Sexual Health
Enhanced Services from Community Pharmacies
Chlamydia Screening
Service Level Agreement between
(Provider – Community Pharmacy)
and
Commissioner – Black Country Chlamydia Screening Programme
and
Dudley Primary Care Trust
Commencing 22nd December 2008
Review date 1st July 2010
Reviewed June 2010
To commence 1st July 2010
Next review date 1stJune 2011
CHLAMYDIA SCREENING 2008
Service Description:
Pharmacies will support the National Chlamydia Screening Programme by distributing screening packs to patients aged between 15 and 24 years in conjunction with specified criteria in order to facilitate the diagnosis and management of Chlamydia.
Appropriate advice and support will be given to patients following consultation, which may include information on ongoing contraception, supply of condoms and information on other sexually transmitted diseases.
Pharmacies will operate a signposting scheme to allow referral to other sexual health services, and health and social care professionals in relation to other sexually transmitted diseases (STD’s)
Pharmacies will link into existing local networks for sexual health and community contraceptive services so that there is a robust and rapid referral pathway for people who need onward signposting to access contraception or GUM clinics.
Pharmacies will link into existing services for provision of emergency hormonal contraception (EHC), where appropriate, to ensure women who need EHC will obtain it in a timely fashion.
Background:
Genital Chlamydia trachomatis is the most common Sexually Transmitted Disease (STD) in the UK with 104.155 cases reported in 2004. The incidence rose by 223% from 1995-2004. Costs to the NHS are estimated to be over £100 million annually.
In the UK the highest infection rates are among 16-24 year olds for both men and women.
A screening programme is essential as a large number of cases are asymptomatic (50% men and 70% women display no symptoms). Chlamydia impacts highly on reproductive health issues with 10-40% of untreated women developing pelvic inflammatory disease (PID). 1 in 5 women who develop PID will as a consequence become infertile, and the risk of ectopic pregnancy is greatly increased.
The National Chlamydia Screening Programme was introduced in 2002, with an overall aim to control Chlamydia through early detection and treatment of asymptomatic infection; to reduce transmission and prevent consequences of untreated infection. This has proved successful with more screens and positive results rising at a greater level than previously. The 2005 annual report demonstrates that a high level of infection would have been missed in the absence of a screening programme. 75% of these cases were identified in community screening settings.
Chlamydia screening is currently carried out across England as part of the National Chlamydia Screening Programme (NCSP) which is managed by the Health Protection Agency (HPA).
There is a Vital Signs Indicator for 2009/10 with a target of achieving 35% for 2010/11 Chlamydia screening and testing in young people between 15 and 24. Community Pharmacy can play a key role in increasing screening opportunities.
The white paper “Choosing Health” identified Chlamydia screening as a new national priority area. “Choosing Health through Pharmacy” highlighted the provision of sexual health services though pharmacy as key feature of the strategy, citing advantages of community pharmacy as:
- Easy access
- Longer opening hours
- Anonymous environment
- Availability of confidential consultation rooms.
Aims and intended service outcomes:
To encourage uptake of the national Chlamydia screening service by distributing screening packs and further increase the knowledge of risks associated with STI’s in the target group of patients (male and female) aged 24 or less.
To refer to care pathways to signpost clients who may have been at risk of Chlamydia and other STI’s to an appropriate service.
To strengthen the local network of contraceptive and sexual health services to help ensure easy and swift access to advice.
To refer clients, especially those from hard to reach groups, into mainstream contraceptive services.
To improve access and choice of sexual health services to patients who request a screening for Chlamydia.
To increase awareness of the risks of unprotected sex amongst the target local population by general promotion of the service.
To increase the numbers of young people accessing Chlamydia screening to help reach local targets.
To reduce the numbers of untreated Chlamydia infections in women and help reduce complications such as PID, and fertility problems.
Service outline
Responsibility of the Pharmacy:
Pharmacies will provide a consultation area that ensures confidentiality for the client. Area at the level deemed appropriate for conducting MURs will be acceptable.
All Pharmacists and pharmacy staff providing this service must be trained to PCT standards (See Accreditation page 7).
The pharmacy contractor must ensure the PCT is informed of any change of personnel such that the screening service becomes unavailable at that pharmacy.
