NHS Nottingham City Local Enhanced Service for community pharmacies to provide Emergency Hormonal Contraception Service via a Patient Group Direction

This Locally Enhanced Service (LES) agreement for community pharmacies is supplementary to the Community Pharmacy Contractual Framework (2005) and is not intended to replace any part of it.

The need for provision of a service fits within national targets (e.g. Selbie Six, Choosing Health) and local targets (e.g. NHSNottinghamCity local delivery plan). Teenage Sexual Health leads in local government also support the need for a robust commissioned service.

  • Reducing the under-18 conception rate by 50% by 2010 is a Department of Health and Department for Education and Skills Public Service Agreement.
  • The Local Delivery Plan (LDP) states as one of its targets a reduction in the under-18 conception rate per 1,000 population from the 1998 baseline figure of 74.7/1000 population to 33.6/1000 population in 2010.
  • Choosing Health Through Pharmacy - A programme for Pharmaceutical Public Health, published in April 2005 encourages PCTs to consider commissioning sexual health services through pharmacy, including access to EHC, condoms and signposting to appropriate sources of advice and support, particularly in disadvantaged areas
  • Wards with high rates of teenage conception and termination of pregnancy within NHSNottinghamCity have been identified.
  • Levonelle 1500- a progestogen post-coital contraceptive (PCC) or Emergency Hormonal Contraceptive (EHC) containing Levonorgestrel will be provided on a Patient Group Direction (PGD) by trained community pharmacists in nominated NHS Nottingham City pharmacies.
  • Timely access to Levonelle 1500 is key to its potential success. One recent study showed that for the sample population clients accessed pharmacy services more promptly than Contraception and Sexual Health (CASH) services, increasing the likelihood of a successful treatment.

1.Aims and intended service outcomes

  • To increase the knowledge, especially among young people, of the availability of emergency contraception and contraception from pharmacies.
  • To improve access to emergency contraception and sexual health advice.
  • To increase the appropriate use of Levonelle 1500by women aged 14-24 years that have had unprotected sex and help contribute to a reduction in the number of unplanned pregnancies in the client group.
  • To refer clients, especially those from hard to reach groups, into mainstream contraceptive services.
  • To increase the knowledge of risks associated with STIs.
  • To refer clients who may have been at risk of STIs to an appropriate service.
  • To strengthen the local network of contraceptive and sexual health services to help ensure easy and swift access to advice.

2.Service Specification

  • Pharmacists will supply Levonorgestrel Emergency Hormonal Contraception when appropriate to clients in line with the requirements of the NHS Nottingham City Patient Group Direction (PGD). The PGD specifies that clients from 14 years of age are eligible to receive treatment.
  • Pharmacies will offer a user-friendly, non-judgmental, client-centred, confidential service.
  • The supply will be made free of charge at NHS expense to clients aged 14 to 24 years inclusive.
  • Pharmacists will link into existing networks for community contraceptive services (e.g. CASH) so that women who need to see a GP can be referred on rapidly.
  • Clients excluded from the PGD criteria will be signposted to another local service that will be able to assist them, as soon as possible, e.g. GP, CASH, or the Walk-In Centreor will be invited to purchase the P (pharmacy-only) product if the exclusion from supply via the PGD is only due to an administrative matter, e.g. the age range determined by the NHS Nottingham City.
  • The pharmacy will provide support and advice to clients accessing the service, including advice on the avoidance of pregnancy and sexually transmitted infections (STIs)through safer sex and condom use, advice on the use of regular contraceptive methods and provide onward signposting to services that provide long-term contraceptive methods and diagnosis and management of STIs.
  • The consultation room used for provision of the service must provide a sufficient level of privacy and safety and be accredited by the PCT as being in line with the MUR specification.
  • The accredited pharmacist will assess the need and suitability for a client to receive EHC, in line with the PGD. Where appropriate a supply will be made; where a supply of EHC is not appropriate, advice and referral to another source of assistance, if appropriate, will be provided.
  • Clients who have exceeded the time limit for EHC will be informed about the possibility of use of an IUD and should be referred to a local service as soon as possible.
  • The pharmacist will apply inclusion and exclusion criteria during provision of the service. These criteria are detailed in the PGD.
  • The pharmacy service will be provided in compliance with Fraser guidance[1] and Department of Health guidance on confidential sexual health advice and treatment for young people aged less than 16 years[2].
  • National guidance on child protection is available at Local guidance on child protection is available at andfamilies/childprotection.nscb.htm. Local guidance on protection of vulnerable adults is available at Pharmacists participating in the scheme will be expected to adhere/ comply with local child protection guidance.
  • The pharmacist will provide verbal and written advice on the avoidance of STIs and the use of regular contraceptive methods, including advice on the use of condoms, to the client. This should be supplemented by signposting to a service (e.g. CASH) that can provide treatment and further advice and care.
  • The only person who will provide the service will be the accredited pharmacist who will be appropriately trained in the operation of the service, including sensitive, client centred communication skills.
  • The pharmacist providing the service will be required to attend all relevant training provided by the PCT (usually on an annual basis).
  • The pharmacist contractor has a duty to ensure that other pharmacists (e.g. locums) and staff involved in the provision of the service are aware of local protocols.
  • The pharmacy must maintain appropriate records to ensure effective ongoing service delivery and audit. Records will be confidential and should be stored securely and for a length of time in line with local NHS record retention policies.
  • The PCT will provide a framework for the recording of relevant service information for the purposes of audit and the claiming of payment. Records of provision of EHC (EHC1) will be submitted to the PCT by the 5th of each month along with their payment claim form (EHC2).
  • Pharmacists may need to share relevant information with other health care professionals and agencies, in line with locally determined confidentiality arrangements, including, where appropriate, the need for the permission of the client to share the information
  • The PCT will provide an EHC Resource pack containing up to date details of other services, which the pharmacy can use to refer service users who require further assistance.
  • The PCT will provide health promotion material, including leaflets on EHC, long-term contraception and STIs to pharmacies via the EHC Resource pack.
  • The PCT will promote the service locally, including the development of publicity materials, which pharmacies can use to promote the service to the public.
  • The pharmacist must have completed the Centre for Postgraduate Education (CPPE) Open Learning Programme “Emergency Hormonal Contraception” (booking reference 36456) prior to initiating the service. On completion of this pack a copy of the certificate must be forwarded to Sam Travis, Nottingham City PCT, 1 Standard Court, Park Row, Nottingham, NG1 6GN.
  1. Quality Indicators

