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 PHARM-2017-2018-003 Access to Palliative Care Medicines Andrea Loudon Period 1 st of April 2017 to 31 st March 2019 Date of Review 31 st March 2018 1. Population Needs 1.1 National/local context and evidence base Patients with a terminal illness often experience new or worsening symptoms and often need access to a different medication or an increased strength of medication promptly to manage these changing symptoms. Delays in accessing medicines can cause distress to both patients and their carers and increase the workload of nurses tasked with patient care. 2. Outcomes 2.1 NHS Outcomes Framework Domains & Indicators Domain 1 Preventing people from dying prematurely X Domain 2 Enhancing quality of life for people with long-term X 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 X Domain 5 Treating and caring for people in safe environment and protecting them from avoidable harm X 2.2 Local defined outcomes To improve access to palliative care medicines for patients, carers and healthcare professionals when they are required, by ensuring prompt access and continuity of supply 1
3. Scope 3.1 Aims and objectives of service To ensure that there is on-demand availability of palliative care medicines from Community Pharmacies in North Cumbria. To ensure that there is easy access to palliative care medicines to provide palliative care patients with good symptom control and ensure that their symptom control is maintained. To ensure that there is good access to palliative care medicines seven days a week. 3.2 Service description/care pathway This service is aimed at the supply of palliative care medicines, the demand for which may be urgent and/or unpredictable. The pharmacy contractor will stock a locally agreed range of specialist medicines (Appendix 1) and will make a commitment to ensure that users of this service have prompt access to these medicines during opening hours. The list also includes vitamin K injection for the treatment of bleeding. The pharmacy will provide information and advice to the user, carer and clinician. They may also refer to specialist centres, support groups or other health and social care professionals where appropriate. The pharmacist will promptly inform NHS North Cumbria CCG if there are supply problems (manufacturer or wholesaler). 3.3 Population covered This service is available to all patients registered with a GP practice in North Cumbria CCG 3.4 Any acceptance and exclusion criteria and thresholds 3.5 Interdependence with other services/providers To work seamlessly together with other professionals as appropriate for the benefit of the patient. Any healthcare professionals involved in the care of service users must be appropriately trained with the necessary competencies to deliver the service 4. Applicable Service Standards 4.1 Applicable national standards (eg NICE) Palliative care for adults: strong opioids for pain relief Clinical guideline. Published: 23 May 2012 http://www.nice.org.uk/guidance/cg140 2
4.2 Applicable standards set out in Guidance and/or issued by a competent body (eg Royal Colleges) 4.3 Applicable local standards The service will be provided by a practising pharmacist registered with the General Pharmaceutical Council. The pharmacy shall maintain the required stock (range and quantity) of palliative care drugs against an agreed list of palliative care drugs (Appendix 1) which will be reviewed when necessary. There must be a named individual who ensures that the stock is managed appropriately. The attached list identifies minimum stock levels that the pharmacy must stock and maintain. The contractor will identify where supply problems prevent compliance with this requirement and notify NHS North Cumbria CCG, within one working day to Phil Utting Phillip.Utting@cumbria.NECSU.nhs.uk or telephone 07769 160815 or 01228 603050 The identified range and quantity of medicines are in addition to any demand requirement arising from the pharmacy s normal within hours dispensing service. The pharmacy must operate this service for their full opening hours. The pharmacy must maintain appropriate records for the pharmacy and NHS North Cumbria CCG to cover ordering, receipt, batch number, expiry date checks and audits to meet legal and NHS North Cumbria CCG requirements and ensure effective, ongoing service delivery. The pharmacy will have and maintain Standard Operating Procedures to meet all of these service requirements and reflect changes in practice or guidelines. Ensure that pharmacists and staff involved in the provision of the service are appropriately trained and can deliver the service for the full contracted or voluntarily extended opening hours. The pharmacist shall provide information and advice relating to the use of palliative care medication to patients and carers where appropriate and palliative care drug information on request from healthcare professionals involved in the service. In circumstances where the pharmacy is unable to supply the item(s) on demand, they will direct/signpost the patient, carer or healthcare professional to the nearest pharmacy provider of palliative care drugs, checking first that they have the required item(s) in stock. The pharmacy shall co-operate with any CCG -led assessment of the service, audit of service provision and service user evaluation of the service if requested. 3
The pharmacy contractor shall notify NHS North Cumbria CCG Medicines Optimisation Team of any changes to the contact details of the pharmacy manager. 5. Applicable quality requirements and CQUIN goals 5.1 Applicable Quality Requirements (See Schedule 4A-D) The pharmacy contractor must comply with all the requirements of the Essential services of the NHS Community Pharmacy Contractual Framework. The pharmacy contractor shall ensure that pharmacists and staff involved in the provision of the service are appropriately trained, are aware of and operate within local procedures and guidelines. The pharmacy contractor shall ensure that any paperwork relating to the service, local procedures and guidelines issued by NHS North Cumbria CCG are easily accessible within the pharmacy. This will include NHS North Cumbria CCG Palliative Care Formulary and list of participating pharmacies. The pharmacy will undertake Significant Event Analysis of incidents relating to the service and demonstrate learning from incidents where required by NHS North Cumbria CCG. The pharmacist must report to NHS North Cumbria CCG on an incident alert form (IAF) any items that are unable to be dispensed on-demand and inform NHS North Cumbria CCG how the incident has been resolved. The pharmacy will contact NHS North Cumbria CCG Medicines Optimisation Team to authorise the destruction of any controlled drugs which expire to Phil Utting Phillip.Utting@cumbria.NECSU.nhs.uk or telephone 07769 160 815 or 01228 603050 5.2 Audit requirements The pharmacy will be required to undertake an audit relating to the service NHS North Cumbria CCG will provide an audit template to be completed. 6. Location of Provider Premises The Provider s Premises are located at: 7. Individual Service User Placement Not applicable 4
APPENDIX 1 CUMBRIA CCG COMMUNITY PHARMACY PALLIATIVE CARE DRUG LIST APRIL 2017 See next page 5
Drug Strength Stock level Alfentanyl injection 1mg/2ml 10 amps Cyclizine injection 50 mg/1 ml 20 amps Dexamethasone injection 3.3mg / 1ml (or 3.8mg in 1ml if 3.3mg not available) 20 vials Diamorphine injection 30mg 20 amps Glycopyrronium 200mcg in 1ml 10 amps Haloperidol injection 5 mg/1 ml 5 amps Hyoscine Hydrobromide injection 400 mcg/ml 10 amps Levomepromazine injection (Nozinan ) 25 mg/1 ml 20 amps Metoclopramide 10 mg/2 ml 10 amps Midazolam injection (high strength) 10 mg/2 ml 20 amps Morphine sulphate injection 10 mg/ml 20 amps Morphine sulphate injection 30 mg/ml 20 amps Oxycodone injection 10mg/1ml 10 amps Oxycodone injection 50mg/1ml `10 amps Oxycodone oral solution (OxyNorm ) 5mg/5ml 250ml Phytomenadione inj (Konakion MM ) 10mg/ML 10 amps Water for injection 10mls 10 amps 6