SCHEDULE 2 THE SERVICES

Transcription

1 SCHEDULE 2 THE SERVICES A. Service Specifications Mandatory headings 1 4: mandatory but detail for local determination and agreement Optional headings 5-7: optional to use, detail for local determination and agreement. All subheadings for local determination and agreement Service Specification No. Service Commissioner Lead Provider Lead Think Pharmacy Urgent Palliative Care Medicines Service NHS Vale Royal CCG Superintendent Pharmacist Period 1 April 2014 to 31 March 2017 Date of Review 1.1 National/local context and evidence base Patients who have been assessed as entering the last days of life require access to a set range of palliative care medicines in anticipation of need. Community pharmacists included in this service guarantee to continuously stock the medicines in the palliative care formulary so that patients can be assured of supply when required. The stock held for the Think Pharmacy Urgent Palliative Care Medicines Service should be over and above the core stock holding, and the CCGs agree to reimburse contractors should the medicines be held beyond their expiry date. This service: Supports patients and their carers to access medicines that may be required for palliative care purposes in a location close to their home (or preferred place of death) Avoids unnecessary hospital admissions where the sole purpose of admission is to access appropriate medicines Supports pharmacies to hold palliative care medicines in stock Provides assurance to commissioners that patients who require palliative care medicines will have access to the medicines during core hours from specified locations. 2. Outcomes 2.1 NHS Outcomes Framework Domains & Indicators Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long-term

2 conditions Domain 3 Helping people to recover from episodes of ill-health or following injury Domain 4 Ensuring people have a positive experience of care Domain 5 Treating and caring for people in a safe environment and protecting them from avoidable harm 2.2 Local defined outcomes To improve access across the geographical area covered by the commissioners (NHS South Cheshire CCG, NHS Vale Royal CCG and NHS Eastern Cheshire CCG) for patients and health care professionals to Palliative Care medicines when they are required within normal pharmacy opening hours. To guarantee continuous availability of formulary stock from named pharmacies for patients and health care professionals who require immediate / urgent access to palliative care medicines. 3. Scope 3.1 Aims and objectives of service To continuously hold the range and quantity of medicines specified by the palliative care formulary and to dispense these in response to NHS prescriptions presented for the total number of hours the pharmacy is open To have a process in place which ensures that all new staff, are aware of commissioned services provided by the pharmacy and maintain continuity of service during and after staff changes. 3.2 Service description/care pathway The service provider must order and continuously hold the range and quantity of medicines specified by the formulary and will dispense these in response to NHS prescriptions presented. See Appendix 1 The service provider will provide the service for the total number of hours the pharmacy is open. The stock for this service should be in addition to any stock holding the service provider would usually stock. Expiry dates for this stock should be monitored to prevent waste; short dated stock should be rotated with the service provider s usual stock holding. Dispensed or date expired stock for this service must be replaced immediately. The Commissioners will reimburse the cost of stock specifically purchased for this service that cannot be used and has reached its expiry date. This will be done by completing the Expired Stock Claims form. See Appendix 3 In the event of any significant availability issues concerning products required to be kept in stock for this service the serviced provider must contact the Commissioner. The service provider must telephone the next nearest service provider in advance

3 to ensure that they are able to dispense the prescription before signposting a patient or carer. The contract payment is for provision of a Think Pharmacy Urgent Palliative Care Medicines Service Payments will be made as follows annual fee for providing the service irrespective of the number of prescription items dispensed. - The fee will be paid as a lump sum on the receipt of an annual declaration from the service provider of their intent to continue the service from the named community pharmacy - Claims will be made and paid annually on submission of the declaration and invoice in Appendix 4. Accreditation Any registered pharmacist may dispense palliative care medicines on receipt of a valid prescription. Suggested training that may support this service. CPPE Care of the terminally ill communicating with patients open learning. Standard Operating Procedure The service provider will have a Standard Operating Procedure (SOP) / protocol which specifically details the operational delivery of the Think Pharmacy Urgent Palliative Care Medicines Service in accordance with this specification. The service provider must ensure that all staff working in the pharmacy have relevant knowledge, are appropriately trained and operate within protocols / SOPs, this includes understanding when to recommend the service to clients and using sensitive client-centred communication skills. The SOP / protocol should be reviewed at least every two years or before if circumstances dictate. Each review should be documented and the SOP / protocol subject to version control. Staff must read, date and sign the SOP/protocol after a review. Changes to procedure must be highlighted within the SOP / protocol for special attention. The Standard Operating Procedure / protocol must be available to the commissioner if requested. Record Management Records maintained in association with this service must be available to the commissioner on request. Service Continuity It is the responsibility of the service provider to have a process in place that ensures that all new staff and locums are aware of the Think Pharmacy Urgent Palliative Care Medicines Service and must maintain continuity of service during and after staff changes. The service provider has a responsibility to ensure that all staff members provide the service strictly in accordance with the service specification and Standard Operating Procedures. If concerns are raised regarding the continuity of service provision the commissioner reserves the right to instigate discussions with the contractor, which could lead to termination of the contract Complaints

