COVID-19 (Coronavirus): our latest updates

FAQs from our members on their pharmacy services

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Medicine delivery services

England: On April 10^th NHS England/Improvement shared the details of a new service to deliver medicines and appliances during the COVID-19 outbreak. The service is currently commissioned until 1st July 2020.

As part of this:

• The Terms of Service have been amended to require all pharmacy contractors, (except distance selling pharmacies*), to help eligible** shielded patients (extremely vulnerable patients who have been requested to self-isolate at home for 12 weeks) receive their prescriptions. These patients are
• An Advanced Service, which contractors can provide if they wish to, has been commissioned to pay a ‘per delivery fee’ where a patient cannot make their own arrangements for the prescription items to be delivered.

* Distance Selling Pharmacies (DPS) will not have deliveries to shielded patients added as an essential service. This is because they are already expected to deliver as per the conditions of being a DSP. ** The requirement outlines in the amended Terms of Service and the Advanced Service only apply to patients who are being shielded. Appropriate checks should be made to ensure that a patient is eligible for the delivery service. The pharmacist can check this on the Summary Care Record. Where a patient does not identify themselves as shielded, but the nature of the prescription leads the pharmacy team to consider that the patient may fulfil the ‘shielding’ criteria, the pharmacy should enquire if the patient if they have been asked to self-isolate for 12 weeks, via a letter from the NHS or their general practice. Other than for deliveries to patients in this shielded group (and deliveries of Specified Appliances), contractors continue to be able to charge patients for the delivery of prescriptions. Changes to the Terms of Service

Eligible patients should be first asked to see if their medicines can be collected from the pharmacy and delivered by family, friends or a carer.

If the patient cannot identify a family member, friend or carer to collect their prescription, they have been advised to contact the pharmacy. The pharmacy must then:

1. 1. provide advice to the patient on how to identify a local volunteer to collect the prescription from the pharmacy on their behalf and then deliver it. This could be locally organised volunteer arrangements or volunteers from the NHS Volunteer Responders programme; or
   2. where no volunteer is available, deliver the medicine as part of the Advanced service; or
   3. where no volunteer is available, arrange for another pharmacy to deliver it on their behalf. The other pharmacy will be able to claim payment for the delivery under the Advanced service; or
   4. where no volunteer is available, arrange for the prescription to be dispensed and delivered by another pharmacy (by referring the patient to another pharmacy, including a distance selling pharmacy).

Shielded patients can request Community Support volunteers themselves. Pharmacy colleagues can refer patients for support via the NHS Volunteer Responders referrers’ portal or call 0808 196 3382. The RPS and the GPhC will be issuing further guidance about pharmacies using volunteers in due course.

Advanced Service

The Advanced Service provides funding for each delivery of a prescription that a contractor makes under options 2 or 3 above.

Contractors will be able to claim, via the Manage Your Service (MYS) portal, a payment of £5 per delivery, plus VAT, as part of the normal end of month process.

More details are available here.

  Scotland: The medicines delivery service to ‘shielded’ patients is being co-ordinated locally by humanitarian centres (Red Cross) and local resilience centres (Scotland Cares). Wales: An update on the Welsh Government coordinated Delivery Solution for Wales can be found here. Temporary suspension of the prescription charge In terms of the cost of prescriptions themselves, the CCA supports the call for the prescription charge in England to be temporarily dropped at this time. The temporary removal of the charge will help every patient to access the medicine they need to keep well. It will also make it easier for businesses and volunteers to deliver medicines.

The Pharmacy workforce during COVID-19

Returnees to the register The General Pharmaceutical Council (GPhC) has given temporary registration to over 6,000 pharmacists and pharmacy technicians who have left the register in the past three years. It includes staff who voluntarily removed themselves or were removed for non-renewal from the GPhC register and did not have Fitness to Practise issues. These measures mean that these pharmacy professionals can now practise in Great Britain if they choose to do so during the coronavirus pandemic.

