OLPC A0901/04b


Oxfordshire Primary Care Trust

Drug Misuse Local EnhancedService

Oxfordshire Drug and Alcohol Action Team and Oxfordshire Primary Care Trust Partnership

Local Enhanced Service Specification for

Community Pharmacists providing a

Drug Misuse Service 2010-211

SLA 2010-2011

Service Level Agreement 019/DAAT

The Service Level Agreement commenced on the 1st day of April 2010and shall continue in force until the 31st day of March 2011 unless terminated in accordance with point4.The Commissioner may at their discretion propose to the Provider that the Agreement should be extended for up to twelve month plus twelve month roll on period thereafter. The DAAT/PCT reserves the right to amend categorisation (i.e. Band 1, Band 2). All providers accepted onto this agreement must at all times, meet the appropriate required standards as detailed below.

The pharmacy must be complying with community pharmacy contractual service framework for essential services before entering into this agreement.

The Oxfordshire DAAT wishes to provide funding to the Pharmacy Contractor under a Local Enhanced Service (LES) in a partnership with Oxfordshire Primary Care Trust (PCT) for the provision of a DrugMisuse Service on the terms and conditions appearing below.

In accepting funding the Organisation agrees to the following:

PRACTICE

1.The Conditions of this Service Level Agreement may only be varied by written agreement of the Oxfordshire DAAT in partnership with the Oxfordshire PCT and the Pharmacy Contractor.

2.In the event that the Pharmacy Contractor fails to provide the Services in accordance with this Agreement and Schedule one to four attached, the Oxfordshire DAAT, in conjunction with the Oxfordshire PCT, reserve the right to withhold funding until the default is rectified.

3.The Pharmacy Contractor shall at all times maintain insurance cover with a reputable company to include: Public Liability in the sum of a minimum of £5,000,000 (five million) per claim andEmployers Liability in the sum of £5,000,000 (five million) per claim.

4.TERMINATION

This Service Level Agreement may be terminated by either party at any time by normally giving three months notice in writing to the other party.

The Signatories may at their discretion terminate this agreement with immediate effect if either party is in serious breach of the agreement.

5.WAIVER

Oxfordshire DAAT may waive any provision of Conditions of this Service Agreement provided that any such waiver is confirmed in writing and signed by the DAAT Director.

6.SIGNATURES

Name of Pharmacy: …………………...……………...... Maximum patients to be supervised: ....…......

Address:……………………………………......

Email address:......

Tel:...... Fax:......

Signed on behalf of the Contractor: …………………………………………......

Please Print name:……………………………………………………...... Date:......

Signed On behalf of Oxfordshire DAAT and PCT

………………. ………...... Date: ……...... ……

(DAAT Director)

Page 1 of 11

OLPC A0901/04b


Oxfordshire Primary Care Trust

Drug Misuse Local EnhancedService

  1. Background

All pharmacies are expected to provide essential services as per the pharmacy contract and any enhanced services are commissioned by local agreement. This enhanced service specification outlines the more specialised service to be provided for drugusing patients under the Substance Misuse scheme co-ordinated by the Drug and Alcohol Action Team (DAAT)and Primary Care Trust (PCT) partnership, supported by the Local Pharmaceutical Committee (LPC),through the Shared Care Management Group (SCMG). No part of the specification by commission, omission or implication defines or redefines essential or advanced services.

Introduction to the specification

There are two possible levels of participation for pharmacy contractors in the care of drug users:

  • local enhanced services
  • national enhanced services

This specification is concerned solely with a local enhanced service (LES).

  1. Specification-Service description

AimThe principle aim of the Drug Misuse service in the clinical context is to provide a comprehensive, service to drug users that will reduce drug-related harm and the potential for death. This will usually involve substitute prescribing of either methadone or buprenorphine. It is based upon the multi-disciplinary partnership between GPs, Specialist Community Addiction Service (SCAS) nurses, Non-Medical prescribers, community pharmacists and the patient.

For pharmacies the aim is to:

  • Ensure compliance with an agreed care plan
  • Reduce the risk to local communities
  • Provide service users with regular contact to healthcare professionals
  • Provide referral or signposting to other related services
  • Support achievement of NTA targets in relation to delivering the Drug strategy at a local level

2.1This service will require the pharmacy to provide a DrugMisuse Service to patients over eighteen years living in Oxfordshire;capacity will be determined by the pharmacy in agreement with the DAAT & PCT partnership

2.2The Pharmacy will offer a user-friendly, non-judgmental, patient-centred and confidential service

2.3The Pharmacy will work in partnership with Specialist Community Addiction Nurses, Non-Medical Prescribers (NMPs) and General Practitionersas part of thedrug misuse service.

