Supervised Consumption
Service Specification
LOCAL ENHANCED SERVICE
Commissioner: NHS Blackpool
And
Provider:
Pharmacist Signature: ………………………………………….
Commissioning Signature: ……………………………………
Date: ……………………………………………………………….
Date of Next Review: ……………………………………………
1. Service Description
1.1 This service will require the pharmacist to supervise the consumption of prescribed medicines at the point of dispensing in the pharmacy, ensuring that the dose has been consumed by the patient.
1.2 Pharmacies will offer a user-friendly, non-judgmental, client-centred and confidential service.
1.3 The pharmacy will provide support and advice to the patient, including referral to primary care or specialist centres where appropriate.
1.4 Examples of medicines which may have consumption supervised include Methadone and other medicines used for the management of opiate dependence including Buprenorphine (Subutex) and Buprenorphine/Naloxone (Suboxone)
2. Aims and intended service outcomes
2.1 To ensure compliance with the agreed treatment plan by:
- dispensing in specified instalments (doses may be dispensed for the patient to take away to cover days when the pharmacy is closed*),
- ensuring each supervised dose is correctly consumed by the patient for whom it was intended.
2.2 To reduce the risk to local communities of:
- diversion of prescribed medicines onto the illicit drugs market
- accidental exposure to the supervised medicines.
2.3 To provide service users with regular contact with health care professionals and to help them access further advice or assistance. The service user will be referred to specialist treatment centres or other health and social care professionals where appropriate.
3. Service outline
3.1 The pharmacy must sign the service level agreement with NHS Blackpool prior to undertaking supervised consumption of medication.
3.2 This service is primarily for Blackpool patients identified as under the care of NHS Blackpool commissioned substance misuse services. In the event a patient from out of area access the supervised scheme, notification to NHS Blackpool must be made with immediate effect.
3.3 The pharmacist has a duty to ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service and comply with all the points within this service specification. The PCT will require evidence of this, and recommends the following ‘good practice’ points (Appendix 12 should be used for evidence)
3.3.1 Any pharmacist and registered dispensing technician involved in the provision of the service should have completed the ‘Substance Use and Misuse’ distance learning pack available from the Centre for Pharmacy Postgraduate Education (
3.3.2 As training packages are updated or replaced from time to time, participating pharmacists will undertake to complete any appropriate new or updated package as soon as reasonably convenient.
______
* Doses given to the patient to take away are not classed as supervised consumption under this service and cannot be claimed for
3.3.3 Participating pharmacists should be familiar with current National,
Regional and local guidance including ‘Drug misuse and dependence – guidelines on clinical management’ issued by Department of Health, 2007 (Available at:
and ‘Best practice guidance for commissioners and providers of pharmaceutical services to drug users’ issued by RPSGB, PSNC & NTA in 2006 (available at:
ces_for_drug_users_pharmguide06.pdf)
3.4 A Standard Operating Procedure (SOP) for the service is in place in the pharmacy, and the pharmacist must ensure that all dispensary staff, including locums, are aware of the content of the SOP, and have signed to confirm their understanding (refer to Appendix 1 Community Pharmacy Procedure).
3.5 The patient’s identity must be checked to ensure the prescription is dispensed to the correct person. The patient identification form will assist in this process (Appendix 4)
3.6 The part of the pharmacy used for provision of the service must provide a sufficient level of privacy and safety. Transactions should preferably take place within a designated area (not the dispensary). It is envisaged those pharmacies that have consultation rooms should utilise these wherever possible. The procedure detailed in Appendix 1 must be followed.
3.7 The pharmacy will present the medicine to the service user in a suitable receptacle and will provide the service user with water to facilitate administration and/or reduce the risk of doses being held in the mouth.
3.8 Pre-packing of doses for supply the next day must in line with a written procedure and be undertaken in line with current guidance for Good Manufacturing Practice.
