1. HUB AND SPOKE: RIGHT FOR INDEPENDENTS?
The Hub &
Spoke debate
NPA investigates: The NPA’s investigation into Hub
and Spoke dispensing has highlighted a number of
significant concerns with Government plans
An NPA ‘task and
finish group’, was set
up in response to the
Government’s plan to
consult on legislative
change to allow Spokes to
be in a different corporate
entity to the Hub.
The Department of
Health (DH) suggests that
45% of medicines could
be dispensed in Hub and
Spoke arrangements within
three years. The NPA group
agreed that Hub and Spoke
could potentially release
capacity to deliver services,
but stressed:
• Inter-company Hub and
Spoke could result in serious
unintended consequences,
including inflationary
pressures on medicines
costs for the taxpayer, due
to reduced competition and
choice in the pharmaceutical
wholesale / Hub market.
• There is no evidence
that there are cash savings in
pharmacies, and it is highly
questionable that Hub &
Spoke is safer.
• There are a number
of significant legal, practice
and economic barriers to
implementation.
The NPA believes
that the Government
doesn’t understand the
full consequences of its
proposals, and should re-
think their policy. The NPA
recommends:
• The DH should commit
to new national clinical
services which would utilise
any additional capacity
created by Hub and Spoke
and give independant
pharmacies an incentive to
invest.
• Certain policy
commitments from
Government would help
with the uptake and
implementation of Hub
and Spoke: Original Pack
Dispensing and greater use of
electronic Repeat Dispensing
are two prime examples.
• Government must
look again at restrictive
distribution practices such as
Direct to Pharmacy, Reduced
Wholesale and quotas - or
these schemes could act as a
barrier to entry for a range of
potential Hub providers.
• A set of national
standards and KPIs should
be developed for Hubs, to
complement and enhance
the GPhC inspection regime,
providing quality assurance
and due diligence for
independents to make free,
“Government must look again at restrictive
distribution practices such as Direct to
Pharmacy, Reduced Wholesale and quotas
- or these schemes could act as a barrier
to entry for a range of potential Hub
providers.”
NPA May 2016 43
essential
fair and informed choices
about Hub providers.
• Government should
engage with the concerns
of the independent sector,
especially around the risks
to procurement which has
delivered more than £10bn
savings for the taxpayer since
2005.
Visit npa.co.uk to view a
webinar on the results of
the NPA’s investigation.
News, views & must-dos: your update from the NPA
Welcome to the first issue of NPA essential, brought to you in close collaboration between Independent
Community Pharmacist and the National Pharmacy Association. This regular eight-page supplement to ICP
magazine gives independent pharmacy teams the latest news and views from their key representative body.
www.npa.co.uk
essential
IMPROVING OPERATIONAL EFFICIENCY?
When asked whether Hub and Spoke would improve
the operational efficiency of their business, only 17% of
NPA members surveyed agreed.
IN THE LONG-TERM INTERESTS OF COMMUNITY
PHARMACY?
More than 75% of NPA members surveyed disagreed
that Hub and Spoke would be in the long-term interests
of independent community pharmacy.
PHARMACY CLOSURES
Almost 80% of NPA members surveyed felt Hub and
Spoke would lead to pharmacy closures.

2. PETITION: CALL TO ACTION
Campaign
to secure
your future
Latest situation NPA Chairman on Support
Your Local Pharmacy campaign activity
www.npa.co.uk44 May 2016 NPA
As this edition of
NPA essential goes to print,
the Downing Street petition
has collected over a million
signatures.
The numbers are rising by an
average 25,000 signatures
every day.
Ian Strachan, NPA Chairman
said: “We warned the
Government that this wasn’t
going to be the walk in the
park they were perhaps
expecting.
“We’re not done yet. It must
be made very clear to the
Department of Health that its
plans are not acceptable to
patients and concerned citizens
across the country.
“If we can keep up the
momentum of the campaign,
there is a real opportunity
to re-set the direction of
Government policy in relation
to pharmacy.”
