Q. What is the CPCS?
The CPCS is an Advanced Service introduced to enable community pharmacy to play a greater role in urgent care provision. It is part of the Community Pharmacy Contractual Framework and replaces the NHS Urgent Medicine Supply Advanced Scheme (NUMSAS) as well as local pilots of the Digital Minor Illness Referral Service (DMIRS).

Q. Who is eligible to provide the CPCS?
Any community pharmacy which meets the requirements for service provision can register to provide the CPCS.

Q. Is it compulsory to provide the CPCS?
No. As the CPCS is an Advanced Service in the Community Pharmacy Contractual Framework, contractors can choose whether they wish to provide this service.

Q. Can distance selling pharmacies provide the CPCS?
Yes. A distance selling pharmacy may provide both Advanced and Enhanced Services on their pharmacy premises. They must not provide any Essential Services to any person present on their premises while providing the Advanced or Enhanced service. Medicines supplies made under the urgent medicines strand of CPCS are not deemed to be Dispensing (Essential service) and advice given on minor illnesses, as part of the minor illness strand of CPCS, would be deemed part of the CPCS service provision rather than it being classed as Support for Self-care (Essential service). Note – the CPCS minor illness strand of CPCS does not include supply of a medicine, although that may take place through separate OTC purchase or via a locally commissioned minor ailments service.

As with all pharmacies, a distance selling pharmacy must fully meet the requirements for the provision of the CPCS, which includes having a consultation room on the pharmacy premises.

Q. Is the CPCS a pilot?
No, the service is being commissioned on an ongoing basis.

Q. Can community pharmacies in Wales provide the CPCS?
No. The CPCS only applies to contractors in England.

Q. How do I inform NHS England and NHS Improvement (NHSE&I) that I intend to provide the CPCS?
Contractors must notify NHSE&I that they intend to provide the service by registering for CPCS on the Manage Your Service (MYS) application on the NHSBSA website.

Q. Do I need to use MYS to state my intention to provide CPCS for each pharmacy I own?
You can register each pharmacy separately via MYS, but multiple pharmacy contractors can also use a bulk registration approach. Email the NHSBSA MYS team (nhsbsa.mys@nhs.net) to discuss how to bulk register pharmacies.

Q. Do I need to use MYS to register individual pharmacists to provide the service?
No. Pharmacies have to be registered, not pharmacists.

Q. I am an LPS contractor; will I be able to provide the CPCS?
All the services to be provided by an LPS contractor must be agreed between NHSE&I and the pharmacy and be included in their LPS contract. If LPS contractors want to provide the service, they should contact their local NHSE&I team to propose a contract variation which includes the CPCS.

Q. My pharmacy doesn’t have a consultation room; can I provide the service?
No. Having a consultation room is a prerequisite for the provision of the CPCS. The consultation room, which can be used to consult with the patient or patient’s representative, must comply with the minimum requirements set out below:

• the consultation room must be clearly designated as an area for confidential consultations;
• it must be distinct from the general public areas of the pharmacy premises;
• it must be a room where both the person receiving services and the pharmacist providing those services are able to sit down together and talk at normal speaking volumes without being overheard by any other person (including pharmacy staff), other than a person whose presence the patient requests or consents to (such as a carer or chaperone); and
• from 1st April 2020, the pharmacy must have IT equipment accessible within the consultation room.

Q. Is the CPCS only used out of hours, when general practices are closed?
No. Where appropriate for the patient, NHS 111 will refer patients to a pharmacy during normal working hours. Consequently, the service must be available throughout the opening hours of the pharmacy (both core and supplementary hours).

Q. Does my pharmacy need to be able to access Summary Care Records (SCR) to provide this service?
Yes.

Q. Is a standard operating procedure (SOP) required for the CPCS?
Yes. A template SOP is available for amendment and adoption by pharmacy contractors.

Q. How does my pharmacy get a shared NHSmail account?
Please visit PSNC’s page on NHSmail for guidance on this topic.

Q. What do I do if I’m having trouble accessing my pharmacy’s shared NHSmail account?
All queries relating to these accounts should be sent to the NHSmail pharmacy helpdesk: pharmacyadmin@nhs.net.

Q. Does my pharmacy have to have a shared NHSmail account using the ‘nhspharmacy…’ naming convention to provide the service?
Yes.

Q. If I don’t have a computer in my consultation room, but have plans to have one by 1st April 2020, can I still register to provide the service from 29th October 2019?
Yes.

