1. How to achieve the quality criteria
Leyla Hannbeck MSc. MPharm. M.A.

2. Quality Payment Scheme

3. Overview
For 2017/18, up to £75 million available for contractors to claim as quality payments
Payments can be claimed at two review points:
28 April 2017
24 November 2017
Payments from April’s review point paid at end of June/start of July 2017
Payment depends on achieving specific quality criteria
The review points are dates at which pharmacies can claim quality payments. At each review point, if all the gateway criteria have been fulfilled and some or all of the quality criteria have been fulfilled, pharmacies can make a declaration to the NHSBSA on the approved form and claim payment.
Further guidance to be issued by the Department of Health by 1 December 2016.

4. Overview
There are eight criteria, each of which can earn a pharmacy ‘points’
The maximum number of points a pharmacy can achieve across the two review points is 100
Each point will entitle the pharmacy to a quality payment, initially at a value of £64 per point
Any funding remaining following the two review points will be distributed to qualifying pharmacies in the form of a reconciliation payment, based on the number of points they have achieved – this will be paid with the full value of services payment for March 2018
This could lead to a maximum of £128 per point being paid depending on the total number of points achieved by all the pharmacies in England

5. Gateway criteria Four gateway criteria:
Provision of at least one specified advanced service
MUR
NMS
NHS Urgent Medicine Supply Advanced Service (NUMSAS)
NHS Choices entry up to date
Ability for staff to send and receive NHS mail
Ongoing usage of EPS
You must meet all four criteria in order to be able to claim any quality payments
Details still being finalised by Department of Health (DH)
In addition, the DH has stated that it will be commissioning a new urgent medicines supply service pilot as an Advanced Service
Registration for the service is anticipated to begin from December 2016
It is currently unclear what is meant by a ‘specified’ Advanced Service and whether this means any of the Advanced Services listed above or an Advanced Service specified by the DH
Not clear what ‘specified advanced service’ means – any advanced service, or is the DoH going to specify particular ones?
Currently, there are 5 advanced services:
Flu vaccination
MUR
NMS
Stoma Appliance Customisation
Appliance Use Reviews
According to DoH final package, “NHS England will be commissioning a new urgent medicines supply pilot as
an advanced service, which will require changes to Directions”.
NHS Choices - If not yet registered, contact NHS Choices helpdesk -
Regularly review your pharmacy profile to ensure details such as opening times, telephone number and services provided are correct
NHS Mail - If you don’t currently have any accounts, contact NHSmail national helpdesk on
Note, the details of the gateway criteria are still being finalised; there may be some flexibility – for example, if NHS Mail 2 is not available

6. Gateway criteria – NHS Choices
NHS Choices information must be up to date:
Opening hours
Facilities provided by the pharmacy
Services provided by the pharmacy
If not yet registered, contact NHS Choices helpdesk
3 applicable advanced services:
MUR (evidenced by claims for payment)
NMS (evidenced by claims for payment)
NHS Urgent Medicine Supply Advanced Service (evidenced by registering for the service)
According to DoH final package, “NHS England will be commissioning a new urgent medicines supply pilot as
an advanced service, which will require changes to Directions”.
NHS Choices – Each review the following information will need to be amended or validated:
Opening hours
The facilities the pharmacy provides e.g. consulting room, parking etc
The services the pharmacy provides
Will need to validate from 7 February 2017 for April review point and from 1 May 2017 for November review. There should be regularly reviewed. Further information on how to validate and amend pharmacy entries will be released in January.
This the contractors responsibility. Multiples can use an Application Programming Interface (API) to automate the process. Further information can be found by ing the NHS Choices Service Desk requesting a call back from the Syndication team. Please add ‘Pharmacy Organisation API’ in the subject field of the ; please include one contact per organisation
Further guidance will be provided regarding distance selling pharmacies in the near future (they have a different NHS Choices profile)
NHS Choices - If not yet registered, contact NHS Choices helpdesk -
In the , please quote your pharmacy’s name, address and ODS code (F code) and the name and address of the staff member(s) to be given web editor and/or comment administrator rights.

