Schedule 1
Service Specification – Improving Inhaler Technique through
Community Pharmacy
1. Service description
1.1
The pharmacist will provide an augmented Medicine Use Review
(MUR)/prescription intervention (PI) service to patients on inhaled medication for
the treatment of asthma or chronic obstructive pulmonary disease (COPD). There
is no age restriction for patients, but the service must be provided directly to the
patient, not to the parent/carer on the patients’ behalf.
1.2
The pharmacist will assess the patients’ disease control, inhaler technique and
provide health promotion information (e.g. smoking cessation advice). The
pharmacist will perform a prescription intervention on eligible patients with a follow
up brief intervention 6-8 weeks later.
1.3
The service is built on the MUR/PI advance service defined in The Pharmaceutical
Services (Advanced and Enhanced Services) (England) Directions 2013. This
service can only be provided face to face; telephone consultations will not be
allowed. The service may be provided away from the pharmacy premises e.g. at
the patient’s homes; however prior permission must be granted from NHS
England. Details on how to apply for off-site MUR/PIs can be found at
www.england.nhs.uk.
2. Aims and intended service outcomes
2.1



The aim is to provide a service for patients diagnosed with either asthma or COPD
that achieves:
Improved patient outcomes through;
o Assessment of inhaler technique;
o Improved patient understanding and hence adherence with inhaler therapy;
o Optimum use of inhaler therapy;
o A reduction in adverse events associated with inhaler treatment;
o Ensuring that patients who smoke are offered appropriate advice with
regard to stop smoking.
Reduction in waste of inhaler therapies through;
o A possible reduction in prescribed inhalers for poorly controlled conditions
o Patients being encouraged to order only the prescription items that they
need.
Measurable outcomes
o Reduced prescribing of reliever inhalers as preventer inhalers are used
more effectively.
o Reduced need for additional therapy for poorly controlled asthma or COPD.
o Prescription synchronisation as only the inhalers needed are ordered
leading to a reduction in time spent both ordering and dispensing repeat
medication and the possibility of excess ordering being reduced.
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
Improved management of patient’s asthma or COPD, measured through the use
of technique demonstration and standard questions at initial screening and during
follow up consultation.
3. Service outline
Contractors providing this service are required to adhere to the maximum number of
MUR/PIs as defined in the Drug Tariff. Any claims above this limit will be recuperated.
This service shall only be provided by an accredited pharmacist.
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
The pharmacist shall identify suitable patients and seek written informed consent
before enrolling in the service.
The pharmacist shall then complete a PI focusing solely on medication for the
patient’s respiratory disease with an emphasis on inhaler technique. This
intervention must be clearly marked as a PI. If, in the clinical opinion of the
pharmacist, the patient would benefit from a MUR/PI that covers all the patients
medication at this point the pharmacist may undertake this. Alternatively they may
carry out a full MUR at a later date.
The PI must be completed on the Improving Inhaler Technique through
Community Pharmacy- Initial Assessment form. The form can be downloaded from
the
Community
Pharmacy
Greater
Manchester
website,
http://psnc.org.uk/community-pharmacy-greater-manchester/.
The pharmacist must capture all of the information present on the assessment
form, and transfer the relevant information onto the PharmOutcome module. The
form must be kept in the pharmacy’s standard MUR records for post payment
verification purposes. The form must be kept for a minimum of two years from the
date of consultation. A copy of the form must be sent to the patients GP practice.
The pharmacist should invite the patient for a brief intervention 6-8 weeks after the
PI. The maximum time period between the PI and the brief intervention is 12
weeks.
The brief intervention must be completed on the Improving Inhaler Technique
through Community Pharmacy- Brief intervention form. The form can be
downloaded from the Community Pharmacy Greater Manchester website,
http://psnc.org.uk/community-pharmacy-greater-manchester/.
The pharmacist must capture all of the information present on the brief
intervention form, and transfer the relevant information onto the PharmOutcome
module. The form must be kept with the assessment form in the pharmacy’s
standard MUR records for post payment verification purposes. The form must be
kept for a minimum of two years from the date of consultation. A copy of the form
must be sent to the patients GP practice.
This service is available to any patient registered with a Greater Manchester GP
presenting to a community pharmacy in Greater Manchester who has a diagnosis
of either asthma or COPD. Patients registered with GP practices outside of
Greater Manchester are excluded from the service but can receive inhaler
technique training via the normal MUR service.
The patient is entitled to a maximum of one MUR; one PI; and one brief
intervention per year. Pharmacists must take reasonable steps to ensure the
patient has not received the service from a different pharmacy in the last 12
months. Patients do not have to have been using the pharmacy for a minimum
time period before being offered the service.
4. Training and Premises Requirements
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4.1 The pharmacy contractor has a duty to ensure that pharmacists and staff involved
in the provision of the service have relevant knowledge and are appropriately
trained in the operation of the service.
