Community Pharmacy Home Delivery Service During the COVID-19 Outbreak: commissioned (England)

12 Apr 2020

IMPORTANT: Please note that this update is only intended to provide NPA members with a brief overview of the new service. You are strongly advised to read the full details of the ‘Community Pharmacy home delivery service during the COVID-19 outbreak’ accessible via the links available at the end of this update. Further guidance and a template SOP will be available from the NPA shortly to support you in implementing this new service.

 

NHS England & NHS Improvement (NHSE&I) has now commissioned the Community Pharmacy Home Delivery Service during the COVID-19 outbreak. This service is designed to support shielded patients in England to access their prescribed medicines and appliances while they are self-isolating at home during the pandemic period. The service went live from 9 April 2020 and will run during the pandemic until 1 July 2020 initially; it may be extended beyond this date following a review. NHSE&I published the service specifications and detailed guidance on Friday 10 April 2020.

  • Distance-selling pharmacies (DSPs) are excluded. The Essential Service and Advanced Service are not applicable to DSPs as they are already contractually required to delivery prescription items to patients. They are however able to deliver prescriptions on another pharmacy’s behalf where that pharmacy has exhausted all other options for delivering the prescription.

 

How will the service be delivered by community pharmacies?

There are two aspects to the Community Pharmacy Home Delivery Service During the COVID-19 Outbreak:

  • Essential Service requiring pharmacies to ensure the prescribed items are delivered to shielded patients via a duly authorised person (this can be the patient’s carer, relative, friend, neighbour, or a volunteer such as NHS Volunteer Responder for example, where appropriate.
  • Advanced Service allowing pharmacies to choose / opt in to provide a ‘paid for’ delivery service if the pharmacy is not able to facilitate delivery of the prescribed items to shielded patients via the Essential Service route.

 

Who can access the community pharmacy home delivery service?

  • Patients who are self-isolating at home, having been identified as being extremely vulnerable (shielding), and have received a letter from the NHS, their GP or hospital consultant, are eligible for this service. (See eligibility criteria below)
  • GPs are able to add or remove patients to the extremely vulnerable list as their clinical condition changes.
  • A flag has been added to the NHS Summary Care Record (SCR) of these patients, to confirm that they are an eligible patient; this SCR flag went live on Friday 3 April 2020.

 

What is the eligibility criteria?

Only patients who come under one or more of the criteria listed below are eligible to receive home deliveries under the NHS commissioned Community Pharmacy Home Delivery Service During the COVID-19 Outbreak:

  • Solid organ transplant recipients
  • People with specific cancers
  • People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
  • People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • People having immunotherapy or other continuing antibody treatments for cancer
  • People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  • People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs;
  • People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD;
  • People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell);
  • People on immunosuppression therapies sufficient to significantly increase risk of infection;
  • People who are pregnant with significant congenital heart disease; and
  • People who have been added to the list by their GP because of the very high risk (in line with the risk of those above) to them associated with COVID-19.

 

 

What about patients who may be eligible but have not been flagged on their SCR?

There may be cases where a patient has not been identified as being eligible; however, during the dispensing process, the prescribed items (e.g. immunosuppressant medication) indicate that the patient may fall within the eligible group of patients. In these cases, the patient should be asked if they have been advised to self-isolate for 12 weeks, because they have received a letter from either the NHS, their GP or hospital. If so, such patients should be treated as eligible for the service.

 

What should eligible patient do to receive home delivery of their prescribed items?

Patients are expected, or advised, to take the following actions in the following order:

  1. Ask someone to collect their prescribed items from their usual pharmacy. This can be a representative or a volunteer.
  2. Contact the pharmacy to ask them to help them find a volunteer.
  3. Request the pharmacy to make the delivery.

 

What is the difference between a representative and a volunteer?

  • A representative is an individual who is known to the patient, trusted and chosen by them (such as a carer, relative, friend, neighbour) to collect their prescribed items and deliver it to them.
  • A volunteer is an individual who is not likely to be known to the patient, provided by local volunteer groups or via the NHS volunteer responder service/GoodSAM app. The patient may have no choice but to use a volunteer if they are not able to arrange for a representative to collect and deliver their prescribed items.

 

Can a volunteer deliver Controlled Drugs to shielded patients under this service?

Where a volunteer is to be used, the pharmacist must be satisfied that the volunteer is an appropriate person to deliver the prescribed items to the patient. Under this service:

  • Volunteers should not deliver Schedule 2 and 3 Controlled Drugs. The delivery should be arranged via the patient’s representative, or the pharmacy’s own delivery service under the Advanced Service.
  • Pharmacists are required to use their professional judgement to determine whether it is appropriate for a volunteer to deliver Schedule 4 or 5 Controlled Drugs.

 

What checks should the pharmacy make regarding volunteers?

  • Where the pharmacy is supporting patients to find a volunteer to make the delivery, they should ensure they are comfortable with the status of the volunteer or the volunteer organisation they are recommending to the patient.
  • The pharmacy has an obligation to ensure that the volunteer is suitable, and has the appropriate skills and competencies to carry out the required role. This means ensuring that the volunteer has had a recent Disclosure & Barring Service (DBS) check.
  • Before using unknown volunteers to delivery prescribed items to patients on your behalf, please ensure that you have taken into account guidance from the PSNC and NPA.
  • The pharmacist has the right to reject a volunteer where they are not satisfied with the checks made, and/or they believe that the volunteer is not the appropriate person to make the delivery.
  • If the pharmacy is not able to recommend / does not have access to volunteers that have been DBS checked, they should use their own delivery driver and claim for making the delivery under the Advanced service.