• England: For more information about returning to the register and working in England, please complete this survey.
• Scotland: NHS Education for Scotland (NES) are coordinating returning registrants Please see the national recruitment portal for more details.
• Wales: For information regarding returning registrants in Wales, please see here.

  Pre-registration pharmacists and technicians On 26th March GPhC announced that the 2020 pre-registration exams, scheduled for June and September 2020 would be postponed. The GPhC is currently considering the implications of the COVID-19 pandemic on pre-registration training and assessment and more information is expected in due course. HEE, NES and HEIW, have published guidance for pre-registration trainee pharmacists and pre-registration trainee pharmacy technicians across England, Wales and Scotland.   Undergraduate students Alongside the RPS, the Pharmacy Schools Council (PhSC) and British Pharmaceutical Students Association (BPSA) HEE, NES and HEIW have published joint guidance to support the deployment of undergraduate pharmacy students during the coronavirus pandemic. The guidance sets out the principles of good practice when students are supporting the pharmacy workforce. It also provides information to students and employers in being deployed or receiving a student.

Opening hours of pharmacies

Reduced opening hours England: The Standard Operating Procedure sets out new ways of working in England. At the discretion of the responsible pharmacist, pharmacies may close their doors to the public for up to 2.5 hours a day, including lunch. All pharmacies (that are contracted to) should be open to the public between 10am and 12pm and 2pm and 4pm. 100 hours pharmacies should be open from 10am–12pm and 2pm–6pm. Scotland: To catch up on work, pharmacies in Scotland may open one hour later in the mornings and close one hour earlier in the evenings. They may also close for lunch between 1 and 2. Wales: On 21st March contractors in Wales were given flexibility to open one hour later in the mornings and close one hour earlier in the evenings and close for a two-hour period during the daytime. Pharmacies were required to remain available for urgent prescriptions and advice during any daytime closure. Contractors are now asked to review their opening hours to the public and where it is safe to do so (in relation to the health and wellbeing of staff and management of workload) to consider reducing the amount of time that they are working behind closed doors.   Early May Bank Holiday England: NHS England and NHS Improvement (NHSE&I) has announced that pharmacies are required to open for 3 hours, between 2pm and 5pm, on Friday 8th May 2020. Contractors will be paid same as they were for Easter openings – £250 an hour for a maximum of 3 hours. Scotland: Scottish Government have confirmed that community pharmacy contractors have been requested, where possible and safe to do so, to open and provide a full range of pharmaceutical care service. Fees payable will be set at the same level as that provided for opening on Good Friday and Easter Monday: that is, £1,200 for a full day opening; £700 for a half day opening.] Late May Bank Holiday England: During last week’s COVID-19 Community Pharmacy Webinar, NHS England and NHS Improvement (NHSE&I) stated that they are hoping to revert to standard locally determined opening arrangements for the Spring Bank Holiday on 25th May 2020.. Contractors are strongly encouraged to tell their local NHSE&I team if their premises will be open on the 25th May bank holiday.

Safety: Security, Personal Protective Equipment, physical barriers, and mental health

Security The CCA and our members take the safety of our people and patients very seriously. Our members are working extremely hard at this current time to protect their pharmacy teams from the direct and indirect harms that COVID-19 presents, including the unacceptable abuse that some pharmacy teams have experienced. We are working closely with our members, the police and other partners to ensure that pharmacies remain as safe an environment for the workforce as possible. Our members engage directly both at a local and national level with police forces across the UK.  In addition the CCA is directly engaging with the National Business Crime Centre and the National Policing Lead for the police network of Controlled Drugs Liaison Officers to identify and address all risks and issues facing pharmacy teams in the light of the Covid crisis, which includes the abuse of staff. We believe that pharmacy owners and the employers of pharmacists should have the freedom to choose how they will deliver a safe and secure working environment for their people. This includes, for example, choosing which public information posters to display, such as the existing NHS materials that make clear that violence towards pharmacy teams should not be tolerated. Resources

• The metropolitan police have issued guidance for pharmacies on security for pharmacies during the ongoing coronavirus pandemic. It can be accessed here.
• The RPS, the Mental Wealth Academy and Pharmacist Support have produced a poster to support pharmacy teams manage conflict. It can be accessed here.

