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Local Enhanced Service (Community Pharmacy)

Service Specification for provision of

Pharmacy First Minor Ailments Service

Issue Date: march 2010

Version no: 7Status:Final

Review date: March 2013 Destruction date: September 2013

Document change history

Version Status Summary of changes Date of issue1 Draft First draft based on discussion with Ruth Lacey September 20082 Draft Incorporating comments from KSS September 20083 Final October 20084 Draft Review (due sept 2009) February 20105 Draft Incorporating comments from Karin Lane and PSC March 20106 Draft Comments addressed March 2010

of 23Pharmacy Minor Ailments Service Level Agreement March 2010

Contents

Introduction 3Background 3Nature of the service to be provided 3Service Aims 3Access to the service 4Service specification 4Commencement and duration 4Training and accreditation 4Service description 4Service funding 7Data collection 7Payment mechanism 7Record keeping 8Service activity 8Target outcomes 8Performance monitoring 8Termination of the service 9Confidentiality and Data Protection 9Continuing professional development 10Patient Safety Incident reporting 10Complaints 11Professional Indemnity insurance 11Equity and diversity 11Health and safety 11Agreements 12Contacts and Future Enquiries 12

AppendicesAppendix 1: Service Formulary and Conditions Covered 14Appendix 2: Consultation Form 21Appendix 3: Payment Claim Form 22


Introduction

This Service Specification defines the Pharmacy First Minor Ailments Service (“the Service”) which accredited community pharmacists (“the Pharmacist”) will provide to patients presenting for treatment at pharmacies in Waltham Forest Primary Care Trust (“the PCT”).

1. Background

General practice and unscheduled care providers manage a high level of self limiting or potentially self treatable conditions. Community Pharmacists operating a Pharmacy Minor Ailments Service (the “Service”) can take over the management of a number of patients presenting with a minor ailment who would usually consult a GP or unscheduled care service . The outcomes expected are: A reduced number of inappropriate consultations elsewhere;Improved access to help/alternative support for the patient;Improved patient education with regard to self care;More consistent management of minor ailments, and;Better use of the Pharmacist’s professional skills.

2. Nature and Scope of Service to be provided

2.1 Service Aims

To provide Waltham Forest residents with access to a pharmacist or qualified member of the pharmacy staff who can treat a range of minor ailments, as an appropriate alternative to use of General Practice and unscheduled care services.

To provide the service to users who might otherwise have visited their GP or unscheduled care provider for advice and treatment of minor ailments;

To improve choice, convenience and access to treatment for minor ailments.

To address health inequalities. To provide self care through the pharmacy, including provision of

education and advice, supply of medicines from a limited formulary To make better use of the skills of pharmacists and provide community

pharmacists with an opportunity to extend their role. To improve primary care capacity (freeing up GP appointments in order to

provide more appointments for more complex conditions) by reducing the number of medical practice consultations for minor ailments.

To provide support and advice for patients, including referral to the GP and other healthcare professionals where appropriate.

To provide a quality service that patients find acceptable and useful; To incur reasonable cost that is likely to redeploy resources more

appropriately in other parts of the wider health service.


3. Access to the Service

3.1 Patients may self refer.

3.2 Patients may be referred by the Out of Hours Services, NHS Direct or other relevant contact Health professional person /service in the NHS.

3.3 Patients who telephone or present with identified symptoms at the GP surgery may be assessed by an appropriate health professional and offered transfer into the Service. General practice reception staff will provide a sign posting service where appropriate; however GP appointments must remain available to patients who request them.

SPECIFICATION

4. Commencement and Duration

The Pharmacist will provide the Service strictly in accordance with the specification described in this document. The Service should be provided for the duration of the agreement period between the pharmacy contractor and the PCT. The service specification will be subject to review at 12 monthly intervals or at the discretion of either party.

5. Training and Accreditation

5.1 Eligibility to provide the service is gained by attendance at a PCT training session and submission of a suitable standard operating procedure for the pharmacy. Pharmacists moving to Waltham Forest from other PCTs will be considered subject to references being provided.

5.2 The Pharmacist will ensure that the service specification is strictly followed. This will include the provision of medicines from a limited formulary.

5.3 The Pharmacist will ensure that other staff and locums involved in the provision of the Service have relevant knowledge, are appropriately trained (including sensitive, client centred communication skills), and operate within protocols and standard operating procedures (SOP).

6. Service Description

6.1 All pharmacists including regular locums engaged by the pharmacy contractor must be appropriately trained in the local operation of the Service. This may include in-house training regarding the pharmacy’s standard operating procedure. The pharmacy contractor should provide the Service at all times during core and supplementary opening hours.


6.2 If the pharmacy cannot provide the Service, then the pharmacy should direct the patient to the nearest pharmacy that can. This should be confirmed by a phone call by the directing pharmacy to the accepting pharmacy before re-directing the patient.

