Draft Service Level Agreement for Pharmacy Based Supervised Self-Administration Service

This agreement serves as a formal contract between Richmond and Twickenham Primary Care Trust (RTPCT) and the Community Pharmacist detailed below for the provision of supervised self-administration services to substance misuse clients in the London Borough of Richmond upon Thames (LBRuT).

Pharmacist / Company:

Address: ______

Tel. No: ______

Fax No: ______

Email Address: ______

  1. Service Description
  2. This service requires the Pharmacist to supervise the consumption of prescribed medicines in relation to substance misuse at the point of dispensing in the pharmacy to ensure that the dose has been administered to the service user.
  3. Pharmacies will offer a user friendly, non-judgmental, client centred and confidential service.
  4. The pharmacy will provide support and advice to the service user, including referral to primary care and specialist drug and alcohol services where appropriate.
  5. The medicines which the pharmacy will supervise consumption are prescribed methadone and Buprenorphine
  1. Aims and intended service outcomes
  2. To ensure compliance with the service users treatment plan through the dispensing of prescribed Methadone and Buprenorphine in specified instalments. Doses will be dispensed to the service user to cover days when the pharmacy is not open.
  3. To ensure each dose is correctly and safely consumed by the person for whom it was intended.
  4. To reduce the risk to local communities of prescribed medicines entering the illicit drugs market and to prevent accidental exposure to supervised medicines.
  5. To provide the service user with regular contact with healthcare professionals and to help them access further advice and assistance. Referral to specialist drug and alcohol treatment services or other health and social care facilities will be used where appropriate.
  1. Quality Measures
  2. The Pharmacist is expected to operate the scheme in line with the code of Ethics and Professional Standards laid down by the Royal Pharmaceutical Society of Great Britain.
  3. The pharmacy must be open for 6 days a week (including Saturdays) for at least 40 hours.
  4. The pharmacy has sufficient consultation / private space to deliver the service.
  5. The pharmacy will maintain adequate stock levels of Methadone and Buprenorphine.
  6. The pharmacy reviews its standard operating procedures and referral pathways for this service on an annual basis.
  7. Locum Pharmacists must be made aware of the service and the operational procedures in advance of providing local cover for the Pharmacist.
  8. The views of service users will be sought on at least an annual basis to inform planning of and improvements to the service.
  9. The Pharmacy will provide the service in such a way as to promote equality of access across all community groups regardless of ethnicity, gender, disability or sexuality.
  10. The Pharmacy will undergo an annual Risk Assessment in line with PCT guidelines.
  11. The Pharmacy will conduct an annual Impact Assessment around equality of access.
  1. Service Outline
  2. To provide supervised self-administration to clients whom in the prescriber’s opinion would benefit from supervised consumption of the medicines outlined in 1.4.
  3. The area of the pharmacy used for the provision of the service provides a sufficient level of privacy and safety for the service user. The service user must consume the prescribed dose away from public view.
  4. The service user will receive the dose in an appropriate receptacle (disposable plastic cup) and will be provided with water to facilitate administration and prevent the holding of the dose in the mouth.
  5. Upon initial presentation the Pharmacist must check the clients details and ensure they understand the terms of the service.
  6. The pharmacist will observe the consumption of the dose and engage the client in conversation to ensure the client has swallowed the dose.
  7. Methadone or Buprenorphine must not be dispensed when clients are intoxicated with sedative drugs and/or alcohol. The Pharmacist is expected to use their discretion in this situation. If appropriate the client should be referred back to the prescriber. If this situation occurs the Pharmacist should advise the client to take the Sunday dose as late as possible in order to facilitate a sober condition.
  8. Clients who miss three consecutive doses should be referred back to the prescriber as their tolerance may have decreased. These clients should receive no further doses until the prescriber has seen them.
  9. The PCT will provide the Pharmacy with a fax template to use to notify the prescriber in the event of missed doses or any other erratic behaviour.
  10. It is the responsibility of the pharmacy to ensure that the correct dose is administered to the correct client.
  1. Data collection and monitoring
  2. As part of the service the following data will need to be collected for every client who accesses the service for each month
  • Client identification reference e.g. initials or other identifiable information.
  • The gender of the client.
  • The age group of the client.
  • The ethnic group the client belongs to.
  • Hepatitis vaccination status.
  • Postal code of area of residence.

5.2A client’s refusal to provide this information is not a reason for refusing access to the supervised self-administration service. Where a client has refused to provide information ‘N/A’ should be recorded.

5.3The PCT will provide the pharmacist with an electronic monitoring spreadsheet to be populated and maintained by the pharmacist. This spreadsheet should be sent to the Commissioning Support Officer, Substance Misuse on a monthly basis.

  1. Critical Incidents
  2. In the event of a critical incident such as violent, aggressive or threatening behaviour towards pharmacy staff and the public or theft the pharmacist and their staff are not to put themselves in any risk of injury. It is not expected that pharmacy staff will accept threatening, violent or other abusive behaviour from supervise self-administration clients.
  3. In the event of such an incident the client should be asked to leave the premises with a verbal warning.
  4. If the client returns subsequently and there are no changes in behaviour the Pharmacist has the right to withhold the service.
  5. If the client refuses to leave voluntarily when requested the pharmacist should call the police to escort the client from the premises.
  1. Training
  2. The Pharmacist will attend training organised by the Substance Misuse Commissioning Team. The key elements of the training will be around Blood Borne Viruses, Drug Related Deaths, overdose prevention and dealing with problematic clients.
  3. The Pharmacy will be required to attend 50% of the training provided in order to receive the retainer.
  4. The PCT will provide two training sessions per year for this service.
  1. Payments
  2. The pharmacy will be paid £1 for every day of supervision for every client who accesses the service.
  3. The pharmacy will be paid £1.20 for every day of supervision for every client who receives Supervised Self- Administration for Subutex.
  4. The payment will be processed on a monthly basis by the PCT upon receipt of the pharmacies monthly payment claim form and the receipt of the monitoring data outlined in section 5. The Commissioning Support Officer will process payments within 5 working days upon receiving the invoice.

Contract Agreement:

The signatures below constitute an agreement between the parties concerned for the provision of supervised self-administration services. The Substance Misuse Commissioning Team will review the agreement annually.

The Pharmacist

Signature: ______

Print Name: ______

Date: ______

Signed on behalf of the PCT

Signature: ______

Print Name: ______

Position in PCT: ______

Date: ______

Either side, giving three months notice in writing to each other, may terminate the above agreement. If the agreement is terminated must ensure that all equipment and paraphernalia are returned to the appropriate place/individual.

Contact Details:

Richmond and Twickenham Primary Care Trust, Thames House, 180 High Street, Teddington, TW12 8HU.

Joint Commissioning Manager, Substance Misuse – Sarah Darcy, 0208 973 3166,

Commissioning Support Officer, Substance Misuse – Luke Paterson, 0208 973 3095,

Community Pharmacy Advisor – Narinder Bal, 0208 973 3137,