Community Pharmacy Chlamydia Testing Service
Locally Enhanced Service
Steve Searby
Public Health Specialist
Public Health
Julia Bramble
Chlamydia Screening Co-ordinator
Public Health
Ruth Buchan
Community Pharmacy Facilitator
Medicines Management
Produced March 2008
For review March 2009
Contents
Section / Page NumberExecutive Summary / 2
1. Background / 2
2. Aims and intended service outcomes of the Service / 3
3. Service Description / 3
4. Resource implications / 4
5. Evaluation / 4
Locally Enhanced Service Agreement / 5
Schedule 1- The services / 10
- Purpose of the Agreement
- Duration of Agreement
- The Services
- Payment
- Termination of Agreement
- Health and Safety
- Training and Development
- Core Competencies
- Confidentiality
- Indemnity
- Complaints
- Incidents and Near Misses
- PCT Duties
11
11
15
16
16
17
17
18
18
18
18
19
19
20
Scheme Authorisation Form / 21
Appendices / 22
A – Screening Template / 22
B – Self Certificate / 24
C- Ethnicity coding / 25
Executive Summary
Background
Chlamydia is the most common bacterial STI in England and as many people are asymptomatic this has lead to a situation where there is an estimated 1 in 10 sexually active young people under 25 being infected. This has potentially serious consequences for the long term health of individuals which needs to be addressed.
A key element of the solution to this issue has been to undertake Chlamydia screening amongst 15-24 year olds and within Calderdale we have a target of 3504 screens by March 31st 2008. In December 2007 we are falling significantly short of this with a total number of screens for Calderdale at less than 300.
The aim of using community pharmacy is to boost this number of screens and help prevent similarly low take up in 2008/2009.
The aim is to target pharmacies currently providing an EHC service and where appropriate offer Chlamydia screening to those who access EHC. However, if we limit the screening activity to this population group we significantly limit opportunities to increase screening and raise awareness of STI’s and consequences. Therefore the proposal is to broaden the service to include any person (irrespective of age), and offer the service across any pharmacy interested in undertaking the work.
The key elements of the scheme are summarised below;
· People accessing the scheme will receive a brief consultation with a member of pharmacy staff to discuss the screening process, information regarding STI’s and where appropriate discuss EHC.
· People will then be provided with a sample jar for them to provide a urine sample which will be taken away by the client and returned to Pharmacy where it will be sent to for testing. This process to be negotiated between Chlamydia Screening Coordinator and Pharmacy at time of training.
At this point involvement from the pharmacy will end and results will be sent directly to the person and treatment if necessary, will be provided by the Chlamydia Screening Programme team.
The provision of screening in pharmacies has been used elsewhere to good effect and the development of Pharmacies as public health / health promotion deliverers is in keeping with essential services within the pharmacy contract.
The Pharmacies for this service will be selected on the basis of:
· Availability of a suitable consultation area (as defined for the Medicines Use Review service)
· Pharmacy able to provide the enhanced service during extended opening hours, including late openings, Saturdays and Sundays
· Proximity to a school or college.
· Pharmacy provides the Emergency Hormonal Contraception Service
· Pharmacy is in a position to provide, or providing all the essential services to a satisfactory level as identified by the PCT contract-monitoring visit
Aims and intended service outcomes of the Service
To reduce the pool of undiagnosed, untreated genital C. trachomatis infection in young sexually active men and women aged 15 to 24 by offering urine testing for genital C. trachomatis infection.
To improve choice, convenience and access to chlamydia tests for sexually active men and women.
To provide an opportunity to promote good sexual health information and advice, including referral to other health care professionals and information on related services such as Emergency Hormonal Contraceptive service and C-card.
Links with Strategic plans and other services
· National Strategy for sexual health and HIV
· Best Practice Guidance for Doctors and other Health Professionals on the provision of advice and treatment to young people under 16 on contraception, sexual health and reproductive health.