6.3 The pharmacy contractor must inform the PCT if they are unable to provide the Service due to any circumstances (on a sessional or daily basis).

6.4 Pharmacy contractors unable to provide the Service must inform their local health community (ie. Out of Hours Service; local general practices; NHS direct; community nurses etc.) not to refer patients to their pharmacy during this period of time (on a sessional or daily basis).

6.5 The area of the pharmacy premises offered for the provision of the Service must provide a sufficient level of privacy and confidentiality. A consultation area/room is desirable for those consultations that may require a higher degree of privacy.

6.6 Pharmacists may prescribe medicines from a limited formulary for the conditions as set out in Appendix 1.

Patients who present with a minor condition covered by the Service will receive a consultation which will consist of: patient assessment by an accredited pharmacist or trained pharmacy

assistant provision of advice on the management of the condition provision of medication from the formulary if/where appropriate and supported

by advice on its use.

Where a patient does not fit the criteria for inclusion into the Service or the Pharmacist considers that the patient should see their GP or another healthcare provider, the patient will be advised to make an appointment in the normal way. If outside normal surgery hours and the Pharmacist assesses that the patient needs immediate treatment then the patient should be directed to the local Out of Hours Service.

6.7 The patient must be present if treatment is requested for minor burns and scalds, lacerations and soft tissue injuries. The patient does not need to be present for other conditions, however the Pharmacist must be satisfied that the request is genuine before providing the Service.

6.8 If in the opinion of the Pharmacist the patient presents with symptoms for conditions NOT covered under the Service they should be dealt with in the usual way or referred back to their GP, Out of Hours Service or another healthcare provider.

6.9 If the Pharmacist suspects that a patient, a patient’s parent or guardian, or a patient’s carer, is using the Service inappropriately then the patient should be advised to make an appointment with their GP practice in the usual way.

6.10 A note must be made on the patient’s consultation form (see Appendix 2) and Patient Medical Record. The pharmacist will use their professional judgment in deciding if the circumstances require a discussion with the patient’s GP, and information will be shared in accordance with relevant information governance arrangements.


6.11 The pharmacist will provide information about a patient’s use of the service to the patient’s GP on request, provided the patient has consented to this on the consultation record. Where a patient has not explicitly consented to information sharing, careful consideration will need to be given as to whether the circumstances justify overruling this, and further advice should be sought. The scope of the service suggests that this should not normally occur.

6.12 Supply of ALL medicines must be in accordance with the Medicines Act 1968 and within the medication’s product licence. Where conditions relating to the supply of any of the items listed in the formulary change between reviews, amendments supercede any placement the product may have in the service formulary, and it is the responsibility of the pharmacist to amend documentation accordingly.

6.13 All medication supplied under the Service must be in original packs and must contain a patient information leaflet (in English).

6.14 Rapid Referral Procedure

If a patient presents with symptoms indicating the need for an immediate consultation with the GP, the Pharmacist should contact the surgery and make an appointment for the patient within an appropriate time frame. If the surgery is closed and/or the symptoms are sufficiently severe the patient should be advised to contact the Out of Hours Service or attend A&E immediately.

It is expected that this will be a very rare occurrence.6.15 For each consultation the Pharmacist must complete the consultation form (see

Appendix 2). In the event of a consultation not leading to a supply of medication, the pharmacist should indicate this on the form and the patient should sign the back to confirm validity.

6.16 Patients who are not exempt from prescription charges will pay an amount equivalent to a prescription charge for each item supplied except where the retail price of the item is less than the prescription charge; in this case the patient will be sold the item and charged the retail price. If the patient is charged the retail price the pharmacist cannot claim a consultation fee: the pharmacist will retain the profit from the sale.

6.17 Patients who are exempt from prescription charges will receive medication supplied under this service free of charge. The Pharmacist should ensure that the patient completes and signs the declaration of exemption on the reverse of the consultation form.

6.18 The pharmacy contractor must develop a standard operating procedure which described how the service will be delivered. This should be reviewed annually and the review documented. A copy of the SOP must be submitted to the PCT prior to commencement of the service.

6.19 The pharmacy contractor may be required to demonstrate it has appropriate health promotion material available relating to the conditions covered by the service, actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate.


6.20 The PCT will be responsible for the development and supply of publicity material. The pharmacy contractor will be required to designate space for the material and must be able to demonstrate that it makes full use of it.

7. Service Funding

7.1 Medicines will be reimbursed at the pharmacy contractor’s cost price + VAT. The cost price will be used by the contractor to prepare an invoice for drugs supplied under the Service.

7.2 The PCT shall have the right to conduct post payment verification checks to confirm that the contractor’s claims for payment are accurate. Evidence supporting the calculation of the cost price should be retained by the contractor for a period of three years for all claims made.

