ADAC – Module 4: Pre-2017 Textbook (England and Wales)

A number of changes have occurred since the publication of your Module 4 textbook. In order to ensure that your knowledge is current, please read and implement the additional text below.

Module 4: The Drug Tariff – England and Wales

A number of changes have occurred since the publication of your Module 4 textbook. In order to ensure that your knowledge is current, please read and implement the additional text below.

 

Section 6: Quantity to be Supplied

Please remove the following paragraph from your Module 4 Textbook:

 

“There are two types of pack for which allowance has been made with regard to quantity:”

 

Section 6: Half-Way Pack Rule

Your Module 4 textbook will state:

 

“The half-way pack rule does not apply to oral liquid antibiotics. You are allowed to supply enough to cover the full course and will be paid as long as you endorse what you have supplied.”

 

Please change this to:

 

“The half-way pack rule does not apply to the reconstitution of certain granules/powders for oral suspensions, such as antibiotics; this is outlined in Part II, Clause 13 of the Drug Tariff. When the quantity reconstituted is unavoidably greater than the quantity prescribed, and the remainder has not been used for supplying against another prescription, payment will be based on the nearest number of packs that are dispensed, to ensure the patient can complete the full course of the medication prescribed. This means that if a patient requires a course of 140mL of antibiotics (that require reconstitution), where the pack size is 100mL, you would be paid for 2 x 100mL (provided you endorse this).”

 

 

Section 8: Bandages on FP10

Notes on supplying bandages on FP10/WP10

Please remove the following paragraphs from your Module 4 Textbook:

 

“In the case of bandages, the term ‘quantity’ refers to length. If no quantity is indicated by the prescriber you should give the shortest length.

 

The prescriber must indicate size or width; if he has not done so the pharmacist will be paid on the smallest size/width available.”

 

 

Section 13: Non-Medical Prescribing

Independent Prescribers

Please replace this section with the following:

 

“Nurses, pharmacists, optometrists, physiotherapists and podiatrists/chiropodists may undertake a programme of approved training to become independent prescribers.

 

Independent Prescribers can prescribe as follows:

  • Pharmacist and nurse independent prescribers – can prescribe any medicine (including unlicensed) for any medical condition within their competence, including any controlled drug (CD) listed in Schedule 2-5, except diamorphine, cocaine and dipipanone for treating addiction. They may also prescribe ACBS and ‘SLS’ items within their scope of professional practice and for specified patient groups in specific circumstances

 

  • Optometrist independent prescribers – can prescribe licensed medicines for conditions affecting the eye and surrounding tissue only. They cannot prescribe any other medicines or appliances or any controlled drugs

 

  • Physiotherapist independent prescribers – can prescribe any licensed medicine for any condition within their competence within the overarching framework of human movement, performance and function, including a limited list of CDs to be administered by specified routes only, for the treatment of organic disease or injury

 

  • Podiatrist independent prescribers – can prescribe any licensed medicine within their competence and relevant to the treatment of disorders affecting the foot, ankle and associated structures, including a limited list of CDs to be administered by specified routes only, for the treatment of organic disease or injury

 

For further information on the prescribing rights of independent prescribers in England, visit https://psnc.org.uk/dispensing-supply/receiving-a-prescription/who-can-prescribe-what/”

 

NB: the rest of this section can remain in your Textbook as it is.

 

 

Section 13: Supplementary Prescribers

Please add “midwives” to the list of those who can work as supplementary prescribers.

