COVID-19 Frequently Asked Questions
COVID-19 Frequently Asked Questions
This page contains answers to frequently asked questions (FAQs) which have been posed by pharmacy contractors, their teams and Local Pharmaceutical Committees (LPCs).
Page last updated: 19th January 2021
Responding to the pandemic and advising patients
Q. What does PSNC advise pharmacy teams to do during the pandemic?
Guidance for pharmacies has been published by NHSE&I and this is subject to review as the situation changes. Our general guidance is that pharmacy contractors and their teams:
- Read the NHSE&I guidance whenever it is updated and implement its recommended actions;
- Clearly display the COVID-19 posters at points of entry to your pharmacy;
- Complete a risk review for your pharmacy and put steps in place to mitigate any risks identified;
- All pharmacy staff should wear facemasks;
- Implement your business continuity plan where required and seek assistance and advice from your Local Pharmaceutical Committee;
- Keep up to date with developments by regularly checking the information on COVID-19 on GOV.UK, the NHSE&I Coronavirus Primary Care webpage and checking your NHSmail shared mailbox on a regular basis for updates from NHSE&I; and
- Where possible, display the public health advice posters on hand washing, social distancing etc.
Q. Where can I find information on how to operate my pharmacy in relation to COVID-19?
A COVID-19 Standard Operating Procedure and guidance to support community pharmacy teams can be found on the NHSE&I website. Please note that this document is subject to changes and updates, so please ensure you are always referring to the most up to date version and are also referring to the separate updates for additional information.
Q. Where can I find a poster to display in my window to prevent symptomatic patients from entering the pharmacy?
A poster can be found on the Public Health England (PHE) Campaign Resource Centre website to display at the entry points to your pharmacy. Please note that this poster is subject to changes and updates, so please ensure you are always displaying the most up to date version.
Q. What should I do if members of the public present at the pharmacy with symptoms of COVID-19?
Anyone who presents with symptoms of COVID-19 should be asked to leave immediately. If they need advice on how to manage the condition, they should be advised to visit NHS 111 online via 111.nhs.uk or, if that’s not possible, they can call NHS 111.
Q. What advice should I be giving to concerned patients?
Members of the public should continue following HM Government and NHS advice about the COVID-19 coronavirus. This includes:
- staying at home as much as possible;
- working from home if they can, limiting contact with other people;
- keeping their distance if they go out (2 metres apart where possible);
- washing their hands regularly;
- Not leaving home if they or anyone in their household has symptoms.
For NHS information about COVID-19, or if someone thinks they might have it, they can visit nhs.uk/coronavirus.
CPCF requirements and pharmacy services during the pandemic
Q. Can I claim under the Community Pharmacist Consultation Service (CPCS) if I don’t see the patient face to face in the pharmacy?
Patients being referred to the CPCS for minor illness consultations, are now being told by the NHS 111 health adviser to phone the pharmacy and to speak to the pharmacist. Unless there is a clinical need for the patient to be seen in the pharmacy, the pharmacist can provide a consultation by telephone, as is provided for in the service specification. If the consultation is conducted in this manner, the pharmacy is eligible to claim the fee for provision of the service.
Q. Will pharmacy contractors be required to complete the Community Pharmacy Assurance Framework questionnaire 2020/21?
No. NHSE&I have agreed not to undertake this contract management activity during 2020/21.
Q. Why haven’t services such as NMS been suspended for the duration of the pandemic?
The choice of provision, or not, of Advanced Services is down to individual contractors. While all contractors saw significant increases in dispensing volume and associated workload during the initial phase of the pandemic, the peaks have been different for each contractor and therefore each contractors‘ option to stop, or to continue to provide services has also been different.
Q. How will PSNC ensure funding for MURs and NMS isn’t lost?
In line with the announcement on the Community Pharmacy Contractual Framework (CPCF), NHSE&I and DHSC agreed a five-year deal for community pharmacies, guaranteeing funding levels until 2023/24. Under this agreement it was announced that Medicines Use Reviews (MURs) would be decommissioned at the end of March 2021 with the funding associated to be reinvested into community pharmacy to keep the overall funding sum at £2.592bn. For the year 2020/21 the budget for MURs will be reduced, with a maximum of 100 MURs permitted per pharmacy, but fees associated with the service will stay the same. The New Medicine Service (NMS) remains within the CPCF and both the budget allocation and the fees associated with the service will be maintained.
Where the notional budgets for MUR and NMS are not spent, the unused funding is distributed to contractors via other fees and allowances, so the funding is not lost to the sector.
Question on the Pharmacy Quality Scheme 2020/21?
Click here for all our FAQs on the scheme
Question on the Flu Vaccination Service 2020/21?
Click here for our FAQs on the service
Pandemic Delivery Service
Q. How will the Pandemic Delivery Service work and what funding will I get to provide it?
Full details on the service requirements are available on our Pandemic Delivery Service page.