7.3 Professional fees for the consultation will be paid to contractors, as agreed with the Local Pharmaceutical Committee. The consultation fee will be adjusted in line with inflation annually and reviewed every three years

7.6 A consultation fee of £5 will be paid for each consultation that is undertaken with a patient.

8. Data Collection

8.1 Details of consultations undertaken must be recorded on the consultation form or other suitable format provided by the PCT, and the pharmacy PMR system.

9. Payment Mechanism

9.1 The summary claim form (see Appendix 3) should be completed and sent or submitted to the PCT by the 5th day of each month following the month in which the consultations take place. The summary claim form will be provided by the PCT.The PCT will then pay the community pharmacy an amount equal to: the total net ingredient cost of the drugs (+VAT) supplied to patients who paid

a prescription charge and to patients exempt from prescription charges (not those drugs sold Over The Counter).

MINUS prescription charges collected under the scheme

PLUS a sum of money equal to payment required for the professional consultation

service provided by the pharmacist

9.2 Payments will be made to contractors through the Prescription Pricing Division Local Payments Facility. Any claims received after the 5th of the month will be processed the following month.

9.3 Medication supplied by retail sale is not to be included in this calculation. Supply by this route will remain a transaction between the community pharmacy and the patient. This method of supply may not be recorded on the consultation form in order for the pharmacy to receive a consultation fee.

9.4 Claims should be submitted each month. Payment for claims older than three months, unless agreed in advance and with good cause, will not be honoured.


10. Record Keeping

10.1 The pharmacist must keep ALL completed consultation forms for a period of 2 years from the date of the consultation, unless agreed otherwise during post-payment verification. Electronic patient records should also be kept, to support this service and to meet terms of service of the NHS (pharmaceutical services) regulations 2005.

10.2 The pharmacy must maintain appropriate records to ensure effective ongoing service delivery and audit. Records will be confidential and should be stored securely.

10.3 The PCT will provide a framework for the recording of relevant service information. This framework comprises the consultation form and the referral form (Appendix 2).

11. Service Activity

11.1 The pharmacy should provide the service at all times during its core and supplementary opening hours, and during any commissioned out-of-hours or bank holiday rota.. The pharmacy must inform the PCT Pharmacy contracts manager if they are unable to provide the service due to whatever circumstance. Where notification is absent the PCT reserves the right to impose penalties for consistent non delivery of service.

12. Target Outcomes

12.112.2

To provide a quality service that reflects the service specification.To provide a service to patients that demonstrably reduces attendances at General Practice or other unscheduled care provider.

13. Performance Monitoring

13.1 The pharmacy must fully comply with the terms of service (contract regulations) for Essential Services before enhanced services can be provided.

The PCT retains the right to monitor any part of the Pharmacy Minor Ailments Service provided by the community pharmacist to ensure the continued quality of service at any time. The scheme will also be evaluated according to its stated aims and objectives.

13.2 The pharmacy will co-operate with any locally agreed PCT led assessment of service user experience or audit of the service.

13.3 Changes to the level or quality of the service will not be introduced without prioragreement with the PCT. Changes will be authorised in writing.


13.4 Post payment verification checks will be undertaken periodically by the PCT.

14. Termination of the Service

14.1 The PCT reserves the right to stop the service in one or all of the provider’s pharmacies if: a pharmacist fails to comply with the service specification. there are prolonged periods of time where the pharmacy is unable to provide

the service. This will depend on individual circumstances but normally a single period of one week or 5 occasions of a whole day without good cause, or notice being given to the PCT.

if at any time it becomes clear that the service will cost more than the allocated budget. This decision will be made in full consultation with the community pharmacy development group, the Local Pharmaceutical Committee and the PCT. All pharmacies will be given 30 days notice in writing

the individual pharmacist and/or contractor acts outside the ethical governance framework for the profession, brings the profession into disrepute, or is subject to an NHS or professional disciplinary process. In this case the termination of the service will be with immediate effect.

14.2 If any of the above circumstances apply, the PCT will be responsible for informing

GP practices and patients of the changes to the service.

14.3 Community Pharmacy contractors reserve the right to leave the service at any point. However in this case it is the contractor’s responsibility to inform patients and GP practices.

Contractors must give the PCT Pharmacy First Minor Ailments Service Contact 30 days notice in writing. During this 30 day period the contractor must continue to provide a full service for its patients.

15. Confidentiality and Data Protection

15.1 The pharmacy will provide a non-judgmental, patient centred, confidential service.The pharmacist must not disclose to any person other than authorised by the PCT or the patient, any information acquired by them in connection with the provision of the service which concerns.