 

 

 

Section 15: Broken Bulk

Please add the following points to the list beginning with “You can claim Broken Bulk on”:

 

“(v) Ingredients which are used to make extemporaneously dispensed medicines

(vi) Chemical reagents – but, many reagents have special container status for which broken bulk cannot be claimed (see below)”

 

Then, in the next list beginning with “You cannot claim Broken Bulk on”, your Module Textbook will state:

 

“(iv) reagents in Part IXR of the Tariff

(iiv) specials and imported products in Part VIIIB”

Please replace this with:

 

“(iv) Any unlicensed specials and imports (except the ingredients used to prepare an extemporaneously dispensed item)”

 

 

Section 15: Out of Pocket Expenses

Please add the following points to the list beginning with “You can claim Out of Pocket Expenses on”:

 

“(iv) borderline substances in Part XV of the Drug Tariff

(v) oxygen”

 

Section 15: Additional Fees

Please add the following text to this section:

 

“Regarding the set professional fee for dispensing, in England, this is called a Single Activity Fee, which is currently £1.25. In Wales, this is called a Professional Fee, which is currently 90p – see Part IIIA of the Drug Tariff.”

 

Section 15: Prescriptions which are Incomplete with Respect to Quantity or Strength

No cheaper stock obtainable (NCSO)  

Please replace the text under this sub-heading with the following:

 

“From time to time, there may be problems in obtaining products listed in Part VIIIA of the Drug Tariff for example due to a manufacturer’s delay. This can result in pharmacies losing money in dispensing these items as they will need to supply an alternative brand which costs more than the Drug Tariff listed price. In such situations, the Department of Health (DoH) can grant a price concession or No Cheaper Stock Obtainable (NCSO) status. The price concession and NCSO list is published on a monthly basis and can be found on the PSNC website.

 

Price concessions are more commonly used than NCSO statuses. When the DoH sets a price concession, pharmacies will be automatically reimbursed based on the set price stated in the list produced each month; there is no need to use any endorsement for price concessions.

 

When an NCSO status has been granted for a product, the reimbursement price will be based upon what has been endorsed on the prescription. The prescription needs to be endorsed fully and it is important to include:

  • NCSO
  • Pharmacist initials
  • Date
  • Supplier, manufacturer or brand name
  • Pack size
  • Price if appropriate”

 

Section 15: Guide to Prescription Endorsements

Please replace the text under point “7. Broken Bulk”, with the following:

 

“Endorse ‘BB’ and the amount dispensed over the pack size used”

 

Also, please replace the text under point “8. Out of Pocket Expenses”, with the following:

 

“Endorse: ‘OOP’ or ‘XP’ on paper prescriptions, and ‘XP’ for electronic prescriptions; full details of what is being claimed; the amount being claimed.”

 

 

 

Section 16: Exemption from charges

Welsh Prescriptions

Please add the following text to this section:

 

“In order to be exempt from payment, patients must be registered with a Welsh GP and obtain their prescriptions from a pharmacy in Wales. Patients who live in Wales but are registered with a GP in England due to their closeness to the England-Wales border can be issued with ‘entitlement cards’. Patients who present with the card and an English prescription can obtain free prescriptions.

 

Prescription forms from England (without an entitlement card) in Wales will be charged the set charge for each prescription item. Prescriptions from Scotland and Northern Ireland will be dispensed free of charge.”

 

Section 16: Exercise 20

Please remove “12. Prothiaden 100mg (tablets and capsules dispensed)” from this exercise.

 

 

Section 17: What to do with Prescriptions at the end of the Month

Please add the following to this section:

 

Sorting and submission of prescriptions in Wales

Submission of prescriptions

Complete the WP34C submision document as follows:

Part 1: Contractor details and authorisation

 

Must include:

  • Pharmacy stamp
  • Signed and dated

Part 2: Submissions

 

  • Record the number of:
  • Forms and items in Groups 1 and 2, and add up the total
  • Forms and items for private Controlled Drugs prescriptions
  • Controlled Drugs requisition forms
  • Repeat authorisation forms

Part 3: Declaration

 

  • Month and year
  • Account number
  • Number of staff dispensing hours

NB: Prescriptions must be submitted for pricing no later than the 5th day of the month.

