Local Authority Service Specification (LASS)
SEXUAL HEALTH SERVICES FOR UNDER 25s, 2015-16
Content
- Background
- Service Aims and Outcomes
- Service Specification
- Clinical Governance Arrangements
- Criteria for Eligibility and Accreditation
- Reporting and Monitoring
- Contacts for further information
Appendix 1
a. Issuing of condoms protocol
b. c – card monitoring and claim form
Appendix 2 - Fraser Guidelines
Appendix 3 - Patient Group Directives (PGDs)
Appendix 4 -Young People Friendly Criteria
1. BACKGROUND
1.1. Context
The Service Specification incorporates work that supports the modernisation agenda for both sexual health services and pharmacies and will contribute to the achievement of targets for Chlamydia Screening, reducing Teenage Pregnancy and improving Genito Urinary Medicine (GUM) Access.
This service specification should be read in conjunction with Council policies and professional guidance, including appropriate and relevant guidelines on the British Association of Sexual Health and HIV website - www.bashh.org/BASHH/home ).
1.2. Essential Services
All community pharmacy services, whether offering the Service Specification or not, will continue to provide essential services including:
1.2.1. Participating in all North Somerset Public Health-organised annual health promotion campaigns per annum, of which sexual health is usually one.
1.2.2. Providing opportunistic sexual health advice, including the supply of Chlamydia screening kits to young people under 25 years old, in postal boxes which are returned to the Avon Chlamydia Screening Office laboratory.
1.2.3. Signposting people to other services (incl. The WISH Clinic, “No Worries!” service and their local general practitioner or specialist SH GP practice) – including display of relevant leaflets.
1.2.4. Services who do not offer this service specification are still encouraged to meet the young people friendly criteria (see Appendix 4) so that they can brand themselves as offering a good sexual health service for young people.
2. SERVICE AIMS AND OUTCOMES
2.1. Aims and intended service outcomes
2.1.1. To increase the knowledge, especially among young people, of the availability of emergency hormonal contraception[1] and Chlamydia screening.
2.1.2. To improve access to emergency hormonal contraception, treatment for Chlamydia, pregnancy testing and sexual health advice.
2.1.3. To increase the use of emergency hormonal contraception by women who have had unprotected sex and help contribute to a reduction in the number of unplanned pregnancies in the client group.
2.1.4. To increase opportunities for young people to talk in, a confidential environment, about their sexual health
2.1.5. To refer clients, especially those from hard to reach groups, into mainstream sexual health services
2.1.6. To promote free condoms in order to reduce unwanted pregnancy and transmission of STI’s
2.1.7. To increase the knowledge of risks associated with Sexually Transmitted Infections (STIs).
3. SERVICE SPECIFICATION
Community pharmacies offering the Sexual Health Service Specification will offer a client-centred and confidential service in line with the quality criteria of our local sexual health services for young people.
This service will include
3.1. Condom distribution
Pharmacies can issue free condoms (in bags of 10) to young people against either:
· The North Somerset 17 – 24 year old condom card (c-card)
or
· The “No Worries!” c-card
This should be used as an opportunity to offer young people an chance to talk about their sexual health in a confidential environment.
The c-card number should be recorded on PharmOutcomes for audit and monitoring purposes.
3.2. Condom Registration
The provider can opt to have pharmacists, dispensers or counter staff trained to register 17 – 24 year olds to receive a 17-24 c-card, through a confidential one to one consultation (which will take around 15mins). If trained staff are not available, staff should be able to refer young people to another pharmacy with trained staff, or to a specialist Sexual Health GP Practice or to another local service that will be able to assist them as soon as possible.
If the young person is under 17 they should be referred to the “No Worries!” Service for a condom card (c-card)
Pharmacists will ensure all staff are familiar with the scheme and have up to date information concerning referral if this is deemed appropriate
3.3. Emergency Hormonal Contraception (EHC)
Pharmacists will supply emergency hormonal contraception (EHC) to women where there is a clinical need, in line with the requirements of the Patient Group Direction for Levonorgestrel 1500microgram tabs (Appendix 3). The supply will be free to women under 25 years old at North Somerset Council expense.
All women should be informed about the possibility of use of an Intra-uterine device (IUD) as a more effective form of emergency contraception, and should be referred to a local service as soon as possible as required.
