Quality Payments – Asthma referrals

Quality Payments – Asthma referrals

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 six short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a six month period, have since 29th June 2018 (i.e. the last review date), been referred to an appropriate healthcare professional for an asthma review; and can evidence that they have ensured that all children aged 5-15 years prescribed an inhaled corticosteroid for asthma have a spacer device where appropriate in line with NICE TA38 and have a personalised asthma action plan. Refer to an appropriate healthcare professional where this is not the case’.


Click on a heading below for more information.

NHS England guidance

NHS England has published guidance for the February 2019 review point of the Quality Payments Scheme. The new guidance should be read in conjunction with NHS England’s previously published gateway criteria and 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.

Quality criterion points and value

The value of this quality criterion is as follows:

Total points for the February 2019 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 clinical surveillance and evidence based interventions.

This quality criterion encourages the surveillance of patients with asthma by contractors to:

  • routinely monitor patients’ use of inhalers by ensuring they are given appropriate advice and are referred for an asthma review, where appropriate;
  • specifically identify children aged 5-15 years without a Personalised Asthma Action Plan (PAAP) and refer to an appropriate healthcare professional when this is not the case; and
  • specifically identify children aged 5-15 years that are prescribed a corticosteroid press and breathe pressurised metered dose inhaler (pMDI), without a spacer device and refer them for clinical review.

The National Review of Asthma Deaths (NRAD) made a number of recommendations to improve the care of people with asthma. These included:

  • People with asthma should have a structured review by a healthcare professional with specialist training in asthma, at least annually; and
  • All patients who have been prescribed more than 12 short-acting beta agonist (SABA) inhalers in the previous 12 months should be invited for an urgent review of their asthma control, with the aim of improving their asthma through education and changes in their treatment if required.

The report made further recommendations identifying:

  • People with asthma should be provided with a PAAP which can help to identify worsening asthma, support corrective action and advise patients and carers of how and when to seek help; and
  • Patients with a PAAP were four times less likely to die from an asthma attack but 77% of patients included in the NRAD report had no record of having a PAAP.

In addition, the National Institute for Clinical Excellence Technology Appraisal 38 (NICE TA38) guidance recommends the use of spacer devices in combination with press and breathe corticosteroid pMDIs to achieve optimum asthma management in children.

Pharmacy professionals are in an ideal position to detect the under and over usage of asthma inhalers through surveillance of patients’ use of inhalers over a fixed period and to identify children between the ages 5 and 15 years inclusive, that may benefit from using a spacer device to aid delivery of corticosteroids and check that they have an up-to-date PAAP. These interventions may already be commonplace in community pharmacies but this quality criterion seeks to ensure this vital information is used to trigger an appropriate review as recommended by the NRAD report and support prevention of further preventable asthma deaths.

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;
  • 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 060/18: Quality Payments – Asthma referrals (November 2018)

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

Asthma referrals – Suggested process for referring patients for a review of their asthma treatment (Word)

Asthma referrals – Suggested process for referring patients for a review of their asthma treatment (PDF)

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

Asthma referrals – Suggested process for referring patients aged 5-15 years for a review of their asthma treatment (Word)

Asthma referrals – Suggested process for referring patients aged 5-15 years for a review of their asthma treatment (PDF)

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.

Data collection

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.

Data collection form (Word)

Data collection form (PDF)

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.

GP practice briefing document (Word)

Gp practice briefing document (PDF)

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.

Template letter for GP practice (Word)

Template letter for GP practice (PDF)

Where the notification to the GP practice is undertaken via hardcopy/fax the Community pharmacy referral form can be used.

Community pharmacy referral form (Word)

Community pharmacy referral form (PDF)

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 the ‘Services’ tab on the PharmOutcomes homepage; you should see ‘Quality Payment criterion – Asthma referrals’ and ‘Quality Payment criterion – Children’s asthma referrals’ under the ‘Quality Payment Criteria’ heading.

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 NHSBSA online declaration page (this webpage is not live yet) that they meet this quality criterion.

FAQs

Q. Are there any resources available to support the referral of suitable patients 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 has produced a template data collection form which pharmacy teams can choose to use.

Q. How many patients with asthma need to be referred to a healthcare professional 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 suitable patients with asthma, 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 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 suitable patients to meet this criterion?
No. Contractors do not need to review PMR systems to meet this criterion. There must be a process in place to identify these asthma patients as they present to the pharmacy. This process can be incorporated into daily practice (PSNC has suggested a process for referring patients for an asthma review).

More FAQs on the Quality Payments Scheme can be found on the Quality Payments – FAQs page.

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