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NHSE announces pharmacies can dispense COVID-19 antivirals from April

NHS England (NHSE) has published guidance for a COVID-19 treatment service that will enable community pharmacies to dispense antiviral medicines from April 2023.

Pharmacists in England cannot currently dispense antiviral COVID-19 medicines to patients.

In December last year, COVID medicine delivery units (CMDUs) were set up to provide access to therapeutics for non-hospitalised patients at highest risk – currently around 1.8 million potentially eligible patients – on an interim basis.

But now, integrated care boards (ICBs) will commission community pharmacies – as well as hospital pharmacies – to dispense oral COVID-19 antiviral medicines, NHSE wrote in a guidance document published yesterday (December 22).

NHSE said: “As the NHS moves from a pandemic to an endemic response to COVID-19 infections, ICBs will be at the forefront of providing timely access to COVID-19 therapeutics to their local populations.

“As part of that transition, we expect ICBs to support access to existing COVID-19 therapeutics, as well as new therapeutics as they become available.”

Read more: MHRA approves second Pfizer/BioNTech COVID-19 booster vaccine

"Routine” primary care service “preferred route”


“This framework is intended to assist ICBs in establishing and maintaining timely access to COVID-19 therapeutics during the remainder of 2022/23 in preparation for routine provision from April 2023,” it added.

NHSE’s ambition is “for access to COVID-19 therapeutics to become part of routine services, with the long-term preferred route of access through primary care and integrated urgent care”, it said.

It added that the service will need to “enable oral antiviral medicines to be dispensed by local community pharmacy and/or hospital pharmacy”, as well as providing “any service necessary to meet any newly-approved treatment types” such as intramuscular injections.

Read more: Which Boots, Well and Day Lewis branches are offering COVID-19 booster jabs?


Dispense antivirals “as soon as possible”


Community pharmacies should be prepared to “dispense and deliver oral antiviral medicines as soon as possible after receipt of prescription to meet the window of treatment efficacy”, NHSE said.

Most COVID-19 treatments currently approved for use in England “should be started within five days of symptom onset”, so services should have on-call clinical arrangements to enable “dispensing over the weekend, out of hours and during bank holidays”, it added.

Pharmacy teams should also ensure they are able to “dispense oral antivirals as required to eligible patients or for collection by a patient representative”.

Pharmacists should also give patients “verbal advice and patient information leaflets for oral antiviral treatments” when they dispense the medication, it said.

ICBs will be required to have “robust plans” in place to manage surges in demand for COVID-19 treatment services, that will “enable increases in service capacity” and result in “limited impact on routine NHS activities”.

Those eligible to receive oral antiviral treatments through the new service will include:

  • “Non-hospitalised ‘highest’ risk patients with COVID-19”;
  • Those “eligible for treatment following the outcomes of the PANORAMIC study and any other relevant information”;
  • “Patients potentially eligible for any new therapeutics that may be approved for use in England”; and
  • “Wider patient cohorts identified in the event of a surge in COVID-19 infections, vaccine escape or emergence of a variant of concern”.

However, eligibility will be determined nationally by the UK chief medical officers, NHSE said.

Read more: Everything pharmacy teams need to know about integrated care systems

Requirements and assurances


NHSE will require ICBs to submit “a high level bi-monthly report”, to show that “potentially eligible” patients “continue to have timely access to assessment and treatment” and to update NHSE on their progress in transitioning “out of pandemic-specific arrangements to more routine and local access for patients in the longer-term from April 2023”.

It also noted that there may be “may be local variation in service delivery”, so different healthcare professionals might end up providing each element of the service.

Therefore, all healthcare professionals involved in its provision should “understand their role in the triage, assessment, monitoring and treatment of patients” and be familiar with available COVID-19 therapeutic treatments and patient eligibility criteria.

They should also undertake available training and “regularly” maintain and update their clinical competencies for assessment and prescribing “as new treatments are made available”, NHSE said.

They should “understand how to access support for clinical decision making…including when and where to refer eligible patients into other services for assessment or treatment with COVID-19 therapeutics”, it added.

C+D reported in January that "selected" pharmacies in the Greater Glasgow and Clyde area had been involved with providing the treatment to eligible infected patients since December last year.

A circular published by the Scottish government in January revealed that community pharmacies in Scotland would be paid £45 per item to dispense the COVID-19 antiviral molnupiravir to eligible patients.

Read more: What is community pharmacy’s place in integrated care systems?

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