Service Specification
Pharmacy Integrated Sexual Health Local Service Agreement 2010/11
1. Introduction
The traditional role of the community pharmacist as the healthcare professional who simply dispenses prescriptions written by doctors has changed. In recent years community pharmacists have been developing clinical services beyond this traditional role to allow better integration and team working with the rest of the NHS.
Pharmacy is already successfully delivering Emergency Hormonal Contraception for patients, both over the counter and through NHS Patient Group Direction (PGDs). Pharmacies also have some experience of provision of non-NHS over the counter Chlamydia Screening (Clamelle) and there are many NHS schemes nationally.
This enhanced service specification outlines additional sexual health services to be provided within community pharmacy. No part of the specification by commission, omission or implication defines or redefines essential, advanced or enhanced services.
Background
The past decade has seen substantial increases in high-risk sexual behaviours in the UK population. During the 1980s and early 1990s, new diagnoses of sexually transmitted infections (STIs) declined, but since 1995 STIs including HIV have risen and diagnoses of Chlamydia, gonorrhoea and syphilis have doubled in the past five years. Teenage pregnancy rates in the UK are the highest in Western Europe.
The National Chlamydia Screening Programme (NCSP) is a control and prevention programme targeted at the highest risk group for Chlamydia infection in England, young people under 25 who are sexually active.
The government’s national strategy for sexual health and HIV aims to:
· reduce the transmission and stigma of HIV and STI's
· reduce the prevalence of undiagnosed HIV and STI's
· reduce the rates of unintended pregnancy
The Department of Health launched its “You’re Welcome” initiative in 2007 which aims to make all health services young person friendly and accessible. “You’re Welcome” outlines a set of 10 quality standards that a provider would need to meet if they were to achieve verification as a Young Person Friendly service. The key principles of these standards will need to underpin the implementation of this LES if they are to be accessible and well used by young people.
A recent consultation project undertaken by NHS Berkshire West in 2009 found evidence consistent with that informing the Department of Health’s “You’re Welcome” initiative. For services to be well used by young people some of the priority aspects of service delivery and design are as follows:
· Services need to provide reassurance of confidentiality and provide young people with a service that protects their privacy.
· Services need to be delivered by friendly staff with the right attitudes and skills for communicating effectively with young people
· Services need to be provided on a drop in basis and after school hours, particularly at weekends and in the school holidays.
Sexual Health in Community Pharmacy
Accessing sexual health services within community pharmacy has many benefits. Pharmacies are easy to access for advice and no appointment is needed. Most pharmacies open outside normal working hours, at weekends and during bank holidays. If advice is targeted at young people and hard-to-reach groups in the population, it can help to reduce inequalities in health.
Community pharmacy has an important role to play in optimising the opportunities for integrated working between all sexual health service providers. The NHS Community Pharmacy contract recognises community pharmacy as an integral part of the NHS, making use of the skills and knowledge of pharmacists. Its framework has considerable potential to support community pharmacists and to make a significantly positive impact on improving the sexual health of individuals and communities.
This document sets out the elements required of sexual health enhanced service including the standards and quality.
Overall Desired Aims and Objectives
To improve the sexual health of young people by integrating Emergency Hormonal Contraception (EHC), Chlamydia screening / treatment and provision of free condoms. This approach provides a bundle of complimentary services, with each component reinforcing a sexual health message that aims to prevent unplanned conceptions and subsequent abortions, screen and treat the most common sexually transmitted infection, and provide condoms for safer sex.
The principle aims and objectives of the service are to:
· Increase access to EHC for young women between 13 to 19, and reduce unintended teenage pregnancies
· Reduce the prevalence of Chlamydia and prevent onward transmission and re-infection in sexually active men and women aged between 15-24 by actively supporting the NHS Berkshire West’s Chlamydia Screening Programme through local promotion and implementation
· Improve access to treatment for Chlamydia
· Increase access to testing of Chlamydia
· Improve onward signposting to contraceptive services and further tests/screening for other sexually transmitted infections (STI)
· Empower clients to practice safer sex through condom use / C card scheme
· Improve client understanding of the connection between unprotected sex and STI and thereby reduce the incidence of STI
· Enhance the confidence and skill level of pharmacists and appointed others
· Encourage local pharmacies to achieve verification of the You’re Welcome Standards ensuring that they provide a young person friendly service.
