Home Changes to the supply of Appliances
Summary of the changes to Essential services and new Advanced services linked to the supply of Appliances
In 2010 changes were made to the Terms of Service for pharmacies that dispense appliances listed in Part IX of the Drug Tariff. These changes came into effect from 1 April 2010, and affect all pharmacies – even if they do not normally supply these appliances.
The changes mark the end of a long consultation process, which set out to improve the service provided to patients, and to harmonise the arrangements so far as possible, between supply made by a pharmacy and a supply made by a Dispensing Appliance Contractor (DAC).
Pharmacists may regularly dispense appliances in the course of their business, or they may dispense such prescriptions infrequently, or they may have taken a decision not to dispense them at all. Whilst the terms of service requires a pharmacist to dispense any (non-blacklisted) medicine ‘with reasonable promptness’, for appliances the obligation to dispense arises only if the pharmacist supplies such products ‘in the normal course of his business’.
The information in this section of the website and the associated Regulations and Secretary of State Directions are essential reading for those pharmacies that dispense appliances after 1 April 2010. For other pharmacies, this website section provides a summary of the changes, and identifies those changes to practice which may be needed for all pharmacies.
This page is broken down into several areas for easier navigation:
Specified Appliances
Essential Services
Advanced Services
Inducements
Fee levels
Timescales for implementation
Specified Appliances
The new arrangements apply to all appliances, but some, known as ‘Specified appliances’, have additional requirements. ‘Specified appliances’ are:
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catheter appliances (including a catheter accessory and maintenance solution); tracheostomy and laryngectomy appliances; anal irrigation systems; a vacuum pump or constrictor ring for erectile dysfunction, or a wound drainage pouch; that are listed in Part IXA of the Drug Tariff;
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incontinence appliances that are listed in Part IXB of the Drug Tariff; and
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stoma appliances listed in Part IXC of the Drug Tariff.
Essential Services
Under the new arrangements, all pharmacy contractors choosing to dispense qualifying products in the normal course of their business are required to comply with new Essential services requirements:
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A home delivery service and supply of wipes and disposal bags: there is a requirement to make available home delivery for all qualifying items in Part IXA, Part IXB and Part IXC of the Drug Tariff. It is the patient's choice whether they collect their appliance from the pharmacy or have it home delivered. A reasonable supply of wipes and disposal bags for qualifying items should be supplied with the appliances. Entries in the Drug Tariff indicate whether the supply of wipes and disposal bags, or home delivery applies to the products listed.
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Provide appropriate advice: there is a requirement to ensure that pharmacy contractors 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. Pharmacy contractors must also ensure that a patient may consult, if the patient so wishes, someone to obtain expert clinical advice regarding the appliance being dispensed.
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Signposting: if a pharmacy cannot dispense the item prescribed or cannot provide the required stoma appliance customisation, there is a requirement - with the patient’s consent - to refer the prescription form or repeatable prescription to another pharmacy or dispensing appliance contractor (DAC). If the patient does not consent to referral, then contact details for at least two other contractors who may be able to dispense the required item or provide the specific service should be provided, where these details are known. Pharmacy contractors cannot accept or receive any gift or reward for making such referrals.
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Emergency Supply: a prescriber may request an emergency supply of a medicine or an appliance, provided that he undertakes to furnish a prescription within 72 hours (or transmit an electronic prescription). This is the same provision that applies to the emergency supply of Prescription Only Medicines. Note, that although the facility exists, the decision on whether to make the supply in accordance with the request remains with the pharmacist.
PSNC has produced a summary of the changes, with suggested actions that pharmacy contractors can take to comply with the new requirements. A detailed description of the changes to Essential services can be found here.
Advanced Services
All pharmacies are able to provide two new Advanced services if they wish to do so and have the necessary facilities and knowledge. The requirements for these new services are defined in the Secretary of State Directions.
Appliance Use Reviews (AURs): Pharmacy contractors are able to choose to provide AURs in relation to Part IXA (qualifying items), Part IXB or Part IXC prescription items. Such reviews must be conducted by a pharmacist or by a specialist nurse – working on behalf of the pharmacy contractor that dispensed the appliance. It is permitted to conduct AURs at the patient’s home or at the pharmacy contractor’s premises. If the AUR takes place at the pharmacy contractor’s premises, it must be conducted in a clearly designated area for confidential consultation. AURs are intended to complement the care provided by healthcare professionals working in the NHS, therefore the pharmacist or specialist nurse must maintain close contact with the NHS healthcare professional looking after the patient wherever possible.
Stoma Appliance Customisation: Stoma appliance customisation refers to the process of modifying multiple identical parts for use with a stoma appliance to the same specification, where the modification is based on the patient’s measurements or a record of those measurements and, if applicable, a template.
For a detailed description of these new Advanced services click here.
Inducements
The terms of service prohibit a pharmacy from receiving any gift or reward in respect of only providing contact details of other providers of appliances, or for only referring prescriptions to a provider. This is because the signposting to other providers and referral are requirements under the terms of service - so the NHS already funds these activities.
Some pharmacies have commercial relationships with appliance providers so that where they themselves are not able to provide appliances (or under these new provisions, cannot provide the Advanced services), they refer patients on to a third party. If the pharmacy does nothing more than forwarding the prescription, the prohibition on inducements prevents the receipt of referral fees. But, if the pharmacy undertakes any other activity in relation to the transaction, for example, contacts the provider for stock availability information so that the patient can be informed of expected delivery date; liaises with the provider over the delivery preferences of the patient; collects the prescription charge or carries out the checking of exemption claims; or provides for example, the supplementary items, then the receipt of an agency fee associated with those activities would not be prohibited.
