Kevin Barron

The Department has made no assessment of the number of patients refused prescriptions for over the counter medicines.

The Department has made no such assessment. From December 2017 to March 2018, NHS England carried out a public consultation on reducing prescribing of over-the-counter medicines for minor, short-term health concerns, ‘Conditions for which over the counter items should not routinely be prescribed in primary care: A consultation on guidance for CCGs’ which can be found at the following link:

https://www.engage.england.nhs.uk/consultation/over-the-counter-items-not-routinely-prescribed/

At the end of March 2018, NHS England published guidance to enable savings of up to £100 million for frontline care each year by curbing prescriptions for ‘over the counter’ medicines. The guidance does not affect prescribing of over the counter items for longer term or more complex conditions, or where minor illnesses are symptomatic or a side effect of something more serious.

We are informed by NHS England that in the 12 months to January 2019, the total National Health Service spend in England on over the counter items was £449.4 million. This was a saving on total spend of £25.9 million from the corresponding figure for the 12 months to January 2018, which was £475.3 million. This saving does not account for the potential impact to the NHS from a reduced number of general practitioner appointments, for which no assessment has been made.

NHS England established the United Kingdom Antimicrobial Resistance (AMR) Diagnostics Collaborative in 2018 to deliver the UK’s diagnostic ambitions for AMR. The Collaborative has played a valuable role in developing the diagnostic elements of the new five-year UK AMR national action plan, published in January this year.

The work of the Collaborative contributes directly to the Government’s commitments on AMR, and the Collaborative’s secretariat communicates with the Department on a regular basis and it has been represented by its secretariat and former chair in the UK AMR Programme’s governance groups.

The Collaborative’s chair remains vacant while NHS England develops detailed plans to support the implementation of the new national plan on AMR. As part of this work, the membership of the Collaborative is under review.

Current membership is drawn from a range of stakeholders across Government and its agencies, the devolved administrations, the health system, veterinary medicine, professional bodies, academia, the research community and industry. Members at or above ‘very senior manager’ (VSM) level and partner agencies involved in the Collaborative are listed in the following table.

The National Health Service (Clinical Negligence Scheme for General Practice) Regulations 2019 were laid in parliament on 25 February 2019 and come into force on 1 April 2019. The Regulations establish a scheme which provides indemnity cover for future clinical negligence liabilities of general practitioners, and others working in general practice in respect of services provided as part of the National Health Service in England.

The Department also intends to establish the arrangements for an existing liabilities scheme in April 2019, subject to satisfactory discussions with the Medical Defence Organisations.

In 2017/18 the National Health Service carried out 21.9 million diagnostic tests, nearly 1.7 million more than in 2015/16.

NHS England publishes monthly data on diagnostic waiting times which includes the volume of patients waiting for a diagnostic test. The data is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/diagnostics-waiting-times-and-activity/monthly-diagnostics-waiting-times-and-activity/

The 2015 Comprehensive Spending Review made a commitment to invest up to £300 million per year by 2020/21. The published financial profile agreed for the NHS England Cancer Programme over the four years to 2020/21 was:

This is being invested in earlier diagnosis and personalised care, including additional staff capacity and equipment. In addition, £130 million has been invested to modernise radiotherapy equipment. Funding has been allocated for over 80 new or upgraded linear accelerators across the country since October 2016.

The Government has been clear that it wants to change the focus of the health and care system onto prevention and Ministers have also set out an ambition for local pharmacies to play a stronger role in helping people stay well in the community. The Department has committed to publishing a Green Paper on prevention that will set out how these plans will be achieved in more detail. An assessment specifically focusing on the potential merits of nationally commissioning more public health services through community pharmacy has not been undertaken.

An updated list of the 1,413 pharmacies found to be eligible for the pharmacy access scheme was published in January 2018, this is publicly available and can be found at the following link:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/670305/PhAS_List_20122017_updated.pdf

A small proportion of the pharmacies eligible for the scheme will not receive a payment because they do not meet the payment criteria as set out in the Drug Tariff. This means their income in 2016/17 is greater than their 2015/16 income less a 1% efficiency saving, and/or their estimated income in 2017/18 and 2018/19 is greater than their 2015/16 income less a 3% efficiency saving. The number and proportion of pharmacies on the scheme in receipt of a payment, for each year that the scheme has been running, is set out in the following table.

^[1]Two additional pharmacies have been accepted on to the scheme since the publication of the updated list. This explains the difference in the figures of 1,413 and 1,415 for 2017/18.

The fees and allowances paid under the Community Pharmacy Contractual Framework (CPCF) for the provision of essential services, including dispensing, provided by community pharmacies each year from April 2015 to March 2018 are detailed in the following table, based on data provided by NHS England. The structure of fees and allowances does not allow payments just for dispensing to be isolated. These payments do not include the medicine margin that community pharmacies earn as part of the payment for essential services, which is paid through reimbursement within the drugs’ bill.

