NATIONAL ENHANCED SERVICE
FOR NEAR PATIENT TESTING
1. Introduction
The National Enhanced Service (NES) for Near Patient Testing (NPT) is for
the shared care and management and monitoring of patients on ‘Amber’
drugs.
Drugs are categorised as Red, Amber or Green.

Red

Amber

Green
Initiation by secondary care, management and monitoring by
secondary care.
Initiation by secondary care, joint shared care management
and monitoring.
Unrestricted use.
The NPT NES has been developed, and a ‘basket’ approach has been
adopted. Those drugs in the ‘basket’ are those included in a NPT NES. The
‘basket’ contains all Amber drugs where shared care protocols have been
agreed.
As new drugs move from Red to Amber or Amber to Green, so the drugs
included in the ‘basket’ would change. The Area Prescribing Committee
agrees the classification of ‘Amber’ drugs and issues shared care guidelines.
It is important to note that whilst drugs may be categorised as Amber, they will
not enter the basket unless there are agreed shared care guidelines.
2. Claiming
The process for claiming payment for providing the NPT NES is as follows.

Claims are made once every quarter when a new claim form will be
issued to each practice the week prior.

The number of patients, at the time of making the claim, should be
entered onto the claim form against the relevant drug and the level of
service. This is a ‘snap shot’ of the number of patients on a date of your
choice within the quarter being claimed for.

Claims are paid for the full quarter against this ‘snap shot’.
National Enhanced Service for Near Patient Testing. Oct to Dec 2013
Please return forms to Jen Love, Greater Huddersfield CCG.
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
Claims are only applicable for the specified indication for that drug.

The Service Specification should be met for levels 2, 3 and 4 at all times,
and is advised as good practice for levels 1, 1(a) and 1(b).

The level of payment is dependant on the level of service provided (see
interpretation of levels page 8).

GPs should be familiar with the interpretation of the levels of service.

Claim forms should be returned to the CCG for payment to be made.

GPs should make claims using the relevant claim form only.

Claim forms should be returned within the quarter or no later than 10 days
following the quarter they are claiming for.

The CCG is free to cross reference claims made against service
specification and level of service provided at any time in order that claims
made are accurate.

Note; ‘Amber’ drugs used in this NES for NPT, are those that are
categorised as ‘Amber’ by the Area Prescribing Committee and have
agreed and implemented shared care guidelines.
National Enhanced Service for Near Patient Testing. Oct to Dec 2013
Please return forms to Jen Love, Greater Huddersfield CCG.
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NATIONAL ENHANCED SERVICE FOR NEAR PATIENT TESTING
CLAIM FORM
Period of Claim
October to December 2013.
GP Practice
GP signature
Details of the Service Specification required and the level of service provided
follow the list of ‘Amber’ drugs. The indication for which there are shared care
guidelines is highlighted with a bullet point below each drug. Claims are only
applicable for the use of this drug for the indication highlighted.
Additions since last quarter
Enter the number of patients currently
receiving the drug against the level of
service provided
Level of service provided
1
1(a)
1(b)
2
3
4
Drug
APOMORPHINE

Doperminergic
disease
drug
–
Parkinson’s
ATOMOXETINE

Attention deficit hyperactivity disorder
AZATHIOPRINE


Post adult Renal Transplant
Immunosuppressant
–
Rheumatoid
Arthritis
 Inflammatory bowel disease
BICALUTAMIDE

Prostate Cancer
CABERGOLINE

Parkinson’s disease
CICLOSPORIN

Post adult renal transplant
Immunosuppressant – rheumatoid arthritis
COLISTIMETHATE SODIUM
National Enhanced Service for Near Patient Testing. Oct to Dec 2013
Please return forms to Jen Love, Greater Huddersfield CCG.
3
(COLISTIN)

Cystic fibrosis management
COLOMYCIN (inc Promixin)

Cystic fibrosis management
CYPROTERONE Prostate Cancer
Drug
DONEPEZIL

Enter the number of patients currently
receiving the drug against the level of
service provided
Level of service provided
1
1(a)
1(b)
2
3
4
Reversible inhibitor of
acetylcholinesterase – mild to
moderately severe Alzheimer’s Disease
DORNASE ALFA

Phosphorylated glycosylated
recombinant human deoxyribonuclease
1(rhDNase) – Cystic Fibrosis
FLUTAMIDE

