Service Level Agreementbetween Lifeline Project, Sefton Treatment and Recovery Service (STARS) and
Community Pharmacy Needle and Syringe Provision Scheme
Requirements for Needle and Syringe Provision Services
As a locally commissioned, enhanced service, community Pharmacists are required to provide a service aiming:
- To offer a user-friendly, non-judgmental, client-centered and confidential service
- To assist service users to remain healthy until they are ready and willing to cease injecting and ultimately achieve a substance-free lifestyle
- To reduce the rate of sharing injecting paraphernalia and other high risk behaviours by providing sterile injecting paraphernalia
- To reduce the rate of blood-borne virus infection transmission amongst people who inject drugs
- To reduce the risk of overdose related deaths
- To promote safer injecting practices
- To provide focused harm reduction advice and information
- To provide sexual health advice and information
- To promote access to substance misuse treatment services, signposting and referring where appropriate
- To ensure the safe disposal of used injecting paraphernalia
- To encourage alternatives to injecting and prevent initiation where possible
- To improve the health of local communities by preventing the spread of blood-borne viruses and by reducing the rate of discarded used injecting paraphernalia.
Communication and Ordering Stock
All communication is to be directed to the Contract Support Manager at Sefton Treatment and Recovery Service (STARS), Person designated(Jan Soul 07702 900676); with the exception of ordering of supplies which is to be done directly from Exchange Supplies via fax order sheet (appendix 1) or the webshop ( using username and password provided by Exchange supplies.
All pharmacies are to designate a lead person to be contacted in regards to the needle and syringe provision (NSP). Any orders that are larger than usual or are not of stock detailed on the pick & mix list/order form will be checked by STARS prior to dispatch. Exchange supplies will invoice STARS directly for each order/pharmacy.
STARS have appointed a lead day to day contact for any operational queries regarding NSP, David Farrell.
Financial Compensation
From 1st April 2015 all pharmacies will be operating using one payment system and as such the payment schedule will be amended accordingly. There will be a monthly administration fee or retainer of £45 alongside a flat rate per transaction of £1.70 for every 10 syringes/barrels givenor part of 10 in any one transaction i.e.
1-10 = £1.70, 11-20 = £3.40, 21-30 = £5.10 + the retainer.
N.B. The retainer will only be paid were at least 1 exchange hasbeen given out in any one month and/or the pharmacy has dealt with returns.
STARS will be able to extract the necessary information via the WEBSTAR database in order to inform the monthly invoicing and payment.
N.B. All staff will be trained on the WEBSTAR recording database by the end of March 2015. As requested and agreed by the LPC, WEBSTAR is currently being programmed. Going forward WEBSTAR will be used by all pharmacies to record transactions and stock and will automatically generate your invoice for payment. This must be done on a monthly basis to ensure your claim is entered and you receive prompt payment. The cut- off date for exchanges will be the last day of each month with a date of the 15th of each month to have data entered. IT IS IMPORTANT TO ENSURE YOUR DATA IS ENTERED ON THE SYSTEM BY THE 15TH SO AS TO ENSURE YOU ARE PAID AS WEBSTAR WILL NOT BE ABLE TO BACK DATE ANY TRANSACTIONS
Record Keeping
The pick & mix service user sheets (currently being used in all pharmacies), should be completed by the service user upon each presentation for NSP; however, it is the pharmacy staff’s responsibility to take note of their initials, D.O.B and the first part of their postcode for the database (this can be done verbally during transaction, or by taking note of what has been written on the user sheet). It is also preferable that a basic assessment (appendices 2 and 3) is completed on the first presentation to NSP in order to ascertain the level of need, any risky practice and onward referral; these are useful to inform the first input onto the database. However, if the service user refuses to provide this information the transaction should still be completed, obtaining the minimal information required for the database. The pick & mix sheets will not be collected by STARS and will only be kept by the pharmacy if they feel they need to keep as an audit trail. Pharmacies will need to dispose of these sheets confidentially in a confidential waste bin or shredder.
At each transaction all paraphernalia issued, returned and any information disseminated should be recorded on the database. This can be utilised to inform the communication at the service users’ next presentation and ultimately will be used to calculate the monthly payments. WEBSTAR database will be used, meaning that no written recording will be needed by the worker in the Pharmacy (unless you choose to). The reporting tool will be utilised to calculate your monthly number of transactions and automatically generate your invoice for payment.
All pharmacy staff must be made aware of the Data Protection Act 1998 and comply with this when dealing with personal data. The NSP scheme is a confidential service and the pharmacy staff must respect this; ensuring that there is no discussion in regards to any personal information or that none is passed on to friends, family or other organisations. Where separate consultation rooms are available they should be used to protect confidentiality.
