Community Pharmacy Emergency Contraception Scheme

SERVICE SPECIFICATION for Tier 1 Sexual Health Services for under 25year olds

1.Introduction
  • This service is available to females aged under24 years of age. Barking and Dagenham reserves the right to review the service and may restrict or expand access to Barking and Dagenham residents in the future.
  • The service must be provided by a pharmacist who is accredited to the satisfaction of Barking and Dagenham PCT.
  • If the pharmacy premises, for whatever reason, are unable to supply emergency hormonal contraception (EHC) then they must be able to refer the woman to an alternative local provider.
  • Advice and support are as important to the service as the supply of EHC.
2.Definition of service provided

2.1For the purpose pf this specification emergency hormonal contraception (EHC) is defined as progestogen only oral EHC (levonorgestrel).

2.2The pharmacist will provide information about the drug usage and possible future contraception. He/she will not provide advice, support or guidance on the possibility of a pregnancy but will provide the client with information on how to receive this guidance.

2.3The pharmacist will be responsive to clients who are excluded from the Patient Group Direction and will assist them in finding an alternative service (e.g. Walk-in-Centre, GP, sexual and reproductive health clinic).

2.4The contract to provide EHC services is with the pharmacy contractor (owner) and not with the individual pharmacist employees. It is the responsibility of the pharmacy contractor to ensure that their nominated pharmacist employees fulfil the criteria of the specification.

2.5The pharmacist must ensure that their professional indemnity cover is either provided by the National Pharmaceutical Association (NPA) or other organisation that has confirmed that this activity will be in their policy.

3. Service Aim

To provide emergency hormonal contraception and accompanying advice to young women in Barking and Dagenham within 72 hours of unprotected sexual intercourse or a known contraceptive failure.

4. Definition of client group

Young women aged up to 24 years of age requesting EHC. Pharmacists will not be required to obtain proof of a person’s age, but can judge each request on merit. Most clients will self-refer. If the client is believed to be under 16 years, the pharmacist must apply the Fraser Rulings (previously known as Gillick competence).

5. Eligibility criteria

Any woman in Barking and Dagenham, who fulfils the criteria within the Patient Group Direction (PGD) is eligible. Although the PCT has introduced this service for women living in this area, proof of home address or general practitioner is not required.

6. Accreditation to provide EHC

The service can only be provided from pharmacy premises that has been approved by B&D NHS to provide “under 24 year olds sexual health services.”

The Pharmacy Contractor must comply with all the standards for essential pharmacy services. In particular, evidence will be required that the Pharmacy has the clinical governance requirements in place as specified in Appendix 1.

The service can only be provided by accredited pharmacists who have satisfactorily completed training approved by B&D PCT. All accredited pharmacists must attend at least one evening update within a twelve-month period. The accredited pharmacist must also agree to attend additional courses as deemed appropriate by B&D PCT. The PCT will provide EHC PGD training at regular intervals as required to maintain the required number of accredited pharmacists to ensure continuity of supply.

7.Patient Group Directions

A Patient Group Direction for the supply of licensed emergency contraceptive products has been developed in collaboration with the consultants in family planning within the local PCT. The Patient Group Direction complies with the requirements of the August 2000 Health Service Circular on Patient Group Directions. It has been approved by the Clinical Governance Lead for the PCT.

8. Termination of Service

If an accredited pharmacist ceases to work at an authorised pharmacy, the Pharmacy Contractor must inform B&D PCT immediately. If another pharmacist is not avaiable to be trained and acreditated then the PCT has then this part of the Under 24 year old has to be stop and the PCT has the right to terminate the whole Young people under 24 sexual health contact .

If the contract has been terminated, all the completed patient records must be safely forwarded to B&D PCT for safe storage. This will be performed in agreement with B&D PCT.

9. Description of Service

9.1 The pharmacy must be able to provide the service for at least 5 days a week, equivalent to 40 hours per week. One day of this regime should be a Saturday. There should not be a gap in service of longer that 48 hours, or 2 days.

9.2Any requesting client will be seen as soon as possible. If they are unable to be seen immediately they must be given a time in which to return. This will not exceed 30 minutes.

9.3It is the responsibility of the pharmacy contractor to have a full and current list of all alternative EHC providers to give to all potential clients, if they are unable to fulfill a request for EHC.

9.4The pharmacy premises must have a designated quiet private area / room with an open door through which the client can be seen if the pharmacist is male. So the requirement for a chaperone is not required. The client must at all times feel comfortable and confident that the consultation is private..

9.5The Pharmacy must be accredited for the Young People Friendly logo.

9.6Every client contact must be recorded on a client assessment and record sheet, in accordance with the PGD. These are to be treated as confidential and must be stored in a secure area, preferably under lock and key. They should be stored in the pharmacy premises. Access to the records is for approved staff only. Authorised PCT staff may wish to access these records from time to time, for audit purposes. They should be filed in such a manner that allows for easy retrieval. All records must comply with The Data Protection Act 1998.

