NHS WANDSWORTH MINOR AILMENTS

SERVICE LEVEL AGREEMENT

2010-2011

INFORMATION FOR WANDSWORTH PCTCOMMUNITY PHARMACISTS

ES 8– Minor Ailment Service

Wandsworth PCT Commissioning Strategic Goals

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

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Index

Contents Page

PART A SERVICE LEVEL AGREEMENT

1. Introduction 2

2. Advantages of the Scheme 2

3. Service Outline 2 3.1 Patient Access 23.2 Minor Ailments Conditions and Products 43.3 The Community Pharmacy Contractual 4

4. Clinical Governance 44.1 Service Promotion 44.2 Service Continuity 44.3 Patient care & Referrals 54.4 Abuse of the service 54.5 Reciprocal Arrangements 54.6 IT 6

5. Indemnity 6

6. Confidential information and data protection 6

7. Payment Structure 6

8. Audit 7

9. Variation 7

10. Default and Termination 7

Appendices:

Appendix 1 Pharmacy Consultation form 9

Appendix 2 Minor Ailments Claim Form 10

Appendix 3 Minor Ailments Formulary 11

Appendix 4 Pharmacy Referral Form 16

Appendix 5 Pharmacy Feedback form 17

Appendix 6 Patient Satisfaction Evaluation form 18

(please refer to the Minor ailments formulary for referral guidelines)

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1. Introduction

Community Pharmacy is in a very strong position to increase access and help take pressure off General Practice and other Forms of Primary Care e.g. Walk-in Centres and out of Hours, by providing consultations for minor ailments. There are many projects across England that has demonstrated the value of a Minor Ailments Service.

This service is a stepping-stone to patient medication reviews by community pharmacists and formalising a two-way referral system between General Practice and Community Pharmacy.

Minor ailments vs. Self Care

A minor Ailments service is different from the term self care.

MINOR AILMENTS SERVICE SELF CAREPCT FUNDED FUNDED BY PATIENT

LIMITED FORMULARY PATIENT/PHARMACIST CAN RECOMMEND ANY BRAND OF MEDICATION

HIGH USAGE BY PATIENTS WHO ARE EXEMPTING FROM PRESCRIPTION CHARGES.

AREAS OF DEPRIVATION

LOW UPTAKE IN AREAS OF DEPRIVATION.

AFFLUENT AREASOutcomes Improved Access

2. Aims of the scheme Service

The service is a management of minor ailments provided by Community Pharmacists within Wandsworth Teaching PCT. This service is available to all Wandsworth residents and patients registered with Wandsworth PCT GP surgeries. Patients are at liberty to refuse this Scheme. In addition a Community Pharmacist is at liberty to refuse the service if there is patient abuse of this service and offer appropriate self care to the patient.

3. Service Outline

3.1 Patient Access

The service is a fast track referral service that allows residents that live in Wandsworth and patients registered with a Wandsworth PCT GP with a minor ailment:- To be referred from General Practice or a Walk-in Centre to a Community Pharmacy

for appropriate treatment Self referral by Wandsworth PCT registered patients to a Wandsworth PCT

Community pharmacy for suitable treatment. .

A pharmacy consultation form (see Appendix) is filled in stating patient’s GP or name of GP Practice, the conditions seen, symptoms and the product(s) chosen that is appropriate to the condition.

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Patients registered outside Wandsworth PCT are not eligible for this scheme but can purchase OTC medication in the usual way. Appropriate patients from the Tooting Walk-in Centre can be referred into the service.

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Telephones GP Practice for an appointment

Attends GP Practice or Walk-in Centre to make an

appointment

Patient refuses Minor Ailments

Scheme and sees GP

Receptionist explains Minor Ailments Service

Patient attends participating pharmacy

Product recommended within scheme criteria

Paperwork completed

Symptoms outside scope of scheme

Referral to GP by pharmacies

Copies to:PCTPharmacy

Community Pharmacy Practice to inform PCT if

patient is possibly utilising the MAS inappropriately

Minor Ailments Pharmacist Consultation

Patient

Patient Attends a Community

Pharmacy

Non urgent-GP referral

Urgent Condition Rapid/Immediate referral to GP or A&E

Rapid Referral to GPWandsworth PCT acknowledges the work done by Ealing PCT’s Minor

Ailment Service on which this flow model is based.

