2. The NHS Urgent Medicine Supply Advance Service NUMSAS

3. Introduction
National pilot service – commissioned as an Advanced Service
Funded by the Pharmacy Integration Fund (PhIF) - £2m budget
The service will
started to roll out from 1st December 2016
will end on 31st March 2018
with a review point to consider progress in September 2017

4. Background
PSNC proposed an emergency supply service as part of its service development and counter proposals to DH and NHS England
Fully funded and with additional funding, not from within the CPCF funding envelope
Covering all patients – walk-ins, referrals from other HCPs and NHS 111
NHS England proposed that the PhIF could fund a pilot scheme to test and evaluate a service to inform possible future commissioning
The national Emergency Supply Audit conducted by community pharmacies in 2015 and existing locally commissioned services have informed the development and design of the service

5. Aims and intended outcomes of the service
To appropriately manage NHS 111 requests for urgent supply of medicines and appliances
To reduce demand on the rest of the urgent care system, particularly GP Out of Hours (OOHs) providers
To identify problems that lead to individual patients running out of their regular medicines or appliances and to recommend potential solutions that could prevent this happening in the future
To increase patients’ awareness of the electronic Repeat Dispensing (eRD) Service
To ensure equity of access to the emergency supply provision irrespective of the patient’s ability to pay for the cost of the medicines or appliances supplied

6. Training, premises and other requirements
Pharmacies must have a consultation room that meets minimum requirements
The pharmacy contractor must have a Standard Operating Procedure in place covering the provision of the service
The pharmacy’s Business Continuity Plan should be updated to cover the service

7. Training, premises and other requirements
Training requirements
Pharmacists’ core knowledge includes making emergency supplies
Urgent care: a focus for pharmacy (CPPE, September 2016) may provide useful background knowledge
Ensure other staff know how the service operates
Make sure locums know how to operate the service
Contractors must sign up to service delivery through the NHS BSA website

8. Roll out of the service
The service is a fully integrated service that requires a number of key elements to be in place before it can go live
To support the efficient roll-out of the service, particularly putting in place mechanisms for referral from NHS 111 to community pharmacy, a phased introduction will take place.

9. IT requirements
The pharmacy must be enabled to receive and dispense Electronic Prescription Service (EPS) Release 2 prescriptions
Pharmacies must have a shared NHSmail inbox
Access to the Directory of Services
If available, pharmacists providing the service should have access to the NHS Summary Care Record (SCR)
Locally commissioned IT support, e.g. PharmOutcomes, may be used to support referrals from NHS 111 and notifications to GPs
This will not however be nationally commissioned by NHS England

10. How will the service work?

11. Referral of patients to the service
Patients contact NHS 111 to request access to urgently needed medicines or appliances (previously supplied on script)
Referral to a pharmacy, chosen by the patient, that is providing the service - referral via NHSmail or other electronic solution
NHS 111 provide the phone number of the selected pharmacy to the patient, advising them to call the pharmacy in the following 30 minutes
The pharmacist will assess the need of the patient for an emergency supply

12. Referral of patients to the service
Patient/Carer calls 111
Advice Only
Supply Medicines
Obtain prescription from GP OOH’s
NHS 111
Pharmacy
Post Event Message (PEM)
Survey of Experience
Patients GP
Patient Survey

13. Referral of patients to the service
NHS 111 call handlers will not be assessing patients’ suitability for emergency supply
If a patient calls the pharmacy but no referral has been received from NHS 111, contact the NHS 111 professionals line
If a referral is received and no contact is made by the patient, the pharmacy should attempt to make contact; referrals can be closed if no contact is made before the next working day

14. Referral of patients to the service
This service will not be actively promoted directly to the public by either the pharmacy contractor or the NHS
Pharmacy teams should regularly check for an or electronic message throughout the day to pick up referrals from NHS 111

15. Pharmacy consultation: Over the telephone
An initial telephone consultation will normally take place to:
determine further information about the patient
assess the need for an emergency supply (suitability and legality)
decide whether or not to invite the patient to the pharmacy for a face-to-face consultation and/or supply
If the patient indicates that they cannot visit the pharmacy, the pharmacist should use their professional judgement as to whether it is appropriate for a representative to collect the medication or appliance

16. Pharmacy consultation: face-to-face
If appropriate, the pharmacist can invite the patient or their representative to come into the pharmacy
The pharmacist will then conduct a face-to-face consultation, to collect any additional information that was not obtained during the telephone conversation with the patient

17. Decision making aids
If appropriate the patient’s SCR should be checked to confirm the previous prescription history and whether a prescription has recently been issued by the patient’s general practice
Where the requested item has recently been issued by the patient’s general practice, the prescription may still be available on the NHS Spine
The pharmacist can use the EPS tracker to see if a prescription is available; if so, this can be used to fulfil the patient’s need for urgent medicines

