Annex A2
Department for Children,
Adults and Health
Health & Wellbeing Division
Provision of Levonorgestrel by PGD
Service Specification 2015-18
Introduction
A Service Specification describes the minimum requirements for a particular service. It sets out all the important elements of that service.
All types of service that might be commissioned for someone by the Council will be described in Specifications, and the Specification will form a part of any Contracts or Agreements that are drawn up with those who are to provide the service or part of the service.
This Specification will apply until further notice. The views of Service Users, Carers and Providers will be taken into account in any review of the Specification during that time, and their views will be welcomed at any time.
Further information can be obtained from the Partnerships & Commissioning Team, Directorate for Children, Adults & Health, PO Box 298, South Gloucestershire Council, Civic Centre, High Street, Kingswood, South Gloucestershire, BS15 0DQ.
Provision of Levonorgestrel by PGD
Service Specification 2015-18
Programme Lead: Lindsey Thomas, Specialist Public Health Manager
Tel: 01454 864664
Email:
1. Service Background
1.1 The provision of sexual health services in community pharmacies contributes to the following key local and national health priorities:
· reducing the rate of under 18 conceptions
· reducing STI rates amongst young people
· Increasing the number of Chlamydia diagnoses
· Outcomes indicated in ‘A Framework for Sexual Health Improvement in England’ (Department of Health 2013)
· Meeting the local Chlamydia screening target for 15-24 year olds.
1.2 All community pharmacies are required to provide some sexual health services as part of their essential services, e.g. promotion of healthy lifestyles, providing opportunistic sexual health advice in Public Health campaigns, signposting people to other services (including Contraception and Sexual Health Services [CaSH], Genito-Urinary Medicine [GUM] and maternity access), and support for self-care.
1.3 This specification for emergency hormonal contraception Levonorgestrel in pharmacies builds on these services, to provide a full and co-ordinated range of sexual health services to young people.
1.4 This Service will operate from 1st April 2015 until 31st March 2018. It will be reviewed annually in the light of any changes to pharmacy provision and the healthcare needs of the local population.
2. Service Aims
2.1 To improve access to emergency contraception and sexual health advice.
2.2 To increase the use of emergency hormonal contraception (EHC) by women who have had unprotected sex and help contribute to a reduction in the number of unplanned pregnancies.
2.3 To refer clients into mainstream contraceptive services.
2.4 To increase client knowledge of the range of contraception methods available, including long acting reversible contraceptives and refer clients to suitable services.
2.5 To raise awareness of sexually transmitted infections (STIs) and provide support and advice to young people on safe sex, condom use, and advice on use of regular contraceptive methods.
2.6 To increase awareness of Chlamydia infection and transmission, its often asymptomatic nature, and potential for harm.
2.7 To increase uptake of the local Chlamydia Screening Programme, thus increasing the number of identified cases and increase the number of infected patients being treated.
3. Service Description
3.1 Community pharmacies participating in this service undertake:
· To provide free Levonorgestrel via patient group direction (PGD) to eligible under 25 year olds
· To provide a Safer Sex pack (6 free condoms, lubrication and a local services leaflet) to young people presenting for emergency hormonal contraception
· To offer free Chlamydia screening kits to 15-24 year olds
· To give advice on condom use, contraception, sexual health and sexually transmitted infections
· To signpost to services that provide reliable regular contraception and prevention and management of sexually transmitted infections
· To ensure their service meets the Baseline Standards specified by ‘You’re Welcome’
4. Service Criteria
4.1 Pharmacists will supply Levonorgestrel free to under 25 year olds following an assessment of need and suitability for a client in line with the requirements of the South Gloucestershire Council Patient Group Direction (PGD) for Levonorgestrel, having explained all methods of emergency contraception available (hormonal and non-hormonal).
Supplies will be made free-of-charge to women aged up to 24 years old within 72 hours of unprotected sexual intercourse. There is no exclusion for treating under 13s, but the pharmacy Safeguarding lead must be notified and there is an additional requirement to notify FirstPoint (Children & Families Service) on 01454 8666000 of any incidents involving young people aged 12 and under. All under 16s must have been assessed as appropriate for treatment using the Fraser Guidelines and Gillick Competency. Where a young person is deemed not to be competent they should be referred to an appropriate sexual health clinic or GP practice. Any Safeguarding concerns must be recorded and discussed with the pharmacy nominated Safeguarding Lead. Clients excluded from the PGD for supply must be signposted to an alternative, appropriate service.
