Quality Payments – Over use of asthma treatments
Quality Payments – Over use of asthma treatments
Please note, the interim Quality Payments Scheme for the first six months of 2017/18 has now ended. No decisions have been made by the Department of Health and Social Care and NHS England on the future of Quality Payments beyond the first six months of 2018; this will be a matter for discussion with PSNC, once substantive negotiations for 2018/19 commence.
Community pharmacy contractors passing the gateway criteria will receive a Quality Payment if they meet one or more of the quality criteria. One of the quality criteria is:
‘On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, have since 24 November 2017 (i.e. the last review date), been referred to an appropriate health care professional for an asthma review.’
Click on a heading below for more information.
NHS England guidance
NHS England has published new guidance ahead of the June 2018 review point of the Quality Payments Scheme:
- NHS England – Pharmacy Quality Payments Guidance for the June 2018 Declaration (published 30th April 2018).
The June 2018 guidance should be read in conjunction with NHS England’s gateway criteria guidance and the quality criteria guidance:
- NHS England – Pharmacy Quality Payments Gateway Criteria Guidance (published 23rd December 2016); and
- NHS England – Pharmacy Quality Payments Quality Criteria Guidance (published 27th February 2017).
These documents are available on the NHS England website.
PSNC strongly encourages all contractors to read the new NHS England guidance, as well as the previous guidance, to ensure they are fully briefed on the requirements of the Quality Payments Scheme ahead of the June 2018 review point.
Quality criterion points and value
The value of this quality criterion is as follows:
|Total points for the June 2018 review point||20|
|Value of total points||£640-1,280*|
*The funding will be divided between qualifying pharmacies based on the number of points they have achieved. Each point will have a minimum value worth £32 and a maximum of £64.
Aim/rationale of this quality criterion
The aim of this quality criterion is for community pharmacy to contribute to reducing preventable deaths from asthma through surveillance of patients’ use of inhalers. The quality payment encourages contractors to routinely carry out surveillance of patients’ use of inhalers ensuring patients are given appropriate advice and are referred for an asthma review when this is indicated.
The National Review of Asthma Deaths (NRAD) made a number of recommendations to improve the care of people with asthma. This included:
- people with asthma should have a structured review by a healthcare professional with specialist training in asthma, at least annually; and
- all asthma patients who have been prescribed more than 12 short-acting bronchodilator (SABA) inhalers in the previous 12 months should be invited for urgent review of their asthma control, with the aim of improving their asthma through education and change of treatment if required.
Pharmacy professionals are in an ideal position to detect the under and over usage of inhalers by asthma patients through surveillance of patients’ use of inhalers over a fixed period. These interventions may already be commonplace in pharmacies but this quality payment seeks to ensure this vital information is used to trigger an asthma review as recommended by the NRAD report.
Further information on the importance of surveillance of patients’ use of asthma inhalers is included in Annex 4 of NHS England’s Pharmacy Quality Payments Quality Criteria Guidance.
How to achieve this quality criterion (includes PSNC resources)
It is up to the contractor how they choose to engage and implement regular surveillance of patients’ use of inhalers into their processes and procedures but at a minimum, historical dispensing of SABA and steroid inhalers for patients should be assessed at every point a SABA inhaler prescription is presented for dispensing for the treatment of asthma, without a prescription for a steroid inhaler also being presented at the same time. These tasks could be undertaken by any appropriately trained staff within the pharmacy team.
The surveillance could also include a combination of one or more of the following:
- monitoring the number of SABA inhalers dispensed in a rolling 6-month period through the pharmacy patient medication records (PMR) or through routine or opportunistic access to SCR;
- monitoring patient emergency supply requests for SABA inhalers;
- monitoring out of hours or urgent prescriptions for SABA inhalers;
- monitoring emergency supply requests through the NHS Urgent Medicine Supply Advanced Service;
- monitoring repeat prescription requests for SABA inhalers;
- monitoring the number of SABA inhaler dispensed as part of a Medicines Use Review or New Medicine Service; and
- monitoring non-collection of prescriptions for steroid inhalers.
Where no patients are identified for referral, the contractor will still be eligible for payment as long as they can evidence that they have been working to identify suitable patients and that they have a process in place for referral should they identify someone.
Information on this quality criterion is available in PSNC Briefing 020/18: Quality Payments – referrals for asthma reviews (April 2018)
A suggested process for pharmacy teams to follow to incorporate this quality criterion into their daily practice can be found below.
This process looks to identify patients who have been diagnosed with asthma and have been prescribed more than 6 short-acting bronchodilators in the last 6 months as these patients are likely to require their asthma to be assessed urgently.
