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The Dispensing Services Quality Scheme (DSQS)

Nick Chapman reports

 

The DSQS was introduced in 2006/07 following work done by the NHS Employers, the GPC and the DDA. It is a useful portfolio to show the excellent quality most dispensing practices provide. There is payment for participating and achieving; £2.58 per dispensing patient (don't forget the temporary residents) as listed per financial year as on the 1st January of that year. However it is an all or nothing payment- you must achieve all standards in all sections in order to be paid.

 

The Dispensing Doctors' Association (DDA) has become aware of that there has been some confusion in the interpretation of the specification for the DSQS. We thought that a brief article reminding us all of the specification might be helpful. The full specification can be found at

http://www.dispensingdoctor.org/docs/GMSDispensary.pdf

or

http://www.bma.org.uk/employmentandcontracts/independent_contractors/general_medical_services_contract/dispensescheme010806.jsp

 

The DDA also has a DSQS resource pack for DDA members. Click here

 

Participate

In order to participate, and to receive payment for that year, you MUST provide the PCT with a written undertaking to carry out and achieve the standards by the 1st JULY in each year.

Someone must be accountable. You need to provide the PCT with the name of the GP who will be accountable for the year, if that changes, you must tell the PCT within 28 days, who the new person is.

 

SOPs

Standard Operating Procedures. Most of us will now have these all up and running and of a good quality. Please look closely at the specifications for these SOPs. 

SOPs

  • Should be in place
  • Should reflect both good clinical practice
  • Should reflect the procedures that are actually being performed by the practice.
  • Should be specific to the practice, setting out in writing what should be done, when where and by whom.
  • Should be reviewed at least once every 12 months.

All staff ought to know what the SOPs are and should follow them- no point having a brilliant SOP if no-one actually follows that process.

If there are changes made to the SOPs, then a written trail should be kept, so that there is an audit trail.

 

Audit

The audit is contractor lead, i.e. you choose what you want to audit as long as it involves dispensing services. Some PCTs have kindly suggested topics for audits, and this can be useful, but the choice rests with you. This is a valuable tool to improve patient care and experience.

 

Training

Staff  need to be competent. Besides stating the obvious, we also need to demonstrate this, either with certificates or qualifications. All staff involved in dispensing need an annual appraisal and must participate in continuing education and development. Trainee staff must be supervised unless they have worked 1000 hrs and are certified competent.

 

Staff levels

Staff levels should be as per the guidance. There is a chart which acts as a GUIDE and can be used to determine the staffing levels. It is not exact; however the specification states "the contractor must, in consultation with the PCT, agree a level of staffing that reflects the dispensary's configuration and hours of opening".

 

 

Risk Management and Policies

We all need to have a written policy for managing risk in dispensing. There are several EXAMPLES given in the guidance, but most of these are already part of the practice and are required for other reasons, so it is often a case of sharing the policies with the DSQS.

 

DRUMs

There is a misconception that dispensing doctors get paid £2.58 per DRUM. The DRUM is just a part of the DSQS and we get paid £2.58 per dispensing patient on our list for the entire DSQS.

You MUST perform a DRUM on at least 10% of your dispensing patients every year. This is a face-to-face review.

What are DRUMs? This is not easy to answer, as the guidance itself is somewhat confusing, telling you more what a DRUM is not rather than what it is. DRUMs are described as not being the same as a MUR in community pharmacy and not covering all aspects of the advanced MUR service.

The guidance makes some suggestions of what could be recorded. Concordance, compliance, side effects, special needs and waste could be recorded. I think the easiest way to record this information is through the use of a template and saving the information directly in the patient's notes.

There is the potential for real benefit and change through DRUMs. Reducing waste will reduce costs for the NHS, improving compliance can improve the clinical condition, becoming aware of side effects can change prescribing patterns and if patients are unable to open packaging can have result in significant change e.g. dosette boxes, liquid formulations, smaller tablets etc.

 

This is a brief summary of the Specifications. Please read the full specification for further information. . Click here

 

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