Knowsley Metropolitan Borough Council
Service Level Agreement
for
Community Pharmacist Provision of Needle and Syringe Exchange Service
1.Parties to the Agreement
This agreement is between:
…………………………………………… (“The Pharmacy”)
AND
Knowsley Metropolitan Borough Council (“The Council”)
2.Purpose of the Agreement
This agreement relates to the provision of and access to sterile needles and syringes, within auser friendly, non-judgemental, client centred and confidential service.
- Agreement Period
3.1The agreement will commence on1ST April 14
3.2This agreement terminates on 31st March 16 (see point 6 for information)
- Background
In 2006 it was estimated that there was over 129,977 injecting opiate and/or crack cocaine in England aged 15 to 641and that 0.1% of people aged 16 to 59 inject performance- and image-enhancing drugs (PIEDs) today1.
Current figures of people on new treatment journeys in Q4 2012/13are 1391 injecting in England with 9 in Knowsley, compared with 1752 in England and 53 in Knowsley previously2.
People who inject drugs using contaminated equipment (for either the preparation or injection of their drugs) are at risk of contracting – and transmitting – blood-borne viruses such as HIV, hepatitis B and hepatitis C. They are also at risk of a range of other infectious diseases and injection-site infections1
Although HIV rates remain relatively low among injecting drug users in the UK, there is concern that rates may be rising. In addition, approximately 40% of them are infected with hepatitis C. HIV and hepatitis C can be transmitted among those who are injecting and, in some cases (via sexual contact, pregnancy and childbirth) to others who do not inject.
Providing people who inject drugs with clean injecting equipment is cost effective from a public health perspective.
The Needle Syringe Exchange Programme brings service users into contact with services which may help by:
- emphasising the dangers of overdosing (about 1% of people who inject drugs die of an overdose each year)
- encouraging people to switch from injecting to less harmful forms of drug taking
- encouraging people to opt for opioid substitution therapy
- encouraging people to stop using drugs
- encouraging people to be tested and treated for hepatitis C and HIV
- encouraging people to address their other health needs.
- Parties to the agreement
Knowsley Council
Pharmacy Contractor-
- Duration
2 years with an option to extend further by two one year extensions
- Notice Period
Three months notice is required from Knowsley Councilto the pharmacy, should they not meet the quality standards of the service. This would occur only if after formal discussions with the contractor the standards had not improved. To leave the scheme, threemonths notice is required from the pharmacy to Knowsley Council.
- Confidentiality and Data security
8.1Caldicott
Where for the purposes of delivering the agreed services it is necessary for the contractor to hold patient identifiable information i.e. that is subject to NHS Rules on protection and disclosure under the supervision of a named “Caldicott Guardian” on behalf of the partners, it shall not disclose such information without the prior consent in writing of the Caldicott Guardian of the organisation from which the patient identifiable information has originated. It may then disclose patient identifiable information for proper purposes under procedures supervised by the Caldicott guardian of the Host organisation.
This consent may be given in general or specific terms, but cannot authorise any greater degree of disclosure than would be permitted under the Caldicott arrangements of either party.
8.2Data protection.
Data held and processed for the purposes of this contract shall be registered under the relevant provisions of the Data Protection Act 1998.
8.3Confidentiality
All parties will endeavour to maintain appropriate confidentiality regarding information that is proprietary to each of the partners within the context of shared working.
8.4Commerciality
All parties shall treat the contents of this contact as “Commercial in confidence” .
- Audit Access
Knowsley Council reserves the right to access any paperwork relating to the service provided, within the appropriate confidentiality boundaries.
- Financial Arrangements
Input of information onto Webstar will generate monthly invoices for payments of: £1.70 per unit cost (pack) plus £150 retainerper month.
This covers any additional costs incurred during this contract including sharps & clinical waste collection and vaccinations.
11 Changes in Service Provision
If the requirements of the service change, and after consultation with the contractors and agreement with Knowsley Council, the pharmacies will be notified and asked to support the new initiative.
