CHRONIC MEDICATION SERVICE

1. CHRONIC MEDICATION SERVICE Dawn Balfour Community Pharmacy IT Facilitator

2. CMS – Early Adopter • NHS Fife was asked to be involved in the EA process in April 2009 • Quickly identified sites to approach • Pharmacy/GP practice with close links • Spread across 3 CHP areas • Incorporate all GP systems where possible • Pharmacies using Pharmacy Manager software

3. CMS Early Adopter • First sites commenced in May 2009 (Kirkcaldy) • Up to 10 patients • Levothyroxine • 8 week prescription to be dispensed weekly

4. CMS Early Adopter • July 2009 – commenced with a GPass practice (Anstruther) feeding 2 pharmacies • September 2009 – commenced with a further GPass practice (Pittenweem) feeding 2 pharmacies • October 2009 – commenced with an INPS practice feeding 1 pharmacy (Cowdenbeath)

5. CMS Early Adopter • All sites started with an 8-week script then moved to a 24-week script for the same patients, same drug • In mid October go ahead was given to add any other regular medication for the patients to the 24-week script but to date that has not been possible

6. CMS Early Adopter • Now working with 2 EMIS GP sites (St Andrews and Cupar) • This brings in 2 of the other pharmacy suppliers, Nexphase and Rx Proscript and the final GP system • Also working with a Boots site in Cowdenbeath (Nexphase) • Only other pharmacy system to be tested is Lloyds - Compass

7. CMS – Who is eligible? • Patients must • Be registered with a GP practice in Scotland • Receive regular prescriptions • Have a long-term condition • Not eligible • A patient in a care home setting • A temporary resident

8. CMS - Eligibility • If the patient meets these conditions the pharmacist can register them for CMS – Stage 1 • Once registered the pharmacist can enter into CMS Stage 2 with the patient – pharmaceutical care planning • Initially, only if the patient is exempt under age or medical grounds can they receive a serial prescription

9. CMS – Data required • To register a patient for CMS you must have • Full name • Gender • Address, including Postcode • Date of Birth • Exemption category • CHI number

10. CMS – CP2/CP3 form • The registration form for CMS is now a combined form with the MAS CP2 form • MAS will print on the left hand side (CP2) • CMS will print on the right hand side (CP3) • There are 4 declarations on the reverse of the CP3 ALL of which MUST be crossed.

12. CMS – Process • Patient registers at the pharmacy for the service (very much like a MAS registration) • If the patient is registered at another pharmacy for CMS the system will prompt the pharmacist to check that the patient definitely wants to transfer their registration • Electronic message from pharmacy system is sent to the ePharmacy Message Store (ePMS) • GP system electronically requests any data from the store every day • Registration status is updated in GP patient record if exempt on age or medical grounds

13. CMS – Process • From the date of registration the pharmacist has 3 months to undertake an initial priority profile (Stage 2) • Once registration is received in the GP practice system, the GP has the option to generate a serial prescription for either 24 or 48 weeks (Stage 3) • NB – you may never receive a serial prescription for a CMS registered patient

14. CMS – Prescription • How to identify a CMS prescription • CMS 24 (or 48) weeks printed in bottom left hand corner of GP10 • Dispensing interval identified for each item • UPN (barcode number) starts with the letter K

16. CMS – Process • When the prescription is scanned in the pharmacy, the system will pull down the relevant electronic message – same as AMS • Pharmacist will use the information to dispense the item(s) in line with the dispensing frequency identified by the GP – this includes setting up the schedule for 24/48 weeks • An electronic message will be sent to the practice confirming that the item(s) has been dispensed and on what date

17. CMS – Process • Patient will present at the pharmacy the next time they are due their medication (there is no need to go back to their GP) • Pharmacy system will allow pharmacists to plan ahead • Scan script again at the next dispensing date – this action will check with the store to ensure that there are no cancellation messages from the GP • Schedule has already been set up from first dispensing so if nothing has changed the process is very quick

18. CMS – How it works • Each time the pharmacist does a dispensing on their system, and claims for it, an electronic claim will go to PSD and a dispensing notification will go back to the practice • Please bear this in mind when sending your claims – best practice is to wait until the patient has collected their medication if preparing in advance

19. CMS – GP10 submission • The GP10 must be held in the pharmacy until the end of the dispensing period • At the last dispensing the patient should sign the back of the GP10 • The GP10 is then submitted to PSD in the normal way • NB – there is no paper endorsing for CMS it is all electronic

20. Treatment Summary Report • At the end of the dispensing period the pharmacy systems will generate an End of Treatment Summary Report • This report summarises the dispensing episodes, provides any additional information (free text) the pharmacist thinks is necessary and requests another prescription, if appropriate

23. Treatment Summary Report • The TSR will be available in the GP system the following day • Pharmacists/GP Practices need to think about how they will use this report. • Is this the method you want to use for the repeat prescription or would you rather use existing methods, eg the right hand side of the GP10