NHS DORSET

ENHANCED SERVICE FOR COMMUNITY PHARMACY

CHLAMYDIA TREATMENT PROGRAMME

SUPPLY OF AZITHROMYCIN TABLETS

  1. Background

1.1.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. Since many infections are asymptomatic, a large proportion of cases remain undiagnosed, although infection can be diagnosed easily and effectively treated.

1.2.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.

1.3.The NCSP covers the whole country and is managed 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.

1.4.Chlamydia treatment within community pharmacies complements the provision of Emergency Hormonal Contraception (EHC), by offering a more holistic sexual health care service to this user group.

  1. Aims and intended service outcomes

2.1.To increase the number of locations offering treatment for chlamydia, therefore improving access and treatment uptake.

  1. Service description and outline

3.1The service will form part of the locally run service and is intended only for people who are resident in the NHS Dorset area.

3.2The service comprises of supply of azithromycin tablets to people under the age of 25 and supply of a test kit and epidemiological treatment to their sexual contacts.

3.3All management of results and tracing of contactswill be dealt with by the local Chlamydia Screening Office (CSO).

3.4Advice on potential side effects and drug interactions with azithromycin will be offered by the pharmacy.

3.5Pharmacies will offer a user-friendly, non-judgmental, client-centred and confidential service.

3.6Pharmacies will provide support and advice to people accessing the service, including advice on safe sex, condom use and advice on the use of regular contraceptive methods, when required.

3.7Consideration must be made with respect to whether young people under the age of 16 are Fraser competent. Pharmacists and their staff should be mindful of the young people accessing treatment and where appropriate assess the patient according to Fraser competence criteria.

3.8 The pharmacy contractor must have a Standard Operating Procedure in place for the service.

4.Care pathway

4.1A care pathway is shown in appendix 2

4.2Patients who test positive for Chlamydia (index patient)

  • If the patient tests positive for chlamydia, the CSO will contact the patient and offer options for treatment e.g. GUM, GP, pharmacy.
  • If patient opts to receive treatment in community pharmacy, the CSO will contact the pharmacy to arrange for the patient to attend for treatment. Once it has been established that a suitably trained pharmacist is present, the CSO will fax a communication form (appendix 1) to the pharmacy to confirm the patient details and. No azithromycin can be supplied to the patient without the authorisation of this form.
  • The patient is seen in the pharmacy at the agreed time. The pharmacist will use the PGD and checklist to ensure that it is appropriate to supply the treatment. If the patient cannot be treated under the PGD, they will be urgently referred back to the CSO.
  • Consumption of the azithromycin must be supervised at the time of the treatment consultation.
  • Patients who receive treatment must be given a supply of 6 condoms.
  • When the consultation is completed, the pharmacy must complete section B of the communication form (appendix 2) and fax this back to the CSO to verify that the treatment has been supplied and taken by the patient.

4.3Treatment of contacts of patients who have tested positive for chlamydia

  • If a patient tests positive for chlamydia, the CSO will complete the contact tracing process and offer options for treatment to sexual contacts of the patient as above.
  • If the contact opts to receive treatment from a community pharmacy, the CSO will contact the pharmacy to arrange for them to attend for screening and treatment. The CSO will send the communication form by fax to the pharmacy to confirm details and authorise treatment. No azithromycin can be supplied to the contact without this form.
  • Contacts must be asked to carry out a screening test before the azithromycin is supplied. The contact will be supplied with a postal test kit from the pharmacy and will return to the pharmacy with the completed test to receive the azithromycin. It is not necessary to wait for the result of the test for contacts, azithromycin can be supplied immediately after they have completed the test.
  • Once the test has been completed, the pharmacist will use the PGD and checklist to ensure that it is appropriate to supply the treatment. If the contact cannot be treated under the PGD, they will be urgently referred back to the CSO.
  • Consumption of the azithromycin must be supervised at the time of the treatment consultation.
  • Patients who receive treatment must be given a supply of 6 condoms.
  • Treatment will be offered to all contacts, even if they are over the age of 25.
  • When the consultation is completed, the pharmacy must complete section B of the communication form (appendix 1) and fax this back to the CSO to verify that the treatment has been supplied and taken by the patient.

5.Training

5.1The 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.

5.2Before offering the service, all pharmacists providing treatment under the PGD must:

  • Attend training offered by the PCT covering provision of the service including training on the use of the PGD.

AND

  • Complete the CPPE online assessment on Safeguarding Children.

OR

  • Have attended one of the PCT training sessions on Safeguarding Children within the last 2 years

6.Quality Indicators

6.1The pharmacy has appropriate PCTprovided health promotion and other promotional material available for the client group, actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate.

