Induction to Community Pharmacy COVID-19

This is a summary of current practice in community pharmacy to support pharmacists who are being deployed from other sectors of practice or non-clinical roles, or for people who are returning from recent retirement in response to the coronavirus (COVID-19) outbreak. 

At this time your workload will be primarily focussed on medicines supply and treating minor health conditions, but this will vary from day to day and location to location. This page assumes you have a general understanding of community pharmacy practice in Scotland and focuses on the key information required right now. If you require a broader overview, please visit our general Return to Practice page in our CPD resources section. At the time of production this information was accurate, however this is a rapidly changing landscape, please visit Community Pharmacy Scotland COVID 19 Toolkit for updates on changes to services and advice from Scottish Government. 

Most health boards and some pharmacy contractors have Locum information packs available, which will be a useful resource to you at this time. If after reading this guidance you have any questions or feel you require further information to support your preparation as a community pharmacist, please submit your questions/suggestions here

Induction video from Adam Osprey (Community Pharmacy Scotland)

Please watch this brief video from Adam Osprey from Community Pharmacy Scotland for a quick overview of practice in community pharmacy at this time. Adam helps set the scene and describes what your key focus should be to help you prioritise your CPD with the purpose of working in community pharmacy. They may be to support the dispensing process and medicines supply, as well as minor ailment consultations. Adam also offers some key contact for support should you require this while you are in practice.

Your role as Responsible Pharmacist in Community Pharmacy

During this unprecedented time, the GPhC have issued a joint statement with PSNI recognising that professionals may need to depart from established procedures in order to care for patients and people using health and social care services. This is a summary of the key aspects of the Responsible Pharmacist legislation. 

In October 2009, the Medicines Act 1968 was amended and the Medicines (Pharmacies) (Responsible Pharmacist) Regulations 2008 came into force. The changes introduced the role of the Responsible Pharmacist (RP), in connection with the lawful conducting of a retail pharmacy business. 

The Responsible Pharmacist Regulations require every registered pharmacy premises to have a Responsible Pharmacist in charge to secure the safe and effective running of the pharmacy premises when dispensing, selling, supplying medicines and providing pharmacy services. The Responsible Pharmacist may be an employed or locum pharmacist, however if there are two pharmacists on the premises only one can be the RP (usually the employee). There can only be one RP in charge of one pharmacy premises at any one time, so if moving premises must sign out from the first pharmacy. 

The legal requirements associated with the responsible pharmacist role include: 

  • displaying a notice that gives the details of who the RP is (this can be printed off in most pharmacies) 

  • making and keeping records 

  • pharmacy procedures 

  • the responsible pharmacist’s absence from the pharmacy 

 

For further information on the legal requirements that apply, pharmacy professionals can refer directly to the legislation, to professional leadership organisations (such as the Royal Pharmaceutical Society and the Association of Pharmacy Technicians UK) and pharmacy organisations (such as the National Pharmacy Association), Company SOPs or should seek their own legal advice. 

Guidance on the requirements for the role of the responsible pharmacist was published by the Department of Health in 2009 and can be viewed here

Standard Operating Procedures (SOPs)

A Standard Operating Procedure is a written procedure that specifies what should be done, when, where and by whom. 

SOPs play a fundamental role in continuous quality assurance and ensuring best practice in the pharmacy, in order to assist you in protecting the safety of your patients and members of the public. They are a tool to protect the safety of patients, minimise risk and assure the quality and consistency of process and services. Following SOPs protects our registrants and also other members of the pharmacy team. SOPs are the backbone of all processes in a pharmacy and are a regulatory, contractual and company requirement to make sure colleagues are working to best practice and adhering to legislation. 

The implementation of SOPs, which are specific to your pharmacy, aim to: 

  • ensure quality and consistency of service to patients 

  • ensure good practice is always achieved  

  • utilise the expertise of the pharmacy team effectively 

  • facilitate delegation of appropriate tasks to trained members of the pharmacy team 

  • provide role clarification for all members of the pharmacy team 

  • provide staff training 

  • provide assurance of staff understanding of processes to be followed in the pharmacy 

  • provide an opportunity for pharmacists to define and assess their practice 

  • facilitate communication and teamwork 

 

Who is responsible for SOPs? 

All members of the pharmacy team are responsible for following the implemented SOPs that are relevant to their roles and responsibilities. 

Controlled Drugs

The UK Health Act 2006 introduced new monitoring and inspection requirements for controlled drugs. These new arrangements are designed to work within and alongside existing governance systems to promote the safe, secure and effective use of controlled drugs. Each healthcare organisation holding stocks of CDs must have standard operating procedures (SOPs) for the use and management of CDs. Please refer to the SOPs of the community you are working in but good practice guidance can be accessed here

Recent Changes to Controlled Drug Regulations 

It is worth noting that in recent years Tramadol, pregabalin and gabapentin have been reclassified as schedule 3 control drugs. You must ensure they are ordered appropriately, and all prescriptions must have the legal CD prescription requirements.  They are not subject to safe custody requirements.

The Pharmacy Contract

The community pharmacy contract centres on the provision of four core service strands. 

  • Acute Medication Service (AMS) - Electronic Transfer of Prescriptions (ETP) and supporting pharmaceutical care services for acute episodes and any counselling and advice. 

  • Medicines: Care and Review (MCR) (Formerly CMS) 

  • Minor Ailments Service (MAS) – local formularies can be found here

    • PLEASE NOTE: on 20/3/20 the Scottish Government announced a change to the eligibility criteria for MAS meaning that community pharmacy contractors will be able to offer MAS consultations to anyone presenting at the pharmacy.  This is an interim measure and this service will be replaced on the 22nd April with the new NHS Pharmacy First Scotland service. These services are intended to place community as the first port of call for common conditions and minor ailments. 

