[2014/15
PUBLIC HEALTH SERVICES CONTRACT]
[PLEASE DELETE THIS HEADER IN EACH FINALISED CONTRACT]
APPENDIX–SPECIFICATION
Specification No. / SCHPH00147Service / PROVISION OF SEXUAL HEALTH SERVICESIN COMMUNITY PHARMACIES
Authority Lead / Dr Chris Stanley Public Health Development Officer (Sexual Health and Wellbeing)
Provider Lead / Community Pharmacy to be added
Period / 1stAugust 2014 to 31st March 2015
Date of Review / Quarter 2 – End September 2014
Quarter 3 – End December 2014
1. The Services
1.0 Introduction
Public Health Staffordshire is committed to the Staffordshire County Council vision of a “Connected Staffordshire, where everyone has the opportunity to prosper, be healthy and happy”. Sexual health is an important and wide-ranging area of public health. Most of the adult population of England are sexually active, and having the correct sexual health interventions and services can have a positive effect on population health and wellbeing as well as individuals at risk.
Pharmacies are well placed to provide easy accessto high quality services including certain sexual health services, and can often be the first point of call for Service Users seeking Emergency Hormonal Contraception.
The service is underpinned by the following:
- Service Standards for Sexual and Reproductive Healthcare (FSRH 2013)
- Clinical Guidance – Emergency Contraception (FSRH 2012)
- UK National Guideline on Safer Sex Advice (BASHH & BHIVA 2012)
- National Chlamydia Screening Programme Standards (7th Edition 2014)
- Standards for the Management of Sexually Transmitted Infections (BASHH & MEDFASH 2010)
- Progress and Priorities - Working Together for High Quality Sexual Health (MEDFASH 2008)
- PH3 One to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups (NICE 2007)
- CG30 Long-acting reversible contraception (NICE 2005)
- Recommended Standards for Sexual Health Services (MEDFASH 2005)
- Research Governance Framework for Health and Social Care (Department of Health 2005
- To contribute to a reduction in the number of unplanned pregnancies by improving access to emergency hormonal contraception (EHC) and sexual health advice to women of all ages through one to one advice and treatment in community pharmacies.
- To increase early detection and treatment of chlamydia in 15 – 24 year olds and therefore reduce transmission and complications associated with it as part of the National Chlamydia Screening Programme (NCSP)
- Where appropriate, to refer Service Users into mainstream contraceptive services and to ensure that pathways for post-coital IUD fitting for emergency contraception are known to Service Users who request EHC.
- To encourage responsible use of condoms to young people via the C Card scheme.
- To increase the knowledge of risks associated with Sexually Transmitted Infections (STIs).
- To refer Service Users who may have been at risk of STIs to an appropriate service.
- To strengthen the local network of contraceptive and sexual health services to help ensure easy and swift access to advice.
In all cases, people declaring symptoms suggestive of sexual ill health should be risk assessed and managed appropriately. This may include referral to specialist sexual health services.
- Levonorgestrel 1.5mg, Ulipristal acetate 30mg and Azithromycin must only be prescribed by an accredited pharmacist who has completed the training specified, under the current Patient Group Directions authorised by Staffordshire Public Health.
- It is expected that there will be a named lead within each participating pharmacy responsible for responding to queries relating to EHC and Chlamydia screening and testing. The named lead will act as the Governance Lead and Champion for the service(s).
To provide, where clinically indicated, a free supply of EHC as specified within the Patient Group Direction (PGD) for Levonorgestrel or Ulipristal acetate.
- The pharmacist must provide the service in person. Medicine counter staff must refer all such Service Users to the accredited pharmacist without delay.
- If an accredited pharmacist is unavailable the Service User should be informed when an accredited pharmacist will be available or signposted to an alternative service where EHC can be obtained or post-coital IUD can be fitted (list in EHC support pack).
- Service Users attending an accredited pharmacist should be given access to the service even where this may mean that the consultation is completed after opening hours. This is at the discretion of the pharmacist who should always ensure the safety of the Service User, staff and themselves. Ifthis is not possible pharmacists should advise the Service User of a timely alternative source of EHC or post-coital IUD.
- The pharmacist takes a Service User history to ensure that they have sufficient information to assess the appropriateness of the supply.
- If the pharmacist is satisfied that emergency contraception is appropriate and that the Service User understands the circumstances in which emergency contraception will be effective, the pharmacist supplies, according to the PGD, Levonorgestrel 1.5mg as a single dose within 72 hours, or Ulipristal acetate 30mg as a singe dose between 72 – 120 hours of unprotected sexual intercourse.
- The product may only be supplied to be taken on the premises of the pharmacy and should not be supplied for possible future use.
- The pharmacist must ensurethat the Service User is counselled on other sexual health matters and related topics. Written information should also be available on these topics.Referral with local sexual health services should be made as appropriate.
- The pharmacist must ensure maintenance of records for each supply and may be required to share information with appropriate parties in line with confidentiality protocols.
