| With the new community
pharmacy contract now firmly bedded in,
primary care organisations (PCOs) have started visiting pharmacies to
audit implementation
of the new requirements. Ahead of the visit, the prospect of being monitored
can be daunting, but to help reduce the amount of work that needs to
be done — and, therefore, the amount of time that needs to be taken
up in the pharmacy — many PCOs have been asking pharmacists to
provide information and evidence in advance.
Preparations and visits
Useful resources
The Royal Pharmaceutical Society has produced guidance
on what pharmacists can expect to happen, and be asked about, during
visits
by external
monitoring bodies (including primary care trusts and local health
boards) to pharmacies in England (PDF (40K)
and Wales (PJ,
21 January, p89 and 28 January, p115, respectively).
In addition, the Pharmaceutical Services Negotiating Committee’s “New
Contract Workbook 2005/06”, published in September 2005,
contains sections for recording information that may be requested
during monitoring
visits.
NHS Primary Care Contracting’s community
pharmacy assurance framework may also be helpful for pharmacists
planning for monitoring of the community pharmacy contract. |
Supplying documentation in advance is proving to be a help to pharmacists
as well as PCOs, Jane Newman, a community pharmacist in Essex, says.
Her local primary care trust provided a toolkit which was based on
NHS Primary Care Contracting’s framework and designed with the
Pharmaceutical Services Negotiating Committee’s workbook in mind
(see Panel).
“The toolkit provided tick boxes for evidence that we may wish to
submit in advance, for instance standard operating procedures, examples
of incident
reports and audits carried out,” Ms Newman says. However, if the
pharmacy staff were unable to copy some evidence easily, such as part
of the patient medical record that cannot be printed, then they did not
have to pre-submit it, she explains. “We sent in only what we chose
to send, but the more we were able to send the shorter the visit.”
Steven Gill, a community pharmacy contractor in Sunderland, says his
PCT also suggested he gather documentation in advance and he sent his
in 10 days before the visit. “We were asked to provide SOPs for
all our processes — dispensing, repeat prescriptions, disposal
of unwanted medicines, counter sales, etc — along with signatures
from all staff and locums to confirm that the SOPs were actually being
followed,” he says. “We were also asked for samples of blank
referral forms to show how we are signposting customers and our signposting
pack. We sent as much as we could and, in fact, gathering the information
and sending it in ahead of the visit helped us as much as the PCT,” he
says.
The preparation for the monitoring visit can take some time, however,
Anoop Shah, community pharmacist at Daya Pharmacy in Hayes, Middlesex,
warned. “We followed the PSNC’s booklet and just worked our
way through the whole thing. We were notified about the visit two and
a half months before it was due to happen and, all in all, we probably
spent the equivalent of two or three days’ work over that time
going through the whole booklet.”
Simon Moul, chairman of Essex local pharmaceutical committee, who has
represented the LPC on monitoring visits in Essex, says the interviews
have generally lasted about an hour “Then the PCT member of staff
and I spend another 10 minutes or so talking about the visit and what
recommendations we will be making, and then we meet with the pharmacist
again for another 10 minutes and give feedback on anything that needs
doing,” he says.
Visits by other PCTs have taken a similar length of time — Mr Shah
says his visit took about one and a half to two hours. “We’re
in a slightly unusual position in having three dispensing technicians,
so we were able to keep the dispensary working during the visit and did
not employ a locum,” he explains. “We arranged the visit
during the lunch break, though, but it did over-run the break slightly,
so some of the visit was carried out as we were working. Obviously it
would have been ideal to employ a locum and that is something we would
definitely look at in the long-term as I expect the monitoring visits
will become more involved and demanding in the future,” he adds.
Prior preparation and completion of checklists means that problems can
be corrected before the visit, Ms Newman points out. “Working through
the toolkit and finding evidence for the pre-visit submission was enormously
helpful. I discovered one or two things that we hadn’t quite got
right and was able to rectify them. It concentrated my mind on what sort
of things were going to be discussed during the visit and allowed me
to check the understanding of my staff,” she
explains. Recommendations
Mr Gill says he found that the thoroughness of his PCT’s approach
and his preparation meant that the recommendations made at the end of
the visit were fairly minimal. “In the end, the only thing we hadn’t
covered was the refrigerator procedure — what would happen if the
refrigerator went above or below standard temperature, both in terms
of the contents and the refrigerator,” he says. “That was
something I had not thought about, but I am now writing an SOP for it
and the PCT will check in three months’ time that that is done.”
Ms Newman’s visit resulted in a few recommendations, but these
were principally about improvements that could be made, rather than omissions. “The
main recommendations were about sharing learning from the review of complaints,
incidents and near misses. While we do this as a matter of course — but
were unfortunately unable to find the evidence — the PCT assessors
felt that we should share the information more widely, for instance with
relief dispensing staff and other members of the pharmacy staff. The
superintendent has always circulated a review of dispensing incidents
so we have now included the latest report in future pre-visit evidence,” she
says.
A few recommendations were also made at the end of Mr Shah’s visit
and these were confirmed in a follow-up letter letting the pharmacy staff
know what needed to be done. “There was nothing major that needed
to be done, but that still took two hours or so,” Mr Shah says. Overall impressions
Ms Newman says that the most surprising thing about the whole monitoring
process was how nervous she felt before and during the visit. “Considering
that I knew all the people doing the monitoring quite well, I was confident
that we had nothing to worry about and that it was done in a very non-threatening
manner, it was still an unpleasant experience,” she says.
Mr Gill found the whole process informal. “I had been quite concerned
about the visit before it happened, and other members of staff were worried
they would be asked a huge number of in-depth questions, but it all went
well,” he says. “It was much less onerous than I thought
it would be.”
Mr Shah says he found the visit useful. “Although it is all about
things we comply with anyway, it was helpful having to collect all the
information together. It certainly did not feel like an interrogation,” he
says. |
The
Pharmaceutical Journal