  When to use Personal Protective Equipment On 2^nd April the UK government published updated guidance on the use of personal protective equipment. The guidance is co-branded by Public Health England, Public Health Wales and Health Protection Scotland. The guidance for pharmacy staff (see table 3) recommends workers wear fluid resistant mask when working in an area with possible or confirmed cases of coronavirus and are unable to maintain 2 meters social distancing. On April 10^th the NHS clarified via the Primary Care Bulletin that pharmacy staff who cannot stay more than 2 metres away from symptomatic people need masks. Pharmacy staff working in dispensaries but unable to maintain 2 metres from their work colleagues do not necessarily need to wear masks.   How to use Personal Protective Equipment The UK Government has published advice for safe ways for working for all health and care workers. It states that:

• staff should be trained on donning and doffing PPE. Videos are available for training
• staff should know what PPE they should wear for each setting and context
• staff should have access to the PPE that protects them for the appropriate setting and context
• gloves and aprons are subject to single use as per SICPs with disposal after each patient or resident contact
• fluid repellent surgical mask and eye protection can be used for a session of work rather than a single patient or resident contact
• gowns can be worn for a session of work in higher risk areas
• hand hygiene should be practiced and extended to exposed forearms, after removing any element of PPE
• staff should take regular breaks and rest periods

When disposing of PPE, the following best practice should be considered: Used PPE unlikely to be contaminated can be placed directly into the normal general waste. Used PPE, disposable wipes and tissues which could potentially be contaminated i.e. when in contact with someone who has suspected/confirmed COVID, or from cleaning should be:

• carefully placed in a plastic rubbish bag and tied
• placed in a second bin bag which is tied when full
• stored safely away from areas where colleagues may come into direct contact with it
• left untouched for 72 hours before placing in the normal general waste

Public Health England has also published guidance on how to take off and put on PPE. It is available here.   Getting Personal Protective Equipment England: In mid-March NHS England confirmed that packs of PPE (1 box of face masks, 1 roll of aprons, 1 box of gloves) had been delivered to community pharmacies in England. On March 31^st Chief Pharmaceutical Officer Keith Ridge advised contractors that further supplies of face masks, aprons and gloves should be ordered via normal wholesalers.

NHS England has now set up a page on their website to support health and social care services access PPE. The website outlines that:

• Additional supplies of PPE have been made available to wholesalers that routinely supply pharmacies.
• Local Resilience Forums have received PPE supplies to respond to local spikes in need. This is intended to support service providers which have exhausted their usual routes for PPE.
• Any organisation running critically short of PPE, which has exhausted other supply routes, can phone the National Supply Distribution Response (NSDR) on 0800 915 9964 for an urgent delivery.

A new online ordering site is also being developed to enable primary care, community care and social care providers to register their PPE requirements more easily.

