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THE INDISPENSABLE DOCTORS JOURNAL
WWW.DISPEX.NET
Online version available to download at www.dispex.net
VOLUME SIX JULY 2014
In association with
IN THIS ISSUE
GP CARES
Your GP Cares Campaign 11
news
opinion
articles
learning & development
technology
offers
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2 / MAY-JUNE 2014
CONTENTS
THIS MONTH
This month we highlight the increasingly demanding
environment in healthcare for GPs. The British Medical
Association has launched “Your GP Cares” campaign
aimed to work with the government and patients towards
improving and sustaining our healthcare system.
Also on the agenda is professional development of the
dispensary staff. Here at Dispex, we believe people are the
best investment and can only grow through continuous
development.
We are pleased to announce our Autumn/Winter courses,
and we have also launched special workshops to help
unravel the complexities of CQC visits, improving
dispensing profitability and how to get up-to-date with
latest regulations.
CHIEF EDITOR / SENIOR CONTRIBUTOR
Greg Bull
BUSINESS MANAGER
Linda McCammont
CONTRIBUTIONS EDITOR/
ADVERTISING/PRODUCTION
Isacc Ali
SALES & TRAINING CONTRIBUTORS
Jade Pirard / Michelle De La Bertauche
The Dispensary Gazette
Dispex Ltd, 7-8 Prospect Court,
Courteenhall Road, Blisworth,
Northamptonshire NN7 3DG
England
Telephone 01604 859000
Fax 01604 859687
Editor gbull@dispex.net
Advertising enquiries@dispex.net
Website www.dispex.net
The views of contributors and guest columnists are not
necessarily the views of Dispex Ltd. The Dispensary Gazette
is a monthly magazine circulated free to qualifying readers
including Dispex Members.
Whilst every care has been taken to ensure the accuracy of
the contents of this magazine, the publishers cannot accept
liability for any errors or omissions or any incorrect
interpretation on any subject matter(s). If in doubt, you
should seek the appropriate professional advice.
All third party content, registered trademarks , logos and
images are owned by the respective brands. No reproduction
of any part of this magazine is allowed without prior written
consent from Dispex Ltd.
Copyright © Dispex Ltd. All rights reserved.
NEWS
4-6
DDA News
MEDICINES FOR CHARITY
9
Working with
INTERCARE
EDITORIAL
12-13
Parallel Imports
COVER STORY
11
Your GP cares
campaign
News
Prescription parcels 4
Trainee dispensers working unsupervised 5
Access to prescribing data is changing 8
Insurance for health professionals 8
Janet Parker to retire 8
Pharmacy Plus withdrawal 16
Editorial
Parallel imports 12-13
Flexible working 15
Owning a practice 23
Updates
Controlled Drugs reclassified 21
Education
Role of the Receptionist 17
Training from Dispex 18-19
FAQs
Controlled Drugs 10
JULY 2014 / 3
Welcome to the first of our Dispensing Doctors’ Association (DDA) News pages brought to you in
association with Dispex. We are delighted to be working with Dispex and are very grateful for their
support for the DDA and look forward to working with them in future.
There has been an earth quake. Don’t worry because it was only a political one! UKIP is now the
Heineken party; it reaches parts of the UK that most politicians now can’t reach. Why does this
matter to dispensing practices? It matters because there is a General Election next May and all
politicians are going to become hyper-sensitive to the concerns of their constituents. GPs are likely
to see their patients far more often than a Member of Parliament sees their constituents, which
presents an unrivalled opportunity to get your concerns across to the political class at a time that
matters.
The DDA produces briefings for MPs in all parts of the country. You can find them
here www.dispensingdoctor.org/category.php?pid=24 . Use the time between now and
the election to invite your MP, and the candidates from rival parties, to visit your
surgery and get a photo in the local paper. Impress upon them the value of dispensing
practices to the community; how we need the reimbursement system to change and
that we need the Electronic Prescription Service (EPS) in England.
Don’t forget that the DDA conference is now part of the Best Practice Show on
22/23rd October at NEC www.dispensingdoctor.org/category.php?pid=52 Entry is
free so don’t delay and book today!
Matthew Isom
Chief Executive
Dispensing Doctors’ Association
GENERIC ESCITALOPRAM IS NOW AVAILABLE
FROM TEVA FOLLOWING THE PATENT EXPIRY
OF LUNDBECK'S CIPRALEX. By Ailsa Colquhoun
Escitalopram is indicated for the treatment of major
depressive episodes, panic disorders with or without
agoraphobia, social anxiety (social phobia) disorder,
generalised anxiety disorder and treatment of obsessive
compulsive disorder. 5mg, 10mg and 20mg strengths are
available following the day one launch.
He has told Dr Richard Simpson (Labour MSP for Mid
Scotland and Fife) that the £0.5 million spent on locum
cover following the resignation of the GPs at the Cumbrae
Medical Practice "would have been far better spent in
investment in other parts of the health service".
Mr Neil told Dr Simpson: "It is because I have recognised
those problems that I have taken action to deal with them.
That is why the regulations are now before Parliament.
Assuming that they are approved by Parliament, they will
be implemented at the earliest possible opportunity."
But pressing the secretary further on rural general practice,
Dr Simpson told the secretary that it was "disappointing
that there is not a proposal to have joint pharmacy and GP
dispensing established." He asked Mr Neil: "Does he
recognise that, although a marketing programme is
welcome, he will have a recruiting problem until the
uncertainty around current applications for pharmacies for
some areas is dealt with?
Cumbrae dispensary closure dubbed "regrettable"
HEALTH SECRETARY ADMITS REGULATORY
PROBLEMS By Ailsa Colquhoun
Scottish health secretary Alex Neil has admitted his regret
that in Cumbrae a GP dispensary was lost because of a
successful pharmacy application.
4 / JULY 2014
"Does he recognise the problems that have been created by
existing pharmacy applications in Killin and Drymen and
also possibly in Aberfoyle if the appeal against the
pharmacy is not successful?"
In association with
MPIG CUTS RAISED IN
PARLIAMENT GPS TAKE TO THE
STREETS IN PROTEST
By Ailsa Colquhoun
But, Anne McIntosh, Conservative MP for Thirsk and
Malton, believes that the removal of minimum practice
income guarantee funding may make certain rural practices
unviable.
GPs affected by MPIG cuts are being
"punished", a Labour MP has told
Parliament.
Supporting her call, Paul Blomfield MP (Labour, Sheffield
Central) said: "The minimum practice income guarantee
was introduced to meet the specific needs of specific
practices. Will the Minister give a guarantee that no
practice will close as a result of the withdrawal of the
minimum practice income guarantee, and will he provide
the funding to achieve that?"
In a debate on health following the Queen's Speech,
Valerie Vaz, Labour MP for Walsall South, told fellow MPs
that GPs were being denied a 1% pay rise. Small practices
in urban and rural areas were also losing Minimum
Practice Income Guarantee funding affecting front-line
services.
The Secretary of State wants to "punish the very people
who have borne the brunt of the reorganisation", she told
Parliament.
Defending the MPIG cuts, health chiefs have said that the
redistribution of MPIG through an increased global sum,
and allocations based on rurality, "should be of benefit to
many rural practices".
