1. www.england.nhs.uk Improving Inhaler Technique through Community Pharmacy Service Greater Manchester Area Team January 2015

2. www.england.nhs.uk Service Specification

3. www.england.nhs.uk Built upon the MUR/Prescription Intervention advance service Any patient eligible for a Prescription Intervention can be invited to join the scheme Patients newly prescribed an inhaler should receive inhaler technique training via NMS- outside of this project Patients entitled to one PI; one brief intervention and one MUR in a 12 month period Service Details

4. www.england.nhs.uk The pharmacist will provide an augmented Medicine Use Review (MUR)/prescription intervention (PI) service to patients on inhaled medication for the treatment of asthma or chronic obstructive pulmonary disease (COPD). There is no age restriction for patients, but the service must be provided directly to the patient, not to the parent/carer on the patient’s behalf. The pharmacist will assess the patient’s disease control, inhaler technique and provide health promotion information (e.g. smoking cessation advice). The pharmacist will perform a prescription intervention on eligible patients with a follow up brief intervention 6-8 weeks later. Service Details

5. www.england.nhs.uk The brief intervention must be completed on the Improving Inhaler Technique through Community Pharmacy- Brief intervention form. The form can be downloaded from the Community Pharmacy Greater Manchester website, http://psnc.org.uk/community-pharmacy-greater- manchester/. http://psnc.org.uk/community-pharmacy-greater- manchester/ The pharmacist must capture all of the information present on the brief intervention form, and transfer the relevant information onto the PharmOutcomes module. The form must be kept with the assessment form in the pharmacy’s standard MUR records for post payment verification purposes. The form must be kept for a minimum of two years from the date of consultation. A copy of the form must be sent to the patient’s GP practice. Service Details

6. www.england.nhs.uk

10. Required data and patient consent to be captured on consultation form(s) Information to be entered on to PharmOutcomes Consultation form(s) to be retained in the pharmacy; copy to be sent to patients GP Payment for PI to be claimed via FP34c (£28) Payment for brief intervention generated via PharmOutcomes (£10) Expressions of Interest to provide the scheme has been circulated to contractors Service Details

11. www.england.nhs.uk PREM1 to be submitted to AT (if not previously done) Intervention to take place in the consultation room Telephone interventions are not allowed Offsite consultations are permitted, apply to the AT via the standard NHS England procedure http://www.england.nhs.uk/pharm-adv-serv/ http://www.england.nhs.uk/pharm-adv-serv/ Signed SLA submitted to AT Premises Requirements

12. www.england.nhs.uk Pharmacist Accreditation

13. www.england.nhs.uk Accredited to undertake MURs Undergone face to face inhaler technique training since 2011 Completed the Declaration of Competence for Improving Inhaler Technique through Community Pharmacy – now available at: https://www.cppe.ac.uk/services/declaration-of- competencehttps://www.cppe.ac.uk/services/declaration-of- competence Pharmacist requirements

14. www.england.nhs.uk Launched – December 2014 Pharmacists that have undergone face to face inhaler technique training are able to start and accredit retrospectively Contractors have been informed DoC available, pharmacists providing the service will have 2 months after launch to complete Copy of DoC to be kept in the pharmacy Declaration of Competence

15. www.england.nhs.uk Top Tips

16. www.england.nhs.uk 1.Check the patient’s PMR for frequency of ordering of medication before starting the review. For patients with asthma Ordering more than twelve short-acting reliever inhalers over the last year may indicate poor control and that preventative treatments need to be stepped up. Generally patients with asthma should require thirteen inhaled corticosteroid (ICS) preventer inhalers per year (might be less for 200 dose metered dose inhalers). Is the patient prescribed a long-acting beta 2 agonist (LABA) without an ICS? This requires a review of the regimen. Top Tips for Respiratory MURs

17. www.england.nhs.uk 2.What does the patient know about their condition and its treatment? 3.Has the patient had a review before? Who did the review? Does the patient see anyone else for their condition? Explain that the reviews are being done with the knowledge of GP practices in the area and that the aim is to improve medicines use for respiratory conditions. 4.Check adherence with the information from the PMR and document any reasons for non-adherence e.g. difficulty in using device, side-effects, perception of ineffectiveness, lack of knowledge of indications for different inhalers. Does the patient experience any problems taking / using their medicines? Top Tips for Respiratory MURs

18. www.england.nhs.uk 5.Assess inhaler technique - use In-check device. Would the patient benefit from a device switch, adding a spacer? Does the patient have the same devices i.e. MDI or Turbohaler? 6.Does the patient know how to take other medicines prescribed for their respiratory condition e.g. rescue packs of corticosteroids / antibiotics, mucolytics or theophylline for COPD. 7.Give smoking cessation advice if appropriate. 8.Does the patient need flu or Pneumococcal vaccination? Top Tips for Respiratory MURs

19. www.england.nhs.uk 9.Does the patient have any questions / need more information about their medicines? 10.Refer patients if they report: An increase in exacerbations Their symptoms are not controlled Side-effects of medicines Severe or life-threatening asthma exacerbation Haemoptysis- spitting or coughing up blood Top Tips for Respiratory MURs

20. www.england.nhs.uk Questions? agm.optometry- pharmacy@nhs.net