Q. Why haven’t people 70 years and over been included in the scope of the pandemic delivery service requirements?
The Government and NHSE&I only wished to commission a service to support the most vulnerable, shielded patient group. Many other patients are requesting home deliveries, but they are not covered by the NHS-funded service. Where appropriate volunteers are available locally, they may be able to assist contractors with delivering prescriptions to people 70 years and older. Other than for deliveries to patients in the shielded group (and deliveries of Specified Appliances), contractors continue to be able to charge patients for the delivery of prescriptions if they wish.
Q. There seems to be a lot of work to do for the £5 + VAT fee. How was this fee arrived at?
The £5 + VAT fee relates only to the delivery of a prescription to a shielded patient and not the Terms of Service requirements. The fee was agreed after seeking information from a range of pharmacy contractors about the cost of making an individual delivery to a patient.
Q. How much work will be required under the new Terms of Service requirements for an “average” pharmacy?
It is impossible to assess how the shielded group of patients will be distributed across the network of English pharmacies and how many shielded patients will need support from their pharmacy with the delivery of their prescriptions. There were originally estimated to be around 2.24 million patients that had been identified by the NHS, GPs and Hospital Consultants as needing to be shielded, which provides an average number of approximately 200 patients per pharmacy. All shielded patients were asked to identify a family member, friend or carer that can collect their prescription from the pharmacy in the first instance, before they seek support from their pharmacy with the delivery of their prescriptions.
Q. Does the service include deliveries to people infected with COVID-19?
No, unless a shielded patient is infected with COVID-19 at the time their prescription is delivered. As with all people needing a delivery of a prescription, people that are currently infected with COVID-19 are advised by the Government to identify a family member, friend or carer to collect their prescription from the pharmacy. This should not be somebody from the immediate household of the infected person, that is living with them, as they should be self-isolating, alongside the infected individual. Where volunteers or pharmacy staff deliver any prescriptions to people’s houses, they should adopt social distancing to avoid the risk of infection.
Q. Does the service include deliveries to people who share a home with a shielded patient?
No, the service only covers shielded patients.
Q. Why did the service start on 9th April 2020 and not at the start of the pandemic?
Reaching agreement on the service requirements took much longer than PSNC had hoped, as NHSE&I wished to maximise use of volunteers, even where the suitability of the volunteer could not be assessed by the pharmacy contractor. This was not acceptable to PSNC and getting to a position that both sides could agree upon therefore took some time. To comply with regulatory requirements, for the service to be formally commissioned, it was necessary for a formal announcement to be made by NHSE&I. Unfortunately the NHSE&I internal governance processes introduced a further delay before the announcement could be made.
Q. Why are the service requirements so complicated, particularly with the potential involvement of volunteers?
The delivery service requirements are not as simple as PSNC would have liked them to be, but people at the top of Government and the NHS are insistent that the massive volunteering response from the population must be utilised during the pandemic. As a consequence of this, incorporating the use of volunteers alongside normal pharmacy delivery systems has meant that agreeing a straightforward set of service requirements was not possible.
Q. My pharmacy dispenses a very high volume of prescriptions each month, so I expect that we serve many shielded patients. How will my team have time to identify and phone all of them?
The Terms of Service requirement is for the contractor to provide support to shielded patients with the delivery of their prescription, where the patient requests this support. In many, if not most cases, shielded patients are likely to have family members, friends or carers that can collect their prescription from the pharmacy and the Government has asked shielded patients to try that approach first, before contacting the pharmacy for help.
Q. What about where the patient does not identify themselves as being shielded?
If a patient does not identify themselves as being shielded, but the prescription items make the pharmacy team think they are within that group of extremely vulnerable patients, e.g. the prescription is for an immunosuppressant drug, they should ask the patient if they have been asked to shield, via a letter from the NHS, their general practice or hospital consultant. If that is the case, and there is no family member, friend or carer that can collect and deliver the prescription, advice and support should be offered on getting the patient’s prescription delivered, where this is necessary.
This requirement in the Terms of Service does not require the pharmacy team to check with every patient, that has not had their prescription collected from the pharmacy in a timely manner, whether they are within the shielded group. It does however expect this to be checked where the pharmacist is prompted by their knowledge of the patient or their medication regimen, to think that they may be a shielded patient and the prescription has been awaiting collection at the pharmacy for longer than might otherwise be expected.
Q. Why are distance selling pharmacies (DSPs) not covered by the service requirements and payments?
DSPs are already required by the Terms of Service to deliver all prescriptions to their patients with reasonable promptness, so NHSE&I and DHSC did not believe it was necessary to make any further additions to the Terms of Service applying to this group of pharmacies in order to ensure they delivered prescriptions to their shielded patients.
Q. Will there be a template Standard Operating Procedure (SOP) for the service?
Pharmacy organisations, such as the National Pharmacy Association, provide template SOPs for use by their members, so contractors will be able to obtain an SOP for deliveries to patients from such organisations.
Q. Do we have to check the NHS Summary Care Record (SCR) for every shielded patient we are asked to deliver to?
If a patient asks a pharmacy to deliver a prescription to them and they tell the pharmacy staff that they are a shielded patient, it would be appropriate for a pharmacist or pharmacy technician to check the patient’s SCR to confirm that their record has been annotated with a “shielded patient” flag. Explicit consent can be requested to make this check, but NHSE&I have advised that this is not necessary, where the pharmacy professional is just checking the SCR for a flag.