CommunityPharmacist/staff

explains the service

WANDSWORTH PCT

3.2 Minor Ailment Conditions & Products

The Minor Ailments Service covers the following conditions below. Each condition has a protocol and formulary of medication that can be supplied. The formulary can be found in Appendix 3. Products within that formulary can be supplied if they are appropriate for the condition.

The PCT reserves the right to review conditions and medications. The PCT will give one months notice to Community Pharmacists of this decision and will send out revised protocols and formularies.

3.3 Patient Pharmacy Charges

Pharmacy charges and exemption categories apply. If the patient pays for their prescriptions charges and the cost of the medication

supplied is less than a prescription charge the patient can purchase the items and a pharmacy consultation form does not have to be filled in.

If the patient is supplied with a medication from the formulary and wishes to have another brand of OTC medication, advise the patient they can purchase an item. A Pharmacy consultation form does not have to be filled.

3.3 The Community Pharmacy Contractual Framework

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

Self Care & Signposting – - Pharmacies will help manage minor ailments and common conditions, by the provision of advice and where appropriate, the sale of medicines, including dealing with referrals from NHS Direct. Records will be kept where the pharmacist considers it relevant to the care of the patient advice given will be in line with the NHS Direct recommendations e.g. flu if required

http://www.nhsdirect.nhs.uk/Zones/Zone.aspx?zoneId=51

http://www.nhsdirect.nhs.uk/encyclopaedia/subjects/?categoryId=10

4 CLINICAL GOVERANCE

4.1 Service promotion

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

4.2 Service Continuity

It is the responsibility of the Community Pharmacy Provider to ensure that all members of their pharmacy team including locum pharmacists, new pharmacists, pharmacy technicians and staff are made aware of this service and provided with cascade information. New Pharmacists will be expected to complete the CPPE course in minor ailments. If a Community Pharmacy has a change in staffing where the new Community Pharmacist has been not been trained in the service,

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the Community Pharmacy Provider must inform the PCT so the list of participating pharmacists can be adjusted to the public has the correct information.

4.3 Patient care and referrals

Due to the nature of the service, all Community Pharmacy providers must provide an understanding and supportive environment. This will require that all members of the pharmacy team and made aware of the responsibilities of this service and the importance of providing a conducive and supportive environment.

At all times the pharmacist should use their professional judgement in counselling patients and supplying medicines. The consultation will consist of

Patient assessment by the pharmacist Provision of advice Supply of a medication if necessary from the agreed formulary appropriate to the

patient’s condition, or the purchase of an appropriate over the counter medicine.

Serious conditions – if you come across patients, who present with a serious condition, please refer back to the GP and communicate with the GP practice. A community pharmacist can use the form enclosed in Appendix 3 or which ever method if communication is used in a Community Pharmacy to ensure continuity of care and patient safety.

Complaints should be dealt with via your standard procedures.

Review the decisions you make regarding with the patient consultations.

Make sure you have read the minor ailment protocols and you have covered any training needs around these areas. The protocols only provide brief guidance; pharmacists should refer to the BNF and relevant manufacturer’s product literature for dosages.

Patients are encouraged to fill in patient surveys of the service and send to the PCT or give to their Community Pharmacist to back this will be part of the evaluation and development of this service.

4.4 Abuse of service

The Community Pharmacist reserves the right to refuse the service where there is patient abuse or over usage of medication. The Minor Ailments service is not to be used as a method of receiving free medication but for supply when appropriate.

If a patient requires regular medication due to a clinical condition a Community Pharmacy provider should explore repeat dispensing with the patient and the patients GP. The Minor Ailments service should not be used for supply of repeat medication.

4.5 Reciprocal Arrangements

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

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4.6 IT

Pharmacy providers must have the following arrangements in place PC with N3 connection, access to the internet, Windows and Microsoft Office

software applications e.g. Word, Excel, and PowerPoint. Telephone, printer, fax and an NHS email account to allow transfer of patient

sensitive data to the PCT, GP practices and the Respiratory nurses.

5 Indemnity

The pharmacist must ensure that their professional indemnity cover is either provided by the National Pharmaceutical Association (NPA) or other organisation who has confirmed that this activity will be included in their policy.