Enhanced services are locally commissioned. As such they are funded outside of the national CPCF and the Department does not hold the information sought.

²This comprises the fees and allowances paid under Part IIIA: Professional Fees (Pharmacy Contractors) and Part VIA: Payment for Essential Services (Pharmacy Contractors) of the Drug Tariff, and through the Quality Payment Scheme and Pharmacy Access Scheme. This does not include medicines margin.

Within the NHS Long Term Plan, Government has committed to expanding the number of pharmacists in Primary Care Networks. These pharmacists are well placed to work alongside the wider medical team to optimise the use of medicines, promote medicines adherence and improve the clinical and cost effectiveness of prescribed medications. Identifying and supporting patients on complex polypharmacy and those with long term conditions necessitating repeat prescriptions will form an important part of their role. Alongside this, in August 2018, NHS England, announced plans for a new pilot scheme, with investment of £1 million from the Pharmacy Integration Fund to develop system leadership within pharmacy across all settings. These pharmacy leaders will set the vision to systematically tackle medicines optimisation priorities for the local population within GP Network and Integrated Care System foot prints, further supporting medicines adherence, and in turn reducing medicines wastage.

The Government has been clear that it wants to change the focus of the health and care system onto prevention and Ministers have also set out an ambition for local pharmacies to play a stronger role in helping people stay well in the community. The Department has committed to publishing a Green Paper on prevention that will set out how these plans will be achieved in more detail. An assessment specifically focusing on the potential merits of nationally commissioning more public health services through community pharmacy has not been undertaken.

An updated list of the 1,413 pharmacies found to be eligible for the pharmacy access scheme was published in January 2018, this is publicly available and can be found at the following link:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/670305/PhAS_List_20122017_updated.pdf

A small proportion of the pharmacies eligible for the scheme will not receive a payment because they do not meet the payment criteria as set out in the Drug Tariff. This means their income in 2016/17 is greater than their 2015/16 income less a 1% efficiency saving, and/or their estimated income in 2017/18 and 2018/19 is greater than their 2015/16 income less a 3% efficiency saving. The number and proportion of pharmacies on the scheme in receipt of a payment, for each year that the scheme has been running, is set out in the following table.

^[1]Two additional pharmacies have been accepted on to the scheme since the publication of the updated list. This explains the difference in the figures of 1,413 and 1,415 for 2017/18.

The fees and allowances paid under the Community Pharmacy Contractual Framework (CPCF) for the provision of essential services, including dispensing, provided by community pharmacies each year from April 2015 to March 2018 are detailed in the following table, based on data provided by NHS England. The structure of fees and allowances does not allow payments just for dispensing to be isolated. These payments do not include the medicine margin that community pharmacies earn as part of the payment for essential services, which is paid through reimbursement within the drugs’ bill.

Enhanced services are locally commissioned. As such they are funded outside of the national CPCF and the Department does not hold the information sought.

²This comprises the fees and allowances paid under Part IIIA: Professional Fees (Pharmacy Contractors) and Part VIA: Payment for Essential Services (Pharmacy Contractors) of the Drug Tariff, and through the Quality Payment Scheme and Pharmacy Access Scheme. This does not include medicines margin.

Within the NHS Long Term Plan, Government has committed to expanding the number of pharmacists in Primary Care Networks. These pharmacists are well placed to work alongside the wider medical team to optimise the use of medicines, promote medicines adherence and improve the clinical and cost effectiveness of prescribed medications. Identifying and supporting patients on complex polypharmacy and those with long term conditions necessitating repeat prescriptions will form an important part of their role. Alongside this, in August 2018, NHS England, announced plans for a new pilot scheme, with investment of £1 million from the Pharmacy Integration Fund to develop system leadership within pharmacy across all settings. These pharmacy leaders will set the vision to systematically tackle medicines optimisation priorities for the local population within GP Network and Integrated Care System foot prints, further supporting medicines adherence, and in turn reducing medicines wastage.

The Government has been clear that it wants to change the focus of the health and care system onto prevention and Ministers have also set out an ambition for local pharmacies to play a stronger role in helping people stay well in the community. The Department has committed to publishing a Green Paper on prevention that will set out how these plans will be achieved in more detail. An assessment specifically focusing on the potential merits of nationally commissioning more public health services through community pharmacy has not been undertaken.

