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One evening whilst I was watching TV, my phone pinged with an all too familiar WhatsApp alert with a message preview saying "Can you help". I recognised the name as one of our Titan pharmacy customers who was clearly in a state of panic. I replied offering my assistance and asked him what was up. What followed over the next 24 hours was an interesting case study of how innovative technology can genuinely solve real challenges in pharmacies. Mr P (let's call him that) had booked a locum to cover in his dispensary on the next day so he could focus on his vaccination service. The problem - his locum had just called to cancel his booking (no reason given) and now he had no cover. Meanwhile, he was fully booked with back to back appointments and could not cancel them. He had phoned round his usual network of pharmacists and no one was available at short notice. He was asking if there was anything that Titan could do to reduce his workload and said he had heard about Titan's artificial intelligence module. Unfortunately, Titan. X had not been installed at this site and was not an option at this late stage. Equally, Titan's digital workflow cannot be circumvented so there was no way steps could be taken out of the process.

The Medicines and Healthcare products Regulatory Agency (MHRA) has advised 'no one should stop taking valproate without advice from their healthcare professional.' The latest data on the use of valproate in England revealed that in the last 6 months the number of pregnant women prescribed valproate in a 6-month period has fallen from 68 women in April to September 2018, to 17 women in October 2021 to March 2022. In light of concerns that the current regulatory requirements for safe use are not being consistently followed, the MHRA conducted a review of the available data and asked for advice from the independent Commission on Human Medicines (CHM). "The CHM has advised that no one under the age of 55 should be initiated on valproate unless two specialists independently consider and document that there is no other effective or tolerated treatment," said MHRA. "Where possible, existing patients should be switched to another treatment unless two specialists independently consider and document that there is no other effective or tolerated treatment or the risks do not apply."

There is no sign of a surge of the Omicron coronavirus variant in Britain so far, the chief of the UK Health Security Agency said on Tuesday, adding that there was no rise in the proportion of tests with a quirk that distinguishes it from Delta. Jenny Harries said there were five confirmed Omicron cases in England and 10 "highly likely" cases, but that was not a sign of an increase in "S-gene target failure" in PCR tests in Britain, which is a feature of Omicron. "Right across the country we watch for… S-gene target failure, which is a sort of proxy measure," Harries told BBC radio. Cases with S-gene target failure can then be prioritised for full genomic sequencing.

A community pharmacy contractor would be charged £25 if a paper prescription bundle is submitted late to the NHSBSA. "A charge for processing of a late bundle would only apply if a contractor cannot provide evidence, where requested by the NHSBSA, that their bundle was submitted using secure track and trace delivery no later than the 5th day of the following month in which supply was made," said the Pharmaceutical Services Negotiating Committee (PSNC). "Where evidence is submitted, no administrative deduction will be made. If no evidence is provided within the required time, then an administrative deduction will be made from the next Schedule of Payments. The deduction which will appear on schedules as 'Late Fee' under the section "Details of other amounts authorised"." Since the introduction of an administrative charge for late bundle submissions, 16 contractors received a fine for submitting their March prescription bundles late.

A Boots UK branch store in Hinckley town centre closed 'until further notice' as there was 'no pharmacist available' to work on Monday (May 9). A local news report said: "The sign on the door reads: "Unfortunately, we are unable to open until further notice. We are working hard to get this rectified. "We apologise for the inconvenience. Hearing care appointments please wait here to be greeted."" LeicestershireLive reported a patient saying that their appointment for a hearing aid check had been postponed until Tuesday. It added: "The customer was surprised to be told by staff that the store had to close as there was no pharmacist available."

Recently, the English Health Secretary has talked about introducing a 'Pharmacy First' model similar to that which exists in Scotland. This would be a win-win outcome providing people with better access to essential healthcare support, advice and treatment whilst relieving strain on other parts of the NHS, not least GPs and A&E. It is a no-brainer and yet despite a few media headlines there are still no firm proposals on the table to make this a reality. It surely cannot be right that you can receive a broad range of patient care services in Scotland which are not available in England. It works well in Scotland, Wales is keen to develop more pharmacy-based services and Northern Ireland, leaving aside the current funding dispute, has had a minor ailments service for many years. If the English Health Secretary is sincere in his interest in adopting an English version of the Scottish model, then there are critical aspects he needs to consider. Firstly, start with the patient journey through the healthcare ecosystem from illness prevention through to long-term condition management. What is the role of community pharmacy and how do we guide people to seek support from the most appropriate healthcare professional? What is the vision for community pharmacy delivering patient care in the next decade? The lesson from Scotland is that the government needs to sit down with the sector and map that out together. There are no quick fix overnight solutions. This needs to be a long-term commitment backed by adequate funding. Supervision regulations need to change and there needs to be a thought through workforce strategy which avoids community pharmacy shortages as that does nothing to deliver improved patient outcomes.

