THE INDISPENSABLE DOCTORS JOURNAL WWW.DISPEX.NET

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IMPORTANT! Influenza 2018/19NHS England is now advising all practices to use the adjuvanted trivalent vaccine (Fluad - Seqirus)for all patients over 65 and a quadrivalent vaccine for any ‘at risk’ groups including pregnantwomen aged 18-65 years.

This decision has been based on clinical evidence from the Joint Committee on Vaccination andImmunisation (JCVI) and cost effectiveness studies by Public Health England.

Suppliers of the adjuvanted trivalent and quadrivalent vaccines have given NHS Englandassurances that they will be able to cope with the increased demand for their vaccines.

Additional funding has been found to cover the additional costs of using the adjuvanted trivalentand quadrivalent vaccines, so practices do not need to worry about not being reimbursed.

News and Updates on Dispensing Doctor IssuesGeneric Profitability, Training, News, Drug Tariff Changes and More Inside...

VOLUME FIFTY MARCH 2018

IN-HOUSETRAINING

w w w . d i s p e x . n e t

Did you know we can come to you?

If our current classroom training courses are just too far from your practice, or on the wrongday of the week, or its just not convenient to send your dispensary team out on an away day

- then why not get us to come to you?

We charge a flat rate to DISPEX members to train up to 6 delegates on site, at your surgeryof

£350 + travel at cost + VAT.

If you are considering re-joining Dispex please contact michelle@dispex.net for details of our current re-joining scheme.

Dispensing For Profit

For more information visit our website or call

01604 859000

MARCH / 3

EDITORIAL

What’s Inside Page

DDA Update 4

Dispensary Training 6-8

Generic Profitability 11

Drug Tariff News 12-13

NHS Prescription Open Days 14

Drug Tariff - How Well Do You Understand It? 15

Latin Terms and Abbreviations 16

Managing Complaints 18-19

Fridge Tips 20

Your Sickness Policy 22

The Ongoing Practice Lease Saga 24-25

Money Matters! 26

Arabic and Roman Numerals 28

DDA News Roundup 30-31

opefully you will, by now,have sorted your Flu2018/2019 orders followingthe advice and guidance

issued in February.

Every month we try and feature asmuch news, help and advice fordispensing doctor staff as we can.

And to that end it is vital that this copyof The Dispensary Gazette is beingsent to the correct person at yoursurgery; if you have to currently go andhunt it down then please emailmichelle@dispex.net and she willupdate your contact detailsaccordingly.

On a separate but related topic it wouldbe great if you could email us in ideasfor articles and topics you would like

us to cover, from Controlled Drugs tothe Drug Tariff to SOPs - email megreg@dispex.net with yoursuggestions.

The DDA and Dispex Mini-Conferencein Somerset [at time of writing] isalmost full, and by the time thismagazine hits down there may be nospaces left. But please feel free tocontact the office and double check asthis has proved very popular.

And where do you stand onprofitability and do you regularlycheck your reimbursement against theactual cost of the medicines youdispense?

Are your dispensary accounts splitfrom the main practice accounts so thatyou have a good idea of your actual

profitability? Or are they lumped inwith the general practice accounts?

One really important tip would be toensure that you know exactly whatyour cost and income is from thedispensary, and ask your accountants ifit stands up to local benchmarkprofitability.

It is well worth considering utilising aspecialist company who know andunderstand dispensing practice.

All the best for the Spring!

CHIEF EDITOR / SENIOR CONTRIBUTOR Greg Bull gbull@dispex.net

TRAINING & MARKETING CONTRIBUTORSJane Norrey and Michelle de la Bertauche

The Dispensing Doctor GazetteDispex Ltd, 7-8 Prospect Court, Courteenhall Road, Blisworth, Northamptonshire NN7 3DGEngland

Telephone 01604 859000

Fax 01604 859687

Advertising enquiries@dispex.net

Website www.dispex.net

The views of contributors and guest columnists are notnecessarily the views of Dispex Ltd.

Whilst every care has been taken to ensure the accuracy of thecontents of this magazine, the publishers cannot accept liabilityfor any errors or omissions or any incorrect interpretation on anysubject matter(s).

If in doubt, you should seek the appropriate professional advice.

All third party content, registered trademarks, logos and imagesare owned by the respective brands.

No reproduction of any part of this magazine is allowed withoutprior written consent from Dispex Ltd.

Copyright 2017 © Dispex Ltd. All rights reserved.

H

A colleague drew to my attention arecent story from one of the ‘redtop’ tabloids. The gist of it is that awell-known high street chain ofpharmacies charged the NHS£1,500 for a single £2 pot ofmoisturiser. A 500ml tub isregularly prescribed across Britainfor just £1.73, according toanalysis by the newspaper inquestion.

It seems this is another exposeabout ‘specials’ and you may recall reading stories abouta similar situation involving a manufacturer as few yearsago.

As a taxpayer, stories like this make me very angry. Ihave no objection to manufacturers, wholesalers andNHS contractors making a reasonable margin on thedelivery of their services. We live in a global marketplace, whether we like it or not, and the market moreoften than not delivers consumers the best deal.

However, key is what is ‘reasonable’ and we must notforget that the NHS is not a perfect market and it neverwill be.

The Department of Health and Social Care realised thislast year and legislation now exists to deal withcompanies and contractors throughout thepharmaceutical supply chain who abuse their marketposition and overcharge the NHS. I hope that thislegislation will be used in the case revealed by theSunday newspaper. In my view, the Department ofHealth and Social Care only needs to make an exampleof a few rouges to get this situation under control.Taxpayers’ money is scarce and should be spent wisely;it is not a bottomless pit to be mined by the greedy few.

Mention of making a reasonable margin brings me to therecent letter to all practices and community pharmaciesfrom NHS England giving final advice on ordering ’fluvaccine for the 2018/19 season.

The guidance, comes in the form of a letter from NHSEngland’s National Medical Director and Director ofPrimary Care, and Public Health England’s MedicalDirector asks GPs and community pharmacy contractorsto ensure their influenza vaccine orders for the 2018/19season use the most effective vaccines for thepopulation.

http://psnc.org.uk/wp-content/uploads/2018/02/07648-

Vaccine-ordering-for-2018-19-influenza-season-GPpharm-05022018.docx.pdf

The letter says the clinical evidence is clear that for the2018-19 winter season, GP practices and pharmacycontractors should offer:

1.The adjuvanted trivalent vaccine (aTIV) for all 65sand over;

and

2.The quadrivalent vaccine (QIV) for people in the 18 tounder 65s at risk group.

The letter also states that:

1.GPs and pharmacy contractors should review allorders (provisional and firm) for the 2018/19 season andensure these are in line with the evidence-based clinicalview;

2.Vaccine suppliers have confirmed that there will beenough adjuvanted trivalent vaccine and quadrivalentinfluenza vaccine to meet demand;

3.Orders for these vaccines will need to be placed by29th March 2018;

4.There is no change to the way in which contractorswill be reimbursed for vaccines administered – thesystem will be the same as for the current 2017/18service; and

5.If pharmacy contractors encounter any difficultiesfrom a manufacturer placing or amending an order, theyshould advise their local NHS England team.

The letter also contains the answers to a number offrequently asked questions, including on changing orswitching vaccine orders.

Please ensure that you orderyour vaccines by 29th Marchand that you are ready to gowith your ’flu vaccinationsthis year!

