COVID-19


Section last updated: 3 December 2020

This page contains links to further information both national and local on the COVID-19 coronavirus pandemic.

Please note that this is an area that changes regularly and the information and guidance will be updated on a regular basis.

We will do our best to support and advise you on any query and rely on your continuous feedback.

The LPC contact details can be found in the contact us section.

Standard Operating Procedure

Updated COVID-19 SOP

NHS England and NHS Improvement (NHSE&I)  issued an updated Standard Operating Procedure (SOP) for community pharmacies in relation to the COVID-19 pandemic.

A key amendment enables regional NHSE&I teams to notify pharmacies that they may work behind closed doors without the need for contractors to apply for such closed-door working. This change has been made to help healthcare bodies to tailor their response to the pandemic dependent on the local or regional situation. NHSE&I will consult with LPCs.

Full information on key changes to the SOP are highlighted clearly in yellow on the updated, published SOP and further information is available on the PSNC website.

Emergency and Business Continuity Planning

All businesses and NHS providers, including community pharmacy contractors, need to have an ability to cope with emergency situations, so that wherever possible, they can continue to provide services to patients and the public therefore ensure you update your Business Continuity Plan 

GPHC has confirmed where no locum cover can be secured at the pharmacy, and recognising the potential effects of the current pandemic, it would be in the patient’s best interest for medicines already dispensed to be supplied from the pharmacy. They have also relaxed the inspection process. Please see full details on the GPHC website.

Community pharmacy security

The Metropolitan police has issued guidance specifically for community pharmacy premises offering advice on security of premises, and safety and well-being of staff and customers during the pandemic.

Occupational Health Service Provision

NHS England and NHS Improvement have contacted all community pharmacies to notify them that the suppliers identified below have agreed to provide an Occupational Health service provision to support the COVID 19 risk assessment onward referral for staff in the high-risk categories working in primary care. This service is currently available from 1 September to 31 December 2020.

All suppliers are offering either telephone or video conference referral appointments. We have been asked to advise you of the following information should you wish to refer a member of staff for support following the outcome of their individual risk assessment.

  • Contact the preferred provider to register as a customer on their referral portal.
  • Be advised of costs associated with either the Occupational Health Nurse or Physician appointment which will include an advisory report
  • During the registration process you will be asked to provide a purchase order number or billing details as the employer responsible for payment. Occupational Health services made available to primary care colleagues in support of their employees are funded by the employer.
  • Referrals will normally be seen within 10 working days.

You will be advised during the registration process of any additional steps you need to undertake to ensure your colleagues are seen as soon as possible.

The list of preferred suppliers that can be contacted for support are:

COPE Occupational Health – Tel: 0115 925 9222
Management referral with Occupational Health Advisor
Management referrals with Occupational Health Physician

Health work – Tel: 0161 831 9701/ Email: admin@healthworkltd.com
Management referral with Occupational Health Advisor
Management referral with Occupational Health Physician

OHRD – Phone: 028 9026 8460/ Email: admin@ohrd.net
Management referral with Occupational Health Advisor
Management referral with Occupational Health Physician

We recognise that some organisations have already put in place arrangements to provide Occupational Health support for colleagues and there is no requirement to use any of those named above.

NHS England and NHS Improvement have asked each supplier to report on monthly usage.  Please be assured that no patient/staff member identifiable information will be included in the report and we will be working within the required Information Governance guidelines.

If you have any questions, please contact england.pharmacyeast@nhs.net.

COVID-19 Vaccinations

This is a very fast moving area and we will update new information here as soon as it becomes available.

 

Update from NHSE&I – Pharmacy Covid-19 Vaccination LES and Guidance

Following a positive Government update on progress to develop a COVID-19 vaccine, the NHS has released documentation to help GP practices prepare for a potential vaccination programme.

In a letter to GP practices, NHS England and NHS Improvement (NHSE&I) stated that “PCN partners in community services or community pharmacy may be able to support delivery”. PSNC is in discussions with officials about how the community pharmacy sector will be involved and we will provide further information as soon as we are able.