6. Information Governance, Confidential information and data protection

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

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

All participating Community Pharmacies will be compliant with information Governance requirements.

7. Payment Structure

Participating community pharmacists will be reimbursed by the following means.The Pharmacy will be paid according to the following schedule: Payment is for medication supplied:-

Exempt patients - £4.50 (per item supplied) + Formulary cost + VAT

Non Exempt patients £4.50 (per item supplied) + Formulary cost + VAT –Current Prescription Charge (£7.20)

Retainer £100.00 for patient audit.

Pharmacy Consultation forms should be submitted to Wandsworth PCT by the 5 th

working day after the end of the Month.

Submit your monthly total to the Primary Care Support Service for payment and send a copy of your monthly and forms to Wandsworth PCT PCSS Fax 0208 335 1408. This must be sent by the 10th of the following month.

You do not need to calculate drug costs and VAT as this is already calculated in the Minor Ailments formulary in Appendix 3. Please make sure that you enter the medication cost and Vat on the Minor Ailments form.

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8. Audit

Community Pharmacists will take part in a patient survey of the service. Community Pharmacists will be expected to provide at least 25 survey forms. Community Pharmacists are encouraged to feedback their experiences of the services. This will contribute towards the development of the service.

9. Variation

The services and fee structure or any aspect of this agreement may be varied if: The parties agree in writing, or Upon request by the PCT where there is a change in the Trust’s service

priorities or where there is a change in the way in which this agreement is required to work as requested by: Changes in legislation, guidance or directions from the Department of Health, or Other exceptional circumstances

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

there are local or national changes to the service specification and formulary. The PCT will provide participating Community Pharmacists one months notice of such decisions and send out a revised formulary and protocol.

10. Default and termination

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

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

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

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

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

The PCT may contact with Pharmacy contractors outside the PCT who may service NHS Wandsworth registered patients. Pharmacy contractors must be compliant with their contract monitoring framework in their host PCT.

The pharmacist shall co-operate fully with the PCT during any handover leading to termination of this agreement. This co-operation shall extend to full access to all documents, reports, summaries and any other information reasonable required by the

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PCT to achieve an effective transition without disruption to routine operational requirements.

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

Signed: ……………………………………..PCT

Signed:………………………………………Pharmacy Contractor

Date: …………………

NHS Wandsworth Minor Ailment service 2010-2011

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Appendix 1 Pharmacy Consultation Form

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Appendix 2 LOCAL SCHEME 1 MINOR AILMENTS CLAIM FORM

PAYMENT MONTH…………………………PHARMACY NAME AND ADDRESS

OSC CODE:

PLEASE ENDORSE WITH PHARMACY STAMP

TOTALFORMS

TOTAL ITEMS

TOTAL PRODUCT COST

A

TOTAL VAT-

B

TOTAL DISPENSING

FEE/ ITEM £4.50/ITEM

C

LESS DISPENING TOTALCHARGE

(£7.20) D

GRAND TOTAL (A +B+C MINUS D)

SIGNATURE ………………………………PHARMACIST IN CHARGE

DATA EXTRACTION SEND IN COPIES OF INDIVIDUAL PATIENT FORMS AND A COPY OF THE MONTHLY CLAIM FORM TO

Mr FADI DEXTER PRIMARY CARE SUPPORT MANAGER Wandsworth Teaching Primary Care TrustThird Floor, Wimbledon Bridge House Hartfield Road London SW19 3RUFAX 020 8812 7780

PAYMENT -PLEASE SUBMIT YOUR MONTHLY FORMS BY THE 8TH OF EACH MONTH TO ENSURE PROMPT PAYMENT TO:

Mary Clarke, Medical AdministratorPrimary Care Support Service187 Ewell Road,Surbiton, Surrey KT6 6AUTelephone:  020 8335 1327 / Fax: 020 8335 1374E-mail: mary.clarke2@nhs.net

This must be sent by the 8th of the following month.