Pharmacies will actively promote this scheme and supply a screening test to eligible patients, i.e. those under 25, who request other sexual health services such as supply of EHC.
Pharmacies will actively promote this scheme and supply a screening test to any asymptomatic sexually active client/customer under the age of 25 who either requests a Chlamydia screening test or when dispensing contraceptive pills or purchasing condoms. Clients should be registered with a Dudley PCT GP practice or resident within Dudley.
The scheme/service will include:
- Provision of a Chlamydia screening kit and an explanation of its use.
- Provision of a patient form and an explanation of how to complete it.
- Provision of a Chlamydia return kit and an explanation of where to return it.
Patients who describe symptoms of an STD should be referred to an appropriate sexual health clinic.
Pharmacies will provide verbal and written advice on the risks of contracting Chlamydia in line with national guidelines. Advice on other STI’s and the use of regular contraceptive methods will be given.
Pharmacies will display posters advertising the availability of this service and will be expected to display promotional material at suitable points around the store e.g. by sanitary products, contraceptive products.
The pharmacy will carry out the service in line with this specification; with reference to the Fraser guidance; Working Together to Safeguard Children and the Sexual Offences Act 2003 when supplying to young people aged below 16 years. The pharmacist andpharmacy staffwill have knowledge of national and local child protection guidelines and will ensure that up to date details on who to contact and how re any child protection concerns are held in the pharmacy.
Pharmacists and pharmacy staff may need to share relevant information with other health care professionals and agencies. This should be in line with local confidentiality, data protection arrangements and safeguarding children guidelines. Where appropriate they may need to obtain consent from the client to share the information.
The pharmacy contractor must have a Standard Operating Procedure in place for this service.
The pharmacy contractor has a duty to ensure that pharmacists and pharmacy staff involved in the provision of the service are aware of, operate within and have signed that they comply with the pharmacy’s Standard Operating Procedure.
The pharmacy must maintain appropriate records to ensure effective ongoing service delivery and audit. Records must be kept confidential and stored in line with PCT and national information governance requirements.
Accredited pharmacists may provide treatment to men and women with laboratory confirmed asymptomatic Chlamydia and their partners in line with the Dudley PCT PGD Azithromycin supply for Chlamydia.
Responsibility of the PCT:
Chlamydia Screening Kit Supplies
The Community Pharmacy Development Officer will liaise with the Black Country Chlamydia Screening Programme Coordinator/ Manager to ensure that all pharmacies involved in the scheme will receive sufficient screening packs to meet the needs of their service.
Paperwork
The Chlamydia Screening Programme Coordinator will ensure that all pharmacies involved in the scheme will receive sufficient quantities of relevant paperwork to meet the needs of their service
Training
The PCT will undertake to provide initial training and an annual meeting to promote service development and to keep pharmacy contactors and their staff up to date with new developments, knowledge and evidence. Training will be provided free of charge.
Health Promotion and Signposting
The PCT will support pharmacy contractors in providing up to date details of other services that pharmacy staff can use to refer service users who require further assistance. The PCT will provide relevant health promotion materials which pharmacies can use to promote the service to the public.
Evaluation and Monitoring
The PCT will undertake an annual meeting as part of the Community Assurance Framework assessments to determine that all aspects of the Service Level agreement are being met.
The PCT will provide the pharmacy with key contacts including:
- People with overall responsibility for co-ordinating and managing the Chlamydia ‘project’
- Person responsible for processing forms for payment
Quality Indicators:
The pharmacy reviews its Standard Operation Procedure and the referral pathways for the service on an annual basis.
The pharmacy completes all records accurately and maintains data on the number of tests given out.
The pharmacy participates in an annual PCT organised audit of service provision. Service providers are expected to maintain a register of ongoing and previous audit projects. Clinical audits should take account of the National Clinical Audit and Patients Outcomes Programme, relevant NICE guidance and National Service Frameworks, as well as local areas of clinical priority and interest.
The pharmacy co-operates with any locally agreed PCT led assessment of service user experience. This may include patient surveys or mystery shopper exercises.
Pharmacist and other staff involved in delivering the service attend training updates as organized by the PCT.