The characteristics of the COVID-19 vaccines – including initial storage requirements at very low temperatures and the way they will be supplied to the NHS – have implications for how the COVID vaccination programme will be organised and the scale of the sites used. This means the programme will work very differently to flu vaccination.

Further information will be released as soon as it is available but, in the meantime, contractors should be aware that the rollout will be coordinated by the NHS at a local level and that GPs and pharmacies will need to work together to make this work for their communities.

Contractors can also be assured that PSNC has stressed that community pharmacy teams must be vaccinated alongside all other health and social care professionals: NHSE&I has now confirmed to us that this will be the case.

Pharmacy Closures

For full information on the regulatory and contractual requirements of opening hours for pharmacies during the current period please refer to the PSNC website.

Please remember that you must inform the DOS when the pharmacy is closed and the best way to do this is to use the DOS Profile Updater. If you have any problems with using the DOS Profile Updater please email the DOS team.

PharmOutcomes has developed a reporting template allowing pharmacies to record their operational status. This will allow pharmacies to record the level at which they are operating against a Red, Amber and Green traffic light system and provide feedback to LPC leads and Head Offices about the challenges they are facing. For sites recording an Amber status, the template allows a pharmacy to record and feedback details of their operational challenges and also provide information on planned closures, in line with the revised COVID-19 SOP. For pharmacies faced with no alternative other than to close, i.e. recording a RED status,  all information recorded and saved will prepopulate a form that can be printed when data is saved. This form can then be emailed to the East NHS England and Improvement (NHSE&I) office to inform them of the closure.

The PharmOutcomes template would be very useful for the LPC to help monitor service delivery and support you better and we recommend that you use this template going forward to record your operational service where possible.

PPE

Face coverings are now compulsory for retail staff
From Thursday 24 September 2020, it becomes compulsory for community pharmacy staff to wear a face covering in areas that are open to the public and where they come, or are likely to come, within close contact of a member of the public.

However, there is existing Public Health England guidance on the wearing of face masks in community pharmacy, for staff in both clinical and non-clinical roles, which is applicable to all primary and community health care providers in England. Further details can be found on the PSNC website.

 

All COVID-19 PPE now available via portal
The Government’s PPE portal can now be used by community pharmacies to obtain all the COVID-19 personal protective equipment (PPE) they need; the supplies will be provided free of charge.
Community pharmacies will have received an email invitation to register to access the service, which will have been sent to their NHSmail shared mailbox.  If you cannot find the email, you can still create an account by visiting the portal and using your NHSmail shared mailbox email address to register.
Visit the portal
Pharmacies can use the portal to meet the extra need for PPE that has arisen as a direct result of the COVID-19 pandemic. You should not use the portal to order PPE for non-COVID-19 requirements; this should be ordered through your normal supply channels. Further details can be found on the PSNC website.

Test and Trace

PSNC has updated its guidance on NHS Test and Trace based on recent discussions between NHS England & NHS Improvement (NHSE&I) and Public Health England (PHE).

These discussions have indicated that contractors should, in particular:

  • Ensure the PHE Local Health Protection Team consider community pharmacy contact tracing cases. If the local team don’t make the initial contact with the pharmacy, contractors should escalate cases to the team, or call the team direct. This may not be necessary if a contractor is satisfied with the decision without full assessment.
  • Ask pharmacy staff NOT to give their colleagues’ names to NHS Test and Trace if they test positive for coronavirus, but to provide the contact details of the pharmacy. This is because any names given will be entered automatically into NHS Test and Trace systems with no assessment of whether they are close contacts – this is difficult for the local health protection team to ‘overturn’ if its assessment finds that pharmacy colleagues are not close contacts of the individual.
  • Continue to take all appropriate steps to make the pharmacy COVID-secure, so far as practicable, including social distancing, the proper use (donning and doffing) of appropriate PPE, but recognise that if one staff member tests positive, sometimes other staff may still be close contacts and asked to self-isolate depending on the PHE Local Health Protection Team assessment

 

NHS COVID-19 app: QR code posters optional for community pharmacy
The long-awaited NHS COVID-19 app is launched on 24 September 2020. It will be heavily promoted to members of the public, as the Government sees this as a vital part of the NHS Test and Trace service in England. The Government is encouraging businesses and organisations, such as hospitality services, to display official NHS QR code posters at their venue entrances to help support contact tracing. Community pharmacies are not required to display NHS QR code posters but may do so, according to Government advice. Further details can be found on the PSNC website.

