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).

PSNC is working with NHS England and NHS Improvement (NHSE&I) and the Department of Health and Social Care (DHSC) to address the issues being faced by the community pharmacy sector during the pandemic and we will post new FAQs here on a regular basis.

Page last updated: 3rd July 2020


Responding to the pandemic and advising patients

Q. What does PSNC advise that pharmacy teams do during the pandemic?
Guidance for pharmacies has been published by NHSE&I but the situation is evolving rapidly and guidance is therefore being updated on a very regular basis. Our general guidance is that pharmacy contractors and their teams:

  1. Read the NHSE&I guidance whenever it is updated and implement its recommended actions;
  2. Clearly display the COVID-19 posters at points of entry to your pharmacy;
  3. Complete a risk review for your pharmacy and put steps in place to mitigate any risks identified;  
  4. Implement your business continuity plan where required and seek assistance and advice from your Local Pharmaceutical Committee;
  5. 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
  6. Where possible, display the public health advice posters on hand washing, social distancing etc

The latest information from PSNC on COVID-19 is available on our webpage: psnc.org.uk/coronavirus

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 frequent 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 frequent 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?
Following the Government’s lockdown announcement to the nation, people should now only be visiting pharmacies to seek healthcare advice and to collect medicines for themselves or on behalf of vulnerable or self-isolating patients. 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. I would like to stock COVID-19 test kits in my pharmacy; am I allowed to do this?
The Government has advised that it is illegal to supply COVID-19 home tests in the UK because none have so far received a CE mark. Some manufacturers are selling products intended to detect COVID-19 antibodies. These typically use a few blood drops applied to a small cassette. These tests should be available to healthcare professionals only.Read further information from the MHRA 

Q. Will pharmacy contractors be required to complete the Community Pharmacy Assurance Framework questionnaire 2020/21?
Currently this CPCF requirement has not been suspended by NHSE&I. PSNC is in discussions with NHSE&I on this and will communicate any further updates once a decision has been reached.

Q. Pharmacists must attend facetoface training every 3 years in order to provide the flu vaccination service; how will this be possible given the importance of social distancing?
Following PSNC requesting changes to the usual face-to-face training requirements for the service, Public Health England (PHE) has confirmed that anyone who has undertaken the vaccinations training before and is due to undertake face-to-face training this year can delay that training until next year.  

For more information see Flu Vaccination – training requirements and resources 

Q. How will the 2020/21 Flu Vaccination Service be delivered safely by pharmacists?
Due to the public health advice on social distancing and shielding, the flu vaccination programme this year may need to be provided in a different way, for example, with pharmacists wearing PPE. It is also likely that increased public awareness of infection control will mean there is an increased demand for vaccination from eligible patients. Public Health England, NHSE&I and DHSC are considering the potential changes that may need to be made when administering flu vaccines this year and further guidance will be issued to contractors in due course. 

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 contractorsWhile all contractors have seen significant increases in dispensing volume and associated workload during the initial phase of the pandemicthe peaks have been different for each contractor and therefore each contractors option to stopor to continue to provide services has also been different. 

Q. During the pandemic, do we still need to get the patient to sign a paper consent form for MUR and NMS? 
Yes. The Secretary of State Directions require that all patients receiving the MUR service or NMS service must sign a consent form, so signing or making their mark on a consent form is required in all cases. PSNC is discussing with NHSE&I and DHSC moving to a verbal consent model for Advanced services, so the need for a signed paper consent form would be removed. If this is removed, PSNC will notify contractors; until then, paper consent forms must continue to be used.

Q. As MURs and NMS can’t be done face-to-face at the moment, can we do them over the phone instead?
NMS can be conducted over the phone. MURs can also be provided exceptionally by telephone, but only where the local NHSE&I team gives its approval for a particular patient, and on a particular occasion. The Directions require a telephone MUR to be carried out such that no-one can overhear the consultation. Contractors can use PSNC’s PREM2 forms to make applications to their local NHSE&I team for telephone MURs and offsite MURs. 

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. 

Q. Will pharmacies be able to rollover any MURs that could not be carried out in March 2020 (out of the permitted 250) to 2020/21?
No. NHSE&I does not have any facility to allow the rollover of NHS budgets from one financial year to the next. 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. 