Fee levels (April 2010)
| Service | Fee Level |
| Home delivery | Other than for intermittent self-catheters (ISC), a fee of £3.40 will be paid for each of the qualifying items which is dispensed. A fee of £9.30 will be paid for each ISC dispensed. The fee is paid per qualifying item dispensed, regardless of whether the patient has requested collection from the pharmacy or home delivery. Qualifying items for home delivery are items in Part IXB and IXC 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. |
| Dispensing of appliances measured and fitted | £2.60 per item (Based on the contractor's endorsement of measured and fitted. To include belts and girdles) |
| Stoma Customisation | £4.32 for every qualifying Part IXC prescription item dispensed. The fee is paid per qualifying Part IXC item dispensed, regardless of whether customisation was required. Qualifying Part IXC items for stoma customisation are one-piece closed bags (under “colostomy bags” chapter heading of current Drug Tariff), drainable bags (under “ileostomy bags” chapter heading) and bags with tap (under “urostomy bags” chapter heading), items under “two piece ostomy system” and “flanges” chapter headings, as well as Skin Protectors and Stoma Caps. |
| Appliance Use Review | £28 for AURs conducted on the pharmacy premises. £54 for AURs conducted at the patient's home. Where more than one AUR is conducted in the same, non-pharmacy location within a 24-hour period, £54 for the first AUR and £28 for each of the subsequent AURs. |
Timescales for implementation
Although the Regulations came into force on 1 April 2010, pharmacies that are already on the pharmaceutical list before that date have until 31 December 2010 to comply, unless they intend to provide the new Advanced services (Stoma appliance customisation service and Appliance Use Review) – in this case, the new terms of service must be complied with from the time at which the pharmacy proposes to provide the new Advanced services.
For pharmacies that are included in the pharmaceutical list on or after 1 April 2010, compliance with these new terms of service is required from the date the pharmacy opens.
Template documents to support the provision of these services
PSNC has developed a range of template documents to support the provision of the new appliance services. Click on the links below to download Microsoft Word versions of the documents.
The documents can be personalised by pharmacy contractors to fit with their locally developed SOPs. The documents contain form fields (generally grey boxes) that direct where text or other information can be added. Many of the documents have document protection enabled to facilitate use of these form fields. If you wish to edit the structure of the documents you may need to unprotect the document (no password has been set for the protection).
APPL01 - AUR PCT notification form. This form can be submitted to the PCT to notify them of the intent to carry out the Appliance Use Review Advanced Service.
APPL02 - Stoma Customisation PCT notification. This form can be submitted to the PCT to notify them of the intent to carry out the Stoma Customisation Advanced Service.
APPL03 - Stoma customisation record form. A form to record the details of any stoma customisations carried out.
APPL04 - AUR record form. A form to record the details of any AURs carried out.
APPL05 - AUR GP notification template. This form would be used to inform the GP that an AUR has been conducted but that no action points have arisen that the GP needs to be aware of.
APPL06 - Appliances count sheet. This form can be used to keep track of the number of specified appliances dispensed during the year in order to determine how many AURs may be provided.
APPL07 - Clinical advice and referral form. This form can be used to record advice given and referrals made during the provision of Essential Services for appliance scripts.
More information and resources
The contents of this website section are available to download as a PDF document.
A PowerPoint presentation which may be used for training purposes is available here.
An overview of the new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology - and related services - in primary care (Department of Health) (N.B. the AUR fee quoted in this document is incorrect, the fee has been set at £28 not £27)
Advanced Services Declaration form for submission to NHS Prescription Services
Copies of the consultation documents that have led to the service changes, along with the responses from PSNC, can be accessed in the PSNC online publications database.
Frequently Asked Questions
1) How would a contractor based in England be reimbursed for submitting a script for a Part IX item to NHS Prescription Services in England for a patient registered and residing in Wales?
NHS Prescription Services have confirmed that this script would be reimbursed in accordance with the new English regulations.
2) Now the regulations have changed, will I still be able to participate in an Appliances Agency Scheme?
If the agreement between the pharmacy and the Dispensing Appliance Contractor (DAC) only consists of forwarding on the prescription, then this would be allowed under the new regulations, but the pharmacy would be prohibited from receiving referral fees for this activity.
If however, the pharmacy undertakes any other activity in relation to the transaction, for example, contacts the provider for stock availability information so that the patient can be informed of expected delivery date; liaises with the provider over the delivery preferences of the patient; collects the prescription charge or carries out the checking of exemption claims; or provides for example, the supplementary items, then the receipt of an agency fee associated with those activities would not be prohibited.
3) I do not dispense the specified appliances, do I need to comply with the new terms of service?
The changes apply to all contractors and as such, the relevant changes to the Essential services must be complied with, in line with the terms of service. The Essential service requirements that all contractors need to comply with are related to minimising waste, repeat dispensing, identification of the pharmacy when dispensing any appliance and signposting. More details on these can be found here.
The requirements for home delivery, provision of supplementary items and provision of expert clinical advice only apply when supplying the specified appliances.
4) When do I have to be compliant with the new regulations?
The new regulations came into force on 1st April 2010. Pharmacies that are already on the pharmaceutical list before that date will have until 31 December 2010 to comply, unless they intend to provide the new Advanced services (Stoma Appliance Customisation service and Appliance Use Review (AUR)) - in this case, the new terms of service must be complied with from the time at which the pharmacy proposes to provide the new Advanced services. For pharmacies that are included in the pharmaceutical list on or after 1 April 2010, compliance with these new terms of service is required from the date the pharmacy opens.