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Pharmaceutical Services Negotiating Committee

SAC

Stoma pouchStoma Appliance Customisation (SAC) is the third Advanced service in the NHS community pharmacy contract. The service involves the customisation of a quantity of more than one stoma appliance, based on the patient's measurements or a template. The aim of the service is to ensure proper use and comfortable fitting of the stoma appliance and to improve the duration of usage, thereby reducing waste. The stoma appliances that can be customised are listed in Part IXC of the Drug Tariff.

If on the presentation of a prescription for such an appliance, a pharmacy is not able to provide the service, because the provision of the appliance or the customisation is not within the pharmacist's normal course of business, the prescription must, subject to patient consent, be referred to another pharmacy or provider of appliances. If the patient does not consent to the referral, the patient must be given the contact details of at least two pharmacies or suppliers of appliances who are able to provide the appliance or the stoma appliance customisation service, if contact details are known to the pharmacist.  The NHS England Area Team (AT) may provide the information or it may be established by the pharmacist.


Conditions to fulfil before providing SAC 

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

1) The pharmacy must notify the NHS Business Services Authority that it wishes to provide the service before beginning to provide the service. The Advanced Services Declaration form on the NHS BSA website can be used to make this declaration.

2) The pharmacy must notify the AT that it wishes to provide the service before beginning to provide the service. Form APPL02 - Stoma Customisation AT notification can be submitted to the AT to notify them of the intent to carry out the Stoma Customisation Advanced Service. 

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 where the stoma appliance is not suitable for further customisation or where a stoma appliance has been customised and is not a proper fit for the patient.

6) The service must be provided from an ‘acceptable location', which means:

  • an area within the pharmacy that is distinct from the public area;
  • is clearly designated as a private area whilst the service is being provided;
  • is suitable and designated for the retention of the appropriate equipment for customisation;
  • is suitable and designated for modification of the appliances; and
  • that it is suitable for the volume of customisation being undertaken at any given time.

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

The pharmacy contractor can carry out customisation at alternative premises provided that they are distinct from public areas of the alternative premises and that they meet the above conditions.  If premises other than the pharmacy are used, the pharmacy contractor must have procedures which ensure co-operation with any reasonable inspection or review of the premises by the AT of the area where the service is provided.


Requirements when providing SAC

The pharmacy contractor must also ensure that:

1) The service is provided only by appropriately trained and qualified persons. It is anticipated that the Department of Health guidance will clarify this requirement. Appropriate training is likely to cover knowledge of what the appliances are used for, the importance of proper fitting, hygiene etc.

2) A record of each customisation is completed which includes:

  • details of advice given;
  • the type of stoma appliance;
  • dimensions used in respect of the modification of parts of the appliance;
  • measurements of the patient (if taken);
  • dimensions of any template made or modification of any existing template; and
  • any referrals made to the prescriber.

 Form APPL03 - Stoma customisation record can be used to record the details of any stoma customisations carried out.

3) The record must be retained for a minimum of 12 months or such longer period as NHS England reasonably requires. Records may be made and stored electronically.

4) A copy of the record must be supplied to the patient or, if requested by the patient, to the prescriber or another health care professional.

5) Three months notice must be given to the AT and the NHS Business Services Authority before the pharmacy can cease to provide the service (unless illness or other reasonable cause prevents such notice being given).

 

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