Local Enhanced Service for Community Pharmacy

Local Enhanced Service for Community Pharmacy

Supply of Emergency Hormonal Contraception (EHC)

Under Patient Group Direction

Contents:

1. Document Purpose
2. Service Description
3. Aims and Intended Service Outcomes
4. Role of the Pharmacy Contractor
5. Role of the Accredited Pharmacist/Accredited Locum Pharmacist
6. Role of the PCT
7. Dispute Resolution and Deviation from the Service Level Agreement
8. Notice of Termination
9. Consultation Area Standards of the Pharmacy Contractor
10. Clinical Governance Standards of the Pharmacy Contractor
11. Confidentiality
12. Other Standards for Better Health Framework elements
13. Payment Details
14. Signature Sheet
15. Annex 1 – Claim Form

1.1  This document is a formal agreement for the supply of emergency hormonal contraception under a patient group direction within Bassetlaw community pharmacies.

1.2  The agreement shall be between NHS Bassetlaw and ______(the pharmacy provider)

1.3  This agreement covers the period from 01/04/2010 to 31/03/2011. The contract will be renewed annually, subject to a review of performance by the PCT and ongoing requirement for the service.

2.1  This service will require the ‘accredited’ pharmacist to undertake the appropriate one to one consultation and supply Levonelle 1500 free of charge to females of all ages requesting emergency hormonal contraception and who are clinically eligible under the patient group direction.

2.2  Where the patient is found not to be clinically eligible under the patient group direction after the appropriate one to one consultation, the ‘accredited’ pharmacist will provide appropriate advice to the patient and refer/signpost the patient to their medical practitioner, Family Planning Services / Contraception and Sexual Health Services or out of hours service provider.

2.3  Pharmacies will offer a user-friendly, non-judgmental, patient-centred and confidential service.

2.4  The pharmacy will provide appropriate support and advice to the patient on emergency hormonal contraception, regular contraception, sexually transmitted infections and consult / refer / signpost to their medical practitioner or Family Planning Services / Contraception and Sexual Health Services when appropriate.

2.5  The pharmacy will provide the service for all of its full opening hours (both core and supplementary).

3.1  To improve access to emergency contraception and sexual health advice among females of all ages especially amongst the teenage population.

3.2  To help contribute to a reduction in the number of unplanned pregnancies and abortion rates especially amongst the teenage population.

3.3  To help contribute to a reduction in the rates of sexually transmitted infections.

3.4  To complement and strengthen the local network of current contraceptive and sexual health services being provided by GPs and Family Planning Services / Contraception and Sexual Health Services.

4.1  Ensure that as many pharmacists as possible (including locum pharmacists) employed to work in the pharmacy are accredited to provide the service.

4.2  Ensure that only accredited pharmacists provide the service.

4.3  Ensure that the accredited pharmacists are enhanced CRB checked and have been successfully cleared. Pharmacists already accredited to provide the service (prior to 1st April 2008) to be CRB checked by 30th April 2010. Newly accredited pharmacists (after 1st April 2008) have to be CRB checked and cleared within 3 months of commencing the service.

4.4  Ensure that provisions have been made in the pharmacy for the one to one consultation to take place in a suitable, confidential and private consultation area (See 9 for required standards of the consultation area).

4.5  Make up to date written information and leaflets relevant to the service (see below) available in the pharmacy so that accredited pharmacists who are providing the service have ready access to this:

·  Service Level Agreement.

·  Patient Group Direction.

·  Consultation template records and other paperwork relating to the service (Fraser Assessment and Risk Assessment tools).

·  National Child protection guidance ‘Every Child Matters’.

·  RPSGB Practice Guidance on Child Protection.

·  RPSGB Practice Guidance or DoH guidance on managing sexual abuse and sexual activity in children.

·  Local Child Protection procedures (current version) approved by Bassetlaw PCT.

·  Department of Health guidance on confidential sexual health advice and treatment for young people aged less than 16 years.

·  Contact details of local family planning clinics / Contraception and Sexual Health Services .

·  Contact details of local child protection / Safeguarding Children Specialist Advisory Services and designated health professionals for child protection / safeguarding children.

