nhs standard contract minor ailments service...

2013/14 NHS STANDARD CONTRACT FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH

AND LEARNING DISABILITY SERVICES

Particulars – DS39 2013/14 NHS STANDARD CONTRACT

NHS Standard Contract

2014/15

Minor Ailments Service

Particulars

NHS ENGLAND 2014/15 NHS STANDARD CONTRACT

PARTICULARS

Particulars 2014/15 NHS STANDARD CONTRACT

2

NHS Standard Contract

2014/15

Particulars

First published: December 2013

Gateway No: 00821


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Contract Reference

DATE OF CONTRACT

1st

October 2014

SERVICE COMMENCEMENT

DATE

1st

October 2014

CONTRACT TERM

6 Months (Subject to extension in accordance with Schedule 1 Part C)

COMMISSIONERS Gloucestershire CCG (11M) Sanger House 5220 Valiant Way Gloucester Business Park Brockworth Gloucestershire GL3 4FE

0300 421 1500

www.nhsglos.nhs.uk

PROVIDER Participating Pharmacy

http://www.nhsglos.nhs.uk/


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CONTENTS

PARTICULARS CONTRACT SERVICE COMMENCEMENT AND CONTRACT TERM SERVICES PAYMENT QUALITY GOVERNANCE REGULATORY CONTRACT MANAGEMENT PENSIONS

SCHEDULE 1 – SERVICE COMMENCEMENT AND CONTRACT TERM A. Conditions Precedent B. Commissioner Documents

C. Extension of Contract Term

SCHEDULE 2 – THE SERVICES A. Service Specifications B. Indicative Activity Plan C. Activity Planning Assumptions D. Essential Services E. Essential Services Continuity Plan F. Clinical Networks G. Other Local Agreements, Policies and Procedures H. Transition Arrangements I. Exit Arrangements J. Social Care Provisions K. Transfer of and Discharge from Care Protocols L. Safeguarding Policies

SCHEDULE 3 – PAYMENT A. Local Prices B. Local Variations C Local Modifications D. Marginal Rate Emergency Rule: Agreed Baseline Value E. Emergency Re-admissions Within 30 Days: Agreed Threshold F. Expected Annual Contract Values G Notices to Aggregate/Disaggregate Payments H. Timing and Amounts of Payments in First and/or Final Contract Year


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SCHEDULE 4 – QUALITY REQUIREMENTS

A. Operational Standards B. National Quality Requirements C. Local Quality Requirements D. Never Events E. Commissioning for Quality and Innovation (CQUIN) F. Local Incentive Scheme G. Clostridium difficile

H. Sanction Variations I. CQUIN Variations

SCHEDULE 5 - GOVERNANCE

A. Documents Relied On B1. Provider’s Mandatory Material Sub-Contractors B2. Provider’s Permitted Material Sub-Contractors C. IPR D. Commissioner Roles and Responsibilities E. Partnership Agreements

SCHEDULE 6 – CONTRACT MANAGEMENT, REPORTING AND INFORMATION REQUIREMENTS

A. Recorded Variations B. Reporting Requirements C. Data Quality Improvement Plan D. Incidents Requiring Reporting Procedure E. Service Development and Improvement Plan F. Surveys

SCHEDULE 7 – PENSIONS


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SERVICE CONDITIONS

SC1 Compliance with the Law and the NHS Constitution SC2 Regulatory Requirements SC3 Service Standards SC4 Co-operation SC5 Commissioner Requested Services/Essential Services

SC6 Service User Booking and Choice and Referrals SC7 Withholding and/or Discontinuation of Service SC8 Unmet Needs SC9 Consent SC10 Personalised Care Planning and Shared Decision Making SC11 Transfer of and Discharge from Care SC12 Service User Involvement SC13 Equity of Access, Equality and Non-Discrimination SC14 Pastoral, Spiritual and Cultural Care SC15 Services Environment and Equipment SC16 Places of Safety SC17 Complaints SC18 Service Development and Improvement Plan

SC19 HCAI Reduction Plan SC20 Venous Thromboembolism

SC21 Not used

SC22 Not used

SC23 Service User Health Records SC24 NHS Counter-Fraud and Security Management SC25 Procedures and Protocols SC26 Clinical Networks, National Audit Programmes and Approved Research

Studies SC27 Formulary

SC28 Information Requirements SC29 Managing Activity and Referrals

SC30 Emergency Preparedness and Resilience Including Major Incidents

SC31 Force Majeure: Service-specific provisions

SC32 Safeguarding SC33 Incidents Requiring Reporting SC34 Death of a Service User SC35 Duty of Candour SC36 Payment Terms

SC37 Local Quality Requirements and Quality Incentive Schemes SC38 Commissioning for Quality and Innovation (CQUIN)


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GENERAL CONDITIONS

GC1 Definitions and Interpretation GC2 Effective Date and Duration GC3 Service Commencement GC4 Transition Period GC5 Staff GC6 Not used GC7 Partnership Arrangements GC8 Review GC9 Contract Management GC10 Co-ordinating Commissioner and Representatives GC11 Liability and Indemnity GC12 Assignment and Sub-Contracting GC13 Variations GC14 Dispute Resolution GC15 Governance, Transaction Records and Audit GC16 Suspension GC17 Termination GC18 Consequence of Expiry or Termination GC19 Provisions Surviving Termination GC20 Confidential Information of the Parties GC21 Data Protection, Freedom of Information and Transparency GC22 Intellectual Property GC23 NHS Branding, Marketing and Promotion GC24 Change in Control GC25 Warranties GC26 Prohibited Acts GC27 Conflicts of Interest GC28 Force Majeure GC29 Third Party Rights GC30 Entire Contract GC31 Severability GC32 Waiver GC33 Remedies GC34 Exclusion of Partnership GC35 Non-Solicitation GC36 Notices GC37 Costs and Expenses GC38 Counterparts GC39 Governing Law and Jurisdiction


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CONTRACT This Contract records the agreement between the Commissioners and the Provider and comprises

1. the Particulars; 2. the Service Conditions;

3. the General Conditions,

as completed and agreed by the Parties and as varied from time to time in accordance with General Condition 13 (Variations). IN WITNESS OF WHICH the Parties have signed this Contract on the date(s) shown below

SIGNED by

………………………………………………………. Signature

Mark Walkingshaw For and on behalf of Gloucestershire Clinical

Commissioning Group

………………………………………………………. Title ………………………………………………………. Date

SIGNED by

………………………………………………………. Signature

For and on behalf of Participating Pharmacy

………………………………………………………. Title ………………………………………………………. Date


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SERVICE COMMENCEMENT AND CONTRACT TERM

Effective Date

1st

October 2014

Expected Service Commencement Date

1st

October 2014

Longstop Date

Not Applicable

Commissioner Documents

Set out in Schedule 1 Part B

Service Commencement Date

1

st October 2014

Contract Term 6 Months (Subject to extension in accordance with Schedule 1 Part C)

Option to extend Contract Term

NO

Expiry Date 31st

March 2015


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SERVICES

Service Categories Tick all that apply

Accident and Emergency (A+E)

Acute Services (A)

Ambulance Services (AM)

Cancer Services (CR)

Care Home Services (CH)

Community Pharmaceutical Services (Ph)

Community Services (CS)

Diagnostic, Screening and/or Pathology

Services (D)

Hospice Services (H)

Mental Health and Learning Disability

Services (MH)

Mental Health Secure Services (MHSS)

Patient Transport Services (PT)

Radiotherapy Services (R)

Substance Misuse Services (SM)

Surgical Services in a Community Setting

(S)

Urgent Care/Walk-in Centre

Services/Minor Injuries Unit (U)

