A Guide to Locuming in Scotland

25 Feb . 10 min read.

So you want to come and locum in Scotland? Training is available in the form of both distant learning as well as face-to-face courses. These are undertaken by NES (NHS Education for Scotland), CPS (Community Pharmacy Scotland) and Turas Learn (https://learn.nes.nhs.scot).

Patient Group Directions (PGDs) for all services can be found under the relevant NHS Boards on the following website: https://www.communitypharmacy.scot.nhs.uk You must sign and send off each PGD for every service you intend to provide for every health-board you intend to work in.

Community pharmacists carry regulated work which means providing healthcare services to vulnerable groups. The PVG scheme (Protection of Vulnerable Groups) safeguards children and protected adults and therefore you must have a PVG certificate before undertaking locums in Scotland.

Section 1: Core Services

The community pharmacy contract has four core services which must be provided:

Acute Medication Service (AMS)
Medicines: Care and Review (M:CR)
Minor Ailments Service (MAS)
Public Health Service (PHS).

In addition to this, there are other private, local and optional services which pharmacy contractors may choose to offer. 

Acute Medication Service

On receiving a prescription in the pharmacy, the barcode is scanned that retrieves the electronic prescription message for that prescription.

The pharmacist then uses this information for dispensing purposes, reducing the need for data entry and transcription. Dispensing a prescription creates and sends an electronic claim message to support payment.

Medicines: Care and Review

This involves covering pharmaceutical care of patients with long-term conditions, who can register with a community pharmacy of their choice. The aim of this service is to improve a patient’s understanding of their medicines in order to optimise the benefits of their therapy.

Stage one:

Patients register with a pharmacy, they can only register with one at any one time.
This is voluntary and includes an informed patient consent process which is given to the registering pharmacist.

Stage two:

The pharmacist assesses all registered patients to identify and prioritise those with unmet care needs.
A pharmaceutical care plan is completed with the pharmacists documenting the patient’s needs, care issues, any desired outcomes and the actions required to meet them.

Stage three:

Provision of a Serial Prescription (SRx) for appropriate patients
The patient’s GP practice produces a 24, 48 or 56-week serial prescription to be dispensed at a an interval indicated by the GP.
Details are sent back to the GP practice after each dispensing by the Community Pharmacy has been submitted.

Minor Ailment Service

Allows patients to register with and use a Community Pharmacy as the first port of call for the treatment of minor ailments by NHS–Scotland. This service has been running since 2006.
Currently, only patients meeting the eligibility criteria for this service may register with a pharmacy of their choice.
However, this service will be replaced with the new Pharmacy First Service from April 2020, which includes a new remuneration model where the pharmacy team will be remunerated for the activity undertaken and reimbursed for dispensed items.

The activity will be based on Advice: Referral: Supply.
There will also be increased eligibility and access to the service.
Preferred treatment options are set out in formularies decided upon by each NHS Health Board currently. Access to most of these formularies is available via the Community Pharmacy Scotland website. (https://www.cps.scot/nhs-services/core/minor-ailment-service/)
It is vastly important that all locums provide this service as it shifts the balance of care from GPs/nurses to community pharmacists where it is appropriate.

There are a number of resources available which explains how the MAS operates and refreshes your knowledge of Common Clinical Conditions and Minor Ailments. These include:

Public Health Service

The PHS currently consists of 4 elements:

Ensuring that there is a health-promoting environment in the pharmacy – including promoting national campaigns using a combination of window posters, promotional materials and staff training (e.g. raising awareness of bowel cancer screening, flu vaccination uptake, hydration etc.)

Offering a sexual health service (EHC)
Offering a smoking cessation service – includes NRT and Varenicline
Offering access to prophylactic paracetamol for childhood vaccinations where appropriate

The service is delivered against a specification which has developed over the years to include the processes to be followed in carrying out the service and a PGD for prescribing Varenicline which is adapted and adopted for local use by each Health Board.

