PSD 2

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  • Created by: LBCW0502
  • Created on: 15-01-19 12:41
What is the NHS Community Pharmacy contract? (1)
Designed to integrate community pharmacy services fully within NHS and enable community pharmacists to play greater role in help to achieve NHS objectives
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Community pharmacists should provide a service that does what?
Supports patients who wish to care for themselves. Respond to diverse needs of patients and communities. Helps deliver aspirations within NHS. Helps tackle health inequalities. Supports making the NHS more efficient
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Describe features of community pharmacy funding
Government imposed 2-year funding packaging (currently, cap is fixed/not increasing). Issues between PSNC and government about funding
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What is the CPCF?
Community Pharmacy Contractual Framework. Made up of three different types of services - essential and clinical governance, advanced and locally commissioned services
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What are essential and clinical governance services?
Provided by all pharmacy contractors and are commissioned by NHS England. National pay rate
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What are advanced services?
Can be provided by all contractors once accreditation requirements have been met and are commissioned by NHS England
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What are locally commissioned services?
Commissioned by local authorities, Clinical Commissioning Groups and NHS England in response to the needs of the local population
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What are the 7 essential services and clinical governance?
Dispensing medicines, repeat dispensing, supply of appliances, disposal of unwanted medicines, public health (promotion of healthy lifestyles), signposting, support for self-care (plus clinical governance)
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Describe features of dispensing?
Supply all medicines/appliances ordered on NHS Rx with reasonable promptness. Info/advice. Enable safe/effective use of medicines. EPS, keep records of dispensed medicines/interventions, collect Rx charges, check exemption claims
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What percentage of the population do not pay for a prescription?
80% (e.g. pregnant, under 16, unemployed)
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How much does a prescription item cost?
£8.80 (with exemptions)
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Describe features of repeat dispensing
Manage and dispense repeat NHS Rx for management of long term conditions in partnership with patient and prescriber. Aims to increase patient choice/convenience, minimise wastage, reduce GP workload
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Repeat prescribing is appropriate for which type of patients?
Patients with long-term, stable conditions who require regular medicines and whose condition is unlikely to change in short-medium term (don't need to visit GP for check up)
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Describe features of supply of appliances (1)
Pharmacists may regularly dispense appliances in the course of their business or may dispense such prescriptions infrequently or they may have taken a decision not to dispense them at all
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Describe features of supply of appliances (2)
Terms of Service requires a pharmacist to dispense any (non-blacklisted) medicine with reasonable promptness for appliances the obligation to dispense arises only if the pharmacist supplies such products in normal course of business
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Describe features of disposal of unwanted medicines
Pharmacies accept back unwanted medicines from patients. Required by NHS/waste contractor, sort into solids/liquids/aerosols, arrange to collect at regular intervals. Additional segregation required under Hazardous Waste Regulations
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What are the reasons for pharmacies disposing unwanted medicines?
Easy method for safe disposal of unwanted medicines. Reduce risk of accidental poisoning. Reduce risk of exposing the public. Reduce environmental damage
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Describe features of public health
Annual. 6 campaigns at request of NHS. Involves display/distribution of leaflets provided by NHS. Pharmacies undertake interventions on major areas of public health concern e.g. encourage smoking cessation
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Describe features of support for self-care
Pharmacies help manage minor ailments and common conditions with advice, sale of medicines and referrals. Records kept where pharmacist considers it is relevant to care of patient. Care for themselves/families. For those with a long-term condition
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Describe features of signposting (1)
NHS provide pharmacists with lists of sources of care and support in the area. Expected to help people who ask for assistance by directing them to the most appropriate source of help. Refer/provide information about support groups/advice
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Describe features of signposting (2)
Treatment which cannot be provided by the pharmacy. Aims to minimise inappropriate use of health and social care services
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What is clinical governance?
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
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Why is clinical governance important?
Being accountable, taking professional responsibility, right systems/processes in place, continuously improving. Fundamental element of healthcare practice. Relevant to everyone, counter assistants/technicians/pharmacists/contractors
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What are the seven components of clinical governance?
Patient and public involvement (leaflet, survey, chaperone policy). Clinical audit (practice/clinical). Risk management (SOPs, incident reporting). Clinical effectiveness. Staffing/management (whistle-blowing). Use of information. Premises standards
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Which quality related issues does the clinical government requirements of the CPCF cover?
Audit, chaperone policy, clinical governance lead, complaints procedures, confidentiality, CPPQ (patient satisfaction survey), patient safety incident reporting, practice leaflets, raising concerns (whistle-blowing)
