1. CHRONIC MEDICATION SERVICE Dawn Balfour Community Pharmacy IT Facilitator

2. CMS – Early Adopter NHS Fife was asked to be involved in the EA process in April 2009 Quickly identified sites to approach –Pharmacy/GP practice with close links –Spread across 3 CHP areas –Incorporate all GP systems where possible –Pharmacies using Pharmacy Manager software

3. CMS Early Adopter First sites commenced in May 2009 (Kirkcaldy) –Up to 10 patients –Levothyroxine –8 week prescription to be dispensed weekly

4. CMS Early Adopter July 2009 – commenced with a GPass practice (Anstruther) feeding 2 pharmacies September 2009 – commenced with a further GPass practice (Pittenweem) feeding 2 pharmacies October 2009 – commenced with an INPS practice feeding 1 pharmacy (Cowdenbeath)

5. CMS Early Adopter All sites started with an 8-week script then moved to a 24-week script for the same patients, same drug In mid October go ahead was given to add any other regular medication for the patients to the 24-week script but to date that has not been possible

6. CMS Early Adopter Now working with 2 EMIS GP sites (St Andrews and Cupar) This brings in 2 of the other pharmacy suppliers, Nexphase and Rx Proscript and the final GP system Also working with a Boots site in Cowdenbeath (Nexphase) Only other pharmacy system to be tested is Lloyds - Compass

7. CMS – Who is eligible? Patients must –Be registered with a GP practice in Scotland –Receive regular prescriptions –Have a long-term condition Not eligible –A patient in a care home setting –A temporary resident

8. CMS - Eligibility If the patient meets these conditions the pharmacist can register them for CMS – Stage 1 Once registered the pharmacist can enter into CMS Stage 2 with the patient – pharmaceutical care planning Initially, only if the patient is exempt under age or medical grounds can they receive a serial prescription

9. CMS – Data required To register a patient for CMS you must have –Full name –Gender –Address, including Postcode –Date of Birth –Exemption category –CHI number

10. CMS – CP2/CP3 form The registration form for CMS is now a combined form with the MAS CP2 form MAS will print on the left hand side (CP2) CMS will print on the right hand side (CP3) There are 4 declarations on the reverse of the CP3 ALL of which MUST be crossed.

12. CMS – Process Patient registers at the pharmacy for the service (very much like a MAS registration) If the patient is registered at another pharmacy for CMS the system will prompt the pharmacist to check that the patient definitely wants to transfer their registration Electronic message from pharmacy system is sent to the ePharmacy Message Store (ePMS) GP system electronically requests any data from the store every day Registration status is updated in GP patient record if exempt on age or medical grounds

13. CMS – Process From the date of registration the pharmacist has 3 months to undertake an initial priority profile (Stage 2) Once registration is received in the GP practice system, the GP has the option to generate a serial prescription for either 24 or 48 weeks (Stage 3) NB – you may never receive a serial prescription for a CMS registered patient

14. CMS – Prescription How to identify a CMS prescription –CMS 24 (or 48) weeks printed in bottom left hand corner of GP10 –Dispensing interval identified for each item –UPN (barcode number) starts with the letter K

16. CMS – Process When the prescription is scanned in the pharmacy, the system will pull down the relevant electronic message – same as AMS Pharmacist will use the information to dispense the item(s) in line with the dispensing frequency identified by the GP – this includes setting up the schedule for 24/48 weeks An electronic message will be sent to the practice confirming that the item(s) has been dispensed and on what date

17. CMS – Process Patient will present at the pharmacy the next time they are due their medication (there is no need to go back to their GP) Pharmacy system will allow pharmacists to plan ahead Scan script again at the next dispensing date – this action will check with the store to ensure that there are no cancellation messages from the GP Schedule has already been set up from first dispensing so if nothing has changed the process is very quick

18. CMS – How it works Each time the pharmacist does a dispensing on their system, and claims for it, an electronic claim will go to PSD and a dispensing notification will go back to the practice Please bear this in mind when sending your claims – best practice is to wait until the patient has collected their medication if preparing in advance

19. CMS – GP10 submission The GP10 must be held in the pharmacy until the end of the dispensing period At the last dispensing the patient should sign the back of the GP10 The GP10 is then submitted to PSD in the normal way NB – there is no paper endorsing for CMS it is all electronic

20. Treatment Summary Report At the end of the dispensing period the pharmacy systems will generate an End of Treatment Summary Report This report summarises the dispensing episodes, provides any additional information (free text) the pharmacist thinks is necessary and requests another prescription, if appropriate

23. Treatment Summary Report The TSR will be available in the GP system the following day Pharmacists/GP Practices need to think about how they will use this report. Is this the method you want to use for the repeat prescription or would you rather use existing methods, eg the right hand side of the GP10