Draft Version 4 (23-12-08)
Service Specification for the provision of a Local Enhanced Service (LES)
December 2008
Supply of selected medicines out of hours for end of life care patients in the
community setting.
Lead Pharmacist for End of Life Care Sekhar Pillai 020 896 26562
Background
The End of Life Care Programme emphasizes that “the care of all dying patients must improve to the
level of the best “in all healthcare settings – this includes the patient’s home. The End of Life Strategy
also stresses the need to ensure that patients are symptom and pain free towards the latter stages of
life. The strategy emphasise the need for a robust and co-ordinated approach to managing these
patients.
Kensington and Chelsea PCT are keen to support the national “ End of Life Strategy “ and this LES is
one step in ensuring that patients have the access to medicines that will help them to be pain and
symptom free.
Aims of this Local enhanced Service

To improve access to palliative care drugs out of hours in a way that best meets the needs of
patients at the end of life in the community setting.

To improve the quality of service delivery for the end of life patients and their carers.

To ensure a coherent audit trail for prescribing of controlled drugs dispensed out of hours.
Service Specification
1. The scheme will operate on a PCT wide basis utilising community pharmacies located in the north
and south of the PCT and St Charles Pharmacy on call service for patient specific needs that the
community pharmacies could not provide.
The cover for the service will be as follows:
Zone
PCT
within
North
North
the
Pharmacy
Sainsbury’s
Ladbroke Grove
My Pharmacy
Mon-Fri
Saturday
Period of cover
Sunday
7am – 11pm
7am – 10pm
11am- 5pm
9am-7pm
9am-5pm
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Outside of
operating hours
Call St Charles on
call pharmacy
service, or if the
Closed
south zone
pharmacy cannot
provide the required
medication
Chair: Peter Molyneux
Chief Executive: Diana Middleditch
Clinical Executive Chair: Andrew Steeden
Draft Version 4 (23-12-08)
South
North + South
Zafash
St Charles Hospital
pharmacy on call
service
24 hours
24 hours
24 hours
Only to be called upon if the community pharmacy is unable to
provide the medication or the pharmacy is closed
2. Where the weekend is followed by a Bank Holiday Monday, the south zone will not be affected. In
the north zone if the designated pharmacies are closed then for OOH medication purposes call the
St Charles Hospital on call service.
3. The pharmacist will be provided with a faxed prescription and where possible with a photo of the
driver collecting the medication in advance so that the pharmacist will be made aware of the
authentic nature of the request. Should the pharmacist still need further information then they can
phone the following numbers:Co-op: - (Covers Kensington and Chelsea PCT) 020 8969 7777
Harmoni - On call (for South Zone only) 0845 602 6292
4. The contact telephone numbers of the relevant pharmacies participating for this service will only be
given to relevant out of hour’s organisations and health care professionals. For security reasons, it
must not be given to patients. The organisations who will be given this information are:
a)
b)
c)
d)
e)
GP out-of-hours service
District Nursing service
Night Nurse service
Palliative Care service
Pembridge Centre
5. The on-call pharmacist at St Charles Hospital should only be contacted if it is not possible to obtain
the prescribed items from a pharmacy which is open until late or open on Saturday or on Sunday
or from those pharmacies’s participating in this service.
6. The participating pharmacist’s should be able to supply the medicines indicated on the approved
list (appendix 1) within two hours.
7. Selected pharmacies will be required to stock the palliative care drugs listed in Appendix 1.
Arrangements will be made by the GP or healthcare representative to collect the medications from
the pharmacy.
8. The patient, his or her representative, or the night nurses should take the prescription to the
pharmacy at an agreed time for the medications to be dispensed.
If the Night Nurse is
transporting the medicine, she should take it to the identified patient immediately. The medicine
should be stored out of sight in a locked car boot, or in the case of an estate car, it should be
stored out of sight.
9. If the prescription presented to the pharmacist is for a controlled drug and does not comply with
the legal requirements for a controlled drug then the pharmacist can dispense the prescription,
provided the pharmacist is satisfied :


That the patients needs are urgent
That the prescriber is aware of the need to rectify the prescription and have agreed that a
new replacement prescription will be provided at the next earliest opportunity but within
48 hours.
Chair: Peter Molyneux
Chief Executive: Diana Middleditch
Clinical Executive Chair: Andrew Steeden
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Draft Version 4 (23-12-08)
10. The named pharmacist shall not, whether during or after their appointment, disclose or allow to be
disclosed to any person (except on a confidential basis to their professional advisers) any
information of a confidential nature acquired by the pharmacist in the course of carrying out their
duties under this Agreement, except as may be required by law or as directed by Kensington and
Chelsea PCT.
11. The pharmacist must protect personal data in accordance with the provisions and principals of the
Data Protection Act legislation and must ensure the reliability of the staff who have access to such
data.
Monitoring & Evaluation

The pharmacy should maintain appropriate records to ensure effective ongoing service delivery
and audit. Participating pharmacies will be expected to submit a record of drugs dispensed
during the out of hour’s period.