Matthew

4 / MARCH

DDA News Updateby Matthew Isom

DDA NEWS

MARCH / 5

Choose a Bonus Reward from one of the following dependent upon your volumerequired:

Buy 1000 doses and get a Free Half Day Dispex Classroom Training Courseplace [worth £102],

Buy 2500 doses and get a Free Years Dispex Membership [worth £198]

Buy 5000 doses and get a Free Practice Visit [worth £420]

Three reasons to buy your 2018 Influenza vaccines via Dispex

Great Discounts

Easy Ordering -

Download, fill in and faxback the form found here:

www.dispex.net/flu2018 to 01604 859687

OR

Telephone 01604 859000 and place your order

OR

Email sales@dispex.net

Influenza Vaccine NHS List Discount Net Price Order Volume

RequiredDeliveryDate

Generic Quadrivalent £8.00 50% £4.00

Influvac Quadrivalent £9.94 50% £4.97

6 /MAR 2017

COURSE DATES & LOCATIONS

6 / MARCH

Dispex Training Updatesby Jane Norrey

Three Easy Ways to Book:OBTAIN a booking form from the Dispex office and return a SIGNED copy to:-E:training@dispex.net F:01604 859687 OR submit your booking online www.dispex.net/training-services

2018 DELEGATE PRICES & BOOKING METHODS

Full Day prices*:Members: £135+vat Non-Members: £250+vat

COURSE TIMES: 9am-5pm (includes a light lunch)

Half Day prices: Members: £85+vat Non-Members: £160+vat

COURSE TIMES: 1-5pm(includes tea,coffee & biscuits)

*All courses are half days unless stated otherwise

March 7th-Practical Dispensary Management-NORFOLK, Caistor Hall, Caistor St Edmund, Norwich NR14 8QN7th-Monitored Dosage Systems “Best Practice”-SUSSEX, Roundabout Hotel, West Chiltington RH20 2PF8th-Controlled Drugs / Drug Tariff & Endorsing-SUSSEX, Roundabout Hotel, as above FULL DAY*8th-Maintaining Dispensary Accuracy- GLOUCESTERSHIRE, Priory Inn, London Road, Tetbury GL8 8JJ14th-Monitored Dosage Systems “Best Practice”-BEDFORDSHIRE, HI Express Bedford, A421/A6, MK42 9BF15th-Controlled Drugs-WILTSHIRE, Stanton Manor, Stanton St Quintin, Chippenham SN14 6DQ21st-Practical Dispensary Management-AVON, Arnos Manor Hotel, Bath Road, Bristol BS4 3HQ21st-Business Management of a Dispensary-CAMBRIDGE, HI Express Cambridge/Duxford Whittlesford, CB22 4NL21st-Maintaining Dispensary Accuracy-OXFORDSHIRE, Clarendon Business Space, Sandford Gate OX4 6LB

Dispex is proud of our renowned Drug Tariff & Endorsing,

Controlled Drugs and BusinessManagement training courseswhich are fully accredited by theDispensing Doctors’Association

TRAINING COURSE PRICES HELD FOR 2018Here at Dispex we are proud of the classroom training, help, advice and support we give to ALL dispensingdoctors, and so we are pleased to announce there will be no rise in delegate rates for the first half of 2018.

Dispex is proud to support the NHS and rural dispensing.

And don’t forget that if there isn’t any training in your area we are happy to come to your practice and carryout the same training “In House” where practical. This has the added bonus of making your annual CPDrequirements much easier to attain, and if you have a number of staff waiting for training then it could saveyou money; especially if you are Dispex Members.

Please remember to assess your staff training needs and contact Dispex to discuss your requirements!

COURSE DATES CONTINUED Dispex Training Updatesby Jane Norrey

MARCH / 7

Dispex Ltd reserves the right at any time to change any course date/or venue or to cancel it altogether if we deem it necessary for any reason orcause beyond our control. Booking/cancellation terms apply please see a booking form for details.

April 19th-Drug Tariff & Endorsing-NOTTINGHAMSHIRE, Bestwood Lodge, Arnold Rd, Arnold, Nottingham NG5 8NE19th-Drug Tariff & Endorsing-WORCESTERSHIRE, Gainsborough House Hotel, Kidderminster DY11 6BS25th-Drug Tariff & Endorsing-SUFFOLK, Worlington Hall, Bury St Edmunds IP28 8RX26th-Business Management of a Dispensary & Controlled Drugs-KENT, HI Ashford North A20, Ashford TN26 1ARFULL DAY*26th-Drug Tariff & Endorsing-DORSET, BW The Grange, Sherborne DT9 4LA

May 9th-Controlled Drugs-WARWICKSHIRE, Walton Hall, Wellesbourne Warwick CV35 9HG16th-Monitored Dosage Systems “Best Practice”-BUCKS, BW Garden Court, Watermead, Aylesbury HP19 0FY17th-Practical Dispensary Management-DORSET, George Albert Hotel, Evershot, Dorchester DT2 9PW17th-Practical Dispensary Management-HEREFORDSHIRE, Talbot Hotel, Leominster, Hereford, HR6 8EP23rd-Drug Tariff & Endorsing-AVON, Thornbury Golf Centre, Bristol, BS35 3XL23rd-Monitored Dosage Systems “Best Practice”-OXFORDSHIRE, Witney Lakes Resort, Witney OX29 0SY

June 6th-Controlled Drugs-SUFFOLK, The Riverside House Hotel, Mildenhall IP28 7DP6th-Monitored Dosage Systems “Best Practice”-NORTHAMPTONSHIRE, DISPEX Office, Blisworth NN7 3DG7th-Maintaining Dispensary Accuracy-SHROPSHIRE, tbc13th-Maintaining Dispensary Accuracy-DEVON, tbc20th-Monitored Dosage Systems “Best Practice”-HAMPSHIRE, tbc21st-Practical Dispensary Management & Drug Tariff & Endorsing-HAMPSHIRE, tbc21st-Maintaining Dispensary Accuracy-WILTSHIRE, tbc27th-Monitored Dosage Systems “Best Practice”-NORFOLK, Kings Lynn, tbc27th-Controlled Drugs-GLOUCESTERSHIRE, The Kings Hotel, The Square, Chipping Campden GL55 6AW28th-Maintaining Dispensary Accuracy-WORCESTERSHIRE, tbc

NEW Spring and Summer Course DatesWe are pleased to announce our Spring and Summer schedule, which includes our new Monitored DosageSystem “Best Practice” course, plus we are teaching our Practical Dispensary Management course in manymore counties during the year. Please note we have finalised venues for January - March therefore pleasekeep an eye on our website www.dispex.net for training announcements. We shall also communicate thevenue details via our email bulletin service.

8 / MARCH

TRAINING NEWS Dispex and DDA On Tour Agendaby Philip Koopowitz

The DDA, in conjunction with Dispex, is running two dispensing roadshows during April and May. Placesare limited to 25 delegates on each course so please book now.

The cost is £79 + VAT per delegate for DDA or Dispex Members and includes:

Light lunch included plus servings of tea/coffee and biscuits.

Event 1: Venue: Woodlands Castle, Ruishton, Taunton, Somerset, TA3 5LU

Date: Wednesday 18 April, 9am-4pm

Event 2: Venue: Redworth Hall Hotel, Newton Aycliffe, near Darlington, DL5 6NL

Date: Tuesday 8 May, 9am-4pm

Who should attend? The full day of seminars is aimed at dispensary managers, practice managers anddispensers and dispensing GPs, with presentations from speakers including DDA Board members.

Programme Agenda

The following companies will be supporting the event by the purchase of an exhibition stand: Takeda UKLimited and Lexon UK Limited

9.00 – 9.30 Registration

9.30 – 10.25 Back to basic, PA and VAT - PDK

10.30 – 11.25 NHSBSA – Improving prescription returns

11.25 – 11.45 Coffee

11.45 – 12.40 Regulations, regulations, regulations – FMD, Mergers, CQC, DSQS – PDK

12.40 – 13.20 Lunch

13.20 – 14.15 dm+d , Agency schemes, Specials, Training and online learning, – Dispex

14.15 – 14.30 Tea

14.30 – 15.45 Improving margins – practical advice on how to dispense smart – PDK andDispex

15.45 – 16.00 Question and Answer Session - PDK and Dispex

16.3 Close

Come to our Dispensing Doctor Master Classes!