Health minister Dr Daniel Poulter replied: "NHS England
is working at local level with practices that are, for
whatever reason, in financial difficulties to make sure that
it can help them get to the right place."
The discussion comes as London GPs have marched in
protest over the MPIG cuts.
GP committee chair Chaand Nagpaul and negotiators
Beth McCarron-Nash and Dean Marshall joined East
London GPs and patients to protest over funding changes
affecting small practices in urban and rural areas.
HEALTH BOARD FACES FURIOUS QUESTIONS
OVER DRYMEN PHARMACY DECISION
PATIENTS DEMAND TO UNDERSTAND THE
PHARMACY ADVANTAGE
By Ailsa Colquhoun
equivalent services already available from the GP.
The Board was also tasked to explain its contingency plan
should the new Drymen pharmacy fail. Residents are said
to have left the meeting without satisfactory responses to
these questions.
NHS Forth Valley Health Board has faced furious
questioning from angry residents and patients following its
decision to close the dispensary at the Drymen Health
Centre.
However, the Board did offer some reassurances about the
provision of medical services in Drymen, following the
departure of Dr Foster. The meeting was told that medical
services would continue at Drymen Health Centre,
provided by two locum doctors for at least four months
until the practice vacancy was advertised.
Around 150 people filled the village hall for the Drymen
Community Council meeting to discuss with the Health
Board the way forward for medical and dispensing services
in Drymen. The meeting follows the successful pharmacy
application in the practice's neighbourhood, which has
prompted the resignation of single-handed GP Dr Jennifer
Foster.
Furious residents and patients attending the meeting
demanded that the Health Board overturn its decision to
allow the pharmacy. The Health Board also came under
intense pressure to discuss the advantages of the
pharmacy's pharmaceutical services, compared to the
6 / JULY 2014
Dr Allan Tennant adds, "Scottish rural vacancies are
unfilled in 25% of posts. The problems at Millport have
shown how expensive a longterm locum service can be.
The Drymen pharmacy application had already stopped
Dr Foster recruiting for a practice vacancy. I think it
possible that the situation is unlikely to be resolved in four
months.
"Readers also have to remember that Boards' interpretation
of medical services, does not include quality levels or
convenience and availability to patients."
NEWS
THE WAY GPS ACCESS PRESCRIBING DATA IS
CHANGING
Since April 2014 the NHSBSA has decommissioned the
Electronic Prescribing & Financial Information for
Practices (ePFIP) system. Hence, currently all prescribing
data will be accessible from the Information Services
Portal.
NHS Prescription has been contacting all GPs and other
prescribing organisations to let them know they need to
sign up to the Portal to continue to view these reports. A
fact sheet has been published on their website which gives
advice on accessing the Portal.
INDEMNITY OR INSURANCE COVER
A new law will require that all health professionals hold
indemnity or insurance cover.
The Department of Health has published its response to
the consultation on the need for all health professionals to
hold indemnity or insurance to cover their professional
activities as follows:
“The Department received 816 responses to the
consultation setting out a wide variety of views and
concerns about this proposed legislation. The Department
has considered the responses in full and decided to
introduce these provisions to ensure that those who suffer
at the hands of a negligent registered health professional
can get compensation. It is right that the healthcare
professional should take responsibility for making sure the
right arrangements are in place. The draft Order will be
laid in Parliament shortly.”
The Department’s response accepts that there is a need
and so the legislation (Healthcare and Associated
Professions (Indemnity Arrangements) Order 2014 which
accompanied the consultation itself ) will be laid before
Parliament this month with a view to enforcement from
July 2014.
PRESCRIPTION PARCELS
NHS prescription services have informed us that they have
recently noticed an increase in the number of batches that
are sent to them in polythene packages, and many of these
contain loose prescriptions when they arrive.
Whilst couriers (including UK Mail and Parcel Force)
encourage contractors to pack their batches in these bags,
please note that contractors are also required to submit
their prescriptions securely. This means ensuring that the
enclosed prescriptions cannot move around and become
8 / JULY 2014
mixed up within the package.
Prescriptions that have become mixed up in transit cause
NHS Prescription severe processing problems, which
could lead to a delay in payment to contractors. You can
help to prevent this by making sure your prescriptions are
packaged securely within the polythene bags, either inside
appropriately sized boxes or smaller polythene packets.
Don’t forget the following when preparing your batch:
• Please sort your prescriptions into exempt and
chargeable, and secure these two separate groups with
strong elastic bands or string.
• It’s very important that you sort prescription forms
alphabetically by doctor name within each group, but
there’s no need to separate individual doctors with elastic
or paper bands.
• Secure forms with an elastic band and leave MDA forms
unfolded.
• If you pack your batches into boxes, please make sure the
boxes are the correct size to ensure that the enclosed
prescription forms are secure.
CONGRATULATIONS TO JANET PARKER ON
HER IMMINENT RETIREMENT!
Janet Parker, a long term trainer for Dispex, and previously
Surelines, is to retire from work in both general practice
and as a tutor for Dispex. We would like to congratulate
her on choosing to spend more time with her friends and
family. Janet has worked tirelessly for every company and
GP practice she has been employed by and has worked as
both gamekeeper and poacher! We at Dispex will miss her
friendly and informal teaching of our courses and of
course her input into our advice and support. Janet “Jed”
Parker will remain a friend to us all at Dispex and I am
sure she will keep in touch with the friends she has made
over the years in the dispensing doctor arena.
Thank you for all the hard work you have done for us over
the years.
The Dispex Team
INTERCARE
WORKING WITH INTERCARE
by Amanda Chell
I was introduced to Intercare by a colleague of mine, who
had used Intercare in her previous practice.
As a practice, we were constantly frustrated by patients
ordering medication and then returning it months later as
they were no longer using it. So when I discovered the
Intercare charity, I was delighted that we could put some of
this wasted medication to good use.
Initially I emailed Intercare, asking if they could send me
out a Registration Form, which they promptly did, once
registered, they sent me all the relevant information I
needed to start sending them unwanted medicines.
The process with Intercare is very straightforward, they
send out very specific instructions on what they can and
cannot take, for example;
-The medication should have at least 15 months expiry
date on it, be in its original packaging and be in
complete ‘strips’.
-Items such as Controlled Drugs, Cytotoxics, Insulins
and all fridge lines are excluded from the scheme, for
obvious reasons!
-Patient identifiable information needs to be removed
from the medication boxes, either by removing the
labels or by blacking out the patient name.
Once all the medication is ready, you need to find a
suitable sized box, fill it with the medication, complete and
enclose a ‘Duty of Care Transfer Note’ and then ring UPS
for collection instructions;
What I thought was a really nice touch is that I received an
e-mail from them a couple of weeks later, thanking me for
the medication. Attached to the e-mail was a copy of a
“Letter of Appreciation” from the Sister-in-charge of
Madonna Maternity Clinic in Ghana, one of the many
clinics and hospitals supported by InterCare in Africa. It
was a very touching letter, the dispensary team and I were
very pleased to be able to make a difference in communities
afflicted by hardship whom are unable to have access to the
most basic of medication.
So the next time a patient brings in a bin-liner full of
returned medication, I can be reassured that it is going to
good use in an African Health Centre.
