Public Health & Health Strategy
Service Specification
Community Pharmacy Sexual Health Enhanced Service
Document Version / Author / Comments / Date1.0 / Sara Garratt / Initial internal draft for comments / 25.02.08
1.1 / Sara Garratt / Internal Draft for Comments / 18.03.08
1.2 / Sara Garratt / Draft following internal consultation / 23.04.08
1.3 / Sara Garratt / Revision following LPC / 08.05.08
1.4 / Sara Garratt / Revision following LPC / 07.07.08
1.5 / Sara Garratt / Final revision / 29.07.08
Contents Page
1 Introduction and Service Description
2 Statement of Intent
3 Client Group
4 Referral and Access
5 Principle Elements of Service
6 Organisational Standards of Service Provider
7 Location of Service
8 Quality Framework
9 Performance Management
1 Introduction and Service Description
Sexual health has risen up the NHS and Social Care agenda in recent years following major national policy initiatives. Although the NHS provides a comprehensive range of sexual health services, including GUM clinics, community contraception and services in primary care, the DH recognises there is scope for significant improvement.
The DH National Strategy proposes a wide-ranging and holistic model for modernising sexual health services and aims to:
- Reduce the transmission of HIV and STI’s
- Reduce the prevalence of undiagnosed HIV and STI’s
- Reduce unintended pregnancy rates
- Improve health and social care for people living with HIV
- Reduce the stigma associated with HIV and STI’s
The vision of Tameside and Glossop PCT is to promote good sexual health through high quality holistic and integrated sexual health services to all members of our local community in an appropriate, accessible, equitable and patient centred manner.
Locally the Sexual Health Needs Assessment completed in 2005 requires review against changing local needs. The establishment of formal engagement practices locally is required to help support and inform service redesign/improvement in the coming years and to review and inform the local Sexual Health Strategy. The recent (Jan 2008) report “CONTRACEPTIVE SERVICES IN THE NORTH WEST” details a number of recommendations that support the need for a local Sexual Health Strategy to further improve contraceptive and sexual health services to support the national Teenage Pregnancy and Sexual Health Strategies.
Since January 2001 Emergency Hormonal Contraception (EHC) has been available without prescription across Britain to women aged 16 or over at a cost of between £20-25. EHC is also available on prescription from various sources within Tameside and Glossop including general practice, contraception and sexual health clinics, Tameside Hospital NHS Foundation Trust.
Sales of EHC over the counter has not increased its use or changed the patterns or predictors of use. However the sole predictor of whether or not EHC is obtained over the counter is income[i]. Cost is an important barrier in uptake from this source, particularly in lower income groups.
Whilst all women may access this service it will be targeted to younger women who are at highest risk of unprotected sex and unwanted pregnancy. A section of this service specification relates to a scheme for the free supply of emergency hormonal contraception (EHC) and associated sexual health advice in Tameside and Glossop as described in the Patient Group Direction by community pharmacists in community pharmacies.
The Tameside and Glossop Condom Distribution (CCard) scheme is designed to support the challenge set out in the government’s strategic review Teenage Pregnancy: Accelerating the Strategy to 2010. Increasing access to condoms and safer sex information for young people is an essential part of young peoples sexual health. The scheme will be targeted at young people deemed at risk and/or vulnerable but will be open to all young people aged 19 and under.
This service will support the distribution of condoms via the CCard Scheme. This scheme forms part of the prevention and Core service within the young people’s sexual health care pathway. The pharmacy distribution element within this specification will be linked to the delivery of services within the correlating section of the care pathway.
The public health White Paper, Choosing Health: Making healthy choices easier identified sexual health as a new priority area. Unacceptably high levels of sexually transmitted infections, particularly chlamydia, require a step change in the way sexual health services are organised and delivered, building on the recommendations in the Governments National Strategy for sexual health and HIV launched in 2001. The Choosing Health White Paper indicated that the final phase of the rollout of the national chlamydia-screening programme would be achieved by 2007.
There is considerable evidence indicating a high prevalence of chlamydia and subsequent disease burden in young people aged 25 and under, with up to one in ten found to be infected. Approximately 50% of men and 70% of women with chlamydia do not have symptoms. If left untreated, genital chlamydia can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Also, there is growing evidence that active case finding for genital chlamydia infection through population based screening can have a significant effect on associated morbidity and its sequelae.
Locally there are approximately 32 thousand people aged between 15 and 24 based on 2005 population data.
2 Statement of Intent
The service will support the extension and availability of some contraception methods and chlamydia screening specifically (unless indicated) for young people.
