NHS Urgent Medicine Supply Advanced Service (NUMSAS)
NHS Urgent Medicine Supply Advanced Service (NUMSAS)
On 20th October 2016, the Department of Health and Social Care (DHSC) and NHS England announced that as part of the 2016/17 and 2017/18 community pharmacy funding settlement, money from the Pharmacy Integration Fund (PhIF) would be used to fund a national pilot of a community pharmacy Urgent Medicine Supply Service. The service was commissioned as an Advanced Service, initially from 1st December 2016 to 31st March 2018. In November 2017, NHS England announced that the service would continue to be commissioned until the end of September 2018 and this was further extended until the end of March 2019.
The decision to commission the service came after PSNC proposed a community pharmacy emergency supply service as part of its counter proposal to the NHS and Government, but was clear that any new national service would need additional funding rather than being funded from within the existing community pharmacy funding envelope. DHSC then proposed that the PhIF could be used to fund a pilot scheme to test and evaluate such a service in order to inform possible future commissioning.
NHS England has shared the following to provide updates on progress with the service:
Click on a heading below for more information.
The service specification, Directions and guidance
The objectives of the service are to:
- manage appropriately NHS 111 requests for urgent medicine supply;
- reduce demand on the rest of the urgent care system;
- resolve problems leading to patients running out of their medicines; and
- increase patients’ awareness of electronic repeat dispensing.
Secretary of State Directions
The Directions provide the legal basis for the provision of Advanced Services. The DHSC has signed amendments to The Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2013 allowing NUMSAS to commence from 1st December 2016.
These Directions have been amended a number of times since publication. The amendment Directions are printed in the Drug Tariff. PSNC has created a document which consolidates the 2013 Directions and subsequent amendments.
NHS England training module
A training module developed for NHS 111 health advisors and pharmacy teams to help describe the NHS Urgent Medicine Supply Advanced Service (NUMSAS) and to illustrate the change in the patient journey since its introduction.
Funding from the Pharmacy Integration Fund is being used to test and evaluate the service in order to inform possible future commissioning, i.e. the funding for the service is not from the main community pharmacy contractual framework (CPCF) funding.
In summary, the following fees will be paid for provision of the service:
(a) For ANY referral received from NHS 111 for a request for an urgent medicine or appliance supply, whether or not a supply is made and irrespective of the reason for any non-supply;
(i) a Consultation fee of £10; AND
(ii) an Administration fee of £2.50 per consultation to reflect the additional work/documentation required to support evaluation of the service;
(b) Where a medicine or appliance has been supplied, a supply fee of £1.50 will be made for the first item and an additional £0.50 will be paid for each additional item supplied.
The cost of medicines or appliances supplied under the service will be reimbursed using the basic price specified in Drug Tariff Part II Clause 8 – Basic Price. An allowance at the applicable VAT rate will be paid to cover the VAT incurred when purchasing the supplied medicine or appliance.
Full details of the payments and when they can be claimed are set out in the service specification.
PSNC's advice to contractors
During the 2016 discussions with DHSC and NHS England, PSNC proposed the commissioning of an emergency supply service as part of our service development and counter proposals. These proposals were for a fully funded service which would include patients referred by NHS 111 and patients that request an emergency supply in the pharmacy. We therefore support, in principle, the commissioning of emergency supply services, as they drive value for NHS commissioners, reduce the burden on general practice and GP out of hours services and provide a timely and convenient service for patients. In the commissioning of the service, PSNC is pleased to see recognition of how community pharmacies can help patients and the NHS, but we are disappointed that the scheme has only been commissioned as a pilot. We are also disappointed that the service will not cover patients who have been referred by other health professionals or come to pharmacies in the first instance themselves.
The NUMSAS is part of the DHSC imposition of changes to the Community Pharmacy Contractual Framework (CPCF) and as such the service, including the funding, has not been agreed by PSNC. We have however sought to work with NHS England to ensure the service specification and requirements are, wherever possible, as manageable as possible for contractors and that the experience from similar locally commissioned services has informed the development of the service.
IT support – the service requirements, and in particular the lack of funding to provide nationally commissioned IT support for the service, mean that it may be more bureaucratic and hence costly for contractors to provide, in comparison to equivalent locally commissioned services which are supported by appropriate IT systems for the transfer of referrals from NHS 111, maintenance of service records, service claims and communication with patients’ GP practices.
It has not been possible for NHS England to procure specific IT support for the service, such as PharmOutcomes; this is regrettable, particularly when the Pharmacy Integration Fund is funding this pilot service and it may therefore seem logical for this funding to also be used to provide IT infrastructure that would support the flow of information between NHS 111 providers, community pharmacies and general practices.
