On the 5th of January P3 Pharmacy magazine published an article by Susan Hunneyball, Healthcare Regulatory Lawyer.
See the full article below.
“The Community Pharmacy Consultation Service is up and running. The stated aims include bringing community pharmacy into the front line of the urgent care system and increasing patient awareness of the role of community pharmacy. This is a huge win for the image of pharmacies as providers of effective and professional healthcare and a move away from the outdated view of a pharmacy as just a retail emporium with overheads.
Pharmacists have had many top tips on the service but here are a few more from a legal point of view:-
Diversion of prescriptions
The service specification states that “the service must not be used to divert or attempt to change the patient’s use of their usual pharmacy”.
Direction of prescriptions is well known as an issue in community pharmacy and this requirement supports the established position that it is patients who choose which pharmacy they attend rather than pharmacists or GPs. The difficulty here is that under the CPCS pharmacists are offering support to a patient when they really need it. If the pharmacist does the job well, the patient will be happy (usually) and may well want to use that pharmacy again. The pharmacist should make sure there is a note of the conversation they have had about how the patient’s usual community pharmacy would be able to support the patient. Ultimately though it is the patient’s .
It seems unlikely that bias will creep into the system through 111 call handlers: a blog from call handlers on NHS Digital suggests that they will receive systems driven recommendations based on distance and availability of services. These recommendations may not always lead to the most geographically appropriate pharmacy as they are distances as the “crow flies” rather than the distance by road but it seems likely that the call handler will just present the information on the system rather than making recommendations. The GP surgery receptionist will, on the other hand, get to know who is offering a good service because of the pharmacist’s obligation to inform a GP of an intervention where clinically appropriate.
Consultation of Summary Care Records (SCR)
The service specification says the pharmacist must consult the SCR if the referral from 111 is about Urgent Medicines Supply unless there is good reason not to. However the NHS England guidance says that verification can be simply examining physical evidence such as repeat medication slip or current labelled medication. The pharmacist should be able to justify the decision not to access SCR with reference to a contemporaneous note.
Onward referral
If the pharmacy cannot supply medication, having made a decision that supply is appropriate, then there is provision for onward referral to another pharmacy, and that pharmacy will also be paid the fee. There does not appear to be anything in the service specification or guidance to say that there cannot be a branch to branch referral if the related pharmacy is convenient for the patient. However, there is bound to be monitoring of the service and pharmacies that constantly refer on to one branch are likely be picked up as outliers when the payment pattern is scrutinised.
Labelling requirement
The service specification is silent on labelling and the labelling requirements of the Human Medicines Regulations must be followed. NHS guidance adds that the words “Emergency Supply” should be on the label in the way it recommends for an emergency supply outside CPCS. This is beyond the requirements of the HMR but clearly good practice.
Liability
The duty of care of a pharmacist will extend to the acts carried out while providing the CPCS. The CPCS will involve a pharmacist exercising professional judgment and discretion and if they get it wrong there could be a claim. The pharmacist’s duty of care will, of course, extend to the situation where the system goes wrong and there is a patient standing at the pharmacy door with no proper referral notification. It will also extend to the position in the future when the patient understands the expertise that a pharmacist can offer and bypasses the 111 system to come straight to the pharmacy. This responsibility is part of the pharmacist’s role as a clinical and the scenarios above are no different to the pharmacist exercising their professional discretion all other circumstances.
However, the fact that the CPCS is an NHS Commissioned service will also mean that the local NHS Area Team will be scrutinising the ongoing ability of the pharmacy to provide the service. If there are problems with the service provision the NHS 111 directory of services will be amended to stop referrals until the issue is resolved. If this suspension of service is carried out unfairly there would be legal remedies available.
In summary, there are elements of the CPCS that pharmacists need to be careful about but it is an opportunity to deliver a valuable local service.”
About the Author
Healthcare Regulatory Lawyer
D.D: 01483 366064
Tel: 01483 451900
Email: susan@gordonsols.co.uk