An updated list of the 1,413 pharmacies found to be eligible for the pharmacy access scheme was published in January 2018, this is publicly available and can be found at the following link:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/670305/PhAS_List_20122017_updated.pdf

A small proportion of the pharmacies eligible for the scheme will not receive a payment because they do not meet the payment criteria as set out in the Drug Tariff. This means their income in 2016/17 is greater than their 2015/16 income less a 1% efficiency saving, and/or their estimated income in 2017/18 and 2018/19 is greater than their 2015/16 income less a 3% efficiency saving. The number and proportion of pharmacies on the scheme in receipt of a payment, for each year that the scheme has been running, is set out in the following table.

^[1]Two additional pharmacies have been accepted on to the scheme since the publication of the updated list. This explains the difference in the figures of 1,413 and 1,415 for 2017/18.

The fees and allowances paid under the Community Pharmacy Contractual Framework (CPCF) for the provision of essential services, including dispensing, provided by community pharmacies each year from April 2015 to March 2018 are detailed in the following table, based on data provided by NHS England. The structure of fees and allowances does not allow payments just for dispensing to be isolated. These payments do not include the medicine margin that community pharmacies earn as part of the payment for essential services, which is paid through reimbursement within the drugs’ bill.

Enhanced services are locally commissioned. As such they are funded outside of the national CPCF and the Department does not hold the information sought.

²This comprises the fees and allowances paid under Part IIIA: Professional Fees (Pharmacy Contractors) and Part VIA: Payment for Essential Services (Pharmacy Contractors) of the Drug Tariff, and through the Quality Payment Scheme and Pharmacy Access Scheme. This does not include medicines margin.

Within the NHS Long Term Plan, Government has committed to expanding the number of pharmacists in Primary Care Networks. These pharmacists are well placed to work alongside the wider medical team to optimise the use of medicines, promote medicines adherence and improve the clinical and cost effectiveness of prescribed medications. Identifying and supporting patients on complex polypharmacy and those with long term conditions necessitating repeat prescriptions will form an important part of their role. Alongside this, in August 2018, NHS England, announced plans for a new pilot scheme, with investment of £1 million from the Pharmacy Integration Fund to develop system leadership within pharmacy across all settings. These pharmacy leaders will set the vision to systematically tackle medicines optimisation priorities for the local population within GP Network and Integrated Care System foot prints, further supporting medicines adherence, and in turn reducing medicines wastage.

The Government has been clear that it wants to change the focus of the health and care system onto prevention and Ministers have also set out an ambition for local pharmacies to play a stronger role in helping people stay well in the community. The Department has committed to publishing a Green Paper on prevention that will set out how these plans will be achieved in more detail. An assessment specifically focusing on the potential merits of nationally commissioning more public health services through community pharmacy has not been undertaken.

An updated list of the 1,413 pharmacies found to be eligible for the pharmacy access scheme was published in January 2018, this is publicly available and can be found at the following link:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/670305/PhAS_List_20122017_updated.pdf

A small proportion of the pharmacies eligible for the scheme will not receive a payment because they do not meet the payment criteria as set out in the Drug Tariff. This means their income in 2016/17 is greater than their 2015/16 income less a 1% efficiency saving, and/or their estimated income in 2017/18 and 2018/19 is greater than their 2015/16 income less a 3% efficiency saving. The number and proportion of pharmacies on the scheme in receipt of a payment, for each year that the scheme has been running, is set out in the following table.

^[1]Two additional pharmacies have been accepted on to the scheme since the publication of the updated list. This explains the difference in the figures of 1,413 and 1,415 for 2017/18.

The fees and allowances paid under the Community Pharmacy Contractual Framework (CPCF) for the provision of essential services, including dispensing, provided by community pharmacies each year from April 2015 to March 2018 are detailed in the following table, based on data provided by NHS England. The structure of fees and allowances does not allow payments just for dispensing to be isolated. These payments do not include the medicine margin that community pharmacies earn as part of the payment for essential services, which is paid through reimbursement within the drugs’ bill.

Enhanced services are locally commissioned. As such they are funded outside of the national CPCF and the Department does not hold the information sought.

²This comprises the fees and allowances paid under Part IIIA: Professional Fees (Pharmacy Contractors) and Part VIA: Payment for Essential Services (Pharmacy Contractors) of the Drug Tariff, and through the Quality Payment Scheme and Pharmacy Access Scheme. This does not include medicines margin.

Within the NHS Long Term Plan, Government has committed to expanding the number of pharmacists in Primary Care Networks. These pharmacists are well placed to work alongside the wider medical team to optimise the use of medicines, promote medicines adherence and improve the clinical and cost effectiveness of prescribed medications. Identifying and supporting patients on complex polypharmacy and those with long term conditions necessitating repeat prescriptions will form an important part of their role. Alongside this, in August 2018, NHS England, announced plans for a new pilot scheme, with investment of £1 million from the Pharmacy Integration Fund to develop system leadership within pharmacy across all settings. These pharmacy leaders will set the vision to systematically tackle medicines optimisation priorities for the local population within GP Network and Integrated Care System foot prints, further supporting medicines adherence, and in turn reducing medicines wastage.