The PCT, its staff or procedures The identity of any service user The medical condition or any treatment received by any service user

15.2 In exceptional circumstances, for example where there is a safeguarding concern,


then the pharmacist may need to disclose information without the patient’s consent or against their wishes. In these circumstances the pharmacists must comply with local and national policies and should seek advice if there is any doubt. The pharmacist must be prepared to justify their decision to the patient, if appropriate, and to the Courts if called on to do so. Any such disclosures should be documented at the earliest opportunity.

15.3 Pharmacists may need to share relevant information with other health care professionals and agencies, in line with locally determined confidentiality and data security arrangements, including, where appropriate, the need for the permission of the patient to share the information.

15.4 The pharmacy must protect personal data in accordance with provisions and principles of the Data Protection Act 1998 and relevant Information Governance requirements.

15.5 The pharmacist must ensure that all their staff conform to the NHS Code of Practice on Confidentiality and data protection, and ensure that all staff involved with the service are appropriately trained, in accordance with Information Governance requirements.

16. Continuing Professional Development

16.1 All pharmacists providing the service must ensure that they continually and regularly update their knowledge and treatment of minor ailments as part of their Continuing Professional Development. This may include independent review of the service formulary if licensing or usage recommendations change between scheduled formulary reviews.

16.2 Updates are recommended every two years or as directed by the PCT , which may be in the form of a self declaration of competency or other method of assessment as considered appropriate by the accrediting PCT.

16.3 Where there are concerns regarding poor performance, this will be addressed separately as a clinical governance matter.

17. Patient Safety Incident Reporting

17.1 The pharmacy must have an adverse incident and near miss reporting system in place which includes maintaining a log of patient safety incidents.The pharmacy should be able to demonstrate that it has learnt from an event.

17.2 Patient safety incidents directly linked to this service must be additionally be reported to the PCT.

17.3 Any patient safety alerts or recommendations that are issued between service reviews must be incorporated into the pharmacy’s delivery of the service.


18. Complaints

18.1 The pharmacy must have a complaints procedure that complies with current national standards.

Complaints directly linked to this service must additionally be reported to the PCT who reserve the right of directly investigating any complaints about the service.

18.2 Feedback both positive and negative should be forwarded to the PCT Community Pharmacy Contracts Manager in order that action can be taken to amend the service as necessary.

18.3 Any issues from pharmacist contractors or GPs relating to the service itself should be directed to the PCT Pharmacy First Minor Ailments Service Contact.

19. Professional Indemnity Insurance

19.1 It is the responsibility of the contractor/accredited pharmacist to maintain insurance in respect of public liability and personal indemnity against any claims, whatsoever, which may arise out of the terms, conditions and obligations of this agreement.

20. Equality and Diversity

20.1 The pharmacist/pharmacy staff must comply with requirements of the Race Relations Act of 1976 and the Race Relations (Amendment) Act 2000, and will not treat one group of people less favourably than others because of their colour, race, culture, religion, gender, nationality, age, marital status, sexual orientation, disability or ethnic origin.

21. Health and Safety

21.1 The community pharmacy shall comply with the requirements of the Health and Safety at Work Act 1974, the management of health and safety at work regulations 1999 and any other acts, regulation, orders or rules of law pertaining to health and safety.


LEAD OFFICERS FOR AGREEMENT

The lead commissioning officer for this agreement is:Name: Carol RobertsPosition: Head of Medicines ManagementAddress: NHS Waltham Forest

4th Floor Kirkdale House7 Kirkdale RoadLondonE11 1HP

Telephone: 020 8430 7372Email: [email protected]

The PCT Pharmacy First Minor Ailments Service Contact is: Name: Karen Samuel-SmithPosition: Community Pharmacy Contracts ManagerAddress: NHS Waltham Forest

4th Floor Kirkdale House7 Kirkdale RoadLondonE11 1HP

Telephone: 020 8430 7313Email: [email protected]

The lead service provider officer for this agreement is:

Name: ………………………………………..

Position: ………………………………………..

Pharmacy: ………………………………………..

Address:

Telephone: ………………………………………

Email: ………………………………………


SIGNING OF THE AGREEMENT

This document and the attached notes comprise the Agreement concluded between Waltham Forest PCT and the pharmacy contractor named above.

SIGNED (on behalf of the PCT):

Date:

SIGNED (Pharmacy Contractor ) ………….............………………………………...

Date:………………………...….….

A copy of this service specification to be held in the Pharmacy First Minor Ailments Service folder in the participating pharmacy.