If the patient’s SCR does not contain a shielded patient flag, but the patient confirms that they have been asked to self-isolate for 12 weeks by their GP or via a letter from the NHS, their general practice or hospital consultant, the pharmacy can assume at that time that the patient is eligible for the delivery service. The patient should however be advised to contact their general practice to ask whether their records have been flagged to indicate they are a shielded patient.
The list of shielded patients is subject to change over time, as GPs have the ability to add or remove people to the list as their clinical condition changes. Consequently, a further check of the patient’s SCR would be appropriate if they ask the pharmacy to deliver another prescription in due course.
Q. Do we need to see a copy of the letter that the shielded patient received from the NHS/GP/Hospital or is verbal confirmation enough?
No, there is no requirement for pharmacy contractors to see a copy of the letter that informed the patient that they are in the shielded group. The service specification requires the pharmacy contractor to ensure appropriate checks are made to ensure that the patient is eligible and remains eligible for this service. This can be undertaken by checking for a Shielded flag on the patient’s Summary Care Record (SCR); where a flag does not appear on their SCR, the pharmacy team could seek verbal confirmation from the patient or their representative that they received a letter from the NHS/GP/Hospital consultant asking them to self-isolate for at least 12 weeks.
Q. Who needs to check whether a volunteer has a recent Disclosure and Barring Service (DBS) check?
PSNC advises that, where the pharmacy is directly involved in the selection or request process for a volunteer, for example, booking a delivery driver for an afternoon or requesting an NHS Volunteer Responder via the GoodSam app to deliver a prescription to a shielded patient, there is an obligation to ensure that the individual is appropriate for the role, in skills and competence, and that other checks have been made, such as the individual having had a recent DBS check (within the last 12 months).
Other matters, such as indemnity insurance need to be considered by contractors in relation to the use of volunteers and further guidance from other bodies should be read and acted upon before selecting and using volunteers to deliver prescriptions on behalf of a pharmacy. Further guidance is available from:
Q. What is the dataset that I need to keep to claim for the home delivery Advanced Service?
Contractors should retain a copy of their delivery logs (i.e. those they would normally keep for deliveries undertaken) which as a minimum, should contain the names and addresses of the eligible patients to whom a delivery was made under this service and the date of the delivery. Contractors should annotate their logs to indicate which deliveries relate to shielded patients.
Q. Is there a recommended retention period for delivery logs related to this service?
As an Advanced Service, the home delivery service could be the subject of post payment verification (PPV), so contractors who choose to provide the service should retain their delivery logs for a period after providing the service. Records can be kept electronically or in hard copy.
In the absence of guidance from NHSE&I, it is recommended that records be kept for at least two years after the date on which the delivery was provided.
Q. How do I access volunteers locally?
Volunteers may have been organised by local councils or voluntary bodies; your LPC may be able to advise on the availability of local volunteer schemes. Local volunteers may also be available via the NHS Volunteer Responders programme. Read more about volunteers in section 9 of our guidance on the Pandemic Delivery Service.
Q. I have received a prescription for a shielded patient late in the day; can I make a professional judgment to deliver to ensure they get medication in a timely manner? What evidence is required for audit/payment purposes?
In relation to the Terms of Service requirement to ensure shielded patients can have their prescriptions delivered, the NHSE&I guidance says:
Where there is no volunteer available who can deliver the medicine(s) to the patient in the timescale that they are required, the pharmacy contractor must ensure that eligible patients get their prescription delivered.
In this scenario, your professional judgement needs to consider the urgency for the supply of the medication verses the time available to identify and select a suitable volunteer. If the timely supply of the medication will be inappropriately delayed by the process to identify and select a volunteer, then the pharmacist may determine that on this occasion it is necessary for the delivery to be undertaken directly by the pharmacy, utilising the Advanced service.
Contractors should retain a copy of their delivery logs (i.e. those they would normally keep for deliveries undertaken) which as a minimum, should contain the names and addresses of the eligible patients to whom a delivery was made under this service and the date of the delivery. Contractors should annotate their logs to indicate which deliveries relate to shielded patients.
Q. In terms of DBS checks, do these have to be performed if I have provided volunteer group contact details to a patient and the patient arranges collection of their medication for delivery via the volunteer themselves?
No. Where the patient has chosen to utilise a volunteer and they have made the direct request to the voluntary organisation, then the organisation and therefore the volunteer is deemed to have been selected by the patient to act on their behalf. In this case, the obligation to ensure that the individual is appropriate for the role, in skills and competence does not fall to the pharmacy.
Q. I have been checking patients’ SCRs to confirm whether a Shielded Patient Flag is present, but I have noticed that this access is not captured in the NHS Digital SCR dashboard and it is not registered in the SCR audit reports. Why is that?
The Shielded Patient Flag can be seen when accessing a patient’s SCR, but as the information is stored on the Spine Personal Demographic Service, it is visible to the pharmacist or pharmacy technician before they actually enter the patient’s full SCR. Unless the full SCR is accessed, access to the record will not be registered in the dashboard or audit reports.