Patients that fall into this criteria may benefit from receiving a check of their inhaler technique and an MUR to help them to understand how to optimise use of their medicines and management of their condition. If these interventions are provided, it is important that this is noted in the referral to the GP practice, so that they know that the pharmacy has already taken positive steps to address the patient’s identified issues with asthma management.
Contractors should retain evidence that this process has been carried out in the pharmacy and may be required to provide evidence to local NHS England teams to show that they have met the quality criterion. A data collection form is provided below which could be used to aid this process. Please note, if this form is used, the left-hand side of the form containing patient information, should be hidden if it is shown to NHS England representatives to prevent a breach of patient confidentiality.
Referral to an appropriate health care professional
The contractor will normally be referring the patient to their general practice. The health care professional to whom the patient is referred should be a professional who has undertaken specialist training in asthma. This may be the patient’s GP, GP practice based respiratory nurse specialist or ‘asthma nurse’.
Communicating with GP practices
The briefing document below can be used by contractors to talk local GP practice teams through the new referral process. This includes the main points that could be discussed with the local GP practice teams.
The below template letter can be used by contractors in addition to the briefing document. Although the letter could be used instead of the briefing document, it may be useful for contractors to speak to the local GP practice teams to inform them of the referral requirement rather than just sending a letter. This will allow contractors to hear what feedback the local GP practice teams would like to receive or how they would like patients to be referred.
Where the notification to the GP practice is undertaken via hardcopy/fax the Community pharmacy referral form can be used.
If contractors are claiming payment for this quality criterion in June 2018, they should review their staff’s knowledge and understanding of the process to follow to identify suitable patients. Methods used to identify ‘at risk’ patients and for referral should be reviewed for effectiveness.
PharmOutcomes support for asthma referrals
Contractors can access support on PharmOutcomes for this quality criterion.
This support is available to all contractors as PSNC has agreed to use their licence to provide access to the asthma referrals service on PharmOutcomes.
This PharmOutcomes tool allows contractors to record patient details who have consented to be referred to their GP practice because of them having been dispensed more than 6 short acting bronchodilator inhalers without any corticosteroid inhaler within a 6 month period. When this data is saved on PharmOutcomes a referral will automatically be sent to the patient’s GP practice (if an NHSmail email address is held for that GP practice on PharmOutcomes).
Once a contractor has logged into PharmOutcomes, the tool can be accessed by clicking on the ‘Services’ tab on the PharmOutcomes homepage.
PharmOutcomes log in details
If a contractor has not used PharmOutcomes before, log in details can be obtained by sending a message to the PharmOutcomes helpdesk. Contractors will need to provide details of the pharmacy, contact information and an email address to issue the login details to.
The declaration process
Contractors will be required to confirm through the NHS BSA online declaration page (this webpage is not live yet) that they meet this quality criterion.
Q. Are there any resources available to support the referral of asthma patients who have been prescribed more than 6 short acting bronchodilator inhalers without a corticosteroid inhaler within a 6-month period, to an appropriate healthcare professional for an asthma review?
Yes. Further information on this quality criterion and support materials to help contractors implement the requirement are available on the Quality Payments – Over use of asthma treatments page.
Q. Will there be a national template form for recording the referral of patients with asthma that contractors can use?
No. There will not be a national template form; however, PSNC produced a template data collection form which pharmacy teams can choose to use.
Q. How many patients with asthma need to be referred to meet the quality criterion?
There is not a specified number of people with asthma that need to be referred to meet the quality criterion.
Q. If a contractor has not been able to identify any asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period since 24th November 2017, do they still meet the criterion?
Where no patients are identified for referral, the contractor will still be eligible for payment as long as they can evidence that they have been working to identify suitable patients since 24th November 2017 and that they have a process in place for referral should they identify someone.
PSNC has produced a suggested process for referring patients for an asthma review.
Q. Do I need to go through all the patient records on the PMR system for the last 6 months and identify any patients who have been prescribed more than 6 short acting bronchodilator inhalers without a corticosteroid inhaler within a 6-month period to meet this criterion?
No. Contractors do not need to have reviewed 6 months of patient records to meet this criterion. On the day of the review the pharmacy must be able to show evidence of the asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6-month period, that have been referred to an appropriate health care professional for an asthma review. There must, therefore, be a process in place, to identify these asthma patients. This process can be incorporated into daily practice (PSNC has suggested a processfor referring patients for an asthma review).
Further FAQs on the Quality Payments Scheme can be found on the Quality Payments – FAQs page.