Homecare Standards Handbook Appendices

This was published when the organisation was the Royal Pharmaceutical Society.

• Appendix 1 – National Homecare Patients’ Charter ★★
• Appendix 2 – Patient information for Homecare Services Guidance (PDF) ★★★ (NHMC) Note: GDPR update 2019
• Appendix 2a – General Homecare Service Information for Patients – Template (Word document) ★★★ (NHMC)
• Appendix 2b – How can I make a complaint or report an incident – Example patient leaflet (Word document) ★ (NHMC)
• Appendix 2c – Service Specific Information for Homecare Patients – Template (Word document) ★★★ (NHMC)
• Appendix 3 – Example therapy-specific patient leaflet ★★ (BUPA Home Healthcare)
• Appendix 4a – Patient registration form Guidance (PDF) ★★★ (NHMC)
• Appendix 4a – Patient registration form (Word document) ★★★ (NHMC)
• Appendix 4b – Patient change request form ★★★ (NHMC)
• Appendix 4c – Patient Information Record Form Guidance (PDF) ★★★ (NHMC)
• Appendix 4c – Patient Information Record Form (Word document) ★★★ (NHMC)
• Appendix 4d – Patient registration form Administration Supplement Guidance (optional for Clinical Referring Centre use) (PDF) ★★★ (NHMC)
• Appendix 4d – Patient registration form  Administration Supplement (optional) (Word document) ★★★ (NHMC) 
• Appendix 4e – Guidance for Use of the Homecare Prescription Templates (PDF) ★★★ (NHMC)
• Appendix 4e(i) – Homecare prescription form standard template (Word document) ★★★ (NHMC)
• Appendix 4e(ii) – Homecare prescription form complex initiation dose template (Word document) ★★★ (NHMC)
• Appendix 5  – Homecare Patient Satisfaction Survey Guidance (PDF) ★★★ (NHMC)
• Appendix 5a  – Template Homecare Patient Satisfaction Questionnaire (English) (Word document) ★★★ (NHMC)
• Appendix 5b  – Template Homecare Patient Satisfaction Questionnaire (Welsh) (Word document) ★★★ (NHMC)
• Appendix 6 – Example patient pathway for outpatient parenteral antimicrobial therapy ★★ (BUPA Home Healthcare) 
• Appendix 7 – Home suitability and needs assessment checklist ★★ (NHMC)
• Appendix 8  – Example of a simplified Homecare Suitability and Needs Assessment ★★ (NHMC) 
• Appendix 9  – Example technical agreement ★★ (North East Pharmacy Procurement Group)  
• Appendix 10 – National KPI definitions V6 approved 10/12/19 ★★★ (DH Commercial Medicines Unit)
• Appendix 10a – Key Performance Indicators Guidance v7 ★★★ (NHMC)
• Appendix 10b – NHMC Homecare KPI v7.0.1 (spreadsheet) ★★★ (NHMC)
• Appendix 11 – Example product quality assessment for an unlicensed compounded antibiotic ★ (Quality Control North West) 
• Appendix 12 Guidance for Transfer of Patients between Homecare Providers within an Existing Homecare Service ★★ (NHMC)
• Appendix 13 – Homecare Policy ★ (University College London Hospitals NHS Trust)
• Appendix 14 – Use of pharmacy IT systems to support homecare services ★★ (DH Homecare Strategy Board) 
• Appendix 15a – Output Based Specification: System-wide Delivery of Medicines in Homecare V10 approved 14 Sept 21 ★★★ (NHMC)
• Appendix 15b – Technical Specification: System-wide Delivery of Medicines in Homecare ★ (DH Homecare Strategy Board).  This technical specification reflects v1 of the output based specification and is currently under review and being updated in line with the updated Output Based Specification Appendix 15a.
• Appendix 16 – Example job description Homecare Pharmacist ★★ (Royal Wolverhampton Hospitals Foundation Trust) 
• Appendix 17 – Example job description Homecare Pharmacy Technician ★ (Leeds Teaching Hospital NHS Trust) 
• Appendix 18 – Example job description Homecare Medicines Administrator ★ (Chelsea and Westminster Healthcare NHS Foundation Trust)
• Appendix 19 – Further guidance on managing complaints and incidents within homecare services ★★★
• Appendix 20a – Template patient complaint and incident form (homecare organisation) ★★★ (NHMC)
• Appendix 20b – Template complaint and incident form (patient self-reporting) ★★★ (NHMC)
• Appendix 20c – Template for acknowledgement for complaints and incidents ★★ (NHMC)
• Appendix 20d – Template for response to complaints and incidents ★★★ (NHMC)
• Appendix 21 – AIC reporting template ★★★ (AIC)
• Appendix 22 – Homecare complaint and incident codes master list ★★ (NHMC)
• Appendix 23 – Maintaining “the Cold Chain” in patients’ homes – Guidance for temperature control, storage & handling of homecare medicines by patients  ★★★ (NHMC)

★★★ Documents approved for national use by multidisciplinary bodies after wide consultation and are being kept up-to-date and are subject to change control.

★★ Examples from existing homecare services which are consistent with the best practices described in the RPS Professional Standards for Homecare Services and this handbook.

★ Example documents developed and used locally by homecare teams. Considered to be useful, but need to be reviewed carefully and adapted before use. They are likely to have been prepared prior to the publication of the RPS Professional Standards.

It is expected that nationally approved documents (marked ★★★ in the handbook) will be used wherever they are appropriate to the homecare service being provided. The remaining documents have been shared with the permission of the originating organisation or NHS Trusts as useful examples and templates for you to adapt to support your own homecare services.