Today (2 September), registration opened for the national community pharmacist consultation service (CPCS), which will see pharmacists paid £14 for each consultation resulting from an NHS 111 referral for minor illnesses or urgent prescriptions.
With the new service set to go live on 29 October, The Pharmacist has combed through NHS England’s draft service specification document, published today.
Here’s our roundup of everything you need to know before you sign up for the CPCS.
Are there any requirements for delivering the service?
Contractors who wish to sign up must complete the registration declaration on the NHS Business Services Authority (NHSBSA) Manage Your Service (MYS) platform. The draft service specification adds that they must:
- Have a clearly-designated private consultation room
- Be ‘satisfied’ that all staff including locums are ‘competent’ to provide the service and trained in its operation
- Update their standard operating procedures (SOPs) and business continuity plan to include the service
- Have access to the NHS summary care record (SCR), the pharmacy’s shared NHSmail mailbox and the local secure electronic messaging system used by NHS 111 (the CPCS IT system)
- ‘Be satisfactorily complying with their obligations under Schedule 4 of the Pharmaceutical Services Regulations (Terms of Service of NHS pharmacists) in respect of the provision of essential services and an acceptable system of clinical governance.’
What technology will I need?
All pharmacists involved in delivering the service must have access to the secure CPCS IT system which will be used to receive referrals, maintain records and send messages to NHS 111 or the patient’s GP after a consultation.
A licence for the CPCS IT system software will be provided by NHS England for the first 18 months of the service, NHS England said.
However, from 1 April 2021, contractors will need to source their own IT systems to continue providing the service and make records during consultations. Any hardware needed, such as a tablet or monitor and keyboard, will be the full responsibility of the contractor, NHS England added.
What support will I receive?
The draft service specification says: ‘The necessary knowledge and skills to provide the service are core competencies for all pharmacists.’
However, it adds that pharmacists should ensure they have up-to-date knowledge and understanding of minor conditions, the law around emergency supply of prescription only medicines (POMs), how to identify ‘red flags’ as set out in NICE’s clinical knowledge summaries and how to refer patients on as appropriate.
A self-assessment framework has been provided to help pharmacists identify any gaps in their knowledge, but completing it is not mandatory.
Support will include:
- Free face-to-face training for any pharmacist delivering the service, facilitated by the Centre for Pharmacy Postgraduate Education (CPPE), to include consultation and physical assessment skills training
- A dedicated helpline connecting pharmacists with their local GP out of hours (OOH) and NHS 111 services
- Updated guidance on the CPPE website on dealing with minor illnesses
- A toolkit to be released by NHS England soon
How will I be paid?
A consultation fee of £14 will be paid for each completed referral. Payment is tied to the consultation – whether face-to-face or over the phone – and cannot be claimed if no consultation has taken place.
Contractors must make a record of the consultation and any medicine supplied or suggested for purchase on the CPCS IT system, as well as details of the referral and outcome. This record will be used to generate the pharmacy’s month-end payment claim.
Monthly claims should be made via the NHSBSA portal and/or the CPCS IT system (where this functionality is available) and payments will be made in the same payment month as other payments for NHS pharmacy services.
Claims will be accepted by the NHSBSA within six months of completion of a referral, but later claims will not be processed, NHS England said.
How will referrals work?
When appropriate for a patient to be referred to a community pharmacy, NHS 111 providers will use the directory of services (DoS) to offer patients a choice of pharmacies participating in the service. This selection will be ‘based on location and availability at the time of the call’, the draft service specification document says.
The chosen pharmacy will then receive an electronic referral message from NHS 111 via the CPCS IT system and NHSmail, which will be used as a backup. Meanwhile, the patient will be given the phone number and details of the pharmacy and advised to call or attend within a set time period.
If no contact from the patient is received within 12 hours of the referral, the pharmacy must ‘make a reasonable attempt to contact the patient… as soon as possible’ using the contact details provided in the referral, the document adds. If the patient has not made contact during the next working day, the pharmacist can close the referral via the CPCS IT system – however, no payment can be claimed if no consultation has taken place.
To ensure referrals are acknowledged ‘in a timely manner’, the CPCS IT system should be checked with ‘appropriate regularity’ during the pharmacy’s opening hours, NHS England said. The NHSmail mailbox should also be checked at open and close to pick up any messages that may have failed to come through the CPCS IT system. NHS England recommends that pharmacies respond to referrals on the same day, or the next morning if they are received at the end of opening hours or during the night.
If a patient makes contact but the pharmacy has not received a referral message, the pharmacy must contact their local NHS 111 telephone line to confirm whether a referral has been made. Patients who have not been referred via NHS 111 are outside the scope of the CPCS and payment cannot be claimed for any consultation.
For more specific details on how to deal with referrals for minor illnesses or emergency medicine supply, see the draft service specification document.
Can I decline referrals?
No, referrals cannot be turned away and the service must be available throughout a pharmacy’s full opening hours. Once signed up, contractors ‘must be able to receive and complete any referrals made to them by NHS 111’, the NHS England document confirms.
If the service must be withdrawn temporarily due to unforeseen circumstances, contractors must inform their local NHS 111 provider and local NHS England team as soon as possible to prevent any referrals being made.
The document adds that if a referral cannot be made or a patient is unable to speak to a pharmacist on two consecutive referrals, ‘NHS England will investigate this issue and action may be taken in line with the local dispute resolution policy’.
One month’s notice is required to de-register from the service.
Do I need to inform the patient’s GP?
For minor ailments referrals, the pharmacist can use their clinical judgement to decide whether the patient’s GP needs to be informed of the consultation’s outcome.
However, if the pharmacist considers it ‘clinically important’ to inform the patient’s GP or if any emergency medicine supply is made, they must send an electronic notification to the GP practice via the CPCS IT system, NHS England said. This should be sent on the same day or as soon as possible after the pharmacy opens the following working day.
What if the problem can’t be dealt with in the pharmacy?
If the pharmacist needs additional advice or feels the patient might need to see another healthcare professional, they should refer the patient for an urgent in-hours GP appointment, call the dedicated NHS 111 telephone line for further advice, refer the patient to A&E or call 999, according to their judgement.
If the referral is for an emergency medicine supply but the supply cannot be made, the pharmacist should refer the patient to their GP. Alternatively, they could ‘contact the local GP OOH provider to discuss a solution, and if necessary, request that the patient be contacted by an appropriate healthcare professional’, the NHS England document says.
If it is appropriate for a supply to be made but the item is not in stock, the pharmacist should use the directory of services to identify another appropriate pharmacy with the patient and forward the referral once stock at the second pharmacy is confirmed. Both pharmacies will be eligible for the £14 service completion fee in this case.
Will GPs also refer patients to pharmacies?
For now, referrals are only through NHS 111 but GP referrals to community pharmacy are being piloted this financial year. If these pilots are successful, the service may be extended to include GP referrals, NHS England said.
How do I sign up and is there a deadline?
No, registration is on a rolling basis. The service will launch on 29 October and contractors can sign up at any time before or after this date via the online NHSBSA platform.
However, contractors must sign up by 1 December 2019 in order to claim a £900 transition payment or between 1 December 2019 and 15 January 2020 to claim a reduced payment of £600. No transition payments will be provided for those who register after 15 January 2020.