Q. Can community pharmacies request a list of their nominated patients who are also on the Shielded patient list?
PSNC has discussed with NHSE&I the potential for such lists of patients to be provided to pharmacy contractors, but it has been determined that the lists would rapidly become out of date, so it is best that where a patient states they have been asked to shield themselves, this is checked via their SCR. The fluidity of the list of Shielded patients is occurring as a result of changes that GPs and hospital consultants are making to the list and ongoing changes in the clinical condition of individuals. During the pandemic, there has also been an increase in patients changing their EPS nominations, so that would further impact on the accuracy of any patient lists provided to pharmacies.
Pharmacy finances during the pandemic
Q. How is PSNC addressing contractors’ financial pressures?
We understand that the pandemic is placing unprecedented demand on pharmacy teams and PSNC has made representations to HM Government and NHSE&I on this. We have highlighted the very significant challenges contractors are facing – both in terms of keeping services going and financially – and we are seeking additional funding for the sector.
Q. Why is so little information being shared with contractors?
DHSC and NHSE&I have various procedures for signing arrangements off which sometimes prevent PSNC from announcing changes as soon as we would like to. PSNC will issue news, updates and guidance to contractors as soon as decisions are made and, to help improve the flow of information to contractors, we have launched a daily COVID-19 update to ensure you can find all the latest information you need.
These updates will automatically be sent to everyone signed up for PSNC’s email newsletters (please register at psnc.org.uk/enews if you don’t already get them).
Q. Aren’t the cash injections effectively loans of our own money that will need to be paid back? Won’t this mean funding pressures are increased later in the year?
The £300m, £50m and £20m cash advances were not new money. PSNC’s position is clear that this is not sufficient to cover the rising costs and unprecedented challenges being faced during the COVID-19 pandemic. Nevertheless it was important to secure an increase to cashflow in the immediate term in order to help pharmacies during these crucial months, while talks continue.
We are still in ongoing discussions with DHSC and NHSE&I, who recognise the wider issues on COVID-19 related costs and we are urgently seeking long term resolution on this. This includes seeking to prevent contractors having to repay any of the advance payments that they have so far received during 2020/21.
Q. Will Distance Selling Pharmacies also receive the uplift payments?
Q. Will the cost of providing PPE, hand gels, other ancillary items to enable safe practice on a daily basis be reimbursed with additional money or will contractors be expected to fund it from the existing funding ‘uplifts’?
Contractors are able to make a claim for reimbursement of their PPE costs (including hand sanitiser); further information is provided on our PPE page. Contractors can now obtain free PPE from the Government’s PPE portal.
On other costs, Ministers’ immediate priority has been to address the significant cash flow pressure community pharmacies are under as a result of increased prescription numbers, extra staff costs from the increased dispensing activity, covering for sickness and the rise in locum rates, and other one-off costs. The advances of £300m, £50m and £20m over the past few months are in recognition of these costs.
PSNC has stressed to HM Government that cash advances are not enough to help many contractors to meet the rapidly increasing costs that they are facing as a result of this pandemic. We are continuing our dialogue with the Minister, with officials and with the NHS, and have put yet more evidence to them, trying to persuade them of the very urgent need for lasting emergency funding support, over and above the agreed global sum of £2.592 billion, for this vital part of the NHS.
Data has been collected from a wide range of contractor businesses to support our claim, including the costs of extra protective equipment required to operate under the current pandemic conditions.
Q. The cash flow uplifts are advance payments which will place financial burden on our pharmacy when it is recovered. What is the PSNC doing to stop our pharmacy being negatively impacted financially by the pandemic?
PSNC’s position is clear that cash advances are not sufficient to cover the rising costs and unprecedented challenges being faced during the COVID-19 pandemic. Nevertheless, it was important to secure an increase to cashflow in the immediate term in order to help pharmacies during these crucial months, while talks continue. We are still in ongoing discussions with DHSC and NHSE&I, who recognise the wider issues on COVID-19 related costs and we are urgently seeking long term resolution on this.
Q. The March 2019 items uplift (estimated at about 20%) means the global sum funding for 2019/20 may overspend the agreed sum. Will fees and Category M take this into account? What is the PSNC’s position on this?
PSNC has raised this issue with Government as part of our representations. Final out-turns for 2019/20 are not yet available but PSNC’s view is that activity related spending due to COVID-19 must be funded by the Government and not from our existing sum.
Q. To what extent is PSNC taking account of reduced income to contractors: national services, local NHS and PHE commissioned services, retail income, private services?
We have been gathering data with the other pharmacy organisations and have prepared a dossier of evidence to try to persuade Government of the very urgent need for additional funding (over and above the agreed global sum) for the sector. Community pharmacies are reporting a number of extra costs associated with maintaining patient services during the COVID-19 pandemic, including from increased prescription numbers; extra staff costs from the increased demands for advice and medicines, covering for sickness and the rise in locum rates; and one-off costs, such as decontaminating pharmacies when someone infected had visited. Our business case to Government included information on all of these, warning that the current situation is not sustainable.
