Service Level Agreement

For
Wandsworth Pharmacy Asthma
Management Service

April 2010-March 2011

Wandsworth PCT Commissioning Strategic Goals

CSP4- Improve access to, and the responsiveness of, GP and other
Primary Care services.

CSP 5- Improve the quality of services for people living with complex
and/or long term conditions.
1 Agreement
3

2 Objectives 3

3 The Community Pharmacy Contractual Framework 3

4 CLINICAL GOVERANCE 4

4.1 Training & Accreditation 4

4.2 Service promotion 4
4.3 Premises 4
4.4 Service Continuity 5
4.5 Patient sensitivity and Confidentiality 5
4.6 Clinical Support 5
4.7Reciprocal Arrangements 5
4.8 Record Keeping 5
4.9 IT 6

5 Information Governance, Confidential information and data protection 6

6 Patients 6

7 Payments 7
7.1 Role of the PCT in processing completed forms. 7

8 Indemnity 7

9Transfer and subcontracting 7

10 Termination of Service 7

11 Audit 7

12 Variation 7

13 Default and termination 8

Appendix 1 PHARMACY INTERVENTION FORM 10

Appendix 2 INVOICE FORM 12

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 1. AGREEMENT

This agreement is made on the date shown on page 8, between NHS Wandsworth
(the Commissioner, hereinafter referred to as the PCT) and the pharmacy named on
page 5 (hereinafter referred to as the Service Provider).

2. OBJECTIVES

The principal aim of this service is to improve management of patients with

asthma, through:
o Increased use of inhaled corticosteroids in those at Steps 2 and 3 of the
British Thoracic Society (BTS) guidelines;
o Increased patient understanding of asthma, by providing tailored patient
education.
o Increased use of patient self-management action plans.
o To work with local PCT Prescribing Guidelines.
o To improve patient compliance and reduced wastage

Other aims are:

o To increase partnership working and improved communication between
pharmacists, the local Respiratory Nursing Network, specialist pharmacists
and prescribing advisors and other healthcare professionals;
o To enhance pharmacists professional practise.
o To link into the PCT Long term Conditions strategy around Asthma and
COPD.

3. THE COMMUNITY PHARMACY CONTRACTUAL FRAMEWORK

The Essential part of the Community Pharmacy Contractual Framework can add
value and support a PCT locally commissioned service. The service will be supported
by the Community Pharmacy contractual framework where the following services will
be provided:-

Signposting - The PCT will provide pharmacists with general information, named
individuals and details for the following services
Wandsworth Council Air Text Campaign
Asthma UK
Stop smoking service

Self care The pharmacist will be expected to provide self care advice around
lifestyle and improved compliance to empower patients to take more control on
their asthma.

Health Promotion to display and provide suitable Health promotion Literature

from asthma UK, Stop smoking and Airtext

Medicines Use review (MUR) patients appropriately selected for the WPAMS
service could be drawn from patients who have received an MUR in the past. If
an appropriate patient is selected into the service and has not received an MUR,
then an MUR could be offered at a later date if required as part of a follow up.

Information supplied will be regularly reviewed and updated by the PCT.

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 4 CLINICAL GOVERANCE

4.1 Training & Accreditation

Accreditation

A pharmacist must attend and complete (to the PCTs satisfaction) the PCT training &
accreditation programme comprised of the following elements
Attendance at a PCT accreditation workshop
Completion the CPPE modules on asthma
Completion of a Criminal Records Bureau (CRB) check with no adverse
outcome
The pharmacist will then be accredited as an approved practitioner for
providing this service;
The pharmacist should maintain clinical knowledge appropriate to their
practice by attending relevant study days, courses and to make them aware
of appropriate literature.
Pharmacists will provide evidence of appropriate CPD based on their training
needs assessment, to the Prescribing Team by the end of each financial year.

Records of completion of these packs must be kept within the pharmacy and can be
seen on request by the PCT.

Re-accreditation
Updates are recommended every years or as directed by the PCT which may be in
the form of attendance at additional or refresher training events, CPD declarations or
other methods of assessment as considered appropriate by the PCT.

The PCT will provide training as follows:

Meeting(s) to provide an update on asthma management and the Wandsworth
Pharmacy Asthma Management Service (WPAMS)
o service for participating pharmacists;
o Joint meeting(s) between participating pharmacists and GPs and other staff
from practices identified to take part in the pilot phase of the service;

Where there are concerns regarding poor performance, this will be addressed
separately as a clinical governance matter.

