CONTENTS

INTRODUCTION / 3
AIMS OF THE SERVICE / 4
SERVICE DETAILS
  1. Who can access the service?
  2. Referral into the service
  3. Referral to the Patient’s GP or GUM clinic
  4. Consultation Process
  5. Notification of results and contact tracing
  6. Treatment of Infection
/ 5
5
5
5
5
6
6
SERVICE REQUIREMENTS
  1. Who can provide the service?
  2. Pharmacist and staff accreditation
  3. Pharmacist and staff re-accreditation
  4. Sign up and termination
  5. Display
  6. Record keeping
  7. Payments
  8. Confidentiality
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7
7
8
8
8
8
9
9
Appendix 1: Useful telephone numbers and background information / 10
Appendix 2: Care Pathway / 11
Appendix 3: Community Contraceptive Clinics / 13
Appendix 4: Safeguarding Telephone Numbers
  • Child Protection
  • Vulnerable Adults
/ 15
Appendix 5: Consultation Monthly Summary Form / 21

INTRODUCTION

Genital Chlamydia Trachomatis infection is the sexually transmitted infection most frequently diagnosed in genitourinary medicine (GUM) clinics in England. Prevalence of infection is highest in sexually active young men and women, especially those aged less than 25 years. Untreated infection can have serious long-term consequences, particularly for women, in whom it can lead to pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility. Chlamydia can also lead to infertility in men and also impaired sexual function.

Chlamydia infections are asymptomatic in around 70% of women and 50% of men, therefore a large proportion of cases remain undiagnosed, although infection can be diagnosed easily and effectively treated.

Chlamydia screening is currently carried out across England as part of the National Chlamydia Screening Programme (NCSP). The objective of the programme is to control Chlamydia through the early detection and treatment of asymptomatic infection, preventing the development of sequelea and reducing onward transmission of the disease.

The aim is a multi-faceted, evidence based and cost effective national prevention programme in which all sexually active young men and women under 25 years of age and those under 16 years of age deemed Fraser competent are aware of Chlamydia, its effects, and have access to services providing screening, prevention and treatment to reduce their risk of infection, the development of untoward sequelae and onward transmission.

An opportunistic approach is used bringing on board a diverse combination of healthcare and non-healthcare screening venues to deliver the programme. The voluntary and business sectors also play a key role in delivering the NCSP.

The NCSP covers the whole country and is monitored by the Health Protection Agency. National standards apply to the programme and funding has been provided to Primary Care Trusts (PCTs) to commission the service.

Chlamydia Screening Offices (CSOs) coordinate the service locally across the PCT. Screening, using first-void urine samples, is initiated in a range of settings, both clinical and non-clinical. Samples are sent to a laboratory for analysis using the nucleic acid amplification test (NAAT) and the results are returned to the CSO; patients are then informed of their result and contact tracing is conducted with people with positive results and treatment is offered to people who screen positive and their partners[i].

Chlamydia screening within community pharmacies complements the provision of Emergency Hormonal Contraception (EHC), by offering a more holistic sexual health care service to this user group.Offering Chlamydia screening kits and condoms will also engage young men.

In November 2005 a two year partnership between the Department of Health (DH) and Boots the Chemists to pilot free Chlamydia screening and treatment for 16-24 year olds within the greater London area commenced. The pathfinder was independently evaluated by TNS Healthcare. The evaluation shows considerable promise with over 87% of young people reporting they would recommend the service. The evaluation is available on the DH website at: This pilot demonstrated the feasibility of pharmacies distributing Chlamydia screening kits.

AIMS OF THE SERVICE

The service is designed to meet the following aims:

  • To increase access to the National Chlamydia Screening Programme by providing additional locations where people can access screening.

Added benefits include:

  • To increase access for young people, to sexual health advice and referral on to specialist services where required.
  • To increase clients’ knowledge of the risks associated with Sexual Transmitted Infections.
  • To strengthen the network of contraceptive and sexual health services to help provide easy and swift access to advice.
  • To increase access to treatment of Chlamydia infection, if deemed appropriate.

SERVICE DETAILS

Pharmacies will offer Chlamydia screening kits to sexually active males and females aged under 25, for example when supplying condoms, dispensing oral contraceptive pills and supplying EHC, in agreement with the local Chlamydia Screening Office. Advice on how to utilise the kit, how to compete it, return it for testing and what will happen following completion of the test will be provided in line with the approach adopted by the local Chlamydia Screening Office. Pharmacies will also be required to offer screening clients free condoms available through the EHC enhanced service via Lancashire and South Cumbria Agency (LaSCA). The service will form part of the locally run National Chlamydia Screening Programme (NCSP).

