Unscheduled Care (CPUS)

Unscheduled care can be described as:

“NHS care which cannot reasonably be foreseen or planned in advance of contact with the relevant healthcare professional, or is care which, unavoidably, is out with the core working period of NHS Scotland. It follows that such demand can occur at any time and that services to meet this demand must be available 24 hours a day.”

In the past the largest group of patients requiring unscheduled care tended to use one of the following routes:

  • an urgent appointment with their GP
  • advice from NHS 24
  • referral to the Out of Hours service via NHS 24

Service developments, implemented within community pharmacy, have led to pharmacies becoming an important access route for people requiring unscheduled care particularly over weekends and public holidays such service developments implemented by community pharmacy contractors include:


National Patient Group Direction for the Urgent Supply of Repeat Medicines and Appliances

The PGD for urgent provision of repeat medicines and appliances has been developed by NHS 24 on behalf of NHS Scotland, and implemented by NHS Boards. The PGD enables community pharmacy contractors to provide patients with up to one prescribing cycle of their repeat medicines and appliances when the patient’s prescriber is unavailable; the surgery is closed or an out-of-hours system is in operation.

Patient Group Directions (PGD) are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for prescribing treatment. By using the national PGD for the urgent supply of repeat medicines and appliances pharmacists can provide a supply of the patient’s medicine for up to the equivalent of the quantity of medicine normally prescribed for the patient.

For further information on the National Patient Group Direction is available click here


Direct Referral to local Out of Hours services

Community pharmacy contractors provide a valuable support service to both NHS 24 and the local OOH service.

Sometimes when patients are reviewed by a pharmacist, it is in the pharmacist’s opinion that they require to see a doctor or OOH nurse. Instances of this can include tracking skin infections, UTI symptoms where the patient has systemic symptoms and impetigo.

Pharmacists wishing to refer patients to an OOH centre or other health service should complete the Direct Referral Form Template and using the table below as a guide contact appropriate support required. Professional to Professional numbers for each OOH service are contained within the NHS 24 folder kept in each pharmacy, and these should never be made available to the public.

Where do you wish to refer the patient How to refer the patient Why you would refer the patient here
Local OOH Service

PCEC – Primary Care Emergency Centre

MIU – Minor Injuries Unit

CPN – Community Psychiatric Nurse

DN – District Nurse
Call the professional to professional number for your local area

Direct Referral Form Template

Number can also be used to discuss referral options.
To arrange a consultation at PCEC or MIU

To organise a prescription for medication not eligible for supply under PGD or emergency supply legislation

To query a prescription written in the OOH period

To arrange for patient to see CPN or DN

To access special notes Special notes are written by the patients GP and can often be useful for community pharmacist particularly in palliative care
Accident and Emergency Send patient direct (May require ambulance transport via 999) Accidents eg: suspected fractures Emergencies eg: anaphylaxis
Emergency Ambulance Ambulance transport via 999 Serious symptoms presenting in Pharmacy
Dental treatment Check local arrangements NB: Dental patients not routinely referred to OOH service
Social Services Check local arrangements Child protection issues Community care

Remuneration

Contractors are responsible for ensuring all their Pharmacists who are using the National Patient Group Direction for the Urgent Supply of Repeat Medicines and Appliances have completed the PGD Authorisation Form and send it to the Primary Care Chief Pharmacist of the Health Board they are working.

Contractors who fail to ensure the completed authorisation form is returned to the Health Board should be aware that the CPUS prescriptions presented will not be reimbursed for the products supplied.