All participating pharmacies are expected to operate within the following quality indicators and to provide evidence as such.

  • The pharmacy has the appropriate PCT provided health promotion material available for the client group. Actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate.
  • The pharmacy must review its standard operating procedures and the referral pathways for the service on an annual basis.
  • The pharmacy must participate in an annual PCT organised audit of service provision if asked to do so.
  • The pharmacy must agree to co-operate with any locally agreed PCT led assessment of service user experience if asked to do so.
  • Pharmacists and appropriate support staff must attend a PCTorganised update meeting each year if asked to do so.

4.Contractual and Payment Arrangements

  • This agreement will commence from 1st April2010 to run until March 2012. The PGD will be reviewed in September 2011.
  • NHSNottinghamCity or the pharmacy contractor shall give two months’ notice in writing for any agreed changes to the service agreement or termination of the agreement.
  • NHSNottinghamCity reserves the right to immediately suspend this agreement should the provider be found to be in serious breach of the service agreement. The notification will be made in writing.
  • Claim forms should be sent to:

Marilyn Longstaff

NHSNottinghamCity

1 Standard Court

Park Row

Nottingham

NG1 6GN

  • Community pharmacists will be paid on a fee basis for this service.
  • Fee per visit will be £6.00 reimbursement for the provision of Levonelle 1500 plus £11.33 consultation fee.
  • For disputes and operational problems regarding the provision of the service, the PCT will seek to resolve through a standard dispute resolution agreed with the LPC.

5.Monitoring and Review

  • Records of pharmacy activity will be reviewed by financial and professional audit by officers working for NHSNottinghamCity.
  • There may be a random visit to a pharmacy by a representative of the PCT to check the quality of the service being provided to the EHC clients.
  • Adverse incident reports and complaints on service standards from clients shall result in discussion with the individual pharmacist concerned. These reports will be integrated into NHSNottinghamCity’s Incident Reporting Mechanism and Complaints Procedure.

6.Additional Information

CPPE training which may support this service:
Emergency Hormonal Contraception Workshop
Sexual Health: testing and treating Open Learning Pack
Sexual Health: testing and treating Workshop
Contraception Open Learning Pack
Child Protection: a guide for the pharmacy team Open Learning Pack
You may wish to voluntarily undertake this training if you have not already done so. It is recommended, but not compulsory to the provision of the service.
  1. Parties and Signatories to this agreement

Commissioner for NHSNottinghamCity

Signature:

Name:Samantha Travis, Senior Pharmacist – Clinical Governance Lead

Date: 29/04/2010

PCT Representative:

Signature:

Name:

Date:

Community Pharmacy Contractor:

For and behalf of:

[Name and address of Community Pharmacy]

Signature

Name:

Date:

Caroline Badder

Medicines Management Project Co-ordinator

April 2010

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[1] Fraser Guidelines – based on a House of Lords Ruling; A health professional can give advice or treatment to a person under 16 without parental consent providing they are satisfied that;

  • The young person will understand the advice;
  • The young person cannot be persuaded to tell his or her parents or allow the doctor to tell them that they are seeking contraceptive advice;
  • The young person is likely to begin or continue having unprotected sex with or without contraceptive treatment; and
  • The young person's physical or mental health is likely to suffer unless he or she receives contraceptive advice or treatment.

[2] Guidance available at