Appendix 1Conditions covered and formulary

1. Viral and URTI1.1 Colds and flu1.2 Sore throat1.3 Fever1.4 Post immunisation fever1.5 Nasal congestion1.6 Cough (advice or referral)1.7 Earache2. Dermatology2.1 Eczema/dermatitis2.2 Allergic rash2.3 Bites/stings2.4 Sunburn2.5 Nappy rash2.6 Seborrhoeic dermatitis2.7 Acne3. Pain3.1 Headache3.2 Toothache3.3 Sprain/strain3.4 Soft tissue injury3.5 Teething3.6 Minor burns3.7 Lacerations

4. Gastro-intestinal4.1 Constipation4.2 Diarrhoea4.3 Indigestion/dyspepsia4.4 Haemorrhoids4.5 Mouth ulcers4.6 Infant colic5. Women’s health5.1 Cystitis5.2 Vaginal candidiasis5.3 Dysmenorrhoea5.4 Cracked/sore nipples6. Miscellaneous6.1 Hay feverMiscellaneous infections6.2 Athletes’ foot6.3 Warts and verrucae6.4 Conjunctivitis6.5 Cold soresMiscellaneous infestations6.6 Headlice6.7 Scabies6.8 Threadworms


Condition DrugViral and URTI

Colds and flu Ibuprofen S/F suspension 100mg/5ml (100ml)Colds and flu Ibuprofen tablets 200mg (12/24)Colds and flu Ibuprofen tablets 400mg (12/24)Colds and flu Menthol and Eucalyptus inhalation (100ml)Colds and flu Paracetamol S/F suspension 120mg/5ml (100ml)Colds and flu Paracetamol S/F suspension 250mg/5ml (100ml)Colds and flu Paracetamol tablets 500mg (32)Colds and flu Paracetamol tablets 500mg soluble (24)Colds and flu Sodium Chloride 0.9% nasal drops (10ml)Colds and flu Soluble Aspirin 300mg (32)Sore throat Ibuprofen S/F suspension 100mg/5ml (100ml)Sore throat Ibuprofen tablets 200mg (12/24)Sore throat Ibuprofen tablets 400mg (12/24)Sore throat Paracetamol S/F suspension 120mg/5ml (100ml)Sore throat Paracetamol S/F suspension 250mg/5ml (100ml)Sore throat Paracetamol tablets 500mg (32)Sore throat Paracetamol tablets 500mg soluble (24)Sore throat Soluble Aspirin 300mg (32)Fever associated with viral URTI Ibuprofen S/F suspension 100mg/5ml (100ml)Fever associated with viral URTI Ibuprofen tablets 200mg (12/24)Fever associated with viral URTI Ibuprofen tablets 400mg (12/24)Fever associated with viral URTI Paracetamol S/F suspension 120mg/5ml (100ml)Fever associated with viral URTI Paracetamol S/F suspension 250mg/5ml (100ml)Fever associated with viral URTI Paracetamol tablets 500mg (32)Fever associated with viral URTI Paracetamol tablets 500mg soluble (24)Post-immunisation fever Ibuprofen S/F suspension 100mg/5ml (100ml)Post-immunisation fever Ibuprofen tablets 200mg (12/24)Post-immunisation fever Ibuprofen tablets 400mg (12/24)Post-immunisation fever Paracetamol S/F suspension 120mg/5ml (100ml)Post-immunisation fever Paracetamol S/F suspension 250mg/5ml (100ml)Post-immunisation fever Paracetamol tablets 500mg (32)Post-immunisation fever Paracetamol tablets 500mg soluble (24)Nasal Congestion Menthol and Eucalyptus Inhalation (100 ml)Nasal Congestion Sodium Chloride Nasal Drops 0.9% (10ml)Nasal Congestion Xylometazoline 0.05% Nasal Drops (10ml)Nasal Congestion Xylometazoline 0.1% Nasal Spray (10ml)Cough Advice and patient educationEarache Ibuprofen Susp SF 100mg / 5ml (100ml)Earache Ibuprofen Tablets 200mg (12/24)Earache Ibuprofen tablets 400mg (12/24)Earache Paracetamol 500mg Tablets (32)Earache Paracetamol tablets 500mg soluble (24)Earache Paracetamol Susp SF 120mg / 5ml (100ml)Earache Paracetamol Susp SF 250mg / 5ml (100ml)