The service provided will be compliant with Standards for Better Health and the relevant core standards within the PCT Commissioning for Quality and Improvement Framework (available via the PCT), these include:
- Services provided will be evidenced based with proven clinical and cost effectiveness.
- Service culture systems and working practices ensure that probity, quality assurance, quality improvement and patient safety are central components of all activity.
- Services are provided in partnership with patients, their carers and relatives, respecting their diverse needs, preferences and choice.
- Patients receive services as promptly as possible and do not experience unnecessary delay at any stage of service delivery or of the care pathway.
- Care is provided in environments that promote patient well-being, respects their needs, preferences, beliefs and culture.
Service providers are expected to demonstrate that services are not discriminating against any particular sector of the community.
Any incidents (clinical or non-clinical) relating to this service must be reported to the clinical governance team at the PCT.
Accreditation:
Level 1 – Screening
The Pharmacy contractor will need to ensure that pharmacists and pharmacy staff offering the service meet the training requirements.
- PCT provided training is compulsory for every staff member involved in the service. Pharmacy assistants can offer the screening kit distribution service by attending the PCT training, but the treatment part of the service must be provided by accredited pharmacists.
- Pharmacists and staff providing this service must be aware of local and national guidance on safeguarding children, as it is possible that people under the age of 16 will request screening.
- Pharmacists must complete the CPPE Sexual Health Testing and Treating package to become accredited for this service. This is detailed in the Harmonisation and Accreditation Group(HAG) document for Chlamydia Screening Level 1. Plus attendance at PCT workshop facilitated by the Black Country Chlamydia Screening Programme. Pharmacists meeting these criteria will later receive a certificate which accredits them in all PCTs signed up to the HAG.
Level 2 – Screening and Treatment
- Pharmacists must complete the CPPE Sexual Health Testing and Treating package to become accredited for this service. This is detailed in the Harmonisation and Accreditation Group (HAG) document for Chlamydia Screening and Treatment Level 2.
- Attendance at Dudley PCT Azithromycin PGD Workshop. Pharmacists meeting these criteria will later receive a certificate which accredits them in all PCTs signed up to the HAG.
Attendances at training updates as arranged by the PCT is a mandatory requirement for delivery of this service.
Remuneration:
- Pharmacies will be paid £1.00 for each test kit given out and mandatory instruction given to a client. Pharmacies will be required to complete a monitoring form for each kit given out.
- Pharmacies will be paid a further £4.00 for each valid completed test returned.
- Pharmacies will be paid £7.50 per treatment consultation PLUS reimbursement of the drug cost (most recent drug tariff price).
Commissioning/Decommissioning of service:
Services will be commissioned annually in accordance with local contracting arrangements. All providers will be expected to demonstrate how they meet the requirements of the current service specification.
Service providers will be given a minimum of one month’s notice of any decision to decommission the service.
The PCT reserves the right to withdraw this service at any time from any pharmacy that does not fulfil the conditions set out in this specification.
Contact Details:
Heidi Mitchell
Chlamydia Screening Manager
Willenhall Health Centre
Field Street
Willenhall
West Midlands
Tel: 01922 604820
Email:
Michelle Dyoss
Community Pharmacy Development Officer
Dudley PCT
St Johns House
Dudley
DY2 8PP
Tel: 07500 097314
Email or
Acceptance of Chlamydia Screening SLA
A signed copy of this Agreement will be kept by the Pharmacy and the PCT.
I accept this Service Agreement on behalf of
Pharmacy Name:______
Phone number: ______
Fax number: ______
Email address: ______
Signature:
Name:
Designation:
Date:
Pharmacy StampLevel 1
Chlamydia Screening – distribution of kits
Level 2
Treatment of Infection
I accept this Chlamydia Screening Service Agreement on behalf of Dudley PCT:
Signature:
Name:
Designation:
Date:
1
Michelle Dyoss
Community Pharmacy Development Officer
July 2010
Dudley PCT Pharmacy Distribution of Chlamydia Screening Tests To Men and Women Aged 24 or Less
1
Michelle Dyoss
Community Pharmacy Development Officer
July 2010
1
Michelle Dyoss
Community Pharmacy Development Officer
July 2010