Gonadorelin analogue – Prostate Cancer
GALANTAMINE

Mild to moderately severe Alzheimer’s
Disease
HYDROXYCHLOROQUINE

Disease modifying anti rheumatic drug
(anti malaerial) rheumatoid arthritis
LEFLUNOMIDE

Rheumatoid Arthritis
LITHIUM

Bipolar disease / depression
MERCAPTOPURINE

Inflammatory bowel disease
METHOTREXATE (oral)
• Immunosuppressant – rheumatoid
arthritis
METHYLPHENIDATE
• Attention deficit hyperactivity disorder
MODAFINIL

Narcolepsy, obstructive sleep apnoea,
MS, Parkinson’s disease.
MYCOPHENOLATE
Cytotoxic immunosuppressant –
prophylaxis acute renal transplant rejection
PENICILLAMINE

Disease modifying anti rheumatic drug –
rheumatoid arthritis
National Enhanced Service for Near Patient Testing. Oct to Dec 2013
Please return forms to Jen Love, Greater Huddersfield CCG.
4
PERGOLIDE

Parkinson’s disease
Enter the number of patients currently
receiving the drug against the level of
service provided
Level of service provided
Drug
PHENELZINE
• Monoamine oxidase inhibitor for
1
1(a)
1(b)
2
3
4
resistant depression
RILUZOLE

Extend life/time to mechanical
ventilation with amyotrophic lateral
sclerosis
RIVASTIGMINE

Reversible inhibitor of
acetylcholinesterase, mild to moderate
dementia in Alzheimer’s disease
SODIUM AUROTHIOMALATE (im
gold)

Disease modifying anti rheumatic drug,
Rheumatoid arthritis
SOMATROPIN (adults)

Acquired adult onset, post surgery.
SOMATROPIN (children)

Growth hormone deficiency/shortness in
Turner’s syndrome.
SULFASALAZINE

Immunosuppressant – Rheumatoid
arthritis
TACROLIMUS (oral)

Immunosuppressant – primary
immunosuppressant in liver and kidney
allograft recipients and allograft rejection
resistant to conventional
immunosuppressant regimens
TAURINE

Cystic fibrosis management
TOBRAMYCIN (nebulised)

Cystic fibrosis management
National Enhanced Service for Near Patient Testing. Oct to Dec 2013
Please return forms to Jen Love, Greater Huddersfield CCG.
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VENLAFAXINE