COVID-19 Trial (PRINCIPLE)

Researchers at the University of Oxford are appealing for people with typical COVID-19 symptoms, aged 50-64 years with existing medical conditions, or 65 years and over with or without existing medical conditions, to take part in a national priority status clinical trial -PRINCIPLE.

Currently, there are no effective treatments available that have been shown through clinical trials to reduce disease burden in the community.

PRINCIPLE is evaluating whether certain commonly used medicines may prevent patient with COVID-19 from becoming more unwell and needing hospital care. Several medicines with well-known safety profiles are being evaluated and compared with usual care.

The trial is funded from UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research as part of the UK Government’s rapid research response fund. The trial team are working with GP surgeries, care homes, NHS111 and ambulance services across England, Wales, Scotland and Northern Ireland to recruit in to this study.

More information about the trial is available on the Principle website- www.principletrial.org.

The attached PRINCIPLE poster can be displayed in your pharmacy and any interested participants can contact the Oxford study team directly.

National Updates and Information

A joint letter from the Competition and Markets Authority and the General Pharmaceutical Council regarding pricing during the COVID-19 pandemic has been sent to all pharmacies regarding a small minority of pharmacies seeking to benefit from the coronavirus pandemic by charging unjustifiably high prices for essential products.

 

Nationally the key actions that pharmacy teams are advised to undertake during the pandemic are as follows:

  1. Read the NHSE&I guidance whenever it is updated and implement its recommended actions;
  2. Clearly display the COVID-19 poster at points of entry to your pharmacy;
  3. Implement your business continuity plan where required and seek assistance and advice from your Local Pharmaceutical Committee;
  4. Keep up to date with developments by regularly checking the information on  COVID-19 on GOV.UK, the NHSE&I Coronavirus Primary Care webpage and checking your NHSmail shared mailbox on a regular basis for updates from NHSE&I; and
  5. Where possible, display the public health advice posters on hand washing, social distancing etc.

Please note all changes to the CPCF during Covid-19 can be found here

A wealth of useful and practical information is available from the following key organisations on their websites:

The GPhC has published and will continue to publish new standards in their knowledge hub that helpfully clarifies some of the key areas for COVID-19 that may be causing you queries such as working with other pharmacies and volunteer groups. The standards will continue to be updated with new areas as and when they arise. This can be found on the knowledge hub of the GPhC website.

Pandemic Delivery Service

With the commencement of the second national lockdown in early November 2020, the service was restarted across England on 5 November 2020 and it will run until 3 December 2020.

Due to the new national restrictions across England, new advice has been issued to people who are clinically extremely vulnerable from COVID-19 (those previously referred to as shielded patients).

Two new groups of patients have also been identified as being clinically extremely vulnerable from COIVID-19 and have been added to the list of such patients: adults with Stage 5 chronic kidney disease and adults with Down’s syndrome. NHS trusts and general practices respectively will be adding patients from these groups to the shielded patient list. The need for children and young people to stay on the list will also be reviewed considering individual circumstances. The Summary Care Record will be updated accordingly.

People who are clinically extremely vulnerable will be advised by the Government not to go to a pharmacy, and as a consequence of this new advice, the Secretary of State for Health and Social Care has decided to restart the Pandemic Delivery Service from 5th November 2020 until 3rd December 2020. The service applies across the whole of England.

This change to the service requirements was announced on 4 November 2020 in a letter published by NHS England and NHS Improvement.

The Terms of Service requirements therefore apply to all contractors in England (excluding Distance Selling Pharmacies) and will receive the Essential service payment for the days the service is active, as set out in Part VIA of the Drug Tariff.

