CONTRACT AGREEMENT

Between

The Council of the Metropolitan Borough of Bury

Department for Communities and Wellbeing

Town Hall

Knowsley Place

Bury

BL9 0SW

And

«Pharmacy_Trading_Name»

«Address»

«Postcode»

For the

Participation in the Ruclear chlamydia and

gonorrhoea screening programme (Pharmacies)

Component A

SERVICE SPECIFICATION

Service / Participation in the Ruclear chlamydia and gonorrhoea screening programme (Pharmacies) Component A
Authority Lead / Shenna Paynter, Programme Manager -Population Healthcare and Sexual Health
Period / 1st April 2018– 31st March 2019
Date of Review / January 2019
  1. POPULATION NEEDS
  1. NATIONAL AND LOCAL CONTEXT

1.1NATIONAL CONTEXT

1.1.1Overview of commissioning responsibilities

  1. Local authorities have the lead for improving health and for coordinating efforts to protect public health. Public health teams within local authorities are responsible for commissioning and funding a number of mandated services and other services to improve the health and wellbeing of local populations.
  1. Local authorities are mandated to commission and fund comprehensive, open-access HIV/STI testing services, STI treatment services (excluding HIV treatment) and contraception services for the benefit of all persons of all ages present in their area. NHS England is responsible for commissioning and funding HIV treatment services. Clinical Commissioning Groups are now responsible for funding abortion services; vasectomies and sterilisation procedures; and for the promotion of opportunistic STI testing and treatment within general practice.

1.1.2National Chlamydia Screening Programme (NCSP)

  1. Genital chlamydia infection is the most commonly diagnosed bacterial sexually transmitted infection in the UK. Prevalence of the infection is highest in sexually active women aged 16-19 and men aged 20-24. Untreated infection can have serious long-term consequences including pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility. Chlamydia often has no symptoms and opportunistic screening of asymptomatic young people is considered the best approach for detecting and treating this infection.
  1. The National Chlamydia Screening Programme (NCSP) in England was established in 2003 ( The programme aims to prevent and control chlamydia through early detection and treatment of asymptomatic infection, so reducing onward transmission and the consequences of untreated infection.
  1. The Department of Health considers that general practices and pharmacies have an important role in screening for chlamydia, treatment and partner notification. Embedding the offer of an opportunistic screen in core services including general practices and community contraception and sexual health services is recommended practice and the approach that is considered the most viable option for further extending the reach of local programmes.

1.1.3Public Health Outcomes Framework

  1. The Public Health Outcomes Framework( sets out a vision for public health, desired outcomes and the indicators that will be used to monitor how well public health is being improved and protected. The Framework includes three indicators relating to sexual health:
  • Indicator 2.04: Under-18 conception rate
  • Indicator 3.02: Chlamydia diagnosis rates among young adults aged 15-24s
  • Indicator 3.04: % of persons presenting with HIV at a late stage of infection
  1. Local areas are tasked to continue to work to reduce the number of under-18 conceptions, to prevent and control the transmission of chlamydia, and to promote and increase uptake of HIV testing in order to reduce the number of patients entering HIV treatment services at a late stage of infection. Participation in the Ruclear chlamydia and gonorrhoea screening programme is expected to contribute to increasing the number of access points for asymptomatic young people aged 15-24 to obtain an opportunistic screen.
  1. Public Health England recommends that local areas should be working towards achieving a chlamydia diagnosis rate of at least 2,300 per 100,000 young people aged 15-24. Modelling suggests that achieving a diagnosis rate of >2,300 will contribute to further reducing the prevalence of chlamydia.

