Pharmacy & Surgery Pressures – Guidance and Resources for Pharmacy Display

Norfolk LPC is aware of the immense pressure every part of the primary care system is currently experiencing.

We understand the critical shortages of workforce and funding in community pharmacy are major factors, which require national changes, but we have also been working with the Norfolk & Waveney Local Medical Committee (LMC) and Norfolk & Waveney Health & Care Partnership to seek to foster greater understanding between healthcare professionals of the issues faced, and foster support for mitigating the impact of these pressures.

We have identified two issues commonly resulting in additional pressures, and have jointly produced some resources for pharmacies and practices to utilise, if they wish:

1) Late ordering of repeat medication by patients, and waiting to collect medication until they have (almost) run out: Get medication early poster_v2.1 (1)

We understand that some patients order their prescriptions without adequate time for the pharmacy and surgery to process the request. We also recognise that the time required to handle prescription requests has increased for some surgeries and pharmacies, due to a number of factors, including staffing, availability of medicines and wholesaler pressures.

As a result, we have agreed with the above partners, a poster to display in both pharmacies and surgeries which encourages patients to be aware of the pressures, and to order their repeat medication 10 days before running out. There will be some patients for whom this cannot be applied, and pharmacies using “managed repeat” systems may operate differently, but this may provide a little more time to cope with patient demand and stock availability issues. We suggest that you consult your surgery(ies) on this first, although the LMC has consulted widely on this already, this is ultimately for local agreement. If there are concerns, please let us know.

The poster also encourages patients not to leave collecting their medication to the day they run out and suggests medicines should be collected while they have 2-4 days left.

2) Unavoidable Closures: Printable poster available here.

The LPC/PSNC have already produced general guidance for pharmacies on actions to take if unable to open. This includes a checklist of actions.

Ensuring your local surgery/surgeries are aware of the closure as soon as possible is vital in all cases, and clearly, such communication is also necessary to allow a temporary change in such matters as GP-CPCS referrals. If known, please share the expected duration of the closure, along with other relevant information such as if staff are still on the premises to answer queries. Unless agreed otherwise locally, this notification should normally be by email to the practice generic email address, as shown on NHS Service Finder. If a closure is last minute, you may also try to call the surgery bypass/non-public number, also available on the service finder. We would advise all pharmacies to note these contact details in advance and have them readily accessible.

Where a pharmacy is unable to open for part or all of a day, this may result in patients presenting at surgeries asking for duplicate prescriptions to be urgently produced. Many surgeries struggle to cope with this additional demand. Currently, information displayed on closure at a pharmacy is variable, as is advice on what such patients should do.

We would hope that the “ordering early” poster will reduce the urgency of medication collections; if patients do not wait until they have run out before collection.

We would also encourage pharmacies to have resilience plans in place to reduce disruption, with particular regard to returning scripts to the spine, but recognise this is not always possible.

Our second agreed resource is a template standard poster that the closing pharmacy can print out, complete, and display prominently.

This provides advice on when the pharmacy will reopen (if known, if not add “To be Confirmed), and suggests that if a patient has enough medication to last until their usual nominated pharmacy reopens, they should return later.

If a patient will run out of their medication before the pharmacy reopens, patients are encouraged to visit a nearby pharmacy for advice, rather than contacting the surgery.

If contacted by such a patient affected by the closure of a nearby pharmacy, we would suggest that pharmacy should seek to help the patient wherever possible, within the limits of legislation.

This may include:

· Checking if an EPS prescription is available to download and dispense.

· Assessing the immediacy of the patient need for medication

· Consulting the patient SCR (with consent).

· Considering if an emergency supply, under the locally-commissioned scheme, is legal and appropriate.

· You must be fully aware of the Regulations before making an emergency supply The Human Medicines Regulations 2012 (legislation.gov.uk)

Emergency supply of medicines | Medicines guidance | BNF content published by NICE

· Consider the pressure on the patient’s GP practice, and the practicalities of obtaining a duplicate prescription without undue delay. If you are aware that the practice is under immense pressure (and our discussions with the LMC would lead us to the view that this can currently be assumed) you may be consider issuing an emergency supply.

The RPSGB guidance states: “You are able to make an emergency supply even when the surgery is open. Trying to obtain a prescription may sometimes cause undue delay in treatment and potentially cause harm to the patient.”

· The legalities of supply of a controlled drug (schedule 4&5) must be considered (note the additional limitations), and caution exercised if supplying medication of potential abuse.

· None of the above in any way amends or extends the legal powers around emergency supply, nor do we seek in any way “normalise” the use of the emergency supply service. The final decision to make such a supply or not rests solely with the Pharmacist.

If you want the full briefing document that was sent out with these documents please contact info@norfolkpharmacies.co.uk