Service Requirements

Service Specifications Set out in Schedule 2 Part A

Indicative Activity Plan Not applicable

Activity Planning Assumptions Not applicable

Essential Services (NHS Trusts only) Not applicable

Services to which 18 Weeks applies NO


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PAYMENT

National Prices Not applicable

Local Prices

Set out in Schedule 3 Part A

Local Variations Not applicable

Local Modifications Not applicable

Small Provider NO

Expected Annual Contract Value Agreed NO

Any Services not included in Expected

Annual Contract Value

NO

First/Last Contract Year less than 12

months

YES

Notice given to aggregate payments NO

Notice given to disaggregate payments NO


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QUALITY

Sanction Variations

NO

CQUIN Scheme(s)

NO

CQUIN Variations

NO

CQUIN Payments on Account Made Not Applicable

Local Incentive Scheme NO

Provider type

Other

Clostridium Difficile Baseline Threshold Nil


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GOVERNANCE AND

REGULATORY

Documents Relied On Set out in Schedule 5 Part A

Mandatory Material Sub-Contractors Not applicable

Permitted Material Sub-Contractors

Not applicable

Intellectual Property Rights (IPR) Set out in Schedule 5 Part C

Commissioner Roles and Responsibilities Not Applicable

Nominated Mediation Body

Centre for Effective Dispute Resolution

CEDR

Provider’s Information Governance Lead For Participating Pharmacies

Provider’s Caldicott Guardian

For Participating Pharmacies

Provider’s Senior Information Risk Owner


Provider’s Accountable Emergency

Officer


Provider’s Safeguarding and Prevent Lead



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CONTRACT MANAGEMENT

Addresses for service of Notices

Commissioner:

Gloucestershire Clinical Commissioning

Group

Sanger House

5220 Valiant Court

Gloucester Business Parl

Brockworth

Gloucester GL3 4FE

Email: [email protected]

Tel: 0300 421 1406

Provider: Participating Pharmacy

Frequency of Review Meetings

Ad hoc

Commissioner Representative(s)

Teresa Middleton

Deputy Director of Quality

Gloucestershire Clinical Commissioning

Group

Sanger House

5220 Valiant Court

Gloucester Business Parl

Brockworth

Gloucester GL3 4FE

Email: [email protected]

Tel: 0300 421 1735

Provider Representative Participating Pharmacy

mailto:[email protected]



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PENSIONS

New Fair Deal applies NO


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SCHEDULE 1 – SERVICE COMMENCEMENT AND CONTRACT TERM

A. Conditions Precedent

The Provider must provide the Co-ordinating Commissioner with the following documents:

1. Essential Services Continuity Plan; 2. Business Continuity Plan; 3. Confirmation that all Indemnity Arrangements (acceptable to the Commissioner)

required under GC11 are in place; 4. Confirmation that the Provider has adopted the Safeguarding Policies: Level 2

Kwango or CPPE; 5. Written details of the Information Governance Lead 6. List of any Partnership Agreements to which the Provider is a party which relate

to or otherwise affect the provision of any of the Services. 7. Suitable and appropriate premises to be secured and operational by service

commencement date; 8. Declaration of competence from each pharmacist. (as referred to as Appendix 6

in the Service Specification and is shown in Schedule 5 Part A)

The Provider must complete the following actions:

1. Put in place appropriate Counter Fraud and Security Management

Arrangements; 2. Sustainability Policy.


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B. Commissioner Documents

Date

Document

Description

26/11/13

DRAFT GCCG Commissoining Intentions 2014-15_221113_PDF v0.01.pdf

Draft Commissioning Intentions


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C. Extension of Contract Term

Not Applicable


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SCHEDULE 2 – THE SERVICES

A. Service Specifications

Mandatory headings 1 – 4: mandatory but detail for local determination and agreement Optional headings 5-7: optional to use, detail for local determination and agreement. All subheadings for local determination and agreement

Service Specification

No.

Service Minor Ailment Scheme

Commissioner Lead Teresa Middleton

Provider Lead Community Pharmacists within Gloucester City Locality

Period 1st October 2014 to 31

st March 2015

Date of Review 31st March 2015

1. Population Needs

1.1 National/local context and evidence base Minor ailments are ‘common or self-limiting or uncomplicated conditions which can be diagnosed and managed without medical intervention; many of these ailments such as coughs, colds, sore throats and earache frequently occur during the winter months.

Our Minor Ailment Service is an NHS service that provides free medicines in participating pharmacies for people who would otherwise obtain a prescription from their GP, and is likely to include those (although not restricted to) who do not normally pay for their prescription i.e. for those patients exempt from paying prescription charges.

2. Outcomes

2.1 NHS Outcomes Framework Domains & Indicators

Domain 1 Preventing people from dying prematurely

Domain 2 Enhancing quality of life for people with long-term

conditions

Domain 3 Helping people to recover from episodes of ill-health or

following injury

Domain 4 Ensuring people have a positive experience of care

Domain 5 Treating and caring for people in safe environment and

protecting them from avoidable harm

2.2 Local defined outcomes

PharmOutcomes


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It is a requirement of the service that all consultations are recorded on PharmOutcomes for invoicing and audit purposes. This information must be recorded at the time of the consultation.

All pharmacies contracted to provide the service will require individual logins to access the Minor Ailments Scheme Service Part A (patient registration) and Part B (consultation), and these are provided separately by PharmOutcomes team.

Payments will be made at the end of the month on a quarterly basis following that to which the quarterly payment relates.

3. Scope

3.1 Aims and objectives of service The scheme aims to ensure that patients access self-care advice for the treatment of winter ailments and where appropriate can be supplied with over the counter medicines at NHS expense, in order to treat their minor ailment. This provides patients with an alternative and more accessible location from which to seek advice and treatment, rather than seeking treatment via a prescription from their GP or Out of Hours (OOH) Provider, or via a Walk In Centre or Emergency Departments (ED)

In summary –

The scheme will improve patient access to advice and appropriate treatment for minor ailments

Reduce GP, OOH and ED workload for minor ailments increasing capacity for greater focus to be

delivered on more complex and urgent medical conditions.

Promote the role of the Pharmacist and Self Care

Further develop working relationships between Doctors and Pharmacists in the Gloucester City

Locality.

The service is only available from Pharmacies who have signed up to deliver the service shown in Appendix 1 – as referred to in item 6 of the Service Specification , and only for the minor ailments listed in Appendix 2 – as referred to in Schedule 2 Part G. Only medicines specified in the protocols and formulary (Appendix 3 – as referred to in Schedule 2 Part G) and Schedule 4 - as referred to in Schedule 4 Part B, may be supplied for the minor ailments listed. For ease, Appendix 5 – as referred to in Schedule 4 Part B, lists the products by minor ailment group.

Patients may choose to refuse participation in this service and continue to access treatments in the same way as they have done previously. The scheme aims to promote patient choice and encourages them to Choose Well.

3.2 Service description/care pathway Who can provide the service?

This service may be provided by an accredited Community Pharmacy within the Gloucester City Locality (Appendix 1.) subject to the following –

1.1.1 All Pharmacists working at the participating pharmacies can provide this

enhanced service if they are clinically competent in the treatment of minor

ailments as demonstrated by CPPE Declaration of Competence – Minor Ailments

(see Appendix 6 as referred to in Schedule 5 Part A)

1.1.2 All Pharmacists working at the participating pharmacies and providing the scheme

should ensure that they continue, via CPD, to keep up to date with guidance

issued around the treatment of minor ailments and OTC medicines and have

Safeguarding of Children and Vulnerable Adults Kwango Level 2 or CPPE

accreditation. Declaration of Competence must be completed.

1.1.3 The Pharmacy must meet, or be able to provide evidence that they are working

towards meeting the requirements for all essential services in the Community


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Pharmacy Contractual Framework.