Meanwhile, NPA members
have been sharing their
personal experiences of what
makes community pharmacy
special. 100 case studies
have been submitted from
pharmacists and their patients,
which can be read online at
supportyourlocalpharmacy.org.
NPA member Divyakant Mazny,
from Nu-Ways Pharmacy
in Middlesex, shared: “A
patient complained of serious
abdominal pain and wanted
some advice on taking
painkillers. Upon questioning, I
ruled out minor problems.
I suspected appendicitis but as
the pain was moving, I could
not be 100% so I advised her
to go to A&E. She came into
the pharmacy a few weeks
later and told me I had saved
her life. She had an ectopic
pregnancy which could have
burst and potentially, she could
have died.”
To keep up to date with
the campaign or to share
your pharmacy story, visit
npa.co.uk/step-forward.
Follow the NPA on Twitter: @NPA1921
NEWS NPA BURSARY
Pharmacists can now apply
for the NPA’s £10,000 Health
Education Foundation
bursary. The closing date for
applications is 30 June 2016.
More information is available
at npa.co.uk/bursary.
NPA MEMBERS TAKE
TO THE AIRWAVES
NPA members and LPC
representatives took part
in 160 radio interviews
to raise awareness of the
Support Your Local Pharmacy
campaign. More at npa.co.uk/
step-forward.
NPA FLU VACCINATION TRAINING
May-September
Face-to-face practical training is available for flu
vaccinations. Training packages are available to members
and non-members. To find out more and to register, call
01727 891 800 or email npapgdservices@npa.co.uk
NPA PRE-REGISTRATION PHARMACIST
TRAINING PROGRAMME
2016/2017
New training, with new course venues. NPA members
who enrol a trainee onto this course can also sign up
for free pre-registration tutor training for pharmacists.
For more information, call 01727 800 402 or email
professionaldevelopment@npa.co.uk.
NPA BUSINESS AND PRACTICE WEBINARS
Year-round
Free evening webinars covering a variety of practice and
business issues affecting community pharmacy. Topics
coming up include GPhC inspections, EPS, use of social
media and Medicines Safety. Sign up at npa.co.uk/events
NPA AT THE PHARMACY SHOW
25-26 September
The NPA will be at this year’s Pharmacy Show at the
Birmingham NEC. Visit us on stand PF50.
For more information on all upcoming events, visit
npa.co.uk/news-and-events.
Campaign
UPCOMING
NPA EVENTS
LOCAL AUTHORITY
BOOKLET AVAILABLE
NPA members can download
a guide to engaging local
authorities in England and
using pharmacy’s influence.
The resource is available at
npa.co.uk/step-forward.

3. www.npa.co.uk NPA May 2016 45
NPA Guidance & Advice
ESTABLISHMENT AND
PRACTICE PAYMENTS
EXTENDED
The levels of Establishment
Payments for pharmacies in
England and Wales and the
increased Practice Payments
from November 2015 have
been extended until 30 June
2016.
NEW NPA BUSINESS
PARTNER
NPA members can have a free
three month trial with KPMG
Small Business Accounting,
which provides business
and strategic insight. Email
KPMGpartner@npa.co.uk for
more information.
NEW PROJECT
TRIALLED IN WALES
A project to reduce
the number of people
dying prematurely from
cardiovascular disease in
some of the most deprived
communities in Cwm Taf is to
be extended across Wales.
NPA
CONFERENCE IN
HUDDERSFIELD
The conference helped
members to improve
working environment,
profitability and service to
patients.
OPTIMISE BUSINESS PERFORMANCE
Check34
The NPA’s Check34 resources cover 13
KPIs. In this edition, we include an extract
on the first KPI: ‘Number of items’
Submission of
prescriptions:
Consider the following points
that may affect the number of
items dispensed:
• Resolve all outstanding
queries on prescriptions so that
they can be included in the
relevant month’s submission.
• Ensure all prescriptions
for emergency supply at the
request of the prescriber
are furnished in time for
submission of prescriptions.
• Ensure prescriptions are
submitted no later than
the fifth day of the month
following that in which the
medicine was collected by
the patient. If prescriptions
are sent later than the fifth,
this will affect the calculation
of the advance payment the
contractor will receive.