4 The service provider must have a complaints procedure that complies with Local Authority Social Services and National Health Service complaints (England) Regulations Complaints directly linked to the quality of this service must be reported to the commissioner. 3.3 Population covered Patients resident within the geographical area covered by NHS Eastern Cheshire CCG, NHS South Cheshire CCG and NHS Vale Royal CCG who present a prescription for palliative care medicines are eligible for inclusion in the service. The total population is estimated to be as follows: 204,000 in Eastern Cheshire 176,000 in South Cheshire 103,000 in Vale Royal. Equality and Diversity The service provider must comply with the requirements of the Equality Act 2010, and will not treat one group of people less favourably than others because of age, disability, gender reassignment, marriage or civil partnership, race, religion or belief, sex or sexual orientation. It is the responsibility of the service provider to make reasonable adjustments to meet the individual needs of their patients. Where providers are able to identify a cohort of patients for whom reasonable adjustments may be required, they should discuss this with the Commissioner. 3.4 Any acceptance and exclusion criteria and thresholds Community pharmacies must hold an NHS contract for the provision of Pharmaceutical Services. Pharmacies will be selected for inclusion in the service to provide sufficient coverage in each town /locality so that patients are not unduly inconvenienced when seeking to have their prescriptions for palliative care medicines dispensed. 3.5 Interdependence with other services/providers Community pharmacies are expected to liaise with out of hours / urgent care providers and general practice to facilitate access to the palliative care formulary medicines. 4. Applicable Service Standards 4.1 Applicable national standards (eg NICE) Supply of ALL medicines must be in accordance with the Human Medicines Regulations The commissioner and the commissioned service provider recognize that this service specification and/or associated recorded information may be subject to Freedom of Information Requests (FOI). Each party shall comply with any such Freedom of Information requests received, in accordance with the Freedom of Information Act 2000 legal obligations. The service provider shall comply with the requirements of the Health and Safety at Work Act 1974, the management of Health and Safety at Work Regulations 1999 and any other acts, regulation, orders or rules of law pertaining to health and safety. 4.2 Applicable standards set out in Guidance and/or issued by a competent body (eg Royal Colleges) The Think Pharmacy Urgent Palliative Care Medicines Service may only be provided by

5 Pharmacists with a current registration with the General Pharmaceutical Council from premises that hold a current contract to supply NHS Pharmaceutical Services. 4.3 Applicable local standards The Think Pharmacy Urgent Palliative Care Medicines Service shall be available during ALL of the community pharmacy provider s core opening hours. Any medicines dispensed from the Palliative Care stock should be immediately replaced to ensure continuity of supply. 5. Applicable quality requirements and CQUIN goals 5.1 Applicable Quality Requirements (See Schedule 4 Parts [A-D]) Not Applicable 5.2 Applicable CQUIN goals (See Schedule 4 Part [E]) Not Applicable 6. Location of Provider Premises The Provider s Premises are located at: 7. Individual Service User Placement