For more information about fundraising or registering as a
dispensing practice please call (0116) 2695925, e-mail
info@intercare.org.uk or simply visit www.intercare.org.uk.
JULY 2014 / 9
FAQs
CONTROLLED DRUGS
The following Question and Answer section are real life
queries sent to us by current dispensing practices. The
answers have been provided by Nigel Morley MRPharmS.
Nigel Morley is a freelance independent registered
pharmacist and is considered a leading expert in controlled
drugs regulations and his book “Controlled Drugs in
Primary Care - The Law, Probity and Good Practice” is an
indispensable source for those wanting to know more
about the legislation and best practices with CD’s.
Q
We are a dispensing GP surgery and have just started
obtaining Zomorph from AAH. They want a list of
signatories who are authorised to sign for CD's but they
want them all to be doctors. This is not very practical as
we do not always have a GP available to sign for deliveries.
Would it be ok for the senior partner to authorise
dispensers to sign for CD's as we have been doing with
Phoenix for years?
A
Dispex is currently holding further Controlled Drugs
workshops for the Autumn/Winter training programmes.
Refer to the training and events listing located on page 16
or simply subscribe to our E-bulletins or check the
Training section at www.dispex.net.
SPECIAL OFFER FOR JULY
Purchase “Controlled Drugs in Primary Care - The Law,
Probity and Good Practice” 3rd Edition for only
£12.95+VAT each (RRP £35.99) with
FREE postage.
*While stocks last, offer ends 31st August 2014.
CONTROLLED DRUGS
CD Registers, CD Guide,
CD Training, Denaturing Kits,
All your CD needs fulfilled
Only registered doctors can supply signed orders for
Schedule 2 and 3 Controlled Drugs.
Any authorised person can sign for the receipt of Schedule
2 and 3 Drugs therefore it would be ok for the senior
partner to authorise dispensers to sign for CDs.
Q
We are moving premises shortly, can you tell me the
correct way to move our Controlled Drugs from one
premises to the other?
A
In a locked container accompanied by a member of staff.
A full stock check should take place on departure and
arrival.
Q
If we have a patient that is working in Bristol and we are
in Devon and he wants a repeat of his controlled drug, are
we permitted to send his CD script to him in the post or
do we have to send it to his nominated Pharmacy?
A
You can do either, the prescription should be posted by
recorded delivery though.
10 / JULY 2014
2
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Fax completed form to 01604 859 687
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COVER STORY
YOUR GP CARES CAMPAIGN by BMA
The UK family doctor service is widely admired around
the world for its equitable, cost effective and leading edge
provision of locally accessible high quality care and doctors
remain our most trusted professionals.
However, the environment which GPs are striving to
provide services in is increasingly challenging. An increased
demand on general practice caused by demographic
changes, more complex health needs, and some care
moving out of hospitals is all contributing to unsustainable
pressures on the service.
These inter-related factors are having a worrying impact on
how care is delivered to patients. Issues within General
Practice NHS England estimates that some 340 million
consultations are now undertaken every year, an increase of
40 million since 2008.
The number of consultations in Scotland has also
increased, with NHS Scotland estimating that at least 24.2
million patient consultations are now undertaken every
year, up by 1.6 million since 2006.
Patients in some areas are not always able to get an
appointment when they need one. In 2013, an estimated
26.2 million people waited over one week to see their GP.
The needs of patients visiting their GP practice have also
changed. For example in England 15 million people live
with a chronic condition.
More care for patients with chronic diseases, such as
diabetes and asthma, previously carried out in hospital
settings is now increasingly being provided through GP
service
GPs are also facing rising patient demand from an ageing
population. In Northern Ireland, for example, the
proportion of the population aged 75 and over is predicted
to rise from 6.7% in 2012 to 9.2% in 2024.
Your GP cares that is why the BMA’s General Practitioners
Committee has launched a new campaign, “Your GP
cares”, to highlight some of the pressing issues facing
general practice.
Your GP and practice team care about the current situation
and want to work with patients and government to find
solutions and provide a better service. The BMA is calling
for long term, sustainable investment in GP services now
to:
• Attract, retain and expand the number of GPs
• Expand the number of practice staff
• Improve the premises that GP services are provided from
THE BURNING ISSUES
The environment in which GPs are striving to provide
services is increasingly challenging.
An increased demand on general practice caused by
demographic changes, more complex health needs and
some care moving out of hospitals is all contributing to
unsustainable pressures on GP services.
Based on the current number of doctors working as GPs,
and the staff who support them in the general practice
team, there are simply not enough hours in the day to meet
everyone’s needs.
GPs are telling us that they are struggling to recruit to
vacant posts in their practices and to find locum cover so
that patients can still be seen if a colleague is sick or absent.
The increasing demand and workload pressures are leading
to low morale and stress causing many GPs to leave the
profession or to consider early retirement.
Many GP practice buildings are old and need investment
to create more room for patients to be seen or simply to
make them fit for purpose.
GPs and their practice teams must have greater support to
deliver high quality services that meet the requirements of
all their local patients. For further information visit
bma.org.uk/working-for-change/your-gp-cares.
JULY 2014 / 11
EDITORIAL
PARALLEL IMPORTS by Richard Freudenberg
WHAT IS A PARALLEL IMPORTED MEDICINE?
A Parallel Import [PI] is a branded pharmaceutical product,
which is sourced and imported from within the European
Economic Area [EEA], i.e. the 28 existing Member States
of the EU, plus Norway, Iceland and Liechtenstein. The
imported product must be therapeutically equivalent to the
UK brand with which it competes, and has to fulfil all UK
packaging and leafleting requirements; each individual pack
is inspected and must bear details of the importers’ product
licence. All PIs are either re-labelled or re-boxed in legible
and authorised packaging, and have to contain a Patient
Information Leaflet [PIL) in English, referenced to the
most recently approved UK leaflet.
WHEN SHOULD I CONSIDER USING A PI?
ou should consider using a PI where there are either no
manufacturers’ discount schemes available on the UK stock,
the UK stock is hard to source due to manufacturer
problems or where the UK discount is lower than clawback.
For example, there are many UK pharma companies who
now offer a direct discount to dispensers, which is less than
the “clawback” applied to ALL items dispensed by a
dispensing doctor.
12 / JULY 2014
IS THE QUALITY OF THE PACKAGING UP TO
STANDARD? WILL MY PATIENTS COMPLAIN IF
THEY RECEIVE A PI?
PI packaging is very much up to the same standard as UK
pharma stock and most patients now are happy to be
dispensed a PI. Dispensing of PIs is becoming more
commonplace across all dispensing contractors. A parallel
importer may change the packaging and may re-affix the
trademark on the new packaging or even replace it with the
trade mark used for the same product in the Member State
of destination provided that certain conditions are met. It
must be stated on any new packaging by whom the product
has been repackaged, and by whom manufactured. Also,
the presentation of the repackaged product must not be
liable to damage the reputation of the trademark and of its
owner. Finally the proprietor of the trademark must receive
prior notice before the repackaged product is put on sale.
WILL THERE BE ANY DIFFERENCE IN THE
QUALITY OF THE PRODUCT FROM UK STOCK?