Q. What kinds of IT equipment could be used to access the CPCS IT system in the consultation room?
The CPCS IT system (Sonar or PharmOutcomes) is web-based, so any computer that allows access to the internet could be used, e.g. a desktop PC, laptop or tablet device.

Q. Do pharmacists have to undertake any training to be able to provide the CPCS?
Pharmacists providing the CPCS should read the service specification and the CPCS Toolkit to be clear on what is expected of them and how the CPCS should be provided.

The necessary knowledge and skills required are a core competency for all pharmacists, but those wishing to provide the CPCS should ensure that they:

• are able to explain the service to patients and carers;
• have an up to date understanding of the Human Medicines Regulations;
• are able to communicate with and advise patients appropriately and effectively on low acuity conditions;
• are able to assess the clinical needs of patients, including the identification of red flags; and
• are able to act on the referrals received and make appropriate referrals to other NHS services and healthcare professionals.

A CPPE CPCS self-assessment tool is available on the NHSBSA website to help pharmacists to assess their learning needs in relation to the service.

Q. Do non-pharmacist staff have to be trained on the service?
Contractors must ensure that all pharmacy staff involved in the provision of the service are appropriately trained on the operation of the service, including relevant sections of the standard operating procedure. Contractors could consider:

• holding a briefing session for their team;
• providing them with the one-page CPCS Service Overview on how the service will work (see Annex A of the CPCS toolkit);
• discussing as a team how you can work together to make the service a success;
• making sure team members and locums are clear on the daily activity required, such as checking for referrals; and
• making sure team members and locums know how to identify a walk-in patient who may have been referred from NHS 111.

Q. Will there be a training programme for CPCS?
As announced in the 5-year CPCF agreement, NHSE&I and Health Education England will use funding (c. £2m) from the Pharmacy Integration Fund to commission continuing professional development sessions for pharmacists related to the CPCS. This training will build on the CPD already delivered in the DMIRS pilot areas. While it is not mandatory to undertake, PSNC recommends that pharmacists do participate in the training in 2020/21, as it will help them to undertake effective consultations, communications and clinical assessments. The CPD sessions will have a particular focus on identifying red flags, referring appropriately to the wider NHS network, if needed and effective patient follow-up.

Q. I want to undertake the CPCS CPD training in 2019/20 but I haven’t been able to get a place on a training course. Will I miss out on this completely?
No. CPPE are running some training across England this year, which builds on the programme they ran in the DMIRS pilot areas. This training is the forerunner to a major roll out of training in 2020/21. Health Education England are currently procuring this programme (November 2019) with funding from the Pharmacy Integration Fund. This training will be made available to all pharmacists that want to access it in 2020/21.

Q. Should the pharmacy’s consultation room be used for all CPCS consultations?
The consultation room should be used for all minor illness referrals, as the service is an alternative to the patient seeing a doctor, which would happen in a consulting room.  The consultation room should also be used in most cases for urgent supply consultations – where most of the consultation with the patient has already been conducted over the phone, there may not need to be a significant conversation with the patient and hence there may be less need to use the consultation room in that circumstance.

Q. Why do you have to phone the NHS 111 health professionals line in some areas of the country in order to speak to the GP OOH service?
In some areas, the GP OOH service and NHS 111 are integrated and hence access for patients and professionals to the GP OOH service is via NHS 111. If this is the case in the area where you practice, it should be detailed in Annex C of the service specification.

Q. Can patients who do not live in England, such as temporary visitors or tourists, access the CPCS to obtain an urgent supply of a medicine or appliance?
An urgent supply via the CPCS is available to anyone in England who has recently been treated by the NHS and has received an NHS prescription for the item that is being requested. Patients treated in Wales, Scotland & Northern Ireland would be eligible, as would patients with prescriptions generated from other NHS organisations, for example, acute trusts.

For overseas patients visiting from countries outside the UK, an urgent supply under the CPCS could be made for a patient who was receiving ongoing care under the NHS with an NHS prescription and needed an urgent supply of medicines to continue treatment. For example, this might include a patient who was recently discharged from an NHS hospital or who were treated on the NHS and had received an NHS prescription under a reciprocal healthcare arrangement.

Q. Are there any age limits for patients using the CPCS?
There are no age limits for patients referred for the urgent medicine supply strand of the CPCS. The minor illness strand has a minimum age limit of 1 year, therefore you should not see referrals for children younger than this.

