2- Further COVID 19 guidance for CIOS Contractors


Practical Advice on how to deal with the current crisis

We are very aware that the information coming out of national organisations is constantly changing and front-line staff will struggle to know how to apply it. The sections below will help you to find the key guidance and interpret it for your business. This section will be constantly updated as new guidance is issued.

Protecting the Pharmacy Team

Pharmacy Entry Point Signs

Please make sure you have the PHE Covornavirus poster displayed at all entry points to your pharmacy.

In the warmer months, you may want to use an external display sign with the above poster in it and keep the door to your pharmacy open to allow fresh air to circulate. This will also help avoid the public making contact with the door handle on entry and exit.

Please refrain where possible from using vented heating and air-conditioning which could circulate the virus further within the building.

Hand washing

Follow NHS How to wash your hands guidelines, which should be carried out for 20 seconds.

Increase the frequency that all staff do so, for example, you may wish to set a phone or computer alarm to remind you on an hourly basis.  As the pandemic continues you may find it hard to remember to do this vital step.

Consider placing hand sanitiser if available at entry points for customer use or before signing for their script.

Cleaning arrangements

Increase cleaning of touching points such as door handles, countertops, and shelving – particularly at shoulder and head height where contact is made most and where sneezes or coughs may land.

Remove large quantities of stock items from shelving to allow for swift cleaning.

Maintain social distancing

2 meters between patients where practicable (consider ‘staff at risk’ for example those that may be asthmatic, or consider limiting the number of people entering at the premises at any one time). Consider using barriers or screens in front of the counter, if available or use tape to mark distances on the floor.

PPE

PPE should only be used if you have a suspected case in your isolation area or if you have had to come into close contact with that individual. It should also be worn during decontamination. Guidance on how to wear and remove PPE has been given. Please follow environmental cleaning guidance given and see section 4. Post-transfer actions in the Community Pharmacy SOP.

Physical & Emotional Wellbeing

Staff will be suffering from stress, anxiety, and fatigue; a major risk to the wellbeing of staff and in-turn an increased risk of dispensing errors and mistakes in their work. You may find the link to emotional and psychological survival guide useful to help maintain your teams wellbeing during this time.

Vulnerable people – at risk staff

For a full list of people who are deemed to be at risk of getting severe symptoms from the Coronavirus please click here

It is your responsibility to assess the risk to your staff and take appropriate decisions to protect them (multiple pharmacies will be given HR support by their Head Office. If this means that staff have to self-isolate and you can no longer operate your pharmacy safely for your contracted hours, please follow the information below on reducing your hours or closing your pharmacy.

School places for children of key workers

The government has announced that all front-line healthcare staff who are unable to get their children looked after at home will have access to school places. The Guidance states the following:

  1. If it is at all possible for children to be at home, then they should be.
  2. If a child needs specialist support, is vulnerable or has a parent who is a critical worker, then the educational provision will be available for them.
  3. Parents should not rely upon those who are advised to be in the stringent social distancing category such as grandparents, friends, or family members with underlying conditions, for childcare.
  4. Parents should also do everything they can to ensure children are not mixing socially in a way that can continue to spread the virus. They should observe the same social distancing principles as adults.
  5. Residential special schools, boarding schools, and special settings continue to care for children wherever possible.

If your work is critical to the COVID-19 response, or you work in one of the critical sectors, and you cannot keep your child safe at home then your children will be prioritised for education provision. This includes pharmacy staff. Please click here for PSNC guidance on what to do in your pharmacy.

Reducing your hours or closing your pharmacy

March 22, 2020

NHS England and NHS Improvement (NHSE&I) have today issued an updated Standard Operating Procedure (SOP) for community pharmacies in relation to the COVID-19 pandemic. Critically, the SOP gives pharmacies some flexibility in the hours in which they need to open to the public during the COVID-19 pandemic.Read the SOP

Opening hours flexibility

Specifically:

• 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.

Temporary closures

NHSE&I has also 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.

The new guidance from NHSE&I is included in the pharmacy SOP updated today. Read the SOP

Pharmacy response

PSNC, CCA, NPA and AIM welcome the revised SOP and the flexibility that this gives to contractors.

The changes should help to ensure that pharmacies can stay open to the public, and 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.

The pharmacy organisations are working together on detailed guidance for contractors to help them to implement this new SOP.

We would remind you of the contractual requirement to notify NHSE&I of any closures or reduction in opening hours immediately. As well as this being a contractual requirement, this is needed to facilitate the mapping of the impact of the COVID-19 situation and the wider coordination of support.

The relevant forms for notification to NHSE&I can be found here:

https://www.england.nhs.uk/commissioning/primary-care/pharmacy/app-forms/

This should be emailed to [email protected] )

For planned closures, you should make every attempt to discuss the situation with NHSE&I in advance, emailing them at the above address and requesting a call. However, if you have made the necessary notification and you need to close the pharmacy to maintain staff or customer safety, this is a professional decision and the LPC will support you.

Thank you again for all that you are doing.