6 Appendix 1 Central and Eastern Cheshire Palliative Care Formulary Emergency Palliative Care Drugs Listed service providers in Central and Eastern Cheshire will always have this range and quantity of drugs in stock Health Care Professionals can access help via. the 24hr advice line numbers for Specialist Palliative Care Advice South Cheshire and Vale Royal: Eastern Cheshire: Drug Form available Quantity Main indications in acute situation Commoner acute side-effects Dosage Diamorphine 5mg ampoule 10mg ampoule; 30mg ampoule; 100mg ampoule 5 ampoules 5 ampoules 5 ampoules 5 ampoules Severe pain not controlled by weak opioid Patient unable to take morphine orally Drowsiness (settles with time); nausea, vomiting (try metoclopramide or haloperidol); unsteadiness Confusion, hallucinations (tolerance does not occur, reduce or change drug) If no previous opioid 5mg 4 hourly & prn, or 30mg/24h SC in syringe driver (half if frail) If changing from oral morphine - 1/3 total daily morphine dose, given SC via syringe driver The prn dose is 1/6 of 24h diamorphine dose

7 Drug Form available Quantity Main indications in acute situation Commoner acute side-effects Dosage Morphine Sulphate 10mg ampoule; 30mg ampoule; 10 ampoules 10 ampoules Severe pain - to be used as an alternative to diamorphine if diamorphine is not available Drowsiness (settles with time); nausea, vomiting (try metoclopramide or haloperidol); unsteadiness If no previous opioid 5mg-10mg 4 hourly & prn, or 30mg-45mg/24h SC in syringe driver (half if frail) Confusion, hallucinations (tolerance does not occur, reduce or change drug) If changing from oral morphine - 1/2 total daily oral morphine dose, given SC via syringe driver If changing from SC diamorphine 1.5 times total daily SC diamorphine dose, given SC via syringe driver The prn dose is 1/6 of 24h morphine dose Oramorph 10mg/5ml oral solution 2 x 100ml Severe pain not controlled by weak opioid Drowsiness (settles with time); nausea, vomiting (try metoclopramide or haloperidol); unsteadiness Initially 10mg (5mg if frail) as needed 2 hourly, or depending on previous morphine dose 100mg/5ml concentrated oral solution 1 x 30ml Confusion, hallucinations (tolerance does not occur, reduce or change drug) Breakthrough dose = 1/6 of regular 24h total morphine dosage

8 Drug Form available Quantity Main indications in acute situation Diclofenac 100mg suppository 10 supps Inflammatory pain, especially bone pain, musculoskeletal pain Commoner acute side-effects Occasional bronchospasm; nausea; dyspepsia Dosage mg stat; 150mg-200mg/day in divided doses Cyclizine 50mg in 1ml ampoule 5 ampoules Nausea caused by pharyngeal stimulation, visceral distension or deformation, vestibular disturbance, raised intracranial pressure Drowsiness, anti-muscarinic effects (blurred vision, palpitations, palpitations, arrhythmias, dry mouth, constipation, heartburn, urinary retention) 50 mg SC prn tds; mg/24h SC via syringe driver (may be increased to 300mg if needed and tolerated) Haloperidol 5mg in 1 ml ampoule 5 ampoules a)anti-emetic for chemical or toxic causes b)agitation or acute Extra-pyramidal - including tardive dyskinesia, sedation, dry mouth, neuroleptic malignant syndrome a) 1.5-5mg SC stat dose up to 6 hourly or 5-15mg per 24h via syringe driver b) 1.5-5mg SC stat, then 5-30mg SC od to bd, or over 24h via syringe driver confusional state Metoclopram ide 10mg in 2ml ampoule 10 ampoules Nausea and vomiting due to gastric irritation or impaired emptying (stasis) Extrapyramidal effects; neuroleptic malignant syndrome; sedation in high doses 10mg stat SC every 3-4 hours or 30-60mg/24h SC via syringe driver (up to 100mg on specialist advice) Levomeprom azine (methotrime prazine) 25mg in 1 ml ampoule 10 ampoules Nausea and vomiting (broad spectrum) Severe agitation, psychosis Sedation; postural hypotension; extra-pyramidal 5-25mg SC once or twice a day in divided doses, or via syringe driver (stepwise to 300mg/24h if tolerated) Midazolam 10mg in 2ml ampoule 10 ampoules Terminal agitation Myoclonus Seizures Sedation; hypotension mg SC stat (10-20mg SC or slowly IV for repeated seizures); then 20-60mg/24h via syringe driver (up to 100mg/24h has been used)

