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

Preventing entry where possible
– Provide a door service – Consider installing a child safety gate to the entrance of your pharmacy and provide a door service. You may need to consider a contactless payment option that will reach the door and updating your risk assessments to include training and adequate routes for fire escape. Some pharmacists may wish to consider providing a service using hatches / tannoys to prevent entry.

– Delivery of medicines – Is an excellent way to prevent footfall within the pharmacy too.  You can arrange delivery using your pharmacy service if available or by directing the patient to volunteering services, please see Funded Deliveries and Emergency Supply Service section below for more details.

– 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.

Maintain social distancing– 2 metres 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.

Queue management – Use a volunteer or staff member to aid in queue management outside the pharmacy to maintain social distancing of 2 metres. 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.

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 refrain where possible from using vented heating and air-conditioning which could circulate the virus further within the building.

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 . As the pandemic continues you may find it hard to remember to do this vital step.

Consider placing hand sanitiser if available 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. You may want to consider using a hand reacher to give out medicines especially if you have a pick-up point or a door service as this is easy to disinfect after use. 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 – £300 funding has been given for providing particular measures within the pharmacy including barriers, screens and bollards please consider implementing these if you have not already done so.

PPE

New Guidance On PPE was released on 5th April 2020.
If social distancing of 2 metres is maintained there is no indication for regular PPE use in a pharmacy setting, unless there is direct contact with a patient showing Coronavirus symptoms followed by a need for decontamination .
If social distancing is not maintained though direct care is not provided, sessional us
e of FRSM is recommended.
It is really important that ALL STAFF in the pharmacy that are wearing PPE know how to put it on, remove and dispose of as per guidelines, click here to see easy to follow guide on wearing and removing PPE.

If this equipment IS NOT used correctly and in the correct areas staff will be putting themselves and others at risk, with possible cross contamination or poorly fitted equipment.

PPE should also be worn during decontamination. Please follow environmental cleaning guidance given and see section 4. Post-transfer actions 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

In the Primary Care Bulletin (29th May) they provided a link to the NHS Employers published guidance on risk assessment, particularly for at risk and vulnerable groups within the workforce; including links to the HSE website.  This includes staff returning to work for the NHS, and existing team members who are potentially more at risk due to their race and ethnicity, age, weight, underlying health conditions, disability, or pregnancy.
NHS Employers have taken an inclusive approach and have described that the guidance is applicable, with appropriate local adaptations, in all healthcare settings.

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

NHS Indemnity Scheme- The NHS has put in place a national Covid-19 Indemnity Scheme to ensure that lack of indemnity cover is not a factor in preventing healthcare professionals from doing the job they need to in order to safeguard patients throughout the crisis. For a useful FAQ sheet please click here.

School places for children of key workers

The government has announced that all front-line healthcare staff who are unable to get their children looked after at home will have access to school places. Guidance states the following:

  1. If it is at all possible for children to be at home, then they should be.
  2. If a child needs specialist support, is vulnerable or has a parent who is a critical worker, then educational provision will be available for them.
  3. Parents should not rely for childcare upon those who are advised to be in the stringent social distancing category such as grandparents, friends, or family members with underlying conditions.
  4. Parents should also do everything they can to ensure children are not mixing socially in a way which can continue to spread the virus. They should observe the same social distancing principles as adults.
  5. Residential special schools, boarding schools and special settings continue to care for children wherever possible.

If your work is critical to the COVID-19 response, or you work in one of the critical sectors, and you cannot keep your child safe at home then your children will be prioritised for education provision. This includes pharmacy staff. Please click here for PSNC guidance on what to do in your pharmacy.

Reducing your services, opening hours or closing your pharmacy

March 22, 2020

NHS England and NHS Improvement (NHSE&I) have today issued an updated Standard Operating Procedure (SOP) for community pharmacies in relation to the COVID-19 pandemic. Critically, the SOP gives pharmacies some flexibility in the hours in which they need to open to the public during the COVID-19 pandemic. Read the SOP

Opening hours flexibility

Specifically:

• If under significant pressure, at the discretion of the responsible pharmacist, pharmacies may close their doors to the public for up to 2.5 hours a day, including lunch.
• Community pharmacies are expected to be open to the public between 10am-12 noon and 2pm-4pm as a minimum (if these are contracted core or supplementary hours).
• Similarly, 100 hours pharmacies should be open from 10am–12pm and 2pm–6pm as a minimum.

A sign on the door must give information about how to contact the pharmacy if urgent help is needed.

Temporary closures

NHSE&I has also stated that for temporary closures (not closed-door working), for instance where not enough staff are available to work, NHSE&I must be informed immediately. The pharmacy NHS 111 Directory of Services (DoS) profile must be updated, as must the NHS Website.