The Cancer Workforce Plan for England, published in December 2017 by Health Education England (HEE), set out the actions needed to target additional training support for several priority professions, including diagnostic and therapeutic radiography.

There are several initiatives to prepare the healthcare workforce, through education and training, to deliver the digital future. For example, the Topol Review, led by cardiologist, geneticist, and digital medicine researcher Dr Eric Topol and facilitated by HEE, is exploring how best to enable National Health Service staff to make the most of technologies such as genetic diagnostics.

Public Health England (PHE) operates a number of microbiology laboratories across England which provides national coverage, regardless of geographic location, and works closely with Scotland, Wales and Northern Ireland’s devolved administrations. These laboratories complement and expand on the testing that is undertaken in a larger laboratory network operating throughout the National Health Service to provide frontline diagnostics.

PHE’s laboratories use many different diagnostic technologies, including traditional and molecular microbiological, serological and innovative genomic approaches to recognise pathogens and diagnose infections promptly. These cover infections caused by bacteria, viruses, fungi and protozoal parasites. The results of PHE laboratory testing are provided directly to the NHS to support patient management, to reduce risks of onwards transmission and to minimise threats to public health throughout England.

Pulmonary rehabilitation is one of the most effective treatments for chronic lung disease. Respiratory care is one of the areas being considered as part of the National Health Service long-term plan currently in development and new guidelines from the National Institute for Health and Care Excellence are due to be published in December.

The Department supports the NHS to increase access to pulmonary rehabilitation and improve the quality of care for people with long-term respiratory conditions through the following actions:

- a national roll out of the RightCare programme by NHS England which directs clinical commissioning groups to offer pulmonary rehabilitation as part of an optimal pathway for COPD patients;

- the COPD best practice tariff encourages NHS providers to refer patients for pulmonary rehabilitation as a financial incentive;

- a pulmonary rehabilitation service accreditation programme run by the Royal College of Physicians.

Pulmonary rehabilitation is one of the most effective treatments for chronic lung disease. Respiratory care is one of the areas being considered as part of the National Health Service long-term plan currently in development and new guidelines from the National Institute for Health and Care Excellence are due to be published in December.

The Department supports the NHS to increase access to pulmonary rehabilitation and improve the quality of care for people with long-term respiratory conditions through the following actions:

- a national roll out of the RightCare programme by NHS England which directs clinical commissioning groups to offer pulmonary rehabilitation as part of an optimal pathway for COPD patients;

- the COPD best practice tariff encourages NHS providers to refer patients for pulmonary rehabilitation as a financial incentive;

- a pulmonary rehabilitation service accreditation programme run by the Royal College of Physicians.

The European Union Delegated Regulation on ‘safety features’ under the Falsified Medicines Directive (FMD) comes into force in the United Kingdom on 9 February 2019 and will be directly applicable on all relevant actors in the medicines supply chain, including those dispensing medicines. Healthcare institutions (hospitals and general practitioner practices) and pharmacies will need to be able to decommission products from the national repository by this time. However, in the case of other places where medicines are supplied to patients the delegated regulation allows member states some flexibilities as to where products are decommissioned in the medicines supply chain.

A UK Government consultation on the implementation of the FMD will be released shortly. The consultation and accompanying impact assessment will focus on where the UK has the scope to legislate making use of the flexibilities. The number of dispensing points that will need to have FMD compliant IT systems in place by February 2019 is dependent on the outcome of the consultation.

A United Kingdom Government consultation on the implementation of the European Union Delegated Regulation on ‘safety features’ under the Falsified Medicines Directive will be released shortly. The consultation and accompanying impact assessment will focus on where the UK has legal scope to make changes. This will include the Government’s proposals over penalties and sanctions on hospitals, dispensing doctors and community pharmacies.

The Government is continuing work with stakeholders to assess the full costs of implementing the ‘safety features’ under the Falsified Medicines Directive in the United Kingdom taking account of the different approaches and use of the flexibilities allowed by the delegated regulation.

The European Union has published an assessment of the overall impact of the Delegated Regulation, which includes information on hospitals, doctors and pharmacy, and is available at the following link:

http://ec.europa.eu/smart-regulation/impact/ia_carried_out/docs/ia_2015/swd_2015_0189_en.pdf

The Single Departmental Plan published on 23 May 2018 is a concise summary of the highest level objectives for the financial year 2018-19 rather than a comprehensive account of all the activities the Department is planning to undertake. The fact that a commitment or activity has not been included in the summary does not imply that there is no intention to work on it.