• Ensure Repeat Authorisation
Use of NSAIDs
in children with
chickenpox
You may have seen in the
news the warning about
ibuprofen and chickenpox.
Pharmacists are
advised to be aware of
recommendations made
regarding the use of non-
steroidal anti-inflammatory
drugs (NSAIDs) in children
infected with varicella-zoster
virus (chickenpox).
The National Institute for
Health and Care Excellence
(NICE) Clinical Knowledge
Summaries (CKS) guidance
on treating chickenpox
recommends that NSAIDs
are avoided in children with
chickenpox.
This is because of concerns
that using NSAIDs in children
with chickenpox may increase
the risk of necrotizing
soft-tissue infections and
secondary infections caused
by invasive streptococci.
There is evidence to suggest
an increased risk of skin
adverse reactions in people
with varicella who are being
treated with NSAIDs.
The Summaries of Product
Characteristics and Patient
Information Leaflets provided
by manufacturers of NSAID
products differ in the
information that they provide
regarding the use of their
products in the management
of chickenpox. Some do
not currently contain any
reference to chickenpox.
Therefore, pharmacists are
strongly advised to follow
NICE CKS guidance when
dispensing prescriptions for
NSAIDs in children and when
supplying over the counter
products for use in children
with chickenpox.
Paracetamol can be used
to relieve pain and fever in
children who are unwell with
chickenpox.
For further information on
this or any other query,
please contact the NPA
Pharmacy Services team
on 01727 891 800 or email
pharmacyservices@npa.
co.uk.
NPA NEWS IN BRIEF
For further information see: npa.co.uk/information-and-guidance
(RA) forms or item numbers
have not been included in
the number of items and
forms declared on the FP34C
submission documents.
• In Part 1 of the FP34C
submission document, ensure
you declare the combined total
of electronic claim messages
and paper FP10 items to be
submitted; and the combined
total of electronic prescriptions
and paper FP10 forms to be
submitted.
The NPA has produced a
series of resources relating to
each KPI to use alongside the
Check34 platform. Other areas
covered include:
• expensive items
• zero discount
• average item value
• number of working hours
declared vs required.
Resources can be downloaded
at npa.co.uk/check34-resources.

4. YOUR ‘MUST-DOS’
Monthly
planner
Things to do and things to know in
community pharmacy across the UK
www.npa.co.uk46 May 2016 NPA
Accessible Information Standard: are you ready?
All organisations in England that provide NHS and adult social care
are informed through the Standard about what they need do to
ensure that patients and service users (and their carers/parents if
applicable) receive information in an accessible format that they
are able to understand. The aim of the Standard is to support
communication with patients who have a disability, impairment or
sensory loss.
By April 2016, pharmacy contractors are required to have
started planning implementation of the Standard and conducting
an assessment of existing systems and processes within the
pharmacy.
By 31 July 2016, pharmacy contractors must comply with all
aspects of the Standard. To find out more about the requirements,
visit npa.co.uk. ENGLAND
The National Living Wage
The Government’s National Living Wage was introduced in April
2016 for all working people aged 25 and over, and is set at £7.20
per hour. The current National Minimum Wage for those under the
age of 25 will continue to apply. Employers need to ensure they
are paying their employees the correct rates of pay in all instances.
