Service Level Agreement for NHS Health ChecksCommunity Pharmacy Programme
1stApril 2010 – 31stMarch 2011
Contents:
1. Period of Service
2. Scope and Definition of the Service
3. Parties to the Agreement
4. Background and Service Aims
5. Summary of Local Need
6. Service Objectives and Intended Outcomes
7. Service Outline
8. Location of Service
9. Integrated Governance
10. Information Management
11. Service Monitoring and Evaluation
12. Funding
13. Contract Management
14. Review, Variation and Re-commissioning process
15. List of Appendices
For further details and queries please contact:
Philip Ray –Health ImprovementPractitioner
Pemberton House
Colima Avenue
SunderlandEnterprisePark
Sunderland
SR5 3XB
1.1This Service Level Agreement will run from 1st April 2010 to 31st March 2011.
2.Scope and Definition of the Service2.1The service shall be available to all patients who are registered with a GP within the NHS South of Tyne and Wear Boundary, or not registered with a GP but living in the NHS South of Tyne and Wear area, in accordance with equality and diversity legislation.
2.2The service is to be delivered by Community Pharmacists within the NHS South of Tyne and Wear Boundary.
2.3This is an interim SLA to enable a number of community pharmacists to become early implementers of the NHS Health Checks programme in relation to vascular risk identification and assessment. The programme has been developed in line with national guidance, in consultation with professionals locally, and will use social marketing outcomes to inform practice
- Community pharmacies are commissioned to identify patients aged 40 - 74who are not currently being treated for vascular disease. Patients must either be registered with a GP in the NHS South of Tyne and Wear area, or not registered with a GP but living in the NHS South of Tyne and Wear area.
- Community pharmacies will undertake a NHS Health Check to establish their vascular risk.
- The NHS Health check will be facilitated by a dedicated software package and will include an assessment of lifestyle habits and a range of health indicators.
- All tests and measurements are taken by an accredited member of the pharmacy team.
- All advice and signposting following the processing of the collected data is provided by an accredited pharmacist.
- Those identified at significant risk (≥20% 10 year risk) of vascular disease are referred to their GP.
- Those at lower risk (≤19.9% 10 year risk) are offered lifestyle advice and appropriate signposting.
2.4This NHS Health Checks service will only be commissioned from pharmacies providing the full range of Essential Services as defined by the Pharmacy Contract. All pharmacies providing this service must operate a 6-day opening policy and provide the full range of essential services as defined by the Pharmacy Contract. Exceptions to the 6-day opening policy will only be considered when there is no pharmacy available locally that patients can access and to meet the demands of the local target poulation. All pharmacies must have a private consultation area that has been approved for MUR by the PCT.
2.5This work will complement the overarching NHS Health Checksprogramme being provided within primary care, as well as community based pilots such as the NHS Health Check community delivery team, Occupational Health pilots in Sunderland and Gateshead council as well as the early implementer community pharmacy programme.
2.6Pharmacies must offer a fully accredited NHS Stop Smoking service within their range of services.
3.Parties to the Agreement3.1This document constitutes the agreement between the Pharmacy Contractor and the PCT with regard to the Service Level Agreement for the Provision of NHS Health Checks through Community Pharmacy.
Pharmacy Code:
Pharmacy Stamp/Details:
Names of Pharmacists undertaking the service on behalf of the contractor:
Signature on behalf of the Pharmacy:
Signature / Name / DateSignature on behalf of the PCT:
Signature / Name / Date4.Background and Service Aims
4.1Vascular diseases affect the body in different ways. However, they are all linked by a common set of risk factors. Obesity, physical inactivity, smoking, high blood pressure, disordered blood fat levels (dyslipidaemia) and impaired glucose regulation (higher than normal blood glucose levels, but not as high as in diabetes) all raise the risk of vascular disease. Having one vascular condition increases the likelihood of the individual suffering others.
4.2Damage to the vascular system increases with age, and progresses faster in men than women, in those with a family history of vascular disease and in some ethnic groups. These are called “fixed factors” because they can’t be changed. Importantly, however, the rate at which vascular damage progresses is also determined by “modifiable factors”, i.e. factors which can be altered. Changing these can greatly reduce the probability that vascular disease will strike early, bringing premature death or disability. These modifiable factors are:-
- Smoking;
- Physical inactivity and a sedentary lifestyle;
- High blood pressure;
- Raised cholesterol levels; and
- Obesity
4.3The combined effects of these factors lead to a build-up of atheroma, fatty deposits on the walls of the arteries. In the coronary arteries of the heart, this causes heart attacks and angina. In the arteries of the brain, atheroma and high blood pressure can lead to strokes or transient ischaemic attacks (minor strokes). In the arteries of the kidneys, and small blood vessels that make up the filters of the kidneys, the result is the commonest form of chronic kidney disease that, in turn, increases the risk of heart attacks and may lead to kidney failure. Obesity and physical inactivity may lead to the most prevalent form of diabetes, which, if unrecognised or poorly controlled, itself damages blood vessels and increases the risk of atheroma and therefore other vascular disease.