The Government is continuing to reduce harm caused by tobacco. Last year we published a new tobacco control plan to build on that success and on 7 June 2018 we published a delivery plan setting out actions for meeting the aims of the tobacco control plan and how progress will be monitored. A copy of the delivery plan is available at the following link:

https://www.gov.uk/government/publications/tobacco-control-plan-delivery-plan-2017-to-2022

The Department of Health and Social Care and HM Treasury discuss with National Health Service bodies on a regular basis how to improve value for patients and taxpayers in the commissioning and delivery of NHS services. A number of measures are in place, including NHS RightCare, an NHS England supported programme to ensure the best possible care is delivered as efficiently as possible. NHS RightCare has been rolled out across local health economies in England, with all clinical commissioning groups having a dedicated Delivery Partner to help support and implement the RightCare approach.

NHS England is supporting the development of primary care networks through which local providers of primary care, including general practitioners (GPs) and pharmacies, collaborate to better integrate services for patients. In addition, through the Pharmacy Integration Fund, NHS England is working to better utilise the skills and expertise of pharmacy teams to improve clinical effectiveness and reduce demand on GPs and other parts of primary care system.

To support this, regional pharmacy integration events are being planned to run through 2018. These events will bring together Sustainable Transformation Leads, pharmacy providers and wider stakeholders to promote collaboration and consider how community pharmacies can be better utilised to support people to stay well in the community.

The National Health Service needs to be able to deliver the right care, in the right place, with optimal value. Commissioners must consider the interests of patients when making commissioning decisions, not only the financial cost of commissioning a particular service.

Guidance is available to support clinical commissioning groups. In September 2016, NHS England and NHS Improvement published the NHS Operational Planning and Contracting Guidance 2017-19. Subsequent refresher guidance has also been published. In March 2018, NHS England also published updated guidance on planning, assuring and delivering service change for patients. NHS RightCare is a national NHS England-supported programme committed to delivering the best care to patients, making the NHS’s money go as far as possible and improving patient outcomes.

The United Kingdom has taken a strong global leadership role in the course of the current Antimicrobial Resistance (AMR) Strategy 2013-2018. This includes advocating for sustained political commitment and financial investment at the highest levels of multilateral fora including the European Union, the G7 and the G20. The UK also continues to provide support to the World Health Organization (WHO), the Food and Agriculture Organisation and the World Organisation for Animal Health, challenging them and other United Nations agencies and international organisations to deliver an ambitious, robust and joined-up response which aligns with the 2030 Sustainable Development Agenda and the Global Action Plan on AMR.

The UK was instrumental in drafting and gaining support for a UN political declaration on AMR, which was agreed by 193 UN member states at the UN General Assembly in September 2016. Alongside this political agreement, the UK co-hosted a side event where over £600 million was committed by countries for AMR research and development. To ensure progress of the 2016 UN Resolution, the Interagency Coordination Group (IACG) on AMR was established, with the UK’s Chief Medical Officer, providing pivotal momentum as an expert member and co-convener in her independent capacity. The IACG is due to report to the UN Secretary General in summer 2019.

Since the beginning of the current strategy in 2013, the UK Government has committed over £615 million in delivering domestic and international programmes to tackle AMR, including the Fleming Fund (£265 million) and the Global AMR Innovation Fund (£50 million). These programmes focus on supporting low- and middle-income countries to combat AMR in humans, animals and the environment `by supporting countries to implement comprehensive AMR National Action Plans and by leveraging investment and expertise from around the world. The Department also works with its executive agencies to combat AMR at the global level. For instance, Public Health England provides specialist training programmes internationally and is on the steering group of the WHO-hosted Global AMR Surveillance System.

The UK also continues to work with international agencies to ensure we effectively manage the risks of AMR in the environment. For instance, the UK worked with EU partners to develop the ‘AMR in the environment’ resolution at the UN Environment Assembly in December 2017.

Ministers recognise the important contribution that community pharmacies already make and also that they have so much more to offer. Ministers see community pharmacy playing an enhanced role in the health and care of our country with pharmacy teams supported to do more to help people stay well in the community, and in doing so helping to reduce the demand on other parts of the system, including primary care.

In particular, the Government has been piloting the use of community pharmacies to support urgent care and the management of minor illness in the community. Alongside public awareness campaigns promoting pharmacy as a first port of call for a wide range of minor health concerns, the Digital Minor Illness Referral Service directs patients into community pharmacy from NHS 111 Online and the NHS 111 phone line. The impact of this work is being evaluated and will be carefully considered by Ministers.