No. Parallel importers cannot alter the essential
characteristics of the product itself as that might result in a
different product, which consequently would not fall under
the definition of a product imported in parallel. This means
that the medicine inside the blister pack must be exactly the
same as UK stock of the brand. Further, importers are not
permitted to open the primary packaging (blister, bottle,
etc.).
IS THERE A GENUINE PRICE BENEFIT IN USING A
PI?
Whilst a PI is reimbursed at the same list price as its UK
counterpart, there are discounts available on a PI which are
not available for UK pharma stock. So your drug budget
will not see any savings but your practice income will
benefit if you purchase and use your PIs carefully.
WHAT IS THE EASIEST WAY TO ORDER?
Your wholesaler will have a different PIP code in place for
the PI version of a branded medicine. You need to ensure
that you have your ordering system set up correctly to order
the PI [if you are using automated ordering] or find a
suitable method that suits your dispensary. [see Amanda
Chell’s article for this month’s Gazette explaining how she
did this in her surgery.]
HOW TO SWITCH TO USING PARALLEL
IMPORTS by Amanda Chell
With an increasing number of manufacturers adopting the
Reduced Wholesaler Model which inevitably reduces
wholesaler discounts and profitability of my dispensary, I
decided to investigate the PI market.
Historically, Dispensing Doctors practices have always been
reserved about Parallel Imports, considering them to be
2nd class drugs. My initial investigation revealed that all PIs
are still covered by the strict laws of the MHRA. Firstly, I
had to convince my GPs that this was the way forward.
A small pitch was put together, explaining the laws
governing PIs. I further explained that most PIs are
relabelled or re-packed in practical and informative
packaging and have to contain a Patient Information
Leaflet [PIL] which is written in English.
Then, I presented a list of items which we regularly used
that had the wholesaler discount reduced and compared it
with a list of PIs where the discount was much greater. It
was a success, my GPs thought it made perfect sense in
order to sustain the dispensary business.
CAN YOU TELL US THE PROS AND CONS OF
USING A PI?
Pros: Better overall profitability where PI discount is greater
than UK pharma discount
Cons: Possible lack of continuity of packaging where the PI
is sourced from different importers each month
WHAT IS THE AVAILABILITY OF PIS?
PIs are readily available to buy through most of the BAPW
wholesaler.
For more information Parallel Imports go to
www.baepd.co.uk
So, without haste I made a plan to implement the
procurement of PI’s in my Dispensary. By bulk ordering at
the beginning of a month, I can project purchase quantities
in advance and if a PI is more profitable, an order is made
from Lexon.
Generally, if a PI offers a discount of 10% or more, and it is
a product that we dispense, I would look into the UK
discount that is it attracting. (i.e. Adalat LA 30mg is
attracting limited UK discount, but as a PI, there is a
discount of 42%!) I feel that Dispensary Managers are tired
of the ‘smoke and mirrors’ that surround many UK
discounts and I particularly like the nett pricing of PIs!
No confusion as to whether an item is discountable and
you simply pay the price on the list. It is what we all want! I
am now tasked with educating my dispensers to reorder PIs
when PIs are dispensed. Thus, the packs are now labelled
with an L for Lexon, (where the dispensing label goes).
Hopefully, when this item gets dispensed, they will write it
down on the order pad to be faxed through to
Lexon. It’s a win-win situation!
JULY 2014 / 13
Try Terra-Cortril first-line for adults
with localised infected eczema
Tried and trusted active
ingredients – oxytetracycline
hydrochloride and hydrocortisone
An alternative to cream treatments
Terra-Cortril does not contain
preservatives
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in the
the ffollowing
ollowing ddisorders:
isorders: eexudative
xudative aand
nd ssecondarily
econdarily iinfected
n fe c t e d
eeczema
czema in
including
cluding aatopic
topic eeczema,
czema, pprimary
rimar y iirritant
rritant dermatitis,
dermatitis, allergic
allergic
and
and sseborrhoeic
eborrhoeic ddermatitis.
ermatitis. SSecondarily
econdarily iinfected
nfected insect
insect bbite
ite rreactions.
eactions.
up to
up
to sseven
even ddays.
ays. LLike
ike other
other tetracyclines,
tetracyclines, oxytetracycline
oxytetracycline isis generally
generally
iineffective
nef fective ag
against
ainst PPseudomonas
seudomonas aand
nd Proteus
Proteus species.
species. BBecause
ecause tthese
hese
aree rrecognised
ar
ecognised se
secondary
condar y iinfecting
nfecting organisms
organisms in
in exudative
exudative ddermatoses,
ermatoses,
sensitivit y isis iimportant.
sensitivity
mportant. PPosology
osology and
and method
method of
of aadministration
dministration
AAfter
fter tthorough
horough cleansing
cleansing ooff the
the aaffected
f fected skin
skin areas,
areas, a small
small aamount
mount of
of tthe
he
oointment
intment sh
should
ould be
be aapplied
pplied ge
gently.
ntly. AApplications
pplications should
should bbee m
made
ade ttwo
wo ttoo four
four
ttimes
imes daily.
daily. TTerra-Cortril
erra-Cortril Ointment
Ointment iiss fo
forr ttopical
opical administration
administration oonly.
nly. Use
iinn tthe
he elderly:
elderly: NNoo sspecial
pecial pprecautions.
recautions. Us
Usee iinn children:
chi
hilldren: NNot
ot recommended.
recommended.
(See
(See ‘Contra-indications’).
‘Contra-indications’). Use
Use iinn renal
renal or
or hhepatic
epatic impairment:
impai
airrment: NNoo
special precautions.
precautions. CContra-indications
ontra-indications Hypersensitivity
Hypersensitivit y to
to oone
ne
special
Primary
ooff the
the ccomponents
omponent s ooff the
the ppreparation.
reparation. Pr
imar y bacterial
bacterial infections
in fe c t io ns
eegg iimpetigo,
mpetigo, ppyoderma,
yoderma, furunculosis.
furunculosis. PPregnancy,
regnancy, lactation
lactation and
and iinn iinfants
nfants
aand
nd ssmall
mall cchildren:
hildren: bbecause
ecause ooff tthe
he theoretical
theoretical rrisk
isk of
of damage
damage to
to ppermanent
ermanent
de
ntition. SSpecial
pec i a l w
arnings aand
nd special
special pprecautions
recautions ffor
or uuse
se
dentition.
warnings
Terra-Cortril
Terra-Cortril Oi
Ointment
ntment should
should nnot
ot bbee ccontinued
ontinued for
for more
more tthan
han sseven
eve n
days
days iinn tthe
he aabsence
bsence ooff aany
ny cclinical
linical iimprovement,
mprovement, ssince
ince iinn tthis
his ssituation
it u a t io n
occult
occult eextension
xtension ooff iinfection
nfection may
may ooccur
ccur du
duee ttoo tthe
he m
masking
asking eeffect
f fect ooff tthe
he
steroid.
steroid. EExtended
xtended oorr rrecurrent
ecurrent aapplication
pplication may
may in
increase
crease tthe
he rrisk
isk ooff contact
co n t a c t
sensitisation
sensitisation aand
nd should
should bbee aavoided.