8. Gateway criteria – NHS mail
Ability for staff to send and receive NHS mail
To register for an NHS mail account:
The following information is required:
Owners name
Trading name of the pharmacy and the full address
Pharmacy ODS code (F code)
Pharmacy telephone number
Current pharmacy address
This information must be sent by 1 February 2017 in order to meet April review criteria
NHS Mail – If already have access to address then fine. If not yet been set up then NHS England is looking to roll out a new process for registration. As long as there is an application received by 1 February 2017 to get an address you will pass that criteria in April.
Requesting an NHSmail account for your pharmacy (for the April 2017 Review)
If contractors do not have an NHSmail account for their pharmacy, they can apply for an NHSmail account by ing the following information 1st February 2017):
Trading name of pharmacy;
Owner’s name;
Address, including postcode (for the premises the NHSmail address will apply to);
Pharmacy ODS code (F code);
Pharmacy telephone number; and
Current pharmacy address.
EPS –
You need to be enabled
Nominating patients
Endorse and claim for EPS rxs each month
If GP’s don’t use EPS you would still qualify if other criteria met

9. Quality payments: quality criteria
Eight quality criteria, across six ‘domains’
Patient safety
Written report
Level 2 safeguarding status (80% of staff)
Patient experience
Publish your CPPQ survey on NHS Choices page
Public health
Healthy Living Pharmacy level 1 (self-assessment) – having at least one team member as champion and one of the team undergoing leadership training
Patient safety domain
Production of a written report that demonstrates evidence of analysis, learning and action taken in response to near misses and patient safety incidents, including implementation of national patient safety alerts and having shared learning
80%of registered pharmacy professionals have achieved level 2 safeguarding status for children and vulnerable adults within the last two years
Patient experience domain
Results of patient experience survey from the last 12 months published on the pharmacy’s NHS Choices page
Public health domain
Healthy Living Pharmacy level 1 (self-assessment)

10. Quality payments: quality criteria
Digital
Access to summary care record
NHS 111 directory entry up to date
Clinical effectiveness
Asthma review – make sure the pharmacy team can identify the short acting bronchodilator inhalers and corticosteroid inhalers
Workforce
80% of pharmacy staff are trained ‘Dementia Friends'
Digital domain
Demonstration of having accessed the summary care record and increase in access since the last review point
NHS111 Directory of Services entry up to date at review point
Clinical effectiveness
Asthma patients dispensed more than 6 short acting bronchodilator inhalers without any corticosteroid inhaler within a 6 month period are referred to an appropriate health care professional for an asthma review
Workforce
80% of all pharmacy staff working in patient facing roles are trained ‘Dementia Friends’

11. Quality points: weighting
Criteria
Number of review points at which it can be claimed
Points at any one review point
Total points over two review points
Quality payment (minimum)
1) Patient safety report
April OR November 20
£1,280
2) Safeguarding
Both 5 10
£640
3) Patient survey
£320
4) HLP
5) SCR
6) NHS 111 Directory
2.5
7) Asthma review
8) Dementia Friends
Weighting is judged on how important this criteria is for patients. Payment is linked to the number of points. Certain criteria are completed at both April and November reviews and others only need to be completed once.
In terms of how easy they are to complete:
Patient survey – Already completed as part of contract. Needs to be uploaded as well as putting up in the pharmacy
SCR – May already be up and running. If so, then you just need to increase use over time. If not then complete the training, update smartcards and start using
NHS 111 directory – Once mobile DoS is available will be simple to check records are up to date. If not, then depending on access may be able to amend or can contact local DoS manager
Dementia Friends – Can get members of staff to watch the video online, make a pledge and get registered. Of benefit to both staff and patients.
Safeguarding – May already be up to date with this if conducting emergency contraception for example. If not then can be completed online or by following local guidance on accreditation.
Asthma review -
Patient safety report – Form to be released. NPA is MSO for pharmacies with less than 50 branches. Can report dispensing incidents to us and we will pass on to NRLS. Also produce reports that show common dispensing incidents that can aid learning as part of this criteria.
HLP – The most time consuming of all the criteria. Can be completed. May already have local HLP. This may not meet the criteria. Waiting to see whether grandparenting will be accepted.

