Extended Care FAQs


This information applies to the Extended Care Service across the whole NHSE&I Midlands Region

This page is being constantly updated, as we receive questions the information will be shared here so please keep checking for new information.

Q. Why has the Acute Bacterial Conjunctivitis (ABC) Service been ended today (March 22nd 2021)?

A.  It has been brought to our attention that the SPC for Chloramphenicol eye drops has been updated and now includes a contra-indication for use in children under 2 years. The SPC states the following

Paediatric population: This medicinal product must not be given to a child less than 2 years old as it contains boron and may impair fertility in the future.

Chloramphenicol eye ointment is also now contra-indicated for use in children under 2 years.

As a result, NHSE&I are having to remove the service for the treatment of Antibacterial Conjunctivitis in children under 2 years with immediate effect. The module within PharmOutcomes has been disabled so no further entries can be made.

NHSE&I are aware that consultations may have been undertaken during the 48 hours leading up to the service ending which have not yet been uploaded onto the PharmOutcomes system, so they will send separate comms to provide information on how these are to be dealt with.

Other stakeholders such as GP practices, CCGs and NHS111 are being notified of the cessation of the service today.

Q. Can chloramphenicol eye ointment be used in under 2s?

A. A message has been sent by NHSE&I clarifying the licensing of chloramphenicol.  It is only the eye drops which are contra-indicated in under 2s.  GPs have also had this message and you may see prescriptions for chloramphenicol ointment in under 2s.

Q. So can I supply chloramphenicol eye ointment on ABC service in under 2s?

A. The service was suspended on March 22nd 2021 in response to licensing changes.  Discussion are now under way to determine whether to reinstate the service allowing supply of the ointment, at this time no decision has been made.  If the service is to restart ALL pharmacies will be informed.  Until such time as this may happen, the ABC service remains unavailable.

Q. Who can provide the Extended Care family of services?

A. This service may be provided by authorised Community Pharmacies contracted to NHS England Midlands, who are committed to making staff available to provide the service, subject to the conditions outlined on the service pages.

Tier 1 service can be offered by any pharmacy wishing to sign up

Simple UTI Tier 1 Service 

Tier 2a may be offered by any pharmacy which is also signed up to Tier 1 service

Impetigo Tier 2a Service

Infected Insect Bites Tier 2a Service

Infected Eczema Tier 2a Service

Q. How do I know which pharmacies are signed up to the service

A. NHSE&I are producing master spreadsheets with details of all the pharmacies signed up to UTI  Extended Care Tier 1 service (ABC service now discontinued).  (This will be expanded to cover Tiers 2a and 2b when they are commissioned in 2021).

There are two lists, one for the East of the region and one for the West.  The document is an excel spreadsheet and lists every pharmacy, you can use the filter function on excel to look at specific CCG or STP areas.

The lists will be updated each week so you need to keep looking here to ensure that you have the correct list, in other words, don’t print the list today and treat it as the definitive list.  As of 9th December we had 291 pharmacies signed up across the region but this number is going up all the time, hence the need to keep checking for an up to date list.

Pharmacy Lists: these now include Tier 1 and Tier 2a services.

Please remember that Tier 1 is now only UTI service.

East of Region list – please note there are different tabs in the document for Derbyshire; Leicestershire; Lincolnshire; Nottinghamshire and also Northamptonshire:   Extended Care pharmacy sign up East Midlands 12.04.2021

 

West of Region list – please note there are different tabs in the document for Birmingham & Solihull;  Shropshire & Telford & Wrekin; Coventry & Warwickshire and also Staffs & Stoke on Trent: Extended Care Tier 1 and 2a Pharmacy List West Midlands 12.04.2021

You will see some pharmacies are highlighted in yellow on the spreadsheets, this is simply to show the pharmacies which have been added to the service since the last spreadsheet was uploaded.

Q. I have signed up to Tier 1 but am not on the list yet -why?

A. The lists are prepared on a weekly basis so there is some lag between your signing and sending in the SLA and then appearing on the list.  If it is more than 2 weeks since you sent in an SLA please email the NHS team at East or West and check with them in case the SLA has been missed.