9.7The PCT may collate the data electronically and therefore The Pharmacy Owner will need to work with the PCT to achieve this.

9.8All client records must be kept for a minimum of 10 years. Destruction should be done in line within any guidance on destruction of medical records at the time.

9.9Client confidence in confidentiality is paramount. Pharmacy contractors, pharmacists and pharmacy staff must all understand and respect the issue of confidentiality. No information may be given to a third party without prior consent of the Client. This issue of confidentiality applies equally to clients under the age of 16 years.

9.10Accredited pharmacists must ensure that they access clinical support when appropriate. Pharmacists can access medical and pharmacy support from the telephone cascade, which is included in the EHC folder provided to every accredited pharmacy.

9.11The criteria for supplying EHC must be adhered to at all times.

9.12As well as supplying EHC the Pharmacist also has a duty to provide the client with appropriate contraceptive information and associated health promotion advice/ literature. This will include information on other primary and secondary care providers.

9.13The pharmacy contractors and accredited pharmacists have a duty of care towards their client group. If a client uses the service repeatedly it is the duty of the Pharmacist to try and counsel the client and direct them to an appropriate provider, such as their general practitioner or sexual and reproductive health clinic.

9.14The pharmacy contractor must ensure that all other pharmacy staff who may have contact with potential clients are trained accordingly. This will include areas such as confidentiality, alternative services in the area and how to seek urgent advice.

9.15The pharmacy contractor must designate specific window space or a suitable alternative, to advertise this service. This includes information on how else to obtain this service locally as well.

9.16The pharmacy contractor must provide B&D NHS with information on service availability and must advise on any changes to this availability. B&D NHS will then advise NHS Direct on the changes.

9.17The PCT on a monthly basis will monitor the performance of each individual pharmacy. The pharmacy contractors must ensure that correct data is sent to The PCTs. This data will include the number of consultations, number of supplies, age, postcode and any further information that the PCT may request. This data must be collated and sent to the PCTs no later than the 10th day of each month.

9.18The pharmacy contractor will participate in any new developments in either practice or service, instigated by B&D PCT.

9.19The pharmacy contractor should ensure that the pharmacy has adequate stocks of information leaflets provided by the PCT and YPF service.

9.20The client should always be advised to talk to her GP or local family planning clinic, regardless of whether a supply is made. However, where the pharmacist, on the basis of the information obtained, is not certain that EHC can be supplied, the client should be referred to a GP or specialist clinic immediately.

9.21Clients who choose or require referral for a copper IUD as emergency contraception can be referred to designated clinics. If possible, contact the clinic beforehand. Failing this, advise the client to telephone in advance to confirm that the clinic doctor is available and can fit an IUD. If not, the clinic can provide details of availability at other clinics.

10. Child Protection

When seeing people under 16 years pharmacists are also required to act according to the Child Protection Guidelines.

If the pharmacist has any concerns regarding a possible need to breach confidentiality for the above reasons, please contact the Child Protection Office (Tel: 01708 465 497). Do not act in isolation.

When a young person is judged not to be competent in line with the Fraser ruling, she should be referred to the Family Planning Doctor or their GP. If the non-competent young person attends with a parent and both agree to treatment, then levonorgestrel can be given and both sign the PGD record sheet.

If the non-competent young person attends with a parent but the young person does not agree to treatment they must be referred to the Family Planning clinic or GP.

Clinical Governance Standards that will need to be evidenced for the provision of an EHC service

(N.B. These and other standards are included as an essential service of the pharmacy contract)

  1. The Pharmacy has a named clinical governance lead.
  2. The Pharmacy has produced and displays a practice leaflet, which includes information on the under 24year old sexual health services EHC/condom supply/Chlamydia testing and pregnancy tests.
  1. The Pharmacy undertakes an annual approved client service.
  2. The Pharmacy has an appropriate Child Protection Procedures in place in line with national and local guidance. There is a record kept to confirm that relevant staff have attended child protection training.
  1. The pharmacists and their staff participate in clinical audit.
  2. The Pharmacy has in place a Standard Operating Procedure for the EHC service.
  3. All staff are appropriately trained and understand their role in the provision of an EHC service.
  1. Pharmacists are able to demonstrate a record of Continuing Professional Development
  2. The Pharmacy:
  • has a written complaints procedure
  • keeps a record of complaints made
  • can demonstrate that a review of complaints has led to a change in practice
  1. The Pharmacy has an incident reporting system in place
  2. The Pharmacy has a Health and Safety Policy
  3. Contractors have systems and policies in place to ensure that contractors and employees comply with legal obligations of data protection and confidentiality. Staff are appropriately trained on these issues and employment contracts include a duty of confidence as a specific requirement.
  1. Appropriate patient records are maintained.
  2. The pharmacy has acheived Young People Friendly standards.

EHC SERVICE SPECIFICATION Page 1 of 624/04/19