(c)(viii)
                                                                                                                            the PCT does not monitor compliance, but
S4BH – C4                                                                                                                   the PCT may wish to discuss your
                                                                                                                            monitoring arrangements during the visit.
                                                                                                                            Don’t forget, the Health and Safety
                                                                                                                            Executive website provides valuable
                                                                                                                            information to help you comply with your
                                                                                                                            obligations.
                                                                                                                            Fire Regulations have been updated - you
                                                                                                                            may need to re-examine your fire
                                                                                                                            assessment.
Staff and staff management                                         Do you have records of training for all members          The PCT may ask to see training records          Yes
                                                                   of staff?                                                during monitoring visits. The PCT may
Appropriate training for all staff is in place in respect of any                                                                                                             No
                                                                                                                            also wish to see that the total hours of staff
role they are asked to perform.
                                                                                                                            supporting dispensing activity, who are
ToS - 26 (2) (e)(ii)                                                                                                        adequately trained or undergoing training,
S4BH – C11                                                                                                                  meets the numerical requirements for the

ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                                          Page 23 of 32
                                                                                                                  practice payment.
                                                               Do you have a written induction programme for      The PCT may ask to see the programme            Yes
                                                               members of staff and locums?                       and any documentation during monitoring
                                                                                                                                                                  No
                                                                                                                  visits – see below
The qualifications and references of all staff engaged in      Have you checked the qualifications and            The PCT may ask to see records during           Yes
providing NHS services are checked.                            references of all pharmacists and other            monitoring visits, but will not ask to see
                                                                                                                                                                  No
                                                               members of staff undertaking any activities        individual references.
ToS - 26 (2) (e) (iii)
                                                               within the NHS pharmaceutical services?
S4BH – C10
Appropriate arrangements (having regard to issues both of      Do your procedures ensure that information         The Patient Medication Record is an             Yes
rights of access to information and of confidentiality) to     held about patients is accurate, appropriate and   essential tool to record details of medicines
                                                                                                                                                                  No
support both health care delivery and clinical governance      protected to allow you and your staff to provide   supplied, allergies, and so on. Remember
are in place.                                                  high quality patient care?                         that under the Data Protection Act,
                                                                                                                  anything you record may have to be
ToS - 26(2)(f) (i)
                                                                                                                  disclosed to the patient if a subject access
                                                                                                                  request is made, so must be relevant to
                                                                                                                  the care of the patient. Protection from
                                                                                                                  unauthorised disclosure or modification is
                                                                                                                  essential. Protection against deletion is
                                                                                                                  necessary, and give thought to how you
                                                                                                                  might access the information in an
                                                                                                                  emergency.
Arrangements are in place in respect of compliance with        Do you have confidentiality clauses signed by      The PCT may ask to see records during           Yes
‘Confidentiality: the NHS Code of Practice’. Monitoring        relevant members of staff?                         monitoring visits
                                                                                                                                                                  No
arrangements and appropriate training for staff are in place
in respect of compliance with the Data Protection Act 1998
                                                               Are you aware of the recommendations of the
and with regard to patient confidentiality.
                                                               code? Which have you implemented? E.g.
ToS - (2)(f)(ii)(iii)(iv)                                      included confidentiality clauses within
S4BH – C13, C20                                                employment contracts.
                                                               Have relevant members of staff received            The PCT may ask to see records during           Yes
                                                               training on the Data Protection Act 1998 and the   monitoring visits
                                                                                                                                                                  No
                                                               NHS Code on Confidentiality?
                                                               Have you arrangements to deal with subject         The PCT will not ask to see records of          Yes
                                                               access requests made under the Data                disclosures.
                                                                                                                                                                  No
                                                               Protection Act 1998, and if you have made
                                                               disclosures, do you keep a record of them?
Clinical effectiveness programme                               Do you have a clinical effectiveness programme     The requirement to provide advice in            Yes
                                                               in place?                                          respect of a repeatable prescription is
A clinical effectiveness programme is in place, which                                                                                                             No
                                                                                                                  included in Essential Service 2, and will be
includes arrangements for ensuring that appropriate advice
                                                                                                                  assessed in that section of the CPAF.
ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                      Page 24 of 32
is given by a pharmacist in respect of repeatable                    Similarly the provision of advice for
prescriptions or to people caring for themselves or their            persons caring for themselves or their
families.                                                            families is covered in Essential Service 4
ToS – 26(2)(d),                                                      and is assessed in that section.
S4BH – D2, C7                                                         Note: Clinical effectiveness systems
                                                                      should also be designed to improve
                                                                      concordance and to reduce wastage.
                                                                      The PCT may discuss your clinical
                                                                      effectiveness programme during the
                                                                      monitoring visit to see how you seek to
                                                                      improve concordance and decrease
                                                                      wastage. For example, you may be
                                                                      asked about the following and wish to
                                                                      see evidence of it;