4.4Taking action to reduce these risk factors can make a difference to how fast these diseases progress, or whether they happen at all, and so reduce the risk of vascular disease.
4.5It is well know that people living in deprived circumstances have poorer health than the rest of the population. This is strongly reflected in vascular diseases (coronary heart disease, stroke, kidney disease and diabetes) where people in lower socio-economic groups tend to suffer earlier and more severe disease. What is perhaps less well known or understood is that vascular disease, in some ethnic groups, makes a significant contribution to premature death. For example, in the UK, mortality from coronary heart disease is currently 46% higher for men and 51% higher for women of South Asian origin that in the non-Asian population. The occurrence of diabetes in individuals of South Asian origin is twice that of the general population and the occurrence of chronic kidney disease is six times the rest of the population, which in turn also increases their risk of coronary heart disease.
4.6Evidence shows that it is possible to identify the risk factors for these diseases, and also to act to change them. Early intervention to reduce risk can prevent, delay, and, in some circumstances, reverse the onset of vascular disease. Preventive strategies and risk assessment are topics of considerable interest in the clinical community and the focus on the need for prevention has become sharper in recent years.
4.7NHS Health Checks – National Picture. Vascular risk assessment and management is the subject of the Department of Health’s “Putting Prevention First” document, published April 2008. This document highlights the need to focus more effort on prevention of vascular diseases, namely, coronary heart disease, stroke, diabetes and kidney disease. It states that a vascular risk programme, for people aged 40 to 74, would be both clinically effective and cost effective. The document envisages that PCTs will commission the services from a variety of organisations, which include community pharmacies, as well as traditional GP surgeries and also potentially local third sector organisations.
A subsequent document published November 2008 (Vascular Checks: risk assessment and management: ‘Next Steps’ Guidance for Primary Care Trusts), estimates that the NHS Health Checks programme could, on average, prevent 1,600 heart attacks and strokes and save at least 650 lives each year. The programme could also prevent over 4,000 people a year from developing diabetes and detect at least 20,000 cases of diabetes or kidney disease earlier, allowing individuals to be better managed and improve their quality of life.
4.8NHS Health Checks – Local Picture. This work fits within the remit of the Bridging the Gap initiative. Bridging the Gap is a programme of work aimed at closing the life expectancy gap between the South of Tyne and Wear and England and Wales by addressing Cardiovascular Disease (CVD) and other related diseases. A co-ordinated programme of services is being commissioned to ensure the implementation of evidenced based interventions, particularly ‘high impact changes’ at all stages of the pathway.
Community pharmacists have already been playing an increasingly important health improvement role, for example by providing NHS Stop Smoking Services. There are 83 (out of a total of 133) community pharmacies across the NHS South of Tyne and Wear area who are currently contracting to provide these services. The NHS Health Checks programme is an extension of this health improvement role for community pharmacies.
The work also fits within “Our Vision, Our Future, Our North East NHS” which is a strategic vision for transforming health and healthcare services within the North East of England. A key message from this document is the need to refocus NHS resources on preventing ill health. The NHS Health Checks programme will be one of the ways in which this can start to be achieved.
Also relevant are the results of the recent CVD Pathway Market Research conducted for NHS South of Tyne & Wear. The research investigated attitudes to CVD of practitioners and high risk patients, ways to attract high risk patients, barriers to practitioners and patients, accessibility, information and support needs, and perceptions of the CVD pathway. Of particular relevance to this work was the finding that NHS Health Checks need to be as accessible as possible for members of the public who are unlikely to visit their GP. Pharmacists can play an important role in providing easy access and out of hours appointments.
4.9Weight management and smoking cessation services have been expanded locally to ensure sufficient referral pathways are in place. If you have staff trained as Intermediate Stop Smoking Advisers within your pharmacy, additional payment is available for this service under a separate Local Enhanced Service. Details of local services for weight management and Stop Smoking Services will be provided as part of the training programme for this service.
4.10Service Aims. This service forms part of a long term plan to achieve systematic risk identification, assessment and management of all patients at high risk (≥20% risk of CVD over 10 years) of developing CVD between the ages of 40 – 74.
Evidence shows that it is possible to identify the risk factors for CVD, and also to act to change them. Early intervention to reduce risk can prevent, delay, and, in some circumstances, reverse the onset of vascular disease.
A systematic, integrated approach to assessing risk of vascular diseases for everyone between 40 and 74, followed by the offer of personalised advice and treatment and individually tailored management to help individuals manage their risk more effectively, is both clinically and cost effective.
