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April 2020
Newsletter
April 2020
Leyla Hannbeck
April 2020
Dear Member,

This is our April edition of the AIM Newsletter and yet again the biggest topic dominating is unfortunately the situation with COVID-19. We are concerned about the current pressure that the pharmacy teams are facing, and we would like to reassure you that we are raising these issues at every level and via every channel possible.

Whilst we have played a big role as an organisation, working with others, to boost the profile of pharmacy during this crisis, there is still a lot to do and there are barriers that we need to overcome.
We continue to lobby at every level possible nationally and via our representatives on LPCs locally – we also encourage all our members to write to their local MPs. The more MPs discuss the topic of pharmacy and the challenge that our members are facing the better.

This newsletter covers:
• The funding around COVID-19
• Additional COVID-19 costs to pharmacies (please fill in the questionnaire in spreadsheet and return to me by end of Wednesday this week)
• Easter break
• Deliveries
• Pharmacy practice matters

Funding in brief

As part of negotiations with PSNC, the Department of Health and Social Care (DHSC) has agreed a total of £300 million of advance funding into community pharmacies over the next two months. This is a temporary cash injection into community pharmacies that will have to be paid back at some point in the future. It will be paid as ‘uplifts’ to contractors’ January and February payments which are payable in early April and May. The two injections will be worth £200 million on 1st April 2020 (or soon after) and £100 million at the end of April/early May.

Separately, and not as part of negotiations with PSNC, the DHSC and NHS England have agreed to pay contractors £300 payment for installing screens – this will automatically be paid at the end of April and does not need to be claimed. This fee is outside of the global sum.

Please see below AIM statement regarding the funding:

“Whilst it is good to see some cash injection into this severely cash-starved sector, the delayed English pharmacy funding announcement does not allow for sufficient funding and will have a catastrophic effect on many pharmacies, not just financially, but by also having a deeply negative effect on the morale of all pharmacy staff.

We all know the partial closure of GPs and hospital services has put pharmacy in the front line of primary care in England and we have done everything asked of us, and more, by being there to deal with worried patients and members of the public and relieve pressure on GP’s and hospitals. This is despite staff shortages of self-isolation running at up to 15% and massively increased locum costs. Many staff have worked many extra hours before and after normal opening hours to keep community pharmacies functioning.

Unfortunately, this huge shock of not only continued under-funding, but also the increased operating costs that are directly due to our front-line role in supporting the Governments efforts against the COVID-19 pandemic, is a harsh message to hard working community pharmacies in England. Many businesses that were already losing money will now have to re-consider closure. With some branches currently temporarily closed due to staff shortages possibly not re-opening, that will put vulnerable communities at risk of not getting the pharmaceutical care they need.

In addition, pharmacy teams are putting their own health at risk looking after patients in communities without appropriate PPE. Despite the sector asking for this, it has not been forthcoming.

In a letter to Primary Care Executives on 17 March, Simon Steven highlighted that there will be funding “to cover your extra costs of responding to the coronavirus emergency” and that ”financial constraints must not and will not stand in the way of taking immediate and necessary action.” We, therefore, appeal for fairness, understanding and support from those in the position of power to allow this sector to continue caring for patients by urgently addressing these issues.”

IMPORTANT
It is important to note that further negotiations are taking place to cover the costs that contractors have occurred as part of preparations for COVID-19. As you can see in the AIM statement, we have referred to Simon Stevens letter to Primary Care CEOs telling them that there are no financial barriers standing in the way taking immediate and necessary action against COVID-19.

I have included attached a list of questions that we are currently seeking answers to in order to ensure these are passed on to PSNC to further negotiate with DHSC. I would be grateful if you could please fill in and return by the deadline on Wednesday 8th April.

I have queries with PSNC regarding the time period for this fee to be negotiated. We have highlighted the importance of extra cash for the sector not to be delayed and PSNC are hoping that this will be available by end of April.

PPE

Members have been in touch to raise concerns about he lack of PPE and the onerous process to go through the helpline. Unfortunately pharmacy is not considered by the Royal Colleges as a sector that would need PPE. We are trying to find the reason behind this advice is. It may to do with the viral load and the theory that the more ill a patient is the more viral load they carry and can pass on to others, hence patients in hospitals are more contagious – this is just one speculation and not stated as an official reason. We are pushing as much as we can together with other parts of the sector to have PPE for pharmacy teams.

Business grants

As part of the support package for businesses during this difficult time, the Chancellor has announced a number of measures. To make it easier for our members to see what is available we have included a document attached summarising some of the key points.