 

What are the requirements under the Essential Service aspect of the delivery service?

Pharmacies are required to follow the step-by-step process listed below to make suitable arrangements to ensure that the patients receives the delivery of their prescribed items.

 

  1. Encourage the patient to arrange for someone (for example, carer, relative, friend, volunteer) to collect their prescribed items from the pharmacy.
  2. If the patient cannot identify someone to collect and deliver the prescription items on their behalf, the pharmacy is required to support the patient to identify a local volunteer.
    1. This can be through locally organised volunteer arrangements (e.g. organised by a local council) or volunteers from the NHS Volunteer Responders programme – see Appendix 1: Annex B of the NHSE&I letter/guidance document.
  3. If no volunteer is available, the pharmacy is still required to ensure that the prescribed items are delivered to the eligible patient. Options on how to do so include:
    1. Deliver the medicine as part of the Advanced Service; or
    2. Arrange for another pharmacy to deliver it on your behalf; the other pharmacy will be able to claim payment for the delivery under the Advanced Service; or
    3. Arrange for the prescription to be dispensed and delivered by another NHS commissioned pharmacy (by referring the patient to another pharmacy); this can include a DSP.

 

What are the key points of the Advanced Service aspect of the delivery service?

  1. Community pharmacies can provide this advanced delivery service to eligible patients, where as part of the Essential service:
    1. The prescription has been dispensed in your pharmacy; or
    2. Where another pharmacy has dispensed the prescription and has asked your pharmacy to deliver the prescription on their behalf. In this case, you need to check the patient is eligible on their SCR, or obtain assurance that the patient is eligible from the pharmacy that dispensed it.
  2. Under this Advanced Service, community pharmacies are required to either:
    1. Deliver the medicine which your pharmacy has dispensed, or outsource the delivery via a secure delivery method; or
    2. Deliver the medicine which another pharmacy has dispensed, or outsource its delivery via a secure delivery method.

 

How much will the pharmacy be paid for the Community Pharmacy Home Delivery Service During the COVID-19 Outbreak?

 

Essential Service – community pharmacies (except DSPs) will be paid an allowance aligned to the Transition Payment banding, linked to the pharmacy’s monthly prescription volume. The NHS Business Services Authority (NHSBSA) will make this payment automatically. This is additional funding being made available as part of the pandemic response and does not come from the community pharmacy global sum.

 

Number of items per month from April 2020 Monthly payment from April 2020
0 – 100 £   0
101 – 2,500 £ 34
2,501 – 5,000 £ 396
5,001 – 12,500 £ 500
12,501 – 19,167 £ 542
19,168+ £ 563

 

Advanced Service

  • £5 + VAT per delivery
  • You will be able to claim the payment via the Manage Your Service (MYS) portal as part of the usual end of month process by declaring the number of deliveries made each month.
  • The NHSBSA will provide further details on how to make the claim via MYS before the end of April 2020.
  • This is additional funding being made available as part of the pandemic response and does not come from the community pharmacy global sum.
  • The fee will only be paid when the pharmacy makes the delivery themselves or outsources it via a secure delivery method – robust records must be kept.
  • The fee is not payable if a patient, relative, carer or volunteer could have appropriately delivered the medicine – robust records must be kept.

 

What are the record-keeping requirements?

It is a requirement to keep appropriate records to ensure effective ongoing service provision, and to support post-payment verification under the Advanced Service:

  • Details of the eligible patients to whom a delivery was made under this service – patient details (name, address, a record of which criterion they come under in the eligibility criteria).
  • The date of the delivery

 

It is also advisable to record the reasons why the delivery is being made under the advanced service. For example, it was established that the prescribed items cannot be delivered by a friend, relative, carer or volunteer as required under the Essential Service; this may be due to no suitable volunteer available, or that the nature of the prescribed items (CDs) prevented the delivery being made using a volunteer.

 

Can I make deliveries to other patients under this service?

No. Only eligible patients are covered under this service.

 

You may receive requests for home deliveries from non-eligible patients:

  • Use the NPA poster on delivering medicines to explain to patients that your pharmacy is receiving an increase in the number of requests for delivery of medicines due to the COVID-19 pandemic.
  • Urge the patient to identify a suitable representative to collect their prescribed items from the pharmacy and deliver it to them.
  • Advise the patients to only request delivery of medicines if they have no other option.

 

These measures will help to ensure that you have the ability to deliver to those who are in need. However, if you are able to make deliveries using your own delivery driver, you may wish to prioritise deliveries to other patients who may be vulnerable but are not in the shielded group; for example, those aged over 70 years and/or with long-term medical conditions.

 

Can I charge patients to arrange/make deliveries of their prescribed items?

  • You cannot charge patients for arranging / making deliveries to shielded patients under the NHS-commissioned Community Pharmacy Home Delivery Service during the COVID-19 outbreak. Community pharmacies will be paid the relevant fees by the NHS as described above for providing this service to shielded patients.
  • For making deliveries of prescribed items to other patients, you can choose to charge patients for the delivery if you need to, or wish to; this would be your business decision.

 

Where can I find further information and guidance on this service?

 

What support is available from the NPA?

 

Please call us for advice and support on 01727891800, or email pharmacyservices@npa.co.uk.