Local Authority Service Specification (LASS)

Local Authority Service Specification (LASS)

SEXUAL HEALTH SERVICES FOR UNDER 25s, 2013 - 14

Content

1.  Summary

2.  Service Specification

3.  Condom Distribution Scheme

4.  Emergency Hormonal Contraception

5.  Treatment for Chlamydia Screening

6.  Service Specification Agreement - Sign up Form

7.  References

8.  Contacts for further information

Appendix 1

·  Issuing of condoms protocol

·  c – card monitoring and claim form

Appendix 2 - Fraser Guidelines

Appendix 3

Patient Group Directives (PGDs) and forms for invoicing and monitoring

Appendix 4 - Young People Friendly Criteria

1.  SUMMARY

1.1. Context

The Service Specification incorporates work that supports the modernisation agenda for both sexual health services and pharmacies and will contribute to the achievement of targets for Chlamydia Screening, reducing Teenage Pregnancy and improving Genito Urinary Medicine (GUM) Access.

This framework should be read in conjunction with Council policies and professional guidance, including North Somerset Public Health’s policies for Infection Control, Confidentiality, and Working with Sexually Active under 18 year olds Policy (2008).

1.2. Essential Services

All community pharmacy services, whether offering the Service Specification or not, will continue to provide essential services including:

1.2.1.  Participating in all North Somerset Public Health-organised annual health promotion campaigns per annum, of which sexual health is usually one.

1.2.2.  Providing opportunistic sexual health advice, including the supply of Chlamydia screening kits to young people under 25 years old, in postal boxes which are returned to the Avon Chlamydia Screening Programme laboratory.

1.2.3.  Signposting people to other services (incl. The WISH Clinic, “No Worries!” service and their local general practitioner) – including display of relevant leaflets.

1.2.4.  Services who do not offer this service specification are still encouraged to meet the young people friendly criteria (see Appendix 4) so that they can brand themselves as offering a good sexual health service for young people.

1.3. Service Description

Community pharmacies offering the Sexual Health Service Specification will provide:

1.3.1.  Condom distribution

Supply free condoms to young people against either:

·  The North Somerset 17 – 14 year old condom card

or

·  The “No Worries!” condom card

1.3.2.  Emergency Hormonal Contraception (EHC)

Provide free emergency hormonal contraception to women under 25 years old under a Patient Group Direction (PGD).

1.3.3.  Chlamydia

Provide free treatment for Chlamydia for people under 25 years old under a Patient Group Direction.

1.3.4 Condom Registration

Opt to have pharmacists, dispensers or counter staff trained to register 17 – 24 year olds to receive a 17-24 c-card

2.  SERVICE SPECIFICATION

2.1. Aims and intended service outcomes

2.1.1.  To increase the knowledge, especially among young people, of the availability of emergency hormonal contraception[1] and Chlamydia screening.

2.1.2.  To improve access to emergency hormonal contraception, treatment for chlamydia and sexual health advice.

2.1.3.  To increase the use of emergency hormonal contraception by women who have had unprotected sex and help contribute to a reduction in the number of unplanned pregnancies in the client group.

2.1.4.  To increase the uptake of condoms.

2.1.5.  To refer clients, especially those from hard to reach groups, into mainstream sexual health services.

2.1.6.  To increase the knowledge of risks associated with Sexually Transmitted Infections (STIs).

2.2. Service outline

2.2.1.  The pharmacy will provide support and advice to all clients accessing the service, including:

·  advice on the avoidance of pregnancy and sexually transmitted infections (STIs) through safer sex and effective condom use;

·  advice on the use of regular contraceptive methods;

·  signposting to services that provide long-term contraceptive methods and diagnosis and management of sexually transmitted infections;

·  offer and provide Chlamydia specimen collection kits.

2.2.2.  Pharmacies will offer a client-centred and confidential service in line with the quality criteria of our local sexual health services for young people.

2.2.3.  The part of the pharmacy used for provision of the service provides a sufficient level of privacy (ideally at the level required for the provision of the Medicines Use Review service[2]) and safety meets other locally agreed criteria.

2.2.4.  The service will be provided in compliance with Fraser guidance and Department of Health guidance on confidential sexual health advice and treatment for young people aged under 16[3] in line with the sexual health policy for North Somerset.

