Maintaining access to pharmacy services – opening hours and temporary closures
The COVID-19 pandemic is unprecedented and exceptional measures may be required to ensure patient and public safety, as well as the safety and welfare of the pharmacy team.
The workload and other pressures on community pharmacy during the third phase of the outbreak may be high in certain areas of the country, with staff illness and absence, additional services to provide such as the pharmacy delivery service to shielded patients, and other deliveries to vulnerable patients and those isolating; and the continuing need to manage the ongoing new ways of working such as working behind screens, social distancing for staff, patients and customers and the use of PPE for patient interactions, as necessary. Please see the NHSE&I Pharmacy SOP, and PSNC guidance on business continuity and PPE, staff safety and security pages on the PSNC COVID hub.
Accordingly, the flexible provision of hours or services are in place in accordance with the emergency provisions of the NHS (Pharmaceutical and Local Pharmaceutical Service) Regulations 2013 to assist contractors to manage this workload and pressures.
The NHS Regulations provide that where the Secretary of State declares an emergency, relevant regulations are ‘activated’ and may be used by contractors, and the Pharmaceutical Services (Advanced and Enhanced Services and Emergency Declaration) Directions 2020 declared an emergency requiring the flexible provision of pharmaceutical services with effect from 27th March 2020. Direction 2 states that until 30th September 2021 (following a number of extensions), NHS England must exercise its functions, or where it has discretion, to consider exercising its functions, under NHS regulations:
- regulation 29(2) (contractors – relocation of premises)
- regulation 61 (dispensing doctors)
- paragraph 27 of Schedule 4, (contractors – temporary flexible provision of hours and or closures)
- paragraph 17 of Schedule 5, and (appliance contractors)
- paragraph 26(3) of Schedule 7 (LPS pharmacies)
PCC has issued a helpful briefing on the flexible provision of pharmaceutical services during the current pandemic, which can be found here.
Various dispensations and options for closed door working and the flexible provision of hours or services are in place in accordance with the emergency provisions of the NHS (Pharmaceutical and Local Pharmaceutical Service) Regulations 2013. NHS England and NHS Improvement (NHSE&I) may also require community pharmacies to open as it did for some Bank Holidays in 2020.
Flexible opening provisions
Local management of flexible opening hours
NHS England and NHS Improvement (NHSE&I) regional teams may notify pharmacies that they may work behind closed doors without the need for contractors to apply for such closed-door working. This is to help pharmacies to respond to the workload and staffing pressures of the second wave of the pandemic.
NHSE&I agrees closed door working following consultation with the LPC and whether it is granted depends on the local or regional situation.
Closed door working is as described in the NHSE&I CPVID-19 SOP and is for up to a maximum of 2.5 hours a day, but not during the protected opening hours of 10am-12noon and 2pm-4pm (or 10-12 noon and 2-6pm for 100-hour pharmacies). Closed door working may be for one or more days during the week or all days a pharmacy is open.
NHSE&I give such notification via a pharmacy’s shared NHSmail account, and the discretion to use the closed-door working lies with the responsible pharmacist in the pharmacy.
The NHSE&I SOP and PSNC website give additional information on what to do if (1) a pharmacy cannot open, or (2) if a pharmacy is applying for a temporary closure or (3) a pharmacy is applying for a temporary relocation, or (4) a pharmacy is applying for a temporary change to the days or times it is obliged to provide pharmaceutical services at the pharmacy premises.
Flexible temporary opening hours that may be requested from NHSE&I during an emergency
The flexible provision of pharmacy services may assist contractors as the outbreak continues, if opening hours at one or more pharmacies need to be adjusted to match the staff and resources available. This provision permits contractors to manage the pharmacies across their own network, if NHSE&I agrees with the contractor’s proposal.
Contractors must apply to NHSE&I for the temporary flexible provision of pharmacy services – for temporary changes to the days or times the pharmacy will be open, or a temporary closure of the pharmacy – and to do so, should give:
- 24-hours’ notice of the proposed change or closure to NHSE&I; and
- the reasons for the request.
NHSE&I will only agree with a contractor’s request if it considers the reasons are adequate.