PPE and protecting staff
Q. How am I supposed to protect my staff from catching COVID-19?
Contractors are advised to ensure that:
- Patient information posters for NHS settings are displayed so they can be seen before patients enter the premises.
- A risk review for their pharmacy and individual risk assessments for staff have been completed and steps put in place to mitigate any risks identified.
- All pharmacy staff should wear facemasks;
- All pharmacy staff practice good hygiene and avoiding direct or close contact (closer than one metre when providing health care) with any potentially infected person.
- Users of the pharmacy should be advised to keep a distance of at least two metres from other people.
- Additional appropriate PPE is used – see below.
Public Health England (PHE) has advised that full height screens installed on medicines counters would provide helpful protection for staff and PSNC advises pharmacy contractors to consider installing these wherever possible.
Q. What Personal Protective Equipment (PPE) should pharmacy teams be using?
PHE updated its guidance on the wearing of facemasks in primary and community health care settings in July 2020. In summary, the recommendation is that all pharmacy staff now wear facemasks, unless the pharmacy is COVID-19 secure, including all staff being able to maintain a social distance from one another.
This aligns the PHE guidance with PSNC’s guidance to contractors, issued in mid-June.
It is important to note that while pharmacy staff should now wear masks in line with the revised guidance, it is imperative that social distancing and self-isolation (where appropriate) continue to be practised and hygiene measures, such as regular hand washing, continue to be followed.
Q. Is it safe to handle paper FP10 prescriptions issued by GPs, dentists, hospital outpatient clinics etc.? Is there a risk of catching COVID-19 from “infected” forms?
PHE has provided the following advice on the risk of COVID-19 infection by handling paper:
It is theoretically possible that a person can transmit and/or contract COVID-19 by touching a surface and/or object, (i.e. medication boxes and/or prescription tokens) that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. However, in general, because of poor survivability of coronaviruses on surfaces, it is considered a very low risk that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be spread from packaging including prescription tokens and medication containers. We recommend frequent hand washing to minimise any potential risk.
While paper prescriptions are becoming less common as most prescribing in primary care is undertaken using the Electronic Prescription Service (EPS), pharmacy contractors are reminded that they must dispense legally valid paper prescriptions presented for dispensing, including those from healthcare providers where they do not have access to EPS, such as dental practices and hospitals.
Q. How do I dispose of used PPE?
In accordance with Novel Coronavirus (COVID19) standard operating procedure guidance issued by NHSE&I, waste such as PPE, used tissues and disposable cleaning cloths can be stored securely within disposable rubbish bags. These bags should be placed into another bag, tied securely and quarantined for 72 hours before being put in your usual external waste bin.
Q. My pharmacy staff members have been unable to access testing, what should they do?
Community pharmacists and their staff are classed as essential workers who are prioritised for testing and employers can refer essential workers for testing if they are self-isolating because either they or members of their household have coronavirus symptoms.
They can do this by uploading the names and contact details of self-isolating essential workers to the secure employer referral portal. Referred essential workers will then receive a text message with a unique invitation code to book a test for themselves (if symptomatic) or their symptomatic household members at a testing site.
To get a login to the employer referral portal, pharmacy contractors should email firstname.lastname@example.org with the following information:
- organisation name
- nature of the organisation’s business
- names (where possible) and email addresses of the 2 users who will load essential worker contact details
Once employer details have been verified, two login credentials will be provided for the employer referral portal.
Lateral Flow Testing for asymptomatic pharmacy staff
Full information on Lateral Flow Testing for asymptomatic pharmacy staff can be found on the Staff wellbeing and COVID-19 testing page.
Q. What type of test are the NHS rolling out?
The test is the Innova SARS-CoV-2 Antigen Rapid Qualitative Test, which uses a swab which has been in contact with the nostril of the person being tested. The swab is inserted into the extraction tube with the extraction fluid and then rotated and pressed to make sure that the sample from the swab is released into the extraction fluid (swab is then discarded at this point). The person testing then takes the extraction tube with the nozzle cap and places 2 drops of extraction fluid into the sample well of the LFD testing device cartridge and waits for the results on the test device.
Q. What is the specificity and sensitivity of this particular test?
The Government has published its latest research on these tests.
Q. Who administers the test?
The test is self-administered. A Health Education England instruction video and written instructions, including on interpretation of results, are available for staff to learn to self-administer their test.
Q. Is the test mandatory or voluntary?
The tests are voluntary.
Q. Should staff members continue testing after they’ve received the COVID-19 vaccine?
Yes, staff should continue to test even though they have had the vaccine.
Q. Can these tests be used for patients?
No. These lateral flow antigen tests are solely for asymptomatic patient-facing staff delivering NHS services.
Q. Can staff use the tests for their symptomatic family members?
No. Staff and family members who have symptoms should access PCR tests in the normal way.
Q. How frequently should staff be tested?
Staff should test themselves twice weekly (every three to four days) to fit with shift patterns and leave requirements; for example, Wednesday and Sunday, or Monday and Thursday.