voided. The
The uuse
se of
of oxytetracycline
oxytetracycline and
and other
other
antibiotics
a n t i b i ot i c s m
may
ay rresult
esult iinn an
an ov
overgrowth
ergrowth ooff rresistant
esistant oorganisms
rganisms – pparticularly
a r t ic u l a r l y
ccandida
andida aand
nd sstaphylococci.
taphylococci. CCareful
areful oobservation
bser vation ooff tthe
he patient
patient fo
forr tthis
h is
possibility
possibilit y iiss eessential.
ssential. IIff nnew
ew infections
infections du
duee ttoo nonsusceptible
nonsusceptible bacteria
b ac t er ia
or
or ffungi
ungi appear
appear during
during ttherapy,
herapy, Terra-Cortril
Terra-Cortril should
should bbee ddiscontinued.
iscontinued. IIff
extensive
extensive areas
areas ar
aree treated,
treated, oorr ifif tthe
he oocclusive
cclusive ttechnique
echnique iiss uused,
sed, there
t here
m
may
ay be
be increased
increased ssystemic
ystemic aabsorption
bsorption of
of the
the corticosteroid
corticosteroid aand
nd suitable
suitable
pprecautions
recautions should
should bbee ttaken.
aken. IIff iirritation
rritation develops,
develops, tthe
he pproduct
roduct sshould
hould be
be
ddiscontinued.
iscontinued. TTerra-Cortril
erra-Cortril OOintment
intment iiss nnot
ot rrecommended
ecommended fo
forr oophthalmic
p h t h a l m ic
uuse.
se. U
Undesirable
ndesirable eeffects
ffects Hydrocortisone
Hydrocortisone aand
nd oxytetracycline
oxytetracycline ar
aree well
we l l
ttolerated
olerated bbyy tthe
he eepithelial
pithelial ttissues
issues aand
nd m
may
ay be
be uused
sed topically
topically with
w it h m
minimal
inimal
uuntoward
ntoward effects.
ef fect s. Allergic
Allergic rreactions,
eactions, iincluding
ncluding ccontact
ontact ddermatitis
er m a t it is m
may
ay
ooccur
ccur ooccasionally,
ccasionally, bu
re rrare.
are. RReactions
eactions occurring
occurring mo
st ooften
ften ffrom
rom the
t he
butt aare
most
presence
presence ooff tthe
he aanti-infective
nti-infective iingredients
ngredient s aare
re aallergic
llergic ssensitisations.
ensitisations. TThe
he
following
local
following lo
cal side
side eeffects
f fect s hhave
ave been
been reported
reported with
with topical
topical corticosteroids,
corticosteroids,
eespecially
specially uunder
nder oocclusive
cclusive dr
dressings;
essings; burning,
burning, iitching,
tching, iirritation,
rritation, ddryness,
r yness,
ffolliculitis,
olliculitis, hypertrichosis,
hypertrichosis, aacneiform
cneiform eeruptions,
ruptions, hypopigmentation,
hypopigmentation, pperioral
er ior al
ddermatitis,
ermatitis, aallergic
llergic contact
contact dermatitis,
dermatitis, m
maceration
aceration ooff the
the sskin,
kin, secondary
secondar y
infection,
infection, sskin
kin aatrophy,
trophy, sstriae,
triae, miliaria.
miliaria. The
The use
use ooff TTerra-Cortril
erra-Cortril OOintment
int m ent
should
should be
be ddiscontinued
iscontinued iiff such
such rreactions
eactions occur.
occur. SSecondary
econdary infection:
infection: The
T he
ddevelopment
evelopment ooff ssecondary
econdar y bacterial
bacterial oorr ffungal
ungal infection
infection has
has ooccurred
cc u r r e d
aafter
fter uuse
se ooff ccombinations
ombinations ccontaining
ontaining ssteroids
teroids aand
nd aantimicrobials.
ntimicrobials.
M
MARKETING
ARKETING A
AUTHORISATION
UTHORISATION H
HOLDER
OLDER AAlliance
lliance PPharmaceuticals
harmaceuticals
LLtd,
td, AAvonbridge
vonbridge HHouse,
ouse, BBath
ath Road,
Road, CChippenham,
hippenham, W
Wiltshire,
ilt shire, SSN15
N15 22BB.
BB.
M
MARKETING
ARKETING A
AUTHORISATION
UTHORISATION N
NUMBER
UMBER PPLL 116853/0096.
6853/0096.
D
DATE
ATE O
OFF FFIRST
IRST A
AUTHORISATION
UTHORISATION 2277 December
December 11990.
990. D
DATE
ATE
O
OFF R
REVISION
EVISION O
OFF TTHE
HE TTEXT
EXT 110/06/2011.
0/06/2011. LLEGAL
EGAL CCATEGORY
ATEGORY
PPOM.
OM. TTerra-Cortril
erra-Cortril isis a rregistered
egistered ttrade
r a de m
mark.
ark. Ba
Basic
sic N
NHS
HS pprice
rice ££5.01
5.01
((excl.
excl. VVAT)
AT ) D
Distributed
istributed bbyy IIntrapharm
ntrapharm LLaboratories
aboratories LLimited,
imited,
TThe
he GGranary,
ranar y, TThe
he CCourtyard
ourt yard Ba
Barns,
rns, CChoke
hoke LLane,
ane, CCookham
ookham DDean,
ean,
M
Maidenhead,
aidenhead, BBerkshire
erkshire SSL6
L6 66PT.
PT. FFor
or ffull
ull pprescribing
rescribing iinformation
nformation
iincluding
ncluding ddetails
etails ooff iinteractions,
nteractions, ppregnancy/lactation,
regnancy/lactation, ddriving/operating
riving/operating
m
machinery
achinery aand
nd ov
overdose
erdose ssee
ee tthe
he SSummary
ummary ooff PProduct
roduct CCharacteristics.
haracteristics.
D
ate ooff ppreparation
reparation September
September 22012.
012.
Date
Adverse
A
dverse events
events should
should bbee rreported.
eported. R
Reporting
eporting fforms
orms aand
nd iinformation
nformation ccan
an bbee ffound
ound aatt ww
www.mhra.gov.uk/yellowcard.
w.mhra.gov.uk/yellowcard.
Adverse
Redline
A
dverse eevents
vents sshould
hould aalso
lso bbee rreported
eported to R
edline PPharmacovigilance:
harmacovigilance: TTel:
el: 001908
1908 3363437;
63437; FFax:
ax: 00870
870 44321
321 2279.
79.
TTerra-Cortril
erra-Cortril® is a registered trademark of Alliance Pha
Pharmaceuticals
rmaceuticals Ltd.
Alliance and associated devices are registered trademarks of Alliance Pha
Pharmaceuticals
rmaceuticals Ltd.
CCF-066-001
CC
F- 066- 001
AL/1582/09.13/1.4
DDate
ate ooff preparation:
preparation: September 2013
2013
PEOPLE
FLEXIBLE WORKING by Nick Babington
From Monday 30th June, any of your employees who
have worked with you for 26 weeks or more will have the
right to request flexible working, and you’ll have a duty to
deal with any request in a reasonable manner. Acas will
issue a statutory Code of Practice to give employers
further guidance on what will be considered reasonable.