Scotland: On 24th March Dr Rose Marie Parr, Chief Pharmaceutical Officer for Scotland confirmed that PPE would be provided to community pharmacies in Scotland. Face masks, and a cover letter signed by CPS with details on how to use the masks, started to arrive in community pharmacies on 9^th April 2020. PPE should now be available in all Scottish pharmacies. Details on re-ordering PPE has been sent directly to contractors. Further details are available on the CPS website. On 17th March, Dr Gregor Smith announced that there have been extensions to the shelf-life of PPE masks. Rigorous testing has occurred to ensure that this is safe.   Physical barriers and infrastructure Any member of staff who deals with members of the public from behind a full screen may be protected from airborne particles and pharmacies may wish to consider whether such screens can be installed to protect members of staff England: In a letter to Community Pharmacy colleagues on 31 March Keith Ridge outlined that NHS England and Improvement will pay pharmacies (who are not distance-selling pharmacies) and all dispensing doctors a £300 payment to support installation of physical barriers such as screens and retractable tape barriers or other adjustments to help enforce social distancing. Scotland: Harry McQuillan of Community Pharmacy Scotland confirmed that CPS has requested new funding for infrastructure. More information will be provided when it is available. Legislation has also been passed in Wales to mandate employers to take reasonable measures to ensure 2-meter distancing for employees. From 7th April, Wales has extended the two-meter distancing rule to apply to places of work. Read more here. We are waiting for further guidance from Welsh government following announcements with regards to PPE on 2^nd April.   Mental health support England: NHS England and Improvement have confirmed that a new mental health support line will be available to pharmacy teams across all healthcare settings from 8^th April 2020. The service is available by calling 0300 131 7000. Wales: The Welsh Government has announced that a free mental health support service currently available to doctors will be extended to include every front line health care worker in Wales. The service is available by calling 0800 058 2738 or visiting www.hhpwales.co.uk/. Scotland: Scotland: NES have launched an array of modules on the Turas Learn Portal which look at mental health. You can find the link to access these, alongside further information about maintaining your wellbeing here.

The use of NSAIDs and COVID-19

There have been concerns in the media about the use of non-steroidal anti-inflammatory drugs (NSAIDs) in relation to COVID-19. The Commission of Human Medicines (CHM) Expert Working Group on COVID-19 has concluded that there is currently insufficient evidence to establish a link between the use of ibuprofen, or other NSAIDs, and the susceptibility to contracting COVID-19 or the worsening of its symptoms. Click here for more information. Therefore, paracetamol or ibuprofen can be taken when self-medicating for COVID-19 symptoms and patients should follow NHS advice.  

Controlled Drugs

The government has introduced changes to controlled drugs legislation. These changes are enabling and allow the Government to introduce flexibilities to the law to enable people to continue to receive controlled drugs during the coronavirus pandemic. They relate to

• The emergency supply of controlled drugs
• Supply of controlled drugs under a Serious Shortage Protocol during a pandemic
• Changing the intervals of instalments during a pandemic The RPS has issued guidance on the contingency legislation.This legislation has not been switched on and it is not yet known when or if it will be.The CCA is aware of situations in which prescribers have requested community pharmacists undertake activities which would requires change to legislation (e.g. changing instalment of controlled drugs or providing emergency supplies). However, all legal requirements pertaining to Controlled Drugs (CDs) supply and prescribing remain in force.  

The reuse of end of life medicines

In normal circumstances the reuse or recycling of one person’s prescribed medicines by another is not recommended. However, there are concerns about the ability of the supply chain to meet increased demand for end of life medicines during the COVID-19 outbreak. In response to this the Welsh Government and NHS England/Improvement have published guidance on the reuse of end of life medicines in hospices and care homes. England: The Standard Operating Procedure (SOP) for running a medicines re-use scheme in a care home or hospice settings can be accessed here. Wales: Guidance for Local Health Boards and NHS Trusts on the reuse of end of life medicines in hospices and care homes has been distributed to chief pharmacists.

Status of pharmacy colleagues as key workers

Children of pharmacy colleagues and attendance at schools To reduce the spread of coronavirus the government requested that parents keep their children home from school. This does not apply to children of parents who have been designated as key workers critical to the Government’s response to the pandemic. Key workers include pharmacists, pharmacy support teams and delivery drivers, as well as those working in the health and social care supply chain, such as producers and distributors of medicine. Letters to communicate the status of pharmacy colleagues as key workers have been drafted by the:

• Royal Pharmaceutical Society
• Community Pharmacy Scotland
• PSNC
• Community Pharmacy Wales for each Health Board area

Essential Travel Following reports that pharmacy team members and delivery drivers were being stopped and questioned by the police in Scotland regarding whether there travel was essential, Community Pharmacy Scotland published a letter to support pharmacy colleagues communicate their role as key frontline health workers to the police. The RPS and GPhC have published a letter for use by all pharmacy employees, to law enforcement teams to outline that movement of pharmacy employees between their home and place of work is essential. Dedicated shopping hours The RPS have published a letter, to validate the status of pharmacy colleagues as key workers to enable them to make use of dedicated shopping hours for NHS staff. The letter is available here.