Funding – PSNC has undertaken an assessment of the costs of providing the service; this is set out in the following spreadsheet and is provided for use by pharmacy contractors in order to assist them to assess the likely costs of providing the service. Please note, this calculator was published before the change to the NUMSAS claiming process (click on claiming payment below for up-to-date information).
At PSNC’s January meeting, the Committee considered the costs of providing the service and they expressed concern that contractors would find that the likely costs of provision of the service would exceed the fees that NHS England will pay for its provision.
As with any new service, PSNC recommends that contractors consider the likely costs they will incur in setting up and providing the service and compare this with the likely income that will be available from the service as part of a careful assessment of whether it is sensible for them to seek to provide the service.
The volume of referrals from NHS 111 to contractors is likely to be relatively low, based on information provided by NHS England; the maximum number of all such potential referrals is in the region of 200,000 per annum, and based on the experience of similar locally commissioned services, it is unlikely that it will be possible to transfer all of these patient requests to community pharmacy, at least to begin with. Clearly the likely volume of transactions per pharmacy will also need to be a factor that is considered when contractors make a decision on whether they wish to seek to provide the service.
Signing up to provide the service
Before signing up to provide NUMSAS there are a number of tasks that community pharmacy contractors should complete. PSNC Briefing 033/17: Checklist for the NHS Urgent Medicine Supply Advanced Service (NUMSAS) contains a checklist of tasks to complete before providing NUMSAS.
Contractors are able to notify NHS England of their intention to provide the NUMSAS pilot by completing the notification form on the NHS Business Services Authority (NHS BSA) website.
All contractors that meet the requirements set out in the service specification for the NUMSAS, including the requirement that the pharmacy has a shared NHSmail mailbox, are able to register; however, contractors will only be able to receive referrals from NHS 111 and provide the service when the service goes live in the contractor’s area.
Requirement for a shared NHSmail mailbox
A requirement in the service specification is that if a contractor intends to provide the service, they must have a shared NHSmail mailbox for each of the pharmacy premises from where the service will be provided. Contractors should not register for the service until they have such a mailbox.
To access a shared NHSmail mailbox, users must have their own personal NHSmail address which is linked to the shared mailbox. This is to allow different staff members to access the mailbox without sharing of login details. Currently, only a small number of pharmacies have premises specific shared NHSmail mailboxes.
Requirement to have access to Summary Care Records
A requirement in the service specification is that if a contractor intends to provide the service, they must have Summary Care Record (SCR) access in each of the pharmacy premises from where the service will be provided. Contractors should not register for the service until they have SCR access. The SCR should be accessed during the telephone or face-to-face consultation with the patient and if the SCR was not accessed, the reason for not doing so must be recorded.
Pinnacle Health LLP has announced that a new service template is available on PharmOutcomes to assist service delivery of NUMSAS.
The PharmOutcomes service will be available at no additional cost to NHS England commissioners and LPCs who have a multiple service licence provided there is no change to licence requirements regarding provider numbers. However, a fully integrated version of the service is also available for an additional fee, which will allow the transfer of information (‘the referral’) from NHS 111 straight to a pharmacy’s PharmOutcomes platform (rather than using NHSmail). An email alert will then be generated at the pharmacy to alert the team that a referral has been received. The integrated solution will also provide commissioners with detailed ‘Tracker reports’ allowing a more thorough analysis of outcomes.
Commissioners or LPCs interested in the fully integrated service should contact the PharmOutcomes helpdesk for fee information.
Key benefits of using the PharmOutcomes service for commissioners or LPCs are:
- Access to real time data – This shows levels of engagement and cost of medicines supplied.
- Automated GP notification – A reliable means of ensuring GP notifications are sent in line with this service requirement, which is fully auditable.
- Post payment verification – Efficient means of completing any post payment verification audit.
- For adopters of the fully integrated version of the service – access to patient tracker reports showing clear details of recorded data for referrals (NHS 111 teams) and follow-up (community pharmacy teams) stages of the service.
Key benefits of using the PharmOutcomes service for community pharmacy contractors are:
- Structured service templates – These allow registration and follow up of all patients accessing the service. This makes the identification of repeat users easily identifiable that in turn can trigger relevant discussions about medicines management and medicines optimisation.
- Clinical record – A clinical record of all supplies and the ability to show a clear audit trail of activity and claims made.
- Automated GP notification – Saving data will automatically generate and send a notification form to the patient’s GP practice.
- NUMSAS submission tokens – The PharmOutcomes service will allow the required information, which needs to be included on the FP10DT EPS dispensing tokens, to be printed on the forms in a clear legible format.