Pharmacists will ensure all staff are familiar with emergency contraception, and have up to date information concerning referral if no qualified pharmacist is available.
People should only be invited to buy the Pharmacy medicine product if the young person is 25 or over
3.4. Pregnancy Testing
Appropriately trained pharmacists and other staff located in pharmacies where there is access to toilet and hand wash facilities, can choose to provide a pregnancy test to girls under the age of 25
A service will be provided that provides a safe environment to carry out a free pregnancy test with a girl who has had unprotected sex and is concerned she may be pregnant. The test will be carried out in a consultation room and appropriate counselling, advice and referral will be made as part of the consultation according to the guidelines provided by North Somerset
During the consultation the pharmacist/staff member will promote safer sex and the use of effective contraceptive use.
3.5. Chlamydia
Pharmacies will promote Chlamydia testing to young people in an appropriate way – encouraging them to take a Chlamydia testing kit where it is felt they will return the completed test to the Avon Chlamydia Screening Office
Pharmacists will participate in the Avon Chlamydia Screening Programme by offering free treatment to people testing positive for Chlamydia, under a Patient Group Directive for Azithromycin (Appendix 3), decreasing any delay before treatment.
Treatment will be provided according to the guidelines laid out in the PGD, on referral from the Chlamydia Screening Programme, following a positive result.
Inclusion and exclusion criteria, detailed in the Patient Group Directive will be applied during provision of the service. Clients excluded from the criteria will be referred to another local service that will be able to assist them as soon as possible.eg their GP, WISH Clinic
3.6. Publicity and Young People Friendly
All pharmacy staff will be proactive in routinely promoting and offering the sexual health services to young people, as appropriate, and meet the essential criteria as set out in the Young People Friendly Guidance Appendix 4
4. CLINICAL GOVERNANCE ARRANGEMENTS
4.1. The service will be provided in compliance with Fraser guidance and Department of Health guidance on confidential sexual health advice and treatment for young people aged under 16 in line with the sexual health policy for North Somerset and the
4.2. The service is delivered according to the guidelines laid out in the PGDs
4.3. The pharmacy reviews its standard operating procedures and the referral pathways for the service on an annual basis.
4.4. The pharmacy participates in regular North Somerset Public Health organised audit of service provision.
4.5. The pharmacy co-operates with North Somerset Public Health led assessment of service user experience e.g. through periodic ‘mystery shopping’ exercises to monitor quality.
4.6. Pharmacists will ensure all staff are familiar with the service and have up to date information concerning referral if this is deemed appropriate.
5. Criteria for Eligibility & AccreditationTraining requirements
(details should be reported to Pubic Health and certificates shown)
5.1. Pharmacist should attend a local or complete a CPPE “Safeguarding Children” child protection course (Every 3 years).
· Emergency Hormonal Contraception training complete CPPE EHC course;
· Attend Levonelle Patient Group Directive training in North Somerset, : (every 2 years or whenever PGD is substantially updated)
5.2. Chlamydia Screening
· attend Azithromycin Patient Group Directive training in North Somerset.(every 2 years or whenever the PGD is substantially updated)
5.3. A majority of staff should attend the Basic Sexual Health training provided by North Somerset Public Health
5.4. All staff registering young people for a 17 -24 c-card should attend the condom registration training provided by North Somerset Public Health
5.5. All staff carrying out pregnancy testing consultations should have attended the training provided by the “No Worries!” service
5.6. All trained pharmacists and sexual health lead member of staff should attend annual Networking and Update session with N Somerset Public Health Team
other recommended courses include:
· CPPE Sexual Health: testing and treating Open Learning Programme (8 hrs)
· CPPE Dealing with difficult discussions Open Learning Programme (8 hrs)
· CPPE Patient group direction (PGD) – developing and implementing them safely
6. REPORTING AND MONITORING
6.1 Invoices will be submitted automatically through PharmOutcomes for monthly payment
6.2 Payments will not be made unless the consultation is recorded on PharmOutcomes
6.3 Chlamydia tests completed from the pharmacy will be notified to Public Health by the Chlamydia screening office and need not be recorded on pharmoutcomes
6.4 The remuneration is outlined in Appendix E
7 CONTACTS FOR FURTHER INFORMATION
Chris Burton Health Improvement Co-ordinator,
Public Health Directorate, North Somerset Council
PO Box 238, Castlewood, Tickenham Road, Clevedon BS21 6FW
Tel: 01275 885525 Email:
Avon Chlamydia Screening Programme
Karl Pye
Co-ordinator, Avon Chlamydia Screening Programme
Tel: 0117 922 2265 (General Info)
Email: (Treatment record returns)
APPENDIX 1
Guidelines and checklist for condom distribution
These guidelines should be adhered to when distributing free condoms. Condoms can be distributed against the No Worries! c-card and the 17-24 c-card.