1.1.4 The Pharmacy must have an accredited consultation area which has been

approved for enhanced services for the consultations to take place. All

consultations must take place in a confidential environment.

1.1.5 The Pharmacy must have an SOP or Sale of Medicines Protocol in line with the

requirements of Essential Service 6 of the Community Pharmacy Contractual

Framework – Support for Self Care.

1.1.6 The Pharmacy contractor must participate in all parts of the service as detailed in

this document along with any subsequent amendments as agreed jointly between

Gloucestershire Clinical Commissioning Group (GCCG) and Gloucestershire

Local Pharmaceutical Committee (GLPC) This agreement will be in writing and

signed by the Pharmacist in Charge and be considered a local commissioned

service.

Consultation Record

Consultations for the scheme will be recorded on PharmOutcomes. This is a national web based system in use for the management and invoicing of locally commissioned pharmacy services. Data entry must be completed at the time of consultation for clinical and fraud prevention purposes.

Access to the system is via username and passwords previously sent to all community pharmacies.

Patients who receive medication under this scheme and are exempt from prescription charges will be asked for evidence and this will be recorded on the electronic proforma.

Please note that consultations are paid only when medication has been supplied. Consultation fees cannot be claimed where medication has not been supplied as the provision of advice for self-care is an Essential Service under the Pharmacy Contract.

Urgent referral to GP or other service

In a situation where a patient presents with symptom(s) that needs urgent referral to GP, an Urgent Referral Form from Community Pharmacy (Appendix 8) can be completed. If the patient consents the GP practice may be contacted to alert staff that an emergency appointment is required and if indicated then details of when this may occur can be conveyed to patient.

If the practice is closed and / or symptoms are sufficiently severe to warrant a referral to a doctor, the patient should be advised to contact NHS 111 or attend MIU or ED service. In these circumstances it is not necessary to complete an ‘Urgent Referral Form’.

Evaluation

Pharmacies participating in the scheme will be expected to facilitate the evaluation of the scheme by participating in patient satisfaction surveys or audit which together with PharmOutcomes data will enable GCCG to evaluate the efficacy of the scheme.

Pharmacies will be expected to follow complaints procedure (both internal to the pharmacy and NHS) where issues arise so that improvements can be made following significant events or errors.

Pharmacies should also note that by agreeing to participation in the scheme GCCG and patient forums have the right to inspection in line with NHS guidance.

Incident Reporting

All incidents should be recorded as part of the pharmacy’s clinical governance procedures see Essential Service 8 – Clinical Governance, Community Pharmacy Contractual Framework.

Duties of the Commissioners


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Gloucestershire Clinical Commissioning Group (GCCG) will be responsible for appropriate advertising, promotion and ongoing support to pharmacies where required.

GCCG will be responsible for ensuring timely payments quarterly to Community Pharmacies participating in the scheme as well as dealing with operational and payment based queries.

GCCG will also be responsible for evaluation of the scheme, which includes monthly monitoring of the number of consultations that are being conducted each month, audit of frequent users of the scheme, tracking of costs of the scheme and collection of data about the origins of referral.

3.3 Population covered The scheme is available to any patient who is registered with a GP practice in Gloucestershire, whether exempt from NHS prescription charges or not (in which case the NHS prescription charge for each item will apply, currently at £8.05). 3.4 Any acceptance and exclusion criteria and thresholds Patients will be asked by the pharmacy to confirm they are registered with a GP Practice within Gloucestershire CCG before any supply is made, and where there is doubt and with patient consent, the pharmacist may check the registration with the GP practice (see 5.1)

Patients not registered with a GP practice in Gloucestershire may choose to purchase Over The Counter (OTC) medication and should be managed in accordance with Essential Service 6 – Support for Self Care or if appropriate Essential Service 5 – Signposting.

It is anticipated that patients who will make use of the Minor Ailments Scheme will access the scheme through the pharmacy where they currently get their prescriptions dispensed and the need to contact surgeries to confirm registration will be minimal.

Prescription Exemptions

Patients accessing the scheme that are entitled to free prescriptions will receive the medicine free of charge. The patient will be asked to provide evidence of their exemption and this declaration will be recorded electronically on the consultation pro-forma. Non-exempt patients will be charged the standard NHS prescription fee per item issued, as if it was on prescription, and Pharmoutcomes completed accordingly. The prescription fees collected will be deducted from the scheme payments (just like on FP10) NB in situations where the chosen product is less expensive for the patient to purchase as a pharmacy sale rather than the NHS prescription charge, self-purchase is the preferred route. Checking of GP Registration

Before proceeding to supply the treatment under the scheme, the patient MUST be asked to confirm they are registered with a GP practice in Gloucestershire.

This may be done by:

-checking the patient’s PMR if the patient is already collecting medication from that pharmacy

-asking the patient for a repeat prescription slip

- knowing the patient to be registered with the GP practice

- medical card

Confirmation of the patient’s registration at an eligible GP practice is required if the above documentation is not available, or it is felt that a patient may be attempting to fraudulently use the scheme. Staff may telephone the patient’s GP surgery for confirmation of the patient’s registration with the consent of the patient, and should offer the patient’s details i.e. name, date of birth and postcode or address and merely ask the GP surgery to confirm ‘yes’ or ‘no’ whether the patient is registered with the practice. The


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pharmacy should not expect the GP surgery to offer any other patient information as they should already be in receipt of this from the patient.

When to sell an OTC treatment and when to supply under Minor Ailment Scheme

Treatment can be supplied if appropriate providing the patient is:

Registered with a GP practice in Gloucestershire.

Suffering from a minor ailment listed in Appendix 2.

In the following circumstances treatment should NOT be supplied under the Minor Ailment Scheme:

When a patient requests the medicine by name – this scheme must not be used to divert the sale

of OTC medicines.

GP cannot refer patients for named medicines – if the GP consultation resulted in a medication

recommendation then a prescription for medication should be issued. Additionally a GP cannot

write a prescription for one item and refer the patient for the other named item.

To pharmacy staff and/or their immediate family – this scheme must not be used to divert the sale

of OTC medicines. As detailed in the Medicines Act 1968 and in Professional Code of Conduct

this group must be signposted to alternative pharmaceutical or healthcare services where

appropriate.

Patients must not use the scheme in lieu of regular repeat prescribed medication such as

paracetamol for chronic pain.

Loss of medication already supplied under the Minor Ailment Scheme.

Where a non-exempt patient could purchase the product for lower than the NHS prescription

charges applicable.

Supporting and Referring into the Scheme

The scheme should benefit the surgery by resulting in a decreased demand for appointments for acute minor ailments during the scheme period and thereby allowing patients with other needs to receive an appointment sooner.

GP practices will be asked to display, in a prominent position, a poster advertising the scheme. Other methods of advertising will be encouraged too, for example answer phone messages and in-house information videos etc.

GP practices will also refer patients verbally to the scheme where it is deemed appropriate. This can be done by reception staff who book appointments. Doctors and Nurses can also refer during their consultations for future need where it is felt that the patient would be better served by the scheme rather than using an appointment.

GP practices may also encounter patients who have been referred back to them by a Community Pharmacy following a consultation under the scheme via a referral form (see Appendix 8). The Pharmacists will be using their professional skills to make a judgement based upon the patient’s symptoms – this information will be the basis of the urgency of the referral. Pharmacists will recommend patients to make an appointment the same or following day or to ask for the next available routine appointment. If urgent the Pharmacist may telephone the surgery with patient consent. Practices are asked to accommodate all reasonable appointment requests.