1.2LOCAL CONTEXT

1.2.1Overview of sexual health data for Bury

  1. Improving the sexual health and wellbeing of the population is one of the public health priorities for Bury. Sexual ill-health is a particular issue for Bury with high rates of under 18 conceptions and abortions.
  1. Although Bury does not have high prevalence rates of HIV when compared with other areas, there has been a steady increase in the number of residents that have contracted HIV in the past six years
  1. The Chlamydia diagnosis rate per 100,000 eligible population in Bury (15-24 year olds) was 1,862 against a target of ≥2,300 in 2016. The positivity rate was 11.5% compared to the England rate of 9.1% and the percentage of the eligible population tested was 16.2%, lower than the England rate of 20.7%. This demonstrates that targeting of screening is good in Bury but that the coverage needs to increase in order to meet and exceed the diagnostic target.
  1. Rates of most sexually transmitted infections are highest amongst young people aged 16-24; rates of selected sexually transmitted infections are also high amongst men who have sex with men and women and men from black African and black Caribbean communities living in the UK.
  1. Uptake of contraception amongst residents is good. Residents can obtain contraception from general practices, pharmacies (EHC only) and from contraception and sexual health clinics.
  1. The proportion of women opting for long-acting reversible contraception (LARC) is increasing. Therateper1,000womenof total prescribed LARC (excluding injections) was 50.1 in Bury; 44.2 in the NW and 46.4 in England in 2016.
  1. The rate of abortions among female residents aged 15-44 has been falling since the late 2000s, down from 24 per 1,000 in 2008 to 21 per 1,000 in 2011. The abortion rate in 2016 for Bury was 21.5 per 1,000 (England rate 16.7).
  1. The teenage conception rate in Bury continues to fall and is lower than the NW. In 2016 the teenage conception rate in Bury for under 18’s was 23.8 per 1000 15–17 year olds. This is higher than the England rate of 20.8%. Amongtheunder18conceptions,theproportionofthoseleadingtoabortionwas 51.3%,whileinEnglandtheproportionwas51.2%.
  1. Bury Council is committed to improving access to contraception, sexual health and abortion services. Residents can obtain contraception from their GP practice, from some pharmacies (EHC only) and from contraception and sexual health clinics including dedicated clinics for young people. For up to date information on this see Ruclear ( ) is an established STI screening service. 48 hour access to GUM clinics has been achieved. However, ongoing work is required to promote the use of condoms and to increase the use of contraception including long acting reliable methods such as the Nexplanon implant, in order to control the transmission of sexually transmitted infections and to reduce the numbers of unintended conceptions among women of all ages.

1.2.2Ruclear chlamydia and gonorrhoea screening programme

  1. Ruclear is the chlamydia and gonorrhoea screening programme for Greater Manchester. Ruclear processes screens for chlamydia and gonorrhoea, manages results, undertakes partner notification activities, and arranges treatment.
  1. OUTCOMES

2.1EXPECTED OUTCOMES

2.1.1Direct influence on outcomes

  1. Participation in the Ruclear* chlamydia and gonorrhoea screening programme is expected to contribute to:
  1. Increasing the number of asymptomatic young people accepting an opportunistic screen for chlamydia and gonorrhoea from pharmacies in Bury
  1. Improving knowledge and understanding of chlamydia and gonorrhoea amongst young men and women through the provision of information, advice and guidance.
  1. Improving knowledge and understanding of the risks associated with unprotected sex through the provision of information, advice and guidance.
  1. Improving awareness of the importance of regular screening for chlamydia amongst young women and men through the provision of information, advice and guidance.

2.1.2Indirect influence on outcomes

  1. Participation in the Ruclear* chlamydia and gonorrhoea screening programme is expected to contribute to achieving:
  1. Reducing the prevalence of chlamydia and gonorrhoea amongst young women and men through the prompt detection and treatment of asymptomatic infection.
  1. Reducing the transmission of chlamydia and gonorrhoea amongst young people through the promotion of safer sex practices.
  1. Preventing the consequences of untreated infection.

3.SCOPE

3.1AIMS AND OBJECTIVES

3.1.1Aims

  1. The overall aim is to embed the offer of an opportunistic screen for chlamydia and gonorrhoea for asymptomatic young people aged 16-24 within pharmacies located in Bury. This will contribute to local efforts to prevent and control transmission through prompt detection and treatment of asymptomatic infection.

