National Health Service Act 2006

• The National Health Service Act 2006 sets out the promotion, provision, and regulation of health services in England

Regulatory Details

• Part 7 of the Act deals with pharmaceutical and local pharmaceutical services
• Part 3 of the Regulations deals with routine applications for inclusion in pharmaceutical lists
• NHS operates under NHS contracts between a 'commissioner' and a 'provider or contractor'
• Community pharmacies are NHS contractors

Integrated Care Systems (ICSs)

• Key planning and partnership bodies from July 2022 that aim to:
  • Improve outcomes in population health and healthcare
  • Tackle inequalities in outcomes, experience, and access
  • Enhance productivity and value for money
  • Support broader social and economic development
  • Achieved through Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs)
• ICBs are the strategic decision-making bodies of place-based Integrated Care Systems
• NHS England performance manages and supports NHS bodies working with and through the ICS.
• The Care Quality Commission independently reviews and rates the ICS
• Integrated care board (ICB) allocates the NHS budget and commissions services
  • An individual with expertise and knowledge of mental illness is also included
  • Produces a five-year system plan for health services
• Integrated care partnership (ICP) includes representatives from local authorities, ICB, Healthwatch, and other partners
  • ICP plans to meet wider health, public health, and social care needs
  • ICP develops and leads integrated care strategies but does not commission services

Partnership and Delivery Structures:

• Provider collaboratives: NHS trusts (including acute, specialist, and mental health) and voluntary, community, and social enterprise (VCSE) organizations, and the independent sector operating at the place level
• Health and wellbeing boards: ICS, Healthwatch, local authorities and wider membership operating at system level
• Place-based partnerships include ICB members, local authorities, VCSE organizations, NHS trusts (including acute, mental health, and community services), Healthwatch, and primary care
• Primary care networks include general practice, community pharmacy, dentistry, and opticians

Health and Wellbeing Boards

• Established by the Health and Social Care Act 2012
• Transferred responsibility for pharmaceutical needs assessments (PNAs) from primary care trusts (PCTs) to health and wellbeing boards (HWBs) in April 2013
• Responsibility for using PNAs as the basis for determining market entry to a pharmaceutical list was transferred from PCTs to NHS England and NHS Improvement

Pharmaceutical Needs Assessment

• Produced every 3 years document used to make decisions about commissioning pharmacy services, and to grant or change contracts
• It should include:
  • A statement of the pharmaceutical services that are currently available in the area.
  • A statement of the services that are needed but not currently available
  • A statement of any other services that are provided but not needed, or that could improve access to pharmaceutical services
  • Statement of any other NHS services that could affect the need for pharmaceutical services
  • An explanation of how the assessment was carried out, including how consultation was conducted
  • A map of the pharmaceutical service providers in the area

Community Pharmacy Contract

• Community pharmacy is an NHS contractor
• Community pharmacies are usually independent businesses contracted by the NHS to provide certain services for local populations
• Contracted and commissioned in England under the national Community Pharmacy Contractual Framework (CPCF)
• CPCF sets out the services that need to be provided, how quality is assured, and other expectations, such as safety.

Community Pharmacy Contractual Framework

• Includes the Pharmacy Quality Scheme, Essential Services, Advanced Services, Enhanced Services, NHS locally commissioned services, and Non-NHS locally commissioned services

Pharmacy Quality Scheme

• Introduced in December 2016 as part of CPCF
• Designed to support the NHS long term plan
• Rewards community pharmacies for meeting quality standards in three areas: Clinical Effectiveness, Patient Safety, and Patient Experience
• Gateway Criteria does not trigger a payment but must be met to be eligible for payment
• Domains trigger payments and focus on key areas of healthcare improvements such as medicines Safety and Optimisation / Respiratory / Prevention

Essential Services

• Each contractor must provide all 9 essential services or they will be in breach of their contract:
  • Dispensing medicines
  • Dispensing appliances
  • Disposal of unwanted medicines
  • Public health
  • Repeat dispensing and eRD
  • Signposting
  • Support for self-care
  • Discharge medicines service
  • Healthy living pharmacies

Discharge Medicines Service

• New service in 2021 to optimize medicine use and minimize harm
• Discharge from hospital is associated with increased risk of avoidable medication related harm is a key consideration
• Optimise the use of medicines
• Reduce harm from medicines at transfers of care
• improve patients' understanding of their medicines and how to take it after discharge from hospital
• Reduce hospital readmissions
• Support the development of effective team-working across hospital, community and primary care networks pharmacy teams and general practice teams and provide clarity about respective roles.

DMS Patient Pathway & DMS stages

• Identify patient who will benefit from follow up by community pharmacy.
• Work in partnership with community pharmacy to support safe discharge for patients.
• Medicines reconciliation and clinical check in community pharmacy.
• Resolve issues and consultation with patient.
• Update central records in General Medical Practice (in a Primary Care Network).
• Follow up medical care and/or tests or monitoring.
• Structured medication reviews/Prescribing

Stages of DMS

• The community pharmacy receives a discharge referral and undertakes a clinical check within 72hrs
• Compare the discharge with the PMR and SCR and seek clarification around any issues
• The community pharmacy checks the patient's understanding of their medicine(s) regimen and consideration of other appropriate services

Healthy Living Pharmacies

• Became an essential service requirement in 2020/21
• Aims to improve the health and wellbeing of the local population and reduce health inequalities through consistent provision of a broad range of health promotion interventions
• To become a HLP pharmacy owners must meet criteria relating to workforce development, engagement, and premises requirements.

Workforce Development in HLPs

• All patient-facing pharmacy staff must have an awareness of the public health and pharmaceutical needs of the population they serve, and understand the basic principles of health and wellbeing
• Pharmacy owners must have an appointed health and wellbeing leader from the pharmacy team that has undergone leadership training

Engagement in HLPs

• Pharmacy staff proactively engage with patients/the public using the pharmacy, to offer them advice, support, and signposting to other providers of services in the community
• Pharmacy staff proactively encourage charities and other providers to work with the pharmacy for delivery of key health messages

Premises requirements for HLPs

• Have a dedicated health promotion zone and a consultation room where both patient & staff member are able to be seated together and communicate confidentially

Advanced Services

• Community pharmacies can choose to provide any of these services as long as they meet the requirements
• The 9 Advanced Services are:
  • Appliance use review
  • Lateral Flow Device Service
  • Smoking Cessation Service
  • Stoma Appliance Customisation
  • Flu vaccination service
  • Hypertension Case Finding Service
  • New Medicine Service
  • Pharmacy Contraception Service
  • Pharmacy First Service