2.2.5.  All pharmacists and staff involved in the provision of the service to the public must attend a training session, organised by North Somerset Public Health, before they start to provide the service. They must then attend refresher trainer at least once every three years, or when the PGDs are updated.

2.2.6.  The pharmacy must maintain appropriate records to ensure effective ongoing service delivery and audit. Records will be confidential and should be stored securely and for a length of time in line with local National Health Service record retention policies.

2.2.7.  Pharmacists may need to share relevant information with other health care professionals and agencies, in line with locally determined confidentiality arrangements, including, where appropriate, the need for the permission of the client to share the information.

2.2.8.  The pharmacy should clearly display any logos that are developed to brand any part or all of the service.

2.2.9.  North Somerset Public Health has a duty to ensure that all pharmacists and staff involved in the provision of the service are aware of and operate within a pharmacy Standard Operating Procedures (SOPs).

2.2.10.  North Somerset Public Health should arrange at least one contractor meeting per year to promote service development and update pharmacy staff with new developments, knowledge and evidence.

2.2.11.  North Somerset Public Health will provide a framework for the recording of relevant service information for the purposes of audit and the quarterly claiming of payment.

2.2.12.  North Somerset Public Health will provide up to date details of other services which pharmacy staff can use to refer service users who require further assistance. The information will include the location, hours of opening and services provided by each service provider.

2.2.13.  North Somerset Public Health will be responsible for the promotion of the service locally, including the development of publicity materials, which pharmacies can use to promote the service to the public.

2.3. Quality indicators

2.3.1.  The pharmacy has appropriate North Somerset Public Health provided health promotion material available for the client group and actively promotes its uptake.

2.3.2.  The pharmacy meets the quality criteria to enable the pharmacy to be branded as meeting the needs of young people (appendix 4).

2.3.3.  The pharmacy is able to discuss the contents of the health promotion material with the client.

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

2.3.5.  The pharmacy participates in regular North Somerset Public Health organised audit of service provision.

2.3.6.  The pharmacy co-operates with North Somerset Public Health led assessment of service user experience e.g. through periodic ‘mystery shopping’ exercises to monitor quality.

2.3.7.  Pharmacists and appropriate support staff attend a North Somerset Public Health organised update meeting as appropriate.

2.3.8.  Payments under the agreement will be suspended at any time if the provider fails to demonstrate it’s services adhere to the service specification or fails to meet the eligibility criteria.

2.4 Training requirements

(details should be completed in Training form – section 6 pg 40 and certificates shown)

2.4.1 Attend a local or complete a CPPE “Safeguarding Children” child protection course (Every 3 years).

2.4.2 Emergency Hormonal Contraception: (every 2 years or whenever

PGD is substantially updated)

·  complete CPPE EHC course;

·  attend Levonelle Patient Group Directive training in North Somerset,

2.4.3 Chlamydia Screening

·  attend Azithromycin Patient Group Directive training in North Somerset.(every 2 years or whenever the PGD is substantially updated)

2.4.4 All pharmacists delivering the EHC and azithromycin PGDs should have completed

·  a DBS check (previously called a CRB)

·  CPPE Patient group direction (PGD) – developing and implementing them safely

2.4.5 All staff should attend the Basic Sexual Health training provided by North Somerset Public Health

2.4.6 All staff registering young people for a 17 -24 c-card should attend the condom registration training provided by North Somerset Public Health

other recommended courses include:

·  CPPE Sexual Health: testing and treating Open Learning Programme (8 hrs)

·  CPPE Dealing with difficult discussions Open Learning Programme (8 hrs)

3.  Condom Distribution Scheme

3.1. Condom Distribution Scheme

3.1.1.  Service description

Pharmacists and trained, counter staff and dispensers who have undergone the Basic Sexual Health training, will provide free condoms to young people who are registered with the No Worries Teenage Health service or the 17-24 c-card scheme and have a valid condom card. Counter staff will complete and return monitoring forms to capture this activity.

3.1.2.  Aims and intended service outcomes

To reduce conceptions and the prevalence of sexually transmitted infections among young people by encouraging them to use condoms with the support of the “No Worries!” Teenage Health Service, GP practices and the WISH Centre by:

a.  Increasing the knowledge among young people of the availability of contraception from pharmacies;

b.  Improving access for young people to contraception and sexual health advice;

c.  Referring clients, especially those from hard to reach groups, into mainstream services i.e. “No Worries!” Teenage Health Service, GPs or the WISH Centre;

d.  Increasing the knowledge of risks associated with sexually transmitted infections.