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Describe features of advanced services (1)
Must offer essential services before offering advanced services. Not compulsory but contractors are paid. Centrally funded by government. Accreditation required for pharmacist/pharmacy premises.
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Describe features of advanced services (2)
Pharmacy premises must meet certain standards (confidential and suitable environment)
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Consultation areas must meet which principles?
Both patient and pharmacist can sit down together. Patient and pharmacist should be able to speak at normal speaking volumes without being overheard. Clearly designated as an area for confidential consultations, distinct from general public areas
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What are the six advanced services?
Medicines Use Review. Appliance Use Review. Stoma Appliance Customisation. New Medicine Service. Flu Vaccination Service. NHS urgent medicines supply advanced services
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Describe features of Medicines Use Reviews
Structured review with patients taking medicines for long term conditions. Aims to improve patient knowledge/adherence/medicine usage
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How does an MUR improve patient knowledge, adherence and medicine usage? (1)
Establish patient's actual use, understanding and experience of medicines being taken. Identify, discuss and resolve poor or ineffective medicines use. Identify side effects and drug interactions
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How does an MUR improve patient knowledge, adherence and medicine usage? (2)
Improve clinical and cost effectiveness or prescribed and reducing wastage
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What are the requirements for MURs? (1)
Maximum of 400 MURs in any financial year. Face-to-face with patient in pharmacy. Consent form signed by patient to allow information to be shared
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What are the requirements for MURs? (2)
Patient must be on multiple medicines (exception - high risk medicines, MUR provided if patient is on one medicine). Patient must have used pharmaceutical services from that pharmacy for at least the previous 3 months. Regular MUR every 12 months
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What are the four national target groups?
Patients taking high risk medicines. Patients recently discharged from hospital. Patients prescribed certain respiratory medicines. Patients at risk of/diagnosed with CVD
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Describe features of patients with high risk medicines
Patient taking at least one high risk medicine (e.g. diuretics, anticoagulants including low mwt heparin, antiplatelets and NSAIDs). Patient falls into the target groups - high risk medicines
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Describe features of hospital discharge
Patient taking 2+ medicines. Patient discharged from hospital within previous 8 weeks and has had changes to medicines taken whilst in hospital (offered MUR with in 4 weeks of discharge). Patient falls into post-discharge target group
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Describe features of respiratory medicines (respiratory target group)
2+ medicines (e.g. adrenoceptor agonists, antimuscarinic bronchodilators, theophylline, compound bronchodilator preparation, corticosteroids, cromoglicate/related therapy, leukotriene receptor antagonists, phosphodiesterase type 4 inhibitors)
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Describe features of cardiovascular disease
4+ medicines (for cardiovascular system, drugs used in diabetes, thyroid and anti-thyroid drugs). Patient falls into target group - cardiovascular risk
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What percentage of MURs must be carried out on patients in one or more target groups annually?
Community pharmacy contractors must carry out at least 70% of their Medicine Use Reviews (MURs) within any given financial year on patients in one or more of the target groups
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Describe features of Appliance Use Review
Carried out by pharmacist or specialised nurse (in pharmacy or patient's home). Aims to improve patient's knowledge/use of any specified appliance by - establishing patient use/experience, identify/resolve poor use, advise storage/disposal
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Describe features of Stoma Appliance Customisation
3rd advanced service introduced in CPCR. Customisation of a quantity of more than one stoma appliance, based on patient's measurements of a template. Aims to ensure proper use/comfortable fitting of stoma and to improve duration of use/reducing waste
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What is the aim of the New Medicines Service?
To provide support for people who are newly prescribed a medicine to manage a long-term condition to improve medicines adherence
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What is the NICE definition of adherence?
The extent to which the patient's behaviour matches agreed recommendations from the prescriber
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What is the evidence behind the service?
Research has shown that pharmacists can successfully intervene when a medicine is newly prescribed, with repeated follow up in the short term, to increase effective medicine taking for the treatment of a long term condition
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What is a long term condition?
One that cannot be cured but can be controlled by medication
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Describe features of the New Medicine Service (1)
5 long term conditions (asthma/COPD, type 2 diabetes, anti-platelet therapy, anti-coagulant, hypertension). Research shows these groups will benefit most form the service (and has the most problems with adherence)
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Describe features of the New Medicine Service (2)
Doesn't need to be a regular patient, records must be maintained
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Outline the patient journey (1)
Patient visits GP - diagnosis/reviews LTC - new medicine prescribed - patient referred to pharmacy/pharmacist identifies patient for NMS - patient engagement (day 1 in pharmacy) - intervention (face to face/telephone, day 7-14)
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Outline the patient journey (2)