PLEASE FILL IN ALL RELAVENT FIELDS KEEP A COPY FOR YOUR RECORDS PLEASE SUBMIT MONTHLY

COST CODE 791491 6280Wandsworth PCT xXDAVID TAMBY RAJAHXx

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APPENDIX 3 - Minor Ailments Formulary (the PCT reserves the right to change medicines and prices)

Minor Ailment Formulary Pack Size COST VAT Total FEE

Diarrhoea Loperamide 2mg caps 8 £3.26 £0.69 £3.95 £4.00Dioralyte Sachets 6 £3.42 £0.73 £4.15 £4.00

ConstipationLactulose Solution 300ml £3.29 £0.70 £3.99 £4.00Fybogel High Fibre Sachets 10 £2.30 £0.49 £2.79 £4.00Senna Tablets 20 £1.91 £0.41 £2.32 £4.00Glycerol Supps (adult, Child, Infant) 12 £2.47 £0.52 £2.99 £4.00

VomitingCinnazarine 15mg tablets 15 £2.15 £0.46 £2.60 £4.00Motilium 10mg tablets 10 £3.47 £0.74 £4.20 £4.00Dioralyte Sachets 6 £3.01 £0.64 £3.65 £4.00

IndigestionGastrocote Liquid 400ml £3.88 £0.82 £4.70 £4.00Ranitadine 75mg Tablets 12 £2.96 £0.63 £3.59 £4.00Magnesium Trisilicate Mixture 200ml £2.47 £0.52 £2.99 £4.00Gaviscon Liquid 150ml £2.87 £0.61 £3.48 £4.00Gaviscon Tablets 12 £1.91 £0.41 £2.32 £4.00

Infant ColicInfacol Drops 50ml £3.13 £0.66 £3.79 £4.00

Dry Cough / Chesty CoughPholcodine Linctus SF 200ml £1.64 £0.35 £1.99 £4.00Simple Linctus SF 200ml £1.64 £0.35 £1.99 £4.00Simple Linctus Paed SF 200ml £1.64 £0.35 £1.99 £4.00Menthol and Eucalyptus Liquid 100ml £1.20 £0.25 £1.45 £4.00

Fungal Skin Infection inc Athletes footTerbinafine Cream 1% 7.5g £3.29 £0.70 £3.99 £4.00Clotrimazole Cream 1% 20g £3.42 £0.73 £4.15 £4.00Miconazole Cream 30g £3.01 £0.64 £3.65 £4.00

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Minor Ailment Formulary Pack Size COST VAT Total FEE

Cold SoresAciclovir Cream 2% 2g £3.29 £0.70 £3.99 £4.00

Warts and VerrucasSalactol Paint 10ml £2.49 £0.53 £3.02 £4.00Gluterol Liquid 10ml £3.15 £0.67 £3.82 £4.00Verrugon 1pk £3.92 £0.83 £4.75 £4.00Duofilm 15ml £3.27 £0.69 £3.96 £4.00Cuplex 5g £3.24 £0.69 £3.93 £4.00Occlusal 10ml £4.93 £1.04 £5.97 £4.00

TreadwormMebendazole Tablets 1 £1.69 £0.36 £2.05 £4.00Mebendazole Tablets 4 £4.94 £1.05 £5.99 £4.00Mebendazole Liquid 30ml £5.77 £1.22 £6.99 £4.00Pripsen Piperazine Oral Powder 2 £2.22 £0.47 £2.69 £4.00

Head LiceMalathion aqueous lotion 50ml £3.29 £0.70 £3.99 £4.00Malathion aqueous liquid 200ml £8.24 £1.75 £9.99 £4.00Permethrin crème rinse 59ml £3.29 £0.70 £3.99 £4.00Permethrin crème rinse 2 x 59ml £5.98 £1.27 £7.25 £4.00Full Marks Solution 200ml £9.07 £1.92 £10.99 £4.00

Scabies and Crab LiceMalathion aqueous liquid 200ml £8.24 £1.75 £9.99 £4.00

Cystitis Canestan Oasis Sachets 6 £3.75 £0.80 £4.55 £4.00Cystopurin Sachets 6 £3.92 £0.83 £4.75 £4.00Cymalon Sachets 6 £3.29 £0.70 £3.99 £4.00

Tear Deficiency Hypromellose 0.3% Drops 10ml £2.47 £0.52 £2.99 £4.00Viscotears Gel 10g £3.81 £0.81 £4.62 £4.00Lacrilube Oint 3.5g £2.89 £0.61 £3.50 £4.00

Conjuntivitis

Chloramphenicol Eye Drops 10ml £3.95 £0.84 £4.79 £4.00Chloramphenicol Eye Oint 4g £3.93 £0.83 £4.76 £4.00