Smoking cessation Service FAQs can be found on this link:

https://nhsnss.org/services/practitioner/pharmacy/pharmacy-services/public-health-services/smoking-cessation/smoking-cessation-frequently-asked-questions/

Training required:

Section 2: Additional and Local Services

A lot of local services in Scotland are provided via PGDs which allow specified health care professionals to supply and / or administer a medicine directly to a patient with an identified clinical condition without the need for a prescription or an instruction from a prescriber. The health care professional working within the PGD is responsible for assessing that the patient fits the criteria set out in the PGD.

Unscheduled Care

Patients may attend a pharmacy looking for a supply of a current prescribed medicine, appliance or ACBS product that they may have either lost, run out of, or left at home by mistake. There will also be some people you consult with who need to see a doctor before their surgery re-opens.

Pharmacists practising in Scotland are encouraged to use the unscheduled care tools in delivering care for patients. The Pharmacy Guide to Unscheduled care can be accessed here: https://www.communitypharmacy.scot.nhs.uk/unscheduled-care/

It is strongly advised that you read the whole guide to understand what options are available when a patient presents. The tools include the following options:

PGD for Urgent Provision of Current Prescribed Medicines/Appliances/ACBS products. This allows pharmacists to supply when appropriate.
Direct Referral Line – for arranging a GP out of hours (OOH) appointment if needed, or to discuss the care of a patient with a GP working in your own Board’s OOH service.
Minor Ailment Service – allows pharmacist to treat minor/routine ailments

Currently, many Pharmacists choose not to supply when a supply would be appropriate, and whilst professional judgement should absolutely be applied, there are now very few situations in which a Pharmacist cannot use the PGD to issue medication to a patient. The consequences of not supplying; a prolonged patient journey and an additional burden to in- and out-of-hours NHS services, should be considered when decision making.

If the medicine cannot be supplied via the PGD, then you should consider whether the person needs that medicine and if so, refer them to the GP OOH service using the Direct Referral number, not to NHS 24.

Gluten Free Food Service (GFF)

Eligibility includes, patients:

who have a confirmed diagnosis of Coeliac disease or Dermatitis Herpetiformis

who are resident in Scotland
who have registered with a General Practitioner (GP) practice.

An annual health check is required to be recorded on PCR at registration and annually thereafter.

GFF Service Key facts can be found on this link: https://www.cps.scot/media/1522/110383-gff-key-facts-sheet.pdf

Available training can be accessed on:

https://learn.nes.nhs.scot/1664/pharmacy/cpd-resources/gluten-free-food-service-support-pack

Stoma Services

The service specification sets out the ongoing standards to be met by Community Pharmacists and Dispensing Appliance Suppliers for the purposes of remaining on the approved supplier list. Further information can be found here:

https://www.cps.scot/nhs-services/national/stoma-service/

Pharmacy First

The aim of the Pharmacy First Service is to allow patients access to free advice and/or treatment for uncomplicated urinary tract infections and impetigo from a community pharmacy. Community pharmacists will carry out a consultation in the pharmacy with the patient and provide advice and treatment if required, under locally agreed patient group directions (PGD’s). Some health board areas have expanded “Pharmacy First” to cover other conditions. An eLearning course has been developed to support this.

Onward communication to the patient’s GP practice after supply or referral to the GP is imperative to ensure records are up to date and complete. 

Completion of the NES eLearning resource found below is a requirement to provide the service in most health board areas.

https://learn.nes.nhs.scot/1596/pharmacy/cpd-resources/pharmacy-first

Once you have completed the necessary training above then you must read and sign the pharmacy first PGD’s for the healthboard you will be working for (one for each healthboard) and send to the relevant healthboard admin person.

PGDs for each service are grouped under each healthboard and can be accessed through https://www.communitypharmacy.scot.nhs.uk/nhs-boards/

Locally Negotiated Services

There are a number of services which, while widely offered across Scotland, are subject to localised commissioning and remuneration. You are encouraged to find out what is offered in your local board area and identify any learning needs associated with these.