  • Public Health Service (PHS) – includes the smoking cessation service and the provision of EHC supply 

  • More information relating to the core services can be accessed here and see below for links to related resources and e-learning activities

 

Patient Groups Directions (PGDs)

PGDs allow specified health care professionals to supply and/or administer a medicine directly to a patient with an identified clinical condition without the need for a prescription or an instruction from a prescriber. Health boards use PGDs for the delivery of national and local pharmacy services Health care professionals working within the PGD are responsible for assessing that the patient fits the criteria set out in the PGD. For a legal supply to be made under a PGD a pharmacist must have competed an agreement form for that PGD and have submitted it to the NHS Board to be held on the board’s register. 

  • Links to PGDs for Health boards can be found here

PGDs to support common clinical conditions and minor ailments (formally known as Pharmacy First) 

These PGDs allow community pharmacists to give advice to and if necessary, treat or refer patients with common clinical conditions which require supply of a Prescription Only Medicine (POM). Examples of condidions for which there are PGDs include; uncomplicated urinary tract infections (UTIs), Impetigo, skin Infections, Skin Conditions, Conjunctivitis, Vaginal Thrush, and Shingles). At this time, please utilitse the NES e-learning modules to help you understand how to make supplies under these PGDs and who is eligible, but please check with your local health boards which PGDs are available to you. 

Unscheduled care 

Community Pharmacies are an important access route for people requiring unscheduled care. The unscheduled care tools include a patient group directive for the urgent provision of medicines and appliances. This enables community pharmacists to provide patients with up to one prescribing cycle of their repeat medicines and appliances in a wide range of circumstances where obtaining a prescription is not practical. Wherever possible, we encourage you to use the unscheduled care tools available to you to ensure continuity of care for patients and the public through your pharmacy and easing the strain on our colleagues in primary care and Out of Hours services.  

There are now very few situations in which a Pharmacist cannot use this PGD to issue medication to a patient. The consequences of not supplying; a prolonged patient journey and an additional burden to in- and out-of-hours NHS services, should be considered when decision making 

The Pharmacy Guide to Unscheduled care can be accessed here.

The guide is updated regularly, and it is strongly advised that you read the whole guide to understand what options are available when a patient presents. Here you will also find the latest 'What's New' highlighting any recent changes. 

 

Emergency Care Summary (ECS)

In order to support the extended MAS and wider use of the Unscheduled Care PGD, Health Boards have been authorised to grant access to the Emergency Care Summary (ECS) system to community pharmacists, where it is practical and appropriate to do so. This will give pharmacists and pharmacy technicians access to medication, allergy and adverse reaction information.  We have prepared this quick reference guide to help you when using ECS, however please also refer to any local Health Board guidance.

Additional National and Local services

This is a basic summary of additional services provided in community pharmacy. Some of these are national where as others are locally agreed services. If you are working to support the service during the COVID-19 ourbreak we recommend you use the knowledge of local staff to help guide you in delivering these services. NES has a number or resources to help you if you require a deeper understanding of these services - please let us know what would be useful to at this time. 

Gluten Free Food Service  (This was introduced as community pharmacy led supply service in 2014. Please refer to the Gluten Free Food Service support pack for more detail)

Stoma Service (please refere to the Lower GI Stoma management e-learning)

Local Services which NHS Boards negotiate locally with Community Pharmacy Health Board Committees on remuneration for the following pharmaceutical services: 

  • Advice to Residential Homes 

  • Support for people with substance misuse issues 

  • Needle Exchange Services 

  • Compliance support solutions 

  • Disposal of Patients’ Unwanted Medicines 

  • Out of Hours rotas 

  • Collection and delivery services 

Details of these services per Health Board can be found on the NHS Community Pharmacy website 

 

Universal claims framework

The Universal Claim Framework (UCF) supports electronic claiming for pharmacy-led services. This allows community pharmacy to manage and deliver pharmacy-led services from their Patient Medication Record (PMR) system. Claims for re-imbursement are sent as part of the dispensing process and included in the payment and reporting for that dispensing month. 

Use of this facility has been approved for the following services; 

  • Unscheduled Care 

  • Public Health Services including Emergency Hormonal Contraception and Smoking Cessation 

  • Healthy start vitamins 

  • Gluten-free Food Service 

  • Urinary Tract Infection (Pharmacy First) 

  • Impetigo (Pharmacy First) 

Stress, Coping and Resilience

Pharmacy staff are likely to feel stressed and under enormous pressure during this outbreak – this is perfectly natural and indeed is a reaction to a very abnormal set of circumstances.  Please see below for a helpful visual to assist with information on Stress, Coping and Resilience.  This may be worth bearing in mind or printing out and putting up a copy of in your place of work.

You can also visit the Psychosocial support and wellbeing page on Learn for more information and resources on how to look after yourself, your patients and your colleagues at this difficult time.

Key contacts

Community Pharmacy Scotland (CPS) – Telephone 0131 467 7767 

Pharmacy Champions – Every Health Board has Pharmacy Champions to support developments within community pharmacy network 

Community Pharmacy Development Teams – Key contact for Community pharmacists within the Health Boards 

 

Coronavirus resources:

Health Protection Scotland 

CPS coronavirus COVID-19 page

NES Turas Learn COVID 19 page

RPS COVID-19 Hub

Buttercups Pandemic Training for Additional Staff to Support Pharmacy Services