Service Level Agreement between Lifeline Project, Sefton Treatment and Recovery Service (STARS) and Community Pharmacy Supervised Consumption Service

Requirements for Supervised Consumption Service

As a locally commissioned, enhanced service community Pharmacists are required to provide a service to monitor the consumption of methadone and other medicine used for the management of opiate dependence, within a non-judgmental, confidential and client-centred environment. This includes:

  • Supervised consumption of oral methadone and buprenorphine
  • Prescription support to drug users collecting their dispensed prescription for methadone and other drugs
  • Feedback to prescribers
  • Recording of client information for all clients as detailed in appendix 1 of this agreement.

It is aimed that supervised consumption will:

  • Assist the service user to remain healthy until they can, with appropriate support achieve a substance-free life
  • Ensure compliance with the agreed treatment agreement/recovery plan by:
  • Dispensing in specified instalments
  • Ensuring each supervised dose is correctly consumed by the patient for whom it was intended
  • Provide feedback to prescribers where an individual misses any doses or where there is concern about any health or social related issues
  • Reduce the risk to the local communities of diversion of prescribed medicines onto the illicit market
  • Provide service users with regular contact with healthcare professionals, including access to further advice or assistance where required.

This community pharmacy supervised consumption service will be available to all service users who are registered or eligible to register with a Sefton general medical practice and are receiving substitute medication for opiate dependence at Sefton Treatment and Recovery Service (STARS).

Service Outline

Supervised consumption is provided in conjunction with the local community opiate dependency prescribing service (i.e. STARS), as an integral part of stabilisation and maintenance regimes.

Where a prescription calls for methadone mixture or buprenorphine tablets to be consumed in the pharmacy, the prescribed quantity should be provided to the client in a properly labelled container with the top removed prior to handing over. The client should consume the item in from of the pharmacist, utilising an area with sufficient levels of privacy and safety. It is also advised that water is provided to facilitate the consumption of the medication and reduce the risk of doses being held in the mouth. The pharmacist will ensure that the dose has been consumed and will record if there are any concerns, including any incidents that occur.

As described in Drug Misuse and Dependence: UK clinical guidelines on clinical management (DH, 2007), pharmacies should report to STARS where:

  • The pharmacist is aware that an individual is failing to comply with treatment, e.g. missing pick-ups
  • There are concerns about an individual’s health or wellbeing
  • The service user attends the pharmacy in a state of intoxication
  • There is suspicion that the individual is diverting their medication

Communication, Record Keeping and Data Collection

As outlined above the supervised consumption service is part of an integrated treatment plan and as such any appropriate communication should be made to the relevant STARS team in regards to the individual service user. It is suggested that each service user engaged in the supervised consumption service should sign a three-way agreement between the prescribing service (nominated Recovery Coordinator and prescriber), the pharmacy/pharmacist and the service user (see appendix 2). Therefore once this is provided, there will be a nominated Recovery Coordinator in order to communicate any concerns, missed pick-ups to, similarly the prescribing service will also liaise accordingly to update the pharmacy/pharmacist as needed.

Pharmacies will be required to maintain accurate records for all service users, that comply with the Data Protection Act 1998 and comply with this when dealing with personal data. In terms of record keeping for payment, see appendix 3 (separate attachment) for template; this should be completed on a monthly basis and sent FAO: Ronny Williams, Sefton House, 1 Canal Street, Bootle, L20 8AH. Payment will remain at £35.10 per service user, per month, regardless of the amount of supervised consumption doses attended for.

Operational guidelines

New clients – It is recommended that the Pharmacist induct the service user into the pharmacy, including expectations of attendance, behavior and requirements for attendance in order to continue with supervised consumption within their pharmacy. It is also suggested that the Pharmacist request the signature of the three-way contract (see appendix 1) and maintain a copy of this on site for information purposes. If so desired a further contract can be utilised as per individual pharmacies requirements.

Identification – It is the Pharmacists responsibility to ensure that the service user is identified at each attendance at the Pharmacy, this should especially be adhered to for the first attendance, e.g. identification required prior to dispensing in the first instance. Individual pharmacies may require insist upon other identification purposes, i.e. taking a photo/signature per service user for record keeping purposes.