If a contractor (excluding Distance Selling Pharmacies) is asked to deliver a prescription to a clinically extremely vulnerable patient, this can be undertaken during the above time period, under the terms of the Advanced service and a claim for payment can be made via the Manage Your Service (MYS) platform.

 

The commissioned pharmacy delivery service has been set up and funded to assist shielded patients that are unable to access their required medications.

This does not replace any existing delivery service that is offered by the pharmacy or the service that many have been able to make use of via authorised voluntary organisations.

Full details of the service can be found on the PSNC website.

The LPC has developed a Flow Chart for first time users.

If you are familiar with this service please see PSNC Flow Chart

Eligible patient groups for the delivery service

People falling into the extremely vulnerable (shielded) group, please see attached.

NHS Digital have added a ‘Vulnerability flag’ to the NHS Summary Care Record (SCR) of patients who are on the shielded patient list. This enables community pharmacy teams using NHS Digital’s SCR  portal to see an alert when viewing the SCR of such a patient. Full details on the PSNC website.

It would be well advised to emphasise the message that the NHS has used in its communications to patients, that they should try to get a family member, friend or volunteer to collect the item on their behalf, before asking the pharmacy to deliver.

Vulnerable ‘shielded‘ patients, have been sent details on how to access support via the RVS/GoodSam app on a medicines delivery service in the letter they received from the NHS, so they shouldn’t need a referral from a community pharmacist. Shielded patients are the only patient group that can access such direct support from RVS/GoodSam.

Volunteers

In the first instance patients should be encouraged to identify a family neighbour or relative to pick up their medicines on their behalf where possible. Where this isn’t possible we have therefore agreed with the organisations below that we will promote the relevant organisation’s contact details to community pharmacies that can be provided to the patient as follows.

How to access support:

  • Hertfordshire County Council accessible to all patients across Hertfordshire 

If you are an individual requiring support in collecting a prescription, please contact Herts Help on 0300 123 4044 or go to Herts Help Website.

  • Communities 1st accessible to all patients across St Albans and Hertsmere 

020 8386 4006      memberservices@communities1st.org.uk

  • Welwyn/Hatfield CVS accessible to all patients across Welwyn and Hatfield

whcvscars@yahoo.co.uk

  • London Colney Good Neighbour Scheme accessible to all patients in London Colney

01727 261104      events@londoncolney-pc.gov.uk

  • Watford & Three Rivers Trust (W3RT) accessible to all patients in Watford and Three Rivers

01923 216955      communitycars@w3rt.org

  • North Herts and Stevenage CVS accessible to all patients in North Herts and Stevenage

01462 689402      communitytrs@nhcvs.org.uk

  •  Community Action Dacorum accessible to all patients in Dacorum

01442 212888      ctadmin@communityactiondacorum.org.uk

  •  Harpenden Cares accessible to all patients in Harpenden

01582 460457

  •  Support For All (Wheathampstead) accessible to all patients in Wheathampstead

01582 380910      info@wheathampstead-pc.gov.uk

  •  Colney Heath Community Support Group accessible to all patients in Colney Heath

07803 313525

  •  Redbourn Care Group accessible to all patients in Redbourn

01582 794550      info@redbourncaregroup.co.uk

 

If you are approached by volunteer organisations please do put them in touch with the LPC and we will add them to the list above.

Controlled Drugs Update

As there are several updates from the accountable officer and other regulatory bodies in regard to CDs, we have listed the most important.

  • Reporting Incidents and Concerns

The accountable officer requires only incidents or concerns that you consider are ‘extremely serious’ or have had a ‘catastrophic’ outcome to be reported. Reports must be made as soon as practicable and via www.cdreporting.co.uk. For the avoidance of doubt, they consider serious patient harm or death and any theft or significant loss especially where misappropriation by a Healthcare Professional would meet the above definition. Suspected misappropriation by HCPs at this time is of particular concern to us as colleagues across the system are under intense personal pressure. We receive regular reports of HCPs accessing CDs at work to cope, self-medicate or self-harm. Please do ensure that your governance ensures that the health and wellbeing of your colleagues is protected.