Q. Must locum pharmacists that I book to work in my pharmacy be able to provide this service?
Yes. Once a contractor starts to provide the service, they must ensure that the service is available throughout the pharmacy’s contracted opening hours. Therefore, contractors should ensure that locum pharmacists who are booked to work at the pharmacy can provide the CPCS. When contracting locums, you should ensure that they have SCR access enabled on their NHS smartcard. You should also ensure they have read and signed your CPCS SOP before they provide the service.

Q. Can I offer the service to a patient who walks into the pharmacy without a referral from NHS 111?
No. If a referral has not been made by NHS 111 or the IUC CAS, any request by the patient is out of the scope of this service.

Q. Can a patient use the CPCS if they are not registered with a GP?
Yes. If a patient has been referred via the CPCS for an urgent medicines supply and they are not registered with a GP, you may still make a supply if you decide it is legally and professionally appropriate to do so. This would include having checked the SCR to determine whether the patient has been prescribed the medicine or appliance recently and that the supply will meet the criteria set out in the Human Medicines Regulations. If the patient needs an urgent supply, but it is not appropriate to make such a supply, the patient should register with a general practice as a temporary patient for immediate and necessary treatment in order to obtain a prescription. You may also undertake a CPCS minor illness referral for a patient who is not registered with a GP. In both of these cases, it should be recommended to the patient that they register with a GP as soon as possible. When entering the patient’s details on the CPCS IT system, use the “unknown” option for their GP, to enable you to continue with the consultation.

Q. Are housebound patients eligible for this service?
Yes. The pharmacist can interview the patient by telephone to make an assessment of the need for an emergency supply or to provide advice on management of a low acuity condition (where that is clinically appropriate).  However, if a patient is housebound, needs an urgent medicines supply and is unable to visit the pharmacy, the pharmacist should use their professional judgement as to whether it is appropriate for a representative to collect the medication or appliance on the patient’s behalf.

Q. What can I do if my patient is unable to travel to the pharmacy to collect an urgent supply of a medicine?
If the patient is unable to travel to the pharmacy, the patient should be asked if there is someone they can ask to purchase or collect the medicine or appliance for them. Pharmacies are not expected to deliver medicines or appliances to patients as part of the CPCS.

If this is not possible, the pharmacist will need to consider the impact of the missed dose(s). The pharmacist may want to suggest an appropriate alternative, for example referring the patient to a closer pharmacy offering the CPCS or referring the patient to their GP. If requesting an urgent medicine supply, the patient could be referred to a local pharmacy not participating in the CPCS to obtain an emergency supply of their medicine or appliance, but the patient would have to pay for any medicines or appliances supplied through this route.

Q. What should I do if a patient receives multiple referrals to the CPCS over a short period of time?
Pharmacists are expected to use their professional judgement about any repeated requests for emergency supplies that are referred to their pharmacy. Any concerns should be raised with the patient’s GP as part of the feedback process, with a recommendation for a review. In some cases, it may be appropriate for the GP to add a Special Patient Note (SPN) to the patient’s care record to flag this issue to NHS 111.

If a patient has used the CPCS for the same low acuity symptoms more than twice in one month, and there is no indication for urgent referral, the pharmacist should consider referring the patient to their general practice.

Q. Can I promote the CPCS to patients?
No. This service should not be promoted to the public by pharmacies or by the NHS.

Q. Can I refer patients to NHS 111 to access the minor illness strand of the CPCS?
No. Patients presenting in the pharmacy seeking self-care advice should be dealt with using the normal pharmacy procedures, in line with the requirements set out in the Support for self-care service.

Q. Can I refer patients to NHS 111 to access the urgent supply strand of the CPCS?
Yes, in certain circumstances. If a patient requests an emergency supply from a pharmacy and the request meets the requirements of the Human Medicines Regulations and the pharmacist believes it is appropriate to make a supply, but the patient cannot pay for the emergency supply as a private service and it is also not practicable for them to obtain a prescription from their general practice before they next need a dose of the medicine, it may in those circumstances be appropriate to refer the patient to NHS 111. The patient should be advised to call NHS 111 so the call adviser can determine the most appropriate course of action for the patient, which may include offering them a referral to the CPCS or potentially an appointment with the GP OOH service.