Q. When should staff test?
Staff should be asked to perform the test before attending work, leaving enough time before the start of their shift to alert their employer who may need to arrange cover, should their lateral flow test be positive.
Q. Where should staff test?
Staff should conduct the test at home if possible.
Q. Should staff continue swabbing during annual leave?
Staff may continue to swab while on annual leave of longer than a week, but it is not a requirement.
Q. What should staff do with the used test kits?
Staff can safely dispose of the test items in their normal household waste but should pour any residual buffer solution away first.
Q. Will this testing regime remove the need for staff who have been exposed to a positive COVID-19 case to self-isolate?
No. Government self-solation advice should be followed at all times. This test does not remove the need to self-isolate.
Q. Why is the testing method different from that described in the manufacturer’s original instructions for use?
The NHS are recommending the swab is used and the sample taken in a different way to the instructions for use, with more rotation of the swab at a lower level of penetration, to enable easier self-administration of the test. This is based on advice from experts. The manufacturer has been informed of the planned use of the tests for self-administered asymptomatic staff testing within the NHS.
Q. How should the results of these tests be reported?
Recording of all results (positive, negative, invalid) from lateral flow devices is a statutory requirement. The results from the lateral flow antigen test for primary care staff will be documented at home by the individual using the NHS Digital online platform. Staff can access the NHS Digital platform at www.gov.uk/report-covid19-result
Q. Is there any action regarding reporting test results for primary care employers?
There is no action for primary care employers to report results, as these will be reported to Public Health England by each member of staff individually, in line with statutory requirements for COVID-19 reporting. Primary care contractors should encourage their staff members to test twice weekly and report their results.
Q. What happens if staff get a positive result?
Staff should inform their manager of a positive result in the normal way. Staff should arrange a confirmatory PCR test via the established testing routes. They and their household should self-isolate as set out in Government guidance.
Q. What happens if a test is negative, but staff have coronavirus symptoms?
If you have coronavirus (COVID-19) symptoms, you should refer to NHS guidance.
Q. At what stage is NHS Test and Trace informed of the result?
At the point the confirmatory PCR test result is known, and this is a positive result, test results will, as normal, be referred to NHS Test and Trace.
Q. If a staff member has a positive PCR COVID-19 test, when should they start the lateral flow antigen tests again?
A staff member who tested positive would recommence home testing 90 days after their positive test was taken.
Q. Can the period of isolation following contact tracing be shortened through use of this testing?
No. Ten day isolation following notification that a staff member has been in close contact with a COVID-19 case without relevant PPE should be followed as per Test and Trace advice. Testing with lateral flow antigen tests are being used in pilot sites to verify whether daily testing might lessen the need to isolate, but this is not currently the advice and isolation should be followed as per instructed by Test and Trace.
Q. I have another question which is not answered by the above questions; where can I get help?
Any unanswered questions can be emailed to england.covid-LFD@nhs.net.
Handling workload and staffing issues
Q. What happens if the pharmacy gets too busy?
If the pharmacy becomes busy, the entrance to the pharmacy can be closed with a member of staff managing entry and exit, advising people to wait outside and at least two metres away from others until there is sufficient space inside.
Q. A member of my team has come to work displaying potential symptoms of COVID-19, what should they do?
If a staff member is symptomatic, they should go straight home and self-isolate. If they feel unwell, they should visit 111 online for further advice. Specific guidance on when and how long to self-isolate can be found here.
Q. What happens if I lose staff to illness or self-isolation and can’t open my pharmacy?
NHSE&I has stated that for temporary closures, for instance where not enough staff are available to work, NHSE&I must be informed. The pharmacy NHS 111 Directory of Services (DoS) profile must be updated, as must the pharmacy profile on the NHS website (see the NHS website). NHSE&I also encourages local pharmacies to work together to maintain continuity of services in the event of temporary closures. The CCA and NPA have issued recent business continuity advice and PSNC provides advice on maintaining pharmacy services during the outbreak and a checklist for emergency closures on its COVID hub network resilience page.
PSNC's response to COVID-19 (including negotiations)
Q. Is PSNC listening to my concerns?
We are very aware that everyone in community pharmacy is phenomenally busy and the sector’s response to the COVID-19 outbreak has been very impressive. Community pharmacies are on the front line and we know many pharmacies have experienced very large increases in the number of walk-ins and phone calls, numerous requests for delivery services, substantial price rises for common medicines, and increasing levels of staff sickness. PSNC is very concerned about the capacity and cost barriers which are draining community pharmacies’ reserves so we have been considering a number of ways to free-up pharmacist and pharmacy technician’ time whilst also seeking investment from HM Government to help with cashflow.
Q. Is PSNC raising contractors’ concerns with HM Government?
PSNC is in daily discussions with NHSE&I and DHSC on a significant number of issues related to the COVID-19 response. Matters being discussed include contingency funding for pharmacies; protection for pharmacies against sudden medicines price rises; and measures to support the ongoing provision of pharmaceutical services in the case of significant numbers of staff absences. Much of this builds on discussions we have had with the NHS previously about pandemic planning. There are many details still to be worked out by HM Government and PSNC will be a part of those discussions, looking at how we can best protect the network of community pharmacies and allow them to continue their crucial work through this crisis.