Pharmacies will have a process in place to check the expiry dates of palliative care drugs that
complies with the RPSGB guidelines and to maintain stocks

The pharmacy will co-operate with any locally agreed PCT-led assessment of service user
experience.
Remuneration
The PCT will remunerate the community pharmacist for any expired stock, provided the relevant stock
inventory form (appendix 2) is completed and forwarded to the Medicines Management Team at the PCT
In addition the PCT agrees to pay a retainer fee of £100 per year in recognition of the potential increased
storage costs and the additional costs of stocking the medicines. This will be remunerated to the
Pharmacist as a one off payment from the onset of the agreement.
Pharmacists will be paid:In- hours
£50 if required to dispense medication as specified in appendix 1 during the pharmacy’s normal operating
hours.
Out of hours
£250 if required to dispense medication as specified in appendix 1 for the following situations:


Between the hours of 9pm – 9am Mon to Fri (this applies even if the pharmacy operates
during this time period)
Between the hours of 5pm Saturday – 9am Monday (this applies even if the pharmacy
operates during this time period)
When the St Charles on call pharmacist is called out.
Pharmacists including St Charles Pharmacy can make a claim for payment by completing the relevant
form (appendix 3) and forwarding this to the Medicines Management team at the PCT.
Chair: Peter Molyneux
Chief Executive: Diana Middleditch
Clinical Executive Chair: Andrew Steeden
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Draft Version 4 (23-12-08)
Variation
The services or any aspect of this agreement may be varied if:



The parties agree in writing, or
Upon request by the PCT where there is a change in the Trust’s service priorities or where
there is a change in the way in which this agreement is required to work as requested by:
 Changes in legislation, guidance or directions from the Department of Health, or
 Other exceptional circumstances
Proposals to vary the service may be initiated by any party. A request to vary the service will
require at least one month’s written notice unless the parties agree otherwise.
Default and Termination
Any party may terminate this agreement by immediate notice to the other parties if any of the other
parties refuses or fails to carry out any of its obligations, if the matter complained of is:


Incapable of rectification, or
Capable of rectification, but has not been rectified within 14 days of the notice being sent
to the reasonable satisfaction of the non defaulting party serving the notice.
If the pharmacist has failed to perform the services in accordance with this agreement or is
otherwise in breach of this agreement, and the pharmacist has not remedied the breach where it is
capable of being remedied within such a time as may have been notified to the pharmacist, the
PCT may terminate this agreement in respect of the services only and provide or procure a third
party to provide such services.
The PCT may terminate this agreement by immediate notice if the pharmacist ceases to provide
pharmacy services from the Pharmacy or they are withdrawn or removed from the Pharmaceutical
list, by whatever means.
Upon termination of this agreement each party shall return to the relevant party all the other party’s
documents and materials and all copies thereof which are of a confidential nature.
The pharmacist shall co-operate fully with the PCT during any handover leading to
termination of this agreement. This co-operation shall extend to full access to all
documents, reports, summaries and any other information reasonable required by the PCT
to achieve an effective transition without disruption to routine operational requirements.
The pharmacist shall not be entitled to assign or sub-contract its rights or obligations under this
agreement to any person without prior written consent of the PCT.
Signed: ……………………………………..
Community Pharmacy Development Manager
Signed:………………………………………
Pharmacy Contractor / Head of St Charles Hospital Pharmacy
Signed:………………………………………
Pharmacist on duty
Signed:………………………………………
Pharmacist on duty
Chair: Peter Molyneux
Chief Executive: Diana Middleditch
Clinical Executive Chair: Andrew Steeden
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Draft Version 4 (23-12-08)
Date: …………………
Date of Review of Contract :………………
Appendix 1
List of drugs required to be stocked by selected community pharmacies
Drug
Alfentanil Inj 500mcg/ml
(2ml)
Minimum quantity
5 ampoules
Cyclizine inj
5 ampoules
Diamorphine Inj 10mg
5 ampoules
Diamorphine Inj 30mg
5 ampoules
Diazepam Rectal Tubes
5 tubes
Morphine Sulphate solution 10mg/5ml
10 ampoules
Morphine Inj 30mg/ml
5 ampoules
Water for injection 10ml
10 ampoules
Sodium Chloride for injection 10ml
10 ampoules
Chair: Peter Molyneux
Chief Executive: Diana Middleditch
Clinical Executive Chair: Andrew Steeden
533576155
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Draft Version 4 (23-12-08)
Appendix 2
End of Life Service – Out of date claims forms
Name of Pharmacy ………………………………………..
Drug
Strength + form Batch Number
Expiry date
Quantity
Trade Price (£)
+ VAT
Total Cost
Please return this form to:The Medicines Management Team
Kensington + Chelsea PCT
St Charles Hospital
Exmoor Street
London
W10 6DZ
Chair: Peter Molyneux
Chief Executive: Diana Middleditch
Clinical Executive Chair: Andrew Steeden
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Draft Version 4 (23-12-08)
Appendix 3
End of life – Out of hours call out claim form
Pharmacist’s name:
Pharmacy address:
Name and designation of health care
professional requesting the call-out
Date and time of call-out
Duration of call-out (hours)
Reason ‘emergency’ supply necessary
Patient’s name + address
Drug(s) Supplied
quantity)
(name,
form
and
If you have any comments concerning
your call out then please use this space.
Claim made:
Please circle
below.
the
appropriate
claim
In Pharmacy hours / Out of Pharmacy
hours
Pharmacy Stamp
Pharmacist’s declaration: I confirm the above delivery
Pharmacist
Signature……………………………
Pharmacist
Name in capitals……………………………
Date………….
Please return this form to:The Medicines Management Team
Kensington + Chelsea PCT
Chair: Peter Molyneux
Chief Executive: Diana Middleditch
Clinical Executive Chair: Andrew Steeden
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Draft Version 4 (23-12-08)
St Charles Hospital
Exmoor Street
London
W10 6DZ
Chair: Peter Molyneux
Chief Executive: Diana Middleditch
Clinical Executive Chair: Andrew Steeden
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