Suffering a brain injury is no easy thing. The plurality of potential symptoms meets with the potential long-term effects to create a poor prognosis for many unfortunate enough to experience them. But new technological leaps could pave the way to a better quality of life. What is a Brain Injury? The above question might seem a simple one, with a simple answer. But brain injuries are by no means simple, and by no means simply defined. There are two major categories under which a brain injury can fall: hypoxic and traumatic. Of civil brain injury claims in the UK, traumatic brain injuries (TBIs) are the most common - with 95% of claims revolving around some form of traumatic injury or incident. TBIs are brain injuries suffered as a result of a specific or direct injury. The brain is damaged through direct contact or the transfer of force. A direct strike to the head is in an assault or a serious fall might compromise the cranium, sending shockwaves of energy through the brain and potentially crushing the skull into the cranial cavity. Alternatively, a car accident or sudden stop might see the brain bashed against the occipital bone, causing internal trauma and intracranial hypertension. Hypoxic brain injuries refer specifically to injuries caused as a result of loss of blood or oxygen to the head. These injuries reflect birth injuries that might lead to cerebral palsy, or serious medical events that might alter the brain's response to stimuli. How are Brain Injuries Diagnosed and Treated? While the potential causes of a brain injury are plain to see, diagnosing a brain injury is not as straightforward. There are immediate symptoms that can indicate brain injury, such as the 'fencing response' which can indicate a severe rotational brain injury. Conscious patients might also exhibit difficulty speaking, remembering key pieces of information or responding to any stimuli.

The University of Oxford on Tuesday said there was no evidence that vaccines would not prevent severe disease from Omicron, but that it was ready to rapidly develop an updated version of its vaccine developed with AstraZeneca if necessary. Earlier on Tuesday, the head of drugmaker Moderna said that Covid-19 shots were unlikely to be as effective against the variant, jolting global markets. The University of Oxford said that there was limited data on Omicron so far, and that it would carefully evaluate the impact of the variant on its shot, echoing an AstraZeneca statement last week. "Despite the appearance of new variants over the past year, vaccines have continued to provide very high levels of protection against severe disease and there is no evidence so far that Omicron is any different," it said in a statement.

January 1 2022, the No Surprises Act (NSA) went into effect, opting for more transparency in medical billing and requiring physicians to provide Good Faith Estimates. While a great win for patients, the arbitration it creates between provider and insurer could see many solo/private practices closed permanently.

Community Pharmacy England (CPE) has expressed dissatisfaction with the spring budget as it brings "no specific relief" for the community pharmacy sector, which is grappling with "soaring costs and severe medicine supply and pricing issues." UK Chancellor Jeremy Hunt announced his Spring Budget on Wednesday, confirming an extra £2.5 billion in day-to-day revenue funding for the NHS in England in 2024-25 and a new NHS productivity plan worth £3.4bn to modernise IT systems. The Chancellor said that day-to-day spending would grow by 1 per cent per year on average in real terms, and the productivity plan is estimated to "unlock £35 billion worth of savings" from 2025-26 to 2029-30. However, CPE chief executive, Janet Morrison commented that the budget has "no obvious good news" for community pharmacies who need "urgent relief from the ongoing unsustainable funding and operational pressures" they are facing. Morrison described the investment in Pharmacy First as "the most significant investment in pharmacies in a decade", but emphasised the need for further support to stabilise the sector and its core contractual arrangements.

As per Bambang Brodjonegoro, the Minister of National Development Planning of Indonesia, Jakarta is no longer going to be the capital of the country. President Joko Widodo has decided on relocating the capital of Indonesia on an "important decision". It is yet not known which location is going to be the new capital but if media reports are to be believed, it is probably going to be Palangkaraya, situated on Borneo's island.