3.5 Interdependence with other services/providers Referral into the Scheme

Patients can be introduced to the scheme in a number of ways:

1- Referred by an Emergency Department- where the patient presents during the pharmacy’s

usual working hours with one of the minor ailments listed in Appendix 2, they may be advised of


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the scheme and how to access it through a local participating pharmacy.

2- Referred by GP surgery to a participating pharmacy – patients presenting at a GP practice

with one of the minor ailments listed in Appendix 2 may be advised of the scheme and how to

access it through a local participating pharmacy.

3- Referred by pharmacy staff or other community healthcare professional – where they feel it

to be appropriate.

4- Self-Referral into the scheme at a participating pharmacy – patients who are aware of the

scheme, whether through friends, relatives or advertising may self-refer into the scheme.

5- Referred by OOH Service Provider or NHS 111 – patient may be referred where telephone

triage identifies a minor ailment which can be treated as part of this scheme.

4. Applicable Service Standards

4.1 Applicable national standards (eg NICE) 4.2 Applicable standards set out in Guidance and/or issued by a competent body (eg Royal

Colleges) Confidentiality

Both parties shall adhere to the requirements of the Data Protection Act 1988 and the Freedom of Information Act 2000.

4.3 Applicable local standards Consultation

The Pharmacist must ensure that the professional consultation is carried out with reference to Minor Ailment Scheme protocols (Appendix 3) which involve:

Patient assessment

Provision of advice

Completion of PharmOutcomes proforma

Supply of appropriate medication from the agreed formulary (Appendix 4)

The patient should attend the pharmacy in person in order to receive a consultation and if appropriate a supply of medication. In the same way they would be required to attend at the surgery to see the GP and then obtain a prescription. Exemptions to this requirement include threadworm and head lice – in such cases a parent or carer is allowable.

For patients under the age of 16 the parent/guardian can accept transfer into the scheme on behalf of the patient. These patients must be accompanied by a parent/guardian when they visit a participating pharmacy. NB. Parent/guardian MUST always bring the child with them to the pharmacy in order for a full assessment to be carried out. Young people between the ages of 16-18 can receive a consultation without a parent/guardian as the Pharmacist will have appropriate Safeguarding accreditation and a chaperone may be appropriate.

The Minor Ailment Protocols (Appendix 3) should be available for reference during the consultation. These detail what conditions can be treated under the scheme and the medicines that can be supplied for each condition. It is recognised that Pharmacists will use their clinical/professional judgement when deciding the best treatment for individual patients. Reference to the most current BNF and/or product information should be made during all consultations as appropriate with regard to dosage instructions of medicines and age ranges covered by the scheme. Conditions outside the scheme must not be treated under the service and only the medicines detailed in the Minor Ailments Protocols must be supplied as appropriate.


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During the consultation the Pharmacist will make an assessment of the patient and provide suitable advice as detailed in the Minor Ailment Protocols. If it is deemed appropriate a medication from the list in Appendix 4 may be supplied as an original pack, with a product information leaflet and instructions for use. The decision to provide a medicine for treatment or to refer will be based on symptom and treatment history.

Professional Judgement

Medication can only be supplied by Pharmacists who have completed a Declaration of Competence – MAS from CPPE (see Appendix 6) for the listed conditions to patients presenting in person at the pharmacy with the exception of head lice and threadworms.

In exceptional circumstances professional judgement can be applied to situations such as supplying an oral rehydration product for a patient with acute diarrhoea unable to attend the pharmacy in person due to the obvious inconvenience. In these situations Pharmacists must be satisfied that the supply of medicines to a third party does not put patient at risk and it is in the patient’s best interest.

Professional judgement may also be used to exclude a patient from receiving treatment under the Minor Ailments Scheme when signs and symptoms suggest that a GP referral or urgent referral is needed even though these signs and symptoms are not listed in the Minor Ailment protocol.

Record Keeping

In addition to the consultation data recorded on PharmOutcome, a separate record of any medication supplied through the Minor Ailment Scheme should be documented in the Patient Medication Record (PMR) on the pharmacy IT system.

Minimising Inappropriate Use of the Scheme

Where necessary, GP practices should co-operate with participating community pharmacies in confirming a patient’s registration over the telephone upon provision of suitable information by the pharmacy. It should be noted that this method of registration confirmation is the last resort for the pharmacies and will only be used where they have concerns about fraudulent attempts to misuse the scheme. If GP surgery staff have concerns about the authenticity of the call then surgery staff should offer to call back the Pharmacist with the required confirmation of registration, sourcing the pharmacy contact number from an independent provider e.g. directory listing. If it is deemed necessary to call the pharmacy back, ideally this call should be made immediately as the patient is likely to be waiting in the pharmacy.

5. Applicable quality requirements and CQUIN goals

5.1 Applicable Quality Requirements (See Schedule 4 Parts [A-D])

5.2 Applicable CQUIN goals (See Schedule 4 Part [E])

6. Location of Provider Premises

The Provider’s Premises are located at: Patients can access the scheme at any participating pharmacy (Appendix 1). GP practices, OOH service and ED department will be given a list of participating pharmacies in their area and appropriate advertising of the scheme will be undertaken by GCCG.

Appendix 1 - Participating Pharmacies v2.pdf

7. Individual Service User Placement

Not Applicable


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B. Indicative Activity Plan

Not Applicable

C. Activity Planning Assumptions

Not Applicable

D. Essential Services

Not Applicable

E. Essential Services Continuity Plan

Not Applicable

F. Clinical Networks

Not Applicable


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G. Other Local Agreements, Policies and Procedures

Policy Date Weblink

Minor Ailments List

Appendix 2 - Minor Ailments List.pdf

Minor Ailments Protocol


H. Transition Arrangements

Not Applicable

I. Exit Arrangements

The pharmacy or GCCG may terminate participation in the scheme by giving written notice of their intention at least 28 days before the service end date. No reason needs to be given for the termination of the agreement. It should be noted that if the scheme is unsuccessful it may be terminated to allow investment in other areas. In addition, if the scheme is successful beyond the initial budget estimates, the scheme may be restricted or suspended early pending further budgetary provision. If for whatever reason, the pharmacy does not fulfil its obligation to provide all essential services under the pharmacy contractual framework then the pharmacy will become ineligible to provide the service.

J. Social Care Provisions

Not Applicable


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K. Transfer of and Discharge from Care Protocols

Not Applicable


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L. Safeguarding Policies

AI_5_Safeguarding_Children_Policy_Final_version_June_2013.pdf

Safeguarding Adults Board Policy Oct 2012.pdf

Safeguarding Policies Level 2 Kwango or CPPE to be provided by 1

st November 2014


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SCHEDULE 3 – PAYMENT

A. Local Prices

Reimbursement for the service will consist of a consultation fee plus the cost of any product supplied. Each consultation is paid at a rate of £4.50 per consultation only when a medicine has been supplied (NB. Where a formulary item, is not supplied in accordance with the minor ailments protocols, no reimbursements for the formulary item will occur and no consultation fee will be paid.) Pharmacists cannot claim a consultation fee when a product was not supplied as this is deemed part of Essential Service 6. When a patient is presenting for treatment of more than one minor ailment, this will be treated as separate consultations and reimbursed accordingly. For example, a patient with a cold also requiring treatment for head lice would be considered as two separate consultations. However a patient presenting with a number of symptoms such as cough, congestion, headache, all related to a common cold would be counted as one consultation. More than one product can be supplied in this case in line with protocols. Each symptom in this case relates to one condition and should not be treated separately. Please note that when a threadworm or head lice treatment is supplied to other members of the family, their details will need to be recorded on the same consultation form and only one consultation fee can be claimed. Pharmacies will be reimbursed for the medicines they supply at the Drug Tariff price, or where this is not available, the cost price of the product as listed in the Dictionary of Medicines and Devices (dm&d). No container fee will be paid and no discount ‘clawback’ will be applied. Prices of medicines will be updated monthly from the Drug Tariff and the dm&d.