12. Written patient safety report
Can be claimed at one of the two review points and is worth 20 points
Requires production of written report that shows evidence of: analysis, learning and action taken in response to near misses and patient safety incidents; implementing national patient safety alerts; and sharing learning
The Patient Safety (MSO) page on the NPA website contains further guidance and resources regarding patient safety, including the MSO Quarterly reports
£1280
(20 points)

13. Safeguarding £640 (10 points)
Can be claimed at both review points and is worth 5 points at each review (10 points in total)
Requires 80% of registered pharmacy professionals to have achieved level 2 safeguarding status for children and vulnerable adults within last 2 years
Applies to pharmacists and technicians, including locums
Check when relevant staff members/locums last did level 2 safeguarding training
Ensure that training is carried out by those who need it
NHS England refers pharmacy professionals to their local Clinical Commissioning Groups (CCGs) for support in gaining suitable safeguarding training
The Centre for Pharmacy Postgraduate Education (CPPE) also provides a level 2 safeguarding course and assessment
NPA compiling a list of all CCG safeguarding teams in England
£640
(10 points)

14. Patient experience survey
£320
(5 points)
Can be claimed for at one of the two review points and is worth 5 points
Requires results of patient experience survey from last 12 months to be published on pharmacy’s NHS Choices page
Publish your most recent patient experience survey on your NHS Choices page – further information to follow
We are still waiting to hear more information about the template and how this is done

15. Healthy Living Pharmacy (HLP)
£1280
(20 points)
Can be claimed for at one of the two review points and is worth 20 points
Requires pharmacy to achieve HLP level 1 status – this is self-assessed
HLP level 1 status includes having at least one member of the pharmacy staff being a Health Champion, and at least one member of the team undergoing leadership training

16. What is a Healthy Living Pharmacy (HLP)?
It is a concept which was originally developed in 2009 as a means of improving provision and access to local pharmacy services in Portsmouth
A level 1 framework, commissioned by Public Health England and based on the original HLP model, was released in 2016
This allows pharmacy contractors to achieve level 1 through self assessment

17. What are the aims of HLP? Aims of HLP:
Health champion to provide lifestyle interventions and pharmacy support
E.g. Offering brief advice on various health issues such as smoking cessation and alcohol consumption
Services and support delivered from pharmacy premises fit for purpose
Engagement with local stakeholders (e.g. other healthcare professionals and the local community) to improve patient care

18. Why become an HLP?
HLP level 1 accreditation is worth 20 quality points under the new pharmacy funding quality payment scheme
This is worth a minimum of £1,280
The HLP-related quality points can be claimed at either the April or November review points
If HLP has already been achieved locally, then contractors may be able to claim for the QP without completing the assessment again. This is yet to be confirmed.
If this is not accepted by NHS England, then contractors will need to complete the self assessment. However, as the majority of the criteria will already have been met, it will be a simpler process than contractors who have never done it

19. Checklist for getting HLP accredited
Key requirements:
At least 1 FTE qualified Healthy Living champion (HLC) – certificate required
Pharmacy owner or pharmacist leadership trained – certificate required
Suitable consultation room
Provide MUR, NMS, NHS flu vaccination services
If flu vaccinations are not provided, then there should be active referrals to other NHS providers
Health promotion zone – display HLP logo prominently once accredited
NPA training for HLC and leadership to be provided
FTE = Full time equivalent
• All pharmacy staff understand the basic principles of health and wellbeing, and that every interaction is an opportunity for a health promoting intervention. • At least one member of pharmacy staff (1 Full Time Equivalent) has completed the training and assessment of the Royal Society for Public Health (RSPH) Level 2 Award in Understanding Health Improvement and is therefore a Health Champion.
Not known if the 1 FTE can be split across more than one person or across more than one pharmacy
• An individual from the pharmacy team has undergone leadership training internally or through an organisation that maps to/encompasses the following domains
Inspiring a shared purpose
Sharing the vision
Engaging the team
Developing capability
Influencing for results