- The pharmacist must use their professional judgement to consider, and where appropriate, act on any safeguarding children issues coming to their attention as a result of providing the service. This should be in line with local safeguarding children procedures and any national or local guidance on sexual activity in the under 16s.
- The Sexual Offences Act 2003 states that no child under 13 years is able to consent to any sexual activity. If a child under 13 years of age requests EHC, the pharmacist taking the consultation must keep accurate records, and if there is a reasonable concern that sexual activity has taken place, the pharmacist should always speak to their identified child protection lead or senior manager within their pharmacy. There must always be a presumption that the case will be referred to the Children’s Social Care Services in the area where the child lives (see theFlowchart at the end of this specification). If a decision is made not to refer following discussion with the safeguarding lead/senior manager, then the reasons should be fully documented. However, the duty to safeguard the child from most harm would include protecting them from an unintended pregnancy, so providing that they have been assessed as “Fraser competent”, treatment should not be withheld.
- If, after receiving all the necessary information, the Service User does not wish to take the tablet they should be advised to see their GP or attend a Contraceptive & Sexual Health clinic as an emergency. It should be documented that they did not wish to proceed and a claim for the consultation only can still be made. Some Service Users may want time to consider their options and therefore are free to leave the pharmacy and return later when they have made their decision.
- If, on the grounds of moral or religious beliefs a pharmacist does not supply Emergency Hormonal Contraception (EHC), women must be referred to an alternative appropriate source of supply available within the time limits for EHC to be effective and which will not compromise the woman’s contraceptive cover.
The objective of the service is to reduce onward transmission, and the consequences of untreated infectionin young, sexually active men and women:
- Chlamydia screening should always be offered as part of the Emergency Hormonal Contraception service and be proactively offered with all existing services / sales in under 25s that are appropriate for offering a Chlamydia screen e.g., contraceptive pill prescriptions and condom sales
- Service Users under the age of 25 years should be advised about the risks associated with undiagnosed Chlamydia, supplied with National Chlamydia Screening Programme (NCSP) test kits and strongly encouraged to undertake the screening test and return the postal Chlamydia screening kit to the NCSP lab as directed within the pack.
- Pharmacists should seek to increasethe understanding and awareness of the importance of reducing the risk of transmission of Chlamydia and other sexually transmitted infections.
To treat eligible young people aged 16-24years who have been diagnosed with Chlamydia trachomatis following the PGD for the supply of Azithromycin.
- Azithromycin can only be supplied under the PGD by an accredited pharmacist who has completed the training specified.
- To screen and treat all partners of young people diagnosed with Chlamydia trachomatis following the Azithromycin PGD.
- The pharmacist must provide the service in person. Medicine counter staff must refer all such Service Users to the accredited pharmacist.
- If providing treatment, the pharmacist must initiate the Partner Notification process using the BClear “Management of ChlamydiaPositive Clients” forms which will be supplied to all participating pharmacies
- If an accredited pharmacist is unavailable the Service User should be informed when an accredited pharmacist will be available or signposted to an alternative service where treatment can be obtained.
- All eligible Service Users are given sexual health advice and the importance of treating all current and previous partners is stressed. Service Users should be encouraged to notify current and recent partners.
- As Service Users who have tested positive for Chlamydia are also at increased risk of having contracted other sexually transmitted infections, all eligible Service Users should be referred on and encouraged to attend local GUM services.
Pharmacists are encouraged to be distribution sites for free condoms to under 25 year olds, ideallythroughthe C-Card condom distribution scheme where it is in place. This enables pharmacies to provide 13-25 year olds who have registered with the scheme free condoms on presentation of their C-Card. At present, the C-Card scheme only operates in the north of Staffordshire; pharmacies in the south of Staffordshire will be notified when the scheme is implemented in their area.
1.3Population covered
- The EHC service is for all women presenting at the pharmacy irrespective of home location or GP practice.
- The pharmacy will offer the service to all women of all ages including under 16 year olds seeking advice or information taking into account appropriate accreditation and issues around Fraser competencies and Safeguarding.
- The NCSP Chlamydia Screening Programme is for all people aged 15-24 presenting at the pharmacy irrespective of home location or general practice (GP).
The Provider has the right to refuse service provision to the users for any unreasonable behaviour unacceptable to the Provider, its staff, or the named professional clinically responsible for the management of the care of such Service User.
1.4.1EHC service acceptance
- The EHC service is available to allwomen who think theymay be at risk of pregnancy and who if under 16 aredeemed competent to consent to treatment (refer to Fraser guidelines)
- Whilst there is no limitto the number of times a Service User can access the EHC service pharmacists must use their discretion when faced with repeat attendees. It must be stressed to the Service User that it is an emergency measure only and as above, they should see their GP or the Contraceptive & Sexual Health (CASH) Service to discuss regular methods of contraception.
- Women who are unsuitable for treatment under the conditions of the PGD or this service specification.
- Women aged 16 and under who are deemed not competent to consent to treatment (See Fraser guidelines in EHC Support Pack)
- Women who have not validly consented to the treatment provided under the Services
- Friends, relatives or third parties requesting EHC on behalf of the intended user
- The EHC should not be supplied for possible future use.
