Local Support and Interpretation of Guidance COVID-19


Practical Advice on how to deal with the current crisis

We are very aware that the information coming out of national organisations is constantly changing and front-line staff will struggle to know how to apply it. The sections below will help you to find the key guidance and interpret it for your business. This section will be constantly updated as new guidance is issued.

PSNC Guidance

PSNC produced some useful guidance for pharmacies on reviewing your infection control and social distancing procedures. This can be found here:

Review your social distancing and infection control procedures

We would strongly recommend that all pharmacies make use of the risk assessment template V2 and embedded advice, if you have not already done so.

Protecting the Pharmacy Team

Managing Customers at the Pharmacy

Maintain social distancing– 2 meters between patients where practicable (consider ‘staff at risk’ for example those that may be asthmatic, or consider limiting the number of people entering at the premises at any one time). Consider installing barriers or screens in front of the counter if not already, or use tape to mark distances on the floor.

Wearing face coverings – Face coverings are now mandatory for those entering shops (including pharmacies) and supermarkets from 24th July 2020. Official PHE/NHS posters reflecting the updated Government guidance are now available.
There is also a poster created by the Royal Pharmaceutical Society.

Patients that are exempt from wearing a face covering may feel more comfortable showing an exemption card / badge although they do not have to and it is not necessary by law. They should not be routinely asked to provide any written evidence.
Free exemption cards and badges are now available on the Gov.UK website.

New guidance on staff use of PPE including wearing of face masks in primary care settings and administering vaccinations has also now been published on 21st August 2020.

PSNC also issued guidance on use of face coverings by patients and customers

Limited Entry  – All pharmacies are limiting numbers of customers in the pharmacies in line with social distancing guidance. Patients may be asked to queue outside and wait, or be asked to follow any other guidance given by staff including one way systems.

Queue management – Use a volunteer or staff member to aid in queue management outside the pharmacy to maintain social distancing of 2 meters. Before you close for lunch or at the end of the day you could advise who the last person in your queue to be served is, tell anyone that joins the queue behind them that they are closing and/or put a sign out to say this pharmacy is now closing after this individual.

Delivery of medicines – Many but not all community pharmacies will offer a deliver service. The funded Pandemic Delivery Service for shielded patients ended on the 31st of July so the cost of all deliveries after this date will be the responsibility of the contractor.

Create a pick-up point – Where practical, you could create an external pick-up point for cars to park whereby the individual phones for the medicines to be brought outside (pictured right). You may need to get highways, local and/or parish council approval for such an arrangement.

Pharmacy Entry Point / Internal Signs – Please make sure you have the PHE Covornavirus posters displayed at all entry points to your pharmacy.

The RPS have also released a set of posters that you may wish to use.

In the warmer months you may want to use an external display sign with the above poster in it and keep the door to your pharmacy open to allow fresh air to circulate. This will also help avoid the public making contact with the door handle on entry and exit.

Please risk assess use of vented heating and air-conditioning which could circulate the virus further.

Keeping hands / the pharmacy clean Follow NHS How to wash your hands guidelines, which should be carried out for 20 seconds.

Increase cleaning of touching points such as door handles, counter tops, and shelving – particularly at shoulder and head height where contact is made most and where sneezes or coughs may land.

Remove large quantities of stock items from shelving to allow for swift cleaning.

Increase the frequency that all staff do so, for example you may wish to set a phone / computer alarm to remind you on an hourly basis to wash hands and clean contact points. Consider placing hand sanitiser at entry points.

Processing paper scripts – Wear gloves and put the script in a secure location that can be left in a box etc. for 72 hours before being filed.  Keep offering patients the option of nominating a pharmacy to become paperless. Consider offering hand sanitiser for customer use before signing for their script.

Physical barriers / screens – Pharmacy should have already where practicable installed barriers, screens and bollards.

PPE – Guidance On PPE can be found here from the Gov.UK website. This link also contains information on wearing PPE, knowing how to put it on, remove and dispose of correctly.

New guidance on staff use of PPE including administering vaccinations has also now been published on 21st August 2020.

PPE should also be worn during decontamination. Please see section 3.3.4 in the Community Pharmacy SOP.

If you are struggling to access PPE for appropriate use then please contact the LPC to advise via the Emergency PPE Supply request form.

Physical & Emotional Wellbeing

Staff will be suffering from stress, anxiety and fatigue; a major risk to the wellbeing of staff and in-turn an increased risk of dispensing errors and mistakes in their work. You may find the link to emotional and psychological survival guide useful to help maintain your teams wellbeing during this time.