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Minor Ailment Formulary Pack Size COST VAT Total FEE

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Stye

Brolene Eye Drops 10ml £3.88 £0.82 £4.70 £4.00Brolene Eye Oint 4g £4.04 £0.86 £4.90 £4.00

Golden Eye Drops 10ml £2.76 £0.59 £3.35 £4.00Golden Eye Oint 4g £2.93 £0.62 £3.55 £4.00

Hayfever Cetirizine Tablets 30 £4.12 £0.87 £4.99 £4.00Loratadine Tablets 30 £4.12 £0.87 £4.99 £4.00Sodium Cromogycate Eye Drops 10ml £4.62 £0.98 £5.60 £4.00Beclomethasone Aq Nasal Spray 180 Dose £7.66 £1.63 £9.29 £4.00Chlorphenamine 4mg Tablets 30 Tablets £2.60 £0.55 £3.15 £4.00Chlorphenamine 2mg/5ml Liquid 150ml £3.46 £0.73 £4.19 £4.00Fluticasone Aq Nasal Spray 60 Dose £4.90 £1.04 £5.94 £4.00Loratadine 5mg/5ml Liquid 100ml £4.12 £0.87 £4.99 £4.00Cetirizine 5mg/5ml Liquid 100ml £4.28 £0.91 £5.19 £4.00

Nasal Congestion Menthol and Eucolyptus Liquid 100ml £1.20 £0.25 £1.45 £4.00

Sodium Chloride Nasal Drops 10ml £1.64 £0.35 £1.99 £4.00Otrivine Nasal Drops/ Spray Adults and Child

10ml £2.47 £0.52 £2.99 £4.00

Pseudoephedrine 60mg Tablets 12 £1.77 £0.38 £2.15 £4.00Pseudoephedrine 30mg/5m Elixir 100 £2.14 £0.45 £2.59 £4.00

Pain Relief / TemperatureParacetamol Tablets 32 £0.57 £0.12 £0.69 £4.00

Ibuprofen Tablets 200mg 24 £1.06 £0.23 £1.29 £4.00Ibuprofen Tablets 200mg 48 £1.89 £0.40 £2.29 £4.00Ibuprofen Tablets 400mg 24 £1.89 £0.40 £2.29 £4.00Ibuprofen Tablets 400mg 48 £3.37 £0.72 £4.09 £4.00Paracetamol 120mg/5ml Suspension 100ml £2.30 £0.49 £2.79 £4.00Paracetamol 250/5ml Suspension 100ml £2.80 £0.59 £3.39 £4.00Ibuprofen 100mg/5ml Suspension 100ml £2.72 £0.58 £3.30 £4.00

Travel SicknessCinnazarine 15mg tablets 15 £2.15 £0.46 £2.60 £4.00

Motilium 10mg tablets 10 £3.47 £0.74 £4.20 £4.00Dioralyte Sachets 6 £3.01 £0.64 £3.65 £4.00

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Fungal Infection inc Vaginal ThrushClotrimazole Cream 1% 20g £3.42 £0.73 £4.15 £4.00

Clotrimazole Pessaries 500mg 1 £4.94 £1.05 £5.99 £4.00Fluconazole 150mg Caps 1 £4.94 £1.05 £5.99 £4.00Ear Wax Cerumol Drops 11ml £2.56 £0.54 £3.10 £4.00Otex Ear Drops 8ml £3.01 £0.64 £3.65 £4.00

Sodium Bicarbonate Ear Drops 10ml £2.81 £0.61 £3.50 £4.00

Barrier CreamsSudocream 60g £1.72 £0.37 £2.09 £4.00

Eczema and DermatitisHydrocortisone 1% Cream 15g £2.88 £0.61 £3.49 £4.00Aqeous Cream 500g £2.47 £0.52 £2.99 £4.00

Oilatum Emollient 250ml £4.00 £0.85 £4.85 £4.00Eurax Cream 30g £2.93 £0.62 £3.55 £4.00Eurax HC Cream 15g £2.55 £0.54 £3.09 £4.00Eurax Lotion 100ml £3.87 £0.82 £4.69 £4.00

