Date of prep: December 2020
Prescribing information and
adverse events reporting
For healthcare professionals only
Community Pharmacy Scotland has updated its website and has said that they will be focussed on several areas as they support the community pharmacy network in Scotland as the COVID-19 outbreak situation continues to develop.
In a video published on YouTube Chief Executive of Community Pharmacy Scotland, Professor Harry McQuillan made a statement in support of and in response to the letter published on Monday by the Chief Pharmaceutical officer of Scotland Rose Marie Parr. He used this video presentation to recognise that this is a time of intense pressure on the Scottish community pharmacy network given the current COVID-19 crisis.
“Thank you for all that you are doing to provide care for the people of Scotland in the face of COVID-19 – as always, I am proud of the network’s response.
“This is a worrying time for you as individuals and for the wider population. There is an overwhelming amount of information – and equal parts misinformation – flying around. This must be incredibly difficult to navigate, given that relatively little is specific to community pharmacy
“We encourage teams to refer to our website that links through to Health Protection Scotland’s for all the latest clinical advice. We recognise at CPS that there is a gap in operational advice because we are seeing and hearing your concerns loud and clear. This past few days we have been hard at work addressing them behind the scenes.
He indicated that channels of communication had been opened on Monday with the Scottish Government and went on to highlight the aspects of these conversations that would be relevant to the network in the coming weeks and months.
“This morning we had a productive discussion with our colleagues at Scottish Government, and I would now like to share with you some practical actions we have taken as well as some actions you may wish to consider.
“We do not have all the answers and detail for you yet, and this is a very fluid situation so what I say this afternoon may no longer be the case in a few days or even tomorrow.
Before he described the detail of these conversations he turned to the topic of ‘permission’.
“Understandably for a profession so highly-regulated, something that we have noted is that many of the questions we are getting from pharmacy owners and superintendents start with “Can we?”. For most of these questions, the answer will almost certainly have to come from within your own organisation.
“It is unlikely that there will be blanket advice to, for example, establish a to metre barrier between you and every patient, stop deliveries or to only see people at your doorstep, and no-one else working in healthcare has been issued government advice to take measures like this yet, because the evidence or science behind it is not there to support them.
“You can do any or all of these things if you feel it is necessary to do so to keep the pharmacy running, and you can keep your patients and staff safe.
“Our team is here to help you if you need a sounding board or help to work through any legal, professional or contractual implications, and we will put out some further points for pharmacy owners and superintendents to consider as the situation develops.
“The permission to act, though – is yours to give, once you have identified and assessed any risks.
“What we at CPS can do is to work on what is within our control to remove any additional unnecessary nonsense as I call it, that might distract from dealing with the considerable task at hand. This was precisely the purpose of our meeting with Scottish Government, which I will now summarise.
Personal protective equipment
“We are most often asked about Personal protective equipment (PPE). This has been supplied to healthcare workers in other settings and to community pharmacies in other countries. Following a Scottish Government review of the evidence and science, the policy decision at this time is not to supply these kits to community pharmacies in Scotland.
“This decision will concern many of you who are working on the front line at this time, and I completely understand why, when everyone around you is being provided with something that you are not. What I can say is I have trust in the experts advising our colleagues at Scottish Government and accept their decision. Were PPE as effective a tool as social distancing measures, I would ensure that you had it.
“Turning to Finance. Please Don’t worry about this. You can be confident that your income will be protected to support continued service delivery, and no pharmacy will be disadvantaged for events outwith their control.
“As we finalise the detail behind this, it will be published but rest assured, the government is supportive of the network’s crucial contribution.
“A word about Services. To support pharmacy teams to deal only with what is necessary at this time, we have agreed to freeze CMS registration activity immediately and have asked the Government to look at how to completely separate serial prescribing to attempt minimise the repeat dispensing management burden on your teams.
“You may wish to consider whether to suspend services other than dispensing and MAS, depending on your circumstances.
“We are aware that in some isolated areas repeat dispensing quantities have increased, which doesn’t help you in your efforts to make sure everyone has enough medication.
“Just today, we have also heard that in one area established repeat prescription ordering systems have been shut down, resulting in yet more traffic to surrounding pharmacies.
“Scottish Government will be stepping up communications to make it clear that these actions are not in line with policy, and they are supportive of community pharmacies managing these prescriptions using the endorsing tools available to you – for example, only providing medicine to cover a normal cycle.
“On the other hand, it is safe to say that we are all in support of you using the unscheduled care PGD to its fullest to support patient care where needed. Government colleagues recognise that access to Emergency Care Summary would assist you to do so and are working hard to make this happen.
Signing the back of prescriptions
“Patients signing prescriptions. This can be halted. This will be one less contact point and stops pens being passed from person to person.
“We are aware of the issues around some lines and can assure you that these concerns have been escalated to the UK Department of Health.
Self-isolation and quantities
“We are also aware that to keep people at home, if they are suffering symptoms or self-isolating, will require POM quantities of paracetamol to be supplied and we are working with the Area Drugs and Therapeutics Committee Collaborative to produce this PGD for you.
Daily and weekly prescriptions
“You will need to take a risk-based approach to your decision on how to proceed with prescriptions which are normally issued daily or weekly. We would support the GPhC’s statement on flexible regulation and echo their call for you to document the decisions you make. For MDS this could result in four weeks being issued at a time.
Supervision of daily medicines.
“Some medicines require close interaction with patients. Some of you may be able to adjust your procedures to eliminate or minimise patient contact to keep your teams’ risk of infection low. For those who do not, you will have to make calls on an individual patient basis, taking into account the level of risk involved and involving any other healthcare professional that might be able to assist with your decision. You may have to suspend daily supervision once all risks are considered.
“Health and Safety of your team must come first. If you are able to continue to offer this service by adjusting your standard procedures, for example ringing the bell, leaving the medicine on the doorstep, retreating two metres and waiting to see the patient collect their medicine, please do so. We have asked Scottish Government for financial support at this time to recognise the critical nature of the service and the increased demand you will be experiencing. More information will be provided when a decision is made on this.
Redeployment of the pharmacy workforce.
“All areas of the NHS are under strain. Moving people to where they are needed most is a complex task, and patient safety must come first. Health Boards will carry this responsibility, and discussions have started across the country. All potential outcomes are being considered here.
“We will shortly release a briefing reiterating everything I have covered this afternoon, which will outline some further detail that pharmacy owners and superintendents may find useful.
“Until then, I wish you all the best and once again I must thank you for everything you and your teams are doing.”
Community Pharmacy Scotland has set up an enquiry form for all COVID-19 related community pharmacy queries. They continue to recommend that you check their website regularly and also visit the NHS Inform website for the most up to date trusted information on COVID-19.
You can watch the video in full on YouTube via the embedded link below.
Pharmacy in Practice is a UK pharmacy publication with its roots in Scotland.