Home Supply of Appliances
Additional Essential service requirements linked to the supply of Appliances (introduced in April 2010)
Minimising Waste
There is an obligation when dispensing prescriptions or repeatable prescriptions for appliances, that the patient should be appropriately advised on the importance of only requesting items they actually need. This is similar to the current requirement when dispensing repeat prescriptions for medicines - but note that for appliances, the obligation exists for both repeatable and standard prescriptions.
The clinical effectiveness programme (which is already part of the clinical governance framework in the Terms of Service) is expanded. The pharmacy contractor will be required to consider information in the Patient Medication Records such as the prescribing patterns for the patient and use this to inform the advice provided to the patient about the ordering and use of appliances and the importance of minimising waste. The intention is to ensure that stock-piling of appliances is avoided, and that the appliance is used correctly (for example, discarded at suitable intervals, rather than disposed of too frequently).
Repeat Dispensing
When a pharmacist is asked to dispense a batch issue for a medicine, he must establish before dispensing it, that the patient's medication regimen has not altered in any way which indicates that there should be a review of the patient's treatment. The new addition to that requirement is that when asked to dispense a batch issue for an appliance, the pharmacist should establish whether the ‘manner of utilisation' has changed, such that a review is appropriate. This is a positive obligation, and must be carried out on every occasion that a batch issue for an appliance is dispensed.
Identification of the pharmacy
When dispensing an appliance, the patient should be provided with a written note of the pharmacy name, address and telephone number. As records of all prescriptions dispensed should be entered onto the Patient Medication Record, this information may be provided on a dispensing label if dispensing labels have all the detail required. This amendment ensures that patients have contact details associated with the supply of the appliance. If a dispensing label containing the name, address and telephone number of the pharmacy is not used, then some other written note should be provided - a patient leaflet, a dispensing bag printed with that information, or a complements slip would all be satisfactory alternatives.
Signposting
If any prescription for an appliance is presented for dispensing and the pharmacist is unable to provide the appliance, then subject to the consent of the patient, the pharmacist can refer the prescription to another provider for dispensing. If the patient does not consent to the prescription being referred to another provider, the pharmacist must give the patient the contact details of two providers of appliances, if the pharmacist is aware of the contact details. This information may be made available by the PCT. This amendment to the service seeks to avoid the patient simply being told that the pharmacy does not stock the item, and being left to find a suitable provider himself.
Home Delivery
If a pharmacy normally provides appliances in the course of its business, and is presented with a prescription for a ‘specified appliance', the pharmacist must offer to deliver the specified appliance to the patient's home. If the patient accepts the offer of home delivery, this must be made with reasonable promptness and at a time agreed with the patient. When delivering such appliances, the packaging used for the appliance must not have any markings which could indicate the contents, and the method of delivery must not convey the type of appliance being delivered.
The offer of home delivery need not be made pro-actively on each occasion a prescription is presented. The pharmacy can use additional methods to ensure that patients know that the free service is available, for example by including this in leaflets. The appliances for which home delivery must be offered are:
(a) any of the following appliances listed in Part IXA of the Drug Tariff:
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a catheter appliance (including a catheter accessory and maintenance solution),
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a laryngectomy or tracheostomy appliance,
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an anal irrigation system,
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a vacuum pump or constrictor ring for erectile dysfunction, or
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a wound drainage pouch;
(b) an incontinence appliance listed in Part IXB of the Drug Tariff; or
(c) a stoma appliance listed in Part IXC of the Drug Tariff.
Home delivery could be made by the pharmacy staff, the Royal Mail or another carrier could be used.
Supplementary Items
If a pharmacy normally provides appliances in the course of its business, and is presented with a prescription for a ‘specified appliance', the pharmacist must provide a reasonable supply of appropriate supplementary items (disposable wipes and disposal bags). The appliances with which supplementary items should be provided are indicated in the Drug Tariff.
Clinical Advice about Appliances
If a pharmacy normally provides appliances in the course of its business, and is presented with a prescription for a ‘specified appliance', the pharmacist must ensure that the patient can consult a person to obtain expert clinical advice about the appliance or, where the pharmacist believes it appropriate to do so, to refer the patient to the prescriber or to offer the patient an Appliance Use Review (AUR). Where expert clinical advice is given, this must be provided by a person who is suitably trained and who has relevant experience in respect of the appliance. This might be the pharmacist, or it could be an appropriately trained nurse or other person with suitable experience. The pharmacy may be asked to confirm to the PCT during monitoring visits, how patients will be provided with expert clinical advice.
Where the pharmacist discharges the obligation to ensure that there is access to expert clinical advice by providing a telephone care line, then this must be available at all times, including during the out of hours period, (i.e. the time outside the core contractual or supplementary hours of the pharmacy) or the telephone number of NHS Direct or the website address of NHS Direct on-line should be made available through the telephone care line.
Where an AUR is required, but the pharmacist is not able to provide the AUR service, the patient must be given the contact details of at least two pharmacies or suppliers of appliances who are able to arrange for the service to be provided, if contact details are known to the pharmacist. The PCT may provide these details or it may be established by the pharmacist.
Records must be kept of any advice given to patients or referrals made. Form APPL07 - Clinical advice and referral can be used to record advice given and referrals.
Emergency supplies
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).
PSNC has produced a summary of the changes, with suggested actions that pharmacy contractors can take to comply with the new requirements.