NHS Urgent Medicine Supply Advanced Service (NUMSAS)
NHS Urgent Medicine Supply Advanced Service (NUMSAS)
On 20th October 2016, the Department of Health (DH) 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 is being commissioned as an Advanced Service and it will run from 1st December 2016 to 31st March 2018 with a review point to consider progress in September 2017.
The decision comes 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.
DH 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.
Click on a heading below for more information.
The service specification and the Directions
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 Department of Health has signed amendments to The Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2013 allowing NUMSAS to commence from 1st December 2016.
PSNC has produced a consolidation of the Secretary of State’s Directions to the end of December 2016 which is available here.
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 DH 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 DH 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.
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.
Roll out of the service
The NUMSAS pilot is being commissioned as a fully integrated service and it therefore requires a number of key elements to be in place before it can go live. To support the efficient roll-out of the service, particularly putting in place mechanisms for referral from NHS 111 to community pharmacy, a phased introduction will take place from December 2016 to March 2017, with the pilot running until March 2018:
Phase 1 – December 2016 – Brighton and Hove CCG; Guildford and Waverley CCG; Blackpool CCG and Fylde and Wyre CCG; Nottingham City CCG; Cambridgeshire and Peterborough CCG
Phase 2 – January 2017 – Cheshire & Merseyside, Cumbria & North East, East and Lancashire & Manchester
Phase 3 – February 2017 –North Midlands, South East, South West, Wessex, West Midlands and Central Midlands
Phase 4 – March 2017 – Yorkshire & Humber, London and South Central
Signing up to provide the service
Community pharmacy 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 (see ‘Roll out of the service’ section).
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.
Locum pharmacists will be able to access shared NHSmail mailboxes, but will require their personal NHSmail address to be linked to each shared mailbox.
Phase 1 areas – Information for contractors on obtaining a shared NHSmail mailbox
To enable pharmacies in the phase 1 areas to be able to register to provide the NUMSAS, an interim centralised approach to issuing premises specific and additional personal NHSmail addresses has been implemented by NHS England. Pharmacies in the phase 1 areas will be contacted by their NHS England teams to invite them to register for NHSmail mailboxes in early December with details about how to do this.
Pharmacies not in a phase 2 area – Information for contractors on obtaining a shared NHSmail mailbox
NHS England is working with NHS Digital to develop a more streamlined and simplified national process for applying for NHSmail. The aim is to have all pharmacies that request a mailbox to be set up with it by April 2017.
NHS England intends to issue details about the new process in January 2017.
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.
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:
Patients must be asked to complete a copy of the national patient questionnaire (Annex D of the service specification) following the supply of a medicine or appliance.
NHS England will be launching an IT platform to enable patient questionnaires from the NUMSAS to be completed electronically either by the patient themselves or with help from the pharmacy team.
The IT platform will allow patient questionnaire details to be recorded in a number of ways including:
- completing the questionnaire online – a tablet device could be used in the pharmacy (if available) and the patient could input their responses;
- using a QR code to access the questionnaire if the patient has a smart phone with a QR code reader App installed on it;
- providing the patient with a compliments slip detailing the website address and QR code for them to complete the questionnaire online at a convenient time; and
- a downloadable copy of the patient questionnaire which the patient can complete in the pharmacy.
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.
A guidance document on how to use to complete the process will be made available on the IT platform.
To claim payment for this service, contractors must complete the NHS Urgent Medicines Supply Advanced Service Pilot claim form and submit it to the NHS BSA, along with the completed FP10DT EPS dispensing tokens (completed as part of the NUMSAS), not later than the 5th day of the month following that in which the urgent supply was made.
The process will be separate to the submission of other FP10 forms, do not send the claim form with your prescription bundle at the end of the month. The completed form should be sent to Prescription Services, Bridge House, 152 Pilgrim Street, Newcastle upon Tyne, NE1 6SN in a secure manner that enables tracking and tracing of the delivery.
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.
PSNC slide deck on NUMSAS for LPCs (PowerPoint) (updated 20/1/17)
This slide deck is based on the presentation used in the NUMSAS webinar.
PSNC slide deck on NUMSAS for LPCs (PDF) (updated 20/1/17)