Sore ThroatsStrefen Lozenges 16 £3.05 £0.65 £3.70 £4.00Paracetamol susp SF 120mg/5ml 100ml £2.30 £0.49 £2.79 £4.00Ibuprofen susp 100mg/5ml SF 100ml £2.72 £0.58 £3.30 £4.00Paracetamol 250mg/5ml Suspension SF 100ml £2.80 £0.59 £3.39 £4.00Paracetamol Tablets 500mg 32 £0.57 £0.12 £0.69 £4.00Ibuprofen 200mg Tablets 24 £1.06 £0.23 £1.29 £4.00Ibuprofen 200mg Tablets 48 £1.89 £0.40 £2.29 £4.00Aspirin 300mg dispersible Tablets 32 £0.57 £0.12 £0.69 £4.00Paracetamol soluble 500mg Tablets 24 £1.64 £0.35 £1.99 £4.00

Benzydamine Oral Rinse 200ml £4.12 £0.87 £4.99 £4.00

HaemorrhoidsAnusol Cream 23g £2.71 £0.58 £3.29 £4.00Anusol Oint 25g £2.71 £0.58 £3.29 £4.00Anusol Suppositories 12 £2.55 £0.54 £3.09 £4.00

Scalp PrepsPolytar Liquid 250ml £3.24 £0.69 £3.93 £4.00Nizoral Shampoo 60ml £4.74 £1.01 £5.75 £4.00Alphosyl 2 in 1 Shampoo 125ml £2.47 £0.52 £2.99 £4.00

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Oilatum Scalp Shampoo 100ml £7.42 £1.57 £8.99 £4.00Oral Ulceration and InflammationBongela Gel 15g £2.43 £0.52 £2.95 £4.00Adcortyl in Orabase 5g £3.26 £0.69 £3.95 £4.00Benzydamine Oral Rinse 200ml £4.12 £0.87 £4.99 £4.00Chlorhexidine mouthwash 300ml £3.95 £0.84 £4.79 £4.00

Oral Fungal InfectionDaktarin Oral Gel 15g £3.55 £0.75 £4.30 £4.00

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APPENDIX 4 Pharmacy Referral Form

Presenting Condition:……………………………………………………………………..

……………………………………………………………………..

Reason for referral back to surgery: Give details of advice given and medication supplied if applicable

…………………………………………………………………………………………..

…………………………………………………………………………………………..

…………………………………………………………………………………………..

…………………………………………………………………………………………..

Pharmacy Stamp or Label

Please note this form is a recommendation only

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Appendix 5

PHARMACY FEEDBACK FORM Minor Ailments SERVICE-REFLECTIVE PRACTICE

1. CONDITIONS -

Were all minor ailment conditions covered – Yes no (Please circle) if not please state which conditions should be added

2. Marketing & Promotion

My local GPs, family planning clinics were aware of this service Yes no (Please circle) I feel the service could be promoted better by: -

3. Training

Have you undertaken the CPPE training pack in

4. Your Feedback- please feedback any general comments on the service, how your role and the service could be improved.

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Appendix 6 Patient Satisfaction Evaluation form-Wandsworth PCT Minor Ailments Scheme

We are extremely interested in hearing your views on the service. Please take a moment to complete this evaluation so that we can update and improve the service.

Pharmacy visited…………………………………………

1. How did you hear about the Minor Ailments Scheme? Word of mouth (friend or relative)

Pharmacy

GP Practice

Hospital (Accident & Emergency)

Walk-in Centre

Other (please specify) (Walk-in)

2. What attracted you to the scheme? Happened to be in the pharmacy anyway.

More convenient than GP

Long wait for GP appointment,

Referred from GP or A&E

Thought pharmacy was best place to be treated for ailment

Other (please specify)

3. How many times have you used the service previously? Never 1-2 2-4 5+

4. What time of day did you access the service?……………

5. How satisfied were you with the service you received? Very disappointed Disappointed Neither satisfied nor disappointed

Satisfied Very satisfied

6. Would you recommend the service to a friend Yes No

7. Did the service meet your needs? Yes No

8. Would you use the service in the future? Yes No

9. If you hadn’t have gone to the Pharmacy, where else would you have gone? GP WIC A&E Wouldn’t have bothered

10. Please describe any problems you encountered when using the service.………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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Please add any further comments you have about the service

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