GUIDE TO PRESCRIPTION ENDORSEMENT OXYGEN In order to supply an oxygen service to NHS patients, a pharmacy contractor must apply to the NHS Board. Each NHS Board is charged with assessing the needs of its area and determining the level of provision required. The Board will therefore decide with the help of its Pharmacy Practice Committee whether to grant an oxygen contract to an applicant. The arrangements for the provision of Domiciliary Oxygen in Scotland, is set out in Part 10 of the Scottish Drug Tariff. It gives details of the oxygen equipment which may be supplied on loan to NHS patients. It also sets out payments for the gas, set rental, non-returnable equipment, professional fees, delivery allowances, urgent fees and on cost. However, the remuneration for the service is negotiated locally. This has given rise to some variation in payments between NHS Board areas. It is therefore important that you check your local arrangements and payments carefully. The procedure is as follows: There are several payments for oxygen: Gas (dependent on the size and type of cylinder) Only the cylinders listed in the DT P10 are allowed. Non-Returnable equipment paid as DT Set Rental Not paid in all areas Professional Fees Vary form Board to Board Delivery Allowances Vary from Board to Board Urgent Fees Vary from Board to Board On Cost Not paid in all areas

Set Rental Claims for set rental are made on the GP34 (yellow) form. The Oxygen Rental section is located in the bottom righthand corner of the GP34 form under the heading Oxygen Rental. The number of authorised sets held and the number of sets on loan are required, e.g. authorised sets = 10, sets on loan = 7. These figures should be completed for the Second Half Month submission for 2 part submissions and Full Month for Whole submissions. Please note that not all NHS Boards pay rental.

Professional Fees Part 10 of the Scottish Drug Tariff sets out the basis of payments of professional fees. When a doctor orders on one prescription for more than 3x1360 litres cylinders of oxygen and when the prescribed cylinders are collected from the pharmacist by or on behalf of a patient, the professional fee will be claimable on the basis of one fee: a) for every 3 cylinders (or balance of an order in excess of a multiple of 3 cylinders); or b) for the actual number of visits to the pharmacist by the collector whichever is the less. When cylinders are delivered to the patient the professional fees will be claimable on the basis of one fee:

c) d)

for every 3 cylinders (or balance of an order in excess of a multiple of 3 cylinders); or for the actual number of delivery journeys undertaken whichever is less. The actual fees payable are negotiated locally. NOTE: If a pharmacist chooses to deliver cylinders to the patient singly (or less than 3 at a time) professional fees will still be paid on the basis of one fee per 3 cylinders prescribed unless the prescriber has specified instalment delivery or has stated ‘as required’.

Supply of Sets and Cylinders General Advice • Oxygen Sets (Giving Sets) PSD regards a ‘set’ as a cylinder head, two Ventimasks and 150cm of tubing. The fee for the supply of sets and cylinders is greater than that for supplying only cylinders. PSD will only pay for oxygen sets when these have been prescribed by the GP. Endorsements for headsets, masks or tubing will be ignored if only cylinders are prescribed. If you decide that Ventimasks are not appropriate the Prescriber must state which alternative approved mask or nasal canula is to be supplied. (For cylinders with integral headsets –see below) • Cylinders Only those cylinders listed in The DT Part 10 are allowed on NHS prescription. These are: Oxygen BP 1360 litre Oxygen BP 1360L

composite cylinder with integral headset to specification O2 (where available)

Portable Cylinders: Volume Name Maker Fitting Weight 460L DD BOC Integral 3.2Kg

Cost £20.52

A professional fee is generally paid for the following: Supply of Sets and cylinders 1. Supply of set and cylinders 2. Supply of replacement sets 3. Checking and remedying set malfunction Supply of Cylinders 1. Supply of cylinders when not in conjunction with set 2. Supply of replacement cylinders where original are found to be faulty 3. Supply of masks or nasal canula (when not in conjunction with set or cylinders) 4. Collection of set and cylinders at end of treatment 5. Ineffective journeys for supply of collection of set and cylinders Cylinders with integral head sets Cylinders with integral head sets are becoming more readily available. Prescriptions written for this type of cylinder are treated as cylinders only (not sets and cylinders) thus attracting the lower professional fee and delivery allowance. If the prescription is written for cylinder with integral headset and you cannot supply this type of cylinder, you may endorse that a standard 1360 litre cylinder with set has been supplied. Provided you endorse what you have supplied, PSD will process as endorsed on the GP10. Portable Oxygen Professional Fees are paid on the same basis as the 1360 cylinder.

