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.
Easter opening hours
NHS England and NHS Improvement (NHSE&I) has announced that it will require all community pharmacies in England to open from 2pm to 5pm on 10 April 2020 (Good Friday) and 13 April 2020 (Easter Monday).
- The NHSE&I announcement on Easter opening hours, made with the agreement of the Secretary of State, applies to all community pharmacies in England, including DSPs, but not LPS pharmacies and includes: Under the National Health Service (Amendments Relating to the Provision of Primary Care Services During a Pandemic etc.) Regulations 2020 and with agreement of the Secretary of State we are requiring pharmacies in England to open from 2pm to 5pm on 10 April 2020 and 13 April 2020. The announcement and a clarification of the announcement were set out in the NHSE&I Primary Care Bulletins of 3 April and 7 April 2020 respectively.
- The announcement states that any pharmacy that was planning to open longer hours should still to do so to support access for patients through the day, and accordingly, any existing directions to open and agreed funding should stay in place, unless otherwise agreed by contractors and NHSE&I regional teams. If regional teams have already started to cancel such directed hours, contractors and LPCs will need to clarify the position locally.
- NHSE&I regional teams will consider exceptions (from the requirement to open from 2-5pm on 10 and 13 April) and this local flexibility will be based on the needs of patients in the areas served and the challenges for pharmacy staff.
- Community pharmacies who believe there is no need for them to open on April 10 or 13 should seek an exemption from their NHSE&I regional team – LPCs may be able to support this. Reasons why there may be reduced patient need may include, for example, the location of the pharmacy in a large shopping mall, the closure of local GP practices or proximity of other local pharmacies who will be open. Contractors could also seek flexibility on the three hours in which they must be open (which has been set by NHSE&I nationally as 2pm to 5pm), for example if they are already due to be open in the morning to meet local need.
- If a pharmacy is unable to open for reasons beyond the control of the contractor between 2pm and 5pm on April 10 or 13 they should notify their NHSE&I regional office, update the NHS 111 DoS and ensure their NHS website entry is correct. This may be a temporary closure because the pharmacy is prevented from opening due to illness or other reasonable cause. For more information see PSNC guidance.
- The DoS entry has been set automatically for all pharmacies for 2-5pm on the 10 and 13 April and it is important for a contractor to amend/cancel the entry if appropriate, so that NHS 111 does not send a patient to a closed pharmacy, for example, as part of the Community Pharmacy Consultation Service (CPCS). The DoS Profile Updater is available at https://dos-profile.service.nhs.uk and the emergency change number is 0300 0200 363. For more information see PSNC guidance.
- To support patient access pharmacies will also need to ensure their NHS Website entries reflect their opening hours.
- NHSE&I has committed to provide funding for contractors for the Easter Bank Holiday openings but said last week that it would not apply Bank Holiday premiums. Funding has now been announced.
Further information can be found on our COVID-19 FAQs webpage.
The decision to require all pharmacies to open has been made unilaterally by NHSE&I who say that access to pharmaceutical services will be needed on these day to support GPs who will open for business as usual on Good Friday and Easter Monday as part of the overall NHS response to the pandemic.
PSNC argued against this requirement for all pharmacies to open on the grounds that there will already be sufficient numbers of pharmacies open under usual Bank Holiday arrangements. Our understanding is that between a third and a quarter of the network is open on those two days already and some local NHSE&I teams have already made additional provision for local needs. We also issued a joint statement on Easter 2020 opening times with AIM, CCA and the NPA.
Monies for these opening hours will come from over and above the global sum, but NHSE&I has said funding will not reflect bank or public holiday premiums – PSNC is arguing that it must do so. Funding has now been announced.
Most contractors should not need to update DoS with Easter 2020 hours but read more about DoS and Easter 2020 opening hours at the DoS webpage. NHS website opening hours are set separately (read more at NHS website webpage).
Opening hours flexibility
The SOP for community pharmacy (revised on 22nd March 2020) gives pharmacies some flexibility in the hours in which they need to open to the public during the COVID-19 pandemic.
- If under significant pressure, at the discretion of the responsible pharmacist, pharmacies may close their doors to the public for up to 2.5 hours a day, including lunch.
- Community pharmacies are expected to be open to the public between 10am-12 noon and 2pm-4pm as a minimum (if these are contracted core or supplementary hours).
- Similarly, 100 hours pharmacies should be open from 10am-12pm and 2pm-6pm as a minimum.
A sign on the door must give information about how to contact the pharmacy if urgent help is needed
The guidance below considers the support for pharmacy staff to stay well at work, in the context of opening hours, during what is a difficult and stressful time.
Resilience Guidance – Part 2: Responsible Pharmacist (withdrawn)
Emergency Closure Form (Word version)
Amended models of care during the pandemic – implications for community pharmacies
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:
NHS England and NHS Improvement (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 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 SOP for community pharmacy (revised on 22nd March 2020).
Capacity changes and operational status reporting
NHSE&I will be using the Directory of Services (DoS) to monitor capacity changes within primary care. Contractors are therefore requested to continue to update their capacity status on their DoS profile. 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 revised 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.