The service health outcomes are to: -
- Reduce the overall incidence of unintended / unwanted teenage pregnancy in this age group
- Reduce the overall incidence of sexually transmitted infections in this age group and risk of transmission
- Reduce treatment for STI(s) in this age group
- Reduce the number of terminations of unintended / unwanted pregnancies
- Increase the availability and use of condoms by sexually active young people aged 19 and under specifically but not limited to those young people most at risk
- Ensure early detection of unintended/unwanted pregnancies in young women
- To raise awareness about sexual health services for young people in Tameside & Glossop
The service objectives are to:
- Establish baseline data in year one of the service regarding the percentage of young people using the scheme by ward and activity by sex, age and ethnicity
- Offer confidential advice and discussion regarding sexual health issues with young people
- Offer effective signposting to appropriate services in Tameside and Glossop
- Empower young people to make informed decisions and choices about their sexual health through education and knowledge
- Address health inequalities by specific targeting of those groups who have been identified as less likely to access contraception services
- Encourage young people to be regularly screened for chlamydia
- Increase the availability of screening sites to support the improvement of sexual health services
- To provide EHC over the counter.
- To provide free condoms and pregnancy testing
- To provide out of hours provision (e.g. evenings and weekends)
- Provide early access via signposting to supporting services i.e. TOP
Clients aged under 15
It is anticipated that should a young person under 15 years of age be identified as sexually active, they will be offered and encouraged to be screened for chlamydia. Also, if a young person under the age of 15 requests to be screened for chlamydia this will be accommodated.
3 Client Group
This service is offered to the PCT registered population and people living in the Tameside and Glossop area. Service users would normally be registered with a GP in the area but lack of registration or registration with a non-Tameside and Glossop GP practice will not exclude them from this scheme. Specifically: -
EHC
Women (and in particular young women aged under 19) who require prevention of pregnancy from unprotected sexual intercourse (UPSI) i.e. no contraception, missed pills, failed condom/barrier method.
Condoms
Young people with a valid CCard or aged 19 and under.
Pregnancy Test Kits
Young women aged 19 and under
Chlamydia Screening
Young people aged 24 and under. Any service users aged 25 and over should be directed to alternative local services. The screening programme is specifically targeted at young people aged 15-24 however, as indicated, should a young person aged under 15 request a chlamydia screen, this will be accommodated.
Exclusions:
- Condoms – young people aged 20 and over.
- Pregnancy test kits – women aged 20 and over
Under the Sexual Offences Act 2003, a child under 13 is not legally capable of consenting to sexual activity. Any offence under the Sexual Offences Act 2003 involving a child under 13 is very serious and should be taken to indicate a risk of significant harm to the child.
Cases involving under 13s should always be discussed with a nominated child protection lead in the organization. Under the Sexual Offences Act, penetrative sex with a child under 13 is classed as rape. Where the allegation concerns penetrative sex, or other intimate sexual activity occurs, there would always be reasonable cause to suspect that a child, whether girl or boy, is suffering or is likely to suffer significant harm.
In all cases where a young person under 13 is judged to be sexually active, the pharmacist has a primary responsibility to safeguard the child. The pharmacist must seek advice from the Tameside and Glossop Safeguarding Children Unit or Children’s Social Care for Tameside or Derbyshire, and also make the appropriate written referral.
4 Referral and Access
Referral sources:
Walk in service
Whilst service users can be signposted to their local pharmacy for the above services from other locations it is envisaged that young people will simply walk in to their local pharmacy and request the above services.
Hours and availability
Pharmacy opening hours, which, should include Saturday mornings and access outside normal working hours. Pharmacies who cannot provide access outside normal working hours will still be considered. All pharmacies signed up to this specification are responsible for ensuring that all services are available at all times delivering full continuity of service.
5 Principle Elements of Service
There are two levels of service that can be delivered within this specification. This should ensure that all pharmacies within the Tameside and Glossop area can contribute and deliver sexual health services to service users. All services are detailed earlier in this specification however the levels of service are defined below: -
PharmacistEmergency Hormonal Contraception provided via PGD
(Appendix 1)
Appropriate written and verbal information about all sexual
health services
Core TeamCondom Distribution
Chlamydia Screening via postal kits
Pregnancy Test Kits Distribution
Appropriate written and verbal information about all sexual health services
Should a pharmacy be in a position to deliver both levels of service this will be referred to as: -
Core PlusCondom Distribution
Chlamydia Screening via postal kits
Pregnancy Test Kits Distribution
Provision of Emergency Hormonal Contraception
Appropriate written and verbal information about all sexual health services
Additional Service Information
Condom Distribution
Staff will be trained and will be required to complete monitoring and stock forms and return them to the CCard Co-ordinator on a regular basis. The types of Condoms to be distributed will be confirmed during training.
The Sexual Health Service via the CCard Scheme will provide consumables, monitoring stock forms and training.
Chlamydia Screening
Staff will be trained by appropriate staff, which will be organised by RU Clear. Locations wishing to deliver on site screening will be expected to have the appropriate facilities. If the client accepts on-site testing, a first-catch urine sample will be obtained and sent for testing for genital C. trachomatis infection. All samples are also tested routinely for Neisseria Gonorrhoea. Clients should be made aware of this fact. If the client prefers to take away a postal kit, the pharmacist or trained assistant must educate the client briefly on the contents of the kit box and advise on correct completion of the form.