Pasante supply the condoms, from a budget provided by North Somerset Public Health; the condoms will carry the British Standard Kite/CE quality standard logo. (Contact Public Health on 01275 885138 if further supplies or range of sizes are needed)
(Be aware that “No Worries!” use durex condoms and young people may need to be reassured that the different brand should be used in exactly the same way)
A named Sexual Health Lead in the practice/pharmacy will be responsible for the safety and storage of the condoms ordered.
Distribution Checklist
· Check the young person has a valid (in last 12 months) No Worries! c-card or the 17-24 c-card.
· Give 10 condoms with 2-3 tubes of lube in a bag and sealed. (Include condom instruction leaflet, credit card and consent card).
· ASK “Is there anything you would like to talk about?” If yes refer to a pharmacist or GP or Nurse or take to consultation room if possible.
· Record the condom distribution, with the c-card number, on the condom monitoring form or in PharmOutcomes for payment and to allow stock control.
· Please note
1. A new c-card and teach will need to be given annually for younger people with a No Worries! c-card – if the young person is under 16, they should be referred to a No Worries! Clinic. For 17 – 24 year old’s the trained professional in the pharmacy can issue a new card.
2. Fraser Competence should have been assessed when the c-card was issued but it is advisable to be aware of the young person’s competence.
3. Where a valid c-card is presented questions can be asked to determine the best size and type of condom. (Any problems with condoms slipping off or breaking?)
Condom Distribution Monitoring Form – submit quarterly
Venue:
Bag issued / Card Number / Date / Name of person issuing the condoms1
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5
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15
16
Please send transfer this data to PharmOutcomes for payment, audit and monitoring purposes.
APPENDIX 2
Confidentiality
Fraser Guidelines
A doctor or other professional would be justified in giving advice and treatment without parental knowledge or consent, provided they are satisfied:
· That the young person could understand the advice given and had sufficient maturity to understand what was involved in terms of the moral, social and emotional implications.
· That the young person cannot be persuaded to inform their parents or to allow the professional to inform them that contraception advice was being sought.
· That the young person would be very likely to begin, or continue having, sexual intercourse with or without contraception treatment.
· That, without contraception advice or treatment, the young person’s physical or mental health would be likely to suffer.
· That the young person’s best interests require the professional to give contraceptive advice, treatment or both without parental consent.
The Fraser guidelines were issued following a House of Lords Judgment in 1985
January 2010, Updated January & May 2011, January 2012, December 2013
Patient Group Direction
for the supply of
AZITHROMYCIN
by Community Pharmacists
Valid from: 1st June 2014
Expiry date: 31st May 2016
PGD Reference Number: NS/63/14
Version 1.0
Patient Group Direction (PGD) for the supply of Azithromycin
This patient group direction (PGD) is a specific written instruction for the supply of azithromycin to groups of patients within the areas covered by Bristol City Council, North Somerset Council and South Gloucestershire Council.
The majority of clinical care should be provided on an individual basis. The supply of medicines under Patient Group Directions should be reserved for those limited situations where this offers an advantage for patient care (without compromising patient safety) and where it is consistent with appropriate professional relationships and accountability.
Staff Characteristics· Pharmacist registered with the GPhC who has undertaken relevant training as specified by NHS Bristol
· Has undertaken appropriate training to carry out clinical assessment of client who requires treatment according to the indications listed in the PGD, including use of the Fraser guidelines.
· Has undertaken appropriate training for working under patient group directions for the supply and administration of medicines
· Has undertaken training appropriate to this PGD in line with current requirements of the BNSSG Contraception & Sexual Health Services Guidelines Group
· Pharmacist should be familiar with the information on azithromycin in the current BNF
· All registered Pharmacists are professionally accountable for their practice in accordance with the GPhC. In the exercise of professional accountability there is a requirement to maintain and improve their professional knowledge and competence.