Q. Is PSNC making effective use of the LPC network?
LPCs are feeding local intelligence from their contractors into PSNC to support our discussions with HM Government and they are tackling local matters such as communication with local GP representatives. A COVID-19 Rapid Action Team comprising an LPC Chief Officer from each PSNC region in England was formed to support this work. The group met twice a week during the pandemic peak to capture ideas, feedback and questions from the field, plus gathered case studies on how community pharmacy teams dealt with the pandemic.
Q. How confident do you feel from the conversations you have had with the Government that they will agree to the PSNC Negotiations Action List?
PSNC has been in ongoing discussions with NHSE&I and DHSC since the start of the COVID-19 outbreak in the UK. The scope of discussions means there is a huge amount of work to do and some things will take time because they require legislative changes or wider collaboration. Progress on some of these topics has been much slower than we would like, but often that has reflected the complexity of the discussions and the rate at which NHSE&I has been able to make decisions. However, PSNC is putting forward detailed evidence and pushing for urgent resolution of key issues to support contractors.
Q. Pharmacy’s role is still not being recognised by the Government, so why is PSNC not being more vocal in the media to gain support for the sector?
PSNC has been giving clear messages – to officials, politicians and in the media – about the pressure that pharmacies are under and we are in active negotiations for additional funding (additional to the contract sum). In regards to the media, we are working with the other national pharmacy organisations on this and you can see some of the recent pharmacy stories on the Promoting pharmacy’s role section of our COVID-19 hub.
Q. How can community pharmacy contractors help to support and amplify PSNC’s voice?
The pharmacy bodies are uniting around the brand #pharmacyheroes and are encouraging contractors and LPCs to join us in using this hashtag to promote the great work being undertaken by pharmacy teams. Further information on this joint work is available via the PSNC website where there are some template tweets and graphics available to use, which can be personalised to apply to your local area/LPC. You can also find out more about submitting case studies via the joint hub: www.nhsfrontline.com
Q. Is PSNC collating copies of representations contractors have made locally to MPs – where should we send them?
We are grateful to any community pharmacy contractor who has taken the time to lobby their MP at what we know is a massively busy time. If you would be willing to share any communications you have had – especially responses from MPs – please forward them to email@example.com
Maintaining access to medicines and supply problems
Q. Local GP practices are overwhelmed, how will patients continue to access the medicines they need?
Where people need urgent access to their usual prescribed medicines and they cannot get a prescription from their general practice in time to meet their needs, the NHS 111 Online service can be used to make a referral to the Community Pharmacist Consultation Service. This service was successfully piloted in the north west of England and plans to roll out the functionality across the whole of England were brought forward in response to the huge surge in demand for NHS 111 services as a result of the COVID-19 pandemic. The service has been live across the whole of England since 24th March 2020.
Q. What happens if one of my local GP practices close?
PSNC has been working with DHSC and NHSE&I to put in place measures to maintain the supply of medicines to patients where GP practices close for prolonged periods. Such a scenario has already presented in Devon and local pharmacies were enabled to make emergency supplies of medicines to patients registered with the affected practices. This was enabled through the commissioning of an Enhanced service using Section 226 of the Human Medicines Regulations 2012. The intention is that this service will be used by NHSE&I elsewhere in England where a practice temporarily closes and there is a need for emergency supplies of medicines to be made to its patients.
Q. I am struggling to obtain generic medicines at a reasonable price, will I be adequately reimbursed?
PSNC is keeping a close eye on the generic medicines affected by recent price hikes and is in discussions with DHSC on protection for pharmacies against sudden price rises. Where purchase prices are reported to be above the listed Drug Tariff prices, PSNC continues to make applications to DHSC for price concessions in the usual way. PSNC relies on contractor reports to make its application and we urge contractors to get in touch with us to report any supply issues by using the online reporting form to give us an accurate picture of developing issues.
Q. In March 2020 we saw GPs issuing prescriptions for extended periods of treatment. This practice has an impact on our workload and wholesaler costs; what is PSNC doing to account for this?
NHSE&I and DHSC have issued guidance to practices that changes should not be made to the duration of prescriptions:
“Prescriptions: Practices should not change their repeat prescription durations or support patients trying to stockpile: these actions may put a strain on the supply chain and exacerbate any potential shortages. Practices should consider putting all suitable patients on electronic repeat dispensing as soon as possible. The whole repeatable prescription can be valid for a year, but each repeat should be for no longer than the patient has now. For example, if the patient has prescriptions for a month’s supply now then the repeat dispensing should be set up as 13 x 28 days’ supply.”
If contractors see that this guidance is not being followed, please raise this with your LPC immediately for further escalation and support on a local level. Pharmacies have also been asked not to support any patients trying to stockpile .