B. Local Variations

Not Applicable

C. Local Modifications

Not Applicable


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D. Marginal Rate Emergency Rule: Agreed Baseline Value

Not Applicable

E. Emergency Re-admissions Within 30 Days: Agreed Threshold

Not Applicable

F. Expected Annual Contract Values

Not Applicable

G. Notices to Aggregate / Disaggregate Payments

Not Applicable

H. Timing and Amounts of Payments in First and/or Final Contract Year

Not Applicable


PARTICULARS


32

SCHEDULE 4 – QUALITY REQUIREMENTS

A. Operational Standards

Ref Operational Standards Threshold (2014/15)

Method of Measurement (2014/15)

Consequence of breach Timing of application of consequence

Applicable Service Category

RTT waiting times for non-urgent consultant-led treatment

CB_B1 Percentage of admitted Service Users starting treatment within a maximum of 18 weeks from Referral

Operating standard of 90% at specialty level (as reported on Unify)

Review of monthly Service Quality Performance Report

Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £400 in respect of each excess breach above that threshold

Monthly Services to which 18 Weeks applies

CB_B2 Percentage of non-admitted Service Users starting treatment within a maximum of 18 weeks from Referral

Operating standard of 95% at specialty level (as reported on Unify)




CB_B3 Percentage of Service Users on incomplete RTT pathways (yet to start treatment) waiting no

Operating standard of 92% at specialty level


Where the number of breaches in the month exceeds the tolerance permitted by the



PARTICULARS


33





more than 18 weeks from Referral

(as reported on Unify)

threshold, £100 in respect of each excess breach above that threshold

Diagnostic test waiting times

CB_B4 Percentage of Service Users waiting less than 6 weeks from Referral for a diagnostic test

Operating standard of >99%



Monthly A C CR D

A&E waits

CB_B5 Percentage of A & E attendances where the Service User was admitted, transferred or discharged within 4 hours of their arrival at an A&E department

Operating standard of 95%


Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £200 in respect of each excess breach above that threshold. To the extent that the number of breaches exceeds 8% of A&E attendances in the relevant month, no further consequence will be applied in respect of the month

Monthly A+E U


PARTICULARS


34





Cancer waits - 2 week wait

CB_B6 Percentage of Service Users referred urgently with suspected cancer by a GP waiting no more than two weeks for first outpatient appointment



Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £200 in respect of each excess breach above that threshold

Quarterly A CR R

CB_B7 Percentage of Service Users referred urgently with breast symptoms (where cancer was not initially suspected) waiting no more than two weeks for first outpatient appointment




Quarterly A CR R

Cancer waits – 31 days

CB_B8 Percentage of Service Users waiting no more than one month (31 days) from diagnosis to first definitive treatment for all cancers



Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each excess breach above that threshold

Quarterly A CR R

CB_B9 Percentage of Service Users waiting no more than 31 days for



Where the number of breaches in the Quarter exceeds the tolerance

Quarterly A CR R


PARTICULARS


35





subsequent treatment where that treatment is surgery

permitted by the threshold, £1,000 in respect of each excess breach above that threshold

CB_B10 Percentage of Service Users waiting no more than 31 days for subsequent treatment where that treatment is an anti-cancer drug regimen




Quarterly A CR R

CB_B11 Percentage of Service Users waiting no more than 31 days for subsequent treatment where the treatment is a course of radiotherapy




Quarterly A CR R

Cancer waits – 62 days

CB_B12 Percentage of Service Users waiting no more than two months (62 days) from urgent GP referral to first definitive treatment for cancer




Quarterly A CR R


PARTICULARS


36





CB_B13 Percentage of Service Users waiting no more than 62 days from referral from an NHS screening service to first definitive treatment for all cancers




Quarterly A CR R

CB_B14 Percentage of Service Users waiting no more than 62 days for first definitive treatment following a consultant’s decision to upgrade the priority of the Service User (all cancers)

[Insert as per local determination]


[Insert as per local determination]

Quarterly A CR R

Category A ambulance calls

CB_B15_01

Percentage of Category A Red 1 ambulance calls resulting in an emergency response arriving within 8 minutes


Performance measured monthly with annual reconciliation

Monthly withholding of 2% of Actual Monthly Value with an end of year reconciliation with 2% of the Actual Annual Value retained if annual performance is not met, or the withheld sums returned (with no interest) if annual performance is met

Monthly withholding, annual reconciliation

AM


PARTICULARS


37





CB_B15_02

Percentage of Category A Red 2 ambulance calls resulting in an emergency response arriving within 8 minutes





AM

CB_B16 Percentage of Category A calls resulting in an ambulance arriving at the scene within 19 minutes





AM

Mixed sex accommodation breaches

CB_B17 Sleeping Accommodation Breach

>0 Verification of the monthly data provided pursuant to Schedule 6 Part C in accordance with the Professional Letter

£250 per day per Service User affected

Monthly A CR MH


PARTICULARS


38





Cancelled operations

CB_B18 All Service Users who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding date within 28 days, or the Service User’s treatment to be funded at the time and hospital of the Service User’s choice

Number of Service Users who are not offered another binding date within 28 days >0


Non-payment of costs associated with cancellation and non- payment or reimbursement (as applicable) of re-scheduled episode of care

Monthly A CR S

Mental health

CB_B19 Care Programme Approach (CPA): The percentage of Service Users under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care


Review of monthly Service Quality Performance Reports


Quarterly MH MHSS

Note: The Operational Standards greyed out do not apply for the services commissioned at the time of signing the contract. This position may change and any that become effective will be done so in line with Clause GC13 and the procedure in Schedule 6 Part A: Recorded Variations.


PARTICULARS


39

B. National Quality Requirements

National Quality Requirement

Threshold

(2014/15)


Consequence of breach

Monthly or annual application of consequence


CB_A15 Zero tolerance MRSA <0 Review of monthly Service Quality Performance Report

£10,000 in respect of each incidence in the relevant month

Monthly A

CB_A16 Minimise rates of Clostridium difficile

<0 Review of monthly Service Quality Performance Report

As set out in Schedule 4 Part G, in accordance with applicable Guidance

Annual A

CB_S6 Zero tolerance RTT waits over 52 weeks for incomplete pathways

>0 Review of monthly Service Quality Performance Report

£5,000 per Service User with an incomplete RTT pathway waiting over 52 weeks at the end of the relevant month


CB_S7a All handovers between ambulance and A & E must take place within 15 minutes with none waiting more than 30 minutes

>0


£200 per Service User waiting over 30 minutes in the relevant month

Monthly A+E

CB_S7b All handovers between ambulance and A & E must take place within 15 minutes with none waiting more than 60 minutes


£1,000 per Service User waiting over 60 minutes (in total, not aggregated with CB_S7a consequence) in the relevant month

Monthly A+E

CB_S8a Following handover between ambulance and A & E, ambulance crew


£20 per event where > 30 minutes in the relevant month

Monthly AM


PARTICULARS


40


Threshold

(2014/15)





should be ready to accept new calls within 15 minutes

CB_S8b Following handover between ambulance and A & E, ambulance crew should be ready to accept new calls within 15 minutes


£100 per event where > 60 minutes (in total, not aggregated with CB_S8a consequence) in the relevant month

Monthly AM

CB_S9 Trolley waits in A&E not longer than 12 hours


£1,000 per incidence in the relevant month

Monthly A+E

CB_S10 No urgent operation should be cancelled for a second time


£5,000 per incidence in the relevant month

Monthly A CR

VTE risk assessment: all inpatient Service Users undergoing risk assessment for VTE, as defined in Contract Technical Guidance