Condition DrugDermatological

Eczema / Contact Dermatitis / itch Aqueous Cream (500g)Eczema / Contact Dermatitis / itch Crotamiton cream (30g)Eczema / Contact Dermatitis / itch Emulsifying Ointment (500g)Eczema / Contact Dermatitis / itch Eumovate Cream (15g)Eczema / Contact Dermatitis / itch Hydrocortisone 1% Cream (15g)Allergic Rash Cetirizine 10mg tablets (7 tabs)Allergic Rash Chlorphenamine 2mg/5ml Syrup (150ml)Allergic Rash Chlorphenamine 4mg tablets (30 tabs)Allergic Rash Crotamiton cream (30g)Allergic Rash Hydrocortisone 1% cream (15g)Allergic Rash Loratadine 10mg tablets (7 tabs)Allergic Rash Loratadine 5mg/5ml liquid (100ml)Bites / stings Cetirizine 10mg tablets (7 tabs)Bites / stings Chlorphenamine 2mg/5ml Syrup (150ml)Bites / stings Chlorphenamine 4mg tablets (30 tabs)Bites / stings Crotamiton cream (30g)Bites / stings Hydrocortisone 1% cream (15g)Bites / stings Loratadine 10mg tablets (7 tabs)Bites / stings Loratadine 5mg/5ml liquid (100ml)Bites / stings Aqueous Calamine cream (100g)Sunburn Aqueous Calamine cream (100g)Sunburn Ibuprofen S/F suspension 100mg/5ml (100ml)Sunburn Ibuprofen tablets 200mg (12/24)Sunburn Ibuprofen tablets 400mg (12/24)Sunburn Paracetamol S/F suspension 120mg/5ml (100ml)Sunburn Paracetamol S/F suspension 250mg/5ml (100ml)Sunburn Paracetamol tablets 500mg (32)Sunburn Paracetamol tablets 500mg soluble (24)Nappy rash Drapolene (100g)Nappy rash Zinc and Castor Oil Ointment (100g)Seborrhoeic Dermatitis Ketoconazole Shampoo (120ml)Acne Panoxyl Aquagel 2.5% (40g)


Condition DrugPain inc headache, toothache, joint, sprains, soft tissue and musculoskeletal pain

Pain Ibuprofen Susp SF 100mg / 5ml (100ml)Pain Ibuprofen gel 5% (50g)Pain Ibuprofen tablets 200mg (12/24)Pain Ibuprofen tablets 400mg (12/24)Pain Paracetamol soluble tablets (24)Pain Paracetamol tablets 500mg (16 tabs)Pain Paracetamol tablets 500mg (32 tabs)Sprains and strains Transvasin cream (40gm)Sprains and strains Tubular bandages (B - 0.5m)Sprains and strains Tubular bandages (B - 1m)Sprains and strains Tubular bandages (C - 0.5m)Sprains and strains Tubular bandages (C - 1m)Sprains and strains Tubular bandages (D - 0.5m)Sprains and strains Tubular bandages (D - 1m)Sprains and strains Tubular bandages (E - 0.5m)Sprains and strains Tubular bandages (E - 1m)Sprains and strains Tubular bandages (F - 0.5m)Sprains and strains Tubular bandages (F - 1m)Sprains and strains Tubular bandages (G - 0.5m)Sprains and strains Tubular bandages (G - 1m)Soft tissue injury Crepe bandages (10cm)Soft tissue injury Crepe bandages (15cm)Soft tissue injury Crepe bandages (5cm)Soft tissue injury Crepe bandages (7.5cm)Teething Ibuprofen S/F suspension 100mg/5ml (100ml)Teething Paracetamol S/F suspension 120mg/5ml (100ml)Teething Paracetamol S/F suspension 250mg/5ml (100ml)


Condition DrugMinor burns / lacerations

Minor burns / lacerations DuoDERM Extra Thin (5cm x 10cm)Minor burns / lacerations DuoDERM Extra Thin (7.5cm x 7.5cm)Minor burns / lacerations Ibuprofen tablets 200mg (24)Minor burns / lacerations Ibuprofen tablets 400mg (24)Minor burns / lacerations Mefilm (6cm x 7cm)Minor burns / lacerations Melolin (10cm x 10cm)Minor burns / lacerations Melolin (5cm x 5cm)Minor burns / lacerations Micropore (1.25cm x 5m)Minor burns / lacerations Micropore (2.5cm x 5m)Minor burns / lacerations Micropore (5cm x 5m)Minor burns / lacerations Opsite Flexigrid (6.5cm x 5cm)Minor burns / lacerations Opsite Flexigrid (6cm x 7cm)Minor burns / lacerations Paracetamol soluble tablets (24)Minor burns / lacerations Paracetamol tablets 500mg (16 tabs)Minor burns / lacerations Paracetamol tablets 500mg (32 tabs)Minor burns / lacerations Sodium Chloride 0.9% sterile solution (25ml)Minor burns / lacerations Tegaderm (6cm x 7cm)

