DRAFT for consultation
Needle Exchange Stock Control Proposed NEW System
Current Position
There are 21 sites offering needle exchange in Sheffield, of which 20 are pharmacy needle and syringe programmes and 1 is the specialist needle exchange.
Sheffield DACT purchases needle exchange (NEX) stock on behalf of all needle and syringe programmesin the city from an annual budget of £55,000 for all NEX stock.
Sheffield DACT is the owner of all stock, which means that the risk is carried by Sheffield City Council rather than individual providers. The benefit for Sheffield City Council is that there are economies of scale from bulk purchase. As owner of all stock, Sheffield City Council is able to re-direct stock in the event of shortages.
Individual exchanges are responsible for placing orders with Sheffield City Council (DACT) and for ensuring they carry sufficient stock of all items to comply with NICE Guidance. There is no set date for ordering or service standards around processing orders. Pharmacies do not routinely provide stock returns when they submit orders.
Stock is currently purchased from Exchange Supplies, but this contract for supply will be offered for procurement during 2014/15 – views on the specification from needle and syringe programme providers will be sought, including on issues such as range of stock and time taken to process orders.
Rationale for a NEW system
There are four reasons why a new stock system is being proposed:
Firstly, budgetary control: In the first 9 months of 2013/14 the NEX stock budget was forecast to overspend. Management action was taken to audit the available stock in the city, move this to meet need and prevent ordering of excess stock. As a result, the overall annual budget did not overspend. However, on 31st March 2014 £26,000 of stock was “in hand” at NSPs across the city suggesting services were “overstocked”. Further, out of date stock was disposed of which was unnecessary waste. While, it is not proposed to move to “just in time” ordering because of the clinical risk issues, it is proposed that a system is developed to avoid overstock.
Secondly, during 2014/15 Sheffield City Council will be going out to procurement for the supplier of needle exchange stock and therefore needs to be clear on what the stock needs are for the city.
Thirdly, in October 2014/15 the new Non-Opiates Service provider will become responsible for ordering and managing stock on behalf of all the city’s NEX programmes and therefore this is a lead in period for NEX providers to become accustomed to working together in a city-wide stock control system.
Finally, new clinical guidance has been issued by NICE (NSP52) and Sheffield City Council needs to ensure that all needle and syringe programmes are compliant in terms of stock carried.
Clinical Guidelines relating to NEX Stock
NICE Needle & Syringe Programme guidance (NICE NSP52 March 2014) has a number of recommendations which relate to the type and volume of stock that should be carried by needle and syringe programmes.
The Sheffield Actions required on NEX stock arising from NICE NSP 52 are that:
- all needle and syringe programmes should carry a full range of stock to meet the bespoke needs of all local users;
- there should be no limit to the amount given in a transaction;
- low dead space syringes (LDSS) should be made available through all needle and syringe programmes with advice regarding “flushing”;
- “nevershare” or similar stock should be made available to avoid accidental sharing
The specific NICE recommendations which relate to stock are:-
Recommendation 3
Increase the proportion of people who have more than 100% coverage (that is, the
number who have more than 1 sterile needle and syringe available for every
injection).
Ensure syringes and needles are available in a range of sizes and at a range of
locations throughout the area.
Offer, and encourage the use of, low dead-space injecting equipment.
Recommendation 6
Level 2: distribution of 'pick and mix' (bespoke) injecting equipment and referral to
specialist services plus health promotion advice. (This includes advice and
information on how to reduce the harms caused by injecting drugs.) Some level 2
services might also offer additional services, such as blood-borne virus testing or
vaccination.
Recommendation 7
Provide people who inject drugs with needles, syringes and other injecting equipment. The quantity provided should not be subject to a limit but, rather, should meet their needs. Where possible, make needles available in a range of lengths and gauges, provide syringes in a range of sizes and offer low dead-space equipment.
Encourage people who inject drugs to mark their syringes and other injecting equipment, or to use easily identifiable equipment, to reduce the risk of accidental sharing.
Recommendation10
Provide the equipment, information and advice needed to support [IPED] users.
Proposed new NEX stock order processing system
A set date is agreed for submitting monthly stock audit (3rd Friday of month).
A set date is agreed for submitting orders (3rd Friday of the month). This will be the ONLY order date in the month, so NEX providers will need to base their order on the amounts of each item given out in the previous month.
The audit/order must be submitted on the excel spreadsheet audit/order form by e-mail to nominated SCC/DACT staff by 12 noon on the 3rd Friday of the month.
On receipt of stock audit, Sheffield City Council will review all returns to ensure all pharmacies are compliant with NICE NSP52 guidance in terms of range of stock carried. Needle exchanges may be advised of the need to order additional stock items to be compliant.
Sheffield City Council will match stock and orders within 3 working days from receipt and confirm the final order placed and arrangements for collection of non-ordered stock.
Sheffield City Council will agree service standards with the current needle exchange stock supplier for time from order to delivery (aim is stock received by needle exchange 5 working days from order).
Consultation on new NEX stock order processing system:
There will be a brief (30 day) consultation on this proposed operational change. The consultation will include all current needle and syringe programme providers and the Local Pharmaceutical Committee. The consultation will end on 23rd May 2014. The proposal will be amended following consultation and the new system will be implemented on 2nd June 2014.
Implementation and first stock audit/order date:Friday 20th June 2014
Subsequent dates: Fridays18th July, 15th August, 19th September, 17th October. (From October – the new Non-Opiates Provider will assume responsibility for stock control and will liaise directly regarding the system to be used)
Consultation Responses by 23rd May 2014 to:
Flowchart: Proposed new NEX stock order processing system
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