                                                                     Do you have up to date reference
                                                                     sources, such as the BNF and Drug              Yes
                                                                     Tariff?                                        No


                                                                     Do your staff know how to use them
                                                                     effectively?                                   Yes
                                                                                                                    No
                                                                     Do your staff know when to refer to the
                                                                     pharmacist?                                    Yes
                                                                                                                    No
                                                                     How do you quality assure the advice your    Explanation
                                                                     staff provide to customers?




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                              Page 25 of 32
 MEDICINES USE REVIEW & PRESCRIPTION INTERVENTION SERVICE

Service Description

This service includes medicines use reviews undertaken periodically, as well as those arising in response to the need to make a significant prescription intervention during the
dispensing process. Medicines Use Review is about helping patients use their medicines more effectively. Recommendations made to prescribers may also relate to the clinical or
cost effectiveness of treatment.

Aims Of Service

To improve patient knowledge, concordance and use of medicines by:
 establishing the patient’s actual use, understanding and experience of taking their medicines;
 identifying, discussing and resolving poor or ineffective use of their medicines;
 identifying side effects and drug interactions that may affect patient compliance;
 improving the clinical and cost effectiveness of prescribed medicines and reducing medicine wastage.




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                               Page 26 of 32
Pre-visit questionnaire (xxii) (Pharmacy to complete shaded boxes and return to PCT within 14 days please)
     Service Indicator and Terms of Service (ToS)                       Pre-visit questions                          PCT comment / explanation                 Pharmacy                  PCT
  Reference(xxiii) & Standards for Better Health (S4BH)                                                                                                        response              verification
                       Reference(xxiv)
The pharmacist providing the Medicines Use Review (MUR)   List all pharmacists who have an MUR certificate,   Before an MUR can be undertaken by a                   (list)
should be a registered pharmacist and have an MUR         and for whom a copy of the certificate has been     pharmacist, a copy of that pharmacist’s
certificate a copy of which must be supplied to the PCT   sent to the PCT                                     MUR certificate must be sent to the PCT.
before entering into an arrangement to provide MUR                                                            During the monitoring visit, the PCT may
services                                                                                                      ask to see the pharmacy copies of the
SD - 3(3)                                                                                                     MUR form, to check that they have copies
S4BH - C11                                                                                                    of the MUR certificates for each
                                                                                                              pharmacist who undertook MURs. They
                                                                                                              will not want to see the patient’s details, as
                                                                                                              that is confidential information and is not
                                                                                                              necessary for the purpose of verification.
The pharmacy has a consultation area meeting the          Does the pharmacy have a consultation area          During the monitoring visit, the PCT may         Yes
following requirements -                                  which meets these criteria?                         assess your consultation area against            No
-clearly designated                                                                                           these criteria.
-seating for the patient and pharmacist                                                                       If the area does not comply, then the PCT
                                                                                                              may request remedial action which must
-cannot be overheard
                                                                                                              be completed within agreed timescales.
SD - 3(4)                                                                                                     Further MURs would not be allowed after
S4BH – C20, D12                                                                                               that agreed timescale, if the remedial
                                                                                                              action is not carried out. See DH guidance
                                                                                                              on non-compliance included as part of the
                                                                                                              CPAF resources on PCC website.
                                                          Do you ever conduct MURs in the public part of      In cases where the consultation is to be         Yes
                                                          the pharmacy when the premises are closed?          carried out in the public area of the            No
                                                                                                              premises, at a time when the pharmacy is
                                                                                                              closed to the public, there is no
                                                                                                              requirement to clearly designate the area.
Other arrangements for an ‘acceptable location’ to        Have you gained PCT consent to undertake any        The PCT can be asked for consent to allow        Yes
undertake MURs away from the premises, or by telephone    MURs away from the premises, or by telephone?       pharmacy contractors to carry out MURs           No
SD - 3(4)                                                                                                     away from the premises. If you would like
                                                                                                              to apply, a form is available from PSNC.
S4BH – C18, C20, D11, D12
                                                                                                              If you have undertaken MURs away from
                                                                                                              the premises, the PCT may ask for details
                                                                                                              during the monitoring visit.
Payment will be made up to a maximum of 400 MURs per      How many MURs have you undertaken in the            The PCT may wish to verify the numbers
ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                            Page 27 of 32
pharmacy in any financial year, with the exception of       financial year to date?                           claimed against returns from the NHSBSA          (number on the
pharmacies who have not made arrangements before 1                                                            Prescription Pricing Division. The PCT           pharmacy
October, in which case payment will be made up to a                                                           may also wish to verify the number of copy       premises)
maximum of 200 MURs per pharmacy.                                                                             MUR forms held at the pharmacy during
SD - 3(6)                                                                                                     the monitoring visit.