Pandemic Delivery Service

Q. How will the Medicines Delivery Service work and what funding will I get to provide it?
Full details on the service requirements are now 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 are currently just over 2.24 million patients that have 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 are being 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, which is expected to reduce the number of patients actually requiring pharmacy support.

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 self-isolate for 12 weeks, 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.

NPA SOP (Member login required)

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:

National Pharmacy Association

Royal Pharmaceutical Society

Q. How will contractors claim payment for the delivery service?
The payment which will be made to all contractors (bar Distance Selling Pharmacies) to reflect the costs of complying with the new Terms of Service requirements will be made automatically by the NHSBSA; contractors do not need to claim this payment. Payments will appear under the same line as the Transitional payments with the first payment being due on 1st July 2020. 

Where a contractor makes a delivery under the Advanced service, a claim will need to be made each month, as part of the end of month submission to the NHSBSA. The claim will be made via a declaration on the Manage Your Service (MYS) portal, in a similar way to payment claims for the flu vaccination service. The contractor will need to enter the number of deliveries made under the terms of the Advanced service during the month of claim. Contractors must submit their claims for payment monthly via the MYS platform no later than the 5th of the following month. Payments will appear on the schedule of payments as an Additional Advanced Payment’. 

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 scenarioyour 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?
NoWhere 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 behalfIn 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.

8th May Bank Holiday opening

Q. Why was the announcement that pharmacies would be required to open on 8 May made with such short notice?
NHSE&I indicated that an announcement would be made in its primary care bulletin on 24 April which has given contractors some notice. It is unclear why the formal announcement was made a week later on 1 May.

Q. Where in the regulations may NHSE&I require pharmacies to open?
NHSE&I may require pharmacies to open using new emergency regulations introduced on 26 March 2020.

Q. Who chose 2-5pm; wouldn’t it have been better to stagger opening times?
NHSE&I chose these times as part of primary care’s response, and support for secondary care.

Q. Can I pick different hours that are easier for my staff to do?
The announcement includes flexibility on when to open if agreed with your NHSE&I regional team. For more information please see our key points on the announcement.

Q. Will schools/educational settings be open for key workers’ children at that time?
PSNC is not aware of any additional arrangements for key workers’ children over bank holidays. If there are no such arrangements and no family or household arrangements, this may be a reasonable cause for staff absence given the social distancing and stay at home policies.

Q. Do distance selling pharmacies have to open 2-5pm on the bank holidays too?
Yes, the announcement applies to all pharmacies in England except LPS pharmacies. (LPS pharmacies have a formal contract that already specifies which hours they must open on bank holidays.)

Q. Will extra funding be provided for being required to open on these days?
PSNC and NHSE&I have agreed that contractors will be funded for these openings at a rate of £250 per hour for a maximum of three hours. 

Q. What should I do if I cannot get enough staff to open safely?
You can close temporarily if you are prevented from opening due to staff illness or other reasonable cause. This applies at any time and includes bank holiday opening. If you do, you must notify your NHSE&I regional team and follow the correct procedure – see PSNC guidance.

Q. My staff are exhausted – may I refuse to open?
No. The announcement and requirement to open is valid under the regulations and made with the agreement of the Secretary of State and most important of all is made for the benefit of patients and the public in England and should be respected. If you are prevented from opening by reason of illness or other reasonable cause you may close –but you must notify your NHSE&I regional team and follow the correct procedure – see PSNC guidance.

Q. If I am opening for longer hours on the bank holiday, should I continue to do so?
Yes, the announcement makes clear that you should continue to open for the longer hours.

Q. If I am opening anyway during the day and this includes the hours 2-5pm, will I be able to make a claim?
Yes.

Q. I am opening on the bank holiday already – as planned or as directed by NHSE&I – but at a different time, do I still have to open between 2-5pm?
Maybe. You may open at both times – for the local direction/as planned and the national announcement.

You may decide you only want to open once – the NHSE&I announcement includes flexibility on opening to meet  patient demand due to the Government’s social distancing policy and may allow local agreement for this opening at another time during the day, if agreed with your NHSE&I regional team. You must discuss this with your NHSE&I regional team. Your LPC may also be able to assist.