RU Clear will provide Kits and monitoring forms.
Pregnancy Test Kits
Staff will distribute the clearblue kit and will be required to complete monitoring information
Each pharmacy will be expected to order and hold stock for this element of service.
EHC
Levonelle 1500 EHC to women who meet the inclusion criteria via Patient Group Direction Including if medically indicated a clearview pregnancy test, which will be conducted on site as per the PGD.
Each pharmacy will be expected to order and hold stock for this element of service.
Confidentiality
Without prejudice to the generality of the PGD, the pharmacist and their staff must not disclose to any person other than a person authorised by the PCT, any information acquired by them in connection with the provision of the services here under which concerns:
- The PCT, its staff and procedures;
- The identity of any patient;
- The medical condition of or the treatment received by any patient.
6 Organisational Standards of Service Provider
- Tameside and Glossop Primary Care Trust will be the responsible organisation.
- The service will be “Standards for Better Health “ compliant with supporting evidence.
- Individual staff will be responsible for complying with all PCT policies, procedures and regulations.
- The pharmacist agrees to keep his/her knowledge about EHC and referral pathways as they relate to the service provided, up to date and ensure that this knowledge is shared with clients accessing the service as far as is necessary to provide a competent service.
- Chlamydia screening data should be reported through Greater Manchester programme
- The provider will ensure that the services to be delivered are available at all times.
Terms and fees
Reimbursement will be as follows:
Pharmacist
Emergency Hormonal Contraception
- £10.00 per consultation
- Cost price of one packet of levonelle 1500, plus VAT, if supplied during consultation.
Core
- Cost price of one clearblue pregnancy test kit plus £1.00 per distribution
- £4.50 per Chlamydia Screen Discussion and Issue
- £1.50 per returned Screen
Retainer
- An Annual Retainer of £100.00 paid to each location on commencement of the service and at the beginning of each following financial year.
It is expected that condom distribution will be delivered as part of the service without direct payment.
Core Plus
Payments as above.
Claim forms should be submitted to:
The nominated PCT Officer as defined. The claim form will be issued electronically to all locations signed up to deliver the service. Paper copies can also be made available.
7 Location of Service
All community pharmacy locations are invited to provide a formal response to this service specification noting clearly:
- The level of service to be provided
- Clear evidence of competencies
- Clear evidence to ensure full service continuity
- Clear evidence of suitable facilities (should Chlamydia Screening be delivered on site)
Consideration of each response will be given against the standards outlined in this service specification. The number of locations offering EHC may be limited in the first instance with regular reviews.
8 Quality Framework
- The pharmacist must have completed the most up to date version of the CPPE open learning pack “Emergency Hormonal Contraception information booklet”. A copy of the certificate showing completion of this course must be sent to the PCT.
- The pharmacist agrees to keep his/her knowledge about EHC and referral pathways as they relate to the service provided, up to date and ensure that this knowledge is shared with clients accessing the service as far as is necessary to provide a competent service.
- Any HAG trained pharmacist will be expected to read and sign the local PGD. Furthermore to agree to attend the next available PCT provided training session. The PCT will contact the previous commissioning PCT to confirm eligibility to deliver the service.
- The Sexual Health Service will provide specialist support to the service for detailed queries and advice.
- The PCT Sexual Health Service will provide PGD training for the provision of Emergency Hormonal Contraception. Any pharmacist must be accredited either via this route or other HAG accredited training prior to commencing deliver of the service.
- A detailed PGD will be provided and kept updated by the PCT.
- RU Clear will provide update training for the chlamydia-screening programme.
- Update training if required for the CCard Scheme will be provided by the sexual health serviceon an annual basis and throughout the year via a rolling programme
- Service user satisfaction surveys will be conducted annually.
- The provider will implement a complaints procedure in accordance with NHS requirements.
9 Performance Management
To support the services defined objectives and health outcomes, performance measures will be monitored at quarterly intervals with an annual review. Performance reports will be directed to the nominated PCT Officer.
The service will be required to establish, process, collate and report on the following:
Activity
/Additional Detail
Condom Distribution / The pharmacy will be expected to follow the requirements of this service in terms of monitoring. This will be detailed during training but will involve stock and monitoring form completion.Chlamydia Screening /
- Activity
- Date of request
- Ward i.e. Post Code
- Age
- Sex
- Ethnicity
Pregnancy Test Kits /
- Activity
- Date of request
- Ward i.e. Post Code
- Age
- Sex
- Ethnicity
- No of requests made from clients aged 20 and over
Emergency Hormonal Contraception /
- Date of request
- Age
- Post Code
- Ethnicity
- Time from UPSI
- Was pregnancy test carried out?
- Reason if Levonelle 1500 not issued
Access /
- 100% of agreed services available 100% of the time
All required monitoring and performance data will be summarised by month and submitted to the PCT nominated officer. Data produced by the pharmacy will be married with that compiled by RU Clear and the Sexual Health Service to determine the appropriate payment level.