List 6 ways that pharmacies make money?
Locally commissioned services
Private prescription and pharmacy services
- Pharmacy sales
Specialist services = supplies to prisons/hospices/MOD
List the 3 tiers of service that pharmacies provide if they have an NHS contract
- Essential services
- Advanced services
- Enhanced/locally commissioned services
Describe essential services
- Paid for offering the whole NHS service and for each patient interaction for dispensing
- E.g. dispensing, sign-posting, promoting healthy lifestyle, clinical governance = SOPs
Describe advanced services
- Paid for each patient interaction
MURs, New Medicine Service (info when first dispensed)
Describe enhanced/locally commissioned services
- Paid for each patient interaction
Out of hours, palliative care services, services to schools
What does PMR stand for?
Patient medication record
What 4 things must be included in a PMR?
- Clinical interventions
List the 4 extra services that pharmacies must provide to supplement the requirements of the NHS contract (with no NHS payment)
Prescription collection service
Compliance aids (e.g.monitored dosage systems, MDS)
Care home services
What are repeat prescriptions?
- No need to see GP each month
- Patients can use the repeat request form to reorder medication
- Can also use surgery websites/email/fax to reorder
What is the prescription collection service?
Pharmacy collects prescription from GP so patient doesn't have to drop it in
- They are called when prescription is ready
What is the keep repeat service?
Pharmacy keeps the repeat form and patients phone/email/call in to order medication
- Pharmacy orders medication from GP surgery and collects prescription
What is the managed repeat service?
Pharmacy orders items and collects prescription for the patient
What are compliance aids?
7 day packs
- Each day has time sections
- Tablets/capsules are put in appropriate blister
- Examples = dossette boxes, NOMAD, Medisure
- Pharmacist must be satisfied that patient can use the device safely
What are care home services?
- Medicines for residents of care homes packed into individual blister packs
Colour co-ordinated for different times of day
Easier and safer for care home staff
What is repeat dispensing?
Up to 12 months of prescriptions are issued at once so the patient doesn't need to return to the GP Only for patients on stable medication - pharmacists's responsibility to ensure suitability Formatted for EPS2
What does RA stand for?
Repeatable authorisation form
What is an RA form?
- Only 1
- Not to be dispensed
Number of repeats required
What does RD stand for?
Repeat dispensing batch prescription
What is an RD?
- Many copies
Specifies which repeat
- Can be enough to last 12 months
Describe the disposal of waste medication (essential service)
Unwanted or out of date medication can be returned
- NHS pays for specialist waste contractor
- Can accept waste from care homes
- No sharps/chemicals
Describe the support for self-care service (essential service)
- Provision of advice for self limiting illness (RTS) and long term conditions
- Document interventions
Where can pharmacists signpost patients?
- Information service
- Local support group
- Other healthcare professionals
What are the 5 nationally-commissioned advanced services?
MUR and prescription intervention service
New medicines service
Flu vaccination service
- Appliance use review
Stoma appliance customisaton service
What is the aim of MURs?
Aim is to improve patient knowledge, adherence and use of their medicines
How do MURs achieve their aim?
- Identifying poor or ineffective use of medication
- Identifying side effects/drug interactions that may affect adherence
- Reducing medicine wastage
What must pharmacists have in order to carry out MURs?
- Be accredited through completion of a recognised course
- Be satisfactorily complying with essential services
- Have appropriate SOPs in place
- Have a suitable consultation area
What 4 things are MURs designed to review?
- If patient takes their medication
How they take their medication
- If they have problems with their medication
- Assesses if medication is appropriate and is cost-effective
What 5 things make a patient eligible for an MUR?
- Must take at least 2 medications for chronic conditions (one if high risk medicine)
- Must have been using the pharmacy for the previous 3 months
- Must not have had an NMS in the last 6 months
- Must not have had an MUR in the previous 12 months
- Must be able to provide signed consent
Which 4 categories of patients are targeted for MURs?
- Patients taking high risk medicines e.g. anticoagulants, diuretics, NSAIDs
- Patients recently discharged from hospital
- Patients with respiratory diseases (asthma, COPD)
- Patients at risk of/diagnosed with CV disease and regularly prescribed for at least 4 medicines
What is a prescription intervention prompted by?
Significant problem with patients medication