3.9 The Pharmacy/patient agreement (Appendix 6) states the terms of agreement set up between the pharmacist and patient (to agree how the service will operate, what constitutes acceptable behaviour by the client, and what action will be taken by the GP and pharmacist if the user does not comply with the agreement.
3.10 The pharmacy should maintain all appropriate and legally required records to ensure effective ongoing service delivery and audit.
3.10.1 Recording forms supplied by the NHS Blackpool must be used for recording transactions (Appendix 10)
3.10.2 The following data must be recorded:
- Name of pharmacist responsible for each supervision
- Client initials
- Number of supervisions
- Number NOT collected
- Any out of area client information
- Number discussed with prescriber/drug worker
3.10.3 Completed forms must be returned to both LaSCA and the Substance Misuse Commissioning team by the 5th working day of the month
3.11 Pharmacists will share relevant information with other health care professionals and agencies, in line with locally determined confidentiality arrangements. Concerns should be documented on the concern form provided (Appendix 11) and communicated to the relevant prescriber/drug worker. This is in addition to the pharmacy’s usual incident & near-miss reporting procedure. All incidents involving controlled drugs must be recorded as part of the pharmacy’s clinical governance procedures and reported to NHS Blackpool.
3.12 Pharmacists are expected to develop and maintain close links with the prescriber/drug worker.
3.13 The pharmacist should receive notification from the prescriber in advance of a new client presenting a prescription; where the prescriber has failed to contact the pharmacist in advance, the pharmacist should always contact the prescriber to confirm arrangements.
3.14 If a client has ‘violent markers’, the prescriber or drug worker, will inform the pharmacy in advance of the client presenting for a prescription.
3.15 If a pharmacist has any cause for concern relating to a client, and the prescriber or drug worker is not available (e.g. after 5pm or at weekends), the pharmacist must use their professional judgement in deciding whether to supply. In the case of any incidents, report on the next working day to the prescriber/drug worker.
3.16 The decision to discuss a client with the prescriber or the Substance Misuse Service is a professional one that should be made after considering the risk to the client of non-disclosure and the damage that could be done to the supportive relationship between pharmacist and client.
3.17 NHS Blackpool will endeavour to arrange at least one contractor meeting per year to promote service development and update the knowledge of pharmacy staff. This may be undertaken by the Substance Misuse Commissioning Team.
3.18 NHS Blackpool will provide details of relevant referral points which pharmacy staff can use to signpost service users who require further assistance. Health promotion material relevant to the service users will also be provided and must be displayed.
3.19 In the event of the pharmacy unable to operate, both NHS Blackpool and the local prescribing substance misuse service need to be informed with immediate effect. Further instructions will be given.
4. Key Performance Indicators
Key Performance Indicators / DescriptionAll pharmacies providing this service must have a Pharmacist responsible for the provision of this service. / The pharmacist must sign on behalf of the pharmacy to provide the service in accordance with the terms and conditions stated in the service specification.
The pharmacy must review its standard operating procedures and the referral pathways for the service on an annual basis. / The pharmacy must demonstrate that SOPs (including all SOPs relating to controlled drugs) and referral pathways relating to this service are reviewed and updated on an annual basis.
The pharmacy must demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service. / 100% of pharmacy staff involved in the provision of this service must be appropriately trained, and training or CPD records must be available.
The pharmacy has appropriate NHS Blackpool provided health promotion and harm reduction material available for the user group and promotes its uptake. / Health promotion materials must be promoted within the pharmacy, and all staff (including locums) must be aware of local services for substance misusers and be able to signpost clients to these.
The pharmacy must ensure that any concerns (see section 10 of the community pharmacy protocol - Appendix 1) must be reported to the prescriber/drug worker. / The pharmacy must demonstrate that in 100% of cases, a concern form (appendix 11) is completed and faxed/sent to the prescriber or drug worker in the event of any of the circumstances in section 10 of the community pharmacy protocol (Appendix 1).