Training
Upon joining the NSP scheme is it expected that all participating pharmacy staff be trained in the following:
- Health and safety/ needle stick injury
- Safer injecting practice and advice/Blood Borne virus transmission
- Customer service skills to engage with NSP service users
- Overdose prevention advice and information
- WEBSTAR database use
- Anonymous Dry Blood Spot Testing (DBST) HPA survey
Training will be provided by STARS and workshops will be provided throughout the yearat all pharmacies in order to promote full attendance and engagement whilst not interfering with day-to-day business. It is envisaged that our pharmacy lead, David Farrell will be able to deliver training at each pharmacy at a convenient day and time for the pharmacy and Lifeline.
Dispensing of Paraphernalia to Service Users
The NSP scheme is open to over 18’s only; it is important to check with the service user should you suspect they are under this age and have a conversation about their injecting practice before making a decision to provide or not. If you discover that the individual in question is under 18yrs of age then please refer to the local young persons’ service provider; SMASH - 0151 288 6021.
Dispensing large quantities of paraphernalia may be left at the discretion of the pharmacist and staff; however, it is recommended that the reason for taking large quantities is discussed and that appropriate means of disposal are also issued. If you wish to discuss this further please contact David Farrell at STARS on 0151 944 5334 or Jan Soul on 07702 900676.
Returning of used equipment should always be encouraged and if a service user fails to do so regularly again it is recommended that this is discussed, urging the safe return of used equipment alongside the issuing of items.
Paraphernalia should never be refused as service users may use clinical waste facilities elsewhere to dispose of their equipment. Refusal is only recommended if the service user is under 18 and there is concern for the correct use of equipment; or if there is a threat to staff or other customers.
Clinical Waste Disposal Collection
Those sharps bins that are returned from service users are to be locked by the service user and placed by the service user into the clinical waste bins provided by SRCL (our clinical waste contractor); current proposal 1x30ltr collected 16weekly; or otherwise locally agreed with Pharmacy. If a service user attends with loose paraphernalia, they should be handed an appropriately sized sharps container from stock and asked to place the loose paraphernalia into this prior to putting this into the large clinical waste bin; i.e. no loose paraphernalia should be placed directly into the clinical waste receptacles.
N.B. For pharmacies who need more frequent collections we will do so in consultation with our pharmacy liaison lead, David Farrell who will discuss individual needs and set up the service appropriate to their needs.
Pharmacists are required by law to sign a transfer note, a copy of which is to be kept on file and retained for two years after it expires. All clinical waste is to be kept away from the general public, especially children.
Please Note: The clinical waste bins provided as part of NSP provision are to be used for the disposal of used needles and paraphernalia only; using them to discard pharmaceutical waste is not only a breach of contract but also against the law.
The clinical waste contractor, SRCL, will provide STARS with copies of the return collections and invoices for payment.
Other Agreements
The scheme including those pharmacies participating in it may be advertised through leaflets, posters and by other means throughout the borough of Sefton; although this will take place predominately via the core services in Southport and Bootle.
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.
Pharmacists must display the National Needle Exchange logo in a prominent position in their shop window; this will be provided by STARS as needed.
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.
Participating pharmacies are also expected to encourage the participation of service users in the annual anonymous dry blood spot testing survey for the Health Protection Agency and as such training will be provided for this. Clients can also be directed to STARS in Bootle and Southport to get access to this survey via one of our medical team.
Supporting documents:
NHS.NHS Community Pharmacy Contractual Framework: Enhanced Service – Needle and Syringe Exchange. London, September 2005.
National Institute of Health and Care Excellence (2014). Needle and Syringe Programmes: NICE public health guidance 52. London: NICE.
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
Pharmacy Lead NSP Worker
Signature
Printed
Date
Appendix 1
Sefton Pharmacy Order FormPharmacy Name: / Order placed by:
Address:
Email:
Post Code
Date: / Telephone
Product Code / Description / Usual pack size / Quantity
S247 / 2ml nevershare barrel (5 colours) / 500
LW1 / 1ml syringe (white) / 100
LB1 / 1ml syringe (blue) / 100
LP1 / 1ml syringe (pink) / 100
UY / 12mm yellow needle (1/2 inch) / 100
USO / 16mm orange needle (5/8 inch) / 100
UO / 25mm orange needle (1 inch) / 100
UB / 25mm blue needle (1 inch) / 100
ULB / 30 mm blue needle (1 1/4 inch) / 100
UG / 40mm green (1 1/2 inch) / 100
S140 / 1ml nevershare fixed (5 colours) / 1000
A252 / 5ml barrel / 100
A111 / Plastech Sharps container / 1
A110 / 0.45L Sharps container / 1
A135 / 1L Sharps container / 1
A103 / 2ml water for injections / 10
C115 / Citric sachets / 1000
V213 / Vit C sachets / 1000
S209 / Stericups / 1000
AA128 / Pasante Regular Condoms / 144
A205 / Pre-injection alcohol swabs / 100
Please Fax 01305 262255 or email to Exchange Supplies Ltd
Exchange Suppplies Ltd (v3 Oct 2013)
Appendix 2
SYRINGE EXCHANGE ASSESSMENT
Client No. …………… Initials …………… D.O.B. …………………… Gender M / F
Date of Assessment ……………………… Agency Site ………………………………
First part postcode ……………….. Ethnic Origin…………………………
______
What is your current substance of use?