UK
Auto enrolment
The Pensions Regulator has issued a reminder to small employers
about working out what their automatic enrolment duties are and
whether they need to provide a pension for their staff. For further
information, contact the NPA Employment Advisory Service on
0330 123 0558. UK
Flu vaccination planning
Face-to-face practical training is now available. Available dates
published are May-September. More information at npa.co.uk. UK
Regulating nicotine products
Currently electronic cigarettes are only covered by consumer
product regulation. From 20th May 2016 they will come under the
revised EU Tobacco Products Directive, except where therapeutic
claims are made or they contain over 20 mg/ml of nicotine, when
they will require medicines authorisation under Directive 2001/83/
EC. UK
New Premises regulations – GPhC Pharmacy
Order
Changes to The Medicines Act 1968 and Pharmacy Order 2010
which came into effect on 12 April 2016 include the removal of
the requirement for the GPhC standards for registered pharmacy
premises to be set in rules. There is also the introduction of the
use of interim suspension orders by the GPhC against pharmacy
owners when that is in the public interest. ENGLAND
Pharmacist pre-registration scheme
Deadline to submit your application to enter pre-registration
training for trainees planning to sit the summer assessment is 3
June 2016. ENGLAND
Errors in printed British National Formulary
(BNF)
Pharmacists are advised to use the electronic version of the BNF 70
and the BNF for children 2015-16 for children following errors in
the print editions. UK
Redesigned Patient Safety Incident Form
A new form can be downloaded via npa.co.uk. Any reports
received using the old version will no longer be processed. UK
NPA Guidance & Advice
DATES
FOR YOUR PHARMACY CALENDAR
WORLD DIGESTIVE
HEALTH DAY
29 May
A campaign to raise
awareness of the impact
of diet on gut health.
Resources are available at
worldgastroenterology.org.
WORLD NO TOBACCO
DAY
31 May
An awareness day to draw
attention to the health
problems that tobacco use can
cause. Free NPA posters are
available at npa.co.uk/public-
health.

5. www.npa.co.uk NPA May 2016 47
For more information on the NPA’s health and safety advisory service visit npa.co.uk/hs-advice
NPA Guidance & Advice
DIABETES WEEK
12-18 June
This year’s theme is ‘setting
the record straight’ and aims
to debunk common myths
and misconceptions. NPA
members can download
posters from npa.co.uk/
public-health.
RHEMATOID ARTHRITIS
AWARENESS WEEK
13 -19 June
An annual awareness
campaign designed to help
people recognise the signs
and symptoms of Rheumatoid
Arthritis. More information at
nras.org.uk.
BREATHE EASY WEEK
13-19 June
Organised by the British
Lung Foundation, the annual
awareness week focuses
on lung health. Resources
available at blf.org.uk.
MENS HEALTH WEEK
13-19 June
This year’s theme is about
mental health and wellbeing.
A guide on promoting
men’s mental health is
available to download from
menshealthforum.org.uk.
EMPLOYMENT AND HEALTH & SAFETY
Health and
safety
Michael Jackson, Senior Health and
Safety Consultant at Ellis Whittam, shares
his experiences
Most pharmacies allocate more
space to retail and customer
areas than staff. While this
makes business sense, it often
leads to congested work areas
and limited storage space
This, in turn, can increase the
likelihood of trips (the biggest
cause of major injury in the
workplace) and awkward or
unsafe lifting practices.
The easy solution is down
to good housekeeping.
Walkways need to be clearly
designated, and not become
obstructed. Staff should take
responsibility for their own
work areas.
Also, I’d recommend
you look at opportunities
to increase shelf space, but
be sure to check fixtures
and fittings. I know of one
pharmacy where a retail shelf
collapsed onto a customer.
Customers may bring in
coughs and infectious diseases,
and it astonishes me how little
attention some pharmacies pay
to disinfection.
At one, I found dried blood
on the work surface next to
the needle exchange bin –
both a serious health risk and
a contravention of Principle 3
of the GPhC standards, which
requires good infection control
procedures and a suitable
cleaning programme and
equipment.
Worse, it could be
considered a breach of
The Control of Substances
Hazardous to Health
Regulations 2002, which
can carry a maximum fine
of £20,000, not to mention
serious damage to your
reputation.
All skin contact surfaces
such as door handles and
chairs must be disinfected
at least once a day, and this
should be recorded. Visit the
NPA’s Webshop for a range of
cleaning equipment.
When it comes to fire
safety, a fire alarm may not be
required in a small pharmacy
as long as everyone in the
building can hear you shout
‘FIRE!’. If residents live above,
I’d recommend an automatic
fire alarm linked to upstairs
residential properties (so out-
of-hours fires are not a risk).
Your pharmacy needs a safe
means of exit, but sometimes I
find blocked or even locked fire
escapes.