95% Review of monthly Service Quality Performance Report


Monthly A

Publication of Formulary

Continuing failure to publish Appendix 4 -

Formulary A-Z v2.0.pdf

Withholding of up to 1% of the Actual Monthly Value per month until publication

Monthly A MH MHSS CR R


PARTICULARS


41


Threshold

(2014/15)





Appendix 5 - Formulary by Minor Ailment Group v2.0.pdf

Duty of candour Each failure to

notify the Relevant Person of a suspected or actual Reportable Patient Safety Incident (as per Guidance)

Monitoring system to be implemented to ensure that the responsibilities and duties outlined in SC35 (Duty of Candour) have been carried out and reported to the Commissioner

Recovery of the cost of the episode of care, or £10,000 if the cost of the episode of care is unknown or indeterminate

Monthly All

Completion of a valid NHS Number field in mental health and acute commissioning data sets submitted via SUS, as defined in Contract Technical Guidance

99%



Monthly A MH MHHS

Completion of a valid NHS Number field in A&E commissioning data sets submitted via SUS, as defined in Contract Technical Guidance

95% Review of monthly Service Quality Performance Report


Monthly A&E

Completion of Mental Operating Review of monthly Service Where the number of Monthly MH


PARTICULARS


42


Threshold

(2014/15)





Health Minimum Data Set ethnicity coding for all detained and informal Service Users, as defined in Contract Technical Guidance

standard of 90%

Quality Performance Reports

breaches in the month exceeds the tolerance permitted by the threshold, £10 in respect of each excess breach above that threshold

MHSS

Completion of IAPT Minimum Data Set outcome data for all appropriate Service Users, as defined in Contract Technical Guidance


Review of monthly Service Quality Performance Reports


Monthly MH MHSS

Note: The National Quality Standards greyed out do not apply for the services commissioned at the time of signing the contract. This position may change and any that become effective will be done so in line with Clause GC13 and the procedure in Schedule 6 Part A: Recorded Variations.


PARTICULARS


43

C. Local Quality Requirements

Quality Requirement

Threshold Method of Measurement Consequence of breach


Applicable Service Specific-ation

Insert text and/or attach spreadsheet or documents locally

2014/15 NHS STANDARD CONTRACT PARTICULARS

Particulars 2014/15 NHS Standard Contract – v11

44

D. Never Events

Never Events Threshold Method of Measurement Never Event Consequence (per occurrence) Applicability Applicable Service Category

SURGICAL Wrong site surgery >0 Review of reports submitted

to NRLS/Serious Incidents reports and monthly Service Quality Performance Report

In accordance with Never Events Guidance, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event

All Healthcare Premises

A S

Wrong implant/prosthesis

>0 Review of reports submitted to NRLS/Serious Incidents reports and monthly Service Quality Performance Report



A S

Retained foreign object post-operation




A S



45

MEDICATION

Wrongly prepared high-risk injectable medication



All Healthcare Settings

All except PT

Maladministration of potassium-containing solutions




A

Wrong route administration of chemotherapy




A CR

Wrong route administration of oral/enteral treatment


In accordance with Never Events Guidance, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure


All except PT



46

or necessary care in consequence of the Never Event

Intravenous administration of epidural medication




All except PT, Ph

Maladministration of insulin




All except PT

Overdose of midazolam during conscious sedation




A S

Opioid overdose of an opioid-naïve Service User


In accordance with Never Events Guidance, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this


All except PT



47

Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event

Inappropriate administration of daily oral methotrexate




All except PT

MENTAL HEALTH

Suicide using non-collapsible rails



All mental health inpatient premises

MH MHSS

Escape of a transferred prisoner



All medium and high secure mental health inpatient premises

MH MHSS

GENERAL HEALTHCARE

Falls from unrestricted windows

>0 Review of reports submitted to NRLS/Serious Incidents reports and monthly Service

In accordance with Never Events Guidance, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or


All except AM, PT, Ph



48

Quality Performance Report episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event

Entrapment in bedrails

>0 Review of reports submitted to/Serious Incidents reports and monthly Service Quality Performance Report


All adult inpatient premises

A MH MHSS

Transfusion of ABO incompatible blood components




A&E A AM CR R SM S U

Transplantation of ABO incompatible organs as a result of error




A

Misplaced naso- or oro-gastric tubes

>0 Review of reports submitted to NRLS/Serious Incidents

In accordance with Never Events Guidance, recovery by the Responsible Commissioner of the

All Healthcare

All except PT, Ph



49

reports and monthly Service Quality Performance Report

costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event

Premises

Wrong gas administered




All except PT, Ph, CH

Failure to monitor and respond to oxygen saturation




All except PT

Air embolism >0 Review of reports submitted to NRLS/Serious Incidents reports and monthly Service Quality Performance Report



All except PT



50

Misidentification of Service Users




All

Severe scalding of Service Users




All

MATERNITY

Maternal death due to post-partum haemorrhage after elective caesarean section




A



51

E. Commissioning for Quality and Innovation (CQUIN) CQUIN Table 1: CQUIN Schemes

Not Applicable

CQUIN Table 2: CQUIN Payments on Account – Not Applicable



52

F. Local Incentive Scheme

Not Applicable



53

G. Clostridium difficile

Not Applicable



54

H. Sanction Variations

Not Applicable

I. CQUIN Variations

Not Applicable



55

SCHEDULE 5 - GOVERNANCE

A. Documents Relied On

Documents supplied by Provider

Date

Document

Indemnity The pharmacy shall maintain adequate insurance for public liability and professional indemnity against any claims which may arise out of the terms and conditions of this agreement. Any litigation resulting from accident or negligence on behalf of the pharmacy is the responsibility of the pharmacy who will meet the cost and any claims for compensation, at no cost to GCCG. Indemnity Policy to be provided when requested by the CCG.

Documents supplied by Commissioners

Date

Document

GCCG Infection Control Policy.pdf

Serious Incident Policy v1.0.pdf

Sustainable

Commissioning Clause2014 15 v1 0.pdf



56

Medicines Management Interface Guidance 2014 15 V1.0 Final.pdf

Information Governance Framework 14_15 FINAL.pdf

Appendix 1 - Participating Pharmacies v2.pdf


Appendix 3 MAS Protocols 20140930 v2.0.pdf

Appendix 4 - Formulary A-Z v2.0.pdf

Appendix 5 - Formulary by Minor Ailment Group v2.0.pdf

Appendix 6 Declaration of Competence.pdf

Pharmacists signing the declaration of competence are

expected to be able to provide appropriate evidence upon

request to support their declaration of competence. This

could consist of CPD entries, training certificates relating to

the sorts of minor ailments concerned etc. It would be

helpful to have evidence of this nature to demonstrate

competence, other than claiming against “one’s experience”

alone. This supporting evidence applies in the same was as

would be required for any fitness to practice investigation

and subsequent continued GPhC registration. Checks may

be made on a small sample of Declaration of Competence

submissions.

Appendix 7 GP Reception Staff Protocol.pdf

Appendix 8 Urgent Referral from Community Pharmacy.pdf



57

B1. Provider’s Mandatory Material Sub-Contractors

Mandatory Material Sub-Contractor [Name] [Registered Office] [Company number]

Service Description

Start date/expiry date

Processing data – Yes/No

Not Applicable

B2. Provider’s Permitted Material Sub-Contractors

Permitted Material Sub-Contractor [Name] [Registered Office] [Company number]

Service Description

Start date/expiry date

Processing data – Yes/No

Not Applicable



58

C. IPR

Commissioner IPR

To avoid doubt, licensing of IPRs would be subject to review on a case by case basis to ensure compliance with General Condition 22 of the contract and with Department of Health guidance. The Provider and the commissioner will comply with guidance and codes of practice as issued by the Department of Health. Both parties recognise that where current legal agreements are in place no retrospective requests will be made. Where information shared between both parties in future is ‘commercial in confidence’ it will be respected and treated as such by the other party.

