Nhs Pharmacy Notes

Understanding the NHS and Community Pharmacy: Detailed Notes 1. Structure of the NHS National Level • Department of Health & Social Care: Sets overall policy and strategy for health services. • NHS England: Oversees NHS services and implements national strategies. • NHS England Regional Teams: Manage regional implementation. • Care Quality Commission (CQC): Provides regulatory oversight of health and social care, monitors performance, and ensures quality standards. • Monitors overall performance of ICS and local providers. ICS / Regional Level • 42 Integrated Care Systems (ICS) across England. • Integrated Care Boards (ICBs): Monitor funding, develop plans to meet population health needs. • Integrated Care Partnerships (ICPs): ICS-wide strategy; address public health, social care, and wider determinants of health. Local / Place Level • Primary Care Networks (PCNs): Coordinate local primary care services. • Local Authorities: Oversee public health and social care provision. Service Providers • Primary care (GPs, community services) • NHS Trusts • Non-NHS providers (private & voluntary) • Local public health services & social care Diagram Suggestion: Flowchart showing NHS hierarchy: National → ICS → Local → Service providers 2. Community Pharmacy in England Community Pharmacy Contractual Framework (CPCF) • Contracts and commissions pharmacies. • Sets required services and quality standards. • Ensures pharmacies deliver essential, advanced, and locally commissioned services. 1 Funding • Negotiated by Pharmaceutical Services Negotiating Committee (PSNC) with NHS England & DHSC. • Two main funding aspects: • Fees and Allowances: Payment for services provided. • Retained Margin: Profit from cost-effective purchasing (calibrated via Category M in Drug Tariff). Fees and Allowances • Single Activity Fee: Payment per item dispensed. • Transitional Payments: Based on dispensing volume & clinical activity. • 2A–2F Fees: Drug tariff payments. • Pharmacy Quality Scheme (PQS): Rewards quality achievement. • Pharmacy Access Scheme: Ensures baseline patient access. Services within CPCF • Essential Services: All pharmacies • Repeat dispensing • Discharge medicines service • Public health campaigns (6/year) • Healthy Living Pharmacy initiative • Self-care and signposting • Disposal of unwanted medicines • Advanced Services: Accredited pharmacies • Appliance Use Review • Flu vaccination • Hypertension case-finding • Lateral flow testing • New Medicines Service (NMS) • Pharmacy contraception services • Pharmacy First • Smoking cessation • Stoma appliance customisation • Locally Commissioned Services: Tailored to local population needs. Pharmacy Quality Scheme (PQS) • Rewards quality in: • Clinical effectiveness • Patient safety • Patient experience • Gateway criteria: Must be met to receive payment. • NMS (15 areas) • Medicines optimisation 2 • Respiratory care • Prevention (AMS, vaccinations, etc.) Respiratory Domain Criteria: - 3+ bronchodilators - 6-month referral follow-up - Spacer use (ages 5–15) - Personalised asthma action plans - Inhaler technique check - Inhaler waste management Medicines Optimisation Domain: - High-risk medications - Palliative care Table Suggestion: Compare Essential vs Advanced vs Locally Commissioned Services with examples 3. Professional Practice & Patient Safety Negligence • Three factors for a claim: • Duty of care existed • Duty breached • Loss/damage due to breach • Professional negligence: Duty of care assumed by law. Dispensing & Automation • Automated dispensing: Machines used for medicine supply. • Hub and Spoke Model: Central hub dispenses prescriptions for local pharmacy spokes. • Diagram Suggestion: Flow of hub and spoke dispensing Patient Safety Incidents • Definition: Unintended or unexpected events causing or potentially causing harm. • Reported to NRLS. • Analysis methods: • Significant Event Audit (SEA) • Root Cause Analysis (RCA) SEA Process: 1. Awareness & prioritisation 2. Information gathering 3. Team-based meeting 4. Analysis 5. Implement & monitor change 6. Report, share, and review RCA Methods: - Five Whys - Fishbone diagram - Dispensing Incident Review Grid Example Case Studies: Include sample SEA and RCA scenarios from pharmacy practice 4. Waste Management in Pharmacy • Governed by Environmental Protection Act 1990 • Waste Types: • Cytotoxic (hazardous) 3 • Other (non-hazardous) • Colour Coding: • Purple: Cytotoxic (incineration) • Yellow: Other pharmaceutical waste (incineration) • Black: Domestic waste (landfill) • Consignment Note: Required for collection. • Sharps: Only accepted with specialist contract. • Segregation: ◦ Contaminated cytotoxic sharps ◦ Medicinally contaminated (yellow lid) ◦ Non-medicinal (orange lid) Tables and Diagrams: - Waste colour coding with examples - Flowchart for sharps disposal and segregation 5. Additional Notes and Case Studies • Include practical examples of PQS achievement, SEA and RCA outcomes, hub and spoke model workflows. • Highlight key NHS governance bodies and their roles using diagrams. • Include figures showing funding flow for CPCF and retained margins. • Include examples of essential, advanced, and locally commissioned services in practice. 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