10 / MARCH 2018

PRESCRIBERS Experts Back E-Cigarette Use for Smoking Cessationby Chloe Harman

'Switching from normal cigarettes to e-cigarettes hassubstantial health benefits and should be encouraged,expert witnesses have told a House of CommonsScience and Technology Select Committee hearing.

Scientific evidence shows that there are benefits ofexclusive use of e-cigarettes after using conventionalcigarettes - particularly in areas such as respiratorydiseases and cardiovascular diseases,' Riccardo Polosa,professor of internal medicine at the University ofCatania, in Italy, told MPs.

'Our priority is to have as many smokers as possibleswitch to less harmful products.'

Peter Hajek, professor of clinical psychology at QueenMary University in London, told the committee that,overall, studies have shown that the cancer risk of e-cigarettes is less than half the cancer risk of normalsmoking.

'Nicotine is not a carcinogenic substance and there isno evidence that nicotine has a carcinogenic effect,'added Polosa.

'Combustion releases more [harmful] chemicals, e-cigarettes do not have combustion, so one has toassume that they are much safer than normalcigarettes,' agreed Lion Shahab, senior lecturer inhealth psychology at University College London.

In response to MPs' questions about the impact of e-cigarette use on non-smokers, Paul Aveyard,coordinating editor at the Cochrane Tobacco AddictionGroup, explained that e-cigarettes are rarely a steppingstone from not smoking to smoking.

'The traffic is massively one way and rarely the other,'he said.

'E-cigarettes with nicotine are spectacularlyunattractive to non-smokers,' agreed Hajek. 'It's thesame thing with nicotine replacement therapies - it'sextremely difficult to find a non-smoker who isaddicted to them. If you take away the other elementsof smoking it's not as attractive.'

'Phenomenal quitting aid'

Consistent with the experts' testimonies, Public HealthEngland (PHE) said in 2015 that 'best estimates showe-cigarettes are 95% less harmful to your health than e-cigarettes'.

PHE recommends that smokers who have tried othermethods of quitting without success be encouraged totry e-cigarettes as an alternative method of quitting.

In a session on cancer care in general practice at theRCGP annual conference in October 2017,Wandsworth GP Dr Alex Bobak, one of the first GPs tobecome a GPSI in smoking cessation, called e-cigarettes a 'phenomenal quitting aid'.

'We do not know the long-term risks - although theyare likely to be minimal,' he said. 'But we do knowshort-term risks – which are minimal, and similar toNRT. Smokers want choice, and many want to use it -for goodness' sake let them'.

'It's a fantastic opportunity, but not being used right. It'snot been given with support, and 40% use e-cigarettesalongside smoking. We should be clear that you usethem with absolute cessation of combustible tobacco.'

Article reproduced by permission and taken from:

https://www.mims.co.uk/experts-back-e-cigarette-use-smoking-cessation/health-promotion/article/1454493

MIMS is sent free to UK GPs every quarter. Registerfor your copy at mims.co.uk/reader.

MARCH 2018 / 11

Generic Profitabilityby Gregory Bull

DISPENSARY MANAGERS

As part of running a successful dispensary itis essential that, as a business manager, youmake sure you are purchasing smartly andcorrectly.

By this we mean that you are balancing theamount of time spent against the increasedprofitability of your purchasing.

For example it is common sense that if youare going to make a £5 saving on an order, itisn’t worth spending an hour of your time toachieve that!

Look at your top moving generic lines andconsider tendering these out - ask the genericsuppliers to give YOU a price and thenpurchase from the cheapest supplier.

To help you out we have included some of thefastest moving items in primary care based onthe Prescription Cost Analysis figures. Mostof the generics in the table on the right shouldbe in at least your top 20 generic itemsdispensed.

By smart purchasing your bulk fast movinglines it should save you a lot of time andeffort and at least partially ensures you aregetting a good price.

This is a tried and trusted technique in smartpurchasing.

One caveat, you need to stick to your finalpurchasing decision, as the suppliers whohave failed to get your order should bephoning you back to ask why you aren’t usingthem!

In this instance you need to make it quiteclear that their first price wasn’t good enoughand that you will only consider the first pricesent over as your time is precious.

For those who shop around there are stillplenty of generics with a high % gross profit.

The infographic on the right gives somesample gross profits and is not exhaustive.

DISPENSARY MANAGERS Drug Tariff News March 2018by Gregory Bull

12 / MARCH

Above we have published a list of medicines which willbe added to the Drug Tariff by their generic name fromMarch 2018.

Where the addition is a Category C item, thereimbursement price is based upon the NHS list price ofa brand - in the list above for example tenoxicam20mg tablets will be reimbursed at the Mobiflex [brand]NHS list price from March 1st 2018.

These will all be able to be prescribed, theoretically, bytheir generic name and will be reimbursed accordinglyfrom March 2018.

There may be medicines on the list above which yourprescribers feel still need to be ordered by brand namefor the patient in order to reduce confusion or to ensurecontinuity of supply.

For example would you know what to dispense against

this generic descriptor: Nystatin 100,000units/g /Chlorhexidine acetate 1% / Hydrocortisone1% ointment?

And how would you find out? I have not found a supplierof this as a true generic as of February 9th 2018 - sothat could lead to some interesting prescriptionsubmissions at the end of March!

Ask your wholesaler to send you details of this newCategory A generic.

It is interesting to see the new strength of fluoxetine10mg included from March 1st. Actual purchase pricein the supply chain has been very high recently! Soplease remember to check your purchase price againstDrug Tariff price and write your prescriptionsaccordingly.

Additions March 2018

Drug Name Pack SizeDrug Tariff Categoryfrom March 1st 2018

Fluoxetine 10mg tablets 30 Category A

Lanreotide 60mg/0.5ml solution for injection pre-filled syringes 1

Category CSomatuline Autogel

Lanreotide 90mg/0.5ml solution for injection pre-filled syringes 1

Category CSomatuline Autogel

Mesalazine 250mg gastro-resistant tablets 100 Category C Salofalk

Mesalazine 500mg gastro-resistant modified-release granules sachets sugar free 100 Category C Salofalk

Mesalazine 500mg gastro-resistant tablets 100 Category C Salofalk

Nystatin 100,000units/g / Chlorhexidine acetate 1%/ Hydrocortisone 1% ointment 30g Category A

Nystatin 100,000units/g / Chlorhexidinehydrochloride 1% / Hydrocortisone 0.5% cream 30g Category A

Ranitidine 150mg/5ml oral solution sugar free 150mlCategory C CreoPharma Ltd

Soya oil 84.75% bath oil 1000ml (2x 500ml) Category C Balneum

Soya oil 84.75% bath oil 500ml Category C Balneum

Tenoxicam 20mg tablets 30 Category C Mobiflex

Terbutaline 2.5mg/5ml solution for injectionampoules 10 Category C Bricanyl

Terbutaline 500micrograms/1ml solution forinjection ampoules 5 Category C Bricanyl

MARCH / 13

Drug Tariff News March 2018by Gregory Bull

DISPENSARY MANAGERS

So what to watch out for in the list of changes abovethen?

Where the product is moving from Category A toCategory C then the NEW reimbursement price willbe based on the NHS list price of that brand - so checkhow much you have paid for the generic stock sitting onyour shelf as after March 1st you will be paid the brandprice UNLESS you ensure NHS Prescription Servicesrealise it is a specific supplied generic which you havedispensed. If your purchase price is lower than the NHSlist price of the brand, then you have nothing to worryabout!

Conversley where the product is moving fromCategory C to Category A then beware of losingout and run down your stock of those Cat C items or

make sure that from March 1st that the prescriptionclearly shows that the brand was ordered by theprescriber, and that the brand was dispensed by thedispensary.