In addition to the pharmacy acting as a test kit distribution service, Sexual Health advice will be provided. The management of all results, tracing and treatment will be undertaken by the Chlamydia Screening Office.

1. Who can access the service?

This service will be free of charge to eligible patients and is funded by NHS Central Lancashire.

1.1This service will be offered to any sexually active males and females aged under 25 years of age who are registered with a GP in Central Lancashire PCT.

1.2If the patient does not meet any of the qualifying criteria, the patient cannot access the service at that time. The patient should be advised of alternative methods of accessing care in accordance with the pharmacy contract; Essential Service 6 – Support for Self Care and Essential Service 5 – Signposting. Patients should therefore receive brief advice, supporting patient information leaflets and or signposted to other Sexual Health service providers detailed in the back of this service spec (appendix 4) and care pathway (Appendix 2).

1.3Patients are at liberty to refuse this service.

2. Referral into the service

2.1The pharmacy Chlamydia screening service is an open referral service and therefore anyone can refer patients into the screening service including any healthcare professional, patient self referral and opportunistic recruitment by pharmacy staff.

3. Referral to the Patient’s GP or GUM clinic

3.1The following patients should be referred to their GP or the Genitourinary Medicine Clinic:

  • Any patient over 25 years of age
  • Any patient under 25 years of age with symptoms of a Sexual Transmitted Infection.
  • Any patient under 16 not deemed to be Fraser competent

3.2Pharmacies will link into existing local networks of sexual health and community contraceptive services so that there is a robust and rapid referral pathway for people who need onward signposting to services that provide on-going contraception, for example long acting reversible contraception (LARC)and diagnosis and management of sexually transmitted infections (STIs).

4. Consultation Process

4.1Accredited Pharmacy staff will offer a user-friendly, non-judgmental, client-centred and confidential service.

4.2The pharmacy will offer sexually active males and females less than 25 years of age a Chlamydia screening service; the benefits of screening will be explained. People less than 16 years of age will be provided with the service if deemed Fraser competent. People over the age of 24 will be referred to services where they can be tested e.g. Genito Urinary Medicine clinics.

4.3The service will be provided in compliance with Fraser guidance[ii] and Department of Health guidance on confidential sexual health advice and treatment for young people aged under 16 years[iii].

4.4Accredited staff shall, with people who verbally consent to screening, describe the screening process and how results will be communicated to the person. The person shall be supplied with a Chlamydia screening kit, supplied by the CSO (or via other locally agreed arrangements).

4.5The part of the pharmacy used for the provision of the service must provide a sufficient level of safety and privacy (including visual privacy where appropriate), which in most circumstances will be at the level required for the provision of the Medicines Use Review service[iv].

4.6Pharmacies will provide support, verbal and written advice to people accessing the service, including advice on safe sex, condom use and advice on the use of regular contraceptive methods, when required.

4.7Verbal and written advice on the avoidance of STIs and the use of regular contraceptive methods, including advice on the use of condoms[v], shall be provided to the person. This should be supplemented by a referral to a service that can provide further advice and care where appropriate by the pharmacy.

  1. Notification of results and contact tracing

5.1 The Chlamydia Screening Office will be responsible for notifying people of the result ofscreening and/or contact tracing.

6. Treatment of infection

6.1 The Chlamydia Screening Office will provide a treatment service as per the core requirements[vi] of the National Chlamydia Screening Programme.

SERVICE REQUIREMENTS

The provision of this service can be divided into 4 main areas, which are described below:

1. Who can provide the service?

1.1From 2nd December 09the service will be expanded to any willing pharmacy providing the Emergency Hormonal Contraception Service.

1.2The participating pharmacies must:

  • Agree with the PCT to participate in all parts of the service as detailed in this document along with any subsequent amendments as agreed with the LPC. This agreement will be in writing signed by both parties and be considered an enhanced service.
  • Produce a standard operating procedure (SOP)for the provision of this service, which clearly defines roles and responsibilities of relevant staff within the authorised pharmacy.
  • Ensure that Accredited Medicines Counter Assistant qualified staff, and above, delegated the responsibility of undertaking the screening consultation adhere to this service specification and Chlamydia screening SOP. Overall responsibility and accountability will remain with the responsible pharmacist.
  1. Pharmacist and Staff accreditation

2.1Only accredited pharmacists and accredited pharmacy staff with a Medicines Counter Assistant Qualification or above can provide this service. To gain accreditation the:

A -Pharmacistmust:Complete the CPPE Sexual Health testing and treatingopen learning pack

B – Medicines Counter Assistant and above must: attend a PCT evening workshop

2.2The pharmacy contractor must ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service, including sensitive, client-centred communication skills. Pharmacists and staff providing this service should also be aware of local and national guidance on safeguarding children, as it is possible that people under the age of 16 will request screening.