NHSE&I is encouraging cooperation between community pharmacies and GP practices in primary care networks, to deliver the best care, and protect and maximise the capabilities of staff across practices and pharmacies.

NHSE&I also encourages local pharmacies to work to maintain continuity of services in the event of temporary closures through ‘buddy’ arrangements, stating:

Particular thought should be given to patients receiving services such as supervised consumption or monitored dosage systems. Consideration can be given to providing daily doses rather than supervised consumption on an individual patient risk assessed basis.

The guidance from NHSE&I is included in the updated pharmacy SOP. Read the SOP

New Guidance has now been issued by PSNC to clarify the situations where a pharmacy may need to change hours or close, including the relevant notification required.

Pharmacy response

PSNC, CCA, NPA and AIM welcome the revised SOP and the flexibility that this gives to contractors.

The changes should help to ensure that pharmacies can stay open to the public, and that staff can work safely and are not fatigued by the current high workload and pressures associated with the COVID-19 outbreak. Pharmacy contractors are encouraged to make use of the provisions to support their staff.The pharmacy organisations are working together on detailed guidance for contractors to help them to implement this new SOP.

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.

Thank you again for all that you are doing.

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

As part of the national response to COVID-19, HM Government is seeking to commission two further services from the community pharmacy sector:

Medicines Delivery Service

Community pharmacy contractors will have seen the news that HM Government and the NHS are to ask around 1.5million people who are at high risk of serious illness from COVID-19 infection to stay at home for a period of 12 weeks. This process is being described as shielding and people identified in the categories of patients that the Government would like to be shielded have receive a letter from the NHS. You can find those identified as shielded via the patients Summary Care Record.

Details on the Pandemic Delivery Service which is funded for pharmacies for those being shielded can be found here: 

PSNC Pandemic Delivery Service

Pandemic Delivery Flowchart

FAQ section

NHS Volunteer Responders (National service)

HM Government and the NHS have worked with the Royal Voluntary Service (RVS) to recruit NHS Volunteer Responders via the GoodSam app. Hundreds of thousands of people have already signed up to volunteer, including with:

  • delivering medicines from pharmacies;
  • driving patients to appointments;
  • bringing them home from hospital; and
  • making regular phone calls to check on people isolating at home.

GPs, pharmacists, nurses, midwives, NHS 111 advisers and social care staff will all be able to request help for their at-risk shielded patients via a call centre run by the RVS, who will match people who need help with volunteers who live near to them. Some charities will also be able to refer people to the service.

Please see details below if you wish to try to arrange delivery of medicine for a shielded patient:

NHS Volunteer Responders referrer’s portal or you can call 0808 196 3382

NHS_Volunteer_Responders_PP_FINAL

PSNC has been supporting NHSE&I’s work with the RVS to put in place a process to allow the volunteers to support the delivery of prescriptions during the pandemic, where the pharmacy contractor wishes to use this support. However, PSNC is very concerned that patient and medicines safety are protected, and that undue workload or liabilities do not fall to contractors. We are particularly concerned that there are no plans to DBS check volunteers that may deliver prescriptions to patients’ homes.

Home, But Not Alone (Suffolk only service)

The Home, But Not Alone scheme is a Suffolk County Council initiative whereby willing volunteers, charities, town and parish councils, community and religious groups can all log their details and offers of support on the Tribe app.

The support includes medication delivery (at the request of the patient).

Please see the following that have been developed to give guidance on governance around this service for delivery of non-urgent medicines to patients in Suffolk:

Community Pharmacy SOP

Suffolk Medicines Delivery Algorithm

The telephone number for those in genuine need of help is freephone 0800 876 6926 and will be staffed from 9am to 5pm, seven days a week.

A Home But Not Alone (HBNA) co-ordinator will then collate requests for delivery of medicines and will share the list with a DBS checked individual from the Community Transport Team as their first preference by 3:00pm to carry out collection and delivery of medicines the following day.

In the unlikely event that a member of the Community Transport Team is not available this would then cascade to an NHS or government employee and as a last resort cascade to another volunteer.

Please note: Volunteer drivers generally will not collect money from patients so patients who contact the volunteer hub  will be told to ring the pharmacy to make arrangements for payment. If you are not able to do this and the volunteer is not able to collect the money then please let the LPC know via tania@suffolklpc.org.uk so that we can ensure that you do not lose the payment.

The LPC are aware that other local volunteering schemes that are already happening and each pharmacy is free to engage with these in anyway they see fit by using their professional judgement based on their unique circumstances.

You may find the RPS Volunteer Guidance useful if you wish to implement volunteers to deliver medicines on behalf of your pharmacy.

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.
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,has been halted for the short term.
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 their deliberations.
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 self-isolation.

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

Please also restrict quantities of hand soap, hand sanitisers and over the counter medicines such as paracetamol to prevent individuals stockpiling. These measures are also being implemented in supermarkets

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.