Q. A patient has contacted the pharmacy and said they had been referred for the CPCS, but there is no referral email or message in the CPCS IT system. How do I proceed?
The pharmacist should check with the patient the name of the pharmacy that they were referred to. If the patient has been referred to the correct pharmacy, the pharmacist should check again for a referral message. If no email or referral message is found, the pharmacist should contact the referring service, e.g. calling the NHS 111 Health Professionals Line (this number should be included in your SOP) . This should be recorded in the pharmacy and reported to the referring service provider as an incident.

Q. Will I receive all referrals via the CPCS IT system and NHSmail?
No. Referrals will in the first instance be sent via the CPCS IT system. If there is a problem with that system, referrals will instead be sent via NHSmail, which provides the fallback system in the case of an outage in the CPCS IT system. The CPCS IT system may also be able to send email alerts to pharmacy contractors to highlight that a referral has been received within the system, e.g. PharmOutcomes can have a management email saved within the system, so that email account is sent an email when a referral is received. This email just notifies the contractor that a referral has been received; it does not contain any patient information and therefore the management email address used by the contractor does not have to be a secure email.

Q. How often should I check NHSmail for NHS 111 referrals?
NHSmail is used as the backup referral route, should the CPCS IT system have an outage. It should be checked when a pharmacy opens and before the pharmacy closes each day.

Q. Does verbal consent to check the patient’s SCR over the telephone meet the consent requirements for accessing SCR?
Yes.

Q. How do I find the contact details to complete the “Key contact details” form (Annex C) in the service specification, which needs to be included in my SOP?
The local NHSE&I team will be able to provide these details to you. The details should also be available by searching the DoS, if you have direct access to this.

Q. What is Pharm+, CPCS, CPCS+, CPCS++?
The CPCS is known by the following service names on the NHS 111 Directory of Services (DoS) to reflect the two stands of the service (urgent medicine supply and minor illness):

“Pharm+”, “CPCS”, “CPCS+” and “CPCS++”

The clinical information contained on these different DoS service entries is based on the minor conditions identified for referral to a community pharmacist (referred to in Annex D of the Service Specification).

Q. Where can I find information on how to use PharmOutcomes and Sonar?
PharmOutcomes CPCS guides and an instructional video guide can be found at: https://pharmoutcomes.org/pharmoutcomes/help/home?cpcs

Sonar CPCS guides and an instructional video guide can be found at: https://www.sonarhealth.org/london-dmirs.aspx

Q. I received a minor illness referral, but the patient needed an urgent medicine supply. Why did this happen and what should I do about it?
In some circumstances, where the patient is exhibiting symptoms, potentially due to not having taken their regular medicine, this may be referred by NHS 111 as a minor illness referral, even though the patient’s eventual need is an urgent supply. This is the correct protocol within NHS 111, due to the patient being symptomatic and it can be managed by the pharmacist as an urgent supply referral; there is no need to ask NHS 111 to send another referral through. Your CPCS IT system supplier will be able to advise you how to make an urgent supply record, when the referral has originally been sent through as a minor illness case; generally this will involve using the manual/back-up templates within the system, making sure the NHS 111 case ID is added to the new record. Visit https://pharmoutcomes.org/pharmoutcomes/help/home?cpcs or https://www.sonarhealth.org/london-dmirs.aspx for further guidance.

Q. The patient’s name is not correct within the NHS 111 referral. How do I proceed with making a record in the CPCS IT system?
In this circumstance, you should be able to create a consultation record with the correct patient name by using the manual/back-up templates within the CPCS IT system, making sure the NHS 111 case ID is added to the new record. Visit https://pharmoutcomes.org/pharmoutcomes/help/home?cpcs or https://www.sonarhealth.org/london-dmirs.aspx for further guidance.

Q. Will an NHS 111 call advisor assess the patient to determine if an emergency supply is appropriate under the CPCS?
No. The NHS 111 call advisor will advise patients that the pharmacist may decide to make a supply of the medicine or appliance required, but the supply will only be made at the professional discretion of the individual pharmacist.

Q. Are NHS  111 call advisors required to include the name of the medication the patient requires in the referral for an Urgent Supply under the CPCS?
No. Referrals from NHS 111 may not contain medication details, as the call advisors are not clinically trained, so they are not required to ask for that information. This means that call advisors will not identify if the request is for a Controlled Drug. The referral may come from the integrated urgent care clinical assessment service (IUC CAS) that is integrated with NHS 111 as a clinical call centre service using the same technical messaging as NHS 111.