Provider IPR

To avoid doubt, licensing of IPRs would be subject to review on a case by case basis to ensure compliance with General Condition 22 of the contract and with Department of Health guidance. The Provider and the commissioner will comply with guidance and codes of practice as issued by the Department of Health. Both parties recognise that where current legal agreements are in place no retrospective requests will be made. Where information shared between both parties in future is ‘commercial in confidence’ it will be respected and treated as such by the other party.



59

D. Commissioner Roles and Responsibilities

Not Applicable

E. Partnership Agreements

To which the Provider is a party:

Date

Parties

Description

Not Applicable

To which a Commissioner is a party:

Date

Parties

Description

Not Applicable



60

SCHEDULE 6 – CONTRACT MANAGEMENT, REPORTING AND INFORMATION REQUIREMENTS

A. Recorded Variations Not Applicable

Variation Number

Description of Variation

Date of Variation Proposal

Party proposing the Variation

Date of Variation Agreement



61

B. Reporting Requirements

Reporting Period

Format of Report

Timing and Method for delivery of Report

Application

National Requirements Reported Centrally

1. As specified in the list of assessed mandated collections published on the HSCIC website to be found at http://www.hscic.gov.uk/datacollections as applicable to the Provider and the Services

As set out in relevant Guidance

As set out in relevant Guidance As set out in relevant Guidance

All

2. PROMS As set out in relevant Guidance


All

3. NDTMS As set out in NTA Guidance

As set out in NTA Guidance As set out in NTA Guidance

SM

National Requirements Reported Locally

1. Monthly Activity Report

Monthly Using SUS data, where applicable

All

2. Service Quality Performance Report, detailing performance against Operational Standards, National Quality Requirements, Local Quality Requirements, Never Events, including, without limitation:

Monthly Submit to Co-ordinating Commissioner within 10 Operational Days of the end of the month to which it relates.

http://www.hscic.gov.uk/datacollections

http://www.hscic.gov.uk/datacollections



62

Reporting Period

Format of Report


Application

2.1 details of any thresholds that have been breached and any Never Events that have occurred;

2.2 details of all

requirements satisfied; 2.3 details of, and reasons

for, any failure to meet requirements and;

2.4 the outcome of all Root

Cause Analyses and audits performed pursuant to Service Condition 20 (Venous Thromboembolism).

All All All A

3. CQUIN Performance Report and details of progress towards satisfying any Quality Incentive Scheme Indicators, including details of all Quality Incentive Scheme Indicators satisfied or not satisfied

All

4. Monthly report on performance against the HCAI Reduction Plan

Monthly All

5. Complaints monitoring report, setting out numbers of

Monthly As per pharmacy procedures In line with pharmacy

All



63

Reporting Period

Format of Report


Application

complaints received and including analysis of key themes in content of complaints

procedures

6. Report against performance of Service Development and Improvement Plan (SDIP)

In accordance with relevant SDIP

In accordance with relevant SDIP In accordance with relevant SDIP

All

7. Cancer Registration dataset reporting (ISN): report on staging data in accordance with Guidance

As set out in relevant Guidance


CR R

8. Monthly summary report of all incidents requiring reporting

Monthly All

9. Data Quality Improvement Plan: report of progress against milestones

In accordance with relevant DQIP

In accordance with relevant DQIP In accordance with relevant DQIP

All

10. Report and provide monthly data and detailed information relating to violence-related injury resulting in treatment being sought from Staff in A&E departments, urgent care and walk-in centres, and from ambulance services paramedics (where the casualties do not require A&E department, urgent care and walk-in centre attendance), to the local community safety partnership and the relevant

Monthly As set out in relevant Guidance As set out in relevant Guidance

A A+E AM U



64

Reporting Period

Format of Report


Application

police force, in accordance with applicable Guidance (College of Emergency Medicine Clinical Guidance Information Sharing to Reduce Community Violence (July 2009))

11. Report on outcome of reviews and evaluations in relation to Staff numbers and skill mix in accordance with General Condition 5.2 (Staff)

6 monthly (or more frequently if and as required by the Co-ordinating Commissioner from time to time)

All

Local Requirements Reported Locally

1. Completion of Pharmoutcomes at each and every event

Monthly reports upon request

Pharmoutcomes website to be completed. https://www.pharmoutcomes.org/pharmoutcomes/ Login details are known to the pharmacy.

Ad-hoc

2. Completion of any adverse event reports in line with the pharmacy procedure for reporting events

At the time of the event

Completed as per pharmacy procedures. Stored at pharmacy.

3. Submission of Adverse Event occurrence to Service Commissioner

End of each month Patient anonymised report detailing the event type, numbers and outcomes

Summary at the end of each month to be sent to CCG, if applicable.

https://www.pharmoutcomes.org/pharmoutcomes/



65

C. Data Quality Improvement Plan

Data Quality Indicator

Data Quality Threshold

Method of Measurement

Milestone Date Consequence

Insert text locally



66

D. Incidents Requiring Reporting Procedure

Procedure(s) for reporting, investigating, and implementing and sharing lessons learned from: (1) Serious

Incidents (2) Reportable Patient Safety Incidents (3) Other Patient Safety Incidents

Incidents Requiring Reporting Procedure

Contract Agreement /Schedule between NHS Gloucestershire Clinical Commissioning Group and Provider Organisations 2014/15

Incidents and Serious Incidents

1. Routine incident reporting/monitoring

1.1 The Provider will submit to NHS Gloucestershire Clinical Commissioning Group (the Commissioner), on a quarterly basis, summarised details of all incidents reported to the Provider during the relevant period along with identified risks and actions arising from those incidents.

1.2 A copy of the Provider’s Risk Register which includes summary details of identified risks, risk treatment plans and status will be provided on request. (Risks identified from incident reporting will be included in the register). The Provider will also submit copies of any reports regarding incidents that are provided to the Provider Board or any sub-committee of the Board.

1.3 On request, the Commissioner will be entitled to receive from the Provider, further details of any incident or investigation including a full copy of the action plan arising from an incident, and a status report identifying progress of implementation.

1.4 The Commissioner may request the Provider to undertake investigations into any significant incident (graded orange or above based on the NPSA risk matrix) relating to the Provider’s services that have been reported by the Commissioner, or have been reported to the Commissioner by other providers. The management of incidents classified as Serious Incidents is described below. Details of incidents graded below orange will be provided by the Commissioner for information, although no investigation will be expected.

1.5 Where requested, the Provider will submit a response in relation to each significant incident to the Commissioner within 30 working days. This response will indicate the cause of the incident and the steps taken by the Provider to prevent reoccurrence.

1.6 Where the Provider is engaged with any external patient safety initiatives or programmes, they will inform the Commissioner and share progress reports on request.

1.7 The Provider will upload details of all clinical incidents to the NPSA National Reporting and Learning Service database at least once per month.

1.8 The Provider will share with the commissioner evidence of learning and improved service delivery resulting from managing incidents on at least an annual basis, or more frequently as requested

2. Serious Incident Reporting and Monitoring

2.1 The following paragraphs are based on the NPSA National Framework for Reporting and Learning from Serious Incidents Requiring Investigation, which must be adopted by the provider.