- follow up (face to face/telephone day 14-18) - NMS completed
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Describe features of patient engagement (1)
Dispense new medicine, give advice about medicine/use (indication, MOA, dose, use, side effects, warning, storage, action to take if dose missed), healthy lifestyle advice (e.g. diet, smoking cessation, physical activity, alcohol intake)
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Describe features of patient engagement (2)
(sexual health, weight management), explain NMS, agree intervention stage with patient (time/ 7-14 days, method/face to face or telephone). Explain need to share information (GP, local area team/clinical audit, NHS business service authority)
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Describe features of patient engagement (2)
(secretary of state for heath as part of post-payment verification process). Obtain written consent
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Describe features of intervention
7-14 days after patient engagement stage. Face to face consultation area requirements (designated area, sit down together, speak at normal volumes without being overheard, confidential, away from general public area). Phone (pharmacy/not overheard)
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What are the intervention questions?
Have you had the chance to start taking your new medicine? How are you getting on with it? Any problems? Do you think it is working? Side effects/unexpected effects? Have you missed doses/how often/have you changed when you take it? Any other Qs?
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What are the three possible outcomes from an intervention? (1)
Patient is an adherent/no problems (agree time/14-28 days after stage 1, method/face to face or phone for follow up). Problem identified, solution can be found (agree solution/time/method for follow up)
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What are the three possible outcomes from an intervention? (2)
Problem identified, GP referral required (explain problem to patient, complete NMS feedback form, refer to GP, patient exits the service)
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Describe features of a follow up
14-28 days after patient engagement stage. Face to face consultation area requirements (designated area, sit down together, speak at normal volumes without being overheard, confidential, away from general public area). Phone (pharmacy/not overheard)
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What are the follow up questions?
How are you getting on with the new medicine since last time? Go through issues (confirm issues, offer advice). Did you try anything else? Is it helpful? Problems/concerns? Action to take when missing a dose
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What are the three possible outcomes from a follow up? (1)
Assess patient's adherence, identify problems, determine need for further info/support, give healthy lifestyle advice. Patient adherent/no problems (NMS completed). Problem identified/solution can be found (agree solution, NMS completed)
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What are the three possible outcomes from a follow up? (2)
Problem identified/GP referral required (explain problem to patient, complete NMS feedback form, refer to GP)
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Describe features of the Flu Vaccination Service
PSNC announced as part of community pharmacy funding settlement, NHS had agreed to allow community pharmacies in England to offer a seasonal flu vaccination service for patient in at-risk groups. 5th advanced service in CPCF (started in 2015)
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What are locally commissioned services?
Also known as enhanced services. Commissioned by Primary Care Trusts in line with the needs of their population
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Describe features of commissioning routes
Locally commissioned services can be contracted via a number of different routes and by different commissioners (NHS England, local authority, Clinical Commissioning Group) - 2013
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Give examples of locally commissioned services (1)
Supervised administration, needle/syringe exchange, on demand availability of specialised drugs (palliative care/specialised medicines), stop smoking, care home (support/advice/storage/supply/administration of drugs/appliance)
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Give examples of locally commissioned services (2)
Medicines assessment and compliance support, medication review, minor ailment service, out of hours (access to medicines), supplementary prescribing by pharmacists, emergency hormonal contraception, seasonal flu vaccination, patient group directions
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Give examples of locally commissioned services (3)
Chlamydia screening and treatment, NHS health check (vascular risk assessment and management)
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Describe features of contract monitoring
NHS England's local offices are responsible for monitoring the provision of essential/advanced services. Use CPAF to monitor pharmacy contractors compliance with terms of CPCF. CPAF (pre-visit questionnaire, section used during monitoring visit)
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Describe features of NHS complaints
Clinical governance framework requires all pharmacy contractors to have arrangements which comply with requirements of local authority social services and NHS complaints regulations 2009 for handling/consideration of any complaints
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Describe features of the NHS urgent medicines supply advanced services
Get medicine without prescription, telephone conversation, ask for patient consent to check summary care record
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Other cards in this set

Card 2

Front

Community pharmacists should provide a service that does what?

Back

Supports patients who wish to care for themselves. Respond to diverse needs of patients and communities. Helps deliver aspirations within NHS. Helps tackle health inequalities. Supports making the NHS more efficient

Card 3

Front

Describe features of community pharmacy funding

Back

Preview of the front of card 3

Card 4

Front

What is the CPCF?

Back

Preview of the front of card 4

Card 5

Front

What are essential and clinical governance services?

Back

Preview of the front of card 5
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