Q. How should I update the Directory of Services (DoS) for the bank holiday?
Contractors must update the Directory of Services (DoS) themselves, unless they have confirmation that the NHSE&I Regional Team is doing this for their region. There will be no national block update of contractors’ hours on DoS for the bank holiday opening on Friday 8th May, because the flexibility provided by NHSE&I means it is more appropriate for contractors to update entries. It is important for a contractor to update their DoS entry, so that NHS 111 does not send a patient to a closed pharmacy, for example, as part of the Community Pharmacy Consultation Service (CPCS).

Contractors can use the DoS Profile Updater to make the necessary change by the end of Wednesday 6th May 2020. If you experience a last minute change, for example, due to staff illness, meaning you cannot open, you will need to use the DoS emergency change number instead: 0300 0200 363 (as well as notifying NHSE&I). For more information see PSNC’s DoS webpage.

Q. How will I claim for opening between 2-5pm?
Claims for payment for this service must be made between 25 May 2020 and 22 June 2020 via the Manage Your Service (MYS) platform provided by the NHSBSA.

The NHSBSA will make appropriate payments on 1 July 2020. The payment will not be separately itemised on the FP34 Schedule of Payments. However, the NHSBSA will issue letters to contractors who claimed to inform them of the payment made to them.

Q. If I open as directed at another time of the day and open between 2-5pm, may I claim for both?
Yes. The payment for the other opening will need to be claimed using the local procedure in place for this direction.

Q. What if I was directed locally to open for longer hours?
Contractors who remained open on the bank holiday as per a local agreement with NHSE&I should only claim for payment for up to 3 hours per day based on the number of hours they were open. If they were open for more than 3 hours, the balance must be claimed from the regional team as per local agreement. Pharmacy contractors must not duplicate claims for the same opening hours by claiming on MYS and through local arrangements.

Q. If I have been directed to open, do I claim payment for the directed hours or the national announcement?
Pharmacies are able to claim a payment for opening for at least three hours. If you were open for 3 hours, you should claim only once – the national announcement takes precedence and the claim should be made through that route.

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 is working flat out to make 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 urgent measures from Government including an emergency COVID-19 cash injection into the sector and further measures to protect your teams.

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 now 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. Is this cash injection effectively a loan 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 are 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 this year.

Q. Will Distance Selling Pharmacies also receive the uplift payments?
Yes.

Q. I have received an uplift payment but I’m not sure if it is for the correct amount. How can I know if I have been paid correctly?
The part of the cash injection which is included with the payment for the dispensing month of January should already have been received by contractors. The payments are based on a calculated uplift of the February advance payment, and equate to 30.1% of the value of the February advance. This is the percentage required which was calculated to deliver an additional £200m to the sector overall.

As such, you should find that your first uplift payment is equal to 30.1% of whatever your February Advance payment is, as stated on the FP34 schedule of Payments statement for the dispensing month of January.

Q. The COVID-19 situation is leading to an increase in medicine prices and drugs not available below the Drug Tariff price – what is being done to account for the impact of these rises?
We are receiving reports every day from contractors of medicines not available at Drug Tariff price, and we are aware of the increasing number of problem products. There was a rise in the number of price concession products in March, and we anticipate a further increase in April based on the volume of reports we are receiving. All price concession lines are surveyed as part of the Margin Survey; we are currently in discussions with DHSC about transitioning to a quarterly process which would enable us to make more timely adjustments for margin.

Q. Will the cost of providing PPEs, 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’?
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 in the coming days we and the other national pharmacy organisations will be putting 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. It was announced a portion of the Pharmacy Quality Scheme (PQS) payment will go towards supporting pharmacies during this period. What happens if a pharmacy hasn’t claimed for PQS payment?
The 2019/20 PQS is already closed off, with final payments determined in February 2020. The PQS scheme for 2020/21 has been postponed for three months (with period of delay kept under review) and as yet there has not been a claim period for any PQS payments related to 2020/21. £18.75 million will be released from the 2020/21 PQS funding allocation and delivered to contractors for activity associated with the COVID-19 response. PSNC is in discussions with DHSC regarding how PQS funding will be handled and more information will be published in due course as it becomes available.

Q. With regards to the monies already placed in the system how can this be justified as ‘an advance’; March has already shown to be the busiest month on record and margins appear to have dropped significantly?
The uplift payments were made in recognition of increased activity related cost increases, such as 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 uplift payments were not designed to cover any margin shortfall in the period; this is a separate issue which is under discussion between PSNC and DHSC.