Having given 24-hours’ notice, the contractor does not need NHSE&I’s permission in advance of the change, or closure, so, if NHSE&I does not object to the request, it can be implemented. If, subsequently, NHSE&I does not approve the request, the pharmacy must go back to its original opening hours.
If NHSE&I grant the request, the contractor may revert to the original hours by giving NHSE&I 24-hours’ notice.
What is NHSE&I likely to accept?
What flexible provision of pharmacy services – flexible opening hours – NHSE&I is likely to accept, for example:
- closure of a pharmacy in an area where there is minimal demand due to the Government’s social distancing policy (e.g. large shopping malls);
- pharmacies co-located with GP practice hot sites, dealing with COVID-19 patients, where patient access to the pharmacy is affected;
- closure of a pharmacy unable to open for reasons beyond the control of the contractor.
- Close door working – the NHSE&I SOP references working behind closed doors during normal opening hours, with agreement with NHSE&I (and a poster on the door of the pharmacy telling patients how to contact the pharmacy if urgent help is needed).
In appropriate areas/circumstances, to ensure patient and public safety, as well as the safety and welfare of the pharmacy team(s), contractors may have to consider which days and times they can provide pharmacy services – can open one or more pharmacies – from which they provide NHS pharmacy services.
Primary Care Commissioning (PCC) has provided information and application forms, and contractors are encouraged to use these to send it to their NHSE&I regional office, as appropriate.
Note: If contractors need to close a pharmacy immediately, because they are prevented from providing pharmacy services due to staff illness or other reasonable cause, they may still do so (and without seeking NHSE&I consent) under other provisions in the regulations. Relevant advice is here.
NHSE&I has indicated in the SOP that temporary closures may be granted for:
- closure of a pharmacy in an area where there is minimal demand due to the Government’s social distancing policy (e.g. shopping malls);
And may grant such closures for:
- pharmacies co-located with GP practice hot sites, dealing with COVID-19 patients, where patient access to the pharmacy is affected.
Flexible temporary closures that may be requested from NHSE&I during an emergency
New options for temporary closure and relocations are now available under emergency provisions in the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. PSNC has brought together guidance and resources on how contractors can apply or notify the authorities if they need to close for any of these reasons – see Temporary closures during the COVID-19 outbreak.
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 DoS profile must be updated (read more at: ‘Temporary closures and updating DoS’ section of the DoS webpage.), as must the NHS website.
NHSE&I is encouraging cooperation between community pharmacies and GP practices in primary care networks, to deliver the best care, and protect and maximise the capabilities of staff across practices and pharmacies.
NHSE&I also encourages local pharmacies to work to maintain continuity of services in the event of temporary closures through ‘buddy’ arrangements, stating:
Particular thought should be given to patients receiving services such as supervised consumption or monitored dosage systems. Consideration can be given to providing daily doses rather than supervised consumption on an individual patient risk assessed basis.
This guidance is included in the Community Pharmacy SOP.
Immediate temporary closures due to illness or other reasonable cause
A contractor may also close a pharmacy on a temporary basis if prevented from opening by reason of illness or other reasonable cause – for example, staff illness and absence or for the decontamination of the pharmacy.
NHSE&I has indicated that contractors closing temporarily for this reason must:
- inform NHSE&I of the temporary closure (and any arrangements for continuity of service with other contractors/pharmacies);
- update the pharmacy NHS 111 DoS profile; and
- update the NHS website.
NHSE&I is encouraging cooperation between community pharmacies and GP practices in primary care networks, to deliver the best care, and protect and maximise the capabilities of staff.
See also the ‘Checklist for emergency closures’ section below.
Temporary relocation during an emergency
If a contractor needs to move the provision of pharmacy services from the existing pharmacy premises to new pharmacy premises, this is an excepted application, so involves a more detailed application form (regulation 29(1) of the NHS Regulations). NHSE&I may grant such an application for a period of time no longer than the emergency, which is currently declared until 31st March 2021 (following an extension). A reason for such an application might be, for example, co-location with a GP hot site treating COVID-19 patients, such that patients of the pharmacy are no longer able to access the pharmacy safely.