                                                                                                                                                               (number in other
                                                                                                                                                               premises – if
                                                                                                                                                               approved by the
                                                                                                                                                               PCT)



                                                                                                                                                               (number by
                                                                                                                                                               telephone – if
                                                                                                                                                               approved by the
                                                                                                                                                               PCT)

                                                                                                                                                                       (Total
                                                                                                                                                               number
                                                                                                                                                               undertaken)
                                                            Do you have a SOP for MURs?                       Note, having a SOP for this is not a                Yes
                                                                                                              requirement, but may help you to                    No
                                                                                                              demonstrate how you are meeting the
                                                                                                              requirements of this service.
                                                                                                              The underlying purpose of an MUR is to
                                                                                                              improve a patients knowledge and use of
                                                                                                              their medicines and contractors may want
                                                                                                              to link this to their clinical effectiveness
                                                                                                              programme (refer to ES8 for clinical
                                                                                                              effectiveness programme). The PCT may
                                                                                                              wish to discuss with you at the visit what, if
                                                                                                              any, processes are in place for this.
A copy of the MUR shall be provided to the patient and to   Do you always send a copy to the GP, as well as   The forms must always be sent to the GP,            Yes
the patient’s GP.                                           handing a copy to the patient?                    even if there is no action needed as                No
SD 3(6)(i)                                                                                                    outlined in the SoS Directions.
S4BH – C9                                                                                                     It is important for the GP to be aware that
                                                                                                              an MUR has been carried out, and of any
                                                                                                              advice given to the patient or action
                                                                                                              needed. During our visit, any comments
                                                                                                              that you have received from GPs, or any
ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                              Page 28 of 32
                                                                                                            comments that other pharmacists or
                                                                                                            doctors have shared with the PCT can be
                                                                                                            discussed. Our aim is to encourage
                                                                                                            professional co-operation, and appropriate
                                                                                                            sharing of information between
                                                                                                            pharmacists and GPs. If you think the
                                                                                                            PCT can help develop that co-operation,
                                                                                                            please feel free to discuss with us.
The pharmacist shall keep a copy of the MUR record for as   How long do you keep copies of the MUR forms?   It is for PCTs to determine how long MUR     (years)
long as the PCT may reasonably require.                                                                     forms should be kept. However, unless a
SD 3(6)(j)                                                                                                  PCT states otherwise, guidance from the
                                                                                                            Department of Health is that two years
S4BH – C9
                                                                                                            would generally be sufficient.




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                             Page 29 of 32
 CONTRACTOR FEEDBACK TO PCT

            Pharmacy                               Contractor contact for monitoring
Feedback
Were any information, communications and
documentation, such as the pre and post-visit
papers and reports, received in a timely and
appropriate manner?




How do you feel the PCT carries out its
obligations in relation to the contract, for
example, public health campaigns,
multidisciplinary audit, signposting, issuing of
SMART cards etc?


Do you feel the PCT has approached contract
monitoring in a supportive and appropriate
manner, for example, has the visit been useful
in helping you to improve your compliance with
the contract requirements and have actions
been followed up by you and the PCT?

Any other comments you would like to
feedback regarding the pre and post-visit
approach of the PCT?



Contractor Details

Signed                                             Pharmacist Name:
Position in pharmacy:
Date:


ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                     Page 30 of 32
    1