12 Continuing Professional Development
The service will endeavour to attend, and provide evidence of attendance at updates provided by the drugs treatment provider,Attendance at a minimum of one such update per annum will be required.
13 Description of Services and Objectives & Service Schedule
Are detailed in Appendix 1 the Service Specification.
14. Indemnity
14.1The Provider shall indemnify and keep indemnified the Authority against all actions, proceedings, costs, claims, demands, liabilities, losses and expenses whatsoever, whether arising in tort (including negligence) default or breach of this Contract, to the extent that any such loss or claim is due to the breach of Contract, negligence, wilful default or fraud of itself or of its employees or of any of its sub-contractors save to the extent that the same is directly caused by or directly arises from the negligence, breach of this Contract or applicable law by the Authority.
14.2Imitation of liability
Neither Party shall be liable to the other Party (as far as permitted by Law) for Indirect Losses in connection with this Contract.
14.2.1 Each Party must at all times take all reasonable steps to minimise and mitigate any Losses for which it is entitled to be indemnified by or bring a claim against the other Party pursuant to this Contract.
Nothing in this Contract will exclude or limit the liability of either Party for
a)death or personal injury caused by its negligence; or
b)fraud or fraudulent misrepresentation.
Appendix 1
NHS Community Pharmacy Contractual Framework
– Needle & Syringe ExchangeService
1.Service description
1.1Pharmacies will provide access to sterile needles and syringes, and sharps containers for return of used equipment.Where agreed locally,associated materials,for example condoms, citric acid and swabs, to promote safe injecting practice and reduce transmission of infections by substance misusers will be provided.
1.2Pharmacies will offer a user-friendly, non-judgmental, client-centred and confidential service.
1.3Used equipment should be returned by the service user for safe disposal in sharps bins. The pharmacy is responsible for this, and any costs incurred can be met through the retainer payment.
1.4The service user will be provided with appropriate health promotion materials.
1.5The pharmacy will provide support and advice to the user, including referral to other health and social care professionals and specialist drug and alcohol treatmentservices where appropriate.
1.6The pharmacy will promote safe practice to the user, including advice on sexual health and STIs, HIV and Hepatitis C transmission and Hepatitis B immunisation.
2.Aims and intended service outcomes
2.1To assist the service users to remain healthy until they are ready and willing to cease injecting and ultimately achieve a drug-free life with appropriate support
2.2To protect health and reduce the rate of blood-borne infections and drug related deaths among service users:
by reducing the rate of needle and syringe sharing and other high risk injecting behaviours;
by providing sterile injecting equipment and other support;
by promoting safer injecting practices; and
by providing and reinforcing harm reduction messages including safe sex advice and advice on overdose prevention (e.g. risks of poly-drug use and alcohol use).
2.3To improve the health of local communities by preventing the spread of blood-borne infections by ensuringthe safe disposal of used injecting equipment.
2.4To help service users access treatment by offering referral to specialist drug and alcohol treatment centres and health and social care professionals where appropriate.
2.5To aim to maximise the access and retention of all injectors, especially the highly socially excluded.
2.6To help service users access other health and social care services and to act as a gateway to other services (e.g. key working, prescribing, hepatitis B immunisation, hepatitis and HIV screening, primary care services etc).
3.Service outline
3.1The part of the pharmacy used for provision of the service provides a sufficient level of privacy and safety and meets other locally agreed criteria.
3.2The pharmacy contractor will endeavour to ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service.
3.3The pharmacy contractor will endeavour to ensure that pharmacists and staff involved in the provision of the service are aware of and operate within local protocols.
3.4The pharmacy contractor should ensure that their staffs are made aware of the risk associated with the handling of returned used equipment and the correct procedures used to minimise those risks. A needle stick injury procedure should be in place.
3.6The pharmacy should maintain appropriate records to ensure effective ongoing service delivery and audit.
3.7Appropriate protective equipment, including gloves, overalls and materials to deal with spillages, should be readily available close to the storage site.