GastrointestinalConstipation Glycerol Suppositories 2g (12)Constipation Glycerol Suppositories 4g (12)Constipation Senna Tablets (20)Diarrhoea Dioralyte Sachets (6)Diarrhoea Loperamide Capsules (6)Dyspepsia / indigestion Gaviscon Advance Liquid (150ml)Dyspepsia / indigestion Gaviscon liquid (150ml)Dyspepsia / indigestion Gaviscon tablets 250 lemon/peppermint (16)Dyspepsia / indigestion Co-magaldrox suspension (300mL)Dyspepsia / indigestion Ranitidine tablets 75mg (12)Dyspepsia / indigestion Ranitidine tablets 75mg (6)Dyspepsia / indigestion Domperidone (Motilium 10) 10mg Tablets (10)Dyspepsia / indigestion Omeprazole 10mg Tablets (14)Haemorrhoids Anusol cream (23g)Haemorrhoids Anusol ointment (25g)Haemorrhoids Anusol plus HC ointment (15g)Haemorrhoids Anusol plus HC suppositories (12)Haemorrhoids Anusol suppositories (12)Haemorrhoids Lactulose Solution (300ml)Mouth ulcers Adcortyl in Orabase for mouth ulcers (5g)Mouth ulcers Benzydamine oral rinse (300ml)Mouth ulcers Chlorhexidine mouthwash (300ml)Mouth ulcers Choline salicylate compound gel (Bonjela) (15g)Mouth ulcers Ibuprofen S/F suspension 100mg/5ml (100ml) Mouth ulcers Paracetamol S/F suspension 120mg/5ml (100ml) Mouth ulcers Paracetamol S/F suspension 250mg/5ml (100ml) Infant Colic Infacol Suspension 40mg/ml (50ml)

Condition DrugGynaecological (inc. urological)


Cystitis Cystopurin (6)Cystitis Potassium Citrate Mixture (200mL)Vaginal Candidiasis Clotrimazole 10% cream with applicator (5g)Vaginal Candidiasis Clotrimazole combination pack pessary/cream (Canesten combi) Vaginal Candidiasis Clotrimazole cream 1% (20g)Vaginal Candidiasis Clotrimazole pessary 500mg (500mg)Vaginal Candidiasis Clotrimazole thrush cream 2% (20g)Vaginal Candidiasis Fluconazole 150mg cap (Generic)Dysmenorrhoea (Period Pain) Ibuprofen Tablets 200mg (24)Dysmenorrhoea (Period Pain) Naproxen 250mg Tablets (9)Dysmenorrhoea (Period Pain) Paracetamol 500mg Tablets (32)Dysmenorrhoea (Period Pain) Paracetamol soluble tablets (24)Cracked / Sore Nipples Paracetamol 500mg Tablets (32)Cracked / Sore Nipples Paracetamol soluble tablets (24)Cracked / Sore Nipples White Soft Paraffin (100g)

Hay FeverHay Fever Beclomethasone nasal spray (100 doses)Hay Fever Beclomethasone nasal spray (180 doses)Hay Fever Cetirizine liquid 1mg/ml (100ml)Hay Fever Cetirizine tablets 10mg (30)Hay Fever Chorphenamine (chlorpheniramine) liquid 2mg/5ml (150ml)Hay Fever Chorphenamine (chlorpheniramine) tablets 4mg (28)Hay Fever Loratadine syrup 5mg/5ml (100ml)Hay Fever Loratadine tablets 10mg (30)Hay Fever Sodium cromoglycate eye drops (10ml)

Warts and VerucaeVerruca / warts Bazuka (5g)Verruca / warts Salactol paint ®

Miscellaneous InfectionsAthlete's foot Clotrimazole cream (20g)Athlete's foot Miconazole 2% cream (15g)Athlete's foot Miconazole spray powder (100g)Athlete's foot Terbinafine cream (7.5g)Athlete's foot Terbinafine gel (15g)Athlete's foot Terbinafine spray (15ml)Conjunctivitis Chloramphenicol 0.5% Eye Drops (10ml) Conjunctivitis Chloramphenicol 1% Eye Ointment (4g)Cold sores Aciclovir 5% cream 2g


ConditionDrug

Miscellaneous InfestationsHeadlice Hedrin 4% (150ml)Headlice Hedrin 4% (50ml)Headlice Nit comb with single rowHeadlice Phenothrin liquid and lotion (200ml)Headlice Phenothrin liquid and lotion (50ml)Headlice Wet combs pack (Bug Buster Kit)Headlice Malathion lotion (aqueous and alcoholic) (200ml)Headlice Malathion lotion (aqueous and alcoholic) (50ml)Scabies Cetirizine 10mg Tablets (7)Scabies Cetirizine Oral Solution 5mg / 5ml (150ml)Scabies Chlorpenamine 2mg / 5ml Syrup (150ml)Scabies Chlorphenamine 4mg Tablets (30)Scabies Malathion 0.5% Aqueous Liquid (50ml)Scabies Permethrin Dermal Cream (30g)Threadworm Mebendazole tablet 100mg (2 Tabs)Threadworm Piperazine phos. powder (4g) (dual dose sachet)