Until now, only employees with children aged 16 or
under (under 18 if the child is disabled) or those with
caring responsibilities for an adult have had the legal right
to request flexible working.
Employment Relations Minister, Jo Swinson, recently
stated that offering flexible working could offer financial
benefits to employers, saying, "I believe it will be
economically beneficial to employers. With these
measures, workers are more likely to be happy in work;
you'll see reduced sickness absence, improvement in
mental health issues and more motivated and healthy
workers."
Flexible working can include remote working, but also
many other changes to the traditional “nine to five”
working pattern, including:
-Part-time working
-Job sharing
-Term-time working
-Flexitime (variable start/finish times)
-Career breaks (sabbaticals).
By allowing your employees to work more flexibly, you
and your business could benefit from:
More loyal, motivated employees
-Wider pool of potential employees to recruit
-Greater reputation as a family-friendly and socially
responsible organisation
-Less stressed employees.
For your employees, the benefits include:
-More flexible hours, to accommodate family
responsibilities
-A happier work / life balance.
TRAINEE DISPENSERS WORKING
UNSUPERVISED
Question
I am the Dispensary Manager a surgery in Cornwall and I
have two trainee dispensers. I would like to know when
they can be left in the dispensary without someone to
watch over them.
Both are working toward their NVQ and one of them has
done her 1000 hours.
Answer
A Dispenser who has done a 1000 hours can be left
unsupervised, as long as she/he has been certified as
competent by the Practice Manager and accountable G.P.
The Dispenser who hasn’t done a 1000 hours and is not
yet qualified, should still be supervised
JULY 2014 / 15
CPD
PREPARING FOR CQC VISIT
AND RESPONDING TO CQC
INSPECTION
Dispex has developed a special workshop to help you
prepare for your CQC visit on the 17th of July in
Northampton.
This training afternoon with be a CQC workshop, where
you will have the chance to review what you already have
in place and what is missing. At the end of this training
session you will have a plan of what you need to do in
preparation for an inspection. Working together you will
share the knowledge that you have amongst you and will
help each other start to prepare your practice for an
inspection, this will include getting staff and patients up to
speed and will help you structure the inspection in such a
way that you will get to highlight the positives and really
view this as an opportunity to demonstrate that you are
already a practice that delivers excellent service to your
patients and staff. This is a must do afternoon if you have
not already had your CQC inspection.
Agenda
• Understanding the need and the purpose of CQC
• Preparing for a positive structured CQC inspection
GP
MEDICAL
SYSTEMS
We have received numerous feedback from many
dispensing GP practices about their GP Medical System.
• A look at previous inspection reports and outcomes
• Preparing your team for CQC involvement
• A review of what you already have in place and what is
needed
• Preparing the practice for a CQC inspection
• Structuring the inspection
• Review of actions to take back to the practice
• Review and close
COST
Dispex Members £75 + VAT
Non-members £175 + VAT
Email enquiries@dispex.net or call 01604 859 000 for
more details or to book your place.
16 /JULY 2014
Practices that have migrated or upgraded to a new version
of a GP Medical System, may have been experiencing
various issues or require additional training and support
on the new features and work flow.
We have a trained tutor with years of experience dealing
with GP medical systems. For Dispex members, we are
offering reduced rates for personalised practice visits and
on-site medical system training.
Email enquiries@dispex.net for more details.
SUPPORTING DISPEX MEMBERS
Subscribe to our email bulletins to get instant updates on
Cat M price changes and access full reports and a list of
Cat M price changes downloadable from the Member’s
online hub at www.dispex.net
Book your annual stock take with Orridge with preferential
rates. Email enquiries@dispex.net for more information.
Enhance your knowledge with FREE online learning on
Stock Control at the DISPEX website.
UPDATES
FIVE COLOURS NOW AVAILABLE ON FP10 /
GP10
JOBST® Opaque
Ready-to-Wear RAL Compression Hosiery
Bronze and caramel are now available for all styles and
both compression classes of JOBST Opaque on Drug
Tariff. This means that JOBST Opaque is now offered in
a choice of five colours to complement any wardrobe, for
increased patient choice and improved compliance.
JOBST Opaque is suitable for lymphatic and venous
diseases and provides unbelievable wearing comfort.
Manufactured with JOBST Advanced Comfort,
combining high-quality yarns and a superior knit
structure, makes JOBST Opaque even softer than ever
and incredibly easy to don.
BSN Medical Limited is a limited company registered in England and
Wales. Registered number: 04085346. Registered office: Willerby
Business Park, Willerby, Hull HU10 6FE.
PHARMACY PLUS CONTRACT WITHDRAWAL
Pharmacy Plus are a distance selling pharmacy based in
Bristol providing pharmacy services to several hundred
care homes throughout England, Scotland and Wales.
NHS England has recently received and accepted an
immediate withdrawal from their Community Pharmacy
contract.
All care homes expecting medicines supplied from
Pharmacy Plus have been informed that they will need
to seek an alternative pharmacy provider and their
prescriptions have been returned to them. Pharmacy
Plus has sent communications to care homes they
provided services for. These contain recommendations to
maintain sources of medicine supply and further actions
for care home teams.
Due to the volume and distribution of care homes
potentially affected NHS England is requesting support
to cascade this message to Local Authorities, care home
providers and GP practices as a matter of urgency.
JULY 2014 / 17
EDUCATION
TRAINING & EVENTS ACROSS THE UK
The Dispex Training Team is pleased to announce the
Autumn/Winter course dates. We would like to thank all
our members for the input received on the Training Needs
Analysis form.
For further information please email
enquiries@dispex.net or call the Training Team on
01604 859 000.
Pricing per delegate :
Dispex Members £75 + VAT
Non Members £125 + VAT
Preparing for CQC visit and responding
to CQC inspection (Limited availability)
Dispex has developed a special workshop to help you
prepare for your CQC visit.
This training afternoon will be a CQC workshop,
where you will have the chance to review what you
already have in place and to help you plan and prepare
for the CQC inspection.
Date/Venue
17 July 2014, 1-5 pm
Blisworth, Northampton
(NN7 3DG)
SEPTEMBER
10th, Drug Tariff and Endorsing - Kent
11th, Drug Tariff and Endorsing - Lancashire
11th, Drug Tariff and Endorsing - Shropshire
17th, Controlled Drugs - Sussex
17th, Drug Tariff and Endorsing - Cornwall
18th, Drug Tariff and Endorsing - Oxfordshire
24th, Controlled Drugs - Norfolk
24th, Drug Tariff and Endorsing- Dorset
24th, Controlled Drugs - Surrey
25th, Drug Tariff and Endorsing - Derbyshire
OCTOBER
1st, Business Management of the Dispensary - Sussex
2nd, DRUMs - Northamptonshire
8th, Business Management of the Dispensary - Warwickshire
9th, Controlled Drugs - Gloucestershire
15th, Controlled Drugs - Shropshire
15th, Business Management of the Dispensary - Cambridgeshire
15th, Controlled Drugs - Devon
16th,, Business Management of the Dispensary - Cheshire
16th, Controlled Drugs - Cambridgeshire
16th, Controlled Drugs - Somerset
22nd, Controlled Drugs - Lancashire
22nd, DRUMs - Herefordshire
23rd, Business Management of the Dispensary - Yorkshire
29th, Business Management of the Dispensary - Somerset
30th, DRUMs - Nottinghamshire
18 / JULY 2014
th
Cost
DISPEX Members £75 + VAT
(limited to 2 spaces per practice)
Non- Members £175 + VAT
(limited to 1 per practice)
NOVEMBER
5th, DRUMs - Surrey
6th, Controlled Drugs - Lincolnshire
12th, DRUMs - Somerset
12th, DRUMs - Yorkshire
13th, Controlled Drugs - Yorkshire
19th, DRUMs - Dorset
19th, Competent Dispenser - Sussex
20th, Competent Dispenser- Northamptonshire
26th, DRUMs - Cornwall
27th, Competent Dispenser - Lincolnshire
DECEMBER
3rd, Competent Dispenser - Norfolk
4th, Competent Dispenser - Cheshire
10th, Competent Dispenser - Wiltshire
SPECIAL OFFER
Returning non-members can renew their membership
for £165 + VAT
VAT MASTERCLASS
12TH JUNE 2014
DISPEX HQ, Northamptonshire
“We are so pleased that we attended, it was a very hot
afternoon, the staff at Dispex had put a lot of effort into
making delegates feel welcome, comfortable and at ease.