1.4.3 Chlamydia screening and treatment service acceptance
- Any young person who is identified as sexually active between 15 and 24.
- A person of any age who is identified as a partner of a young person (15-24) who has tested positive for Chlamydia
- Service Users who are unsuitable for treatment under the conditions of the PGD or this service specification
- Individuals with symptoms of sexually transmitted infections (who should be redirected to GP or GUM)
- Individuals outside the target age group of the Programme (other than partners of those NCSP Service Users who have tested positive)
- Young people under the age of 16 years deemed not competent to consent to treatment (SeeFraser guidelines in EHC Support Pack)
- The Service User should be made aware of the need to consider long term methods of contraception and the support and follow up that is available to them through the Contraceptive & Sexual Health (CASH) Services, their own GP and the GU Medicine Service.
- Individuals with symptoms of sexually transmitted infections should be advised to immediately access the local GUM services.
- Other services which may refer people in to this service such as school nursing, or which may also be suitable for further referral such as alcohol, lifestyle, mental health services.
2. Key Service Outcomes and Quality Requirements
ACTIVITY OUTCOMES DATA
Outcome indicator / Threshold / Method of measurement / Consequence of breach
Number of consultations where supply made of Levonorgestrel / n/a / PharmOutcomes report / n/a
Number of consultations where supply made of Ulipristal acetate 30mg / n/a / PharmOutcomes report / n/a
Number ofconsultations where EHC not supplied / n/a / PharmOutcomes report / n/a
Percentage of chlamydia kits offered to EHC service users aged 15-24 / 100% / PharmOutcomes report / Remedial Action Plan
Percentage of chlamydia kits accepted by EHC service users aged 15-24 / 90% / PharmOutcomes report / Remedial Action Plan
Number of tests received at laboratory from pharmacy service users / n/a / PharmOutcomes report / n/a
No of consultations where supply made of Azithromycin for Chlamydia treatment / n/a / PharmOutcomes report / n/a
Number of referrals made to GP/CASH for LARC fitting / To establish a baseline for future activity. / PharmOutcomes report / n/a
% EHC consultation where free condoms were supplied / To be established upon implementation of condom distribution scheme / PharmOutcomes report / Remedial Action Plan
% Chlamydia treatment consultation where free condoms were supplied / To be established upon implementation of condom distribution scheme / PharmOutcomes report
QUALITY STANDARDS
Data item / Purpose / Threshold / Consequence of breach
Identification of a clinical governance lead for EHC provision and Chlamydia screening / Quality indicator / Name provided / Remedial action plan
All staff delivering EHC to have completed relevant CPPE courses/refresher training within last 3 years / Quality indicator / Evidence provided / Remedial action plan
Care pathways to other services defined and referrals made where appropriate. / Quality indicators / Assurance given / Remedial action plan
Achieve or maintain Young people friendly standards e.g.You’re Welcome/DASH / Quality indicator / Assurance given / Remedial action plan
Maintain or achieve LGB friendly standards e.g.Rainbow Charter / Quality indicator / Assurance given / Remedial action plan
Information/feedback forms (to be provided by the Authority) handed out to all EHC and Chlamydia treatment service users. / Quality indicator / Assurance given / Remedial action plan
Number of service users making formal complaints about the service (verbal or written) / Quality indicator / 0 / Learning and action plan
Serious incidents/ near misses to be reported to the commissioner within contract specified timescales. / Quality indicator / 0 / Learning and action plan
Compliance with safeguarding policies and processes (children and adults in vulnerable circumstances) / Quality indicator / Assurance given / Remedial action plan
N.B. – Assurance standards to be reported annually via a template to be supplied by the Authority
3. Applicable Service Standards
3.1 Standards required (including NCSP core requirements for Chlamydia screening and treatment)
Pharmacies providing any element of these sexual health services should:
- Ensure that staff are appropriately trained to deliver the services.
- Offer user friendly, non judgemental, Service User centred and confidential services
- Adhere to national and local requirements regarding the management of under 18s, including use of the Department of Health’s You’re Welcome quality criteria[1] and local resources where available, as guiding principles when planning and implementing changes and improvements, in order for the service to become young people friendly where appropriate.
- Achieve or work towards bronzeaward criteria of Staffordshire Buddies “Rainbow Charter Mark”[2] to ensure that lesbian, gay and bisexual Service Users are treated fairly and able to discuss issues openly with service providers.
- Utilise and prominently display relevant national and local sexual health, emergency contraception and chlamydia screening materials.
- Provide people testing for chlamydia with an information leaflet as part of the consent process
- Be responsible for ensuring timely onward referral for those people who they are not able to manage.
- Be responsible for providing all mandatory data reporting to the local coordination.
- Be responsible for undertaking a satisfactory system of audit in line with the annual requirements to audit key performance indicators of the programme
- Always include consultation with service users and local populations for any service planning and improvement