4.2 Service promotion

It will be important that clients receive accurate information about Pharmacies who
provide the service. Clients must not be placed in a situation where they have to visit
different pharmacies to receive a service.

4.3 Premises

All services must be provided in an approved pharmacy, with a PCT approved private
consultation area as defined within NHS Pharmaceutical Services 2005 for the
provision of Advanced Services
The pharmacy will be required to provide dedicated window space to advertise the
availability of the service from that pharmacy, and an appropriately placed poster
within the pharmacy.

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4.4 Service Continuity

It is the responsibility of the Community Pharmacy Provider to ensure continuity of

service. All members of the pharmacy team including locum pharmacists, new
pharmacists, pharmacy technicians and staff should be aware of the service content
and commissioning requirements of this LES. If a Community Pharmacy has a
change in staffing where the new Community Pharmacist does not meet the
competency requirements defined within the LES the Community Pharmacy Provider
must inform the PCT giving a minimum of 4 week notice along with a proposal for
continuity of service learning no more than a 4 week break.

4.5 Patient sensitivity and Confidentiality

A pharmacists duty of confidentiality is outlined in Part 2 of the Code of

Ethics. It states that:
The public is entitled to expect that pharmacists and their staff respect and
protect the confidentiality of information acquired in the course of their
professional duties. The duty of confidentiality extends to any information
relating to an individual, which pharmacists or staff acquires in the course of
their professional activities. Confidential information includes personal details
and medication, both prescribed and non-prescribed.
Due to the nature of the service, all Community Pharmacy providers must provide an
understanding and supportive environment. This will require that all members of the
pharmacy team and made aware of the responsibilities of this service and the
importance of providing a conducive and supportive environment.

The patient must be asked to sign the declaration on the WPAMS form that they
consent to the information being sent to their GP.

4.6 Clinical Support

The competent pharmacist should not be working in isolation and must feel
confident to refer to other sources of information and support including other
participating pharmacies, the PCT COPD Group, the local respiratory network.

4.7 Reciprocal Arrangements

Wandsworth PCT may recognise the training received by a registered pharmacist

from another PCT within 15 months. Final approval will be based a local decision on
a case by case basis by a PCT Officer. Competent Pharmacists who have been
trained and accredited by other PCTs will have to follow the Wandsworth PCT
Service Level agreement.

4.8 Record Keeping

Pharmacists must keep a record of the consultation and its outcome on the WPAMS
form that has been provided. Ideally computerised medication records should also
be kept. Client records must be kept by the accredited pharmacy for 8 years.

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4.9 IT

Pharmacy providers must have the following arrangements in place

PC with N3 connection, access to the internet, Windows and Microsoft Office
software applications e.g. Word, Excel, and PowerPoint.
Telephone, printer, fax and an NHS email account to allow transfer of patient
sensitive data to the PCT, GP practices and the Respiratory nurses.

5 INFORMATION GOVERNANCE, CONFIDENTIAL INFORMATION AND DATA

PROTECTION

The named pharmacist shall not, whether during or after their appointment, disclose
or allow to be disclosed to any person (except on a confidential basis to their
professional advisers) any information of a confidential nature acquired by the
pharmacist in the course of carrying out their duties under this Agreement, except as
may be required by law or as directed by their PCT.

The pharmacist must protect personal data in accordance with the provisions and
principals of the Data Protection Act legislation and must ensure the reliability of the
staff that has access to such data.

All participating Community Pharmacies will be compliant with information

Governance requirements.

6 PATIENTS

Whilst all patients with asthma are eligible for inclusion in the service, pharmacists
should target those patients presenting:
Repeat prescriptions for inhaled short acting 2-receptor agonists in the absence
of an inhaled corticosteroid (ICS)
Repeat prescriptions for inhaled short acting 2-receptor agonists and ICS but
who refuse the ICS
The Pharmacist will review a maximum of 40 patients in one year. If the
Pharmacists wish to do review more patients, approval will required be at the
discretion of the PCT with professional input from the PCT respiratory nursing
team.

Patients identified for inclusion will be asked to complete the first section of the PCT
intervention form. Patients may also be identified from completed MURS, referrals
from GPs, respiratory nurses and examples of poor compliance.

The pharmacist will discuss the following with the patient:

Their responses to the questions on the form;
Any problems with compliance;
Lifestyle such as stop smoking and referral to a stop smoking service.
Educational needs, e.g. inhaler technique etc.
Raising awareness of the Wandsworth Council Environmental Department Air
Text service.

