Choosing a national topic allowed the audit to focus on a priority issue for the NHS, in this case the provision of urgent and emergency care. The audit was focused on the emergency supply of medicines and it is hoped that positive data from it alongside other data from NHS 111 and GP Out of Hours providers, will help make the case for the commissioning of community pharmacy emergency supply services at NHS expense.

It was hoped that the audit may help to improve the quality of services in three areas:

a) Community pharmacy: services and practices in the pharmacy may be influenced by the results of the audit. For example, the audit would establish the number of patients accessing repeat medication out of hours in the audit period. Pharmacy teams could use this information to work with local GP practices to identify patients who would benefit from management of repeat prescriptions through the NHS repeat dispensing service or who may need more help and education about ordering their repeat medication.

b) Clinical Commissioning Groups (CCG): the audit would highlight the number of patients requesting repeat medication out of hours which may prompt CCGs to review the following issues with their GP practices:

• Improving information to patients in the out of hours period;
• Improving information about repeat prescription ordering systems and the repeat dispensing service; and
• Ensuring requests for repeat prescriptions made at the end of the week are dealt with before the weekend.

c) NHS England: support the development of national policy regarding access to urgent and emergency care.

The aims of the audit were to understand:

• the reasons behind patients requesting/requiring an emergency supply;
• the reasons why an emergency supply was not provided (where that was the case); and
• the patient’s subsequent course of action had an emergency supply not been provided.

Pharmacy contractors had to undertake the audit in one of two defined two week periods:

Period 1 – 23rd March to 5th April 2015 (inclusive)

Period 2 – 6th April to 19th April 2015 (inclusive)

In order to get a good range of results from pharmacies across the country, it was very important that there was a good spread of pharmacies undertaking the audit across the two periods.

Both periods covered part of the Easter public holidays which is a busy time for healthcare providers, including community pharmacies, but as a consequence it is also expected that requests for emergency supplies will be increased, providing plenty of data for the audit.

Pharmacies could choose in which of the defined two week periods they wished to undertake the audit, but PSNC asked Local Pharmaceutical Committees (LPCs) to try to ensure there was an even spread of pharmacies undertaking the audit across both periods. PSNC also asked the multiple pharmacy groups to do the same within their pharmacies.

Following piloting late last year, PSNC agreed the following final paperwork for the audit with NHS Employers and NHS England:

Guidance on the 2014/15 audit

Form A – data collection form

Once the audit data period is over, pharmacies collated their results and then submitted these to NHS England’s online reporting system (see below).

Form B – data collation form (for audit period 1)

Form C – data collation form (for audit period 2) 

PSNC created a video presentation to help pharmacy teams in conducting the national audit.

1. Decide which audit period you are going to undertake the audit within. Seek advice from your LPC or head office before making this choice;
2. Obtain copies of the audit paperwork. This may be emailed to you by your NHS England team or you can download it from the links above;
3. Follow the instructions in the audit guidance on completion of the audit; and
4. Submit your collated audit data to NHS England via their web-based system (see below).

Information on how pharmacy contractors should submit to NHS England the results of the national Community Pharmacy Contractual Framework 2014/15 Emergency Supply audit can be found in PSNC Briefing 021/15: Submission of emergency supply audit results to NHS England (April 2015).

It is expected that the collated results of the audit will be published later in 2015 and the data will be used by NHS England and CCGs to consider whether they can work with GP practices and community pharmacies in order to improve services to patients. 

Q. Do pharmacies have to undertake the audit?
Yes, undertaking the audit is a contractual requirement. If a pharmacy does not undertake the audit it is a breach of their contractual responsibilities.

Q. Who is responsible for sending me the necessary paperwork?
Distributing the paperwork is a matter for local NHS England teams and, in most cases, it would be sent via email; it is also available via the links above.