20. Checklist for getting HLP accredited
The following criteria must also be completed and evidenced:
Staff awareness of local public health and pharmaceutical needs (e.g. JSNA, PNA)
Communication skills
Proactive community engagement by whole pharmacy team, able to signpost to local service providers as appropriate
Commissioner engagement – lists of local contact information
Data collection – IG SOP and IT/internet system accessible in consultation room
Promote environmental sustainability
JSNA = Joint Strategic Needs Assessment
PNA = Pharmaceutical Needs Assessment
Communication skills – all members of pharmacy team able to provide health and wellbeing advice, use NHS Choices, discuss difficult topics sensitively

21. Examples of evidence collection
Certificates – e.g. HLC, leadership training (required when claiming completion of training; certificates for assessment and/or training)
Minutes of pharmacy meeting notes showing HLC sharing learning with the pharmacy team
HLP action plan
Written feedback from pharmacy team members to their team leader
Photos of the pharmacy team engaging with the public (consent), consultation room, pharmacy, HLP logo location, recycling bins, paper disposal system, outreach work
This list is not exhaustive but offers some guidance on how to show that the requirements have been met

22. Examples of evidence collection
Case studies of local outreach programmes conducted by pharmacy
Health and wellbeing notice board – local public health services / initiatives information
Health and wellbeing information in a range of formats (e.g. DVDs, plasma screen, leaflets etc)
Signposting information folder
Lists of local public health commissioners and their contact details along with examples of correspondence with them (e.g. s, letters)

23. HLP action plan Area for improvement / Objective / Goal
Actions to be taken
When by
Who is responsible
Support / resources available
Outcome
HLC training and certification
Identify suitable member of pharmacy team to train, source training (NPA), book, payment, allocate time to undertake
30 April 2017
Joe Bloggs
e.g. Funding to undertake training, training time for individual, training provider identified - NPA
Training undertaken by [a] on [date], certificate available
Team leadership
Source training (NPA), book, allocate time to attend
31 May 2017
Pharmacist/Pharmacy owner
MUR
Continue to provide service
Ongoing
Pharmacist
Service provision maintained
NMS
Health promotion zone
Identify relevant local health topics to promote. Review and update at least every two months
Review every two months and update
HLC
Time to research local issues and update the information. Local health campaigns and resources can be used
HLC regularly updates content and patients are using the resources
Example of an action plan that contractors can set up to ensure standards are met

24. Summary Care Record (SCR)
£640
(10 points)
Can be claimed for at both review points and is worth 5 points at each review (10 points in total)
Requires demonstration of having accessed the SCR, and that there has been an increase in access since the last review point  
Not yet clear what evidence is required
If your pharmacy has not yet accessed the SCR, ensure that you do so as soon as possible – the one-off allowance of £200 is only available until 31 March 2017

25. NHS 111 Directory £320 (5 points)
Can be claimed at both review points and is worth 2.5 points at each review (5 points in total)
Requires pharmacy’s entry in NHS 111 Directory of Services to be up to date at review point
No information yet available
Registration is completed locally. Contractors can find their local Directory of Services (DoS) contact by ing
How contractors will access the DoS in order to check their records is currently being considered by NHS Digital

26. Asthma review £1280 (20 points)
Can be claimed for at both review points and is worth 10 points at each review (20 points in total)
Requires pharmacists to refer asthma patients to an appropriate healthcare professional if they have been dispensed more than six short-acting bronchodilators without any corticosteroid inhaler within a six month period
Evidence required and number of patients to be referred not yet clear
In the meantime, consider what changes may need to be made to, for example, standard operating procedures (SOPs), and Patient Medication Record (PMR) systems
Ensure pharmacy team can identify short-acting bronchodilator inhalers and corticosteroid inhalers

30. Dementia Friends £640 (10 points)
Can be claimed at both review points and is worth 5 points at each review (10 points in total)
Requires 80% of all patient facing pharmacy staff to be trained ‘Dementia Friends’
Ensure that all patient facing pharmacy staff are trained Dementia Friends
Becoming a Dementia Friend involves registering on the Dementia Friends website and either attending a face-to-face training session, or watching an on-line video
Making one commitment, for example either wearing dementia friends badge, spread the word etc
Copies of certificates received as part of the training should be kept as evidence of completion