We are receiving reports every day from contractors of medicines not available at Drug Tariff price, and we are aware of the increasing number of problem products. There was a rise in the number of price concession products in March, and we anticipate a further increase in April based on the volume of reports we are receiving. All price concession lines are surveyed as part of the Margin Survey; we are currently in discussions with DHSC about transitioning to a quarterly process which would enable us to make more timely adjustments for margin.

Q. The March 2019 items uplift (estimated at about 20%) means the global sum funding for 19/20 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. Locally commissioned pharmacy services and their associated funding are being sidelined as resources are focussed on the COVID-19 response, what support is PSNC providing for LPCs handling local issues such as this?
Locally negotiated and funded services come under the purview of LPCs. Additional support is being provided for LPCs by PSNC, to help them in their key role in coordinating local efforts to the COVID-19 response. Richard Brown, CEO of Avon LPC, has joined the PSNC team on a part-time basis.

Richard has launched a COVID-19 Rapid Action Team comprising an LPC Chief Officer to represent every region of England.  The group is meeting a week to capture queries / feedback / questions from the field plus gather great ideas about how community pharmacy teams are dealing with the pandemic.

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 is completed and steps put in place to mitigate any risks identified;
  • 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.
  • Appropriate PPE is used – see below.

PHE have 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?
Public Health England’s (PHE) updated guidance on the use of personal protective equipment (PPE), published on 2nd April 2020, now recommends use of fluid-resistant surgical masks in pharmacies when working in an area with possible or confirmed cases and where staff are unable to maintain 2 metres social distance from the patient. The guidance for community pharmacy staff is included in Table 3 of the guidance –  Recommended PPE for ambulance, paramedics, first responders and pharmacists.

Read the RPS guidance on use of PPE in pharmacies

The updated guidance reflects the fact that coronavirus is now widespread in the community, meaning clinicians are more likely to see patients with the virus, some of whom may have minimal or no symptoms. Despite advice to patients with COVID-19 symptoms that they should stay away from pharmacies, some people are not following that guidance and pharmacy team members are potentially being exposed to possible or confirmed cases.

It is important to note that while pharmacy staff may now choose to 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. We are unable to source additional PPE supplies through national wholesalers; how do we obtain additional supplies to protect our pharmacy team?
The three major wholesalers have indicated that quantities of Fluid Resistant Surgical Masks (FRSM) are freely available. If contractors are close to running out of PPE, in line with DHSC and NHSE&I guidance, they can contact their Local Resilience Forum. 

Local Resilience Forums (LRFs) have received a push of PPE supplies to respond to local spikes in need, including those in social care and primary care, where there are current blockages in the supply chain. The PPE stock provided to LRFs is to support urgent need in vital services, such as community pharmacies, which are not linked to the NHS Supply Chain. This PPE is intended to support service providers which have exhausted their usual routes for PPE and there remains an urgent need for additional stock. Contact your LPC for advice on whether you can access stock from the LRF. 

In addition, any organisation running critically short of PPE, and that has exhausted other supply routes, can phone the National Supply Distribution Response (NSDR) on 0800 915 9964 for an urgent delivery. 

Q. The sourcing of PPE through wholesalers is another financial burden for contractors. What is PSNC doing to ensure pharmacies have access to PPE and that the cost of PPE purchased through wholesalers is accounted for?
PSNC is pressing DHSC and NHSE&I to ensure that pharmacy teams have access to the PPE they need from the PHE stockpile. We are also working to ensure that the cost of PPE is reflected in the additional pandemic funding we are seeking for the sector. 

Q. It is not possible for staff to maintain 2 metres social distancing in our small dispensary. What is the guidance on use of PPE within a small dispensary?
Public Health England’s (PHE) updated guidance on the use of personal protective equipment (PPE), published on 2nd April 2020, recommends the use of fluid-resistant surgical masks (FRSM) in pharmacies when working in an area with possible or confirmed cases and where pharmacy teams are unable to maintain 2 metres social distance from patients. 

The PHE guidance does not recommend use of FRSM where staff do not have contact with patients, e.g. staff working solely in the dispensary. However, we recognise that in most pharmacies, staff cannot confine their work to a single area of the premises, which is either patient-facing or with no direct dealings with patients. It is therefore likely that many pharmacy contractors and their teams will decide that staff working in multiple locations throughout the pharmacy premises may need to wear FRSM. 

