Advanced Services
- The Pharmacy First service will launch on 31st January 2024 (subject to IT systems being in place).
- The service involves providing consultations to give advice and NHS-funded treatment (via Patient Group Directions), where appropriate, for seven common conditions (clinical pathways consultations). The consultations can be provided to patients who self-refer to the pharmacy (e.g. walk-ins) as well as those referred by NHS 111, GPs and others.
- The seven conditions are: sinusitis, sore throat, acute otitis media, infected insect bite, impetigo, shingles and uncomplicated urinary tract infections in women.
- Distance Selling Pharmacies (DSPs) will be able to provide six of the seven Pharmacy First clinical pathways remotely via video consultations but may not provide clinical pathways consultations on their premises (due to links with the support for self-care Essential service and restrictions regarding the provision of Essential services on the pharmacy premises). The acute otitis media clinical pathway requires the use of an otoscope, so that pathway will not be provided by DSPs.
- The Pharmacy First service will also incorporate the existing Community Pharmacist Consultation Service (CPCS). Pharmacies will be paid £15 per consultation.
- An initial fixed payment of £2,000 will be available to claim from December up to the launch of the Pharmacy First service, which will be reclaimed if pharmacy owners do not provide five clinical pathways consultations by the end of March 2024.
- From February 2024, in addition to the £15 consultation fee, a monthly fixed payment of £1,000 will be paid to pharmacy owners who meet a minimum activity threshold of clinical pathways consultations (the threshold will increase over time as set out below).
To view the PharmOutcomes Training video for The Pharmacy First Service click here.
Please find more information here.
To view the slides from the CPSS Pharmacy First Webinar held 24/01/24 click here.
Otoscope FAQ’s
Q. How should I dispose of otoscope and ear thermometer covers and tongue depressors following use in the examination of a patient?
Within the Health Technical Memorandum 07-01: Safe and sustainable management of healthcare waste such single use items are classified as offensive waste – see page 81 of the document (2022 version). This is not clinical waste, but may contain body fluids, secretions or excretions and it needs to be disposed of in yellow and black-striped ‘tiger’ bags.
Q. Can I dispose of offensive waste, such as otoscope covers and tongue depressors, in a clinical waste bin?
The Health Technical Memorandum 07-01: Safe and sustainable management of healthcare waste advises before disposing of an item in the infectious waste stream [clinical waste], consider whether the item is hazardous, or in fact just unpleasant. The over-classification of offensive waste as infectious waste can lead to more expensive waste management handling and treatment of such wastes. If there is no good reason to believe the item is hazardous – i.e. infectious, chemically / pharmaceutically / cytotoxically contaminated or radioactive – do not dispose of it to a yellow, orange or purple [clinical waste] bin/bag or other container for hazardous waste – see pages 81-82 of the document (2022 version).
Q. How do I dispose of offensive waste bags/containers?
Seek advice on this from your waste disposal contractor. The Health Technical Memorandum 07-01: Safe and sustainable management of healthcare waste provides guidance on waste disposal processes to be used by waste contractors (pages 82-93, 2022 version).
- Information for referring patients back into NHS 111 for Pharmacy First referrals can be obtained by emailing lpc@communitypharmacyss.co.uk.
These two services were introduced in April 2010 and they can be provided by both community pharmacy contractors and dispensing appliance contractors.
The service involves the customisation of a quantity of more than one stoma appliance, based on the patient’s measurements or a template. The aim of the service is to ensure proper use and comfortable fitting of the stoma appliance and to improve the duration of usage, thereby reducing waste. The stoma appliances that can be customised are listed in Part IXC of the Drug Tariff. If a pharmacy intends to provide the SAC service the pharmacy must in the first instance notify Local NHS NHS England team and NHSBSA by completing the forms here.
Appliance Use Reviews (AURs) can be carried out by a pharmacist or a specialist nurse in the pharmacy or at the patient’s home. AURs aim to improve the patient’s knowledge and use of their appliances. If a pharmacy intends to provide the SAC service the pharmacy must in the first instance notify Local NHS NHS England team and NHSBSA by completing the forms here.
Community pharmacy has been providing flu vaccinations under a nationally commissioned service since September 2015.
Each year from September through to March the NHS runs a seasonal flu vaccination campaign aiming to vaccinate all patients who are at risk of developing more serious complications from the virus.
Community pharmacists can vaccinate all eligible patients outlined the service specification.
Please view our Flu pages in A-Z here.
More information can be found here.
Hypertension case-finding service has been commissioned as an Advanced service from 1st October 2021.
The service specification and other details; additional information, guidance and support materials are available here CPE information hub.
Download the service specification
Service Directions & Determination
The Secretary of State Directions provide the legal basis for the provision of the service.
CPE Briefing 041/21: Guidance on the Community Pharmacy Hypertension Case-Finding Advanced Service
This CPE Briefing provides additional guidance for community pharmacy contractors and their teams on the service.