Appendix 2: CONSULTATION FORM

CONSULTATION FORM

PART A: to be completed by the patient/ patient’s representative or pharmacy staffPlease complete this section. If you need help with this form please ask a member of staff. Patient detailsTitle: First Name: Surname:

Address:

Ethnicity: Postcode:

Date of Birth: Gender: Male Female

GP Practice:

Have you visited another pharmacy with this illness before coming here? Yes No Have you used this service before? Yes No

PART B: to be completed by a member of pharmacy staff Consultation detailsPharmacy (stamp): Pharmacist/Staff Name: Date of consultation:

DD MM YY

Time of consultation:

HH MM

AMPM

How did the patient access this service:Self Referral Referral from GP Referral from Out of Hours Referral from A&E Referral from NHS Direct Other - please state:

Presenting condition(use WF pharmacy first service code) _______________

Outcome (tick one only)Advice only Advice and Medicine(s) supplied Advice and Referral

Name of Medicine(s) Quantity1

2

If the patient was referred on: which provider?General Practitioner Out of Hours Service Other, please state:Accident and Emergency EUCC _________________________

Reason for onward referral:Condition/age not included in scheme Patient requires medical input Other - please state:


PART C: Patients who do not have to pay (or their representative) must fill in parts 1 and 3.

Those who do have to pay must fill in parts 2 and 3

The patient does not have to pay because he/she:A is under 16 years of ageB is 16, 17 or 18 and in full-time educationC is 60 years of age or overD has a valid maternity exemption certificateE has a valid medical exemption certificateF has a valid prescription prepayment certificateG has a valid war pension exemption certificateL is named on a current HC2 charges certificateH gets income supportK gets income-based jobseeker’s allowanceM is entitled to, or named on, a valid NHS tax credit exemption certificate

If Over The Counter charge made, please enter price, otherwise prescription charge

I have paid £

DATA PROTECTION AND CONFIDENTIALITY Confirmation

I am the patient I am the patient’s representative

The Primary Care Trust and its staff may review consultation information in order to monitor the quality of the care you have received. The staff will be working in accordance with the NHS code on patient confidentiality

I consent to information about my (or the patient’s) consultation being reviewed in the manner detailed above (please tick ONE box) Yes No

Information about this consultation may be shared with your GP if the pharmacist thinks it is important to update your (or the patient’s) record of treatment.

I consent to the pharmacist notifying my (or the patient’s) GP of the treatment I have (or the patient has) received, if appropriate. Yes No

I confirm that:A) I have received:____ (please enter number) items of medicationB) No medication has been issued to me on this occasion

Signature Date

Your pharmacist is providing treatment and/or advice under the Pharmacy Minor Ailments Scheme in line with the symptoms you have described. If your symptoms persist you should seek further advice from your doctor. Please advise the doctor which pharmacy you have attended and what advice and/or treatment you have already received from the pharmacist.


Appendix 3 Payment Claim FormLocal Enhanced Services PaymentsMinor Ailments and Sexual Health

Contractor code: For Month: Pharmacy name:Pharmacy Address:

Please send for authorisation to:Community Pharmacy Contracts ManagerNHS Waltham Forest4th Floor Kirkdale House7 Kirkdale RoadLondonE11 1HP

Claims received by 5th of the month will be paid through the PPD Local Payments system for that month. Any claims that miss that date will be carried over to the following month. Claims more than 3 months old will be returned unpaid.Pharmacy First Minor Ailments Scheme Sexual Health LESNumber of consultations Emergency ContraceptionConsultation fees (£5 ea.) Consults patients ≥18 @ £15Medicines Cost Consults patients under 18 @ £20V.A.T. on medicines Levonelle® costs (Drug Tariff)Total Pharmacy First V.A.T. on Levonelle®

Pregnancy tests @ £8Condom supplies @ £1Total Sexual Health

Supporting documentation:DO NOT send any patient identifiable information to the PCT with regard to any of these services.

Pharmacy First Minor Ailments: Records should be kept in the pharmacy for post-payment verification. Emergency Contraception: White copy is retained in pharmacy for 10 years or until client’s 26th birthday,

whichever is longer. Pink copies should be sent to the PCT, taking care to obscure patient’s name, signature and full postcode.

Pregnancy Tests: Please return the Pregnancy Test Recording Sheet to support claims and to provide data for PCT monitoring.

Condom Supplies: Please return the Condom Distribution Record to support claims and to provide data for PCT and LBWF monitoring.

I declare that the pharmacy has carried out consultations is accordance with the NHS Waltham Forest Local Enhanced Service Level Agreements, and claim payment as above.I understand that the PCT may carry out post-payment checks to verify this, and that fraudulent claims will lead to action being taken.Signed…………………………………………………………………………….. Date………………….

Print Name………………………………………………………………………………………………….For office use only

Date entered on payment schedule

Date submitted to PPD


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