Pharmacy Quality Scheme – Asthma referrals
Pharmacy Quality Scheme – Asthma referrals
Community pharmacy contractors passing the gateway criteria will receive a payment for the Pharmacy Quality Scheme if they meet one or more of the domains. The asthma domain consists of one quality criterion, one of which is that on the day of their declaration (which must be done between 3rd February 2020 and 28th February 2020):
‘The pharmacy can show evidence that patients with asthma, for whom more than 6 short-acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, have since the last QPS review point (i.e. 15th February 2019), been referred to an appropriate healthcare professional for an asthma review, and can evidence that they have ensured that all children aged 5-15 prescribed an inhaled corticosteroid for asthma have a spacer device where appropriate in line with NICE TA38 and have a personalised asthma action plan. The pharmacy must be able to show that they have referred patients with asthma to an appropriate healthcare professional where this is not the case.’
NHS England and NHS Improvement 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 corticosteroid inhalers for patients and use of spacer devices for children in particular, should be assessed at every point a prescription is presented for the treatment of asthma. 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 the Summary Care Record (SCR);
- for patients aged 5-15, checking the pharmacy PMR or through routine or opportunistic access to the SCR for spacer devices or asking the patient or parent/guardian whether they have purchased a spacer device without a prescription;
- asking patients aged 5-15 or their parents/guardians whether they have been given a PAAP;
- 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 (NUMSAS), which will close on 28th October 2019 or the Community Pharmacist Consultation Service (CPCS), when this goes live on 29th October 2019;
- 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 042/19: Pharmacy Quality Scheme – Asthma referrals (September 2019).
Two suggested processes for pharmacy teams to follow to incorporate this quality criterion into their daily practice can be found below.
Suggested process for referring patients for a review of their asthma management: for patients who have had more than six short-acting bronchodilator inhalers dispensed without any corticosteroid inhaler within a six month period
Suggested process for referring patients for a review of their asthma management: for children aged 5-15 years who have been prescribed an inhaled corticosteroid for asthma without a spacer and/or do not have a personalised asthma action plan
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 and NHS Improvement 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 and NHS Improvement 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.
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.
There are two services available; one for patients for whom more than six short-acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a six month period and one for children who have not been prescribed a spacer device and/or a PAAP.
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 ‘Services’; and then the two services are listed under the title ‘Pharmacy Quality Scheme – Quality criteria’:
- Quality criterion – Asthma referrals; and
- Quality criterion – Children’s asthma referrals.
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.
FAQs on the Pharmacy Quality Scheme can be found on the Pharmacy Quality Scheme – FAQs page.