Tmbc Service Specification

TMBC SERVICE SPECIFICATION

SUPERVISED CONSUMPTION

2015 - 2017

Executive Summary

This new contract aims to provide clear minimum standards for pharmacies, reward high quality services and make better use of the skills of pharmacists and their staff. This contract is an enhanced service to be delivered by appropriate pharmacies. Trafford commissioners will not pay for the seven essential services that form part of the essential service delivery; these are:

• Dispensing, including support for people with disabilities
• Disposal of unwanted medicines
• Promotions of healthy life styles (public health)
• Signposting
• Support for self care
• Clinical governance

These essential services should be automatically applied to benefit substance misusers and should be supplemented by the enhanced needle exchange and/or supervised consumption services as described below.

This Trafford specification has been developed to improve the quality of the delivery, and health outcomes for the provision of a needle exchange service and a supervised consumption service.

Trafford recognise the effectiveness of the role played by pharmacists and would like to encourage the growth in quality and breadth of the service. Pharmacists, as part of a team of healthcare professionals, have a key role to play in providing services to substance misusers. They also act as a link to treatment services and other relevant agencies by acting as referral agents for clients to attend treatment.

Aims and Objectives of the services

The overall aim of pharmacy services to drug users are to assist the service user to remain healthy, reduce drug related harm, work towards Recovery, provide service users with regular contact with a healthcare professional and help them access further advice or assistance.

Pharmacies providing dispensing services for substance misusers will ensure compliance with the agreed Recovery Plan and aim to improve retention in drug treatment by providing installment dispensing and ensuring each supervised dose is correctly administered to the patient for whom it was intended. Pharmacists will contribute to the shared care of the patient by liaising with the prescriber or named key worker directly involved in the care of the patient. This should reduce the risk to local communities of diversion of prescribed medicines onto the illicit drugs market. This service will be available to all individuals who have drug-related problems, including dependent opioid users as well as those who present with additional polydrug use or concurrent use of benzodiazepines, pychostimulants and alcohol. Clients using steroids may buy needles, but are not within the scope of the free needle exchange policy.

Pharmacists or other appropriately trained staff should provide direct input wherever possible to promote harm reduction, health promotion and Recovery. Pharmacists should encourage hepatitis B immunization and course completion and hepatitis C assessment if the risk of that disease is high.

It is appropriate for pharmacy supervised consumption services to provide screening, risk assessment, referral, advice where appropriate as well as compliance with legal responsibilities in dispensing.

Pharmacy harm reduction initiatives provide an easy, low threshold, open access and user friendly service. Supervised consumption must take place in a private or quiet area of the pharmacy. There will be a requirement to share relevant information with all professionals involved in the treatment of individuals – this within the bounds of pharmacists professional confidentiality guidelines.

It is essential that pharmacists have an operating procedure in place specific to their premises.

The contracts with each pharmacist or chemist will be managed by the Drugs and Alcohol Action Team for the foreseeable future or until legislative changes remove Public Health from the Local Authority. The main contact for this specification will be:

Kylie Thornton – Commissioning and Service Development Manager

The contact details are:

Drug and Alcohol Action Team

Trafford Council

Children, Families & Wellbeing

Trafford Town Hall

1st Floor

Talbot Road

Stretford

Manchester

M32 0TH

0161-912-4776

Email:

The following pages detail the expectations of this specification, the payment regime and the data reporting requirements.

Definition of Service

This service is recognised as a tier 3 provision as it forms an integral part of the substitute prescribing treatment and requires a high duty of care for the pharmacist dispensing the controlled drugs.

Pharmacy dispensing and supervised consumption are therefore for those patients prescribed:

•For Opioid dependence (titration, detoxification and reduction) and maintenance regimes (methadone or buprenorphine)

•For withdrawal from opioids with non-opioid medications (e.g lofexidine, subutex)

•For stabilization and withdrawal from sedatives, where appropriate (benzodiazepines and alcohol)

•For relapse prevention where appropriate (naltrexone, disulfiram)

•For dependent stimulant use including symptomatic treatment medications

Pharmacists providing services to drug users must:

•Be integrated and co-ordinated with the local treatment services

•Provide the necessary level of privacy to clients

•Provide access to a daily supervised consumption service for prescribed oral medicines (excluding Sundays and Bank Holidays) which ensures the prescribed dose has been administered to the right patient

•Ensure that relevant information can be shared between the Pharmacist / drug treatment professional about the drug user without compromising the individual’s rights

•Provide a range of other harm reduction literature (literature can be provided) for the users of the service including referral to specialist drug and alcohol services

Aims and Objectives of the Service

Largely to ensure compliance with the agreed Recovery or Treatment plan by:

•Dispensing prescribed medication in specified installments

•Ensuring each supervised dose is correctly administered to the patient for whom it was intended (doses may be dispensed to the patient to take away to cover days when the pharmacy is closed – the commissioner must be notified of this practice)

•If dispensing medication for the patient to take away please ensure that they have lockable storage for their medication. If the patient is without lockable storage please refer to Trafford Drugs Service.

•liaising with the prescriber, named keyworker and other directly involved in their care of the patient (where the patient has given written permission)

•monitoring the patient’s response to prescribed medication; for example if there are signs of overdose, especially at times when doses are changed during titration of doses, if the patient appears intoxicated or when the patient misses doses and if necessary withholding treatment if this is in the interest of patient safety, liaising with the prescriber or named keyworker as appropriate

•To offer user friendly non-judgemental confidential and user centred services

•To liaise with healthcare professionals and others involved in the care of the patient having due regard for patient confidentially

•To assist the service user to remain healthy, reduce drug related harm until they are ready to ultimately achieve a drug-free life with appropriate support

•To reduce the dangers associated with drug misuse, including the risks of HIV, hepatitis B and C, other BBVs and the risks if drug related death

•To provide and reinforce focused harm reduction advice and initiatives, including advice on drug overdose

•To facilitate access to primary care where relevant

•To provide a range of information to service users including contact details of other health professionals

•To help service users access other health and social care and to act as a gateway to other services

Pharmacists must not dispense the prescription if it does not fully comply with legal requirements. Dispensing and supply can be refused in certain circumstances as detailed below:

•If the pharmacist believes the prescription is not genuine or for the person named on the prescription form

•If the pharmacist believes the prescriber has made a clinical error or that the prescription is clinically inappropriate

•If the patient or anyone with them behaves or threatens to behave violently, or commits or threatens to commit any criminal offence (in the pharmacy)

Patients may also be excluded as a result of a professional risk assessment – this risk can include patients who have

•Missed collecting their prescribed medicine for specified number of instalments and where their tolerance to the drug may have reduced

Or

•Those who appear intoxicated or under the influence of another substance.

It is important the patients are informed of acceptable behaviour and what types of behaviour may result in exclusion. It is good practice to establish this prior to commencing the programme of dispensing or needle exchange.

The Target Population

Adults over the age of 18 years who are

•Prescribed using FP10MDA (or equivalents)

•Patients prescribed methadone mixture 1mg in 1ml or buprenorphine sublingual tablets

•Patients prescribed injectable Opioid substitute treatment (diamorphine, methadone)

•Patients prescribed by named GPs

•Patients prescribed by the local specialist substance misuse service

•Patients prescribed of other drugs, for example benzodiazepines, naltrexone or disulfiram

Opening Times

Pharmacists should state clearly which times their services are available to the target population and this information must be updated and given to patients when there is any variation to those times. Because confidentiality should be maintained it is useful to avoid times when patients may not attend because they are apprehensive about recognition as drug users from other patients.

Basic assessment and ongoing harm reduction

Pharmacists or their staff should provide direct input wherever possible to promote harm reduction including:

•Recognising people with physical health problems or severe mental health problems and referring them to appropriate services

•Carrying out risk assessments and identification of immediate risks using body mapping (ie injection injuries, abscesses, harm to others or physical and mental health emergencies) and provide advice, treatment and referral as appropriate

•Actively encouraging service users to access hepatitis B immunisation and to complete the course

•Emphasising the risk of over dose and strategies to reduce overdose

Harm reduction work should be provided in a form that is appropriate and meets the needs and desires of the service user.