2.4The Pharmacy will promote harm reduction to the patient, carer and families andreferral to drug services as relevant.

2.5Desired Outcomes

  • Patients are able to gain quick and efficient access to services
  • Reduced complications from drug use
  • Retention of patients in treatment
  • Improved professional, user and carer satisfaction
  • Prevention of transmission of blood borne viruses associated with drug use.
  1. Service Outline

The prescriber requests supervision of consumption of a substance used in the treatment of opioid addiction, on a regular basis, either as part of a detoxification programme or maintenance treatment

3.1‘Regular’ is defined to mean ‘weekly for a minimum of four weeks’or as ‘a minimum of six consecutive days’

3.2Patients are prescribed methadone solution 1mg in 1ml or buprenorphine sub-lingual tablets

3.3Prescriptions are issuedfrom:

  • Specialist Community Addiction Service (SCAS) Oxfordshire & Buckinghamshire Mental Health
  • Rapid Prescribing Clinic-Drug Intervention Programme (DIP)
  • Oxfordshire Drug Treatment Clinics*
  • GP practices providing Shared Care LES
  • HMP Bullingdon or other prisons for Oxfordshire residents
  1. Prescriptionsare issued by:
  • SCAS medical prescribers
  • SCAS non-medical prescribers
  • GPs from a Substance Misuse practice
  • Medical Practitionersworking in a Drug Treatment Clinic

*Replaces the former term ‘Resource Centre’

  1. Criteria for participation in the scheme
  2. Band One

The pharmacy should:

4.1.1Identify a pharmacist who has successfully completed either the distance learning pack Substanceuse and misuse CPPE 2006 or RCGP Part One Certificate in the Management of Drug Misuse (or equivalent as approved by the Oxfordshire DAAT & PCT partnership) to take responsibility for the service on the premises

4.1.2Comply with Shared Care Clinical Guidance for Substance Misuse 2nd Edition Oxfordshire DAAT and PCT July 2006 ( or more recent edition), professional guidance and national treatment guidance

4.1.3Use a patient medication records system

4.1.4Provide safe storage conditions for the supply of methadone and maintain appropriate standard operating procedures for the safer management of controlled drugs

4.1.5Provide advice on safe storage of methadone and buprenorphine at home

4.1.6Follow PCT procedures for documenting and processing a serious untoward incident

4.1.7Provide advice and display health promotion leaflets relating to harm reduction

4.1.8Maintain sufficient staff in place to provide and/or support the service

4.1.9Provide a continuous service on all days of opening

4.1.10Provide access for locum staff, to standard operating procedures for ‘the Substance Misuse Service*

4.1.11Provide hours of service to meet the Substance Misuse service

4.1.12Provide a system to assess service user satisfaction

4.1.13Provide safe disposal and destruction of clinical waste and items which may identify patients.

4.2Band Two

A Band Two pharmacy will be determined by need, as agreed by the Oxfordshire DAAT and PCT partnership but the following criteria must be met in addition to the above.

A Band Two pharmacy will have:

4.2.1A pharmacist who has completed the RCGP Certificate Management of Drug Misuse Parts One and Two and working a minimum of 20 hours per week in the named pharmacy

4.2.2A minimum of twenty patientsregularly supervised on a continual basis

4.2.3Aprivate consultation area which must meet the following principles:

a. The user and the pharmacist can sit down together

b. The user and pharmacist can talk at normal speaking volumes without being overheard by staff or customers

c. The area is clearly signed as a private consultation area (a closed room is not necessary).

*Absence of an accredited pharmacist would normally be considered for days off, holiday or sick leave, for periods extending no longer than a 4- week duration.

  1. Roles and Responsibilities

The pharmacist will provide a level of service as determined by the banding of the LES set out in Shared Care Clinical Guidance for Substance Misuse 2nd Edition Oxfordshire DAAT and PCT July 2006 (or more recent version) andsee Appendix One.