In the event of a power
failure in a fire, it may
not be necessary to install
emergency lighting, providing
everyone can see to escape
using ‘borrowed’ light from
a good street light or other
outside source. Insufficient
light at key points, including
stairs, corridors and the rear
of the premises, will require
emergency lighting. You might
consider LED emergency
lighting or photoluminescent
emergency signs.
This is a small selection of
the health and safety issues.
It is always advisable to have
professional, competent
assistance providing hands-on,
practical help in addressing
these and other issues.
Whatever the risks, you are
legally required to do your best
to manage them and keep
staff and customers informed.
Failure to do so can have severe
consequences for everyone
involved.
“Whatever the risks,
you are legally required to
do your best to manage
them and keep staff and
customers informed. Failure
to do so can have severe
consequences for everyone
involved.”
PREVENTING SLIPS AND TRIPS
Avoid injuries caused by wet floors by installing a weather
mat inside and outside the entrance to soak up moisture.
But remember, weather mats may curl up at the edges and
cause a trip hazard. Umbrella stands are a good idea and
signage to identify wet floor surfaces are sensible. Have a
mop and bucket handy to keep on top of the problem. This
won’t eliminate slop risks but you will have done what is
‘reasonably practicable’ to prevent them.
CHECK FLOOR SURFACES
Monitor the condition of your floor surfaces. I have visited
pharmacies where there were gaps in laminated wood
flooring which can cause injury.

6. The NPA has updated resources to support
pharmacy teams in England to deliver
the New Medicine Service. The resources,
which can be downloaded from npa.co.uk,
includes information on communicating
with patients, record keeping, engaging
with GPs and how to recruit and retain
patients. The following is a case study
extracted from the resource.
Miss F presents in the pharmacy with a
prescription for metformin tablets 500mg.
The dosage instructions are to take one
daily at breakfast for one week, then one
twice a day at breakfast and with the
evening meal for one week, then one three
times a day, with breakfast, lunch and
dinner.
The dispensing technician notices from
the PMR that the patient, who is a regular
patient of the pharmacy, has not had this
medicine before and flags the prescription
as possibly suitable for an NMS.
The pharmacist determines that
metformin falls into the type 2 diabetes
category of the NMS and the patient is
therefore eligible for the service, provided
that this is the first time the patient has
been prescribed metformin and it has
been prescribed for type 2 diabetes. The
technician marks the prescription with a
note that the pharmacist needs to speak to
the patient.
Patient engagement
Miss F collects her medicine and the
pharmacist confirms with her that this
is the first time she has been prescribed
metformin. The pharmacist ascertains that
Miss F has been diagnosed with type 2
diabetes; she has tried diet and lifestyle
changes but her blood glucose levels are
still too high so the doctor has prescribed
metformin.
The pharmacist checks that the
dosage instructions are appropriate for a
person starting metformin, and then goes
through them with the patient to make
sure she understands how to take the
medicine. The pharmacist then explains
the NMS to Miss F, who decides that she
would like to receive this service. Miss F
completes a consent form and agrees that
the pharmacist can telephone her in two
weeks’ time.
Intervention
Two weeks later, the pharmacist telephones
Miss F and determines that she still
consents to the NMS taking place. The
pharmacist discusses with Miss F how she
has been getting on with her metformin.
Miss F took it once a day for week, as
directed, then took it twice a day for a
week, and is about to start taking it three
times a day.
She has had no problems with
remembering to take the medicine as she
takes it with meals. She has had some
diarrhoea, but that seems to have cleared
up now. The pharmacist advises Miss F
that diarrhoea can be a side effect of
metformin, and that it is not usually a long-
term effect.
Miss F has seen a dietician and is trying
to follow his advice on diet. However, she
is concerned that, although she has lost
some weight, she is still overweight. The
pharmacist advises that weight loss can
be very beneficial to patients with type 2
diabetes and that a combination of diet
and exercise should help.
The pharmacist provides Miss F with
advice on increasing her activity levels. Miss
F and the pharmacist agree to speak again
by telephone in two weeks’ time.
