Service Level Agreement s4

Service Level Agreement

1.  Parties to the Agreement for

This agreement is between:

(“The Pharmacy”) and NHS North of Tyne (“The Trust”) for the provision of specialised enhanced sexual health services by the following named authorised pharmacists:

·  (Insert pharmacist name)

2.  Aims and intended service outcomes

The purpose of this specialised, enhanced sexual health service is to ensure equitable and timely access to a comprehensive range of sexual health services for clients who are sexually active delivered in community pharmacies.

The cost of buying emergency hormonal contraception (EHC), approximately £25 per course, excludes many clients from accessing EHC via the community pharmacy. The product licence for over the counter sale further restricts access of this target group, as sales are restricted to those 16 years of age or over.

This service will contribute to a reduction in the number of unplanned pregnancies and terminations, amongst teenagers, in line with public health targets by reducing the barriers to access EHC, and provide a platform to discuss future methods of contraception by direct referral to the local Sexual Health Clinic or timely initiation of implantable or injectable long acting reversible contraception (LARC) as appropriate.

The service and related training will support experienced community pharmacists, in designated pharmacies work towards the Access Standards contained in the Department of Health’s “You’re welcome” criteria.

3.  Scope of service to be provided

3.1  Women, hereafter referred to as clients, may self refer, or be referred for assessment by other professionals.

3.2  All clients requesting EHC from the pharmacists must be informed of the free scheme.

3.3  Clients may attend solely to request initiation of LARC and/or for Chlamydia screening and treatment.

3.4  The pharmacist will provide advice and guidance to the client as well as assessing their suitability for EHC and follow on LARC. This will be in accordance with the relevant Patient Group Direction (PGD). The pharmacist undertaking the specialised enhanced sexual health service will:

·  Undertake a comprehensive sexual health history and practice, and risk assessment.

·  Provide EHC as appropriate, see appendix IV, V, VI

·  Provide verbal and written information about all future contraceptive options to inform choice about future choices.

·  Give information on safer sex practices and provision of information on C-Card Condom Distribution Scheme.

·  Increase uptake of opportunistic Chlamydia screening for 19 years and under in line with the aims of the National Chlamydia Screening Programme (NCSP) by provision of testing kit. At the initial consultation every woman will be counselled about sexually transmitted infections (STIs) and the NCSP. They must be provided with a Chlamydia testing kit and advised they may be asked to return to the pharmacy for treatment and initiation of the partner notification system if found to be positive, see VIII, IX.

·  If requested by Chlamydia Screening Central Office treat clients with a positive test result and initiate partner notification (PN) for follow up by NCSP. See appendix X for care pathway.

·  Provide verbal and written information on effectiveness, duration of use, side effects and those symptoms that require urgent assessment to increase client understanding.

·  Fitting, monitoring, and checking of contraceptive implants licensed for use in the UK, as appropriate. See appendix

·  Injection of Depo-Provera® and three monthly follow-on injections as appropriate.

·  Production of an up-to-date register of clients fitted with a contraceptive implant and depot injection, to be used for audit purposes.

·  Provision of adequate equipment. Certain special equipment is required for implant fitting. This includes an appropriate room fitted with a chair and with adequate space, the provision of sterile or disposable surgical instruments and other consumables, equipment for resuscitation, and facility for local anaesthesia provision. This specification includes the provision of sterile or disposable surgical instruments and other consumables. BP monitoring equipment, weighing scales and clinical waste collection will be provided, see appendix

·  Ensure arrangements in place to review clients experiencing problems with LARC in a timely fashion and the practice able to appropriately manage nuisance side-effects.

·  Ensure the client understands the need for the implant to be removed or replaced within three years, or the need for three-monthly follow up injections of depot injection as appropriate.

·  Production of an appropriate clinical record. Adequate recording should be made regarding the client’s clinical, reproductive and sexual history, the counselling process, the results of any STI screening, problems with insertion, the type and batch number of the implant and expiry date of the device. Any follow up consultations should be documented.

·  An annual audit of the register of clients fitted with a contraceptive implant; reasons for removal; length of continuation; complications or significant events should be undertaken and sent to the Clinical Lead for Contraception and Sexual Health in the PCT.

·  Each woman must be offered the opportunity to be referred directly to their nearest Sexual Health Clinic at all stages of the consultation for STI or contraceptive advice or where there are contra-indications, see appendix 2 for referral information and documentation.