Oxygen Deliveries General Advice When claiming delivery allowances for oxygen via PSD, a green delivery slip (form GP64A) must be submitted. (These instructions do not apply to contractors who claim their oxygen fees and allowances directly from their NHS Board) PLEASE NOTE: When using a GP64A in conjunction with a prescription form, the items claimed on the GP64A must match those that are claimed on the prescription form. If you are not delivering exactly the same items as prescribed, please endorse the prescription form with exactly what you are claiming on the GP64A. If the two forms do not match, PSD will not pay the delivery fees claimed on the GP64A. If the journey is in conjunction with a prescription form, it is imperative that the 11 digit serial number from the prescription form is entered correctly on the GP64A. Where possible a minimum of 3 cylinders should be delivered per journey unless instalment dispensing has been requested by prescriber.) e.g. 2 cylinders should be delivered with 1 journey. 8 cylinders should be delivered with 3 journeys - 3,3,2 10 cylinders should be delivered with 4 journeys - 3,3,3,1 Where more than 3 cylinders are delivered at a time, only the number of journeys undertaken can be claimed. Delivery of Sets & cylinders To claim fees for delivery of sets & cylinders, always ensure that you accurately transfer the 11-digit serial number from the prescription form onto the GP64A. The number of journeys , not sets (or cylinders), should be entered into the appropriate box(s) opposite the reason(s) for said journey(s). e.g. 1 set with 5 cylinders = 2 journeys, therefore 1 would be entered into the box opposite Supply set & cylinders and 1 would be entered into the box opposite Supply cylinders. Do not forget to complete the back of the GP64A by entering the dates and distance of journeys (one way). The purpose of each journey, in the example above:- Supply set & cylinders and Supply cylinders should both be indicated by X. Do not detail masks, nasal canulae or tubing when in conjunction with a set or cylinder. Delivery of Cylinders only If the prescription is for cylinders only, the GP64A should be completed in a similar manner to above; i.e. the 11 digit code from the prescription form must be transferred to the GP64A and the number of journeys, not the number of cylinders, should be entered along with the purpose of the journey. If more than 9 journeys are required for 1 prescription form a second GP64A must be used and must be linked to the prescription form by the 11 digit code. Delivery of Masks, Nasal Canulae and Tubing only If the prescription is for supply of masks, nasal canulae and tubing only, the GP64A should be completed in a similar manner to above; i.e. the 11 digit code from the prescription form must be transferred to the GP64A and the number of journeys, should be entered along with the purpose of the journey. e.g. 2 masks = 1 journey. Enter 1 in the box opposite Supply Masks nasal canula or tubing.

Replacement Set, Replacement Cylinders, Checking and Remedying Set Malfunction and Collection of Set & Cylinders at the end of Treatment. Where a journey has been necessary for any of the above reasons a GP64A must be completed. As there will be no Prescription form linked, the Prescription serial number on the GP64A should be left blank. The number of journeys should be entered in the appropriate box opposite the reason for said journey. e.g. collection of set & cylinders at end of treatment = 1 journey, therefore 1 would be entered into the box opposite Collection of set & cylinders at end of treatment. The back of the GP64A should be completed by entering the date and distance of the journey (one way) and the purpose of journey (Collection of set & cylinders at end of treatment) indicated by X.

Portable Oxygen A patient’s eligibility to receive portable oxygen is determined by assessment from an NHS respiratory physician. In order to provide portable oxygen, the oxygen contractor must establish a contract with the patient/patient’s representative. The oxygen contractor is allowed to hold up to 3 portable cylinders on the patient’s behalf, on the understanding that supply will be on a full for empty basis, and an obligation that the patient/patient’s representative will return the cylinders when no longer required. Fees and delivery allowances for portable oxygen cylinders are paid in the same manner as standard cylinders. For example: A prescription for 3 portable oxygen cylinders will attract one professional fee and one delivery allowance. If you intend/wish to deliver the cylinders singly the prescriber must specify instalment delivery on the prescription form. The only portable cylinder in the Drug Tariff is the DD 460L cylinder supplied by BOC. CD cylinders are not allowed. PD cylinders used to be in the DT and are useful in certain conditions where a variable or low flow rate is needed as they do not have an integral head set. At the time of writing PD cylinders are still being passed for payment by PSD but this may not continue. Please watch our web-site and monthly newsletters for current advice. Rental The portable cylinder rental, charged to you by your supplier, can be reclaimed from your NHS Board using the appropriate paperwork.

Locally Negotiated Fees Finally pleased remember that all Oxygen payments, other than the price of the gas have been negotiated locally between the Pharmacy Contractors Committee and your NHS Board. Please consult the members sectin of our website to see the current payment details for your area.

National Review of the Domiciliary Oxygen Service A national review of this service has taken place over the past year and the report is currently being finalized.

Contact Us If you have any problems or questions about the oxygen service please contact the ePharmacy Customer Service Helpdesk on 0131 275 6600 or email [email protected]. Alternatively, you can contact Community Pharmacy Scotland Contractor Services Department on 0131 466 3540 or email [email protected].