4.2 Irrespective of the provision of treatment or not, pharmacies will give brief information on all forms of contraception (including condoms), sexual health and sexually transmitted infections as well as the location of sexual health services.
4.3 Pharmacies will provide a Safer Sex pack (6 free condoms, lubrication and a local services leaflet) to young people presenting for Levonorgestrel. Packs (for this purpose only) can be ordered free from the Health Promotion Resource and Information Service at The Greenway Centre, 0117 9222290 Email:
4.4 Pharmacies will ensure Chlamydia screening postal kits are given to all clients aged 15-24 presenting for Levonorgestrel. Further, they will seek to extend the reach of opportunistic, free-of-charge screening to any young person aged 15 to 24 attending for sexual health-related reasons. Advice on how to use the kit, how to dispatch it for testing, and what will happen following completion of the test will be provided to the client. Supplies of further kits may be obtained from Michelle at the Health Promotion Resource and Information on 0117 922 3883 or Email:
5. Pharmacy requirements
5.1 Pharmacies must have read, signed and returned the South Gloucestershire Council commissioning contract and service specification documents.
5.2 Pharmacies must have an appropriate consultation room which provides a sufficient level of privacy (at the level required for the provision of the Medicines Use Review service).
5.3 A Chaperone Policy must be produced by the pharmacy and be in place in the pharmacy consultation room.
5.4 The pharmacy will clearly display any logos that are developed to brand any part or all of the service.
5.5 The pharmacy must review its standard operating procedures and the referral pathways for the service on an annual basis.
6. Pharmacist requirements
6.1 Pharmacists must have read and signed the South Gloucestershire Council Patient Group Directions for Levonorgestrel. Up to date copies of the PGD should be held, and be available for reference, in each pharmacy offering this service. The pharmacist must ensure that their professional indemnity cover includes the supply of medicines through patient group directions.
6.2 The pharmacy contractor has a duty to ensure that all pharmacists and staff involved in the provision of the service are aware of and operate within appropriate Standard Operating Procedures (SOPs) which must be in place.
6.3 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.
Pharmacist Training
6.4 The pharmacy contractor has a duty to ensure that all pharmacists and staff involved in the provision of the service are appropriately qualified and checked, have relevant knowledge and are appropriately trained in the operation of the service, including confidentiality, safeguarding, sensitive patient-centred communication skills, and data protection.
6.5 All pharmacists wanting to provide Levonorgestrel by PGD must first attend and show evidence of having completed a PGD-based training session organised by South Gloucestershire Council, Bristol City Council, or North Somerset Council. All pharmacists already trained and providing Levonorgestrel should attend an annual update training evening provided by South Gloucestershire Council.
6.6 Pharmacists providing this service must have completed, and provide a copy of certification of the CPPE course in Emergency Contraception.
6.7 Pharmacists providing this service must have evidence of completing a Level 1 equivalent certificate in Safeguarding Children & Vulnerable Adults delivered by South Gloucestershire Council, Bristol City Council, North Somerset Council or CPPE. Pharmacists are now also required to undertake level 2 Safeguarding training (through the same providers) within 12 months of commencing their service.
Local Safeguarding procedures are available on www.swcpp.org.uk . If you have any concerns about a child or young person, call FirstPoint on 01454 866000. If you are concerned about an adult being at risk, you must report it by calling Adult Care on 01454 868007. If a child, young person or vulnerable adult is in immediate danger, dial 999 and ask for police assistance.
6.8 South Gloucestershire Council also recommends the completion of the following self-learning packages as additional resources:
Centre for Pharmacy Postgraduate Education (CPPE) ‘Sexual health’
CPPE: ‘Contraception’
CPPE: ‘Dealing with Difficult Discussions’.
Contact with any South Gloucestershire Council training questions or bookings.