In addition to this, over 9,000 community pharmacies are registered Healthy Living Pharmacies, proactively delivering lifestyle advice and promoting wellbeing and self-care to people in the community. This is an important resource that local teams can commission to deliver a wide range of services to meet the unique needs of their local population.

Work is underway across Government, the devolved administrations and a wide range of stakeholders to develop a refreshed United Kingdom antimicrobial resistance strategy. Publication is planned by the end of the year.

United Kingdom Standards for Microbiology Investigations (UK SMIs) B 37: Investigation of blood cultures (for organisms other than Mycobacterium species) are developed by the UK SMI Working Groups under the auspices of Public Health England. SMI B 37 describes the processing and microbiological investigation of blood cultures and aims to set standards for each stage of the investigative process. These can then be used as a benchmark to audit against by certification and accreditation bodies if they wish.

The UK SMIs are not mandatory and there is no legal obligation to follow the recommendations in UK SMIs. In using UK SMIs, laboratories should take account of local requirements and undertake additional investigations where appropriate.

UK SMIs are National Institute for Health and Care Excellence accredited and represent a good standard of practice. NHS England has included compliance with UK SMIs in the National Health Service Standard Contract 2017-18.

The Department has not made any recent assessment of the level of uptake or adoption of technology for reducing inadvertent dispensing errors in pharmacies or acute settings.

There are many ways to reduce the incidence of near misses and errors, and the solution to responding to these will vary depending on the nature of the error. The professionalism of the pharmacy workforce and robust systems of governance are the first line of defence in preventing dispensing errors. New technologies, such as the as electronic prescribing, the electronic prescription service, auto-mated dispensing and barcode scanning are being adopted by pharmacy teams, which will further help reduce risks of some types of dispensing errors.

All registered pharmacy professionals and registered pharmacies are required to meet the relevant standards set by the General Pharmaceutical Council. Documenting, reflecting and learning from near misses, dispensing errors or incidents is critical to compliance with the standards and ensuring that patients and the public receive safe and effective care from pharmacy.

The Department has not made any recent assessment of the level of uptake or adoption of technology for reducing inadvertent dispensing errors in pharmacies or acute settings.

There are many ways to reduce the incidence of near misses and errors, and the solution to responding to these will vary depending on the nature of the error. The professionalism of the pharmacy workforce and robust systems of governance are the first line of defence in preventing dispensing errors. New technologies, such as the as electronic prescribing, the electronic prescription service, auto-mated dispensing and barcode scanning are being adopted by pharmacy teams, which will further help reduce risks of some types of dispensing errors.

All registered pharmacy professionals and registered pharmacies are required to meet the relevant standards set by the General Pharmaceutical Council. Documenting, reflecting and learning from near misses, dispensing errors or incidents is critical to compliance with the standards and ensuring that patients and the public receive safe and effective care from pharmacy.

NHS Improvement is leading the transformational changes in pathology services across England, with the formation of 29 Pathology Networks serving England well underway. These networks will realise an improved quality of service, timely access to diagnostic results and access to expert clinical advice in this very diverse clinical specialty.

One of the most significant benefits of this reconfiguration will be to increase the availability of microbiology services, so vital in the diagnosis of life threatening conditions such as sepsis. Currently not all microbiology services are available 24/7 and access to state of the art equipment is variable.

The establishment of networked pathology services will allow for best practice to be deployed across trusts, not only allowing for 24/7 services and faster access to targeted treatment, but also ensuring the latest technology such as molecular genetic testing is available to more patients. To support this development, this year the Government announced £61.5 million to develop the laboratory and IT infrastructure needed to monitor and review results and systems from any point in the network.

NHS Improvement are also working closely with the Office of Life Sciences to ensure digitisation and deployment of artificial intelligence is built in to ensure maximum benefit to the National Health Service and patient outcomes as these technologies develop.

These transformational changes are being performed with the full engagement of the pathology professional bodies and working with the Department’s procurement category tower 8 to improve the purchasing power and choice of equipment to the NHS.

There have been very few prosecutions in regard to preparation and dispensing errors made by pharmacists to date, and we expect the number to reduce even further. The fundamental premise on which this Order is based is that new defences for offences concerning dispensing errors will reduce the risk of prosecution, leading to an increase in the number of reported errors. Over time, learning from increased numbers of error reports is expected to lead to improvements in training and practices, which should reduce the number of errors made.

An Impact Assessment, published alongside the Order, records that there have only been three prosecutions by the Medicines and Healthcare products Regulatory Agency since 2003 and a similarly very low number by the Crown Prosecution Service and the Public Prosecution Service for Northern Ireland. No specific figure was given for the likely number of prosecutions in future, either for prosecution for the offences to which the defences relate or under the general criminal law. However, the Impact Assessment did seek to put a monetary value on the benefit from a reduced risk of prosecution and estimated a benefit to business of £565,770. The consultation responses supported this part of the analysis.