9 Drug Form available Quantity Main indications in acute situation Commoner acute side-effects Dosage Diazepam Rectal Solution 4mg/ml 2.5ml tube = 10mg 5 x 10mg tubes Hyoscine Butylbromide 20mg in 1ml ampoule 5 ampoules Bowel colic obstruction Moist, noisy breathing if patient is comatose Anticholinergic (blurred vision, palpitations, palpitations, arrhythmias, dry mouth, constipation, heartburn, urinary retention); does not cross bloodbrain barrier 20mg stat, then 60mg/24h via syringe driver, increasing to 120mg if needed (occasionally to 300mg in obstruction) Glycopyrroni um Bromide (Robinul ) 200micrograms/ml ampoule 10 x 1ml ampoules Bowel colic Moist, noisy breathing if patient is comatose Anticholinergic (blurred vision, confusion, palpitations, palpitations, arrhythmias, dry mouth, constipation, heartburn, urinary retention) micrograms SC repeated as needed every 3 hours micrograms per 24 hours by SC infusion

10 Drug Form available Quantity Main indications in acute situation Commoner acute side-effects Dosage Dexamethas one 2mg tablet 50 tablets Pain & symptom relief from raised intracranial pressure, spinal cord compression, liver capsule pain, nerve compression Acute - mental disturbance, impaired glucose tolerance, masking of symptoms of acute infection 8 to 16mg orally once daily For acute spinal cord compression - where intervention is appropriate, give 16mg once to twice daily & admit urgently Relief of pressure in superior vena caval obstruction, stridor, spinal cord compression Adjunct to anti-emetic in resistant nausea Water for Injections 10ml ampoule 2 x 10 ampoules Making up of diamorphine and diluting to correct volume for syringe driver

11 Appendix 2 Think Pharmacy Urgent Palliative Care Service Providers in Central and Eastern Cheshire TOWN / AREA PHARMACY NAME & ADDRESS CONTACT N0 OPENING HOURS ALSAGER LLOYDS PHARMACY Mon-Fri 8.15am-6.30pm 25 Lawton Road Alsager ST7 2AA 9.00am-5.00pm CONGLETON Co-Op Healthcare Ltd Mon- 9.00am-5.30pm 2 Mill Street Congleton CW12 1AB (Tel. & Fax.) 9.00am-1.00pm CO-OP HEALTHCARE Ltd (Tel.) Mon-Fri 8.45am-6.30pm 1 Park Lane 9.00am-1.00pm Congleton CW12 3DN Tesco In Store Pharmacy Barn Road (Fax.) (Tel) Mon 8. 00am 10.30pm Tue- Fri 6.30am 10.30pm Congleton CW12 1LR Sun 6.30am 10.00pm 10.00am 4.00pm. Boots UK ltd Barn Road Congleton CW12 1LR (Tel) (Fax) Mon Fri 8.00am 12.00pm 8.00am pm Sun 10.00am 4.00pm CREWE ASDA IN-STORE PHARMACY Mon 8.00am-11.00pm Victoria Centre Tues-Fri 7.00am-11.00pm Crewe CW1 2PT Sun 7.00am-10.00pm 10.00am-4.00pm BOOTS UK LTD Market Street Crewe CW1 2EX (Tel.) (Fax) Mon- 9.00am-5.30pm Tesco In Store Pharmacy (Tel) Mon 8.00am 10.30pm Vernon Way (Fax) Tue Fri 6.30am 10.30pm Crewe CW1 2DD Sun 6.30am 10.00pm 10.00am 16.00pm Boots UK Ltd Unit Mon-fri 8.00am midnight