 

  • Authorised persons to witness the destruction of obsolete Schedule 2 controlled drugs 

In primary care we are currently not able to arrange for an authorised person to attend any premises. If you are unable to store expired stock safely please report this as an incident on www.cdreporting.co.uk

 

  • The CGL website is regularly updated and is very comprehensive with lots of useful links.

CGL is going to honour all payments for instalment dispensing even though supplies are now going out in 14-day instalments. Click here for further information.

 

  • Information for community pharmacies to support Health and Justice (HJ) services and released detainees for COVID-19

This guidance   is to provide you with information about supporting people that have been released from prison to access medicines.

The LPC is in discussions about reimbursement for instalment dispensing.

 

  • Message from Police to Pharmacies regarding transportation, delivery and storage of controlled drugs. Click here for further information.

Dealing With Returned Medicines

National pharmacy bodies have today published guidance on dealing with unwanted medicines that have been returned to community pharmacies.

PSNC has worked with the National Pharmacy Association, the Royal Pharmaceutical Society and the Community Pharmacy Patient Safety Group to produce the joint guidance for community pharmacies in England.

The contractual requirement for community pharmacies to accept unwanted/out-of-date/waste medicines for disposal from the public remains an important service during the COVID-19 pandemic, but it does bring potential risks for pharmacy teams.

This guidance has been compiled to help contractors determine how best to safely handle returned unwanted medicines at this time. It contains a list of considerations and a suggested procedure, as well as checklists to work through.

Guidance on dealing with patient-returned / unwanted medicines

Checklists on dealing with patient-returned / unwanted medicines

Smartcard multi-site code added to cards of pharmacy professionals

NHS Digital are adding the multi-site FFFFF Smartcard code to Smartcards with the pharmacist or technician role, for the duration of the pandemic. The initiative has been supported by PSNC and NHS England and NHS Improvement. The bulk activity performed by NHS Digital is scheduled to take place across this week and to be finished by the end of the week.

A temporary Smartcard position has been created to provide greater flexibility for pharmacists and technicians during the ongoing pandemic. This will help pharmacy staff if they unexpectedly find themselves working at their non-usual pharmacy – e.g. because of staff shortages.

FP10 Prescribing and EPS

Updated 4 September 2020: National COVID-19 Clinical Assessment Service electronic prescriptions
From 1 September 2020, the COVID-19 Clinical Assessment Service (CCAS), hosted by the South Central Ambulance Service, added the functionality for GPs within the service to prescribe, using the electronic prescription service (EPS). This is intended to improve the patient journey and allow the CCAS GPs to complete an episode of care. The scope of prescribing will be for acute prescriptions only and may include controlled drug medicines where clinically appropriate.

EPS prescriptions coming from the CCAS are not restricted to patients in the South East Region as the service manages patient enquiries from across England. Pharmacists and dispensers will be able to use the contact details on the EPS token to telephone the service to contact the prescriber in the event of a query.

________________________________________________________________________________________________

Whilst the LPC position is that ideally EPS should be available for dispensing of FP10s this is not currently possible for all providers as outlined below. It is essential that community pharmacies ensure locum pharmacists or a member of the community pharmacy team is able to access the shared generic nhs.net pharmacy email address when the pharmacy is open. 

Community Trusts
The Community Trusts that support patients locally do not currently have access to the EPS system and are setting up contingencies to support virtual clinics. The LPC has therefore agreed that in these cases that as the risk of posted prescriptions not arriving in time for a patient is a genuine concern, we have recommended that the prescription is scanned and emailed via nhs.net which will be auditable and traceable. This should then be followed by the original prescription being posted to the community pharmacy. We have been assured that the number of prescriptions should not be too onerous but wanted to make you aware that you might receive some prescriptions via this route at the current time until a better process can be identified.