Q. If I provide a patient with a ‘loan’ of prescription medicines, should this be included in the audit data?
Yes. In some cases, where a patient is due to receive a prescription, the pharmacy may ‘loan’ medicines, until the prescription arrives; this is technically an emergency supply (and therefore the appropriate records of the emergency supply should be made) and so it should be included in the audit data. It is important that pharmacies include all emergency supplies made within the audit period within their consolidated data, as this will help to demonstrate the significance of the work that pharmacies are undertaking to support patients that run out of their prescribed medicines.

Q. My pharmacy has been commissioned by the NHS to provide emergency supplies at NHS expense to patients. Should I include these emergency supplies in the audit data?
Yes.

Q. Why has this topic been chosen? 
The audit will contribute to NHS England’s ongoing work on identifying ways in which to reduce pressures on urgent and emergency care services and improve medicines optimisation, both of which are important areas for the organisation. By uncovering the number and underlying reasons for which patients request emergency supplies, the audit should demonstrate how this can be mitigated in the future. For example it may highlight patients whose regular medicines are suitable for repeat dispensing, helping to encourage prescribers to adopt the service. In addition to this, by determining the impact that this pharmacy service is having in keeping patients from attending urgent and emergency care services such as NHS 111, out of hour GP services or Emergency Departments, the audit may provide useful lessons for local commissioners, and yet more evidence for pharmacy to use to demonstrate the positive impact it can and does have in reducing pressures elsewhere in the health service.

Q. Does the audit cover emergency supplies at the request of a GP or ‘faxed prescriptions’ from a GP practice?
No. The audit data capture only relates to emergency supplies requested by patients.

Q. Why has the audit been agreed to cover the Easter period? 
Both of the audit periods will include two full weekends so that emergency supplies made when GP practices are closed can be assessed. Both periods also cover part of the Easter holiday period and were selected to provide an opportunity to audit provision of emergency supplies during a peak period for healthcare provision. PSNC has stressed that this is a very busy time for many pharmacies and to help mitigate any potential risks to patient safety resulting from increased operational pressure we have ensured that the audit paperwork is straightforward to complete. Contractors will have up to two weeks after the final day of data collection (for each audit period) in order to collate the audit data prior to submission to NHS England.

Q. How much work will the audit be? 
Contractors are already required to undertake an audit every year under the CPCF. PSNC has ensured the audit paperwork is straightforward to complete and feedback from the pharmacies involved in piloting the audit suggests that it should not take up a significant amount of pharmacy team time to complete.

Q. What do I do if I have no emergency supply requests during the audit period? 
In the unlikely event that a pharmacy receives no emergency supply requests from patients during the audit period, they should still submit ‘a nil return’ via the NHS England online platform (see above) to demonstrate that they undertook the audit.This means completing all the questions on the online platform with zero as the answer (bar the question which requests the pharmacy’s ODS code).

Q Why was there a delay in publication of the audit documentation?
The audit was originally planned to start on 9th March 2015, but NHS England was not able to get the audit paperwork approved via its internal governance procedures in time for that date. PSNC therefore advised the NHS that the delays would mean the audit due to begin on 9th March could not go ahead.

Q Why has PSNC agreed that the audit should still go ahead?
At PSNC’s recent meeting on 11th March 2015 the Committee agreed that the audit could still proceed across the two revised audit periods. The Committee was very disappointed that the audit had to be delayed due to NHS administrative processes, but it believes the audit will provide valuable information on the pharmacy service and it is therefore pleased to have agreed that this can now go ahead. It is hoped that positive data from the audit alongside other data from NHS 111 and GP Out of Hours providers, will help make the case for the commissioning of community pharmacy emergency supply services at NHS expense.

Q Do distance selling pharmacies have to undertake the audit?
Yes, all pharmacies must undertake the audit. The business model for distance selling pharmacies may mean it is less likely that patients will request emergency supplies of medicines from this type of pharmacy, but the pharmacy should still undertake the audit. If there are no emergency supply requests during the audit period, they should still submit the totals for each answer indicating ‘a nil return’ for every question on the NHS England online platform to demonstrate that they undertook the audit.