Pharmacy Quality Scheme

A new Pharmacy Quality Scheme(PQS) has been made available to Community Pharmacies as part of the 5yr Community Pharmacy Contractual Framework deal announced in July. The new scheme which replaces the Quality Payments Scheme, will come into effect “for the remainder” of 2019/20.

Funding and payment

Pharmacies will receive payment based on the number of eligible criteria/composite bundles they meet. The total funding of £75m will be divided between qualifying pharmacies, based on the number of points achieved and will be calculated to distribute the full £75 million funding.

The new scheme will have one review point in February 2020 when a PQS payment can be claimed. Claims will be paid by the end of March 2020.

Pharmacies can claim an Aspiration payment in October 2019 for the 2019/20 Pharmacy Quality Scheme.

Aspiration payments

An aspiration payment will be made within the scheme, ahead of contractors completing all the work on the various composite bundles/standalone criteria. These are advance payments of up to 70% of the pharmacy’s earnings under the Quality Payments Scheme in 2018/19.

In order to receive an aspiration payment, pharmacies will need to meet the gateway criteria and state which of the composite bundles/standalone criteria they expect to achieve. This declaration must be undertaken by the end of October. The aspiration payment will be made by the end of November.

NHSBSA Manage Your Service application

The first step in participating in the PQS is registration for the NHSBSA Manage Your Service (MYS) application. MYS will be the only way to claim a PQS Aspiration Payment and make a PQS declaration.

The system will also be the route for claiming payment for the Flu Vaccination Service 2019/20 and notifying readiness to provide the new Community Pharmacist Consultation Service.

Pharmacies must register with MYS by the end of October 2019 to ensure their application can be processed in time to allow them to claim the Aspiration payment.

Gateway criteria

There are four gateway criteria which pharmacy contractors must meet. Achieving the gateway criteria will not, in and of itself, earn a payment for the pharmacy.

There are four gateway criteria which pharmacy contractors must meet. Achieving the gateway criteria will not, in and of itself, earn a payment for the pharmacy. The gateway criteria are:

1.   Advanced Services – The pharmacy must be offering:

  • NHS Community Pharmacy Seasonal Influenza Vaccination Advanced Service and/or
  • New Medicine Service (NMS)

These services must be listed on the pharmacy NHS.uk profile if they are being provided.

2.   NHS Mail

  • Pharmacy staff at the pharmacy must be able to send and receive NHSmail from their shared premises NHSmail mailbox.
  • The NHSmail mailbox must have at least two active linked accounts.

3.   NHS Website

  • The pharmacy profile on the NHS website be regularly and promptly updated with opening hours (including Bank Holidays), services and facilities to ensure information is accurate for the public.
  • Pharmacies must edit and/or validate their NHS.uk entry during the specific timeframe contractually indicated (not yet confirmed).

4.   Safeguarding Level 2

  • 80% of all pharmacy professionals must have achieved Level 2 safeguarding status for children and vulnerable adults in the last two years.

The Quality Criteria

Quality criteria are either standalone requirements or composite quality ‘bundles’. Pharmacies will need to achieve all activities within a bundle to receive payment for that bundle.

1. Risk management and safety (Composite)

a) 80% of all pharmacy professionals must complete the CPPE Risk management training and assessment.

b) 80% of all pharmacy professionals must complete CPPE Sepsis training and assessment and:

  • Apply learning to respond in a safe and appropriate way when it is suspected that someone has sepsis.
  • Disseminate alert symptoms to staff, to ensure referral to pharmacist.

c) The pharmacy has available, at premises level, an update of the previous risk review that the pharmacy team at the premises had drawn up as a risk in that pharmacy. This update must include a recorded reflection on:

  • Risk and the risk minimisation actions the pharmacy team has been taking.
  • Any subsequent changes identified as a result of the reflection.
  • The risk of missing sepsis identification as a new risk.
  • Demonstrable risk minimisation actions undertaken to mitigate the risk.

Note: Pharmacies that did not claim for the risk management quality criterion previously and wish to claim at the next review point must have two identified risks, including the risk of missing sepsis as above, as part of completion and claiming for this whole composite bundle.

d) 80% of all pharmacy professionals to complete CPPE Reducing look-alike, sound a-like errors (LASA) e-learning and assessment.

e) A new written safety report (and subsequent actions completed in line with current criterion) at premises level available for inspection at review point, covering:

  • Analysis of incidents and incident patterns (taken from an ongoing log), incorporating learnings from CPPE LASA e-learning.
  • A review of and subsequent actions where mitigation taken has failed to prevent a LASA incident from occurring.
  • Evidence of sharing learning locally and nationally
  • Actions taken in response to national patient safety alerts.
  • Demonstrable evidence of actions identified in the patient safety report have been implemented.