3.1.2 Objectives

  1. Contractors participating in the Ruclear* chlamydia and gonorrhoea screening programme will:
  1. Promote the Ruclear* chlamydia and gonorrhoea screening programme and communicate the importance of regular screening to young people (16-24s) accessing services from the pharmacy.
  1. Issue Ruclear* chlamydia and gonorrhoea home screening kits to young people (16-24s) accessing services from the pharmacy, as and when appropriate.
  1. Ensure that clients accepting a Ruclear* chlamydia and gonorrhoea home screening kit are provided with information, advice and guidance about how to take and return the sample.
  1. Ensure that clients accepting a Ruclear* chlamydia and gonorrhoea home screening kit are provided with information, advice and guidance about sexually transmitted infections including chlamydia and gonorrhoea.
  1. Ensure that clients accepting a Ruclear* chlamydia and gonorrhoea home screening kit are offered up to 10 condoms.

3.2SERVICE DESCRIPTION

  1. Bury Council is commissioning and funding the Contractor to offer contraception and sexual health services as described in this specification. This section details:
  • Specific requirements relating to participation in the Ruclear* chlamydia and gonorrhoea screening programme (Component A - see section 3.2.1)
  • General requirements relating to the provision of all services detailed in this specification (see section 3.2.2)

3.2.1Opportunistic screening of asymptomatic young people for chlamydia and gonorrhoea(Component A)

  1. Bury Council is commissioning and funding the Contractor to participate in the Ruclear* chlamydia and gonorrhoea screening programme in line with the requirements set out in this specification. Ruclear is the opportunistic screening programme for asymptomatic young people aged 16-24 living in Greater Manchester.
  1. The Contractor shall arrange for trained pharmacists / counter staff to issue Ruclear* chlamydia and gonorrhoea home screening kits to asymptomatic young people aged 16-24 attending the pharmacy.
  1. Pharmacists / counter staff should assess the appropriateness of offering a Ruclear* chlamydia and gonorrhoea home screening kit. It could be appropriate to issue a home screening kit for instance if:
  • Young person attends the pharmacy for emergency hormonal contraception
  • Young person attends the pharmacy and asks for information, advice or guidance about contraception or sexually transmitted infections.
  1. Pharmacy professionals / counter staff should ensure that clients accepting a Ruclear* chlamydia and gonorrhoea home screening kit are provided with information, advice and guidance about how to take and return the test.
  1. Pharmacy professionals / counter staff should ensure that clients accepting a Ruclear* chlamydia and gonorrhoea home screening kit are provided with information, advice and guidance about sexually transmitted infections including chlamydia and gonorrhoea. Symptomatic young people should be referred to STI testing / treatment services.
  1. Pharmacy professionals / counter staff should ensure that clients accepting a Ruclear* chlamydia and gonorrhoea home screening kit are offered up to 10 condoms.
  1. The Contractor must ensure that pharmacy professionals / counter staff are competent and trained in the operation of this service.
  1. The Contractor is required to ensure that pharmacy professionals / counter staff have the skills to consult with clients in a sensitive and appropriate manner.

3.2.2General requirements

  1. The Contractor is required to ensure that consultations occur in a designated room or area. The designated room or area should meet, as a minimum, the requirements detailed in the NHS Act 2006, The Pharmaceutical Services (Advanced & Enhanced Services) (England) Directions 2013, Part 2, Advanced Services: Pharmacy contractors only; Direction 5 (a) for MUR Services.
  1. The Contractor is required to adhere to national and local guidelines for offering sexual health advice and treatment to young people aged under-19 including the requirement to assess Fraser competence.
  1. The Contractor will ensure compliance with local policies and procedures for safeguarding children and vulnerable adults including the Greater Manchester protocol for working with sexually active young people
  1. Bury Council requires the Contractor to log the distribution of Ruclear* chlamydia and gonorrhoea home screening kits (Component A) using PharmOutcomes. The Contractor will need to record the unique identification number on the screening kit as well as their site reference number. PharmOutcomes will be used for the purposes of audit and for generating and submitting invoices.
  1. Bury Council will ensure that the Contractor has information about local contraception and sexual health services to aid pharmacists to make accurate and appropriate referrals.
  1. Bury Council will supply the Contractor with condoms. Please contact
  1. RU Clear will provide promotional materials including window stickers. The Contractor should ensure that window stickers are displayed and are prominent.
  1. Bury Council will arrange at least one service monitoring meeting per annum.
  1. The pharmacy contractor must ensure that all staff are familiar with the Department of Health ‘You’re Welcome’ quality criteria, and that the pharmacy environment is ‘young people friendly’.