12 Grand Junction Retail Parl 8.000am -10pm Crewe CW11 2RP Sun 11.00am 5.00pm DISLEY CO-OP HEALTHCARE Ltd Mon,Tues,Thur,Fri 11 Fountian Square 9.00am-6.00pm Disley SK12 2AB Wed, pm HANDFORTH CO-OP HEALTHCARE Ltd Mon,- Fri 8.30am 6.30pm 110 Wilmslow Road 9.00am-1.00pm Handforth SK9 3ES TESCO IN-STORE PHARMACY Mon- 9.00am-9.00pm Kiln Croft Lane Sunday 10.00am-4.00pm Handforth SK9 3HL HOLMES CHAPEL LLOYDS PHARMACY London Road (Tel.) Mon-Fri 8.30am-7.00pm 8.30am-5.00pm Holmes Chapel CW4 7AP (Fax) KNUTSFORD MANNINGS CHEMIST Mon-Fri 9.00am-7.00pm 38 Princess Street 9.00am-5.30pm Knutsford WA16 6BN Boots (Tel) Mon 9.00am 5.30pm 64 King Street (Fax) Sun 11.00am 4.00pm Knutsford WA16 6DT MACCLESFIELD ASSURA PHARMACY (Tel.) Mon- 7.00am-10.00pm Waters Green Medical Centre Sun `` 10.00am 8.00pm Sunderland Street (Fax) Macclesfield SK11 6JL LLOYDS PHARMACY Mon am-10.30pm Charlotte Street Sun 9.30am-10.30pm Macclesfield SK11 6JB THE WESTON PHARMACY 5-6 Weston Square (Tel.) Mon,Tues,Thur,Fri 9.00am-6.00pm

13 Earlsway (Fax) Wed, 9.00am-5.30pm Macclesfield SK11 8SS Tesco In Store Pharmacy Hibel Road Macclesfield SK10 2AB (Tel and Fax) Mon 8.00am 8.00pm Sunday 10.00am 4.00pm Sainsbury s Pharmacy 61 Cumberland Street Macclesfield SK10 1BJ (tel-fax Mon - 8:00 am 11:00 pm Tues Fri 7:00 am 11:00 pm 7 00 am 10:00 pm Sun 10:00 am 4:00 pm MIDDLEWICH ROWLANDS PHARMACY Mon,Tue, Thur, Fri 24 Lewin Street Middlewich CW10 9AS 09.00am 13.00pm & 13.20pm 18.00pm Wed 09.00am 13.00pm & 13.20pm 17.30pm 09.00am 13.00pm & 13.20pm 16.30pm NANTWICH CO-OP PHARMACY Tel : Mon Fri Church View Primary Care Centre Fax : am 18.30pm Beam Street Nantwich CW5 5NX SAINSBURY S IN-STORE PHARMACY Middlewich Road Nantwich CW5 6PH (Tel.) (Fax) Mon-Fri 7.00am-11.00pm Sun 7.00am-10.00pm 10.00am-4.00pm NORTHWICH DAVENPORT CARMICHAEL LTD (Tel.) Mon-Fri 9.00am-6.00pm 76 Runcorn Road 9.00am-1.00pm Barnton CW8 4EY (Fax) ROWLANDS PHARMACY Mon Fri 09.00am 13.00pm &

14 299 Chester Road Hartford Northwich CW8 1QL TESCO IN-STORE PHARMACY pm 18.00pm 09.00am 13.00pm Mon- 8.00am-8.00pm Manchester Road Sun 10.00am-4.00pm Northwich CW9 5LY Sainsburys Supermarkets Ltd Mon & 700AM-10.00PM Venables Road Tue Fri 7.00am-11pm Northwich Sun 10.00am 4.00pm CW9 5RT POYNTON ROWLANDS PHARMACY 67 Park Lane (Tel.) Mon Fri 09.00am 13.00pm & 13.20pm 18.30pm Poynton SK12 1RD (Fax) 09.00am 13.00pm & 13.20pm 17.30pm PRESTBURY D K WOOD LTD Mon,Tues,Wed,Fri The Village Pharmacy 9.00am-5.30pm Unicorn House Thur 9.00am-6.00pm Prestbury SK10 4DG 9.00am 13.00pm SANDBACH CO-OP HEALTHCARE Ltd (Tel.) Mon-Fri 8.30am 19.00pm Ashfields Primary Care Centre Middlewich Road Sandbach (Fax) WILMSLOW Boots UK Ltd Mon-Thur 9.00am pm Within Waitrose Store Fri 09.00am 21.00pm 5 Church Street 9.00am pm Wilmslow SK9 1AY Sun 10.00am-4.00pm WINSFORD ASDA IN-STORE PHARMACY (Tel.) Mon 08.00am 23.00pm Dene Drive Winsford CW7 1BD (Fax) Tue Fri 07.00am 23.00pm