In the event of an adverse incident or near miss, the pharmacist will fill in The PCT an
incident reporting form and forward a copy to the PCT

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7 PAYMENTS

Service providers will receive 30 per consultation for an appropriately selected

patient. Reimbursement will be dependent on submission to the PCT of a fully
completed intervention form. The bottom copy of the intervention form should be sent
to the PCT by the 8 th day of the month following the month in which the intervention
form was returned by the patients GP.

7.1 Role of the PCT in processing completed forms.

The PCT will check that the intervention form has been completed satisfactorily
and obtain any missing information.
The PCT will agree the appropriate reimbursements to the pharmacist in each
case and make arrangements for payment.
The PCT will monitor vouchers received for duplicate claims/ recurrent claims by
patients and any other misuse of the scheme.
The PCT will ensure comprehensive audit trail for payments

8 INDEMNITY

The service provider will operate in accordance with all Acts of Parliament,
statutory regulations or other such laws, recommendations, guidance or practices
as may affect the provision of services specified under the Agreement.

Any litigation resulting from an accident or negligence on behalf of the Provider is

the responsibility of the Provider who will meet the costs and any claims for
compensation, at no cost to the PCT. The pharmacist must ensure that their
professional indemnity insurance provider has confirmed that this activity will be
included in their policy.

9 TRANSFER AND SUBCONTRACTING

The service provider will not assign the whole or any part of the Agreement or sub-
contract the supply of services without the previous consent in writing of the
Purchaser, unless special conditions are included elsewhere in the Agreement.

10 TERMINATION OF SERVICE

Either party may terminate this agreement by providing written notification of their
intention to do so. A notice period of 28 days shall be given.

11 AUDIT

The audit for the service should provide information on the following criteria: -
Demand for the service and monthly supply of asthma service activity.
Incidents where Community Pharmacists could not provide the service

12 VARIATION

The services and fee structure or any aspect of this agreement may be varied
if:
The parties agree in writing, or
Upon request by the PCT where there is a change in the Trusts service priorities
or where there is a change in the way in which this agreement is required to work
as requested by:

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 Changes in legislation, guidance or directions from the Department of Health,
or
Other exceptional circumstances.
Changes to service as a result of evaluation.

Proposals to vary the service may be initiated by any party. A request to vary
the service will require at least one-months written notice unless the parties
agree otherwise.

13 DEFAULT AND TERMINATION

Any party may terminate this agreement by immediate notice to the other parties if
any of the other parties refuses or fails to carry out any of its obligations, if the matter
complained of is:

Incapable of rectification, or Capable of rectification, but has not been rectified within
14 days of the notice being sent to the reasonable satisfaction of the non-defaulting
party serving the notice.

If the pharmacist has failed to perform the services in accordance with this
agreement or is otherwise in breach of this agreement, and the pharmacist has not
remedied the breach where it is capable of being remedied within such a time as may
have been notified to the pharmacist, the PCT may terminate this agreement in
respect of the services only and provide or procure a third party to provide such
services.

The PCT may terminate this agreement by immediate notice if the pharmacist ceases
to provide pharmacy services from the Pharmacy or they are withdrawn or removed
from the Pharmaceutical list, by whatever means.

Upon termination of this agreement each party shall return to the relevant party all
the other partys documents and materials and all copies thereof which are of a
confidential nature.

The pharmacist shall co-operate fully with the PCT during any handover leading to
termination of this agreement. This co-operation shall extend to full access to all
documents, reports, summaries and any other information reasonable required by
the PCT to achieve an effective transition without disruption to routine operational
requirements.

The pharmacist shall not be entitled to assign or sub-contract its rights or obligations
under this agreement to any person without prior written consent of the PCT.

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LEAD OFFICERS FOR AGREEMENT

The lead commissioning officer for this agreement is:

Name: David Tamby Rajah

Position: Community Pharmacy Lead

Address:

Telephone: 020 8812 7770

Email: david.tambyrajah@wpct.nhs.uk

The lead service provider officer for this agreement is:

Name: ..

Position: ..

Pharmacy: ..

Address:

Telephone:

Email:

SIGNING OF THE AGREEMENT

This document and the attached notes comprise the Agreement concluded
between NHS Wandsworth and the pharmacy named above.

SIGNED: . Date: .....

SIGNED: . Date: .....

PHARMACY ASTHMA SERVICE

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 APPENDIX 1 PHARMACY INTERVENTION FORM
ASTHMA CONTROL TEST (ACT)
Patient's Name and Address ACT SCORE
AT 1ST
(affix Pharmacy Label here) REVIEW ACT SCORE AT 2ND REVIEW

DOB: .. Attach ACT review to this form

Doctor's name :
Practice Name:
SYMPTOM REVIEW
Do you have asthma? YES / NO Do you have COPD? YES / NO

Do you smoke? YES / NO If so how often? .