All claims for service provision must be submitted to NHS Blackpool/LaSCA no later than five working days following the month end that the claims relate to. / The pharmacy must demonstrate that 100% of claims for service provision using the ‘Pharmacy Recording Forms’ (Appendix 10) are submitted to both the commissioning team and LaSCA, no later than 5 working days following the month end that the claims relate to.
The pharmacy may be required to participate in an annual NHS Blackpool organised audit of service provision. / As and when required, on an annual basis.
The pharmacy co-operates with any locally agreed NHS - led or Prescribing service-led assessment of service user experience. / As and when required.
5. Payment for the service
5.1 Each pharmacy will receive a fee of £1.50 for every supervised dose of methadone and £2.50 for sublingual Buprenorphine (Subutex) and Buprenorphine/Naloxone (Suboxone).
5.2 Payment will be dependent upon the timely submission of monthly pharmacy record forms and accompanying data. If data is not received by the 5th working day following the month to which the claims relate, invoices will not be paid. Recording forms (appendix 10) should be sent directly to LaSCA with a copy to the substance misuse commissioning team
Claims SectionEmily Jane Grundy
Lancashire & South Cumbria Agency (NHS)Commissioning Officer – Substance Misuse
3 Caxton RoadCommissioning & Modernisation
Fulwood NHS Blackpool
PR2 9ZZThe Stadium
Seasiders Way
Blackpool
FY1 6JX
5.3 No patient, clinical, professional or other confidential details (other than those requested on the on pharmacy recording sheet Appendix 3) should be included in any reimbursement claim.
5.4 One transaction is defined as one client visit to receive supervised consumption on the premises, irrespective of the number of doses issued at the visit.
5.5 Contractors will be paid via LaSCA (unless otherwise specified)
5.6 For out of area patients requesting supervised consumption, pharmacist must notify NHS Blackpool on the pharmacy record form with any additional patient information
6. Exit Clause
6.1 NHS Blackpool reserves the right to withdraw the service from a pharmacy:
- If a site fails to comply with the Service Agreement.
- If there are prolonged periods of time where sites are unable to provide the scheme.
If the PCT decides to discontinue the service for other reasons, it will give 90 days notice to contractors.
6.2 If for whatever reason, the pharmacy does not fulfil its obligation to provide all essential services under the pharmacy contractual framework then the pharmacy will become ineligible to provide this enhanced service.
6.3 Community Pharmacies reserve the right to leave the service at any point; however 90 days notice must be given to NHS Blackpool.
7. Agreement
We agree to work within the guidelines laid out within this specification for supervised consumption and provide evidence of compliance to NHS Blackpool during clinical governance reviews and on request ad hoc through out the year.
Termination of the contract by either party will be in writing with a minimum notice period of 90 days.
NHS Blackpool reserves the right to terminate the contract immediately in exceptional circumstances in respect of inappropriate clinical conduct or if there is a suspected risk to patient safety, the public interest or suspected criminal or professional misconduct.
Pharmacy Stamp
Signed (on behalf of the PCT)
______
Emily Grundy – Commissioning
Signed (on behalf of the pharmacy)
______
Pharmacist in charge
Please sign and return original to:
Emily Grundy – Commissioning Officer
NHS Blackpool, The Stadium, Seasiders way, Blackpool, FY1 6JX
______
Date
LOCAL Enhanced Service for Supervised Self Administration of
Methadone and Buprenorphine
Schedule of Agreement
This schedule, and the documents it refers to, replace all previous agreements to deliver this service undertaken by precursor health organisations.
- Schedule 1 – The Care Service
This agreement forms the basis for the provision of supervised self administration of Methadone and Buprenorphine to drug users resident in Blackpool and aged 18 and over, in accordance with the service specifications laid outlined the document ‘Supervised Self Administration of Methadone and Buprenorphine – Guidelines for Pharmacists’.
This local guidance has been developed to ensure clinical guidelines and good practice are embedded in local practice.