15 CO-OPERATIVE CHEMIST Winsford Health Centre Dene Drive Winsford CW7 1AT am 22.00pm Sun 10.00am 16.00pm Mon-Fri 8.30am-6.30pm

16 APPENDIX 3 Service Provider Address Emergency Palliative Care Medicines Support Service Date Expired Stock Claim Form Expired stock Drug Form Quantity Purchase cost Purchased from Claims will be paid within 28 days of submission of this form accompanied by a purchase invoice. Send completed claims form to: CCG Geographical location Invoice details of Pharmacy service provider NHS Vale Northwich NHS Vale Royal Clinical Royal CCG Winsford Commissioning Group (and surrounding areas) 02D Payables K955 Phoenix House Topcliffe Lane Wakefield WF3 1WE NHS South Alsager NHS South Cheshire Clinical Cheshire CCG Crewe Commissioning Group Haslington 01R Payables K945 Middlewich Nantwich Sandbach (and surrounding areas) Phoenix House Topcliffe Lane Wakefield WF3 1WE NHS Eastern Cheshire CCG Alderley Edge Bollington Congleton Disley Handforth Holmes Chapel Knutsford Macclesfield Poynton Wilmslow (and surrounding areas) NHS Eastern Cheshire Clinical Commissioning Group 01C Payables K935 Phoenix House Topcliffe Lane Wakefield WF3 1WE

17 Appendix 4. Think Pharmacy Urgent Palliative Care Medicines Service Declaration and Self Assessment Monitoring Document: Community pharmacies providing an Urgent Palliative Care Medicines Service will be reimbursed at 200 per year, irrespective of the volume of items / prescriptions dispensed. The fee will be paid as a lump sum on receipt of an annual self assessment service monitoring declaration and declaration of intent to provide the service from the named community pharmacy for the proceeding 12 month period. 1. Service Monitoring, self assessment declaration The pharmacy has the following procedures/processes in place (Please circle as appropriate) A standard operating procedure (SOP) or guidance which specifically details the overall delivery of this service. Y N Completed and documented review of the SOP/guidance annually. Y N Trained all staff to follow the service delivery specification. Y N A training log that details training given to staff. Y N A process in place that ensures that all new staff are aware that this service is proved by the pharmacy and continuity of service is maintained during and after staff changes. Y N A copy of the latest service specification, in the pharmacy for reference. Y N Summarise any issues the pharmacy has encountered with the delivery of the service

18 2. Provision of Service, Declaration of intent I confirm that the named pharmacy will continuously provide an Urgent Palliative Care Service in accordance with the Service Specification for the period I confirm that by agreeing to provide the Service this form acts as an Invoice for payment. Pharmacy Full address Signed Print Date Position Please complete the Self Declaration and submit this form for payment. Claims will be paid within 28 days of submission of this form accompanied by a purchase invoice. Send completed claims form to: CCG Geographical location Invoice details of Pharmacy service NHS Vale Royal CCG NHS South Cheshire CCG provider Northwich Winsford (and surrounding areas) Alsager Crewe Haslington Middlewich NHS Vale Royal Clinical Commissioning Group 02D Payables K955 Phoenix House Topcliffe Lane Wakefield WF3 1WE NHS South Cheshire Clinical Commissioning Group 01R Payables K945 Phoenix House

19 NHS Eastern Cheshire CCG Nantwich Sandbach (and surrounding areas) Alderley Edge Bollington Congleton Disley Handforth Holmes Chapel Knutsford Macclesfield Poynton Wilmslow (and surrounding areas) Topcliffe Lane Wakefield WF3 1WE NHS Eastern Cheshire Clinical Commissioning Group 01C Payables K935 Phoenix House Topcliffe Lane Wakefield WF3 1WE

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