………………………………………………………………………………………………………
Have you injected current substance before? Yes No
How many times a day/week do you inject whilst you are using the above substance?
………………………………………………………………………………………………………………….
Are you currently in treatment with any service regarding the substance you are using?
Yes No
If answer is No please give details of referral options locally.
Have you been tested for any of the following? (Tick all that apply)
Yes / No / Not SureHepatitis B
Hepatitis C
HIV
If you have been tested for any of the above, approximately when were you last tested?
In the last 6 months / 6-12 months ago / Over 12 months ago / Result of testHepatitis B
Hepatitis C
HIV
Have you been vaccinated against Hepatitis B?
Yes No Not sure
Would you like to be referred for testing of Blood Borne Viruses (BBVs)?
Yes No
Have you ever re-used your own works?
Yes No
Have you ever used works previously used by others?
Yes No
Where have you obtained needles before?
Agency Syringe Exchange Pharmacy Friends/Family
Other:(Please state)……………………………………………………………………………………………..
Any other comments:
Appendix 3
SYRINGE EXCHANGE ASSESSMENT
FOR ANABOLIC STEROID (AS) USERS ONLY
Client No. …………… Initials …………… D.O.B. …………………… Gender M / F
Date of Assessment ……………………… Agency Site ………………………………
First part postcode ……………….. Ethnic Origin…………………………
______
Have you used AS before? Yes No
If ‘No’, then please state what AS you are planning to use. (Tick all that apply):
*P / *I / Oral / Inject / Dose1(mg not ml) / 2Daily/ Weekly / Last Cycle Length / Age First Used
Nandrolone / Deca, Anabolin / D / W
Methandrostenolone / Dianabol / D / W
Methandienone / Pronabol / D / W
Oxandrolone / Anavar / D / W
Oxymetholone / Anapalon / D / W
Methenolone / Primobolan / D / W
Stanozol / Stromba, Winstrol / D / W
Sustanon / Sostenon / D / W
Formebolone / Esiclene / D / W
Boldenone / Equipoise / D / W
Testosterone Cypionate / Testex Leo, Testex / D / W
Testosterone Enanthate / Testoviron / D / W
Testosterone Undecanoate / Andriol, Restandol / D / W
Methyltestosterone / Android / D / W
D / W
NB: If the AS used is unlisted, please add it to the list in the boxes provided
* P = Previously used (Past 12 mths); I = Intend to use next. (Please tick all that apply)
1: Please state mg rather than ml.
2: Use “Weekly” for any injecting regime other than “Daily”. (Please delete as appropriate)
How many times a week do you inject whilst you are using AS?
…………………………………………………..
How long was your last cycle (Or intended first cycle if new user)?
On:………………………………… Off: ………………………………..
What other drugs have you take orally/injected in the last 12 months?
*P / *I / Oral / Inject / Dose1(mg not ml) / 2Daily/ Weekly / Age first used
Clenbuterol / Spiropent, Ventolase / D / W
Growth Hormone / Somatropin / D / W
HCG / HCG / D / W
Insulin / D / W
Tamoxifen / Nolvadex / D / W
Ephedrine / D / W
Diuretics / Frusemide, Lasix / D / W
D / W
D / W
NB: If the drug used is unlisted, please add it to the list in the boxes provided
* P = Previously used (past 12 mths); I = Intend to use next. (Please tick all that apply)
1: Please state mg rather than ml.
2: Please delete as appropriate
Have you been tested for any of the following? (Tick all that apply)
Yes / No / Not SureHepatitis B
Hepatitis C
HIV
If you have been tested for any of the above, approximately when were you last tested?
In the last 6 months / 6-12 months ago / Over 12 months ago / Result of testHepatitis B
Hepatitis C
HIV
Have you been vaccinated against Hepatitis B?
Yes No Not sure
Would you like to be referred for testing of Blood Borne Viruses (BBVs)?
Yes No
Have you ever re-used your own works?
Yes No
Have you ever used works previously used by others?
Yes No
Where have you obtained needles before?
Agency Syringe Exchange Pharmacy Friends/Family
Other:(Please state)……………………………………………………………………………………………..
Have you experienced any adverse effects relating to injecting AS?
Yes No Sometimes
(If yes or sometimes, describe below)
Have you experienced any side effects due to AS use?
Yes No Sometimes
(If yes or sometimes, describe below)
Any other comments: