COMMUNITY PHARMACY PILOT

CHLAMYDIA SCREENING PROGRAMME

LOCAL ENHANCED SERVICE SPECIFICATION

2009/2010

INTRODUCTION

  1. This new scheme is for those pharmacies currently providing Plymouth tPCT Emergency Hormonal Contraception (EHC) service to offer Chlamydia screening to all young women accessing the pharmacy for EHC. The specification of this service is designed to cover the enhanced aspects of clinical care of the patient, all of which are beyond the scope of essential services. No part of the specification by commission, omission or implication defines or redefines essential or additional services. The specification is valid from its launch until 31st March 2010, when a full evaluation will take place.

BACKGROUND

  1. Genital Chlamydia trachomatisinfection is the most commonly diagnosed bacterial sexually transmitted infection in genitourinary medicine (GUM) clinics in the United Kingdom. The number of diagnoses of uncomplicated genital chlamydial infection in GUM clinics has risen steadily since the mid-1990s, and between 2003- 2007 rates of new cases rose from 96,159 to 121,986 Prevalence through the Plymouth Chlamydia Screening Programme is approximately 9% positivity (April 2009).

The prevalence is highest in young sexually active adults under the age of 25 years,. As most people are asymptomatic, large proportions of cases remain undiagnosed. Untreated genital chlamydial infection may have serious long-term consequences, especially in women in whom it is a well-established cause of pelvic inflammatory disease (PID), ectopic pregnancy and infertilit Recent research suggests that the fertility of men may also be affected by the infection (Gallegos, G, 2007).

  1. The annual cost of chlamydia and its consequences in the United Kingdom is estimated to be more than £100 million (1National Chlamydia Screening Programme for England, 2006).
  1. The Vital Signs Indicator target for NHS Plymouth for 2009/2010 is to undertake Chlamydia screening for 25% of the sexually active 15 -24 year olds. In order to reach these targets it is essential that all core services are offering screening to young people, this includes pharmacies.
  1. There is recognition of the importance of pharmacies taking part of the screening programme and that they can improve the access to healthcare for young people as part of this scheme (

7. Many pharmacists nationally are offering treatment for Chlamydia under a PGD or through Clamelle.

AIMS

6. In 2009/2010 the Plymouth Chlamydia Screening Programme is designed to be one in which:

(i)25% of women and men who are sexually active, asymptomatic and aged between 15 – 24 undertake an opportunistic Chlamydia screening test.

(ii)The service to the patient is convenient and they are offered the screening test at the pharmacy or other registered test site. The service to the patient is safe

It is hoped that the community pharmacy scheme will:

  • Improve access to testing for young women and improve the uptake in women who may not seek testing
  • Increase patient choice
  • Offer a more holistic sexual health service
SERVICE OUTLINE

7.

(i)Period. This scheme will operate from 1st September 2009 until 31st March 2010. A review of the scheme will then take place.

(ii) Criteria for testing. Only pharmacies where the pharmacist has been accredited for and is providing the Plymouth tPCT Emergency Hormonal Contraception LES are eligible to participate in the Chlamydia screening pilot. A screening test should be offered in conjunction with a request for the provision of EHC.

(iii) Referral Policies. No referral is required for the screening test. A screening test should be offered in conjunction with a request for the provision of EHC and a test can be offered for their partner/s

(iv) Clinical procedures. The pharmacists should ensure that the young woman attending for EHC is aware of the importance of having a Chlamydia test straight away (to test for any infection that may be present) and to test in 2 weeks time (to test for this new risk exposure). To ensure that a correct diagnosis is obtained, the Chlamydia screening test should be carried out by the patient in line with the instructions contained within the postal kit

(v) Results. All results will be actioned by the Chlamydia Screening Office. Pharmacies will be informed of their volume of screens and positivity rate on a regular basis by the CSP (testing site information pack Appendix 1).

(vi) Record keeping. The pharmacy must maintain adequate records of the performance and results of the service provided, incorporating appropriate known information. The pharmacy must complete and return the PCT audit form (Appendix 2) to the PCT by the set deadlines.

(vii) Training. All pharmacists undertaking this LES must attend group-training sessions, which will be facilitated by the Chlamydia Screening Co-ordinator. Training updates will be available on a regular basis.

(viii) Review. All pharmacies involved in the scheme will perform an annual review which shall include:-

a)Number of Chlamydia screening tests issued Number of Chlamydia screening tests issued

b)Number of patients undertaking a Chlamydia screening test (returned kits)

c)Number of negative results per year.

d)Number of positive results per year.

e)Any significant incidents related to this LES.

f)Complete any questionnaires/evaluations required by the CSP

g)Any other issues.

(Information relating to B, C & D, will be provided regularly by the Chlamydia Screening Office).

(viii) Protocol and guidance. All pharmacies involved in the scheme will adopt the Plymouth tPCT Chlamydia Screening test clinical guidelines, included in the testing site information pack (Appendix 1).

(ix) Patients. All patients presenting for the provision of EHC will be offered the test but will be positively encouraged to do so. Pharmacists must ensure that clients are aware of the complications of Chlamydia in order for them to make an informed decision about whether to test or not.