  1. Pharmacist and staff re-accreditation

3.1Updates are recommended every two years or as directed by the PCT, which may be in the form of a Harmonisation Accreditation Group (HAG) self-declaration of competency or other method of assessment as considered appropriate by the PCT.

  1. Sign up and termination

4.1All pharmacists and pharmacies must agree to the terms of service contained within this service specification/service level agreement.

4.2Participating authorised pharmacies may withdraw from the scheme at any time and the PCT may also terminate provision from a pharmacy. Any such intention must be made in writing to the same individual identified on the Enhanced Service agreement form. A notice period of 28 days applies.

4.3If pharmacies withdraw from the scheme, then the pharmacist authorised to provide Chlamydia screening may continue to provide the service from other authorised pharmacy premises located within Central Lancashire PCT.

4.4Changes of ownership will require reapplication to provide the service. Changes to pharmacy staff (e.g. new manager or regular locum) who are not already accredited will require accreditation to enable continued provision of the service.

  1. Display

5.1All participating authorised pharmacies will be required to provide clearly visible and viewable dedicated space for a logo/poster indicating the availability of the service.

5.2The PCT will coordinate the promotion of the service locally, including the development of publicity materials and the use of nationally produced materials, in order to ensure young people and other local health care providers are aware that the service is available from local pharmacies. Pharmacies should use these materials to promote the service to the public and should ensure they coordinate their promotional activities with those of the PCT.

6. Record Keeping

6.1During each consultation the accredited staff member must complete the EHC/Chlamydia Screening Monthly Summary form (appendix 3) recording the following information:

  • Date of Consultation
  • Age
  • Gender
  • Postcode (first 4 digits)

6.2Completed Monthly Summary forms must be securely stored until transferred to Lancashire and South Cumbria Agency at month end for payment.

6.3Pharmacy contractors can choose to keep a tally recording the number of consultations and screening kits supplied each month. Any such record should not contain patient identifiable data and must be for internal use only and should not be submitted to LaSCA or the PCT.

7.Payment

7.1Pharmacy contractors will be reimbursed according to the following payment structure:

A consultation fee of £3.00 per kit supplied and consultation logged

A consultation fee of £4.00 per kit supplied resulting in more than 20 postal kits being returned to the Chlamydia Screening Office per month and achieving a return rate of greater than 50%

7.2Claims for payment should be made by the 5th working day of the following month, late submission may delay payments, by submission of the consultation form to Lancashire and South Cumbria Agency (LaSCA) at:

Contractor Services

Lancashire and South Cumbria Agency

3 Caxton Road

Fulwood

Preston

PR2 9ZZ

7.3Payments will be made at the end of the month following that to which the payment relates and can be identified from the pharmacy contractors PPA statement.

7.4Incomplete Monthly Summary consultation forms will be deemed invalid and as such will be returned to the contractor for resubmission or will not be processed for payment.

  1. Confidentiality

8.1All staff providing the service must have signed a confidentiality clause as determined by Essential Service 8 Clinical Governance.

8.2Pharmacists may need to share relevant information with other health care professionals and agencies, in line with local and national confidentiality and data protection arrangements, including the need for the permission of the person to share the information

APPENDIX 1

USEFUL TELEPHONE NUMBERS

Carolyn Blythe Chlamydia Screening Programme Co-ordinator 01772 255317

Bridget Gray Acting Clinical Co-ordinator – Sexual Health 01772 777138

Stephen GoughCommunity Pharmacy Adviser 01772 676179

Mike HawkinsProgramme Support Officer – Sexual Health 01772676176

Background information – not part of the service specification
The following documents and websites provide background information on Chlamydia screening and treatment:
National Chlamydia Screening Programme

Cumbria and Lancashire Chlamydia Screening Programmes

UK National Guideline for the Management of Genital Tract Infection with Chlamydia trachomatis

The Manual for Sexual Health Advisors

Page 1 of 13

[i] More information on the NCSP is available at:

[ii] 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.

[iii] Guidance available at

[iv] The requirements for consultation areas are detailed in The Pharmaceutical Services (Advanced and Enhances Services) (England) Directions 2005 as amended (

[v] Commissioners may wish to consider the inclusion of condom supply as part of the service and the integration of participating pharmacies into the local Chlamydia screening programme.

[vi] National Chlamydia Screening Programme Core Requirements are available at