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Issue 18 - 8 February 2006 Introduction Welcome to Issue 18 of HOS@PCC Our aim is to continue to keep you fully informed on the implementation of the new Home Oxygen Service from 1 February 2006 and to ensure that we help keep the transition period as smooth as possible. We will continue to share best practice and pass on your views, experiences and questions. If you have any feedback please contact us at hos.newsletter@pcconline.info Please feel free to forward this email to any colleague you think might be interested in the information it contains. Anyone wishing to subscribe may do so. Subscribing & unsubscribing Click here to subscribe to receive your own copy of this newsletter. Click here to unsubscribe yourself from this newsletter. Previous Issues If you have missed any previous issues click here. News and information In this issue … IMPORTANT INFORMATION ABOUT THE NEW SERVICE: ACTION ADVICE ON COMPLETING HOME OXYGEN FORMS Key deadlines Key documents including FAQs Key links HOME OXYGEN SERVICE FROM 1 FEBRUARY 2006: ACTION NOW Key Problems Problems have arisen in transferring to the new service arrangements, including Incomplete/insufficient information in orders for home oxygen. This results in the need for checks, re-orders and delays in delivering the required service to patients. Ordering services for all patients on the same day, including advance orders, and this is causing problems in ensuring priority is given to patients with emergency and immediate need for oxygen High use of ordering and advice lines to check receipt of orders or raising queries on services - this is hindering action to process orders and deliver the service required on time Phasing the transfer of patients using home oxygen before 1 February to the new suppliers. Planning supports a managed programme of patient transfer between 1 February 2006 and 31 July 2006 in order to maintain continuity of service - particularly for patients receiving a cylinder service from pharmacies. These must be resolved as quickly as possible to ensure patients receive the oxygen they need when they need it. The following sets out action agreed by the Department of Health, the NHS and the new suppliers. See Below ACTION CHECKLIST It is essential that patients, healthcare professionals, NHS managers and new suppliers work together to achieve greater stability in provision of the home oxygen service so that we can move forward with plans to manage the changes over the next six months. See checklists for action below SHAs /PCTs SHAs/PCTs need to lead and co-ordinate action by all concerned through Ensuring action checklists are communicated to all stakeholders immediately Taking local action to support healthcare professionals in completing HOOFs and ordering home oxygen Co-ordinating local communications with patients, carers and patient groups Engaging with local pharmacy contractors to continue to provide a cylinder service to support a phased transfer of patients to a new supplier. Feedback suggests that in most areas, the majority of community pharmacy oxygen contractors are restocking and will be in a position to contribute to maintaining services to patients over the next few weeks. Informing new suppliers of continuing "hot spots" and agreeing plans with them to resolve problems, including changes in priorities to maintain supplies to patients Highlighting the need to maintain confidentiality of personal information in any transfer of patient information HEALTH CARE PROFESSIONALS ORDERING HOME OXYGEN Patients receiving a cylinder service GPs should continue to issue FP10 prescriptions to patients requiring cylinder oxygen. Pharmacy contractors can continue to dispense prescriptions for home oxygen in the usual way. Payment to contractors for this service will be under current arrangements. Not all pharmacy contractors are in a position to continue to supply cylinder oxygen. Information on local pharmacies with cylinder stocks will be available from PCTs and patients should be directed to these pharmacies If an FP10 is issued to a patient, a GP should fax a Home Oxygen Order Form (HOOF) to the supplier at the same time (if not already done so) MAKING CLEAR THAT A PHARMACY CONTRACTOR IS PROVIDING A CYLINDER SERVICE FOR THE VALIDITY OF THE PRESCRIPTION AND INDICATING A DATE WHEN SUPPLIES WILL NEED TO BE RENEWED. The supplier will activate the HOOF a few days before that date to maintain oxygen supplies. Once activated, the new supplier assumes responsibility for the patient. DO NOT SEND ANOTHER HOOF TO THE SUPPLIER UNLESS THERE IS A CHANGE IN THE PATIENT'S REQUIREMENTS. If a patient's needs change during the period a cylinder service is provided by a pharmacist, issue a new HOOF to the supplier indicating clearly that it is a MODIFIED HOOF to be activated on the given date. If the patient has not previously received home oxygen therapy, a GP may issue an FP10 for oxygen and at the same time send a HOOF to the new supplier. Please indicate NEW PATIENT in the HOOF comments box. Please ensure that the GP indicates whether the oxygen required is for a cylinder or concentrator patient. Patients receiving a Concentrator service A new HOOF is not required where the new supplier is already providing a concentrator service - unless the patient's requirements have changed since transfer. Send a HOOF to the supplier for NEW concentrator patients requiring this service Hospital Discharge Involve the supplier at the earliest possible stage where there are plans to discharge a patient from hospital, so that he has time to ensure that oxygen is available at home when the patient leaves hospital SEE ALSO ADVICE ON ORDERING HOME OXYGEN INCLUDED WITH THIS BULLETIN (Below) Information to Patients Advise patients that they do not need to contact the supplier - the supplier will contact them in good time. PATIENTS If they need supplies urgently, patients should contact their GP who will issue a prescription for use at the pharmacy Patients issued with FP10s should have clear information that should be taken to a pharmacy that continues to hold oxygen stocks where the pharmacist is able to provide oxygen that the new supplier will contact them to arrange to deliver supplies as their supply at home runs out At the same time, the supplier will inform the patient of arrangements to maintain/re-order supplies Patients should not call the supplier - the supplier will contact them Patients already receiving oxygen from a new supplier or who have already been contacted by the supplier need take no action other than to call the supplier's freephone number to order new supplies of cylinders. NEW SUPPLIERS New suppliers will Check each HOOF received for accuracy and completeness Refer incomplete HOOFs back to healthcare professionals Enter HOOF details in systems supporting service