REMUNERATION TO Pharmacies
  1. Each pharmacy providing this pilot will be paid according to two factors, these being:-
  • A £2.50 payment for each Chlamydia consultation
  • A further £2.50 payment for each of the returned Chlamydia Screening tests.
  1. Claiming for payment will be undertaken via the PCT quarterly ‘claiming spreadsheet’ provided by the PCT. Pharmacies who fail to return the PCT audit sheet when required will not be paid.
  1. The postal testing kits and promotional materials will be provided free of charge to practices from the Chlamydia Screening Office.

REFERENCES

1 National Chlamydia Screening Programme, England, Core Requirements, 4thd Edition January 2008.

2. Gallegos,G. et al. sperm DNA fragmentation in infertile men with genitourinary infection by Chlamydia Trachomatis and Mycoplasma SP. Fertil.Steril 2007

COMMUNITY PHARMACY PILOT

TREATMENT OF CHLAMYDIA

LOCAL ENHANCED SERVICE SPECIFICATION

2009/2010

Treatment of Chlamydia

This pilot scheme is for 2 central community pharmacies currently providing Plymouth tPCT Emergency Hormonal Contraception (EHC) service to offer Chlamydia treatment under a PGD.

The specification of this service is designed to cover the enhanced aspects of clinical care of the patient, all of which are beyond the scope of essential services. No part of the specification by commission, omission or implication defines or redefines essential or additional services. The specification is valid from its launch until 31st March 2010, when a full evaluation will take place.

AIMS

It is hoped that the pilot community pharmacy scheme will:

  • Improve access to treatment for young people
  • Increase patient choice
  • Offer a more holistic sexual health service
SERVICE OUTLINE

(i)Period. This pilot scheme will operate from 1st September 2009 until 31st March 2010. A review of the pilot scheme will then take place.

(iii)Criteria for treatment.

(iv) The pharmacists in the selected pharmacies will have been accredited for and providing the Plymouth tPCT Emergency Hormonal Contraception LES as well as offering Chlamydia screening.

(v)Treatment for Chlamydia will be offered under a PGD for those who receive a positive test Chlamydia through the CSP and their partners

(vi)Pharmacists will receive training from the Chlamydia Screening Programme for the Azithromycin PGD.

(vii)Only clients suitable for the PGD will be issued with treatment

(viii)Pharmacists will have signed up to the Azithromycin PGD.

(ix)The CSP will maintain a list of all those pharmacists able to offer treatment through the PGD.

(x)Take part in an evaluation of the pilot

(iii) Referral Policies.

Referals for the treatment of Chlamydia positive clients and their partners will be made by the via the CSP only. (see the Plymouth Teaching Primary Care Trust Policy on Treatment of Chlamydia).

Any clients deemed to be unsuitable for treatment via the PGD must be referred to the GU clinic or their GP immediately for treatment (the pharmacist may need to facilitate this). The CSP must be informed immediately of any clients not receiving treatment via the patient management form.

CSP immediately or onto the local GU clinic, returning the patient management form to the CSP

(iv) Clinical procedures.

Pharmacists will follow Plymouth Teaching Primary Care Trust Policy on the Treatment of Chlamydia.

The CSO will assess client’s suitability to receive treatment via the PGD and offer treatment options (pharmacies being one of those options)

The pharmacists will deliver the treatment within the criteria set down in the PGD and the Plymouth Teaching Primary Care Trust Policy on the Treatment of Chlamydia.

The pharmacists will ask the young person to complete a short evaluation form as part of the pilot

(vi) Record keeping. The pharmacy must maintain adequate records of the performance and results of the service provided, incorporating appropriate known information.

The pharmacist must complete and store all records pertaining to the PGD.

The pharmacist must complete and return the PCT audit form (Appendix 2) to the PCT by the set deadlines.

(vii) Training. All pharmacists undertaking this LES must attend group training sessions which will be facilitated by the Chlamydia Screening Co-ordinator.

The pharmacists will attend a PCT organised annual update

(viii) Review. All pharmacies involved in the scheme will perform an annual review which shall include:-

h)Number of Chlamydia treatments issued

i)Any significant incidents related to this LES.

j)A young persons evaluation

k)A pharmacists led evaluation

l)Any other issues.

(Information will be provided regularly by the CSP).

(viii) Protocol and guidance. All pharmacies involved in the scheme will adopt the Plymouth tPCT Chlamydia Treatment Policy, included in the testing site information pack (Appendix 1) and the PGD for Azithromycin.

(ix) Patients. All patients presenting for the treatment of Chlamydia will have confirmation of their test from the CSO

REMUNERATION TO Pharmacies
  1. Each pharmacy providing this pilot will be paid according to two factors, these being:-
  • A £15 payment for each Chlamydia treatment consultation
  1. Claiming for payment will be undertaken via the PCT quarterly ‘claiming spreadsheet’ provided by the PCT. Pharmacies who fail to return the PCT audit sheet when required or do not complete in full the patient management form and return to the CSP will not be paid.
  1. The paperwork for the Treatment will be supplied by the CSP.
  1. The costs of Azithromycin will be reimbursed by Plymouth PCT via the claiming procedure.

REFERENCES

See Plymouth Teaching Primary Care Trust Treatment for Chlamydia Policy

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