Easter break

NHS England highlighted the following message to contractors at the end of last week:

Under the National Health Service (Amendments Relating to the Provision of Primary Care Services During a Pandemic etc.) Regulations 2020 and with agreement of the Secretary of State we are requiring pharmacies in England to open from 2pm to 5pm on 10 April 2020 and 13 April 2020.
Any pharmacy that was planning to open longer hours should still to do so to support access for patients through the day. If you believe your pharmacy is unable to open for reasons beyond the control of the contractor, then you should notify their NHS England and NHS Improvement regional office in the usual way and importantly update the NHS 111 DoS to prevent patients being referred to your pharmacy from NHS 111 when it is not open. Please make sure NHS website profiles include correct opening hours to support patient access.
Community pharmacies in areas where there is minimal demand due to the Government’s social distancing policy (e.g. large shopping malls) should seek exemption from their NHS England and NHS Improvement Regional team. Contractors will be able to claim a payment over and above the £2,592 million settlement for opening these hours. In line with the fact that this will look like a normal working day for the rest of the NHS, the rate will not reflect a bank or public holiday premium

AIM is concerned about the way this message was communicated to contractors and will provide feedback to NHS England accordingly.

Whilst it is highlighted in the NHS England letter that pharmacies will be paid for opening, the fee is currently being negotiated with PSNC. This fee will be from outside the contract sum. We have urged that this information is shared with contractors as a matter of urgency because Easter is just four days away and contractors will NEED to know this information in advance in order to plan.
Another issue is the opening times referred to in the letter, this is also being clarified.

Some of our members have shared their thoughts about how they are going to proceed regarding the Easter message above:

“We will stress to the public it’s skeleton staff only on these days and they are best coming on the Thursday and Saturday and Tuesday – plus we won’t be able to get deliveries (biggest issue although I think they were asking the wholesalers to be open for 3 hours too!).”

“Make decisions based on balance of likely need vs capacity and morale of your team? Then strike that balance, inform NHS England what you are doing and move on. We shall not be open everywhere as we do not have the capacity – it may also worsen in the period between our notification and days themselves.”

AIM advice: Please read the specific regulations in place for Pandemic and if you are unable to open for various reasons please notify NHS England regional team 24 hours in advance.
https://psnc.org.uk/wp-content/uploads/2020/04/Emergency-legislation-–-opening-hours.pdf

Pharmacy deliveries to patients

The PSNC have highlighted that last week they were informed by NHS England that pharmacies will need to use the help of volunteers via GoodSam app, as the first steps when delivering to vulnerable patients, and only if they cannot find any volunteers then they can claim for payment.

We have become aware that there are currently no additional checks on the volunteers apart from the identity checks and there is a lack of bona fides checking for some of the volunteers. We understand that all volunteers will be ID checked (their identity will be verified to ascertain that they are not using an alias) but only a few will have a check against the data held by the Disclosure and Barring Service (DBS) – and of those, none will be used for medicines delivery. As you can imagine we are very concerned about this. There are all sorts of regulatory concerns around this and in addition concerned about the use of this volunteering initiative by fraudsters to gain access to the vulnerable.
There are also concerns about reputational damages for community pharmacy. We have raised our concerns with NHS England accordingly.

PSNC are currently in discussions with NHS England about these concerns. Unfortunately, the sector is not much further with this at this point and discussions are ongoing between PSNC and NHS England. The GPhC and RPS have been invited by NHSE to look at guidance for pharmacies around this but this has not yet progressed.

We will update members as soon as there is further information about this.

Regular communication with NHS England and DHSC

Every Wednesday there is a telephone conference between pharmacy organisations and NHS England and DHSC. I would like to encourage members to get in touch if there is anything that you would like to be raised on your behalf. There is cross sector ‘Issues and Risk’ register that we can use to capture all issues and risks. Please feel free to get in touch if you wish to contribute.

Media activities

AIM has been generating a lot of media coverage in the National media and pharmacy press. We have been highlighting the great work that pharmacy teams are doing and how hard things are at the moment, the need for PPE and testing, and that members of the public need to be kind and understanding as we have experienced higher levels of complaints and abuse. Below I have included a few links and clips of as example of the media activity.

Channel 5 interview: https://www.youtube.com/watch?v=kS_0y50grMM
Express: https://www.express.co.uk/news/uk/1263347/Coronavirus-UK-Pharmacy-abuse-warning-COVID-19-pandemic-UK-latest
iNews: https://inews.co.uk/news/pharmacists-coronavirus-uk-outbreak-abuse-customers-2520272
Daily Mail: https://www.dailymail.co.uk/news/article-8168905/Thieves-stealing-vital-equipment-ambulances-putting-lives-risk-coronavirus-crisis.html
Daily Express: https://www.express.co.uk/news/uk/1264537/Pharmacies-coronavirus-UK-shortages-abuse-complaint-COVID-19-latest-news-update
The Guardian: https://www.theguardian.com/world/2020/apr/02/uk-pharmacists-facing-abuse-and-violence-during-coronavirus-lockdown

In addition, as you are aware, we wrote to Prime Minster asking for pharmacy teams to get recognition and be supported as the healthcare professionals on the front line. We also encouraged all pharmacy bodies to join and wrote a joint letter to Matt Hancock with a similar message. Whilst it was great to see that the Prime Minister and the Health Secretary took note of this and recognised the efforts of pharmacy teams in their public messages, we are still lobbying, together with other bodies, for appropriate funding, PPE and testing for community pharmacy.

