NHS CONTRACT FOR COMMUNITY SERVICES – BILATERAL
Schedule 2 Part 1
SCHEDULE 2 - THE SERVICES
Schedule 2 Part 1: Service Specification
[Mandatory headings, but detail for for local determination and agreement]
SERVICE SPECIFICATION
Service / Pharmacy - Needle Exchange and Harm Reduction ServiceCommissioner Lead / Kate Martin, Joint Commissioning Manager DAAT
Provider Lead
Period / 1st April 2009 to 31st March 2010
1. Purpose
1.1 Aims
The purpose of this Enhanced Service is to continue to ensure that service users have access to needle exchange facilities in as convenient a location as possible and that pharmacists are able to receive a payment for undertaking this service for service users.
The specific aims of the service are:
To offer user-friendly, non-judgmental, client-centred and confidential services.
To reduce the physical and social harm associated with injecting drug use.
To reduce the spread of infection associated with injecting drug use in Darlington.
To maximize the benefits that injecting drug users will obtain from community pharmacies, such as signposting to other services and advice on safer lifestyles.
To increase the access to service provision for injecting drug users who are not part of the substance misuse services already.
To reduce the incorrect/unsafe disposal of injecting equipment and associated risks to public health.
To monitor and evaluate the scheme and obtain information on its effectiveness.
To provide the appropriate training and support to community pharmacists.
1.2 Evidence Base
Policy guidance relating to the Harm Minimisation Service:
Draft Protocol for the Implementation of The Darlington Drug Intervention Programme.
County Durham and Darlington Harm Reduction Strategy 2006-2008 – establishes a robust performance management framework to measure the impact of strategies on key objective orientated outcomes.
Harm Minimisation Service Operational Policy – provides clear operational direction for the service.
The National Treatment Agency- identifies clear objectives and targets for service improvement.
Best Practice for Commissioners and Providers of Pharmaceutical Services for Drug Users (NTA, DOH 2006)
Prescribing programme for Buprenorphine and Buprenorphine/ Naloxone Guidance for Nursing Staff (TEWV NHS Trust May 2008)
1.3 General Overview
Darlington is a compact Borough covering an area of approximately 198 sq kilometres (76 sq miles) and a population of around 104,000 of whom 85,000 live in the town itself. The DAAT’s analysis of need for treatment through various estimations concluded that there is a PDU population in Darlington in excess of 800 and may be as high as 1200, of which at least 200 are likely to be treatment naive.
Based on the targets set for 2009/10 the numbers coming into structured drug treatment will increase and strategic plans will need to take account of this need for increased capacity.
The Drug Intervention Programme is designed to engage with the broad range of drug misusing offenders, who are at different stages in their drug misuse and offending careers. It aims to prevent crime through early interventions as well as reduce crime levels by engaging the most problematic offenders.
1.4 Objectives
The provision of pharmacy-based needle exchange and harm reduction services to injecting drug misusers in the Borough of Darlington.
Services to be provided include:
Distribution of free sterile needles and syringes.
Distribution of other appropriate harm minimisation injecting paraphernalia as determined by the Harm Minimisation Service of Tees, Esk and Wear Valley NHS Trust
Safe disposal of injecting equipment including supply of personal sharps bins.
Provision of advice and information on harm reduction and health promotion as determined by the Harm Minimisation Service.
Provision of advice and support to the service user on general health and social care issues, including referral.
Periodic participation in harm reduction and health promotion campaigns.
Opportunistic facilitation of referral into treatment
The following should be noted:
(i)There should be close liaison between pharmacist and the Harm Minimisation Outreach Nurse, who co-ordinates the scheme. Any problems or queries should be addressed to the Outreach Nurse.
(ii)Pharmacists and their staff taking part in the service will undergo training provided by the Harm Minimisation Service and the PCT/DAAT.
(iii)Pharmacies will offer a user-friendly, non-judgment, client-centred and confidential service.
(iv)All necessary equipment and written information will be provided by the Harm Minimisation Service.
(v)The safe disposal of waste will be collected by a clinical waste disposal agency as contracted by Tees, Esk and Wear Valley NHS Trust
(vi)The pharmacy must follow the standard operating procedure and complete monthly information returns and identified by Tees, Esk and Wear Valley NHS Trust as indicated in the good practice guidance and information pack provided.