·  PCT developed leaflet relating to the service or Family Planning Association leaflet entitled ‘Emergency Hormonal Contraception’.

4.6  Ensure that there are processes and information in place to signpost the patient to other service providers (including other pharmacy providers) where the pharmacist on duty is not accredited to provide the service.

4.7  Ensure that the relevant poster (‘Need the emergency pill urgently?’) is displayed prominently in the pharmacy window.

4.8  Ensure that the pharmacy participates in any service evaluation or audit organised by the PCT.

5.1  Ensure that they are familiar with the contents of the Patient Group Direction (PGD), Service Level Agreement, consultation template records, assessment tools, national and local guidance (see 4.5) and know where information is located in the pharmacy to signpost / refer patients to local Family Planning Services / Contraception and Sexual Health Services where appropriate

5.2  Ensure that they are familiar with national guidance and local guidance (see 4.5) on child protection and know where information is located in the pharmacy relating to child protection / safeguarding children including names and contacts of Safeguarding Children Specialist Advisory Services / safeguarding children health professionals/leads.

5.3  Ensure that they are aware of the legislation governing sexual offences.

5.4  In order to be accredited to provide the service, the pharmacist will either need to meet criteria 5.4.1, 5.4.2, 5.4.3 and submit the PGD sign up sheet to the PCT, or, they need to meet 5.4.4 and submit the PGD sign up sheet to the PCT. The PCT will confirm the accreditation status of the pharmacist and the list of accredited pharmacists will be maintained by the PCT.

5.4.1 The pharmacist has undertaken recent training (within the last 3 years) of the CPPE pack Emergency Hormonal Contraception (ref 36456)

OR

Has undertaken training of the CPPE pack Emergency Hormonal Contraception (ref 36456) and has been providing the service on a regular basis within the last 3 years

5.4.2  The pharmacist has completed the training sessions on supply of EHC under PGD (including supply to the under 16s) organised by one of the following organisations:

·  Ashfield and Mansfield District PCTs / Bassetlaw PCT / Southern Derbyshire PCT / Nottingham City PCT / Gedling PCT / Rushcliffe PCT / Broxtowe and Hucknall PCT before April 2008 and has been providing the service on a regular basis within the last 3 years.

·  Bassetlaw or Nottinghamshire County teaching PCT from April 2008.

5.4.3  Pharmacists that have met criteria 5.4.1 and 5.4.2 will attend an update course developed by NHS Bassetlaw or NHS Nottinghamshire County each year, if requested by the PCT.

5.4.4  New pharmacists (pharmacists that do not meet criteria 5.4.1 and 5.4.2), they need to complete the CPPE training on Emergency Hormonal Contraception (ref 36456) AND attend a training event organised by NHS Bassetlaw or NHS Nottinghamshire County. It is strongly recommended that the pharmacist also completes CPPE training on Patient Group Directions (ref 38034) and Child Protection (ref 37025).

5.5  Undertake a one to one consultation with the patient in a suitable, confidential and private area. The consultation must include all the issues as requested in the consultation template / proforma provided by the PCT.

5.6  Assess the need and suitability for a patient to receive EHC in line with the PGD and give appropriate advice regarding emergency contraception, regular contraception and the avoidance of pregnancy and sexually transmitted infections through safer sex and condom use, the diagnosis and management of sexually transmitted infections.

5.7  Ensure that a supply of EHC is made only if the patient is clinically eligible under the PGD.

5.8  When the patient is not clinically eligible under the PGD following one to one consultation, the ‘accredited’ pharmacist will provide appropriate advice to the patient and refer/signpost the patient to their medical practitioner, Family Planning Services / Contraception and Sexual Health Services or out of hours service provider. The signposting information must be accurate and relevant to the time when the patient presents at the pharmacy, e.g. do not advise the patient to go to Family Planning Services / Contraception and Sexual Health Services or their GP during the weekends/out of hours period when those services are unavailable. The pharmacy should give advice to the patient on how to access the relevant out of hours providers / walk in centres).

5.9  Provide patients with verbal and written information and leaflets relevant to the service (i.e. the PCT developed leaflet for the service or the Family Planning Association leaflet entitled ‘Emergency Hormonal Contraception’)

5.10  Ensure that the consultation is fully recorded on the consultation template / proforma provided by the PCT.

5.11  When the patient is under 16, the ‘accredited pharmacist’ will make clear to the patient at the outset that assessments will need to be carried out (i.e. certain questions will need to be asked) during the course of the consultation and that absolute confidentiality cannot be guaranteed and that there will be some circumstances where the needs of the young person can only be safeguarded by sharing information with others.

5.12  When the patient is under 16, assess the patient on Fraser ruling using the PCT developed assessment form and ensure the assessment is recorded and kept in the pharmacy. The EHC consultation should only proceed where the patient has been assessed as competent to consent to treatment under the Fraser Ruling. Where the patient has been assessed as not being competent to consent to treatment, the pharmacist still has a duty of care to assess the likelihood of harm / child protection issues using the trigger questions contained in the consultation proforma (see 5.14 below).

5.13  When the patient is under 16, assess the likelihood of harm / child protection issues using the trigger questions contained in the consultation proforma. If there are any concerns of harm / child protection issues at this stage, the pharmacist should then conduct the risk assessment tool to assess whether the young person or child may be at risk of harm and ensure the assessment is recorded and kept in the pharmacy.

5.14  When the risk assessment has identified a definite need to refer the patient to the Police or Children’s Social Care, the ‘accredited pharmacist’ should consult with the local Safeguarding Children Specialist Advisory Services/Named Nurse for child protection / safeguarding children where possible. Conversations should be recorded. Where the discussions have resulted in a joint decision to refer the patient to the Police or Children’s Social Care, the pharmacist shall make the appropriate referral by contacting the police or Social Care, making records of the referral and confirming it in writing.

5.15  If the pharmacist is unsure as to whether a referral is warranted after conducting the risk assessment, they should seek guidance by consulting with the local Safeguarding Children Specialist Advisory Services/Named Nurse for child protection / safeguarding children.

5.16  When the patient is under 13, the expectation is that a referral will be made to the Police or Children’s Social Care. Decisions not to refer must be discussed with the Safeguarding Children Specialist Advisory Services/Named Nurse for child protection / safeguarding children or the senior manager of the pharmacy (pharmacy head office/ area manager). Decisions not to refer and the reasons for not referring must be recorded.

5.17  It is recommended that pharmacists providing this service have suitable professional indemnity insurance - a copy of which should be provided to the PCT if required.

5.18  Maintain appropriate records as required by legislation and as required as part of the service.

5.19  Ensure that they have undertaken the enhanced CRB check and have been successfully cleared within 3 months of providing the service (Pharmacists already accredited to provide the service prior to 1st April 2008 have to undertake the CRB check by 30th April 2010.

5.20  Ensure the monthly claim form and consultation record forms are completed and sent to the PCT Administrator by the 5th of each month (ensuring a photocopy of the paperwork is kept in the pharmacy).

5.21  Attend any refresher training organised by the PCT.

5.22  Participate in any service evaluation or audit exercise as organised by the PCT.

6.1 Ensure service level agreements and the appropriate paperwork (including PCT developed leaflets, consultation record templates, assessment tools) are sent to pharmacies.

6.2 Collate the signed service level agreements and maintain an accurate and up to date database of pharmacies that have signed and returned their service level agreements and database of accredited pharmacists.

6.3 Ensure that payments are made to the pharmacies by the end of the month following receipt of the claim form by the 5th of the month.

6.4 Maintain accurate and auditable records of submitted claims and payments made to pharmacies.

6.5 Check claim forms against the consultation records for financial audit and monitoring purposes. Audit checks will also be made on the consultation records to ensure that the supply of EHC is in line with the conditions of the PGD.

6.6  Promote the service to the local health community and public where appropriate and maintain a database of pharmacies that have accredited pharmacists and ensure the updated information is sent to local community pharmacies.

6.7 Organise accreditation events and refreshers training for pharmacists.

7.1  Any initial disputes should be resolved locally between the relevant parties.

7.2  In the event that a dispute cannot be resolved informally, the issue must be put in writing and senior representatives of the parties should meet to facilitate local resolution. (The Local Pharmaceutical Committee can act as representatives of the pharmacy contractor). Should local resolution not be achieved, the matter will be referred to an independent arbitrator.