i
   Pharmacies are required to supply any drugs ordered and such of the appliances so ordered as he supplies in the normal course of their business
ii
    The completion of a pre-visit questionnaire by the pharmacy contractor is not mandatory, but highly recommended. The pre-visit questionnaire covers matters that can be self
assessed, and apart from random checks for verification purposes, avoids the need for these matters to be covered during visits. Pharmacy contractors might find it helpful to refer also
to the Contract Workbook published by the Pharmaceutical Services Negotiating Committee, when completing the questionnaire.
iii
    The Terms of Service are set out in Part 1, Schedule 1, of the NHS (Pharmaceutical Services) Regulations 2005 – Number 641
iv
    The Core and Developmental Standards are mapped from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4894544
v
    Pharmacies are required to supply any drugs ordered and such of the appliances so ordered as he supplies in the normal course of their business
vi
    The completion of a pre-visit questionnaire by the pharmacy contractor is not mandatory, but highly recommended. The pre-visit questionnaire covers matters that can be self
assessed, and apart from random checks for verification purposes, avoids the need for these matters to be covered during visits. Pharmacy contractors might find it helpful to refer also
to the Contract Workbook published by the Pharmaceutical Services Negotiating Committee, when completing the questionnaire.
vii
     The Terms of Service are set out in Part 1, Schedule 1, of the NHS (Pharmaceutical Services) Regulations 2005 – Number 641
viii
     The Core and Developmental Standards are mapped from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4894544
ix
    The enforcement of the legislation on waste is the responsibility of the Environment Agency. However, compliance with statutory requirements related to the storing or disposal of
waste is also a requirement of the Terms of Service – see paragraph 13(3)(c)
x
    The completion of a pre-visit questionnaire by the pharmacy contractor is not mandatory, but highly recommended. The pre-visit questionnaire covers matters that can be self
assessed, and apart from random checks for verification purposes, avoids the need for these matters to be covered during visits. Pharmacy contractors might find it helpful to refer also
to the Contract Workbook published by the Pharmaceutical Services Negotiating Committee, when completing the questionnaire.
xi
    The Terms of Service are set out in Part 1, Schedule 1, of the NHS (Pharmaceutical Services) Regulations 2005 – Number 641
xii
     The Core and Developmental Standards are mapped from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4894544
xiii
     The completion of a pre-visit questionnaire by the pharmacy contractor is not mandatory, but highly recommended. The pre-visit questionnaire covers matters that can be self
assessed, and apart from random checks for verification purposes, avoids the need for these matters to be covered during visits. Pharmacy contractors might find it helpful to refer also
to the Contract Workbook published by the Pharmaceutical Services Negotiating Committee, when completing the questionnaire.
xiv
     The Terms of Service are set out in Part 1, Schedule 1, of the NHS (Pharmaceutical Services) Regulations 2005 – Number 641
xv
     The Core and Developmental Standards are mapped from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4894544
xvi
     The PCT will provide pharmacies in their area with details of health and social care providers to whom patients can be referred. Likewise contact details for local patient and support
groups can similarly be provided to pharmacies who in appropriate cases, refer the person to that provider.
xvii
      The completion of a pre-visit questionnaire by the pharmacy contractor is not mandatory, but highly recommended. The pre-visit questionnaire covers matters that can be self
assessed, and apart from random checks for verification purposes, avoids the need for these matters to be covered during visits. Pharmacy contractors might find it helpful to refer also
to the Contract Workbook published by the Pharmaceutical Services Negotiating Committee, when completing the questionnaire.
xviii
      The Terms of Service are set out in Part 1, Schedule 1, of the NHS (Pharmaceutical Services) Regulations 2005 – Number 641
xix
     The Core and Developmental Standards are mapped from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4894544
xx
     At the time of preparation of this Community Pharmacy Assurance Framework, the statutory mechanism for specifying the contents of the practice leaflet has not yet been determined.
Pharmacies can refer to the PSNC Contract Workbook 2007 – 2008 for the details that have been agreed between the Department of Health and the Pharmaceutical Services
Negotiating Committee. These can be used for preparation of new leaflets until such time that the statutory mechanism for specifying contents has been determined.
xxi
     It is good practice that contractors should share with their PCT the area where the survey identified the greatest potential for improvement and the action being taken to improve
performance, along with the areas in which the pharmacy is performing strongly. Pharmacies will be aware of the commercial sensitivity of some of the information that will be collated
and may decide not to share this with the PCT.



1

ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                   Page 31 of 32
xxii
      The completion of a pre-visit questionnaire by the pharmacy contractor is not mandatory, but highly recommended. The pre-visit questionnaire covers matters that can be self
assessed, and apart from random checks for verification purposes, avoids the need for these matters to be covered during visits. Pharmacy contractors might find it helpful to refer also
to the Contract Workbook published by the Pharmaceutical Services Negotiating Committee, when completing the questionnaire.
xxiii
      The Terms of Service are set out in Part 1, Schedule 1, of the NHS (Pharmaceutical Services) Regulations 2005 – Number 641
xxiv
      The Core and Developmental Standards are mapped from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4894544




ASHTON, LEIGH & WIGAN PCT - Community Pharmacy Assurance Framework                                                                                                 Page 32 of 32

								
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