Q. Can I reject an urgent supply CPCS referral from NHS 111 if it does not state what the patient is requesting?
No. Referrals from NHS 111 may not contain medication details, as the call advisors are not clinically trained, so they are not required to ask for that information. The Pharmacist is required to conduct a private consultation with the patient to establish their needs before deciding how they can procced with the service to best support the patient. The appropriate actions as a result of establishing the patient’s need, may include supply or onward referral if another action is required. Rejection of the referral should only occur if patient is non-contactable.

Q. Are patients who pay for their prescriptions eligible for a supply of an urgent medicine under the CPCS?
Yes. NHS prescription charges are collected as normal if an emergency supply is made as part of the service.

Q. I have received a CPCS referral from NHS 111 for an urgent supply while my pharmacy was closed. In what instances can such referrals be sent?
CPCS referrals for urgent medicines supplies may be made to a pharmacy when the pharmacy is closed if the patient declares that their next dose is due within the next 2, 6, 12 or 24 hours. In such instances, the patient will be advised that they need to call the pharmacy when it is next open.

Q. Which medicines can I supply under the urgent supply strand of the CPCS?
Technically, any medicine or appliance that can be supplied on an NHS prescription – in line with the provisions of the Human Medicines Regulations – and has previously been prescribed on an NHS prescription can be supplied as part of the service, where the pharmacist determines that it is appropriate to do so.

Claims to the NHSBSA for reimbursement for the cost of urgent medicines or appliances supplied will be made via the CPCS IT system. The NHSBSA can only process these electronic claims; there is no paper claims process available for the service and electronic claims must use dm+d codes. It is possible that in some circumstances, a medicine or appliance may be requested that is not listed in dm+d, e.g. specials. Where it is deemed appropriate to make an emergency supply, but the item is not listed in dm+d, it will be necessary for the patient to be referred to another service which can issue an urgent prescription, such as the GP OOH service.

Q. How many days’ supply of treatment can I give a patient?
The pharmacist should apply their professional judgement to determine the most appropriate length of treatment to supply, in line with the provisions of the Human Medicines Regulations.

Q. Is there a maximum number of times that a patient can use the service for an emergency supply?
No. The pharmacist should apply their professional judgement to determine the appropriateness of an emergency supply each time a patient is referred. Pharmacists are expected to use their professional judgement about any repeated requests for emergency supplies that are referred to their pharmacy. Any concerns should be raised with the patient’s GP as part of the feedback process, with a recommendation for a review. In some cases, it may be appropriate for the GP to add a Special Patient Note (SPN) to the patient’s care record to flag this issue to NHS 111.

Q. Is there a maximum number of medicines or appliances that can be supplied as part of the service?
No. The pharmacist should apply their professional judgement to determine the appropriateness of making a supply of each requested medicine or appliance.

Q. Can I make an urgent medicine supply if a patient does not provide evidence of entitlement to exemption from NHS prescription charges?
Yes. Where a patient is unable to provide evidence of their exemption from NHS prescription charges, the contractor should record this on the FP10DT EPS dispensing token, in the usual way. NHSE&I may make checks on patients’ claims to the entitlement of exemption from NHS prescription charges.

Q. Do I have to follow local OOH prescribing guidelines?
Where local prescribing guidelines exist, they should be noted and act as a guide when considering whether it is appropriate to make an emergency supply.

Q. How does the urgent medicines supply aspect of the CPCS work in my area because there is already a locally commissioned emergency supply service in place?
In some areas, commissioners may decide to continue with a local walk-in scheme, and consequently, contractors may decide to provide both the local service and CPCS. This is acceptable, but consideration would need to be given to how to avoid confusion between the two services and payment claims.

Q. Will an urgent supply of a medicine or appliance through the CPCS show on a patient’s SCR?
The pharmacist is required to ensure that a notification (‘Post Event Message’) is sent to the patient’s GP practice of any urgent supply made via the CPCS. This must be sent on the same day as the supply or as soon as possible after the pharmacy opens on the following working day.

The medicine or appliance will only be visible on the patient’s SCR if the information is received from the pharmacist and added to the patient’s record at the GP practice as an acute or repeat item. If it is added as an acute item, it will appear as ‘prescribed elsewhere’ under the acute medicines list. If it is added as a repeat item, it will appear under the repeat item list as ‘repeat prescribed elsewhere’.