Pharmacist supervision has been the subject of debate for as long as I can remember. Strikingly, no one is sure what supervision requires. The Human Medicines Regulations 2012 say it is a criminal offence to sell or supply Pharmacy medicines or Prescription Only Medicines unless a pharmacist makes the sale or supply or, if the transaction is carried out by a non-pharmacist, that person acts under the supervision of a pharmacist. Over the years, some people have argued that supervision requires a clinical check. Others say it requires an accuracy assessment. Yet others have asserted that it requires a final check before a medicine leaves the pharmacy. Things are made more uncertain by the NHS terms of service which require prescription medicines to be supplied under the direct supervision of a pharmacist. No one knows what the word "direct" adds. The wording of the Human Medicines Regulations is not identical to the wording of earlier legislation. In particular, on the only occasions when the courts have been called upon to interpret the requirement for supervision, the Pharmacy and Poisons Act 1933 was in force. In cases decided in 1943 and 1953, the courts decided that a pharmacist who was upstairs when a supply was made could not have been supervising; and that a sale was supervised by pharmacist standing at the cash desk because the pharmacist could intervene if a sale would not be appropriate.

England won't have any new Covid-19 restrictions before the end of 2021, health secretary Sajid Javid said on Monday (December 27) whilst the government awaits more evidence on whether the NHS can cope with high infection rates in the new year. "There will be no further measures before the new year," Javid told reporters, adding: "When we get into the new year, of course we will see then whether we do need to take any further measures." He said that the highly transmissible Omicron variant of the virus now accounted for around 90 per cent of cases across England and urged people to celebrate New Year cautiously. The government's attention is focused on the number of patients being hospitalised with Omicron after early data last week suggested the variant carried a lower risk of admission. The latest data showed the number of patients in hospital in England with Covid-19 was its highest since March, at 8,474, but a long way off peaks above 34,000 in January. A combination of factors, including Britain's vaccination programme, the lag between infections and hospitalisations and the potentially less harmful effects of the Omicron variant have all been put forward by health experts as possible explanations for lower numbers.

Health secretary Sajid Javid said on Monday (December 6) there is now community transmission of the Omicron variant of the coronavirus across regions of England but it is too early to say if this will "knock us off our road to recovery". Defending the introduction of stricter rules to slow the spread of the virus, Javid told parliament that the government was "leaving nothing to chance" while scientists assessed the variant, which was first reported in South Africa last month. Javid said there are now 261 Omicron cases in England, 71 in Scotland and four in Wales - a total of 336. "This includes cases with no links to international travel, so we can conclude there is now community transmission across multiple regions of England," Javid said. Prime minister Boris Johnson said on Monday no further restrictions were currently needed to deal with the Omicron variant, but refused to rule out imposing such measures before Christmas.

The Pharmacists' Defence Association (PDA) has advised its member to check their understanding of what activities can legitimately take place when no RP is signed in at the pharmacy or the absence provisions are used. The advisory to its member was followed after noticing a considerable talk on social media about compliance with the Responsible Pharmacist (RP) regulations which also included unauthorised activity occurring when no RP is signed in. "There have been comments made that some pharmacists and pharmacy team members may fear repercussions from challenging or whistle-blowing about such behaviour," PDA said. "To assist members with the interpretation of the RP regulations, the PDA has made available a legal briefing note about the RP regulations produced by a specialist pharmacy regulation law firm." It further added: "Non-compliance with the regulations by pharmacy teams should be reported to the pharmacy superintendent."

To help the pharmacists understand the Serious Shortage Protocols (SSPs) for three Hormone Replacement Therapy (HRT) products that was recently announced by the Department of Health and Social Care (DHSC)'s, the Pharmaceutical Services Negotiating Committee has shared top tips on the correct SSP endorsement and submission requirements. Top Tips by PSNC for pharmacists on HRT SSPs: Always double check that endorsements reflect the requirements outlined in the supporting guidance published for each SSP on the dedicated page of the NHSBSA's website. When endorsing using EPS, contractors are reminded to select the SSP endorsement and input the correct three-digit reference number leaving a space in between 'SSP' and the three-digit reference number for example, SSP 019. Remember to insert the leading zero in the three digit reference number. Each of the affected HRT medicines has its own SSP reference number. Check that the correct SSP number is endorsed for e.g. for Oestrogel® Pump-Pack 0.06% gel the SSP endorsement should be 'SSP 019'. Please note the 'NCSO' endorsement is no longer accepted for SSPs. Endorse the SSP product dispensed including the quantity. Ensure your endorsements are accurate and clear - NHSBSA processing staff must be able to determine what has been supplied. Contractors should note that SSP claims submitted using EPS tokens are no longer permitted.