2. Medicines safety audits complementing Quality Outcomes Framework Quality Improvements (Composite)

a) For all patients prescribed lithium, the pharmacy must:

  • Ask the patient if they have had their lithium levels checked in the last 3 months as well as other relevant blood tests at appropriate intervals, e.g. for kidney (renal) and thyroid function every 6 months.
  • Record this information on the PMR, or appropriate form/patient record.
  • Refer patient as appropriate.

b) Ask the patient whether they understand signs of lithium toxicity, e.g. upset stomach and:

  • Go through these with the patient
  • Record whether the patient did or did not know the signs of lithium toxicity.

c) Ask the patient whether they know what to do if they miss one or more doses:

  • Record whether the patient did or did not know the appropriate action to be taken when the miss dose(s).
  • Record whether this advice was provided.

d) Ask the patient if they understand how to prevent toxicity, e.g. adequate fluid intake especially if exercising heavily:

  • Record whether the patient did or did not know how to prevent toxicity.
  • Record whether this advice was provided or not.

e) Provide the patient with general healthy living advice.

f) Monitor the patient for interactions (OTC and prescription medicines) with lithium, including:

  • Record whether patient was taking or had taken medicines OTC which interact with lithium with/without the advice of a pharmacist or doctor.
  • Record whether patient was given advice not to take OTC medicines, including herbal remedies or supplements, without speaking to a doctor or a pharmacist.

If the pharmacy has no patients prescribed lithium, they must:

a) Complete a safety audit of patients prescribed phenobarbital, methotrexate or amiodarone as alternatives, in line with the QOF

b) Complete an audit of the provision of advice on pregnancy prevention for girls and women of childbearing potential taking valproate, ensuring that:

  • All girls and women of childbearing potential who have presented a prescription for valproate, during a specified 3-month period are:
    • Advised on the risks of taking valproate in line with all the requirements as detailed in MHRA Drug Safety Update 2018.
    • Advised of the potential impact on an unborn child.
    • Provided with a Patient Guide.
    • Confirmed to have had a discussion with their GP or specialist to discuss treatment and the need for contraception.
  • This intervention is recorded on the PMR, or appropriate form/patient record.

c) Report the number of patients dispensed a prescription for valproate who are old enough to become pregnant and have been provided advice and information in line with the MHRA Drug Safety Update 2018.

d) Pharmacies should implement, into their day-to-day practice, the findings and recommendations from the previous clinical audit on NSAIDs prescribed for those 65 years and above without gastroprotection (undertaken as part of the Quality Payments Scheme for the February 2019 review point). The findings and recommendations from the audit will be published in a report by NHS Specialist Pharmacy Service (publication date still to be confirmed).

e) The pharmacy must then repeat the audit of NSAIDs and gastro-protection for all patients 65 years and over, including notifying the patients’ GP and must:

  • Flag any professional concerns that are identified.
  • Share their anonymised data with NHS England.
  • Incorporate any learning from the re-audit into future practice.

Submission of information to NHS England should be reported on the MYS application as part of all above audits.

3. Prevention (Composite)

a) The pharmacy is a Healthy Living Pharmacy Level 1 (self-assessment).

b) All patient-facing staff are Dementia Friends.

c) The pharmacy has completed a specified dementia-friendly environment checklist and created an action plan which includes making some demonstrable recorded changes to the environment in line with the checklist, as appropriate.

d) Check all patients aged 12 years and over with diabetes and who present with a prescription from 1st October 2019 to 31st Jan 2020, have had an annual foot and eye check (retinopathy). The following actions must then be completed:

  • Signpost/refer patient as appropriate.
  • Make a record on the PMR or appropriate form/patient record:
    • The total number of patients who have had this intervention.
    • The number that have not had one or either check in the last 12 months.
    • Where they have been appropriately signposted/referred

e) The sales by the pharmacy of Sugar Sweetened Beverages will account for no more than 10% by volume in litres of all beverages sold.

f) The pharmacy must have either achieved by this by the review point or declare that they will be meeting this by 31st March 2020.

4. Primary Care Networks

a) Demonstrate that pharmacists in a PCN area have agreed a collaborative approach to engaging with their PCN, including agreement on a single channel of communication, for example, by appointing a lead representative for all community pharmacies in the PCN footprint to engage in discussions with the PCN.

5. Asthma

a) The pharmacy can show evidence of asthma patients, for whom more than 6 short-acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6-month period (since 28/6/2018) have been referred to an appropriate health care professional for an asthma review. Pharmacy must be able to evidence:

  • That they have ensured that all children aged 5-15 prescribed an inhaled corticosteroid for asthma have a spacer device where appropriate in line with NICE TA38
  • Have a personalised asthma action plan and/or referred to an appropriate healthcare professional where this is not the case

6. Digital enablers (Composite)

a) NHS 111 DoS profile. The pharmacy must:

  • Update promptly its NHS111 DoS profile via the DoS updater, including:
    • opening hours for Bank Holidays
    • Information changes

b) Demonstrate access to Summary Care Records.

The Pharmacy Quality Scheme 2020/21

PSNC has already agreed some of the features of the 2020/21 Pharmacy Quality Scheme. These include:

  • Completion of suicide prevention training by pharmacy staff
  • Audits focussed on:
    • inhaler technique
    • anticoagulation

Further details on these points will be published by PSNC in due course.