Have you ever wondered what those four letters mean and the importance surrounding them? ‘Discussing Stupid Questions and Suggestions’? No, for once this doesn’t relate to PCSE! I have to admit to not remembering whether these letters were even uttered at my practice manager interview but then I have been a PM for a while, got the required T-shirt more than once and erm… I have a large passion for gin so I’m not surprised by the memory loss!

DSQS… Dispensing Services Quality Scheme

I admit it gave me nightmares and it probably still does for most dispensing PMs at one time or another during the year. I guessed it had something to do with dispensing but that was about it. I remember it came as a bit of a shock when the guidance was plonked on my overflowing desk with a mumble about looking on the internet for some idea. All I found were very limited resources that didn’t really help a new PM through the inevitable pain of learning something completely alien in a totally foreign language. So, what is there? Well, grab a large gin, read on and I’ll enlighten you.

The shortish version

The DSQS came into effect in September 2006 as part of the General Medical Services (GMS) change. The scheme is voluntary and rewards organisations for providing high-quality services to dispensing patients. Practices have to sign up annually, by 1^st July, via the CCG and provide the name of the GP in the practice who’s accountable for the quality of dispensing services. The delivery may well be delegated to a dispensary manager or practice manager but ultimately the buck stops with the accountable GP, so remember not to lumber Dr Laid Back Horizontal with the privilege.

Payment is based on the number of dispensing patients on your organisation’s list on 1^st January in the financial year to which the payment relates, as measured by the Open Exeter system. Dispensing patients are the patients for whom the organisation, or any practitioners working for them, have consent to dispense under the NHS (Pharmaceutical Services) Regulations 2005, or relevant sections of the GMS and PMS regulations. The payment hasn’t changed since its inception and remains at £2.58 per dispensing patient per financial year so depending on your list size, it’s not a bad little earner. However, you won’t be paid for simply wishing Mrs Jones a good morning every 28 days when she picks up her repeat meds. You will need to earn it.

You’ll be required to follow the extensive requirements set out in the DSQS Guidance around:

• Payment conditions
• Dispensing staff training and/or experience
• Minimum level of staff hours
• Duty of confidentiality
• Standard operating procedures and risk management
• Patient information
• Review with patients of compliance and concordance with use of medicines
• Audit
• Assessment of performance against the criteria for payment

All these requirements get tied up in key performance indicators that need to be met to achieve payment verification. This is usually done via the Medicines Management Team of the CCG who are required to review the organisation’s arrangements to ensure that the stated level of service is in place – if necessary, asking for written evidence and/or carrying out an organisational inspection before payment is agreed by the commissioning organisation.

It’s usual practice for organisations and CCGs to agree the appropriate key performance indicators, audits and required evidence sooner rather than later at the start of the year; however, don’t be surprised if you get to January and you still don’t know the topic of your audit for completion, submission and sign off by the end of March. In my experience this is a common occurrence, so be prepared to set some time aside at the busiest time of the primary care calendar to do this – along with just about everything else sacred to general practice at year end.

Submit all that has been (eventually) agreed as evidence that you have complied with the obligations and, hey presto, about three months later you get your financial delight… usually just in time for the partners’ carve-up. Me, cynical? Never!

Did I mention that was the short version? Well, now you need to put the gin down, set aside some time and look the ‘devil in the detail’ firmly in the face!

How Practice Index can help

We have produced a whole new suite of comprehensive SOPs, exclusively relating to the requirements of the DSQS and CQC regulatory inspections to help you learn about the processes you need to observe, the training required and to provide the aide-memoire that’s required to get you quickly through your dispensing KPIs when your list of tasks seems endless. The SOPs contain appendices providing pro forma templates and all are linked to applicable organisational policies where appropriate.

These include:

• The DSQS Handbook – providing a succinct overview of all the DSQS requirements
• SOP – Dispensary Audit – providing a comprehensive guide to the importance of audit, an overview of the audit requirements for both the DSQS and CQC, audit quality and examples of clinical audit relating to dispensing
• SOP – Dispensary Confidentiality Policy – providing a detailed guide to dispensing confidentiality processes and procedures, data protection and relevant General Data Protection Regulations (GDPR)
• SOP – Dispensary Management – providing an in-depth guide to prescription charges, patient exemptions and declarations, endorsing, the cold chain, financial management, staff training, joint working arrangements across Primary Care Networks and an overview of the inspection process and regular themes reported from organisations undergoing CQC inspections
• SOP – Dispensary Risk Management – providing a thorough guide to potential sources of risk in the dispensary, SOPs, health and safety regulations, security, appropriate record-keeping and financial risks
• SOP – Dispensing of Prescriptions – providing detailed guidance on dispensing both NHS and private prescriptions, selecting medications, preparing medications, packaging and labelling medications, checking medication and supplying medications to patients
• SOP – Medication Disposal – providing an overview of the requirements for the disposing and destruction of medications, receiving returned medications, duty of care, denaturing and waste exemption
• SOP – Near Miss and Significant Events Reporting – providing a comprehensive guide to acknowledging mistakes, the necessary actions to report all incidents, reducing the risk of recurrence, processes for reporting incidents to appropriate external agencies and reinforcing the principle that staff are required to share best practice
• SOP – Ordering and Storage of Medications – providing a detailed guide to the ordering of all NHS and private prescriptions including dressings, appliances and specials, suppliers of medicines and storage of medicines including refrigerated products
• SOP – Relationships with Pharmaceutical Companies – providing an overview of the role that the pharmaceutical industry has to play in aiding healthcare professionals in the provision of treatments that are safe and cost-effective. This SOP also provides a guide to the professional code of conduct that reps should adhere to
• SOP – Prescription Security – providing an in-depth guide to security processes, prescription logs, adequate safe storage of prescriptions, ordering of prescriptions, receipt of prescription forms, stolen/missing prescription processes, preventing the alteration of written prescriptions, disposing of obsolete prescription forms and audit of prescription security
• SOP – Provision of Information to Patient or Representative – providing detailed guidance on maintaining confidentiality, patient information leaflets, storage requirements and what information can and cannot be provided to the patient or representative

Whilst I can imagine that you’re incredibly excited right now… there’s even better news as, in addition to the above, there will soon be a further guidance document to support what the CQC expect to see in a dispensary.

So now you know the scale of the ask for your dosh!

However, all joking aside, I hope with the information provided above you’ll understand the complexities, anomalies and the requirements of the DSQS just a little bit more than you did before you started on your DSQS journey, and you won’t be too daunted to peek behind the dispensary door.

Good luck,

Michele Petrie