3.8The pharmacy is encouraged to display the national scheme logo or a local logo indicating participation in the service.
3.9Staff involved in the delivery of this service should be offered immunisation for Hepatitis B which will be provided by their own GP.Any costs incurred can be met through the retainer payment.
3.10Pharmacists will share relevant information with other health care professionals and agencies, in line with appropriate confidentiality principals.
3.11The substance misuse provider willarrange one contractor meeting per year to promote service development and update the knowledge of pharmacy staff.
3.12The CRIwill provide the exchange packs and associated materials (see appendix for flow chart).
3.13The collection and frequency of waste collection should be arranged by the pharmacy and agreed to ensure there is not an unacceptable build up of clinical waste on the pharmacy premises.
3.14All relevant information will be inputted ontoWebstar to generate a monthly payment
3.15The council will provide details of relevant referral points which pharmacy staff can use to signpost service users who require further assistance.
4.Quality Indicators
4.1The pharmacy has appropriatehealth promotion material available for the user group and promotes its uptake.
4.2The pharmacy reviews its standard operating procedures and the referral pathways for the service on an annual basis.
4.3The pharmacy contractor will endeavour to ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service. The pharmacist will maintain own competencies through CPPE and ensure records of all trained staff are held within the pharmacy for audit purposes
4.4The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service.
4.5The pharmacy participates in any Council organised audit of service provision.
4.6The pharmacy co-operates with any locally agreed assessment of service user experience.
Declaration & Agreement Signatories
I confirm that this Pharmacy wishes to provide the Needle and Syringe Exchange Service from 1st October 2013 to 31st March 2015 as per the above specification.
I declare that the information given on this agreement form is true and complete to the best of my knowledge. I understand that action may be taken against me if I make an incorrect claim.
Pharmacy’s signature………………………………………Date.…………………………….
Pharmacy’s Name (print) …………………………………….
Address of premises …………………………………………………………………………………………
…………………………………………………………………………………………
Authorised by:
Date: / Who / SignedMatthew Ashton / Director of Public Health
Julie Tierney / Public Health Specialist
For supplies of needle exchange materials please see attached pathway or
Background information – not part of the service specificationThe National Treatment Agency for Substance Misuse service specification for Needle Exchange and Harm Reduction sets out a series of objectives for needle exchange services generally, these apply to services commissioned from community pharmacy and are reflected within the service specification:
- To offer user-friendly, non-judgmental, client-centred and confidential services;
- To assist the service users to remain healthy until they are ready and willing to cease injecting and ultimately achieve a drug-free life with appropriate support;
- To reduce the rate of sharing and other high risk injecting behaviours by providing sterile injecting equipment and other support;
- To reduce the rate of blood-borne infections among drug users;
- To reduce drug-related deaths (immediate death through overdose and long-term such as blood borne infections);
- To promote safer injecting practices;
- To provide focused harm reduction advice and initiatives, including advice on overdose prevention (e.g. risks of poly-drug use and alcohol use);
- To provide and reinforce harm reduction messages;
- To help service users access drug treatment to refer to other specialist drug (and alcohol) treatment services;
- To help service users access other health and social care and to act as a gateway to other services (e.g. key working, prescribing, hepatitis B immunisation, hepatitis and HIV screening, primary care services etc);
- To facilitate access to primary care where relevant;
- To ensure the safe disposal of used injecting equipment;
- To prevent initiation into injecting and to encourage alternatives to injecting;
- To aim to maximise the access and retention of all injectors, especially the highly socially excluded, through the low-threshold nature of service delivery and interventions provided; and
- To improve the health of local communities by preventing the spread of blood-borne viruses and by reducing the rate of discarded used injecting equipment.
Background information for Drug Action Team (DAT) commissioners:
Service Specification Tier (2 or 3), Pharmaceutical Services for Drug Users, National Treatment Agency for Substance Misuse, 2005,
National scheme logo: /
CPPE training which may support this service:
Opiate treatment: Supporting pharmacists for improved patient care open learning
Public Health – drug users, harm reduction workshop
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