So keep an eye on your stock levels of Atarax if this issomething you use and dispense. Check the new DrugTariff prices as soon as your copy hits down.

Or better still the Drug Tariff can be found online fivedays before the beginning of the month. This is theperfect way to get ahead and stay ahead with Drug Tariffchanges.

Also note that some changes are where a brand is beingdiscontinued but still being manufactured by the samecompany, but listed as a “generic”

Changes March 2018

Amiloride 5mg/5ml oral solution sugar free 150mlCategory C Amilamont willbe:

Amiloride 5mg/5ml oral solution sugar free 150mlCategory C RosemontPharmaceuticals Ltd

Colestyramine 4g oral powder sachets sugar free 50 Category A will be:

Colestyramine 4g oral powder sachets sugar free 50 Category C Questran Light

Docusate 12.5mg/5ml oral solution sugar free 300mlCategory C Typharm Ltd willbe:

Docusate 12.5mg/5ml oral solution sugar free 300ml Category A

Hydroxyzine 10mg tablets 84 Category C Atarax will be:

Hydroxyzine 10mg tablets 84 Category A

Hydroxyzine 25mg tablets 28 Category C Atarax will be:

Hydroxyzine 25mg tablets 28 Category A

Indometacin 100mg suppositories 10 Category A will be:

Indometacin 100mg suppositories 10 Category C Indocid

Liothyronine 20microgram tablets 28 Category C AMCo will be:

Liothyronine 20microgram tablets 28 Category A

Nystatin 100,000units/g / Chlorhexidine hydrochloride 1%cream 30g

Category C Nystaform willbe:

Nystatin 100,000units/g / Chlorhexidine hydrochloride 1%cream 30g Category A

Tamoxifen 10mg/5ml oral solution sugar free 150ml Category C Soltamox will be:

Tamoxifen 10mg/5ml oral solution sugar free 150mlCategory C RosemontPharmaceuticals Ltd

14 / MARCH

DISPENSARY MANAGERS

We hold monthly open days so our customers can comeand see how we process prescriptions. We hold them atdifferent times of the day to make it easier for people tocome to them and each session lasts about three hours.

Anyone involved in sending in prescriptions forreimbursement and remuneration should find themuseful, such as a pharmacist, dispensing doctor or GPwho claims for personally administered items, or adispensing appliance contractor.

NHS Prescription Services Open Daysby NHS Prescription Services

Date AM session PM session Evening session Venue

11th April 18 1.30pm Wakefield

9th May 18 10.00am Wakefield

13th June 18 10.00am Wakefield

8th August 18 1.30pm Wakefield

10th October 18 10:00am Wakefield

12th December 18 1:30pm Wakefield

Spaces are limited to 12 people at sessions held in Newcastle and 10 people for each session atMiddlebrook and Wakefield, so it's important to book early.

Priority will go to customers involved in sending in prescriptions for reimbursement andremuneration. For other people who are interested, we’ll put your details on our reserve list andcontact you if spaces become available on any session.

Sessions are also subject to sufficient demand, so please let us know as early as possible if you'reinterested in coming along as undersubscribed sessions will be withdrawn.

Contact us to book your place, or if you have any queries:

Newcastle bookings

Telephone: 0191 203 5490 or 0191 203 5237

Email: nhsbsa.open-days@nhs.net

Wakefield bookings

Telephone: 01924 334210

Email: nhsbsa.Central.pharmacy-visits@nhs.net

Middlebrook bookings

Telephone: 01204 677901

Email: nhsbsa.nwadm@nhs.net

MARCH / 15

How Well Do You Know The Drug Tariff?by Gregory Bull

DISPENSARY MANAGERS

I started working with and for dispensing doctorsover twenty years ago. One of the first things I wasasked to do was to look up the “Drug Tariff” price ofRanitidine and compare it to the NHS List price ofZantac, as that medicine was coming off patent andthe original brand manufacturers were worried aboutthe impact on their income.

This was all new to me and I started askingquestions straight away. Prior to working withdispensing doctors I had never even considered thatthere was any sort of commercial aspect todispensing. Then it suddenly all made sense, there isa need to ensure that those who supply medicines topatients [dispensing doctors, retail pharmacies] arefinancially viable businesses in order to make surethat they can operate and maintain the supply OFthose medicines to patients!

It was this Drug Tariff mechanism that dispensingdoctors needed to understand in order to achieve amargin and make money which could be used tosupport rural dispensing. So I was tasked withlooking at the relationship between the Drug Tariffprice and market price, amongst other things, as Iwas being educated in the way the drug budget isused within the NHS. I have [at times in the past]read nearly ALL of the Drug Tariff purely out of asense of geeky interest.

On the whole the Drug Tariff isn’t that easy tounderstand, but luckily for dispensing doctor staffthere are only a few sections/parts/chapters whichyou need to look at.

Checking the preface, which contains the AdvanceNotice of changes, current changes and updatedinformation is your most urgent task, and should bedone every month without fail . The reason beingthat your dispensary income is dependent upon theDrug Tariff and those pesky changes to Category [Cto M for example] could have a major impact onyour prescribing and dispensing decisions. [Ofcourse clinical need must come first!]

So here is my brief “role and purpose of the DrugTariff” list!

To define the NHS terms of reimbursement forpharmacy and appliance contractors. [The

situation for dispensing doctor contractors isprimarily set out in the Statement of FinancialEntitlement and overrides the Drug Tariff.]

To determine the basic reimbursement price of drugsand other devices, oxygen, dressings, appliances andreagents [This is very relevant to dispensing doctorsand you should make sure you are aware of PartVIIIA and Part VIIIB as a minimum requirement!]

To determine what medical devices and items areallowable for reimbursement against NHSprescriptions. [You will need to check Part IXA, B orC to make sure that any CE marked items, thisclassifies them as devices, ARE listed in the DrugTariff or prescriptions for NON TARIFF devices willbe rejected for payment]

To specify reference parameters and details ofmanufacturing compliance for some prescribableitems such as bandages, dressings and other items.

To define a limited list of allowable items which maybe prescribed by Dentists (DPF) and nurses (NPF)upon NHS prescriptions.

The above list is not exhaustive!

Make sure you read and understand the changesevery time your copy of the Drug Tariff lands onyour desk.

Latin Terms and Abbreviationsby Gregory Bull

DISPENSARY MANAGERS

16 / MARCH

Latin has been used in writing prescriptions formany years, the main reason being that Latinabbreviations provide a convenient form ofshorthand for prescribers.

Due to the possibility of errors of interpretation,prescribers have been discouraged from using Latin

names and terms on prescriptions. However, theircontinued use is likely especially when writingdirections for the use of a preparation.

A List of the more common Latin terms andabbreviations used on prescriptions follows:

B.d. .. .. .. bis die .. .. .. twice daily

Cap. .. .. .. capiantur .. .. .. let them be taken

(capiendus, a, um .. .. .. to be taken

(capsula .. .. .. a capsule

Conc. .. .. .. concentratus, a, um .. .. .. Concentrated

Emul. .. .. .. emulsion .. .. .. an emulsion

Fort. .. .. .. fortis. e. .. .. .. strong

Linct. .. .. .. linctus .. .. .. a linctus

Liq. .. .. .. liquor .. .. .. a solution

M. .. .. .. mane .. .. .. in the morning

Mist. .. .. .. mistura .. .. .. a mixture

Mitt. .. .. .. mitte .. .. .. Send

N. Or Noct. .. .. .. nocte .. .. .. at night

P.r.n. .. .. .. pro re nata .. .. .. when required

Pess. .. .. .. pessus .. .. .. a Pessary

Q.d.s .. .. .. quarter die sumendus.. .. ..to be taken fourtimes daily

Q.i.d. .. .. .. quarter in die .. .. .. four times daily

S.o.s. .. .. .. si opus sit. .. .. .. if there is need

Stat. .. .. .. statim .. .. .. immediately

Suppos. .. .. .. suppositorium .. .. .. suppository

T.i.d. .. .. .. ter in die .. .. .. three times daily

T.d.s. .. .. .. ter die sumendus a, um .. .. ..to be taken threetimes a day

Tab. .. .. .. tabella .. .. .. a tablet

.. .. .. tabletta .. .. .. a tablet

Ung. .. .. .. unguentum .. .. .. an ointment

MARCH / 17

CONSIDERING INSTRUCTING AN EXPERT WITNESS?