5.1Band One

The pharmacist will:

5.1.1Manage patients according to Shared Care Clinical Guidance for Substance Misuse 2ndEdition Oxfordshire DAAT and PCT July 2006 (or more recent version) see Appendix One

5.1.2Take on the number of patients by agreement with Oxfordshire DAAT/PCT that he/she feels is appropriate for the pharmacy, without affecting or compromising the quality of services provided to other patients/customers or the neighbourhood in general

5.1.3Comply with monitoring and auditing requirements of the Oxfordshire DAAT/PCT

5.1.4Demonstrate evidence of maintaining skills and training appropriate to the individual and service

5.1.5Dispense prescriptions for titration of treatment, reduction and detoxification and long term maintenance treatment

5.1.6Provide supervision for consumption as per the Oxfordshire Shared Care Clinical Guidance

5.1.7Referpatients for access to assessment,to appropriate treatment services

5.1.8Report concerns involving controlled drugs to the PCT Accountable Officer,

5.1.9Conform with the PCT serious untoward incident policy

5.2Band Two

In addition to the above,pharmacists will be expected to:

5.2.1Identify issues with concordance and compliance and seek to resolve issues

5.2.2Be trained and experienced in dealing with Substance Misuse issues

5.2.3Maintain competencies as per RCGP Certificate in the Management of Drug Use

5.2.4Work with Oxfordshire DAAT/PCT (LPC)to develop and expand a specialist role subject to agreed negotiation

5.2.5Provide support and advice to colleagues and other professionals.

6.Monitoring

6.1A minimum data set should be recorded on a monthly basis using Neo the web-based data system, data should be retrievable by the DAAT within 7 days of the end of the previous month

6.2The Shared Care Management Group (SCMG) will monitor the scheme on behalf of the DAAT/PCT partnership

7Audit/Review

7.1The pharmacy participates in DAAT/PCT organised audit of service

7.2The pharmacy participates in audit of prescribing

7.3The pharmacy co-operates with any locally agreed DAAT/PCT assessment of service user experience

7.4The pharmacy can demonstrate that key staff have undertaken CPD relevant to this service

7.5The Shared Care Management Group (SCMG) will review the service on behalf of the DAA/PCTpartnership and LPC,on a regular basis as well as responding to issues which may require a more urgent review

7.6Review of the LES will take place on an annual basis by the Shared Care Management Group or earlier if required

8Oxfordshire DAAT and PCT Partnership

The Oxfordshire DAAT and PCT Partnership will:

8.1 Provide a direct point of contact for service provision:

Substance Misuse: Pharmacist-Tel 01865 290800

8.2 Support pharmacies through training, visits and phone calls as appropriate and relevant

8.3Provide a Service Directory of drug related services in Oxfordshire

8.4Provide detailsfor referral points or signposting to other relevant services for service users

8.5Provide harm reduction literature for service users, carers and families subject to funding and availability.

9Finance

The Oxfordshire DAAT /PCT partnership will pay thepharmacy:

9.1Band One pharmacies = £27.50per patient per month.

9.2Band Two pharmacies £27.50 per patient per month plus £1,500 retainer

9.3The retainerwill be paid at the start of the financial year and a monthly fee will be paid based on the numbers of individuals supervised for that month

9.4Payments will be paid in the proceeding weeks following the given month through Oxfordshire PCT finance system

9.5Any queries regarding payments should be taken up initially with the DAAT Substance Misuse Pharmacist.

Appendix One Responsibility:-

Please note this guidance is being updated

Extract

Shared Care Clinical Guidance for Substance Misuse 2nd Edition Oxfordshire DAAT and PCT July 2006

Shared Care Local Enhanced service

The pharmacist will have undertaken training through completion of the most recent open-learning pack on substance misuse from the Centre for Pharmacy Postgraduate Education (CPPE) or equivalent training and pharmacies will be expected to provide a discreet area for consumption of medication.

Pharmacists are involved in Shared Care for patients under the LES when the prescriber’s request forsupervision of consumption of either methadone or buprenorphine is:

  • on a daily basis, minimum 6 days of treatment
  • on collection of a regular prescription for taking away (longer than four weeks, minimum supervision once a week at point of dispensing)

The prescriber may be a GP, GPwSI or from Specialist Care (SCAS). Prescriptions are valid for Shared Care from both primary and secondary care services. The need for supervision is the trigger for providing the Shared Care LES, but ‘no supervision’ does not diminish the pharmacist’s duty of care.