Public Health Suffolk have also launched the Mental Health, Emotional Wellbeing and Learning Disabilities COVID-19 Information Hub which brings together guidance, tips and support in one place on the Healthy Suffolk website. The Information Hub is available from this link: www.healthysuffolk.org.uk/COVIDHub

Suffolk and North East Essex ICS have created the following Health and Wellbeing Support Poster which covers both local and nation support available for those on the frontline including pharmacy teams.

Norfolk and Suffolk Foundation Trust (NSFT) have summarised the Kings Fund’s advice and provided a Stress Diagram.

Vulnerable people – at risk staff

For a full list of people who are deemed to be at risk of getting severe symptoms from the Coronavirus please click here. It is your responsibility to assess the risk to your staff and take appropriate decisions to protect them (multiple pharmacies will be given HR support by their Head Office). If this means that staff have to self-isolate and you can no longer operate your pharmacy safely for your contracted hours, please follow the information below on reducing your hours or closing your pharmacy.

Risk assessments for BAME and other staff

Staff returning to work and existing team members who are potentially more at risk due to their race and ethnicity, age, weight, underlying health conditions, disability, or pregnancy should complete a risk assessment so that their risk rating can be identified and measures taken to reduce these where practicably.

PSNC NEWS – NHSE&I request urgent completion of risk assessments at least for all staff in at-risk groups (including Black, Asian and Minority Ethnic (BAME) staff).
Pharmacy teams have been requested to complete this before the end of July.

Please see the following links:
letter from NHSE&I
Risk Assessments in Primary Care
Individual Employee Risk Assessment – COVID-19 Template

(Multiples should follow any guidance provided by your head office)

Opening hours or closing your pharmacy

Network Resilience

For information on closures or change in hours please click here.

Resilience Reporting

A new resilience reporting template has now been launched on PharmOutcomes to record the issues you are experiencing in trying to maintain patients services. The LPC would encourage all contractors to complete this regularly so we know what is happening across the community pharmacy network. This will allow us to target system support to individual pharmacies as issues arise.

There are three status reports that a pharmacy can make:

PharmOutcomes User Guide – Operational Status Reporting

The above guide also gives you a list of actions to take like notifying your GP, notifying patients collecting methadone, patients collecting daily pick-ups, local treatment agencies, placing a sign on your pharmacies window and informing NHS England and the DOS team.

The system will default to green unless you update it. If you report issues with your service daily, this will be shown as an amber status and this will be visible to the LPC so that we can look at ways to support you.

If you can no longer operate your service safely and you need to close (red status), please notify NHSE&I of any closures or reduction in opening hours immediately. As well as this being a contractual requirement, this is needed to facilitate the mapping of the impact of the COVID-19 situation and the wider coordination of support. This can be done via the template generated on the PharmOutcomes system or the relevant forms for notification to NHSE&I can be found here:

https://www.england.nhs.uk/commissioning/primary-care/pharmacy/app-forms/

Notifications should be emailed to: england.pharmacyeast@nhs.net

For planned closures, you should make every attempt to discuss the situation with NHSE&I in advance, emailing them at the above address and requesting a call. However, if you have made the necessary notification and you need to close the pharmacy to maintain staff or customer safety, this is a professional decision and the LPC will support you.

PSNC have also working closely with NPA, CCA and AIM, and have published resilience guidance to help support and maintain the community pharmacy network during the response to the COVID-19 pandemic. You may find their Emergency Closure Form which is a to-do checklist particularly useful.

Changes in professional guidance for registered staff

Professional Judgement
These are unprecedented times, and all Pharmacists will have to make many professional decisions about the most appropriate course of action to take in many scenarios. Your LPC is having continual discussions with all system partners to ensure they understand the pressures and difficulties you face, and that we expect and demand that you receive backing for your actions from commissioners.

Communication is key, so please ensure you keep local surgeries and NHS England informed of significant issues, including any suspension of normal services or regarding contractual matters via england.pharmacyeast@nhs.net

If you have a query in regards to Covid-19 please send an email to: england.eastofengland-covid19@nhs.net

General Pharmaceutical Council

Please Read-Statement issued to registered staff about using professional judgement in staff and patients’ best interest. Including options such as access to a pharmacist by phone or video link for short durations to allow continuity where all other options have been exhausted. Main point- completed prescriptions could be given out to patients in the absence of the responsible pharmacist for short periods.

Postponement of revalidation submissions

The GPhC has announced that those registrants with a submission date between March and August 2020 will not be required to submit their four CPD records, one peer discussion and one reflective account on their normal submission due date. Instead, they will be required to submit their full revalidation record on their normal submission due date in 2021; i.e. with their renewal in 2021. Please note that all registrants will be expected to renew their registration as normal in 2020; the postponement only applies to the submission of revalidation records. 