6.2The pharmacy is making full use of promotional material provided by the PCT.

6.3The pharmacy reviews its standard operating procedures and the referral pathways for the service on an annual basis.

6.4The pharmacy participates in any PCT organised audit of service provision.

6.5The pharmacy co-operates with any national or PCTled assessment of service user experience.

6.6The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service.

7.Payment

7.1The pharmacy will receive a £10 service fee for each occasion that that azithromycin is supplied, in addition to the drug tariff price (including VAT) of the azithromycin tablets.

7.2Payment will be based on the returns of the faxed communication forms to the CSO.

7.3Payment will be made on a quarterly basis.

8Azithromycin

8.1Azithromycin must be supplied as 4 x 250mg tablets.

8.2Consumption of the azithromycin must be supervised at the time of the treatment consultation.

9Useful Contacts

9.1 NHS Dorset Chlamydia Screening Office

Phone Number: 01305 816 208

Fax Number: 01305 814 915

Appendix A

CHLAMYDIA TREATMENT THROUGH PHARMACY

SECTION A: To be completed by the CSO to confirm client needs treatment and faxed to contacted pharmacy to request treatment:

POSITIVE CLIENTS / CONTACTS / PATIENT NUMBER
Name / Date tested
Place tested
Telephone No / D.O.B / Age / Sex
Mobile No / Confirm which number for follow-up calls / Tele / Mbl
Is the patient a contact? / Yes / No / If yes,
Index Patient’s No.
Date & Time of Treatment confirmed with telephone call to Pharmacy
Date and Time of Treatment confirmed with Client / Referred for Treatment by CSO / Print Name: ……………………………………..
Signature: ……………………………………….
Comments:

SECTION B: To be completed by the PHARMACY to confirm client accessed treatment and faxed back to the CSO:

1. CONTACT PATIENTS ONLY

Test pack given / Complete screening record with contact (Blue Form) / D Number of Test Pack:

2. ALL PATIENTS (POSITIVES / CONTACTS)

Treatment given

/ Azithromycin
1g once only / None
If none, why?

Azithromycin PGD Consultation Form completed?

/ Yes / No
Route /
Batch Number
PHARMACIST
Print Name
Signature
Date / ……………………………………………………………………………………………….
……………………………………………………………………………………………….
…………………………………… VENUE CODE OF PHARMACY …………………..

Discuss

/ How to take medication (PGD) / Side Effects (PGD) / Sexual Health Advice + Condoms given / Informed of GUM services (leaflet)

CHLAMYDIA SCREENING OFFICE Fax: 01305 814 915 Telephone 01305 816 208

Appendix B

Care Pathway for Chlamydia Positive Clients Attending

Satellite Treatment Venues including Pharmacy

NHS DORSET

COMMUNITY PHARMACY ENHANCED SERVICE

CHLAMYDIA TREATMENT PROGRAMME - SUPPLY OF AZITHROMYCIN TABLETS

This service specification has been produced by NHS Dorset and discussed with the Local Pharmaceutical Committee

1. / The contract is made between Dorset Primary Care Trust (the purchaser) and ……………………………………………… (the provider), the pharmacy authorised to supply this service.
2. / The contract will commence on ……………………… and is subject to termination as in points 5 and 6 below.
3. / The provider will ensure that the necessary documentation, as detailed in the service specification, is maintained and made available to the purchaser to enable the service to be monitored.
4. / The first points of contact for enquiries about this service specification are: …………………………………………..(the nominated contact manager for the provider) and ……Julia Booth ……... (the nominated contract manager for the purchaser).
5. / This agreement shall be terminated:
  • by either party giving not less than three months notice in writing;
  • if either party commits a breach of the terms and conditions of the contract at any point during the period of the contract. The offended party may service notice in writing of not less than one month to the party in breach, terminating the contract on the expiry of the notice period
  • if the provider ceases to maintain the standards of the service specification.
The PCT must be informed in advance if there is a change in pharmacy staff that will affect the delivery of this service
6. / The contract will be suspended pending the outcome of any investigation into alleged fraud.
7. / The pharmacy must remain compliant with all the essential services under the Community Pharmacy Contractual Framework as part of this agreement.
8. / In the event of a dispute remaining unresolved to the satisfaction of both parties, the issue shall be resolved by arbitration. Within one month of the required meeting between the contract manager for the purchaser and the contract manager for the provider, an arbitrator who is mutually acceptable to both parties shall be monitored. The decision of the arbitrator shall be binding upon both parties.
For the Primary Care Trust / Signed: / Dated:
For the Pharmacy / Signed: / Dated:
I understand that action may be taken against me if I make an incorrect claim.
I consent to the disclosure of relevant information for the purposes of fraud prevention, detection and investigation