Referred to quit smoking service YES / NO
Are you pregnant? YES / NO

Wheeze on
Day Time Symptoms: exertion YES / NO
Exercise induced eg. climbing stairs or brisk walking YES / NO
Cough YES / NO
How many times do these symptoms occur? ../ week
Night Time Symptoms: Disturbed / Broken Sleep YES / NO
Wheeze on waking YES / NO
Nocturnal cough YES / NO
How many times do these symptoms occur? ../ week
How many times have you taken your Blue inhaler over the past 7 days?........................
Are there any known trigger factors including exercise?............................................
In the last month:
how many days off work have you taken as a result of your asthma? .
how many days were normal activities effected by your asthma? ..
What is the patients peak flow reading? ..
MEDICATION
What medication and inhaler do you use to control your asthma?
Medication Device Dose
Reliever / Rescue
ie Salbutamol or Terbutaline
Preventer / Protector
ie ICS / LABA / or combination
Do you experience any unwanted side effects from your asthma meds?..
Do you understand which inhaler does what?...................................
How often time do you use your Preventer Medication (ICS or Combination)?
When I get
Regularly Everyday symptoms When I remember
Are you on Theophyllines? YES / NO

Page 10 of 13
Are you on Leukotriene receptor antagonists? YES / NO
Do you take any NSAIDS such as Aspirin/Inbuprofen? YES / NO
Are you on Beta Blockers YES / NO
Do you take any OTC meds such as Cough Medicine? YES / NO
If so what and how often? .
Medication
Other symptoms Yes No taken
Hayfever / Allergies
Gastric symptoms
Nasal symptoms
Inhaler Technique Assessed? YES / NO
Optimal Inspiratory flow assessed with in-check dial? YES / NO

INTERVENTIONS BY PHARMACIST
Action Taken: YES NO Notes
ASTHMA DISEASE EDUCATION
ASTHMA THERAPY EDUCATION
INHALER TECHNIQUE ADVICE
QUIT SMOKING ADVICE
AIR TEXT SERVICE
OTHER
REFER TO GP / NURSE (see below)
Recommendations Modify / change inhaler Stop smoking advice/ refer
(please delete) Self Management Plan Flu immunisation
Review medication
Add spacer dose
Notes:

Reviewer Signature Date Reference Number

I (patient) consent to this information being sent to my GP:

FOR SURGERY GP OR NURSE

Agree with Review YES / NO
Action: Medical Record Amended
Patient followed up in surgery

Signed Date..
FOR THE PCT

Approved YES / NO

Signed . Date

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 Appendix 2 Invoice form LOCAL SCHEME 9

INVOICE DATE

INVOICE NAME ASTHMA

NAME & ADDRESS OF PHARMACY DETAILS OF THE CLAIMANT

(BANK DETAILS-OR ADDRESS WHERE
PAYMENT SHOULD BE SENT

Email address

INVOICE AMOUNT

NUMBER OF PATIENTS REVIEWED .

Fee/patient 30/patient

TOTAL CLAIMED ..

SIGNATURE PHARMACIST IN CHARGE

DATA EXTRACTION SEND IN COPIES OF PAYMENT -PLEASE SUBMIT YOUR MONTHLY

INDIVIDUAL PATIENT FORMS AND A COPY FORMS BY THE 8TH OF EACH MONTH TO
OF THE MONTHLY CLAIM FORM TO ENSURE PROMPT PAYMENT TO:

Mr FADI DEXTER Mary Clarke, Medical Administrator

PRIMARY CARE SUPPORT MANAGER
Wandsworth Teaching Primary Care Trust
Third Floor, Wimbledon Bridge House
Hartfield Road London SW19 3RU
FAX 020 8812 7780
Primary Care Support Service
187 Ewell Road,
Surbiton, Surrey KT6 6AU
Telephone: 020 8335 1327 / Fax: 020 8335 1374
E-mail: mary.clarke2@nhs.net
This must be sent by the 8th of the following
month.

PLEASE FILL IN ALL RELAVENT FIELDS

KEEP A COPY FOR YOUR RECORDS
PLEASE SUBMIT MONTHLY

COST CODE 791679 6280

Wandsworth PCT xXDAVID TAMBY RAJAHXx
Your signature
PLEASE RETAIN A COPY OF THIS INVOICE FOR YOUR RECORDS.

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Cost code xX David Tamby Rajah

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