Nearly 70 years ago the UK Government recognised the imbalance of power between commercial landlords and tenants and passed the Landlord and Tenant Act 1954 (the Act), giving most commercial tenants a right of security of tenure. What is security of tenure? The Act grants tenants of business premises (so this would include pharmacy tenants) the right when the fixed term of their lease has ended to remain in occupation of the premises and the right to apply for the grant of a new lease. The landlord can only object to the grant of the new lease of the premises to the tenant, and therefore regain possession of the property on certain grounds set out in the Act. The parties to a lease can contract outside the provisions of the Act and where this is the case, a tenant would not have security of tenure. Most landlords will insist on no security of tenure where a lease is granted for a short term. As pharmacy leases have tended to be granted for longer terms (usually between 10 and 15 years) pharmacy tenants often have security of tenure. The Act sets out strict procedures which need to be followed to both contract outside the provisions of security of tenure and also to exercise the security of tenure rights granted by the Act. Pharmacists should take legal advice before agreeing to a pharmacy lease being excluded from the Act, and also at the end of their lease term whether or not they have security of tenure. If the lease is contracted outside of the Act, advice should be sought on agreeing new lease terms, if the pharmacist wishes to remain, as there will be no right to do so beyond the end of the lease term. If the lease is protected by the security of tenure provisions of the Act, advice should still be sought, as the Act prescribes a formal notice procedure that both the landlord and tenant must adhere to, before a new lease can be granted.

The British Generic Manufacturers Association (BGMA) has sought a judicial review of the Department of Health and Social Care's (DHSC) decision to negotiate a new Voluntary Scheme for branded medicines with the Association of the British Pharmaceutical Industry (ABPI). Mark Samuels, Chief Executive of BGMA said: "The Government has decided not to involve the trade body representing these medicine suppliers in its negotiations on the voluntary scheme for branded medicine pricing (VPAS). "We are deeply concerned by this decision. It has left us no choice but to take legal action." "While not all generic drugs fall within VPAS, four out of ten products in the current scheme are branded generics or biosimilars. As the representative trade body for both generic and biosimilar UK manufacturers, we must play a full part in the VPAS negotiations for the next period of the scheme from 2024 to 2028." "The VPAS tax has risen five-fold in under two years, an unprecedented tax increase. Yet our sector currently has no input into the negotiations on future schemes or rates; this is untenable as any decisions made on VPAS could significantly define the future of our sector in the UK and its ability to supply the NHS. The association had raised its full participation in the negotiations with the Government last November.

The National Pharmacy Association (NPA) is calling on NHS England and its member to pause and reflect before further implementing the pharmacy contraception service. NPA board met on Tuesday (25 April) to discuss the Pharmacy Contraception Service and the board decided that - with the community pharmacy sector at breaking point - it cannot support the immediate roll out of this service. The association believes that with no new funding for the service, and all existing funds in effect already allocated to other pharmacy activity, any payments to the sector for delivery of the oral contraception service will ultimately be clawed back by NHS England. Tweeting after the meeting yesterday, the NPA said: "We can't tell pharmacy owners what they can and can't do. But we can tell them the facts; fact number one is that with no new funding currently available everyone will be a loser from the implementation of this service on the current terms." NPA Vice-Chair Jay Badenhorst added: "We cannot be expected to take on more and more services without the increase in funding necessary to deliver them effectively. Meanwhile, taking on additional work when current workload already exceeds capacity risks impacting negatively on the overall quality of care people experience in pharmacies. We still believe this could, in future, be a great new pharmacy service, but not without the extra funding necessary to deliver it safely and effectively. We want to offer women this extra support, but if it's worth doing it's worth doing properly."

The English health secretary has fumbled the opportunity to prevent a crisis in the NHS this winter. She either does not understand or value the role of community pharmacy as the third pillar of patient access to essential healthcare. Her announcement that she wants community pharmacy to provide more services to take the strain off A&E departments and GP surgeries comes on the same day DHSC announces no new long-term investment to sustain the sector. Does she not understand that as a result of years of government underinvestment in England the network is in decline with random closures across the country? Too many pharmacies are temporarily closed every day due to workforce shortages beyond the control of pharmacy owners. Adding a new service here and there, even with some additional funding, does not address the longer term viability of the network which needs to know which patient services it will be expected to provide over the next 10 years - not just the next few months - and how those will be adequately remunerated. Asking more from our sector with no new investment is a strategy which is bound to fail. The pharmacy contract remains economically illiterate. The sector's finances need open heart surgery not a couple of paracetamol tablets.