Q. I have signed up to Tier 2a but am not on the list yet -why?

A. The lists are prepared on a weekly basis so there is some lag between your signing and sending in the SLA and then appearing on the list.  If it is more than 2 weeks since you sent in an SLA please email the NHS team at East or West and check with them in case the SLA has been missed.

Please Note: you can only sign up to Tier 2a services if you have signed up to Tier 1 services. If you have not yet signed the Tier 1 SLA this will prevent you going onto the Tier 2a service.  If you do wish to deliver both Tier 1 and Tier 2a but have so far only signed up to Tier 2a, then you will need to sign and return Tier 1 SLA.

Q. Are there any flow-charts or other documents I use to understand the patient journey?

A. Yes

The first document summarises both Tier 1 and Tier 2a services and would be useful for support staff as well as GP practice staff.

NHSE&I Midlands Extended Care Services Summary UTI, ABC and Skin

The flow charts explain the patient journey and would be useful for support staff and for GP practices staff

UTI Flow Chart

Acute Bacterial Conjunctivitis (ABC )Flow Chart – service ended 22.3.2021

Skin Flow Chart

Q. Can I share the flow-charts and service explanation sheet with my GP practices and other colleagues

A. YES – please share these to help you explain the service to colleagues when you speak to them, you may consider leaving copies with your local GP practices after you’ve spoken to them to explain the service.

Q. How do I sign my pharmacy up to the service

The SLA should be signed, this needs to be stored in the services folder in your pharmacy.  You need to indicate on the signature page which services you are signing up to – UTI service is still running, ABC service has now ended (22.3.2021).

A copy of the signature page should be returned to NHSE&I and you will then be given access to the PharmOutcomes modules.  When access to the modules is turned on you should take this as confirmation that you have a contract with NHSE&I for the extended care services.

Please note that if you work for a multiple, you do not have the authority to sign up your branch to a local service – you should contact your Area Manager or Pharmacy Superintendent to ask about a company sign-up.

Q. Where do I send the signed SLA?

A.  NHSE&I sent a letter explaining the process to the NHS mail address of every pharmacy in the regions.  You can download a copy here – there is one letter for the East of the region and one for the West.  The SLA is the same for the whole region, the reason we have two letters is to share the sign up workload at NHSE&I.

Please read the letter for info and to get the correct address for returning the SLA to.

Extended Care Tier 1 Letter Dec 2020 EAST

Extended Care Tier 1 Letter Dec 2020 WEST

Q. I signed and returned the original 2020 SLA, do I have sign this new Midlands-wide SLA?

A. No, if you have signed and returned the SLA in either Shropshire / Staffordshire or Derby Nottinghamshire you do not have to sign up again.  You should simply print off the new SLA and keep that along with the covering letter from NHSE&I (both available on the website here UTI )

Q. Is there any special training for pharmacists who are going to deliver the service?

A.  Pharmacists working at participating pharmacies can provide this Enhanced Service if they have completed the mandatory training requirements.

The requirements are;

  • That they have worked through the CKS summaries on simple UTIs. Please access the summary; background information; diagnosis; management; prescribing information and evidence sections for each condition to ensure that you have up to date, relevant clinical knowledge http://cks.nice.org.uk/urinary-tract-infection-lower-women
  • They must have satisfactorily completed the PHE Antimicrobial Stewardship for Community Pharmacy e-learning and e-assessment https://www.e-lfh.org.uk/antimicrobial-stewardship-for-community-pharmacy-staff/ and are registered as an antibiotic guardian https://antibioticguardian.com/healthcare-professionals/
  • They must ensure that they have the correct clinical knowledge to provide the service and are familiar with NICE guidance on treating simple UTIs.
  • The requirements of the SLA are understood and the PGD associated with the service issigned.The pharmacist should then print their DoC and add the heading “NHSE&I Community Pharmacy Extended Care Service Tier1”. It must then be signed and dated to complete the process. The pharmacist must confirm on the CPPE website that they have completed and signed the DoC.The accuracy of the DoC is the pharmacist’s professional responsibility.