1.5 Expected Outcomes
Reduced physical and social harm associated with injecting drug use and a reduction in the spread of infection.
Increased access to service provision which maximises the benefits that drug users will obtain from community pharmacies.
A reduction in the incorrect/ unsafe disposal of injecting equipment and associated risk to the general public.
2. Scope
2.1 Service Description
A pharmacy-based needle exchange and harm reduction services to injecting drug misusers in the Borough of Darlington.
2.2 Accessibility/acceptability
In accordance with the Diversity guidance the Diversity Assessment tool will be used to identify the current level of accessibility/ acceptability within the service and develop a strategy and action plan to deliver the required improvements.
The following statutory requirements relating to issues of diversity will be reflected in the service provided:-
Race Relations Act(1976) as amended by Race Relations Amendment) Act 2000, Amendment Regulations 2003
Disability Discrimination Act 1995 (as amended in 2005)
Equal Pay Act 1970
Sex Discrimination Act 1975(Amended 1986)
Sex Discrimination (Gender Reassignment) Regulations 1999
Human Rights Act 1998
Data Protection Act 1998
Equality Act 2006
Employment Equality (Religion or Belief) Regulations 2003
Employment Equality (Sexual Orientation) Regulations 2003
Employment Equality (Age) Regulations 2003
2.3 Whole System Relationships
There should be a close liaison between Pharmacist, Prescriber, Care Coordinator and the Service User.
2.4 Interdependencies
Pharmacies are expected to:
Work within local arrangements outlined within this contract and protocols developed in partnership with Tees, Esk and Wear Valley NHS Trust.
Maintain a close liaison with Tees, Esk and Wear Valley NHS Trust
Submit invoices for payment to Darlington DAAT
To report difficulties to the PCT/DAAT Pharmacy planning group
Tees, Esk and Wear Valley NHS Trust as the specialist treatment provider is expected to:
To offer information, advice and guidance
To provide policies and procedures to guide practice
To provide where appropriate equipment and resources
To monitor contracts and recording
To maintain a contract for clinical waste
To provide training
To attend PCT Pharmacy meetings upon request
To maintain a liaison with Pharmacies, PCT and DAAT
To report difficulties to the PCT/DAAT Pharmacy planning group
Darlington PCT/ DAAT as commissioner is expected to:
To provide information and advice
To make training available
To ensure finance and payments system is maintained
To monitor and report performance
To problem solve any difficulties that may arise operationally
To coordinate, maintain and review scheme
To maintain the DAAT Pharmacy Planning Group
To attend the PCT Pharmacy meetings upon request
2.5 RelevantClinical Networks and Screening Programmes
2.6 Sub-contractors
3. Service Delivery
3.1 Service Model
3.2 Pathways
4. Referral, Access and Acceptance Criteria
4.1Geographic coverage/boundaries
Darlington Borough.
4.2Location(s) of Service Delivery
All participating Pharmacy Premises within Darlington.
4.3Days/Hours of operation
Monday to Friday – excluding Bank Holidays.
4.4Referral criteria & sources
Details required.
4.5Referral route
Details required.
4.6Exclusion Criteria
Details required.
4.7Response time and prioritisation
5. Discharge Criteria & Planning
6. Self-Care and Patient and Carer Information
The service users will be placed at the centre of the service and are fundamental in the delivery of the quality assurance system by setting standards and monitoring service delivery and development. All Service Providers will implement various methods to ensure active user engagement e.g. service user satisfaction surveys. The service will have access to an active user group linking into Darlington User Forum and the work of the DAAT funded User Involvement Worker.
7. Quality and Performance Indicators / Quality and Performance Indicator(s) / Threshold / Method of Measurement / Consequence of Breach
HCAI Control
Service User Experience / Surveys/ Frequency
Improving Service Users & Carers Experience / DAAT User Involvement Worker
Unplanned admissions
Reducing Inequalities / Diversity Guidance
Reducing Barriers / Surveys/ Frequency
Improving Productivity / Level of service take-up / Statistical records.
Access / Waiting periods?