They will review the situation for registrants due to submit their revalidation records after 31 August 2020 at a later date and will keep registrants updated.

Funded Deliveries

Medicines Delivery Service

As from the COVID-19 lockdown eases and people can now go outside more, HM Government’s shielding support package will end on Friday 31st July 2020. This will also bring the national pharmacy medicines delivery service to a close.

This means that from 1st August 2020 community pharmacies will no longer receive any financial support from HM Government to help them to continue delivering medicines to patients’ homes, and many will no longer be able to do so.

Shielding patients should receive a letter from HM Government about the changes.

Advice for Patients
Please ensure you advise your patients of any changes to your local service offerings so they may have time to adjust.
Patients can be advised to:

  • ask a friend or relative to collect their medicines for them;
  • call NHS Volunteer Responders on 0808 196 3646 (8am to 8pm) to arrange support;
  • contact their pharmacy or their local parish council to find a local volunteer.

PSNC has also published a Patient leaflet – lockdown medicine deliveries to end 31st July 2020, for pharmacy teams use.

Home, But Not Alone (Suffolk only service)

In line with changes to Government guidance to those who have been shielding, from 5pm on July 31st the Home But Not Alone phoneline will no longer provide:

  • Free emergency food deliveries
  • Medicine deliveries

Shielded residents in Suffolk have been written to by Government and are aware of these changes.

For the short-term, the team at Home, But Not Alone will still be able to offer help and advice to those most vulnerable in our communities and signpost to neighbourhood or countywide support.

As the Government continue to lift restrictions, especially for those who are shielding, and the levels of COVID-19 continue to fall, we are reviewing the level of support on offer in Suffolk. This may mean that further changes may be announced to the support offered by Home, But Not Alone in the future. However, these services are designed to be reintroduced and stood up once again if there is a significant local outbreak.

Financial support for your business

The NPA has produce some useful summaries and links that highlight the business support that is available to community pharmacies during Covid-19:

Financial Measures Available to Community Pharmacy during COVID-19

HMRC Helpline for deferral of payments

Locally Commissioned Services

Sexual Health Services

Please see the dedicated page on Healthy Suffolk website which will be updated regularly with the service position of key sexual and reproductive health services during the COVID-19 outbreak.

Currently all staff at Terrence Higgins Trust will be working from home where possible, starting Monday 23rd March 2020 until further notice. As a result, the Suffolk office will be closed until we are instructed otherwise. We will send another update about when we are likely to re-open when we know more.

Chlamydia and Gonorrhoea TestingFor the time being, chlamydia and gonorrhoea samples are still being tested. Results will still be sent out as normal. Patients who have not received results 2 weeks after sending their sample are advised to email suffolkchlamydia@tht.org.uk for their results, rather than phoning the office (this email address is printed on the tear off slip at the bottom of each testing form). While we’ve had no indication from the lab that they are planning to close, we will update you in the event that this happens.

If young people are requesting chlamydia tests from you, please instruct them to order a postal kit through youngandfree.org.uk

Chlamydia Treatment– where tests are being done, it is possible that pharmacies commissioned to provide the Chlamydia treatment service may be contacted to see if treatment can be supported in the pharmacy. Pharmacies must decline if workload pressures or staff availability prevent this type of intervention from being carried out safely and effectively.

C-card OrdersAnyone aged 16 or over can request up to two packs of condoms to be posted to them by visiting the THT website and completing the webform. Alternatively, people can contact sexualhealthsuffolk@tht.org.uk and request a pack of six regular condoms. We will need a name, age and full postal address including postcode in order to send condoms by Royal Mail in a discrete envelope. With consent, key/support workers can place an order on behalf of a person aged 16 or over.

TrainingAll training run by THT Suffolk for the next 2 months have been cancelled, this includes in house training. Delegates signed up to our multi-agency training (Eventbrite or Suffolk CPD) will be emailed separately. The health promotion specialist for your area will be in touch soon if you have in house training organised.

EHC– Public Health Suffolk is aware that pharmacy workload is overwhelming at present. If pharmacies receive requests for EHC, and these can be supported either via the commissioned service or by selling the product this would be very much appreciated.

Smoking Cessation

One Life Suffolk stop smoking service are offering telephone support during COVID-19.
To support your pharmacy during this demanding time One Life Suffolk are offering to support your active clients list and any new clients.

Pharamacy teams have been advised that carbon monoxide (CO) monitoring will be paused immediately for the time being and smoking status will become ‘self-reported’ and not ‘CO-verified.
They recommend that behavioural support continues to be provided via telephone.
Please make sure clients continue to receive stop smoking medications and if possible, be adaptable to make sure that this happens. For example: Posting or delivery of medication  to clients/volunteer collection.
We have a vital role to play in preventing the spread of COVID-19 to smokers, and in helping smokers become and remain smoke-free so that they are less at risk of serious health consequences from the virus.

Pharmacies can sign up to the Stop Smoking Service contract in Pharmoutcomes if they have not yet done so and wish to provide.
There is currently a message in the home page dated 6/3/20, Smoking Cessation Contracts and Service Specification NOW AVAILABLE, for Commencement APRIL 1st 2020 containing the contract and paperwork.
For further information and support please contact Julie Newman Stop Smoking Service and Pregnancy Lead for One Life Suffolk
on 07880232345 or email Julie.newman15@nhs.net

Harm Reduction Services – Turning Point

Turning Point have produced a COVID 19 Community pharmacy factsheet 24032020 that provides information for pharmacy teams about the support they are providing to ensure that Harm Reduction services can be maintained.

They have also provided Reducing Alcohol Intake Safely and Drug Use Advice guidance during COVID-19.

Health Checks

*NHS HEALTH CHECKS SUSPENDED WITH IMMEDIATE EFFECT*

The Commissioner for NHS Health Checks, has written to health check pharmacies to inform them of the decision to suspend the NHS Health Checks programme for the short term. This applies to all GP, Pharmacy and One Life Suffolk delivery with immediate effect for an initial 12 week period.

Due to Covid-19, many organisations and individuals are having to change their practice to support the system and reduce the spread of disease. As part of these changes non critical areas of work are being halted to increase capacity for other aspects of delivery.

Public Health Suffolk intend to review the position in 2 months’ time and will keep you informed of local deliberations. Thank you for all you have achieved so far. Please remember to submit any claims for activity up until now at your earliest opportunity.

HLP Level2

The Healthy Living Pharmacies Level 2 initiative had been halted for the first few months of the pandemic but pharmacies who are in a position to start working towards the standards again can now do so.

For information on how to re-engage with the HLP2 framework, please contact Myra myra@suffolklpc.org.uk

Thank you for all you have achieved so far.

ActiveLives

Please see the link to their website for further details as to how they are trying to keep people active during the pandemic.

Shortages reporting and re-imbursement

Reporting medicine shortages

PSNC is aware that there are an an increasing number of shortages in the system and that prices are fluctuating significantly from Drug Tariff listings. They are flagging these issues daily and are in urgent talks with DOHSC about how they can protect contractors from the affects of these changes and we hope to have more information soon.

In the meantime, please report shortages to PSNC via this link.

Prescribing intervals 

NHSE, Suffolk LMC, Suffolk LPC and our CCGs are strongly supporting Primary Care guidance which states that prescribing intervals should not be increased during this crisis to protect the supply chain. GPs are being asked to put all eligible patients onto eRD Please let the LPC know of GPs are not sticking to this guidance using info@suffolklpc.org.uk

Over the Counter (OTC) Sales of Paracetamol to Care Home Staff

Please see the COVID-19 OTC paracetamol sales community pharmacy letter from West Suffolk CCG dated 17th April 2020.

This advises that at this time of national emergency, community pharmacies should expect to receive OTC requests for paracetamol tablets and paracetamol liquid in larger quantities than usual specifically for use in care homes.

Please also find attached pdf final versions of the following for you to note the procedure for care home staff to follow in ordering larger quantities of paracetamol:

We appreciate the concerns around stockpiling and also the regulations governing these sales but this is a legitimate need, which we ask you to support as you see fit, during these unprecedented times.

You may also find the following links useful: RPS FAO’s – Accepting returned unused medicines & RPS Guidance on Ethical, Professional Decision Making.

Profiteering during the Coronavirus crisis

The Competition and Markets Authority (CMA) wants to ensure that traders do not exploit the current situation to take advantage of people.

It will consider any evidence that companies may have broken competition or consumer protection law, for example by charging excessive prices or making misleading claims about the efficacy of protective equipment. And it will take direct enforcement action in appropriate cases.

In addition, the CMA will assess whether it should advise Government to consider taking direct action to regulate prices.

Contact Us

Our LPC teams are working incredibly hard at the moment to try to assist pharmacy teams and influence at a local and national level. However our main concern is to support you and your team so please let us know if you need support with anything. Unfortunately, we cannot guarantee that we will be able to solve your problem but we can guarantee that we will do everything we can to try.

If you wish to contact us please do so on info@suffolklpc.org.uk and one of our team members will get back to you at our earliest possible opportunity.