1. Civil and criminalpharmaceutical cases.

2.Liability and negligence inprescribing or dispensing.

3.Pharmacy valuations.

4.Forensic matters.

5.NHSLA matters.

For a no obligationcomplimentary quotation onany related topic please

contact:-

N V Morley MRPharmS01604 859000

office@nvmholdings.com

Low cost and discounts applyfor Dispex members.

EXPERIENCE COUNTS

PHARMACYVALUATIONS

Do you need a valuation of yourpharmacy because a

Partner/Shareholder is leaving ?

For specialist advice regarding the value of your pharmacycontact

Help and advice is available from Nigel Morley MRPharmS

who assists many practices with obtaining a WDL and/or pharmacy licenceand his recent many successes in

fighting predatory pharmacy applications as reflected inthe National statistics.

N V Morley MRPharmS01604 859000

office@nvmholdings.com

Low cost and discounts apply for Dispex members.

EXPERIENCE COUNTS

18 / MARCH

Let’s imagine all our best efforts have been to no effect andyou have a patient who is angry, abusive and frustrated.

This is the point at which your Customer Care skills need tobe applied with extra finesse.

The important thing to realise when dealing with an upsetpatient, is that you must first deal with their feelings andemotions before moving on to deal with the actual problem.

Upset patients are liable to have strong feelings when you orthe service you deliver lets them down and they'll probablywant to "dump" these feeling on you.

The skill with which you deal with a complaint is paramountnot only in keeping loyal patients loyal, but also turning apotential lost patient into a sustained patient.

Make no mistake about it; patients are primarily driven bytheir emotions. It's therefore important to use humanresponses in any interaction particularly when a patient isupset or angry.

You don't deal with their feelings by concentrating onsolving the problem. Of course you have to do thiseventually but it does take more than just this.

Here are nine action ideas that deal with the patients' humanneeds:

1 - Don't let them get to you:

Keep cool, holding your emotions in check and reactingprofessionally under fire is not always easy. It is particularlydifficult to be nice to people who are not being nice toyou.So what do you do to keep your cool when the patient ishaving a go at you?

Most of the time, it is not even your fault. It could be that

the problem was with a product or a service delivered bysomeone else in your organization. You're getting the blamebecause the unhappy person found you first, and it's notpleasant.

Stay out of it emotionally and concentrate on listening non-defensively and actively. Patients may make disparaging andemotional remarks - don't rise to the bait.

2 - Listen - listen - listen

Look and sound as though you’re listening. It is easy tolisten without appearing to be doing so and this is intenselyirritating to people who are already agitated. The patientwants to know that you care and that you're interested intheir problem.

And while we are talking about listening, it is also useful tomaintain eye contact whilst you are speaking to a patient; itreassures them that you are actually listening and payingattention.

3 - Stop saying sorry!

Sorry is an overused word, everyone says it when somethinggoes wrong and it's lost its value. How often have you heard- "Sorry about that, give me the details and I'll sort this outfor you"?

Far better to say "I apologise for ......"

If you really need to use the sorry word, make sure toinclude it as part of a full sentence. "I'm sorry you haven'treceived that information as promised Mr. Smith".

(It's also good practice to use the patient’s name in adifficult situation).

Continues next page...

Managing Complaintsby The Dispex training Team

PRACTICE MANAGERS

Managing Complaintsby The Dispex training Team

PRACTICE MANAGERS

4 - Empathise

Using empathy is an effective way to deal with the patient’sfeelings.

Empathy isn't about agreement, only acceptance of what thepatient is saying and feeling. Basically the message is - "Iunderstand how you feel". Obviously this has to be agenuine response, the patient will realise if you're insincereand they'll feel patronised.

Try and think how you would be feeling if the roles were tobe reversed and you did not have the benefit of yourprofessional knowledge.

Examples of empathy responses would be - "I canunderstand that you're angry", or "I see what you mean".

Again, these responses need to be genuine.

5 - Build rapport

Sometimes it's useful to add another phrase to the empathyresponse, including yourself in the picture. - "I canunderstand how you feel, I don't like it either when I'm keptwaiting". This has the effect of getting on the patient's sideand builds rapport.

Some staff get concerned with this response as they believeit'll lead to - "Why don't you do something about it then".The majority of people won't respond this way if they realisethat you're a reasonable and caring person.

If they do, then continue empathising and tell the patientwhat you'll do about the situation. "I'll report this to mymanager" or "I'll do my best to ensure it doesn't happen inthe future".

6 – Accept Responsibility

Be accountable to the patient. Let him know that you intendto do whatever it takes to make things right. You can't helpwhat has already happened, but you will come up with asolution to the problem or you will find someone who can.

7 – Action

Before you jump in to speak, STOP and draw a few breaths.Decide what you can do and tell the patient. Are you theright person to deal with this? Do not promise what youcan’t deliver. If the issue was poor service, deliver betterservice. If the issue was wrong information, provide thecorrect information. Take careful note of all details if youneed to pass the matter on to someone else. Make sure thatthe patient is sure and happy about what you intend to do torectify the situation.

8 – Smile

Not in a condescending way, and not all the way through thecomplaint. This will give the impression that you are notdealing with the matter seriously. However, try andconclude the matter on good terms and leave the patientwith a plan of action and with a smile.

9 – Keep your promises

There is nothing more guaranteed to drive a patient into atemper of monumental proportions, than not delivering whatyou have promised, and particularly if that promise has beenthe result of a complaint in the first place.

NEVER, NEVER fail to ring when you promised, writewhen you promised, speak to someone when you promised,deliver something when you promised. Remember theadage: under-promise and over deliver.

If patients like you and feel that you care, then they're morelikely to accept what you say and forgive your mistakes.

20 / MARCH

Most GP Surgeries prepare for the annual ‘fluvaccinations, which must be stored safely according tothe manufacturer’s instructions usually between +2 °c to+8°c.

Here are some tips for consideration to ensure your GPpractice is prepared this year.

HELPFUL TIPS

Is your fridge(s) working properly?

It could be that you bring out the spare fridge for the ‘fluseason’ – now is the time to check it’s still workingcorrectly.

Record fridge temperature before adding new stocks ofvaccines. If other users notice a ‘spike’ in fridgetemperature readings they won’t know when it happenedwhich could cause unnecessary concern about the coldchain integrity.

Do you have adequate medical fridge storage to safelystore ordered vaccines?

Air cannot circulate properly around a fridge stuffed fullof vaccines. This could impact on temperature read outsand vaccine safety.

Tip: Consider purchase of a larger/additional fridge, or aportable fridge.

Is your secondary thermometer monitoring device,calibrated?

Tip: Read our guide on types and usage

Ensure your fridge is calibrated annually. Tip: Look forthe manufacturer’s own calibration service, or add yourfridge to the list of measuring equipment alreadycalibrated at the Practice.

Are your Certificates of Calibration valid?

Tip: Check that the certificates clearly mention ‘testequipment used is traceable to UKAS standards’.MoreGuidance here

Ensure your medical fridge is covered by themanufacturer’s warranty, or extended warranty, tosafeguard against costly breakdowns.

Tip: Read the small print sometimes not all parts arecovered!

Check the Certificate of Calibration for your medicalfridge meets Care Quality Commission inspectionrequirement.