·  Chlamydia treatment can be provided to anyone with a positive Chlamydia screening test result who has requested their treatment to be provided by a participating community pharmacy.

3.5  Data will be collected on the record form provided which should be submitted along with the claim form on a monthly basis.

3.6  In addition the pharmacist will ensure that clients are given details of local services for future use, e.g. Contraception and Sexual Health Clinics (CaSH), and Genito-urinary (GUM) services. This should also include a brief description of what each service provides and leaflets as well as information on effective condom use a pack of condoms and information on where to obtain condoms via the C-card & Chlamydia Screening and treatment schemes. Where client consent is obtained complete and submit contraceptive referral proforma for those clients declining LARC from the community pharmacist

4.  Service restriction

4.1  This agreement is strictly limited to specifically trained specialised pharmacists within specific pharmacies identified by The Trust.

The pharmacists must have completed the approved training course and supportive training material, undertaken mandatory Cardio-Pulmonary Resuscitation & Anaphylaxis within the previous 12 months hold an honorary contract with Northumberland Care Trust, have had a CRB check within the previous three years and have been recognised as competent to undertake LARC insertion and administration by an RCN approved trainer.

5.  Clinical Governance

5.1  The pharmacy has a duty to ensure that pharmacists involved in the provision of the service have relevant knowledge and are appropriately trained and competent in the operation of the service. Practitioners should be familiar with the NICE guidance on long acting reversible contraception and should be working in compliance with this guidance at all times. Specifically, clinicians should be competent in resuscitation, demonstrate a continuing sustained level of activity (at least 6 insertion and 6 injections procedures per year), conduct regular audits and take part in necessary supportive educational activities, including an annual update session.

5.2  The pharmacist involved in the provision of the service must be aware of and operate within local protocols concerning local anaesthetic use, decontamination procedures and handling of clinical waste. The pharmacy must have infection control policies that are compliant with national guidelines including the handling of used instruments, excised specimens and the disposal of clinical waste.

5.3  The pharmacy must maintain appropriate records to ensure effective ongoing service delivery, clinical audit and reporting of activity and billing.

5.4  The named pharmacist(s) will:

·  Assess clients for suitability of treatment at the time of presentation.

·  Obtain and record informed consent for treatment from the client consistent with Department of Health guidance.

·  Provide advice to the client on post-operative care and pain relief.

·  Provide any necessary post-operative follow-up, as required.

5.5  The Trust will alert all practitioners providing this service to any urgent incidents or contraindications relating to implants.

5.6  Confidential records of consultations and competence assessment according to The Fraser guidelines must be securely retained for three years and nine months.

6. Quality Indicators

6.1  The pharmacy will provide a mutually convenient time for implant insertion or depot injection and Chlamydia treatment.

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

6.3  The pharmacist can demonstrate they have undertaken CPD relevant to this service.

6.4  The pharmacy participates in an annual PCO organised audit of service provision.

6.5  The pharmacy conforms to the Decontamination Guidance provided by the PCT.

6.6  The pharmacy co-operates with any locally agreed PCT-led assessment of service user experience.

6.7  The pharmacy records and investigates any clinical incidents or complaints, according to the guidance provided by the PCT and provide a written summary to the Clinical Governance manager at the PCT.

6.8  The pharmacy maintains a register of the clients accessing the service being screened and treated for Chlamydia.

6.9  The Pharmacy takes account of the Department of Health You’re Welcome Standards

6.  Clinical exclusions

6.1  Clinical exclusions to EHC or LARC are outlined in respective Patient Group Direction, but clients may prefer to seek advice from, or be referred to one of the North of Tyne Specialist sexual health services if clients have chronic medical conditions or disorders that cause concern.

7.  Agreement Period

7.1  The agreement will commence on dd/mm/2011.

7.2  It will be subject to renewal if agreed by all parties and successful completion of an annual update at Carlton Street Clinic, evidence of attendance at the Northumberland Care Trust mandatory Cardio-Pulmonary Resuscitation & Anaphylaxis training workshop.

7.3  The agreement may be terminated, without penalty, if the Pharmacy or NHS North of Tyne gives the other party one-month notice in writing.

8.  Obligations of the Pharmacy and the Trust

8.1  The Pharmacy must provide the service, delivered by the named pharmacists, in accordance with the Service specification.