Q. What about locums / relief pharmacists?

A. You need to ensure that any relief pharmacists or locums you use are service ready – all of the information on the service is available on this website on the relevant pages.  UTI

The service does not require the pharmacist to attend special training, simply to understand the service, ensure that their clinical knowledge is up to date and to be familiar with the PGDs.

As with all PGDs pharmacists must sign the pharmacy copy of the PGD in every pharmacy where they deliver this service.

Q. What days should I offer the service?

A. When deciding to sign up to the service you should be aware that there is a requirement to offer the service during all of your opening hours so you need to ensure all of your pharmacists are up to speed and the staff briefed on how the service works.  NHSE&I understand that you may occasionally have to organise a locum at short notice, but for planned days off /holidays you need to ensure that the service will still be available.

This is important because we are asking GP practices and NHS111 to refer patients to you, it is not going to be a success if patients come to you, only to be told that you “don’t do that today” – if that happens at your pharmacy it won’t be long before referrals dry up and unfortunately this will reduce confidence in the service across that patch.

Q. I have a patient who needs the service but I can’t deliver the service today – what should I do?

A. If you are not able to offer the service on a particular day (for any reason) you should check the list of service providers for your area, then contact another local pharmacy to establish that they provide the service and advise the patient to contact them to arrange to be seen.

Pharmacies signed up to the extended care services can be found on the lists on this page, you can click here to go to back to the question with links to both East and West pharmacy lists.

You must NOT refer the patient to NHS111 or back to the surgery – the whole point of this service is helping reduce demand and helping patients to be seen and helped by the community pharmacy.

Q. How do I complete my DoC

A. The pharmacist will need to log in to the CPPE website and access the DoC section to download the DoC Self-Assessment Framework for Minor Ailments. (UTI and ABC services are a Level 2 Minor Ailments Service involving supply of POM medication under a PGD).  More information can be found on the services pages Simple UTI Tier 1 Service 

Q. Can I complete the service remotely?

A.  The SLA has been written to allow you to carry out a consultation face to face, or if it is more appropriate via telephone or video.  You will need to make a professional judgement as to when the patient needs to attend the pharmacy either to access medication or for a dipstick test.

Q. Is there an extension for the UTI PGD?

A. Yes, it now runs to 30.6.2021 Nitrofurantoin PGD APRIL 2021

Q. Do I have dipstick every UTI patient?

A.  NO you should NOT be dip-sticking every patient.  The service is based on up to date guidance for diagnosing simple UTI and diagnosis is based on the woman having 3 of the listed symptoms and no exclusions.

Patient Symptoms – need 3 for treatment

Latest guidance states – Use of Dipsticks is not a diagnostic indicator alone.

So you only use dipstick test to guide treatment decisions in otherwise healthy, non-pregnant women presenting with two or less symptoms of UTI
If a female presents with one or two inclusion criteria symptoms they can only be treated if there is a strong possibility of UTI when tested with a dipstick – these are the only patients who should have a dipstick test and for these patients to be eligible for treatment, it must be positive for nitrite and/or leucocytes.

Q. I don’t have a public toilet, how can I test urine if necessary? 

A. If a patient telephones ahead, you may choose to ask them to bring a urine sample with them “just in case” – remember you only need to dipstick if they have two or fewer of the inclusion symptoms.  If the patient comes to the pharmacy without calling ahead and it turns out that you need to test a urine sample,  it would be acceptable to ask them to go to either a public toilet or home (whichever is nearer) and return with a sample to allow you to do the dipstick test.

Q. Can I use my professional discretion and treat someone with one or two symptoms without using a dipstick test to confirm? 

