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Pharmaceutical Services Negotiating Committee

AUR

Appliance Use Review (AUR) is the second Advanced service to be introduced into the NHS community pharmacy contract. AURs can be carried out by a pharmacist or a specialist nurse in the pharmacy or at the patient's home. AURs should improve the patient's knowledge and use of any ‘specified appliance' by:

  • Establishing the way the patient uses the appliance and the patient's experience of such use;
  • Identifying, discussing and assisting in the resolution of poor or ineffective use of the appliance by the patient;
  • Advising the patient on the safe and appropriate storage of the appliance; and
  • Advising the patient on the safe and proper disposal of the appliances that are used or unwanted.

Conditions to fulfil before conducting AURs

The service can be provided by pharmacies that normally provide the specified appliances in the normal course of their business.  The conditions that must be satisfied are that:

1) Before beginning to provide the service, the pharmacy must notify the NHS Business Services Authority that it wishes to provide the service and inform them as to whether the service will be provided at the patient's home; and unless the AUR will only be provided solely at patient's homes, a statement of each location at which the service is to be provided. The Advanced Services Declaration form on the NHS BSA website can be used to make this declaration.

2) Before beginning to provide the service, the pharmacy must notify the NHS England Area Team (AT) that it wishes to provide the service and inform them whether the service will be provided at patients' homes and / or at the pharmacy. The pharmacy contractor must also provide the AT the following information in relation to pharmacists or specialist nurses who are to provide AURs:

  • Full name;
  • Documentary evidence of qualifications (i.e. education, training or experience in respect of the use of specified appliances); and
  • Details of competency in respect of the use of specified appliances (i.e. details as appropriate of relevant clinical training and practice in respect of the use of specified appliances).

Form APPL01 - AUR AT notification  can be used to make these declarations to the AT. 

3) The pharmacy must be satisfactorily complying with the Terms of Service for the Essential services.

4) The pharmacy must have an acceptable system of clinical governance.

5) The pharmacy must have a Standard Operating Procedure (SOP) in place to ensure referral of patients to the prescriber of the appliance in any case where a matter relating to the patient's use of a specified appliance arises in the course of an AUR but falls outside the scope of the service.

6) Where the service is provided at the pharmacy, the consultation area must:

  • be distinct from the public area;
  • be clearly designated as an area for confidential consultations; and
  • allows all persons taking part in the AUR to sit down together and talk at normal speaking volumes without being overheard by other visitors to or staff at the pharmacy.

Having regard to the nature of specified appliances and the underlying purpose of the AUR service, the consultation area should be suitable for a consultation to determine how a patient uses an appliance and the extent of the patient's knowledge about it.  For example the discussion about appliances might require higher standards of visual privacy than would be expected in an MUR, or access to handwashing facilities may be required in some circumstances.

There is no requirement for the AT to accredit or otherwise approve the pharmacy before the service commences.

The Directions which establish the Appliance Use Review service do not require the pharmacist or specialist nurse to undertake a Criminal Records Bureau (CRB) check, but pharmacy contractors will wish to consider whether CRB checks should be carried out, as part of the pharmacy contractor's own risk management policies.


Requirements when providing an AUR

1) The service must be provided, where reasonably possible, within 2 working days of the patient requesting a review or agreeing to one.

2) The pharmacist or specialist nurse must obtain the patient's written consent before providing the service.

3) A record must be completed, containing:

  • the date of the review;
  • the name of the pharmacist or specialist nurse who undertook the review;
  • the name of the patient, and the address at which the review took place;
  • the name of any other person present during the review (and their relationship with the patient);
  • the reason why a review is required;
  • the advice given to the patient;
  • any intervention made.

Form APPL04 - AUR record can be used to record the details of an AUR.

4) The patient must be informed in writing that the record will be made and that it will be forwarded as follows:

  • A copy must be sent to the pharmacy contractor; 
  • The information about the date of review, the identity of the patient and the pharmacist or specialist nurse who carried out the review must be sent to the patient's GP if they are registered with one. Form APPL05 - AUR GP notification template can be used to inform the GP that an AUR has been conducted but that no action points have arisen that the GP needs to be aware of;
  • Any information which the pharmacist or specialist nurse considers it necessary for the GP to be aware of, must be forwarded to the patient's GP (if they are registered with one); and 
  • Any information sent to a patient's GP must also be copied to any nurse who is practising with the GP and providing relevant primary medical services to the patient, if it is known that there is such a nurse.

5) The record of the AUR must be retained for a minimum of 12 months or such longer period as the AT requires. Records may be made and stored electronically.

6) Information about the number of AUR services provided each month should be declared on the FP34C submission form.

7) The maximum number of AURs for which claims for payment may be made is not more than 1/35 of the aggregate number of specified appliances dispensed during that financial year (1st April to 31st March).  It is therefore likely that a pharmacy would need to institute a cumulative record of how many of the specified appliances have been dispensed, so that it does not unwittingly exceed the threshold of how many AURs can be undertaken. Form APPL06 -  Appliances count sheet can be used to keep track of the number of specified appliances dispensed during the year in order to determine how many AUR may be provided.

A table highlighting the key differences between an AUR and an MUR can be found here.

 

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