Read additional guidance on face masks and face coverings

Q. Are pharmacy staff eligible for testing, and if so, how is this accessed?
Yes, frontline workers, including community pharmacy staff in England, can access free testing for COVID-19, via the Department of Health and Social Care’s (DHSC) national testing service. Testing will allow those currently unable to return to work because they or a member of their family or household have symptoms of coronavirus to know whether they do have the virus.

A new portal for booking COVID-19 tests for key workers, including community pharmacy team members, is now available for use by team members and employers: Essential workers: apply for a coronavirus test (GOV.UK)

Handling workload and staffing issues

Q. How is PSNC addressing contractors’ workload pressures?
The revised community pharmacy SOP (updated 22nd March 2020) provides contractors with some much-needed flexibility in the hours in which they need to open to the public. This should make it easier for pharmacies to stay open to the public, and help to ensure 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. Further guidance from PSNC, CCA, NPA and AIM on how to implement this new SOP is available on the COVID-19 Network Resilience page.

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. Are those working in community pharmacies considered ‘key workers’ by the Government?
Whilst pharmacists have not been included by name in the Government’s list, it takes more than one person to keep a pharmacy running. The Government needed to ensure that all those important workers – pharmacists, pharmacy technicians, pharmacy dispensers, pharmacy drivers, staff in wholesalers, distributors, etc. – were included and therefore settled on a wider definition. PSNC has developed a template letter that pharmacy contractors can issue to their staff to confirm to their children’s schools that they are frontline healthcare workers.

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 to isolate for 7 days versus 14 days can be found here: www.gov.uk/government/news/new-guidance-for-households-withpossible-covid-19-infection

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 (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 pharmacy profile on the NHS website (see the NHS website).

NHSE&I also encourages local pharmacies to work to maintain continuity of services in the event of temporary closures through ‘buddy’ arrangements. Further guidance is included in the revised community pharmacy SOP (updated 22nd March 2020). PSNC is discussing the need for appropriate essential funding for contractors to continue if a pharmacy is closed and staff are redeployed elsewhere. In such circumstances it will also be necessary for contractors to have special indemnity arrangements in place, and this is also part of ongoing discussions with HM Government.

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 at the moment and the sector’s response to the COVID-19 outbreak so far has been 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 the provision of PPE for pharmacies; 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. Richard Brown, Chief Officer of Avon LPC, has joined the PSNC team on a part-time basis to support collaborative working and communication between PSNC and LPCs. A COVID-19 Rapid Action Team comprising an LPC Chief Officer from each PSNC region in England has been formed to support this work. The group meets twice a week to capture ideas, feedback and questions from the field, plus gathering case studies on how community pharmacy teams are dealing with the pandemic.

Q. Why PSNC has been slow to respond to my queries?
The team at PSNC are engaged in daily COVID-19 discussions with DHSC and NHSE&I that are of vital importance to all community pharmacy teams across England. This work has to take priority, so our responses to individual emails and phone calls may be a little slower than usual. The best way to contact the team is via email (info@psnc.org.uk) but, if you would prefer to speak to someone in person, please call 0203 1220 810 and you will be directed to the appropriate person.

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 NHS England and Improvement (NHSE&I) and the Department of Health and Social Care (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. 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 patients 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.

Q. Has the possibility of introducing a pharmacy COVID-19 immunisation programme been broached yet in talks with DHSC?
A vaccine for the COVID-19 coronavirus has yet to be determined. Once such a vaccine exists and is available in sufficient quantities, there may be an opportunity for community pharmacies to be one of the vaccine providers.

Q. How has Scotland managed to secure more support for their community pharmacies – can we learn from them?
Health is a devolved issue and the two Governments handle things differently for various reasons – one being scale. PSNC put a strong case to our Pharmacy Minister, Jo Churchill, but cash advances are the maximum that the Government has been prepared to give English pharmacies so far. We accepted this in the hope that it would be enough to help many contractors with their immediate bills, but we have been clear that a loan is not enough. Since then we have provided a dossier of evidence, prepared with the help of the other pharmacy organisations, to try to persuade Government of the very urgent need for additional funding (over and above the agreed global sum) for the sector.