Depressive illness or generalised anxiety
disorder
ZOTEPINE

Atypical antipsychotic – schizophrenia
PLEASE TOTAL EACH COLUMN
In addition, where sampling requires a domiciliary visit a payment of £5.12 will be
made for each visit.
Number of domiciliary visits in the period of this claim ……………..
Claim forms should be returned to;
Jen Love
Greater Huddersfield CCG
Broad Lea House
Bradley Business Park
Dyson Wood Way
Bradley
Huddersfield
HD2 1GZ
Any queries about the claim form or this National Enhanced Service should be
directed to;
Jen Love
01484 464026 or jen.love@greaterhuddersfieldccg.nhs.uk
National Enhanced Service for Near Patient Testing. Oct to Dec 2013
Please return forms to Jen Love, Greater Huddersfield CCG.
6
Service outline requirements for levels 2, 3 and 4
A register.
Practices should be able to produce and maintain an up to date register of all shared care
drug monitoring service patients, indicating patient name, date of birth, and the indication
and duration of treatment and last hospital appointment.
Call and recall.
To ensure that systematic call and recall of patients on this register is taking place either in
hospital or general practice setting.
Education and newly diagnosed patient.
To ensure that all newly diagnosed / treated patients (and / or their carers where
appropriate) receive appropriate education and advice on management of prevention of
secondary complications of their condition. This should include written information where
appropriate.
Continuing information for patient.
To ensure that all patients (and / or their carers and support staff where appropriate) are
informed how to access appropriate and relevant information.
Individual management plan.
To ensure that the patient has an individual management plan, which gives the reasons for
treatment, the planned duration, the monitoring timetable and, if appropriate, the
therapeutic range to be obtained.
Professional links. To work together with other professionals where appropriate. Any health professional
involved in the care of patients in the programme should be appropriately trained.
Referral policies.
Where appropriate to refer patient promptly to other necessary services and to the
relevant support agencies using locally agreed guidelines where these exist.
Record keeping.
To maintain adequate records of the service provided, incorporating all known information
relating to any significant events e.g. hospital admissions, death of which the practice has
been notified.
Training.
Each practice must ensure that all staff involved in providing any aspect of care under this
scheme and has the necessary training to do so.
All practices involved in the scheme should perform an annual review which could include:
Annual review.
(a) brief details as to arrangements for each aspect highlighted in the NES
(b) details as to any computer-assisted decision-making equipment used and arrangements for
internal and external quality assurance
(c) details as to any near-patient testing equipment used and arrangements for internal and external
quality assurance
(d) details of training and education relevant to the drug monitoring service
(e) details of the standard used for the control of the relevant condition
National Enhanced Service for Near Patient Testing. Oct to Dec 2013
Please return forms to Jen Love, Greater Huddersfield CCG.
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(f) assurance that any staff member responsible for prescribing must have developed the necessary
skills to prescribe safely.
National Enhanced Service for Near Patient Testing. Oct to Dec 2013
Please return forms to Jen Love, Greater Huddersfield CCG.
8
ANTI-COAGULANT MONITORING AND NEAR PATIENT TESTING – INTERPRETATION OF LEVELS
Level
GMS blue book description
Interpretation
Level 1
Laboratory outreach sampling,
test and dose
Level 1
(a)
CCG locally enhanced service
Level 1
(b)
CCG locally enhanced service
Level 2
PCO, trust or other externally
funded phlebotomist or
pharmacist etc, practice
sample, laboratory test,
practice dose.
Level 3
Practice funded phlebotomist
or pharmacist etc, practice
sample, laboratory test,
practice dose.
Level 4
Practice funded phlebotomist
or pharmacist etc, practice
sample, practice test, practice
No involvement at any stage, phlebotomy, testing and dosage all external to the practice with no practice involvement in this
aspect of care.
Patients have phlebotomy, testing and dosing external to the practice. Practice will have records of patients on anticoagulation or Rheumatology therapy; receive communication from external body regarding the patients’ current therapy.
Practices will be able to provide information to patients as necessary, for example an issue with a type of medication.
Prescribe as required.
The following is routine.
 Phlebotomy at the practice by a non practice funded phlebotomist.
 Laboratory testing external to the practice.
 The practice takes clinical responsibility for the patient’s therapy. Blood results are received and in combination with a
review of the patient’s current health and medical history, alter the dose, as appropriate, and prescribe medication. There is
reference to secondary care as required.
The following is routine.
 Phlebotomy at the practice by a practice funded phlebotomist.
 Laboratory testing external to the practice.
 The practice takes clinical responsibility for the patient’s therapy. Blood results are received and in combination with a
review of the patient’s current health and medical history, alter the dose, as appropriate, and prescribe medication. There is
reference to secondary care as required.
The following is routine.
 Phlebotomy at the practice by a non practice funded phlebotomist.
 Laboratory testing external to the practice.
 Practice dosing that is to say the practice takes clinical responsibility for the patient’s therapy. Blood results are received
and in combination with a review of the patient’s current health and medical history, alter the dose, as appropriate, and
prescribe medication. Clinical review and alteration of medication dosage is without reference to secondary care. All
elements of service outline met.
The following is routine.
 Phlebotomy at the practice by a practice funded phlebotomist.
 Laboratory testing external to the practice.
 Practice dosing that is to say the practice takes clinical responsibility for the patient’s therapy. Blood results are received
and in combination with a review of the patient’s current health and medical history, alter the dose and prescribe medication
as appropriate. Clinical review and alteration of medication dosage is without reference to secondary care. All elements of
service outline met.
The following is routine.
 Phlebotomy at the practice by a practice funded phlebotomist.
 Laboratory testing within the practice.
National Enhanced Service for Near Patient Testing. Oct to Dec 2013
Please return forms to Jen Love, Greater Huddersfield CCG.
Costs £
0
£10.69
per patient, per
annum
£21.41
per patient, per
annum
£29.44
per patient, per
annum
£93.65
per patient, per
annum
£101.68
per patient per
annum
£109.72
per patient per
annum
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dose.

Practice dosing that is to say the practice takes clinical responsibility for the patient’s therapy. Blood results are received
and in combination with a review of the patient’s current health and medical history, alter the dose and prescribe medication
as appropriate. Clinical review and alteration of medication dosage is without reference to secondary care. All elements of
service outline met.
National Enhanced Service for Near Patient Testing. Oct to Dec 2013
Please return forms to Jen Love, Greater Huddersfield CCG.
10