2.2 A ‘Serious Incident Requiring Investigation’ is defined as “an incident that occurred in relation to NHS-funded services and care resulting in one of the following:

the unexpected or avoidable death of one or more patients, staff, visitors or members of the public (where the



67

unexpected or avoidable death is as a direct result of NHS care, where we need to understand whether an act or omission or different pathway of care may have prevented such a serious outcome);

serious harm to one or more patients, staff, visitors or members of the public or where the outcome requires life-saving intervention or major surgical/medical intervention;

permanent harm or will shorten life expectancy or result in prolonged pain or psychological harm (this includes incidents graded under the NPSA definition of severe harm);

a scenario that prevents or threatens to prevent a provider organisation’s ability to continue to deliver healthcare services, for example actual or potential loss of personal/organisational information, damage to property, reputation or the environment or IT failure;

allegations of abuse;

adverse media coverage or public concern for the organisation or the wider NHS;

one of the core set of ‘Never Events’ as updated on an annual basis;

events which affect a number of patients, i.e. rogue staff, infected health care worker, incorrect interpretation of specimens; and

all deaths where C Diff or MRSA is either the underlying cause or a contributory factor (at Part 1) recorded on the death certificate (DoH CMO 2007)

2.3 The Provider will report details of Serious Incidents to the Commissioner’s Risk Management Lead as soon as is practicable. It is expected that declarations will be made verbally and confirmed in writing (or via STEIS) as soon as is practicable after the incident has occurred. Any delay beyond one day in the notification to the Commissioner will be explained by the Provider. Out of hours, the on-call Director for the Commissioner will be informed verbally and confirmation in writing provided, copied to the Commissioner Risk Management Lead.

2.4 The Commissioner expects the details of each Serious Incident to be entered onto the Strategic Executive Information System database (STEIS) within two working days of the organisation becoming aware of the incident.

NHS providers will be expected to enter this information directly. The e-mail notification generated by STEIS will be accepted by the Commissioner as a means of initial notification, provided that the requirements of paragraph 2.3 above are complied with. Providers will ensure that STEIS entries are kept up to date at all times.

Non NHS providers are required to inform the Commissioner within 1 day to enable the Commissioner to enter on STEIS on the providers behalf.

2.5 The Strategic Executive Information System (STEIS) is intended to be replaced by the Serious Incident Management System (SIMS) in the future. Once the SIMS has been introduced, providers will be required to use this database to record details of Serious Incidents.

2.6 Guidance on the types of incidents that should be reported can be found in the NPSA document ‘Information Resource to Support the Reporting of Serious Incidents’ available on the NPSA website. http://www.nrls.npsa.nhs.uk/resources/?entryid45=59847 This guidance is not exhaustive. Where further clarity is required, guidance should be sought from the Commissioner’s Risk Management Lead e-mail :-

[email protected]

2.7 Incidents should be graded as 0, 1 or 2. Definitions of the gradings can be found in the NPSA National Framework for Reporting and Learning from Serious Incidents Requiring Investigation. Incident grades should be agreed with the Commissioner for Grade 1 incidents and the Commissioner and the NHS Commissioning Board (NHSCB) for Grade 2 incidents.

2.8 Within three working days of the Serious Incident being declared, the Provider will submit an Interim Investigation Report to the Commissioner including the following:

STEIS identification number

the principal facts/description of the incident (including date, description, location, background and consequences)

initials, gender and date of birth of the client, where appropriate;




68

Grade of investigation and whether a Never Event;

details of the initial investigations undertaken including the scope, methodology and the individuals involved (including relatives/carers);

immediate action taken

initial recommendations; and

proposals for the full investigation (including scope, methodology and details of the review team with clear timeline and accountability).

2.9 The ‘0’ grading is used when notifying an incident where the actual grading (1 or 2) is unknown at the time of notification. The actual grading should be determined within three working days of notification. If a Grade 0 incident is requested to be downgraded, a report is also required setting out the reasons for the request to downgrade.

2.10 The Provider’s investigation will be undertaken using the NPSA Root Cause Analysis process or other recognised review process in agreement with the Commissioner. Where appropriate these investigations should involve representatives from other agencies such as the ambulance service, primary or acute care.

2.11 The Provider will submit a comprehensive final investigation report, using the structure and format recommended by the NPSA, to the Commissioner as follows:

2.11.1 Grade 1 - 45 working days from the date the incident is notified on Strategic Executive Information System;

2.11.2 Grade 2 (those incidents not requiring independent investigation) - 60 working days from the date the incident is notified;

2.11.3 Grade 2 (requiring independent investigations such as Homicide Investigations) – Internal investigation should be completed within 60 working days from the date of the incident. Where an Independent Investigation is commissioned this should be completed within 26 weeks from the date of commissioning.

2.12 The report will incorporate a detailed action plan identifying precise actions, responsible managers (job titles, not names) and timescales for implementation. The provider will advise the Commissioner at the earliest opportunity if these timescales are not achievable (e.g. due to an investigation being undertaken by external agencies, absence of key witnesses, etc.) and a revised deadline agreed with the Commissioner (and with the NHSCB for Grade 2 incidents).

2.13 It should be noted that, in the interests of confidentiality, all reports should contain anonymised information. The content of any reports relating to serious incidents should not contain the names of practitioners or patients or information which could lead to the identification of practitioners or patients.

2.14 Once a satisfactory final report and time-bound action plan has been received and reviewed by the Commissioner (and following the completion of all relevant entries on STEIS by the provider), the incident will be closed on STEIS by the Commissioner. The exception to this is Grade 2 incidents where an independent investigation has taken place. In these cases, the Commissioner and the NHSCB will continue to monitor the action plan and only close the incident once assurance has been received that all action points have been completed.

2.15 The Provider will maintain a schedule detailing the progress of all investigations be forwarded to the Commissioner on a monthly basis. It is expected that written assurance regarding the completion of all actions will be provided by an Executive Director of the Provider organisation.

2.16 The Commissioner Risk Lead (and Clinical Governance representatives, where required) will meet with the representative(s) of the Provider on a monthly basis to review compliance with the requirements and timescales outlined in the preceding paragraphs.

2.17 Should the requirements of this agreement not be met, the Commissioner Risk Lead will escalate the matter to the relevant Commissioner Director who will raise the matter with the appropriate Provider Director. If this course



69

of action fails to resolve the situation, the matter will be referred to the Contract Board.

2.18 The Provider will alert the Commissioner to referrals to, or investigation, assessment or inquiries by external bodies such as the Care Quality Commission or the Health and Safety Executive. Copies of reports issued by external bodies will be forwarded by the Provider to the Commissioner.

2.19 Any direct approach to the Provider from any external agency (such as NHS South of England) requesting information should be referred to the Commissioner and a response agreed jointly.

2.20 Contract breach consequences for non-compliance with the timeliness, completeness or quality of the information required by this schedule will be enforced (unless extensions to time have been previously agreed with commissioner)

Late submission of initial report/minutes or STEIS recording will require an Exception Report. Late submission of an investigation report and associated action plan results in a financial consequence of a £3000 penalty.

2.21 The terms of this schedule may need to be re-considered in the light of any changes to national or local systems, relevant guidelines or practices and the schedule will be reviewed at least annually in line with contract review timescales.

3 Being Open

3.1 Being open: communicating patient safety incidents with patients, their families and carers (Ref

NPSA/2009/PSA003, November 2005. Re-launched November 2009)

3.2 The Provider is expected to adopt the new framework as a best practice guide for all healthcare staff, including boards, clinicians and PALS.



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E. Service Development and Improvement Plan

Milestones Timescales Expected Benefit

Consequence of Achievement/ Breach

Not Applicable

F. Surveys

Type of Survey Frequency Method of Reporting Method of Publication

Friends and Family Test (where required in accordance with FFT Guidance)

As required by FFT Guidance



Service User Survey [Insert further description locally]



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SCHEDULE 7 – PENSIONS

Not Applicable