Coronavirus testing

Coronavirus testing is available for community pharmacy staff who are self-isolating.This ensures that those who test negative and are symptom free can return to work. England: On April 2^nd 2020 the Government set out a target to test 100,000 people a day in England by the end of April. On April 4^th the Government published their strategy to scale up testing programmes. They confirmed that testing would be prioritised in the following way.

• Patients
• NHS staff and their families
• Critical key workers
• Wider community

Currently, to be eligible for a test, you must either be:

• A key worker with COVID-19 symptoms,

OR

• Someone with COVID-19 symptoms who lives in the same household as a key worker.

For further information see this NHS England and NHS Improvement letter (published 12 April). On Friday 24th April, the Government launched the self-referral portal to directly book a test at a regional test site or order a home testing kit. This portal replaces the temporary system that was put in place by the CQC. The user guide for the self-referral portal can be found here. Scotland: Individual Health Boards hold the responsibility for the testing of community pharmacists and their family members for Coronavirus Further information, and details of the different processes is available on the CPS website. Drive-through facilities are now open at Glasgow, Edinburgh and Aberdeen airports, as well as in Inverness. These are available for CP teams and family. Wales: Welsh Government and the Chief Medical Officer for Wales released their plans for testing Key Frontline Healthcare workers on the 18^th March, this included pharmacists. Further details are available here. Testing has begun across all Health Boards for pharmacy colleagues who are symptomatic more details on who to contact for each Health Board can be found here.

Indemnity

NHS Resolution have published an updated set of FAQs to outline indemnity arrangements in England. in light of the coronavirus outbreak. Indemnity for community pharmacists, including those returning to the profession Pharmacists and Pharmacy technicians are regulated health professionals and must ensure they have adequate indemnity insurance cover, either personally or through their employer. Pharmacy businesses and insurers that provide insurance for community pharmacists and pharmacy technicians have confirmed that usual indemnity insurance arrangements will cover pharmacy activities undertaken in response to the coronavirus pandemic. This will include pharmacists that are temporarily registered. NHS Resolution will continue to liaise with insurers where any additional services are commissioned from community pharmacy. If pharmacists or pharmacy technicians are asked to work in pharmacies of a different ownership, they should confirm with the superintendent pharmacist the indemnity insurance cover that the company provides.   Crown indemnity Where existing indemnity arrangements are not in place, or do not provide sufficient cover for the NHS services a pharmacist is providing as a consequence of the Coronavirus outbreak, the Coronavirus Act 2020 contains a coronavirus indemnity safety net provision. This gives the Secretary of State powers to provide indemnity for clinical negligence liabilities arising from NHS activities carried out for the purposes of dealing with, or in consequence of, the coronavirus outbreak, ensuring that staff have indemnity cover.   Indemnity for pharmacists working in general practice and secondary care Information about indemnity for pharmacists working in general practice and secondary care, including those returning to the profession is available here.

Business Continuity

The National Pharmacy Association and the Company Chemists’ Association have issued new joint guidance about maintaining continuity of pharmacy services in the event of crises. With the UK facing a second wave of coronavirus, the organisations are helping their members to plan ahead for all eventualities including staff sickness and COVID-19 lockdowns. Providing Pharmaceutical Care in Crisis Situations sets out the stages of a response to a crisis for individual pharmacies and for pharmacies working together. In some circumstances this could include the sharing of staff and stock, to maintain essential services. It provides a coordinated approach to dealing with significantly increased demand and reduced capacity that may be caused by national emergencies and local major incidents, including the impacts of COVID-19. The guidance for each country is available here