4.2 The pharmacy contractor has a duty to ensure that pharmacists and staff involved
in the provision of the service are aware of and operate within local protocols.
4.3 The pharmacist providing this service must be accredited to provide MURs. A
copy of their certificate of accreditation must be submitted to NHS England.
4.4 The pharmacist must have undertaken face to face inhaler technique training from
an approved trainer since 2011.
4.5 All pharmacists providing the service are to self-declare their competence using
the ‘Declaration of Competence for Improving Inhaler Technique through
Community Pharmacy’ available at www.cppe.ac.uk. Pharmacist should ensure
they re-accredit in line with the requirements of the ‘Declaration of Competence’.
This is usually every three years.
4.6 The contractor is responsible for ensuring only pharmacists holding a valid
Declaration of Competence provide the service. The contractor should retain a
signed copy of the Declaration of Competence on the pharmacy premises, a copy
should be provided to NHS England if requested.
4.7 All patient counselling should take place in a location approved for the provision of
advanced services. It is the contractor’s responsibility that a PREM1 form has
been submitted to NHS England for any on-site applications. Contractors wishing
to provide the service off-site should apply to NHS England following the
procedure described in the ‘provision of advanced services by pharmacy and
dispensing appliance contractors’ document.
4.8 A pharmacy must be fully compliant with their Essential Services before being
commissioned to provide the service. If the pharmacy becomes non-compliant
with their Essential Services the scheme may be withdrawn.
4.9 A pharmacy must be fully compliant with any local services/schemes which are
supported by their Local Pharmaceutical Committee to provide the service.
4.10 The pharmacy must have a selection of placebo inhalers covering the different
device types. The pharmacy must also have an In-Check® device. Where
possible the commissioner will provide this equipment; however the ultimately
responsibility is on the pharmacy to source and purchase the equipment.
5. Service availability
5.1
5.2
5.3
Pharmacist must ensure that there are sufficient accredited members of staff are
able to provide the service before enrolling a patient.
If the pharmacy for whatever reason cannot provide the service, then the patient
should be directed to the nearest pharmacy providing the service.
The pharmacy should inform the commissioner if they are unable to provide the
service for an extended period (defined as 4 weeks or more) due to any
circumstance.
6. Quality Standards
6.1 The pharmacy is making full use of any promotional material for the service, made
available by the commissioner.
6.2 The pharmacy has appropriate health promotion and self-care material available
for the user group and promotes its uptake.
6.3 The pharmacy participates in any commissioner organised audit or post payment
verification of service provision.
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6.4 The pharmacy should co-operate with any commissioner-led assessment of
patient experience.
6.5 The pharmacist ensures that clinical advice given is in line with national/local
guidelines.
6.6 The pharmacist ensures that any patient incidents that occur are reported to the
NPSA via the NRLS on-line reporting system.
6.7 The pharmacist ensures that the pharmacy has a complaints procedure in place
that meets the NHS pharmaceutical contractual standards.
6.8 The pharmacist activity promotes the service to those patients
7. Claiming payment
7.1
7.2
The commissioner will provide access to a web-based system for the recording of
relevant service information for the purposes of audit and the claiming of the brief
intervention payment.
Payment for the PI element will be made by the NHSBSA. The number of
MUR/PIs should be included in the number of interventions claimed on the
FP34c submission document.
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Inhaler Technique Patient Pathway Flow Chart 1
Step One Patient on inhaled
medication and meets the standard
requirements for a MUR.
Step Two Patient asked to complete
the ACT/CAT assessment. Is the score
≥ 20 for ACT or ≤ 10 for CAT?
Yes
Patient
demonstrating good
control, but may have
poor technique. See
flow chart 2
No
Step Three Patient invited to
participate in inhaler training
Patient not had full MUR in last 12 months
Prescription Intervention undertaken
on inhaled medications only- claim via
FP34c
6-8 weeks later
Brief intervention follow up checkclaim via PharmOutcomes
Patient had full MUR in last 12 months
Prescription Intervention undertaken
on inhaled medications only- claim via
FP34c
6-8 weeks later
Brief intervention follow up checkclaim via PharmOutcomes
Full MUR within 12 months- claim via
FP34c
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Inhaler Technique Patient Pathway Flow Chart 2
Patient has an ACT/CAT score ≥ 20
for ACT or ≤ 10 for CAT?
Inspiration rate checked using InCheck® device
In-correct inspiration rate
demonstrated
Correct inspiration rate
demonstrated
Does the patient
meet the standard
requirements for an
MUR?
Follow Flow Chart 1
from Step Three
Yes
Perform MUR- claim
via FP34c
No
Patient to be invited back
for an MUR when meets
national eligibility criteria
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