If the pharmacist dispenses an electronic prescription as part of CPCS instead of making a supply, then this prescription item will be visible on the patient’s SCR.

Q. Can I make an urgent supply of a Schedule 2 or 3 Controlled Drug for the treatment of epilepsy as part of the CPCS?
The legal requirements regarding the emergency supply of Controlled Drugs also apply to the CPCS. Emergency supplies of Schedule 2 or 3 CDs cannot be made, except for phenobarbital or phenobarbital sodium for the purpose of treating epilepsy.

Further advice on requests for controlled drugs

The urgent medicines supply strand of the CPCS follows the same rules and legislation as any other emergency supply. 

A referral from NHS 111 does not automatically indicate that an emergency supply is appropriate; that is for the pharmacist to determine. Pharmacists who receive CPCS referrals for urgent supplies should use their professional judgement to determine whether an emergency supply is appropriate and legal to make. If it is not, the patient may need to be escalated to the GP OOH service or signposted to their own GP practice. Particular care should be taken when deciding to supply any medicine that has a potential for misuse. 

The Human Medicines Regulations 2012 (HMR) set out the maximum quantity of a POM that can be supplied as an emergency supply. Professional judgement should be used to supply a reasonable quantity that is clinically appropriate, particularly where the requested medicine is liable to misuse. 

To make sure urgent medicines supplies for Controlled Drugs are provided appropriately, please remember that: 

• Emergency supplies of Schedule 2 and Schedule 3 Controlled Drugs are not permitted by the HMR, with the exception of phenobarbitone or phenobarbital sodium for the treatment of epilepsy; 
• Temazepam, gabapentin, pregabalin and tramadol are all Schedule 3 Controlled Drugs.  Emergency supplies of these medicines are not allowed and so they cannot be supplied via the CPCS; 
• Medicines such as benzodiazepines (apart from temazepam, which is Schedule 3), zopiclone, and zolpidem are Schedule 4 Controlled Drugs. Up to five days’ treatment may be supplied, if it is clinically appropriate and after an assessment has been made of the risk that the patient is using the CPCS to inappropriately gain additional supplies; 
• Medicines such as dihydrocodeine and codeine containing products (including co-codamol 30mg/500mg) are Schedule 5 Controlled Drugs. Up to five days’ treatment may be supplied if it is clinically appropriate and after an assessment has been made of the risk that the patient is using the CPCS to inappropriately gain additional supplies. 
• Where the legislation does permit an emergency supply, it limits the supply to a maximum of 5 days for Controlled Drugs; 
• Some CCGs have issued guidelines to local GP OOH services on the supply of medicines liable to misuse. Whilst it is for the pharmacist to determine whether a supply is appropriate, they should check if any such local guidelines are in place. The pharmacist needs to balance the potential for misuse versus the need and the impact on the patient of not supplying a medicine. A limited supply of up to 5 days treatment, until the GP practice reopens, may be appropriate. It is particularly important to check the patient’s NHS Summary Care Record for such requests, as part of the assurance that the patient has been prescribed it before and that there has not been a recent supply made; 
• A GP OOH service will only prescribe medicines liable to misuse in limited circumstances and will not usually prescribe medicines such as methadone or buprenorphine. If the pharmacist decides not to make a supply for a medicine liable to misuse, they should consider advising the patient to wait until they can collect their usual prescription from their GP practice or usual pharmacy, rather than referring them to the GP OOH service.

Q. I have received an urgent medicine supply referral for a patient, however their GP practice is still open. What is the best way to proceed?
Patients should be advised to contact the GP practice if this is practically the most appropriate option to obtain their medicine or appliance. This may not be possible if, for example, the patient is away from home and unable to access their GP practice or where the GP practice will not be able to issue a prescription in a timely manner, such that the patient can get that prescription dispensed in time for their next required dose of the medicine. The pharmacist will need to assess each individual request and the circumstances of the patient to determine whether it is appropriate to make a supply via the CPCS.

Q. NHS 111 has sent an urgent medicine supply referral for a patient requesting a Controlled Drug. Why has this occurred?
The majority of NHS 111 call advisors are not clinicians so do not assess the legality or clinical appropriateness of the emergency supply request. They are also not trained on the Human Medicines Regulations to determine what constitutes a valid emergency supply. An NHS 111 call handler will advise patients when sending a referral that the pharmacy may decide to make a supply, however this will be at the professional discretion of the pharmacist.

