All DACs and PCs must provide the following Essential Services for dispensing appliances:
- Emergency supply
- Repeat dispensing
- Record keeping
- Home Delivery of Stoma and Incontinence Appliances
- Provision of wipes and disposal bags
- Provision of appropriate advice
For Essential Services both contractors will be paid a set of fees that is based on the different Part IX A, B or C items. For payment information please see the table illustrated at the end of the section explaining the Essential Services.
In the case of urgency, the supplier of appliances may supply an appliance if asked to do so by a prescriber as long as the prescriber undertakes to issue a prescription to the dispenser within 72 hours (or transmit an electronic prescription). In practice, this change is likely to have little impact.
The new terms of service require DACs to provide this service in line with Pharmacy Contractors.
Repeat dispensing is an alternative model for prescribing and dispensing regular medicines and appliances to patients on stable long-term treatment. Repeat supplies of appliances may be managed by the patient's chosen supplier of appliances. The prescriber produces a repeatable prescription and a set of identical 'batch' forms - the number required, is equal to the number of times the prescription is to be repeated and this is to be indicated on the form, for example, 1 of X, 2 of X.
Each repeatable prescription can be dispensed at regular intervals, for example, monthly for a period of up to twelve months. However, an NHS repeatable prescription needs to be dispensed for the first time within six months of being written and can then only be dispensed subsequently for up to a year from being written or until any expiry date specified by the prescriber, whichever is less.
A dispensing interval does not have to be set by the prescriber, so that the supplier has maximum flexibility to make a professional decision when to dispense the next supply for the patient. This is of particular benefit for patients with certain appliances or for patients that may be travelling and require an additional supply of their items ahead of time.
The aims and intended service outcomes for repeat dispensing is:
Stoma appliance customisation must be provided at an 'acceptable location' as specified below:
- To increase patient choice and convenience, by allowing them to obtain their regular prescribed medicines and appliances directly from a supplier of their choice for a period agreed by the prescriber.
- To minimise wastage by reducing the number of medicines and appliances dispensed which are not required by the patient.
- To reduce the workload of General Medical Practices, by lowering the burden of managing repeat prescriptions.
A detailed service specification was developed for the implementation of this service element into the Community Pharmacy Contractual Framework in 2005. This can be found on NHS Primary Care Commissioning website.
The supplier of appliances must keep accurate records of all supplies made to patients.
The purpose of the records is to ensure there is an accurate audit trail for items supplied, and also to assist suppliers of appliances to provide advice and support to patients with regard to their appliance(s), provide continuing care for patients, and document any interventions or referrals made during the dispensing process.
Home Delivery of Stoma and Incontinence Appliances
The regulations state there is a requirement to make available home delivery, which is only applicable to Incontinence and Stoma Appliances. This will include all items listed in part IX B & C of the drug tariff and certain qualifying items* listed in part IX A (mainly catheters). This service has to be offered, but is not compulsory and it is the patient's choice whether they collect their appliances from the pharmacy or have it home delivered.
Provision of wipes and disposal bags
A reasonable supply of wipes and disposal bags for qualifying items also need to be supplied against all items that are indicated in the drug tariff part IXA (qualifying items*), B & C. It is indicated that a reasonable supply would be a one for one ratio for actual number of stoma or continence bags verses the free bags and wipes. i.e. 1 box of 30 stoma bags would provide 30 disposal bags and wipes.
Provision of appropriate advice
There is a requirement to ensure that both Pharmacy Contractors (PCs) and Dispensing Appliance Contractors (DACs) provide appropriate advice to patients about any stoma or incontinence appliance provided to them in order to enable them to utilise, store and dispose of the appliance appropriately. Advice may already be available by some pharmacies, however arrangements must be in place for giving appropriate advice, both written and verbal, when patients order their appliance and when the items are dispensed. This can be provided through a telephone care line. PCs and DACs must also ensure that a patient may consult, if the patient so wishes, someone to obtain expert advice regarding the appliance being dispensed.
Referrals and signposting
If the supplier of appliances cannot dispense an item prescribed, for example it is out of stock, or cannot provide the required stoma appliance customisation, then he or she must - with the patient's consent - refer the prescription form or repeatable prescription to another supplier of appliances (i.e. another pharmacy or DAC). If the patient does not consent to this, then the supplier of appliances must provide contact details for at least two other suppliers (if he or she has the details) that may be able to dispense the required item or service. If the supplier of appliances is unable to provide the AUR service then he/she must give the patient the contact details of at least two people who are suppliers of appliances who are able to arrange for the service to be provided, if these details are known to the supplier.
The terms of service for Pharmacy Contractors with regards to inducements were extended by amending regulations in September 2009; The terms of service for DACs have been brought into line with Pharmacy Contractors under the new contractual arrangements.
DACs may not give, promise or offer to any person, including Pharmacy Contractors, any gift or reward as an inducement to or in consideration of them presenting a prescription for an appliance, or for nominating the DAC as their dispensing contractor, or one of them, in an NHS Care Record (Schedule 3 paragraph 15). Therefore, Pharmacy Contractors that signpost patients to a DAC either because they do not provide appliances, or because they do not provide that appliance in their normal course of business, are complying with their terms of service and therefore should receive no gift or reward for doing so.
However, there are circumstances where Pharmacy Contractors may provide an element of Essential Services to a patient when signposting them to a DAC, where a payment may be appropriate. These circumstances could include:
- Provision of advice to the patient on their appliance where the patient requests this and where the pharmacy contractor does not supply any appliances in their normal course of business.
- Collection of the patient charge.
- Receiving the dispensed item from the DAC and handing or delivering it to the patient.
In these circumstances the pharmacy contractor would be acting outside of their NHS terms of service and this would be a commercial arrangement.
NWOS have introduced their Appliance Partnership to support Pharmacy Contractors in providing the required services that fall within the guidelines issued by DH, but without the hassle to the pharmacy.
In 2005, the DH introduced a new 'Community Pharmacy Contractual Framework' and as part of this framework Pharmacy Contractors had to operate their business in a clinical governance framework. From April 2010 this clinical governance framework was extend to Dispensing Appliance Contractors. It is designed to ensure that all paperwork and procedures are in place to enable a relevant monitoring and audit to be carried out by the regulating body and also ensure both patient and contractor accountability.
Essential Services Fee Structure Table
|Normal Dispensing||As Current||For all items in Part IXA, B and C - a fee of 90p will be paid.|
|Additional Dispensing Service||Home delivery (NB: the fee is paid per qualifying item dispensed, regardless of whether the patient has requested collection from the pharmacy or home delivery).||A fee of £3.40 will be paid for each item listed in Part IXA (qualifying items¹), Part IX B and C dispensed, with the exception of all intermittent self-catheters (ISC) listed in Part IX A where a fee of £9.30 will be paid for each ISC dispensed.|
|Dispensing of appliances measured and fitted||The measure and fitting of applicable appliances - this has been extended to include belts and girdles||£2.60 per item (based on the contractor's endorsement of measured and fitted).|
|Expensive Prescription Fee||Additional fee paid on all prescription items over £100||2% of the net ingredient cost (pharmacies already receive this fee)|
1. Qualifying items for home delivery are items in Part IXB and IC of the Drug Tariff and the following products in Part IXA of the Tariff: catheter, laryngectomy and tracheostomy, catheter accessories, catheter maintenance solutions, anal irrigation system, vacuum pumps and constrictor rings for erectile dysfunction, and wound drainage pouches.