Colin and Nick made what is a very dry subject matter,
interactive, engaging and informative. Delegates were
encouraged to ask questions throughout the presentation
and we felt able to ask, what we thought might be basic
questions, without feeling exposed. We would recommend
this course to staff in general practice with responsibility for
VAT.”
Caroline & Lyn
Harrold Medical Practice
Dispex members since 2005
Nick Babington from Moore & Smalley pictured here
with Lyn & Caroline (left and right)
THE FOLLOWING COURSES ARE AVAILABLE FROM DISPEX THROUGHOUT AUTUMN 2014
Business Management of the Dispensary – How To Run a Profitable Business
This course will provide you with the key skills and knowledge to successfully manage your dispensary and how to
increase and maintain your profitability. Learn from our experienced tutors about remuneration, how to improve
dispensary management, how to maximize income from The Drug Tariff, or renowned top tips for profit, where and
how to make your buying decisions and more!
DRUMs – How to Get the Most out of them!
Learn how to carry out a successful and useful Dispensary Review of the Use of Medicine[s] [DRUM] with our
experienced and dedicated tutors ALL of whom work in primary care and deliver DRUMs regularly for their surgeries.
Turn your DRUM experience into a pleasure from a chore.
The Competent Dispenser – Moving Forwards with Your Dispensing Career
This course is aimed at dispensing staff who want to gain a better understanding of how the dispensary works and your
role within it. In addition to improving self-confidence and working efficiency, the course will also provide a valuable
background for future professional development. The course is run interactively, enabling you to exchange views and key
ideas and tips with other managers and increase the value of the course.
The Drug Tariff and Endorsing for Profit – An Essential Course for Experienced Dispensers and GPs
To run a successful dispensary you need to fully understand the Drug Tariff and how it affects your surgery
reimbursement. The Drug Tariff is a complicated area and the more you understand it the more likely you are to increase
and maximize your dispensing income. Learn how purchasing decisions can affect profitability.
Controlled Drugs – All You Need to Know on This Thorny Topic
This course is designed to ensure that you are complying with the requirements of the law on controlled drugs. From
purchasing to dispensing we help you with the entire process of holding and managing controlled drug stock. The course
is suitable as a grounding for new dispensers to give them the background on CD legislation AND those entrusted with
CD control in the surgery.
All delegates attending our Controlled Drugs course will receive a free copy of the latest edition of “Controlled Drugs in
Primary Care, The Law, Probity and Good Practice” worth £34.99 which provides invaluable information in this
complex area.
JULY 2014 / 19
PEOPLE
ROLE OF THE RECEPTIONIST
by Vanessa Kingsbury
Are GP receptionists a treasure, a resource that is
undervalued and under-developed, or fierce and
unprofessional call takers?
Receptionists are of course gate keepers- GP time is not
unlimited and it’s vital that the most seriously ill are
prioritised. Many of their interactions with patients are
with those who are ill, anxious, concerned and so it’s not
surprising that they often bear the brunt of the anger and
frustration that the patients end up feeling.
It’s surprising therefore, that receptionists are rarely given
customer service training, nor basic questioning skills to
facilitate a decision to refer, prioritise, or defer.
Receptionists are usually friendly, approachable and
efficient. They know their patients and are often living in
the locality, thus they can communicate well, appreciating
the diverse needs of their community. But there are some
obvious barriers - they may not be seen as part of the
professional healthcare team. They may not be seen as
personnel who appreciate the importance of patient
confidentiality, or they may not be perceived to have the
knowledge to make any decisions about the severity of
symptoms.
Firstly, let’s address the image. We could start with the job
title. The term ‘receptionist’ for most conjures an image
of someone behind a desk making appointments or
reservations. Presumably filing their nails when the phone
is quiet and certainly not qualified, busy with a whole raft
of other administrative tasks, or entitled to ask questions or
give advice. So, my initial recommendation would be to
equip them with a smart healthcare uniform, a new job
title – (Patient Care Facilitator is my best suggestion thus
far, but I’m open to ideas) and a badge.
Then, training is vital - a structured programme of
development to equip this new Patient Care Facilitator to:
•Greet the patient
•Acquire the required information
•Assess the situation
•Decide on a course of action which could include
arranging for a call, making an appointment, signposting
to another agency...
•Deal with any resistance, high-pressure situations
•Give opportunistic wellbeing advice
•Record the outcome
Sufficient support and mentorship must also be in place.
Dealing with so many patients and carers who can be
20 / JULY 2014
distressed, demanding, angry and abusive can be
emotionally exhausting.
And lastly, for now anyway, their role needs marketing.
Patients can be programmed to understand the role and
their expectations can be managed. Maybe ‘Tell the Patient
Care Facilitator’ with an explanation of what they need to
know – and why. Simple methods such as flyers
introducing the role of ‘Mary, your PCF’, leaflets detailing
the questioning protocol they will use, websites, radio
advertising, videos in the waiting room...
There’s lots to be done to slay the dragon myth – and it
doesn’t stop with the metamorphosis of the receptionists.
Jonathan Hammond, lead author on the paper from The
University of Manchester’s Institute of Population Health,
said: “It might be the case that what are portrayed as
individual failings on the part of receptionists are actually
due to systemic problems within GP practices.
Any further training to address negative aspects of
receptionist-patient relationships should reflect on the
organisation and social dynamics within practices if wholepractice functioning and overall patient care are to be
improved.”
Buttercups Training will be launching a training
programme for ‘Patient Care Facilitators – the new GP
receptionists’, in September 2014.
UPDATES
CONTROLLED DRUGS RECLASSIFIED
The legal status of four drugs changed on Tuesday 10 June
2014.
Lisdexamfetamine will become a schedule 2 controlled drug
(CD POM)
-Secure storage regulations apply for Dispensing Practices –
-Lock in CD cupboard
-Create new CD Register page for lisdexamfetamine
Tramadol will become a schedule 3 CD (CD No Register
POM), but will be exempt from Safe Custody Regulations.
