Extended Care Services: Tier 1 Simple UTI Service


Updated 05/02/2021

Simple UTI Tier 1 Service


Background

On 1st December 2021 the Community Pharmacy Extended Care Tier 1 services (Simple UTI and Bacterial Conjunctivitis) services were rolled out across the whole NHSE&I Midlands footprint. This means that these services are now accessible from participating pharmacies to patients registered with GPs n the East Midlands, Central Midlands and West Midlands areas.
For more information, please see the letter from the NHS&I Regional Team below:

You can read more on the Extended Care Services Background page too


The UTI Tier 1 Service

You can scroll down to access the information, or use the links below to jump to the relevant sections of this page.

Community Pharmacy Extended Care Tier 1: UTI Service for females aged 16-64 years

Please read all of this information carefully

Introduction

The service aims to provide any eligible patient who is registered with a GP practice contracted to NHS England and Improvement (NHSE&I) Midlands, with access to assessment and treatment for simple urinary tract infections (UTI) via Community Pharmacy. The service will be provided through Community Pharmacies contracted to NHSE&I Midlands who have signed up to provide this service.

The service is only available for the treatment of uncomplicated urinary tract infection (UTI) in adult females. Only medicine(s) specified in the PGD(s) may be supplied following the correct protocols, and only in those pharmacies who have signed Service Level Agreements (SLAs) for the service.

Back to section list

Service Specification (until 31st March 2022)

The current service specification is written with a general PGD Service Specification at the beginning,  and then individual specifications for each of the current Tier 1 services: the UTI service and the acute bacterial conjunctivitis service.  This means that pharmacies can sign up to one or both of these PGD services.

To provide the service, you must completed the the signed SLA and return this the NHSE&I team by email to england.eastmidspharmacy@nhs.net.

Please also copy in Community Pharmacy Lincolnshire (info@pharmacylincolnshire.org), as this will allow us to support you and identify which pharmacies are signed up to provide this service.

Back to section list

UTI PGD: Nitrofurantoin

All pharmacists delivering the service must be familiar with, and sign the PGD. This is the legal basis for provision of a prescription-only medicine (POM) for this service.

You need to keep a copy of the signed PGD in the service file in your pharmacy (signed by all pharmacists delivering the service) but you are not required to send the PGD signature page to the NHSE&I team or Community Pharmacy Lincolnshire.  It is to be kept in your pharmacy records.

Deferred Treatment

Many infections get better without antibiotic treatment. Deferring treatment gives the patient the opportunity to ‘watch and wait’ and not take antibiotics immediately. This minimises the risk of the patient suffering from side-effects as well as reducing antimicrobial resistance.  Information on how to record deferred treatment on PharmOutcomes can be found on the PharmOutcomes Extended Care Information page on this website.

Remember, you must not provide the service until the NHSE&I regional team have a copy of your signed SLA.

Back to section list

Training Requirements

The pharmacist will need to log in to the CPPE website and access the Declaration of Competence (DoC) section to download the DoC Self-Assessment Framework for Minor Ailments.

The UTI service is a Level 2 Minor Ailments Service involving supply of POM medication under a PGD. The DoC framework document allows the pharmacist to assess their readiness against the mandatory core competencies (consultation skills and safeguarding) as well as suggesting other training they may find useful regarding minor ailments and PGDs. The pharmacist then needs to download their personalised Minor Ailments DoC (interactive PDF document).

Section 1 of the DoC will automatically contain details of all CPPE training and assessments they have undertaken and which are relevant to this service.

In section 2 of the DoC, pharmacists providing the service are reuqired to declare that they have completed mandatory training to provide this service:

  • That they have worked through the CKS summaries on simple UTIs.
  • They must have satisfactorily completed the PHE Antimicrobial Stewardship for Community Pharmacy e-learning and e-assessment at electronic Learning for Health and be registered as an antibiotic guardian.
  • They must ensure that they have the correct clinical knowledge to provide the service and are familiar with NICE guidance on treating simple UTIs.
  • The requirements of the SLA are understood and the PGD associated with the service is signed.