· Reduce health inequalities by providing better access, better range of services, more integrated services, delivered by the most appropriate member of the health care team
2. Service Outline
Service Outline
Participating Pharmacies will be required to provide timely and convenient access for 13-19year olds to EHC, Condom distribution and Chlamydia screening service and treatment, as detailed below:
Section A – Supply of Levonelle-1500® Emergency Hormonal Contraception (EHC)
A1. Supply Levonelle Emergency Hormonal Contraception (EHC) under the current locally agreed Patient Group Direction (attached PGD), free of charge to clients aged 13 to 19 irrespective of place of residence.
A2. Support and advice will be provided to clients accessing the service, including advice on the avoidance of pregnancy and sexually transmitted infections (STIs) through safer sex and condom use, advice on the use of regular contraceptive methods and onward signposting will be provided to services that provide long-term contraceptive methods, and the diagnosis and management of STIs including signposting or referral to local sexual health service including signposting to the young peoples outreach Nurse (Karen Suvarna) for the most venerable young Reading residents accessing the service.
A3. Supply the young person with a Chlamydia screening kit and encourage them to carry out the test either on or off site. If ‘off-site’ the pharmacy staff will need to go through the instructions for returning the kit using the freepost envelope. (For further guidance on procedure and requirements see section B.)
A4. Provide free condoms with each supply of Levonelle (condoms and accompanying instructions will be provided by the C Card Scheme).
Section B1 – Provision of Chlamydia Home Testing Kits (provided through the Chlamydia Screening Office)
Screening for Chlamydia for men and women within the National Programme aged 15-24 years and their partners
B1. Offer asymptomatic sexually active males and females aged 24 years and under, a Chlamydia screening service; where the benefits of screening are explained.
B2. Provide the service to young people under 16 years of age if deemed Fraser competent.
People less than 16 years of age who present for screening and who are not deemed to be Fraser competent should be referred to their GP practice. 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 under the age of 16 years.
B3. Complete the appropriate consent and demographic documentation with people who consent to screening and shall describe the screening process and how results will be communicated to the person.
B4. The client will complete relevant sections of the Test Form with advice from the pharmacist on the importance of ensuring their relevant sections are completed in full. Pharmacist to check the details.
B5. Supply the young person with a Chlamydia screening kit and encourage them to carry out the test either on or off site. If ‘off-site’ the pharmacy staff will need to go through the instructions for returning the kit using the freepost envelope.
B6. Provide free condoms with each home testing kit distributed (condoms and accompanying instructions will be provided by the C card Scheme).
NB: Pharmacists do not contact clients regarding test results. The Chlamydia Screening Office (CSO) notifies all clients of their test result and informs those who test positive, the need for treatment. The CSO will offer all Chlamydia positive clients a range of treatment sites
Section B 2 – Administration and Supply of Azithromycin for Chlamydia
B1.On receipt of the details of the client requiring treatment from the Chlamydia screening office, assess the suitability of the person to receive the locally agreed antibiotic treatment, in line with the inclusion and exclusion criteria detailed in the NHS Berkshire West attached PGD for the administration and supply of Azithromycin for Chlamydia.
B2. Where appropriate a supply will be made; where a supply of the specific antibiotic is not appropriate, the person should be referred to the Chlamydia Screening Programme, GP or another clinician.
B3. Completion and return of the treatment record to the Chlamydia screening programme office – see appendix for care pathway ( retaining pharmacy copy)
B4. Provide verbal and written advice on the avoidance of STIs and the use of regular contraceptive methods, including advice on the use of condoms. This should be supplemented by a referral to a service that can provide further advice and care where appropriate.
