We realise, however, that many of you will feel overwhelmed with anxiety and stress trying to deal with the pharmacy and your own personal situations.  In its recent meeting the LPC thought it would be useful to pool together as much information as possible to help.

We appreciate this is a long email however we will put it on our website for reference and hope it will help you to work in the challenging conditions.

Thanks
Sami

1. Business Continuity

Ensure that you have reviewed your Business Continuity Plan. Consider planning for staff shortages of up to 50% given the recent government guidance on social distancing strategy.  Also consider your cleaning protocols to ensure all surfaces touched by patients and staff are frequently cleaned.

Other practical ideas that you may wish to consider under different scenarios within your continuity plan include the following.

• Limit numbers entering the pharmacy
• Encourage contactless payements instead of cash
• Distance patients from counter areas and each other.  Eg implement a meter distance.
• Clean down pharmacy routinely in particular areas of high contact. Eg. Benches, door handle, till
• Implement distancing measures such as offering to sign prescriptions instead of handing over pens and paper to patients except where legally necessary eg cd collections.   or reducing the handling of goods using paper bags to hand over products safely.
• If shortages of staff become extreme consider locking door and serving at the door way
• Consider rationing of medication if shortages escalate. (This can apply to sales of medicines and owing of NHS prescriptions)
• Establish lines of communications with colleagues in other pharmaices locally and potentially and locums.
• Use PPE where necessary

2) Pharmacy Cleaning
Do you have a deep clean plan? We have confirmed with CCG that deep cleaning process is the same for cleaning process you would follow for any other body spillages within your pharmacy. e.g vomit or blood.

3) Pharmacy Closures
In the event of closure please follow your processes as well as informing NHS england and local surgeries. A copy of the  closure form can be downloaded by clicking here. To help us undertand the local picture we would appreciate it if you copy us in when informing NHS England of any closures.  Please copy Louise, our secretary in.

Returning Undispensed Prescriptions
In event of closure, please consider returning any undispensed prescriptions back to the spine so that other pharmacies can pull them through if needed.

4) Prescription Deliveries
Do you have process in place for delivery drivers delivering medications to patients that are self isolating?

5) Supervised Consumption
Consider how you will manage any patients on methadone or buprenorphine.   Gateshead Recovery Partnership and Humankind in ST have confirmed that supervision may be relaxed and they have been asked to ensure that all scripts have wording for ad hoc temporary closures. 

 Although where indicated on a prescription supervised consumption should be observed under normal circumstances, it is not a legal requirement. 

If a client reports they are too ill to come in, or are self-isolating, whether on supervised consumption or not, you may like you to observe the following protocol, given that both services are VERY AWARE that pharmacies will NOT be delivering methadone or buprenorphine to clients.

1. Contact the service by phone and report that the client is ill and has made this request.
2. Allow for a specified representative to collect once the service has been informed. This will not require a new prescription. Pickup days must remain the same.
3. If you have any concerns over specific clients or that medication may be being diverted, inform the service ASAP by phone.

Should the situation deteriorate, the intervals between pickups may be reviewed. This will be based on a risk assessment - and therefore will be on a case by case basis.

The services have direct access to the LPC and so if there are any changes they will let us know.  Again if you think you will need to close, please let our secretary, Louise Lydon, know asap so that we can make the services aware, and again help to plan capacity with other local pharmacies.

Bypass Phone Numbers
To help facilitate communication, if pharmacies have an alternative phone number that can be contacted in case of emergency, can you please forward this number to the Drug and Alcohol Services.  They may also be able to give you their bypass number for emergency use.  

6) Collobaration
At this time we would ask you to consider working closely with your local pharmacies to potentially share stock, staff and delivery drivers if this becomes necessary for patient care and pharmacy operational requirements. We urge you to speak to your neighbouring pharmacies now and establish channels of communication and cooperation.

This could be facilitated by your PCN leads.
 

7) Combatting Drug Shortages
The LPC became aware of GPs considering increasing the duration of prescriptions to “help patients access medication”. 

We have robustly rejected this with local GP leadership.

Any increase in the prescribing duration during the Covid 19 pandemic from monthly repeats to say 56 or 84 day repeats WILL create stock shortages that don’t exist at present and deny patients of important medication. It will also result in increased workload for GPs and pharmacies moving to alternative products. Please push back with surgeries using a similar argument should practices go off message.  We do not want artificial shortages to occur as has been seen with panic  buying of grocery items in supermarkets.

Patient Advice
The NPA and CCA have issued an open letter to patients, asking them to act in the interests of the whole community by helping pharmacies maintain vital services.

The letter highlights steps to maintain the supply chain in order to prevent shortages.  

It asks patients to

•  Act responsibly by not entering a pharmacy if you have symptoms of infection, such as a cough or fever.

• Please ask friends or family who are symptom-free to collect essential medicines for you.
• Only buy the medicines and supplies that you need right now to treat you and your family.
• Follow any instructions from our pharmacists and pharmacy teams.
• Treat our pharmacy teams in the way that you would wish to be treated yourself.
• Keep up to date with the latest online advice from the NHS.

A copy of the letter can be downloaded here

8) NHS Standard Operating Procedure (SOP)

Part of this SOP requires you to have a list of local NHS contacts.

The Local NHS England team have now prepared a useful list.  This can be downloaded here.

9)  GP2Pharmacy Service (South Tyneside)
The LPC has been in discussion with ST health collaboration regarding the GP2P service.

Please note that as a result of the current COVID19 outbreak, GP receptionists have been informed to temporarily cease referring sore throat symptoms to pharmacies under the GP2P scheme as these patients may be masking Covid 19 symptoms. Further all referrals should be accompanied by a patient telephone number.

Please review your current operating procedures & consider telephone screening of all patients & advising not to attend the pharmacy in person if there is any suspicion of Coronavirus.

Medication may still be supplied to any patient representative, for other conditions, under the scheme after a telephone consultation with the patient.

Key points to note:

• Practices still book into GP2Pharmacy appointments diary
• They include the patients telephone number
• They tell the patient that the pharmacists will call them at that time
• The pharmacists calls the patient for a telephone appointment
• The pharmacist will be required to still complete the GP2Pharmacy diary as if the patient had arrived - this way the practices can see that the patient has been contacted.
• Pharmoutcomes will still need to be completed

We understand that Simon Dukes (PSNC Cheif Executive)  has recently been in the media and in discussions with government around help that is needed for pharmacies and we welcome this and hope it results in positive action to help us maintain the valuable pharmacy network that is struggling but is extremely vital.  You can see more about this by clicking here.