Final Version 08.01.15
Community Pharmacy Falls Prevention Service Specification
NHS Doncaster CCG
Period: 1st April 2015 to 31st March 2016
Introduction
This service specification outlines the service to be provided.
The specification of this service is designed to cover enhanced aspects of
clinical care of the patient, all of which are beyond the scope of essential
services. No part of the specification by commission, omission or implication
defines or redefines essential or additional services.
The pharmacy providing the service must fully comply with the NHS
Pharmaceutical and Local Pharmaceutical Services regulations 2013
available at: http://www.legislation.gov.uk/uksi/2013/349/contents/madefor the
delivery of Essential Services and be registered with the GPhC.
All staff working in the pharmacy providing the service must conform to the
NHS code of practice on confidentiality. All staff working in the pharmacy
providing the service must conform to the Data Protection Act.
Background
The aim of this specification is to enable pharmacy to play an even stronger
role at the heart of more integrated out-of-hospital services for patient’s that
deliver better health outcomes, more personalised care, excellent patient
experience and the most efficient use of NHS resources.
Description of Service
This community pharmacy service aims to address the issue of primary
prevention of falls and fractures: identifying patients at risk and preventing the
first fall/fracture.
Patients aged 65 years and over taking three or more medicines or patients
prescribed ‘high-risk/culprit’ medication (appendix 1) will be targeted for a face
to face consultation with a trained pharmacist who has undertaken targeted
falls prevention training.
During the consultation the pharmacist will enquire about falls history, side
effects which may contribute to falls, identify any culprit/high-risk medicines,
perform an assessment of gait/balance using the ‘Turn 180° test’ (appendix
Final Version 08.01.15
2)and ask the patient if they have any problems with vision or continence. All
patients will be provided with oral falls and fracture prevention advice
(appendix 3) and given a leaflet to take home (appendix 4).
A checklist has been devised for the pharmacist to use during the consultation
to ensure a high quality review is conducted (appendix 5).
This service can be used as an extension of the existing Medicine Use
Review (MUR) service or if the patient is not eligible for a MUR or for example
the pharmacy has reached the 400 yearly MUR cap, then it can be provided
as a stand alone service. Patients who have fallen in the past year will be
referred directly to the Specialist Falls Clinic at Tickhill Road Hospital and a
GP notification form will be completed for patients identified as having falls
risk factors that the GP may not be aware of. Any adherence issues identified
to bone protection medication that cannot be resolved by the community
pharmacist will also be highlighted to the GP.
The part of the pharmacy used for the provision of the Falls Prevention
Service must meet the requirements of the MUR specification for consultation
areas:
 The consultation area should be where both the patient and the
pharmacist can sit down together
 The patient and pharmacist should be able to talk at normal speaking
volumes without being overheard by any other person (including
pharmacy staff)
 The consultation area should be clearly designated as an area for
confidential consultations, distinct from the general public areas of the
pharmacy.
Patient Recruitment
Patients may be recruited in to the service in the following ways:
 Self referral following advertising of service
 Presenting in pharmacy following a fall
 Identified by dispensing staff during dispensing process.
Inclusion Criteria
Patients eligible for inclusion in this service:
≥ 65yrs on 3 or more medicines
≥ 65yrs and have fallen/been frightened of falling in the past 12 months
≥ 65yrs and currently prescribed a ‘culprit/high risk’ medicine
Patients referred to the pharmacy by another healthcare professional
Falls Clinic Referral Criteria
Patients identified as having fallen in the past 12 months: refer patient directly
to Tickhill Road Specialist Falls Service (SFS) via their referral form (appendix
6) Include additional information identified e.g. culprit/high risk medicines, fall
inducing side effects etcon this form. Fax/post/secure email the referral form
to SFS.
Final Version 08.01.15
GP Notification
Patients identified as at risk of falling but who have not fallen in the past year
and the pharmacist feels there are falls risk factors that the GP should be
aware: complete a GP notification form informing the GP of the falls risk
factors identified (appendix 7).
For example the types of issues that would be appropriate to include on a
notification form:
 Frequent side effects
 Patient has been sign posted to optician as they are experiencing
vision problems.
 Patient has continence problems which they have not previously raised
with their GP or which have worsened.
 Balance/gait problems that the GP may not be aware of.
 Patients identified as having a previous fragility fracture but are not
currently prescribed bone protection.
 Patients identified as experiencing compliance issues with bone
protection medication that cannot be resolved by the community
pharmacist.
Pharmacist Interventions
Interventions made as part of this service, but not exclusively include:
 Advice on managing side effects e.g. patients experiencing dizziness
on rising from sitting or standing to be advised to rise slowly.
 Identification of patients who have fallen in the past year and are
referred appropriately.
 Identification of patients with vision problems not corrected by glasses
sign posted to optician.
 Identification of compliance issues with bone protection therapy.
 Falls and fracture prevention advice e.g. lifestyle advice and home
hazard advice.
Accreditation
The service shall be provided by a practising pharmacist, registered with the
General Pharmaceutical Council of Great Britain and who declare themselves
as competent in falls awareness, evidenced by completing appropriate CPD.
Final Version 08.01.15
Monitoring
The Pharmacy should retain a copy of Appendix A and Appendix B for their
records. NHS Doncaster CCG reserves the right to review and/ or audit data
in relation to payments processed for this service.
Monthly monitoring should be sent to the CCG by way of an invoice detailing
the following information:





Number of patients reviewed
The registered practice of the patient
Age of patient
Falls risk factors identified
Outcome; i.e. advice, referral to Tickhill Road Specialist Falls Clinic,
sign posting, GP notification of risk factors etc
Appendices
1g (Appendix A) Falls
Appendix B Falls
Appendix 1 List of
Appendix 2 Turn
Prevention Service Patient Feedback
serviceForm.docx
dataset revised version.docx
drugs associated with falls.docx 180o Test.docx
Appendix 3 Oral Falls
Prevention advice.docx
Appendix 4 staying
sready leaflet.pdf
Appendix 5
Consultation Checklist.docx
Appendix 6 DCH day
services referral form V4.docx
GP Notification Letter
NEW FALLS
Appendix 7
(revisedService.docx
version April 2014).docx
REFFERRAL FORM SPECIALIST FALLS SERVICE.doc
Community Pharmacy Falls Prevention