delivery Contact the patient to Supply oxygen as stocks provided by the pharmacist run out Request patients to contact pharmacy to arrange return of pharmacy cylinder and headset Make arrangements for re-ordering oxygen As appropriate, make arrangements for installation of a concentrator Continue to ensure that new patients are not subject to unnecessary changes in equipment ( eg installation/removal of a concentrator) Acknowledge orders and confirm provision of service via fax Where already delivering a service to existing and new patients from 1 February 2006, the supplier will continue to do so. PHARMACY CONTRACTORS PROVIDING A CYLINDER SERVICE Community pharmacies are no longer contractually obliged to dispense oxygen but pharmacy contractors that supply against an FP10 prescription will be paid until the patient transfers to a new supplier. See Part X of the Drug Tariff. Attention is drawn to PSNC advice to pharmacy contractors on providing a cylinder service Gas suppliers will continue to supply community pharmacies and orders should be placed with suppliers to restock oxygen Pharmacies should continue with arrangements to wind down cylinders stocks and return to suppliers as patients transfer to new suppliers over the six month transition period which ends on 31 July 2006 Pharmacy contractors should also advise patients that they do not need to contact the supplier - the supplier will contact them in good time. WHERE THERE ARE GAPS IN LOCAL SERVICES BECAUSE PHARMACY CONTRACTORS HAVE WITHDRAWN FROM PROVISION OF A CYLINDER SERVICE, PCTs SHOULD INFORM NEW SUPPLIERS IMMEDIATELY OF AFFECTED POST CODE AREAS SO THAT THE SUPPLIER CAN MAINTAIN SUPPLIES TO ALL PATIENTS IN THOSE AREAS CYLINDER SUPPLIERS Will continue to supply pharmacies with oxygen cylinders as required ADVICE ON COMPLETING HOME OXYGEN FORMS Health care professionals, including GPs, are using the new home oxygen order form (HOOF). This is good news as this supports the transition to the new service arrangements as soon as possible. However, new suppliers have received a huge volume of orders for the new service in the first few days and many forms provide insufficient information to support delivery of the required service. This is causing delays, as suppliers have to contact health care professionals to check the service required and when this needed at the patient's home. To help suppliers deliver the required service, health care professionals should Ensure the Home Oxygen Order Form (HOOF) is completed correctly and in full (notes on completion are on the reverse of the form). This avoids delay in processing the order. It is essential to state the flow rate and service required. Note that the British Thoracic Society clinical best practice guidelines recommend specialist assessment for long-term use of oxygen, use of ambulatory oxygen and where children require home oxygen therapy. Where a patient is awaiting specialist assessment, the BTS advises that a flow rate of 2l/min may be specified in completing the HOOF. Advice on flow rates is also available in the British National Formulary. Allow sufficient time (unless oxygen is required on an emergency basis - when it will be delivered in 4 hours) for the supplier to provide the service in the required response times. For the most part, the supplier will supply the service required within three days of receipt of an order, delivering this to the patient's home in working hours. The exceptions are provision of oxygen as an emergency and where a patient is being discharged from hospital Keep the supplier informed about hospital discharge plans so that he is aware of any changes in the date or timing of discharge. It will help him ensure that oxygen is available in the patient's home when it is needed. Please do not telephone the supplier to check receipt of an order. He will fax confirmation of receipt and delivery of the required service to you. Telephone calls to check or sending in duplicate form hinders the process and delays action on priority calls from patients and clinicians about the service. If you have already arranged with a supplier, prior to 1 February 2006, for a patient with high use of oxygen cylinders to receive a concentrator service, you do not need to send a HOOF to the supplier. He will continue to provide the service until he hears from you that the patient's needs have changed or the service can be withdrawn. Suppliers have already successfully transferred thousands of patients using an oxygen concentrator. Patients using cylinders will transfer at different times - usually when they come forward for a repeat prescription. Arrangements to support transfer from provision through pharmacies to the new supplier are included in this Bulletin and in Part X of the Drug Tariff. SUMMARY The intention is that there should be a phased transfer of patients to new suppliers under the new arrangements. However, it is clear that orders are being sent to new suppliers at a much higher volume than anticipated and this is affecting transitional planning arrangements. As a result, suppliers are having difficulties in prioritising orders, further complicated by significant numbers of HOOFs containing incomplete information. The above actions will support measures already in place to prioritise orders and allow new suppliers to meet their commitments to provide the new service. The priority now is to ensure that oxygen supplies are maintained and that all patients continue to receive a safe, reliable and effective service. The HOS Bulletin will continue to be the main communication channel for information and news about the home oxygen service. The aim will be to continue to work with all interested parties to ensure clear, consistent messages to reinforce the above action points. Key documents HOOF (Home oxygen order form: Word version) HOCF (Home oxygen consent form: Word version) Second model letter for patients (to accompany supplier leaflet) The BTS Clinical Oxygen group has prepared a Home Oxygen Record Form The DH approved HOOF is available here The HOCF is available here The cylinder return poster Local communications guide Please click here for full details of your new regional oxygen supply company. Comprehensive FAQs can be found at PSNC news Drug Tariff letter to GPs Model Letter to GPs and pharmacists to accompany patient information leaflet Patient Data Collection Template Patient Data Collection Toolkit Model letter for patient consent to transfer data Key links British Thoracic Society clinical guidelines www.brit-thoracic.org.uk/c2/oads/oxygenserviceaug05.pdf British Lung Foundation www.lunguk.org Cystic Fibrosis Trust www.cftrust.org.uk Long Term Medical Conditions Alliance www.lmca.org.uk Guidance on DPA and consent www.doh.gov.uk/consent www.informationcommissioner.gov.uk
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