Maintaining pharmacy services during the outbreak (the emergency regulations)
Ensuring the continued provision of services in an area where there is a flexible temporary opening or closure during an emergency a closure
If one or more contractor closes pharmacies temporarily in an area, there is the potential for patients and the public to lose reasonable access to a pharmacy. Therefore, it is suggested that contractors liaise with NHSE&I well in advance of seeking temporary flexible opening hours and temporary closures where reduced hours or closures could affect the overall provision of medicines and pharmacy services to patients and the public – i.e. that contractors give more than the 24 hours’ minimum notice where possible. This is to ensure that closures by a number of contractors do not result in all the pharmacies in one area closing at the same time. LPCs should also be able to assist in discussions with NHSE&I.
See PSNC information on Maintaining pharmacy services during the outbreak.
NHSE&I may also require community pharmacies to open
NHSE&I may also require community pharmacies to open as it did for some Bank Holidays in 2020. Existing contractor intentions to open recorded on the DoS and NHSE&I directed opening will be sufficient to provide sufficient pharmacy services for patients on that day. See PSNC information on the National Health Service (Amendments Relating to the Provision of Primary Care Services During a Pandemic etc.) Regulations 2020.
Emergency regs on flexible provision of services
The Pharmaceutical Services (Advanced and Enhanced Services and Emergency Declaration) Directions 2020 declared an emergency requiring the flexible provision of pharmaceutical services with effect from 27th March 2020. Direction 2 states that until 3oth September 2021 (following a number of extensions), NHS England must exercise its functions, or consider exercising its functions, under NHS regulations relating to: relocation of premises, and temporary flexible provision of hours and/or closures for community pharmacy contractors, appliance contractors and LPS pharmacies.
The emergency provisions of regulation 61 also mean that NHSE&I may allow a dispensing doctor practice to dispense medicines temporarily to normally ineligible patients if required to maintain adequate provision of pharmaceutical services in the area.
Primary Care Commissioning (PCC) has issued a helpful briefing on the flexible provision of pharmaceutical services during the current pandemic.
Checklist for emergency closures
If you need to close your community pharmacy because of the ongoing COVID-19 pandemic, it is important that you do as much as you can before you leave the premises, where it is safe to do so. The pharmacy may be run by locums or other staff who are unfamiliar with your processes and procedures, or the pharmacy may be closed. It’s important that you do what you can, where it is safe to do so, to make sure everything is in place to ensure patients are able to access their prescriptions, and that your business can resume easily and effectively. You should not put yourself, your staff, or your patients at any unnecessary risk. For more information, please see our emergency closure checklist prepared with NHSE&I.
Amended models of care during the pandemic (hot sites)
In most circumstances, the NHS is seeking to provide treatment required by COVID-19 infected patients remotely or in their home. In exceptional circumstances, infected patients may need a face-to-face consultation and Clinical Commissioning Groups (CCGs) and general practices have been asked to put in place local arrangements to allow this to happen, while also ensuring appropriate separation of these patients from others, particularly the extremely vulnerable group.
In some areas, ‘hot sites’ are being set up at general practices, out-of-hours hubs or other locations, which may deal solely with COVID-19 patients (sometimes described as red sites) or may deal with all patients, but with clear segregation between the two cohorts (sometimes described as red and amber sites).
Where this is happening at GP practices and other sites which have a co-located community pharmacy, there could be a profound impact on the normal patient flows and subsequent use of the pharmacy during the period of the pandemic. The following document provides guidance for contractors and LPCs to consider when having local discussions:
Capacity changes and operational status reporting
NHSE&I will be using the DoS to monitor capacity changes within primary care. Contractors are therefore requested to continue to update their capacity status on their DoS profile. Read more in the ‘Using DoS Capacity status tool’ and ‘Temporary closures and updating DoS’ sections of our DoS webpage.
Please also remember to inform your local NHSE&I team of unavoidable closures and update the NHS website for patients and the public.
Pinnacle Health, now operating as part of the EMIS group, has been working closely with PSNC to develop a reporting template allowing pharmacies to record their operational status. This will allow pharmacies to record the level at which they are operating against a Red, Amber, Green traffic light system and provide feedback to LPC leads and Head Offices about the challenges they are facing. For sites recording an Amber status, the template allows a pharmacy to record and feedback details of their operational challenges and also provide information on planned closures, in line with the COVID-19 SOP.