Personalised Care Planning
Outcomes / Measures/ Targets
Additional Measures for Block Contracts:-
Staff turnover rates
Sickness levels
Agency and bank spend
Contacts per FTE
8. Activity
Activity Performance Indicators / Threshold / Method of measurement / Consequence of breach
Details required.
Activity Plan
9. Continual Service Improvement Plan
10. Prices & Costs
10.1 Price
Basis of Contract / Unit of Measurement / Price / Thresholds / Expected Annual Contract Value
Block Arrangement/Cost and Volume Arrangement/National Tariff/Non-Tariff Price______* / £ / £
2009 Quality Payment
Total / £ / £
*delete as appropriate
Schedule 2 Annex 1: Summary of Activity Plans
[DN: Each to be a summary of any Activity Plan set out in a Service Specification]
Schedule 2 Annex 2: Summary Quality and Performance Indicators
[DN: Each to be a summary of any Quality Standards set out in a Service Specification]
Eligibility
1)The pharmacy must employ a pharmacist who is accredited by the PCT. Accreditation is conditional on the following conditions:
a)Completion of a suitable CPPE Open learning package either:
i)Substance use and misuse or
ii)Or equivalent advanced training
A certificate of completion will be held by the PCT.
b)Attendance at annual training updates
c)Signed pharmacy signature sheet.
d)It is important that all staff involved with clients have a positive attitude to the scheme. It is the responsibility of the pharmacist to ensure that any staff they employ are fully advised of the occupational health and safety procedures, especially with regard to the risk of infection.
2)The pharmacist, not the premises is accredited. Should the pharmacist leave the employ of the premises owner and not be replaced immediately by an accredited pharmacist, Tees, Esk and Wear Valley NHS Trust must be informed and the pharmacy will no longer participate in the scheme until the replacement pharmacist is in post It is the pharmacists responsibility to ensure that any locum is fully aware of the local arrangements for needle exchange services. Any training needs will be met by Tees, Esk and Wear Valley NHS Trust on a needs led basis.
3)The Department of Health recommends that the pharmacist and their staff participating in the scheme are vaccinated against hepatitis B. Hepatitis B vaccinations are available via local Primary Care Services. This is optional, but it is important that staff are aware of the recommendations. Those staff not wishing to be vaccinated must sign an appropriate disclaimer. Those staff who are unresponsive to the vaccine should be managed appropriately within pharmacy risk management procedures.
4)The pharmacy must comply with the guidelines laid down by the RPSGB.
5)Pharmacists and their staff should maintain the anonymity of service users using the scheme. No member of the public, solicitor, parent or police officer will be allowed access to the information contained in the pharmacy register. The only exception to this being if a police officer holds a valid warrant and the divulgence of information is in the best interests of public safety. In the event of this happening, it is advised that the scheme co-ordinator within the Harm Minimisation Service, be contacted immediately.
6)All pharmacists participating in the scheme will be supported by the Harm Minimisation Worker via Tees, Esk and Wear Valley NHS Trust. Additional concerns or difficulties can be brought to the DAAT Pharmacy group via the DAAT Pharmacy lead and or the PCT Pharmacy lead.
Governance Arrangements
Confidentiality/Information sharing
Pharmacies should be mindful of the need to protect patient confidentiality by avoiding, where practical, data flows which identify individuals.
It is well recognised that there is an obligation to share information between professionals and agencies to ensure that appropriate services are provided and safe working practices are adopted as and when appropriate.
Risk Management
The pharmacist must ensure that appropriate arrangements are in place to minimize risks to client, provider, pharmacy staff and other service users.
Clinical
The pharmacist will have clinical responsibility for dispensing the injecting equipment, ensuring necessary checking procedures for accuracy and safety are in place.
Incident Reporting
The pharmacy will undertake to complete an incident report, as appropriate, for every incident occurring during the provision of needle exchange.
An incident is defined as any occurrence that is not consistent with the professional standards of care of the service user or routine operation/ policies of the organisation. These will be reported to PCT Clinical Governance arrangements for consideration
NHS CONTRACT FOR COMMUNITY SERVICES – BILATERAL
Schedule 2 Part 1
Schedule2 Part 2: Essential Services
[for local agreement]