Refusal – The Pharmacist may refuse to dispense to the service user if he/she appears intoxicated. Pharmacists should use their professional judgment to assess the degree of intoxication and should inform STARS at the earliest possible opportunity if this occurs. It is recommended that in such instances the service user is requested to return at a later time for further re-assessment of intoxication levels.

Receptacle disposal – Following supervised consumption the receptacle utilised should be disposed of using the existing hazardous waste bins.

Training

Workshops will be provided throughout each year in consultation with Pharmacies covering but not limited to the following:

  • Customer service skills to engage with service users
  • Overdose prevention advice and information
  • Anonymous Dry Blood Spot Testing (DBST) HPA survey
  • Blood borne virus transmission
  • Health & Safety

Training will be provided by STARS and will be provided in agreement with each pharmacy in order to promote full attendance and engagement whilst not interfering with day-to-day business.

Other Agreements

Pharmacists participate in this scheme at their own risk and should be covered by work place insurance. If vaccination is required or desired by employees, they should be completed/requested via their own GP and reimbursement will be facilitated via STARS should payment be required.

STARS will conduct an annual review exercise, in the form of a mystery shopper, in order to inform any future training events. Any issues which evidence a breach of contract may result in the termination of such contract.

Termination of Contract

This SLA is to be reviewed and renewed annually and any change to contract to be expressed in writing to the pharmacy.

Lifeline Project, as STARS, reserve the right to terminate the contract if any breach to this agreement occurs and will take the necessary steps to ensure the services provided for clients are compliant with wider national guidelines from Public Health England (PHE), NHS and National Institute for Health and Clinical Excellence (NICE).

Pharmacies are required to give one month’s notice in writing should they wish to terminate this contract. Paraphernalia and all other materials pertaining to the scheme are to be returned to STARS within 15days of contract termination.

Pharmacy

Address

Pharmacist

Signature

Printed

Date

Appendix 1

SUPERVISED CONSUMPTION AGREEMENT

DATE:

Name:
DOB: / Address:
Pharmacy:
Telephone Number:

PRESCRIPTION SERIAL NUMBER…………………………………………………………………..

CLIENT REFERENCE NUMBER…………………………………………………......

The above named client has requested to take their medication under your supervision. They are aware of the contents of the ‘Client Contract’ and have agreed to adhere to it.

RECOVERY CO-ORDINATOR SIGNATURE………………………………………………………

CLIENT SIGNATURE…………………………………………………………………………………

Take this letter to the pharmacy that you will have your medication dispensed from. Your Recovery Co-Ordinator will have entered the name of the pharmacy in the box above. You will also need to take a copy of your Client Contract along with your prescription.

Appendix 2

Sefton Treatment and Recovery Service

Contract for Medication Prescribing

  1. I have been given a ______information leaflet and I have had the opportunity to read it or have it read to me and understand the implications, benefits and the risks of this treatment.
  2. I understand that my GP service will be informed that I am undertaking this treatment and have access to information relating to it.
  3. I will give specimens of urine for drug screening when asked to do so.
  4. If non prescribed drugs are found in my urine, I understand that my treatment maybe stopped.
  5. I understand that failure to attend appointments with the STARS team may result in my treatment being suspended.
  6. I understand that medication will not be replaced for any reason.
  7. I understand that my ______is for my use only and no one else must use it. I know that if I break this rule my treatment will be stopped.
  8. I understand that failure to collect my medication on three consecutive days may lead to my treatment being stopped.
  9. I understand that any attempts to obtain extra medication by deception including approaching other Doctors outside the STARS Clinical Service may result in my treatment being stopped.
  10. I understand that any verbal or physical aggression towards any member of staff including pharmacists may result in the termination of my treatment in accordance with STARS guidelines.
  11. I understand that a full explanation will be given to me for any discontinuation of treatment.

I have read or been read the above contract and fully understand and agree to the terms.

Client Name: / Signature: / Date:
Recovery Coordinator: / Signature: / Date:
Contact Details for Recovery Coordinator:
Prescriber: / Signature: / Date:
Pharmacist: / Signature: / Date:

Appendix 3

See attached Supervised Consumption Pharmacy Claim form