The service will have two stages – the first is identifying people at risk of hypertension and offering them blood pressure monitoring (a ‘clinic check’).
The second stage, where clinically indicated, is offering 24 hour ambulatory blood pressure monitoring (ABPM). The blood pressure test results will then be shared with the patient’s GP to inform a potential diagnosis of hypertension.
The following fees have been agreed:
- A set-up fee of £440;
- A fee for each clinic check of £15; and
- A fee for each ambulatory monitoring of £45.
In addition, the following incentive fees across Years 3, 4 and 5 of the CPCF 5-year agreement, will be available. Pharmacies must reach a threshold of ABPM activity to trigger the payment of the incentive fee.
- An incentive fee of £1,000 will be available if 5 ABPM intervention are provided in 2021/22.
- Followed by a payment of £400 in the subsequent years if the pharmacy reaches the thresholds for those years (15 ABPM interventions will be required in 2022/23 and 20 in 2023/24).
- Contractors who sign up after Year 3 must achieve the ABPM activity thresholds specified for the given financial year and will receive £1,000 as a first payment. If a contractor signs up in Year 3 and fails to do 5 ABPMs, they can earn £1000 by doing 15 ABPMs in Year 4.
Contractors must notify NHSE&I that they intend to provide the service by completion of an electronic registration through the NHS Business Services Authority’s (NHSBSA) application. Further information is available.
To view an interactive map of pharmacies who have signed up for the service please click here.
The pathway has been developed as a guide for using AccuRx messaging in a targeted approach and can be adapted locally as required. It has been designed to enable a collaborative approach between GP surgeries and Community Pharmacies, targeting specific patient cohorts to increase detection rate. This pathway may facilitate workstreams such as Quality and Outcomes Framework (QoF) and Impact and Investment Fund (IIF) indicators including tackling neighbourhood health inequalities outlined in the Directed Enhanced Service.
There are pilot sites in Surrey and Sussex with the ambition to rollout across Sussex and Surrey Heartlands offering viable options to aid capacity in GP practice by reducing some demand on nursing and health care assistant appointments.
How to guide- Implementing the Accurx Pathway in a GP practice or PCN.
The LPC and NHS Sussex created a document for GPs and PCNs to use which supports the implementation of the AccuRx pathway. This how to guide provides guidance on suggested text message content, using AccuRx to send batches, cohort searches, the pathway diagram and more.
Please view “How to implement the AccuRx Pathway“.
The Pharmaceutical Journal published the Community Pharmacy Surrey and Sussex AccuRx Pathway
We are proud to announce that The Pharmaceutical Journal has published the AccuRx pathway, this article outlines the pathway, outcomes of the pilot, the importance of working collaboratively and how using digital tools can support the identification of undiagnosed hypertension.
Please read the published article here:
Download PDF here.
Please contact LPC@commmunitypharmacyss.co.uk if you would like to know more or are a GP practice interested in implementing the pathway.
Community Pharmacy Surrey & Sussex and NHS Sussex have been shortlisted as a finalist at the HSJ Digital awards. For more information click here.
The NHS offers COVID-19 treatment to people with COVID-19 who are at risk of becoming seriously ill. Prior to the introduction of this service, rapid lateral flow device (LFD) tests were available to order by these patients on GOV.UK or by calling NHS 119. These kits were then delivered directly to the patient’s home.
From 6th November 2023, LFD tests will no longer be available via GOV.UK or via NHS 119. LFD tests still need to be available and easily accessible to people who are potentially eligible for COVID-19 treatments through routine NHS access routes. It is estimated, that in the short-term, the number of potentially eligible patients will remain at around 3.9 million. Although access to LFD tests may be supplemented by other pathways (e.g. through anticipatory or specialist care), community pharmacy is well placed within the local community to provide local and rapid access for patients.
Access to COVID-19 community-based treatment will continue to be based on a confirmed COVID-19 infection, which can only be reliably achieved with a diagnostic LFD test, in line with some of the recommended treatment’s product licences. Given the short efficacy window for treatment and practical implications of point of care testing, tests need to be available for patients to access in advance of developing symptoms.
The objective of this service is to offer eligible at risk patients access to LFD tests to enable testing at home for COVID-19, following symptoms of infection. A positive LFD test result will be used to inform a clinical assessment to determine whether the patient is suitable for and will benefit from NICE recommended COVID-19 treatments.
More information is available here.
The service provides support for people with long-term conditions newly prescribed a medicine to help improve medicines adherence; it is focused on specific patient groups and conditions.
Changes to the NMS service were agreed as part of the Year 3 5-year CPCF deal, with these implemented from 1st September 2021:
- Additional eligible conditions were added to the service – see the Patients eligible for the service and the NMS medicines list section below for the details. The rationale for selection of the conditions mirrors that used in identifying the original four therapy areas/conditions: firstly, that there is evidence from research that adherence to medication in this condition could be improved and secondly that reviews of available research suggest these are areas where community pharmacists are best able to support improvements in patient understanding and adherence to treatments.
- Contractors who have received an exemption from the requirement to have a consultation room (due to their premises size) from their regional NHSE&I team, can provide the service remotely or at the patient’s home. All other contractors providing the service can similarly continue to provide the service remotely, where appropriate, and in the patient’s home.
- The cap on the number of NMS which can be provided by contractors increased from 0.5 percent to one percent of monthly prescription volume and additional bandings were included.
- The service can be offered to support parents/guardians/carers of children and adults newly prescribed eligible medicines who could benefit from the service, but where the patient is not able to provide informed consent.
Supporting documents and information can be found on CPE website here and on NHSBSA here.
Service specification can be downloaded here.
Expanded NMS drug list can be downloaded here.
Expanded NMS BNF categories can be download here.
Smoking Cessation advanced service is a stop Smoking service for people referred to pharmacies by a hospital, commissioned as an Advanced service from 10th March 2022.
The service specification and other details; additional information, guidance and support materials are available here.
Download the patient flow diagram
Service Directions and Determination
The Secretary of State Directions provide the legal basis for the provision of the service.
CPE Briefing 008/22: Guidance on the Smoking Cessation Service
This CPE Briefing provides additional guidance for community pharmacy contractors and their teams on the service.
This service enables NHS trusts to refer patients discharged from hospital to a community pharmacy of their choice to continue their smoking cessation care pathway, including providing medication and behavioural support as required, in line with the NHS Long Term Plan care model for tobacco addiction.
The following fees have been agreed:
- A set-up fee of £1,000;
- A fee for the first consultation of £30;
- A fee for each interim patient consultation of £10; and
A fee last consultation of £40.
To view an interactive map of pharmacies who have signed up for the service please click here.
Bitesize video Smoking Cessation Advanced service.
To view the Community Pharmacy and University Hospitals Sussex (UHSX) launch of the advanced SCS service click here.
Click here to see our News article which includes links to the OnDemand webinar and webinar slides.
Pharmacy Contraception Service
The NHS Pharmacy Contraception service has been commissioned as an Advanced service that Started on 24th April 2023, allowing the on-going supply of oral contraception (OC) from community pharmacies. From 1st December 2023, the service included both initiation and on-going supply of Oral Contraception this update relaunched the service from 1st December 2023.
Download the service specification and Patient Group Directions
PGD Progesterone only contraceptive pill
PGD Combined oral hormonal contraceptive pill
Service Directions & Drug tariff determination
Download the service pathway for initiation
Download the service pathway for ongoing supply
Briefing 031/23: Guidance on the Pharmacy Contraception Advanced Service
This Community Pharmacy England Briefing provides additional guidance for pharmacy owners and their teams on the service.
To find a pharmacy who is offering the service please use the service finder here.
To access your local formularies to determine the most appropriate medication to offer in line with the formulary for your local area, please click on the links below
- Sussex ICB combined hormonal contraception
- Sussex ICB Progesterone only contraception
- Frimley ICB Combined hormonal contraceptives
- Frimley ICB Progesterone only contraceptives
- Surrey ICB Formulary
The service will involve providing initiation and ongoing management of routine oral contraception.
The supplies will be authorised via a Patient Group Direction (PGD), with appropriate checks, such as the measurement of the patient’s blood pressure and body mass index, being undertaken, where necessary.
Pharmacy owners must use an NHS-assured clinical IT system to make their clinical records and payment claims for the service and, where the person has consented, to send messages containing the individual’s consultation outcomes to their general practice.
Details of the IT solutions available to support the service can be found on our Pharmacy services IT requirements webpage.
All payment claims for the service must be made through the API this transfers the data to MYS.
The following fees have been agreed for the service:
- A set-up fee of £900 per pharmacy premises paid in instalments as follows:
- £400 paid on signing up to deliver the service via the NHSBSA’s MYS portal;
- £250 paid after claiming the first 5 consultations;
- £250 paid after claiming a further 5 consultations (i.e. 10 consultations completed); and
- A fee for each consultation of £18.
A consultation fee is claimable irrespective of the outcome of the consultation.
Where a pharmacy owner is commissioned to provide any related services, e.g. the Hypertension Case-Finding Service (incorporating BP clinic measurement), the pharmacy owner may not claim twice for the same activity.
The product price for the OC supplied will be reimbursed in accordance with the Drug Tariff determination
Training requirements and competency
Pharmacy owners must ensure that pharmacy staff providing any aspect of the service are competent to do so in line with the specific skills and knowledge in the service specification and the relevant PGDs. This may involve completion of training.
Pharmacy owners need to keep documentary evidence that all pharmacy staff involved in any aspect of provision of the service are competent with regards to the specific skills and knowledge outlined in the service specification and the relevant PGDs.
Pharmacists providing the service will be personally responsible for remaining up to date with the skills and competencies identified in the service specification and associated PGDs.
To provide the service, the pharmacist should have evidence of competence in the clinical skills and knowledge covered in the below listed training modules on the Centre for Pharmacy Postgraduate Education (CPPE) and/or the Health Education England e-learning for healthcare (elfh).
CPPE also has a list of the modules and other useful tools and resources on the NHS PCS page of their website.
Note – packages that are highly recommended are indicated by an asterisk *
Mandatory training
Pharmacists providing the service must have completed one of the recommended Safeguarding level 3 training materials OR have direct access to professional advice from someone who can advise on Safeguarding at Level 3.
- Safeguarding Level 3 - Safeguarding Children and Adults Level 3 for Community Pharmacists – video on elfh;
OR
- Safeguarding Level 3 elfh Safeguarding Children and Young People (SGC) – Safeguarding Children Level 3.
Recommended training modules
- * CPPE Emergency contraception e-learning including emergency contraception e-assessment;
- * CPPE Contraception e-learning including contraception e-assessment;
OR the following four subsections of:
- *Module 3 – Contraceptive Choices of the FSRH Sexual and Reproductive Health e-learning (e-SRH) on elfh:
-
- 03_01: Mechanism of action, effectiveness and UKMEC;
- 03_02: Choosing contraceptive methods;
- 03_03: Combined hormonal contraception; and
- 03_04: Progestogen only methods (oral and injectable).
- * CPPE Sexual health in pharmacies e- learning and e-assessment;
OR the following four subsections of
- *Module 9 – STIs of the FSRH e-SRH on elfh:
-
- 09_01: Epidemiology and transmission of STIs;
- 09_02: Sexually transmitted infection (STI) testing;
- 09_03: STI management; and
- 09_04: Partner notification.
AND one subsection in the
- *External Resources module of the Sexual Health (PWP) e-learning on elfh:
- FSRH – Contraception counselling eLearning.
Initiation of contraception
- The following subsections of Module 2 – Consent and history taking of FSRH e-SRH on elfh:
-
- 02_01 Health history and risk assessment; and
- 02_02 Confidentiality, chaperones, and consent.
- The following subsection of Module 3 – Contraceptive choices of the FSRH e-SRH on elfh:
-
- * 03_07 Barrier contraceptives
- The following subsections of Module 5 – Contraception: managing side-effects and complications of the FSRH e-SRH on elfh:
-
- 05_01 Managing bleeding problems in women using contraceptives;
- 05_02 Managing contraceptive side-effects; and
- 05_03 Managing side-effects and complications of IUD and IUS.
Other training to support clinical practice
- CPPE Documenting in patient clinical records e-learning;
- CPPE Remote consultation skills e-learning;
- Patient group directions e-learning on elfh; and
- CPPE consultation skills for pharmacy practice: taking a person-centred approach and e-assessment.
Pharmacy team training
The whole pharmacy team can proactively promote this service. Teams should be briefed on the service and coached on how to best approach people about the service. A pharmacy team briefing and a guide on how to recruit people is available to assist pharmacy owners to engage and coach their team members.
Pharmacy staff who are going to provide blood pressure measurements and BMI calculations must have the necessary training required to undertake blood pressure readings and measure an individual’s weight and height. These staff need must:
- Be familiar with the appropriate sections of NICE guideline Hypertension in adults: diagnosis and management [NG136];
- Have read and understood the operational processes to provide blood pressure and BMI measurements; and
- Have completed the recommended training on how to use the blood pressure monitoring equipment which should be provided by the equipment manufacturer/supplier.
Equipment that is to be used to undertake clinic blood pressure checks in the service must be validated by the British and Irish Hypertension Society (BIHS), so pharmacy owners must use a ‘normal’ BP meter which is included on one of the two following BIHS lists:
- For more information
- Please click here to see the National Services provided by West Sussex infographic for LPC’s 2021/22.
- Please click here to see the National Services provided by West Sussex infographic for LPC’s 2022/23.
- Please click here to see the National Services provided by East Sussex infographic for LPC’s 2021/22.
- Please click here to see the National Services provided by East Sussex infographic for LPC’s 2022/23.
- Please click here to see the National Services provided by Surrey infographic for LPC’s 2021/22.
- Please click here to see the National Services provided by Surrey infographic for LPC’s 2022/23.
- Please click here to see the National Services provided by CPSS infographic for LPC’s.
- See Community Pharmacy Contractual Framework 2019-2024 (NHS England)
- See Community Pharmacy Contractual Framework 2019-2024 (CPE)
- Contact us at lpc@communitypharmacyss.co.uk