3.2.3Requirements of the Ruclear chlamydia and gonorrhoea screening & treatment programme

  1. Bury Council commissions and funds Ruclear (CMFT) to:

i)Support screening sites through the provision of consumables including home screening kits.

ii)Deliver a results management service and to arrange treatment for index cases and their partners in line with NCSP guidelines

iii)Deliver partner notification activities in line with NCSP guidelines

iv)Provide on-site training and support for providers offering chlamydia screening

v)Provide on-site training and support for providers offering treatment of chlamydia

vi)Produce and distribute promotional materials – e.g. poster and leaflets

  1. Ruclear* (CMFT) is required to provide a breakdown of returned home screening kits to allow the Commissioner to determine and authorise bonus payments.
  1. Ruclear* (CMFT) is required to provide a breakdown of chlamydia treatments to allow the Commissioner to verify and audit invoices submitted to BMBC.

3.3CLINICAL GOVERNANCE

3.3.1General

  1. The Contractor is responsible for ensuring that sufficient arrangements for clinical governance are in place to allow for the provision of safe, effective services delivered to a high standard. The Contractor is required to adhere to Department of Health guidance( including:

i)To establish and maintain links with reproductive and sexual health services.

ii)To have processes and procedures in place for reporting incidents including serious untoward incidents (SUIs). The Contractor is required to inform the Director of Public Health on incidents and near misses as well as reports on complaints and complements and other patient feedback.

  1. The Contractor is required to ensure that all staff involved in the provision of Ruclear* home screening kits (Component A) have received appropriate training.
  1. The Contractor will ensure that a Standard Operating Procedure is in place for each of the components described in this specification.
  1. Bury Council reserves the right to liaise and share information with NHS England and NHS Bury CCG to ensure patient safety.

3.3.2Clinical skills and competencies

  1. The Contractor is required to ensure that all staff (pharmacy professionals and counter staff) involved in the distribution of Ruclear* home screening kits have received on-site training from Ruclear (CMFT).
  1. Pharmacy professionals delivering or supervising counter staffdeliver this service should complete the Declaration of Competence (DoC) relevant to this service, supported for use across England by Health Education England and endorsed by NHS England and Public Health England, and should, on request, make the declaration available to the council.
  1. The Contractor is also required to ensure that each pharmacy professionals / counter staff member involved in one to one private consultation for the distribution of Ruclear* home screening kits (‘Participation in the Ruclear chlamydia and gonorrhoea screening programme (Pharmacies) Component A’) and/or treatment of Chlamydia (Component B – See separate specification)has had a Disclosure and Barring Service (DBS) enhanced check and that this is undertaken at least every three (3) years.

3.3.3Care pathways and protocols

  1. The Contractor is required to support the development and implementation of care pathways and protocols relating to the provision of chlamydia screening and/or treatment of chlamydia.

3.4POPULATION

  1. Bury Council is responsible for commissioning and funding contraception and sexual health services for residents of Bury.
  1. This service is not restricted to residents of Bury. However, the Contractor is required to ensure that, for all clients attending to collect Ruclear* chlamydia and gonorrhoea screening kits (Component A) and / or treatment of chlamydia (Component B), that postcode data is collected and recorded to enable the Commissioner to monitor equity and access.

3.5INCLUSION AND EXCLUSION CRITERIA

3.5.1Opportunistic chlamydia and gonorrhoea screening for asymptomatic young people

(1)Inclusion criteria

  1. The Contractor is required to offer Ruclear* screening kits to:
  • Asymptomatic residents of Greater Manchester aged 16-24.

(2)Exclusion criteria

  1. The Contractor is required to exclude:
  • Symptomatic young people
  • Young people aged under-16
  • Adults aged 25 and over
  • Young people not resident in Greater Manchester
  1. The Contractor should refer excluded clients, as appropriate, to other services including:
  • Symptomatic young people should be referred / signposted to STI testing services.
  • Young people aged under-16 should be referred / signposted to STI testing services.
  • Adults aged 25 and over should be signposted to STI testing services
  • Young people not resident in Greater Manchester should be signposted to STI testing services in their own area of residence.

3.6REFERRALS