Changes in professional guidance for registered staff

Professional Judgement
These are unprecedented times, and all Pharmacists will have to make many professional decisions about the most appropriate course of action to take in many scenarios. Your LPC is having continual discussions with all system partners to ensure they understand the pressures and difficulties you face, and that we expect and demand that you receive backing for your actions from commissioners.

Communication is key, so please ensure you keep local surgeries and NHS England informed of significant issues, including any suspension of normal services or regarding contractual matters via [email protected] )

If you have a query in regards to Covid-19 please send an email to;[email protected] )

General Pharmaceutical Council

Please Read-Statement issued to registered staff about using professional judgment in staff and patients’ best interest. Including options such as access to a pharmacist by phone or video link for short durations to allow continuity where all other options have been exhausted. Main point- completed prescriptions could be given out to patients in the absence of the responsible pharmacist for short periods.

Postponement of revalidation submissions

The GPhC has announced that those registrants with a submission date between March and August 2020 will not be required to submit their four CPD records, one peer discussion, and one reflective account on their normal submission due date. Instead, they will be required to submit their full revalidation record on their normal submission due date in 2021; i.e. with their renewal in 2021. Please note that all registrants will be expected to renew their registration as normal in 2020; the postponement only applies to the submission of revalidation records. 

They will review the situation for registrants due to submit their revalidation records after 31 August 2020 at a later date and will keep registrants updated.

Funded Deliveries and Emergency Supply Service

As part of the national response to COVID-19, HM Government is seeking to commission two further services from the community pharmacy sector:

Medicines Delivery Service

Community pharmacy contractors will have seen the news that HM Government and the NHS are to ask around 1.5million people who are at high risk of serious illness from COVID-19 infection to stay at home for a period of 12 weeks. This process is being described as shielding and people identified in the categories of patients that the Government would like to be shielded will receive a letter from the NHS in the next few days.

The following information is being provided to shielded patients in the letter from the NHS:

The government is helping pharmacies to deliver prescriptions. Prescriptions will continue to cover the same length of time as usual. If you do not currently have your prescriptions collected or delivered, you can arrange this by:

1. Asking someone who can pick up your prescription from the local pharmacy, (this is the best option, if possible);

2. Contacting your pharmacy to ask them to help you find a volunteer (who will have been ID checked) or deliver it to you.

You may also need to arrange for the collection or delivery of hospital specialist medication that is prescribed to you by your hospital care team.

PSNC is currently concluding discussions with NHS England and NHS Improvement (NHSE&I) and the Department of Health and Social Care (DHSC) about a new national community pharmacy medicine delivery service to support this group of shielded patients.

We will issue full guidance to contractors as soon as we are able to and we anticipate the service will commence in the next few days.

Information that we can share about the service under negotiation are:

  • This will be a service commissioned nationally by NHSE&I, with associated changes to the Terms of Service for all pharmacies;
  • As noted in the letter to shielded patients, they will be asked in the first instance to have their medicines collected and delivered to them by friends, family or a volunteer, rather than being directed straight to the pharmacy provided delivery service;
  • Patients will be able to ask for support from volunteers, who are part of a national volunteer network which is being mobilised in response to the COVID-19 pandemic; and
  • Contractors will also be able to request support from volunteers to undertake deliveries of prescriptions to any patient, not just those that are being shielded.

Further information and guidance will be published as soon as possible.

  • An NHS Urgent Medicines Supply Service: This would be a service for patients whose GP practice is closed, allowing them to continue receiving their medicines without a prescription. The service will be switched on locally as needed – this has already happened in some locations.

For full details on the Local Funded Emergency Supply Service click here.

Shortages reporting and reimbursement

Reporting medicine shortages

PSNC is aware that there is an increasing number of shortages in the system and that prices are fluctuating significantly from Drug Tariff listings. They are flagging these issues daily and are in urgent talks with DOHSC about how they can protect contractors from the effects of these changes and we hope to have more information soon.

In the meantime, please report shortages to PSNC via this link

Please also restrict quantities of hand soap, hand sanitisers and over the counter medicines such as paracetamol to prevent individuals from stockpiling. These measures are also being implemented in supermarkets

Prescribing intervals 

NHSE, Kernow LMC, Cornwall & Isles of Scilly LPC, and our CCGs are strongly supporting Primary Care guidance which states that prescribing intervals should not be increased during this crisis to protect the supply chain. GPs are being asked to put all eligible patients onto eRD Please let the LPC know of GPs are not sticking to this guidance using [email protected]

Profiteering during the Coronavirus crisis

The Competition and Markets Authority (CMA) wants to ensure that traders do not exploit the current situation to take advantage of people.

It will consider any evidence that companies may have broken competition or consumer protection laws, for example by charging excessive prices or making misleading claims about the efficacy of protective equipment. And it will take direct enforcement action in appropriate cases.

In addition, the CMA will assess whether it should advise the Government to consider taking direct action to regulate prices.

Supporting those released from prison access medication

NHSE has released guidance on how to support those released from prison during COVID-19 pandemic, to access medication. Please see the below link to the letter to Pharmacies.

https://www.england.nhs.uk/coronavirus/publication/preparedness-letters-for-community-pharmacy/