Follow up
Two weeks later, the pharmacist telephones
Miss F to see how she has been getting on
with her metformin. Her GP has issued a
further prescription for metformin tablets
500mg, one to be taken three times a day.
She has not experienced a recurrence
of the diarrhoea and has had no other
side effects. She has started increasing
her activity levels by going for a brisk
walk most evenings and is thinking about
joining a Zumba class that has started
in her local village hall. The NMS is now
complete, and the pharmacist completes
the necessary records.
The full NMS pack can be
downloaded via npa.co.uk.
Resources
from the NPAThe NPA’s updated New Medicine Service resource
helps the whole pharmacy team to provide excellent
pharmaceutical care
Support for self-care
and signposting
The resources include a self
care and signposting directory,
guidance document on
training, and record keeping
and reporting requirements. A
template standard operating
procedure is also included.
Accessing summary
care records
Pharmacists with an NHS
contract are now required to
access a patient’s Summary Care
Record (SCR) under specific
circumstances as the Health
Service (Pharmaceutical and
Local Pharmaceutical Services)
(Amendments) Regulations 2016
have now come into effect.
The NPA’s SCR resources will be
updated to reflect the changes.
Safeguarding
Members in Northern Ireland
and Scotland can access new
resources on providing support
on safeguarding vulnerable
adults and children.
Service user
consent policy
Designed as an aid for
community pharmacists to use
when obtaining patient consent.
Controlled Drugs
resources
Following Controlled Drugs
amendments in Northern Ireland,
the NPA has produced resources
to support pharmacies.
Business
support pack
The new resources cover SWOT
analysis, a drug tariff guide,
how to improve your pharmacy
business, the benefits of renting
out a consultation room,
daily and weekly checklists
and CPAF and GPhC inspection
top tips. The resources are
available to download
from npa.co.uk.
NEW NPA RESOURCES
Further information can be found at: npa.co.uk/information-and-guidance
New resources to support members
www.npa.co.uk48 May 2016 NPA

7. QThe local surgery is issuing prescriptions on a
prescription pad for a GP who has left the practice; is
this allowed?
ANo. Prescription pads for a GP who is no longer working for
a practice should not be used and should be destroyed in a
secure manner. If a prescription has been issued on a prescription
pad from a GP who no longer works at the practice, this will still
be processed for payment by the NHS Business Services Authority.
However, the prescribing cost may not be correctly assigned
because the GP no longer works at the practice; the local Clinical
Commissioning Group should be contacted if this is the case.
Your questions,
answeredLeyla Hannbeck, NPA Chief
Pharmacist shares the answers
to three of the 700 questions
fielded every day by the NPA’s
Pharmacy Services
Department
Department of Health - Amendments to the Human Medicines
Regulations 2012: ‘Hub and spoke’ dispensing, prices of medicines
on dispensing labels, labelling requirements and pharmacists’
exemption.
This consultation seeks comments and views on a number of
proposed changes to the Human Medicines Regulations 2012 and
the Medicines Act 1968.
Closing date - 17 May 2016
Department of Health - Putting community pharmacy at the heart
of the NHS.
The government wants to better integrate community
pharmacy into primary care. The consultation covers a number of
proposals for funding cuts and so-called efficiencies.
Closing date - 24 May 2016
Department of Health, Social Services and Public Safety (DHSSPS) -
Public consultation on pharmacy regulation.
Health Minister Simon Hamilton has agreed in principal to
split the regulatory and professional leadership functions of the
Pharmaceutical Society of Northern Ireland which could potentially
mean a UK-wide regulatory arrangement.
Closing date - 14 June 2016
The General Pharmaceutical Council - GPhC.
The GPhC is asking members of the public and pharmacy
professionals to give their views on proposed new standards for
pharmacists and pharmacy technicians in Great Britain.
The GPhC’s Consultation on Standards for Pharmacy
Professionals asks for feedback on nine core standards that all
pharmacy professionals will have to meet, to ensure that patients
and the public receive safe and effective care and to uphold public
trust and confidence in pharmacy.
