17 NOVEMBER 2015
Service Specification for Lung Health Service CXR Pilot
Period: 4th September 2015 to 3 September 2016
Introduction
All pharmacies are expected to provide essential services which they are contracted
to provide to all their patients.
This specification outlines the more specialised services to be provided. The
specification of this service is designed to cover the 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.
Background
The CCG is working with a range of partners on a 12 month pilot to evaluate whether
the introduction of direct access to chest x-ray by community pharmacists increases
early detection of symptomatic lung cancer presented as a non-emergency, in the
Doncaster area.
The Primary objective: The hypothesis is that, providing community pharmacy with
direct access to chest X-ray, will increase detection of early lung cancer. Therefore
patients will not present at accident and emergency with advanced lung cancer.
The Secondary objective: To diagnose previously undetected lung abnormalities
other than cancer.
Service Outline
The aim of this service is to identify patients who are presenting at the community
pharmacy with high risk “red flag” signs and symptoms as detailed below and to refer
them accordingly.
Eligibility Criteria
Smokers or ex-smokers aged over 40, and who have one of the following symptoms
not explained by obvious causes, such as current lower respiratory tract infection,
know heart failure or known cancer etc.
All patients presenting at the community pharmacy who answer yes to one of the
following questions:
 Cough for three weeks or more
 Fatigue
 Shortness of breath
 Chest pain
 Weight loss
 Appetite loss
 Coughing up blood (haemoptysis)
 Persistent or recurrent chest infections;
will be eligible for further assessment by the community pharmacist.
Pharmacists to confirm which GP practice the patient is registered with and to
follow the appropriate pathway.
Pathway A
Explain to patient what will happen
Check if patient is safe for x-ray (IRMER)
Pharmacists will advise patient to see their GP if they have had a CXR within 1
month.
Complete Referral form for chest x-ray
Complete notification form for GP – copy to GP, copy to patient
Record on PharmOutcomes
Patient takes form and has x-ray
Pathway B
Advise patient to see their GP
Complete notification form for GP – copy to GP, copy to patient
Record on PharmOutcomes
Patient visits GP
Pathway C
If patient is registered with a different practice pharmacists will verbally advise the
patient to see their GP and record on Pharm Outcomes (Do not complete notification
from).See GP lists on Pharmoutcomes.
Chest X-ray
If following the assessment, it is clinically appropriate for the patient to be referred for
a chest x-ray, the pharmacist should complete a referral form for chest x-ray and
mark the form as “urgent”.
The report will automatically go to the patients GP practice and a copy will go to the
pharmacist.
Any suspicious chest x-ray results will be picked up by the chest physicians
as per standard care.
A copy of the Chest x-ray result will be sent to the community pharmacist and GP.
The community pharmacist will NOT be responsible for following up any abnormal
chest x-ray results. This is the responsibility of the GP and chest physician.
Patient Follow-up
The referring community pharmacist will contact the patient one week after the
referral and ask the Friends and Family Test question.
“How likely are you to recommend this service to family and friends if they needed
similar care or treatment?”
Any additional comments made can also be captured in the blank text box.
A 6 month follow-up will be undertaken by Doncaster CCG performance team.
Training
This is a pharmacist led service.
All participating pharmacists will have
 skills around ‘sensitively sharing information’
 reviewed the lung cancer awareness training slides from January 2015
( See LPC website).
 received training on the signs and symptoms for referral which will include respiratory chest symptoms from the Local Lung Cancer MDT lead from
DBHFT in July 2015
 attended IRMER training, Understanding the Implications of Ionising
Radiation provided by DBHFT and hold an accreditation certificate.
All pharmacies must maintain Standard Operating Procedures to meet all of these
service requirements and reflect changes in practice or guidelines and ensure that
pharmacists and staff involved in the provision of the service are appropriately
trained and can deliver the service for the full contracted period.
Performance and Payment
The assessment fee is £25 per patient consultation.
Payments will be made monthly according to activity data submitted via
PharmOutcomes. Activity not recorded at the time of the consultation with the patient
should be recorded on PharmOuctomes within 3 working days.
Activity should be submitted within 14 days of month end for activity undertaken in
that month.
Activity for March 2016 should be submitted within 7 days of month end. DCCG
reserve the right to withhold payment on activity not received within these time
scales.