A. A straight forward NO – the SLA outlines the service and within the service, medication may only be provided under the strict terms of the PGDs, every patient you treat must meet the inclusion criteria as well as having no exclusions as per the current PGD.  The UTI PGD clearly states that treatment is dependant on a patient presenting with 3 symptoms from the list or if a female presents with one or two inclusion criteria symptoms they can only be treated if there is a strong possibility of UTI when tested with a dipstick – there is therefore ZERO opportunity for you to “interpret” the service and treat a patient, their symptoms must fit the specific inclusion criteria.

If you do not wish / are unable to test the urine from a patient with 1 or 2 symptoms you must refer that patient onwards to another practitioner see below.

Q. If I am unable to either dipstick or unable to treat a patient who should I refer the patient to?

A. If you need to test a urine sample but cannot dipstick test for practical reasons which are specific to your pharmacy, please refer the patient to another UTI pharmacy who may be able to dipstick the urine sample.  As part of this consultation, which you will be paid for completing, NHSE&I would expect you to call and check the pharmacy can deal with the patient – this will prevent a wasted journey and frustration for the patient.  Pharmacies signed up to the extended care services can be found on the lists on this page, you can click here to go to back to the question with links to both East and West pharmacy lists.

If you cannot dipstick for another reason you should refer the patient to their GP practice.

Q. I have carried out the consultation but the patient needs a dipstick test and I cannot do that, do I still record the consultation?

A. Yes, if you have conducted the full consultation and given advice and found an alternative health care provider for the patient to see, you should record the consultation and the outcome and save on PharmOutcomes.  You will be paid the professional fee for the consultation.

Q. How do I get my clinical waste bin?

A. Once NHSE&I receive your signed SLA your pharmacy will be put on the list to receive a bin, this will be on the soonest available drop but will not be immediate, please be patient as NHSE&I are working hard to sort the contract across the region and you will get a bin as soon as possible.

Q. Can I use my clinical waste bin for waste from any other source?

A. NO – this bin is only for the extended care service and will be a small capacity as you should only use for extended care and you should NOT be dip-sticking every patient.

Q. How often will my clinical waste bin be collected?

A. Because the amount of clinical waste generated by this service is small, the clinical waste bins will be collected and a replacement provided 6 months after you first receive it and then again 6 months after that.

Q. Do you have an example SOP that I can base mine on?

A. NHSE&I have said they will not provide a template SOP.  It is felt that the SLA and PGDs together give adequate description of the service and it’s delivery and that because many pharmacies have their own template for SOPs, NHSE&I will not be providing one.

A simple local services SOP has been prepared by Simon Hay at South Staffs LPC and can be downloaded, personalised and edited to suit your needs.  Many pharmacy SOPs for local services are written in this manner – (ie follow SLA, supply under terms of PGD etc) and provided that this type of SOP is stored with a copy of the service documentation it would fulfil the requirements to have a SOP for a locally commissioned service.

It is not intended that this example SOP replaces any SOP your company has already produced, it is here as an aid for those without a SOP.  Do remember to add pharmacy details, relevant dates etc

Locally Commissioned Services SOP

Q. What do I do if I can’t get onto PharmOutcomes to do the consultation?

A. The requirement for all locally commissioned NHSE&I services is that they are recorded live on PharmOutcomes.  There may be an occasion where the IT fails and you are unable to access the system.

For this reason we have produced a pro forma that can be printed out and used to record the consultation.  If you have to record the service while “off-line”, using the pro forma will ensure that you collect all of the required data.

A copy of the pro forma can be downloaded from the PharmOutcomes module or from the service pages on this website and stored in the service file just in case BUT you should be aware that if there is any variation in the service the pro forma would be updated to match.  For this reason we would recommend that you only print a small number of pro forma’s to keep in your service file and that if there are service or PGD updates you check on the system to check if a new version of the pro forma has been uploaded – future versions will be clearly dated.

Q. What about other services e.g. EHC, needle exchange, supervised consumption, smoking?

A.  These are commissioned on a smaller, more local footprint, funded by local authorities.  They do not fall under the remit of the NHSE&I commissioned extended care services.  If you require details of these services please consult your local LPC website or contact your LPC for information.