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 have 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 commsteam@psnc.org.uk

Q. How will PSNC use this experience to negotiate appropriate levels of funding for community pharmacy?
PSNC recognises that we need to have a full and frank discussion with NHSE&I and DHSC about how the impact of the COVID-19 pandemic, and community pharmacy’s response to it, should inform the future of the sector. The NHS is relying on something that, given the funding and capacity issues we have previously highlighted to Government, should not be taken for granted.  Those underlying issues still need to be addressed.

Our first job is to ensure community pharmacies have enough financial support to get us through COVID-19, and then we can turn to a full review of the Contractual Framework. We hope the huge amount of work we have done with officials this month will make future negotiations and decisions easier to navigate, but we absolutely recognise that there is more to do to persuade the NHS of pharmacy’s importance and value.

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. Whilst there is still further work to do on this, 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. Can I repackage paracetamol tablets from the 100 POM pack to OTC packs of 20 or 30?
PSNC has discussed the stock shortages of OTC packs of paracetamol with DHSC, who have indicated that they are in regular discussions with manufacturers and wholesalers to ensure supplies are being made available.

DHSC has expressed concern about repackaging paracetamol from POM packs for OTC sale, because of the risk that this has on ongoing supply of POM packs. Where a pharmacist believes it is appropriate to re-package POM packs of paracetamol for OTC supply, in order to meet the needs of individual patients, guidance on how to label the medicine etc. has been issued by the Royal Pharmaceutical Society.


Q. In March 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. What is being done about medicine shortages?
DHSC has well-established procedures to deal with medicine shortages and it is working with medicine suppliers to assess the impact that COVID-19 is having on the supply chain. As well as banning the parallel export of some medicines, DHSC have asked medicine suppliers who still retain some of their EU exit stockpiles to hold onto these. Suppliers have also been asked to assess the risks relating to continuity of supply, particularly medicine supplies from China and other areas affected by COVID-19. For non-prescription items, the Chief Pharmaceutical Officer has asked pharmacies to restrict quantities of soap, hand sanitisers and OTC medicines so there is enough for everyone.

Q. Can we adjust incorrect endorsements post submission?
Existing Drug Tariff provisions allow for the return of prescriptions with insufficient information to the pharmacy to enable NHS Business Services Authority (NHSBSA) to calculate and make payment (see our Prescription returns page).  However, there is currently no mechanism in place (except for EPS claim amend functionality – see below) to allow contractors to rectify incorrect or missing endorsements on prescriptions already submitted for payment. We have been in discussions with DHSC around this issue pre-COVID-19 and are seeking a way forward to allow contractors to retrospectively adjust incorrect or missing endorsements post-submission.

With electronic prescriptions, it may be possible to make a change (such as amending an incorrect endorsement or adjusting the patient exemption category) after the prescription claim message has been submitted to the NHSBSA.

This is subject to the following criteria:

  • your PMR system supplier must have added the functionality required to recall claim messages;
  • it must be before the deadline of the 5th day of the month following that in which supply was made (after the 5th, NHSBSA’s pricing process will begin and the prescription can no longer be recalled).

If the above criteria are met, your PMR system can allow you to recall, correct, and then resend the electronic script to NHSBSA.

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 several weeks ago. 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, especially now where there so many price increases and drug shortages?
PSNC are 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.

End of month submission

Q. Are all NHSBSA prescription processing sites open as usual to receive end of month bundles?
All NHSBSA prescription processing division offices will be staying open so bundles should continue be posted via secure track and trace method to the normal delivery addresses no later than the 5th day of the month following that in which the supply was made.

It would be prudent to check in advance with your regular courier if there are any planned changes to collection/delivery timings for your end of month bundle. If your regular courier service is unavailable, contractors should make alternative arrangements for delivery of bundles using a secure track and trace delivery method.

Q. Are there any planned changes to the end of month submission period?
There are no planned changes to the end of month submissions process. Contractors must therefore continue to submit their end of month bundle and FP34C as normal using their usual secure delivery method no later than the 5th day of the month following that in which supply was made. PSNC has put together a list of top tips to help contractors with their end of month process.

Q. Will NHSBSA have staff on site to receive end of month bundles which are hand delivered?
NHSBSA staff will be on site at processing centres to sign for and receive bundles hand delivered by contractors. Staff will be observing social distancing protocol as much as possible when receiving bundles. If for any reason NHSBSA are not in a position to receive hand delivered bundles in the future they will notify contractors.


Return to the main COVID-19 hub page.



Latest Healthcare Landscape news

View more Healthcare Landscape news >