Need more help?

Call us on 01903 733877 or email ask@shoreline-medical.co.uk

Fridge Tipsby Shorelines Customer Service

DISPENSERS

Our services and product refit includes both modularand traditional systems.

Our design team excel in offering 3D CGI floor plansand scaled layouts to carefully plan all theequipment required to deliver the optimumdispensary and work environment.

For a better safer environment call us on

01704 823600 for a FREE consultation

Email: richard@pharmacystoragesolutions.co.uk

Is Your Dispensary Safe and Efficient?

Pharmacy Storage Solutions special services:

•Script storage and retrieval systems

•Counters and joinery services

•Building, ceiling and flooring solutions

T: 01604 859000 F: 01604 859687 W: www.dispex.net

CONTROLLED DRUGS

Controlled Drug Registers

Denaturing Kits

DISPEX CAN PROVIDE YOU WITH ALL YOUR NEEDS IN CONTROLLEDDRUGS Every General Medical Practice, Registered Pharmacy, Veterinary Practice and Care Home will be aware that it is a legal requirement to record the obtaining and supply of Schedule 2 Controlled Drugs.

W E H A V E T H E S O L U T I O N S2 0 1 8

Controlled Drugs Training Courses

Every general medical practice and registered pharmacy are legally required to record the obtaining and supply ofSchedule 2 Controlled Drugs.

The Controlled Drugs Registers are fully compliant with Controlled Drugs current legislation.

The denaturing of Controlled Drugs could be classified as ‘wasteprocessing’, and as such, may require a waste processing licence. However, the Environment Agency and the Home Office haveagreed that the denaturing of medicines as required under the Misuse of Drugs Regulations will not be subject to this requirement.Instead a Denkit should be used.

This course is designed to ensure that you are complying with all requirementsof the law on controlled drugs. From purchasing to dispensing we help you withthe entire process of holding and managing controlled drug stock. This course issuitable as a grounding for new dispensers to give them the background on CDlegislation AND those entrusted with CD control in the surgery.

Dispex Ltd, 7 & 8 Prospect Court, Courteenhall Road, Blisworth, Northamptonshire, NN7 3DG, E: sales@dispex.net

For further details on all our courses please visit www.dispex.net/training-services

Controlled Drugs Cabinets If you need to replace or upgrade your controlled drugs cabinet you can nowpurchase Denward Cabinets through the Dispex office. All cabinets are fullycompliant with the requirements of "The Misuse of Drugs (safe custody)Regulations 1973". For further details please call us on 01604 859000

22 / MARCH

Your Sickness Policyby Owen Clark

EMPLOYMENT LAW

There’s no getting away from the fact that your employeeswill get ill. Especially at this time of year when everyoneseems to be coughing and spluttering.

But staff illness can be tricky to manage if you’re running asmall business. Even if someone’s only off for a day ortwo, it can feel like a big knock to the team.

To help your staff get back to health and back to work, puttogether a sickness policy. Not sure where to start? Hereare some tips on what to put in yours.

Why should I put a sickness policy together?

Your sickness policy should set out your company’s aimsfor handling staff illness.

You might want to highlight your hopes of reducing theamount of ‘absenteeism’—when employees regularly stayoff work without a genuine reason—in your workplace.

If you do mention absenteeism, it’s important to explainthat your business recognises the need for employees totake time off when unwell.

Making this clear will help to stop a culture of‘presenteeism’—when employees feel they have to attendwork while they’re ill.

Putting together a sickness policy will help you manageand monitor your team’s sickness. It will also let youremployees know the process you expect them to followwhen they’re sick.

What should I include in it?

Put yourself in the mindset of an employee. What would

you want to know about your rights and responsibilitieswhen sick? Then give the answers in your sickness policy.

Your policy can include information on:

How you want an employee to tell you they’re ill. Forexample, by calling their manager before 10am.When you’ll need them to fill out a self-certification form.When you’ll need them to provide you with a fit note.Your employees’ rights to Statutory Sick Pay.Your company’s sick pay scheme (if you have one).The policy should make it clear that you can takedisciplinary action if the employee doesn’t follow theserules.

Set out the absence triggers

Your sickness policy should outline the absencemanagement ‘triggers’. This is the level of absence thatwill start formal action.

This is usually set up in stages:

Stage one: an informal ‘return to work’ meeting with theemployee.Stage two: a formal ‘return to work’ meeting with theemployee.Stage three onwards: take disciplinary action wherenecessary.It’s important not to scare your employees with thisinformation. But you still need to be firm in showing howyour business will address regular sick leave.

You can set out the absence management triggers based onyour business needs. But usually, employees with lots ofshort absences should reach the trigger before employeeswith long-term absences.

Prepare them for their return to work

It can be daunting for an employee to return to work.Particularly if they’ve been off for a long time or theirabsence was due to workplace stress.

To help put your staff at ease, set out in your policy whatwill happen once they return to work.

It’s a good idea to have a ‘return to work’ meeting withyour employees. Discuss whether they need any supportand give them an update on what’s happened since theywere last in work.

The policy should also explain any support your businessoffers. You could mention making reasonable adjustmentsunder the Equality Act 2010 or highlight workplacebenefits like Employee Assistance Programmes

WHY TAX CHARGES ARISE ON NHS PENSION CONTRIBUTIONS

Unfortunately, how this is achieved is complex and involves reducing high earner’s pension annual allowances and clawing back tax relief.

The standard annual allowance, the tax-deductible amount an individual can set aside each year for a pension, remains £40,000 and any unused relief in the prior three tax years can be brought forward.

For GPs, the amount to measure against the annual allowance is the ‘growth’ in their fund in the NHS scheme - not the actual superannuation payments made by the practice. This growth figure is provided by NHS Pensions but isn’t available before the tax return deadline each year. Therefore, any likely tax charge must be estimated and marked on the tax return as provisional until final figures are available.

Where GPs have moved into the 2015 NHS Scheme, NHS pensions provide separate statements showing growth in both the 1995/2008 scheme and the 2015 scheme – both must be counted along with any contributions to non-NHS pensions.

To calculate whether an individual’s annual allowance must be reduced there are two tests. Firstly, if ‘threshold income’ (total gross taxable income from all sources, less any pension contributions made) is £110,000 or less, there is no reduction to the £40,000 allowance. If threshold income exceeds £110,000, a second ‘adjusted income’ test is applied.

Adjusted income is the total gross taxable income from all sources, plus employer pension contributions, and before any deductions. Where adjusted income exceeds £150,000, the individual’s annual allowance is reduced by £1 for every £2 – although the minimum allowance is £10,000.

For example, a GP has partnership income of £135,000, dividends of £20,000 and superannuation contributions of £30,000 (although her pension fund grew by £36,000 for the year). She would have a threshold income of £125,000 – so her annual allowance must be reduced. Adding the fund growth to her threshold income makes her total adjusted income £161,000. So her annual allowance is reduced by £5,500 to £34,500. As the fund grew by £36,000, she will have a tax charge on £1,500 - unless she has unused annual allowance to bring forward from earlier years.

Such tax charges can be paid from the pension fund but the NHS ‘scheme pays’ facility is only available where annual growth is above £40,000: any charge on growth below £40,000 must be paid by the GP personally.

This is a complex area so please contact our team if you wish to discuss your position.

The rules for tax relief on pension contributions changed from April 2016 - limiting the tax relief available to high earners.