- NUMSAS claim submission form generation – The NUMSAS claim form will be automatically system generated using recorded data and made available for printing on the 1st day of every month (please note this form must be posted to the NHS Business Services Authority, it cannot be submitted via PharmOutcomes).
A User Guide for the NUMSAS service is available from the PharmOutcomes Help tab.
An instructional video guide is also available on the PharmOutcomes website.
For more information on any aspect of this new PharmOutcomes service please contact the PharmOutcomes helpdesk.
Communicating with GP practices
Notifying the patient’s GP practice when a supply of a medicine or appliance is made is a requirement of the NUMSAS.
Contractors must ensure that a notification is sent to the patient’s GP practice on the same day the medicine or appliance is supplied or as soon as possible after the pharmacy opens on the following working day. This can be undertaken by secure email or secure electronic data interchange. If necessary the pharmacy should contact the GP practice for details of their secure email address. Where electronic notification is not possible, the pharmacy contractor should send the notification via post, hand delivery or “safe haven” fax (this should only happen where the pharmacy has confirmed with the GP practice the number of the fax and that it is a “safe haven”).
Where the notification to the GP practice is undertaken via hardcopy/fax the national GP Practice Notification Form should be used:
Informing GP practices about NUMSAS
The briefing document below can be used by contractors to talk to local GP practice teams about NUMSAS. It includes the main points that could be discussed with a GP practice as well as a copy of the GP notification form which must be sent to a patient’s GP practice if a supply of a medicine or appliance is made.
The below template letter can be used by contractors in addition to the above 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 notification requirement rather than just sending a letter. This will allow contractors to hear how local GP practice teams would like to receive notifications. A copy of the GP notification form is also included in the letter.
- PSNC Advanced Services PowerPoint presentation for GPs and hospital colleagues (August 2017)
- PSNC Advanced Services PowerPoint presentation for GPs and hospital colleagues (August 2017) (PDF)
- PSNC Briefing 040/17: NHS community pharmacy Advanced Services – information for general practitioners and practice staff (June 2017)
Patients must be asked to complete a copy of the national patient questionnaire following the supply of a medicine or appliance. NHS England has launched an IT platform to enable the patient questionnaire to be completed electronically, either by the patient themselves or with help from the pharmacy team. When patient questionnaires are completed on paper, contractors should utilise the functionality available on the IT platform to submit patients’ responses to the questionnaire so that these responses can be collated and analysed along with those submitted electronically.
In order to claim for NUMSAS, contractors must do the following each month:
- complete the existing NHS Urgent Medicines Supply Advanced Service Pilot claim form;
- place the completed NUMSAS claim form along with the completed FP10DT EPS dispensing tokens (completed as part of the NUMSAS) in an envelope clearly marked ‘NUMSAS’; and
- send the NUMSAS envelope to the NHS BSA with the normal monthly submission bundle.
Please ensure that FP10DT EPS tokens (completed as part of NUMSAS) are separated from other tokens, or there is a risk that claims will not be reimbursed if the NUMSAS tokens are scanned and stored with the other tokens.
PSNC Briefing 034/17: NHS Urgent Medicine Supply Advanced Service (NUMSAS) – checklist for completing an FP10DT EPS dispensing token and end of month submission process contains a checklist for completing an FP10DT EPS dispensing token after each referral and a checklist for submitting the tokens and claim form at the end of the month.
PSNC Briefing 035/17: Services Factsheet – NHS Urgent Medicine Supply Advanced Service (NUMSAS) – how much will I be paid? is a quick reference guide to see how much contractors will be paid for each referral they receive depending on the outcome of the referral.
Frequently asked questions (FAQs) on the NUMSAS can be found on the NUMSAS – FAQs page of the PSNC website.
National Pharmacy Association – NUMSAS Standard Operating Procedure (please note NPA login required)
NHS Identity Guidelines: NHS logo use by pharmacies
In January 2017 NHS England updated the guidelines on the use of the NHS Identity, including revised guidance for all primary care contractors who are commissioned under a primary care contract. Where pharmacy contractors choose to use the NHS identity, they must ensure that the revised guidance is adhered to when producing, updating or replacing designs.
NUMSAS webinar and Slide Deck
PSNC held a webinar about the NUMSAS on Wednesday 30th November; watch the on-demand version here. Please note, this webinar was recorded before the change to the NUMSAS claiming process (click on claiming payment above for up-to-date information).
PSNC slide deck on NUMSAS for LPCs (PowerPoint) (updated 26/2/17)
This slide deck is based on the presentation used in the NUMSAS webinar.
PSNC slide deck on NUMSAS for LPCs (PDF) (updated 26/2/17)