If it is not possible to make an emergency supply due to prohibitions within the Human Medicines Regulations or other factors, but the pharmacist believes that there is a genuine patient need to obtain a supply of their medicine, the pharmacist must contact NHS 111 to ensure that the patient is contacted by another appropriate healthcare professional. Contacting NHS 111 service must not be delegated to the patient.

Q. What action should I take if an urgent medicine supply under the CPCS referral is for a medicine liable to misuse?
While it is for the pharmacist to determine if a supply is appropriate, they should check if the Clinical Commissioning Group has issued guidelines to local GP OOH services on the supply of medicines liable to misuse. This information should ideally be included in the pharmacy’s SOP for the service. The supplying pharmacist needs to balance the potential for misuse versus the need and the impact on the patient of not supplying a medicine or appliance. A limited supply of one or two days could be considered, to allow the patient time to access their GP surgery.

Q. If I don’t have an item in stock (Pharmacy 1) to provide an urgent medicines supply, how do I send the referral to another pharmacy (Pharmacy 2)?
Where it is appropriate for an emergency supply to be made, but the medicine or appliance is not in stock at the pharmacy (Pharmacy 1), with the agreement of the patient, the pharmacist will identify another pharmacy (Pharmacy 2) that provides the service, and which is convenient for the patient, by searching the DoS tool, which is used in the area.

The pharmacist (Pharmacy 1) will contact the pharmacist at Pharmacy 2 to check whether they have the item in stock. If Pharmacy 2 confirms they have, then Pharmacy 1 will forward the electronic referral received from NHS 111 to Pharmacy 2 via NHSmail (the referral can be downloaded as a PDF) and the pharmacist at Pharmacy 2 should contact the patient and follow the process from 6.3.4 of the service specification. In this instance, both pharmacies are eligible for the service completion fee.

Q. Is the provision of an OTC medicine NHS-funded as part of the CPCS?
No. The outcome of referrals received in relation to low acuity conditions / minor illness may include giving self-care advice and support, the sale of OTC medicines, referral to locally commissioned pharmacy services, referral to the patient’s GP or relevant GP OOH service, or general signposting to other appropriate services (including other health professionals). Therefore, patients may have to purchase an OTC medicine if no locally commissioned minor ailments service exists.

Q. I have undertaken CPPE or other training related to management of minor illness and I learned how to incorporate pulse oximeters and other equipment into consultations with patients. Do pharmacies need to have such equipment to provide the service?
No, such equipment is not necessary to provide the service. However, if a pharmacist has been trained in the use of such equipment, the pharmacy contractor may want to consider making it available for them to use in consultations with patients. PSNC will continue to discuss with NHSE&I and DHSC how the funding to support availability of such equipment in pharmacies could be supported.

Q. Can I sign up a patient who presents to the pharmacy with a low acuity condition or minor illness to the CPCS?
No. Only patients who have called NHS 111 or IUC CAS and have been referred to the pharmacy are eligible to receive advice and treatment under the CPCS.

Q. Can I refer the patient into another NHS pharmacy service?
Yes. Pharmacy services such as a Patient Group Direction or a Minor Illness Service can be used where they are appropriate to meet a patient’s needs.

Q. I have received a referral from NHS 111 for a patient, but they haven’t presented in the pharmacy. What do I do?
The pharmacist must phone the patient. In most cases, this should be the same day as the referral unless it is received overnight when it would be appropriate for the pharmacist to phone the patient the next day if the patient still hasn’t attended.

Q. I need to refer a patient for an urgent appointment at their general practice, but I can’t get through on their main phone line. Is there a way to find out their ex-directory direct dial numbers?
Direct numbers to access GP practices (“bypass numbers”) can be found by searching the Directory of Services.

Q. I have received a minor illness referral while my pharmacy was closed. Is this a mistake by NHS 111?
Probably not, as the NHS Pathways system that guides the conversation between the NHS 111 call adviser and the patient may identify that the best course of action is for the patient to speak to a primary care professional, such as a pharmacist, within a few days, rather than immediately.

Q. I have received a referral that says the patient needs to see a GP within 72 hours. Is this an incorrect referral from NHS 111?
Generally, no. The disposition names used in DoS and the NHS Pathways system can sometimes look like they are not appropriate referrals to community pharmacy, but despite some of the names/descriptors, they have all been clinically assessed as being appropriate for referral to and management in community pharmacy. Pharmacists should therefore deal with these CPCS referrals as they would any others.
Where a pharmacist believes an inappropriate referral has been made, this should be reported via the incident report form which can be found in Sonar and PharmOutcomes.

