The stated aims of the Community Pharmacist Consultation Service include bringing community pharmacy into the front line of the urgent care system and increasing patient awareness of the role of community pharmacy.
This is a huge win for the image of pharmacies as providers of effective and professional healthcare, and a move away from the outdated view of a pharmacy as just a retail emporium with overheads. Pharmacists have had many top tips on the service, but here are a few more from a legal point of view.
Diversion of prescriptions
The service specification states that “the service must not be used to divert or attempt to change the patient’s use of their usual pharmacy”. Direction of prescriptions is a well known issue in community pharmacy and this requirement supports the established position that it is patients who choose which pharmacy they attend, rather than pharmacists or GPs.
this requirement supports the established position that patients choose which pharmacy they attend
The difficulty here is that under the CPCS pharmacists are offering support to a patient when they really need it. If the pharmacist does the job well, the patient will be happy (usually) and may well want to use that pharmacy again. The pharmacist should make sure there is a note of the conversation they have had about how the patient’s usual community pharmacy would be able to support the patient if the individual receiving the service is not one of their usual clients. Ultimately though, it is the patient’s choice.
Consulting Summary Care Records (SCR)
The service specification says the pharmacist must consult the SCR if the referral from NHS111 is about urgent medicines supply, unless there is good reason not to. However, the NHS England guidance says that verification can be simply examining physical evidence such as a repeat medication slip or current labelled medication. If a query is raised, the pharmacist should be able to justify the decision not to access SCR with reference to a contemporaneous note.
If the pharmacy cannot supply medication, having made a decision that supply is appropriate, then there is provision for onward referral to another pharmacy, and that pharmacy will also be paid the CPCS fee.
There does not appear to be anything in the service specification or guidance to say that there cannot be a branch to branch referral if the related pharmacy is convenient for the patient. However, there is bound to be monitoring of the service and pharmacies that constantly refer on to one branch are likely to be picked up as outliers when the payment pattern is scrutinised.
The service specification is silent on labelling and the labelling requirements of the Human Medicines Regulations must be followed. NHS guidance adds that the words “Emergency Supply” should be on the label in the way it recommends for an emergency supply outside CPCS. This is beyond the requirements of the HMR, but is clearly good practice.
The duty of care of a pharmacist will extend to the acts carried out while providing the CPCS, which involves a pharmacist exercising professional judgment and discretion. If they get it wrong there could be a claim.
The pharmacist’s duty of care will, of course, extend to the situation where the system goes wrong and there is a patient standing at the pharmacy door with no proper referral notification. It will also extend to the position in the future when the patient understands the expertise that a pharmacist can offer and bypasses the 111 system to come straight to the pharmacy. But this responsibility is part of the pharmacist’s role as a clinical professional.
In summary, there are elements of the CPCS pharmacists need to be careful about, but this should not detract from the opportunity to deliver a valuable local service.
This is a general overview. Independent legal advice should be sought for any specific concerns.