Pharmacy Practice matters

Patient medicines return to pharmacies – Concerns have been raised regarding the disposal of unwanted medicines, which is an essential service, and the risk of contaminated products possibly being returned to the pharmacy but additionally we are all aware it is an essential service.

We are currently liaising with the Environmental Agency about this to get official advice. The generic advice is that any returns should be handled with gloves and/ relevant protective equipment and put in a place out of the way of staff, ideally in an isolated place. Important to bear in mind how long a virus stays on the surface of things.

GPhC temporary register – following a few concerns reported about the lack of information about what those who have joined the register can and cannot do, the GPhC has explained that the temporary registrants will use their old GPhC registration number and it is up to the owner or superintendent to decide what activities the registrant can be involved in and if they feel that the knowledge is not up-to-date then they can perhaps consider asking them to be second pharmacist rather than responsible pharmacist.

Clinical guidelines booklet – please watch out for the April edition of these useful booklets arriving in pharmacies soon.
Pre-reg matters – Health Education England (HEE) have asked us to highlight the below to our members:

“Following the recent General Pharmaceutical Council (GPhC) announcement (26 March) to postpone both the June and September 2020 pre-registration pharmacist examinations, we have published a joint statement with NHS Education for Scotland and Health Education and Improvement Wales. Our statement outlines our support for the proposed approach and our continued engagement in exploring the processes needed to support current pre-registration pharmacists. This statement is published on HEE’s Coronavirus (Covid-19) Information for trainees web page: https://www.hee.nhs.uk/coronavirus-information-trainees. Please access the direct link here or read the attached pdf.”

If you have any questions about pre-reg matters please contact us. One of our members Khalid Khan works with HEE on pre-reg matters and will be able to provide advice and information.

Legal advice – members that would like further advice on below matters are encouraged to get in touch with us as some of our honorary members can offer you advice (20min free of charge).
Rent holiday, Furlough, dealing with lenders, help with Negotiations with 3rd parties like banks and landlords:
Wills and lasting powers of attorney
Buying or Selling your pharmacy (or residential property)
Help with contracts and terms and conditions
Other concerns or opportunities
Fitness to Practice
Disputes
Shareholder Agreements

Patient safety – please find a report by Claude Pereira who is representing AIM as Medicines safety Officer (MSO) on the cross sector Patient Safety Group (PSG) on the latest discussions of the group around this topic:

• Social distancing in some pharmacies is big challenge as not always possible to keep 2m distance from each other due to dispensary being too small. The group recommended that staff should keep a distance from each other where possible and all staff to demonstrate good hygiene such as frequent washing of hands and wiping down surfaces, keyboards etc.
• Some MSOs mentioned that it had been a struggle with trying to limit the number of patients in the pharmacy, there have been issues in some pharmacies where customers have become aggressive and smashed windows and front doors in response to being asked to wait.
• Questions were posed over members of staff who decide to not come in to work due to the risk it poses to family members – the MSO group decided it was a company decision what to do, namely if you could move staff into non patient facing roles if possible.
• Concerns were raised regarding near miss dispensing incidences involving retired pharmacists that are now back in work. There were words that most retired staff were coming into the profession quite satisfied to work as dispensers or 2nd pharmacists on duty and not RP.
• There were discussions about delivering of medication and the hazards of going into a patients house. A scenario developed where an elderly patient walking with a frame had a delivery for 40 fortisip drinks. Leaving this on the doorstep for the patient to carry inside themselves would not be practical for the patient. Advice for pharmacy delivery drivers would be to maintain a safe distance from the patient and practise good hand hygiene.
• Several surgeries are requesting that pharmacies no longer order repeats by paper and instead to email to a centralised email address in ordering repeats. Many pharmacies have given this email address to patients directly.
• There is a lot of worry amongst superintendents and MSOs regarding lack of PPE. Some MSOs have reported staff threatening to leave the pharmacy unless they can put on PPE. Some pharmacies have suggested staff bring a change of clothes to work and change into them/out of them when they arrive and leave.
Paracetamol – at the NHS England and DHSC call last week it was highlighted that advice given by the NPA regarding Paracetamol has been incorrect. Members are advised to double check advice received from organisations before implementing.

As highlighted in the previous newsletter, AIM members can use the PharmaSmart’s ReportSmart tool to report patient safety incidents free of charge. Please see link below on our website under support and patient safety https://www.aimp.co.uk/


As always, please do not hesitate to get in touch if you have any questions or feedback. We keep members in the loop with the latest updates and developments. Please feel free to follow us on social media and visit our website.

Take care and stay safe.

Kind regards,

Leyla

Leyla Hannbeck FRPharmS, MBA, MSc, MA
Chief Executive
AIM
Tel: 0750 8932868
Email: Leyla.hannbeck@aimp.co.uk
Website: https://www.aimp.co.uk
Twitter: @Aimpharmacies
Twitter: @LeylaHannbeck


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