BDO LLP is authorised and regulated by the Financial Conduct Authority to conduct investment business.© February 2018 BDO LLP. All rights reserved.

www.bdo.co.uk

SARAH MOSS+44 (0)121 352 6365sarah.moss@bdo.co.uk

HB010422

FOR MORE INFORMATION:

NORTH HILARY SHARPE+44 (0)161 833 8302hilary.sharpe@bdo.co.uk

SOUTH WEST AND WALESSHIRLEY WHITTLE+44 (0)117 930 1642shirley.whittle@bdo.co.uk

MIDLANDSSARAH MOSS+44 (0)121 352 6365 +44 (0)7791 397 696 (mobile)sarah.moss@bdo.co.uk

LONDON AND SOUTHIAN DODGE +44 (0)1483 408 063ian.dodge@bdo.co.uk

EAST ANGLIASARAH ELMS+44 (0)1473 320 732sarah.elms@bdo.co.uk

SCOTLANDANDREW MCNAMARA+44 (0)141 249 5249 andrew.mcnamara@bdo.co.uk

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EAST ANGLIAEAST ANGLIASARAH ELMSSARAH ELMS

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24 / MARCH 2018

Unfortunately, questions relating to property ownership inprimary care have risen to the top of many practices’agendas in recent months, as the impact of the workcarried out by NHS Property Services (NHSPS) hasbecome all too clear.

Essentially, NHSPS was set-up in 2013 to sort out a realmess. Somebody had to take on the estate responsibilitiesof the former Primary Care Trusts that weren’t transferredto providers when the PCTs disappeared. Crucially,however, it was given the remit of acting like acommercial landlord. As a result, numerous GP practicesacross England who operate from leased premises havebeen receiving unexpected and often quite substantialinvoices from NHSPS for both building rental andmanagement, as well as provision of services such ascleaning.

The situation reached tipping point last year when theBMA’s GP Committee announced it could consider legalaction on the matter, which has left some of the 14% ofGP practices under NHSPS facing an increase in servicecharges of more than £60,000 a year.

The BMA says that these increases are being levied withseemingly no reference to the contractual arrangements(or lack thereof) that are in place, or the sums historicallypaid.

This issue is further complicated as practices are often

not provided with an itemised list of charges, or whenthey are, there are often errors or incorrect chargesincluded.

It’s worth pointing out here that the issue isn’t exclusiveto NHSPS either – practices that lease from CommunityHealth Partnerships (CHP) have also been affected.

What can you do?

1.Signing a contract:

Thankfully, it’s estimated that a good number of practiceson the receiving end of the hiked charges haven’t yetagreed their contract.

If that’s the case, the BMA advises that in respect of leasenegotiations, although it supports the view that practicesshould engage in the process, it is vital that they do notsign any lease or Heads of Terms (including thosepurporting to be based on the national template GP leasenegotiated between the BMA and NHS PS) unless anduntil they fully understand and are comfortable with yourpotential liabilities.

To this regard, appropriate due diligence as to potentialliabilities should be carried out.

[Continued on next page]

The Ongoing Practice Lease Sagaby Practice Index

DISPENSERS

MARCH 2018 / 25

2.Service charges:

Particular care should be taken on the issue of servicecharges so as to avoid a situation where there is an exposureto uncapped and unreasonable costs that bear noresemblance to what arrangements previously existed.

Ultimately, the GPC is pushing to reach a negotiatedagreement nationally, but it is prepared to consider all andany other possibilities to realise a situation whereby a fairand reasonable process for calculating service charges isagreed, which has due regard to historic arrangements anddoes not result in practices having to fund the historicneglect of buildings.

This guide to service charges on the BMA website is wellworth a read.

3.Lease template:

A template lease which is very favourable for the tenants hasbeen negotiated and it includes:

•a break clause allowing a practice to break their lease if they lose their core contract, and favourableassignment clauses enabling a practice to assign thelease to different partners or NHS allowed entities –these will ease the ‘last man standing’ phenomenon

•maximum lease term of 30 years, with in-built renewal clause

•mechanisms built into the lease to ensure that reviewed/revised rents match what will be reimbursed via the premises cost directions

•a requirement for service charges to be agreed before the lease is signed

The lease is intended to be a framework for practices tonegotiate with NHSPS, and details of the lease will benegotiated on an individual basis. Before entering into alease, it’s strongly recommended that practices undertakedue diligence and seek legal advice. More information aboutthe template lease can be found here.

Some good news

There is one small crumb of good news for affectedpractices. Various incentives are available to practices tohelp them get this issue sorted out. Qualifying practices canbenefit from the following:

•Reimbursement of Stamp Duty Land Tax for the initialterm (up to 15 years) – generally on new long-term leases

•Contributing up to £1,000 plus VAT of legal fees related tothe lease transaction – this is for legal fees and has nothingto do with District Valuers etc.

•Reimbursement of management fees for the financial year2016/2017 and 2017/2018.

The money was made available via the General PracticeForward View, which committed to providing financialsupport to every GP practice that is a tenant in an NHSPS orCHP building to enter into a new lease.

However, be aware that applications must be made by 31March 2018 – a date that has already been extended fromthe original deadline of November 2017.

The process for claiming this support is as follows:

•The GP practice should formalise their lease withCommunity Health Partnerships/NHS Property ServicesLtd.

•The GP practice will incur costs and should apply forreimbursements by submitting the Lease Incentives ClaimForm to gppremisesfund@nhs.net by 31 March 2018

•The claim form is sent to the GP practice’s commissionerfor review and subject to approval, the NHS EnglandCentral Finance Team will be instructed to release therevenue to the local commissioner so they can reimburse theGP practice.

The GP lease saga is a sorry one and has cost practices dear,even forcing some practices to close and prompting othersto purchase their premises.

The Ongoing Practice Lease Sagaby Practice Index

PRACTICE MANAGERS

26 / MARCH

The 31 March is a popular year end formany GP Practices and with this date fastapproaching, ensuring that your booksand records are correct and accurate willnot only help assist your accountants butwill also ensure that everything for that

financial year has been considered.

However, with a practice / finance / business manager’stime being stretched more than ever, it can be difficult toknow which areas to concentrate on and what you shouldbe looking for. Using our knowledge from dealing with avast array of practices we have created a list of commonproblem areas and how we suggest you deal with them:

Reconcile

Does your bank balance in your specific system match thebalance shown on your bank statements?

If not, do you have a list of differences or uncleared itemsat your year end?

This is the most important area for you to check as if thebank is correct / balances then you know that all thetransactions for income and expenses that pass through thebank have been included.

Income streams

Have you fully analysed all your income streams, so youdo not have large amounts labelled as CCG / NHS in yoursystem, which could be broken down into enhancedservices? This has become a problem more recently withlocal CCGs not sending remittances or making it clearwhat an amount or deduction is for.

Ensuring that your Open Exeter reports match what hasbeen banked is vital. If it doesn’t, ensure that you have theremittance which shows what the extra income ordeductions are for and enter this onto your system.

Debtors (income that is owed to the practice)

At your year end you should have a list of services andindividuals who owed you money for either enhancedservices or for items such as insurance reports.

It is also useful to know, especially for CCG income,which quarters have been paid as some services are paid aquarter in arrears.

Can your accounts package/system provide an “ageddebtors” report? Are all the entries on there going to bepaid and if not, should they be written off? Carryingforward old debts can complicate a system and can lead tochasing debts which will not be paid.

Creditors (expenses that have not yet been paid for)

As with debtors you should have a list of people andbusinesses you owed money to at the year end. The largestones would normally be for items such as drugs andmedical expenses, with some being two or three monthsbefore payment is due.

If your system can produce an “aged creditors” reportensure that the list is accurate and does not hold any oldbalances or small differences which need to be removed.

Stock

As close to your year-end date as possible, take stock of allitems, including reimbursable drugs, consumable items andstationery. Stationery has become a significant figure inrecent years due to the cost of printer and toner cartridges.

Professional expenses paid personally statements (PEPPS)While not strictly a part of the practice’s records theseshould be made available alongside the accounts to ensurethat nothing is missed and items which have been paid forby the practice are not duplicated. The GP partners mayhave been asked to fill in a questionnaire to provide theinformation required, please check that they have dealtwith it.