There are two levels of service within the LES that a pharmacist may provide.

Band One

The pharmacist will:

  • have standard operating procedures in place for Shared Care
  • provide the patient with both written and verbal information about their medicines
  • provide information on the safe storage of medicines
  • supervise either methadone or buprenorphine as requested at the point of dispensing
  • Refer and collaborate with the GP or SCAS worker, where appropriate, on a need to know basis.
  • Pharmacists are encouraged to ask patients to sign a consent form (see Section Three page. 68)
  • review and feedback on the patient’s progress at the request of the GP or SCAS worker, this may be

verbal or written using the Refer, Incident and Feedback (RIF) form (see Section Three page. 69)

  • provide a valuable link when a patient transfers from one service to another
  • provide written information on harm reduction and sexual health
  • promote the uptake of hepatitis A and hepatitis B vaccination and screening for hepatitis B, C and HIV
  • promote and advise on general health issues
  • signpost and provide information on drug related services
  • provide a continuous service when locum cover is used
  • adhere to Oxfordshire Child Protection Procedures 2002 (developed by Oxfordshire’s Area Child Protection Committee) and Guidance on Child Protection RPSGB June 2006

Band Two

A Band Two pharmacy will be determined by need, as agreed by the Oxfordshire DAAT and PCT partnership but the following criteria must be met:-

  • A Band Two pharmacy will have a pharmacist who has completed the RCGP Certificate Management of Drug Misuse Parts One and Two
  • The pharmacy premises are accredited by the PCT for advanced services
  • The pharmacy will be routinely supervising a minimum of twenty patients

Pharmacies in Band Two will see a minimum of 20 patients on a regular continual basis.

Band Two pharmacists/pharmacies will provide the same service as for Band One and the following:

  • act as a resource for other pharmacists and healthcare professionals, to share knowledge and experience and offer support
  • advise healthcare professionals on medicines management for patients receiving substitute prescribing and other medicines
  • provide both verbal and written advice on harm reduction methods, for a wide range of drug users
  • be willing to develop or pilot a specialist role subject to agreed negotiation
  • offer training at a local level for healthcare professionals or frontline staff as required
  • liaise with the GP/SCAS worker on recommended doses for individual patients
  • refer for vaccination

Contacting the GP or SCAS worker

Pharmacists will contact either the prescriber or SCAS worker when:

  • the patient fails to turn up for three consecutive days
  • the patient turns up after an absence of three days or more
  • the patient continually misses odd days of treatment
  • the patient exhibits unacceptable behavior (based on the pharmacist’s professional judgment)
  • the patient exhibits unacceptable behavior on a second occasion and service is withdrawn
  • the patient presents in an intoxicated state and treatment is withheld
  • the pharmacist is concerned at the observed deterioration in the health of a patient
  • the pharmacist believes the patient may benefit from a dose alteration or increased/ decreased rate of supervision
  • the pharmacist is concerned about possible drug interactions with the patient’s other prescribed drug therapies
  • thepharmacist believes there may be a concordance issue with other prescribed drugs
  • the patient indicates to the pharmacist that he/she, and maybe their family, would like to be vaccinated for hepatitis A and B or screened for hepatitis C
  • the pharmacist suspects the supervised client has not consumed the whole dose
  • a patient or carer requests supervision
  • the pharmacist believes the patient may have additional social problems that affect

compliance(e.g. client has been made homeless)

  • the pharmacist is informed by the patient that he/she is leaving treatment or changing pharmacies

Standard operating procedures should be in place in each pharmacy and all staff, including locums, should be made aware of them. The procedures should address:

  • a new patient entering Shared Care; new either to dispensing or to the pharmacy
  • a patient on regular scripts
  • feedback to the clinical Shared Care team
  • referral
  • maintenance of records including patient medication records
  • legality of prescription
  • details for preparation of daily doses
  • supervised consumption procedure (see Section Three) pages 70 and 71
  • missed doses
  • discreet and efficient supervision by the pharmacist
  • withholding a dose
  • disposal of waste
  • doses to be collected to cover days when the pharmacy is closed
  • safe storage for ‘take homes’
  • confidentiality
  • behaviour in and around the pharmacy
  • safe storage and management of controlled drugs

Medicines Use Review