· Teenage pregnancy; accelerating the Strategy to 2010
· Teenage pregnancy strategy action plan for Calderdale
Service description
The screening service is available and promoted to young people aged 15 - 24 who present to a participating registered community pharmacy in Calderdale. Pharmacy staff will offer kits to young people with advice, and ask individuals to supply urine sample in pot provided within the kit and return this to the pharmacy.
Although the service is not primarily aimed at the over 24’s age group, individuals requesting screening will still be eligible and pharmacies will receive payment for undertaking this work. Pharmacy staff will provide kits and advice to this population who self request a Chlamydia screen and ask individuals to supply urine sample in pot provided within the kit and return this to the pharmacy.
The pharmacy will provide sexual health information and give appropriate advice or make referrals to individuals requesting Chlamydia screening.
Notification of test results and treatment will be provided by the Chlamydia Screening Programme team (CHLASP).
Resource implications
Pharmacies will be paid one £5 fee for each completed Chlamydia screen. This will apply to all clients accessing the service.
Evaluation
The service will be annually reviewed with feedback to the LPC/PCT and any other stakeholder PCT groups using the following criteria:
§ Number of Chlamydia screens undertaken through community pharmacy referral vs. usual access routes
§ Number of Chlamydia screens issued at the pharmacy that are not returned
§ Demographics of clients screened
§ Trends in numbers accessing the service from through each pharmacy
§ Costs of service
§ Evaluation of client questionnaire
§ Number of positive screens in this route compared to other venues
§
Locally Enhanced Service Agreement
Agreement for services
Chlamydia Screening Service
Between Calderdale Primary Care Trust (we/us/our/the commissioner)
And The Community Pharmacy (you/your/the provider)
Services covered: CHLAMYDIA SCREENING SERVICE
INTERPRETATION
In this NHS Locally Enhanced Service Agreement for the provision of services from The Provider the following definitions apply:
· Calderdale PCT means Calderdale Primary Care Trust, Dean Clough Mill, 4th Floor, F Mill, Calderdale HX3 5AX and is inclusive of its employees, partners and voluntary workers.
· The Provider means the community pharmacy as named on the Authorisation and is inclusive of its employees, sub-contractors, associates, secondees, partners and voluntary workers.
· Calderdale PCT is the commissioner of services.
· The Provider is the provider of services
· LES means Locally Enhanced Service Agreement including all written specifications and appendices.
· The services mean the services and goods that The Provider is required to supply, as stated in the service specification of the LES.
· In addition to the specific terms and conditions set out below, this LES is governed by the general terms and conditions, quality specifications, arrangements for contract management and monitoring procedures for pricing payment, which has been established by the Department of Health.
· The headings to the conditions in this LES shall not affect their interpretation.
DURATION OF AGREEMENT
This agreement shall commence on the date the authorisation signed by both parties and shall continue until 31 March 2009.
POINTS OF CONTACT
The following are responsible for the LES with nominated leads who will act as key managers and will be the initial point of contact on any aspect of this agreement:
For the commissionerFor queries on the content of this LES / Name: Judith Salter (temporary)
Position: Sexual Health Services Commissioner
Address: Calderdale Primary Care Trust,
4th Floor, F Mill, Dean Clough
Tel: 01422 281300
For general and operational queries regarding the scheme / Name: Julia Bramble
Position: Chlamydia Screening Programme Coordinator
Direct line: 01484 344279
Email:
For the provider / As stated in the Authorisation
It is agreed as follows
1. Pharmacy Services
1.1 You are engaged by us to provide services as described in the schedule hereto (the services see schedule 1 and associated appendices) and you agree to provide such services upon the terms and conditions set out below.