Examples of these services include:

Advice to Care Homes
Care at Home
Rota Services

Direct Acting Antivirals in Hepatitis C
Healthy Start Vitamins
Injection Equipment Provision
Opiate Replacement Therapy
Naloxone Service

Palliative Care

Section 3: Additional Information

Contract Obligations

The company or agency that hires you will be in breach of contract if you are employed to locum in Scotland but do not provide core and additional services. CPS is interested in recording this and more Scottish locums and pharmacy support staff are willing to report locums who do not provide services. You will be required to have a PVG which cost approximately £59 and is equivalent to the DBS check in England. Please note that a PVG Scheme Record or Scheme Record Update applied for through a locum agency will only cover working hours booked through the agency.

Turas Learn

Turas Learn is NHS Education for Scotland’s platform for learning and support resources. It provides NHS Scotland health and social care staff with access to learning and practice support resources produced by NHS Education for Scotland.

The Pharmacy Care Record (PCR)

This provides registered community pharmacists and pharmacy technicians with the capability to record details of a patient’s care. It can be accessed from supported browsers on a PC.

This functionality is a key part of the delivery of Medicines: Care & Review (MCR) and allows users to record care provided at the patient’s registered Pharmacy.

The key capabilities of PCR are:

Search for and add patient (Incl. CHI lookup)
Pharmaceutical care plan
Patient profile
Gluten-free (diet)
Care issues and care issue outcomes
Stage 1 medication review (formerly “Care needs assessment”)
Stage 2 medication review
Add Medication or import from PMR
High risk medicine
High-risk medicines care risk assessments
New medicine
New-medicines intervention support tool
Support tools
Gluten-free foods annual health check
Smoking cessation
SBAR (Pharmacy Communication).
Pharmacy home (Summary totals with links to detailed information)
Reports

Pharmacists have full access to all functions in the Pharmacy Care Record whilst Pharmacy technicians have restricted access to Smoking cessation and Gluten-free support tool functions.

The Universal Claim Framework (UCF)

UCF supports electronic claiming for pharmacy-led services.
This allows community pharmacy to manage and deliver pharmacy-led services from their Patient Medication Record (PMR) system. Claims for re-imbursement are sent as part of the dispensing process and included in the payment and reporting for that dispensing month.
Some services require a form to be printed as part of the service description. Information is printed on the form on who needs to see what service was provided to the patient. The pharmacy may also choose to print forms to support the dispensing and checking process in the pharmacy. Where this functionality is unavailable or in the absence of a CHI number a hand written CPUS form may be used.

For some services supported by the Universal Claims Framework, the patient’s Community Health Index (CHI) number is needed to send the electronic claim. This number may already be known through previous contact with the patient but where the patient’s CHI number is not known the lookup facility in PCR allows the CHI number to be obtained using the patient’s name, gender, date of birth and NHS registered postcode.

Use of this facility has been approved for the following services:

Unscheduled Care
Public Health Services including Emergency Hormonal Contraception and Smoking Cessation
Healthy start vitamins
Gluten-free Food Service
Urinary Tract Infection (Pharmacy First)
Impetigo (Pharmacy First)

For many claims the GP practice code must also be present – this can be found on the “GP practice fax numbers” spreadsheet on the unscheduled care pharmacy guide.

Author: Farzana Haq

Reference List

Community Pharmacy Scotland. Available at: https://www.cps.scot/nhs-services/core/ (Accessed on 16/02/2020)
NHS Scotland Community Pharmacy Website. Available at: https://www.communitypharmacy.scot.nhs.uk (Accessed on 16/02/2020)
NHS National Services Scotland. Available at: https://nhsnss.org/services/practitioner/pharmacy/ (Accessed on 16/02/2020)
NES Turas Learn. Available at: https://learn.nes.nhs.scot (Accessed on 16/02/2020)
NES. Pharmacy Return to Practice (2019). Available at: https://learn.nes.nhs.scot/7057/pharmacy/cpd-resources/pharmacy-return-to-practice (Accessed on 16/02/2020)