NHS Devon

This Local Enhanced Service (LES) Specification details the agreement between NHS Devon (the commissioner) and Pharmacies(the service provider) for the provision of emergency hormonal contraception (EHC).

Time Plan / Date
Start / 1stApril 2010
End / 31st March 2011
Review / 31st March 2011
Renewal / On yearly evaluation

1. Background

The Department of Health has always advocated that the first choice for women to protect themselves against unwanted pregnancy should be reliable contraception used on a regular basis. However emergency situations do arise and women should have the ability to make responsible choices about preventing pregnancy if they wish.

Research shows that the vast majority of teenage pregnancy (under 18 years) is unplanned (DfES, 2006). Since the launch of the national Teenage Pregnancy Strategy in 1998 there has been an slight increase in the under 18 conception rate in Devon by 1.4%. Approximately one half of all teenage conceptions in Devon end in terminations (see table 1).

Access to emergency contraception is vital and offering it within a wide range of settings to ensure access is quick and easy is important. The utilisation of pharmacists to provide free Emergency Hormonal Contraception to 13-19 year old age group is a key component of the strategy to reduce teenage pregnancy within Devon.

Table 1: Under 18 conceptions leading to terminations (3 year average 2006-08( including NHS & private terminations)

Area of residence / Number of conceptions / % leading to abortions
England / 118,286 / 50
South West / 10,038 / 50
DevonCounty / 1,298 / 50
East Devon / 236 / 61
Exeter / 260 / 42
Mid Devon / 115 / 43
North Devon / 143 / 47
South Hams / 93 / 54
Teignbridge / 266 / 55
Torridge / 112 / 40
West Devon / 73 / 48

Source: Department of Health

2. Aims of the Locally Enhanced Service for Emergency Hormonal Contraception

The main aim of this LES is to support the reduction of unwanted pregnancy for 13-19 year olds in NHS Devon.

The LES also aims to:

  • Increase choice and improve access to emergency contraception, providingquick, easy and convenient access to EHC across the county
  • Promote self-care through the pharmacy, including the provision of advice and signposting information.
  • Supply EHC free of charge to the client at the point of delivery.

3. Service Outline

3.1 The Provider (Pharmacy) will:

  • Provide Emergency Hormonal Contraception (EHC), under NHS Devon current1Patient Group Direction (PGD), to women between 13 and 19 years of age inclusive, who meet the inclusion criteria of the PGD.
  • Provide EHC under NHS Devon Protocol for Levonorgestrel Emergency Contraception by Registered Nurses, Emergency Care Practitioners and Named Community Pharmacists.
  • Provide EHC during pharmacy opening hours.
  • Ensure that the enhanced service is available for a minimum of 75% of the pharmacy opening hours (core and supplementary hours) on a weekly basis. Any exceptions to this requirement must be put in writing to NHS Devon for consideration on a case by case basis.
  • Where EHC is supplied under this enhanced service, the service-user shall be encouraged to consume the medication before leaving the pharmacy premises.
  • Provide a consultation room or area or other quiet area of the pharmacy that offers suitable privacy and confidentiality to the client and use this when consulting with the client for this service (unless the client does not wish to do so, or the pharmacist believes this would threaten his or her safety).
  • Satisfactorily comply with his obligations under Schedule 1 to the Pharmaceutical Services Regulations to provide essential services and has an acceptable system of clinical governance.
  • Confirm (verbally) the eligibility of the client to access the service based on the patient group direction (13 to 19 years old inclusive).
  • In the event that a person presents requesting the service, but who is ineligible, signpost the client appropriately. Furthermore, if the person is under 13 years of age, the Pharmacy shall, wherever reasonably practical and with the young person’s agreement, telephone ahead to arrange an ‘appointment’ for the young person with an appropriate source of support, such as the Family Planning Clinic or the young person’s General Practitioner.
  • Ensure that appropriate records are made, as detailed in the PGD, including a record of assessment of competence, in accordance with Fraser Guidelines where the young person is under 16 years old. These records shall be retained in a secure location in the pharmacy for a period of 8 years or for patients under 18 years of age, until the patient is 25 years of age.

1PGD 10.1 Version 1.0 June 2008, due for renewal May 2010

  • Report to NHS Devon, as soon as reasonably practicable (and timely in relation to the significance of the event) all significant events associated with this enhanced service (including but not limited to, persons under 13 years of age requesting the service; situations where the pharmacist involves the Child Protection Team and any complaints made about the service) using the NHS Devon significant incident report form.
  • Pharmacists involved in delivering this enhanced service will apply for CRB Enhanced Disclosure via NHS Devon, prior to commencement of the enhanced service and every 3 years thereafter(whilst continuing to provide the enhanced service), unless otherwise specified by NHS Devon.

Pharmacists should contact Brenda Sharland on 01392 449700 to request a CRB application form or write to PCSS, NHS Devon, Newcourt House, Old Rydon Lane, Exeter EX2 7JU.