Whilst it is estimated this policy will result in a reduced risk of prosecution, in the most serious cases, for example where a dispensing error leads to the death of a patient, prosecution will continue to be possible under the general criminal law – for example for gross negligence manslaughter.

The Department has not made any assessment of the effectiveness of the General Pharmaceutical Council (GPhC) as a regulator of pharmacy professionals and pharmacy premises. The Professional Standards Authority, which in its review of the GPhC’s performance in 2016-2017, found that the GPhC had met all of the standards for good regulation, including all of the standards for fitness to practise.

Standards to safeguard the health, safety and wellbeing of patients and the public are set by the GPhC. It is important to note that there are very different legal frameworks for upholding these standards and how the regulator deals with these for pharmacy premises as compared to pharmacy professionals. 87% of the pharmacies inspected by the GPhC in 2016-17 were meeting all of the standards it sets. Any pharmacy not achieving all of the standards is required by the GPhC to implement an action plan to improve the services they provide. In this period the GPhC agreed 469 action plans with pharmacies to ensure they improved the services they provide, and 99% of them made the necessary improvements so that they were meeting all of the standards. In the same period 140 cases were made affecting an individual pharmacy professional’s registration.

The Department has not made any assessment of the effectiveness of the General Pharmaceutical Council (GPhC) as a regulator of pharmacy professionals and pharmacy premises. The Professional Standards Authority, which in its review of the GPhC’s performance in 2016-2017, found that the GPhC had met all of the standards for good regulation, including all of the standards for fitness to practise.

Standards to safeguard the health, safety and wellbeing of patients and the public are set by the GPhC. It is important to note that there are very different legal frameworks for upholding these standards and how the regulator deals with these for pharmacy premises as compared to pharmacy professionals. 87% of the pharmacies inspected by the GPhC in 2016-17 were meeting all of the standards it sets. Any pharmacy not achieving all of the standards is required by the GPhC to implement an action plan to improve the services they provide. In this period the GPhC agreed 469 action plans with pharmacies to ensure they improved the services they provide, and 99% of them made the necessary improvements so that they were meeting all of the standards. In the same period 140 cases were made affecting an individual pharmacy professional’s registration.

The Department does not hold information on the number or names of Freedom to Speak up Guardians in community pharmacies.

NHS England is responsible for issuing the guidance on Freedom to Speak Up in primary care and has provided the following response:

The number and names of Freedom to Speak Up Guardians in community pharmacies is not held centrally. Guidance for primary care providers was published in November 2016 on the NHS England website and a number of models for Freedom to Speak Up are detailed within that guidance, including having a named Guardian who is independent of the line management chain and not a direct employee. NHS England is working with the National Guardian's Office to assess the support that primary care providers, including community pharmacies, may need to comply with this guidance.

The adjuvanted trivalent influenza vaccine was not available for use in 2017/18.

General practitioners (GPs) and pharmacies are responsible for ordering and purchasing flu vaccines for the adult seasonal flu programme (eligible individuals aged 18 years and over) directly from manufacturers.

Information on what vaccines are being ordered by these independent contractors is not routinely collected. Information on vaccines used by pharmacies and GPs will be available after the end of a flu season when practice/pharmacies claim reimbursement for the cost of the vaccines they have used.

Officials at the Department and Public Health England have regular discussions with manufacturers on a range of issues. This has included discussion with Seqirus, the company that has produced the new adjuvanted trivalent flu vaccine (aTIV).

Officials have had no discussions with general practitioner representatives or patient groups on the aTIV.

Officials also attend meetings of the Joint Committee on Vaccination and Immunisation, which includes a lay member.

Public Health England has updated their advice in the Green Book chapter on influenza so that clinicians are aware of the advice of the Joint Committee on Vaccination and Immunisation in relation to the adjuvanted trivalent influenza vaccine.

In addition, NHS England wrote to general practitioners and clinical commissioning groups (via NHS England local teams) in December 2017 to provide an update on the use of the adjuvanted trivalent influenza vaccine for 2018/19.

This update will also be made available to community pharmacies as part of confirming that the Advanced Influenza Vaccination service has been recommissioned in early 2018. Community pharmacies are able to order relevant vaccines as detailed in the service specification, including the enhanced vaccine for patients within the relevant cohort.

The Five Year Forward View made a specific commitment to do more to support people with long term conditions manage their own health. Further to this, sustainability and transformation partnerships (STPs) have a remit to consider how to improve self-care.

In 2015 NHS England established the Realising the Value Programme. This was designed to identify evidence-based approaches that engage people in their own health and care and develop practical tools to support implementation. The programme has now published tools and guidance for local health economies, as well as an economic modelling tool to help services understand the costs and benefits.