The benefits of this approach are to:
- enable more people to be identified at an earlier stage of vascular change, with a better chance of putting in place positive ways to reduce substantially the risk of premature death or disability;
- enable the prevention of diabetes in many of those at increased risk of this disease;
- sustain the continuing increase in life expectancy and reduction in premature mortality that are under threat from the rise in obesity and sedentary living; and
- offer a real opportunity to make significant inroads into health inequalities, including socio-economic, ethnic and gender inequalities.
5. Summary of Local Need
5.1Locally, Vascular diseases are the most common cause of death and disability, and there is a significant relationship between the prevalence of CVD and deprivation. Work undertaken in 2008 showed that there are 264,000 people aged 40-74 across the NHS South of Tyne and Wear area. There has been some initial risk assessment work undertaken by the NHS South of Tyne & Wear, which has identified 10,000 people as being at high risk of vascular disease. However it is estimated that over the next five years 76400 in Gateshead, 57300 and 100500 people aged between 40 and 74 years require a NHS Health Check. These figures include 22200 in Gateshead, 16000 in South Tyneside and 30000 in Sunderland who are currently on the hypertension register but still need a NHS Health Check.
5.2Equitable access to NHS Health Checks will support the achievement of the Bridging the Gap initiative across South of Tyne and Wear.
6. Service Objectives and Intended Health Outcomes6.1All Pharmacies are expected to provide the essential services they are contracted to provide to all their patients. This service level agreement outlines the more specialised services to be provided. The specification of this service is designed to cover the enhanced aspects of the provision of NHS Health Checks, some of which are beyond the scope of essential services. No part of the specification by commission, omission or implication defines or redefines essential services.
6.2The overall aim of the service is to provide NHS Health Checks to people aged 40-74.
6.3The following outcomes are specified for this service:
6.3.1Minimum of 150 NHS Health Checks completed over a 12th month period.
6.3.2Hard copy of NHS Health Check results given to each patient
6.3.3Hard copy of NHS Health Check results given to GP for each of their patients
6.3.4All patients identified as being high risk will be followed up via telephone after 7 days to determine whether or not they have made an appointment to see their GP.
6.3.5A summary list of all patients, who have undertaken the NHS Health Check, is given to GPs on a monthly basis
6.4Suggested quality indicators for the service:
6.4.1 The pharmacy has appropriate PCT / DH provided healthy lifestyle advice leaflets and other promotionalmaterial available for the client group, actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate.
6.4.2 The pharmacy is making full use of promotional material provided by the PCT (where appropriate).
6.4.3 The pharmacy reviews its standard operating procedures and the referral pathways for the service on an annual basis.
6.4.4 The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service on at least an annual basis.
6.4.5 The pharmacy can demonstrate robust quality assurance for any processes or equipment used.
6.4.6 The pharmacy participates in an annual PCT organised audit of service provision.
6.4.7 The pharmacy co-operates with any local assessment of service user experience
7. Service OutlineOnly Pharmacy Contractors that are signed up to the Service Level Agreement for the Provision of NHS Health Checks through Community Pharmacycan operate under this service specification.
The following pages contain some further guidance from the PCT on expected processes, outcomes and deliverables for this Service Level Agreement. On aspiring to this service pharmacies are required to submit plans under each of these items to the PCT.
7.1Undertaking an NHS Health Check
7.2Communication of risk to patients
7.3Qualifications, Accreditation, Training and Competency
7.4Equipment
7.5Clinical Governance/Health and Safety
7.1: Undertaking a NHS Health Check
Details
The pharmacy will initially complete a pre-check questionnaire with the patient to ascertain eligibility for entering into the service.Eligible population
- Males and females aged 40 to 74 years
- Patients areeither registered with a Sunderland, Gateshead or South Tyneside PCT GP, or are not registered with a GP but live in the NHS South of Tyne and Wear area (the pharmacist should advisepatients on how to register with a local GP).
- Patients must not: -
- Have had a full vascularcheck by their GP practice in the last 12 months
- Be currently prescribed any vascular disease treatment
- Be a diagnosed diabetic patient
- Patients must give signed consent to entering into the NHS Health Checks programme. Consent is required: -
- To inform the patient’s GP of the test results
- To allow the pharmacy/PCT to contact the patient and patient’s GP for follow up purposes and to discuss patient experiences and outcomes
- To provide patient anonimised data to NHS South of Tyne and Wear PCTs for the purposes of service evaluation, publication or research
- Age
- Gender
- Family History
- Ethnicity
- Smoking Status
- BMI
- Alcohol Units
- Blood pressure (hypertension)
- Total Cholesterol and Cholesterol /HDL ratio
- Physical Activity
A fridge/ cold storage is required on the premises for storage of the cholesterol testing cassettes.
Based on Framingham, a risk score will be calculated by the software package, which is consistent with the risk scores used by local GPs. This risk score will be recorded for each patient on a template approved by the PCT. The risk will be communicated to the patient, using the risk communication tool in the software package. Where appropriate patients will either be referred to their GP for follow up and intervention or signposted to lifestyle changes to improve their score.