Publication approval reference: C0201

To: community pharmacies

4 April 2020

Dear community pharmacy colleagues

Information for community pharmacies to support health and justice (HJ) services and released detainees for COVID-19

This letter is to provide you with information about supporting people to access medicines who have been released from prisons and other prescribed places of detention for adults and children.

NHS England and NHS Improvement directly commission healthcare and pharmacy services within prisons, immigration removal centres and the children and young people secure estate, which includes young offender institutions for people under 18 years, secure training centres and secure children’s homes.

Information for pharmacies supplying medicines to HJ sites

1. There are significant reductions in healthcare and custodial staff and a high number of detainees in self-isolation in many HJ settings due to COVID-19. The healthcare and pharmacy teams are introducing new measures to make sure patients continue to receive their medicines on time and safely. This includes remote prescribing.
2. The HJ healthcare and pharmacy teams should be working together with the community pharmacies that provide contracted and urgent dispensing services for their detained patients. This means that measures being taken in both the community pharmacy and custodial setting support a continued service to the detained population. As advised for other pharmacy services, we encourage community pharmacies that provide dispensing services for detained patients to have a ‘buddy pharmacy’.

Information for all community pharmacies

1. Probation officers working for the National Probation Service, community rehabilitation companies’ teams and youth offending team workers from the Youth Offending Service prepare detainees for release to the community, as well as supervising and supporting them on their release. These key workers may contact pharmacies on behalf of a released person to ask advice about accessing medicines.
2. Usually, when detained people are released from custody, at least seven days of medicines or an FP10 or FP10MDA prescription is supplied to the patient or their carer (for young people). The impact of COVID-19 means that it is likely that more patients will leave custody without these and will require urgent supplies to prevent harm from missed doses. As these patients may not be registered with a GP or be able to access a timely prescription, all community pharmacies are:
   1. reminded that FP10 and FP10MDA prescriptions issued from HJ sites which have the practice address prefix ‘HMP’ are exempt from the prescription charge – see other reasons for exemption in this PSNC link
      Please note: If the necessary information is on the prescription, the patient is classed as automatically exempt and does not need to sign or tick the declaration on the back of the form. For people with no fixed address, the following advice in the Medicines Ethics and Practice advice can be used: ‘If the patient does not have a fixed address (eg because he or she is homeless or under a witness protection scheme), ‘no fixed abode’ or ‘NFA’ is acceptable. Use of a PO Box is not acceptable.’
   2. encouraged to use current regulatory and usual community pharmacy and COVID-19 mechanisms and services to supply urgent medicines to released patients to avoid harm.Contact the site’s healthcare team during office hours to confirm the medicines being requested. Switchboard telephone numbers for all HJ sites are available online using the Prison Finder page for prisons and young offender institutions or typing the site’s name into a search engine. Pharmacists can ask to speak with the healthcare team, who will direct you to the prescriber or HJ pharmacy lead. This team can also provide the contact details for the contracted HJ pharmacy, which will have records of dispensed medicines.
3. While in custody, people will have had all doses of methadone and buprenorphine administered under supervision by the healthcare team. On release, FP10MDAs are usually provided for access to doses until a supply is arranged via community substance misuse services. Continuation of supervision of doses or daily pick-ups will be needed for this vulnerable group. The prescriber should be contacted if the supervision cannot be provided. Note that if a detained person visits the pharmacy on the day they are released, they are likely to have had their dose of methadone or buprenorphine in the HJ site that day. Pharmacists can contact the healthcare team at the releasing site to confirm this before issuing the dose.
4. Released prisoners or children released from secure settings may be living in their own homes, in homeless hostels or approved premises. Those who are self-isolating should arrange for representatives to collect medicines from pharmacies on their behalf. NHS volunteers and other local volunteer services may be used to support delivery. More information can be found here. For controlled drugs, the prescription should be collected by an individual authorised by the patient to collect. Identification will be required. If there is any doubt about controlled drugs collection, the prescriber can be contacted to confirm that the person is in self-isolation, or the patient can be asked to contact the pharmacy by phone to confirm this.

We hope this information is useful and thank you for continuing to support our vulnerable patients with community pharmacy services.

Yours faithfully

Kate Davies CBE | Director Health & Justice, Armed Forces & SARCs | NHS England and NHS Improvement

Dr Keith Ridge CBE | Chief Pharmaceutical Officer for England | NHS England and NHS Improvement