-Schedule 3 CDs cannot be issued via Electronic
Prescription Service (EPS), as an NHS Repeat Dispensing
(RD) prescription, or as a repeatable private prescription
-Remove tramadol from any RD Permissions on your
Clinical System
-Respond to requests for new non-repeatable prescriptions
from any Community Pharmacies who have a current RD
prescription.
Zopiclone and Zaleplon will become schedule 4 part 1
controlled drugs (CD Benz POM)
Processes for Controlled Drugs that all staff should be
aware of
•All prescriptions for CDs are only valid for 28 days from
date of prescribing.
•Any obsolete or patient returned CD medication needs to
be denatured before disposal.
•Schedule 2 and 3 CDs are subject to more stringent rules;
-prescription writing - ensure that your Clinical System
supports this for the “new” CDs
-emergency supplies are not allowed
-Any stock transfers will require a CD requisition
If you have any queries or require further information,
please contact your local NHS England Area Team
DRUG SHORTAGES
You will be familiar with the ongoing issues concerning
stock shortages of pharmaceutical products. Regardless of
the reasons for this we are committed to helping dispensing
doctors find suitable medicines for dispensing and to give
you an alert to those items which may be in short supply in
the near future by looking at the supply trends.
The list below is of items which may be in short supply or
out of stock with some wholesalers.
BACTROBAN CREAM & NASAL OINTMENT
CO-AMILOFRUSE 5/40MG
CO-AMILOFRUSE 2.5/20MG
CO-AMILOZIDE 5/50mg TABS
CO-TENIDONE 50/12.5MG
CO-TENIDONE 100/25MG
COLESTID SACHETS
COLESTYRAMINE SACH 4G SF
DOSULEPIN 75MG TABS
FEMSEVEN
ISTIN 5 & 10MG TABS
PANOXYL 5 CREAM 40G
PANOXYL 10 ACNE GEL 40G
PIROXICAM GEL
POLYFAX OINTMENT
SLOW K TABS 600MG 100
TRAXAM FOAM
VERAPAMIL 40, 80 AND 120MG TABS
Contact Lexon on 0800 614242 to check their stock status.
JULY 2014 / 21
UPDATES
CATEGORY M UPDATES APRIL-JULY 2014
Main Price Drops Cat M April 2014 to July 2014
Drug Name
Pack Size
Price in April Price in July
Change
Memantine 20mg tablets
28
28.85
14.53
-14.32
Levetiracetam 100mg/ml oral solution sugar free
300ml
27.64
20.65
-6.99
Memantine 10mg tablets
28
14.42
7.84
-6.58
Modafinil 200mg tablets
30
78.75
74.95
-3.80
Pramipexole 88microgram tablets
30
4.45
2.33
-2.12
Drug Name
Pack Size
Price in April Price in July
Change
Sulfasalazine 500mg gastro-resistant tablets
112
7.67
11.93
4.26
Hydroxocobalamin 1mg/1ml solution for injection ampoules
5
3.67
8.65
4.98
Trazodone 50mg/5ml oral solution sugar free
120ml
29.04
36.39
7.35
Mycophenolate Mofetil 500mg tablets
50
11.82
20.61
8.79
Mebeverine 135mg tablets
100
5.06
15.64
10.58
Main Price Rises Cat M April 2014 to July 2014
Drug Tariff Category M Changes for July 2014
12 lines have been added to the Cat M list for the Quarter commencing July 2014 with 10 showing a price fall and 2 a
price rise. Category M continues to reduce the profitability of dispensing doctor income making the correct purchasing of
generics one of your dispensary managers’ greatest concerns.
Product
Pack Size June 2014 Drug July 2014 Drug
Tariff Price
Tariff Price
Price
Change
Flucloxacillin 125mg/5ml oral solution
100ml
£21.38
£5.07
-£16.31
Hydrocortisone 10mg tablets
30
£66.88
£51.46
-£15.42
Hydrocortisone 2.5% cream
15g
£24.20
£10.26
-£13.94
Co-careldopa 25mg/100mg tablets
100
£26.23
£13.78
-£12.45
Propylthiouracil 50mg tablets
56
£60.43
£50.56
-£9.87
Amorolfine 5% medicated nail lacquer
5ml
£14.72
£5.97
-£8.75
Colchicine 500microgram tablets
100
£36.23
£31.03
-£5.20
Flucloxacillin 250mg/5ml oral solution
100ml
£26.04
£20.94
-£5.10
Ibuprofen 600mg tablets
84
£6.93
£2.91
-£4.02
Indoramin 20mg tablets
60
£12.28
£8.64
-£3.64
Mometasone 50micrograms/dose nasal spray
140dose £7.57
£5.76
-£1.81
Sodium valproate 200mg/5ml oral solution sugar free
300ml
£5.66
£4.64
-£1.02
Calcium and Ergocalciferol tablets
28
£10.77
£10.03
-£0.74
Hydroxychloroquine 200mg tablets
60
£4.95
£4.96
£0.01
Macrogol compound oral powder sachets NPF sugar free
30
£6.68
£7.81
£1.13
22 / JULY 2014
EDITORIAL
OWNING THE PRACTICE by David Walker
IS OWNING THE PRACTICE PROPERTY STILL A
GOOD IDEA?
This is not a straightforward question. On the one hand,
there are apocryphal stories of premises valuers considerably
discounting their figures because of uncertainty in
continued notional/cost rent funding. On the other hand,
we see new developments and redevelopments where, given
all the necessary due diligence and risk analysis, valuation
remains high and lenders are still prepared to offer a high
proportion of borrowing.
We are not at all sure, however, that this is much different
to the way it has been for many years. The key is that,
providing that the NHS is getting what it wants from
general practice property, it will be prepared to pay for it.
Recent developments are merely further proof of that.
For instance, the Health and Social Care Act 2012 wishes
to approach patient care differently. There is a wish to
integrate social care with primary care and remove patients
from hospitals. If your practice property, apart from your
own GP consulting and treatment rooms has on-site
diagnostics, extended opening, a minor surgery theatre,
physiotherapy, counselling and rehabilitation services and
also provides offices for the Citizens’ Advice Bureau to
utilise, then you are providing a premises fit for the 21st
century NHS and you will probably receive the necessary
backing, from banks, Health Boards, valuers etc.
If not?
This is not to say either that services should ever stand still.
Amendments will be necessary for CQC registration from
April 2013.
-Is the practice geared up for telemedicine?
-Is there on-line appointment booking?
-Is the available space used as efficiently as possible for the
things that you do now?
-What about a pharmacy?
-What about car parking?
Patients now have the freedom to register with any GP
practice they wish, provided that practice does not have a
good reason why it cannot register you; for instance, it has
no room left. It seems natural, therefore, that patients will
gravitate to practices where they are getting the best care,
with the widest range of services, provided most efficiently.
The future is still uncertain regarding property, but it seems
to us that the NHS will continue to back its image of itself.
If that is how the practice premises that you are considering
buying into looks, and you can afford to do so, it still seems
like a sensible option.
This article was written by David Walker Healthcare
Services Senior Tax Consultant at Moore and Smalley – he
can be contacted directly on 01253 404404 or by email at
david.walker@mooreandsmalley.co.uk
JULY 2014 / 23