This service constitutes a Local Enhanced Service under the New Contractual Framework for Community Pharmacy and recognises, and develops, the key role of pharmacists in the shared care of substance users.
Supervision of the self administration of Methadone and Buprenorphine is a key element in ensuring treatment compliance and safety for clients commencing prescribed opiate substitution treatment.
- Schedule 2 – The Provider
This service will be delivered by:
Name of Pharmacist (1) ______
Name of Pharmacist (2)______
Address of pharmacy from which the scheme will be administered:
______
______
Skills of provider
This service must be delivered under the supervision of an accredited pharmacist who has undertaken the required training as outlined in ‘Supervised Self Administration of Methadone and Buprenorphine – Guidelines for Pharmacists’.
Any changes to interruptions to this service must be reported to the PCT via the ‘Changes in the provision of Supervised Self administration of Methadone and Buprenorphine by accredited Pharmacist’ form contained in the guidance.
The provider is responsible for ensuring they have appropriate insurance cover and professional indemnity to deliver the service as outlined in ‘Supervised Self Administration of Methadone and Buprenorphine – Guidelines for Pharmacists’.
The provider is responsible for submitting to the PCT Standard Operating Procedures for the delivery of this service from their premises.
The service must be delivered in accordance with the PCT Diversity and Equality Commitment as contained in ‘Supervised Self Administration of Methadone and Buprenorphine – Guidelines for Pharmacists’.
The provider undertakes to liaise with prescribers regarding the safety and treatment of the client, whilst maintaining an appropriate level of confidentiality at all time. Please see ‘Supervised Self Administration of Methadone and Buprenorphine – Guidelines for Pharmacists’.
Schedule 3 – Contract Period and Payment Procedures
This agreement will run from ******* 2010 to ******* 2011 and will be subject to annual review.
Payments will be made at the following rates per supervision:
£1.50 for Methadone supervision
£2.50 for Buprenorphine supervision
Payments will be made monthly by LaSCA three month in arrears. Delayed and late claims will be held over for payment the following month.
Payments forms should be completed and submitted as outlined in the document ‘Supervised Self Administration of Methadone and Buprenorphine – Guidelines for Pharmacists’. Please see the ‘Pharmacy Record Form’ for guidance on correct completion. Failure to complete correctly may result in payments being made at the lower methadone rate.
Copies of these forms should be sent to Emily Grundy, Commissioning and Modernisation, NHS Blackpool, Blackpool Stadium, Seasiders Way, Blackpool FY1 6JX, for audit purposes only.
Termination of the agreement
NHS Blackpool reserves the right to withdraw a pharmacy from providing this Local Enhanced Service and to cease payments if it is considered that the requirements of the scheme are not being met. Such action will be taken following consultation with the Local Pharmaceutical Committee and following attempts to resolve issues with the pharmacy.
If the pharmacy wishes to withdraw from the scheme they should inform the Primary Care Trust of this intention three months in advance to allow for re-allocation of clients.
Schedule 4 – Monitoring requirements
Copies of the claims forms will be submitted to NHS Blackpool as outlined above.
Annual audit and service reviews will be conducted as outlined in ‘Supervised Self Administration of Methadone, Buprenorphine & Suboxone – Guidelines for Pharmacists’. This will require Pharmacies to maintain patient records as outlined in the guidance.
Complaints - The pharmacy will be required to report any complaints regarding this service to the PCT on a quarterly basis including their response to the issues raised.
Schedule 5 – Responsible Officers
The Responsible Officer for the provider agrees to deliver the service as specified in this contract and ‘Supervised Self Administration of Methadone and Buprenorphine – Guidelines for Pharmacists’.
Provider
/Commissioning Body
Name:
Position:
Address:
Telephone:
Signature:
Date:
/Name:
Position:
Address: NHS Blackpool, Blackpool Stadium, Seasiders Way, FY1 6JX
Telephone: 01253 655229
Signature:
Date:
Issues regarding payments should be directed to the named LaSCA contact identified in the guidance.