Hertfordshire Partnership University NHS Foundation Trust (HPFT) 
Medicines prescribed in HPFT community outpatient appointments are usually done so through issuing FP10 prescriptions which are dispensed by community pharmacies. To support (a) the government’s social distancing and isolation measures, (b) avoid any unnecessary clinic appointments and (c) support any staffing shortages the following actions have been recommended to be taken by HPFT prescribers:

  •  FP10 prescriptions (including prescriptions for Controlled Drugs) can be posted via the royal mail tracked service to the service users preferred pharmacy. The pharmacy must be told in advance that they should expect these FP10s in the post and an NHS.net email address requested. Prior to posting the FP10 prescriptions they should be scanned and emailed to the chemist and the envelope labelled “FAO Responsible Pharmacist”. The service user should be informed once the FP10 prescriptions have been posted.
  • Prescription quantities must not be changed from normal practice as increasing quantities will put the medicines supply chain at risk.
  • In order to provide an increased supply of medication several FP10s can be written at the same time to cover the next couple of months but each prescription must be clearly post-dated for example one dated for now, another dated for the next month and thereafter. However this must only be done if the patient is stabilised on their medication and the prescriber does not anticipate any dose changes.
  • If the patient is stable on their medication and the medication being prescribed is within the HPFT formulary then GPs should be encouraged to take over prescribing responsibilities as per normal practice.

Dentistry
Remote prescribing may be undertaken for some dentistry patients where necessary. Dentists have been advised to follow the below steps for remote prescribing:

STEP ONE:

  • Complete prescription and sign.
  • Scan copy and email securely to pharmacy email address.
  • Contact pharmacy via phone or by other appropriate means to advise them you will be emailing scanned prescription.
  • Attach copy to patient’s clinical records.

STEP TWO

  • Send original signed copy to pharmacy postal address within 72 hours.
  • Log all sent prescriptions, confirming receipt with pharmacy.

We would also like to remind all pharmacists that you can dispense private prescriptions from a private dentist as an Emergency Supply at the request of a prescriber. This can be in the form of a secure email followed up with the paper prescription sent in the post as per the process for NHS prescriptions.

Medicines Supply Chain

  1. OTC Paracetamol: National messages have been confusing regarding the shortage of paracetamol and whether you can repackage POM packs. Please see updated recommendations on the NPA website and  RPS website that has clear guidance on this that allows you do so that does not require a prescription from a GP. Please seek any guidance from your head office if in a multiple company and make your own business and professional decisions regarding this.
  2. The situation of medicines shortages is being monitored at a national level. Community pharmacy contractors are encouraged to use the reporting tool on the PSNC website to help PSNC build their evidence base to medicine shortages. Please see full details on the PSNC website.

Repeat Prescription and Prescription Duration

We have been working with local CCGs to get the following messages out:

  1. GP Practices should be encouraging patients to order repeat prescriptions online or through their normal channels. Patients should not be directed to the community pharmacy who would normally drop their prescriptions to the GP practice in person as according to CCG guidelines.
  2. GP practices should not extend prescription duration at the current time which could potentially affect the supply chain detrimentally. This was included in Nikki Kanani’s letter to general practices nationally. Pharmacies are also reminded they should also not be advocating this approach for any of their patients.
  3. GP practices and pharmacies are asked to consider the opportunity for electronic repeat dispensing which will also decrease requests from patients.

Important Contact Details

Key Local Commissioner Emails

•Drug and Alcohol Services:  Herts@cgl.org.uk
•Sexual Health Service: PublicHealth@hertfordshire.gov.uk
•Directory of Services NHS 111:  herts.dos@nhs.net
•East and North Herts CCG:  enhertsccg.covid-19@nhs.net
•Herts Valleys CCG:  hvccg.pmot1@nhs.net

Information for COVID-19 SOP

•Regional/local health protection teams

Find your local health protection team at www.gov.uk/health-protection-team

•NHS Regional Pharmacist: William Rial   William.rial@nhs.net
•NHS Local Pharmacy Network (LPN) chair: Jane Newman  england.eastpharmacylpns@nhs.net
•Local NHS lead for commissioning: Andrea Patman  apatman@nhs.net
•Local NHS Incident Room: england.eastofengland-COVID19@nhs.net
•Local Infection Prevention and Control Team: Frances Bolger, Head of Infection Control and Prevention frances.bolger@nhs.net.

FAQs

Answers to frequently asked questions which have been posed by pharmacy contractors and their teams.