1.2 For the purposes of this agreement and in the provision of these services you will be responsible to ADD COMMISSIONER TITLE of Calderdale Primary Care Trust
1.3 We undertake to provide training to staff provided by you to undertake this service, as we deem appropriate.
2. Duration
2.1 This agreement shall commence on the date the authorisation is signed by both parties and shall continue except as provided for below;
2.2 The agreement is subject to review by the Service Commissioner
2.3 The agreement will be reauthorised every financial year.
3. Pharmaceutical services
3.1 You are retained on a non-exclusive basis to provide the services as reasonably required by us
3.2 Throughout the term you shall perform the services to the best of your knowledge power and ability and shall act in and use all reasonable endeavours to promote our interests and shall give us all information and assistance as we may reasonably require in connection with the provision of the services
3.3 No party shall assign transfer charge or deal in any other similar manner with this agreement or its rights or any part of them under this agreement, nor subcontract any or all of its obligations under this agreement without the prior written consent of the other party
3.4 Nothing in this agreement shall be construed as or having effect as constituting the relationship of employer and employee between us and you or staff provided by you.
4. Fees and expenses
4.1 We shall pay to you;
A fee of £5 is payable per completed screen. The payments may be subject to revision dependant on any changes in fees following negotiations between the LPC and PCT.
4.2 Any subsequent payments to employee pharmacists are a matter for agreement between the contractor and the employee
5. Termination
5.1 Notwithstanding the provisions of clause 2 of this agreement, either party may terminate the agreement subject to providing one month’s notice in writing
5.2 Notwithstanding the provisions of clause 2 or sub clause 5.1 of this agreement, we shall be entitled (without prejudice to our rights and remedies for any breach of this agreement and without prejudice to any continuing obligations you have under this agreement) to terminate this agreement immediately if you seriously breach the terms of this agreement including by any act or omission which prejudicially affects or is likely so to affect our interests.
5.3 For the avoidance of doubt and without prejudice to any other reason for invoking sub clause 5.2 any breach of sub clause 6.1 would constitute a serious breach of the terms of this agreement and constitute grounds for immediate termination of the agreement.
5.4 Upon termination of this agreement for whatever reason you shall deliver to us all books documents papers memoranda notes records (including any contained in magnetic media or other forms of computer storage) and any other property and materials relating to our business which may be in your power or control. The ownership of all such property shall at all times be vested in us.
6 Confidential information
6.1 You agree to treat as confidential and restrict access to records and documents containing information relating to individual clients treated under the terms of this LES to personnel authorised to participate in the service and, in the appropriate circumstances, other health care professionals and agencies, in line with local confidentiality arrangements, including where appropriate, the need for the permission of the client to share the information. All parties will comply with the Data Protection Act, Caldicott and other legislation covering access to confidential client information. The requirement for confidentiality will be balanced with the needs of the service user. Other than the above circumstances you agree to treat as confidential and not disclose to any person or otherwise make use of or permit to be made use of the following information gained as result of providing this service,
6.1.1 Any information relating to the health records of any client
6.2 This restriction shall continue to apply after the termination of this agreement without limit in time but will cease to apply to information which may come into the public domain otherwise than through unauthorised disclosure by you
6.3 You shall not be prevented by clause 6 and its sub clauses from using any general knowledge experience or skill gained through the provision of these services
6.4 The restrictions of this agreement shall not apply to any disclosure or use authorised by us in writing or required by law or by this agreement.
7 Restrictive covenants
7.1 You agree that throughout the term of this agreement services will only be provided by a registered pharmaceutical chemist trained by us, and following the Royal Pharmaceutical Society of Great Britain’s Code of Ethics and Professional Standards as published in the current edition of Medicines, Ethics & Practice, Code of Ethics and Professional Standards and Guidance Documents or as amended provided such amendments have been published or notified in the Pharmaceutical Journal
7.2 You agree to provide evidence to us that the services provided by you under this agreement are covered by adequate professional indemnity arrangements
7.3 You agree that in providing the services you will produce and follow only the Standard Operating Procedures written by you that correspond to the procedures outlined by us and not deviate from them and use only the documentation provided by us
7.4 You agree that in the event that through providing these services you become aware of any possible fraudulent activity poor practice or professional misconduct on the part of an independent contractor their employees or agents or any employee of Calderdale Primary Care Trust you will communicate your concerns within one working day to the service co-ordinator or, as needs be, the Head of Clinical Governance and Clinical Risk.