WP34C forms are obtained from http://www.primarycareservices.wales.nhs.uk/

 

For further guidance, refer to:

 

Separation of Prescriptions

New Section: Quality Payments

After the Department of Health’s introduction of the Quality Payments Scheme in England, a new section has been devised. Please add the following section to your Module 4 textbook:

 

Quality Payments Scheme – Part VII

Objectives

By the end of this section you should:

 

  • Have a better understanding of the quality payments scheme in England
  • Know about the gateway criteria
  • Know the quality criteria to be fulfilled in order to earn ‘quality points’

Part VII of the Drug Tariff covers the quality payments scheme in England. The Department of Health (DoH) has introduced a quality payments scheme whereby pharmacy contractors are able to claim payment depending on achieving specific quality criteria.

  • There are eight quality 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

Gateway criteria

In order to receive any quality points, a pharmacy has to first meet four gateway criteria. The four gateway criteria are:

 

  • Provision of at least one specified Advanced Service
    • The specified Advanced Services are:
      • Medicines Use Reviews (MURs)
      • New Medicine Service (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 the Electronic Prescription Service (EPS)

 

Quality criteria and quality points

If the gateway criteria are met, contractors can claim quality payments by earning ‘quality points’.

 

  • The eight quality criteria have been weighted so that the number of points allocated to each one is based on the difficulty of achieving them and the benefit to patients
  • The eight quality criteria, together with the number of points applicable to each one are set out in the table below
  • Three of the quality criteria can only be claimed at one of the two review points – these quality criteria account for 45 of the 100 points available

Claiming quality payments

Contractors will need to complete an online submission to the NHS Business Services Authority (NHSBSA); this will be a declaration that the gateway and quality criteria have been met at each review point.

 

Once a submission has been made it cannot be amended, therefore, it is important to check thoroughly before submitting a declaration.

 

Domain Quality criteria Review points at which quality points can be claimed Points at any one review point Total points over two review points
Patient Safety Written safety report at premises level available for inspection at review point, covering analysis of incidents and incident patterns (taken from an ongoing log), evidence of sharing learning locally and nationally, and actions taken in response to national patient safety alert 1 20 20
On the day of the review 80% of registered pharmacy professionals working at the pharmacy have achieved level 2 safeguarding status for children and vulnerable adults in the last two years 2 5 10
Patient experience On the day of the review, the results of the Community Pharmacy Patient Questionnaire from the last 12 months is publicly available on the pharmacy’s NHS Choices page or for distance selling pharmacies it is displayed on their website and the NHS Choices service desk has been notified 1 5 5
Public health On the day of the review, the pharmacy is a Healthy Living Pharmacy level 1 (self-assessment) 1 20 20
Digital On the day of the first review, the pharmacy can demonstrate a total increase in access to Summary Care Records (from 27/06/2016 – 27/11/2016 compared to 28/11/2016 – 30/04/2017); and on the day of the second review, the pharmacy can demonstrate a total increase in access to Summary Care Records (from 03/10/2016 – 30/04/2017 compared to 01/05/2017 – 26/11/2017) 2 5 10
On the day of the review, the pharmacy’s NHS 111 Directory of Services entry is up to date 2 2.5 5
Clinical effectiveness On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than six short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a six-month period, are referred to an appropriate health care professional for an asthma review 2 10 20
Workforce On the day of the review, 80% of all pharmacy staff working in patient facing roles are trained ‘Dementia Friends’ 2 5 10

 

Summary

You should now:

 

  • Have a better understanding of the quality payments scheme in England
  • Know about the gateway criteria
  • Know the quality criteria to be fulfilled in order to earn ‘quality points’

 

Section 19: Answers to Inter-text Exercises

 

Due to the frequent changes of the Drug Tariff, published monthly, some of the answers to the inter-text exercises have changed since the publication of your Module 4 Textbook. We suggest that you disregard the answers provided in Section 19 where appropriate and refer to the latest Drug Tariff.

 

 

 

Download ADAC Module 4 Addendum for Pre-2017 textbook – England and Wales