  • Have a Standard Operating Procedure(s) (SOP(s)) for the service signed by all members of staff providing any part or all of the service and shall review the SOP(s) annually. Records shall be kept in the pharmacy of SOP(s) staff training and SOP reviews.
  • Be able to demonstrate that all pharmacists involved in the provision of the service have successfully completed the CPPE distance learning pack Emergency Hormonal Contraception (CPPE Reference 36456) and CPPE distance learning pack Child Protection(CPPE Reference 37025) and have successfully completed recognised PCT training or a multiple choice questionnaire where available. (CPPE training must be completed before attending local training).
  • Pharmacists involved in the provision of the serviceare recommended toattend EHC training updates annually if provided by the PCT to ensure best practice. These updates will be made available across the region.
  • Notify NHS Devon, in writing, of any personnel changes within the pharmacy that may affectthe pharmacist’s delivery of the service, as soon as they become aware of such changes.
  • The pharmacy contractor and/or pharmacists are responsible for ensuring that professional indemnity insurance arrangements are in place to cover the activity outlined in the PGD.
  • Cooperate with any locally agreed NHS Devon led assessment of the service including service user experience.
  • Participate in any NHS Devon organised audits relating to the service.
  • Advertise the availability of the service within the pharmacy (posters, leaflets & window stickers available from NHS Devon)
  • Provide completed monitoring information to NHS Devon on a monthly basis, using theNHS Devon EHC monitoring form.
  • Submit completed claim forms for fees and reimbursement of drug costs to the PCT on a monthly basis. Claims submitted later than three months after the provision of EHCto the patient may result in payment not being made or delayed.
  • Clients requesting the EHC service, having had unprotected sex, must be counselled about sexually transmitted infections. (STI).If signed up to the Devon Chlamydia Screening LES, a Chlamydia Testing Kit should be supplied (if appropriate) and the “Assessment and Record Sheet” updated accordingly.Pharmacies not signed up to the Devon Chlamydia LES must signpost clients to a location where a testing kit and advice is available.

3.2 The Commissioner (NHS Devon) will:

  • Provide details of relevant referral points, which pharmacy staff may use, to signpost service users who require further assistance, such as Family Planning and Genito-urinary Services.
  • Provide PGD, local protocols & Significant Event form as detailed in the LES. These will also be available on the NHS Devon website to download.
  • Advertise and promote this enhanced service and make available to patients a list of pharmacy contractors providing the service.
  • Provide pharmacies with posters, leaflets and window stickers to advertise the service
  • ProvideaccessibleNHS Devon training forpharmacists to support the delivery of this LES.
  • Provide annual EHC training updates if appropriate to ensure best practice. These updates will be made available across the region.
  • Maintain a list of appropriately trained pharmacists providing the service and cascade best evidence and any updated information relating to the provision of EHC.
  • Remunerate the pharmacy fees, as specified in the payment schedule, within three months of claims being submitted.
  • Monitor the provision of EHC under the enhanced service, reporting back where appropriate.

4. Access to the service

Access routes to the service may include:

  • Direct self referral by the individual
  • Referral by another pharmacy not offering the service
  • Referral by another practitioner

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5. Quality Indicators

  • Contractor on ‘fitness to practice’ list (i.e. on the appropriate NHS Devon list of contracted pharmacies for the provision of NHS community pharmacy services).

6. Payment Schedule

Fee of £12.75 per consultation with client 13 to 19 years of age.

Reimbursement cost of levonorgestrel 1.5mg supplied under the PGD at appropriate Drug Tariff price.

Fee of £5 per consultation with a person younger than 13 years of age (requesting EHC for personal use) where all appropriate procedures are followed and records kept, as detailed in this agreement.

NHS Devon will pay £50 per EHC training event to each pharmacist for his/her full attendance at and full compliance with NHS Devon provided training. NHS Devon will pay this for a maximum of 3 pharmacists per pharmacy in any two year period (except in extenuating circumstances, as determined by NHS Devon)

Payment will only be made on receipt of an EHC claim form and monitoring form.

7. Monitoring & Evaluation

Service delivery and quality will be monitored by NHS Devon

The results of any assessment of the service and audits as detailed in 3.1 will be used to inform future service delivery and development.

Local Enhanced Service – Emergency Hormonal Contraception

This document constitutes the agreement between the service provider and NHS Devon in regards to the local enhanced service for Emergency Hormonal Contraception.

Service Provider Name and Address
Accreditedpharmacists providing the service – please complete on separate sheet if required.

Practices can sign up to provide the service without EHC accreditedpharmacists in place.

However,accredited pharmacists must be in place to provide the service.

Signature on behalf of the service provider:

Signature / Name / Date / Job Title

Signature on behalf of NHS Devon:

Signature / Name / Date / Job Title

The agreement is to cover a 12 month period commencing 1st April2010

Payments will only be made once NHS Devon is in receipt of a signed copy of this sheet.

Please complete this form and fax it to Dasa Miklosovicova on 01392 267886

A copy signed by NHS Devon will be returned to you for your records.

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