B5. Provide free condoms with each supply of Azithromycin (condoms and accompanying instructions will be provided by the C Card Scheme).
Section C – Supply of free condoms through the C Card scheme
C1. Provide condoms, sexual health information and support to young people aged between 13 and 19 years old.
C2. Keep the C Card Coordinator or lead contact informed of any issues that arise whilst involved with the C Card Scheme
C3. In addition the named contact (s) will fill in monitoring forms for all young people accessing free condoms via the scheme
C4. If the named contact has any concerns or problems they will immediately contact the
C Card lead workers for advice or information.
C5. All staff within the distributing outlet will adhere to Child Protection Policy
In addition, Pharmacies will be expected to:
· Promote a safer sex messages including use of appropriate literature
· Improve referral and signposting to other sexual health services and promote the NHS Juice branding.
· Signpost for full STI screen if indicated by sexual health history and risk assessment
· Signpost or referral to young peoples outreach contraceptive nurse for the most vulnerable young Reading Residents.
· Seek involvement of young people in the monitoring and evaluation of the service and their views sought through user satisfaction surveys.
· Encourage the young person under the age of 16 years to involve their parents or guardians according to the Fraser Guidelines.
3. Accreditation
Eligibility Criteria
· Offered to Pharmacies currently providing EHC for under 20 year olds
· Satisfactorily complying with their obligation under schedule one to the Pharmaceutical Services Regulations 2005, to provide Pharmaceutical Essential Services
· Have an approved Consultation area
· Must be able to provide all standard items within the BNF within 24 hours of receiving a prescription, except where there is a manufacturing problem. The PCT will notify pharmacy contractors of any recommended items not likely to be available from usual suppliers and contractors must hold these in stock within a specified time period (the PCT will reimburse any out-of-date stock providing that sensible quantities have been ordered).
· Must be located within NHS BW area
· To ensure that services are delivered by a highly skilled workforce, that are trained in all relevant aspects of sexual health as well up to date Child Protection training and skills in working with and communicating with young people.
· Providers providing services to service users under the age of 18 shall hold or be working towards accreditation against the “You’re Welcome” service standards for young people’s services. (PCT to provide information and support on the verification process)
Accreditation, Training and PGDs:
The Enhanced Sexual Health Service must only be provided by a PCT accredited pharmacist for EHC and Chlamydia Treatment or a PCT trained member of pharmacy staff as appropriate to the service (Chlamydia screening and condom distribution through appropriate training). A trained staff member is someone who has attended the annual training session or is deemed competent by the accredited pharmacist to support this service.
To initially become accredited, a pharmacist must have satisfactorily completed training delivered by NHS Berkshire West detailed below:
The NHS Berkshire West Young Persons Emergency Contraception Training and submit a certificate to demonstrate that they have completed the CPPE or equivalent EHC training pack. It is also expected that providers will complete and submit evidence of passing CPPE contraception and Safeguarding Children within 3 months of starting the service
The Contractor is required to ensure that the PGD back sheets are signed by all Accredited Pharmacists working at the pharmacy and submitted to the Primary Care Trust within three weeks of circulation. Failure to submit back sheets will result in non payment of any submitted invoices or removal of the Accredited Pharmacist and pharmacy from the Enhanced Sexual Health Service list of service providers
The PCT will provide EHC Scheme, Chlamydia Screening, Patient Group Direction and Child Protection Foundation Level Training on an annual basis to enable new pharmacists to become accredited.
To remain accredited, pharmacists will be required to attend a PCT organised update as appropriate. The theme of this meeting will either be service developments and/or health improvement activities.
The contracted Pharmacy should normally be available 100% of its declared opening hours. The Provider shall ensure that a client seeking EHC or treatment for Chlamydia (Azithromycin), outside of the pharmacy opening hours will be sign-posted to an alternative provider.
It is the responsibility of the pharmacy contractor to inform the PCT of any changes to the services resulting from staff changes within 7 days of the pharmacy contractor becoming aware of a change in service provision.