The pharmacist should then print their DoC and add the heading “NHSE&I Community Pharmacy Extended Care Service Tier 1”. It must then be signed and dated to complete the process. The pharmacist must confirm on the CPPE website that they have completed and signed the DoC and permit access to PharmOutcomes. Further information on DoC and how to permit access to PharmOutcomes is available on our DoC page.

The accuracy of the DoC is the pharmacist’s professional responsibility.

All Pharmacists working at participating pharmacies and providing the scheme should ensure that they continue, through continuing education and CPD, to keep up to date with guidance issued around the treatment of simple UTIs.

Back to section list

Service Paperwork and Recording

The service should be recorded live on PharmOutcomes.  A pro-forma is supplied for use only in the event of an IT failure.

Service Recording on PharmOutcomes

Please click here for more information on using PharmOutcomes for this service.

Only pharmacies who have returned the signed SLA to NHSE will have access to the new PharmOutcomes modules.  There are several different modules for Extended Care Services.

Pharmacist Enrolment

In order to record the consultations on PharmOutcomes the pharmacist must complete a pharmacist enrolment form within the new UTI module. They must give the CPPE system permission to allow PharmOutcomes to access their CPPE record in order to confirm completion of the Declaration of Comptence (DoC) for this service. If this was not done while on the CPPE website a link within the PharmOutcomes pharmacist enrolment module will take the pharmacist to the relevant part of the CPPE website.

Community Pharmacy Extended Care  – Patient Registration

The new Community Pharmacy Extended Care Patient Registration module is to be used for all Extended Care services (inlducing Tier 1 and future Tier 2 services).  This should reduce the number of times you have to record patient details.

If the patient has registered with another service at your pharmacy you will see their details in a drop down list; you can select this if it is the correct patient but you will still need to complete this registration module to record consent to this service specifically, and capture details.

Consultation and Supply 

There is a separate module for each of the Community Pharmacy Extended Care Tier 1 services and these are linked to the same registration module.

Deferred Treatment Record

There is a single deferred treatment record for the Community Pharmacy Extended Care services and this should be used to record supply of deferred treatment for any of the conditions covered by the different services.  The deferred treatment module is linked to the same registration module.

IT Failure

In case of an IT failure the pro forma below can be used (please not that this is only for emergency use and must not be used for routine service provision).

If you are not able to record live on PharmOutcomes you will also need to get the patient to sign the declaration of exemption from NHS levy.

Back to section list

Service Requirements (outlined in SLA and PGD)

Who can provide the service?

This service may be provided by authorised Community Pharmacies contracted to NHS England Midlands who are committed to making staff available to provide the service, subject to the following:

  • All professional consultations, with a service accredited pharmacist, must take place in a confidential environment.

Pharmacist training requirements

Pharmacists working at participating pharmacies can provide this Enhanced Service if they have completed the mandatory training requirements (see Training Requirements)

As with all PGDs pharmacists must sign the pharmacy copy of the PGD in every pharmacy where they deliver this service.

If your pharmacy has signed an SLA to deliver a Community Pharmacy Extended Care Service you have agreed to offer the service throughout your usual opening hours.

Q. What if you are signed up for the service but are not able to offer this service today?

A. This situation should only happen in exeptional circumstances, as you will need to work with any locum or relief pharmacists to ensure that they can deliver the service using the information on these pages. This service does not require the pharmacist to attend special training events, simply to understand the service, ensure that their clinical knowledge is up to date and to be familiar with any PGDs.

If you are not able to offer the service on a particular day (for any reason) you must NOT refer the patient to NHS111 or back to the surgery ; the whole point of this service is helping reduce demand and helping patients to be seen and helped by the community pharmacy.

Back to section list