Pharmacy operating procedure

The standard operating procedure for pharmacy supervised consumption must detail requirements around the following issues:

-Security of staff, stock and premises

-Minimising of risk to staff and members of the public

-Storage and dispensing of medications in accordance with current legislationincluding the procedure in the event of over dispensing and consumption of supervised consumption medications

-The provision of supervised self-administration procedures that are discreet and efficient to ensure dignity of client

-Dealing with unacceptable behaviour and guidance on – what is unacceptable and ways of minimising unacceptable behaviour

-Strategies and procedures for ensuring the dose has been fully consumed

• In case of methadone oral mixture – drink water before hand and speak after swallowing the dose

• For buprenorphine a longer time will be needed to allow dissolution of the tablets. Patients should be offered a water before taking their dose
• What procedure to follow if the pharmacist suspects the patient is avoiding supervised consumption by palming tablets or not swallowing methadone but keeping it in the mouth

-Safe storage, disposal and destruction of clinical waste (in line with Environment agency requirements) for containers etc used for administering supervised doses

-Safe storage disposal and destruction of items which may identify patients e.g. labelled containers which are discarded after SC

-Guidance on what to do if a patient is at risk – i.e. at risk of overdose, someone recently released from prison, intoxicated etc

-Guidance on the policy if the patient requests another person collects their prescription

-Client confidentiality – including what to do when a patient requests needle exchange who is also being prescribed substitute medication

-Advice and health promotion materials relating to harm reduction

-Ensure all staff involved in the service are instructed on procedures to be followed in order to minimise risk

-How client can access Patient Opinion or other ways to make comment on the service

-Advice on access to vaccination against hepatitis A and B, relevant to both staff and patients

-Information on who to contact in the event of drug litter not being collected

-Guidance on what the pharmacist should do when a prescription or patient does not meet the agreed target population criteria

-Guidance on what to do when an expected patient does not appear

-Understanding of Safeguarding concerns including how to respond to such concerns

Quality Indicators and performance management

1.Pharmacists must demonstrate that they have undertaken appropriate training to deliver supervised consumption

2.Pharmacists will demonstrate that they have standard operating procedures and that these are reviewed annually for the supervised consumptions services

3.Pharmacists will demonstrate annually that they have undertaken training or refreshed their skills in the delivery of supervised consumptions services

4.Numbers of client using the service/s

5.Number of clients referred to and accepting treatment services

6.Numbers of people accepting additional health information

Serious Untoward Incidents (SUI)

In the event of a SUI the provider must:

• Inform the service user and ensure harm to the client is minimised

• Inform AIM Trafford as a matter of urgency
• Inform the commissioner within 5 calendar days
• Record a detailed timeline of the incident including dates and times
• Ensure and evidence that locums have the same standards of operating as permanent staff
• Provide evidence of implementing the pharmacy SUI process

Service Monitoring

Monitoring is an integral part of any commissioned service agreement and compliance with the terms of service is essential for continuity by the provider. Information agreed between the commissioner and the provider will be supplied to Trafford Council.

The Provider will submit monitoring data for each service user with each claim that is sent to Trafford Council via the Clinical Support Unit (CSU).

Contract Management

This agreement will be governed in accordance with Trafford’s local Terms and Conditions in the form of a contractual agreement.

Training Requirements

Providers will be offered appropriate training where required e.g.

-Safeguarding

-Harm Minimisation

PRICING SCHEDULE

1 / per supervision (more than one dose at the same time is classed as one supervised consumption) / £2

Payments will be made quarterly in arrears.

The 2015/16 quarterly claiming deadlines are:

Q1 (1st April 2015 – 30th June 2015) - 31st July 2015

Q2 (1st July 2015 – 30th September 2015) - 31st October 2015

Q3 (1st October 2015 – 31st December 2015) - 31st January 2016

Q4 (1st January 2016 – 31st March 2016) - 31st April 2016

All contractors must submit an invoice and audit data in a timely manner (including nil returns). Payments will not be made if audit data is not submitted.

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