3.1.3.  Service outline

a.  A free condom supply service will be provided to young people up to the age of 25. Where young people under 21 without a “No Worries!” condom card seek registration with the scheme they will be signposted to the most convenient and appropriate “No Worries!” service. If they are 17 – 24 they may be registered in the pharmacy, if trained staff are available, or referred to another pharmacy with trained staff, or to a specialist Sexual Health GP Practice or to another local service that will be able to assist them as soon as possible;

b.  Pharmacists will ensure all staff are familiar with the scheme and have up to date information concerning referral if this is deemed appropriate.

3.1.5  Monitoring and audit

a.  For monitoring and audit purposes the form in appendix one needs to be completed each time a bag of condoms is distributed.

4. Emergency Hormonal Contraception (EHC)

4.1 Emergency Hormonal Contraception

4.1.2 Service description

a. Pharmacists will supply emergency hormonal contraception (EHC) to women where there is a clinical need inline with the requirements of the Patient Group Direction for Levonorgestrel 1500microgram tabs (Appendix 3)

b. The supply will be free to women under 25 years old at North Somerset Council expense

c.  Pharmacists will promote safer sex and the use of effective contraceptive use.

d.  Women excluded under the Patient Group Directive criteria will be referred to another local service as soon as possible, e.g. general practitioner, WISH Clinic, or will be invited to buy the Pharmacy medicine product if the exclusion is only due to an administrative matter e.g. age outside of the commissioned service[4].

4.1.3 Aims and intended service outcomes

a. To increase people’s knowledge of the availability of emergency contraception[5] particularly, but not exclusively, among young people;

b. To improve access to emergency contraception and sexual health advice;

c. To increase the use of emergency hormonal contraception by women who have had unprotected sex and;

contribute to a reduction in unplanned pregnancies in the client group;

d. To refer women, especially those from hard to reach groups, into mainstream Contraceptive and sexual health services;

e.  To refer women who may have been at risk of sexually transmitted infections to an appropriate service.

4.1.4 Service outline

a. A service will be provided that assesses the need and suitability for a woman

to receive emergency hormonal contraception, in line with the Patient Group Directive. Where appropriate a supply will be made.

Where a supply of emergency hormonal contraception is not appropriate, advice and referral to another source of assistance will be provided as appropriate. All women should be informed about the possibility of use of an Intra-uterine device (IUD) as a more effective form of emergency contraception, and should be referred to a local service as soon as possible as required.

b. Inclusion and exclusion criteria, which are detailed in the Patient Group Directive, will be applied during provision of the service.

b.  Pharmacists will ensure all staff including counter staff are familiar with the scheme and have up to date information concerning referral if this is deemed appropriate.

4.1.5. Quality Indicators

a. The pharmacy has appropriate North Somerset Public Health -provided health promotion material about emergency hormonal contraception available for the client group and actively promotes its uptake.

b. The pharmacy is able to discuss emergency hormonal contraception with

clients and signpost them to alternative emergency contraception.

c. Levonelle and azithromycin will be dispensed according to the guidelines laid out in the PGSs, and records keptconfidentially. Any non compliance should be reported on a quarterly basis

5 Chlamydia treatment

5.1 Service description

Pharmacists will participate in the Avon Chlamydia Screening Programme by offering free treatment to people testing positive for Chlamydia, under a Patient Group Directive for Azithromycin (Appendix 3).

5.2 Aims and intended service outcomes

To reduce the prevalence of Chlamydia and associated harm by:

a.  Increasing the uptake of treatment;

b.  Decreasing any delay before treatment;

c.  Referring clients, especially those from hard to reach groups, into mainstream sexual health services;

d.  Increasing young people’s knowledge of the risks associated with sexually transmitted infections.

5.3 Service outline

a.  A service will be provided that assesses the need and suitability for a client to receive treatment (Azithromycin) for Chlamydia infection under a Patient Group Direction, based on:

·  confirmation of a positive result from the Avon Chlamydia Screening Programme (CSP)

·  the client signing a form to confirm that they do not have any medical condition which would contraindicate Azithromycin treatment and that CSP has described the treatment (Appendix 3).