CPOSS – Community Pharmacy Optometry Supply Service
Supply Service Against Optometrist Signed Orders.
Community led minor eye condition schemes allow high street optometrists to advise and treat patients with minor eye conditions. This reduces the need for them to be referred to the GP or urgent eye clinics for treatment. A Covid Urgent Eye Scheme (CUES) has been commissioned from optometrists, it is available to patients who are registered with a GP in five of the Staffordshire Clinical Commissioning Groups (CCGs). These are Cannock Chase CCG; North Staffordshire CCG; South East Staffordshire & Seisdon Peninsula CCG; Stafford and Surrounds CCG and Stoke-on-Trent CCG. Patients with a GP in East Staffordshire are not eligible for the service (this is a CCG commissioning decision).
Optometrists outside of the 5 CCG’s footprint may sign up to provide the service but are only able to see patients registered with a GP practice located in one of the 5 commissioning CCGs (for example, a Uttoxeter optometrist could see a patient who lives in Stoke and who has a Stoke GP and provide the service to them, but could not offer the service to a Uttoxeter patient because East Staffs CCG do not commission the service.
Optometrists who are part of the CUES service can be found in this leaflet – although the leaflet is about the MECS service, these optometrists are delivering CUES. It is possible that more optometrists may join the service, if this is the case the Local Optometrists Committee will update the leaflet and if we get an updated leaflet we will add it here.
The new CPOSS pharmacy service is being commissioned by NHS England & NHS Improvement Midlands (the commissioners) on behalf of the Staffordshire group of CCGS.
The pharmacy service may be delivered from any community pharmacy in Staffordshire, including those in East Staffordshire, provided that the patient is eligible (as determined by their optometrist).
The pharmacy service will support patients purchasing over the counter (OTC) preparations or allow the pharmacy to dispense medication directly to a patient who presents with a signed order on the agreed form written by a registered optometrist.
Patients may also be prescribed products on FP10 by an Optometrist Independent Prescriber and the process for these prescriptions to be sent to the pharmacy is also outlined in the SLA document.
Caution: Pharmacists should be aware that patients registered with a GP practice in East Staffordshire CCG area are not eligible for this service and so the pharmacy should not refer these patients to an optometrist because they cannot receive this optometrist led service.
How the CPOSS Pharmacy Service Works
The formulary in the SLA contains both POM and OTC products.
OTC products are included in the formulary and the optometrist will recommend that the patient purchases these OTC unless the patient which falls outside the OTC product license (for chloramphencicol products).
For POM products the supply route will be FP10 or signed order:
You may receive an FP10 from an optometrist independent prescriber and this should be dispensed in the normal way and would not be considered part of the CPOSS service.
For those optometrists who are not independent prescribers they are now able to write a signed order as part of CPOSS which is being introduced in Staffordshire.
This allows the pharmacy to supply a POM to the patient against the signed order and the patient will either pay an NHS levy or if they are exempt from NHS levy, they will receive the item free of charge and will have to sign an exemption form (printed on the signed order).
The pharmacy must enter the item into the patient’s PMR and label the item and give appropriate advice about how to use the product. In addition, the pharmacy will need to add the details of the supply to the new CPOSS PharmOutcomes module – they will be paid a professional fee (VAT exempt) along with the cost price of the medication (DM+D price + standard rate VAT).
The service is only available in Staffordshire and in order to provide the service the pharmacy must sign and return the SLA to firstname.lastname@example.org and also include a copy to email@example.com to ensure that you get access to the new PharmOutcomes module.
Please note that following feedback from our community pharmacists the SLA was updated on 7th September 2020 to reflect the non-availability of lacrilube and also the very high-cost price of simple eye ointment meaning that patients would be unlikely to go on to purchase the item. These products have now been replaced in the formulary with Xailin Night. Also, to reiterate that because this product is available to purchase the supply would be as an OTC sale on recommendation of the optometrist.
The signed order route is intended for fusidic acid eye drops and also for patients who fall outside the OTC license for chloramphenicol.
A further updated SLA version has been added on Sept 8th, 2020, the service is unchanged but a paragraph on page 7 was missing half a sentence, and this has now been corrected
Please note, the formulary lists fucithalmic but it is the generic product fusidic acid 1% which is intended to be supplied as the brand is no longer available.
Signed Order: expect signed orders for POM medication only (fusidic acid eye drops and also for patients who fall outside the OTC license for chloramphenicol). Optometrists may use a variety of signed order but it must state that it is part of the CUES eye service. Some example forms are shown below. Please note, the optometrist may print out a form from their electronic system but there is no facility for the signed order to be signed and sent electronically, it has to be printed on paper and signed in ink so the pharmacy must receive a paper version.
OTC products: patients should be advised to purchase OTC products in line with NHS OTC guidance. The optometrist may give the patient a referral form to take to the pharmacy. Example of Optometrist referral to pharmacy for OTC products
If a patient needs an OTC product (GSL or P) the optometrist will recommend that the patient purchases this. The optometrist may provide a referral note for the patient to bring with them to the pharmacy or may simply recommend that they purchase a product. This is in line with the NHS OTC guidance and pharmacies should NOT be suggesting that patients who are exempt from prescription charges go to see their GP for a prescription for the OTC item as this goes against the CCG prescribing policy.