Software

A final note would be to ensure that the software you areusing is up to the task and its functions match your specificrequirements. With “Making Tax Digital” just around thecorner, it is even more important that the software you areusing is compliant with HM Revenue & Customsrequirements.

These are just a few useful guidelines. Each practice isdifferent and the systems you use will be unique to you,some of these tips will be more relevant than others.

However, if you follow these steps it will give you a headstart on your year-end to assist in ensuring the records arein the best position to be processed into the annualaccounts.

If you would like to discuss your bookkeeping and yearend processes, or you would like to speak with a memberof our team, please call 0115 972 1050 to be put in touchwith a member of our Healthcare Team.

For more information, contact:Nick StevensonPartnerTel: 0115 972 1050Email: nick.stevenson@mooreandsmalley.co.uk

Year End Bookkeeping Health Check by Nick Stevenson of Moore and Smalley

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28 / MARCH

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PRACTICE MANAGERS Arabic and Roman Numeralsby Gregory Bull

On page 16 of this month’s Dispensary Gazette we talkabout the use of Latin and this article is a companionwork regarding the use of Roman Numerals within theNHS. For example the Drug Tariff “chapters” arereferenced and named using the Roman Numeral systemrather than the much more commonly used ArabicNumerals.

The question that most readily sprang to mind was why?

Is it because GP prescribers and pharmacists are taughtusing Latin and Roman Numerals?

Or is it some other reason?

Either way it seems to be extremely anachronistic to stillbe using these outdated languages and numberingsystems as we approach the year 2020.

It has long been best practice that prescribers shouldalways use Arabic numbers [1, 2, 3, 4, etc] when statingquantities on prescriptions and where necessary theyshould also state the number in words in order to avoidany risks of misinterpretation.

Also it is clear that using abbreviations whilst usingRoman Numerals can double the problem - so what ismeant by IV for example? Intravenous or the numberfour?

So wherever a Roman Symbol is used on theinstructions for generating or writing a prescription, orwhere the original prescription has been generatedoutside of the surgery, they should be returned to theprescriber for clarification and re-written using the“normal” Arabic number with any abbreviationsclarified and written out in full.

The dispenser should never attempt to convert a RomanSymbol to an Arabic Number without full consultationwith the prescriber. It should be the prescriber whodecides what the number should be NOT the dispenser.

However, it may help the process if the dispenser andprescriber have a knowledge of how the RomanSymbols translate into Arabic Numbers.

Please see a list of Arabic and Roman Numerals below.

ArabicNumbers

RomanSymbols

ArabicNumbers

RomanSymbols

ArabicNumbers

RomanSymbols

1 .. I 12 .. XII 24 .. XXIV

2 .. II 13 .. XIII 28 .. XXVII

3 .. III 14 .. XIV 29 .. XXIX

4 .. IV 15 .. XV 30 .. XXX

5 .. V 16 .. XV1 40 .. XL

6 .. VI 17 .. XVII 50 .. L

7 .. VII 18 .. XVIII 60 .. LX

8 .. VIII 19 .. XIX 70 .. LXX

9 .. IX 20 .. XX 80 .. LXXX

10 .. X 21 .. XXI 90 .. XC

11 .. XI 22 .. XXII 100 .. C

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30 / MARCH

DDA NEWS UPDATE News Roundupby Ailsa Colquhoun

GPs may need to wait six monthsbefore the clinical pharmacistindependent prescriber (CPIP) canyield significant benefits for thepractice and patients, a report to NHSEngland has found.

Researchers found that a key area where theCPIPs made a significant impact is

medication reviews, accounting for just over half of theirworkload. Yet it took six months before CPIPs weredelivering these off site, in patients’ own and in residentialhomes.

Researchers also said it took CPIPs six months to learnhow to handle hospital discharges and also toindependently support GPs with the management ofchronic disease.

Nevertheless, the report concludes that “CPIPs conductingmedication reviews saves money for a GP practice fromday one. This is true even where mentoring support and/orreferrals are required”.

Successful mentoring will utilise “a reducing scaffoldmodel, often as per registrar training”, the report notes.

Commissioned to inform the national roll out of the CPIPprogramme, the report also warns that GPs may need toinvest significant initial time in induction: an eight-dayinduction may be needed to provide “a good qualityintroduction to the new work context, creates a sense ofbelonging and trust and forms a solid base for mentoringand role development.”

This should include (as a minimum) the opportunity toshadow a range of staff, learn and practise working withthe IT system(s), and build mentoring relationships.

In the report, which was commissioned by NHS England toinform national roll-out of CPIP in general practice,researchers from the University of Nottingham studied sixpractices involved in an 18-month trial scheme.

They concluded that CPIPs have the ability to offerbenefits including capacity and service quality gains forGPs, improvements in patient satisfaction and that this roleeffectively harnesses the clinical pharmacist skill set.

However, practices are warned that may fail to find a readysupply of clinical pharmacist independent prescribers(CPIP) and that “further upskilling of pharmacists may bebeneficial to the overall development of the sector”.

New Falsified Medicines Directive (FMD) guidancefor community pharmacy contractors has beenissued by the UK FMD working group forcommunity pharmacy.

The detailed guidance is intended to buildunderstanding of the options, which also apply to GPdispensing staff, as the 12-month milestone forimplementation (February 9, 2019) approaches.

The Way Forward for FMD in community pharmacycovers the following information:

Key assumptions about FMD

High level processes for incorporating authentication in toexisting dispensing workflows

Handling stock transition after 2019

IT system requirements: Stand-alone FMD system orFMD-capable PMR?

Implications for patient safety.

The document makes clear that there is much work still todo prior to implementation, including to ensure that FMD-related costs are recognised in future NHS fundingsettlements.

The DDA has already identified the FMD as a challenge todispensing practice, and it will ensure that negotiationsinclude the cost of implementation and operation. Costswill include initial set-up, IT, both software and hardware,plus ongoing operational costs.

Within the next 12 months, the implementation processwill include:

Updating IT systems and associated hardware

Connecting dispensaries to the FMD verification system(“registration/on-boarding”)

Revising workflows and standard operating procedures

Training staff

Providing patient information .

The guidance has been published on FMD Source, and willbe updated as new information becomes available.

MARCH / 31

Population Growth in Rural Areasby Ailsa Colquhoun

DDA NEWS UPDATE

Rural town and fringe areas are showingthe greatest population growth of all ruralarea types, latest Department ofEnvironment, Food and Rural Affairs(DEFRA) statistics show.

Its January 2018 Statistical Digest ofRural England shows that within ruralareas, rural town and fringe areas grew in

size by 3 per cent, while rural villages and hamlets insparse settings showed the smallest rate of populationincrease within rural areas at 0.4 per cent.

Estimates for 2016 show that of an estimated Englishpopulation of 55.3 million, 9.4 million (17 per cent)lived in rural areas.

Although the rural population has increased by 0.3mpeople, as a proportion of the total population the ruralpopulation is getting smaller – down 0.2 per centcompared to 2011, due to the faster rate of increase inthe urban population.

In terms of age demographics, rural areas continue tohave a higher proportion of older people compared withurban areas. Just over 45 per cent of those living in rural

areas are aged below 45 years, compared with almost 60per cent in urban areas, and overall there areproportionately fewer younger people living insettlements in a sparse area.

The population aged 65 and over increased by 37 percent in predominantly rural areas between 2001 and2015, compared with 17 per cent in predominantlyurban areas.

The average age in rural areas was 44.4 years in 2016,5.5 years older than in urban areas.

Other key statistics:

People born in mainly rural areas in 2013-15 are onaverage expected to live two years longer than peopleborn in urban areas

In 2015/16 people living in the most rural areas travelledalmost 50 per cent farther per year than those in themost urban areas

In 2014/15 10 per cent of households in rural areas hadno access to a car or van.

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