8.2  The Trust will manage the scheme in accordance with the Service specification.

9.  Terms and Fees

9.1  The pharmacy will be remunerated according to the fee rate set out below, 9.5, uplifted for inflation as agreed each year when the contract is reviewed. Payment will be made against a monthly claim submitted by the pharmacy and supporting detail as follows:

·  Clients treated identified by :

-  Age of client

-  Postcode

·  Date of treatment

·  Details of consultation/treatment provided to each client

·  Consultation/treatment provided by

·  Previous form of contraception used

·  Remuneration claimed.

·  Numbers of clients being screened for and receiving treatment Chlamydia infection as part of the NCSP

9.2  The pharmacy will bear the costs of:

·  Consumables used in providing the treatment

·  Cleaning equipment and the treatment room

·  Administration of the service

·  Provision of necessary information to the PCT to audit the contract and settle invoices.

Client transport costs will not be met by the pharmacy or the Primary Care Trust.

NHS North of Tyne will arrange for BP monitors, weighting scales and the collection of clinical waste to be provided.

9.3 Payment will be paid monthly in arrears to the pharmacy on receipt of the completed relevant signed forms by BACS from NHS North of Tyne direct into the bank account of the pharmacy. The Community Pharmacy Record Audit should be completed and submitted to:

FAO Medicine Management

NHS North of Tyne

Bevan House

1 Esh Plaza

Sir Bobby Robson Way

Great Park

Newcastle

NE13 9BA

Fax: 0191 217 2506

Description of relevant forms

Form Number / Form / location
1 / LARC monthly audit sheet / To be submitted monthly to NHS North of Tyne / Appendix I
2 / Referral proforma for contraceptive support / To be faxed to relevant Sexual Health Service as appropriate / Appendix II
3 / Summary record of EHC consultations / To be submitted monthly to NHS North of Tyne / Appendix III
4 / Record of consultation for Plan B (POEC) (Levonelle 1500®) / To be retained within the Pharmacy for 3 years and 9 months / Appendix IV
5 / Assessing competence for clients according to Fraser guidelines / To be retained within the Pharmacy for 3 years and 9 months / Appendix V
6 / Invoice for supply of Plan B (POEC) / To be submitted monthly to NHS North of Tyne / Contained within each specific PCO Plan B SLA
7 / Record of consultation for long acting reversible contraception (LARC) – Nexplanon®/ Depo-Provera® / To be retained within the Pharmacy for 3 years and 9 months / Appendix VI
8 / Northumberland, Tyne & Wear CSP Partner Notification Form / To be faxed to NTWCSP Central office as appropriate / Appendix VII
9 / Northumberland, Tyne & Wear CSP Pharmacy Treatment Sheet / To be faxed to NTWCSP Central office as appropriate and NHS North of Tyne / Appendix VIII

9.4 Banking details

Banking details
Name of Bank
Address:
Sort Code
Account Number

9.5 Fee structure

Description / Fee* / Plus drug cost (Drug Tariff + VAT) / Form to be submitted to make claim
Plan B consultation fee / £8.00 / N/A / 3
Supply of EHC
Levonelle
EllaOne / £5.20
£16.95 / Yes / 3 & 6
Receipt of Chlamydia screening test by Microbiology Department[1] / £1.00 (after 1st seven) / N/A / Payment made automatically monthly in arrears.
Chlamydia treatment and PN initiation / £8.00
(plus drug cost)[2] / Yes / 8 & 9
Insertion of the Nexplanon® device / £60.00
(plus drug cost)2 / Yes / 1
Initiation of Depo-Provera® / £30.00
(plus drug cost)2 / Yes / 1
Follow up Depo-Provera® injection (3 monthly intervals) / £7.00
(plus drug cost)2 / Yes / 1

* Fees may be updated, but notice will be provided.

10.  Resolution of disputes

10.1  It is expected that any disputes will be resolved between the pharmacy and the PCT. However, in the event that they cannot, the dispute will be referred to an arbiter that is acceptable to both parties.

11.  Authorisation

Name of Pharmacy / Boots,
3 Tyne View,
Lemington
NE15 8DE
Agreed on behalf of the Pharmacy / Agreed on behalf of the NHS North of Tyne
Name / Rosie England
Position/Title / Associate Director Medicine Management
Signature
Date

By signing this agreement the Pharmacy and those trained pharmacist(s) will comply with and work in accordance with the provisions of this SLA and the attached Service Specification.