For pharmacies faced with no alternative other than to close, i.e. recording a RED status, the template supports recording of actions taken in line with the requirements of Annex 14 of the NHSE&I pharmacy manual, and details of the closure itself. All information recorded and saved for a RED status will prepopulate a form that can be printed when data is saved. The form can be sent to the regional NHSE&I office to inform them of the closure.
2020 Bank Holiday opening arrangements
The arrangements for previous 2020 Bank Holiday opening hours are set out below. Any bank holidays not listed below were not subject to a national direction for community pharmacies to open.
Early May Bank Holiday (8th May): NHSE&I required community pharmacies in England to open between 2pm and 5pm on Friday 8th May 2020 (the Early May Bank Holiday). Contractors needed to submit their claim for the £250 per hour payment between the 25th May 2020 and 22nd June 2020, with payment due on 1st July. This payment did not appear on the FP34 Schedule of Payment but the NHS Business Services Authority (NHSBSA) provided confirmation of payment via individual contractor letters.
Easter opening hours: NHSE&I required all community pharmacies in England to open from 2pm to 5pm on 10 April 2020 (Good Friday) and 13 April 2020 (Easter Monday). Contractors needed to submit their claim for the £250 per hour payment between the 17th April and 5th May 2020, with payment due on 1st June. This payment did not appear on the FP34 Schedule of Payment but NHSBSA provided confirmation of payment via individual contractor letters.
See also the ‘Updating bank holiday hours on DoS’ section of our DoS webpage.
2021 Bank Holiday opening arrangements
On 16th February 2021, NHS England and NHS Improvement (NHSE&I) confirmed that there are currently no plans to ask all of primary care, including community pharmacy, to routinely open on Good Friday (2nd April) and Easter Monday (5th April) again, but that it would keep its position under review, subject to the changing demands of the pandemic.
NHSE&I indicated that Regional Teams have been working with LPCs and pharmacy contractors to ensure sufficient cover arrangements are in place to meet expected demands for services over Easter and expressed gratitude to those who will be working during the bank holiday weekend.
NHSE&I also indicated that COVID-19 vaccination services remain the exception, providing a 7-day service where necessary, including bank holidays.
The emergency provisions of regulation 61, which are applicable to dispensing doctors, seek to ensure the adequate provision of pharmaceutical services in an area if any pharmacies nearby temporarily close. The regulation provides that during the emergency period, currently until 1st July:
- where there is a temporary closure of a pharmacy in the area of the relevant HWB;
- and in order to secure continuing adequate provision of pharmacy services and medicine supplies;
- it is necessary for the dispensing doctor to provide ‘pharmaceutical services’ to normally ineligible patients (dispense prescriptions to those patients who usually have prescriptions dispensed at the pharmacy)
- for a specified period of time (not longer than the emergency period)
NHSE&I may allow the dispensing doctor practice to dispense medicines temporarily to normally ineligible patients.
The provision is permissive only, and NHSE&I may not give such permission to a dispensing doctor even if a nearby pharmacy closes temporarily. For example, if the provision of pharmaceutical services by other pharmacies in the area provides adequate ‘pharmaceutical services’ in the area, there would be no reason for NHSE&I to give the dispensing doctor such permission.
Regulation 61 while ‘activated’ during the emergency period, does NOT give any authority for dispensing doctors to dispense medicines temporarily to ineligible patients:
- unless a nearby pharmacy has closed temporarily (this does not include flexible opening hours/closed door working) AND
- unless and until NHSE&I has agreed that the dispensing doctor may do so (a dispensing doctor does not have to agree to provide such temporary services).
Regulation 61 also allows NHSE&I to grant a dispensing doctor temporary premises approval in appropriate circumstances.
If pharmacy services remain open in a rural area – even with the flexible provision of opening hours/closed door working – there should be no reason for the use of Regulation 61 by a dispensing doctor: no reason for NHSE&I to grant such use.
PSNC would expect local LPCs to be involved by NHSE&I if it considers exercising its powers under regulation 61 of the NHS regulations.
For any queries, please contact Gordon Hockey, PSNC’s Director of Operations and Support.