Closing date - 27 June 2016
To read consultations that the NPA has previously responded to,
visit npa.co.uk/representing-you. To give your opinion on any
matter of policy or regulation email independentsvoice@npa.
co.uk.
YOUR OPINION COUNTS
www.npa.co.uk NPA May 2016 49
Follow the NPA: @NPA1921
CURRENT CONSULTATIONS
Make your voice heard at independentsvoice@npa.co.uk
QCan I use correction fluid on the back of an FP10
prescription form if the patient’s signature covers
part of the ‘paid’ box?
ANo. This can prevent it from being read correctly
by the prescription scanning equipment at the NHS
Business Services Authority (NHSBSA). The patient’s or their
representative’s signature, including any other writing, which
covers/partly covers the ‘paid’ field in Part 2 of the FP10, does
not require erasing. Such prescriptions will be picked up by the
NHSBSA scanning equipment and sent for manual checking to
so that the prescription can be placed into the correct group –
either ‘exempt’ or ‘paid’.
QCan misoprostol be used prior to insertion of an
intrauterine device to improve ease of insertion and
to reduce pain?
AStudies have been conducted to find out whether
the use of misoprostol prior to insertion of an intrauterine
device (IUD) eases the insertion process and decreases pain due
to its potential to soften the cervix. A Cochrane Review has
concluded that the use of misoprostol for this purpose does
not ease the insertion process and reduce the level of pain. In
addition, the use of misoprostol was found to cause side effects
in a number of the studies.
The NPA frequently responds to policy consultations on behalf of members.

8. Quarterly summary of
patient safety incidents
Medicines Safety Update
50 May 2016 NPA
Medicines safety update:
How to minimise the risk of errors following
the publication of the Medication Safety
Officer quarterly report
Leyla Hannbeck is officially
the Medicines Safety Officer
for pharmacy independents.
Here is a summary of her
latest report:
The main types of
medication incidents reported
were wrong drug/medicine
(32%) and wrong/unclear dose
or strength (30%).
The most important factor
was found to be ‘medicines
with a similar looking or
sounding name’ (58%).
‘Work and environment’
factors were cited as the main
contributing factor (52%).
90% of reports involved either
a near miss (34%) or an error
causing no harm to the patient
(56%).
Medicines with similar
names commonly involved in
the wrong drug errors include
amitriptyline/amlodipine,
Brinzolamide/brimonidine and
Escitalopram/esomeprazole.
Medicines commonly
involved in ‘wrong strength’
errors include Amlodipine,
Atorvastatin and Co-codamol.
Medicines commonly
involved in ‘wrong formulation’
errors include aspirin dispersible
tablets/enteric coated tablets,
Insulin cartridges/pre-filled
pens and madopar capsules/CR
capsules.
We continued to see
monitored dosage system
(MDS) errors, including
drugs being omitted, added
and placed in the wrong
compartments.
Tips for minimising
risk:
• Put warning stickers on
shelves near items that feature
in error reports reminding staff
to take care when selecting
drugs with similar names,
strengths and formulations.
• Remind staff to take extra
care when putting away
dispensary stock to ensure
that items are placed in the
correct location and not
inadvertently mixed up with
other products.
• Review the dispensary
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layout and consider whether
particular drugs, strengths or
forms need to be physically
separated from each other.
• Review staffing levels.
• Review standard operating
procedures (SOPs) and ensure
staff are familiar with them.
• Take care when checking
MDS to ensure that there are
no missing medicines, each
blister contains the correct
number of tablets or capsules,
the medicines have been
placed in the compartments
for the correct time of day
and any changes in strength,
dose, formulation or medicine
have been noticed – always
dispense from the prescription
and not from the PMR.
• Take extra care when
dispensing and checking
during busy periods and try to
minimise distractions.
For more information
contact Pharmacy Services
on 01727 891 800
or email
pharmacyservices@npa.
co.uk.
NPA essential is published on behalf of the NPA by The Independent Community Pharmacist and the views expressed are not necessarily those of ICP
www.npa.co.uk