33. Who will monitor that the gateway criteria are being met?
Pharmacies will make a declaration to the NHSBSA at each review point. Spot checks are to be managed by NHS England as part of the Community Pharmacy Contractual Framework (CPCF) monitoring

34. When do I receive the Quality payments?
Payments will be received with your dispensing payments for April and November (i.e. the April Quality payment will be received by most contractors in late June/early July)

35. My local surgeries do not use the Electronic Prescription Service (EPS); will I still be eligible for the Quality payments scheme?
As long as the contractor is EPS enabled they will meet this requirement of the Gateway criteria.

36. We are supposed to show increase in usage over previous period
We are supposed to show increase in usage over previous period. How can we find out, how many times the pharmacy assessed SCR (it could be done combination of several pharmacists)
The contractors privacy officer should be able to access this information. Alternatively, there will be a spreadsheet published by PSNC that will show each contractors usage each month

37. Registration of NHS net email by 1st Feb
Registration of NHS net by 1st Feb. No registration acknowledgement is issued by NHS digital. Other than audit trail, should a proof of receipt be issued
The guidance from NHS England is that evidence of application for an account by 1 February 2017 is sufficient for meeting the April 2017 review point. An example of evidence of application may be a record of the sent requesting an NHS mail account

38. Asthma- linked with QP can we do intervention MUR
If appropriate, a patient could be invited for an MUR as part of the asthma review referral. This would need to be determined on an individual patient basis

39. Should we proceed with QP now or wait outcomes of judicial review first
In order to minimise the immediate impact of the pharmacy imposition, it is advisable to begin to put procedures in place to ensure that as many quality points are achieved as possible until the outcome of the judicial review is received.

40. Quality points: example 1
April 2017 review point
November 2017 review point
Advanced service
EPS
Advanced service
EPS
NHS mail
NHS Choices
NHS mail
NHS Choices
Gateway criteria met 
Gateway criteria met 
Patient safety report 20
Patient survey 5
SCR 5
SCR 5
NHS 111
2.5
NHS 111
2.5
Dementia friends 5
Dementia friends 5
The patient safety report can only be claimed at one of the review points.
The patient experience survey can only be claimed at one of the review points.
SCR, NHS111 and Dementia Friends can all be claimed at both review points.
Points value based on £64 per point. The final reconciliation may result in extra payment being made.
Total points: 32.5
= £2,080
Total points: 17.5
= £1,120

41. Quality points: example 2
April 2017 review point
November 2017 review point
Advanced service
EPS
Advanced service
EPS
NHS mail
NHS Choices
NHS mail
NHS Choices
Gateway criteria not met 
Gateway criteria met 
Safeguarding
Safeguarding 5
SCR
SCR 5
Asthma review
Asthma review 10
Dementia friends
Dementia friends 5
This pharmacy failed to keep their NHS Choices entry up to date at the time of the April review, so did not meet the gateway criteria. Consequently, they gained no points, despite meeting the criteria for safeguarding, SCR, asthma review and Dementia friends.
By November, the pharmacy had updated their NHS Choices entry and thus qualified for points.
Points value based on £64 per point. The final reconciliation may result in extra payment being made.
Total points: 0
= £0
Total points:25
= £1,600

42. How can I reduce the impact of funding cuts?

43. Check if you qualify for the Pharmacy Access Scheme If not, check if you are eligible to request a review - if so, submit your application by end of February 2017 – recheck the eligibility list because it has been updated

44. 2. Aim to claim your quality payments: Ensure that you meet all the ‘gateway’ criteria Aim to meet as many of the quality criteria as possible and start collecting the evidence £64 per point  £6,400 for the year This is equivalent to £533 per month
This figure could increase when the reconciliation payment is taken into account (up to £128 per point)