NHS England is also rolling out the Patient Activation Measure (PAM). The PAM is a tool which captures the extent to which people feel engaged and confident in taking care of their health and wellbeing, helping professionals to tailor support. NHS England has agreed to grant 1.8 million people with long term conditions across 27 areas access to the tool.

Eight STP areas to take part in its new one year Building Health Partnerships programme supported by NHS England to facilitate strong engagement with the voluntary sector and local communities on actions that improve wellbeing and self-care. NHS England is also working with 15 new care models across the country to test how to deliver support for self-care, systematically and at scale. By working with the new care models, NHS England plans to offer tailored self-care support to 25,000 – 30,000 people by end of March 2018, delivered through health coaching/self-management education and social prescribing, supported by use of the PAM.

This information is not held centrally.

There has been no such assessment.

Information is not available in the format requested. However, the attached table provides the total number of accident and emergency attendances and the proportion of those at ‘type 3’¹ sites, for England and by provider for the period November 2015 to October 2017. These data are not broken down at general practice or clinical commissioning group level.

Note:

¹‘Type 3’ sites include a range of facilities such as hospitals and other sites, including walk-in centres and urgent care centres, that can be general practitioner-led.

NHS England and clinical commissioning groups commission minor ailment services from community pharmacies to meet local need. These services have been developed in areas of high demand on general practices, to treat minor illnesses and are reviewed locally by the commissioner of the service.

Whilst the Government has not made an assessment of the impact of the costs associated with a reduction in the number of general practitioners consultations, Monitor in its publication in 2013 “Closing the NHS Funding Gap – How to get Better Value Healthcare for Patients” estimated that with a 1% uptake of pharmacy-led minor ailments schemes nationally, £64 million could be saved.

There is a growing body of evidence for the benefits of self-care both in improved patient outcomes and reductions in demand on the National Health Service. ‘Self-care’ covers a broad spectrum of interventions and is defined in different ways in different situations. We do not hold national data on the potential savings linked directly to self-care.

NHS England has worked alongside the Self Care Forum to promote Self Care Week across the National Health Service, including showcasing best practice on social media. References can be found to the campaign both via NHS Choices and on NHS England’s on-going winter campaign, Stay Well this Winter. Links can be found below:

www.nhs.uk/selfcare/Pages/self-care-week-2017.aspx

www.nhs.uk/staywell/#SoKX6vgcUb035h8m.97

NHS England commissioned the Murray review and is now actively progressing transformation of pharmacy practice and working with the pharmacy professions to improve the quality and efficiency of services in line with many of the recommendations set out in the Review. This includes:

- An increased focus on improving value and outcomes from medicines.

- Measures to promote pharmacist and pharmacy technician integration in primary care settings, making the most of their clinical skills, supported by the Pharmacy Integration Fund (PhIF).

Some examples of the actions underway as part of this include:

- Programmes to deploy pharmacists and pharmacy technicians in integrated multi-disciplinary teams to carry out medicines optimisation and relieve the pressures on general practitioner practices and hospital admissions, funded by the PhIF and with evaluation in place. These include recruiting pharmacists to work in the Integrated Urgent Care Clinical Assessment Service contact centres and NHS 111 services, and the ongoing development of a care homes medicines optimisation scheme to tackle inappropriate polypharmacy.

- A programme of education and development is being developed in collaboration with Health Education England to support this transformation. This will include access to post-registration training and development for community pharmacists, equivalent to 1,000 postgraduate diplomas a year up to 2019, a new training pathway for pharmacists who work in care homes and integrated urgent care hubs/NHS 111, and independent prescribing qualifications for up to 2,000 pharmacists.

- A digital medicines strategy for pharmacy to upgrade the digital infrastructure to support transformation.

- NHS England has set up four Regional Medicines Optimisation Committees, chaired by regional medical directors, which are working to ensure system wide medicines optimisation.

The Department is working closely with Public Health England (PHE) and the Medicines and Healthcare products Regulatory Agency (MHRA) to encourage research into the use of electronic cigarettes (e-cigarettes) and monitor the emerging evidence.

PHE’s next updated evidence report on e-cigarettes is expected to be published before the end of the 2017. In addition to the publication of an evidence review, PHE have partnered with Cancer Research UK and the UK Centre for Tobacco and Alcohol Studies to develop a forum that brings together policy makers, researchers, practitioners and the non-governmental organisation representatives to discuss the emerging evidence, identify research priorities and generate ideas for new research projects, thereby enhancing collaboration between forum participants.

The MHRA will continue to undertake market surveillance of e-cigarettes as part of their role as the Competent Authority, feeding back any intelligence to the Department and PHE.