18. If a supply is not possible…
If an emergency supply is not possible at any stage pharmacists should refer the patient:
to their own general practice; or
contact the local GP Out of Hours (OOH) provider to discuss a solution
Do not refer the patient back to NHS 111

19. If stock is not available…
If the required medicine or appliance is not in stock, with the agreement of the patient, identify another convenient pharmacy (Pharmacy 2) that provides the service, call them to see if they have stock and if so, forward the electronic referral received from NHS 111 to them
Pharmacy 2 will then contact the patient
Inform NHS 111 of the onward referral to pharmacy 2
If Pharmacy 2 does not hold the stock, contact the local GP OOH provider to discuss a solution

20. Deciding whether to make a supply
All supplies must be made in line with the provisions and requirements of Regulations 225, 253 and Schedules 18 and 23 of the Human Medicines Regulations (HMR) 2012
The pharmacist should apply their professional judgement in order to determine the most appropriate quantity of medicine or appliance to supply, in line with the provisions of the HMR
If the patient (or representative) is not on the premises, then the pharmacist must ensure the patient is able to obtain the supply in a timely manner by discussing with the patient (or representative) all reasonable options for accessing their medicines

21. Provision of advice and information
The pharmacist must advise the patient or their representative on the importance of ordering prescriptions in a timely manner from their GP practice and the benefits of the NHS eRepeat Dispensing Service
If appropriate, the pharmacist can also raise the patient’s awareness of the Medicines Use Review or the Appliance Use Review services
The patient or their representative should be asked to complete a patient questionnaire; an IT platform (like the flu vac platform) will be made available to record the results electronically

22. Records and documentation
A blank FP10DT EPS dispensing token will be used to document ALL referrals received from NHS 111, irrespective of whether or not a supply has been made
Information will need to be printed or recorded in legible handwriting on the token – IT support may be available
An NHS prescription charge per item should be collected, unless the patient is exempt from prescription charges

23. Records and documentation
The patient (or representative) must complete the relevant sections of the reverse of the token to claim any exemptions from NHS prescription charge payment and confirm supply when they receive the medicine or appliance at the pharmacy
Make your usual records of the emergency supply in accordance with the HMR
A Post Event Message notification to the patient’s general practice must be sent either electronically, via hardcopy or fax on the same day or the next working day

24. Payments and how to claim them

25. The claims and submissions process
Contractors who fail to notify NHS England that they intend to provide the service by completion of the NHS BSA form will not be paid if they submit any claims
To claim payment, the contractor must complete the NHS Urgent Medicines Supply Advanced Service Pilot claim form and submit it to the NHS BSA along with the completed FP10DT EPS dispensing tokens
This process will be separate to the submission of other FP10 forms and NHS BSA will advise contractors on this process as part of the registration process

26. Fees that will be paid A Consultation fee of £10, and
For ANY referral received from NHS 111 for a request for an urgent medicine or appliance supply, whether or not a supply is made and irrespective of the reason for any non-supply:
A Consultation fee of £10, and
An Administration fee of £2.50 per consultation to reflect the additional work/documentation required to support evaluation of the service
Where a medicine or appliance has been supplied, a Supply fee of £1.50 will be made for the first item and an additional £0.50 will be paid for each additional item supplied

27. Fees that will be paid
Where an item is out of stock and the pharmacy is able to refer a patient to Pharmacy 2 which has the item in stock and accepts the onward referral, both pharmacies will be eligible to claim the Consultation and the Administration fees; only Pharmacy 2 can claim the Supply fee
Where a pharmacy receives a referral from NHS 111 and subsequently finds a prescription for the patient on the NHS Spine and downloads and dispenses it, the pharmacy is eligible to claim only the Consultation and Administration fees (as long as an FP10EDT EPS token is completed)

28. Fees that will be paid
Where a pharmacy receives a referral from NHS 111 but the patient has not made contact and the pharmacy has made at least 3 attempts to contact the patient without success, the pharmacy will be eligible to claim the Consultation and Administration fees (as long as an FP10DT EPS token is completed)
No payment will be made under this service, for patients outside of the service specification requirements, for example, walk-in patients who have not been referral by NHS 111

29. Reimbursement for items supplied
The cost of medicines or appliances supplied under the service will be reimbursed using the basic price
An allowance at the applicable VAT rate will be paid to cover the VAT incurred when purchasing the supplied medicine or appliance

30. Key resources NHS England - Service specification
NHS England - Service guidance
NHS BSA web-based form for notification of intention to provide the service
NHS BSA claims form (will be sent to contractors by the BSA)
Further guidance and resources are available at psnc.org.uk/numsas

31. Opinion of NUMSAS PSNC’s view NUMSAS Costs Calculator Local Impact
Long Term View of NUMSAS/DOS/NHSmail

32. Questions psnc.org.uk/pharmacychanges psnc.org.uk/numsas
psnc.org.uk/numsasfaqs