Q. Are there paper forms I can use to record a consultation where the pharmacy doesn’t yet have access to the CPCS IT system in the consultation room or where the internet connection is temporarily unavailable?
Yes, both Sonar and PharmOutcomes have made forms available to download within their systems which can be printed out and used in these circumstances. Following the consultation, the information recorded on the paper form must then be copied into the CPCS IT system.

Q. Where can I obtain copies of the GP notification forms?
Notification forms to inform GPs of urgent medicines supplies and referrals for low acuity and minor illness are available from the CPCS hub page , and in the Annexes of the service specification.

Q. Must patient consent be recorded in writing?
No. NHS 111 will obtain patient consent for receiving the service and for the pharmacy sharing information with the patient’s GP practice, NHSE&I and the NHSBSA.

Q. Does the patient’s GP practice always need to be informed if a patient has used the CPCS?
The requirement is that a notification (post-event message) is sent to the patient’s GP practice on the same day the patient has used the CPCS, or as soon as possible on the following working day where an urgent supply has been made. For minor illness consultations, a notification only needs to be sent where the pharmacist considers it clinically important to inform the patient’s GP or to ensure the patient’s GP based record is updated.

Q. How do I claim payment for the provision of the CPCS?
All payments must be claimed via the MYS application on the NHSBSA website; no paper-based claims process is available for the service. The CPCS IT system (Sonar or PharmOutcomes) will be able to pre-populate claim information in MYS each month (from the start of December 2019 – this first claim will include activity from October and November 2019), so that the contractor then just needs to confirm that the information is correct and submit the claim.

Q. If we don’t agree with the CPCS claim information pre-populated into MYS by Sonar or PharmOutcomes, what should we do?
The claim information pre-populated into MYS will be a direct feed from Sonar or PharmOutcomes, based on the consultation information you have entered into whichever system is used in your pharmacy. If the data in MYS does not tally with your expectation, you should first check that all relevant referrals have been correctly processed in Sonar and PharmOutcomes; if a consultation has not been completed within the system, it will not appear in your MYS claim. Any consultations subsequently completed after the month end will appear in the claim created for the subsequent month.
If the above guidance does not address the discrepancy, you should contact Sonar or PharmOutcomes, as appropriate.

Q. If I receive a referral but cannot contact the patient, can I claim the Consultation fee?
No.

Q. Do I need to print an FP10DT EPS dispensing token for each urgent supply referral I receive from NHS 111?
No, not for all urgent supply referrals. An FP10DT EPS dispensing token only needs to be printed out, with the reverse of the form being completed by the patient, where the pharmacy makes an urgent supply and the patient is claiming exemption for the NHS prescription charge. However, as with normal prescriptions, where the patient is age exempt and their age or date of birth is included in the referral from NHS 111, an FP10DT EPS dispensing token would not need to be printed and then completed by these patients. Where a patient pays the NHS prescription charge for their urgent supply, there is no need for a token to be printed and the reverse of the form to be completed by the patient.

Q. What do I do with an urgent supply FP10DT EPS dispensing token on which the patient has completed the exemption declaration?
The FP10DT EPS dispensing tokens should be sent to the NHSBSA as part of the month end submission, clearly separated within the batch, e.g. by placing them in an envelope marked CPCS or bundling them together, covered by a paper note clearly stating CPCS. They will be retained by the NHSBSA to allow verification of patients’ exemption claims.

Q. Do contractors get paid the concession price for a medicine if dispensing an item with a concession price in place that month?
Yes.

Q. Can I claim Broken Bulk on an urgent medicine supplied under the CPCS?
No. The cost of medicines or appliances supplied under the CPCS urgent medicines provision will be reimbursed using the basic price specified in Drug Tariff Part II Clause 8 – Basic Price. No other elements of the Drug Tariff in relation to reimbursement of medicines or appliances apply to this service. An allowance at the applicable VAT rate will be paid to cover the VAT incurred when purchasing the supplied medicine or appliance.

Q. If we do not have an item in stock, and we refer the patient to another pharmacy, are we still able to claim the Consultation fee?
Yes. When another pharmacy offering the CPCS is found that has a required medicine or appliance in stock and is willing to take the referral, both pharmacies are eligible to claim the Consultation fee.