7. Quality Measurement and Monitoring Requirements
7.1 An assessment of need and suitability for a client to receive Levonorgestrel must be recorded using PharmOutcomes.
7.2 A summary of the outcome of the consultation for EHC must be recorded using PharmOutcomes.
7.3 The PGD relating to the service may be downloaded from the LPC website.
7.4 The Provider will maintain an effective system for Quality Assurance based on the outcomes for Service Users, in which standards and indicators to be achieved are clearly defined and regularly monitored.
7.5 Outcomes from the Quality Assurance process will be made available to Service Users, Carers, and all stakeholders including the Department.
7.6 The Provider will have responsibility for monitoring of their service and maintain sufficient records for this purpose. These records should be retained and kept up-to-date and made available on request for inspection by a nominated representative of the Department.
7.7 The Provider will have a system in place to identify and put in place continuous and sustainable improvements in the quality of the service. Details of improvements are to be provided to the Department on request.
7.8 The performance of the Provider will be reviewed by the Department. The Provider will allow access for service review or inspection by Officers designated by the Department if required. Financial information will be supplied as requested by the Department from time to time.
8. Equalities
8.1 South Gloucestershire Council is committed to ensuring that it is operating fairly and equitably through services delivered directly by the Council and through those it commissions.
8.2 Commissioned services are expected to determine the appropriate level of monitoring required in order to ensure that an effective analysis can be undertaken to inform both the ongoing delivery of that service and future commissioning intentions.
8.3 All relevant sections of the patient information form must be completed in relation to the required data sets: age, gender, ethnicity, and postcode
8.4 Commissioners will utilise this information collected to undertake an analysis of the data gathered in relation to these specific issues.
9. Review and Audit
9.1 All data inputted into PharmOutcomes will be automatically saved in line with the legal requirements for data storage and protection.
9.2 The pharmacy will co-operate with any locally agreed assessment of service user experience, this can include ‘mystery shopping’.
9.3 The pharmacy will participate in a periodic South Gloucestershire Council audit of service provision and usage.
10. Contact Details
Lottie Lawson
Department for Children, Adults and Health
PO Box 298, Health & Wellbeing Division
Kingswood Civic Centre,
High Street, Bristol, BS15 0DQ
11. Financial Details
11.1 In 2015-18 each pharmacy contracted to provide this service will receive:
· A payment of £10 per sexual health consultation (whether suitable for supply of medication under PGD or not, providing paperwork and signposting completed).
· A payment of £5 per ‘completed’ Chlamydia test received by the lab for testing will be paid. A ‘completed’ test is where the sample yields a positive or negative result. This payment will be made following information received by South Gloucestershire Council from the Chlamydia Screening Office.
· A payment of £6 per individual Levonorgestrel supply under PGD. One supply is 1 x 1500mg Levonorgestrel tablet.
11.2 Claims must be submitted monthly to South Gloucestershire Council using PharmOutcomes. Any claims made over 3 months from when activity was undertaken will be voided and not paid. Payments will be made quarterly.
12. Safeguarding
Summary
12.1 All staff who come into contact with the public have a responsibility to safeguard and promote their welfare and should know what to do if they have concerns about safeguarding issues, including child protection. This responsibility also applies to staff working primarily with adults who have dependent children that may be at risk because of their parent/carers health or behaviour. To fulfil these responsibilities, it is the duty of healthcare organisations to ensure that all health staff have access to appropriate safeguarding training, learning opportunities, and support to facilitate their understanding of the clinical aspects of child welfare and information sharing.
12.2 Pharmacists and pharmacy staff need to:
• Be alert to the possibility of abuse or neglect
• Be able to recognise and act upon indications that a child’s welfare or safety may be at risk
• Be familiar with and follow local Safeguarding procedures and protocols, other than in exceptional circumstances
• Know where to find the contact details of professionals in their locality with specific Safeguarding expertise and responsibilities
12.3 If you, as a pharmacist or registered pharmacy technician, suspect that a child or young person is being abused or neglected:
DO
• seek advice from a local professional with expertise in Safeguarding and child protection
• follow local Safeguarding and child protection procedures and report your concerns to the appropriate authority (phone FirstPoint on 01454 866000 to access advice or report a concern or 999 if someone is in immediate danger)