At a national level, PSNC has been in discussion with DHSC on the impact extensions to period of treatment are having on the supply chain and drug pricing. To help reduce inequality for contractors, PSNC will continue its work to seek a long-term solution for dealing with prescriptions with increased period of treatment. Currently, Drug Tariff Part XIVC sets out the temporary safeguarding arrangements which have been put in place for instances where pharmacy contractors are adversely affected if prescribers systematically increase prescription duration on all or a significant percentage of their prescription items.
As part of the work on supporting funding negotiations, PSNC collected data from pharmacies to substantiate the extra costs, impacts and activities taking place as a result of COVID-19. This data was collected to support our ongoing negotiations for a long-term increase to total pharmacy funding to help pharmacies cope with the COVID-19 pandemic.
Q. Monitored dosage systems (MDS) are a time-consuming task that is proving difficult at maintain especially where we have members of staff off self-isolating. Is there anything that can be done to reduce the pressure of this unfunded service? For MDS that we need to continue to supply how can we ensure we will receive 7-day prescriptions?
The COVID-19 pandemic poses one of the biggest challenges that community pharmacy has ever faced. Pharmacies risk losing team members either through infection, self-isolation or parental/caring responsibilities and as you are aware, the dispensing and checking of community multi-compartment compliance aids (MCAs) is a highly labour-intensive task. As part of business continuity planning, all patients therefore need to be assessed to determine the level of risk posed to the individual by removing the service (low/ medium/high). An Equality Act assessment may also be required to determine any additional support necessary in relation to their long-term disability.
This process is not about removing the service from all patients but protecting the most vulnerable in society who need it. To support the patient review process, a template letter has been provided for pharmacies to share with their patients explaining the reasons behind the review and emphasising that this is about ensuring that all patients receive the care they require in these challenging times.
PSNC has issued guidance on the Provision of Multi-compartment Compliance Aids (MCA) to patients living in the community including a template letter to share with patients.
We would recommend speaking to your LPC Secretary/Chief Officer who can support you on a local level and liaise with practices regarding the benefits of issuing 7-day prescriptions.
Q. Why is the administration of the prescription charge still deemed an essential function for community pharmacy right now? Is there the possibility to suspend NHS levy charges to reduce cash handling and administration of prescriptions?
PSNC raised the collection of prescription charges during the COVID-19 pandemic as an unnecessary administrative burden and potential infection risk (through the handling of money) in discussions with HM Government at the start of the pandemic. We believe the charge should be suspended and as such we support the work that the Royal Pharmaceutical Society (RPS) and others are also doing to press for this.
PSNC, the British Medical Association (BMA) and Dispensing Doctors Association (DDA) wrote to the Secretary of State for Health and Social Care, Matt Hancock, to highlight this issue. In a response to a recent parliamentary written question on removing the need to collect and pay prescription charges during the COVID-19 pandemic, the Government highlighted that the prescription charge is a valuable source of income for the NHS and that they had no plans to suspend them.
PSNC is disappointed by this decision given the increased administrative burden and safety issues that collecting prescription charges poses for pharmacies during the pandemic.
Q. What actions have been taken to ensure pharmacies have access to reasonable stocks; considering our increased dispensing volume and the need to supply within a reasonable timeframe?
The Department of Health and Social Care (DHSC) recently responded to a question on accessing stock:
“The country is well prepared to deal with any impacts of COVID-19 and we have stockpiles of generic drugs in the event of any supply issues or significant increases in demand. The Department is working closely with industry, the National Health Service and others in the supply chain to help ensure patients can access the medicines they need, and precautions are in place to reduce the likelihood of future shortages. The Government has no plans to create facilities in the United Kingdom to manufacture further active pharmaceutical ingredients. There are 16,000 medicines on the market in the UK. Whilst some of these are manufactured in the UK, most are manufactured abroad. Where medicines are manufactured here, the active ingredients and excipients for those medicines may be manufactured abroad. It is not realistic to manufacture all 16,000 medicines and the active ingredients and excipients needed for these medicines in the UK.”
As you may know the Government has already banned the export of a number of medicines. The restrictions came into place on 3rd October 2019 as part of efforts to prepare for a possible no-deal Brexit and the list of drugs under export ban has continued to grow. PSNC remains in regular contact with DHSC Supply team to share information and discuss any current or expected supply issues so DHSC can monitor and take appropriate action, where necessary.
NHSE&I and DHSC have issued guidance to practices that changes should not be made to the duration of prescriptions, this advice is important to ensuring access to stock for those who need it.
Q. How can PSNC become faster at dealing with price concession issues, if further drug price increases and supply issues are expected due to Brexit?
PSNC is actively monitoring reports received of pricing over Tariff through the pricing issues reporting tool and continuing to receive these reports is essential to our work negotiating price concessions. Given the unprecedented pressure pharmacy contractors and their staff are under, we have urged DHSC to exercise more flexibility in determining price concessions quickly and responsively given the number of drugs reported to have been affected by price hikes, updating our requests for lines to be considered throughout the month. We have raised with DHSC the increased volume of lines being reported and the impact the pricing has on cashflow. Reports regarding shortages, through the new shortage reporting tool are highlighted to DHSC to investigate. Our briefing details how the price concession system operates.