45. 3. Don’t miss MUR and NMS opportunities

46. MURs Medicine Use Reviews (MURs) In 2014/15:
£41 million in MUR fees remained unclaimed by community pharmacies due to not delivering the maximum of 400 MURs/pharmacy
The average number of MURs delivered was 292
The average unclaimed amount for each of the 10,916 pharmacies that did carry out 400 MURs was over £3,000

47. MURs Medicine Use Reviews (MURs) In 2015/16:
Over £38 million remained unclaimed from pharmacies that did not deliver 400 MURs for the financial year
Average number of MURs completed was 282
The average unclaimed amount across all pharmacies stands at over £3000
These figures are based on PSNC statistics that do not exclude pharmacies that did not conduct MURs. Therefore the average number of MURs delivered will be less but the overall funding figure is still correct.

48. NMS New Medicine Service (NMS) In 2014/15
£141 million in NMS fees remained unclaimed due to not delivering NMS
2,366 did not deliver any NMS – an average loss of £13,440 annually
The average number delivered per month was 7 – leaving an average loss of £11,760 annually

49. NMS New Medicine Service (NMS) In 2015/16
820,026 NMS were delivered in 2015/16
This averages to 7 NMS delivered per pharmacy every month
Based on cumulative number of pharmacies claiming payments from October 2011
Based on PSNC data. Includes all registered pharmacies so the information may differ slightly from NHS digital data.
The average of 7 is taken from the cumulative figure of pharmacies that have conducted NMS from October 2011

50. 4. Know your Drug Tariff and endorse correctly!!

51. Areas where errors commonly arise
Unlicensed Specials/Imports
Broken bulk claims (BB)
Out of pocket expenses
Expensive Items
Doctor’s signature
Supplementary information
Not dispensed
Flavours
Drug Tariff areas where errors commonly arise
Endorsing
Switching

52. December DT
As a result of the changes to pharmacy funding, from 1 December 2016, for pharmacies in England:
A single activity fee of 113p per prescription will be paid for all prescriptions dispensed
This includes a payment for auxiliary aids provided to patients who are eligible under the Equality Act 2010
Pharmacists conducting a repeat dispensing service have to be appropriately trained to do so – this includes successful completion of the NHS repeat dispensing ‘focal point’ programme by the Centre for Pharmacy Postgraduate Education (CPPE)
The practice payment, repeat dispensing payment and monthly EPS payment will no longer be paid
Smaller establishment payments will be received than previously
In addition to the above changes, two new sections have been added to the December 2016 England and Wales Drug Tariff for pharmacy contractors in England:
Part VII Quality Payments Scheme
Part XIIA Pharmacy Access Scheme
Details of the new NHS Urgent Medicine Supply Advanced Service (NUMSAS) pilot scheme in England have been added to Part VIC.

53. Pharmacy staff can play a crucial role, for example in ensuring the gateway criteria are met

54. Staff engagement
Involve staff in decisions
Communicate clearly with staff
Maintain staff morale
Improve staff morale
Better patient outcomes
Better business outcomes
Getting staff engaged is crucial to the success of the business
NHS Employers website has plenty of resources on staff engagement, including briefings, newsletters and case studies.

55. SMART objective for staff: example
‘Check and, where necessary, update the pharmacy’s NHS Choices profile in the first week of every month of 2017 so that the pharmacy meets this gateway criterion at both 2017 review points’
Specific – Check and update the pharmacy’s NHS Choices profile in the first week of every month
Measurable - pharmacy meets gateway criterion at both review points
Agreed – individual needs to agree to this objective and understand its importance
Realistic – this should be easily achievable
Timed - every month of 2017
This should be a non-negotiable objective
Example
Specific– Check and, where necessary, update the pharmacy’s NHS Choices profile in the first week of every month
Measurable - pharmacy meets this gateway criterion at both 2017 review points
Agreed – make sure staff allocated this objective agree to it and understand its importance
Realistic – this should be easily achievable
Timed - every month of 2017
This target should be non-negotiable

56. What is available to support you

58. NPA Support for achieving the quality criteria
Patient safety
Safeguarding
HLP training (HLC and HLP Leadership course)
Asthma review
Dementia Friends
SCR resources
EPS resources